HomeMy WebLinkAboutBld-20-0882 1,/,, , • !" '',i't..12`.•' i: ..'',' ca. l' , ...1' i ..-,f '--..t-ii:' I 0 f L.,%, ,'d'',„ •,:, Permit#
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EXPRESS STIED PERMJT APPLICA (I ' CEIVE01
TOWN OF YARMOUTH
1 I
Yarmouth Building Department AU 1 . I 9
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1146 Route 28
N..:
South Yarmouth,MA 02664 B ti I it*.LN,,F,ingb[ N•I ENT
By
(508)398-2231 Ext. 1261 '41111111111-Itiim ...-
ye CONSTRUCTION ADDRESS: 3( COCCf--f-1:56L-t3- Wes f YttivAdAt MA - 024'13
ASSESSOR'S INFORMATION:
IMap: '" I Parcel:
.-
0OWNER: meaft le_ Ei-(con 3 t Cc,4-Ped31 1,0.yd r tAlcul-4 WA- - (g 6_0361- liscp_
CONIRACTO NAME PRESENT ADDRESS
get TEL #
'7-8 Od
NAME MAILING ADDRESS TEL.#
Atacsidential 0 Commercial Est Cost of Construction$ Hoop'
Home Improvement Contractor Lie.# i Ac2)9 35 Construction Supervisor Lie.#C '`A--0"1.. a(. 3
Worianan's Compensation Insurance: (check one)
0 lam the homeowner 0 I am the sole proprietor %..I have Worker's Compensation Insurance
insurance Company Name:IriliN.10.44'il'irE',1s Worker's Comp.Poliey#LC.( . 08-1-1
, IrMil e IV,(Z. asn*I1 a. )e(' adr1
and INFORMATION
%
New )( Size L 6( . w la . Hutit Corner Lot: Yes No
Per Town of Yarmouth Zonina By-Law Sec 203.5 B:
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 K W x H
,
*The debris will be disposed of er: i I. (.,... .e...fl AC\C\ICRCI -411;000i'Crn% % NA CI
Location of Facility
I declare under penal' of penury that, statements herein contained are true and warm to the best of my knowledge and belief. I understand that any WV answer(s)
will he just cause for, ial ,,t4, of my license and for prosecution under M.O.L.Ch.Mt Section I.
,iif ell
Amlicant's S':,P”' : hr Date: S 1‘51 V1
i
)(Owners Signature(or 4' hment) ' if - Date: 81151 1(t
Approved B Date:
y:
Building • des' ) EMAIL S:
Zoning District:
Historical District: D Yes D No Flood Plain Zone: Li Yes U No
Water Resource Protection District: Within 100 ft.of Wetlands:***
C Yes L' No L. Yes fl No
***Note:Conservation review required if within 100 It of Wetlands
9/13
..,a vve avl2+ IV 40111 FAX 1!W4301115+
PINE HARBOR
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7., CI New aonstruetion
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propdants ,o re ° orb ► t..� io 0 s ri7ergg a
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;Any applicant dat ataxia box t stag aim ill oat tbasaation belowshourieseeit sweet'eoupeoweiee- 1111111ft. - .
InemanDe Company Nast
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MAN*a*MY eta*weelwre
Failure
�a aes required under poajY radon page(showing �:
dayMOO.c. 152.RSA is a criminal viol pelicly nor aad,nc
end*ono.year - as well as civil penaltiesPcRDER e
A Dopy�`tts statement s fbtm cafe STOP WORK Oatt7 by a Sae ap to 5;. 00
ida may��dt+s the O of a�3af � m .04a
reuesigetiaes Odle
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(Sty or Towle
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PLOT PLAN
FOR LOT
Indicate din
A locatice of oraccessoryshed lines -__-_ _..b u� 9
Well 'Moral (cesspool)
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Abutbor'a tT
Lot )t 1 —•
Ahuttor
Name
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f this is a REAR YARD Lot #
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d` street.
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/ Information
\ Supplied by
ARK NORTH POINT
AC MCGRPOS-01 THORNE
4.......-- CERTIFICATE OF LIABILITY INSURANCE DATE(MNUDD/YYYY)
7/8/2019
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: It the certiflcate holder is an ADDITIONAL INSURED,the poiicyges)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 certificate holder in lieu of such endorsement(s).
PRODUCER "-) iACT
3Gra
a 'Insurance Agency,Inc. ( Elm:(800)553-1801 i cM,No):t877j 818-2158
ertrtesSouth Dennis,MA 02680 ita6s,mall@rogersgray.aom
„ t 't , INSURER(S)AFFORDNGCOVEAAGE MAIDS
r,,` NSURERA:Traveiers Indemnity Company 25658
INSURED /f.*,
McGrath if m C ° INSURER B:New Hampshire Employers Insurance Compan 13083
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dba Pine ood R INSURER C
259 cry•�" L.Rd d,kAN,e,,s31" INSURER D:
,s 'a NSURERE:
', sloe, .;;- INSURER F:
COVERAGES gl t
5 ' ; CI- 1FlC: , nIUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT lHE POLICIESaV, URA. ;.STED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED. NOTWITHSTANDING kta� ENT
CERTIFICATE MAY BE ISSUED OR � � ','�° .��*CONQITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
, zi AIN THE'. AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF { ^'c�+LICIES LIMITSSHO Y HAVE BEEN REDUCED BY PAID CLAIMS.
INSRLTR TYPE OF INSURANCE `' INDSDL a R OI JCN POUCY EFF ` POUCY EXP
A X COSUAERC1ALGENERAL1. Y 4 ? c� ''r ( ,DWYYYY) (N$IYDJUYVYY► LASTS
CLAMS MADE v€ r`,� 9. ,, EACH OCCURRENCE $ + .�
X OCCUR +liliti.g60. IND- ,k i-`" 1/31/2019 1/3112020 PREMicsESO(Ea acairr°er�ce) $ 100,000
;� `€ '"1 MED FRCP(Any one person) $ 5,000
GENL AGGREGATE kvg € PERSONAL&ADV INJURY $
1,000,000
X �{ 1 s,t = b s GENERAL AGGREGATE $ 2,�,000
POUCY1-1; Lrfi Ai+`40 PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: a , : 'a s s` f t $
A AUTOMOBILE I� k '1 'e1 441 t E�"4 iti'�',�,�, _(Ea J,7i., COMBINED INGLE UMIT $
ANYAUTO �k
OWNED ° SCHEDULED 8A-4487B686-1 0 vy II ,k,a �,t ai BODILY NJURY(Per person) $
_ AUTOS ONL g ,V .
E� si r a k � `W„„ BODILY INJURY(Par 1, ,000
X H� a 4 44 ,a{ �H r C v p. a derd)�$
_. AUTOS ONLY a N ;i, d n n s 4`4l a 44 s f�y a PROPSR7TyY AMAGE
� �� �i,�'� , � °�'" r�i ,1 urn,, �a� � (Per BfzKfint
F Itok fix` 9'4h( $
INNL1 A LING OCC�, ar �t ° c(i.
EXCESS LOW T GLA E th tt CURRENGE $
c, A" AGG 3
DED RETENTION$ �„ rA + r''4,
B C ATION # .., ;� �. 44 ! ��% O rH- $
AND EMPLOYERS'LUUNJEY i` ; ""' " �l 'WOOL STA t
Y/ �'^��s�'«,'EC �.� ' � as� STATU7 �ER
ANY PROPRIETORtPAF 1 PIE R EXECUTIVE s'*�"ar+.+ 718/2019{�
gaVaRIME it EXCLUDED? NIA '„'�F ` 0"s0 �0 F� CHACCIDEN'' $ m 500,000
Ryes,
y inn �2 c E.L.DISEASE E" E $ 500,000
DESCRIPTION OF OPERATIONS below gyp ` ' E L DISEASE�r y 500,000
"'�,� k�l/ �` 'qkt0. FL i+ Yt �5C W{4A�T, y Q A ': kF
itarl
f x4ih`M1 k LN tyF'+ �7.40,
" `a r. ttk x".^ 33 S,,P,,
Dt�RIFRONOF OPERATIONS/LOCATIONS/VEtICLE,S(ACORD1St,AdditionslRemarksSchedule,� to1.
cif is mod) 1
:ERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Building Dept ACCORDANCE WITH THE POLICY PROVISIONS.
1146 Main St,Route 28
South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE
i 4. -.:",,f---ARAT-ITIY 7/40"1.A."---------
►CORD 25(2016/03) 01988-2015 ACORD CORPORATION. Ail rights reserved.
The ACORD name and logo are registered marks of ACORD
Y .-•• v.,cr cii t ,,c �/(iG E.as-6,2, ✓ !Jacz
f/t c/i,o ,/!f Office of Consumer Affairs and.gusiness Regulation
= 10 Park Plaza-- Suite 5170 -
' ' -
Boston, Massac.,_ et s 0-2116
Home Improvement Rc ;u tor Registrati.orr..
1, commonweann of Massachusetts
ae�rr:rt ta�aaaC r DWIS10R 0t Professional .censwe
cGRATH POST& i standards
(��p��'����. =- °-~�- t end
l "I�Y) � iilNltit�i;f. :
GiH��
JAMES CGRATH t . : : aFamily
F
. 259 QUEEN ANNE RD. ,� !!1 ,• ; CSFA-07$88s 0: * ems:03/14F
920
- HARWICH,NIA 02645-
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'a $Ve 4� ' Z84 CRANVIE111 a
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Office of Consumer Affairs and Business Regulation
1000 Washiri-1 n Street-Suite 710
Boston, M;. usetts 02118 •
Home Improve - tractor Registration
Typo Corporation
I RATH POST$BEAM CO. iligi " Registration: 132935
DBIA PINE HARBOR WOOD PRODUCTS iris r 4tatlat: 10/3W2020
259 QUEEN ANNE RD. �..Kg
HARWICH,MA 02645 _ _014 ti. `
nc
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1
4'
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ib
Al 0 zae o6n7 tpdras Add orts and Rodent Card.
Moe of Consumer/ s a ilusiness Regulation
HOME IM • _;-1 .ENT CONTRACTOR Registration valid for Individual use only
before the expiation dais. N found return to:
0Mcs of Consumer Ma s and Business Regulation
i ." R
MtX3RATH . t015QIZ� 186
0 6'Washington so st-Suite Tie
- rt Boston,MA 02118
.
DJB/A PINE H 1 ,,• 5
r +ir
,riv t
JAMBS R. r c s j
2 9 QUEEN ANNE
HARWICH,MA 02845 Undemeashey Not valid without signature
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