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HomeMy WebLinkAboutBLD-93-797 oF.Yq� ml{ /a/cl g� •. ) ° k,. o TOWN OF YARMOUTH e K f / a/n/f3 N MATTACHEES� K CS,,4° .e & ApplicationTfora Permit to Build No. 797 UPON FINAL APPROVAL /-9-�3 MAP act LOT /:/ ?) FEE MUST ACCOMPANY THIS APPLICATION. DATE `t- LC 19 1 3 The undersigned hereby applies for a permit to build /0 2j ac�ording to the following specifications SOA"9 a V 1. Name of property owner --1-0 a V` iOricro.�� cp /Tel. 3I¢ /2416 Address $ C-o1(9eevs o -1c E . y4el- • 2,.Name of Architect(if any) Tel. v/3. Name of builder 3t(4- kith we rnAln Address 3 3Z Hardt 4. License No. Ott --ti o I Tel. S-4,"/ `4/t'f F.d�«SZw+o�� 0253 5. Name of Mason Address 6 icense No. Tel. 7. Construction address 8' Gd 1cf Pec c c inc-1,2 Olt�' District n �/� 8. Date of subdivision Approval plain zone C Zone 7 9. Private dwelling 0 Estimated Cost Qtr q�- DO NOT WRITE THIS SPACE Lai �Q0 crn- Type of room No. 10.Multi family 0 ),S-oo q Gffag/?2 eat 11. Commercial 04 oo_ deeja__. Kitchen 12. Other 0 /acxa 9 ' c; Dining Rm. 13. No. of stories 3 6_0 Living Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 ., / 'Bath ! 15. Materials — Wood 0 Cement 0 Other 0 _ Deck,l,;�xaY 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 A !ca•rr Closed orch Family Rm. 17. Garage — 1 ❑ 2 ❑ Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size Shed 20. Stove — Wood 0 Coal ❑ - 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 2a Distance from nearest building: Front Ft. side Ft. side • Rear 24. Distance back from line or street From rear of line Side line 25. H.I.C.R. No. I D to al LOT RELEASED BY Signaturf PLANNING BOARD Address / 3 3 Z )1 J c'1Qncea Date • E v-1.0✓th 0ZS3c, BUUIILDING PERMIT APPLICATION SIGN OFF APPLICANT: SQ_4- 6!&n yjew, 1%01 BUILDING PERMIT II: ADDRESS: 33.. fY U/IIQ X TELE. NO. : ,C767,--C/5)4 DATE FILED: BLDG. SITE LOCATION: Cr6-0(71--.94,s (lrr.c.to MAPA: ge-g LOT/l: ,--/ 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 ATE: ie /A 9 s 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: / ) 9411-1+.e24. '`ice"" `/nzZ /0 f? AYtto.�yo lr ., ttene7 re"" itr foe( 01.) Sc k/ Co,vi. , rz0 so F j&'ck rs 30402 Ho RE *soaE GQM-', 1?Ac[ nor," Moss 8e ~re; Comae' (67i 9 /¶ 3 BIM/89 ^ TOWN OF .YARMOUTH BUILDING DEPARTMENT . CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: Ci / JOB_-LOCATION: �S G"•OECc�/V'S ' • Ctrc� S • �144.piOv d NUMBER STREET • VILLAGE .OWNER OF PROPERTY: - ' S0 e.' Y l O-city cit t 12% ' CONSTRUCTION SUPERVISOR: �e_ $,g •�1thQ,wtu . o f o r 5 6� • !—d'/9e{ L/ NAME .'',��'�IILICCENSE NO. . PHONE NO. ' • ADDRESS: .% 3 Z...,' W c.� 01./p a, : /� (/vIOo -0 i-s` �%`. '-' • LICENSED DESIGNEE: :2 . ' . . . ' (IF OTHER•THAN SUPERVISOR) NAME - LICENSE NO. 2.15 RESPONSIBILITY OF'EACH LICENSE HOLDER:" ' 2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE ' ' IS SUPERVISING. HE,SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE • BUILDING CODE AND THE DRAWINGS AS APPROVED BY THE BUILDING OFFICIAL _- . ' ' 2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION, ALTERATION, REPAIR, REIOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING • AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE COMMONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB- CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. . 2.15.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE DISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY THE BUILDING PERMIT. • . ' 2.15.4 ANY LICENSEE WHO SHALL WILLFULLY VIOLATE SUBSECTIONS 2.15.1, 2.15.2 OR 2.15.3 OR ANY -- ' 1 OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL BE SUBJECT •1 TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. -.1‘-"---•••••;---: -.:',.%`.......?;.',;- :-.-.. ',-. • f - . . tom . .. 2.16. 'ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME, .SIGNATURE AND LICENSE NUMBER OF . THE CONSTRUCTION SUPERVISOR WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION,' RECON- STRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.: OF THE CODE AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING . SAID PERSONS, THE WORK SHALL IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS .SUBSTITUTED . ' ON THE RECORDS OF THE BUILDING DEPARTMENT. : _` _ ;.. - - ♦1, I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR :ICENSING CC:1- STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTAN: THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING INSURANCE COVERAGE: ,-.-._ - . . - • .. ,t,":- : ,• . I have a current li lity insurance policy or its substantial equivalent which meets the requirements of MGLth.I52 .- �,y,,i ` '`' `,.�:No ❑ :«. _:_`. ::.... . o _. .__... '--:.::..: :_ :. ..._.-:-:_:::':: .;._�- :: ` �-:.:±,.::..., It you have checked ves• please indicate the type c average by checking the appropriate box. .• =i-S.:%.'"--..••••-::: -1?'!'-'1::C__,• - A liability insurance pc:icy ' Other type of'ndemnify❑ --_. Bond 0 • Yt .,,,..z.,:,;;_:.: OWNER'S INSURANCE A IVER:I am aware that the ecensee does rot have the Insurance coverage.requiredL:/ C.`.apter 1520 he /as renerai Laws• ana that my signature on th:s permit ccptication waives this requirerner.t • i�1.0A> • Check one: Owner❑ Agent Er Signature, 12azi � (/ SIGNATURE: , I//,/ ' BUILDING OFFICIAL APPROVAL: PLOT PLAN • FOR LOT # • Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) ® , , We11 to I (lot / 9-4" ft. rear) Abuttor's I Abutt Name I Name Lot # ' I • Lot # REAR YAI•D , If this is a 3 0 ' If tt • corner lot, ® ft. ,. corne write in name 3o. e, - writ of street. `9 name �Z� I oP. a ..othe 0 • 042 ' o stree m ,b . C SIDE YARD 54 ( • DE YARD HOUSE b 0 FT .r? FT. 0a j'')• • o • • -Cr • • O SET BACK ct0l • o I ft. ..rj I I • 0 • (lot 133- ft. frontage) \ 5 © f (Reg & 01-1-• t.1,02, • • \ / \ / (NAME OF STREET) • / \ < • / \ -Information / \ Supplied by `rFFP1-kw-co.- Q\\ 1- Ow^'e-c - / \ • COMMONWEALTH OF MASSACHUSETTS = c � - `c • DEPARTMENT OF INDUSTRIAL ACCIDENTS • 600 WASHINGTON STREET James Camooel BOSTON, MASSACHUSETTS 02111 • Commrssrone• WORKERS' COMPENSATION INSURANCE AFFIDAVIT (licensee/perminee) • with a principal place of business/residence at 3ez 1/ Av (te Y1_60 a o (City/Snte/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 Xi 1 am a sole proprietor and have no one working for me. ( ) I am a sole proprietor. eneral contracyt)ar homeowner (circle one) and have hired the contactors listed below who have the following workerswmp nsation insurance policies. -- • • . . -•- Name of Contractor Insurance Company/Policy Number . . Name of Contractor - Insurance Company/Policy Number - • Name of Contractor Insurance Company/Policy Number Q 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(GLC. 152.sect 1(5)).application by a homeowner fora license or permit may evidence the legal status of an 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 Insurance for overage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to tlic imposition of criminal penalties • consisting of a fine of up to 51500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day ai st Signed this Z 5 day of - Sa • . 19 3 Lice^r:eiPer-:-ec • Lice::str:PeIml".Jr • • Suggested Affidavit for Home Improvement Contractor Permit Application • For orrice use only ` NAME OF CITY/TOWN Permit No. 6Ln 14-1 a Dale i • AFFIDAVIT • Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the"recons[ntction,alteration.renovation,repair.modernization.conversion,inprovement,removal,demolition. orconstruction of an addition to any pre-existing owner-occuoied building containing at least one but not more than,four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with ocher requirements. Type of Work: )Qo Est. Cost / co c� Address of Work ? 6-0 (u - c_ G 1 rC Owner Name: \ o-e_ y Date of Permit Application: er 1/4-L e- - ? 3 I hereby certify that: Registration is not required for the following reason(s): • _Work excluded by law _Job under 51,000 _Building not owner-occupied _Owner 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: 2rtv6�-1 / 067. 2-1 Date Contractor Name Registration No. OR: • Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name i I " " L, { 1 43 i „ 11 "C-N- , tie.r\pS0 • 41 I, "e ( . -43(\el \\ h ---1 2 t?1/4 r t C ) f n ) I /ipMv/a�R Y) S �I , �� 1 ,f,P1'Zx4 1 , kz_x,,5p ,Gro . c. -1 ,,,,. \-- 15") (7L- II1,_ tA;rislitirkietficyeth 0 l L -\ I` r I ,� cy 4o D1 ` i y I QN rd ,lab 1) . a 1; m, Z µ.e,w.VSA }'1;4 . 4,ack IS O.Its4ost-etr • 71/4.t ._rga^R sta d wr(( 6-z- 3 2. 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