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Home My WebLink AboutBLD-19-001420 entail Mk _ SHEDS LESS TI4AN 1. ;i. iet �• l': I • L A..„„, 3.50.0 V� E. PLACED A bt NIP�IUM OF 3C FEET V FROM THE FRONT LOT LINE AND A permit • 7 `" o`ra MINIMUM OF 6 FEET FROM SIDES AND 180aayarrom REAR LOT LINES, xissue cine • EXPRESS SHED PERMIT APPLICATICifirchCEIVED TOWN OF YARMOUTH l • Yarmouth Building Department s7'i3 2o18 157) 1146 Route 28 • South Yarmouth,MA 02664 BUILDING DEPARTMENT (508) 398-2231 Ext. 1261 Ely:__ ��y CONSTRUCTION ADDRESS: �7 d" 4.7-e.2(nar y„,,,,e4.,,qASSESSOR'S INFORMATION: J/ Map: Parcel: OWNER ,P S•2 ,1,, // a, 7/ju13e M7 'gygrO�i et OCV)) PRESENT ADDRESS TEL. Email Address: CONTRACTOR • NAME MAILING ADDRESS TEL.# ' .� Email Address: Residential Commercial Est.Cost of Construction$ . Home Improvement Contractor Lie.# Construction Supervisor Lie.# Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# o SHED INFORMATION 1\5•421$ � 1 tt7DrOldie"° 00/7 (S),uu• zor New _ Size L x W x H alte,0/6— GI edlee '(diel . / ldi// /gar/ Nike afater Per Town of Yarmouth Zoninz By-Law Sec 203.5 E: •" j / Side and rear setbacks for accessory buildings less than 150 square feet sing a stoly, shall be 6 feet in all districts, but in no case built closer than 12 feet to any other buildings - — - - Replace existing* _ Size L 1IN x W 1z H O • "'he debris will be disposed of at • 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 answers) will he just cause for denial or revocation of my license and for prosecution under MG.L Ch.268,Section 1. Applicant's Signalize: Dare: Owners Signature(or attaehmen /.�GG�CG�1-� .�r/ .� ... Date: 11•��i��G/,p2U�h Approved By: ��.ti! , Date: `r u`V— t 0 Building Official(or designee) Zoning District Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District Within 100 ft.of Wetlands:*** Yes No Yes No ***Note:Conservation review required if within 100 ft.of Wetlands 9/13 • `1'' t + The Commonwealth of Massachusetts • rA-- =3c " Department oflndustrialAccidents � 1.. t I Congress Street,Suite 100 1 ' Boston, MA 02114;2017 "'.'-1/ www mass.;ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMTPfING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): . Address: City/State/Zip: Phone #: Are you an employer? Cheek the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/orpart-time).• 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp. insurance required] 8. ❑Remodeling 3.0 t am a homeowner doing all work self 9. ❑Demolition try [No workers'comp.insurance required]t 4.0 I am a homeowner and will be hiring contactors to conduct all work on my property. I will 10 Building addition ensure that all contactors either have workers'compensation insurance or are sole 11.0 EIectrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.01 oto a general contractor and I have hired the sub-coo2acurrs listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.: 13.0 Roof repairs 6.0 We are a corporation end its officers have exercised their right of exemption per MGL c. 14'❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t flomecwnera who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contactors that check this box must attached an additional sheet showing the Dame of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'camp.policy number. I inn an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site utformmton. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine 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 of up to$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information providad above is true and correct Signature: Date: Phone#: 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#: • ;J4 , 1 ..i 7 PLOT PLAN FOR LOT I indicate local ica of garage or accessory building Additiccx with dashed linea Sewerage disposal: (cesspool) ED >8 I - - - -• I (lit ft' ) I Q - -. Abutters I Name I Abutter's Lot# I Name If this is a - F -> Lot# corner lot, REAR YARD If this is a write in eomelot, name of street Iftwrite I in I name of street I 41 EWE YARD • HOUSE SIDE YARD • fl---�.€rs. O p-----fro c • • •• I • I SET BACK •: . .. ' . I 'd (lot ft. fiuttage) . • / I S E n1 erct An l AYE. \ 1 / \ / (NAME OF STREET) / \. Supplied by J • a, r YARMOUTH OLD KING'S HIGHWAY REGIONAL HISTORIC DISTRICT COMMITTEE eft. 4 1146 R UTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664 ".:-. Tel phone(508)398-2231 Ext.1292 Fax(508)398-0836 Colleen McLaughlin,Office Administrator (cmclaughlin@yarmouth.ma.us) • ERTIFICATE OF EXEMPTION Application is hereby made for the iss ante of a Certificate of Exemption under Sections 6 and 7 of Chapter 740, Acts of 1973, as amended, for the p ed work as described below and on plans, drawings, or photographs accompanying this application. EASE SUBMIT TWO (2l COPIES OF APPLICATION FORM & ACCOMPANYING INFORMATION(IN LUDING PHOTOS). I Type or print legibly, I C�yytf_� L �Nn Address of proposed work 758 12)E .M n? 1' • ` Map/Lot s Owned s):—Z4/^hea n ant -R0,{Apr ' C3 in i^Q Phone t.52:,8 3 74;:)30.2 6 3 I .JJ Mailing address: SirlrrtiP_ 1 Year built: / Email: CrbaY D 'eh4 yahoo , COPY] Preferred notification method: Phone ✓ Email Agent/contractor: Phones: I Mailing Address: Email: i Preferred notification method: Phone Email Lc/ � p�e�scripUon of Proposed Work(Additional pastes may be attached If necessary); �l� ?..via, Vaonte y Ca.¢.&-(5pra ebi, At s)t(.e- - atYL�� 53-tcp,cYwte-d. �� .� APP_RQ_D i T !". 1 i YARMOUTH_ I r /� ( - } OLD_ KING'S HIGHWAY Signed(Owner or agent): r,1A71' ' • Date: I 4 > Photos (2 sets)showing all sides of build MUST accompany application. • Owner/contractor/agent Is aware that a pe ;ova may be required from the Building Department(Check other departments,also.) > This certificate Is good for one year from I date or upon dale of expiration of Building Permit,whichever date shall be later. For Committee use only i Received by OKH: _Aihproved Approved with changes �Denied Date: asiVCheck fi: Reason fo Cr denial: /1.4.-e. � . .A a-+ // Ox--e; _ _t t- e- ALit Rcvdby: cf.-wt./L..4 . 04 . /ve" �9i t- iq p Date signed: /4/2-'2!7- Signed: �X eic..... ' «- e--/d3 Awa rnvoro�c nnlcn r ... ` SEWAGE P' SYSTEM PROF! OBSERVED WATER TABLE ( / /• ) .!) / / / /NOT TO SCA^E BOTTOM OF TEST HOLE Ell • .' .0 i / / / / \ 21.8 / / / , / / V / / / / . I? / / / . // / /// I=> •-1,G, • /- /- / / \\\1V I„e r/ // / - / • j5.7 // / \, 24.2 ; \ < ,/ ,/ // // ,/ ! I 1 \ / 41 , / / \ `y1\ \ \ / b0 / / / / 4IMIi OF OIL 1 /S / / /5' OVERDIG ' ST 1 /1 \\ \ / N. / / / \ • 4(5, +\ \ R°1 �' 111 lc a 1 * L0� / / SOIL \ \ ```\� I \ L�. :: i / f F:!i • 37.0 ijy •. o,`i,'h�n / 3 J) /1SOOGAL0N F : MNK I I - ' C. IV • N. ' \ \ link ew \ \\\ Sqy.\\ ,bra)NOP.WV) a =.5 N. \ N. \ > 0 1 �''/�, \\�// `+ 38.5 � •g r I OCT122� \ 2--,\39.1// / 37.6�F"• / . . y'"' \ . / 40.6 '/ �j 9` / ! / A 41.5 41.6 • ,r _ 1- 40.8 i \ —• _20'S. �S HIGH I 1 \ , I 1 I 3 427 /a-6/979 ,J, elbeiad-79-1-41 *ape; &4 _---;;;Te)7._finzeb7ziaed4cA)d,' lc'_Vaeccl4ir� _/XL- - _a___ A _ _- _ �r_ _oma t/ _. ____. �,�___-- _ -- -- gez 04( , ��1sy- yob fesd. YLh4C// 6a1-=c _ -- - - -RECEIVED ----- _ SEP-- 6-2018- -- ----- -BUILDING DEPARTMENT_ _