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Home My WebLink AboutBLD-93-794 ' r ,'� TOWN OF YARMOUTH pliq fq3 Vett.. HE s 441 Application for a Permit to Build No. 71 pHq -9.& UPON FINAL APPROVAL Id" MAP it LOT C. g FEE MUST ACCOMPANY THIS APPLICATION. DATE C2r-AP 19 FY The undersigned hereby applies for a permit to build 9/q--3 according to the following specifications //Q/Q2 1. Name of property owner Ellen R ronnnrc el. 39R-9974 Address 39 Briar Circle. So. Yarmouth. MA. 02664 2.NameofArchitect(if any) N/A Tel. 3. Name of builder N/A Address 4. License No. _ ,T/el. 5. Name of Mason 2u Ltd/ #4 e-ola n ' ddress 6. License No._ Tel. 7. Construction address 39 Briar Circle. So. Yarmouth. MA. Flood District 8. Date of subdivision Approval plain zone Lift Zone R �� 9. Private dwelling ® Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family 0 $2,400.00 Type of room No. faf trace 11. Commercial 0 FIREPLACE o Kitchbn 12. Other ❑ d. Dining Rm. Living Rm. 13. No. of stories Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath 15. Materials — Wood 0 Cement 0 Other 0 Deck 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch Family Rm. 17. Garage — 1 0 2 0 Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size Shed 20. Stove— Wood 0 Coal 0 Alterations 21. Size of lot: No. of feet front No. of feet rear No. of feet deep 22. Size of building. No. of feet front No. of feet side No. of feet rear 23. Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street From rear lot line Side line 25. H.I.C.R. No. LOT RELEASED BY Signature Cr.); - - PLANNING BOARD Address dr9 4 v. Q• -c '.; Date 57, .5,-1-0,—Y-40,..-2-0 �� Cay TOWN OF YARMOUTH BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE 10/18/93 JOB LOCATION 39 Briar Circle, So . Yarmouth, MA. NUMBER STREET ADDRESS SECTION OF TOWN "HOMEOWNER" . " " " " " _ • , • NAME HOME PHONE WORK PHONE . PRESENT MAILING ADDRESS 39 Briar Circle, So. Yarmouth , MA. ' 02664 CITY OR TOWN STATE ZIP CODE THE CURRENT EXEMPTION FOR "HOMEOWNER" WAS EXTENDED TO INCLUDE OWNER- OCCUPIED DWELLINGS OF ONE OR TWO UNITS AND TO ALLOW SUCH HOMEOWNERS TO ENGAGE AN INDIVIDUAL FOR HIRE WHO DOES NOT POSSESS A LICENSE, PROVIDED THAT SUCH HOMEOWNER SHALL ACT AS SUPERVISOR. (STATE BUILDING CODE SEC- 109.1. 1) DEFINITION OF HOMEOWNER: PERSON(S) WHO OWNS A PARCEL OF LAND ON WHICH HE/SHE RESIDES OR INTENDS TO RESIDE, ON WHICH THERE IS, OR IS INTENDED TO BE, A ONE OR TWO FAMILY ATTACHE D OR DETACHED STRUCTURES ASSESSORY TO SUCH USE AND/OR FARM STRUCTURES. A- PERSON WHO CONSTRUCTS MORE THAN ONE HOME IN A TWO-YEAR PERIOD SHALL NOT BE CONSIDERED A HOMEOWNER, SUCH "HOMEOWNER" SHALL SUBMIT TO THE BUILDING OFFICIAL, ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HE/SHE SHALL BE RESPONSIBLE FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1) THE UNDERSIGNED 'HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGU- LATIONS. THE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIRE- MENTS AND THAT HE/SHE WILL COMPLY WITH SAID PROCEDURES AND REQUIREMENTS. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL • • INSURANCE COVERAGE: I have al cusrrent liabUity lnsoum ce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. If you have chheeckedye , please indicate the type coverage by checking the appropriate box. • A liability Insurance policy CX Other type of Indemnity 0 Bond 0 OWNER'S INSURANCE.WAIVER•.I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: - '`- Owner Agent 0 Signature of Owner cr Owners Agent i • • _ COMMONWEALTH OF MASSACHUSETTS - ' @ DEPARTMENT OF INDUSTRIAL ACCIDENTS =. 600 WASHINGTON STREET • aures Camooeu BOSTON, MASSACHUSETTS 02111 Comm:ssoner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • I, Fllep R Connors (licensee/permittee) •• with a principal place of business/residence an 39 Briar Circle, So . Yarmouth, MA. 02664 (City/State/Zip) do hereby certify, under the pains and penalties of perjury,that: [) I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number [ ) I am a sole proprietor and have no one working for me. ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below - who have the following workers' compensation insurance policies: •• Name of Contractor Insurance Company/Policy Number . . Name of Contractor Insurance Company/Policy Number - • Name of Contractor Insurance Company/Policy Number - I am a homeowner performing all the work myself. NOTE:.Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)),application by a homeowner for a license or permit may evidence the legal sums of ICI employer under the Workers' Compensation Act. I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of Insurande for coverage verification and that failure to secure coverage as required under Section 25A'of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of S100.00 a day against me. Signed this 18 day of October 19 93 X- Licensee:Permitter.. LicensoriPermirtor Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use only NAME OF CITY/TOWN Permit No. Dale AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the"reconstruction,alteration.renovation.repair,modernisation.conversion,inprovement,removal.demolition, orconstruction of an addition to any pre-existing owner-occupied budding containing_at least one but not more than four dwelling units....or to structures which are adjacent to such residence or budding"be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Fireplace Est. Cost $2, 400.00 Address of Work 39 Briar Circle, So . Yarmouth, MA. Owner Name: Ellen R. Connors Date of Permit Application: 10/18/93 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _hob under 51,000 Building not owner-occupied 20wner pulling own permit _Other (specify) • Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: • Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: 10/18/93 Date Owner Name APPLICANT: Ellen R. Connors BUILDING PERMIT 1/: 'ADDRESS: 39 Briar Circle, So. Yarmouth TELE. NO. : 398-2926 DATE FILED: 10/18/93 BLDG. SITE LOCATION: 39 Briar Circle, So. Yarmoxth LOT#: • • THE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD, ALTER, OR ADD TO A STRUCTURE WITHIN THE TOWN OF YARMOUTH. THE BUILDING DEPARTMENT WILL DETER- MINE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGH THE FOLLOWING DEPARTMENTS: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: DETERMINES COMPLIANCE OF WATER AVAILABILITY. • ENGINEERING DEPARTMENT: DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE. CONSERVATION COMMISSION: DETERMINES COMPLIANCE TO WETLANDS ACTS, I.E. : IF LOT(S) BORDER ANY TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH LAND, ETC. HEALTH DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E. : REQUIRE- MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES. FIRE DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REQUIREMENTS FOR PERSONAL .SAFETY, -PROPERTY PROTECTION, I.E. , SMOKE DETECTORS, SPRINKLER SYSTEMS, ETC. THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR ISSUING THE REQUIRED BUILDING PERMIT: REVIEWED BY: 1. WATER DEPARTMENT DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: • PLEASE NOTE ALL STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING PERMIT. COMMENTS: • BLM/89