HomeMy WebLinkAboutBLD-19-000708 u-rc: !.F 30511 IAN +'• CFT !St I-JJ ':Office Use Only
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EXPRESS SHED PERMIT APPLICATION
TOWN OF YARMOUTH RECEIVED
Yarmouth Building Department
1146 Route 28
ccr�(� e, ,South Yarmouth, MA 02664 FijitiGAUG
/ �"""� (508) 398-22311Ext. 1261 i Bt, r
'CONSTRUCTION I9' 'sat Uet•I �Iree+ S • nYASSESSOR'S INFORMATION: J
Map: ;deet Parcel: G\ \ (� MA
1/ OWNER: PA.0 I -4.,, ,„5 lel 1 ,„I( ILI� mecf S•l°tf txT 503 CIq 7 IZ[D .
NAME / PRE ENT ADD S TEL. I
✓ CONTRACTOR: 'L so ir, e ea . I • ■if • 4 H _ D 4302800
NAME MAILING • •D SS TEL#
Vesidential ❑Commercial Est.Cost of Construction S 3I Q
Home Improvement Contractor Lie.4 132q , 1 1,Constrnction Supervisor Lie.if 07 3`j19L/
Workman's Compensation Insurance: (check one)
❑ I am the homeowner ❑1 I am the sole proprietor
� O I have Worker's Compensation Insurance �,,�/
Insurance Company Name: V�[f yt. rot .IC Worker's Comp.Policyi!F�—�1ZQ" �1 51- Z(7IQf�.
humble rI SITEDPINFORMATION
New ✓ Size L 8 x 6V IDx H t i 1 Z t Corner Lot: Yes ✓ Ifo_ .
Per Town of Yarmouth Zoning Bp-Law Sec 203.5 E:
Side and rear setbacks for accessory buildings less than 150 square feet and single story, shall be 6 feet in all districts. but
in no case built closer than 12 feet to any other building.
Replace existing* _ Size L x W x K
.
/t � s
'The debris will be disposed of at .✓tbt hreCaMcskt A fv_ s ptnt S , lMil \‘. -fV1 ! V CC•
Location of Facility
I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false=wens)
will be just cause for denial or revocation of my license and for prosecution under M.G.L.Ch.269.Section I.
Applicant's Signature: Date:
Owners Signature(or attachment) Pe_A a,`.� Date:
Approved By: Date:
04.:.27#/......11"..
alr designee) IL ADDRESS: ^_u'_—'
Zoning District:
Historical District: 7 Yes 11 No Flood Plain Zone: n Yes G No
Water Resource Protection District: Within 100 ft.of Wetlands:***
I] Yes C No 11 Yes 0 No
**'Note:Conservation review required if within 100 R of Wetlands
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=_ rOffice of Consumer Affairs and �usiness Regulation ••
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y11— 1 l 0 Park Plaza - Suite 5170
- Boston, Massace .4etts 02116• 5 I
Home Improvement _5 _: for Registration.
^ —*, _ C. Commonwealth of Massachusetts
,,�� = Division of Professional Licensure
McGRATH POST & BEAM .CO. = 1 ®�
Board of Building Regulations and Standards
JAMES McGRATH n _..ay—_ ConstructionaSL�g1t Iij 1 &2 Family
259 QUEEN ANNE RD. ... et
it a _ 4 CSFA-073865 J' 0i/fres:03/14/202(
• HARWICH, MA 02645 4 __=r � Isr� .T:; +� l s
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v JAMES R VIE R IN d f r
�o,M is- ,, 1 204 CRANVIEIN RD ` ,+:�}..
BREWSTER MA 243 .r' t It,I I ''
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Commissioner a-
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1yEa1 Office of Consumer Affairs and Business Regulation
'
,...„,0' 10 Park Plaza- Suite 5170
Boston, Mahusetts 02116
Home Improveme� �tractor Registration
a
ityii ac=0 Type Corporation
Registration: 132935
MCGRATH POST& BEAM CO. Expiration: 10/30/2018
259 Queen Anne Rd. t( - = `
Harwich, MA 02645 _ __ (T 1 •
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-- -- -'-, /0:/
\Ur�'c-
-T" • Update Address and return card. Mark reason for change.
SCAT O 20M-05/11 0 Address 0 Renewal 0 Employment 0 Lost Card
c.V on:ooraaeat(a.af6e
Office of Consumer Affairs a Business Regulation
=t. ® HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
„i l:-
dppi e; on before the expiration date. If found return to:
'I EglstrC eptl�or�t Fxolrotton Office of Consumer Affairs and Business Regulation
- -132035 Fiw ra 018 10 Park Plaza-Suite 5170
-- d`: :. Boston,MA 02118
McGRATH POST&REA61tQ.
Proa Pile H tbak 7.41-' U -
Products
James McGRATH. ' .•.
259 Queen Anne Rd.-" '" Undersecretary Not valid without signature
Harwich,MA 02645
•I
The Commonwealth of Massachusetts
t• —i�it
Department of Industrial Accidents
_ >V;=; Office of Investigations
en- ? 600 Washington Street
3=��= s• Boston,MA 02111
.`"•�' '` www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information 1 �,w /1�Pleease Print Legibly
Name(Business/Organization/Individual): MC �(-Q_'trh 'Pos ' + 13eam Ltwpolati� _
Address: 9561 Qum flint Road
City/State/Zip: Harwich.rnH 049(945 Phone#: S08'�1�
130'49$00
Are ou an employer?Check the appropriate box: Type of project(required):
1.Q1 am a employer with '50 4. 0 I am a general contractor and I
employees(full and/or part-time).' have hired the sub-contractors 6. [✓1New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
workingfor me in anycapacity. employees and have workers'
p 9. 0 Building addition
No workers'comp.insurance comp.insurance.:
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MGL
12.0 Roof repairs
. insurance required.]t c. 152,§1(4),and we have no
employees.[No workers' 13.0 Other
comp.insurance required.] d
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
;mployees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
!am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. r_
Insurance Company Name:, (1� H2tnpshfein tajers Inetiran(t (1J[fl
Policy#or Self-ins.Lic.c.#: ECe- - iote J l` 018A Expiration Daate::'v.1.Ju� 8, dole!
lob Site Address: 1-I T3ttdeg S'ket+ City/State/Zild:\. IQrmau t.YYlfl. orticeid •
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fie up to$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 • ••. . Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DI• ''r insurance cover. e verification.
!do hereby cert y a der the .a•l a . .al es of perjury that the information provided above is true and correct.
jignature: Date: �cu343 , .Qpl&,•
Phone#: 508 ' 10t • =e ;
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
PLOT PLAN
FOR LOT N
Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool)
Well. 0
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_ _ _ I (lot ft. rear) I
Abutter's 'fl'—
Name ) I //�� 1 Abutter'
Lot M I 1 1 Name
V Lot i
f this is a 100 IV—. REAR YARD
arner int, ft. L 1 --� If this
vrite in name I corner
sheet. 30 write f
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Information
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