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Home My WebLink AboutBLD-93-822 oF'YaR` . 4 /0/2./PS r TOWN OF YARMOUTH g va.fgs - , tta MATTACMEEE 441 oo..0 Application for a Permit to Build No. 2 Rae y.__.. Q1 X13 UPON FINAL APPROVAL 1 0- MAP LOT /" Cr FEE MUST ACCOMPANY THIS APPLICATION. DATE octo 1993 The undersigned hereby applies for a permit to build id according to the following specifications ,O��(%3 1. Name of property owner Frank J. Shealey & Glenn E. Shealey - Trustees Telt 17-"S*N3z Address 37 Stage Harbor Road - Chatham, Mass. 02633 2.Name of Architect(if any) None Tel. 3. Name of builder John Handren d/b/a Handren Bros.Address Rte 28 - So. Hariwch, Mass. 4. License No. 058-207 - Tel. 432-2047 5. Name of Mason None Address 6. License No. N/A Tel. 7. Construction address 10 Elton Road - West Yarmouth, Mass. Flood District n 8. Date of subdivision Approval plain zone Ci Zone 9. Private dwelling E Estimated Cost .-W.P OT WRITE IN THIS SPACE t n../ p 6;0--o4r-�Z ' Type of room No. 10. Multi family 0 $.r',�C, --- G 11. Commercial 0 /�/�3 Kitchen _ 12. Other 0 �,vicer ,45, ge �� DiningRm. ?8 F�-rni gen" 13. No. of stories 1 Caps g� Mr Living Rm. z a6 if SF' Bed Rm. 14. Foundation — Full 0 Half ® Crawl 0 Slab 0 Bath 15. Materials — Wood 11 Cement 0 Other 0 64 m----- � Deck 16. Type of heat - Oil 0 Gas ® Electric 0 Other 0 j -f o PEP Closed porch A'' 17. Garage — 1 I 2 ❑ lint Family Rm. �i Si a Sun room ' 18. Swimming pool - Size N/A Garage V 19. Storage shed — Size N/A Shed ` Alterations 20. Stove — Wood 0 Coal 0 21. Size of lot: No. of feet front 140' No. of feet rear 140' No. of feet deep loo' 22. Size of building. No. of feet front 72' No. of feet side 24' No. of feet rear 72' 2a Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street 30' Fe • ••e 45' Side line 28' & 4o' 25. H.I.C.R. No. /a b' 6,2fi LOT RELEASED BY Signature ' / PLANNING BOARD Address37 Stage H-« Road Date Chatham, Mass 02633 fr/ild 1993 i 1 F1 1 APPLICANT: Frank J. Shealey - Trustee BUILDING PERMIT //: • ADDRESS: ' 37.Sta*Harbor Rd. Chatham,Mass. TELE, NO. : 945-9500 DATE FILED: 10/18,1993 BLDG. SITE LOCATION: 10 Elton Rd. W. Y. MAP//: 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 COMH'LIANCE 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. ONSERVATION: A DATE: N/A: C4CHEALTH DEPARTMENT Jg _MOr DATE: ion 1 N/A: fRIAL AND/OR COMMERCIAL PERMITS y. WIRING INSPECTOR: Arefir �r / DATE: OCT 2 6 1993 N/A: OCPLUNBING INSPECTOR ..rflj A fl/ D Eye) a(- 9 , N/A: a:- 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. \ J COMMENTS: ea J /1N) 1/'.4', . "XoJ '5Y- eotc ,r At-oc,,u1? ?,x'in'crria (rF LY'f�/Li 1T.� fau en/.E- 5 . ec Pcr',crc,72, 5 -its c-H-rno,y(S) fleets c2 y yrD /4ND �itPt et- fit- jil; • Nods-et 10/z 6/4.2 BLM/89 r�-/O/f Pf_9-3— PLOT PLAN • . FOR LOT O r Indicate location of garage or accessory building Additions with dashed lines . Sewerage disposal (cesspool) • Well isi I • I (lot 140' ft. rear) I — Abuttor's I Abu' Name I Nam Lot # • .ctLot n REA � • If this is a • - If t corner lot, 45 ft. corn write in name 1 wri of street. I name • a othe b sire e0 t` • • SIDE YARD • JI HOUSE SIDE YARD ' • 0 40' FT_._ 0 rcitil . . (j 28' FT 0, . • O. K o • I • Z SET BACK 30' ft. w +- • °' ° � o I w A 47> Ul • (lot 140' ft. frontage) .. \ / ELTON ROAD • \ / \ / (NAME OF STREET) . / • . • • / \ -Information Frank J. Shealey ' / \ Supplied by TOWN OF YARMOUTH BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE JOB LOCATION NUMBER STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOME PHONE WORK PHONE PRESENT MAILING ADDRESS 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 a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked/es, please indicate the type coverage by checking the appropriate box. • A liability Insurance policy 0 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 0 Agent 0 Signature of Owner or Owner s Agent ` ' 1- COMMONWEALTH OF MASSACHUSETTS --_�?.. DEPARTMENT MENr OF INDUSTRIAL ACCIDENTS -17 600 WASHINGTON STREET James Camvoei, BOSTON, MASSACHUSETTS 02111 • comm:ss poet WORKERS' COMPENSATION INSURANCE AFFIDAVIT • IX (licensee/permit-tee) • with principal place of business/residence ac (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 [tam 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 hoo have the following workers' compensation insurance policies: -, .-,.... - .. V Name of Contactor . . Insuance 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(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 I 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 iecure coverage as required under Section 25A'of MGL 152 can lead to the imposition of criminal penalties • consisting of a fine 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 5100.00 a day against me. Signed/ this day of 19 v V Lia^see.Pcrrni7C: LicensoriPermirtor • Suggested Affidavit for Home Improvement Contractor Permit Application • For Office Use Only NAME ORM/WI-OWN Permit No. YARMOUTH • Date AltIDAVIT Home Improvement Contractor Law • Supplement to Permit Application MOL c.142A requires that the"reconstruction,alteration.renovation.repair,modernization.conversion,inprovement,removal.demolition, or construction Man addition to any preexisting owner-occupied building containing at least one hut not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors,with certain aceptions,along with other requirements. Type of Work: Temporary hobby area in single car garage Est. Cost $750.00 Address of Work 10 Elton Road — West Yarmouth, Mass. Owner Name: Frank J. Shealey — Trustee Date of Permit Application: October 18, 1993 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under $1,000 _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: Date Contractor Name Registration No. OR: • Notwithstanding the above notice = apply for r permi as t owner of the above property: October 18, 1993 Fran]c he. _t — .740 . I re Date Owner Name V