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HomeMy WebLinkAboutBLD-23-003167 CO 1 S ectra, i.A.- Ii ' -- �f ARRECEIVEDOffice Use Only lin— fi4C\ F • 'liaj .r �01/0/2'C._. Permit# � T; n c,. DEC 0 6 2022 22 ",..,..:�.j"_a I Amount JS BU E' • ` tt- • * Permit expires 180 days from By issue date EXPRESS SHED PERMIT ��—a3 I(� 7 APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 � J/- (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS:_� V// I i-on �Q� W e s f Gill, p(�(��-11 /11 XI OWNER:Se,-Kr`e v-CJ J fazzIalr-� yoSs L.�,(4J,_ Rvfe,4, FL 33yg7 NAMFU /� �9 PRESENT ADDRESS � TEL # ,Q CONTRACTOR: ��G0c�SI) �_ _ L "% s,ill C. aCo .o*eeYl 12 '. / i,,,,j�l� NAME MAILING ADDRESS TEL.#xpg-39y, 1.3ss,0 9 36 v gytefidential C Commercial Est.Cost of Construction$ ✓',3 , C.o - `-'" Home Improvement Contractor Lic.# / p2Y 7 6,9 Construction Supervisor Lic.# CCJ —O 7 D/ 7 7 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor 'have Worker's Compensation Insurance Insurance Company Name: 45SCe.,&Vivi e(.S 7ihSu/t.: Co. Worker's Comp.Policy# &)CC 'SDO ' 0P Sooa -Zo z a 4- SHED INFORMATION New V Size L /y x W /0 x H l L/ Corner Lot: Yes No x Per Town of Yarmouth Zonin,Bh-Law Sec 203.5 Note E: Side and rear yard setbacks for accessory buildings containing one hundred fifty(150)square feet or less and single story, shall be six (6)feet in all districts, but in no case shall said accessory buildings be built closer than twelve (12)feel to any other building on an adjacent parcel. All sheds are required to be located thirty(30�feet from anyfront lot line Replace existing* Size L x W x H ��QnN4t 7407tpIll4 *The debris will be disposed of at: ./7//2/t7Z_____ Location of Facility I declare under pena " . ha e sta ents herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for deni rev "on o y license and for prosecution under M.G.L.Ch.268,Section I.— f� Applicant's Signature: Date: ' 2 Owners Signature(or attachment) Date: 1 Z • 5 v Z'L Date: Approved By: /�• .< Building Official(or d ee EMAIL ADDR ' Zoning District: I listorical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands:*** Yes No Yes No ***Note:Conservation review required if within 100 ft.of Wetlands 3/22 PLOT PLAN FOR LOT #(2.. 9• c Abe locatica r# garage or building Additions with dssta� lines �' Sewerage disposal (cesspool)~ 059, ,_- Wefl21 I I I Co ( ................ft. rear) Abutter's i Name �^ 10X j Lot# �1(/ 4 Abutter's Name Lot# • If this is a REAR YARD corner lot, If this is a write in corner lot, name of street. 1 ft. write in f' name of street. •d $ v tq SIDE YARD SIDS YARD • �_ • HOUSE . • • f • SBT BACK • ft. i `0, ( ct ft. frontage) \ i I t-d n IZ oaaQ_. / (NAME OF STREET) , ( / ` SI Gl)Supplied by C The Commonwealth of Massachusetts ►"_ r, Department of Industrial Accidents = 1 Congress Street, Suite 100 ='= f= Boston, MA 02114-2017 www.rnass.a ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansiPlumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information /�/� PIease Print Legibly Name (Business/Organization/Individual): S Ii e_ rilA.S 1 o hi Ca r p ��1'�(�1 Z h L' • Address: ,2 D 1)Ofe P.DRZ d Cci`t°-e- cool D l�l hi iL.�'�l) I�'J/=} D`Pho�e #: • 3—O 8' City/State/Zip: Are you an employer?Check the appropriate box: Type of project(required): I.'I am a employer with 6? employees(full and/or part-time).* 7. E 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.] 9. ❑Demolition 3.El I am a homeowner doing all work myself.[No workers'comp.insurance required.]I. 10 [] 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.n Plumbing repairs or additions 5.❑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.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.['Other 5 Gt 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: S,SCC• imp/D er•S .Ln. r`�z�C t� COm i .n!)i Policy#or Self-ins. Lic.#: A) -e-— SOD- SO.23 00.- a 0 a P../Expiration Date: v$l02 $ a o Job Site Address: q U1//f on l ,Ct 1 l�($t �C�r-v7 j D ii l 'atelfi 'O a 7,3 Attach a copy of the workers' compensation policydeclaratfbn page(showing the policynumber and expiration date). P P ) 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$250.00 a day against •= ' o ator. • co. of this statement may be forwarded to the Office of Investigations of the DIA for insurance covera;- - . c. '.441 ►' 1 do hereby c• . r• rains and penalties of perjury that the information provided 'hove true and correct. -4010 Sian, Date: 1 Z S 2 2--- Phone '19$ 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#: A�ORL�� DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/9/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: RogersGray, Inc. -Kingston Branch PHONFAX E 63 Smith Lane8_746-3311 ,Not 677 816 2156 (Arc,�-FXti: Kingston MA 02364 E-MAILADDRESS: mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Main Street America Assurance 29939 INSURED SHEACUS01 INSURER B:Arbella Protection Insurance Company,Inc. 41360 Shea Custom Carpentry, Inc.20 Doten Rd INSURER C:Associated Employers Insurance 11104 Plymouth MA 02360 _INSURER D: INSURER E: INSURER F- COVERAGES CERTIFICATE NUMBER:92168012 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONCITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER (POLICY LTR INSD� DIYYYY) (MMIDDVYYYY) LIMITS LT WVD A X COMMERCIAL GENERAL LIABILITY MPJ1774M 3/12/2022 3/12/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 �_�JECT X POLICY PRO LOC PRODUCTS-COMP/OP AGG $2,000,000 $ OTHER: B AUTOMOBILE LIABILITY 1020010065 12/11/2021 12/11/2022 Ca aBINED NGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS PROPERTY DAMAGE X HIRED x NON-OWNED (Per accident) $ AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ RETENTION$ C COMPENSATION WCC-500-5023002-2022A 8/28/2022 8I2812023 �PER E ��� WORKERS AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) i EL DISEASE-EA EMPLOYEE $500,000 It yes,describe under I EL DISEASE-POLICY LIMIT $500,000 _DESCRIPTION OF OPERATIONS below A Commercial Property MPJ1774M I 3/12/2022 3/12/2023 Personal Prop 1' $5,000 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU_THQg12EDREPRESENTATIVE =' tip;_ 141,,,--Z -- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • Commonwealth of Massachusetts 1 Division of Professional Licensure Board of Building Regulations and Standards Consti!utti6044parvisor CS-070177 E cpires:05/30/2023 EDWARD E SHEA ;. 20 DOTEN RD, PLYMOUTH MA 02360 t()l I t0,v • '. Commissioner cAa.� Totemitur— • Office of Consumer Affai usiness Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Corporation Registration Expiration 124769 08/19/2023 SHEA CUSTOM CARPENTRY,INC. EDWARD E.SHEA .c(Gl• 20 DOTEN RD. l PLYMOUTH,MA 02360 Undersecretary .rir.mom Of CONSERVATION 001 )14 OFFICE H• ** 'x bdirienzo@yarmouth.ma.us Yarmouth Conservation Commission Administrative Review Applicant Information: Name: S + - C445fo147 Cpei N, ANC • I Ed ,S' �► ��0� Mailing Address: oho i>ol"el-i oet c7I r pw�(s� M ft c 23( t- Phone: 508 '3 V/ - S. SS Email:or!e.. Ccr' €ntrcJ. c- - I hereby authorize the individual members of the Yarmouth Conservation Commission and its agent(s)to enter upon the property listed below for the purpose of gathering information regarding this,Administrative Review form. Property/Location of Work: /- ( r / 4-0 n R(it:LLt) l)eS ' victitmq t`t t A- /Street Name and Number Signature: Detailed Description and Reason for Proposed Work: FreC+ w /D ' - > t/ r S 1-2eJ o1-1 C h S os o fu be- o fi fr2 3 ) �:� /EVe 13 i^p 14.k)ce. f+ co,s�Uib � f.1, +V 5,,i-\- Y"c,r uscsi- mac( �F Closest Distance to Resource Area: p/S • re f e-r I-tr S K vr•ek+Y pi oposed /pe4.,t i- n Proposed Start Date: ki ei c/a. `7 t l IJO/•5 f CA-5 e 3-/- o . Company to do Work:Name: S C pS74Dh't Cr-pen �y`t,l ) .L✓i C Address: oZ 0 .bOfP yt Phone: 5th? .39 y ` S3,5 S Email:of tA•! A.sli eiazzissivni Car`p441 4r l7 . VV("^7 Administrative Approval: ) ?--7.7 pi. 27 p_-12 -7 7- This approval is valid for one year. This Approval does not grant any property rights or any exclusive privileges;it does not authorize any injury to private property or invasion of property. Yarmouth Conservation Commission•1146 Route 28,South Yarmouth,MA 02664•(508)398-2231 Ext 1288 *ter " Rn w r . , . itt Ns. ,, t r *4IP 9 Chilton Rd al • ."'""..'..... .... . ••••mw........_......._,.......... ...,.__........ ) 40 .16 On Dec 8, 2022, at 4:24 PM, DiRienzo, Brittany<BDiRienzo@yarmouth.ma.us>wrote: Hello, The property is in the flood plain and several other wetland resource areas, so filing type will depend on the size and location of the proposed shed. Please provide a copy of the site plan or sketch showing this information so I can determine how to move forward. Regards, Brittany DiRienzo Conservation Administrator Town of Yarmouth bdirienzo@yarmouth.ma.us 508-398-2231 x1288 From: office sheacustomcarpentry.com <office@sheacustomcarpentry.com> Sent:Thursday, December 8, 2022 3:57 PM To: DiRienzo, Brittany<BDiRienzo@yarmouth.ma.us> Subject: 9 Chilton Road,West Yarmouth- Express Shed Permit 2 DiRienzo, Brittany From: office sheacustomcarpentry.com <office@sheacustomcarpentry.com> Sent: Friday, December 9, 2022 10:39 AM To: DiRienzo, Brittany Cc: office sheacustomcarpentry.com Subject: Re: 9 Chilton Road, West Yarmouth - Express Shed Permit 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. Good morning Brittany, Thank you for quick response on this so far. I spoke with Kieran at BSC who does most of our work in this area, he attached a quick sky view of the proposed location being as far away as possible on this property. This is the desired spot for these folks to have some sort of storage. Please let the know what you think the possibilities are of, or path of least resistance in getting an ok to put this little shed here. (10x14) Thank you, enjoy your weekend! Ed Shea