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HomeMy WebLinkAboutBLD-23-002708 Ito) ermolRECEIVED 11/%(L, Yak R �y' 9 �d ® Office Use Only 7 O p - i' -y e Permit/0 6 / .,.TT �. NOV[ 72o2a 3 J ./ N4gifi`4w.w:a'�F<<a' Amount BUILDING DEPARTMENT Permit expires 180 days from issue date 66-9-6'23 LC -7Dr' EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 'Pond 398-2231 Ext, 1261 CONSTRUCTION ADDRESS: d® Pry 1 and Wati OWNER:_, SDI'L. 11Ci �POLe„r )IMP{'] ldrlP,t LLL ,mAol E 5 77'�l •( ,U• � NAM , PRESENT ADDRESS �p� j�, ,/� TEL. # CONTRACTOR: ?NL HAehp(Wccrl 1Mti5, )59 [klY1t1 6C4., 1Wt4�l(h1Y1F ta/y5 5Ds• LBO - 02 866 NAME MAI. G ADDRESS TEL.# ,Residential Commercial Est.Cost of Construction$ Lit 119 0. D. Home Improvement Contractor Lic.# 1 h3Q el 3 S Construction Supervisor Lic.# ®738(9, Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor /I have Worker's Compensation Insurance Insurance Company Name:Neu) tpsh j re. &'YIpial&S Worker's Comp.Policy# Ea-(0 "1 croG3 Si- e be0.4 Insuretned Company SHED INFORMATION OKI/eif,/vJ New ✓ Size L f^, x W 8 . x H 8 , '� d Corner Lot: Yes No //- 7- 2-2. Per Town of Yarmouth Zonin2 Bp-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)feetfrom anyfront lot line Replace existing* Size L + x W x H Q *lite debris will be disposed of at:3`� F LO,pa) '6Ircal- WCST(/rl� A r 9 o'in t$r l�i4 ow,3 U Location of Facility I declare under penalties of perju a statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answers) will be just cause for denial or r ,ocations, ` ;license and for prosecution under M.G.L.Ch.268,Section I. Applicant's Signature: (. - _Date. 1\10 V,mbet' e, ,00a, Owners Signature(or attar',.en. &e Date: Approved By. Date: Building Official(or d ' ee EMAIL ADDRE oning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 II.of Wetlands:*** Yes No Yes No ***Note:Conservation review required if within 100 ft.of Wetlands 3/22 ! . ya ° , , / . Office of Consumer l - : AI 1 ^ ' -ffi ui 1 Boston, :. � 4 1 came rrhpro e ; ' � ;: Registration,, r€ttaaaavaattra t aaacraataattre �..z� s i tvrstc of ccu notions lc:nau Boar raft tt Cat a i/lio s aril Standards �'� „.,» CsSla8 �c � s` JAMESRA' _ ,"`, 0)73sh_s /) • "4 - i!e ;S311 2 2 jj JAr `. ,ti......==..." BREWSTER yitot 9 ' ," ...--• ,, 2"cRAWIP",ct!,4 fr, '''',,,1* : ' ,t.." fro: ;$'11 N, ,.3 i Commissioner . THE COMMONWEALTH OF MASSACHUSETTS • Consumer ° : :, • es Regulation 1 `; , .z -Stu 1 :_.�._ .,-•• - '1 Home im pro ri .--'. - r1:•Is ra Son- 132635 H POST _ : 1 0 4 A PINE PRODUCTS ".."`.. ti_ 2:5 RD P QUEEN i,MA r � . • HARWIC — . Update Andreas and Ream Card. I _ T k�_•. WEALTH OF. _. MASSACHUSETTS *Mob of Co A &Matinees Regulation expirationn validd Y before the HOME IMPROV CTCR . It feted MUM to: • Altana arel 9 Reputation 1 Washington Suite 710 Boston,MA 02118 MCGRATH POST&P Milifei PINE HARBORNFVt :; ,f JAM ES R. 4CG ATH : ' r-"� o 1.5J QUEEN ANN RED.'' ry?i`:51 J 1' ld. 4` i1AR�VCCH,MA 45 ;.`-��`=' Undersecretary �i The Commonwealth of Massachusetts ►"=_ �_. 1 Department of Industrial Accidents x =M = 1 Congress Street, Suite 100 P, -,I' Boston, MA 02114-2017 www.rnass.gov/dia IMP \Z orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information PIease Print Legibly Name (Business/Organization/Individual): , t&rash '�I+ 'Cpm Cor p:ea-4 ion Address: a541 Queen AnneTtitcl City/State/Zip: . , •G •a : •. , Phone #: '50 s '3® a sop _ Are you an employer?Check the appropriate box: Type of project(required): 1.2 I am a employer with NO employees(full and/or part-time).* 7, Z 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.] ' 3.0 I am a homeowner doing all work myself. [No workers'comp_insurance required.]t 9. C. Demolition 10 El Building addition 4.0 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 11.0 Electrical repairs or additions proprietors with no employees. I2.❑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.a 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 it I must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such_ tContractors 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:N`) 1oipshtr . empialitS 1 m rtlrltt [/1 lympei tit Policy# or Self-ins.Lic.#: ea.: (pro. 9 fl(yjg j7-o7dcqp� Expiration Date: \ju 1, 5 r.-01) 1 Job Site Address:dO ePtreh Ted Wail City/State/Zip:Vijirioulh f—Pilt LIMO aaU 1<) 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 der the pal and penalties of perjury that the information provided above is true'and correct. Signature: I i Date: Nolen*r 9, aOa a Phone#: 303 1-1 30 a8(�L) 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#: 1 /V /�i 0. , rtt, \ \ k rv, / , o. 4, , . ,, 1 1 1 e9ria.,, T \ .,,,, 1 i 1 .... ,•. .. / , 1 1 .. , 1 Gl / 1 -�� 6. 1 1 1 ; T7 \` r�r - 1 1 11il' It \ y6, \.® prr/ I i II t 7 1 i 1\ 1 / 0,16/-\\(:„...,..,_ 1 pp \ 1 .--..,,,rf. / ' 1\ 1. , .2y. / II e ._ '--� I I • -, ! \ ..,... pec i U / ..,- 4., 41. Aerr — _ �`i � TRIrv1 — - - �� ..� ...o lvn +p �•�� ..� ti ',v.. 1 A a. 4 dddd//// tea ~ �� o .34. �3 t° ea �. A - 1 r tl»� .� S ' <,st)vj 22 PINE HARBOR WOOD PRODUCTS 259 Queen Anne Road I Harwich MA, 02645 (508)430-2800 I pineharbor.com I info©pineharbor.com Homeowner Authorization 1 • 3Svf! L .2i,,, , as owner of the property located at Q P12c77( ,6 A,w,¢y y4,'a A. �� 2c have requested that Pine Harbor Wood Products apply for this building permit on my behalf. Pine Harbor will be serving only as my contractor and representative for matters relating to this application. I will be acting as the applicant and will assume all responsibilities associated with this permit. As owner of the subject property, I authorize Pine Harbor Wood Products to file this permit application in my name. Signature: Date: f v! 9-S101—e2--- Pine Harbor Wood Products-259 Queen Anne Road, Harwich MA, 02645 `YA cM±It• Tf G att F'I i TOWN OF YARMOUTH ?2i_t{8pw :5; RED it. 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4451 RECEIV , Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 NOV 0 7 202C OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE YARMOUTH APPLICATION FOR •L. KING' HIGHWAY 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: 490 f ch ?yid d \dlu Map/Lot# 114- ill Owner(s): • JOe3ph t the ) J Ap Ore_ Phone#: 111.1�jto•f ClaQ All applications must be sub(itted by owner or accompanied by letter from owner approving submittal of application. Mailing address:� 01 aftGh �n�t �4hrtWSbufy, ! t71595 Year built: i q8 Email: `,JOG PL kcirfloDk....roAk. Preferred notification method: Phone r Email Agent/Contractor: fRrte. Horb f word poildSPhone#:,5ne A436 a8na Mailing Address: d3 t jje.. i Arble:gatfl, HayWich,mc c (9'lS Email: ��4 &p'neh4iblor.CC,t.t _Preferred notification method: 111 Phone Email Description of Proposed Work(Additional pages may be attached if necessary): I0 e y 4roc+ .. 8,„ rz. shed plated on .col fit Con cre l-e bIvck 5 .The shed will Cort sfs4 off' a s e-1 of&ix o to d rs s s ( ivre Cedar 5hini VS on -the -?cnf- coat( and -fhe reutatnrry .5 r, IIS ►' feral board ; bec kti stdiny, TJt skit torsi h4lt. S kb graq A ) r6afshinglr5 (,ji-Fh all uMik p.v.c. frrm. . T Colar Lot nrp-kh the C46Sf(nq 110)3 Signed(Owner or agent): Date: 1lyernbtr a.=ag Owner/contractor/agent is that a permit may be required from 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 be later. For Committee use only:Date: 1/ !' .7'2� V Approved Approved with changes Denied Amount 3 0, Reason for denial: APPROVED Cash/CK#: Ne3 NOV 0 7 2022 Rcvd by: YARMOU t H OLD KING'S HIGHWAY Date Signed: Signed: je-Q- a d -e/141` i I APPLICATION#: �C V5 2017 o . Git,e) RECEIVED PINE HARBOR NOvo7Z_°22 WOOD PRODUCTS YARMOUI H OLO KI NG 259 Queen Anne Rood I Harwich MA, 02645 (508)430-2800 I pineharbor.com I infocapineharbor.com APPROVED Homeowner Authorization Nov 0 7 2022 YARMOUTH OM KING HI HWAY I • rsf/d/I "d r2/0, , as owner of the property located at ' r 2 c/{ (�'1 w t-�Z C --have requested that Pine Harbor Wood Products apply for this building permit on my behalf. Pine Harbor will be serving only as my contractor and representative for matters relating to this application. I will be acting as the applicant and will assume all responsibilities associated with this permit. As owner of the subject property, I authorize Pine Harbor Wood Products to file this permit application in my name. Signature: �—c_` Date: /0! r /,1-,2 2 7 Imo' Pine Harbor Wood Products-259 Queen Anne Road, Harwich MA,02645 io o o e. C O- N of o: $1 c 1 u I ° °O. CO p a 4 m 61 rT,o - �r a c 1�� a �i� a W N J u V' J r i i 2 1; m N a Bi q yo r W d� N 1 H u x p oft, W o o am 0 c G >r� el > N W LIJ` N W22oO W >'CC o 2 Y a o >z cc • 0 a i OD N co ..1_2) .9 ::,) O \\VV{{ (/0 W IILLI 11 LLJ w _C w c- _1 I/ a 1 t .0-2 = - - T T - i l a;:;0 M v r t