HomeMy WebLinkAboutBuilding Permits BackfilePERMIT 167 3/18/98
3/18/98'
LOT E218
Laband, Mr. & Mrs. Peter
47 Capt. Noyes Road
South Yarmouth, MA 02664
Remove 1 window/replace with 2 larger windows.
$1,300.00
SHEET 59
TOWN OF YARMOUTH
Application for a Permit to Build
UPON FINAL APPROVAL T J% I0 � MAP S7 LOT / � 6�
FEE MUST ACCOMPANY THIS APPLICATION. DATE 19
The undersigned hereby applies fora permit to build 1 (1q
�a cording to the following specifications / 7
t Name of property owner z.;7.- %.ems �efe✓ �rs'��N1� Tel. 39�-/
Address y-Z ��N c�-R-� S ��rm • s')'�r
Name of Architect (if any) Tel.
3. Name of builder / viN Triar k) Address b2R=kk 7 y i I JS i ou 04
4. License No. es nr, 1-266 Tel. '76a-0koa3
5. Name of Mason Address
6. License No. Tel.
7. Construction address y7 n-� 'ya -e s
FI od District y0
8. Date of subdivision Approval plain zone IVA Zone
9. Private dwelling ❑ Estimated Cost D NOT WRITE IN THIS SPACE
Type of room No.
10. Multifamily ❑ 3 �, — /
11. Commercial ❑ A42ee 6,e- �� `�1 � Kitchen
12. Other � A �� Dining Rm.
a`7v(/yr�
13. No. of stories Living Rm. 3s l �. � Bed Rm.
14. Foundation — Full ❑ Half ❑ Crawl ❑ Slab ❑ Bath
15. Materials — Wood ❑ Cement ❑ Other ❑ Deck
16. Type of heat — Oil ❑ Gas ❑ Electric ❑ Other ❑ Closed porch
17. Garage —1 ❑ 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size Shed
20. Stove — Wood ❑ Coal ❑ 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
25. H.I.C.R. No. �/ 4 9a 9
LOT RELEASED BY Signaturec/2- L/
PLANNING BOARD Address
Date
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT: /
JOB LOCATION: l/ 7 5
NUMBER STREET VILLAGE
OWNER OF PROPERTY:_ /j2/%. +4-`y//,V e
CONSTRUCTION SUPERVISOR:
ADDRESS:
LICENSED DESIGNEE:
oG 3-2
LICENSE
PHONE NO.
(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, MIOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING
AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LA';S 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 REGLIATIONS AND ANY PROCEDURES, AS AMENDED, SHALL 3E 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 REGLIATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISING
SAID PERSONS, THE WORK SHALL I124EDIATELY 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 CON•
STRUCTION SUPERVISORS IN ACCORDANCE ,:ITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERSTAN:
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILDING
OFFICIAL.
INSURANCE CO RAGE:
I have a current ability insurance policy or its substantial equivalent which meets the requirements of MGLCh.152
Yes & No 0
If you have checked ves, please indicate the hjpe c average by checking the ap:rcpriate box.
A liability insurance pc:icy CY lO;her type of '..idemnity 0 Bond 0
OWNER'S INSURANCE WAIVER: 1 am aware that the ncensee does not have the insurance coverage required :y
Chapter of the M : Ge eral Lws, ana that my signature on this permit acplication waives this requirerrert.
Check one:
��'� ❑
Signature of t.�«ner or O.vnEr's anent Owner) Agent
SIGNATURE: Xe-" BUILDING OFFICIAL APPROVAL:
Suggested Affidavit for Home Improvement Contractor Permit Application
For Office Use Only
Permit No.
Date
NAME OF CITY/TOWN
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MGL c.142A requires that the "reconstruction, alteration. renovation, repair, modernization, conversion, inprovement, removal, demolition,
or construction of an addition to any pre{cisting owneroccupied building containing at least one but not more than four dwelling units .... or
to structures which are adjacent to such residence or building" be done by registered contractors, with certain exceptions, along with other
requirements.
Type of
Address of
� v
Owner Name:
Date of Permit Application: o?/ A?
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law
_Job under S1,000
_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 permit as the agent of
the owner:
'`�eirc/ C3ri��t/rirt Cis'oG37G,4
Date 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
4._
The Commonwealth of Massachusetts
Department of Industrial Accidents
ONCO811MOS ONVOis
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Applicant information: f�feaie�liilQ'1'Teds'Idt<
7 y /{Iu5`106f- VX t4f�
cit. G s %%tiysils phone N �7e F- Z73 .s2 <3
I am a homeowner performing all work myself.
21,11 am a sole proprietor and have no one working in any capacity
C3 I am an emplover pro%iding workers' compensation for my employees working on this job.
comnanyname: L1AI t0
address: /2 4✓poi%63 621 4
i
city: St t/em /zwcL-,7` i phone N: re f-241 _ 2 e 2 7
insurance co. noiiev # 7 A9 v/S - 3 z 8 X 32 2
2/1 am a sole proprieto 1 contractor or homeowner (circle one) and have hired the contractors listed below ssho hose
the following worker.' compe a Ion polices:
company name:
city: phone #•
insurance co. policy #
Failure to secure coverage as required under Section 25A of MGL 152 tan lead to the imposition of criminal penaltles of a pae up to 3195NAh and/or
one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a flue otSI00.00 a day against me. 1 understand that a
Copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
! do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
signature ate 3/�F/��
Print name !n/ (5—' /1< �voh/ hone N 5 D �!— %�D — 2 6 2 3
official use only do not w rite in this area to be completed by city or town offleial
city or town YARMOUM
❑ check irimmediste response is required
contact person:
permit/license N riBuilding Department
❑Licensing Board
261 ❑Selectmen's Office
08j 3 ❑Health Department
phoneN;- (5— 98-2231 eat. mOther
(,e .sed 3,95 P:AI
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
entploN ees. As quoted from the "law', an employee is defined as every person in the service of another under any
contract of hire, express or implied, oral or written..
An erephr ver is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise. and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual , partnership. -association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the
dN%elline house of another who employs persons to do maintenance , construction or repair work on such dwelling house
or un the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
%IGL chapter I:'_ section :5 also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionall%. neither the commomvealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e
been presented to the contracting authority.
Applicants
Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and
suppling company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not the Department of Industrial accidents. Should you have any questions regarding the "law" or if you are required
to obtain a workers' compensation policy. please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
.be sure to fill in the permit/license number which will be used as a reference number. The affdavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,.
please do not hesitate to give us a call.
The Department's address, telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Inflee of IavestUetleos
600 Washington Street
Boston, Ma. 02111
fax #: (617) 727-7749
phone if: (617) 7274900 ext. 406, 409 or 375
r
,�►,a(`�' �y ^ 01
The Commonwealth of Massachusetts "`< Use '
Department of Public Safety
Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12.b0 3/90 cleave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed In accordance with the Macsachuserts Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR HYPE ALL INFQRHATION) Date
City or Town ofO To,the Inspector o � res-
The undersigned applies for a permit to perform the elect ical work described below D
v Location (Street 6 Number) i /0 C� 22 F JAN 2 7 1999
Owner or Tenant 4 ArW
Owner's Address -S:17101-e By
N
l K
Is this permit in conjunction with a building permit: Yes ❑ No W (Check Appropriate Box)
Purpose of Building Utility Authorization NO.
Existing Service -�LO Amps -AVe Volts Overhead � Undgrd El No. of Meters__
New Service. O % Amps 4 -d' /62 YdVolts Overhead Undgrd ❑ No. of Meters %
Number of Feeders and Ampacity
Location and Nature of Pro posed Electrical Work J✓ P c Se �b
No. of Lighting Outlets
No, of Hot Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Swimming Pool Above In-
grnd. ❑ grnd. ❑
Generators KVA
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting
BatteryUnits
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No, of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Municipal
Local ❑ Connection[]Other
No. of Ranges
No. of Air Cond. Total
tons
No. of Disposals
No. of Heats Total Total Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
Signs No. of Ballasts
LowVoltage
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage o its substantial
equivalent. YE NO I have submitted valid proof of same to this office. YE NO ❑
If you have Checked YES, please indicate the type of coverage by hecking the appropriate box. /1
INSURANCE BOND ] OTHER ❑ (Please Specify) �r�fi Y ~
Estimated Value of Electrical
Work S r Expiration Date a
Work to Start` ! / Inspection Date Requested: Rough
Signed under the penalties of perjury -
FIRM NAME c �� ® O�J�+ Eii O �� LIC. NO.[ 1-95 Ll
Licensee es erC6h Signature
Address Bus. Tel. No. 7J,y- /8" 9
Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licen ee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
application waives this requirement. Owner Agent (Please check one) .
Telephone No. PERMIT FEE $
Signature of Owner or Agent
1 4 . A
WIRE l aRMEcrorl, o
SoUrH yAR UrH rowtv HALL MENT
Mour~I MASS 2664
Fee
Date _
Name of fob � _ „L
c�
Name of Electrician
Location �rti a