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Home My WebLink AboutBLD-93-818 - £9 °i•YeRi? YARMOUTH G �'!�`a�X93 :44, ' TOW OF YARMOU ltd. c � avis/fy S " t 'CS, _ g Application for a Permit to Build No. lig/ UPON FINAL APPROVAL 6/°"4'5 MAP 10 LOT wi-11 FEE MUST ACCOMPANY THIS APPLICATION. DATE Sept 30/ 19 93 The undersigned hereby applies for a permit to build /61/a.4 9-3 according to the following specifications /l?4 679x0 (201) /Name of property owner Charles and Maryr.ou Hardy Te1445-5 91 Address 704 Howard Street . Ridgewood, NJ 07450 N of Architect(if an ) Tel. Name of builder Address 3 9 ' W - o ('C s 1-7 4. License No.`t` //6d *' Tel. S, y.�9- c'P '7/ 2.di"`e �( rn 5. Name of Mason _ Address 6. LI LI ense No. Tel. a.. t;onstruction address 1 Powers Lane. West Yarmouth MA 02671 Flood District 8. Date of subdivision Approval plain zone Zone i 2-f 7 C DO NOT WRITE IN THIS SPACE 9. Private dwelling 0� Estimated Cost Type of room No. 10. Multi family:'❑ 3, ape 11. Commercial 0 Kitchen 12. Other 0 4 b-6 Dining Rm. 13. No. of stories / Living Am. Bed Rm. 14. Foundation - Full ❑Half 0 Crawl 0 Slab ❑ ' Bath _ 15. Materials - Wood /Cement 0 Other 0 t Deck 16. Type of heat - Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage - 1 ❑ 2 ❑ Family Rm. Sun room 18. Swirttiriing pool=` ..., „ , Size- . Garage Veil) ICYL';• !Ct 1u� :-r r.. 19, Storage',shed=,Size Shed 2O .v. . " t, ` ` r'"j' . StdQS `- Wood'0 Coati❑ Alterations 21. Size of lot: No.of feetxfront' No.tf 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 om , - lot line Side line 25. H.I.C.R. No. � / �� LOT RELEASED BY Signat . ��_ — PLANNING BOARD Addre� riIif7 /tel/ Date c7z? - A ,,/ BUILDING rLiu;i'c arrLicalSIGN 0If e(rO I `�. „ a� U� f -` r APPLICANT: Charles and Mary Lou Handy BUILDING V. _ ADDRESS: '70 4 Hallird Lane , Ridgewood NJ TELE. NO. :201-445-5591 DATE FILED: • BLDG. SITE LOCATION: 1 Powers Lane West Yarm. MAP//: /Q LOTI/: Wf'I �, 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. t 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: REVILt4P.D BY: ✓1. WATER DEPARTMENT actimia•CalaS DATE: ° -tQ5-ot 3 N/A: 2 ENGINEERING DEPARTMENT: DATE: N/A: ONSERVATION: DATE: N/A: HEALTH DEPARTMENT • 1 ' DATE: !0- - -i'3 N/A: .HISTORICAL CO � u ,11" r a. - DATE: /o%3193 r INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: itA6 .-ILUMBING INSPECTOR: n DATE: N/A: ./ . FIRE DEPARTMENT: LT1?tc� RA 2ADATE: 101151°)3 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': WP; C:P - %)(lccftNG u. —6/z SGPA/tr.4: '7O 13e cvT °4-G4jPE1). V--'o ,cf.v;.",4? �1�QST ).imerP6 u>rflp$) 5 ' ()iv PRopt WD/ LINE, oft L£,Ac-4-1 Ft&LTA stoke . LP-PA/Fab 1a A acs tne F_XrEATT O F C-SWI.7 Ft et N • A q.. ti 4 R- Sc-AY, ' ,.)n1" V. -re, 1 c efrotp►-ET6h Ar &ujAndz5 R.)?PP-N5? 1,1,?*mR . cr- :'V -rte )1A- 112Spt.aTGj> p,Y us-rsR. Dept VRIog--rz, I .1Cr- • 1 I BLM/89 4# fOL!770 K BUILDING PERMIT APPLICATION SIGN OFF APPLICANT: ' �/40/14 BUILDING PERMIT 4/: ADDRESS: 7��710W /'U. _ _TELE. NO. : DATE FILED: BLDG. SITE LOCATION: //Q/l /,! IE' MAP!!: /Os 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.BUILDINCNDgPARTMENT 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 THEIAPPLICANT THOUGH THE FOLLOWING DEPARTMENTS: RESIDENTIAL AND/OR COMMERCIAL BUILDING 1 ' 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 SEPTACE 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: REVI BY: 1. WATER DEPARTMENT DATE: N/A: 2. ENGINEERING DEPA NT: DATE: N/A: kli. CONSERVATION: DATE: /n.- /J r 73 N/A: GC HEALTH DEPARTMENT DATE: N/A: / INDUSTRIAL AND/OR COMMERCIAL PERMITS � WIRING INSPECTOR: rd., DATE: N/A: £Ii LUMBING INSPECTO _ DATE:/d .�,e, � Q j N/A: /j7. 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 g DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING PERMIT. COMMENTS: . /BLM/89 • • Suggested Affidavit for Home Improvement Contractor Permit Application . • For;'lace Use Only - • NAME OF CITY/TOWN Permit No. West Yarmouth Date AFFIDAVIT Home Improvement Contractor Law . Supplement to Permit Application MGL e.142A requires that the"reconstruction.alteration.renovation,renair.modernization.conversion.inprovement,removal.demolition. or construction of an addition to anv preeristing owner+xcunied building containing ar 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: Demolish building Est. Cost .3,000 Address of Work 1 Powers Lane, West Yarmouth, MA 02673 Owner Name: Charles and MaryLou Handy Date of Permit Application: 405{-7 I hereby certify that: Registration is not required for the following reason(s): • Work excluded by law o nder $1,000 wilding 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 per44/ m of the owner: /003 //0/94/ 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 t - -- COMMONWEALTH OF MASSACHUSETTS ‘e", ` ea • DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET .lames. CamwpeB BOSTON, MASSACHUSETTS 02111 Come ss,one 11/171don' WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • • / (licensee/permittee) • with a principal place of business/residence an AVL & Comapnies, 39 Wilber Street, Box• 3, Lowell, MA 01851 (City/State/Zip) • do hereby cemfy, under the pains and penalties of perjury, that: 1 am an employer providing the following workers' compensation coverage for my employees working on this job. • 10� sU�6-P 411a/S6 , e#/C4Y9 Insurance Company Policy Number j I 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 _ 0 I am a homeowner performing all the work myself. NOTE_Please be aware that while homeowoen 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(CL.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. 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 NGL 152 can lead to the impoiition of criminal penalties consisting of a line of up to $1500.00 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 /C_G Y�/ day of • , 19 • Seat LicerectiRt. r. - / Lic:nsor;Permittor ._ . . • TOWN OF YARMOUTH BUILDING DEPARTMENT - . CONSTRUCTION SUPERVISOR FORM •c" PLEASE PRINT: JOB LOCATION: ✓ f/ 2i�%!/L !'r ""'� NUMBER//�� // r�.,), WET y/�/ ., VIL� . OWNER OF PROPERTY: ' a3 e / �!':cam/4 „/".". ' //f✓ L - :. • CONSTRUCTION SUPERVISOR: • • " ' / /, ��/ �� / NAME LICENSE NO. .PHONE: NO. ADDRESS: ;.3'94 ✓• ®�C/�U /��!1e5 . ', LICENSED DESIGNEE: Ati ✓�� 0 ' a()ga - (IF OTHER.THAN SUPERVISOR) • 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, 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 • • 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 ! OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL 3E SUBJECT I 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 DMOLITION 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 I}INEDIATELY CEASE UNTIL A SUCCESSOR LICEISE HOLDER IS SUBSTITUTED . - - ON THE RECORDS OF THE BUILDING DEPARTMENT. • ' I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ‘.FOR LICENSING CC:I- STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTANI THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING OFFICIAL. •' INSURANCE COVE GE: .. . ' . _ '_; _. • - . _.,• :. ar . I have a current t' . ity insurance pclicy or its substantial equivalent which meets the requirements of MGLtCh 152 'i:.- -iYes No ❑ _ _'. . __... _ - ... , ._..._ '- • If you have checked ves, please Indicate the type c abd..verage by checking the aparcpriate b - .L:".:•••;• 7•;•'-'1'•• +„i_„ +... A liability insurance peaty @! Daher type of:.idemnity❑ --- Bond 0 b: OWNER'S INSURANCE WAIVER:I am aware that the ucensee does rot have the insurance coverage required'ay. • • Chapter 152 of the Maas: General Laws, aria Mat my sig-:lure on tn:s permit ::alit::ion waives this requirement - ' Check one: • - Owner) Agent 0 - Signature m Ownal a Ane s Agent • .. I SIGNATURE:�� ,4 mi BUILDING OFFICIAL APPROVAL: I • I I\ , . 1 AFFIDAVIT As a result of the provisions of MGL c 40, S54, I acknowledge that as a condition of Building Permit Number all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. • p. • I certify that I will notify the Building Official by /�aste (I\vo months maximum) of the location of the solid disposal facility where the debris resulting from the said construction activity shall be disposed of, and I shall submit the appropriate form for attachment to the Building Permit. tX 49 ' , Date Signature of Permit Applicant • \• (Print or type the following information) 671,067 64° 1 • . Name of Permit Applicant • vv��,� i Firm Name, if any , 194:Jae Y7re—A a el t Address i . liny ,�q,,P, ,-744 /74,J ; // Gil � r , i 4 I