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T o TOW 0 YARMOUTH
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,6cee Application for a Permit to Build No. (e
UPON FINAL APPROVAL ell-- /l--°1gi ° MAP /0/ LOT .1'7
FEE MUST ACCOMPANY THIS APPLICATION. DATE // 19 96
The undersigned hereby applies for a permit to build /� 2 2 f
according to the following specifications
1. Name of property owner / ' ' 'Cer F /10 6,t dire. Tel.34-33aa
Address /Or LV G.4. Y4 n ole..,/.t .,/
2.Name ofArchitect(if
�any) Tel.
3. Name of builder UaN..#%r .'/47'�N Address 7/V4-74-7 3 .X 4/"^^ J
4. License No. 0/a -337 Tel. 3AS- ra9 C
5. Name of Mason "------- Address
6. License No. Tel.
7. Construction address /GS 4/ 6 A I �4 /
Flood District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
Type of room No.
10. Multi family 0 al-CM, — el/W °tHe nitro
11. Commercial ❑ Cay ��o�et��s _ Kitchen
12. Other 0 do e//tYaa.s. Dining Rm.
13. No. of stories Living Rm.
"� tr-o Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 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 0 2 0 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 /l.',
PLANNING BOARD Address 7/9 4/...,, a✓ ,0-4)-..? se il1
Date
•
'fes
•
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT: // //
JOB LOCATION: /(p5- ,€, . . 6-4 YA aa,ldan
NUMBER G •, STREET VILLAGE
OWNER OF PROPERTY: ,Cr/Q*'C'/J' E. kg,44/� . 1
CONSTRUCTION SUPERVISOR: Lk..44 if /e /'// 6' O/O.327 Scr-s--Sa9 G
NAME ,/� 1 LICENSE NO. PHONE NO.
ADDRESS: XI/ ,444 Ups/ tC/40.2 $. UANN/f /41. 00 66d
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 COI
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTAI
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
SIGIAIAR.
SIGNATURE:
BUILDING OFFICIAL APPROVAL: