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$At "it �4s� TOWN OF YARMOUTH ,�.�4�4a
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4° °"6 Application for a Permit to Build No. '707
oUPON FINAL APPROVAL IZ '� -i' MAP 73 LOT (1)-1-
FEE
U-LFEE MUST ACCOMPANY THIS APPLICATION. DATE KW 19 fid/
The undersigned hereby applies for a permit to build X4/9/ 96
according to the following specifications LO
1. Name of property owner 1-0(d ry do (rtiV l(J[�( ° Tel.
Address `71-11---n i repe42I
2.Name of Architect(if any) Tel.
3. Name of builder 192ekyv 2e-i4rle Address tlx: Meld C43) Ci'ale OetQwye*
4. License No. 09 S3 / y Tel. 3940' da69
5. Name of Mason _ Address
6. License No. Tel. ��
7. Construction addressAnatee Riley
o� �}�� District
District
a Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
10. Multi family 0 /p?-,�) Oda
tV� te Type of room Na
11. Commercial A l/ ,0-ic , \ G Kitchen
12. Other ❑ ,J i cA Dining Rm.
�" ,� P�aJ Living Rm.
13. Na of stories 1 pc'a Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath
15. Materials — Wood Cement al/
Other 0 Deck
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: Na of feet front No. of feet rear No. of feet deep
22. Size of building: Na 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.. ain.� 4f0_iA.(^
PLANNING BOARD Address Lo. P1I 1d Rcs-i C" i rc C P r m emv,6poi'
Date
—v \a
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
JOB LOCATION: Ajq 7,� Ld #
NUMB .Rj TREET� VILLAGE
/
OWNER OF PROPERTY: "w ? 012 )Cd (Mll ,. c�
CONSTRUCTION SUPERVISOR: 10 )-CP
1A, IJ tie �) <(c,?/zi 77 91/ ` d
NAME /� LICENSE NO. PHONE NO.
ADDRESS: £]z Pi;/�( Ga `)- Ctit l(`P DPN)vTSecy �.
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 COP
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTAP
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDINC
OFFICIAL.A `Z��'"�0 X16
SIGNATURE: ;;/nlVytu�
BUILDING OFFICIAL APPROVAL: