BLD-90-574 i, - . POSTED V/00 1"
'; o TOWN OF * ARMOUTH
ttao A� `� V
"4 .qtt ' J Application for a Permit to Build No.
� ��'
UPON FINAL APPROVAL lits �/9v MAP )t V9 LOT, ��I/-'�
FEE MUST ACCOMPANY THIS APPLICATION. DATE 2/,7 19 ?- U
The undersigned hereby applies for a permit to build 9'//9/q0
according to the following specifications
1. Name of property owner 6-lt Oct Id ie C. Tel. 3c1"4-t.qt '
Address lr (m• is Rd 5. Yt,.,0..lt rtr4
2.Name of Architect(if any) Tel.
3. Name of builder _ Sin 41 s Address 2H3 icl 86,4- til S. 9Vlunilh
4. License No. not cn- Tel. 39 g-Bst S
5. Name of Mason Address
6. License No. Tel.
7. Construction address 7s or-. is GA. , s. Y4rt"`'h.
Flood District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling ft Estimated Cost DO NOT WRITE IN THIS SPACE
jS,4l,A,n t Type of room No.
10. Multi family ❑ /S-04• :...e.,
11. Commercial 0 / ent-a-falleir Kitchen
12. Other gr Q..A -.1- Dining Rm.
13. No. of stories I Living Rm.
Bed Rm.
14. Foundation — Fully Half 0 Crawl ❑ Slab 0 -- Bath
15. Materials — Wood a Cement 0 Other ❑ /6C) Deck
16. Type of heat — Oil ❑ Gas al Electric 0 Other ❑ Closed porch
17. Garage — 1 Ej 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size — Garage
19. Storage shed — Size — Shed
20. Stove — Wood 0 Coal ❑ — 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 Signatures-- 0r^"'
PLANNING BOARD Address Z"(3 14 S ` 124
Date S• Tctav-vuvet, rig- 0,4 i.q
ii -._ S
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
- / Davis 2 d 5. YoNir► uv k'h
JOB LOCATION: 1 STREET VILLAGE
NUMBER II �,_
OWNER OF PROPERTY: O- 4m L Oil ' n e''�
CONSTRUCTION SUPERVISOR: Titi 0,443 b0 ) SSM-2_ 31 b-8.5-1(9
NAME
LICENSE NO. PHONE NO.
ADDRESS: 24(3 1 ;i1 Pardc Rd s - %a n to fh / ri A-
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 ISING. HETHE SHALL BE RAWINRESPONSIBLE FOR
ED BSEEING
Y THE BTHAT
ALL
OWORK
IS DONE PURSUANT TO THE STATE
CODE
D
AS
AL
2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION,
ALTERATION, REPAIR, REMOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDINGOF
AND STRUCTURES O
ND ALL
COMMONWEALTH, EVEN THOUGH PURSUANT TTHE BUILDING ODE A
E
S
THOUGH HE, THELICENSE THEHOLDER, ISNOTOTHER I
PERMITHO DERBUTLONLYWA SUB- ,
CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER.
D2.15.3 ISCOVERY LICENSE HOLDER SHALL
WHICH AREICOVEREDIATELY OBYFY THEHE BUILDINGNOFFICIAL IN WRITING OF THE
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.
USUPERVISORS
INSPECTIONACCORDANCE
PROCEDU ES ANDSECTION
THE SPECIFICIINSPECTIONSTATE
AS CALLED FOR BUILDING
CODE.
FOR
THE CONSTRUCTIONBY THE BUILDING
OFFICIAL. ,/ /
SIGNATURE: „35 h^� `� 3"__� /
BUILDING OFFICIAL APPROVAL: i'J .s,�-�
1