HomeMy WebLinkAboutBld-20-004770 r
r SHEDS LESS THAN 150 SO FT SHALL BP
.-
Office Use Only
./O" PLACED MINIMUM OF- 30 FEET FROM THE P rnnit-;
rf . .� }c4 FRONT L NE AND A M!NIMUM OF 6 FEET �-"
Q : y; _R THE I� AND R Amount
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=: ' Perna expires ire ISO days fr tot
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1 E E VED_I,
EXPRESS SH l I ' A P yA , +7
TOWN OF YARMOUTH 1FEB 27 2O2ui i
i
Yarmouth Building Department J 1
1146 Route 28 ! BUh_DING DEPAR M IL:NT i
South Yarmouth. MA 02664 t _''''„_.w_ ._.w -- y=_�
(508) 398-22 1 Ext. 1261
CONSTRUCTION ADDRESS: / / aOMip/io "'9 N y)&mo'U1 PUl'c1 / w"- ��' 7�
ASSESSOR'S INFORMATION:
Map: / 3 I Parcel: / 0
OW N l R: KPII E`i i-eMOY/lni D3X.0}►L&E 1 S Y OtMp9yvo 1W \hyte 11u11}• PM- .ram-?G 2-iti.6 9
NAME PRESENT ADDRESS TEL ,':'
CONTRACTOR: I,►Kie )119(1.43c - 2 3 , ( u' .1ti AA) (10_ - /-knU.t c 11, /WI p2G4J W-430-?.j'o D
NAME MAIL DICr ADDRESS ILL.If
csideutial 0 Commercial Est. Cost of Construction';; LI OOO • D 0
Monte Improvement Contractor Lic. / 33 Construction Supervisor Lie.# 0 73k .5.-
Workman's Compensation Insurance: (check one)
-' 1 am the homeowner . I am the sole proprietor I have Worker's Compensation Insurance
1 /� C cc 0 y 0 OD Q -
insurance Company Name: � I�(/ 1 l 1 1� ----- Worker's Comp.Pt,iic-,-, L+ � V
SIZED INFORMATION J v 1 ti"r
New ✓ Size L x IC x H Corner Lot: Yes No +.
Per Town of Yarmouth ZouinE Bp-Law See 203.5 E:
Side and rear setbacks for a Ce.Ssoty buildings less then 150 Spare,feet and single sloi'1C s/tall be A ft et in all districts, but
in no cash built closer than 12feet to any other building.
Replace existing Size L. O x l /0 a H
"l he 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 knov,teiltte and belief- I uudersLuxl that any Ruse aittocerl:;;
will be just cause for denial or revocation of my license and for prciCeution urdcr\.I.0 L.CI) CA),Section 1
;Applicant's Signature: 1 17-7s- Date: 2- /5- Z d
Owners Signature(or attachment) . .--- Date: 7-) )���Z°��yy
Approved Bs:: ,/ Date_ .ep G0(
Buildut_011ie' or ,.lne_) [SlAl DRESS.
Zoning District ---
I
I lisiorit al District: 't es No Flood Plain Zone: • Yes Ni. 1
Water Resource Protection I)isirict: Within. IOtt ft.of Wetlands: .
Yes No Ye-_ No
***Note: Conservation review reyuir=art if within 100 I) of:Wetlands
t':`1=
1"`‘ ;✓/2e 1 . t/l kezot, .
~ r Office of Consumer Affairs and Business Regulation
f a' 10 Park Plaia-- Suite 5170
...,.....,4--- - Boston, Massac,, etts 02116
Home Improvement at t• :,� tor Registration,. - .
• - 7�=u. Commonwealth of Massachusetts
Division of Professional Licensure
= vi Board of BuildingRegulations and Standards
IVIcGRATH POST& BEAM CO. _ ��_ Constructio ,� otr� �.1 &2 Family
DAMES McGRATH •
_ •
. 259 QUEEN ANNE RD. ==_ CSFA-073865 : - r
- HARWICH, MA 02645 tr
........7...
- `*t JAMES RM e.
• - s. - 204 - ki. C
O'1M.0 ' :; i BREWSTER ,y. . < &f
.? ciuManir1111,1 - 0/' 00
Commissioner a
•
Office of Consumer Affairs and Business Regulation
1000 Washing •n Street-Suite 710
Boston, -r-c husetts 02118 .
Home Improve �" tractor Registration
- R = a Type: Corporation
MCGRATH POST&BEAM CO. • __v Registration: 132935
DB/A PINE HARBOR WOOD PRODUCTS " Expiration: 10/30/2020
259 QUEEN ANNE RD. =_== t
HARWICH,MA 02645 5. — ` W
•
vs
SCA 0 17 Update Address and Return Card.
•
Office of Consumer Affairs&Business Regulation
HOME lM- - • ,= ENT CONTRACTOR Registration valid for Individual use only
t before the expiration date. If found return to:
- Office of Consumer Affairs and Business Regulation
710/30/2020 1000 Washington Street-Suite 710
MCGRATH '• .72 -a s`" Boston.MA 02118
• D/B/A PINE y- _ __- -ODUCTS
JAMES R.MCG- 1- /
259 QUEEN ANNE
HARWICH,MA 02845 Undersecretary Not valid without signature
•
. 4
The Commonwealth of Massachusetts
► _ At Department of Industrial Accidents
®� a 1 Congress Stree4 Suite 100
= y 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): Mr (-j(a-}h ?tom-} t 3earn G f x Io
Address: a.sq Queen Anne. Road _ � `'
City/State/Zip: HQrW I ch,m A °J(P l I5 Phone#: 508 '130 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. ❑New construction
2.0I am a sole proprietor or partnership and have no employees working for m&iji 8. El Remodeling
any capacity.[No workers'comp.insurance required.] •`'
3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9., 0 Demolition
10 Q 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 11.0 Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.0 1 am 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.:
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Qothe[
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 Hampshire Ernploiers lncura nl e Cornpiny
Policy#or Self-ins. Lic.#:FCC,'oUO- L1 Q D 1S 7 -Q I$A Expiration Date: V ult.' i�t p7On
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 he pains an Le t e` I�' s o erjury t e information provided above is true and correct
Signature: 4 / 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#:
��,z°�_YARo TOWN OF YARMOUTH RECEIVED
;"' 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451
,..\:. , Telephone (508) 398-2231 Ext. 1292—Fax(508) 398-0836 FEB 2 5 2020
RECEIRB
YYARMOUTHKING'S HIGHWAY HISTORIC DISTRICT COMMIT D KING'S HIGHWAY
FEB 2 7 2020 APPLICATION FOR
TOWN CLERK CERTIFICATE OF EXEMPTION
SOUTH YARMOUTH, MA
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: -7 9 1(�U'Mv Di No (C-0 \) 'cri Rx� Map/Lot# /3 V/0 )
Owner(s): blrir Al 4 I t)i j o/V/j l-) Ll 1- Phone#: S -3(L" CAC 1
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: Year built: / ((P.1)
Email: TJ...dor L-c.0 C_oyr cif-t-. n,,&± Preferred notification method: Phone v Email
Agent/Contractor: J )e'' I"i'tj bn- Phone#: SQ-y 3 0- 2-11v0
Mailing Address: 5.9 Q ti' -E ffA/ 4/vA)E R9 / M l,J" %1 , Y' 1 U2 C J—
Email: /t'FOC Q: NE-hIr V yf_ - (o,') Preferred notification method: t/ Phone Email
Description of Proposed Work(Additional pages may be attached if necessary):
f Jed d;NG 4 0 N'lA f14 0 -it) 0- p)vie ect (yv I;c 3 k J', (pis OF I-k)'Ji T -
A\\ S;c1, u.e et -1/4.-,,— -t,.) l`1 , 0r.A-e_ dc3o r,
Signed(Owner or agent): .1:;---- • r) --- Date: Z' 2°
> 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: ,
ac ,91-.) Approved Approved with changes Denied
Amount
� a Reason for denial: APPROVED
cast #: a,-..\-73 FEB 2 7 2020
Rcvd by: L Y
YARMOUTH
nLD KING'S HIGHWAY
51)
Date Signed: aJ�7/aoaU Signed: Cy 6_ / —..,.,� APPLICATION#:2 0 E 0 1 6
v52017
REt E�VEp 1 APPROVED j
FEB 2 7 2020 ? FEB 2 7 2020
POMPANO RD KYINARD'S MOHUIGTHHWAY OLD K NG SO
UTH OLD HIGHWAY
t 100' >
AA
IRECEIVED IVED
F EB 2 7 2020
32'
TOWN CLERK
SOUTH YARMOUTH, MA
41'
22' .....+EFOUNDATION
aAG
110' , A 22' 27, 110'
G
110 .44
6' E
mm
<- 8xio E 14' —>shed
FENCED YARD
35 ) 47'
L —
e
t 100' >