The URL can be used to link to this page

Home My WebLink AboutBLD-93-838 •' .' -al:'YgR, 0t DSS lo�zt�93 , , s, 4fr 'Rl 4 Ii 'l- OWN OF YARMOUTH d Few io/6/3 ` tTTACXo 5�NV$` Appli tionf` ta•Perrhit to Build No. g3 8 1/4c , UPON FINAL APPROVAL O MAP ti /� LOT 15; 4 l FEE MUST ACCOMPANY THIS APPLICATION. DATE 1 The undersigned hereby applies for a permit to build jG a /G according to the following specifications a fee 0— d //� 1. Name of property owner Pa k.L A CN 1 Lt Tell Re5C Mg Address is gyro ift 1 gee Zci -120 71,01), sin 074,38 2.Name ofArchitect(ifan ) Tel. 3. Name of builder A a or is . •ddress 2A . Li I cRIZI eI • rni M 4. License No.Ric. 1rIngoivl; Tel. 3$S-71(0-5 5. Name of Mason ND1,1f= Address 6. License No. Tel. `r ' 7. Construction address 2. 37)(4g HAM( GMTWi q yAf2Mt etkent e Flood District 8. Date of subdivision Approval plain zone Zone i- ?D _ tN RITE IN THIS SPACE 9. Private dwelling 0 Estimated Cost P�o""2,�q , A — DO l0 /y 9.3 Type of room No. 10. Multi family 0 */& c00. to�Q UM//D ry go / 11. Commercial 0 ,if i/�-lAdd (m a.de, Kitchen - 12. Other 03. (C'ANb '/4� . ,n ° , i/J�T iv/ St= Dining Rm. 13. No. of stories 'L , Lf" Living Rm. 14. Foundation — FuII ❑ 2 Cr frilal* /1177r fed RmClcsc r I �, -p la,4'40p ► 15. Materials — Wood 0 Cement 0 Other 0 ,Arl�� Deck 16.Type of heat — Oil 0 Gas S. Electric 0 Other 0 /'�T7 ' 75 d�1, 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 2a 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. 1010 (n& //�� / LOT RELEASED BY Signature M ,llll/ ((dr GC/L E'Gtt/t�►Jft6�lPLANNING BOARD Address 2S S�1 ►vc k 2i( Date E(fs t7 >intN►(► 1114- 02-64-1 /0//94,33717 BUILDING PERMIT APPLICATION SIGN OFF d 11 APPLICANT: Tritql Cp1i,ll /�. ._ - _ r BUILDINGG PERMIT If:O • ,w ADDRESS: IC Mrfer �, i ?,ru`s TELE. NO. :3 11414 v DATE FILED:401,9412 BLDG. SITE LOCATION:: is SC4AI h1// t y!. MAPlf: �2 0 LOT#:f's6At./ 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: /o4 .t ) N/A: ' NDUS RIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 4 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: $er-D '- i) kaeXien,on a . .re- tcs 7 9.E wj4-i-tnP2ooF.r-D 7/fatoSen- tit taFac , �� .1) Sift piw�c -) Celtiw6 /{n Cur o& Mn.'. 7 3 /f// A , • BIM/89 /Q// �j/jam. • �cr _ COMMONWEALTH OF MASSACHUSETTS • DEPARTMENT OF LNDUSTRIAL ACCIDENTS • •, . 600 WASHINGTON STREET James.; Camooei: • BOSTON, MASSACHUSETTS 02111 • comnss,one WORKERS' COMPENSATION INSURANCE AFFIDAVIT • I, \AIIII1Am a i,e sP- (licensee/perm ittee) • with a principal place of business/residence at 25 Sb iuER.IC k {?oc4 , �ASTTh 801a1S I in 2404• 1 (Ciry/Srate/-Lip) do hereby certify, under the pains and penalties of perjury,that•. () I am an employer providing the following workers' compensation coverage for my employees working on this job. • Insurance Company Policy Number 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 polities: - •- Name of Contractor Insurance Company/Policy Number . . _... . • Name of Contractor - • Insurance Company/Policy Number • • Name of Contractor Insurance Company/Policy Number ..- - Q 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(5Th 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 Aeddenu'Office of Insurance for coverage verification and that failure to secure coverage as required under Section 25Aof MGL 152 an lead to the impoiition 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. Si.I / chi . N 1 esjelt day of O&t'oL ec , 19R 3 . ii ......r:so::Per rnt ` Suggested Affidavit for Home Improvement Contractor Permit Application , For Office Use Only NAME OF CITY/TOWN Permit No. Date • • AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGLc.1424 requires that the"reconstruction.alteration.renovation.reoair,modernization,conversion.inprovement,removal,demolition. or construction of an addition to anv pre-cristing owner-occupied bra Wing containing a t least one hut not more than four dwelling units....or to structures which are adjacent to such residence or budding"be done by registered contractors,with certain exceptions,along with other • requirements. • Type of Work: I'INlS\\ INAL,'kou% A4eSieU' 1 Est. Cost 121500 Address of Work 7J Jpkfi f►A�I eA-(LI a tai r')a4t2Mot..t1L jx*T M 14 Owner Name: pAuL C4ht1I Date of Permit Application: Oct WI' 199 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 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. Moss 84.44ce seep 10- ter -q3 I41 MT2Akrz.= 61Z- Hie- 441090(04v - 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 - ' ' ' -- TOWN OF YARMOUTH , • - BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM ' : -PLEASE PRINT: _• _• __. _ __. , - . ' JOB LOCATION: 25 3.06 1-1-Alt gftn.TLw f?I�ouZ14poi E' -, NUMBER , STREET . . I . VILLAGE • .OWNER OF PROPERTY: - PAGCL C i1 k 1 I I ' M Ass> 80-0fl 130 '... CONSTRUCTION SUPERVISOR: WI IIIfl TQf}is2.6 "4r— 1i-I€4i 0x,1° 385-7/6, •• NAMELICENSE NO. PHONE NO. ADDRESS: ' ' 5 5 1 vgrg,?k • 72, 5."1:idm r I I Gp 04/ 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 ' CO1•LMONWEALTH, 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 DE1OLITION AS REGULATED BY. SECTION 109.1.1 OF THE CODE AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING SAID PERSONS, THE WORK SHALL I2..EDIATELY 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 LICENSING CCI- . 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: : • " " ? `' _ `'s.T�_ `• I have a curren m iability insurance policy or its substantial equivalent which meets the requirements of MGLth.152 -:---1,:- • • Yes . r No ❑ It you have check.ed v`s, please indicate the type c average by checking the ap:rcpriate bez . • • • . . . A liability - . . o • insurance pc:icy Other type of Indemnity 0 • - Band ❑ ., - :-• OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required Chapter 152 of the Mass. General Laws. ana that my signature an trigs permit a:pile:titiv n waives this requirerrer.t . • Check one: - Owner`; Agent 0 Signature of O tier ccOwners Agent ' SIGNATURE: WIN , Ili 4 BUILDING OFFICIAL APPROVAL: