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Home My WebLink AboutBLD-23-005948 /--fil ti/oZ i/d3 0 4/4--. , ----,4, REcEIVED ...._ , - Office Use Only $' APR 2 6 2023 , iAmount .35—/Od B Permit expires 180 days from issue date D_E_PA_RI _E_Nli 15 Lb —01-3 4)6561Lie 8LvULED:11 NGLM EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: V /gni j I-441C -frt, 62 67,,,S Y4 rn 01:_k___Pr_.- 0 -f_____ _.....— .....---- ,,_ OWNER: ...la ote5 4- Nif b e/C. co e•-/O ke i I co,./1\ ,........ 6V 6321 NAME PR SENT ADDRESS TEL # CON TRACTOR: R gl AI 0 6tIE DS O bkrd 1 rus Slf"- We-120V Al 41 6Z396 NAME MAILING ADDRESS i TEL.#1 5-oe Lis)? 6"4 Vesidential Commercial Est.Cost of Construction$ 3/nO0 . 00 Home Improvement Contractor Lie.# Construction Supervisor Lie.# 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 j Size L ? x W lit x ti 6 Corner Lot: Yes No V" Per Town of Yarmouth Zoning Bp-Law See 20.3.5 Note E.. Side and rear yard setbacks for accessory buildings.containing onw hundred fifty(150),square feet or less and single story, shall be six (o)feet in all districts, but in 170 case shall said accessory buildings be built closer than twelve (12t feet to any other building on an adjacent parcel. All sheds are required to he located thirty(SO) feet from anyfront lot line .4 k g Wail"' Replace existing*NO Size L x W x H 11/0231c2i, *The debris will he 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 knowledue and belief I understand that an false answer(s) %kill be just cause far denial or revoc• ion of my license, ci for prosecution under M.G.L.Ch.268,Section 1 Applicant's Signature: 11- -ce-te et.... 7- - Date. 9 157 013 ....., Owners Signature tor attachme 0 i ,t Building ta27-- Date: Approved By: Date- Official r d s nee) WA! DRESS. 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 "� The Commonwealth of Massachusetts ---1:--1E--filkar r Department ofIndustrialAccidents 1 congress Street, Suite 100 t� e ?_s _ i. Boston, MA 02114-2017 ,." www.mmass.gov/dia \Yorkers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers_ TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Please Print Legibly Name (Business/Organization/Individual): - q, s (,:t.ii boll Address: ' fi---Os 1.41 City/State/Zip: r»y vv Ptir4- Phone #: 5-6 ? £25 2 d J 2.e Are you an employer?Check the appropriate box: Type of project(required): LEI I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in S. ❑ Remodeling any capacity.[No workers'comp.insurance required.] m a homeowner doing all work myself. [No workers'comp.insurance required.]t 10 El Building addition 9. ❑ Demolition 4 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 1 1.❑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,❑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. r 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: Policy#or Self-ins.Lic.#: Expiration Date: 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 der the pains and penalties of perjury that the information provided above is true'and correct. Signature: C„,� 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#: PLOT PLAN FOR LOT � arage or y building location b -- Sewerage disposa1 (cesspool)) Wel/ or I I (� t ................ft. I __... __.. .,. -,_ rear) I Abutter's Name I Abutter's Lot# ( J Nae If this is a Lotm E] REJ. write in corner lot, YARD If this is a name of street. itft. corner lot, In E` - namewrite of street. . •L. -a il 8 SIDE YARD • SIDE YARD HOUSE • is- • . ; 1 SET BACK • . • 4 1 ID' (lot ft. frontage) (NAME OF STREET) Informatirn Supplied! by 1 m el t '" n YPRMOUTH IC:4N CLE'Rk: ak''. ,92,r43,----, -,- •,,-,- ,-,-, „,- ,fr..,,,, TOWN OF YARMOUTH - - '' •----' ----k-' 1146 ROUTE 28,SOUTH YARMOUTH, MA 02664-4451 Telephone(508) 398-2231 Ext. 1292-Fax(508)398-0836 ..........._......_...........—....._, ,_ : ..., .D KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE t . i APPLICATION FOR , CERTIFICATE OF EXEMPTION pki,10,.A. ,. I OW KING'S 1-416HVV8, 1 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: :17 firyi 1....„ ri zi1 e Map/Lot# 1"R / I°-3 ..._.,-- Owner(s): N.let/A-10,5 ± NJ oefi( Ca frlyie/i phone#: 547 _al?? 63.24 All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: e ()nil ,t.. ce,,rti.. yarpi,,,44. Pnr"1-- 6?1-.25year built: /61 Ye) Email, j i.4.1C- e Cr, et.71- I.et9/1•1 Preferred notification method Phone t./ Email ActenVContractor: pil,k70 6 1tee(5 Phone#: c a Mailing Address: 20 I-Arde 13- 5 1- P 1 CalehP or / M .(i. 2 3 2/6 Email: Preferred notification method. Phone Email Description of Proposed Work(Additional panes may be attached if necessary): Signed(Owner or agent): 4,A....9 9-trt— , .. Date: /-2 /-23 ). Owner/contractor/agent is aware that a permit may be required from the Building Department.(Check other departments,also.) f+ 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: ;AP*Rrnir:D Date: 440 510,& I Approved Approved with changes --- i Denied Amount .t; °-et) Reason for denial: I , CashiCk it CeS h -,i-Y-ttv, .t:i , ______ Rcvd by Date Signed: 60612'.. Signed: ,..:;•ee ?-41K Ked "elhlz.)‘) APPLICATION#: R 3 V5 2017 Lisa From. ��mV. R�hmrdyenUnne «oavQ463��gmaU.corn» , Tuesday,April 2O2] 1O'�O4A�� To: ' Sherman, Lisa Smb�� ,- Re:23-EO]48 Amy Lane Attachments: 23-EO34O Amy Lane.pdf YAPROP-��T�� Atbemthmm!/This email originates outside of the organization. Do not open attachments urclickZLiP sure this enmai|is[romna known sender and you knovxthe content/suafe Call t links � Otherwise delete thi»�nmai| ' �/ ovyrify/funxure. � . APPROVED.� Thank you. 06 Richard A.Ventnone,Jr. Yarmouth Port, Massachusetts On Apr 25,2033.at9:39 AM,Sherman, Lisa<L5herman@yanmouth.nma.us»wrote: Hi Rick, Residents VV{}Uid like to build @ shed in the hBCkc*rd of Amy Lane. Please let yO8 know if you need any additional information, Thanks Rick, Lisa ' Lisa Sherman Town nfYarmouth Administrator,Old King's Highway Historic Disth t and 5O0-39Q-2231,exL1J9J c rrnouthHistohca|Commn|syion bherman@yarmouth.nmo.us 1 ~ � ~� � �� m^ �n��-~ y