The URL can be used to link to this page

Home My WebLink AboutBLD-93-824 Y �/ '24' 4'o \'TOWN-OF YARMOUTH Y ' �� "sAORMcM%t y pliit for a Permit ito Build No. ?a `� i` kcir,zany ' .UPON FINAL APPROVAL ibg 93 MAP 51 LOT g /-95— FEE MUST ACCOMPANY THIS APPLICATION. DATE at+2,5 19 `n The undersigned hereby applies for a permit to build • le)/ le/93 according to the following specifications /ti, ///93 } 1. Name of property owner rt pity fJ n .,au arr Tel. -Y. Address -a.; Sc. ;ad- g•-en 're..12.Name of Architect(if any) Tel. 3. Name of builder R4rr, he t ) Address ' % t 5k.,..k. 0. 1G7,I+ ) MA 4. License No. CS94aR Tel. 8'S— $K0'I 5. Name of Mason Addiess 6. License No. Tel. • 7. Construction address 'X3 <i.- {--4- ar"°IC lid, ' S _ / District A 8. Date of subdivision Approval plain zone G Zone ft" - 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE 5TrL J P-1 c,eev,c- Type of room No. 10. Multi family 0 4,2.k t, do% 0 o 11. Commercial 0 lie,-Fact kl ti`, )<ZTk-t. Cpari, _Kitchen • 12. Other ❑ SA'r1 P 4 P"fdeCDining Rm. vB''? /4? Gi�� Living Rm. ,r 1 a 13. No. of stories , /J ,,�� / ).(7 Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath 15. Materials — WoodI O Cemerit'❑:Other O :• - • , . Deck 16. Type of heat --Oil ❑l Gas ❑ Electric P Other.❑1 `0l;• , ;;.'r..- Closed porch •... , ,+ , . . . -,.I id ci :Ise; r ,• _ . 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 J 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 lot line • Side line , 25. H.I.C.R. No. \ ogbte i LOT RELEASED BY Signature U k T.M . I --PLANNING BOARD Address Date •_ /0/2�/j:3 . .P4S TOWN OF YARMOUTH • • BUILDING DEPARTMENT . ' CONSTRUCTION SUPERVISOR FORM ' PLEASE PRINT: . . . 44.,* . • JOB LOCATION: X7c• • S tin ,�C' R.raa IC-- Sc• :er : NUMBER •4 uu • . STREET VILLAGE ' OWNER OF PROPERTY: ' • ' .. 1 �S .• • cb b na Jai. • . • C4c�.>_ w.Q r:-I 1 J • ' nSLI`� Z_K . 3 ss— ka"a CONSTRUCTION SUPERVISOR: • �' ' • • NAME LICENSE NO. PHONE NO. . -• . ADDRESS: • -It 2; • ' 'C1<,t..... Fri.Z4-1' ' • r • ' 'Ca.^. -- ') - ... • • . LICENSED DESIGNEE:.' . , • �e.nno. .�,' • •' .0 t rl. i ' , • (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, RE`:OVAL 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 BE 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 DEWLITION AS REGULATED BY SECTION 109.1.1 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 DEPART:ENT. ' ' ' . .. - ` - ^'s• : ' 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 COVERAGE: •. . _ . . --- . • • . . • • •. _ _...- .• I have a currentli bility insurance pclicy or its substantial equivalent which meets the requirements of MGLth.152 .-Z.72.:('.:: If,you have checked is please indicate the hype coverage by checking the appropriate bez - •C;'` -'-' <: . A liability insurance pc:icy 0--/' 0:her type of indemnity in --- - Bond 0 -- _ • • • OWNER'S INSURANCE WAIVER:I am aware that the ncensee dcei rot have the insuranr_ coverage rcquirec:r Chapter 152 of the Mass. General L-ws. ana that my signature cn this permit :ta:ic::ion wa.—es this requirement. ' • Check are: •• . - . , _Owner° Ager:0 Signatwa o caner r Onner s Agent SIGNATURE: ..U9_e_a BUILDING OFFICIAL APPROVAL: • Suggested Affidavit for Home Improvement Contractor Permit Application . - •For 0111ce Use only }NAME OF CITY/I.OWN Permit Na .. ` e„r µa l�l� Date • AFFIDAVIT Home Improvement Contractor Law • Supplement to Permit Application MGL c.142A requires that the"reconstruction,alteration,renovation,repair,modernization.conversion,inprovement,removal.demolition. or construction of an addition to any pre-existing owner-occupied huiidingcontaining 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: R e_ e�,� Est. Cost 4 a_,e 40, a a Address of Work a S &rcr a k J 0. Owner Name: p1 rc nein aur� Date of Permit Application: TOIL S h3 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 oft e owner:, GILS �� Rarr2 errs! 10?4lS Date Contrr for Name Registration No. OR: • Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name • • = COMMONWEALTH OF MASSACHUSETTS • DEFAKFMENT OF INDUSTRIAL ACCIDENTS • 600 WASHINGTON STREET • names Campoeu BOSTON, MASSACHUSETTS 02111 • Comm,ssfone WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • 1 he,cr1 � (licensee/perminec) • with a principal place of business/residence an • - � L skcLk ec a—(L CQ J (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. & Yarn a sole proprietor,general contractor or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation insurance policies: •••• -- • • -• ,_ - . . . . f`�-e-n,.•r, L �n. r r 1 L ' r.. U t lv e,c) Name of Contractor • Insurance Company/Policy Number . . PL.ti I J ril l Cu t yULo Name of Contractor - • Insurance Company/Policy Number • Name of Contractor Insurance Company/Policy Number . _ • •` [] I am a homeowner performing all the work myself. NOTE.Pleue 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 iccure coverage as required under Section 25A'of MGL 152 can lead to the impoiition 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$100.00 a day against mc. Signed this 2 S day of d , 19 q? LicenseeiPermi,L • LicensoriPermittor