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Home My WebLink AboutBLD-23-001701 ()tell, . w Po i&Ltd5 Office Use Only }Os O 61IZAJLL 1RECE 1VE ® Penni (� .3) 1 i .f1 S e p Amount 6 0•o t0�' .- �x SEP 2 8 2022 Permit expires 180 days from issue date B U I L cBy _ .> tco"2.3-ela 9/9 i EXPRESS BUILDING PERMIT APPLICAT ON TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 t.4 14_j j C 1(lCt 11 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: (.O 0 ‘LX,f\A.\C•e Ak'"),44.41\d--•\IS --- eovp me.,,,,, ,,,,,,....A2,A,47'3.` ASSESSOR'S INFORMATION: ki\ -9,g i•J 0. Map: Parcel: OWNER: 1��rt�� CA\/\j (,{ V�- 5 CC cC-Ld � (��'� 1 l\O N PRESENT ADD SS r CONTRACTOR: ac�� \.c.,•&"4.. \D Cr...,\,-.0 e. c-NAM E MAILING ADDRESS ��r vVTEL.# °Residential commercial Est.Cost of Construction$ 5 00 k Home Improvement Contractor Lic.# t "o\.-e.,\1 Construction Supervisor Lic.# c 'rs zt Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor have Worker's Compensation Insurance 517S ar$ c. Insurance Company Name: �1\/'t� Worker's Comp.Policy# WORK TO BE PERFORMED Tent DI Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares (._____\.\)iU 1 eplacement windows:# Replacement doors: # Roofing: #of Squares (0)Remove existing*(max.2 layers) Insulation I I r- / k ' • YI iS3l2 n 1 mgs ig6way/Historic Dist. Replacing like for like Pool fencing j; \s *The debris will be disposed of at: U)C r.,/\i ,g \-/N.54,12S--- l'''qcr-\)tz),,..._/ Location of Facility I declare under penalties of 'ury 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 ' n of my license and for prosecution under M.G.L.Ch.268,Section 1. R\ �� .� D te: \l li Applicant's Signature: n� ..• / ate: of Owners Signature(or attachment) � �'.--22 12-. �/ � Date: .ss Approved By: ) MAIL ADDRESS: Building Official or designee) Zoning District: Historical District: ❑ Yes [I No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District: Within�100tft.of Wetlands: '0 Yes 0 No The Commonwealth of Massachusetts �r ,_i` , 1 't Department of Industrial Accidents _ir ill 1= 1 Congress Street, Suite 100 '• ,I Boston, MA. 02114-2017 . � �, www.mass.gov/dia -JiiiiWorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMTTTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): d,4, cro. Address: t', c, i?...w . City/State/Zip: .."1 ,� 2r•Cwki5t- I J'i1 Phone#: sbz, r (a1 —`vc Are you an employer?Check the appropriate box: Type of project(required): 1.Erram a employer with `( employees(full and/or part-time).* 7. 0 New construction 2.0 I 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 I am a homeowner doing all work myself(No workers'comp.insurance required.)t 10 0 Building addition 4.EI I am 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.❑Electrical repairs or additions proprietors with no employees. 0 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.[,tither Si\ iet 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: it\I\-1„ Policy#or Self-ins.Lic.#: \C,(, 'SS.0 c"bk'"j b<2,61% 4 Expiration Date: tZ\u. 22, Job Site Address: {tv., �s W e�� City/State/Zip: ys.crivekv bel 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 c e pains and penalties of perjury that the information provided abov is true and correct. __--- 5._ e Date: iit t Phone#: Lial use only. Do not write in this area,to be completed by city or town official. , or Town: Permit/License# ing Authority (circle one): oard of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector ther tact Person: Phone#: Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards cons rptttt'6irvisor • ri CS-075281 � cpires:03/12/2023 TODD J CANJ ARA 10 ECHO RD WEST YARMOJTI ° 1. }: • ,p ors ,i3 Commissioner diaa '. Crru.ta�.. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affailk&Business Regulation PE w�du Registration valid for individual use only before the expiration date. If found return to: HOME IMPROVEi dual TOR Office of Consumer Affairs and Business Regulation ii n 1000 Washington Street -Suite 710 Nrr +io 24 Boston,MA 02118 TODD CANTARA D/B/A CANTARA HOME ti TODD CANTARA 10 ECHO RD. •g Not valid without signature W.YARMOUTH,MA 026`i 8 - Undersecretary Sherman, Lisa From: RICHARD GEGENWARTH <rgegenwarth@comcastnet> Sent Wednesday,September 28,2022 11:41 AM To: Sherman, Lisa Subject Re:King's Circuit Golf Maintenance Shed Attentioni:This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe.Call the sender to verify if unsure. Otherwise delete this email. I approve. Will look proper next to other building, Richard On 09/28/2022 9:30 AM Sherman,Lisa<Isherman@yarmouth.ma.us>wrote: Hi Richard, King's Circuit is requesting to cover their golf maintenance shed with the same grey vinyl siding that was approved earlier this year for another maintenance building next door. Both are behind a gated area and can't be seen from the street. Please let let me know if you need additional information. ? 4 /, Thanks Richard, Lisa Lisa Sherman 22„t19 • • ,aimay... ' Tiiiiii t,'.4 ,„.,,,..,'.:',..,:':::.:..,...,. ''' _..--...; '' :. - I, .: ,..i...i.„, ., 1, . .,- ;; r ^ r - : ,3 „,....,.... •....,.. •. •......,•••i,,,,;•,'...•••:.2..t:••,-;%.,,t,,,,,,i,,,,,,,!,,,,ap,!..-.0.,,,,,,.:•i,.-• • ' . i 1 : . .‘ • '; N . } Y 3 ?f•�a•R •, f iy hK f ib. • A : if .P, • ; ... Y b.. , ,. ....�.. z.., .r•b&4. e. .......... E3 t m ox r ' s r :::::::::::::::::::::Flic:::1:::::::::::::::!:::::!:n72:::! • ! p'D 9 8 2 i,9,' 'F4,W p ; a)-.054