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Home My WebLink AboutBld-20-003770 Y y :^ SHEDS LESS THAN 150 SCE FT SHALL BE Office Ilse t.)nt�, -, PLACED MINIMUM OF 30 FEET FROM THE 244_aZO - 003? a ( : `}o FRONT LOT L NF AND A M!Nirv1UM OF 6 FEET ' n -- !^ S n!17otim cJ THE tyy�-,, ..OM ` SI DES C".=:iVD RF.,>R L%>I _,N� - ----. ... Permit expires ISO dry,:,from issue date n En EXPRESS SHED PERMIT PLIC O TOWN OF YARMOtilII Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 /' (508) 398-2231 JExt. 1261i , �/ CONSTRUCTION ADDRESS: /,� (�4 R./.__ (/` ' /�1 " a ek ASSESSOR'S INFORMATION: Map: /` Parcel: /5 OWNER: I= W 4wsce-14.) / h/ -T R I. cesr 3,7-6 Y240 NAME PRESENT ADDRESS TEL CONTRACTOR: # 511eO /9 .._ . NAME MAILING ADDRESS TEL,. sideutial 0 Commercial Est.Cost of Construction'S c Home Improvement Contractor Lie.g Construction Supervisor Lie.# Workman's )pcnsation Insurance: (check one) am the homeowner I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. Policy,+ SHED INFORMATION New Size L x TV /Z x H Corner Lot: Yes No V Per Town of Yarmouth Zonin,Br-Law Sec 203.5 E: Side and rear setbacks for accessory buildings less than 150 sCjuare.f'ct and shi le stu'h, stall be 6 feet in all districts, but in no case built closer than 12feet to any other building Replace existing* Size L _X I;t N I-I 'The debris wilt be disposed()Fat: 4 Location of Faeillt.v I declare wider penalties of perjury that the state nTaats herein contained are true and correct to the best of my knowledge and belief !uu:lct tt:1nd that am,Use aniwerts: will be just cause for denial or revocati n of my license and icr prosecution under M.G.L.Ch.2o5,Section 1. Applicant's Signature: _...._..__ __-- I,)&IC. /1 /7;' Owners Signature p attachment) Date:_..,,./9 y.,_ZO Approved l3•y; '.� r� Date. Buntline Official fort ann' Llv AIL ' DDEf 5.S, Zoning District: I lir;toricol District: Yes - No timid Plain Lone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands Yes No r e Psi, .Note: Conservation review required if within 100 t1 of Wetlands The Commonwealth of Massachusetts I / Department oflndustrialAccidents 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): Address: \5 City/State/Zip: fi► � Phone #: �0 a/U Are you an employer?Check the appropriate box: Type of project(required): I.�I am a employer with employees(full and/or part-time).* 7. E New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑ Demolition `f m a homeowner doing all work myself. [No workers'comp. insurance required.]t 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 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.�lam 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.❑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: 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 a er tl d penalties o ze information provided above is true and correct. Sitrnature: 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#: f , . . • soi PLOT PLAN FOR LOT # Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool.) Well. IN I I _ _ I (lot it. rear) I Abuttor's 10' Name Abettor' Lot M I Name I Lot # this is a REAR YARD :orner lot, ft. If this vrite in name comer If Street. I write i name of a. other I, ,� street. i • • . • SIDE YARD • HOUSE SIDE YARD : . • SET BACK . • . ,4 ft. I 40. (lot ft. frontage) / \ , ti (NAME OF STREET) Information / ` Supplied by PARK NORTH POINT