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,e< o. t Application for a Permit to Build No.
UPON FINAL APPROVAL S 60-?6-90 MAP toZ LOT/.25
FEE MUST ACCOMPANY THIS APPLICATION. DATE GjI'4 19 ` o
The undersigned hereby applies for a permit to build &/a41/0
according to the following specifications / nii
1. Name of property owner 1,1 Pit NR3 µFP�6EPT sCN N1TZF_P., Tel. 3Ee-6101 i
Address* ► t i WEST y p-t ahi Rb YAFzi.netftPOrz-,-
2.Name of Architect(if any) Tel.
a Name of builder hga�t e av )Even-u Cn►i,sr, Address Wi OLD C-1-141 pr t+ter- YA end,enrra
4. License No. 03 + 9 °8 Tel. 342 -905s
5. Name of Mason Address
6. License No. Tel.
7. Construction address I t k WEST YYg,chrn+ i-v YAPswisnarit-
Flood District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling,®- Estimated Cost DO NOT WRITE IN THIS SPACE
Den et/SN e e� Type of room No.
1(
10. Multi family 0 c3 G o o ' O° eR
11. Commercial 0 sca�iz1� peRc#- ��µ K"� Kitchen
12. Other Reptpeit peek /yx /7 /��59,-r Dining Rm.
13. No. of stories berme<'5�'%x/s"~` beef' • 15-
Living Rm.
roans.'sis Bed Rm.
14. Foundation - Full 0 Half 0 Crawl ❑ Slab 0 , 7, 30 Bath
15. Materials - Wood ® Cement 0 Other 0 ) - be Art"'`) Deck Obi-••' 1
nu
16.Type of heat - Oil 0 Gas 0 Electric 0 Other QS- 3 o porc�i
17. Garage - 1 0 2 ❑ NONE Family Rm.
Sa room
18. Swimming pool - Size Garage
19. Storage shed - Size Shed
20. Stove -Wood 0 Coal 0 Alterations
21. Size of lot: No. of feeettoRnt 1,--z.c.44 �� No. of feet rear '-'fit No. of feet deep I?3
22. Size of building: No.of feet front St,' No. of feet side 2' No. of feet rear ss
23. Distance from nearest building: Front Ft. side 3e' Ft. side - Rear g-
I24. Distance back from line or street 38 From rear lot line es' Side line rso'
LOT RELEASED BY Signatu
PLANNING BOARD Addres Z 0Lo c44.-,R-Ga A•
Date `E-4 RL.o. -n4-o irrir OA 0zto-t s
APPLICANT: Npsc MRS uEosFer Sci+NnzFJ • BUILDING PERMIT ;l:
ADDRESS: /11 NJESr YA-n--nnalna itp TELE. NO. : 36 z-Srq ` DATE FILED: (o.jg.Qo
•
BLDG. SITE LOCATION: (tt wESr yA2 lO nt} es) MAP1i: lot. LOTD: 25
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 is. L", 4 DATE: 4,-AP-90 N/A:
2. ENGINEERING DEPKRTMENT:/ DATE: N/A:
3. CONSERVATION: DATE: / N/A:
4. HEALTH DEPARTMENT DATE: d //' O//9c5 N/A:
I y STR 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: iz Sege- /e/) /'g'/ PceaV /2/ 29AR O/✓CY.
BLM/89
4
TOWN OF YARMOUTH
BUILDING DEPARTMENT •
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
_JOB_LO_CATION: t t t vJn.ST N asnairrtt. Rn - '? QA.AcM+'taP no
NUMBER STREET VILLAGE
OWNER OF PROPERTY: MR sl tAtz S LI E Izt-,F2i &100J tTLFe
CONSTRUCTION SUPERVISOR: Jas { IaU 051 SP?) (`Z'goss
. _ NAME r LICENSE NO. PHONE NO.
ADDRESS: �1 OIa C4.1 -c + 5T (• kmotmfPC-fl-�
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 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 DEMOLITION 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 IMMEDIATELY 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 CON
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTA
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
OFFICIAL.
SIGNATURE:
BUILDING OFFICIAL APPROVAL:
•
• + e rY 1d O
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•
' (1 in the Town of Yarmouth fora•. 3s3,6
•
(. 4 4--“A....)
y�� 1 CERTIFICATE OF APPROPRIATENESS •
Application is hereby made in triplicate,for the issuance of a Certificate of Appropriateness under Section 6ofChapter 470, '
Acts and Resolves of Massachusetts. 1973,for proposed work as described below and on plans,drawings or photographs •
accompanying this application for. ..
CHECK CATEGORIES THAT APPLY:
' 1. Exterior Building Construction: Q New Building Addition ,t Alteration rp • '
Indicate type of building:Q House Q Garage ❑Commercial Q Other r''"
2. Exterior Painting: Q
• 3.Signs or Billboards:Q New sign Q Existing sign Q Repainting existing sign a `��
4.Structure: Q Fence Q Wall CI Flagpole Q Other T r D - '
• (Please read other side for explanation-and requirements).
• TYPE OR PRINT LEGIBLY - DAME (Yak/ 317eb
• ADDRESS OF PROPOSEDWORK `/1( ft) II-IP fl
y g._ R4 ASSESSORS MAP NO. r 0�
OWNER 15eL q tkitc'4-- --L.13,t ' • ASSESSORS LOT NO. ii
HOME ADDRESS hii /4J .Lau/f(44n4 /p ✓✓✓1P1 TEL NO. �6.� —�9/
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
street or way. (Attach additional sheet if necessary).
darr k+ Srb C- r c - - 11+ 10 yo-r1 s1/4tg 0 - ,(�
1 /c11-•
g (c204 P Y Cf/o b tills - 3 s Cat4 6(twi
n (P
f baro ,Jt a1"L� TR a F Z-t 17 Ii � 'W
( � -p
T it 1�.�L — n6c4 , . . -
A ENT CR CONTRACTOR TEL NO,
•
ADDRESS
DETAILED DESCRIPTION OF PROPOSED WORK:Give all particulars of work to be done(see No.8.other side),including
materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and '
proposed locations of new signs. (Attach additional sheet,if necessary).
R - w Ili S. -.QS) /�
Signed (B 4- '? At t &
Owner-C n5vra€ter-»genr✓
Space below line for Cammntee use. •
Received by H.O.C. ,
Date Chi/9° The Cern cate is hereby ',• Date
,3O f , , vv.Y /L, /„jlY ./
j
v�. Time Jl anw' / 1
Approved ., IMPORTANT: If Certificate i o roved,approval is suctec:to the 10 day apceal period
provtoed in the Act.
Oisaocroved ❑ Please return :o: Yarmouth Historic Cisme:Committee €/,3/90�
Town Halt. 1146 Rt. 22. South Yarmoutn, Mass.02664APPROVED
"
YARMOUTH COMMITTEE
OKHRO
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YARMOUTH COMMITTEE
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PLOT PLAN .
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FOR LOT # 25
Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool) ED
Well 0
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Abuttor's 1 Abuttor'
Name 1Name
Lot # I Lot #
REAR YARD A
If this is a • .9 ET i I If this
corner lot, ft. corner
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of street. N name of
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YJL«'SOUWH COMMITTEE
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3534,
OLD KING'S HIGHWAY REGIONAL HISTORIC DISTRICT COMMITTEE
SPECIFICATION SHEET 3 S 3-4
APPLICANT'S NAME 6,A0 A aillarl( SA or-fOR:- f/ l
1.0 yokern.MIL
FOUNDATION: TOLune.ri CinuEi4 K• frit \ COLOR MI-
-SIDING: iihrile., COLOR:
CHL`LNEY: wle COLOR:
ROOF MATERIAL: As u S ,i /es PITCH: 7. Jt 42 COLOR: Sale- N`
443 ct ski/es 40 h/1 .
WLNDOWS: Node SIZE:
TRIM COLOR: W L
DOORS: I tODOC Sc- eQYLQc door 3o"x l,' O COLOR: LOLA .
Sc�u11�4S: , YwK,Q- COLOR:
GUTTERS 1.WOOC{ Lj+4S 40 "a" _ etZ COLOR: 10/14-
pro SC t* —frQos(d /wl.t SIZE: 131 ry COLOR: Y-
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U''d i1j�`e+;`;,� 11-
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G L4GE DOORS:. }-•O - SIZE: COLOR , F coMMITTEE
CKHR'D
STORM WINDOWS h DOORS: knit-e COLOR: --
n � 3o" X39 'if ��
SKYLIGHTS (FLAT ONLY) A.- SV 14 SIZE: a COLOR:
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ADDITIONAL INFORMATION: _5 aJ • tip ICo &it 3 S (a.0
rY`e_�,C-�U�l,,�t'e +\ e I (` lir i,.J Ca • ?o s� '4 I 1 CD IA/i
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APPROVED
9/88:c1 YARMOUTH COMMITTEE
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APPROVED
• YARMOUTH COMMITTEE
OKHRD
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3536