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HomeMy WebLinkAboutbld-20-000857 LESS THAN 150 SC, FT SHAU ,Office Use Only Y44. -:•*; tlr,iiviUt.1 OF 30 Permit# 0 . r 'f,ONT LOT LINE AND A Vtit,IMUM OF 6 H.-JET FROM SIDES AND 0 .4 Amount 4 LC1' 2,Permit expires 180 days from issue date RECEIVED EXPRESS SHED PERMIT APPLICAT QN TOWN OF YARMOUTH AUG 14 2_0:1 Yarmouth Building Department 1146 Route 28 BUILDING DEPARTMENT By South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 3 / e (F/4.)0, opeet; at ASSESSOR'S INFORMATION: Map: Parcel: OWNER: OG(. I/ a ia Yee‘0491//1 NAME PRESENT ADDRESS TEL. # CONTRACTOR: /J7 ti-e *3 191 s°Co 64 5-,571-lie ya 1(fitesuifr'co g4ev--deya AME MAILING ADDRESS TEL.# 0 Residential Commercial Est.Cost of Construction$ Rome Improvement Contractor Lie.# e,'3 5 5.4 Construction Supervisor Lie.# 06' 7 Workman's Compensation Insurance: dfieck one) 0 1 am the homeowner VI am the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp,Policy# SHED INFORMATION New V Size L 551 x W xff 7/(1.1. Corner Lot:Yes No / Per Town of Yarmouth Zoninz By-Law Sec 203.5 Er 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 *The debris will be disposed of at T u-r1 l >/t/t/?&PA 7- vn5.ler S'hg,y Location of Facility 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 revocati' lj ,01" ssecution under 1V1.G.L.Ch.268,Section 1. —04077 Applicant's Signature: ..ammtdpfie7 Ali I- dr' I sor _dm& 1.s.0wners Signature I attachment) —,n11111r „di Da 41411Orr,0"....- 111111111..— .11111PralOir Approved By: Date: fir Building Offi • - EMAIL ADDRESS: p6z. /71-6474, °711 Zoning District: COO(:144gt 30 Historical District: -1 Yes 11 No Flood Plain Zone: 0 Yes 0 No , %,. -i-rmr,i/z Water Resource Protection District: Within 100 ft.of Wetlands:*** C Yes No 0 Yes D No R. 0 V),. ***Note:Conservation review required if within 100 fL of Wetlands 9/13 The Commonwealth of Massachusetts �_ , ►�.W/ Department of'IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit Builders/ContractorslEiectricians/Plumbers. TO BE FILED WITH THE PERMJTi'INC AUTHORITY. Applicant Information Please Print Legibly ( s/Organization/lndividu G�/ / `(re:; , Name Busines al):/ Address: 3 City/State/Zip: >4€140y#,A,p c, '3 Phone#: — '6/60 Are you an employer?Cheek the appropriate box: I am a employerType of project(required): 1. ❑ with employees(full and/or part-time)_* 7. Iew construction ? am a sole proprietor or parmership and have no employees working any capacity.[No workers'comp:insurance required.] forme in 8. Remodeling 3.0 I am a homeowner doing all work myself. 9. ❑Demolition [No workers'cam insurance required.}t 10 Building addition 4.0 I am a homeowner and will be hiring contractorsconduct to all work on my property. twill ❑ ensure that all Contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired tlx: listed on the attached sheet These have employees and have workers'comp,insurance.: 13.❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per Mal.c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp-insurance required.] *My applicant that checks box#I must also fill out the section below showing their workers'compensation policy infonnation sHomeowners who submit this affidavit indicating they are doing all work and thenhire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name oldie sub-contractors and state whether ornot those entities have employees. If the have employees,they must provide their workers'comp.policy nrmmber. I am an employer that is providing workeers'compensation insurance formy employees. Below is the policy and job site information.. Insurance Company Name: Policy#or Self-ins.Lic,#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. I do hereby certify under h ' ofperjury that the information provided above is true and correct Si ature: ! Date: 57 Phone#: 6 O g Wp/—6O5 C Official use only. Do not write in this area,to be completed by city or town officiaL • City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ' .! , •21 / ii,,,,--lie �� ` ,.a, err. , )1.5 w..,. ,et/. , ta 1)(i A li f(12 - e ' a ,,t J ' f f i COVE CONSTRUCTION&DESIGN PAUL F COVE 33 MASSACHUSETTS AVE WEST YARMOU'TH,MA 02673 ' t i i lat)trtri‘'rez:kde , t fiq PMd/eC1CQ4 ) e3 'i---ar-16— f)II FI('W) ( I '4''ii-- i' . ' I Y6 Pr _ -- 1 4 , , rte,ei-od, I,riti e . 0 n , ,.. ,,,,,.., :„,„ ; , "k tit t t 6 i ..-, ' , if..,.„. ict5 „, , , , ! . (),the51'tipii, 5icifi!tif -I-11G 511 . n of_ r 0 f P I ' ' 1 1 1::-,)p rf,#-Its \ . I r . 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Share 13-.)5 Like QCl Write a comment_ / From: Fuggiero, Amanda Aruggiero@yarmouth.ma.us Subject: FW: Pickle Ball Courts / Shed location Date: Aug 7, 2019 at 3:38:15 PM To: Ofcove@gmail.com FYI Amanda Ruggiero, P.E. Yarmouth DPW-Town Engineer Office 50 )398-2231 Ext. 1253- Aruggiero@yarmouth.ma.us From: Ruggiero, Amanda Sent: Monklay, July 8, 2019 4:23 PM To: Court, Dick<DCourt@yarmouth.rna.us> Cc: Colby, Jeff<jcolbayarmouth.ma.us> Subject: pickle Ball Courts I Shed location Hi Dick, I Went out to Flax Pond this afternoon. I took a few measurements and it appears from the edge of pavement of the courts and edge of roadway pavement of the roadway the measuremOnt is 39'. The back of curbing to the roadway was about 20'then another 9'of sidewalk and green space before the courts. If the shed is placed along the fence line, it would be beyond the 30'buffer noted (assuming the shed is 6'deep). Thanks Amanda Amanda Ruggiero, P.E. Town of Yarmouth DPW-Town Engineer 99 Buck Island Road West Yarmouth, MA 02673 Office 008)398-2231 Ext. 1253 - Aruggiero@yarmouth.ma.us