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Home My WebLink AboutBLD-23-001864 r0.0-- 177/0� o.Y'A`, S„.* t+� rt�,O Office Use Only >i . .�� Permit# \" s " "'f Amount 3 , 'oh. 8 �'� Permit expires 180 days from issue date EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 OCT 06 2022 South Yarmouth, MA 02664 . (508)398-2231 Ext. 1261 BUILDING DEPARTMENT By: _ CONSTRUCTION ADDRESS: op .L(ALiS.T -----1 OAQ 7 IX. E.5 `.I vie MOUTH)DA A OWNER: : 'llr C', 0.0 t-.. iOci idciLL ivi6t.Spors5- t5.. ri t- i-i ii--Q Cr''14- NAME PRESENT ADDRESS S N flt2O,U r TEL. # CONTRACTOR: ' NAME MAILING ADDRESS TEL.# ®Residential Commercial Est.Cost of Construction S is C_ 30 Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) I 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 W x H I Corner Lot: Yes No ‘/ Per Town of Yarmouth Zonin2 Br-Law Sec 203.5 Note E: Side and rear-yard setbacks for accessory buildings containing one hundred fifth(1.50)square_feet or less and.single story, shall he six lbl feet in all districts, but in no case shall said accessory buildings he built closer than twelve(12).feet to any other building on an adjacent parcel.All sheds are required to he located thirty(30/feet front any front lot line Replace existing* V Size L 15 x W 1 d_x H to *The debris will be disposed of at: ()c RR t S i-i n-S ai-it u Ns et,:.is fl AT `t iaa t.le5t. TN f c t r d° Location of Facility I declare under penalties of perjury that the statements 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 denial or revocation of my lice se and for prosecution under M.G.L.Ch.268,Section I. Applicant's Signature: ;_- �„r IU. Date: 1O—(.—a Z c_4 Owners Signature(or attachment) Date: Approved By: r v Date: /0"*"'elf—7`2 2- Building 0 al esignee) EMAIL ESS: 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 3/22 , • I . , . . ....../""fie "C.06/rivtluvizaehsebeal& • . , '‘YF4a4tocr,citce.i.e44.•.... Office of Consumer Affairs and ffuOness-Regulation 10 Park Plaia.- Suite 5170 Boston,Mass. . efts 0-2116 , • 44.41k. Home Improvement 40,-,:,..). - • Rezistration-, • • - -. __-- _-- Commonwealth of Massachusetts . • 11! _ ,‘- --, t!lr. — — - . Division o*OCC Li pationat Licensure r4 _____: Wi____j__-,= '• Board of Building R?Aulations and Standards MCGRATH POST& BEAM Co. ii .•,_,rwi ., S, - :.,G tit,'t,%l114-.0iri'ft;r•kef'.,0 & 2 •=arn,i, JAMES IiiicGRATH 259 R 6WJICEHEN,M AAM 0N2E6 4R5D. ' , CSPA2J0A-04M7 CE3 RA-8A 6 R5N p 3/1 — - 3REWSTERA • , 1,1;.,,,,,,, ,,,): • " arosirarie.issassta • `Ott,v,t;,1`3' t----, '' a.....,- Commissioner dada g. .., -. - • . • . , Office of Consumer Affairs and Business Regulation low Washington Street-Suite 710 Boston, Massachusetts 02118 , Home Improvement Contractor Registration Type: Corporation Registration: 132935 MCGRATH POST&BEAM CO. Expiration: 10/30/2022 D/13/A PINE HARBOR WOOD PRODUCTS 259 QUEEN ANNE RD. HARWICH,MA 02645 Update Address and Return Card. , , Once of Consumer Affairs&Business Reguumon HOME IMPROYFJMENT CONTRACTOR Registration valid for Mauldin!use only TYPE:Corooralon beton the exphetion date. if found return to: SIBMIMBSII MEOW Office of Consumer Mars and Business Regigsdon 132935 1040/2022 1000 MnAllnliton finest-Suite 710 Boston,MA 021Ie MCGRATH POST&BEAM CO. D/B/A PINE HARBOR WOOD PRODUCTS JAMES R.MCGRATH 259 QUEEN ANNE RD. (..,,-,(4 giela.4. 4 ..............._. . 4 ,. • . signature HARWICH,MA 02645 Undersecretary The Commonwealth of Massachusetts t* —=!i Department of Industrial Accidents _:;ort - 1 Congress Street,Suite 100 Boston,MA 02114-2017 v. = www massgov/dia • Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print Legibly Name(Business/Organization/Individual): 1.4r Grail ls+ 4 ?a r l Coy pea-}iorl Address: 0751 n Am . 'knelt' City/State/Zip: !-IiraiiChfl1fl ( ( h 1 S Phone#: Soo L130 0800 Are you au employer?Check the appropriate box: Type of project(required): 1.1:1 I am a employer with employees(full and/or part-time).* 7. EliNew construction 20 I am a sole proprietor or partnership and have no employees working for me in 8. D Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 301 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. t will 10 Building addition D 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 5.1n 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.: 6.0 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 teat is providing workers'compensation insurance for my employees. Below is the policy and job site inforrnatioca. Insurance Company Name: io �-#alupsh+fG Empiers jnsu onfe. ryTpani Policy#or Self-ins.Lic.#:!N�_C .-( -yffl 5 -��q Expiration Date: .....1.)19/ 8 p)U 9 3 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 r I p ' an penalties of perjury that the information provided above is true and correct. Signature: 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#: - a`