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Home My WebLink AboutBld-20-000839 ..,, SHEDS LESS THAN 150 SQ FT SHALL BE !,:,jOffice Use Only *90:44;tbk. 1 * •,.,hr„ iq 10-311 PLACED A MINIMUM OF 30 FEET FROM THE FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM THE SIDES AND REAR LOT LINES ,r)erruitil Amount :.,s41.1 • Permit expires ISO days from issue date Bu --40-- .4.3q ---7- , 7 EXP1,!: 1 SS SHED PEP:, '',,, ill' APPLICATIO- RECEIVED TOWN OF YARMOUTH Yarmouth Building Department AUG 1 3 2019 i BUI "T N.3 South Yarmouth, MA 02664 rBy: . (508) 398-2231 Ext. 1261 • CONSTRUCTION ADDRESS: t b c---\SI lAr g Ak, _rcRi . ,ftvt\-\\ farywol4 (\ 0 2-Co C ( ASSESSOR'S INFORMATION: Map: Parcel: (52,"7tri • ,..--- . OWNER: ( -6elfiN ilA CA r .c 3 Ce. \--) cAn ec.- lo Nur Q:1 c.\( ?3,- S o'i-A-Ock-rol DA NAME PIVENT ADDRESS TEL. # ISC*,.. LIS 0 .6), i CONTRACTOR: et ' k- %/NCI Wi Ql.ketn \:-)- kavv. Rs. NAME MAILING ADDRESS TEL.0 kesidential 0 Commercial Est.Cost of Construction$ 14 I 1 c. °° ,....... Home Improvement Contractor Lie.# iaR g 3 Construction Supervisor Lie.ft 07 5 o S Workman's Compensation Insurance: (check one) AI am the homeown • 0 I am the soleproprietorz. U. I have Worker's Compensation Insurance 16.0 ki ctrAp slr‘,iir C Ir,istO 4 e CS Insurance Company Name: 't-NS‘NA-6,......Lc% L0 • Worker's Comp.Policy0 €,C.C. - t.00 Li no9c-7-A n SHED INFORMATION zog New Size L f x W x H Corner Lot: Yes No Per Town of Yarmouth Zoning B'-Law Sec 203.5 B: Side and rear setbacks)(Or accessory buildings less than 150 square Jet and single story, shall he 6 feet in all districts, but in no case built closer than 12 feet to any other building. I 44 C U Replace existing" 17 Size L ID x W t 0 x H *The debris will be disposed of at: ' 1'6,.C moldk- 's\SI. Location of Facility I declare under penalties of perjury that he 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 revoca'$.1 dilly license and for pro:,cling under M.G.L.Ch.268,Section 1. Applicant's SiaP,lure:___ .. . .i D Date: i 'Owners Si o• attire(or attaelu -- Al _...,,, r Date: Date: • = f 117 Approved By: _ 111....00.--.asiiir ,-.4e.iit, Building Ofifli,iM EMAIL ADDRESS: _____.„, ,_„„_,,_ ,. • _..— -, ,---„--— Zoning District: Historical District: -I Yes 11 No Flood Plain Zone: ri Yes i': No Water Resource Protection District: Within 100 ft.of Wetlands:*** ili Yes CI No t:i Yes iT: No ***Note: Conservation review required if within 100 ft.of Wetlands 9113 The Commonwealth of Massachusetts i.sr- - c. Department of Industrial Accidents 14}- Office of Investigations S'r 600 Washington Street f Boston,MA 02111 .1/4041.4.. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Me. Gth Tom t Bedrn CWpotiott_ Address: a v'i &ueen Anne. 1ciati City/State/Zip: Hirwich.am 02045 Phone#: .50134480.42800 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 0 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 8. 0 Demolition working for me in any capacity. employees and have workers' 9. ®Building addition [No workers'comp.insurance comp.insurance.# required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.0 Plumbing repairs or additions 3.® I am a homeowner doing all work 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#1 must also fill out the section below showing their workers'compensation policy information. t 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 ;mployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Yam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. / Insurance Company Name: P4g / f iTh wc, pkgers lnsorante__e ! Policy#or Self-ins.Lie.#: E_C, "c.c°C0 a"IaO'1 r c7Q sA 14E eztion Date:.�.'tit(j 81 (2019 lob Site Address:_ i,0` l .. ',. bc,`( ?3,-, Oc\J City/State/Zip: S- Q c lv‘.pkkek hi 4ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 6 2(6(e 4 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 3f up to$250.00 a day against ,,- • , : Be advised that a copy of this statement may be forwarded to the Office of investigations of the D yip r .«•_ • r•,•_e verification. f do hereby certify u der the p'"f a r 77.of pedury that the information provided above is true and correct. 'iR1.:ture: Ada Date: Phone#: / • '.'T►- ..' =:f Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: e4• • 6 • PLOT PLAN , • FOR LOT # Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) f$ Well LEI I I (lot ft. rear) I Abuttar's 6 I Name I 66 Abettor' Lot # I Name I �— Lot #:f this i s a REAR YARD i :arner lot, c 3 () If this rite in name .1.. • corner '£ street. I write i, name of other 11 street. : SIDE YARD HOUSE SIDE YARD : . • • . • • • • • : SET BACK . . ft 4 1 1 (lot ft. frontage) / (NAME OF STREET) Information \ Supplied by D Y1 J!-�(y� [ARK NORTH POINT " / . .. . . //ee -Co • ✓!/ ,��,e t . 8.. i . ri g Office of Consumer Affairs and usiness Regulation . f 1, 10 Park Plaza- Suite 5170 • ,4 Boston, Massac. setts 02116 Home Improvement st.., ,tor Registration ' '" =„ Commonwealth of Massachusetts Division of Professional Licensure yf c Board of Building Re ulation and Standards MCGRATH POST & BEAM CO 1 truction W i &2 Family :!AM ES MCGRATH 1. __ w i 259 QUEEN ANNE RD. - CSFA-073865 * Epires:03f1412020 HARWICH, MA 02645. , = ; , 7 , JAMES R M - 3 R r'„�' `/ !O -4�- 204 CRANK ' !I I S,br. ssatt BREWSTER ,r _ -oit iy0,' .. ., rrw.nur#s./=1n»ta JS 7 a 4,--- , Commissioner eZ C Ji .9 /G�(:/ /�It: Office of Consumer Affairs and Business Regulation 1000 Washing•n Street-Suite 710 Boston, v` husetts 02118 , Home Improve =_� tractor Registration Az t. .__# ? � Type: Corporation �, Registration: 132935 MCGRATH POST&BEAM CO. M .v - D/B/A PINE HARBOR WOOD PRODUCTS 4 T � Expiration: 10/30/2020 259 QUEEN ANNE RD. __ _ HARWICH,MA 02645iiik _ A,, "" < Q ✓ay4 — V0 IMO Update Address and Return Card. CAI 0 20M4/5l17 .9ZA ronnaneoeadeo,,../AAsaclla Office of Consumer Affairs 4 Business Regulation HOME IMPRO ; .,ENT CONTRACTOR Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation '-_ �=�110/30/2020 1000 Washington Street-Suite 710 MCGRATH -• 77 1' Boston,MA 02118 D/B/A PINE H ,af - .ODUCTS JAMES R.MC c'+4‘ -jy`>- 259 QUEEN ANNE,' # •' HARWICH,MA 02645 Not valid without signature Undersecretary