HomeMy WebLinkAboutBld-20-002552 V "` SHEDS LESS THAN 150 SQ FT SHALL BE Office Use only
of PLACED A MINIMUM OF 30 FEET FROM THE
Permit.'i
( ry �� FRONT LOT LINE AND A MINIMUM OF 6 FEET
{aid I ,.„H FROM THE SIDES AND REAR LOT LINES Amount 3S-
,,,„.A7T F CSS 4;v
',,,""^ ....., Permit expires 180 days from
issue date
r 'ZSS . RECEIVED
EXPRESS SHED PERMIT APPLICATIOM ---
TOWN OF YARMOUTH NOV 0 1 2019
Yarmouth Building Department
1146 Route 28 BUIL --N�_cc��_rr —_
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South Yarmouth,
MA 02b64 BY L - _
(508) 398-2231 Ext. 1261.
CONSTRUCTION ADDRESS: 16 )'1'&1(Q4 8 D R, W cYno)-A pk �/iI4.
ASSESSOR'S INFORMATION:
Map: Parcel:
OWNER: �4n f rrtQDJcyn tel;viI(& 161).c>le,lsland D2 368 p563V5'7 _
NAME V PRESENT ADDRESS TEL. #
CONTRACTOR: P".t. 41acb' w ode ?ca6oc4s _--9S96,jeen anntc DiAir%AI x,h t"-%6—-7, 3`15-Vg
NAME MAILING ADDRESS TEL.it L.
Residential 0 Commercial Est.Cost of Construction$ -1 7o 5•to 3
Rome Improvement Contractor Lic.N ( Cf 3 S/ Construction Supervisor Lic.R (7(3c-Psf
Workman's Compensation Insurance: (check one)
El I am the homeowner Ei I am the sole proprietor C I have Worker's Compensation Insurance
Insurance Company Name: Worker's Comp.Policy#
(/ STIED INFORMATION
New Size L O x IV la x H 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 14 x H
*The debris will he disposed of at:
Location of Facility
I declare wider 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 atswerls)
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: J//i/19
Owners Signature(or attachment) Date:
077Approved By:____ ci Date: .—..._..<....(...._....... (.._
Building Of7i (or ign EMAIL; RESS:
.*toning District:
Historical District: -I Yes No Flood Plain Zone: Yes ,: No
Water Resource Protection District: Within 100 ft.of Wetlands: ''='
Yes No 11 Yes L., No
***Note: Conservation review required if within 100 ii.of Wetlands
9f 1
The Commonwealth of Massachusetts
_ Department of Industrial Accidents
=::m== a 1 Congress Street,Suite 100
-44_ ��}__ a Boston, MA 02114-2017
Y. — 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 &(a-h 1s-' s Qearn Co j�/)1'(tl�)
Address: ? cI Queen .Ant. Road �`'
City/State/Zip: How leh,MA (2 ko -I1 Phone#: 568143O 02800
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with employees(full and/or part-time).* •
7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for milli, fi
any capacity.[No workers'comp.insurance requited.] 8. El Remodeling
9., ❑Demolition
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]'
10❑Building addition
4.❑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 l 1.0 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.El Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.❑We area 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: New 4an shire ExnplooaS jncura of e ('omptnr j
Policy#or Self-ins. Lic.#.Fit coop- i►.I pm95 7 - O i. A Expiration Date: Its A, do,Q0
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 u the pains an id i e` - ' s o erjury t t e information provided above is true and correct
Signature: El 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#:
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TOWN Of YARMOUTN i
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DUTCNLAND ' DRIVE •
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11181 toe foundelen as rem lo»~'.Ise antis•spool lied OCT .j r 2019 •
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Wed r.ln/w �a TOWN CLERK
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SOUTH YARMO. ;r, ;MA '• . .\
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RAHERTY ASSOCIATES .FOUNDATION AS
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'' YARMDUT
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Data 41e4tto �'' BARNSTABLE HOLDING CO.. INC. l
Scale re•to' • ' �'"• t '' - :/00 IV;MAMIST \
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From: Pine Harbor harwichoffice(Fopineharbor.corr- ,
Subject: Shed Plan
Date Oct 24, 2019 at 3:02:24 PM
To: mtiggerhl@aol.com
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ULU KINGS HIGHvyn,rAWSIIra"Pea:"..11=11=11ZIM
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Sincerely,
Laura Falletti
Pine Harbor Wood Products RECEIVEn
508-430-2800
OCT 3 0 2019
TOWN CL;.-r-
SOUTH
1i-a ); `8_,5
1Y TOWN OF YARMOUTH
k. ,. -V 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 � .
FFrivr D
r Telephone(508)398-2231 Ext. 1292-Fax(508) 398-0836
OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE'OL 28 [i `3
I YNNIVIULI f
APPLICATION FOR ( OLU KING'S HIGHVVAYr#
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: pp
Address of proposed work: II* -D cX'FC.�k a r 11 e0 40 ra 0,..16(3()IA- Map/Lot#
Owners):m a9O q A c `-DcQn,.QI el t� go Phone it: �p�'S '•r95n -- 39I
5
All applicatio must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: /4 '1D- t ci (a,i a -D Year built: / q� /
Email:_/)'TicQc f/'.C o'cl• 64"\ Preferred notification method: Phone ( Email
a4 ccDvc C
Agent/Contractor: ;sJC/1 uOnocl ?C'0cALAAA-S Phone#: l-O(O i0— 7t/3-35yi
Mailing Address: as 5 4 ve e``" cr evAR (L8, /LL �,,o,Ci ( iM O)b t/S .
Email: CI n 3 pa i/Lu Q p,� i gc-bo f, c cy n Preferred notification method: Phone X Email
Description of Proposed Work(Additional pages may be attached if necessary): • i
VED
w}-r Q X (a O ck 51se ', 1
RECEIVED thKlJIUUIf'
I OLD KING'S HIGHWAY I
OCT 3 G 2019
TOWN OLER "
SOUTH YARMOUT \l`J
Signed(Owner or agent): Date: /408/I1
> 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: J'/-. c&//9 V Approved ‘./Approved with changes Denied
Amount T' a 0 Reason for denial: 1 rio y ,tw .i 2 J
Gas S'tf 31Ci44.0v"R�Qis.“,y„r,.� �.tLo4.r -1v - %f.�w�i,y�cr . Q
Rcvd by: ''�V b 91 a.,..�y rw C Ave.a....ir�0k 4C.
Date Signed: 2/d 0o/ j Signed: 02 ,� q 4c �Y
/ APPLICATION#: t// /9
V5.2017
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- i, •
c' Office of Consumer Affairs and Business Regulation •
3
i ?' 10 Park Plaza-- Suite 5 170 _
, .- .- Boston, Massac< efts 02116
Home Improvement 40-,f_:':for Registration. " '"
Commonwealth of Massachusetts
Division of Professional Licensure
G • Board of Building Re Mations and Standards
McGRATH POST & BEAM CO. ! _ � Constructio ,� �_1 &2 Family
JAMES McGRATH
. 259 QUEEN ANNE RD. ==t - - CSFA-073865 A-
- HARWICH, MA 02645" _tiff--
= w� },"i• . A o fl
�4, JAMES R M• .. .1' `' ' '` - 0
..` • 204 CRANV ' y
o• ~M AO `ve:: R BREWSTER ' y , s e1.
wAiuwtif1n1714 �6 �O11
Commissioner •
V"`"
•
•
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Office of Consumer Affairs and Business Regulation
1000 Washing s n Street- Suite 710
Boston, :cry, husetts 02118 •
IhislitikHome Improve tractor Registration
—_-y ' Type: Corporation
�` - o # r' Registration: 132935
MCGRATH POST&BEAM CO. ; —;v .-
D/B/A PINE HARBOR WOOD PRODUCTS -- Expiration: 10/30/2020
259 QUEEN ANNE RD. '�
--
HARWICH,MA 02645 ',, _ -l— `1,,
F. .
A,1M` �Vs
Update Address and Return Card.
SCA 1 0 20M-05/17 .
Office of Consumer Affairs&Business Regulation
HOME IM- - • = ENT CONTRACTOR Registration valid for individual use only
_. before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
jr` _,-10✓30/2020 1000 Washhrgton Street-Suite 710
MCGRATH PU .,. -�s Boston,MA 02118
D/B/APINE y_1-_ 4jb�__ �-ODUCTS
s• T t=I--
JAMES R.MCG- .' -_j`I
259 QUEEN ANNE + -r=`'
HARWICH,MA 02645 Undersecretary Not valid without signature
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