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Home My WebLink AboutBLD-93-828 1A •Ylit ,\ ort iiGm4 /A3 , *.f. f ,4, TOWN OF YARMOUTH or Pcm' la AG fig . 1 • •MATTAGME 5 kt, /l�� eiiCk.....„ ' % Application for a Permit to Build No. CJ UPON FINAL APPROVAL �JO �b /� MAP kg LOT ne. FEE MUST ACCOMPANY THIS APPLICATION. DATE /0 - a-C 19 93 The undersigned hereby applies for a permit to build D i.0�a 6/9_3 / according to the following specifications rn l /9-3 1. Name of property owner DnNc(A al-cit s Te1.398'-8603 Address X'4 Or a .' Au. So AL Yil.0.n✓- 2.Name of Architect(if any) Tel. 3. Name of builder 'Rill Me ('iu c ksv Address 4. License No. Tel. c3Q8-7x77 THERMCO 7-P I IIJNT?NGTON AVI:. 5. Name of Mason Address SQuTI4 V fMOUTH hit,Q2%o4 6. License No. Tel. �/ 7. Construction address s V Oce.... Au. Seal / '. , tj Flood ,\ District 8. Date of subdivision Approval plain zone is l Zone -Z 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family 0 Aroo. Oe 4r71 G ZKSULr i4 Type of room No. 11. Commercial 0 j ie Iate:> Kitchen 12. Other 0 ata Dining Rm. 13. No. of stories 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 17. Garage — 1 ❑ 2 ❑ Family Rm. Sun room 18. 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. /039 024, • LOT RELEASED BY Signature \ \lv ,w PLANNING BOARD Address i;;E ,eJ;CO Date 7-n HI trmvflrQ•' s"E PPNTM YARMOUTH,MA 02584 • - •• BUILDING DEPARTMENT • , • ' CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: • • -• JOB LOCATIONI �T. '°Ce4. - /Vs SCA Y/1._tuU✓P1, • j NUMBER �� (( •^ . STREET VILLAGE • J OWNER OF PROPERTY: ' �k,a,ltt, `11LtLi+S •\, ' CONSTRUCTION SUPERVISOR: Sj II. NIC C1JSK wag et‘ ' A987217' NAMELICENSE NO. PHO\E N0. ADDRESS: THERMCO . • 7-3 HUM(NG i UN Avt . LICENSED DESIGNEE: SOUTH YAfMOUTH, MA 02864 - (IF OTHER THAN SUPERVISOR) NAME. LICENSE NO. 2.15 RESPONSIBILITY OF EACH LICENSE HOLDER: "U j'"�'' 61ii fiOYEidEi4T :;, • • ,'•-) i 1.. :;i::ytort Avcnur% • 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 , • , "2.5.1 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION, ALTERATION. RE?AIR. RE!OVAL 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' • COMMONWEALTH. EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB- CC::TRACTOR OR CONTRACTOR TO THE PERMIT HOLDER. 2.:5.3 THE LICENSE HOLDER SHALL I:•21EDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE DISCOVERY OF ANY VIOL;TIONS WHICH ARE COVERED BY THE BUILDING PER`!IT. :.:5.1 ANY LICENSEE Wn0 SHALL.WILLFtLLY VIOLATE SUBSECTIONS 2.15.1, 2.15.2 OR 2.1513 OR ANY OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALV3E SUBJECT TO RE:'OCATION OR SUSPENSION OF LICENSE BY THE BOARD. i r _.:5. ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME. SIGNATURE AND LICENSEE NU -BER 0: THE CCNSTRUC::ON SUPERVISOR WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUC.:C.,. RECON- STR UCTION, ER .ALTATION. REPAIR. RE`!OVAL OF DE`_!OLITION AS REGULATED BY SECTION 109.1.: 0r THE CC:E AND THESE RULES AND REGLL;TIO::S. •IN THE EVENT TAT SUCH LICENSEE IS NO LONGER SU.ERVISi: SAID PERSONS. THE WORK SHALL I:^'SDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTE: ON THE RECORDS OF THE BUILDING DEPARTMENT. �--911/4...,‘ I HAVE READ AND UNDERSTAND :1Y RES?ONSIBILITIES UNDER THE RULES AND REGULATIONS .FOR __LENSING i STRUC::ON SUPERVISORS IN ACCORDANCE ':TT SECTION 109.1.1 OF TEE STATE BUILDING . ^ CODE. I �..DE3.;: oN TRUC::O INSF CE_URESSPECIFIC-. C . S. ., '""ON PRC AND THE S E 'IC I':SPEC::O:J AS CALLED FOR BY THE•3L'iLD OFFICIA1 L.SUAA:ICE CCVEAACc: " I have s c.^e list:ity insurancec i ' Yes '>?r Nay p ey Crct s sut:,,_n:iJ ec:.rraie.^.t whir.. ...__•. the re�tirer..ents et :.1C�Z,y,152 if you have checked • ,Meas- _ _ 1 imitate ,.. :;. . .�erye by c..^.ecxinq the _.:.cc:is:e box. A liability insurance pc:it, tA' Cher type c: '.ieernn;ty 0 Bond 0 • CWNE::'_ J4 :C: WAI' _ _ e can _ _ . $l.n..• TEFL i ^.. aware 1� . j :II ••... , O:..e.:1 —.vs. :.,,: '�I ^Y ::;n::::::: ... .- ;_.-. _t: __•7,:t•:�- S y'' '''' "•ed 'Admeis1G4.0 w.3-F4-�'es to.aa.e.. aW, .tyt1._!. 7.,' .t , P. 1 * * * TRANSMISSION RESULT REPORT ( APR, 28 v.93. .7:58 ) -* * * - -. -i,: AGM MARINE TIME STORED: 7:56 • FILE DEPT, TOTAL PAGES NO, LABEL LABEL MODE PAGES RESULT NOT SENT 0438 - QUICK DIAL#: 13 TX 1 OK .--k 1 - - . ‘‘) 1 _ � �; , , 1:..;-!.7 I (ter:cr re' q :.7 tH'.A" \i...tut`, - J' l / • J . 1 Y -- ,- - . \ _ I • Suggested Affidavit for Home improvement Contractor Permit Application • • ••roe Officiates Only. NAT OF CITY/TOWN 'Junin Na - 16.1.•.16.1.•(401/1h • . . - J:f d • Date . . Abt•1DAVrr µ'•' • Home Improvement Contractor Law Supplement to Permit Application , • • MGLe.I42A requires that the^reconstruction•alt en t ion.renovation,repair,malcrni>a ion.conversion,inorovement.removal,demolitront or construction of an addition to any pre-ccistineowrer-nccunied budding containine at east one but not more than four dw llin(units....or • .to structures which are adjacent to such residence of huddine'be done by registered contractors,with certain exceptions.along with other, . ' requirements. • ' • Type of Work: t,=0 ro.- 60{y c:).� �� Est. cost'�� i'D .Address of Work TVe2ee& .4 k.tC(tn.",�((t X N n„'j, m •Owner Name: k4 � ' �1..� r,l S Date of Permit Application: (D — 02 — 95 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 • 7 _Other (specify) - Notice,is hereby given that: - .'.OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED' t! • CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORKDONOT HAVE .t'f ACCESS TO THE ARBITRATION PROGRAM OR GUARANTYFUND UNDER MGL- c 142A. 3 Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: • y • io-ate 993 3;11 _NcLys ke�/ lo,g �„ T' , ` Date Contractor Nae Registration No. l OR: \\ tge • Notwithstanding the above notice. I hereby apply for a permit as the owner of the above property- • ? , 1 Date Owner \ame . • • nre..'i":'• £'ii HrifINYFxEail i..... • .t� :t. ri•.rt::,, .tort .itd+ai;i •' MO( Iiiir Mf1YEMENT INC, , • SR. i.a ZAt41Vi:`y:).. ,4.:i •1t4 -( . .... . �.r. •719(1ll(% h -0 FIUNTIrNOTON AVE. • .-:' +'Y`"+rr' . • �} SOUTH YARMOUTH,MA 021394 •'' ' P, 1 `1114- ?" .4 t t,t . * * * TRANSMISSION RESULT REPORT ( APR;2B x93.4;30:-36,) * * ` r;,a5tttAGM MARINE TIME STORED: 10:34 EZ FILE DEPT, ?,•#.r.•!., TOTAL 4-:.;,PAGES NO, LABEL r '2_ LABEL "`—rMODE PAGES RESULT NOT SENT 0444 QUICK DIAL#: 13 TX 1 OK y .. • • • • 7 Algt t COMMONWEALTH OF MASSACHUSETTS i • `.,ra t . DEPARTMENT OF INDUSTRIAL ACCIDENTS 6 .� 600 WASHINGTON STREET • es.; CanDoei: BOSTON, MASSACHUSETTS 02111 ' J onn:ssroner % WORKERS' COMPENSATION INSURANCE AFFIDAVIT . ✓ E 1 THERMCO, INC (licensee/perminee) with a principal place of business/residence at: - 7-D Huntington Ave. , S. Yarmouth, MAS 02664 # (City/State/Zip) t do hereby certify, under the pains and penalties of perjury, that: j i. NJ I am an employer providing the following workers' compensation coverage for my employee's working on this j job. . t • • AETNA Commercial 'Ins. Div. 006C22790586CAA. Insurance Company Policy Number • j () I am a sole proprietor and have no one working for me. • • N. () 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 Insirranee Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number ✓ J • 0 1 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 a1 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(CL C. 152.sect. 1(5)),application by,a homeowner for a license or permit may evidence the legal tutus 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 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$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 tis day of OG1obeir 019 Q.3 i Pres. , Thermco , Inc , 1 i •,r, r764.4 Lieensee• /Per ittee /t Licensor/Permi¢or . "ti t. ., . . r. r: . , - rr'