HomeMy WebLinkAboutBLD-93-827 S ,451:70 0 TOWN OF YARMOUTH
" MATTACNEES •
e,, w.a....:1 t Application for a Permit to Build No. 2a 7
UPON FINAL APPROVAL ID'a--- 3 MAP /3 LOT_ K a /
FEE MUST ACCOMPANY THIS APPLICATION. DATE f D X93
The undersigned hereby applies for a permit to build /L%a6/9-3
according to the following specifications /a/a-69/93
1. Name of property owner Has-0 I ck 13egO{d- Be lA RdTel. 77/-4143
Address 3-s Mau s L o p.4 alk: wed- YY►•w.sf4
2.Name of Architect(if any) Tel.
3. Name of builder a;l I McCloskc.y Address T14FPO/no
4. License No. Tel. C310-7277 7-D HUNTINGTON AVE.
SOU ill •(ARMOUTH, MA 02654
5. Name of Mason _ Address
6. License No. Tel.
7. Construction address 35— Mt.sskspr -2.4k W • 14. 2 •
Flood District -Zb-
8. Date of subdivision Approval plain zone finite.
lo) Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
10. Multi family 0 Doe.00
/9rr,c-4- cvyc`- Tye of room INo.
11. Commercial 0 las', Ic-ho0 Kitchen
12. Other ❑ MM.. .- walls Dining Rm.
13. No. of stories , r 0-6 Living Rm.
Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath
15. Materials — Wood 0 Cement 0 Other 0 Deck
16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch
Family Rm.
17. Garage - 1 ❑ 2
Sun room
la Swimming pool - Size Garage
19. Storage shed — Size , : , Shed
20. Stove — Wood 0 Coal 0 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
23. 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. /4 3/ aG ‘A k
LOT RELEASED BY Signature 1�'.
PLANNING BOARD Address ' HERMC
7-D HUNTINGTON AVE.
Date ¢P 4Th YARMOUTH, MA 02C04
I
• •. BUILDING DEPARTMENT , ' -
CONSTRUCTION SUPERVISOR FORM • "
PLEASE PRINT: ' • . .
• 1 . 1 �/
• JOB LOCATION: • .tC 1' ck._ 8L1'S 2.�L GCI4EV ' x L. 0 L
NUMBER 1 STREET • VILLAGE - • 1
OWNER OF PROPERTY: I-ku-a/f 'Tartu-�
CONSTRUCTION SUPERVISOR: a 1. 6, GAJ ske, f Q 3U.(p .393-7277.
NAME ( .. ' LICENSE'N0. . PHONE NO. .
ADDRESS' 7H RMCO •
7-D fitii TINGTON AVtr.
LICENSED DESIGNEE: SOUTH YARMOUTH, MA 02664 _
(I? OTHER THAN SUPERVISOR) NAME' " : LICENSE NO. .
e.lu:.4.. 44.mt IMPROVEMENT •i :•
2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: L.:;a: ytpn gvepue
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 STAT
BUILDING CODE AND THE DRAWINGS AS APPROVED BY THE 'BUILDING OFFICIAL •
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2.15..2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION,
ALTERATION, REPAIR, RatOVAL OR DE!OLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING
AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND" ALL OTHER APPLICABLE LAWS OF THE' '
CC:"ONWEALTH, 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 IM_!EDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE
DISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY THE BUILDING PERMIT.
!
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=.15.� ANY LICENSEE Wr.0 SHALL 'WILLFULLY VIOLATE SUBSECTIONS 2.15.1, 2.15.2 OR 2:15.3 OR ANY
OTHER SECTION OF THESE RULES, AND REGLLATIONS AND ANY PROCEDURES. AS AMENDED, SHALL 3E SUBJECT
TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD.
I. 16. ALL BUILDING PEF.NIT APPLICATIONS SHALL CONTAIN THE NAME. SIGNATURE AND LICENSE NUMBER 0:
TEE CONSTRUCTION SUPERVISOR WHO IS TO SUPERi'ISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON-
STRUCTION, ,ALTEPJATION. REPAIR, RE`!OVAL OF DD!OLITION AS REGULATED BY SECTION 1094.154 OF THE
000E •AND T1ESE RULES AND REGULATIONS. •IN THE EVENT THAT SUCH LICENSEE IS NO LONGER Z.`RERVISi:
SAID PERSONS. THE WORK SHALL IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER-IS SUBSTITUTE !
ON TEE RECORDS OF THE BUILDING DEPARTMENT. , • .Th
I _AVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS .FOR LICENSING b
STETCTION SUPERVISCRS IN ACCORDANCE SIT':: SECT-ON 109.1.1 OF THE STATE BUILDING CODE. I UNDERS'
TEE CONSTRUCT?ON I::SP----ON PRC - SPECIFIC rNsFEC-I „
• � CE�i;iEp AND Oa AS CALLED F03 BY :HE •3L'iLD2
OFFICIAL. •
•
INSURANCE CCVEAACE: •
I have a cure • liar.:ity insurance- colic; '
Ye: Tr.
NoG e; a s suc.._. :i l ecu::stent wntcG ;nee:: :he requirerr_nts cf Mat:1152
If you have c..ccxed In.. p!e••e incic;:e the ape c7verc^ye by checxing Pe _-_._:nate bex.
A liability insurance policy ?,- C:her type d '.1cemn:ty 0 ecnb 0
C'WNEiv- :.`! AI`
Oh--•... .. .• Ai :G WAIVER: ! C� aware t.`. :.`._ ._...__ _ -^ wU.. M /
j .._..._. C: :... ..._ Central t_--.vs. --- •-_. ._y - — _. _ .. ...-r_ . e;IF:- - refit:rec
i .. ... .. ... __. _ ;e_ 'ia
* * * MEMORY REPORT ( APR, 28 ' 93 7:41 ) * * * •
AGM MARINE
FILE DEPT, TRANSFER ' START TOTAL
NO, LABEL LABEL STATION MODE TIME PAGES
0437 968-3263 -- TX IMMEDIATE 1
REMAINING CALL CAPACITY: 199
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^tyn�n II 7.4 .r.
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' Suggested AffidavitfOr Home Improvement Contractor Permit Application . •
L � =• • Fo�OMeeUseOnly. NAM OFCIfl OWN
AP M.OAh Pann�t Na ' sr--1
•
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. Dale '
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Ar NDA V IT • •.>�•:
Home Improvement Contractor Law „
Supplement to Permit Application
• MGLe142A requires that the'reconstruction.a It en ion,renovation.repair.moderni,.tion.conversion.i nnrovemen I.removal,demolidons
orconstruction or an addition to any pre-existing outer-eccunied building comaininc at least one but not more than four dwelling units....or
•t0 structures which are adjacent to such residence of building"be done by registered contractors.with certain eceeptions,along with other. . '
'Type of Work: tvSb L ow i
•• Est. Cost'/D�v
Address of Work a Ma..LJB c ei4 VA.„..,--/E- - .
•
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Owner Name: laAy•p ld.. —3tiscu-.et
Date of Permit Application: /p — 2.3"— 9 3 .
1 hereby certify that:
Registration is not required for the following rcason(s):
•
• _Work excluded by law
_Job under 51.000 • •
Building not Owner.occupied
_
Owner pulling own permit
_•
Other (specify) .
Notice,ii hereby given that: ) {
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- .:OWNERS PULLING THEIR OWN.PERMIT OR DEALING WITH UNREGISTERED' t ••
• CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DONOT HAVE . •t'
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 ��' 11--n .J_V —1-0s19.2.42_ — �
Contractor Na c
Registration \o,
OR: y � '�
i
Notwithstanding the above notice. I hereby apply for a permit as the owner of the above property;
Date
Owner .,\'amc . . .
intiVi uii r,....
y :t> ;i„el::,rrten .4.v6,i(,'i: MO( IHP?�hyEMENT IRC.
(1.4., t ,;;):::),. la\ ..i�'�lv i „„ .,-, n 'IrJ(1U(•
• 7 D1 fHIMTINGTON AVE. .
SOUTH YARMOUTH, MA 02664
. .
* * * MEMORY REPORT ( APR, 28 ' 93 9: 11 ) * * *
AGM MARINE
FILE DEPT, TRANSFER • • t START TOTAL
NO, LABEL 4ABE6 STATION ' ' r MODE TIME PAGES
0442 1-987-8434 -- ;, : E +'� TX ' IMMEDIATE 2
REMAINING CALL CAPACITY: 199
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T Y t
t COMMONWEALTH OF MASSACHUSETTS
eV' . • b • DEPARTMENT OF INDUSTRIAL ACCIDENTS y ,'
��" 600 WASHINGTON STREET .
esu Gamooea . BOSTON, MASSACHUSETTS 02111
s
omn:ssroner WORICERS' COMPENSATION INSURANCE AFFIDAVIT /
i
•
I, THERMCO, INC ' •
(licensee/permiuee)
with a principal place of business/residence at: • v
7—D Huntington Ave. , S. Yarmouth, MA 02664
i
(City/State/Zip) r
do hereby certify,under the pains and penalties of perjury, that:
[9 I am an employer providing the following workers' compensation coverage for my employees working on this
job.
•
AETNA Commercial 'Ins. Div. • 006C22790586cAA•
Insurance Company Policy Number c
[) 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: J
•• 1
' Name of Contractor Insurance Company/Policy Number
• 4
Name of Contractor Insurance Company/Policy Number `
•
Name of Contractor
Insurance Company/Policy Number
0 I am a homeowner performing all the work myself. .
1
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 1
.considered to be'employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)),application by a homeowner fora license s
e
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 Accidenu'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 i
consisting of a Fine of up to 51500.00 and/or imprisonment of up to one year and civil perialtiu in'tlie form of a Stop Work Order and a '
fine of S100.00 a day against me. ' a i ,•,a ,, It I ,y —
Signed ist.:3,sr_ I °
day of 0C+0)021- . --f , 19• 9.1
Pres. , Thermco, Inc.
Licensee/Per‘
icensee/Per iaee Licensor/Permitter7
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