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HomeMy WebLinkAboutBld-20-002112 T "" SHEDS LESS THAN 150 SQ FT SHALL BE Office use Only •�� Rh; PLACED A MINIMUM OF 30 FEET FROM THE cnnt � .�� FRONT LOT LINE AND A MINIMUM OF 6 FEET OI • ,Iy• FROM THE SIDES AND REAR LOT LINES Amount 4,yy �"°'°#uu � ¢ Pennit expires 130 days from `'issue date EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: -5W 02-A H/:}NN/A 'R A. y421(Lr1.CT14 I eg r ASSESSOR'S INFORMATION: // Map: Parcel: �y OWNER: rCESLifir /�Co.fEt-L,` Jai OLD HI/.tg1Vrs 678 726 `Pi a NAME PRESENT ADDR^ S TEL. Y CONTRACTOR*Pi/I 4 2.8 v� NAME MAILING ADDRESS TEL.# li esidential 0 Commercial Est.Cost of Construction$ 'ie1 WOO . Home Improvement Contractor Lie.# Construction Supervisor Lic.# Workman' Compensation Insurance: (check one) am the homeowner i_ I am the sole proprietor L. I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# SHED INFORMATION New Size L /0 x 4Y 1.0 x H S' Co Corner Lot: Yes No . Per Town of Yarmouth Zoning By-Law Sec 203.5 E: Side and rear setbacks far acces,soay 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 I-I *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 answerfs) will be just cause for denial or rev cation of my I.^nse and for prosecution under M.G.L.Ch.263.Section I. Applicant's Signature: . ..., _I • -� r�„ ` [)ate: Owners Signatur or attac ment) a.� Date: Approved 13y:—._-____ , Date: ((1 6 ` .17 I3uiidina Official(or design ' 'MAIL ADDRESS: Zoning District: Historical District: " 'es No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands:*'''* _ Yes L. No Li Yes No '**Note:Conservation review required if within 100 ii.of Wetlands o%l' r . t . The Commonwealth of Massachusetts I -.a� /, Department of Industrial Accidents • Itd1- 1 Congress Street, Suite 100 C.=,e f_j' Boston, MA 02114-2017 '1/4r 5.•�''� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): ,,L C S ,&. i€ Ro S ..LZ f Address: S'{ OL) /4 y-4AIN,S 022) Y4-4/4 City/State/Zip: p u 7/1f P i Phone#: ,7 6 7,2 6 - 8 18 9 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑ Demolition 3.❑I am a homeowner doing all work myself. [No workers'comp.insurance required.]t 10 Building addition 4. 'I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑ 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.❑Ro f repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. ther 5//CD 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: 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 of the DIA for insurance coverage verification. I do hereby certify t r the pai d penalties of perjury that the information provided above is true and correct. Sigrlat P-R..--& ' Date: /b ' 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#: T e4 PLOT PLAN FOR LOT # Indicate Location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) Ea Well2 I I I (lot ft. rear) I Abuttor's IX '0• Name I I Abettor' Lot # I Name I Lot # :f this is a REAR YARD :orner lot, , If this trite in name corner _ I 'f street. I write i, name of ,�• m other � street. , . SIDE YARD ' ts SIDE YARD • HOUSE . . . • I : . I . : SET BACK • •• ft : I 4 1 a (lot ft. frontage) \ / / 00 D # ,4-vv,y, \ / (NAME OF STREET) Information / \ Supplied by LARK NORTH POINT °lY TOWN OF YARMOUTH t,' + 4' 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 �'` Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 OLD KING'S HIGHWAY HISTORIC DISTRICT COMMI APPLICATION FOR J•. ' ` CERTIFICATE OF EXEMPTION Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 Of-Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or print legibly: \/ RerMap/Lot / Address of proposed work: 54/ OLD /��/,q-,/J Ni S j�, rfi/1ptauTN # / 9 / 30 I c Owner(s): LcS L/g JC o s eI-t ) / Phone* 578 7.2_8- 8/8 ? All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: a.►' 1.5 f 0/-D / yi9-NN/.f J b Year built: .2o/9 Email: Pear 1 j Ym 1 S-el 6 yrY1 c i I. C 044 Preferred notification method: Phone r/' Email Agent/Contractor: n e. MA/2_13 o 2_ -gl el)S Phone#: Mailing Address: Email: Preferred notification method: Phone Email Description of Proposed Work(Additional pages may be attached if necessary): Q sL 4---, lelk II, ff k" CGC ,. Signed(Owner or age ): i��` • Date: /O//J /9 > Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.) > This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later. For Committee use only: Date: t O-15--fj 1 /Approved Approved with changes Denied Amount a a Reason for denial: Cash/CK#: .3(% Rcvd by: Date Signed: /o//S/aa/9 Signed: ,i. e .,.., - /Q APPLICATION#: ! /'L�096 V5.2017 f f 2 • ! 1 `\\\ MEaci 653 nr_9: a \ :re O 2 c� \ o agoi o �' sR �_cs `� 'j `\ Wz, J n 2 g _ ^l o (l a d.Ip 7 MP I I ' I CONCRETE PATO COVERED PDXCi1 J A 9 5(151114 WOOD FRAME QW61.1iNG / CC s OP of NDAnoN -e4.4= 0 , Q s' N N. I / ) / I 6 IT° I'' / o ca s v t O ,x Z °y a o (.., ^ i / I#. - (�j) y z i z ` � r�(N n (a58 .py32 O�, ,f a ?j o _ = i '95 .-'aii� - s �+• Np j �'P �� ��ma o A q� �T 5 O T '�_ > z0g NN' 3 c 0 Fy - . its 1n a ` o C 0 Y ems- • Y v O ` Z 7�17 ,Lll q,- 4 3 X a _ O S D -113 SF'S. ~C., O Front Elevation © Left Elevation PINE HARBOR WOOD PRODUCTS SCA_E. /L, SCALE /4 - -O PINEHARBOR.COM I-800-368-SHED 259 Queen Anne Road Harwich,MA 02645 p:1508)430-2800 f:(508)430-1115 )L P barnsepineharbor.com }-Tab to rTeS I1 I I I I I I I I I I I I I I L I 1, ENGINEER'S STAMPB,acFI I I ) 1 1 1 I 1k I 1 1 1 I 3 1 1 1 I T 0/000 r Ba n PVC Trim• BE' Boa d a d b_tte il r E_verlast Composite Clapboard �— •Canvas 10-yr' 5-0" I PROJECT: I( -II If -II 5 x IC Stony Brook CLIENT: Leslie Resell. ADDRESS: 54 Old H ja nis Road © co Rear Elevation Right E evation va,rnouri Fort r.A 026%5 SCA1_E o = 1-0 SCALE 1/4 = t-fv„ PHONE: 518-728-8189 E-MAIL: ��M �� ��� nezr an'59@ymal. o .__________IN i iTaG Crrlgjeg ���mm aADDRESS OF PROPOSED WORK: s �_ � 54 Old 4yanrs .Road 1'annour port, MA 0275 lUlL REVISION DATE: Board and Batten ■ Board oard and Batten. - _ • DRAWN BY:9� GB — , p J1.al 4" =1'-0" Unless otherwise noted r� Page A.1 -.. _ .__, f N▪• S \Lgi ...,Foci 659 Fa.,-- ..."9'e P. IA o �' 4 3' \ n ii . �s \R. 1 \ A • z \ zaig � n n � sa -� \ my 4 - ��051 — — I , v • d 0 1 `s,u is } ¢0 ItI or c Ti IF•L ii I 1 coNc re PATIO COVERED POFLn i1 `/✓f p'9 EXISTING WOOD FRAME W.:T.1+NG / ;i fi6 TOP OF FOUNDATION E. •h— m tt /1 / ."tn�, .._ )// / \ / \ L / / N. ( \ 1 // i� / zi li; O .vI l v T I n l, MA Q I c L� n o 1 ;+' to } U1 z • v I Cl to 4 o eA za 71 n1 c n �� S2� .,,rp I o� w > g "'^cc \ I t 3 ▪ S (:_in"A > O V! a rr 1 O -........ w R� (cIH O hn�. O t35 HARBOR OFront Elevation ® Left Elevation PINE WOOD PRODUCTS SCALE 1/4" = -o` SCALE I/4 = I'-0" PINEHARBOR.COM 1-800-368-SHED 259 Queen Anne Road Harwich,MA 02645 p.1508)430-2800 I:(508)430-1115 barns®pineharbor.com 3-Tar ;I"`n625•' 1 1 1 1 1 1 1 I 1 1 1 1 L 1 1 1 1 1 1 l BIed< 1 ENGINEER'S STAMP 1 I I 1 1 I 1 1 1 1: PVC Tsrn• ,-,■■■ 5oaru ar.a Barre, W EMI i mil FirEver'ast Cor000s'te Ciaoboard Cl''— •Canvas PROJECT: 0-0 6 x 10 Stony Brook CLIENT: Leslie Roselli ADDRESS: 54 Old jannls Road 1 Rear E evation © Rignt Elevation Yarn orr Fc,,t MA O2F5 sCAOE i,i4 = SCALE /a. = -0.. PHONE: 5'8-728-8189 F-MAIL: _������M��� pear'yarr159@y a: corn 3-Ter ShI?ge5 "Aran �� � lit ADDRESS OF PROPOSED WORK: Black � ���� I�MEMI a 5c 6c - r:,:� 3caC IIIIIIIIIIIII Va.-rnout,'ocrt, MA 02675 o - REVISION DATE: - al� - B.,a, arci 3atte�8o�ra_. ., da,.er9/6/19 8 I_..x DRAWN BY: CB 7 ' Lose 1/4 = I' U" Q A " '� Unless otherwise noted Page A? r ' - �..,. ________ yam'