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HomeMy WebLinkAboutBLD-23-005861 $ ,PTO' @'� V i ® O ce Use Only -�� hPZ3Aosj .. iy ermti \M �� ,E • AN 212023 Amount BUILDING DE AR N Permit expires 180 days from By: issue date EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: ✓O 4119R4A/L, OWNER: �1��!/i4Cd 3-6te pre. /o Me244,V QUO, w.,AR. c/71/ q/3-2fo-�/2 3 NAME PRESENT ADDRESS 7��l TEL. # CONTRACTOR: /�'r'01 w jt t F 5.1r Aefp(/- -51 //tgovc. NAME MAILING ADDRESS TEL # deResidential 0 Commercial Est.Cost of Construction$ Home Improvement Contractor Lic.# /1///4 Construction Supervisor Lic.# /fJ//q Workman's Compensation Insurance: (check one) VI am the homeowner I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. Policy# /1/M j1/fD5 SHED INFORMATION New ✓ Size L /2. x W /z x H )). Corner Lot: Yes No t' Per Town of Yarmouth Zunis Bp-Law Sec 203.5 Note E: Side and rear_lard.setbacks for accessory buildings containing one hundred fifty(150) ,square feet or less and single story. shall he six. (6)feet !n all districts. but 11l n0 case,shall said acces.soii Mukhngs he built closer than twelve (1 2),feel to on,other building on an adjacent parcel. All sheds are required to he located tllirtt'(30)feet from any front lot line Replace existing* /l//9 SizQ L x W x H *The debris will be disposed of at: i4Q/na9V7* "7*-41iU.40C{/Z, 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 license an for pros •ution under M.G.L.Ch.268.Section I. Applicant's Signature: Date: j/7/3 Owners Signature(or attachment) ��/f7 2/ Date: Approved By: Building Official(or desia Date: EMAILADDRE . 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 tt.of Wetlands 3/22 • The Commonwealth of Massachusetts fit Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 r,E www.nzass aov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LegibI's Name (Business/Organization/Individual): 3e i/,Q 4 tj . i (7 j Address: /0 4® .G_4 ,tJ i2j City/State/Zip: vt165 yll2Mev77/ /y1,1 6,2673 Phone#: ''/3- 2 i0 y2 y 3 Are you an employer?Check the appropriate box: Type of project(required): LE 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 8. []Remodeling any capacity.[No workers'comp.insurance required.] 3 I am a homeowner doingall work m sef£ 9. ❑Demolition y [No workers'comp.insurance required.] 4.❑ Y property.I am a homeowner and will be hiring contractors to conduct all work on rnI will 10 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.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: I3•❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.ErOther / /2) 152,§1(4),and we have no employees. [No workers'comp.insurance required.] /2 2 I([2.. r '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: ////A 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: y1/7/3 Phone#: Y/3= 2Id --`/.2 V3 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. EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: JLOCUS INFORMATION REVISIONS: MAIN STREET NO. DATE DESC. CURRENT OWNER' DONALD SCRPTER OVERLAY DISTRICT: NONE k LAURENE SCRPTER ci I� TITLE REFERENCE: CRT. 179864 NITROGEN SENSITIVEON N L♦CUS a ZONE: NOT A ZONE II i� PLAN REFERENCE: LCP 11435-A FD4A FLOOD — 45 y ASSESSORS MAP: 23 ZONE DISTRICT: C.DATED 7/2/1992 — PARS; 45 PANEL#250015 0005 D MINIMUM LOT SZE: 25,000 S.F. SILVER LEAF ROAD ZONING DISTRICT: R-25 SETBACKS: FRONT 30' EXISTING LOT SZE: 10,951t S.F. SIDE 15' EXISTING LOT COVERAGE: REAR 20' (DWELLING,PORCH,PATIO.SHED) 1,1145 S.F. (10.2%) MAAMUM ALLOWED COVERAGE: 2,737* S.F(25%) LOCUS MAP PROPOSED LOT COVERAGE: NOT TO SCALE (DWELLING,PORCH, SUNROOM,SHED) 1,2502 S.F. (11.4%) I CERTIFY TO THE BEST OF MY PROFESSIONAL KNOWLEDGE, INFORMATION AND BELIEF THAT THE LOT CORNERS, DIMENSIONS AND SETBACKS TO THE STRUCTURE AS DETERMINED BY INSTRUMENT SURVEY AND AS SHOWN ON THIS PLAN ARE CORRECT. ----------------------------------------------------- /:7.777 777 11► lin MORGAN ROAD PUBLIC-VARIABLE WIDTH -� 672,Ar PROFE SIONAL LAND SURVEYOR DATE [DGE;OF:WAVEM:KT... .... -- --- ADDITION -S- AS-BUILT 4g N4945104Y100.00'— 1 I A WITH r SSET TAKEI STAKE NEW HELICAL PILE , FOUNDATION I ' AT #10 MORGAN ROAD 1 I I 4 IN I BUILDING SETBACK LINE —; �— �� WEST YARMOUTH ' ' -1 MASSACHUSETTS STONEIDRIVEVAY STING I (BARNSTABLE COUNTY) J a pkopoSiL j I£ TWELVE PLATES DUNE 26, 2009 le 17.T At -1 1L7 7 a• � SWOON 6+ (t�X�\ 41.W - 1; +1g L7 1y-- I 1 ►11 ` \\1\\ PREPARED FOR: Mr. DON SCRIPTER f�1X1 EXISTING 128 ALTHEA STREET DUELLING 010 GAS WEST SPRINGFIELD METER MA 01089 _`,. A111 (413) 210-4243 SHONE EXISTING SHED BULKHEAD ! ----J01 BSC Gi ou EXISTING WOOD PATIO 349 Route 28,Unit D •SETXE • ,.a' West Yarmouth, Massachusetts 02673 • 508 778 8919 _-359A0.501,?m r © zoo9 The BSc Group.xk. • SCALE: 1'- 10' 0 1.25 2.5 5 .... ininhillIMEMaja • -+ 0 5 /0 20 STAKE a SEPTIC LOCATION BASED ON SET CONCRETENCR.: CRAIG FIELD D1F[Xi1MTIDN ON FILE A7 THE FBOUND OUND YARMOUTH BOARD a HEALTH. FIELD: D GAZZOLO/N. MERCIER ,CALC./DESIGN: K. HEALY DRAWN: P. hNGIST CHECK: CRAIG FIELD FILE,._ 405C?P1.DWG DV/G. NO-�5.94466—,022 — 1 . is t—D;:,e a„, �N1 1 (L PLOT PLAN FOR LOT 21® A i}(' 2 A ct( 4/5 rodicate location of Addit e M garage c- access-------- cres, y b� eSexeu sal: (cesspool) 69 _�........_. __ - I I I Abutter's igi '�' Name�t�kE I F)<15T •.... ut to Lot* 0 Abutter's � � Name sk,p mo.c If this is a REAR YARD Lot# f a corner lot, � 0 write in I ,i -r; If this is a name of street. ........ ft. SN . 2�12 ; corner lot, write In E • S\i';6:i: �� 5/4i name of street. !--- - i 5a.vvz. LEAF \ ; SN�2 + a I r . SIDE YARD I _ +f'�, -e • HOUSE ,►g YARD —40 —'at"—— 1:71> • • I i • • SET BACK • .......,..ft. I 4 (fit...........l.9p..ft~!O f�ontsge) . • �! /U Ato /v ko, . ,'i920, / T _ \ (NAME OF STREET) / / t Informatian Supplied by -• �zTr/L