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HomeMy WebLinkAboutBLD-93-829 ,.Y.. ,, . ' �lw/ ,44. r o, TOWN OF YARMOUTH 2� 93 0 .."4,1 11 ' 4! © Fe-�J I o�4.6/43 "_�.�..... lic ion for a Permit to Build No. g�- � �; . App mss: ..• 6 UPON FINAL APPROVAL MAP JO LOT V/ = 1 FEE MUST ACCOMPANY THIS APPLICATION. DATE /0 ----43 1913 The undersigned hereby applies for a permit to build < /OZ, 0/9-3 according to the following specifications ` ' ',4f /Lya(%3 1. Name of property owner MA; Ie N..` Devi a-c, Tel. 7fo-ccaegz Address NLS— Clsc'traAiwa CA-ky Wes+ yt4.,,,, - 2.NameofArchitect(ifany) 13 1 R Ar CloskVy Tel. a Name of builder /Address TIICRMCO 4. License No. Tel. 358-7,a 77 7-D HUNTINGTON AVE, SOUTH YAflMc u''! M-. ."PA 5. Name of Mason _Address 6. License No. Tel. 7. Construction address NS C l e c'e /4.1±- e (.04.� _ __14. /H e rn d(7 A Flood f District 8. Date of subdivision Approval plain zone G Zone ,9 .1 �-� 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE 10. Multi family 0 Lpa, O° ffr7`t G fm,s-PtType of room No. 11. Commercial 0 IjVsukationl Kitchen 12. Other 0 Dining Rm. 13. No. of stories at Living Rm. s. 2_ 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 0 2 ❑ Family Am. 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 f ‘1\X 1 LOT RELEASED BY Signature `�'' PLANNING BOARD Address TI IMMOG Date 7-D HUNTINGTON AVE. SOUTH YARMOUTH, f:'. '.'OR64 i TOWN OF YARMOUTH • BUILDING DEPARTMENT . . CONSTRUCTION SUPERVISOR FORM P . . ' . • ' PLEASE PRINT: ' ' ' ' ' •' . . • JOB LOCATION: lit,. NN (1 We (IASI- 1a-3'Inenk. "fJ C �f.tlG�R»d y NUMBER M t STREET. VILLAGE ' ' OWNER OF PROPERTY: • . ' '4a. .jp &sM�evt„ti.4- • CONSTRUCTION SUPERVISOR: 1W \t CtOs ( e, ' ' 103 f0Z ' 3,9 '72.77 NA} LICENSE NO. • . PHONE NO. . ADDRESS: • THEPMCO • •7•C HUS:r4 NGTOJAVE. LICENSED DESIGNEE:.' • . COtfRIVitn>a^t-1TH. MAO2RR4 ' • • ' . -• . (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, 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 ' COQ'1ONWEALTH, 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..15.112.15.2 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 DEMOLITION 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:2-1EDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSIITI]TED • ' ON THE RECORDS OF THE BUILDING DEPART`:ENT. " . ' • ' '": ;• ' I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR :ICENSING CC:M- 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: • • • • • • • -' ' r.• '- . I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGLth.152 ,h'..'-':-. • .. . . .__ _ ;:. -' No ❑ -- _..y ....._ = :x.:.:. -".. 'fir :. .:.,- ..• .-..:-.� ._ _ . "` s_.>:.••: : If you have checked v_s• please indicate the type c average by checking the ap-rcpriate box, '•- -7. ..i' ' ``?, . A liability insurance pctic/L- `' Other type of indemnify 0 --- Bond 0 ••• i- -- — •• OWNER'S INSURANCE WAIVER: I am aware that the licensee aces rot have the insurance coverage repuirec_r C`apter 152 ct the Mass: General L-ws, ane treat my signature cn tress permit ccp:ica:ion waxes this iequiremer._ ,�{{ (�,,L y/ • Check one:. . Efi6KA t+._j7 A 1-e $ • OwnerU AS-- ❑ . gnmuremC a cr a ye SIGNATURE/ - f/, BUILDING OFFICIAL APPROVAL: Y • Suggested Affidavit for Home Improvement Contractor Permit Application - For orrice use only NAME OF CITY/TOWN Permit Na .- \Qs mouth Date AHHIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGLc.142A requires that the"reconstruction,alteration.renovation.repair,modernization,conversion,inprovement,removal.demolition, Of construction or an addition to any pre-existing owner-occupied building containingat least one but not more than tour 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: tvto14.4tow — A'1 c- Est. Cost d-00.60 Address of Work M5 C (e✓e-(c.wk Way Owner Name: (�at-left / Date of Permit Application: /D —ar- P3 I hereby certify that: • Registration is not required for the following rcason(s): • Work excluded by law THERMCO Job under SI,000 Building not owner-occupied 7.0 HARMOUTH, AVE. • Owner pulling own permit SOUTH YARMOUTH,MA 02664 _Other (specify) Notice is hereby given that: 4 OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENTWORK 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 `v ' or. Registration No. OR: • Notwithstanding the above notice, I hereby apply for a pe - as the owner of the above property: Date Owner Name • Y l • � • COMMONWEALTH OF MASSACHUSETTS a a . DEPARTMENT OF INDUSTRIALACCID.ENTS 600 WASHINGTON STREET es Campoet: . BOSTON, MASSACHUSETTS 02111 i omnas:ones WORKERS' COMPENSATION INSURANCE AFFIDAVIT ` i 2• I, THERNICO, • INC (licensee/permittee) $ I with a principal place of business/residence at: 7—D Huntington Ave. , S. Yarmouth, Mi. 02664 (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that: [1 1 am an employer providing the following workers' compensation coverage for my employees working on this a job. f • • AETNA Commercial -Ins. Div. • 006C22790586CAA: Insurance Company Policy Number • • [3 1 am 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 have the following workers' compensation insurance policies: Sri:arL.•v. ' Name of Contractor Insurance Company/Policy Number • • t • Name of Contractor Insurance Company/Policy Number • i a. Name of Contractor Insurance Company/Policy Number • 0 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 Worker?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 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.ki ' // Signed a day of 2t 4t. , 19 43 , Pres. , Thermco, Inc. Licensee/Per ince Licensor/Permittor •• i