HomeMy WebLinkAboutBld-20-001065 � SHEDS LESS THAN 150 SQ FT SHALL BE office U5C Only
/�f Y� h PLACED A MINIMUM OF 30 FEET FROM THE
' �. Permit4
' i;� l FRONT LOT LINE AND A MINIMUM OF 6 FEET
Ol. ��". 1yy'�,; FROM THE SIDES AND REAR LOT LINES Amotmt
asg `' r rI� �� I UDC-
_ Permit expires 13U days from
1` U --` 0--Iissucdate
RECEIVE 1
EXPRESS SHEDPERMIT APP.L.ICAT --.- .� _—1 !
TOWN OF YARMOUTH BUG r Zak ` !
Yarmouth Building Department i p F 3
i
1146 Route 28 4 nL . - ` ENT
South Yarmouth. MA 02664
(508) 398-2231 Ext. 1261
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^ /,/y�/ ` 1�� err 5 Yd-okotAt/
CONSTRUCTION ADDRESS: qg G�, Yy
lr 1 '/� t
ASSESSOR'S INFORMATION:
j05Maap: Parcel:�y-p��/1 /�� /' C� /OWNER: kl- �5 �;Ai J e 6 �-et ! 6 � �`✓5 3� ! 0222i/
tJAN, - PRESENT !I )RESS TEL. r
CONTRACTOR: uJ Lag ✓ 450
0
0
NAME- AIL ��r G ADDRESS WAIN 1 TEL.#
Q Residential 0 Commercial Est.Cost of Construction$ /(c.JSo 00
Home Improvement Contractor Lie.r /32 q3,5 ✓Construction Supervisor Lie.#SD* 07q 5 (..../7
Workman's Compensation Insurance: (check one)
I am the homeowner 0 I am the sole proprietor 0 I have Worker's Compensation Insurance
Insurance Company Name: Worker's Comp.Policy#
SHED INFORMATION
New Size LS x W x H Corner Lot: Yes No
Per Town of Yarmouth Zoning Iry-Law Sec 203.5 E:
Side and rear setbacks for accessory buildings less than 150 square feet and single stofy, shall be 6 feet in all districts, but
in no case built closer than 12 feet to any other building.
iReplace existing' Size L _4 x 11 E x H
*The debris will be disposed of at:
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 r c. ion of n •license and for prosecution under?� G.L..Ch.263.Section 1. /� )
Applicant's Signature: Date: CS✓26 /9
Owners Signature(or attachment) Date:__
Approved By:—__-__-- �(� Date: V r J.U -1 i-----
Building Official(or designee) EMAIL ADDRESS:
-Zoning District: �.._..._ __._.,_-. .—n. .._, ,. .'_. „.
Historical District: Yes Fl No Flood Plain Zone: Yes iii No
Water Resource Protection District: Within 100 ft.of Wetlands:*.;:.r
Yes iii No Yes .. No
***Note:Conservation review required if within 100 R.of Wetlands
9!1
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The Commonwealth of Massachusetts
Department of Industrial Accidents
_a'_ 1 Congress Street, Suite 100
'!7= �' Boston, MA 02114-2017
Y^� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Name (Business/Organization/Individual): Mc 6rzeth rost t L3earn Grportti I r
Address: a.sq Queen Anne Road
City/State/Zip: HQrw l eh.M A COO y Phone#: 5D8 1 J3 t7 0?800
Are you au employer'Check the appropriate box: Type of project(required):
1.❑I am a employer with employees(full and/or pate-time).' 7. ❑New construction
2.0 I am a sole proprietor or partnership and have no employees working for nne' . 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.] 4
9:, ❑Demolition
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
10 El Building addition
ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.['Other
152,§1(4),and we have no employees.[No workers'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
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: New Hampshire Emploiiers JnCUra ni e (_'orn}xlny
Policy#or Self-ins. Lic. #:FeC - y pppgs 1 -(90 i l A Expiration Date: 111 At p2 n
Job Site Address: City/State/Zip: '1
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 of the DIA for insurance
coverage verification.
I do hereby certify u r he pains an e ' s o erjury t e information provided above is true and correct
Signature: Date:
Phone#:
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#:
� z
•
NTj PLOT PLAN
FOR LOT #
Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool)
Well
I I
(lot ft. rear) J
Abuttor's I Abuttor'
Name Name
Lot M Lot s
REAR YARD
f this is a / If this
:corner lot, 1 ft. (Q corner
trite in name ( ,� write 1.1
xf street. (,, name of
fl, V . other
+ ,� street.
4
SIDE YARD SIDE YARD
HOUSE
SET BACK
� I ft
clot ft. frontage)
fri ekaik
•
♦ j (NAME OF STREET)
Information
♦ Supplied by
LARK NORTH POINT
•
Information and Instructionskiseirefineite ..
General Laws chapter 132 requires all amployi n to provide worker'compoundoa ibr their employees. ,
Pursuant a this statute,as employee is defined tee"..,every pone is the soviet of another under any cored of hire,
express or allied,oral or wrieteat"
An saves r is MINA d sea iodividrelr pasaoeabip aaaorietios.cospowtloa or other
of the hoping�e'Jobe eatuprise.and �as or m1►two or morn
receiver orInnen etas lodtrid portoweblp,ale o� ores gempldemand ee4loyeey or the
owner ofedwelling hone bavios not more than three �° ` Hea.'e the
dwelling bow of seedier who epaetatrwra and resides thss+def,or the aeupaet Odle
l to de mehmedoom o esinicdka or repair work on suct,dwelling house
or as the grand.or building appurtsanot knee shell not because of such eaop1sysent be deemed to be an employer."
MOL cheer 132,123g6)also stelae that"nosy aisle er kcal iaaij spay shall withheld fie hama r or
naawel eta ileum n permit to error a budges er to aaetruat buildup is the ae■■teaweeitlll fbe►
say
spprtaat who ha Net predated sseeptehle evfdesoe of esapalaaee with the ho■raaseesverage
Addidosa,,bit3L dopier 132,121g7)stabs"Neither the commonwealth nor any altar polideai subill area shell
ester late any eoatrsat Ito thr p—I- aaaa of pubis wadi mil acceptable widens at
cengdrece ce ohm eealt adds chapter hove been pommel to thecom odedg authesilyr." with the isarraace
Appaloosa
Please MI me the worker'campensetion
oeoeeeeey�,ssppy►sur�oa■bsatde(i adbesa(w �pksne oembo(s)along with their e��the bore that apply is yarn sirWioa and,if
iraeaamen Limited Liebalsyr Camaeiee(LW)or Limited Liabilityrotaor p(LLP) �a no empleyeas oat
dor the
mobore or poem as sot segdeed to any workers'compumedon roses aece WmLW or her tin
a miry It re drei. Re advised that this aMlisvlt may be subedited to the Deperunit op
fohnirlei
Amid *fir oaaalnaatkee atinoase»coverage. Ain be sure to alp and den she afildavit The Made*should
be mined to the city or:ewe the the sppaleades kr the penis es ltee■as is berg requeited.net the
Depermeot co• Remit Aecideen Simmid pm have lea OAR!fie e the m49a�su the fees Wpm sere pie to elude a of
selilaaasnee bens artier an the desiw�eaat6dr hod below. �� ur mount should nor therein
City or Tem Meld,
Plea.be sure that the affidavit is complete and printed legibly. The Doman*bee providing s
spice at dm bonne
Phan
�sal out in the event the Oaks aILveadptloes lr a corder you r
egording the applicant
P at nee be sent a ft di In the pomirlicenee oxen which will be aged se a redeem'nubst In addition,as wit
a P� appalrado=in or glom year,and only submit one iAldevtt and
poalep ism remise(If neermy)add older"lob She Addrof the appose should write"sal location e or
tower A copy oldie al idieh that has beta oledallyr stamped orsue kid by the city ter mown may be prodded r(city
appalled atpene[thet a valid aQleidvtt is an file Ar Anon poach orlirn.. A new siederit mace be 1Wedonteach
yew.Whoa a hone moor or cilium it obe in g a ikons or pone not asked ter
say baleen aft commucie
(La a dog been or penult*bra leaves ate.)said passe le NOT repine 1s ram t� it venire
The OQloe of lavesdpdione ward like to uteri you is admen fbr your cooparsdoa and should you law
please de oat knee to give es a call, any qusetioan
The ma's address.telephone and This mambos:
The Commonwealth of Massachusetts
Department of ltduspial Accidents
Oahe of Gtftadpysts
600 Washington Sheet
Bottom,MA 02111
Tel.h 617-727-4900 cet 406 or 1_gr B
Revised t 1.22-rib Fax N 617-727-7749
nnmet.0ov/dls
=v', c" B Office of Consumer Affairs and Business Regulation •
1 .g4 10 Park Plaza- Suite 5170
Boston, Massac efts 02116
Home Improvement R4 tor Registration.
4 Commonwealth of Massachusetts
` Division of Professional Licensure
• ��✓✓ Board of Building ations and Standards
MCGRATH POST & BEAM CO.
JAMES MCGRATH ( ; ' Constructio 1 &2 Family
259 QUEEN ANNE RD. CSFA-073865 .*•
ira:03/144020
HARWICH, 'MA 02645 21 �'
`r JAMES RM• • '11 is
_ ' .` • 204 CRAM IEW -
°'1M IMP ' BREWSTER ,,A-_ . 1O
w��.unir�n���e IvOI i0*
a —
_ , .
„, , Commissioner l/
___ . _
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•
Office of Consumer Affairs and Business Regulation
1000 Washing :n Street- Suite 710
Boston, M.1• - usetts 02118
Home Improve p , tractor Registration
A -
R Type: Corporation
MCGRATH POST 8 BEAM CO. 0, --.� i, Registration: 132935
,,.,,.�;.,_- , Expiration: 10/30/2020
DMA PINE HARBOR WOOD PRODUCTS >—•.• �.
259 QUEEN ANNE RD. ===
HARWICH,MA 02645 littair
oIM� o`"
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_ .
Update Address and Return Card.
:CA 1 0 20M•05/17
,9Z gvivnoyu.+e¢d.eo/.4ga.v¢oiisde/
Office of Consumer Affairs&Business Regulation
HOME IMPR• , ENT CONTRACTOR Registration valid for individual use only
before the expiration date. If found return to:
Office of Columnar Affairs and Business Regulation
1, /7110/30/2020 1000 Washington Street-Suite 710
tt "�'=_--I':
, Boston,MA 02118
MCGRATH Pv�'__ ',, a '
D/B/A PINE - - : ' _= "'ODUCTS
�' = =,cam
JAMES R.MCG _! /
259 QUEEN ANNE '1-
HARWICH,MA 02645 Undersecretary Not valid without signature