HomeMy WebLinkAboutBLD-90-571 rerElj
V;:170 TOW • F YARMOUTH R1ielg0
cs): ` 6 Applicat'tor a Permit to Build No. 6‘--7/
UPON FINAL APPROVAL 9-I U -11° MAP II LOT \--1--1
FEE MUST ACCOMPANY THIS APPLICATION. DATE 7/ /rr 1970
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The undersigned hereby applies for a permit to build `/
according to the following specifications
✓1. Name ofproperty owner ( H
8I Jicc ►=,v10 Tel39</'9-5--0/
Address 9 Kelp I ahr ) u7• %
2.Name of Architect(if any) I -tom Tel.
4• Name of builder Su I R- lie:he,- Tin Address 9RO Burncock.S#S Wow- .
4. License No. Tel.
5. Name of Mason Address
6. License No. Tel.
W. Construction address 5 M-M a -+ Kem)r I Ake cd • >4
Flood ' District
8. Date of subdivision Approval plain zone A"S Zone en-'
9. Private dwelling 0 Estimated Cost / DO NOT WRITE IN THIS SPACE
10. Multi family 0 2SO ----' ✓ p Type of room No.
11. Commercial 0 ge rlaS DA-1 Kitchen
'< Dining Rm.
��= � 157.046 Tr°oss
12. Other ❑ ¢ ' j� ,5 oda cz/J
—� Living Rm.
13. No. of stories Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 )1 Bath
15. Materials — Wood 0 Cement 0 Other 0 Deck
16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 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
23. Distance from nearest building: Front Ft. side Ft. side Rear
24. Distance back from line or street From rear lot line Side line
LOT RELEASED BY Signature Z r..
PLANNING BOARD Address-" step Sot lcca7t c5-7/
Date ✓ ore . /1747 of#(DA
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT: ��"e
JOB LOCATION:_ STREET VILLAGE
OWNER OF PROPERTYINMBER(j2} - 1f [ C1^zY1n h
1I ��« 023 Z17 E3�'-3-9s
NAME
CONSTRUCTION SUPERVISOR: I e LICENSE NO. PHONE NO.
NAME / 1� "J �M �/�
ADDRESS: -780 Bu1^Kcez.+ S+. !O1-�. V l IT 01,6 o,'
LICENSED DESIGNEE: LICENSE NO.
(IF OTHER THAN SUPERVISOR) NAME
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
BUILDING CODEAND
GETHE DRAWINGSAS
SHALL BE SNAPPROVEDFOR
BYSEEING
BUILDI GALL
OFFICIAL DONE PURSUANT TO THE STATE
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
S OF THE
OMMOTNWEALTH,SEV NONLYTHOUGH HE,PURSUANT TTHE LICENSE HOLDER,O THE STATE GISONOT THE PERMIT DE AND ALL EHOLDERR IBUTLE WONLYA SUB-
CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER.
G
DISCOVERY2.15.3 EOFIANYSE HOLDER SHALL VIOLATIONS WHICH AAREIATELY COVEREDOBYFY THE THE BUILDINGNPERMIGI� IN WRITING OF THE
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.
UONSTRUCTIONISORS INSPECTIONIN CPROCEDURES ANDSECTION
THE SPECIFIC INSPECTION STATE
AS CALLED FOR BUILDING
CODE.
BY THE BUILDING
TTHE C
OFFICIAL. /
SIGNATURE:
BUILDING OFFICIAL APPROVAL: