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Home My WebLink AboutBLD-93-846 ! 3.7. ;,6_.Y134 •.• TOWN OF YARMOUTH a '�'I 12Wy N w , ,' Application for a Permit to Build No. e it-/-93 •UPON FINAL APPROVAL - MAP ?7 LOT .-r'/t FEE MUST ACCOMPANY THIS APPLICATION. DATE 123 19 3 The undersigned hereby applies for a permit to build d according to the following specifications/ 1/ 1. Name of property owner ,C�,o LnA7<1 ilk/Mel• • Address 4/P4 4.a_.._, 2.Name ofArchitect(if any) // ,s-_aNem /1014+ no/ 3. Name of builder %.4Jai-. /or 47 Address .6...........7 • oa-G LP 4. License No. OYP' 2fl Tel. Sar- 519 S/7 5. Name of Mason - Address 6. License No. Tel. 7. Construction address 4'?' Al 41-0.4-v7 207 Flood C- Zone ct p_S/d 8. Date of subdivision Approval plain zone 9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE Type of room No. 10. Multi family ❑ �c 11. Commercial 0 ` 35', era Kitchen 12. Other 21 ,L%71 S``"' aeA Dining Rm. Living Rm. 13. No. of stories Bed Rm. 14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath 15. Materials — Wood 0 Cement ❑ Other 0 Deck/vX 2-0 16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch Family Rm. 17. Garage — 1 0 2 ❑ 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 L5. E. No. LOT RELEASED BY Signature Gp-;),,A--e-‘3 \--� PLANNING BOARD Address /S-EQ.. /Z+w 4.5-04, Date , /J4.4-...'1 s !%-7/93 BUILDING PERMIT APPLICATION SIGN OFF APPLICANT: %jo L. �j n 4 ��. BUILDING PERMIT ll: /sem its✓ 4i'.rr61+ . ADDRESS: i f 214r4,s /547 02b3F'n TELE. NO. : 8'r-4"959 DATE FILED: /0 2c • BLDG. SITE LOCATION: -.9:5% /1/, /,y,,...As , / NAP//: 97 LOU: 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: aft HEALTH DEPARTMENT . / DATE: /0/.4.7'/ N/A: ' atene RIAL 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: BLM/89 • • • • rrAt--to s �'��•,. �, • In accordance with the provisions of MGL c 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: • • • Y4t7 . L/ .q. a144/ (Location of Facility) • S ture of ermit April= Date • I1 I TOWN OF YARMOUTH • BUILDING DEPARTMENT . !U/Z 3f 95 • CONSTRUCTION SUPERVISOR FORM ' ' PLEASE PRII1Tt •' ,A, _ • ( ` 41 JOB LOCATION: ! P • ' &O r t. r1 S (KO V LLAGE at ifNUMBER E OWNER OF PROPERTY: m r 4 rl % leA 1C IGiiRt' A 61�Y . CONSTRUCTION SUPERVISOR: A ;,-.er_ 7��a (. . ' cep M-N c • - 111 �SY Q�/? r . Nom¢ �y 1 ICENSE NO,..A • - PHONE NO. . ADDRESS: /.5":21 )e .0 o A-o rs 1L G'• •• , eviiiiS IIt \& • O Z-C�- ••" ••-' 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-10 SUPERVISE THE CONSTRUCTION, RECONSTRUCTION, ALTERATION, REPAIR, REMOVAL OR DE•tOLITION VOLVING THE STRUCTURAL ELEMENTS OF BUILDING AND STRUCTURES ONLY PURSUANT TO THE STATE B ILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE ' COILMONWEALTH, 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'Y)tOC9E-DURES, AS AMENDED, SHALL BE SUBJECT - TO REVOCATION OR SUSPENSION OF LICENSE BY THE,BOARD: j../'- • . 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 IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTED • • ' ON THE RECORDS OF THE BUILDING DEPARD ENT. ' : . ' ' • I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS %FOR :ICENSING CC:1- STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERST?::: • • THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING 0£FLCLAL. . I have a cur liability insurance policy or its substantial equivalent which meets the requrerents of MG0th.152 •Z'.•'- If you have checked ves, please indicte the type coverage by'checkingthe appropriate box - '-11-‘' ..;,::JI.,-.:.: (1? f• fit , -.. • A liability insurance pc:icy Other type of :.idemnity 0 -- Bond 0 - •....t.-..:_....... ' • OWNER'S INSURANCE WAIVER:I am aware that the licensee doe; rot have the insurance coverage require:tar - C:apter152 of the Mais: General Lows. ana that my signature on this permit =diction wanes this iequirenent. • - Check one: • , • OwnerpAge:0 • Signature at CCwner or Oarner s Agents • _ . • SIGNATURE: , a t,1• ' C.) y • t- BUILDING OFFICIAL APPROVAL: t • • — COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET • 1.' t,, BOSTON;MASSACHUSETTS 02111 • James J CamPOO: dor m:sstoner WORKERS'.COMPENSATION INSURANCE AFFIDAVIT • • / 1 wc✓ Tan (licensee/permittee) s r , t • with a principal Place A of b//usiness/residence at: • ,-s fief i,4 moo( /93d/.+.G/Y y%-n- Ona& (City/Srate/Zip) 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 [Km am a sok proprieror and have no one working for me. [ j I am a sole proprietor, general contractor or homeowner (circle one)and have hired the contractors lined 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 Worken 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 sccuie coverage as required under Section 25A'of MGL 152 can lead to the impoiition of criminal penalties consisting of a fine of up to S1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of S100.00 a day against me. Si ned this t�S day of 0414-7 19 `j 3 11, ccensee/Perminee' LicensoriPermisor Suggested Affidavit for Home Improvement Contractor Permit Application -. • : . . . . .. . For Office Use Only `/NAME OF/CII'y/TOWN Permit No. JF,<nentne * Date • A1±rIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the"reconst ruction.alteration,renovation,repair,modernization,conversion.inprovement,removal.demolition, orconstruction of an addition to any pre-edsting owner-occupied building conta iningat least one but 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. se Type of Work: ,&-44,/1 -1;44e 4c Est. Cost 975-7C0 Address of Work !'P* /✓i U.y.4.1 oet1 Owner Name: r All ,4'4r.L Date of Permit Application: /0 `eas 9 I hereby certify that: Registration is not required for the following reason(s): . _Work excluded by law vPbb 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: /0-a3-"93 dew eV? 73t 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 " unILVO V- .. -VV nnr; block:' YAHCLL: MORTGAGE INSPECTION PLAN IN YARMOUTH -N x ti.. ^" Deck 115 Story ouse No. 42 101 Lot C Area 37't 8,836 SF± COnerete Bound Concrete 160.46' Bound NORTH DENNIS ROAD liANK USE ONLY THIS IS THE RESULT OF TAPE MEASUREMENTS, NOT THE RESULT OF AN INSTRUMENT SURVEY AND IS CERTIFIED TO THE TITLE INSURANCE COMPANY, HAYES & HAYES AND HERITAGE BANK. THERE ARE NO EASEMENTS OR ENCROACIIENTS WITH RESPECT TO BUILDINGS SITUATED ON THIS LOT DES LAURIERS&ASSOCIATES, INC. EXCEPT AS SHOWN. 161 WASHINGTON STREET EAST WALPOLE, MA 02032 THE LOCATION OF THE DWELLING SHOWN DOES NOT (800) 287-8800 (508) 668-5010 FALL WITHIN A SPECIAL FLOOD HAZARD ZONE. of als THE LOCATION OF THE DWELLING AS SHOWN HEREONte �'. EITHER WAS IN COMPLIANCE WITH THE LOCAL ZONING (,-,eEDWARD s°N', BY-LAWS IN EFFECT WHEN CONSTRUCTED (WITH ei s°oHN� RESPECT TO STRUCTURAL SETBACK REQUIREMENTS s NO. 3136'34 ^ ; ONLY), OR IS EXEMPT FROM VIOLATION ENFORCEMENT c>'t is 44 `cQ ° r ACTIACTONNEC ION NDER7MASS. G.L. TITLE VII, CHAPTER \\, GENERAL NOTES:(1)the declarations made above are on the basis•1 my knowledge.Information.and belief as the result of a mortgage plot plan tape survey Inspection made to the normal standard of care of registered land surveyors practicing In Massachusetts.(2)Declarations are made to the above named client only as of this date.(3)This plan was not made for recording purposes.for use In preparing deed descriptions or for constrictions.(4)Verifications of properly line dimensions. building offsets,fences.or lot configuration may be accomplished only by an accurate Instrument survey PLOT PLAN • r , I . FOR LOT J -:Xi • 1 • Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) • Well 0 (lot ft. rear) Abuttor's ( I ,S-i¢KE6 (3+.1 �' Abu Name d�""" XI /r Nam Lot n G� .2. ! "I0 ^' Lot REAR YARD. If this is a .23.' If t • corner lot, ft. corn write in name Wri of street. '1. 1 /9 %Srf nam ;; n, .othe •s1 • /4 0 iv stre C ro its • • SIDE YARD • SIDE YARD ' HOUSE FT. 0, • . • 0 -- - - - Lir� • I . SET BACK . .. .?. f :3 t. o . - • I 7 I I „P. - — (lot /C: //C1 ft. frontage) • 691 N. AitN.,r ,201 hmowt/ ' . / (NAME OF STREET) / . . - • / \\ •Information � / • / \ Supplied by it,dm"� /OY7/4i