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Home My WebLink AboutBLD-93-833 i„,--•":9 /�F YAC of F a ; $ f /; ,'�C TOWN OF YARMOUTH JOAt=/93 Ou ` I-3 dn �ProC %I MATTACME 5 �i �° e."f.; Appli tion for a Permit to Build No. R�3 t UPON FINAL APPROVAL iv.-3.2-93 MAP E10 LOT G I FEE MUST ACCOMPANY THIS APPLICATION. DATE /O/f-t1993 The undersigned hereby applies for a permit to build //A/9-3 according to the following specifications AV'-eng ,/ 1. Name of property owner GP,Q.aedT bjThe aac.' Tel&2)5'0Y/7yy Address /.z .err&44rr .t1 - i Ag/lie,vf , h'&*•(w) 0 a/ 7 S 2.Name of Architect(if any) a7 �Are� Ca/end Tel. r/ a Name of builder --C/via Iitiov lava/; Address 191.--/e v.d /en!, &/ne.. l)fi9- .74. License No. 0 O 3 9 /3 Tel. VG 9 — 3 .c.3.10 _ . 5. Name of Mason Address 6. License No. Tel. /7. Construction address B6Y ,2-/e .20 -#027 O. • Flood District ,-4tBe 8. Date of subdivision Approval plain zone Zone 9. Private dwelling 0 #, Estimated Cost DO NOT WRITE IN THIS SPACE 4 ci),t,,,o,,,e Type of room No. 10. Multi family 0 i °I .754126 a 11. Commercial /loco. --ill dn / lKitchen 12. Other 0 -tta4....4--� Dining Rm. 13. No. of stories Living Rm. `j Q, o.� Bed Rm. 14. Foundation — Full ❑ Half 0 Crawl 0 Slab 0 Bath 15. Materials — WoodEl Cement >a'OtherJU V /D ,a.• - Deck 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch 17. Garage — 1 0 2 ❑ Family Rm. Sun room 18• Swimming pool - Size Garage 19. Storage shed — Size , Shed 20. Stove — Wood 0 Coal 0 1 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 6, "mi.:, 25. H.I.C.R• No. �/�/ G�,/ ,� LOT RELEASED BY Signature ( / I I J. /f/J rtO• 4.67 PLANNING BOARD Addres / 44 7 ,& /te-c a- Date Oe%o-..// /hit. 0 a / 79 • BUILDING PERMIT APPLICATION SIGN OFF APPLICANT: 3 19a.PQ' ,J Cli•(J /pvq,2/4/7 BUILDING PERMIT 1/: CRESS: 6i 1q,4 ke,e c-/ • 4/iii/J/&ITELE. NOC4/7,y1Y-/799 DATE FILED: MAO.? /BLDG. SITE LOCATION: 8(t//f4a g a7 MAP?): a. p LOU: CC-/ 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) BORDER 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: /01.Ls{ 9 3 N/A: ' ' 'LISTA AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: • ATE: OCT 2 7 1993 N/A: 6. PLUMBING INSPECTOR { / ATE: / Q q 3 N/A: 7. FIRE DEPARTMENT: DATE: 4 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: �/- r f cca.c. — S e �-a-` C . .& M.57 oat c y,2 ci• BIM/89 • TOWN OF YARMOUTH • BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: - . JOB LOCATION: 96 4/2/e 2 $#‘27 NUMBER •• • '. • STREET VILLAGE ' - OWNER OF PROPERTY: -6 e .0./e/// c AA�i�ri0v.4�d% CONSTRUCTION SUPERVISOR: ,C'/t/f e .Uf 74,11,4H-ri: o o 9i3 69 di yA9-3„1-36. NAME . LICENSE NO. PHONE NO. ADDRESS: 99 6 IBitlst% • /CVi ` ` /A�-sfb , 71P ...21� 7J •-•-: . 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, RD!OVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEE.ENTS OF BUILDING AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE • COt1.MONWEALTH, 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 DE*:OLITION 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 I2IEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING DEPART):ENT. ' - - ' I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS ,,FOR LICENSING 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. . INSURANCECOVERAGE: ' - : '. t" .. : :". ,. : . : � .' -,j :. I have a current liability insurance pclicy or its substantial equivalent which meets the reguirrents of MGL'th.152 -,'""e[7:"."::1• ' .._ :Yes ❑ No ❑ _ _ .. _ _ _ . .- - - - - - - If you have checked .pplease indicate the type c:verage by checking the ap_:cpriate box. _ T„ • ' A liability insurance pc:ic/ 0 0:her type of:.idemmty❑ --- Band 0 - OWNER'S INSURANCE WAIVER:I am aware that the ucensee do-s rot have the insurance coverage require^_=r - C.`.aoter 152 of the Maas: General laws. ana that my signature cn th:s permit cam iction wares this requiremer.. _ 4. Check one: • • . .Owner: Agee❑ • S:gt:aa re ar Oe4ner or Own s gent • �IGNATURE: A8A.„, .,.... BUILDING OFFICIAL APPROVAL: t . I = = . COMMONWEALTH OF MASSACHUSETTS _ i DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET James J CamvoeL BOSTON, MASSACHUSEITS 02111 comm:ss over WORKERS' COMPENSATION INSURANCE AFFIDAVIT • •o s. 4 • 6 . • (licensee/perminee) • with a principal place of business/residence at RP /nio.ff � "9- a 2-1 g (City/SutelZip) do hereby certify, under the pains and penalties of perjury, that: [) 1 am an employer providing the following workers' compensation coverage for my employees working on this job. eeoc.4'c • Insurance Company Policy Number ( ) I am a sole proprietor and have no one working for me. () I am a sole proprietor, neral contracI or homeowner(eirde 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 Name of Contractor Insurance Company/Policy Number = . 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 sums of an employer under the Workers' Compensation Act. I understand that:copy of this statement will be forwarded to the Department of Industrial Accidents'Office of lnsunnce for coverage verification and that failure to sccute coverage as rcauired under Section 25A'of MGL 152 can lead to the inpoiition 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 5100.00 a day against me. Signed this &— day of C / , 19 2 2 Lic.nsor;Permicor • - - _ - -- - • Suggested Affidavit for Home Improvement Contractor Permit Application For office Use Only NAME OF CITY/TOWN Permit No. Date • AF•rHVAVIT • Home Improvement Contractor Law Supplement to Permit Application MGL e.142A requires that the"reconstruction,alteration.renovation.repair.modernization.conversion.inprovement,removal.demolition. or construction of an addition to any preexisting owner-occupied building containing at least one but not more than four dwelling units....or to structures which arc adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other requirements. w • Type of Work: �or., ,� Est. Cost�C�i 600 Address of Work • / n Owner Name: 62-e,?�/7 7- .U.. (-Date of Permit Application: 10 /a 0 /93 r—I hereby certify that: - _ Registration is not required for the following reason(s): --==-_.=-- _Work excluded by law _Job under S1,000 _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 of the owner: /p/so/93 4/. /OS • Date Contractor Name Registration No. OR: • Notwithstanding the above notice. I hereby ap ly for a permit as the owner of the above property: /Oh 8/92 Date vncr Name . • • • • In accordance with the provisions of MGL e 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S • 150A The debris will be disposed of in: • • \ re440(4rhi- 4A.u4/C/tC (Location of Facility) • • SiActe.e/A.L44,2-AM e of Permit Applimnt • /0/)-679_,? Date