HomeMy WebLinkAboutBld-20-003335 r
1 THANOffice Use Only
SHEDS LESS 150 SQ FT SHALL BE 9,,
Q�' Ott,:. PLACED A MINIMUM OF 30 FEET FROM THE Y - fl 35"
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tp ��I FRONT LOT LINE AND A MINIMUM OF 6 FEET
Ott R Ho FROM THE SIDES AND REAR LOT LINES Amount
MA�tTACF C 'V
\° =�t,,,,try,, i'ennit expires ISO days front
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t5sue 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: 3 \Qll w.$ %AA o-v, '.T
ASSESSOR'S INFORMATION:
Map: '1 b Parcel: g J
OWNER: ,sLt•w v. Rui'0-,^- ,' 3 I \irs5►wc.•c. tier 1zy a;b 3c(2(
NAME PRESENT ADDRESS TEL. r'
CONTRACTOR: SLG.w v` Zvi,c'w-e 3 (ft IIMSvt't - pr 714 f•36 Svit
NAME MAILING ADDRESS TEL.#
esidential ❑Commercial Est.Cost of Construction$ 31 000
Rome Improvement Contractor Lie.# Construction Supervisor Lie.n
Workman)Compensation Insurance: (check one)
VI am the homeowner I am the sole proprietor C_ I have Worker's Compensation Insurance
Insurance Company Name: Worker's Comp.Policy#
SHED INFORMATIO.N
1 i1
New ✓ Size L lc x IV /0 x H t\ to Corner Lot: Yes t✓No
Per Town of Yarmouth Zoning Bp-Law Sec 203.5 E:
Side and rear setbacks for accessory buildings less than 150 square feet and single stoiy, 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 1-1
*The debris will be disposed of at:
•
Location of Facility
1 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 answers)
will be just cause for denial or revocati n of tv license and for prosecution under M.G.L.Ch.263.Section 1.
Applicant's Signature:___ I Date: �2I I D/ Z O /
--
Owners Signature(or attachment) ..]( 7- Date:_ jUl
Approved[3y:___"- R Date: /��r//��
uildina Official for designee) EMAIL ADDRESS:
Lonnta District:
Historical District: Yes No Flood Plain Zone: Yes : No
Water Resource Protection District: Within 100 ft.of Wetlands: "''
i.] Yes Li No
"'I:Note:Conservation review required if within 100 ft.of Wetlands
9/13
The Commonwealth of Massachusetts
1 Department of Industrial Accidents
1 Congress Street, Suite 100
0__ Boston, MA 02114-2017
r;,.ss* www.mass.gov/dia
\Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
LE I am a employer with employees(full and/or part-time).* ' 7. ❑New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling
any capacity.[No workers'comp.insurance required]
3.0 I am a homeowner doing all work myself. [No workers'comp.insurance required.]t
9. El Demolition
10 E Building addition
4.0 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.]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. j ❑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.Q 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:
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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#:
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
PLOT PLAN
FOR LOT #
Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool) ED
Well 0
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I (lot ft. rear) I
Abuttor's (p 1> _
Name Abettor'
Lot It1 Name
Lot #
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\ Information
Supplied by
PARK NORTH POINT
, R$ 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 RECEIVED
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEEr,R — 6 201
APPLICATION FOR i At (AU'UI c h
CERTIFICATE OF APPROPRIATENESS OLD KING'S HIGHWAY
Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 as
amended,for proposed work as described below&on plans, drawings, photographs, &other supplemental info accompanying this
application. PLEASE SUBMIT 4 copies OF SPEC SHEET(S), ELEVATIONS, PHOTOS, &SUPPLEMENTAL INFORMATION.
Check All Categories That Apply: Indicate type of Building: Commercial ' Residential
1) Exterior Building Construction: New Building Addition _Alterations Reroof Garage
Shed _Solar Panels Other:
2) Exterior Painting: _ Siding Shutters Doors Trim / Other:
3)Signs/Billboards: New Sign Change to Existing Sign
4) Miscellaneous Structures: Fence Wall Flagpole Pool _ Other:
Please type or print legibly:Address of proposed work: /T/'
t/1 oty P.9j/4//4Q '/ //ivlap/Lot# /it/ . .S-'
i
Owner(s): ,5 E1 Even I v P a". Phone#: 70 8'..76'319?S'
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: 3 bl.dbn.S 4-11 f/t Q ' Year built: / 912-___
Email: )' 14e hl t1 1O2-O6) 11-6riii+i/. Cowl Preferred notification method: i� Phone Email
Agent/contractor: Phone#:
Mailing Address:
Email: Preferred notification method: Phone Email
Description of Proposed Work: --
/6 X IT ,ik.ed
iAl • SOLJT,', '
Signed (Owner or agent): 'CI, f ADate: 3/6/,S
> Owner/contractor/agent is aware that a permit is required from the Building Department.(Check other departments,also.)
> If application is approved,approval is subject to a 10-day appeal period required by the Act.
> This certificate is good for one year from approval date or upon date of expiration of Building Permit,whichever date shall be later.
> All new construction will be subject to inspection by OKH.OKH-approved plans MUST be available on-site for framing&final inspections.
For Committee use only: r,/ Approved Approved with Modifications Denied
Rcvd Date: 3 I i Reason for Denial:
Amount 07 s.5- --, _ -• )
Cash: i h I I ,u
i � 9
Signed: IP—
Rcvd by: `7 l 1 I
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,/ :',.;
I
45 Days: �/0c 7 a''/
Date Signed: �/Z 5 / 2-ct 7 /(
1 APPLICATION#: ) 9 A 0 2
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' PLOT PLAN
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FOR LOT # �5 ,RECFI
Indicate location of garage or accessory building MI F 2019
Additions with dashed lines
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IARK NORTH POINT 'I MA
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FOR LOT # P 5 RFCEVEb
Indicate location of garage or accessory building - 6 20i1 Additions with dashed lines
Sewerage disposal (cesspool) ES, Y N K M U U I h
Well " TOLD KING'S HIGHWAY
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