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HomeMy WebLinkAboutBLD-19-001575 �t-. S 1: l,.OTL,F .,rt-EEi C`•�r:Gf C rl::aA 'li•tt f-o:C?rJl r.t?Til"1cl,r�.'D<, jPOr'"ioK 4 ,,, .� vat NM, t,( n Fir'T PROM OV =1r11i:AND r.1 Amount ac s :Pemrh expires 180 days tom ab -WcS /J ,tasue date EXPRESS SHED PERMIT APPLIC • rto E / veal TOWN OF YARMOUTH Yarmouth Building Department SEP 14 1018 1146 Route 28 South Yarmouth,MA 02664 But derma. • • (508)398-2231 Ext. 1261 1 -'-'P 1" CONSTRUCTION ADDRESS: Ilip9 SII1tr Ltd L0..nP i I,(IeST \Inrapa +k ASSESSOR'S INFORMATION: Map: Parcel: i OWNER: Thth&rd .2. e I 13LeaAc1)rhie_ e070octyMlA 478 - 474-3II6 NAME P ENT-ADDRESSn- I - Pn CONTRACI'ORPI &AA V.L' 1:1 Re dt.XJ-S C:251 e^ I Oneei1l rtd otell..Y) •&2c% NAME MAILING ADDRESS TEL.p )(Residential ❑Commecial Est Cost of Construction$ nn14O6C) • oJ 2�� Home Improvement Contractor Lie.N f? 1 ?93") Construction Supervisor Lie.N Ci SCII -Ca 35to9 Workman's Compensation Insurance: (check one) ❑ 1 am the homeowner ❑ I am the'sole proprietor SI have Worker's Compensation Insurance Insurance Company Name:bJW p4 (-& 4\0h4e/c Xtt Worker s Comp.Policy/SECC-(0QW •ci( 51 - / SHED INFORMATION New ,K Size L 141 z W s z H Io q to Corner Lot:lilies No Per Town of Yarmouth Zoning Hp-Law Sec 203.5 E: Side and rear setbacks for accessory l uildings less than 150 square feet and single story,shall be 6feet in all districts, but in no case built closer than 12 feet to arty other building. Replace cabling* _ Size L z W /_ z H__ *The debris will be digwvd of at -h &lie GENA\`_ d -144s)t?. me bac-0V5 Location of Facility I declare nada penalties of per j o Vt -'eau herein contained are tree and correct to the best dilly knowledge and belief I understand that any false enswer(s) will be just cane for denial . • haute and for prosecution under MILL Cb.268.Section I. (� q Applicant's Signature: I Data -111 `t V Owners Signature(or a 'meat) ' ' I Date: [� /� Approved By: (� i Date: F//—/p Bu- g tial( designee) ADDRESS: i Zoning District: i i Historical D strict ❑ Yes CI No Flood Plain Zone 0 Yes Cl No Water Besot rce Protection District Within 100&lof Wetlands:*** ❑ Yes ❑ No ❑ Yes' ❑ No at/Vote:Conservation review required if within 100 It of Wetlands 9/13 07/13/2018 11:01AM FAX 15084301115+ PINE HARBOR i 20001/0001 t .r, • I . The Commonwealth of MarsachttattS ,,,r2:... —,r Department of Industrial Aceldents ' • 1/44...„.:►it ; Office of Investigations ,7:7 ' 600 Washington Street Boston,MA 02111 . ' www mass gov/a!ta Workers'Compensation Insurance Affidavit:Btulders/Contractors/Eketricians/Phlmbcrs Armileant Intormatlon ! Please Ma Gram et tltarn ( ora tot�� Name(Enniacu/pr3enimtiad[adlvlEuo!): ( "� f Address: 9 't Queen Amy Road1, • City/State/Zip: Hanuiehsi O &545 Phone#: Sa8.43S 1•a$00 Are you an employer?Check the appropriate box: I.D I am a employer with 4. 0 I am a general comment and 1 Type or project(required); employees(flill and/or part-time).* have hired the sub-contractors 6. 0 New conarmetion 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers'comp.insurance comp.insuranec.l required.] S. 0 We area corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.]No workers'comp. right of exemption pee MOL 12. insurance required.]t 152,91(4),and we have no 0 Roof kms a employees.[No workers' 13.0 Other comp.insurance regched.] ! ; 'Any applicant that ditch box at mad also fin oat the mesion below showing their workers'coomenmdon policy tafomm leo. Hamoornen who submit the affidavit indicating they am doing an work end then hire whisk wnawters meat submit a new affidavit indicetlng suck Cunoaaors that cheek this box mart attached an additional sheet showing tic norm of the subomosetas and state whether or manliest;eatkk have =player• Ifthe mbcmaaamrsMe empoyeq,they I1105‘paste their worker?comp.policy number. Ismut n employer that b prarldhrg waiters'coupe aaalloa insurance fornot employees. Below hike policy and Job sire Irrfonnatkn. /1 Instnaneu Company Name r+SI f1201:13/111(P j i tc Msoci ce •i Policy#or Self-ins.tic.a: r ra tf1�'y-/{ "�"tae18A F.><p• nation Dee lob Site Address:. City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy camber sad expiration date). failure to sec=coverage as required under Section 25A of MOL a. 152 can lead to the imposition Of criminal penalties of a line up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the item of a STOP WORK ORDER and a fine "flip to$250.00 a day spins' . Be advised that a copy of this statement may be forwarded to the Office of investigations of the D asmanee -. - .. verification. f do hereby certify u do the .., Tar +.. • a of per/ary that the lafdrn atka provided above Line and correct denature: O Date? i Sewo Phone#: • . .1 ^ A Official use only. Do sot mite In Oh art tabecoaipined by cry or town official . City or Town: Permit/tense# 1 passu:Authority(circle one . I.Board of Health 2.BalldFsg Department 3.City/Town Clerk 4.Electrical inspector 5.Planking Icspeetor 6.Other Contact Person: Phone 0: • Isp/Adienuraustm WWII PIM! ria BIMSSYh1-us-I Pa P' 006!-LZL1I9 N Spit ! 11100 Vit Pan epagROVA 009 A Pd.malp MVO SOPPW P1ansPRP laaagaadap • twappoSsonp IppeastimamicoStu. aagaaoaaylaaeaegdepa*We samba ay !aa s a sap w NUM MY aid lIWOaaMal aait5 , Pea selaaedonsta;*omega gmat Wm"wmai PPeraaapa .-tJ seerypaalt, wimp app esgdmeoaspaid=zoom aaexedpp.('aeaea-Meat'wapaedawawSoper W°eA mama*at ansapaq a sas papas indasa r..pxlagsalpump asass ams sa q wit SSsSWsgPowimps as rasa wad am ow Pa wwwapwaasyapped*teegdde EPomMe aelaAmmoweagpAi Man Palate PammulwiWPMW alUeMNr.'lmaa atnt seganaiwa4wl+s Ppaga saawddeapawn s e119t.agaelaa(tawsaaaopSP,taped saaaanihpsalpslip epw!asinnmopow tat aa ild•wsprawddaoaeewipxadsidlgmafaa- awasga saeaedaa�a•W.-w ulqa saaealaatapaasgwee meslaw aaailgaatdMel wit)wassqs it singl rqa Ilawailas Wan au.pa aa'aewtseaw+oafaowowalaeoarasin sawsea>o aaaogogxa•sssdi!Mudd agpooandettall %%Pal pops paMgt=olIMP ogsalaoaasgsmega WOO mei msAID dla9aawe/isopospadaos 7ewalal�oa 11.lit .a aam',ylaa imps*aalags al natela moss atm tan aro maWlgeaaed-Qaipaasiapl odsepeeeiuoa Ppaaaadegai,seale aeiaMpggaeeae�wa ii adngaaaa oway.. amwraw en o01 NI - PPR.ffmcflP 4L slaaPmesiaSNP Paa sde.won aary swsxwaso aaaipaopaaale agsoplay PISPI Jer—r-'eaugq}eIpgasit moo saw wow FIPP.se PIS 114gMdo ogaNIP aasmq aopibaa trim= aa 'e0aaaa4soweendapos apasAsa aspapistsaetiawadawest" P0tlalaopa.1p #PIMP(*PmAgdpealaa,Pe 100es(e missy yee4ddaa7Lawoan A ISM apasla sat as tldila op mom eq Sappy Lq Vpagdaaimps so awaadam.ngasa pp vow au waalldd- si pais moq tug ante war apapbal aauealop ►eeawdaeop �awPdpiessagpill ats peas Me mg ass pylasarlaiaipp Pined Nines aeilaaaaallie-nIMPERIL els(abal'utaad*P 20011%weee_.V .lexla NSkase ea aup eppl.agellsor semorpo swampaawdlean apepompli e asall ta a SIPMan an aaaaaagappram pest+ai-Iaallpass awaiaMiaow.sap&bpi WI NS"van .sateiiae as p a Pear ai sam' t_largo saaangl ion wap WM saranda sagplpq a gag sd ogx aw a ami lamp pasaapsr*dna=papo?ovsaaaagaaq waaadsbiiaaopt ars paaagPellp*p flJ0laadaxaesagaa4iaapMon RAM alsaawaiNIP a4Nasisawalla!ami11liPe ePeawa►o .Wammo 461.12,% JdatapoaaaMgoew *VMS imilfe aapawgaaei a sap aIs(oi8apuma"apasapraaada Mem tlogwer PimpthipePIS nil left aldaailsgap aaa a sq Lax a lLtpa Ida(aaiio a aopsodaoa tospap6oa*Pad t'Figai no ar PM.q—dump%a;pact Iraudear so sada aN efa!iloPuma maspun sagas psaps agtagsaoaadtareapaopsyaisadspissa a M'wrum saitopae *BP saysoPlosaugc.raa)aor diad w Mala P anal Lil aldaga arn Mao spa0arlaPl .,p suopanJJ$UJ pus uopsuuoJuI •--I, • ' PLOT PLAN FOR LOT N Indicata g Additions with as��s or ° Y buildin Sewerage disposal (cesspool) Nell to I (lotI— — _ !t. near) Abutter's ( a -- Name 6- I Lot B I- - - i ( Abettor �' I Sh�l I Name ot i Y this is a — — — REAR YARD corner lot. 3 a' a$ trite in name % ••..tt. _f this if street. write corner : a • I I O ISGP IL�� name of 1 U ' artier b street. 4 : SIDE YARD 3 g i g HOUSE SIDE YARD • • 1.1 • ' _ co i in: -• g Mt >z:les I -O^�• . . SET HACK • �.5� i ft. . A 4 I I 0 (lot ft. heritage) SI i f ` // I vd� h nPi (NAME OF STREET) Information / `\ applied by ARK NORTH POINT I ✓ V/LB oo-,• s =- O ✓/'&zooczciu oet 23 4, d Office of C. sumer Affairs and Business Regulation • ' J i 10 Park Plaza - Suite 5170 ,`;.. • oston, Massac�s+a .setts 02116 3 Home I provement R'r ..; or Registration.. • 5'1 Commonwealth of Massachusetts �= I '•®r Division of Professional Lkensure McGRATH POST& BEAM 10. +tel:. 1� \ ` Board of BuildingRegulations and Standards JAMES McGRATH g l •� � Conatructio�,rSu�fe{•(tlor.l &2 Family 259 QUEEN ANNE RD. HARLVICH, MA 02645• '! ' .� CSFA-073865 ;t � Flpires:03/142020 MW diK � fX A`R �ye:;:.:s9 ` ' . JAMES R MCGRA $ f :4(' 204 CRANVIEW RD...1. t ."' BREWSTER fdA92g1 �,��, . :s sww..ill,.n,s,• Commissioner t/"" Ja•-•••• ,....6,--. , lam/4e c e I , / ��_), �i'GC7.Qci*�'C�2fl kir v. Office o Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Ma • ,(z 02116 H. e Improvemet tractor Registration 1 _ Type: Corporation li� :-.-7.-- -, , 3 if Registration: ,132935 McGRATH POST&B • CO. _( — i• Exp!raton; 14(9012018 259 Queen Anne Rd. 4, = `4, !. Harwich, MA 02645 �;._..s,` t_- • —J .1 i " i 2.-,±.- Update Address and return card. Mark reason for change. scar 0 am-own ❑ Address 0 Renewal 0 Employment 0 Lost Card — 924 Wwm,nowmwa(G{gee , i j Office of Consumer Maim a auainees R-•utation n CORM, HOME IMPROVEMENT CON ,TOR Registration valid for Individual use only 'Ate Type: Capaation before the expiration date: if found return to: a7; r s _ rte,,, Office of Consumer Matra and Business Regtdatlon •,, it=f 10/30/201: 10 • Plaza•Sulte 6170 fr Boa • ,MA 02116 McGRATH Po87&flFaCO. Q D/B/A Phe HerborWi? ti3 . $ ProduJanes tsM 1 4 ,t JarneaM�RATN i t[I 259 Queen Anne Rd.- •• Undersec :.: Not valid without signature Harwkh.MA 02845 1 /wmai _ MCGRPOS-01 ZHELLWIG AC RO perNEDNYM CER IFICATE OF LIABILITY INSURANCE 06/26/2018 THIS CERTIFICATE IS ISSUED AS A MATT ' OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER TINS CERTIFICATE DOES NOT AFFIRMATIVELY •R NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURAN4 E DOES NOT CONSTITUTE A CONTRACT'BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE ERTIFICATE HOLDER. j IMPORTANT: N the certificate holder Is an ,DRIONAL INSURED,the ecotypes)must have ADDITIONAL INSURED provisions or he endorsed. If SUBROGATION IS WANED, subject to terms and condllorn of the policy,certain policies may require en endorsement. A statement on this certificate does not confer rights to the - C , holder In lieu of such endorsement(s). PRODUCER VC &Gray Insurance Agency,Inc. PHONE ..._.. . . _FAR k -.. 436 RM 131 (Wit WS . . Ne (877) 16-2158 . 8 South Dennis,MA 02660 mal ens ra .eom - _wNnmaaIAROROIIOeovEusi ...-----j-_-saes nmmeiw:TreveienIndemnity Company ofAmadei 25686 NAMED .s+turERI:TraveloieIndemnity Company , 125858 McGrath Post 6 Beam Corp 'aauRER C,New Hampshire Employers Insurance Compan ,13083 dbe Pine Harbor Wood Products 259 Queen Ams Rd ;INSURta O: .. .. . . _.._.._. . Harwich,MA 02045 ,einem r r I MUM IT: COVERAGES CERIIFICA E NUMBER: REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF I SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE ISD NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRE ENT, TERM OR COMMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTH , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT/ONS OF SUCH POUCI .LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NM 7VP[OF INa11RAi1C! Wei - -...__ _ _ REDUCED 'I FOLIVY Ma ' LTR SSO , .. POLICY NUMBER IMMIODM'WI IMM!DO/YYYYI LIMITS A X COMra11CIM.GENERALUANun 7,000,000 EACHaCIMRENCF .!7 cTWSAW UE 'X OCCUR 1-660-0368/31110-71A-19 01131/201301/31/2019 m T;E I ,4 100.000 I MED DIP(My one person) 4$ 3,000 PERSONAL A ACV INJURY $ 1,000,000 _ONT.AGGREDATE LMTAPPDES net 2,000.000 • X POl1C'T - (IEtFRR AGGREGATE -7 L LOC PRooucn•COAP/MAW;s 2,000,000 OTHER: I � 5 ... . B AunoMoeac I I .a 0l HOLE LIMIT . .$ 1,000.000 _ ANYAuro Ep�DL® BA-0437B686-10SEL 01/31/2010 01/31/2019 BoarN,AMrinspr.nnl .s .OIIYI,OlfSONLY X AUfO,S ! I BOCLN • Y HAIRY TPeecNwy4$ X:MI alar .X eNl"d'srme°E :s .— s LeaREtLAuAa OCCUR I FACEOCQURRENCE ,f EXCESS UAS i CLAYIAADE I AGGREGATE '7 • DEO : ;RETENTIONS * ( _ •S . C MI HERS UABLLR I j . STAIVIE _.SR J- ApNFFYePEROPA�RIIE,�TOERgIPARTNERIEXECUTIVE y1 ECC-BDO.W00957301$A 07/06/2018 07/08/2019. 1GQ000 tiDarye:RMnrR mRID EXCLUDED? N N/wI s 100.000 itaftlPTION OFF OPERATIONS tam I i �Il,DSEASE-POLICYLaeT S• 509.000 LIEaCA!'TINr OF OPERATIONS/LOCAIUSIIBB.ZB •tel,Aeseew Inn ss wet.may M NSW Nests pace w mitred) li CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION I DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Yarmouth Building an ACCORDANCE WITH THE POLICY PROVISIONS. ept i 1145 Maki St,Route 28 South Yarmouth,MA 02604 AImcIORDJRnRIUN AITV* J,Wal� If i��_ ACORD 25(2016/03) 01983.2015 ACORD CORPORATION. All rights mewed. The r RD name and logo are registered marks of ACORD