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HomeMy WebLinkAboutBld-20-002243 .�Ap O _`A_ 1 L I i l , L_ i}, : -T Permit# O ) ' IL C I�� y `i; f- t ?1 . . t_T �r,OMl f.I�)f AND Amount �" '' ,t ' � l i �!"""": cam` Permit expires 180 days from issue date e6Lb—a v-c g3 EXPRESS SHED PERMIT APPLICATIOM E 1 V ED 1 TOWN OF YARMOUTH 1 Yarmouth Building Department i ' OCT 22 2019 1146 Route 28 ` i South Yarmouth, MA 02664 I3 U I L D I N G D E PA R T M E N T i I �` (508) 398-2231 Ext. 1261 -— CONSTRUCTION ADDRESS: / l�') e e n LOCH ASSESSOR'S INFORMATION: Map: )q ) Parcel: r se I D-f 1-786 OWNER: 'la-rrci J Swain 16-reef, 14) SO 8-367-0125 a. NAME PRESENT ADDRESS j TEL. # 541E1 CONTRACTOR:rn rla. Pish 1. c6I ee,i (Inradn e- A . i- o ic1 9D -- c O O NAMEMAILING ADD SS TEL.# Residential 0 Commercial Est.Cost of Construction$ 0 0 lb -3 /' Home Improvement Contractor Lic.# l 3c. ctas Construction Supervisor Lic.# D7,3 g--Lo.5 Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor ❑ I have Worker's Compensation Insurance �s, Insurance Company Name: A IA �C- Worker's Comp.Policy# (E-CC (p(�U4 cCO9 7 Z, a( 4 v 3 SHED INFORMATION - New V Size L /O x W / /x H Y Corner Lot:Yes % No Per Town of Yarmouth Zoning By-Law Sec 203.5 E: Side and rear setbacks for accessory 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 H *The debris will be disposed of at: 4tl De J�egs 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 revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: �� Date: / ///Owners Signature(or attachment) / ,% © e- __. Date: AO -1 '9 �� / /7 Approved By: O��v �. Date: Build' ial( r designee) EMAIL ADDRESS: Zoning District: Historical District: ❑ Yes fl(No Flood Plain Zone: ❑ Yes ]t No Water Resource Protection District: Within 100 ft.of Wetlands:*** ❑ Yes 'No ❑ Yes .N' No ***Note:Conservation review required if within 100 ft.of Wetlands 9/13 '` - iz e ✓naJ•ac1uzot . ` 4 r Office of Consumer Affairs and Business Regulation • - a i 1 i 10 Park Plaza - Suite 5170 _sue Boston, Massac -eats 02116 , Home Improvement R.,�19_ tor Registration. __• _= Commonwealth of Massachusetts i — _ I Division of Professional Licensure is �✓ Board of Building ations and Standards McGRATH POST & BEAM CO. Constructio 1 &2 Fatuity JAMES McGRATH —; - r' _ f. 259 QUEEN ANNE RD. a� _ _ — w� CSFA-073865 y5' y} fires:p3/1d/ 020 HARWICH, MA 02645 - ,� > •v Q - -- b40 JAMESRMof _fa lk 0 �� . 204CRANVE* -< ,° • o�., - - e:, , - BREWSTER - y; .- s*O —a Commissioner r Office of Consumer Affairs and Business Regulation cat 1000 Washing .n Street- Suite 710 Boston, M:thusetts 02118 Home Improve -ter: = tractor Registration *—u— _ Type: Corporation R tf r MCGRATH POST&BEAM CO. ,0 -=_� y Registration: 132935 D/B/A PINE HARBOR WOOD PRODUCTS 1 iration 10/30/2020 259 QUEEN ANNE RD. _ 'a HARWICH,MA 02645 a W { l�M� e YO ;CA o �� Update Address and Return Card. .fie g90~149a1.1 aadAa1. iavl4faaPii 6lat Office of Consumer Affairs&Cuslruss Regulation HOME IMPRO , ENT CONTRACTOR Registration valid for individual use only t*• '• '' before the expiration dab. If found return to: __ Office Eat Office of Consumer Affairs and Business Regulation (� ,,10/30/2020 1000 Washington Street-Suite 710 MCGRATH Pd , ,-=-tea`' Boston,MA 02118 D/B/A PINE H ` _ ' ,, -()DUCTS 4 JAMES R.MCG /': 259 QUEEN ANNE `,:'- 4HARWICH,MA 02645 Undersecretary Not valid without signature • d The Commonwealth of Massachusetts ► _� _E' Department of Industrial Accidents Ip=_ 1 Congress Street, Suite 100 Boston, MA 02114-2017 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): Mr C](a+h ?l-+ t I3earn C1rX(Ai'iO() Address: as9 Queen Anne. City/State/Zip: HQru chin!) ne)(gyl Phone#: 568 4130 028O0 Are you an employer?Check the appropriate box: Type of project(required): 1 Q[am a employer with employees(full and/or part-time).* 7. New construction 2. am a sole proprietor or partnership and have no employees working for fie . ❑I Y 8. [3 Remodeling any capacity.[No workers'comp.insurance required.] t� r. 3.0[am a homeowner doingall work myself[No workers'comp. 9•. Demolition❑ y insurance required.]f 10❑Building addition 4.[3 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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0[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: Near H n'pshw E iplctiers jnsl era ni e eompny Policy#or Self-ins. Lic.#:FCC-cow-Li oppgs 1 -dot s A Expiration Date: V;Jr, EA, a a-)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 he pains an"+;e` s o erjury t e information provided above is true and correct Signature: �f 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#: 4 • PLOT PLAN FOR LOT # Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) 41, Well is ;uo I - �� w -� I (lot ft. rear) Abettor's Y' '�' i ¢.� — — Name 1� •I� .� ,._ Abut Lot If b` i. \� 1 I 1 She Los# 0 - - - - f this is a _1 , REAR YARD =ner lot, ' \' ft. If this trite in name I1 corner street. I write i r ' name of I _ I, other � � v ig street. L ice% • i d SIDE YARD •• HOUSE SIDE YARD 8-94-..* i .. i •) ' �� • SET BACK - A • • ft 4 I - I (lot ft. frontage) • // / fe &v >, 74A_714.eA4t,l� �l/ cs.� • / (NAME OF STREET) Information /(---?ax -= Supplied by �y �'� ARK NORTH POINT