HomeMy WebLinkAboutBld-20-001700 • .„..e.-• -4.-4: '.. )- 1 A--1:') i', t.li •!Iiiiilitii F: :0 I: P-.1.
F i,:i.q-A lilt f-t:•:0N1 I.OT LINE A ----'`'- '• .. - '40:ti:;i_.%:' ' tAlt,HAM OF 6 Fr...;ri FROM Sii -. EC EIVED •i!
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• SEP 26 2019 issue deo
ILDING DEPARTMENT
EXPRESS SHED PERMIT IL '-- '-- -; - =-.
,a TOWN OF YARMOUTH
ii 6
Yarmouth Bonding Department
"J 1146 Route 28 South Yarmouth,MA 02664
_ (508)398-2231 Ext. 1261
lcalrilkUCTIONADDIUM / PI
- 9 CiCk. /417 641/1 V.19,17-744./t/A-4?-ditg3
ASSESSOR'S INFORMATION:
Map: s-, Parsek
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iowNER: /?LAit Z.----6Z /f 474' / 3--- ..5-4A CiVe Iiiit;OLA A 1 ?g
TEL ti
annitACTOR:VIA C“bni 10S/Yk PRAY4-5 c3g 0\it)ilYtd11 al 53:3(MO .2.800
NAME MARINO ADDRESS TEL d
it(Raideodei OCcesnenid RaL Coat ofCammenise. ; 3800•
Dawn lasprevancet°intraday Lk./1.'21("415 Coastriodles Sapursisor C3P A- 0138(t)
Wedowee&Commandos inserence (deck am)
0 I am dm hoesecivencr 0 I am the sole payday Ohne Waimea Conmentios keen=
insurance Company Namek3tLi... \ir\-6FicvlbLias_.-s.4' 4 % Wodcees Comp.Poll vite,C6-Cft'(400d:151•(will
SHED INFORMATION
i (
New 1K size L I 0 x w 8 z H Corner Lot Yes No a`
Per Tom of Yarwasualk Zook"'Br-lene Sec MI5 II:
Me and rear setbacla for accessory bating,less that 150 square feet and single story,shall be 6,feet in all districts,but
in no awe bsdlt closer thin 12,feet to apsy other building
Replace existing* _ Mee L x W x If
*TM debris van be disposed afateLC\ ("-AYien c4cm-yz_CM% •A\PKarN,C c)-(ok-1---)
Lend=eiradny
i declare mks pensides of, -i * , dm sadesseets heists cloaked memo sod Gamete lie beet of op Ismeledge aid Isla I andessimetbstasy Me ireme.40
- vial liejst imoe ihr Ai .- .. t , easy kens sad tbrpseseaeboo wodarbLO.L.Cb.26/t.Seams I.
nl:SVS SOS= gip d,
440
DOM r-f.)4 c.Z 10319
9 --, 0 ---•/9
—...-
AISwand BY: . 400,701.01,41Kfis Dal=
, . 4-;•;TiFr''''-:...--. , .. ,.. i ALEIRESS: ( 1 /
i -0 4/ / 4144 ‹..f./
Feria;District f
Medea District 0 Yes 0 No Flood Plain Zees 0 Yes 0 No
Weis EasourcePraitstioa District vrain wo ft.of Wank ft*
a Yes a Ilo 0 'Yes 0 No
'monk=Conservaden review required if skids NO ft.ellifiedenis
9113
07/09/2019 12:40PM FAX 1$084301115+ PINE HARBOR 410001/0001
��_ The Commonwealth O,111 acsaC�/td
`- ],�,— Department of Industrial Accidents
-,ate 1 Congress Sbre4 Shrine 100
_yip,-_ Boston,MA 0211�20�17
` www.ns ag,�gotit/,pa
;`}4 Workers'Compensations Insurance Affidavit:Baildep
TO BE FILED WITH THE PEG AUTHORITY.&din saaben
t Information i—t. 'At Legibly
Name(Business/Organimtion/lndividwsl): j„+ ,.rI MS iI, t &Wei
1
Address: ___._.
City/State/Zip: H(ailV i(.al nitOlil Phones: , !93O 80
Are you so employee`Cheek the appropriate Gaut: ______.
I. I am a employer er with Type of project(required):
r..i p oy employees(full and/or patititoe),•
2. [m a tole • • 7. 0 New aonst:�tioth
Q proprietor or partnership and have no employees working for roe'thi -,
sty�Paany.[No warlocks'comp.insurance required.] if•'•r • 8. ❑Rett:odeling
3.0 r am a homeow doing all work myself(No workers•comp.insurance required.]♦ .• 9•..i110Ji Demolition
4.0 z am a homeowner aid will be hiring contractors to conduct all work an my property- l will 10❑Building addition
eswrc that all contractors either have crkers'compensation r neenee or am sole 11.0 Electrical repairs or additions
proprietors with no employees,
!arts12-❑Plumbing tars or additions
S.
❑I am ; ntr to a and I have hired due limed on the attached shack,
employees and have workers'comp.iairahmce.t I3.❑Roof repairs
6.0 We eta a cotpeatios and es o#ioaes have exercised their right a[acoorpaim per MGI.a 14.C]Other _. 2
tit.I1(a).and we have no employees.[No vodkas'comp.immix required.]
'Any applicant that checks box P1 must also fill out the section below showing their workers'composition policy information.
Homeowners*to submit this affidavit indicating they art doing all work end than hire outside vonkseoors must submit a new affidavit indieatin such.
:Coatrooms that check this hex toast mew an addicionral shoot shawls the nurse otthe subcontractors and state wtha t=or sot those entities have
empieyves if the wb•eanta>Ktors have emptoyem,trey mast provide their workers'--, policy number.
f am ea employer that isptoviding workus'compensation&swam for tory ehIployets. Below le the policy da d job site
Insurance Company Name: k it,� r J t/11a1'( ii 1 t; , A I , , a r l o --,tea
, • -f
Policy#or Self-ins.Lic. en-� QK 1- y i la A Expiration Date: 1�lti 8, 0 n
Job Site Address: City/Stat efZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and eoxpiratioa date).
Failure to secure coverage as required under MOL c. 152.f 25A is a criminal violation punishable bye fine up to$I.500.00
andfoc one-year imprisonment,as well es civil penaititm 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. As
I do hereby eerie i„ii' , - :. • , ,Te l+ejorn shear provided shove is tare and correct
ill / r
5411WiMili.....— iff
phone it: _ — _
Official use only. Do act write br this a is be ausaPIded4ycityor town s
City or Town: Permit/Licease#
wing Antkority(circle oat):
L Board of Healer L Building Department 3.Cityll'owa Clerk 4,Electrical Inspector 5.Pittmalat Inspector
4.Odor
Cat tact Person: Phone#:
r
•? ' ' PLOT PLAN
•is ,
FOR LOT I
Indicate location of garage or accessory building
Addition with dashed
Sw 'age disposal (cesspool)
ell gs
I
I
I (lot ft. rear) J
40.
Abutbpris j (0 1
None
I
Name
Lot • Abut
1 r Lot i
this is a ---�' REAR YARD
rinser lot, If this
trite in name /0 , it COL,
write 1
i street.
I
.. (was of
.3 other
• costz+eet.
4
.
: SIDE YARD _ __
SIDE YARD
.
HOUSE
• 444, 1
.
.
•
.
SET BACK
•
1 •
I
oat ft. fron"age)
5 ch i f 4o° / oat
/ (NAME OF STREET)
Information
Supplied by
ARK NORTH POINT
•
''"` ✓//,/e t/t u oe .
='si Office of Consumer Affairs and Business Regulation -
01
10 Park P1aia-- Suite 5170
..,. Boston, Massa, efts 02116
Home Improvement R,_o ' or Registration.
=u- Commonwealth of Massachusetts
— ,. I) Division of Professional Licensure
McGRATH POST & BEAM CO. _ � f Board t tb, :arnd Stan ly
JAMES McGRATH __ :� Constr .„... 18 2 Family
r if..
. 259 QUEEN ANNE RD. ==_ _ •. ..w� CSFA-073S65 0' , * Expires:03/144920
- HARWICH,*MA 02645 i,, _,_
l r
zr JAMES R r e E
O ^ SV16��* �4 r glit i
M•
s ALmmAJV/•i1_1ns,,a t J�'� �
/ .."'
Commissioner CAL
•
e/Z W 6)4AariJaaeacm&A
Office of Consumer Affairs and Business Regulation .,
1000 Wash' •n Street-Suite 710
Boston, M. husetts 02118
Home Improve - = • tractor Registration
A . < V 1
Corporation
L Registration: 132935
MCGRATH POST&BEAM CO. a -:v 1
D/B/A PINE HARBOR WOOD PRODUCTS :, =s! 1�= t 10/30/2020
259 QUEEN ANNE RD. =i_ c
HARWICH,MA 02645 f wr
A.
r
,Q
r,'SM� .ve
Update Address and Radom Card
SCA t A 20M-05/17
OMce of consumer wars&Sieben Reguldlon
HOME IM• • • -.= ENT CONTRACTOR Registration valid far lndividusi use only
. .. before the expiration date. If found return to:
. . . . . _ Office of Consumer Affairs and Business Regulation
_- - -_- 10/30P2020 1000 Washbngton Street-Suite 710
MCGRATH -• 1. a= Boston,MA 02110
DBIA PINE ODUCTS
t!:.-Lir ' --_ - :.•
.TAMES R c- ,';
259 QUEEN ANNE • .;-�-
HARWICH,MA 0�5 Undersecretary Not valid without auipnadur�e
' V 4
,
✓'i1 MCGRPOS-01 THORNE
A RE CERTIFICATE OF LIABILITY INSURANCE ;/°19'
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TIE FFoRD CATE HOLDER THS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFPOFOED BY TIE POLICES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE
LNG INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poilcy(ies)RNIst have ADDITIONAL R SItRED provisions or be endoras ni
I SUBROGATION IS WANED, subject to the terms.and conditions of the policy,cerldn policies may require an endorsement A statement on
this certificate does not confer rights to the certificate older In lieu of such erxlorsement(s).
PRODUCER EUECT
A Gray Insurance Agency,Inc. (NI°Ne Na Exf) (800)553-1801 1(arc.
Nokg877)816-2156
South Deemis,MA 02860 s:mail@rogersgray.Com
INSURERS)AFFORDING COVERAGE NAIL s
INSURER A:Travelers Indemnity Company 25658
INSUREDNSUREx B:NOW HampNdre En IDYrIrs insurance Campan 13083
McGrath Post& � ' '' INSURER C:
f Rood INSURER D
Hmurick 02645 INSURERE: _,
'� i '.- B F:
COVERAGES c IC� UMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT'TH PO URAN ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING AN r RENT TO CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR RAIN. THE SU AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF Simi I OLICIES.LIMITS:3SHOW MAY HAVE BEEN REDUCED BY•PAID CLAIMS.
i'
TYPE OF INSURANCE M ,p0LIC />(RIBER arwarrern nr oW'rirrn UNITS
A X COMMERCIAL GENMUU_whinny 1 EACH OCCURRENCE $ 1,000,000
CLAMS-MADE j X OCCUR ,1-660- 1.9. ,,'' 1/31/2019 1/31/2020 I s(Ea oUTrED I 1 f 100,000
oo.renoa� 5,000
4 ®EX
P(AM ota oaison) f
PERSONAL&ADV INJURY $ 1,000,000
GENL AGGREGATE I SYR7 ItlkR I. S P R GENERAL AGGREGATE '$ 2'000'000
OT1EFt X�'000X 11OLCY . LOC PRODUCTS-COMPIOPAGG $° $COURSED SNGLE LAST $wunwroeBE
x ., (EA aaadentl ANY Auro , BA-44878686.1�, ,.-1 1 19 '1/ 11 020 BODILY INAJRY(Per person) (_$
Amos ONLYOWNED •' AUTOS vi pBROQOtY�NyNRY(Peraocidsi} $ 1'�'�
X r•! ONLY ti leeraeMwif }f
$
` . l,r r!p !1
UMBRELLA LIAR OCCUR $
1 LMB CLA�y ADE '`;AGGRO ' $
B WORIIERSCOIIPCs8ATI0rl f iP3a y #` a.; +a r F1 Pry I': OTH-
AIDEIMLOYBIS'WBLnY Y1it� ,,'ECC . 7/S/Z019 ,. STATUTE . ER
ANY OC 500,000
CLUDED?
N/A -I� ' l8A ! $
yy�es, EL $ 500,660
DESCRIPTION OF OPERATIONS below ,s'• - r EL DI$EASEt POLICY L 500,000
.,
DESCRIPTION OF OPlRA110N6/LOCATIONS/VEHICLES(ACORD 101.RAIROAne Rena a ScherAll i rr z `"
AAT B`NN.spaceh..Pm.*
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF TIE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WRLL BE DELIVERED PI
Bulidbo Dept ACCORDANCE WITH THE POLICY PROVISIONS.
1146 Main St,Route 28
South Yarmouth,MA 02684 AUTHORIZED REPRESENTATIVE
s ).--Almatel 7/a4e01 —
ACORD 25(2016J03) 01988-2015 ACORD CORPORATION. Aft rights reserved.
The ACORD name and logo are registered marks of ACORD