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Home My WebLink AboutBLD-93-814 . -Yq, ctLio,/ i/93 /4'4,_ r t'o TOWN OF YARMOUTH orr-ew io/z,/ys MATTACE taro,,nlossS d',- Application for a Permit to Build No. 8/ UPON FINAL APPROVAL 6-4 10 -A.`cMAP ' - I LOT P I FEE MUST ACCOMPANY THIS APPLICATION. DATE /0/71'T19 R'S The undersigned hereby applies for a permit to build 7eig 7993 according to the following specifics ions t� 1 S�•�r►�1 Name of property owner V�g ! 5 Te1.77S'M9 I Address ' • r -__ . . ' _W ' 2.Name of Architect(if any) Tel. 8: LName of builder'Z(n 0.t D. IA CE,r4h Address 1206r-eat- tries fcn Eb pCLicense No. DUS/ 3S Tel. '7A0 -(4500 • 5. Name of Mason Address 6. License No. Tel. n v7.Construction address . ge ni I IJ.e r 1-C • 9cHm r 1 Flood District nn - 2.s-- 8. Date of subdivision Approval plain zone Zone /` 9. Private dwelling 0 Estimated Costs DO NOT WRITE IN THIS SPACE 10. Multi family 0 /Z•Oo K . m-011-93 /4 OdType of room No. 11. Commercial ❑ ilia Q A I a" ' /0/2_,)/y.3 Kitchen 12. Other %._ -Dining Rm. 13. No. of stories ._0-c) Living Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 - /a pa Bed Rm.Bath 15. Materials — Wood 0 Cement 0 Other 0 / �� Deck 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 0 2 ❑ Family Rm. Sun room 18. Swimming pool - SizeGarage /.---19. Storage shed — Size BX rL. Shed FX12 / 20. Stove _ Wood 0 Coal 0 Alterations 21. Size of lot: No. of feet front No. of feet rear Q No. of feet deep 22. Size of building. No. of feet front f Z- No. of feet side 8 No. of feet rear 12- 23. 223. Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from101,37i�Qrsty street From rear lot line / Side line 25. H.LC.R. No. I J P� �CZ7 c � LOT RELEASED BY Signature 1 ' PLANNING BOARD Address O p C5Y'QO+ td.}eskin ED Date S .0-en n IS MA- U7 O �S/Zdl3 PLOT PLAN :4 ' FOR LOT # 1. 1 ' • Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) ® ' Well 0 ' i 1-i .-) � (lot ft. rear) I y L C C :: Abuttor's 1 \L4 Abuttor's Name I Pitop wwww��... Name ...• Lot # I 61-0 7____c----> Lot # REAR YARD If this is a • If this is ' corner lot, ........i ...ft. • corner lot write in name write in of street. i /9 name of ;-: I a other a street. . 0 � seet. . d • V y 4 i SIDE YARD/, HOUSE SIDE YARD I(-f tFT.• �l FTS{ • 4- I _ • I SET BACK L • J ft. 4ijy i, I I 0 - (lot ft. frontage) t \ / J I I UrL2s' L P Lan(2_, \ / \ / - (NAME OF STREET). OFij b • / Information • 7 / \ Sucpliad by �/ , / i / \ :IAF.:: :IORT:i POINT • BUILDING DEPARTMENT • . CONSTRUCTION SUPERVISOR FORM LEASE PRINT: ' JOB LOCATION: Y% s Iuter L c • � ' ' ✓ ots • NUMBER tet- �p �/ TRREET VILLAGE OWNER OF PROPERTY: ' 1 '� ' 5 1'I I¢t I }JAS,. ] • 7.0-' �. CONSTRUCTION SUPERVISOR: �ToY\MLS 0; ICA Cc-07N' � in '1 �° . ^ ,,.. NAME�y�1 . LICENSE NO. PHONE NO. ADDRESS: • 170 &C.Ct+- Wc&crn 20 • • c.'c ,nr - ' LICENSED DESIGNEE: (IF OTHER.THAN SUPERVISOR) NAMELICENSE 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, REMOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING 'AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE COt1ONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB- CONTRACTOR OR CONTRACTOR TO THE PER`lIT 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 OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS &ENDED, SHALL 3E SUBJECT TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD. . 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 LICENSEEE IS NO,LONGER SUPERVISING SAID PERSONS, THE WORK SHALL I} 1EDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPART:ENT. I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR :ICENSING CC:I 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 OFFICIAL. . INSURANCE ERACE: . • ., I have a curre liability insurance pclicy or its substantial equivalent which meets the requirements of f MGLth.152 Yes . No ❑ If you have c , .ked v, . please incic_:e the type c:verage by checking the apo:ccriate box. � t A liability insurance pc:ice Other type of indemnity 0 ecnd 0 • OWNER'S INSURANCE WAIVER: I am away that the ucensee does rot have the insurance coverage require:: by Chap• 52 c t ass. General Laws. an^ Mat my signature cn C:s permit cap:i :icn waves lis requirement. _,t ��//1 Check one: •,�iL. i Y ) Owners Ag it `caner cr Onner s Agent c237j6Q65-E36A -GNATURE: BUILDING OFFICIA APPROV �- . • 7 = COMMONWEALTH OF MASSACHUSETTS • DEPARTMENT OF LNDUSTRIAL ACCIDENTS ' • 600 WASHINGTON STREET .i BOSTON, MASSACHUSETTS 02111 • • James CafDpelt Comm:ss ones WORKERS' COMPENSATION INSURANCE AFFIDAVIT • .TOPAD S n MCArCIA4V Q , Hoo( Wont.. and -s (licensee/P ermine) • with a principal place of business/residence an • • 120 reed- Dif640rn ed • s • Uennr 5 ' MA (City/Sure/Zip) do hereby certify, under the pains and penalties of perjury, that: - • - • - - - • _- - - am an employer providing the following workers' compensation coverage for my employees working on this )o'. M�T/L A C 23369.656C.AA • Insurance Company Policy Number • 910 am a sole proprietor and have no one working for me. [ J 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.PIeue 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 status of an employer under the Workers' Compensation Act. 1 understand that a copy of this statement will be forwarded to the Department of Industrial Accidents'Office of Insurance 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 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 against me. Signed this day of /0 — , 19 q dal Licer:s et LicensoriPermirtor • Suggest' Affidavit for Home Improvement Contractor Permit Application F- -.Me Use only NAME OF CITY/TOWN tennis No. Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGLc.142A requires that the"reconstruction,alteration.renovation,repair,modemirat ion.conversion,inprovement,removal.demolition. or construction of an addition to any pre-existing_owner-occupied bmldin g_containin g 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 other requirements. �� ^ Type of Work: c d-c `I ')/�/ o a ,/_fir /Est.�cost cony, Owner Address of Work gib slim m ry / ec,f) Ln t u• Lj Ckv Owner Name: • AL_. 6-011 t' ne ek Date of Permit Application: • 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. Signedunder penalties of perjury: I hereby apply for a permit a of the o ner: /o-7.0 i3 - Jo Peat c si3s Date' .ntractor . ame Registration No. t'.:OR: a Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name