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Home My WebLink AboutBSHD-23-34 a"a � � Office Use Only t 53)----t. AAcst�MA;TACM Amount Permit expires 180 days from issue date 1 EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: f 30 ��u� No � � QL�� i 1�� c.d.��/� OWNER: Lat7 `^ l.Vdtvl�y Tho(X Ave 5( 50�'-- 37 -a NAME 1 PRE ENT ADDRESS TEL. # C CONTRACTOR: G-1 C)0 k` 4 �'c 5 6 - L O " o Ob NAME 95 q ram,`n^ - a,Nin,pgAllat4D /1�A ,Q 6A �#rs D Residential 10 Commercial 1�1 C 1� Est.Cost of ConstructionlYtY $Q`t0''{ Home Improvement Contractor Lie.# IzacnG Construction Supervisor Lic.# GGt� "073b 6 S Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor X I have Worker's Compensation Insurance Insurance Company Name: it �Z;;,QejlfiCM ,J�t Ce Worker's Comp. Policy# �_ SHED INFORMATION New / Size Ligx W ID x H / Corner Lot: Yes No V Per Town 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 be built closer than twelve (12)feet to any other building on an adjacent parcel. All sheds are required to be located thirty(30)feet front anyfront lot line Replace existing*I0b Size L x W x H *The debris will be disposed of at 10 0 }r4 Location of Facility I declare under penalties of p- ry 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 deni or re ication of my license and for ution under .G.L.Ch.268,Section I. C:::::) 17// 9/ d 3 Applicants Signatu e: ' Date: Owners Signature(or attachment) i / Date: Approved By: r�� VAdarAliOi Date: ,4,.... . 1 Building Offici. or d`..ee) EMAIL ADDRE 6 Zoning District: Historical District: Yes No Flood Plain Zone: Yes No R E C E I V EN D Water Resource Protection District: Within 100 ft.of Wetlands:*** JUL 14� `� Yes No Yes No �Q23 ***Note:Conservation review required if within 100 ft.of Wetlands I I______.,- _ 3/22 1 BUILDING DEPARTMENT By. r r' Office of Consumer Affairs and usiness-Regulation _ 10 Park Plaza - Suite 5170 Boston, Massac••,, _:efts 02116 . - edit Home Irnprovement ,i s_I tor Reeistratiom. Commonwealth of Massachusetts -` —• Division of Occupational t.icensure v — Board of Building R etiona and Standards LI• MC RATH POST& BEAD CO. —_=' � — . Constructi 'Its ? &2 Family JAMES McGRATH _ r= CRFA-a73e8 3h- 259 OUEEN ANNE RD. _ _) — • ea,/ ',4 4�,''rsa:aa�1�il2o2a �1JAMES R M Welt lt HARWICH, MA 026455 =- =f-- 204 CRANVI \ r a -_ —" BREWSTER 0h. Air g _ UP ?j,}<_ tee .1 '-'. COdituiitiliO4tAr Fait K. S1&inilui. • THE COMMONWEALTH OF MASSACHUSETTS -ti Office of Consumer Aft i�, • Business Regulation • 1000 Washi • �: '- - Suite 710 Bost° i.- - -— 118 Home Im t r° ,_ - - : - _••istrati°n rr alai-1 ammo TYP®: CoTPorlttion MCGRATH POST&BEAM CO. 11 _ ; ,atio_ ,132935 D/B/A PINE HARBOR WOOD PRODUCTS _=- -- : :lion: 10r30/2024 259 QUEEN ANNE RD. --4:44 s _ - HARWICH,MA 02645 �acii r �— = _ �U,.•.;•.ate A.crate as a stern Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer A &Business Regulation Registrallofi wild Fcr Individual use only ears tns HOME IMPROV`'- '•NTRACTOR expiration date. If found return to: n r.:... .... Office of Consumer Affairs and Business Regkdatten •r---; . , , , , 1000 Washington Street -Suite 710 �," ' -:'isr Boston,MA 02118 MCGRATH POST&=a} e1-• •_- - A/B/A PINE HARBOR{,�o',' 1'`, 6'- '` JAMES R.MCGRATH ,'f` i t<g.t"---; ..'' z 59 QUEEN ANNE RD.i ... ''!,t .a' 6d f�y.,cam 'l i All J HARWICH,MA 02645 •':L c.-f= `: - -",:-'• vim•,• U„•arsscrslary 71MI+ia C�4 gEgin 4Mm The Commonwealth of Massachusetts Ilk f!/. Department of Industrial Accidents 1 Congress Street, Suite 100 -;_ t i= Boston,MA 02114-2017 ., — s'' www.mass.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): 1..AC Gf 3)5l i FeArji Co I(pt raI ton Address: a51 been Are fk(ad City/State/Zip: ■i , ' _A ' L. 'il 5 Phone#: 505 930 aSOO Are you an employer?Check the appropriate boa: Type of project(required): 1.1g1I am a employer with 25- employees(full and/or part-time).* 7. J New construction 2.01 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required,] 9. ❑Demolition 3 0 1 am a homeowner doing all work myself.[No workers comp.insurance required.]t 10 Q Building addition 4.❑I ant 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 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 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. 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: No() Ham Rsh ire, piol f rs Inso'ionrr, Compcm(t Policy#or Self-ins.Lic.#: ECG-.—LAD) c —I'S 7 - 09009A Expiration Date: ..Ju I Li a ,000 Job Site Address: () 01,Ct VA.� A\ ' ' tm 0 Ci °State/Zip: !v li'` ) 6�;y 19(0 Attach a copy of the workers'compensation policy eclaration 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 th p ' an penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: r — 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 BE 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 Indicate location ce garage ar- accessccry building Additions' with dashed lime Sewerage disposal (cesaponl) ®Well ag I I I — — -- I (lot ft. ) 1, I o/ 4 Abutter's Name I Abutter's Lot# ' Name Lot# If this is a 7 c-s <` REAR YARD corner lot, —7 �,0 If this is a write in ft. corner lot, name of street. write in '' _ name of street. .a a 8 b c ' SIDE YARD • • `.___ HOUSE _ SIDE YARD • .FTC. 1> a ----——tr • • • •• • SET BACK • ft- . ( 1 ,4Zy (lot ft f t tage) • t.� «�e 1\6� �U �av ou • -_ / (NAME OF STREET) / \ Suppliedb Lv` V t91-014---- -/-