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HomeMy WebLinkAboutBld-20-002362 r. 4 Permit* SHEDS LESS THAN O PLACED A 11.4iNIMLIM (-)F 3C cEFT _Amomlt •,� ,'�'•/d FROM THE FRONT LOT LINE AND Permit expires 180 days from -�' "�/ INIMUM OF 6 FEET FROM SIDES ANT) -,issue date kEAR LOT ! Ii,ir—,S: EXPRESS SEED PERMIT APPLICATI TOWN OF YARMOUTH Yarmouth Building Department I UL1 > 2019 1146 Route 28 ........_._ _._.. ...•..._. .. South Yarmouth,MA 02664 r (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: /J `/ G(,I/A)Aft) '`D a-i) y rn 6 c>i` 1AieU ASSESSOR'S INFORMATION: Map: o2.r4 Parcel: 5d _59 OWNER: J 11Cfi6arr---/-N-DC 3 N/L)/ 15 R/G,, AJitio �> Z,/-Vo49 5 NAME PRESENT ADDRESS TEL # /� Email Address: CONTRACTOR: 1 [C9'UZ) Pent R.)601 , ((a). AS /i4 56j- NAME MAII.ING ADDRESS Y TEL# Email Address: Residential C m omer) Est Cost of Construction$ ' 4?OD aD Home Improvement Contractor Lic.# CPS 36513 5633 Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) I am the homeowner I am,ay() t)sole proprietor I have Worker's Compensation Insurance rn q Insurance Company Name: f v�a V e/{�$ Worker's Comp.Policy# 'WC -414 tbPo2-3—I l y I Z SHED INFORMATION New Size L x W /0 x HPer Town of Yarmouth Zoning By-Law Sec 2015 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 Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the best of my lmowledge and belief. I understand that any false answer(s) will be just cause for deniall or revocation of my lic se and or p/rrosecution under M.G.L. Ch.268,Section 1. Applicant's Signature: (�//t i �/�{' ' /� Date: Owners Signature(or attachment () & � L Date: Approved By: Date: Building Official(or designee) Zoning District Historical District Yes No Flood Plain Zone: Yes No Water Resource Protection District Within 100 ft.of Wetlands: *** Yes No Yes No ***Note:Conservation review required if within 100 ft.of Wetlands 9/13 - '_ __' - _'_ '_ ' _ ' - ' - . - - ' - - - - ~ _^ � � x�� �� `- ^ . ~ ' 4C D? CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) illemorroPTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Heather Vidal Robert E Bouchle Jr Ins Agcy PHONE Exit' 508-564-5560 I FAX No) 508-564-5531 1352 Route 28A ADOREBg rbouch(e@Bouchlelnsurance.com PO Box 400 Cataumet,MA 02534 INSURERIS)AFFORDING COVERAGE NAIL I INSURER A: Scottsdale Ins(Boston Ins Specialists) INSURED INSURER B: Plymouth Rock Assurance HH Structures LLC dba Hoophouse 8 INSURER C: MWCARP(Travelers) The Shed Place Attn: Ralph Bartlett INSURER D: PO Box 2430 Mashpee,MA 02649 INSURER E _INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R TYPE OF INSURANCE ADOL1109R POLICY EFF POLI�y EXP LTR D WVD POLICY NUMBER {MMIDDNYYY) (Og110 Y YYI LIMITS X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE S 1,000,000 TO RENTED CLAIMS-MADE 1TIC OCCUR PREMIES( lloomm 100,000 PREMISES(Ee 0opxralar) $ — MED EXP(Any one person) $ 5,000 A Y CPS3235633 08/07/19 08/07/20 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY Q JEC' ri LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE UABIUTY )tE D SINGLE LSAT $e widow — ANY AUTO BODILY INJURY(Per person) $ 100,000 —B OWNED X SCHEDULED PRC00001001722 08/07/19 08/07/20 BODILY INJURY(Per accident) $ 300 0O0 HIRED NON-OWNE,.^ AUTOS ONLY � AUTOS , _ DAMAGE AUTOS ONLY _ AUT S ONLY [Per a�cedent) $ 100,000 S INAIRELLA LIAR — OCCUR . EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DEC I I RETENTION S S WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I ER ANY PROPRIETORAPARTNERAMOUTIVE=1 EL EACH ACCIDENT S 100,000 C oFFicutaemeert excLuDED? uti N/A WC-4788P02-3-19 08/26/19 08/26/20 Mandyyaasa, EL.DISEASE-EA EMPLOYEE S 100,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Jane Hildebrandt ACCORDANCE WITH THE POLICY PROVISIONS. 154 Wianno Road Yarmouth Port,MA 02675 AUTHORIZED REPRESENTATIVE Robert E.Bouch)e Jr. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • The Commonwealth of Massachusetts Department of Industrial.AccIdents -' I Congress Str red Suite 100 Boston,MA 02114=2017 www rnass.goMedia Workers'Compensation Insurance Affidavit;Busttiers/Cr ntaartocslElectrtt aazs/Piwnbers. TO BE TILED WITH THE PERMITTING AUTHORITY. Applicant jpformatlon Please Print LIMY Name to ' 14-tom, G 1'11 t. )C FS P<-417„ Address: t Li- goAviz, h� CitylStatte/Zip: `YlknimetA .pwr," vok a '`7 Ph0ne#: "t(7• e G Are`yoe an employer?Cheek the appropriate bow j Type of project(required): 1. lam a employer with employees(full and/or part-time).* ; 7.Id New construction 2.0 I am a sole pronde r or pum p and have no employees } any amity.(No was' p. ance required.) waritin$for me in 8. -�Remodeling 3. I am a want doi all work aryl[No workers' 9. LJ Demolition coup.insur ice require!.]' 4. I am a homeowner and will be hiring ors to txesi all wait on 10-'Building edd*.on mare tint all ether have wars' !mope*. i will its ems* ' �, � ( i ?l.�Electrical repairs or additions ( I s.[ I am a ! 12.L]Plume repairs or additions and I have hired the hated on the mantled sheen ; i These lnwe r pdoye and have may'eon, i i. .0 Roof repairs t.0 We area corporation grad its officers have exeeci ed their right of a oc per MOM c. 14. O1ier 152,i l(4).and we have no comicyees.[No v„otimrs'car hates nos required.] *Any app[iaavttbet checks box al most also fill out the=Moo below Mown''their w ens'corapanation polity information. rionneewoms who submit Ws Madam*indeming duty am doing all wale and ten late outside connacross east aokestt a new affidavit indteeng s,elt ors that Mack thus box mat machedmiarkfitional sheetsbnwing the mum of he sub-pc notes and state whether or one those entities have employees. tiros s base°napf hye they must provide their waders'romp.Polley number. I am an employer that isprotddsrrgwarfare compensation irnsrtranae for my employees. Below its the policy and job site in onnadon wee Company Policy#or Self-ins.Lie.#: U1.t..` • - [ '3 - Icj Expiration Date: a- lie' ' 20 • • p I Job Site Address: t 4'14)1.0 yto O , CityiSntteiZ p: (71Zwt2.1 prjp1 IAA o „7r 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 violations punishable by a fine up to$1,5OO O0 andiar one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby�r loader tire pains and penalties of Pit that the information provided above is true and correct Sire. Date: Official aye only. Do mot write in this area,to be computed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.Cit.yffown Cleric 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone ° TOWN OF YARMOUTH. 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 Telephone (508) 398-2231 Ext. 1292—Fax (508) 398-0836 OLD KING'S HIGHWAY HISTORIC DISTRICT COMMI1trTEEff:, ,vlvu i ri 1 OLD KING'S HIGHWAY I%rrLit,.M i iU[1 rUr' CERTIFICATE OF EXEMPTION Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or print legibly: Address of proposed work: % Map/Lot# � J / Owner(s): r9 % jiW ?"!l (///) , /` i/1 T Phone#: Zis 7 o6 Lo f IDS All applications 5 4 must be submitted by owner or a,pcompanied by letter from owner approving submittal of application. Mailing address: I �( )� -k/J r� = ms Year built: s —5- Email\�(,�VV„C k-dC )k , (119 C irY1 t,l ( (_aivt Preferred notification method: Phone X' Email " U Agent/Contractor: Phone#: Mailing Address: Email: Preferred notification method: Phone Email Description of Proposed Work(Additional pages may be attached if necessary): RECEIVED 29201$ SC) Z,yI( ii`-t ,,ii^.; l // YYrr Signed(Owner or agent): ��; • ; i/! A.l. Date: > 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: Li—c`Lk— 19 Approved Approved with changes Denied rr : Amount a>� Reason for denial: a � 7,r Rcvd by: i3\i) tT� 3 _ jjt Date Signed: �// Z 41 9 Signed: l APPLICATION#. E 'I) 4 u V5.2017 Fite number: 140908-3 UNREGISTERED LAND Ittorner: D'ELIA &CAVANAUGH Deed Book Pu e Lender: CAPE COD FIVE CENTS SAVINGS BANK Pfun &iOk Page 1..4m.s; Owner: PHILIP&JESSICA BURT REGISTERED LAND Reg. Book 36848-B Sheet Lot(s): 58&59 Date: 9112/2014 Certificate of Title 184010 Issessor's.ttaD 126 Blk: Lot 25.1 Census Tract 14OR T 6,--I Q L i\'SPL t_ 1.1 i 1.'k 'T.4.N. Scale: 1"=60' 154 Ni4.V\O RU.-9l). l'-1R.110/.THPURT, .i A ! 'TIT F)--,7 \ V, -- - - - (9 - I I .o DRAIN I J , ',e EASEMENT i '�"�1' 1 1 t S 7\. /1\'''., pi/ '7o. e / V Ir�%= - /� TEMPORARY / 0 1 40' DRAIN /,/ / ,EASEMENT �'i 73 1 \\ \ �t -S6, w 1 73.71' RF ,, ,, ;, ,,, ,,,, :, , _... . , I APPROVED • , APR 2 '3 y : �L�`I%0`\'' P.' 2 _- ._ YAKMUU I H �— OLD KING'S HIGHWAY CERTIFICATION I CERTIFY TO THE ABOVE ATTORNEY.BANK.AND THEIR TITLE INSURANCE COMPANY THAT THE MAIN BUILDING,FOUNDATION OR DWELLING WAS IN COMPLIANCE WITH THE LOCAL ZONING BYLAWS IN EFFECT WHEN CONSTRUCTED(WITH RESPECT TO STRUCTURAL SETBACK REQUIREMENTS ONLY)OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS.GENERAL LAW TITLE VII.CHAPTER 40A.SECTION 7. FLOOD DETERMINATION r,A,ce•A,r rnr rm1lri I D.W cLItlUlwi tJ1:D1:.11!1GC KI yr CAI I U1ITLIII.I A CD1 iAI"RI rlrlil LIA'IA DI.vt\w,c AP 111•1 vim! 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