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HomeMy WebLinkAboutBLD-22-002253 /01)0/01-)- Office Use O Only � Permit# , 3n(d 7_ •O . 1,21) Amount 3 5 0*vT� sE Permit expires 180 days from : :;•-• issue date -020?—oW5j D EXPRESS SHED PERMIT APPLICATION pr�Ya� TOWN OF YARMOUTH A t O L" Yarmouth Building Department RECEIVED .61 l 1146 Route 28 South Yarmouth, MA 02664 OCT 0 6 2021 erns (508) 398-2231 Ext. 1261 _ BUILDING DEPARTMENT CONSTRUCTION ADDRESS: / ✓ /h s± - f i oa e) By. ASSESSOR'S INFORMATION: v [.0 9 Map: / Parcel: /� OWNER: j Ll`� 1i1 � �i /2C1 Lf 'pa( l go _gy- yeveJ NAME PRESENT ADDRESS TEL. # CONTRACTOR: NAME MAILING ADDRESS TEL.# ❑Residential ❑Commercial Est.Cost of Construction$ Home Improvement Contractor Lic.# Construction Supervisor Lie.# Workman's Compensation Insurance: (check one) I am the homeowner 7 I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# SHED INFORMATION • New V Size L i bl x W g I x H 1,Sr Corner Lot: Yes I 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. ^n t44 arlt, Replace existing* Size L x W x H ) ����1` 21_ *The debris will be disposed of at: Location of Facility I declare under penalties of perjury th h statements ere' fined are tr e and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or revo io o/f m�,lic for proses tion der :L.Ch.268,Section 1. Applicant's Signature: , Date: /(,)rlc/ Z� Owners Signature(or attachment) Date: /D/6"/Z/ Approved By: % Date: ��_1 — Building OfficialTor designee) EMAIL ADDRESS: Zoning District: Historical 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 9/13 _.\ The Commonwealth of Massachusetts = � t Department of Industrial Accidents ;ram_ 1 Congress Street, Suite 100 e. = 16 Boston, MA 02114-2017 .... `s'• 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): A0161 f/r7c //rk1614 Address: / J /6s f�- �' Li C1ty/State/ZIp: (11.u)iy Phone #: - Rail- YO Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.—I am a sole proprietor or partnership and have no employees working for me in apy capacity.[No workers'comp.insurance required.] 8. ❑ Remodeling 3. I am a homeowner doingall work myself t 9. ❑ Demolition y [No workers'comp.insurance required.] 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑ EIectrical 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.❑Roof repairs These sub-contractors have employees and have workers'comp. insurance.t 6.❑We area corporation and its officers have exercised their right of exemption per MGL c. 14.[]'Other d 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 0 - In employer that is providing workers'compensation insurance for my employees. Below is the policy and job site inform, ': • Insurance Company " e: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy s - aration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §2 • ' 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 o : TOP 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 . - ce of Investigations of the DIA for insurance coverage verification I do hereby certi u er the p i d penalties of perjury that the information provided above is true and correct. Signature: ( 2 Date: w � / Phone#: ` )k -,Ro c/- '(L -20 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 b.Other Contact Person: Phone#: PLOT PLAN FOR LOT # Indicate location of garage or accessory building Additions with dashed lines Sewerage disposal (cesspool) Well. 21 I I (lot ft. near) I `y Abuttor s ' I _ — Name Abuttar' Lot # I I2D Name I Lot # f this a REAR YARD `corner lot, ft. 1 this vrite in name ADD l ? to corner _ street. I l �� � ,.� write i, /� i name of a I I a other b1 a 8 street. l° o/ . : SIDE YARD HOUSE SIDE YARD • --_ _ —.�T..2. 0 -__ ' . p-— ? • • II . • • • SET BACK . ft. • I 4 I I (lot ft frontage) / :7;"6 s--t---Al fz cad t / (NAME OF STREET) ____.-) (---- N InformSupplied by tion �<R%Lr�7?/ L i iI)4 1,i 1 LARK NORTH POINT Information and Instructions MmwC8awttaw acnaai Laws chapter 152 require all euployda to provide wor ors'commotion fit their employees. Pursuant a this statute.as exployee is defined as"—awry pawn is the:cola of another under any castor of hits, express or implied,oral or writer." As sttydryusr is defined ar"aa individual,psrtoesida associatioel corparados or other apt entity,at any two at mom of the tbeepwitg aapaged is a Join at espies,and iachrditg the kp1 tepremenadves ale decamped employ=or the receiver at budge of se indivkksl,peamerwhip►smo iatimw at odor bps eetdtx employlap anplsyea& however the owns/of a derailing beans bevbp not ma:this three epartrmeuts and wile resides therein,or the acmeat of the dwelltrtg haw Omaha who employs prams is de msia1eoar coaatruction or repels work as such dwelling house of as the pounds at buddies apprsrtieomt theme shell not because of sash employment be deemed is be as dyer" title.chepwr 132,133C(6)aee sane than"every state M head tkaosin army shall wftiheid the Isamu*err lea ewel ere"uses at permit Is.pests a Wane at is aetstrwst buildings la the omuseaw.elth Ale say appiitsat who has an predated sa..pfaiis.vida::of sempib mse with the tarmacs avenge rewind." Addtdesaily,PAIL chapter 132,I231C(7)seem"Plaint:the canmoaweallh sot say ants polhfcai subdfridwo shall ester into say comsat flat the pa tternace of pubes work until acesptabht.ridesce alcoarpliamos with the ionsaace requirements of this chapter have been p,esneed is the contrasting audacity." Applauds Phases SI at the workers'oostpeoadts aadsdt completely,by shacking the booms that apply is your Mustioe nerd,If neceaatey supply anb•aa stectoe(i)tents(,).ddrew(se)sod phone nmmbw(s)along with their catidt:ar(a)of insrraaaoa Lambed Liability Canpsaies(LLC)at LWaed Liability Permualops(LU)whh as employees other them the members a proms,as not rear=is carry where oospeanatioa Isaaoa If as LLC ale LL!doss here employees,a policy ie remind. Be advised than this adidavit awy be adteoitsd is the D.pmrtrauan of aulesdai Aaddeett far Goodwo roam atinetmasoe coverage. Al.be sure is alp sad data the adder& The affidavit should be:turned an the city at Was d at tee appneado:It the permit or Home is being tapresa.I aist the Demme*of • ioduerfW Accident Should yes have say assale■w maitillag the law or as NOW to obtain a woriate compensates pansy`phrase call the Depseasent at the number hated below. Self domed oampasies should afar their ssif4esum ere bare amities as tie ogrepdate Boa City or lbws Ofllideie Please be sore Chet the affidavit is complete and primal legibly. The Department her provided s specs at the borax of the sffidtvit ftr you to felt out is the oat the Office atlay.adpeiaas has to coma you regardtag tee appileamt Passe be as is BB in the psui kossa weber which will be and as a es=Wore somber is addidoew,as appllcartt thin meet wine meltipis pemarticease appileadmn in any giro ye=need any submit as affidavit Wi:atieg coma policy indri wn=(If aceesaaey)sad mar"lob SI*Address"the applaud should writer"rid locations is (city a town)."A copy oldie a@ldevit this he bog oflse6d1y sta.e4ed or marked by the city at tem may be provided is the applaud as Foe thee a valid aflhavit is as!fie It Mee perm_at ikeae= A new aflldwrit as be filled out each yew.Vas a Weer rinser or chins Is abtdaing a lkmae or permit not related an sty War or communal venture (1..a dog Swore or parent to has tearer eta)said pew=is NOT required a complete this amdevit. The Odle*of tnvesdptione would like is thank yet is adrenes&w per cooperatives and should you have any gwatioes, please de not hair*to give us a all. The D.psrnosmt't adroit telephsat sad Ike number The Conwiooweaith of Massachusetts Depettn of of Industrial Accidents oslaa et(lnadptffaa 606 Washington Sheet Boston.MA 02111 Tel.p 617-727-4900 at 406 or 1-877-MASSAE8 Revised t t-22�1b FOX 1617-727-7749 www.mt>stl.pvldis Clarke, Kristin From: Barbara Liftman <bliftman@bliftmanlaw.com> Sent: Wednesday, October 6, 2021 1:51 PM To: Clarke, Kristin Subject: 1 Jibstay 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. Thank you! r ., i -4 ,, 4«>` ,..4q .V. prig - - "4, - . ,,,,, , ...4 ‘. . i �r.. .x ti *; sib " 4 4 Y�< Attorney Barbara S. Liftman Law Office of Barbara S. Liftman 405 Grove Street, Suite 204 Worcester, Massachusetts 01605 (508) 753-6778 Bliftman@bliftmanlaw.com www.worcesterfamilylaw.com 1 _s RECEIVED ! OC► 0 6 2021 TOWN OF YARMOUTH 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 i r At-114IIJU i r Telephone (508) 398-2231 Ext. 1292-Fax (508) 398-0836 Ui i)KING'S HIGHWAY OLD 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. Type or print legibly: f� L� G� Address of proposed work: I J l�sf l P r"► Map/Lot# \2 ✓ 10 5 Owner(s): f�f.L ��Lw' t� J . ( / 't0.4Phone#: -J 0 All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: l Jl7.5 f2_ 3 Li `jv/-l1 a 2-tpl r Year built: Email: 6Li )Preferred notification method: Phone / Email Agent/Contractor: l t ` Phone#: Mailing Address: n Email: Preferred notification method: Phone 1 1 Email Description of Proposed Work(Additional pages may be attached if necessary): I v S cc1 ed - Li C.)l ,' '/ oti occ_ei 'J ud ui l y'-to � 1 (Oaf 11 7/e-f I '/ J CQ J l� f fa/ 4&e l p vi . 117)es . &trek( 9f'ec,-,c vs t- tkAii A (ex iq 4AeS . 41eoet (21 ilO be .Se'/) 1i/L/ 7' 6'OcL • pi/60-e/Atf IS t:=1-AV-ed bLf 44a 1-_, /) c.2 a id (ie Signed (Owner or agent): Date: �C/(,, / 2/ 'r 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: i©�/�P)2,-k Approved Approved with changes / " Denied Amounts 2.0& Reason for denial: See a14whe4l eM. ,1 Cash/CK#mac,n�J�O� Rcvd by: JY`f1,C Date Signed: Signed: APPLICATION#: al -00�3 V5.2017 rt / S dicini, Kyle From: Old Kings Highway Sent: Thursday, October 7, 2021 2:22 PM To: 'Barbara Liftman' Cc: Old Kings Highway Subject: 1 Jibstay Road Exemption Hi Barbara, Your application for an exemption to install a shed at 1 Jibstay Road was denied by the committee chairman. Reasons cited were the shed's roof pitch and the after the fact nature of the application (see below email). Please submit a Certificate of Appropriateness application for this shed. A public hearing is required for CoA application and the next open OKH agenda is November 8", with an application deadline of October 20`h. The application cost will be double since the work is already completed, so we will need an $80 application fee with the application. Since we already have a check from you for$20, we would just need an additional one for$60. If you'd like, we can use the site plan/photos you've already submitted as your supplemental application materials. Please let us know if you have any questions. Thank you. From: 'RICHARD GEGENWARTH' Sent:Thursday, October 7,2021 12:26 PM To: Old Kings Highway<okh@yarmouth.ma.us> Subject: Re: 1 Jibstay Road Exemption It appears that this shed is already built in place. That's first problem. It should have roof pitch of 7/12 . It should have at least one door and one proportional window. So I can't approve as an "exemption". They would have apply for a CoA and at double cost since it is already built. Richard 1 , , J .: . , ..-F C FEIV f:11'....4.: °', i TOWN OF YARMOUTH 1146 ROUTE 28, SOUTH YARMOUTH,MA 02664-4451 Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 Oilti KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE 1 ,Ailf,tioui.,, [ OLD KING'S HiGHWAY APPLICATION FOR CERTIFICATE OF APPROPRIATENESS Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 as amended,for proposed work as described below&on plans,drawings,photographs, &other supplemental info accompanying this application. PLEASE SUBMIT 4 copies OF SPEC SHEET(S),ELEVATIONS PHOTOS,&SUPPLEMENTAL INFORMATION. Check All Catenories That Appl : Indicate type of Building: Commercial Residential 1) Exterior Buildin Construction: New Building fl Addition Iterations I Reroof ri Garage FIShed H Solar Panels Other: -S-1/)-eci 2)Exterior Painting: [—biding Shutters 1.1 Doors Trim 00ther: 3)Signs/Billboards: El New Sign Change to Existing Sign 4)Miscellaneous Structures: LiFence Wall LIFIagpole 11 Pool 20ther: Please type or print legibly: Address of proposed work: / I I..42 61.a 12-d Map/Lot# i i //0-i , Owner(s): • Phone#. ITO 6- fip ti- C(0'7 V All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address I II tr,•51-6A1 icJ 114(//..A, )drli /4„).(4. Year built, / i 75' . . Email 6achie A-- I , i " 'Od 2 .: •-, • ferred notification method. IR Phone El Email Agent/contractor. ,(--eil Phone# .5-L.),V- €-(6 70 Mailing Address ,s-a,AA." Email. L iCiV-A-49 Preferred notification method fa Phone 1,___Email Description of Proposed Work: at/f aa AAjel fly 0/-e d 604-4 o 1 if'4-- , P/r-re/iy tit l'ArA 4,e1)..‹See) 31/t9 ,-f r 05 (--- 46( P-S :I- 4,-0-, b-es),4Pd il (-1 _I ( — - L-x- Ac it/bit- (.4_51 b i-e 4.-( sixeo-t- 6 a.4.4.,ti ,s--/ Signed(Owner or agent)" — Date: :///6-2 /2- 2 _ . . Owner/contractor/agent is aware that a ermit is required from the Building Department.(Check other departments.also I . If application is approved,approval is subject to a 10-day appeal period required by the Act. . This certificate is good for one year from approval date or upon date of expiration of Building Permit.whichever date shall be later , All new construction will be subject to inspection by OKH OKI-I-approved plans MUST be available on-site for framing&final inspections For Committee use only: )7 Approved Approved with Modifications Denied Rcvd Date. Egit).).2 Reason for Denial, FA ' :.:. . II; . 10 -/ Amount , .:1)i W . ' ' 1 ,Y;(--- ii1° 1 Cash/CK , Signed: , .. . ..., i OCTocr 1 2 ZU - ' LIIKIIANIRC. S19f..Lif IGIr-Fi t,V _y__j 45 Days: Date Signed. /6} /2 .7-2— 1• , _ .??— 1 1 1 APPLICATION#.