HomeMy WebLinkAboutBld-20-568 r. rcrmtpj
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EXPRESS STIED PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Depar#ment , ;
1146 Route 28
South Yarmouth,MA 02664 CAS k
(508)398-2231 Ext. 1261
CONSTRUCTION ADDRESS: eZ 1 /
ASSESSOR'S INFORMATION:
Map: Parcel:
OWNER: 11,i1 ifkl .C117 ,V7/ g-U NAME
PRESENT ADDRESS -nZ?7- 6/ T tc
CONTRACTOR' 8
NAME I
MAII.dN ADDRESS TEL#
idential 0 commercial �}
er Est.Cost of Construction S
Home Improvement Contractor Lie.# I
h�____,. .._Th
Construction Supervisor Lic.#_(IA — . tEU..5
Workman's Compensation Insurance: (check one)
0 I am the homeowner G I am the sole proprietor 4 I have Worker's Compensation Insurance
Insurance Company Name. /�.,��
Worker's Comp.Policy/!ea-&J • tyR57 .zo6 A
t
_SIRED INFORMA ON
N w L SizeL�x wJ_x H t u t Corner Lot: Yea
_Z No
1 Per Town
1 2� -, ','"'awlawSecZ03SE
Side and rear setbacks for accessory buildings less than 150 square feet and single story, shall be 6feet 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
1
Location of Facility
I declare under Peres of. �herein���are true and
will be just cause for dunpeas under.M.GG..L.Ch.268,Section myrect to the best of knowledge and belief. I understand that any false answer(s)
i vocationat I f tun license and for
immuiv.
Applicant's Signature:ell
Date: Z (q I 19
Owners hmji,ralw
I�<`i�' 1 Date: 7 f /
Approved :
1 I '� ) EMAIL ADDRESS: Die: 7' '/
Zoning District:
Historical District: L Yes 0 No Flood Plain Zone: 0 Yes 0 No
Water Resource Protection District: Within 100 ft.of Wetlands:***
Li Yes LI No
***Note:Conservation review C Yes No
required if within 100 ft.of Wetlands
9/13
�_--_`1 rDep�'tyr sett of ,4
�u` I Cos
^� M4 02114-2017
workers'Caaa "' govda�a
pt:sa as tasatasea Affidavit:BaiideralCoarrittonaleetriebondlimbers.
TO BE FILED WITH THE PITAMTTING AUTHORITY.
Ndtrie(Stains ypr a d„d). `/ k-i • C. 7-��'.1
/ali IMA
Address:
CuY/State/ZiPl j
L shone#:
Aft rim seSyre aka the ap,rspeeea:
t.�too a employer with�..�,cmployeor(brit and/or Plea• •
Type of project(required):
•
3. t
em a pole 7. ❑
e0'capacity. undone parantship have to®ptoyees vroa *roof .,. New Motion
3.Q t am a homeowner doing an tivort ayxt Iola teaMumma '. t i.?i 8' Remodeling
CD t am a heme<awoet and willmetors comp- `"oq""ed J •
' 9. . Demolition
ensure MS at t�omaegn too wvde on my property. t will
10 0 Suilding addition
proprietors with no employees. e0°'PC°mi0a noe or are pole 11.
S. t am a �Electrical main or�
❑These gamey:tarsal t have hired the lasedon the 1I.O Plumbing repairs or
moors have employees and have worms'0orm. attached shoot ;3.� repairsItoof additions
6•[,We earaoaepara,d��4 o�arshtve
153.;t{si,and we have no employees. twateised their a[ per Wit a 14. JO het
Mn?i applicant that box 01 must also Si[out theOsnlp Manna sedan below showing d
oradoire oompeamion policy information.
Lfkaasomms Toolemmors that��� add indirstina itio ore nal doing
Mtwaal sod�hire outride eentnemors alum submil a new affidavit indica*such.
old tithe tears have lariat workers'howing Menem of We aw gial r a ea0e whedia a pot those
amities have
fie time laps wastes' dos er ' rank".
Insurancemy elfillydriOL ltdOOP Is the
CompanyName: L,A. a i ia'al.t
�►�Iobsfre
1t1 1_ . /► a • o aa1 / /
Policy#or Seif.it s.Lie.1: _
Job Site Address:
Expiration Deb
Ashei a copy of she worltera'campeos:�a policy deelaratiob City/State/Zip:
Failure ss securecoverage asunder MGL c. In.¢25A is a criminal p ng the policy n�bcr and e:tpiraBos date
and/or to earimprisonment,as as well as civil inal violation punishable
and re-tea or.Apenalties in the&rat or STOP WORK ORDERby a fineofP to$20000
of
dayaage against the sham. copy Statement may be to the Office ofin and a fine to S a
I de motions of the Diq for instance
„,.:„,1_ `�FFp,,,--77,
I ...di �r C' �n+etdaiKOrrDt roe and comet
•v..I. • ir
Weldest ismot De met*War lk this alr a,be ros deredAY do'sr towa
ekkri
City or Tows;
Using Aar,(circle ese): Epi1'mi cease#
L Board of Heald i Saildlag De
d.Other t 3.City/Town Clerk 4.Eketricci Inspector S.Pluiriblas
impactor
Contact Pelson;
Phone ta,
r Wlir
. P. f
FOR LOT
Indicate location of
Addition. with dashed or a°r�' building
wSe disposal (cesspool) ED
ell fig
I
I (lot................ft. rear) j
Abuttoris 6 ' O.
Name
1
Abutto
Got I Name
Igo ( Name
GI
Lot I)
this is a 3 o REAR YARD
comer lot,
'rite in name ••••••••j....tt. If this
if street. corner
write
.. name o
ii other.
4Is
4
.
• SIDE YARD YARD
SIDEHOUSE
.
• a 0 •
• a—_ --
.
•
•
.
.
.
. .
SET BACK
'• �
.11 ...... ..,�,'. • i7
r
I
I
(lot..................ft. 'i7i)
�, 3 e
(NAME per STREET)
/ t Information
Supp11 by
ARK NORTH POD
.4coR M4tiRPOS-01 THORNS
�
CO'--
CERTIFICATE OF LIABILITY INSURANCE I DATE(MWDONYYY)
7/8/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THE
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. WEE CERTIFICATE Of INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING i
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ).AUTHORIZED
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must have ADDITIONAL CURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the this certificate does not confer rights to the certificate holder in Neu of such�s policies may require an A on
1Ha
84�insurance
�Y,Inc. IEl*(800)553-1801PROMICER
we
South Dennis,MA 02860oic !We Nsk(S7T)818-2156
� ;Iran®regeragray.com
NMLIRER(SIAFFDIIDN000VERAGE IIAICs
PEENED — NMINiERA:Travelers Indemnity Company 25868
McGrath Pasts: im Corp SOURER, a:New Hampshire Employers Insurance COmpen 13083
259 dbe P Rd i DIMMERc:
DIMMER D:
02645 I INSURER E:
COVERAGES INSURER F:
THIS IS TO CERTIFY THAT THE IC j�' UMBER REVISION NUMBER:
THIS I INDICATED. CERTIFY
NOTWITHSTANDINGTHE OU RANC D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
CERTIFICATE MAY BE ISSUED OR 't AIN, THE'INSURANCE AFFORDED BYTHE POLICEDMON OF ANY S DESCRIBED HEROR OTHER EIN NIIS SUBJECTALL THE WITH RESPECT TO THg
EXCLUSIONS AND CONDITIONS OF S� CICIES.LIMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAIMS.
innLIR TYPE OF INSURANCE gen ;POUCy I DIME i PO EFF JJCCYY R�pp
A X 1 COMMERCIAL GE E RAL LIAmuTY �� �rYM° ) Lens
s CLAIMS-MADE X ocCLIR i E�OCCURRENCE I S 1,000,000
I N �' 498-iND-t9 -?� 1�31/9019 11/314020 ,ra ) ;$ 100,000
J1 f ,MED I:XP Any ens eereonl !$ 5,000
j" , } PERSONAL s ADV INJURY $ 1,000,000
X I Pa1CA Y� LOC: I ;GENERAI.AGGREGATE $ 2,000,000
1 OTHEfc .; I Ts-coMProP Acc $ 2,�0,000
A I A,�o oal.a, ;rY
` ! SINGLE L ar
G $+AY BA-048788861 ' 19 BODILY NARY(W►ostson $A0ONLY°,` .X 3
BODILY INJURY(Per accident) S 1,0yw,QbX ZS ONLY )'JAI" it :?47 (Pr l -
iuMNIE LLA LYE
EXCESS UA$ ( CL/N.AADE f , ;
1 I DEO 1 !RETENTION i 1 ►? i$
B 71oN 2 1=
I'Vn' IY/I :), TUT! 1 1 ER
__! N/A` 7/&2019„' ELCH !i ,000
)) i ACCIDENT'
dNvlbs ixidx
�r yes,
DEiCRIPTION OF OPERATIONS babes i EL.DISEASE-. $ 500,000
E.L,-DI.SE/ ,, Y LAPF �. a000
I
1
recroanoN of open w
/LOCATIONS/ w
Ns/vecLeE(ACORD107,Additions!R ohadiAtaMLBessIBINNORNINars i
apses is gssolisd)
•
GIL
Town Ot Yal ITIOuth D ANY OF TIE ABOVE POIJCES BE CANCEt,L®BEFORE
Bu of Dept HEEXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1146 Main St,Route 2a ACCORDANCE WITH THE POLICY PROVISIONS.
South Yarmouth,MA 02594 A R flEBENTAINE
RD 25(2016A13)
01988.2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
1 v rarx riaza JUIte 5170 •
Boston, Massac a. , efts 0-2l I6
Home Improvement.441,1_11t tor Registration:, ,
.
•
nna and Standards
McGRATH POST& BEAM CO, -- v .- �' kardOfBuil q "
JAMES McGRATH , . ' construai l
y Family
259 QUEEN ANNE RD. =-- a •` it
• HARWICH, MA 0264�v. __ �_ CSFA-073865 * ' �
= e. r
��� JAMES R .1 :t t: 0
'41 v s' 204«• ,$ .e
Ana $
+•
o/ssa3chi
Commissioner l/ *'"
•
•
, e92 F
A& J & Je
Office of Consumer Affairs and Business Regulation
1000 Washirn n Street-Suite 710
Boston, usetts 02118 •
Home 1 ��'
';
mprov, , ;,. • traitor Registration
)IR
MCGRATH POST&BEAM CO. ----- —.1._ - 1= 1' on
DIB/A PINE HARBOR WOOD PRODUCTS v ration: 132935
Expiration: 1OV30/2p20
259 QUEEN ANNE RD. k. —
HARWICH,MA 02645 _ -
= f________
f h�
1 O 20µ 05/17
Address end RNYm Card.
Office
FpMofEConaway ffaks a B -: .
ENT CONTRACTOR
Registration valid for
t -., ' before
of he expiration date.onsumer Affairs an bend return d to:
MCGRATH •• ,1 0/30/2020 1000 Washington g .s 710
R�alMlon
D/8/A PINE �` '-ODUCTS Boston,MA 02118
t! ,•z;•
t
JAMES R. c ;, ;;
259 QUEEN ANNE' •, �:�'
HARWICH,MA 02645.
Undersecretary Not valid without signature