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HomeMy WebLinkAboutBLD-23-001594 aiOy.YA ,;, cavil-- ,e,. - �O Office Use Only Oi �.Iy �� ���" �- Permit# eid ATTACH CS �di) ,$),,,,,„.:��!_-,y Amount •(1Cs r.. Permit expires 180 days from issue date 13EXPRESS SHED PERMIT APPLICATION - Z 60 r.SGq TOWN OF YARMOUTH RECEIVED Yarmouth Building Department --- - -— ------ 1146 Route 28 SEP 22 2022 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 ---- _ BUILDING DEPARTMENT ter' B CONSTRUCTION ADDRESS: /S' C i 7 we// 0A'1 ✓e .4-irno ,�. fr rr //c -7g 1V OWNER: 64-X 7 .1 6 /cJ /ce—' Rom GV i✓/x 2/� C a/ " 1!OGs —6 3 O NAME PRESENT ADDRESS TEL. # CONTRACTOR: P/Ail /t4 e6o2 2 )' y,iRm0 i1i rc/9I co ^7 7/- IO 7 NAME MAILING ADDRESS fi-y47t/uiJ TEL.# 4/4 ©26,a r esidential g Commercial Est.Cost of Construction$ ��© C . tO i Home Improvement Contractor Lic.# C S f4 —0 1- cy� If 6 7 3E 3 s 3 � Construction Supervisor Lic.# �� / Workma Compensation Insurance: (check one) lam the homeowner 1 am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: Ma 1''ru 5 a44 - 7/--111 S C, Worker's Comp. Policy# SHED INFORMATION O aperYD New Size L /02 x W / 0 x H // f r 7'6 Corner Lot: Yes No ✓ ' Per Town of Yarmouth Zonin,' Bp-Law Sec 203.5 Note E: Side and rear i'ard setbacks for accessory buildings containing one inuidred flftl' (150) square fed or less and single story, .shall he six (6),feet in all districts, but in no case shall said accessory buildings be built closer lhan twelve (12)feet to any, other building on an adjacent parcel. All sheds are required to be located thirty(30)feet fromanyfront lot lisle IL Replace existing* Size L/c x W/0 x Hi/ % (A ve.*The debris will be disposed of at: .5 I J Eyc 6 - , 00 6 i(' 4f Vf SreAii, Ac L 4 eiv a,t J Location of Facility I declare under penalties of perjury II •t 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''• on of Ijtense and for prosecution under M.G.L.Ch.268,Section I. Applicants Signature: ! Aor 'I ,� ` Date: / / Owners Signature(or attachment . I .�/ ( WA. 1" Q Date: ((( +�!!! Approved By: / r �"��.l� J 7 �Date: Building Official(or des/ EMAIL ADDRESS: 400 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 7 fAf, l= 1 Congress Street, Suite 100 c -' `_ Boston, MA 02114-2017 , www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information �1 PIease Print Legibly Name (Business/Organization/Individual): 6.4ti (.? ?SS y ✓� /Address: / C 20 GCe j( 4/7(V& o City/State/Zip: vTI1.1067( ) 44> i 1O 4 Phone #: ( - ,;2O/ - 0 (a (v 83 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7. El New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] g• Remodeling 3.0 I am a homeowner doing all work myself. 9. ❑ Demolition y [No workers'comp. insurance required.] 4.Ee.am a homeowner and will be hiring contractors to conduct all work on mYProPnY e I will 10 E Building addition . ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.: 1 •❑Roof repairs 6.1=1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. ✓Other Re lJ�/� yl{n/f` 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: 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. I do hereby certify nder the pains nd penalties of perjury that the information provided above is true and correct. 7 ig,nature: ' 7e2A /tea Date: 9/A/ 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: R • PLOT PLAN FOR LOT 1 ThdicatE location OE garage Additions w dashed °r Act-pagan, building Sewerage disposal (cesspool) `ED -- --- Well 0: I I _. — ._ I (lit................ft. rear) ' Abutter's Q Name Lot* t� I Abutter's ( Name If this is a Lot* corner lot, REAR YARD write in I If this is a name of street. ........ ..ft. corner lot, �,• write in i` ( name of street. ie?) t---2t )- SIDE Y. - • �^ HOUSE SIDE YARD • • • • • • • SST BAcX • • ......i..ft. , • (ict..................ft. frcntsge) • ,.\ 1( CROMPV-ell kOR/Ve._ i (NAME OF STREET) ---4 <----: / \ Infcrmat�n Supplied by �j . Office of Consumer Affairs and Husiness.•p egulation r 10 Park P1az,'a•- Suite 5170 l Boston, Massac•. efts 02116-ed , ., :, Home Improvement• ?,, tor Re istratiorr=, _ Commonwealth of Massachusetts �^ Air • Division of Occupational Licensure • — _ _ Board of Building Re�c ulatians and Standards McGRATH POST A BEAM CO. �' L �rs JAMES McGRATHy '`= _ �' r 259 cIJEEN ANNE RD. _ cSFA-073865 �' 4pires,•03/14/2024 HARWICH,MA 02645 JAMES R i F __ 204 CRANVI6W — _ BREWSTER 9 P. Gl6J1U'lAl.9A11PM • CJl,lvaf,a "s` Commissioner d,,.!> K • �Fifitdut, • <, • Office of Consumer Affairs and Business Regulation 1000 Washington Street o Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 132935 MCGRATH POST&BEAM CO. Expiration: 10/30/2022 D/B/A PINE HARBOR WOOD PRODUCTS 259 QUEEN ANNE RD. HARWICH,MA 02845 Update Address and Return Card. OBh»of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Badskallan Eattkdaa Office of Consumer Affairs and Business Regulation 132995 10/30/2022 1000 Washington Street-Suite 710 MCGRATH POST&BEAM CO. Boston,MA 02118 D/B/A PINE HARBOR WOOD PRODUCTS JAMES R.MCGRATH 259 QUEEN ANNE RD. ° e.,a'4.4 " HARWICH,MA 02845 Undersecretary N• w i •ut signature The Commonwealth of Massachusetts Department of Industrial Accidents ' :11'1�=" 1 Congress Street,Suite 100 ":_f= y Boston,MA 02114-2017 a 4,1 www mass.gov/dia • Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aanlicant Information Please Print Leeibly Name(Business/Organization/individual): Ai Gf 5+ d &n1 Cot'palm ion Address: 025 Queer) Anne T(nact_ City/State/Zip: J4trtii(J ,mA agUil 5 Phone#: Soo LJ30 0800 pv Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7. dNew 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.®1 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 PPerry•ro I will 1 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.1:Plumbing repairs or additions 5.0 I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 13.0Roof repairs 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. s'elow is the policy and job site information. Insurance Company Name: N1/) HaMpShtre. EmplarrsAnsuionce. &wipettlfl Policy#or Self-ins.Lic.#: E- o>y()Ljs 7 &O A Expiration Date:_ kJ Iy 8,_„, t)49 3 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. I do hereby certify ,'r t p''1r an ,penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: yr 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.CityIfown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I RECEIVED r r TOWN OF YARMOUT SEP 2 6 2022 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 • -- Telephone(508)398-2231 Ext. 1292-Fax(508) 398-0836 BUILDING DEPARTMENT OLD KING'S HIGHWAY HISTORIC DISTRICT COMMI pNc-;'s APPLICATION FOR CERTIFICATE OF EXEMPTION Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of Chapter 470 of Acts of 1973, as amended, for the proposed work as described below and on plans, drawings, or photographs accompanying this application. Type or print legibly: Address of proposed work' I CI-0 3)t-it4.,..- Yarfn04.4 t1 art-Map/Lot# Li 3/5 4, owneasy (761-14 y s Phone#:‘, 20i "tut All applications must be submitted by owner or accompanied by letter from owner approving submittal of application, Mailing address IS C coo well pr, Yal-mt lf1 F 1 Year built I Email: j ep $5 @ j41(ktI. cc>rei Preferred notification method Phone Email Agent/Contractor. (1,hte- Harbor Phone# 3-6F — 50 7 Mailing Address 325- Ya17 Cltk+k "E'ea- y Ois /1/4 Email WWw,fifte,h arbor. 4.01 Preferred notification method /Phone Email Description of Proposed Work(Additional pages may be attached if necessarv): Pioe uIa,rhr eV If d isma,t eXisting ,511 ex/ and ci, 51.10.s c of flit?Jeri,Ajs # -T 'xco .200 &rrtr Jek4),) Pe-014;5,/1/4- .4 lok 51k,!.d s s 1Jr1h CAD cirttwie)4s will Le... err_ded Oil -the. sa_fre. Fr&fir pre ciered_414131 es Cd.t94.(4)4' Grey(cods('slot w hou-Se 5 ides- and re4r (wila;i1 fl 841114'4' r tiV INI:tAk6 e-(Savae as ho k. dio cAjo koW ate4.--td fn I c4 (4%0C c4or ce' 1144se- Ai&to t.;11e-z4 will hax-e I witveiett; - old 5-beci 440 hace Signed(Owner or agent) Date > Ownericontractoriagent is aware that a permit may be required em the Building Department (Check other departments,also) This certificate is good for one year from approval date or upon date of expiration of Building Permit whichever date shall he later For Committee use only: Date , /Approved Approved with chande 0, • ---Amount 20 ik Reason for denial CashrCK 351 I Rcvdby,_ --711-D-K*7-‘,7G7Tir-jsf> j • Date Signed' 2•2•1•23- Signed .562 '44Ve4\-0`4 e/Wie 1 APPLICATION#, 3t1 si• 2,117 • Sherman, Lisa From: RICHARD GEGENWARTH <r.gegenwarth@comcast.net> Sent: Thursday, September 22,2022 1:58 PM To: Sherman, Lisa Subject: Re:22-E134 15 Cromwell Drive Attention!: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. Very appropriate. I approve. Richard On 09/22/2022 12:42 PM Sherman, Lisa<lsherman@yarmouth.ma.us>wrote: Hi Richard, Residents would like to remove an old shed and replace it with a Pine Harbor shed at 15 Cromwell Drive. Please let me know if you need any additional information. Thanks Richard, Lisa * • I 1 EP 2 2 ?IV?. Lot u oNtr,15 ;