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HomeMy WebLinkAboutBLD-19-001596 a t SR"OS LESS THAN 150 SQ. FT SHALL LHOrtice y 01'11'4 :- PLACED A MINIMUM OF 30 FEET�i:C'A THE F, ONT LOT LINE ANDAO Co ' 'y A41(,IhAUM OF E F GET FFOM SIDCS AND ' riN%AR LOT LINES.,.rh`�+••n•*•�a; 180 days from EXPRESS SHED PERMIT APPLICATI NE L I V E D TOWN OF YARMOUTH Yarmouth Building Department SEP 172018 1146 Route 28 South Yarmouth,MA 02664 - BUILDING DEPARTMENT W (508)398-2231 Ext. 1261 - CONSTRUCTION ADDRESS: 9 0 h rLt e, IZ G �V11/ •\I ASSESSOR'S INFORMATION: Map: 1 Lf Parcel: 135" OWNER: Lemnn'ta F0 ti nr115 lin Whnje Rr) 7S% '-167-9355 NAME PRESENT ADDRESS TEL. k CONTRACTOR: PI✓Ie II-Arbor 3`) G ariMOtA4k RA ) Rt zttest 5og—"77/ NAME MAILING ADDRESSTEL.It 6007 `0!Residential 0 Commercial r� Est.Cost of Construction$ S 1 I CO ' Home Improvement Contractor Lie.k 1 3a p1 ✓5 Construction Supervisor Lie.k til-5 CD (1S— . S Workman's Compensation Insurance: (check one) . 0 I am the homeowner 0 I am the sole proprietor XI have Worker's Compensation Insurance �• / (�, p Insurance Company Name:14ato }i�wtseit.41r0, 5,Lair . *�l`eWorker'sComp.Policyk e.cG" t000 �lOCC !s 1 Sws• 7-ac19A SHE• D INFORMATION New X Size L 19 x W I () x N 0 t y ,x Corner Lot:Yes_ No Per Town of Yarmouth Zoning By-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 H ,.1 (� Q `� *The debris will be disposed of at: �I ',Q0 C•Ire A'- �,f e4e(In EU l 0 C'N ini c gx co Location ofFacility 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 answer(s) will be Just cause for denial or revocation of my license and for. •secution under M.O.L.Ch,268,Section I. q Applicant's Signature: /Lal. Date: O �1 ''7 I ao 1 S wners Signature attachment) e P* Date: c-\\\ \\ (?I Approved By: / / Date: 947 -it- Building Official(or designee) IL ADDRESS: Zoning District: Historical District: 0 Yes }( No Flood Plain Zone: X Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands:'on ❑ Yes 0 N ❑ Yes XNo """Note:Conservation review required if within 100 ft.of Wetlands 9/13 S A s, PLOT PLAN ► it - 135 FOR LOT i Indicate location of garage or accessory blinding Additions with dashed lines Sewerage disposal (cesspool) G Well 0 I I ' (lot JOfl ft. rear) I Abuttor'e �, 0 — — — Name yrs ( Abutbor, PI Name /44.12r Lot 151/4 I Lot Nr rti+• is a REAR YARD (31� orner lot, '7f ft. If thea /Ate in name coiner f write L name of ( f t3 ,o other street. 41 a SIDE YARD SIDEYARD • HOUSE • • a-� .,(—rt. a_�_ _ t. At 0 : falr i JO qvi i I . I . • • SET BACK. . . �� • ....: A.it. • ► -. 0 (lot ) 0> ft. frontage) 4 /� w ha le (NAME OF STREET) --> <a—W / information rr / \` Supplied by Ce�101�,a �0 1�Q�1 s IARK NORTH POINT 07/13/2018 11:01AM FAX 13084301115+ PINE HARBOR 1210001/0001 4 411 • The Conttnonwealth of MassachusaYs Department of IndastrialAccidents = Office of Investigations = 1.r— 600 Washington Street Boston,MA 02111 • wwiumass.gov/dla Workers' Compensation Insurance Affidavit:Builders/Contracto - lectricians/Plnmbers Applicant information (� % J,,,J, Please Print Leeibly Name(B�dlndlvidaan: Mt Gi4x.t jaJ + teal • piton Address: asq &uten Annt 'Road ==tt City/State/Zip: H f O7(9845 Phone#: '�7S l •42800 Are you an employer?Check the appropriate box: • 1,❑ /am a employer wfth 4. 0 I am a general contractor and i °f pro}eel(req aired): employees(MI and/or prrt time).• have hired the 6. III New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. fol Remodeling ship and have no employees These sub-contractors have 8. II Demolition working for me hi any capacity. employees and have workers' 9. •I Buildingaddition [No workers'comp.insurance comp.insurance, required.) S. 0 We area corporation and its 10.■I Electrical repairs or addition 3.❑ I am a homeowner doing all work officers have exercised their 11.a Plumbing repairs or additions myself.[No workers'comp, right of exemption per MDL 12.111 Roof repairs insurance mnrired.'t c.152,§1(4),and we have no employees.[No workers' 13.11 Other comp.insurance required.) !!Any below showing moa waken'mor on policy • Namwwnas who submit 0th off day Indicating they we doing ai work and then hire*tide aooeaemrs mat . anew affidavit Indicating mel tatactors that cheek this bus mtot attacbcd an additional sheet showing the roamalb;sub-coarwtasand state eh I. or actthennentities have mployees. Ham w6•aaaracaoa have employees,they moot provide their workers'comp.policy number. ram an mph/yen/tat that b providing worker'eompeavation insurance for sty cagey= ; - , Jr the poky aadJob she nfornmton. Insurance Company Name:Nksiifititshiee gry I esc !wort •r Policy#orSelfins,Lie,#:jet-toy•b{ e•!rao8 `e v � � En�iration v • lob Site Address: City/State/Zip: Attach a copy of the workers'compcnsadon policy declaration page(showing the policy n her and txplratioa date). Faitcire to scone coverage as required under Section 25A of MGL c.152 can lead to the impost on of criminal penalties of a fine up to 51,500.00 and/or one-year imprisonment,as well as civic penalties in the form of a •P WORK ORDER and a fine rf up to 5250.00 a day agai . • - Be advised that a copy of this statement may be . .. ... to the Office of Investigations of theD .. insurance . - :.• verification. i da hereby calla der the ,• T ar i•. • a ofperJary tomdie Information provided• • bpre end toren Signature: 01 .co� , Phone#: St 8• Official ase only. Do not wire by this area,to be completed by ay or town og'fdal City or Town: PerrnitLirense# Issuing Authority(circle one): • • I.Board of Health 2.Building Department 3.CIty/Town Clerk 4.Electrical Inspect* 5.Plumbing Inspector 6,other Contact Penn: Phone n: L ----"Is MCGRPOS-01 2TIELLYYIG .d►V CERTIFICATE OF LIABILITY INSU ' • NCE "` 6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO 'IGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER E COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT B N THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED,the policypes)must have :DinONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy,certain polio s may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Rpgars 6 Gray Insurance Agency.Inc. I 'Peoxa""........ • — -FAX • -._ 431 Rte 134 'SAS_�i _ 4w N A877)816,2156 ----- South _South Dennis,MA 02660 ' E9:mall©rogars••ray,com - -- NEURER- AFFORONO COVERAGE _1 UGC II vnunvr A:Traveler In• ` oily Company of America 25666 SISI I .Naunaea:Travelers I_'emnNy Company . . ,25658 McGrath Post b Beam Corp ;NSR e:New Nampa Ire Employers Insurance Compare ,13083 dba Pins Harbor Wood Product 259 Queen Anne Rd ;INSURER p: . . .. .. . . _.._..-- • . Harwich,MA 02645 ;swum E: ' INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TH INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENr, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES . SCRIBED HEREIN IS SUBJECT TO ALL TIC TEIIIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY FAO. MS. sIuTR iiiii-CTIPP OFINSISANCI Imo ywva4. POLICY NUMBER 1MM M�1 .,m lana A X COMMERCIAL GENERAL ArA81tlTY EACH OCCURRENCE .:i 1,000,000 china-LIAOE X OCCUR 1-060-0360B156414.1801/312018 01/31/2019 D""'"o nE;Ex , 1 'S 100.000 MED EXP(Any ern person) T i 5,000 PERSONAL&ADVSLRXTY $ 1,000,000 -GENL AGGREGATE UNIT APPLIES PER: 2,000,000 X POLICY -J GENERAL ,5 L Loc PATH••COLIPpPAG4;i 2.00D.00D OBER $ B . _ II I I :CONED LIST . .i auromoste 1,000,000 TAo BA-4487B686-18SEL 01412015 01/312019 BOOAYsanmyp.rp..m) ,$ •AOS ONLY X Mng�OUR� BOeyINJURY(Per ecekrM,i @w° xpM :$,X:XONLY .X .-- twain OCCURi I UR LA EACH ,i EXCESS LI CLAIMS-MADE. I ,AGGREGATE .. ;i • DED ;RETENTIONS ' '$ C µR D ROWERS . Y(N' ' ECC-0o0-4000957d018A 07108201$ OTBtt2019,X STATUTE —.�1_ ANY�ROM:4ETORIPPARTNEDE CAVE N ' N)A ,EL EACH ACCIDENT ,i 100,000 -IDOFyynn,,EEawyInSk73 j I El DISEASE.EA FAIILOrtF S 189,000 ESC+nRIPTIONNOFF OPERATIONS WOW ' SOO,000 R El.DISEASE-FOUCYUMW S DESCRITIDN OF OPERATIONS NOCATIN,/VENCLES(ACORD IPL Aeon RanarkaeeladNP,on be WAched M men epee•,eq.14 CERTIFICATE HOLDER CANCELLATION SHOULD PRY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE Town of Yarmouth TIE EXPIRATION DATE THEREOF, NOTICE WILL BE D6JVBIED H Building Dept ACCORDANCE WITH THE POLICY FROWMONS. 1146 Main St,Rout 28 South Yarmouth,MA 02684 AUTNOI/REO RBRrSEMATNE ACORD 25(201583) 01988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD utete d Cr. :' Office of Consumer Affairs and Bfusiness Ri gulation -WO '. 10 Park Plaza - Suite 5170 ..z-,.„.. Boston, Massac,..,setts 02116 - Home Improvement stew tor Rezistr.tion•. _V �- t Commonwealth of Massachusetts --=-47112%-- ---- ice/ Division of Professional Licensure MCGRATH POST & BEAM CO. _ Board of Building Regulations and Standards JAMES McGRATH —. Construct lor„SnOei�dor.1&2 Family 259 QUEEN ANNE RD. ,.-=r�_ CSFs-073855 Wit'! Expires:03/14/2020 1^[ HARWICH, MA 02645• .> • AMES R MCGRATH� 1 am; ,.,,. �i e."0: 04 CRANVIEW RD •,,, i . '; ,t. ,,.. ,REWSTER MA.:p2631"'7 . �� i r. :.' II r t„„J„A A.flI 19,a 54 • missioner ��+_ • `./ /W. (f'Y/rinno�/'GI.'(1a / l/ 4 4 r 4 J f t • 4. . % 1e Office of Consumer Affairs and Busine-s Regulation 10 Park Plaza- Suite 5170 Boston, Mapfitichusetts 0211 ; Home Improvemggntractor Reg ation k Type Corporation I-1� V.4 A`—,:— I%jb R:• stration: .132935 MCGRATH POST & BEAM CO. ;�• ........• ` ;� •• ration: 10/30/2018 259 Queen Anne Rd. frii M _-3 V''; Harwich, MA 02645 r;4 Wm- .t t;_F, .(•';i-�-•j- .' Update and return card. Mark reason for change. SCAI a 20M-0s'11 0 Address 0 Renewal 0 Employment 0 Lost Card — tom.cesetzeonweerki ofc Qosaa4rv.r� Office of Consumer Attain Business Regulation > HOME IMPROVEMENT CONTRACTOR Registration valid for ISM• -I use only Type: Oration Ian beton the expiration date. found return to: :°MinistrationExpirationOffice of Consumer Affairs nd Buskins Regulation __ Moss t0i30i2018 10 P Plaza-Suite 5170 C ;, 1• Bos •n,MA 02115 it McGRATH PO$t&aE& CQ. / i D/B/A Pine Harbor �2.��•--•- -y', /_ _�. 4 Products U I James McGRATH '41 • ` P l 259 Queen Anne Rd. Undersecretary f Not valid wi •ut signature Harwich,MA 02645