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Home My WebLink AboutBLD-93-830 D ,1-7L/04-5143 ;; , Drr U% TOWN OF YARMOUTH OK F to “0-01.1 He6,,"k `..t.i.0' Application for a Permit to Build No. q 3 V ' ' ! ,' UPON FINAL APPROVAL ID-a']43 MAP (0( LOT X 1 FEE MUST ACCOMPANY THIS APPLICATION. DATE /0/20 19 The undersigned hereby applies for a permit to build /dam 7 93 according to the following specifications /IJ/a-7/ 0 1. Name of property owner (fie Er- e Rose5( Tel. 7e--2/JV Address 9 6ZtUE1€ p S ,?Abet 2.Name of Architect(if any) ' ---- - Tel. 3. Name of builder R RT v ccg r Address 3" C4q aRR rep &.Y( 4. License No. n ince Tel. 775 - CC g 5. Name of Mason Address 6. License No. Tel. p 7. Construction address S41f1 q River_ D2. S J Flood District �5-25� 8. Date of subdivision Approval plain zone G Zone 9. Private dwelling 0 ji Estimated Cost .44119• NOT WRITE IN THIS SPACE !0-a2-v Div,. jo, -690.7.-c Type of room No. 10. Multi family 0 i shoo, 11. Commercial 0 , �6/��3 -Kitchen 12. Other 0 ' 27-i cit S-.0-b Dining Rm. 13. No. of stories r Living Rm. s' �° Bed Rm. 14. Foundation - Full 0 Half 0 Crawl 0 Slab 0 �L7 6 ,n) A 0 Bath 15. Materials - Wood 0 Cement 0 Other 0 ,____.----- '� int Deck / 16.Type of heat - Oil 0 Gas 0 Electric 0 Other 0 is` G 6 ' r-0 VA Closed porch 17.Garage - 1 0 2 0 Family Rm. 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 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.LC.R. No. /0 7 7 023 �� C reel-- LOT RELEASED BY Signature PLANNING BOARD Address 31 ogeti PD Date Gf/ , mg. /YIaii/y' J /a. Ode 7,S /� ^ ,/ /� p/BUILDING PERMIT APPLICATION SIGN OFF APPLICANT:: Y1X64?t/ G"/`�eC H/f?W,//' (� BUILDING PERMIT II: ADDRESS: J C�(/l�p_ /PL. K//M�/ . TELE. NO. : "774 ",fr,3g DATE FILED:tAD/7O/ $ BLDG. SITE LOCATION: ( RnvE� t R. V./INANE: LOTH: 4 / 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 COMPLIANCE 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) BORbER 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. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT DATE: (v/y.4C(3 N/A: �(� INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. 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. COMMENTS: / I d -eA,N Su /-' i).ck — net-70 Re ' 4C .01- Len-7, Oiwr /-x isrixcs PcOnDg->sa-X- Jr, Ng r AQv e- a Op 9 n. / r.-'r G= f�� (e Ro4,C A/tsss.S� j—Lc ' e LU! 344-Lofrote vP#-Ce? i4-)c , arcar- BLM/89 TOWN OF YARMOUTH . . • BUILDING DEPARTMENT . CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: ' . • C J�//, JOB LOCATION: 9 a."ve& flit ✓�' P""-,ri ' at.` NUMBER (�('' TREET VILLAGE OWNER OF PROPERTY: ' • "0e/ I • f'`IB S 1.- r� / • r • CONSTRUCTION SUPERVISOR: 0 R&mV M ec,q 'l/ S'? ° ' 7>c S r3>I° NAME LICENSE NO. PHONE NO. ADDRESS c' 3 c®R-� •• i• e RD v , ti92,- r'�j�. , LICENSED DESIGNEE: ' (� �' (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 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 3E 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 DESOLITION 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:ESEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPARTMENT. I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,FOR :ICENSING CCI- STRUCTION SUPERVISORS IN ACCORDANCE ,LITH 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 curr liability insurance policy or its substantial equivalent which meets the requirements of MGLth.152 Yes Na ❑ • If you have checked vel, please indicate the type a average by checking the appropriate bex. _ - A liability insurance policy p( Other type of :.ndemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does rot have the insurance coverage required =v Chapter 3.52 of the Mass: Genera/ Laws. ana that my signature on this permit :cplicaticn waives this requireme. • Check one: • ' OwnerD Agent 0 Signature or Cone,or Cromer'ss Agent • SIGNATURE:40-4-%/(C . • BUILDING OFFICIAL APPROVAL: ~ • r —�►�9M9 if_rico a s” oc^7,461AS4' s— 52c-tqf lath- -JO? -y 46,so ' y-0 p 71o10 -A4 nN /h 04,,1/( a gga 1 - c ( am7ocry5) c_Acivio -9(1,S73' 2 n Q 774 CNS lz-- —S��d y '9 724CA 51101A • LC; —`� COMMONWEALTH OF MASSACHUSETTS gyp' •= 6 DEPARTMENT OF INDUSTRIAL ACCIDENTS ' 600 WASHINGTON STREET lames J Camooeu BOSTON, MASSACHUSETTS 02111 ' Commissioner WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • I, f3 ?5S/ 4ccQEHJ" (licensee/permittee) • with a principal place of business/residence an • 3d— (- ve 0C R0. fi4 ' s erg, 0)(0? 3 (City/Bute/Zip) do hereby certify, under the pains and penalties of perjury,that: - . - - • - . - • - ° [ j I am an employer providing the following workers' compensation coverage for my employees working on this job. • • Insurance Company • Policy Number r'\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: - - • .- Name of Contractor Insurance Company/Policy Number.. . . Name of Contractor Insurance Company/Policy Number . . • .. 1 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 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 crop 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 5100.00 a day against me. Signed this 2 day of , 19 7 3 ‘etErfyi Licersee:Permi.^.ec' Licensor/Permlaor Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use Only '✓NAME OF CITY OWN Permit No. M Dale AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGLe.142A requires that the"reconst ruction.alteration.renovation.repair,modernization,conversion.inprovement,removal.demolition. or construction of an addition to any pre-costing 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 exceptions,along with other requirements. Type of Work: _yr,v57 �/n er�/J� Est. st 5TO0. Address of Work 9 /2 . v4:00C /7/ `(/ Owner Name: T rG f 1� CRoSgLg` Date of Permit Application: /0/Po/ (3 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 • _Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DE.kL.ING 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: /O/193 B A; /$C re /0 77x3 Date Contractor Name Registration No. OR: • Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name • PLOT PLAN 1 FOR LOT # \ 14 • Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) e . Well 0 I .• I (lot ft. rear) Abuttor's I Abutt Name I Name Lot 4 • I • Lot # REAR YARD If this is a • If corner lot, 1 ft. come write in name - writ of street. I name a othe m • lyl.. . , 0 aoi stree a, V 'fr 4 1 as • . • yVVV��` HOUSE SIDE YARD SIDE YARD 4 • • � A uPDG� �,�iri ii�r�onsigr rl r SET BACK • • o L Ple61 � • ft riI I C (lot ft. frontage) .. IIPR op • . , . , (NAME OF STREET) • • / <\ •Information pY�J /Plec eve / \ Supplied by 'r 'V '` rT/�� ' / on I e--•t! n..assis—rsy> �k71= ' • 1 � .. c acv . )\-e\ , 'CO ••, !r=� 1a a3:imr+b — ,.c.tczc- ...,Z :1a --41 ?.e itho - � � � / chvr,apcci M?cv ttM c _ - ICS • iSifl ." • 1 i t IMINIMMEININ . _ \ I 1 ' .- . 1 1 L •j 0 n . 1 ' . : . • -`*- ;'y 'I F u z I r lie, 05-C .ice 72Cv _ 1�k, s'PitcAz gist/. sr�`izsj C- I6 k .