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Home My WebLink AboutBLD-23-001140 r ,. .;"'"Ai ' Pa (7 17/Z2_ ® at it-4/ -�-' / ` �i �OY��' / . C.U L� Office Use Only Ci Permit# ��,�-h Oi.' �_ IHF ��i` M TA M d�3F/ 8' Q -ICA� � _ Amount J J` Permit expires 180 days from issue date EXPRESS SHED PERMIT APPLICATION��3 Ql�� TOWN OF YARMOUTH f RECEIVED Yarmouth Building Department ____ 1146 Route 28 I South Yarmouth, MA 02664 ' AUG 312022 (508) 398-2231 Ext. 1261 ` / BUILDING DEPARTMENT CONSTRUCTION ADDRESS: �' 4/^�S/i i/� ../� /CC�- /2 By: OWNER: SrJS'/A /P'44 /�.9 e'>t✓" e -0Ec 3,,6 /4 29 NAME PRESENT ADDRESS TEL. # CONTRACTOR: NAME MAILING ADDRESS TEL.# Residential D Commercial Est.Cost of Construction$ 4 3?0 ; v Home Improvement Contractor Lic.# Construction Supervisor Lic.# Works an's Compensation Insurance: (check one) V 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 V x W ( 2 x H (X Corner Lot: Yes 4.-----"iNo Per Tou'n of Yarmouth Zoning By-Law Sec 203.5 Note E: Side and rear yard setbacks for accessory buildings containing one hundred fifty(150)square feet or less and single story, shall be six (6)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 be located thirty(30)feet from any front lot line Replace existing* Size L x W x H *The debris will be disposed of at: ifir �4jc 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 revo n fmy license_ _ and for p secution under M.G.L.Ch.268,Section I. Applicant's Signature: ''t/` Date: / 3 I /2 c2 2 ,/Owners Signature(or attachment) , Date: (, Approved By: �� Date: G J 1 )dN Building Official(o esignee) 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 ft.of Wetlands 3/22 ,` The Commonwealth of Massachusetts _ , _ Department of Industrial Accidents cam-..I= _fir/""1� 1 Congress Street, Suite 100 • =f��- 4 Boston, MA 02114-2017 5.•` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly ry�/� ✓Name (Business/Organization/Individual): 53 � ///,'Z',i/V /7% J g(j� kz Address: 61 Z JO SGt V4 .a') Ii/ti fa d ,./ City/State/Zip: RI - 4 441 p(,/ 7111. Phone #: f� 0 U T Are you an employer?Check e appropriate box: Type of project(required): I. I am a employer with employees(full and/or part-time).* 7. C New construction 2.E I am a sole proprietor or partnership and have no employees working for me in 8. C Remodeling any capacity. [No workers'comp. insurance required.] — 3. I am a homeowner doing all work myself9. _ Demolition y [No workers'comp. insurance required.] 4.❑I am a homeowner and will be hiring contractors to conduct an work on m YProPenY w I ill 10 Building addition _ ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 511 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.: 13.0 Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.7 Other 152,§I(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: 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. II do hereby certify under the pains and penalties of perjury that the information provided above is true'and correct. • ✓S nature: G.- �- ( tA.A...- Date: q' /3//2 o z Z 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#: SHEDS LESS THAN 150 SQ. FT. SHALL RE PLACED A MINIMUM OF 30 FEET FROM THE FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM SIDES AND PLOT PLAN REAR LOT LINES. FOR LOT # hhdicate location of garage or accessccry building Additions with dashed lines Sewwage disposal (cesspool) Ea Well 021 I I — _ — a (mot . rem) I Abutter's ,,/- + /T; I Name %^ CZ7 �� Abutter's Lot# Name Lot# If this is a REAR YARD corner lot, If this is a write in ft. corner lot, name of street. write in �' name of street. (Al I I 8 q I c4v. : SIDE YARD SIDE YARD `] HOUSEr r. • • • • • • I • SET BAC/ • • ft. I . I 3c 3v (lot ft. t ) - 0 i • / ob/011161 U / e / / (NAME OF STREET) Informatics • Supplied by ��Z�✓l i T 3S-- RECE VED TOWN OF YARMOUTH AUG 312022 , 1146 Route 28, South Yarmouth, MA 02664 BUILDING DEPARTMENT 508-398-2231 ext. 1261 Fax 508-398-0836 By Office of the Building Commissioner ZONING VIOLATION NOTICE Maciel Susimara August 19, 2022 62 Joshua Baker West Yarmouth, Ma 02673 RE: 62 Joshua Baker Road- Shed without permit Dear Mr. Surimara. This letter constitutes a formal Notice of Zoning Violation. We have noticed that you have placed a shed on your property without the benefit of a required permit. You must be applied for a zoning registration. (Express shed permit). Your property is in an R-25 zoning district which requires any structure 150 square feet or less be located 6 feet from the side setback, and 30 feet from the front setback. You are hereby ordered to abate and or correct said violations within seven(7)days. Failure to do so may result in criminal/civil complaints being filed against you. You may be subject to fines as prescribed by pertinent laws and regulations. You also have the right to appeal this decision with the Yarmouth Zoning Board of Appeals. 101.3 Penalties.Any person violating any of the provisions of this bylaws shall be fined not more than three hundred($300.00)for each offense. Each day that such violation continues shall constitute separate offense. This order may be appealed to the Zoning Board of Appeals as prescribed under MGL c.40A, §7, §8 and § 15. Questions regarding this matter may be directed to this department. You are required to respond within 7 days. Very truly Brad I ley Local Inspector Town of Yarmouth