HomeMy WebLinkAboutBLD-23-005862 Ca,0d LJZ3
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CEVD f al � Y -- RVED i 1 AP 2 -12023 d BUILDING DEPARTMENT 4 3 Amount ��
BUILDING DEF/AR N Permit expires 1ROdays 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: J/9 ® ,4, R fkee,(T// `�7
/Y �JfjQ . Qc _J_3__
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OWNER: �Drl/�¢CO ScRtPT� --
/o PRESENT
/Y/D/ A',V R.Q, W.VAIPin0407/ q/3.210- f 3
NAME
1 ADDRESS
TEL. /I
CONTRACTOR: , /O7V _ ' t F S'or 4&/
NAME MAILING ADDRESS S /967,iJL
al/Residential Commercial
o Est.Cost of Construction$ I /A=947
Home Improvement Contractor Lic.# /P//jq
Construction Supervisor Lic.# �// )
Workman's Compensation Insurance: (check one)
VI am the homeowner I am the sole proprietor 1 have Worker's Compensation Insurance
Insurance Company Name:
Worker's Comp.Policy#t //..1._
ar
3//z DS SHED INFORMATION
New ✓ Size L 11 x W 12 x H /
Corner Lot: Yes No 1-- -
Per Town of Yarmouth Zot hu; Br-Lint'See 203.5 Note E:
Side and rear 1'cll'd.setbac k fin.ac'cc'Sso/.)'buildings conic-lining one hundred fitly(150),squat(',feet or less and single,Ste/v.
shall he sir (6),feel in all dish ids, but in no case shall.said accessory buildings he built closer than twelve (12)feel to ant'
other building on an adjace/,I parcel. All sheds are required to he located 1hi17i.'r 3pj 1 etii.eJ11_ dry ji'oltt lot line
Replace existing* 4/O Si e L x W x H _
*The debris will he disposed of at:_ ��/eiyja 4, ."rje9i .1 S7"//7av
Location of Facility
I declare under penalties of perjury that the statements herein contained are true and correct to the h. of my - fledge and belief I understand that any false answeris
)
will be just cause for denial or reiyocati m of my license an for pros•-ution to r 11/1.G.L.Ch 268, '•etim
Applicant's Signature:
owners Signature(or attachment) ���i�'4.1 i' L
Date: /, 23
/
Approved By: �_ ���/-Date:
Building Official ror design 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 R.of Wetlands
3/22
The Commonwealth of Massachusetts
gt Department of Industrial Accidents
` 1 Congress Street,Suite 100
f� Boston, M4 02114-2017
�Y www rnass,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): J�ji/4 4 4 .5'c
t
Address: /0 /1% , i
City/State/Zip: l:si NtdrrlDv7// Phone#: . 9/.3- 2 IC yz y 3
Are you an employer?Check the appropriate box:
i. (am a employer with Type of project(required):
❑ employees(full and/or part-time).*
2.0 I am a sole proprietor or partnership and have no employees working forma in 7. ❑New construction
any capacity.[No workers'comp.insurance required.] 9• Remodeling
3 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9 ❑Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 1 ❑ Building addition
ensure that all contractors either have workers'compensation insurance or are sole
•
proprietors with no employees. 11.E]Electrical repairs or additions
5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet I2.❑Plumbing repairs or additions
These sub-contractors have employees and have workers'comp.insurance.: 13•rQ R,00f repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. I L_I tether f,2_j
152,§l(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. 1 Z,
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-contactors 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: /I/I/
Policy#or Self-ins.Lic.#:
Expiration Date:
Job Site Address:
Attach a copy of the workers' compensation policy declaration page(showingtthetate/Zpol cy 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 under the pains and penalties of perjury that the information provided above is true and correct.
Signature:
Phone#: / 2Id -- ,2 3 Date: ` j 7
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#:
'R
LOCUS INFORMATION REVISIONS:
0 MAIN STREET NO. DATE DESC.
CURRENT OWNER: DONALD SCRPTER OVERLAY DISTRICT: NONE
&LAURENE SCRPTFR
TITLE REFERENCE CRT.179654 NITROGEN SENSITIVE
al
ZONE: NOT A ZONE II —
aI I r
` PLAN REFERENCE: LCP 11435-A FEMA FLOOD
H ASSESSORS MAP: 23 ZONE DISTRICT: 'C',DATED 7/2/1992 —
PARC0.: 45 PAN0.�230015 0003 D
MINIMUM LOT SIZE: 23,000 S.F.
SILVER LEAF ROAD ZONING DISTRICT: R-25
—
SETBACKS: FRONT 30' EXISTING LOT SIZE: 10,951f S.F.
SIDE IS' EXISTING LOT COVERAGE:
REAR (DWELLING,PORCH,PATIO,SHED) 1,114*S.F. (10.2%)
MAXMUM ALLOWED COVERAGE: 2,737*S.F(25%)
LOCUS MAP PROPOSED LOT COVERAGE: I CERTIFY TO THE BEST. OF MY
NOT TO SCALE (DWELLING.PORCH,SUNROOM,SHED) 1,250*S.F.(11.4%1 PROFESSIONAL KNOWLEDGE, INFORMATION
I 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.
1
A
.... r
MORGAN ROAD /i,PUBLIC—VARIABLE WIDTH c-:,? L' G.( e/c y
PROFE SIONAL LAND SURVEYOR DATE
. . �------- -7\------I____________________-_____. _ ADDITION
-4,- AS-BUILT
/r N4Dwi0'E\100.00'-- I
STAKE 1 T * WITH
SET i STAKE NEtt
SET
HELICAL PILE
FOUNDATION
1
I AT
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1 #10 MORGAN ROAD
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I 4 IN
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r BUILDING SETBACK LI\E _I T----L.._ WEST YARMOUTH
MASSACHUSETTS
STING I
STONE IDRIVEVAr I 1 (BARNSTABLE COUNTY)
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I j TWELMEW 4'METAL PLATES I JUNE 26, 2009
OVER DX I 1, I METAL P�
5t7' 17.Y tar
1� I PROPOSED 7.--8.1=�—sa
1 I 6 T7 II uwams -4—_— I
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/ _ !- lA4\,\\\\` \\\\\ I\\\\\\\\\\1\1i' PREPARED FOR:
7 Mr. DON SCRIPTER
a ��', `. ! 128 ALTHEA STREET
GAS D eXo WEST SPRINGFlELD
METER MA 01089
---- _ (413) 210-4243
y� _ SHOWER . I
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EXSHED
I TIING BULKHEAD ' J BSC GROUP
• WOOD PATIO
�, • 349 Route 28,Unit D
scr�E 14.. West Yarmouth, Massachusetts
o� 02673
`• 508 778 8919
---- ID 2009 The SSC GrOAP,Inc.
Saootinv low111.1111•
SCALE: 1'.. 10'
0 1.25 2.5 5
_ A
ST O 5 10 20 ,a,
AKE
SEPTIC LOCATION BASED ON
cBOUND
DNCPETE PROJ. MGR.: CRAIG FIELD
INFORMATION ON FILE AT THE FOUND FIELD: D GAZZOLO/N. MERCIER
YARMOUTH BOARD OF HEALTH
CALL./DESIGN: K. HEALY
DRAWN: P. MAOIST
CHECK: CRAIG FIELD
FILE: 9405CPP1.DWG
•
OWC. NO: 5946-02
SHEET 1 O. •
�. 1. 4-9.05.00
•
PLOT PLAN
FOR LOT # -r t1/4e 2 3 - Plamq£c 4/5-
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f�li__ Name
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corner lot, REAR YARD
write in � �® I . i If this is a
name of street. ........ ...ft, � � i 2�1 Z , comer lot,
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SNt 1 name of street.
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