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Q6,,""••ro..n••� 6Ce Applirn for a Permit to Build No. —
UPON FINAL APPROVAL ?\ZLO' ` MAP 30 LOT in
FEE MUST ACCOMPANY THIS APPLICATION. , . DATE /946 19 9
The undersigned hereby applies for a permit to build /V7-17d
according to the following specifications
1. Name of property owner IIA'XIoLD /firr4u,tJC Tel. 371/- L596
Address 27 ,Rewe .rremit-41 s, ` itt/ear:9
2.Name of Architect(if an ) Tel.
ye- otor cyon[,ne chili ems
3. Name of builder _R,cha4,-✓ P. , 7/torr,• Address 33 L,944-S,4o,er4,y. 4Q&ees?i
4. License No. 00 r t S/ Tel. f 6- 4917?
5. Name of Mason Address
6. License No. Tel. de„5,�y /d,,,,7, 51
7. Construction address /00 aIa, d sr, reP at) w. Oip,�rOICC/77f, t ,PT:?&" v "7�
Flood District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated Cost
WRITE IN THIS SPACE
10. Multi family ❑ /pep•aa
Ca Type of room No.
11. Commercial Ql" • e-f � i Kitchen
12. Other ❑ �0---*-~ "enLde,n -t Dining Rm.
13. No. of stories / Living Rm.
/CC&a Bed Rm.
14. Foundation — Full ! Half 0 Crawl 0 Slab 0 Bath
15. Materials — Wood Er 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
z 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 JG�`��"""S /%-lia.G
PLANNING BOARD Address
Date
BUILDING PERMIT APPLICATION SIGN OFF
PPLICANT; R,chanc✓ /? 1;911477" BUILDING PERMIT Il:
DDRESS: :33 Lpii/t-- s/70I5- /J/I. , IA' &JST/IrELE. NO. : 1196-6979 DATE FILED: / Z,3-0rn
LDG. SITE LOCATION: /00 AV/N .517 ca/WW/EA: 3C) LOT#: //f /
HE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD,
TER, OR ADD TO A STRUCTURE WITHIN THE TOWN OF YARMOUTH. THE BUILDING DEPARTMENT WILL DETER-
INE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD
LAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGH
HE FOLLOWING DEPARTMENTS: •
' RESIDENTIAL AND/OR COMMERCIAL BUILDING
ATER DEPARTMENT: DETERMINES COMPLIANCE OF WATER AVAILABILITY.
NGINEERING DEPARTMENT: DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE.
ONSERVATION 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.
ALTH DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E. : REQUIRE-
MENTS FOR SEPTAGE DISPOSAL AND OLxrdt PUBLIC HEALTH ACTIVITIES.
IRE DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REQUIREMENTS FOR PERSONAL
SAFETY, PROPERTY PROTECTION, I.E., SMOKE DETECTORS, SPRINKLER SYSTEMS,
ETC.
E FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR
SSUING THE REQUIRED BUILDING PERMIT:
VIEWED BY:
1. WATER DEPARTMENT DATE: N/A:
2. ENGINEERING DEPARTMENT: DATE: N/A:
3. CONSERVATION: DATE: N/A:
4. HEALTH DEPARTMENT DATE: N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
PLEASE NOTE
L STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE
ISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING
ERMIT.
OMMENTS:
LM/89
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
JOB LOCATION: /00 /72///1/ • lll. ddr/Ylocr,
NUMBER n / STREET VILLAGE
OWNER OF PROPERTY: /7ANail trfU.VG'
/
CONSTRUCTION SUPERVISOR: 1.0040 Pd 19 159414177. Od//.f/ 896-6977
NAME LICENSE NO. PHONE NO.
ADDRESS: 33 Z./94-agoge .04 4%Elvsre/f
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 BUILDING
OFFICIAL.
SIGNATURE: / /.o
a
BUILDING OFFICIAL APPROVAL: /7"..A4