HomeMy WebLinkAbout2000 Building Sign Off - Garage conversion -n TOWN OF YARMOUTH
�?y BUILDING DEPARTMENT
• BUILDING PERMIT APPLICATION SIGN OFF
Applicant: Gv� U�r BuildingPermit
c/ �` � No.:
Address: b d� Q-VA n c C' , Tel. No.: 3 Ci tl-3$�(,Li Date Filed: S '1\0°
Bldg. Site Location: Map No.: Lot No.:
The following information outlines the procedural steps required to obtain a permit to build, alter, or add
to a structure within the Town of Yarmouth. The Building Department will determine compliance to the
following: (A) Zoning Requirements (B) Historical Districts (C) Flood Zones. The Building Department
will be responsible for assisting the applicant through the following departments:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: Determines Compliance of Water Availability. (applicant to obtain)
ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type
of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc.
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
•
for Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
The following Departments must sign off, in the respective order,prior to building inspector issuing the required
building permit:
REVIEWED BY:
1. WATER DEPARTMENT: DATE: N/A:
2. ENGINEERING DEPARTMENT: a DATE: N/A:
3. CONSERVATION: / DATE: N/A:
4. HEALTH DEPARTMENT: 2 DATE: r a N/A:
INDUSTRIAL AND/ R COMMERCIAL PERMITS
5. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
PLEASE NOTE
All stumps and/or brush must be disposed of at an approved site.
COMMENTS:
HGU)-( l v riZz- rvwc,,.) d rig i _
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8/99 Applicant Signature Date
oF'Y` 4.-,„ ONE & TWO FAMILY ONLY - BUILDING PERMIT
i-
O APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
p tt
-3; Town of Yarmouth Building Department
MTTAC„EES 1146 Route 28 • Yarmouth, MA 02664-4492
, ''�4 V Tel: (508) 398-2231 x261 • Fax: (508) 398-2365
Office Use Only Planning Board Information Assessors Department Information:
Permit No4 _ Date-_,. _ 'Ian Type Map Lot Map Lot
Endorsement Date Old New
Permit Fee $
Recording Date 1.4 Property Dimensions:
Deposit Rec'd. $ lb,- Date 511 1 W Plan No.
Net Due $ Other Lot Area(sf) Frontage(ft) Lot Coverage
This Section for Office Use Only
Building Permit Number: Date Issued:
Certificate of Occupancy
Signature:
Building Official Date is is not required
Section 1 - Site Information Use Group: R-4 Type: 5-B
1.1 Property Address: 1.2 Zoning Information:
PC\.• t -0c % k.
• yUc V\Ou` `r‘ Zoning District Proposed Use
1.3 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.4 Water Supply(M.G.L.c.40.S 54) 1.5 Flood Zone Information: Comments:
( ub 115 Private Zone: BFE:
Section 2 - Property Ownership/Authorized Agent
2.1 Owner of Reord: '6). ,1 a
Nam rint) Mailing Address
Signature Telephone 1 li
2.2 Authorized gent: I!
'- f i R Lu:..1 J fi
Name(print) Mailing Address I
By Cr
Signature Telephone
Section 3 - Construction Services
3.1 Licensed Construction Supervisor: Not, ,1 Applicable
License Number
Address
Expiration Date
•
Signature Telephone
3.2 Registered Home Improvement Contractor:
Company Name Not Applicable
License Number
Address
Expiration Date
Signature Telephone
9. 15_99 1 of OVER
ur
Section 4 - Workers'Compensation Insurance Affidavit(M.G.L. c. 152 S 25C(6) .o-;�y�
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure
!to provide this affidavit will result in tfle denial of the issuance of the building permit. rV
4
Signed Affidavit Attached Yes No Q,
Section 5- Description of Proposed Work(check all applicable)
New Construction ❑ No.of Bedrooms No.of Bathrooms
Existing Bldg. Repair(s) ❑ Alterations a- Addition ❑
Accessory Bldg. ❑ Type Demolition Other Specify:
Brief Description of Proposed Work:
QGruuke \\v.. U tcArs. Ctl\N. , ��nS�r«(�:.,r S';vv.0.1
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w S ckowr c,Aruye �.�r \t,v.A �c�,� ,nc ut S �ce �r \AiN\
�VAba, �owv 'vIN\k/ 10e CO.*Ni es,n c+ C\t. wu\\;o �,2\onr �j 1\ Y rt.,SE C\
b\� C4# A\ twQ ovt��n\ 6 '.nCW-aC%
. Q \�N ' CA rr.` \A \Lt_Q• L etActtGI
Section 6 -Estimated Construction Costs
Item Estimated Cost(Dollars)to be Check Below
completed by permit applicant
1. Building ❑ Conservation-Commission Filing
2. Electrical (if applicable)
3. Plumbing/Gas
4. Mechanical (HVAC) ❑ Old Kings Highway& Historical
5. Fire Protection Commission approval
6.Total=(1 +2+3+4+ 5) (if applicable)
7.Total Square Ft. (new houses&additions)
Section 7a- Owner Authorization -To be Completed When
Owner's Agent or Contr ctor Applies for Building Permit
, as owner of the subject property
hereby authorize MySea to act on
my be alf, in I matters relative to work authorized by this building permit application.
/00
Signature of Owner Date
Section 7b - Owner/Authorized Agent Declaration
, as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate,
to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
Print name
/C
Signature of Owner/Agent ``, Date
9- 15-99 2 of 2
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