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EXP SS SHED PERMIT APPLIC 0-
TOWN OF YARMOUTH "' 1 D
Yarmouth Building Department DEC 0 4 2018
1146 Route 28
South Yarmouth,MA 02664
UUILDI ' ARTMENT
(508)398-2231 Ext. 1261 By: �_ —_
CONSTRUCTION ADDRESS: 1 3 '' ; l\ • —
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ASSESSOR'S INFORMATION: S-08—Si E. -241/
(1 a) ' t Cr' Parcel: Salk--174 -tPryq
OWNER: l eJP .-433w.t1/434,J S: - .cam �{\ •..v.Ct1
NAME PRESENT [ADDRESS � (�� TEL I'
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CONTRACTOR . 4( a.st�(�(X4a`39arm TTnK IC r 535' 3D -Z o°
NAME MAILING ADDRESS TEL p
)4Residential 0 Co,. fat Est Cost of Construction S/t Sw—I
Rome Improvement Contractor Lie.ii 1 I. 9 S 5 Construction Supervisor Lie.#`3-PA A -071 .38Lo
Workman's Compensation Insurance: (creek..e)
0 I am the homeowner 0 I am th sole proprietor X I have Worker's Compensation Insurance
Insurance Company NameuQ 410 \ft Emp s tCf'S Worker's Comp.PoGey11 ECC(pto 4&)0 57-2c18:s
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Imo. Se SHED INFORMATION
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New - Size L s W JJ : H —I‘ Corner Lot: Yes No SC
Per Town of Yarmouth Zoning By- . Sec 203.5 E:
Side and rear setbacks for accessoryuildings less than 150 square feet and single story, shall be 6feet in all districts, but
in no case built closer than 12 feet to dny
other building.
Replace casting* _ Size L 'IV x H
*The debris will be disposed ofat.t:Za1 1n0un milt --1-6.0,-zi, m A
Location of Facility
I declare under penalties of. :eat herein . :' -, are true end correct en the best of my knowledge and belief I understand that any false answers)
will be just cause for danceIt ff
foomy license:. .fore • • 1.Ch.268.Section I. ^� •, p�
Applicant's Sigoetura M4 Data a�C L `C r DC)'V
r ,Owsier'Signature(or mens) `�� ` Date:• y
APP S: r ''' ; Date: /d-- # -IO
Building Official(or designee) EMAIL ADDRESS:
Zoning District:
Historical District ❑; Yes 0 No Flood Plain Zone: 0 Yes 0 No
Water Resea-ce Proteaion District Within 100 ft of Wetlands:♦*$
❑ "es 0 N ❑ Ye-s ❑ No
***Note Conservation review required if within 100 S of Wetlands
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11 =-` 10 ParkBaia - Suite 5170
Boston, Massac��•. setts 02116 _
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Home mprovement :7�-I or Regis. .tion•. •
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MCGRATH POST& BEAM CO. =_t'"----"1 I I I I I �+ , �'= it • dor . :. I Licensor,
JAMES McGRATH ==. '1� • Romeo Bonding op Regal • • and standards
259 QUEEN ANNE RD. 7 CocO �1O"$' ? Z Family
HARWICH, MA 0264�v J .r CSF 473865 4ptres•03/142020
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Boston, Ma husetts 0211;
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Harwich, MA 02645 ' � ;',
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�1MCGRPOS-01 ZHEL.LWIG
A�n' CERTIFICATE OF LIABILITY INSURANCE Dm'""°°"'"Y'
06/28/2018
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER.nips
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 nip CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an DTTIONAL INSURED,the pofey(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WANED, subject to , terms and conditions of the policy,certain policies may require an A statement on
this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
PnODIp:ER 1Insurance Agency. .. ..4ors94 a . . WC wpBT )816.2156—
-
South Dennis,MA 02660 .iDattPl8gr ycom
• .____eaueoust AFFORImerpowRAGE ... ___ 1.___MMES
NSAMB A:Travelers Indemnity Company of America 25666
eras .ItNREEta;.TrajelersIndemnityCompany . . .25658
McGrath Poll 6 Beam Corp nevem c:NewHampshire Employers Insurance Coltman ;13083
dba Pine Harbor Wood Products am fK
259 Queen Anne Rd ;NEORBI e:
Harwich,MA 02645 IWEIMER E:
INSURER F:
COVERAGES CERTIFIC E NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF ORANGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWh1STANDING ANY REOUIR ENT. TERM OR CONOION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WWQ4 THIS
CERTIFICATE MAY BE ISSUED OR MAY PERT N, THE INSURANCE AFFORDED BY TIE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICI S.LIMITS SHOWN MAY HAVE BEEN REDUCEDBY PAID CLAIMS.
SINN! TYPE OF MR/AMOR SU _.. Po___.
Nso ,. �. POLICY IRae/AMBPOLICY Err roio
:cv
NeNDomm mNmomrn Lams
A X m1Nasta11.OB16ULLemurs _ EACH_OOCl1RRENCP .:; 1.000.000
ClAmawne • X ocw1R 1-660-03688196-11A-18011312018 01/31/2019 SE ) .;F "Ittli,bob
MED Se PAY PH pawn) ,s 5_.000
• PERSONAL a ROY Warr! r 1,000,000
Cf?JLAGGREGATE CaMAPN.ES PER • GEI,ER/LA0ORECJ1TE _.� Z000,000
X POLICY J
ECT L Loc FRODI M•COMPMEAM9 E 2,000.00o
'OTHER
s
B .. M.
AUTOMOELw) l 1 FgraarNEo)SINGLE LILI/MTi 1,000.000
ANY ALDO I 0A44878688.18SEL 011312018 01!312019
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BODILY INJURY(RrA�rtl)•a_ reraPayir"E .E
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tam a1ALVU1 OCCUR i • .EACHOCOURRENCE •S
EICGEeatNa CIAAe•MADE. I ,AGGREGATE _ :$
DED • ;RETENTIONS ' I 5
C WORKER!COMPexaATa]II •
x PERT{(fE..—.ETH-J_ -
IND EMPLOYERS LIASLLRY
YIN : ECC•600-4000957.2018A 07/08/2018 07/082019'
ANY PROPRIETORPARTNEROD:CUTNE "– El 1OO.DW
4EFICERAITME3 EtCLUDEDr H' Pt/A I . .. EACH r .S RASO
twyyaaait�.Me nYIA NIMU 1 1 I • EL.DISEASE-EA EMPLOYEES 1o9,wV
DESCRIPTION OF OPERATIONS MANN .EL.DISEASE•POLICY LRAn f•
500,000
aEa nlnou mammon/rMaToerwesaEa ^•"•e7.Amens Inot a rOM.my M WNeee a ma EALa.Y 100M1
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
•Town of Yarmouth THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED M ,
Building Dept ACCORDANCE WITH THE POLICY PROVISIONS.
1145 Main St,Route 28
South Yarmouth,MA 02664 A mn�nrrm topitmenaTEM
ACORD 25(2018/03) • 01988-2015 ACORD CORPORATION. AN tights reserved.
The A IP..RD name and logo are registered marks of ACORD
•
��• 326Yarmout Rd. I Hyannis,MA 02601 1508.771.5007 I Fax 508.771.7070 I hyannis@pineharboccom
PINE HARBOR 259 Queen Anne Rd. I Harwich,MA 02645 1508.430.2800 I Fax 508.430.1115 I Info®pineharboccom Schedule Date
� OO.T WOOD PRODUCTS 1.800.388SHED I Customer Service 1.868.SHEDKIT I www.pineharborcom
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