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BLD-93-843
• t, tz FES ;- ,4o , TOWN OF YARMOUTH 9 /y3° <citSiq3 O _ 1\ ---1-3 �"':14..•' / Application for a Permit to Build No. ��� °°.�°°��; UPON FINAL APPROVAL V MAP 4. LOT Y'2.g FEE MUST ACCOMPANY THIS APPLICATION. DATE 9- I - 19 / 3 The undersigned hereby applies for a permit to build /g/ q/93 according to the following specificationsvy� ^ /09/ 1. Name of property owner SLS T ri °t Z-c�i Te . - wSP Address I)1 L6(r4 JacIC f V2 . 111. 7:192nnncth 2.Name of Architect(if any) 1Y/1— Tel. ` 3. Name of builder.: '-e-1-- / A •ddress -4p a-w iiim / he y 4. License No. di 0-350 Tel. 9 95t/3 5. Name of Mason I Address ----- 6. License No. -r- - Tel. `------ 7. Construction address */ hint ter/ mac% 72 air relaMt�,f`j n itt Flood District 8. Date of subdivision// Approval plain zone Zone @ 9. Private dwelling • stimated Cost ` "Wit;,. DOiI.OT WRITE IN THIS SPACE 10. Multi family 0 ''i(9 3t70 q-1-q3 -PE,f1 74, (nit Type of room No. 11. Commercial ❑ l L g7 ,, gn St Kitchen 12. Other )6 0tcu 4. becE 4i .� Dining Rm. 13. No. of stories Remove Exig �+ti Qeet z) -DA,ALiving Rm. __a- /o • n' Die Bed Rm. 14. Foundation — Full 0 Half 0 Crawl Slab 0 6 41. Bath 15. Materials — Wood Yv Cement V Other ❑ a______--35-:01) Pak—Deck /ye SF I 16.Type of heat — Oil 0 Gas X Electric 0 Other 0 it--5' 7, t5 0fn-- Closed porch 17. Garage — 1 ❑ 2 ❑ Family Rm. Sun room / 18.Swimming pool - Size ` si, Garage 19. Storage shed — Size , Shed 20. Stove — Wood 0 Coal 0 ' Alterations 21. Size of lot: No. of feet front 9'2_ No. of feet rear 153 , &t No. of feet deep 9ar,S0 22. Size of building. No. of feet front 36 No. of feet side j1 �� No. of feet rear _ -?51 23. Distance from nearest building: Front _ Ft. side Ft. side Rear 24. Distance back from line or street 31, t From rear lot line � 3� Side line '96 -2,91., 25. H.I.C.R. No. rot I �' / G�i1� 'l LOT RELEASED BY Signature / , ' / /1'li PLANNING BOARD Address Date 79//93 . .BUILDING PERMIT APPLICATION SIGN OFT . , . ,1 ‘1, • ...././HrH,:,,,:-.,,r:/;:,!.,..dirci(':,,:;:r.;”.,,i"ti.,:19'..4,AP,,bire4The_7"rt. -'01,43wON.....N1. -V61:".12,,Ttlitg.trs4":10,,,St.,;AVII,1‘;`,"7.". :.".='..:''''''',"::'" APPLICANT „.... . A ‘ t- ,..,.: ,.4,7.-f.11.1.,r iit .5A.K.A,.0,,,.../t,1t*.I.r.....„'..441`-„„(...4.„” 4)..„4•L,'a„z.,':::''‘'.Z-•':.^A,' -fl Pie:,f,;,,•,', .'. .' .• ' ., /. .3 0o / J„:„":„:„,i,m,7-:..,,,, .., ..,. . ,..,•-•*,•.: • - - • - • • - ....: •.: ,7 ,..):4„:;•;24: ),/t.i, •f.,,,..;;;;;;:.4....?„11.;::,;?.;,,, •- -.Q....a0,s. .•,-,....,.......!,'• .. • - . ADDRESS 4,2,5s.'ffa--ein/ ' ',iv. ' F -2/.(Aiie- Arritt--Ncr'. -I: •55 ' t"- /94.4J•DATE' FILED•- - BLDG. SITE;LOCATION':'::., 1: ._./ 's ,.,. 7",... .--e -'I,e • A',:e,..4:„. ' ' ."...,..{(., :i.;;;;;,.:.;dj10Tii . S1_t45.-.;1;.-.,. 24'1;.; ,...:!t..441 __....."'J4'e:tIC31:-;„ki::i'': '..,,_%:.'1 V. 1fliCs.:j• '.' a. THE FOLLOWINO'IbTFORMATIOnAITL/NE§t;1114;PROVAQInfas-R-WpWi*C10IRED/4T,E9OETAIN,:,A PERMIT.TO BUILD, ALTER, .,OR%A.TeT0'../4/:"STRUGTHReStitHVailitfrOWW14,:kgHlelf,e,tTg.")54441103,LIEPARTMENT-WILL DETER- MINE COMPLTANCEP..p:-TNt4i)tibtOlOsOn#14144oP *prgzooijcoitq-g).p,t#RtCTsf.(C)•'FLOOD • * PLAINS ONING.',.,THE..jEPILDINODEPAR*ElltiWILV 000 ViBI0,1FOlille,4.5;;;SV,NG,',THEI.[APPLICANT THOUGH THE FOLLOWING.DEPARTMENTS;irt; r1(111:,,,,47At'VRIKP'.;:::Ii.:;;;;;;16.-;:i4‘..?/.:,;(,.it'7.,:,,gj..n4yeA:::,.:1:1.,:,:.;,....-i; ;T:e;;'ilc.ittalpintAWOIWOUCOSROi44,10,ttig,fliGP„.‘:s.'•:,.', . . , . . , . •..„- .i.f.,.:s4..,,,..•.4t4:1-.1:.,;:.,,;:,,,,:..,„:1,4„,;,,,..tii:."412,e..-rzaq:1;2 ‘,10:504:r'41.:71::44 ,,, , ,,,I .4%47',.:7.c54f.*117"1;02.,„&!4'.74,a... .,;.,!ii‘j.S., AkS!:5‘4,30-I4•:.r.. WATER DEPARTMENT:-:•*:',,,cc;.*k•,,TpriMpLODFSiD9Mpf,SE,ANAtplir AVAILABII.I.M1:4/i;.",• . ENGINEERING.DEPARTMENT: 43ETOSIXES-LOOTAtIOMP)01744; 400,1)ItAIMGK,, .1-.il',.'-*:' •*,''1 . "" • CONSERVATION COMMISSION:1-'*':DETEEM. Ntt);e i.bOMI`.a.i., 40; ::: ., . 4.,,Adit4•••4i43 t ,32:• rt LOT(S) BORDER ANY - • .• '- .'''.-.-*-*- -24';',A,0%/011;*Exast* Rtvngpdvals BOGS, BAYS, MARSH • . ,• ,,, . ...: ., ,. .,:*•. [.;.,*,..;,';4•,,,•:,...th;.,.4ra,,,:”•to--1.::, ':4-0;3Wat,-'-';',;--%tie.-. ":''11.'t•ttatitti.c.;;;*IP;ThYtijr.•*:•,":***, '':. 't • . ',.. . : .*.-*.• ..,*,,:' ..r3,5..sgs,r.,z,k, ...4-M4 .04, , .a.S...k.;;,,v.A.0,:70'; 44:.:, 1),.e.i...i.:,,.. '-,.:,,. .-. ., • . HEALTH DEPARTMENT::1*,': -',.Itiq',DE'DIEBNOENE44011g4A.NCETO;_$?.,ATEONTI::;*zw, ,' 'EONS i..I:E.: REQUIRE- ''' •'- '-*' ' ' ' ' '' .A* "t*, '::.•'1.1,V• . FIRE DEPARTMENT: ,.., .T..S.. N.O. ltgtpilett[0:5:001fteiNllT:As:CTIVITIES. -FOR•VERSONAL . . • ., : .,•.. ,.., Y.:x.., ,...,::Acc',30.0371rii. goimiegatypptotptViti,:itt;SigHiV)ETECTOR.S,-', SPRINKLER SYSTeLS, i • : . . - '.*. ', , / -'. ..'.*':••.''':,71,..i tyirfe42:),:cc-:b'*•'*".:;:itc,cLfrif.,C:•;;:i!..1.ft:c9.45-1)41:014t.;*11.'ir-t-Ini41),1;kfic.'if•r''•'.'.'• • ; •... , '.-5.' '-•,-.:--:;•::.;•.;-.1.:::c*:',.(,,,.....,:tr;'.,e,t, *:';',/;13,•,:2,:kiei%.,:44,-,,,t,c.,,tp:,; (9*-,fl;;;-ejt;e-,,,,5*,..,t-cer:/.1,a,,t.4,k,i.":".f..„:•.:,:•.!:i.:.."•-. ' •,_ -----.-. --_ _,'.1: '''' '.:;.___,____.. .... .,„__,-•,,,... .J,-.7:..,,,*•••!it.ci..:.:•. . .,,nit ,1_..„.-..._,;:.,.....„„,..,:.,. ,..,,....,,.„.. _1/4..., :,,...„,...„..,,,... .4 THE FOLLOWING DEPIARTFEENTS 14UST.,..HIGIf.0,11;=.*A ' "IVE;",11F.E•SIT.G7a.v4!"-ultur.t*P4,131,,*-KO:BUILDING INSPECTOR . .. . ISSUING THE REQUIRED C Buttbut,g yrtit,-,,..44t.;&-14.- Res .. 14•R4's•••44.1t"'-'4,S: ".''''-'ef.4-4'010.4,4Xi•`'•e4.,4:' 2 .4 . 4 • , • - • ; . .t/,•,••,....• ....4.I.;44 ' .,:t4;,• 4k4444,4,; .,:.f..,., .--r .,t,„.4.s...!, ,•,,4 , -,45,..Ac:f41'.4-Kr •e'd,':IT7,`:`f.'..:..: . . 1 .BY:••":-•'•-• •tf:.::„; .,..:. :$•:',A,•;‘?:-;:4 -3",'±f-,t,.•:*e,,::*;:61"-:.-:..:.:101,..i.62:,'..'-....,aine.. -.144-„.-4::C(rt);i:71->;:iiis)-0-..;,;::':,,•:?,.;...L ...... ,•- - , la•.•WATER:DEPARTMENT?I4 14E7,.‘..-0=V3'scg‘,$'-'71. ,;Astr.••,:,;,,,,;:tAxte .„ ,:.7,,tt:•.-4-%1•4473, x,,:t•- . ....-,,:: N/Af. • • . : •ENGINEERING t:DEpAWTMENT it,L;',1/•?*,;:1.11A4d,"“, id-,.;,:4:4-44.i.*,,, , it:'i":TEI.,',2...,..,;1,..:"4;.*::1It"::m 4?•:..**:g',*-• :. - i N/A: :, -''•3. CONStrt,4119N::-;i,-;"?.er.rn.r9';'''4‘W4,'.A'.-7,/.?.(7-, .j.1*,1* 'M t4 :;;.:4?.&'.rc:-1.4.*t.-''•-*'-' N/A i '• -"4:* HEALTiftEPARTMENVft.:t Atari 1-•,- 'L-4 'Y Th.-').t.q...*:*;n1)1.T.Ei.57..atil,ti.,•1;.*".4..T.''-:•'. -.N/A:-• - . .. . ... • •.: • • • •••7-. "..:,.''', sr.1.'!,;;,,S1..c.' ...c.:!.:!..'.l',4,4-!' ..SY70.1",;-'6.1.-41.1144. :02%,iSti.:Ery7-',q”Ceil1.,1V0,•?"iftti,` . ''. t•' ' '- . t -.. ' -: ...i•1,/,-;..1Y1';.:,'Ir:.': :,:-;;-'rinin • V: : -,.....yp jo C.COSAtist,PERKETsf:-...;A:4,,,,f:',;: ,,,e...• y, ,::. :: -. . - ." ' :-.:. • ' “.: '' ,c ;ia2AZ:10:1312:-.1::6,PPSf:,g,:t,41-',1, 5.. wrkiNd?iNspEcroiti ;•:..4.3 ,#.22:,:k•t.g;'•g,•',.`A!.ZtATIt H•1•:4'OP•A-tE ''s ?').1f4'1""t;', ‘',-f-•;i'''''''''''' • " N/A:• • 6. •PLIRIBINGINSPEGTOR: "Q"'r•'*?,:lt.: :;•••:•••.f:,1,%,zri.•.;.,c.):;c4i*;e0;•;,•1•?••.;;:!,•,41,i4Al'eNr,. ,;••7••‘•ill•,::•-••f•tisa.z•,..iN.,•••• •' , .• • N/A - te'7. FIRE DEPARTMENT: : • ..i':."' .W'i.:t":•*Y1!".1' '‘ • , ...N.NA4 .*:..,? iL.,, ))'./$;IcIrf.ria . .U .,;>: .*•.:',• . •N/A: t': I' ::. (,..:**g.;‘;;;;•.,i',.1,.''?P' '3' ';'t'',IE:4: .41:.,4%- ;;:,11 :;,7; .0 4.:•'?4?....4?•ii,:;Vt4tV0.:',11. ;,..''.4 a . ':'' .:1'''?;"'1,'t:',":::-•-•:•:'';:',4"I'vl.r.; 223 ,1:,14'1'4Y,,it‘.' r! a sSilyieti t411(‘PAr''.1.C.441f:`'',54;iVi•,tr;C44,'"•i: .'` '„''• ' , - _1 _4' _'• _l.,_j•••• 1115::i' 41 k.t4i;.7 4,$!••:?.!emitc;#44.)74 .4 .4.f4i y4t;'i17,k7.6.$1.,441:pl,r,-;,tre:,, 4,k-,•,,,, ,,t4,,,'44, t •.4...... . . , ML'STUMPS AND/0117.BituSikpElgi,gastiasyp$9,:ppie .,,_14„.:-. akywygiiiipT,TE;ki•AIN, , ..!.EEcEIPT FROM•THE DISPOSAL SITE MUSTAREttimiTTWITelo TiMi# ititelittsitioat4i.:illidit*ViallANCE'tit.:THE,•BUILDING PERMIT. -:' ,' .•• r.::-Y.-T.. .: ..:•:' :E.,.i,' '{' '*t.•..?.,4 .,.--,V,;,:t.t..1! .:t ,....1.14*-, - -'.2...,,*-(1 * --• *4,1*,4,--1.:,‘,.? 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ENVELOPE/ALLOWABLE Uoi(PER.T LE 2009:1) <✓.: • . . .::" '.. • ° (Aw •O.OS1 4 (Ac •0.651 + (Aoo 040) +,(AOR 0.0331'+ (Aor 0.0 n -°UoS41a Auow. r_ t _ 05)4( jo'Z',70:1.44.(ga0.40 +(31? .0. 33 �(.31.2tx o•o5��.( '_'x0'93) ,s2# Y 5Z , ao -+ 7,879 4 /0,3/25 1S ffr /•/3,.2�, 9 ', 3, 21/ / AuowAsts PEt to. ta,2009:1 ° . •EiEC"iRIC RESISTANCE'HAET U-VALUE WALLS =.0:05:,U.VALU WINDOWS = 0.20 EN V t Uo ' SLNvr'ACIUALyV?.LUES1.Or.DFSIG 4:OF.EMVELOPE.)' e. t. (Aw.Uw1 `+ (Ac Ucl +'.(AOD,Uool-+''(Aox:Uoot''-i/‘(4A1,C..WUho7rl i (Aow+ Uowi1. . _ Ae rAi,. [ )t(SaX 710X. ..... ,,o {�{/.�. •11If.031\ajI..7� isr; i:` —1 _, . /2661. 30t3ty f 5�' .1- J,0' 4.-t ift°4R • �7i.�v3� COM?.✓R_ V�L'wo . THE ..' VALUES FOR.ENVE:,OPE ACT U'•:.'MUST BE LESS TrIAA' OR EQUAL. TO • VALUE OF ENVELOPE ALLOWAEL.E'TO`•PASS. ' 'L., ' . 1 13,x9"7 t??; ;23 : . • `. ) PASS L_JFAIL i. °r `. •;71, ..f:.:::..:', _ . 0 • :Cr • t 1� "y.,i°: ..r-plt, BUBD "G^ OG770N4,,,: .e'... . ?•Ir"J..4'I r1 II_. . • f1'�J� -:• jr,'-- �•gYf,lo ':tA.,s14 .•,,:,• ••,.‘•• k 'fij:R`Qf1d i�,1t,,,•; :e./C ��S re.,RI a r r ! "7^'^r, 4,1.i- ;�iilop"a1 se res. .Li'a Uzt. /ion �j •y ,P64-4 .1�v}p .Y1 R`.'.ti•5 + : ..r j{ ci .Q II ( /_I,LS, ^NU r ",r ,5'�Y'a�j'7t.'J i::l ,4,,.: ' OQ ''W11.�X•: ? Q�'�+� Aow I: .� C� �7 Y .i g4J.XY.A.e.�':•Yiv:.tl:.iai4' .r�:. qq ;./ �� .-...1-141. :P:n:1: {. 4% •:i.4 ,:+ 'v'iir,,.af-''F,' .-1•: :171;,;• d.;;:.'.n. :. 11�sw.�iL; A ;: .�.'1. , ,1 7r,1.r.i. i/.-4ttl•:r; :4.6A4. ',..V.{ I;,•:4<f1.:;'' "'.., .4:.,,•:, 7.; • • • tiC=11 I I. D .I . 0, p::.. ,c S,:'ryr!.' _i 7r;lUoDt. irz;:Jo },Cdr 11=3 141 A 11: ,i.>1 kj tY.« ,,S,ztj wi;.;. ,' • �: ::; < Hoo a Iilicl K FzTRtUN IIi- 05 I . II. dpJtir a"!..- ; '.�,`: Y x ` 'rc-� IlApo I 1� rr I�t� IIA. - I . A �s ll- tip I <W ' -' . . 1 ., a =rc-'.N,-==6 op k)L zo...15 t t':O4S . .. - 't ios'J '. • • ( .92jrt !' Ill, 1 : ' . Z �re iooit, ""o IF WINDOW AND DOOR ARE;EXC='7''FirT:EtV(15);?E.RCh.L O?THE .. . ROS WALL A.R. Tr_. OVERALL WALL Uo VALUErMAY NO i EXC 7,0:162 (Uo•a 0.105 FOR ELECTRIC FalSTA-NCs HES + :r. " "; RO UVAt- ti{zr---t EQUI'`mr-Lt S()ETAS'E 20)9.1 rOOFiCE .NO.Fi OOR FOUNDPT10N• 7 � . 7 , '.16'- 'n '`1, � wD Uo' FOR WAL''3. '' ' ALL. ULA' = (A. Uwl'.-.(Ao .0&S'+. 4AoS`Uool.:d>f.. , , r, • AQ,:' .... ..`.li:;. '14ti;lih• F:`v*,I::d.n:�`!:'••' :.i}4"• _ ..cti-' „ , v G1,GL I Gti,. �_ :?l , ' i Leon ^ of IIS ' IIll --• . . c - .. _(..._ X = -z":,ia�'.3 W 1 . ` lir: 'I :. . . r X25 t aea' . IK ��, I 11 �a I .:.< •,.r , . f i70,� '�^ IIIC/ �. '-II''�1/'� .I Y.'a:»v d:�"a.'.�'S.Y '.{iii^,, •�.':. •iii ei:} i? II -.(•; Y:,:.pa:. LX e.!LEa n' hive>,....,.>.,L '., r.^:wri ` ' • r;;;;DuFC�Ia- I;. 'C'"-'-';'-`.,II,1JdLi t 1 . •p% Zv Y v A: ";,Y;. :'.. r4''':''ji 'i:" 1 .:GJ u.�.C1'�l II �W .. '' ./ tab../..I,, -,Z: e'r.0e...,1�..,,; •air,....f.':::1,',_,•n•ye: • - .. }Y�w ?7617.: ay',•.,v' ,r:,. '''.:14r1::':-.-:',3,t'!,:',?..' /L '. .,' l:'1•d': (�4�.Y�S '>✓.1Y:;4 :lNytil'.«% .� '.'1.,."'..,� R9i�ja.�.d� .::.'�' ' ::..7<c-:1..4,.v• it J, VOW t )! r �'.y F" � 1 r� y(q�y, r t r '' • •-.r.. •,,,I• AA;4^ 4a a..,. s.C�if l"i•'•w1.1. 1.+?i•1::,' -•....F..-1'.' ...r ..rya n10.7 w.. $:" ! tin SHL_:.. . ,. . Fain. TOTAL R■ "'Z' 9• Kc;: •rl�e3 ceiling Zeg13Ll i 3� U' r ✓' WINDOWS: ewe arl ridgeor 9 TOP .SURFACE • mx*irg. • . R■0.61 pituranImmm .pi 30.0 9" FIBERGLASS U< 0.0 . INSULATION R-3D - - w — n . f/ 111 I 1 J . • • DOORS: al : sBEETROCK DO.RS ! ' R' 0.45 .mil ,. r.• ' l —BOTTOM SUBFACE F R' 0.61 • ------ •/2"'PLYW00D .2 r. SURFACE WALL ASSEMBLY ,.., ie REAR ELEVATION FL'!C?Z.TOTAL R' �/ / 'C .W.A. •R= •0.62 R. 0.68 U' r WOOD }" SBEETROCK SBIN R= 12.5 SBINGLES —R' 0.45 ��� u, 0•C8 WINDOWS: R= 0.87 . , 1 �-- c/� 31" FIBERGLASS �L Rs 20.0 SU �• INSULATION FEM Us 0.05 SURFICE FACE R■11 • R= 0.17C. _._---=- . � SURFACE RESISTANCE �-. ;; C R' 0.61 FLOOR ASSEMBLY DOORS: . _ FINISB FLOOR tat= TOTAL Uim Fir- IA5 '�— J • i?(( R■ 0.91P��fD1QAL CWO KEADS - }" PLYWOOD • RIGIIT SIDE ELEVAT MOEN PG SUBFLOOR 1NDER PLATE I/ R. 0.62 G.W.A. JUTSID-14.t.,V.V V VV/1 O f(/v(/ t � WINDOWS: SURFACE I1=l R- 0.17 ,.. ` • _6}" FIBERGLASS , . 1 I S TION 19 WALL U�SD�ON -- :ONCRETE DOORS: FOUNDATION (may be used instead I i SURFACE RESISTANCE of floor insulation) _____ -- GALL 1 R- 0.61 PC= TOTAL R- LEFT SIDE ELEVATI Z= 1.32 = 8" ' IIr 1.48 = 10" i i Lk 0.08 maDgp1x R= 12.5 G.W.A. INSIDE SURFACE ) . 7-1 . 0.68 • WINDOWS: _3/8" SBEETROCR R' 0.32 _._�— . `• �" STYROFOAM • ' , I DOORS: R= 7:1 Efi ••••••••-g-7-77:77,---. 1 r :4 a I .•.• / • ---- r0TE5: PERMANENTLY INSTALLED STORM WINDOWS TO BE USED CROSS WALL AREA . WINDOW AREA- .e. DOOR AREA- • I ` I FENESTRATIO\■ -6'J., o-,(t`K.gt'.tbxa "•5, ` ;ji' : 5.`'1Y�:•...-4:-.,".. 'g5 "' '1+.Ye Yr',',�k6.N.sia[:;ixl.,;o'.t Suggested AfGdavtt for Home�tdpr�stttduu ' '• •: p, 4car1 t t tit,' ,:,, 1 "' °x yt s Y �:A,. Nwe-t:.t T"• t� r� e -t < '$ i, ; 4 t ' 1�4ZU.r'."4y �eit,4 ‘"Cr. frv. ir' � . I- y ti For Omce Use Only , =a Y��4+ ^ :"t't N5,t,? .. CY IYn"..1 i' <,�a .?ct z r C 1 it fir-' (5>i ^ k,y7'rt'-'xfy.`•`:f.Y, "�'11y,.'e't7t..�"7"a+�,Na+^y4�i�>' z •PeiinitNsr :.L .• 4Y liY AT Vi4 11•,"N.K 3 r„ r�+"t , 2:44,.2•.":•:'n`kf, w,..: s w ,,, t 4. ilg� " at } ' pwdsi, ' Si'Si� +r�-` .•'.3,,.y .' '' t7a4' ' .. . 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Yid kr iL•Vt ., f itt 'et„4 k.IA Pi>�CIi„tUyt Signed•under:penalties-oi,pierjuryf{'7r l µ ,± ` i..<•t 4Q7r stz4u ti'.•t^4 A\Ys +' :f1; 'f aq t :' ' t Ax -t•X,`'',_.n'.;.;;?:` . %e:t:..x` 9 ,'4,"Z:11:44"..:<'•' a.`r4 .y^•'::s1R'-• �. pa:• '•':.'.c•-•,.;',Its', t *!''n"Y+tt , i i*6r i- by ',t.�Fi°.t .vM`k_Y, Sv r e'''x Tfiiv.[ hereby apply fora•permitaslt�e age�t�of the dwfigr, ;, y;// . /J/Jy�.rt'Y t 24"c, (, • ..,n � 4i�ft/, r . r ?Y ,.FJ, } l'ax ;> t, .e-4.:: r ;��/{a ,ti '.h v,t ^s'pt."n t n :c Regis ration Date... y, hi1'attat e'L {. SS:1 4 i 7` "�z': eiLm . • 3 t Yb. ., . - a4 e. • r.,. !i r e {$.,aiti+,� St,Ydi w, dt :e ri rt y ,a r. f' i ,.. 7'A3 •;,�Ilg4 yyY'+`xk ?4-7 .,�,5}':H°''..S LY. 1Sry F�jl. i' r ;' l'i Ywe '%�J.t'` . Da sir''.y,•i ,,,-..r,44,•44,7,. .",.,,. 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"'4�'s-(. L.°.+,'h;4;61:!{1i=>� 9�' :�e'lA:ti.+'n•«a; 4 ..Klf' aij' i.. j .sr` �'t.'^„;} ,l;, s « �. `yi,:c J'•,•:,• 'r lith tiP ��{yants..ea .t;C F. ).;• .-/t;•:: ., _ •••.. ,%-;t�i..:.p-Ri?::srXn'ealiaw b....4i":!"` ,-(1V6 "' y t4.1-ear,, "te;ea.ryy:r 1 a f.,.--; -•i, •••,-.4.• _ ly.i;: i,s;,,x T,-rr '�, SY ,1 3.' t''' ... t'Ku?" •`Y ,,1< i<6m i ' ' `. • ' M1 •--u ':.1.\. aI ��rriY: ..�tiPYc r M'�i',^`,.sy , " r ,l .l ,'F- t 414;'")•`'• JY,.i..,t... .''y '...;$,, ..,,: • C J o'''f'.J,�:.} :�ti 4..r.f w, a. ..�14 I.' I"tita, -•1!4't� krf:�Y4.'Sw:r:'...'..��.t;!, %:; ,.'A1•:f''T-1r,,....Yb cry i'ts a vi ''''.4.41.A. ..7°,. y t _ ..h„•..,,•-7: , +n 4.-.,...i ,• Lt 'b�.v^51d.�i',, ?' "r^,•';4 >A• ��.t:.+` .r `v}-1 y *:',..i,'S,�?. n,, .t p �,+ r P i Iw., „e'•^ y, �:.-.v . . ,, . • — • - -: • ; 'CONSTRUCTION:::'Air,ERITISOR:`;FORM`,--:•,;; ''.1...Y.,.ci't-. ':/.:':' , ' . . ' .. • . , • • • • ": v. •:'' .' ' ••-.,A.••,;';:z• -,..:"•if.:,?••?;•••;,.•401,;."1:•02.,;,:-,;7.:.-- ;• • '-: .., •-:-.:••••;•;(: r;- .: •:. l'. • . ••• PLEASE PRINT: , 4 : 7.".'.• .:--- ::;''',.:.: ;•:- C'f-2,':1:::t•-.1{!: ":77.•".;;;';•.:'Yj '‘'..:- •1 ' '''.:- '''`' .:''''''`•••.: •• . ' '•'•- .- - t : ' : - • . • ..• , , • ..--.. . • .. ., . .. - - JOB ,LOCATION: • e‘fracia'1,7 j.R-L:L NUMB • _ : s. .. t; . . .; '. ..1.2;. :. :-;• -:STREET '. ,... . .'. :•. ::,-.: ,VILLAGE 1 e OWNER OF PROPERTY:: J, CONSTRUCTION SUPERVISOR: Ritth,e ' . : . iriZei i:::, a t/ :ex) --3-ce •.022....2syr .PHONE NO. ik/ .y fit• :-- .:.1,-:::.:•. '1'::-.:C.: -': --____ ___,.. •-• • • .- ',4• ' -". • -- . - - ''.1•-•'•''':-T- - ADDRESS: 9air.r7Teit'‘—ifitiVvt-t/te/ . . . LICENSED DESIGNEE: ' • - • • '.., -- • :'• ," • • , • : -- .. t •-: • . (IF OTHER THAN SUPERVISORY. ,NAME. ' .:, .: :: ,.., ,• . ' -: . ,LICENSE NO. • • , . . . ' . . . . . . 2.15 RESPONSIBILITY OF, EACH LICENSE HOLDER.'S t7 ,i- .. . • • •,• ' , : •.,. , • . . . • . 2.15.1 THE LICENSE HOLDER SHALL .BE_FULLY••AND ,COMPLETELY:RESPONSIBLE,FOR ALL WORK FOR WHICH HE IS SUPERVISING. HE SHALL BE RESPONSIBLE itiOSEEING' THT:ALL WORK':/S:DONE PURSUANT TO THE STATE BUILDING•CODE AND THE DRAWINGS AS.APPROVED BY THE BUILDING•OFFICIAL,•,...:, • • • • '. . ...- _ 2.15.2 THE LICENSE HOLDER. SHALL BE:RESPONSIBLEHTO•itIPERVISE THE CONSTRUCTION. RECONSTRUCTION, ALTERATION, REPAIR, REIOVAL OR-DEMOLITIONf. INVOLVING THE'STRUCTURAL ELEMENTS OF BUILDING AND STRUCTURES ONLY PURSUANT:.TO-,IHE''STATE4130ILDINe: gbE AND ALL OTHER APPLICABLE LAt:S OF THE COMONWEALTH, EVEN THOUGH. HE.','±-THE LICENSEHOLDER, 'is? NOT,TNE'PERMIT',HOLDER BUT ONLY A SUB- CONTRACTOR OR CONTRACTOR TO:THE:PERM= Haan:..;!!.9t-,.-7].y- . , . , tc:',':'.• •:', • . . . ., . . • :;,-,-; ..--,, ;"-V ., ; , ,•':. ,., I'jj,*: ..-•-ti, ' . .'•,-;,2:'‘IT:i. ..:___.. -• . . 2.15.3 THE LICENSE HOLDER SHALLIMMEDIATiLr,NOTIFYTHEJUILDINC:•OFFICIAL IN WRITING OF THE DISCOVERY OF ANY VIOLATIONS,WHICWARE:COVERWEOH*,1UILDINC,PERMIT; : ::H 2.15.4 ANY LICENSEE WHO SHALijiiIllEdittCtIOI.ATEUBSECTIONS ./.15V12..15.2 OR 2.15.3 OR ANY OTHER SECTION OF THESE RULES'AND;REGULAIOASt:ANWIANiy,TROCEDURES;,:ASAkNDED, SHALL 3E SUBJECT • TO REVOCATION OR SUSPENSION OF LICENSE BY TUE . , • , ..,•,•,... . .), , •,.....,. • . . •r• , - • 2.16. ALL BUILDING PERMIT APPLICATIONS<SHALT) CONTAIN THE NAME,' SIGNATURE AND LICENSE NUMBER OF THE CONSTRUCTION SUPERVISOR;WHO. IS TO c-SUPERVISETHOSE PERSONS•.,ENGAGED;•IN CONSTRUCTION, RECON- STRUCTION, ALTERATION, •REPAIR.;- RVOVAI OEIDEWLITIO?k 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.; IleiEflIATELY'cast UNTIL"k. SUCCESSOR LICENSE HOLDER IS SUBSTITUTED ON THE RECORDS OF THE BUILDING OEPART.YiNT.:31J'; :d'•'''-':''':;_' '' ' ' ' ' - • :•• ': .' • • : • . . . . , ,,. . ... ,..... .. . I IL-YE READ AND UNDERSTAND-MY:RESPONSIBILITIES i UNDER,THE„RULES AND REGULATIONS ,.FOR :ICENSING cc STRUCTION SUPERVISORS IN ACCORDANCE'WITH SECTION,100:.1.1-:0E-THE: STATE BUILDING CODE. I UNDERST1 THE CONSTRUCTION INSPECTION;PROCEDURES;AND2THE:',SPECIFICCINSPECTION:'AS CALLED FOR BY THE BUILDIN OFFICIAL. . • . . . ... ... • I have a curr latulity insurance I:solicit:tit subitanyal, 'emitvaieM which Meet's the reqUiterlienis of MGLIth.152. Yesw NaO fl It you have c , ker./ats.please indicatetype,the 7:vet'ge by tit:licking'the ar..tC\ ."i z':box ''... - •-• •:.' ' . • . . ' • .: : . A liability Insurance pclici 0- .. , .::saiitillipeif'fderiiiiitil ''..: ' Send T b . •. '' • • ". '•' : .." ' - , •,. ,,,, . . . , OWNER'S INSURANCE*41 A 1;:.I am Wii-ti:triat'lhiii'iii:diiite:dicei rat !..a<re the Insurancecover ;; require?. by Chascir p 2 a is Mass.9 7 J Lzws..?, • .,artmy:alr.atUre. cn lots permit ace:ict:ten vanes this requirerner- ti/AdelZ6i ' ' h; '‘;1;;*:;••,,;* • ••••itexlane:; Ari /1. 5;2.,,,ii"0.,'.:'::.,,c ;,7i,7:• ,I.V' ::: .•-.,... •':,:, ,•.:. SIGNATURE: 4/71/;11,alr.,1,117, ,„am I LpI frna<gbiiie iAr..• APPROVAL: �; .,;:..;,' USTTS :.. fig: ;Oretsr SSAGI ' , r ,it fr-: {% t 'fie eI �,`u K. Y.. i� f>, r • •':;---:----1111a....- E " ,• > t :•V4Q'�h"'" r u Ik("rl .a•."'�`r'': OSTON) g4 SAfT�.S o2I11 " `„•` Ca ,, c /ebir kri' r'M1,,,,, %.it t"r* 6^,t, ' !"••!)••••-'.,'": x ror * + i �a�omn:ssroner • ` v tr+cbgS.SAnIOINt11NSURANcEAFv1I�AVIT . .WORKERS Y•� . • R. a4e.a. i4 . c-i e .- Olden see/pamz ee) 'li , ")2YF''<.^; F • `N t..n k-`.rr. hjt,rt:i i:' .'l' �,.iY ^,i,; • with a principal'place ofbusiness/residenedat 'Y`;t �i �j`/ n S . .:.;r• ' „" ;(lltyl5riid/7ip),. {., • do hereby certify, under rhe pains and penalties of of-pastry;thank r, t ••.` -. r nth -✓ " n cpvcra form em loyees working on this ) I an employer providing the following workers:',comp On ge Y p. ))( r • , /mss rP ,, :� iF' a -}X'� InsuranceC•mpany • N-•tI '..--1 tsongNumber. 1 " fi • e - rf [J 1 am a sole proprietor'and have no aneworktng{brrM4• F 4 { 4 e°� ir' >;,..-, ty br&!..);;;;';.," ,::.....:?..:v vi r iittl �y "sti`en1 co'titrxaaY�n.E�u�cowne� ne andhaye hrted the contraaors Iistc below I J l•am z sole propnetor:17, , k4 +'4p�J'w'��4 � 'i"•�°W t Sr7P �' .,- ! f r r git1,-tt:Ft i,...; "Y}"F^ ;$1 tlHq- , who hive'the folloarng woEkers`conipen3}uoA nu ince Jt tsr ` ' "�. ' ,. , ?i;ex,':,.A ,1 i0S G'i' .. 314'` •e -;C•';;"•2.f ni , + 5?cit%14ti.'i. ,At1t` q,? ' ,."f, ' c P ••,,...-i-;•:-.:;.,:,4.o- !p1r•£'�.Y..#;"Cr.:f.l �Yin3.�'{+�tY� - a.Y: .'�'..��•".n ... ., CF,i., .>, ,,. , ; '' iPolicy;Number. -.... • ' •' -' r. < . �-L'ti P`.i.;:„'• tj +F�'rnsura{ta:�Otrip$rtZr '-' ' Name of Contractor': •i ?r t ,. �;.> 'rr w -.gig f7c• • > i9vp r) M1 +y• .� , "' uA r'a.0 .5'a'•: p . Cri`T'd",,.. ' .4, .,j.. �n,;;•,tJ'i'ypcf.;.�,'r �:4"i2'> :f.', ; i^ ;px�"'�':r..., r • Y' r • ''- ',,k+, -t 1,• R''�' :,,'"• ♦,, aft L r`•: ;'•:. ... f. >r t,, ' ' 1 a ,; ',$.4-'!'-'5i'Iniuz1!�cs.CdinpaAylpoliry Number :,t Name of Contractorn -r , h' • . . r • ,!:•••,1:,•,:.;,..•.: F•- k1 t:Y h } V t(a tri �f. {5 F "x { r , +4 1• r r ly:, . 11 . , Coinpuiy/Pol'icyNumba , .- 'ame of Contnaor s'."' ^ ' ::G , n n - ;: :•,. . ,_ , - •, • " ' '° � ems ' � " � + ' o I am a homeownerperformingall dteworkr;<jtstlf '`fty , --:',. .,:,::::•-:-,•>,',;„%•7:;/•••=.,--;'.::-..„y` ,, • i r M1 e OA ri0nr CO do mysntena it 4.�COstitNtaion Or repair work 00 1 NOTE : reas o akin•shavw41ubottllia`.�ow0°it 11 Y, ,&on t61c' �o •tidy iti nrre0ant thereto are not generally dwelling of not more than tateq isasp tx4! hitt tlse 11oRi�oetnisd rir pp a license `t''; ' i1 (G s 15?ii ;ltniliiPua„ a by a bomeowoer for considered to - '.3 oloversiiadet b'e""', orkerr,Cpie !� ; C. 1�%� o t . of its°"cm ' ?ih' '?Oorlhri l om nilttois Act;':a:r• •.. or e>ermit cony evidence the legal stilus t p)oyei un fi 4e' R f 3 P�•. lx � "V , Lstr'�:3 y'4V r ,�t` 3yxlY }t afir*a^;,\ �wM EI� :r ,11:1t ',� 'e tail otlbtlustriilk ad'enrt OFas of Insurance for coverage I understand that a mpv•of t}u�sntdtrtent'�1}��d �'!!9�F,°�e,�D� ,e . ..-� r� ' , veritirstion and mai failure.�o leeure cove t;,reeluircautldttSteons,t;�.,1 .bt'24iGL 151eits lead,co the imposition of aininal penalties consisting of a fine,ot up to$1500.00`isid.(ot pruonmin •ots+Fi0na2yeu and avd penainesin the form of a Stop Work Order and a fine of 5100.00 i aav against me," '`;; I f t t - k•� r ,i3 ,+' c� y y`!e <i 'r4 erre i +h 't , r Q4" s.;; r, da`y`oft 19 Sicncc zhts t / r 1 > I t t'e1�''V�Y 14.t el .i'eJ rat Yr 4 r iY ?& �,r � � r .F 't it L4 v4.,, iaj•+r.�i.r..,;,:�drL�4�ry.1�.�,�'t 't +f i�rvl ,So/CJ 'r( . 7/L4if /� ///i/ �1� �t'•n� 't � ..if;g tr +. ora y[ 1 >. ?. ,, ..i:r"Y •;,t .r.•}P�TLr+•+G.`1 '1't�w.i icier r` titor,�" C .,,a • 2.-;,:::;se:/p&—';—e::•• •>✓ � 7,f.�0 ,'arX„:,.. .•U,16;:tea".b:• ,.. , �y .Yc .;/3):,4',n ,..'A-k4, i„I,' ,q'"n✓R +' ,, .:,,,,:..,,,...1•%;z. � ;t .•�.Ii b-,,,,p i•-• • .. t{ 4 , � •' r R� �h fitr=.''Fleti "� •_ph�r"•i`{�•e�...'. .. 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I, , .`t c - • -nii47,.., % .. . , PtlxiiltriiEJ.. R64.'1/.401/ ....I.E4Viiicr -ri. i —1 •." T .i - ' •,4t. Etke,, kki,j• . ...„. • • '. 'T "I. - ""1 ..1.‘,. t... t,••• t i 4 ' i •-• • ei n " , ' nOht) i • .', N. • . .. • . .. /romp • Po ut to ve..)1 •' ".... . : is . ' 4 0; d • ICI IN .61 --ttaiiii.r:E1• .:CI TO 141 • thilt? .0;it'i Ito—K;Aji •P It. I • ! i l '• I . ' . • . • . • • )—--_, • .a • I NN. , \n _ i t b:' 3D 7-23�I .1 • So /, o - . 1•S,, i' b Eris / N .cO " '0. vil i) 19 o. + 36 ' . " '_ 4 . • fl1 • , I . Lc• 92.6o • . •• • . . ..a='/56:06 ' • 1 LUMS PJAC, �/ . r `" • . • A70 e.' T„.. oG ,rti,NVH rio A/ I /5 45 'Am'= 1/4;1/ • /oii✓,— O,G ,&,0 ' OF Mgs .0890CER / /EOP07 PLAN o� CHRISTOPHER cez 7OPVt/ : ,ARMgurN. . ii. • COSTA re; �V� :- No. 31305 FO,c. o • ! CISTERN ec /(/x,44 y _ gait.tht/C Co;cr? 0 I /PE SUB . SCALE : / "'3v OA TE _ 2/�/gc/ REC ; /6/2 o 7'''• :•".......... , • ..-- -t. 7 .. . . . .. 11 .. ..... . .. 17T. - .ir.• .'t:: 1' T : 1^ 7."•': f .• T•p ., .7. _ •il''"nT -1; .71 ^ . . . . •'i:• '•P::: .iC[. " T i E. TE^,1:::r1. T, =7.....1.17,/,7 "Ir .`f,. ;TR 7 TZT 1.34; 7. • . .• •,;•••••••,-"••••-• n p. •. A("3 • .:.. •---geL".. • I4 ALG CAPE LAND S!/RYEY CONSULTANTS 'A1,i 535 OLO BAR ROAD, EAST' AALMOc/TH .VA . \........... i.Y 19 ♦ . t'aeavr 50' • T/D/'a /s" • . t'('e 26 � �� —. . . - ` co ,-� sc ... : • ; ,!' ` _ i I Scj i�i :10.. - 1 -►F ----MC-, ; N /COO/NW. J p: 34 ' ' 0 . • •r • L' 92.•00 • 1 . A00.756. 04. • IU/�SF.cIACt ?�/ .. / . /yore.' ///f OG �CYy/JJ/177" /5 45 ' /71w' ' f/G// • /e/A/7- 0/c-- 12,..), O �.� OF Mgs84cy CERT/F/EOO P.4.1. 07 PLAN CHRISTOPHER 122, TOWAY . YAR/V10UTN, ,. /VIA, O COSTA y ;.' .> No. 31305 J ry�J ,� / �D.Ep !y,EC/STETkX, % • Mc /VE,4�4 y /1 U/L G//liC C, 7,G P, SURAE SCALE : / "=3U OATS : -///8' RE.c : /B�zo . . .. .. • .. - 7;77:,-..-TET) A..: :1T f AT T!". .: - n.. • .. • 7...r T:. .;, ..: .1t,!. . . f' T:._ l'::n!.'r.rn . '.:7!..:•!-7,2 ., 7f.."7) I" :?'�r,1r 1 _' ... •i�9 .� n?T �'A: ^y' :71.. � _ .. 11r r:,nT n.i.,. , . .. . a•V---'-g ..//•'' r: . 7 Z4Yor • • ALL CAPE LAND Se/RI/EY CONSULTANTS 335 OW BA. RNSTABLs BROAD, EAST FALMOYT/y ,ti!,:; . r ..,,., _. 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