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Home My WebLink AboutBLD-23-006033 CenSetVerV7 r/ 571423 ."o -a- • , ,q,11 . , . Peolutt . -+ „., w „t,A i, •...I OT 4it Itiit IV OP i- 1,7-r T InUtil .:.11)E7::Alqr.# -,--'..1: '111.in `17-• Pan*expirm ISO thys float .... issue dste 64-n—aZ 5-6d60. 3 EXPRESS SHED PEWS/n[1 APPLICATION TOWN OF YARMOUTH Yarmouth%Odin' g Departhust RECEIVFD 1146 Route 28 5 „etr\ck... .,1261 j t " 2023j S(outh08)Y,3798_223outhi,Ext.MAv\02664, MAY E3UILDING DEPARTMENT ea- n CONSTRUCTION ADDRRSS: $11 Z-- . a ASSESSOR'S INFORMATION: C11311111111111111 Parcel: Z.t0 . NAAfE PRESEt4T ADDRESS OthA { TM,. d CONTRACTP I 508z-i . 230b NAME MARINO TEL.1 ,----- AReskingial 0 Commerciod Est-Cost of Communion S 2 LO Of) Row hoProroatont Contractor Lle•# 3 al___ Construction Supervisor Lk.fit_ 3,(j2 Workman's Compeasathm Inatome= (check one) 0 I am the homeowner 0 I an the sole proprietor Jaime Worker's Compensation Insurance Insurance Company Name: , Worlmr's Comp.Policy#E522 2454 aiffp_MRA.....mfA. N New _X_ Size UZI.' w_1(21x HILL_ Career Let:Yes No4C. .-: i',,ft.....mdr ihuLan•.c.2&t5i,•• Side and rear sato*foraccessobuilefusgs less than 150 square feet and single story,shall be 6 feet in all districts, but in no false built closer than 12feet to any other building Replace existing* Sire L x W x If nu debris wilt be disposed of sr C\ ' t Location°Mealy I*dere under panddes, ,re.= the statements bruin contained are kW and commie the bad of ray knowledge and befit I understand Ant nay fake atene(s) Will being awe far, ilijiiiiii• ferny license and for resew=andi 14.G.L.CIL 268,Seam I. Applicant's Simms= COLN Osseo alioatarc for:1‘wirmimilirir ..., lAiroli_. lArkkag•.., EMAIL •'..lt;r:`*: , Zoning District Ifirsorical District 0 Yes 0 No Flood Plain Zone 0 Yes 0 No Water Resource Promotion District Within 100 ft.of Wedands:*** 0 Yea 0 No 0 Yes 0 No ***Note:Consenration review required if within 100 ft of%Oen& 9/13 The Commonwealth of Massachusetts _= a►� Department of Industrial Accidents =1 ? 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH no,PERMITTING AUTHORITY. Applicant Information L Please Print Leeiibly Name(Business/Organization/Individual): C Gta �y�S i 4 &QM 6:11'pea4lnl't Address: (9,1 ( pt°h Anne. "koati City/State/Zip: HirtiliCh.mP CIA415 Phone#: 5a5 "130 Are you as 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 2.01 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 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.] 4.01 am a homeowner and will be hiring contractors to conduct all work on my property_ 1 will 10 a Building addition 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 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 131-3Roof 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 that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Neyo a }li(e,. Etripktyrs tnsuronri. CQ+NIpt Ln9 Policy#or Self ins.Lic.#: ELC.-'UM lia0C1S1 ' 9 ia,A Expiration Date: .. t?19 8 e Oc93 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 t p," an penalties of perjury that the information provided above is true and correct. Sit+i.ture: 408 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): I.Board of Health 2.Building liepartment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ..... - p v.1400.. ..:',/iie -CO . Of L.-4' 0 0- --7,-ehtletn* - )Z ,. 10 Park Pla - Suiettste5:i213jeO Boston, is6saegulati°r) Office of CBonsosuine, MrAstsaoffsairs.7d u i It.. Home Improvement ilt.',.:.,4 .: or Resistratiorr,. -- , _..,.... -_L_L--z-"----*--_-:------_-_-_•,-----= 1:i7 , ., _ Laris ,.. 1VicGRATH POST 8 BEAM CO. li -..1 ;"!__ ;__7 -7-__ :-2 -...i. .g. ',,,.. ,,. .,144/3 .1.,,X JAMES WicGRATH 259 QUEEN ANNE RD. ilik 7- - ..--_-7— , JAMES R MQ14RATH IJ HARWICH,MA 02845.. di ------ 7,-- z----= 204 CRANVIEVV RD ......-- BREVVSTrER* 02031 • _ .______ -— , # e THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff.., ?-4,, , I Business Regulation 1000 Washing..•.`74r-771.n.:. -Suite 710 Bosto 7-- ------,----:.4118 Home im•ro --- .---—- - •istration _.w.........__ „,c. MEM;:trtal 7 MIMI 7- ...- iiiimil Type: Corporation MCGRATH POST&BEAM CO. ... ..................1111 ................,W.' :. r". allow 132935 ri„, ,—.1.- -- =.- don: 10/30/2024 D/B/A PINE HARBOR WOOD PRODUCTS -- =L.",:z. * ammur 259 QUEEN ANNE RD. •i4 r.=":••T.= :,.., dik ............ ...- ***i HARWICH,MA 02645 -4. 141111 ;* .G., "sillsir s 01.1111r 1,,i1 7 Ni,1 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer A &Business Regulation Registration valid for individual use only before the HOME IMPROVE'..-41,4,•NTRACTOR expiration date. If found return to: Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suite 710 ,.....,---4-t• ir.,,,:....e7ir-A Boston,MA 02118 . -,.. _,. iL,w MCGRATH POST 6 B 2'; '-- i ,..... ••','`,,,. 4.0' MBA PINE HARBORYV('"'f. f i,'..."- ti.tt`t. 1 '..".° ...4.." ,,,-, AMES Fi.MCGRATH ‘..‹! '''''-:",,„.',A-4-.:4`-4 ::' 59 QUEEN ANNE RD.l', .,,‘:;1". ----/ ,7 ‘,40,01,4.4.4• i A Fi NCH,MA 02645 "...'3..i,:e-.'" .-;'''` ,Q.....-. Undersecretary out slanature i • ' , PLOT PLAN FOR LOT # Li - - Ad � or accessorybuilding ed limas ---....—..._--- Sewerage disposal: (cesspool)We11 fa I cam...1Q.. .•.ft. ) Abutt s ) ' Name ou> i Abutter's Lot# 4� Name Lot# If this is a REAR YARD corner lot, ,� _„� If this is a write in ..... ...ft. 16 corner lot, name of street. _ - write in �' - name of street. ��y 3 ' �_•. �•1 42,E V y� t �L. SIDE YARD SIDS Y7►RD • 111 • SET BACK • • 1 .4:Y (kit../.0.0.:.Y.Ii..ft. ) • s. �' � t 7Cc rmcE i (NAME OF STREET) ('-"' / 'helmet:Ian `. Supplied by o1:*Y'qR 7A. 0 CONSERVATION 0� jiOFFICE *•,, bdirienzo@varmouth.ma.us C�varmouth.ma.us Yarmouth Conservation Commission Administrative Review Applicant Information: Name: ~A,,) en IS ,n r 16 Chi Mailing Address: 9-2 W to s+ YG i rn() t jf?.(‘ Phone: 77 9 �'�' ._ . (v .� Email: r ri� (�J 60 3 6 h ocvc 1 ini 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: ? Q W .S 4 y, , ,,-„ ,%-i-fri -RA Stree Name and Number Signature: s6,,, ,,,'v Detailed Description and Reason for Proposed Work: 6 U i I c 6 ivy ' ? S V I ecf On epiocks Closest Distance to Resource Area: 9 / 4 ' -t Proposed Start Date: U Y\ e, a O Company to do Work: ----P ( . Name: it' { e i"`� if- L(I ' CO(Ind rcrick-i-S Address: c 5'7 a‘) -en Anne_ 2,0(_ f -Q ( (dJ t C ) Phone: co ci. 30 O 0 () Email: Administrative Approval: P 12(1)0\r-td / / j Si/ )101,3 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