The URL can be used to link to this page

Home My WebLink AboutB-10-662 # 117 Building Permits,off 'YgR ONE & TWO FAMILY ONLY - BUILDING PERMIT • ss� �'C APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING G y Town oi'Y:u-rnouth Building i)epartntcau 11.16 Route 28 - Y.u-tnouth, N1.10266-1-4492 1'el: C508) .198-2231 x261 - Fax: (308) 398-0836 Office Use Onl panning rcBoard Information Assessors Department Information: Permit No `�V - ate �0/n �y5e Map Lot Permit Fee $ � orrssement Date / // ding Date New Deposit Rec'd. $ Dater / ` No 1.4 Property Dimensions: Net Due r— her Lot Area (st) Frontage (ft) Lot Coverage Tft Sw*m for Oilfce Use Only Building Pe mtwr Date Issued: Signature: Buildup OBkiat Del CettMcate of Occupancy Is is riot required Section 1 - Site information Use Group: R-4 1.1 Property Address ` t 2 Zoning Information: Zoning District Proposed Use 1.3 9uNding setbacks (R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Suppyl (w.O.L. e. 40. s 154) Pubic Private 1.5 Flood Zorts Information: Cartwrtents: Zone: BFE: OVER SecW6 4 WWrkerrs' Com )na rah Af ivi (,f t3 L ik 1 S9 a 2i a = Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .. ..... No .......... • -Rx►cflhn g - Dakerh9feef of Pmaosed Work (check al accoo k New Construction ❑ No. of Bedrooms No. of Bathrooms Existing Bldg. a- Repalr(s) ❑ I Alterations Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Peed W Po' nkri?- (t-) s N tFeftAaefftt Ar Contractor Applies for 1, hereby authori my behalf, in all matters relative to of Owner 7b - Owner/Authorized Permit Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway $ Historical Commission approval (if applicable) as owner of the subject property to act on authorized by this building permit application. ( I iog7/D`3 Date 1 , hereby declare that the statements and �iformal to the best of my knowledge and belief. Signed under the pains and penalties of perjury. , as owner/Aui 'nr� zea Agf on the foregoing application are true and accurate, 9.15-99 2 of 2 O •YqR� o 3� o r TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT - job Location: Num Owner of Property: — Construction Supervisor. Name I I License No. Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder: Ilage License No. Phone. No. 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 subcontractor 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, reconstruction, 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. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities tinder the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a curren ability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Ye No (J If you have checked ygg, please indicate the type coverage by checking the appropriate box. A liability insurance policy ,CEV—' Other type of indemnity U Bond OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent C1j Signature: Building Official Approval: For Orrice Use Only Permit No. Date TOWN OF YARMOUTH AFFIDAVIT Hoare Improvement Contractor Law Supplement to Permit Appl nden MOL a. 142A requires that the 'reconstruction, ahQatian, renovation, repair, modemintiom, conveyion, improvement, removal, demolitim or tau of ere addition to any pre-existing owner -occupied building containing at Ieast one but not more than tbur dwelling units or muctum which are adjacent to such residence or building' be done by registered cw&sctara, with certain exceptions, along with other requiranents. Address of Wo Owner Name: Date of Permit Application: )41 7 le I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S 1,000 Building not owner occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a 't as the agent of the owner: Dat Contractor Name Registration No. OR: Notwithstanding the above notice. I hereby apply for a permit as the owner of the above property: Date Owner Name ;s • The Commonweadtlh of Massachusetts Department ofTndustddal Aecddents Offlee of byestigadolu 600 Wasbdngton Stud Boston, MA 02111 www.mas&go%1d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ApipUcant IOformadPlease NaMC(BusinessOrgaoizatiotrindividuai): city, • � i � sue/ Are you an employer? Check the appropriate boss Type o[ project (region 1. ClI ant a employer with 4. 0 I an a general contractor and I 6. ❑ New oastructio con employees (bill and(or part-time). • have hired the sub -contractors 2 I am a sole proprietor or partner- listed on the attached sheet Thesesub-conaactors have 7. 2 Remodeling ship and have no employees S. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance required] comp. insurance. = S. 0 We are a corporation and its 10. Electrical arts or additions ❑ repairs 3. ❑ I am a honrcodoing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers comp. right of exemption per 1ti[GL 12.0 Roof repairs insurance required.) t c. 152, 41(4), and we have no 13.0 Other employees. [No workers' coma insurance reouired.] *Any applicant dot cheeks boa MI rout elm fig out the section below showing their wro hn * earrgatodsa policy inhr o m 0 Homeowners who submit this afiWavit indkutina dry are doing aN wart and d m hire outside eontnettoa must submit a new asldavit indicating suck tconvulon dot cheek We ban must atoached so addidmsl sloes show me the mono ot'the nrbeostrsotsa and soft whWW or not don eaddes hsw cmpbyees. lithe sub-convulon have empbyea% they mum provide deist waken' amp poft numbw. 1 owe aw empbper that is prevtidtwa mariners' cowrpexse&w heswrence fir rap emptapaes. Mew & tAe pp&7 and fob sift informedlom Insurance Company Name: Policy # or Self-ina. Lie. li: Expiration Date: Job Site ,Address: City/State/Zip: Attach a copy of the worken' compensatlon policy declaration pate (sbowing the policy number and expiration date Failure to wcure coverage as required under Section 25A of NIGL c. 152 can lead to the imposition of criminal penalties of a tint up to S 1,500.00 and'or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine ,)f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the OtIrce of TOWN OF YARMOUTH 1146 ROUTE 28 SOUTH YARMOL"TH vfASSACHUSETTS02664-4k51 Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 BCILDIrG DEPARTMENT DEMOLITION .DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to 2I.G.L. Chapter 40, Section 54 and 780 CbIR, Chapter 1, Section 111.5, I hereby certify that the debris resulting rom the roposed work/demolition to be conducted at la cmd4v`- Work Address is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. �l Signature of Applicant Da Permit No. - ✓/LG /fV//GV'/a(/GW.LfG 'and �1[Y -`a as act Asaxl l� - L<�/Yl L.12%.M III ■ U1/1M 04111Ll� Board of�dding Regulafio s anduStandards Board of building Regulations and Standards HOME IMPROVEMENT CONTRACTOR .t �onsilruc-tiori Supervisor License Registration: 128922 Licen4e:,-C4 r-73395 Expiration: 6/7/2011 Tr# 281449 Restricted to 00 Type: Individual PETERJ KENNEDY Peter Kennedy 444 MISTIC DR Peter Kennedy r MARSTONS MILLS, MA 02648 44 1.1 lCVRIVE. h1r,ON MILLS, NCA'02648 dmigisti leer - - � Expiration:.Ij/2/2010 x" ('uinmi.�ioner Tr,': 5978 R lad au, � * �� L(L-�-7 q old WC, �. TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.261 ------------ PERMIT NO B-10-662 _ , e ISSUE DATE _ 11/2712009_ ; PROPOSED USE :: _ _ _ _ _ : _ = PERMIT r --------------------- JOB WEATHER CARD APPLICANT Peter Kennedy PERMIT TO Alterations AT (LOCATION) 10121CAMP ST # 117 ZONING DISTRICT= Bldg. Type: Residential SUBDIVISION MAP LOT BLOCK 044.21.1 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-3 LOT SIZE CONTRACTOR remodel existing bathroom - change tub/shower area into sho REMARKS (q�j kP �` AREA (SQ FT) EST COST ($ $2,500.00 PERMIT FEE ($) $100.00 OWNER IDonald Robinson BUILDING DEPT BY ADDRESS 10121CAMPST#117 West Yarmouth MA 02673 LICENSE 1 73395 Kennedy, Peter 444 Mistic Drive Marstons Mills Ma 02648 5082805641 PHONE 5087781201 INSPECTION RECORD FIELD COPY Date Note Progress - Correctionspnd Remarks Inspector