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EXP SHED PERMIT APP CATION
TOWN OF YARMOUTH
. ,
Yarmouth Badding Dripartmem RECEIVED
—1
1146 Route 28 r
1
South Yarmouth,MA 02664 JUN 23 2020 I
1
(508)398-2231 Eat. 1261
NT
1- Phtp,
commuxunorramaips: LI --- 3. ( ut ' c• ......, ,_____,ASSESSOR'S INFORMATION:
CEIIIIIIIIIIIIIIC=IIIIIIIMI
OWNER: cf-- ' 1 CA ib, / • c— I- eMal 4 es . ' • Aait
NAME
Main'ADDRESS
TEL if
- CONTRACTOR. i
e 4 o•cD oo
NAME MAIL1140 ADDRESS
1111-•Ateradenthd 0 Commeread
Est Coe ofCtommemion S._3131C ,6 2________
Home Impromnest Contraeior Lie.013;29aa_ C000irnetion Supervisor Lie.0..C.D...E... ...ea
Worlonat's Comparsetion Immo= (the*..)
0 1 aim dm homeowner 1 0 I am ihe sole pyritic: &rime Wader's comp berm=
insuivoce Company Name: 5 (Widnes Comp.PoSay/ q -.1 Zi5 A
Bilnanutingli ,
New
,,„t
L._ ELL x ',IL._x if.10Y0" Corner Lot Yes No I,K
Side and rear setbacks foramessory buattnis loss than 150 square/eel and:kirk stoty,shall be 6feet hi grit districts, but
be no caw built closer Mann feet to any other bulkfing
Itqplace exisdag* Sim L______jr W x H
i
*Med**will be ditposed°far ,a)? sZci 4-44-n.0i it)f)London ellraellly
I denim under meld=et -• ' ilikinenle - •.twitained are one mad Gomm the belt ernolsowindke and Italia I nedwilwed dot Site
- will Inkjet awn ihr&aid - ,. r iew Nome fiwpweeeedoe ander WM.aL.26e.Section 1.
"Ir allma"
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Applicant 31000= T LP-iek......'..1
Ala____ciLiner.sa3.4..r.
Omen Illantare tor '.,. —41111191111M4are
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A PP a g'ad Br
- EMAIL Maims&
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, Zemke=shift
lifillorkel ' , - 0 Yes 0 No Flood Main Zoom 0 Yes 0 No
Water ' - Protection District Mein 100 It of Wedande*0*
OW. 0 No
***Noic .. , - ,,''• review required if within 100 ft ofWelonds
SV1.3..
, ,
r.,
_ The Commonwealth of Massachusetts
* !� Department of Industrial Accidents
1r 1 Congress Stree4 Suite 100
.1 Boston,MA 02114-2017
%.,..s.-_-_,:....Laril...77...=,/=,:i
www.nras�govldia
`iwti
Workers'Compensation Insurance Affidavit:Builders/Con tractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): MC (jd124h 'PM} d l3eQ117 rfrporithon
Address: a tsq (I ern Alla. Road
City/State/Zip: H rw!ch. A oiaPi'j Phone#: AB U a80a
Are you as employer?Check the appropriate tax: Type of project(required):
1.D I am a employer with employees(ftdl and/or part-time).' �r 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for tt 8. Remodeling
any capacity.[No workers'comp.insurance required.] '' ❑
3.0I am a homeowner doing all work myself[No workers'comp.insurance required.]* . "_ 9:,.❑Demolition
4.❑I am a homeownerud m will be hiring contractors to concoct all work on my property I will 10❑Budding addition
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
50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet
These sub-contractors have employees and have workers'comp insurance.: 13.❑hoof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c_ 14.DOther
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 won.
t Hogs 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'camp.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: 1 6/1 I"arnpshire ErnplaierS M,! lura ni e Corpin r9
Policy#or Self-ins.Lic.#:EJ c, (oO•yoaogs-i-a),$A Expiration Date:AT Iq 8, 420,,20
lob Site Address: '/ Pheusr4'f Co Jc9 a Ade- City/State/Zip: y Alt o✓+A ea rt OM 62.1.e.
Attach a copy of the workers'compensation policy declaration page(showing the policy admber 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 pains ' o information provided above is true and comet
Signature: Date:
4/aa7a0
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 Lone):
a;; ;,;. 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phoue#:
44 •�. PLOT PLAN
FOR LOT 0 / —6-6
Indicate location of Additions with dashed lines
or Y building
Sewerage disposal (cesspool) a
Well as
I I
�- �� ft. rear)
_' - -
Abutter's 4 5 Q
Name U,_ 1 Abuttouc'
Lot 1 at, I 11. Name
REAR YARD
:f this its a r , I'yI�`�io 4xsner lot, �'/b G?o--� If this
+rite in name ft. canner
street. I write 3,
name of
; 42' ` street.
• q
: SIDE YARD T :
• , HOUSE •
SIDE YARD •
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: G 1
LL
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R
A I ; g
(lot R. frontage)
• / et/ ) P)-Yeg g4.-,-21-- C.00-e-- C ft_c)42_
♦ / (NAME OF STREET)
lnfarneartkx
/ • Supper by )-� Q _ )'yr .0
LARK NORTH POINT �� e ms. CO p7 e ��.): A
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REG. t.A PI CI- SU Et V-Ig. . -R
1-,- - itcar :. CERTIFY rsotr THE BUILDING .... . . .-_.
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. - . , _ .._. _ -
I"T 1.9111111194
le .0 a- THIS Ik.-Litlif 1-S.. L.-OC.ATIED... O'N : - '; . • -' ' '' --- - --
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Al- --- - 'I -. .
a
Office of Consumer Affairs and usiness Regulation .
10 Park Plaia-- Suite 5170
-` Boston, Mas . . eats 02116
Home Improvement s or Registration,.
- =*_ -
)� 1 Commonwealth of Massachusetts
f i. Division of Professional Licensure
McGRATH POST& BEAM CO. - i�-- Z, f Board of Building R ulations and standards
JAIVIES McGRATH r- -_Avg Constructio ' s�iy.1 a 2 Family
259 QUEEN ANNE RD. - _ __ �, CSFA-073865 spires:03/14/2022
HARWICH,MA 02645 —
.- JAMES R WARM . l:
\ ----:--_-__---=-- - BREW 4
um ..
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. " suuiai�. .n.sae "�-�)! o* - ,
Commissioner ! r
•
•
*.F.Z. WarlariZepeiteleafel'4,.A2Jo4aalea .
Office of Consumer Affairs and Business Regulation
1000 W, .f;F Street-Suite 710
Boston, . L ,_ _,;�_ 02118 -
Home impro - _ . . : Registration
1 _- �/ Type:
•MCGRATH POST&BEAM CO. ��r Regionalist 132935
`, —_ `' �— 10130/2020
DNA PINE HARBOR WOOD PRODUCTS —°!
259 QUEEN ANNE RD. i :
HARWICH,MA 02645 • *. 11 / NISI
44*
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Ao zaEasra 4110-1-
Updste Address and Return Card.
°Moe od CsasamerMaio i ffssissse llsgebase
HOME • - = CONTRACTOR RsBisbutton valid for Individual use oag f
x �j .a,` ' before Ikeapiretlsa dah. If found morn to
1� t■, �� M
103012020 1eMraeldneou Wrest-Sun.710
MCGRATH - .-a _ J. - '- Boston,MA 01t11i
BIBS.NNE •1. . -
i'
JAMES R. :ter-: 0 :=
259 QUEEN ANNE ' ^r� Not vaNd without fire
--mat MA 02645 .•-.,
1
1 '
ACOR>fl' �-01 CLEF
`...� CERTIFICATE OF LIABILITY INSURANE I °"'E ""°°""�^�►
•
THIS AS A MATTER OF INFORMATION ONLY AND HOLDER.
@20
CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND ALTER �UPON THE AFFORDED B HOLDER.THIS
BELOW. THIS CERTWICATE OF INSURANCE DOES NOT CONSTR'UTE A CONTRACT BETWEEN GE LIRE BY THE POLICES
REPRESENTATIVE OR PRODUCER,AND THE ATE HOLDER lSSUN� Sl.AUTHORIZED
IMPORTANT: if the certMcete holder is se ADDMONAL INSURED,the )must have
If SUBROGATION o does not AN®, subject to the terms and conHNoris of the policy,certain poNcies��M may Mans or be t endorsed.
on
confer rights to the certificate holder in Neu of such ems)• ""� an andorsenwrht, A statement on
�,Inc. Earl. j
South Dennis,MA 02660 PI'01 o• tom)553-1so� (, *own 81 5s
d:8
INSURERON COVERAGE MC.
INSUREDrxA:Travelers
McGrath Post&Beim Corp Neuman:New Hampshire 13083
dha Phis Harbor Wood Products INSURER c
259 Queen Anne Rd INSURER D:
Harwich,MA 02645
INSURER E:
COVERAGESINSURERF:
CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICES OF P4SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INISU
INDICATED. NOTWIT'HSTAND 3 ANY tr, TERM OR CCNDrfCN OF ANY CONTRACToROTC NAMED U FORTCTTO WHICH
CERTIFICATE MAY BE ISSUED MAY PERTAIN, THE WSURANCE AFFORDED BY THE POt 3 RE3PECTLL THE TE S.
EXCLUSIONS AND CONDmONS CIF SUCH POLICIES.LI5T3 S MAY HAVE BEEN BY PAD CLANS. IHEREN NOR
IS SUBJECT T o ALL TE(i�1S,
tilt TYPE OF t ee1D POLICY NUMBER �pprYEFF ACM
yYyn I LAM
CONMERCIAL uaeOrr
1 ChA11r3i1lIDE OCCOR
III�EIr TO
accumanos) $
I EDaao Pmens m son) $
GEHL AGGREGATE MIT APPUES Pat PriiSONAL&ADV N ItJRY $
GENERAL AGGREGATE $
avrlez , P OIICrS-COYPIOPAGc $$
ANY AUTO cOM )Be+oLElaeT ; 1,000,000
1/31/2020 1/31/2021
=ONLY X AUr t 66nsYMtA1RYlParowsan)BSOLY INJURY!Per $
II
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$Ma
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CERTIFICATE HOLDER CANCELLATION I
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Town of YarmouthSHOULD ANY OF THE ABOVE, . POLICES BE CANCELLED Dept
THE E xPIRATION DATE - _. BEFORE
E DATE_
• •,,NOTICE WILL BE DELIYBEED PrVRTN TI
11 Main St,Route 213. 1
South Yarmouth,MA 02664 AhrrthOR�p NTAnre II
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ACORD 25(2016/03) � —�--
0196a.2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered modulo,ACORD
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RECEIVED
JUN — 4 2020
RECEIVE .0.-
TOWN OF YARMOUTH OLD ING'S HIGHWAY
JUN 1 8 2021 0 1146 ROUTE 28,SOUTH YARMOUTH, MA 02664-4451
Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836
TOWN CLERK
SOUTH YARPhOUTh ►vOLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
APPLICATION FOR
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.
Time or print leuibly: L'
Address of proposed work: 41 Pheasant Cove Circle Map/Lot# /4 47 - 6
Owner(s): Gerald & Kathleen McClellan Phone#.508-744-7396
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: 41 Pheasant Cove Circle, Yarmouthport, MA 02675 Year built: 1973
Email: KSM06795@gmail.com Preferred notification method: Phone X Email
Ment/Contractor: Phone#:
Mailing Address:
Emai: Preferred notification method: El Phone El Email
Description of Proposed Work(Additional panes may be attached if necessary):
Installation of 8'X 10' Pine Harbor Quivett Cape shed. The left side back corner of the shed will be
located 13'from the rear property line and the back right side corner of the shed will be located 20'from the
right side property line. The shed will have cedar shingles on the front wall and wide pine exterior wall
board (natural color) on remaining walls. Roof will be covered in architectural shingles that match the
house roof. The front of the shed will have one 24"X 38"window with white shutters (matching house).
The 3' shed door will be painted the same color as the front door of the house.
Signed(Owner or agent): tact 1-� Date: 6/1/2020
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: (0-L}'oZ 0 Approved Approved with changes Denied
Amount a() Reason for denial: . a Is i1
Cash/CK#: I I 1
Rcvd by: per/ JUN 1 7 2020
YARMOUTH
0 D KING'S HIGHWAY
20-E046
Date ApprOVed Via Email on 06/17/2020 APPLICATION#: (90—ECM/
By:OKH Chair,Richard Girth
V52017
Vozella, Beth
From: RICHARD GEGENWARTH <r.gegenwarth@comcast.net>
Sent: Wednesday,June 17, 2020 1:08 PM
To: Vozella, Beth
Subject: Re:41 Pheasant Cove Cir 20-E046 Shed
Attention!This email originates outside of the organization.Do not open attachments or click links unless you
are sure this email is from a known sender and you know the content is safe..Call the sender to verify if unsure.
Otherwise delete this email.
Simply elegant. I approve.
Richard
On June 17,2020 at 12:07 PM "Vozella, Beth" <BVozella@yarmouth.ma.us>wrote:
Hi Richard-
RECEIVED
Attached is another COE for your review/approval. JUN 18 2020
TOWN CLERK
SOUTH YARM O U T H, MA
Thank you,
-Beth
Beth Vozella
Office Administrator
Yarmouth OKH Committee& Historical Commission
Town of Yarmouth
1146 Route 28,South Yarmouth,MA 02664-4451
Tel: 508-398-2231 X 1292
1
RECEIVED
c TOWN OF YARMOUTH JUN - 4 2020
1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-4451 YARMOUTH
Telephone(S08)398-2231 Ext.1292 Fax(508)398-0836 OLD KI NG'S HIGHWAY
OLD ICING'S HIGHWAY HISTORIC DISTRICT COMMITTEE
WAIVER OF 45-DAY DETERMINATION
The applicant/applicant's agent understands and agrees that due to the current declared National
and State public health emergencies the determination of our Application for a Certificate of
Appropriateness/Demolition/Exemption may not be made within 45 days of the filing of such
application.
The applicant agrees to extend the time frame within which a determination is to be made as
required by the Old King's Highway Regional Historic District Act.
SECTION 9-Meetings,Hearings, Time for Making Determinations
"As soon as convenient after such public hearing; but in any event within forty-five (45) days
after the filing of application, or within such further time as the applicant shall allow in writing,
the Committee shall make a determination on the application."
Applicant understands that the review of this application will be scheduled as soon as the
situation allows. / / /
Applicant/Agent Name (please print): 6 eac/ S ' Pe`e ` ` -
Applicant/Agent signature: -^+' /' yY` Date: ‘0l//,?,0 o)a
RECEIVED
JUN 18 2020
TOWN CLERK
SOUTH YARML i. 71-,, i.9,
Application#: Rty-i1O�
3/2020
E y
C_ C ^ c l e_ 1 RI CEIVED
JUN - 4 2020
`.'c- YARMOUTH
Cc? lug- OLD KING'S HIGHWAY
APP�®VED
JUN 1 7 2020
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So Much Comes Standard!
O Solid concrete block footings 0 Premium wide pine exterior wall boards 0 36"x72"bead board door 0 Board&batten siding on 3 walls
O 2"x6" pressure-treated joists 0 6'5" interior wall height with ramp&black hinges 0 3-tab asphalt roof shingles
16"O.C.-2"x8"for 12'wide buildings 0 Diagonal wind bracing at corners 0 Lockable door handle system with 25-year warranty
O 5/8"StabledgeTM flooring 0 5/8"StabledgeTM roof sheathing 0 Two 12"black strap hinges 0 Variety of options to customize your shed
with 50-year warranty O 4'deep storage loft(Quivett Cape only) O 8"x8"aluminum gable louvers 0 12'walls or less across the front
O Triple 2"x4"wall corners 0 Solid cellular vinyl PVC Trim boards 0 White cedar shingles,primed include 1 window
O Double 2"x4"door posts 0 Classic vinyl single hung 24"x38" clapboard or Everlast•Composite 0 14'walls or larger across the front
O European spruce premium framing, window with b5 screen Clapboard on front wall include 2 windows
panelized walls
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CLASSiC 25 Year Asphalt
halt Roof Shingles
The perfect blend of fashion & function ROOF PITCH-10/12(Quivett)
5/8"Stabledge""Roof Sheathing COLLAR TIES-2"x4" ®24"O.C.
TRIM-Solid Cellular 4
RAFTERS 2"x4" 024"O.C. -..i_I
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WINDOWS-Vinyl 24"x38" ';',t; �,- i ,1 with premium 1"x12"fine Boards
Single Hung with Screens ,' 1 I ~`'�=� /' (Total Wall Height=6'41/2")
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SHUTTERS Optional 11 a i i j_:_ q/ i —
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RAMP-Pine ((�� OAL DOORS on ble Erig poirn
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or Everlast®Composite Clapboard ;i ® 16"O.C.(12'Wide Buildings use
s---. SIDES and REAR WALL-Board&Batten a Pressure-Treated 2"x8" (Zo 16"O.C.)
CONCRETE BLOCKS-8"x8"x16""Solids" FLOORING-5/8"Stabiedge"'