HomeMy WebLinkAboutBLD-19-003240 .�• "_ I FSS THAN 1,.5)c;o I t ; v I. Office use Only
01 rrAit h t t l'tJh 9 t t i ti- 3 r . T
pk •'tt0 t r _ G 7I r t r t NN L t Permit: 2 e
�Df C Jt It.ti_! . tr E ',( T t f r`a ,IUv.; AND Amount W
`; "'w„w..y., (Permit expires ISO days from
issue date
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EXPRESS SHED PERMIT APPLI I 10303E I V E D
TOWN OF YARMOUTH
Yarmouth Building Department NOV 20 2018
1146 Route 28
South Yarmouth, MA 02664 Bury 1r: jj I
n (508) 398-2231 Ext. 1261 —
CONSTRUCTION ADDRESS: 3Z `�rttvl1t G�.d ��L,
ASSESSOR'S INFORMATION: `2
Mitt-hitt—
�/� t ,y,�, Map: (I JS Parcel: (Lig
OWNER 1 • \it- i 1� -5Q LI U N
ggres (cutd eA& j
NAM PRESSEIAADDRESS TEL.
l�1 (
CONTRACTOR: it Pt ftt/d<i ZS outthQn
MA-
NAIVE MAILING ADDRESS TEL.M
0 Residential 0 Commercial 2Q( Est.Cost of Construction$ 5�v
Rome Improvement Contractor Lic.U 013E f Construction Supervisor Lic.N 13 ti 3S
Workman's Compensation Insurance: (check one)
❑ I am the homeowner 0 I am the sole roprie or 0 I have Worker's Compensation Insurance
Insurance Company Name: Worker's Comp.Policy#
U1.
✓ , SITED INFORMATION
/��j 1
New _ Size L 1'1 x 0' IP x if to Corner Lot: Yes_ No
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 stoty, shall be 6 feet in all districts, but
in no case built closer than 12 feet to any other building.
Replace existing* C-/
x 6V x K
'The debris will be disposed of at SILT Lit to - £'. JEp rOL 3, MA
Location of Facility
I declare wider penalties of perjury that the stat -• i in contained are true and correct to the best of my knowledge and belief. I understand that any false answerts)
will be just cause for denial or revocation. my hicenf a . • nosecution under M.G.L.Ch.268,Section 1.
Applicant's Signature:
4
Lktil Date: I I «+ I I el
Owners Signature(or attachment) V1 JJ (YV I Date:
Approved By . _ Az ----2-= Date: // _ Q
Du-
Ai • cial(. designee) AIL ADDRESS:
Zoning District:
)historical District: -I Yes fi No Flood Plain Zone: n Yes r No
Water Resource Protection District: Within 100 ft.of Wetlands:***
0 Yes C No L1 Yes 17! No
***Note:Conservation review required if within 100 ft.of Wetlands
9/13
The Commonwealth of Massachusetts
iiii:'.tas a/ Department of Industrial Accidents
`_;w=; puke of Investigations
= `m=
. . ✓tie �i e =. al ✓//GG��aolueoee7,d,
pe Office of Consumer Affairs and Business Regulation
-s e_ pi
L1 10 Park Plaza- Suite 5170
Boston, Massac• lefts 02116 ,
Home Improvement o�,�,PcorRezistratiorr,
a rrson»AntImmf mnua,
ma®ofn Pottesnarmuliw®rartre
McGRATH POST & BEAM CO. isi e : I IBnardolf®uitdmg IRepti atmsca ndlltanflinrts
JAMES McGRATH ` • r Construction$trhoYVisbr,1 & 2 Family
259 QUEEN ANNE RD.
• HARWICH, MA 02645 , W4�i-f � . `"i.. mp1[c�pi rn4 I
-f4 T Y
. ,n N.. • JAMES RMCORATN :•p
~A' - ' 204 CRANVIEW RD 3.,-
>
'BREWSTER'MA,02631 ••• r I
f
I rtc Li.tl��
Rimntm®�r®r
•
Cr& W��Cc CiP/G a� se
V I!; Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Mahusetts 02116
Home ImprovemetrContractor Registration
F- 7
m Type: Corporation
McGRATH POST & BEAM CO. j jai - , i ' =?'_�� Registration: 132935
,M, lei-- �,'� Expiration: 10/30/2918
259 Queen Anne Rd. IN - ,
Harwich, MA 02645 4 r;i
1 Update Address and return card. Mark reason for change.
SCA 7 0 20M 05/11
0 Address 0 Renewal 0 Employment 0 Lost Card
—
•
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
Reaistratiort. Eviration Office of Consumer Affairs and Business Regulation
132935`:_,_ ,-,10/30/2020 1000 Washington Street-Suite 710
MCGRATH POST&BEAM CQ.`,' Boston,MA 02118
D/B/A PINE HARBOR WOOD PRODUCTS
-/
JAMES R.MCGRATH /
259 QUEEN ANNE RD Not valid without signature
HARWICH,MA 02645 Undersecretary
=p4 `. TOWN OF YARMOUTH .
3 c
1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 r° RECEIVED
Telephone(508)398-2231 Ext. 1292-Fax(508) 398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMNITTEev 2 0 P018
APPLICATION FOR YAKr�UUTH
OLD KING'S HIGHWAY
CERTIFICATE OF EXEMPTION
Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of
Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs
accompanying this application. Atee/ye
Type or print legibly: r recede. Nov D
Address of proposed work: 3 J G rett7 1, rr1 2 o?D�B Map/Lot# 125 - ly5
ro
Owne s): Tte,A- (-NQcCQ SOV rN} FRK Phone#:
All applications must be submitted by owner or accompanied by letter fromUo149R pproving submittal
�ofapplication.
Mailing address: \3a Giffin la n(1 Oral' . Year built: 19 C i
Email: (Yl bOI'l'SS 7 Q G hMrr fi 1' .Co A Preferred notification method: Phone 1 Email
Agent/Contractor
Iint friat&1WM)4 TR-O(kL Phone#: S .'-I30 -0800Mailing Address: aM Qnfl !lint 1.0a4 3 r(li l Ch. rflft Oa(x15
Email:t jrrY1 19 Preferred notification method: Phone " Email
Description of Proposed Work(Additional pages may be attached if necessary):
T construct- o. &' 11' Sheet placed or) zol lc( Concrete ata-S, Tine Sheol ail '
I')ail, 4 3 sand `I ' beaded doors with one ate 38" Sl'ngIC hune1 vtn± I eoiintloa:
with uru till I(r•S . 'Ti frim will be. whik- p•VG... and -Ike #614- a.m.( '
will be. t ue.Iosf pvc,. Clqpboarcl , mit Edo( -to be .• itist j ltwpt .Je le ff;
Ytclh+ are Eac _uotiIS wtiI be- . . 1}G. cedar zhtnglts . -TFe -oo-f'ir`y
W.11 be to ottthatrit -aI ?tinier .. '�� ( ,�
Signed(Owner or agent): Date: I
61
> Owner/contractor/agent is aware that a permit may b- =euired n•- . e Building Department.(Check other departments,also.)
> This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later.
For Committeeuse only:
Date: i/do//t /Approved _Approved with changes _Denied
Amount a0 Reason for denial: AP 'R <,,.1, rn
Cash/CK#:... .1±1.±daN UV 2 ti 3
Revd by. "V YARMuu i H
JD
� OLD KINGS HIGHWAY 8 — E 1 2 8
Date Signed: VZ e�z 8 Signed: le '
APPLICATION#:
1
V5.2017 •
•
t 1'
• Commonwealth of Massachusetts R C ' "' �®
'Firth P Title 5 Official Inspection Form NOV 20 2018
—t.t1 YARMOUTH
E __ _. 1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
{= OLD KING'S HIGHWAY
Na a , 32 Greenland Circle
Property Address
Peter LaRocca Trust
I Owner
Owner's Name
I information is
required for every Yarmouthport Ma 02675 7/31/2018
1 page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
whererepublic water supply enters the building. Check one of the boxes below:
E hand-sketch in the area below
0 drawing attached separately A O
VCD
•
•
FC �VF NOV 2 0 203
�o
2020 YARMOUTH
/\V SOUT1Y cC EAfa OLD KING'S HIGHWAY
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the S Mae repealed Fora SubeuRea Frage DePosel Paler•Pebe IS 4 IT
18 E129
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PINE HARBOR •
Front Elevation • Left Elevation RECEIVED WOOD PRODUCTS
61.-.; SCALE: 1/4' = 1-0' �G SCALE: 1/4' = 1.-0' Pft EHARBOR.COM
• - - • . - Nov 'A 0 2018 - ' 1"800-368-SHED
259 Queen Anne Road
' Y • IVIVUTH Harwich, MA 02645
• 1 1 1 1 1 1 1 1 1 1 1 1 1 1 10/12 Pitch OU ' I 'S HIGHWAY p:(508)430-2800
I 1 1 1 1 1 1 1 1 f:(508)430-1115
1 1 I I 1 1 1 , 1 1 , —1i barnsmpineharbor.com
I 1 1 , 1 1 1 1 1 1 , r •• Architectural Shingles
1 , r 1 1 I , 1 1 , ,
, I 1 1 , 1 1 1 1 1 1 , 1 - ENGINEER'S STAMP
1 I 1 1 1 1 1 1 L f 1
1 I 1 1 1 1 1 1 1 I 1
- I 1 I 1 1 1 1 1 1 1 I -
• 1 I 1 1 1 1 1 1 1 1 I
• 1 I 1 1 1 l L 1 1 1
1 ��� PVC Trim ' 111111111111 , A. . .. . '
��� • O
1 I I I ■�
rWhite Cedar Shingles rr S NG'b G�UUAY
Everlast Composite Clapboard • IIIII 1111 0 101111
PROJECT:
12' 0" $ 4 8'-0" .- • 8' x 12' Quivett Cape
RECEIVED CLIENT:
•
f Michael Bolton
NOV 2OZO18 ADDRESS:
• TOWN CLERK 32-Greenland Circle
• C-.
Rear Elevation (#74
Right Elevation SOUTHygRMOUTH, MgYarmouthport. MA 02675/ SCALE: 1/4' = 1'-0" / SCALE: 1/4' = 1'-0"
- PHONE:
703-244-2653
, I I .1 , 1 1 ' 1 1 1 , ' , ' , ' 1 ' 1-' •T E-MAIL:
1 , 1 I , 1
I I --r 1 , , 1 , , 1 1 -1 •
I , 1 , 1 1 , 1 ,
1 ' I ' 1 I I 1 1 1 1 1 1 ' 1 1 , 1 1 1 1 �---•Architectural Shingles mbolts70@hotmail.com
1 1 1 r , 1 , I , 1 1
1 t 1 1 1 1 1 1 1 1 1
1 1 1 1 , r 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 ADDRESS OF PROPOSED WORK:
1 , I , 1 1 1 1 1 1 1 1
1 1 1 1 , 1 1 1
1 1 1 I 1 1 1 1 1 1 1 1 32 Greenland Circle ' '
• Yarmouthport. MA 02675
•
White Cedar Shingles • t
Ih
4 I
> (-1 L1IREVISION DATE:SIO :
•
•
•
1;�Iii, r I ` • White Cedar Shingles DRAWN B1Y:
1 (1 4 � GB
•
--e-:-........,ei .e.....---0—
•
•
Scale: 1/4' = 1-0"
1 8 0 E II ?' R Unless otherwise noted
. Page- A.1
•
/'"r1 MCGRPOS-01 KDOYLE
A��. CERTIFICATE OF LIABILITY INSURANCE Doe WDDNa
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder la an ADDITIONAL INSURED,the polley(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certlficate holder In lieu of such endorsement(s).
PRODUCER CONTACT
Rogers&Gray Insurance Agency,Inc. NNAME
434 Rte 134 jib Na Ee): 1 juC,xo5(877)816-2156
South Dennis,MA 02660 Itinallerogersgray.com
INSURER(S)AFFORDING COVERAGE MAIC
INSURER A:Travelers Indemnity Company of America 25666
INSURED INSURER S:Travelers Indemnity ompany 25658
McGrath Post&Beam Corp INSURER C:New Hampshire Employers Insurance Compan 13083
ribs Pine Harbor Wood Products
259 Queen Anne Rd INSURER D:
Harwich,MA 02645 NSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR ADDL BURR POLICY EFT POLICY EXP
LTR TYPE OF INSURANCE NSD WW POLICY NUMBER IfIWDD/TYYYI IMMDD/YYYYI LIMITS
A X COMMERCIAL GENERAL LIABILITY1,000,000
EACH OCCURRENCE _�____
CLAIMS-MADE X OCCUR 146043688196-TIA-18 0113112018 01/3112019 FREsuri Immo
)__.1 100,000
MED EXP/Any one__ sagI__1 5.000
—
PERSONAL&ADV INJURY $ 1,000,000
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY/rI.7P6 I I LOC PRODUCTS COMP/OP AGO___;_ 2,000,006
OTHER: f
B AUTOMOBILE LABILITYCOMBINED SINGLE LIMIT 1,000,000
fEaeCUEBnII $
ANY AUTO —CrBA-4481B686-18SEL 01/31/2018 01/31/2019 ,BoDtYINJURY1Perpe,wn) 1_._— .
A�UU�pT�O���S ONLY AUTOSSW EOp _pBODILY tWRgYM(PP�er accident) 1_,___ __
X AUTOS ONLY X AUTOS ONLY (Pe� Cann E _$
$
UMBRELLA UAB _ OCCUR EACH OCCURRENCE $
EXCESS LAB CLAMS-LADE AGGREGATE _ 1 _,
DED RETENTIONS f
C WORKERS COMPENSATI N
AND EMPLOYERS'LIABILITY X STATUTE ERµ
ANY PROPRIETOR/PARTNER/EXECUTIVE VtN ECC-600-4000951.2018A 07/0812018 07/08/2019 EL.EACH ACCIDENT 1 100,000
oFFICERAI M EXCLUDED? N N/A
IMwd.wy`In NIL) 100,000
E.L.DISEASE_EA EMPLOYEE 1__.
II yea describe 500,000
DESCRIPTION OF OPERATORS OF Debw _ E.L.DISEASE•POLICY LIMIT f
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Adaelen.l Remarks Schedule,may be attached II mem.pace Is required)
CERTIFICATE HOLDER CANCELLATION
• SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of Yarmouth ACCORDANCE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N
ACCORDANCE WITH THE POLICY PROVISIONS.
Building Dept
1146 Main St,Route 28
South Yarmouth,MA 02664 AUTHORED REPRESENTATIVE
I �.&LAa✓ 7
ACORD 25(2016/03) 451988.2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
/ze �. , _o/-C ✓aGc oacfu�a e
gOffice of Consumer Affairs and Btisiness Regulation •
:1►-j 10 Park Plaza - Suite 5170
Boston, Massace. setts 02116
Home Improvement iM• tor Registration., •
)1n €4 _ aboin mActo tthuGM•P.t+X• .ttiP:a±ni,
n —_w�Fi� ' OCivenzmail M4cctsonrAi lim.»riauxe
V.
MCGRATH POST & BEAM CO. nr ,mkauienl„_g% ri„l;nn;,M,-,n,i;etamiaidt
JAMES MCGRATH m '- = ConstructionSnpervisor 1 & 2 Family
259 QUEEN ANNE RD, a
_
b _ LF1ar >HARWICH, MA 02645. =_ _ 4.ti ••A „.
onm &fftlaffat
tent
'n = 4� . JAMES R MCGRATH h• ' 12.
1A' IMO`ye 204CRANVIEW RD ;t?
:_ eoulumi.r.,n,ou - BREWSTER MA 02631 J/„ }11. ti
. 0aarorngisarner Cia. 4``
m- Wk Wo4rennoguyeaN offigArzoczalteuseek.
nm
g�Y
' :mat
- lira�
�.� Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Maseitchusetts 02116
Home Improvemet*altractor Registration
_ Type: Corporation
MCGRATH POST & BEAM CO. iJ �•I: Registration: 132935
-' - ^' `'^ Expiration: 10(30/2018
259 Queen Anne Rd. Iv,+ ? \-`i,
Harwich, MA 02645 � � 1"
<�`. =_
__: Update Address and return card. Mark reason for change.
SCA I 0 20M-05!11
0 Address 0 Renewal 0 Employment 0 Lost Card
rf� m cinif !4.1615
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only
TYPE:Coroora0on before the expiration date. If found return to:
ftealstration Fxolratioq Office of Consumer Affairs and Business Regulation
132935 10/30/2020 1000 Washington Street-Suite 710
MCGRATH POST&BEAM CO, Boston,MA 02118
D/B/A PINE HARBOR WOOD PRODUCTS
JAMES R.MCGRATH tard2�a---
259 QUEEN ANNE RD. C.�
Not valid without signature
HARWICH,MA 02645 Undersecretary •
•
PINE HARBOR
WOOD PRODUCTS
It's all about the wood'"
259 Queen Anne Road,Harwich MA 02645 326 Yarmouth Road,Hyannis MA 02601
508430.2800 harwlchoffice(Apineharbor.com 508-771-5007 hyannis@pinehabor.com
Owner's Authorization
I in 1r. ( iL as owner of the property
located at3a. GQiziutibtA Lon . '(. tMn„Ati, me
(PropertyAddress)
authorize Pine Harbor Wood Products to act on my
behalf in all matters relative to work authorized
by this building permit application.
Owner's Signatures�.z,r
Date: //MK
•
r
•
1 The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
__ 600 Washington Street
N= Boston,AU 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /!-Please Print Legibly
Name(Business/Organization/Individual): MG (cQ3h Pas f' 4. Begin t, o'p/s/tti
Address: 9'j I Queen Annt 'R� I��
City/State/Zi.: / • tell A QQt9 J Phone#: Z08'430.01800
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and 1
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New 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
working for me in any capacity. employees and have workers' 9. Buildingaddition
[No workers'comp.insurance comp.insurance.: 0
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 11.0 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.]
'Any applicant that checks box N1 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
nnployees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
ram an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site
btformatlon.
Insurance Company Name: 1W ��j��mpf It($ !mar
Policy#or Self-ins.Lic.trete tan'yenryi5l.• ao18A Expiration Date:_sjU,(_8, a. I9
lob Site Address: (3a 6rr/r1)44 col, City/State/Zip: Ypcmotrth }fit- f, ()IA 026175
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
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
sf up to$250.00 a day agains • • Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the D • .r insurance coy e verification.
►do herebycerci u der the a '1 a .al a o r
fl' jperfury that the information provided above is true and correct
5igrtature; 4 Date:
Phone#: .5 08 • - • -•a •j
Official use only. Do not write in this area,to be completed by city or town ofciaL
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: