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HomeMy WebLinkAboutBLD-23-001866 L.,yr) D Office Use Only Permit# � I/13 o ly Amount 35.00 MATTACF' �sE��d "t09e0""tc,i, Permit expires 180 days from issue date 4/.3-ba lg&& EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department RECEIVED 1146 Route 28 South Yarmouth, MA 02664 OCT 07 20;1 (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT CONSTRUCTION ADDRESS: / 6ea �j G l/I/E �'JJ/By OWNER: -7:7-~>% L [S ( 6�- ✓f!G!(� I�! 5 �J�/3 '7 -, / 9 NAME / PRESENTNESS TEL. # CONTRACTOR: NAME MAILING ADDRESS TEL.# vitesidential D Commercial Est.Cost of Construction$ Qev, Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) am the homeowner I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. Policy# SHED INFORMATION o vi appravie New V Size L 1 x W 10 x H //7 Corner Lot: Yes No f /7� Per Town of Yarmouth Zonin;;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 from any front lot line ��Replace existing* Size L x W x H V *The debris will be disposed of at: /)fL i1arbor 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 revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: 9/79/420 _ V/Owners Signature(or attachment) Date:9�a7/Rp _ Approved By: Date: /0 Building Offici r d onee)' EMAIL DRESS: 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 L Department oflndustrialAccidents _1AI= 1 Congress Street, Suite 100 '=h4 Boston, MA 02114-2017 :' www.nzass.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): ( 7 Address: / e) ' -i die City/State/Zip: A,rnc-4,t ,i jar Phone #: 5vs 4/37 C17 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with employees(full and/or part-time).* 7. New 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.E I am a homeowner doing all work myself. [No workers'comp. insurance required.] 9. Demolition 10 Building addition 4.Cam 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.ri Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑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.I (� 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. — :her 34r. 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 under the pains and penalties of perjury that the information provided above is true and correct. nature: i,I J, _ Date: 2/ay/ e. Phone#: 5' '7 3 5-7 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 Phone#: Contact Person: • SHEDS LESS THAN 150 SC.), 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 # / Indicate location of garage or accessory building Additions: with dashed lines Sewerage dispoeal (cesspool) Ego Well Lgi < ,6 I _ _ _ (lot.. , ft. ) I Abutter's Name Eyre.... Abutter's Lot# 3S" Name Lot# If this is a REAR YARD corner lot, !f this is a write in ft. Sye4 iD a76, corner lot, name of street. �c oZ J write in ' r.,i name of street. I la SIDE YARD .0_ —tisro la; HOUSESmB t ARD I SET BACK • • • 1 a Oct / ft. frontage) , . \ // 6eih- t9 " ice 14, % \ / (NAME OF STREET) / \ Informat inn / Supplied by �iv, c-li J2,--9 ) of Ye'LriA F T . ._-_ _- -____...,...- s 1146 ROU'E 28, SOUTH YARMOUTH MA 02664-4451 ECTTIF -le=ephone(508)398 2231 Ext 1292-Fax(508)398-0836 i i,;i 0 7 20L OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE YAi=iMOU 1 t s APPLICATION FOR a>KING'S 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 lectibly: r _ /f `'!+� Address of proposed work / /�c 7/ _ t . e- ii- rs./ g 12 Map/Lot tr /3 , X 7 Owner(s) '7-',SIC�� C'. ! rc ,-, Phone k `3_'_. _''..._{ o t AU applications must Se submitted by owner or accompaaJnie/ by letter from owner approving submittal of application, Maiing address. /4,,G_.__ i'`�- Year built /.9 8-j" Email: ;_'1 7�n &_�27`� 6-0/'7 Preferred notification method Phone __ Email ca 1) AcAgent/Contractor _. ,2u l rbG71f`' — Phone# 6 �-'_ _ � Ma ling Address l. .r..t-_Qu.., ` _. Email Preferred notification method ,.,.._�__Phone ,,, ____. Ema' Doscri lion of Pro ased Work JAdditional a Jes ma ,be/attached if nines a : Q n /C2 x J,-2.. Berl S lie e- "7� e- YJakaLr/ h g,,,, &(`,, / 4.0 ec i r"�Y.,,,". e P� h s R, T 5' e W grv2v-- . C ,c1r;51.s rs,2/ k.PP- .e ,, 3 s.1,++rs,, (r. ---//-f',�14•c�l uJ ..-4 gr T..,._f'��'r..t4---- :`7e-, Signed(Owner or agent) ..,. t- '"._..----_� - Date, 14 ,,�,t" #2r*r' ? Chmerlcantractor/agent is aware that a permit may be required horn the Building Department.(Check other departments,also.) Y This certrricate is good for one year from approval date or upon date of expiration of Building Permit whichever dale shalt be tater For Committee use only: Date._ }U/1 1)) Approved Approved witOr - ",. -- Denied i 4 `" * 111 Vi. GfJ ..,, --- _ Amount r Reason for den al . sty ,' _ .. ._. CastslCK tt- 1 I1 Rcvd by;_, -m.L._ ('i ii n P 4 C.! \A 1 r 2t4 Signed Al'Pt.ICATIOtS Date Signed.._...-...-. ,. __ VS VS 2017 Sherman, Lisa From: RICHARD GEGENWARTH <r gegenwarth@3comcast.net> Sent: Friday, October 7, 2022 3.17 PM To: Sherman, Lisa Subject: Re:22-E144 1 Belle of the West Road 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. The property does roll off so it won't be very visible and it is pretty far back from the road. I approve. Richard On 10/07/2022 11:08 AM Sherman, Lisa <Isherman@yarmouth.ma.us>wrote: Hi Richard, Resident would like to build a Pine Harbor shed in the backyard of 1 Belle of the West Road. He tried to capture that the back yard drops off so you won't be able to see the shed from the road, but hard to tell that in his picture of the shed location. Please let me know if you need any additional information. Thanks Richard, •41 41', •V Et Lisa cot, L ) Lisa Sherman Town of Yarmouth Administrator,Old King's Highway Historic District and Yarmouth Historical Commission 72, e iiitt ,4„ I I 1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-4451 t• Telephone(508)398-2231 Ext. 1292 Fax(508)398-0836 OLD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE WAIVER OF 45-DAY DETE INATION The applicant/applicant's agent understands and agrees that due to the current declared National and State public health emergencies the determination of our Application for a Certificate of Appropriateness/Demolition/Exemption may not be made within 45 days of the filing of such application. The applicant agrees to extend the time frame within which a determination is to be made as required by the Old King's Highway Regional Historic District Act. SECTION 9-Meetings, Hearings, Time for Making Determinations "As soon as convenient after such public hearing; but in any event within Ji.rty-five (45) days after the filing of application, or within such further time as the applicant shall allow in writing, the Committee shall make a determination on the application. " Applicant understands that the review of this application will be scheduled as soon as the situation allows. _.� Applicant/Agent Name(please print): 7rn©Jh 0--r747 Applicant/Agent signature:_ —® _Date: Application it: yq ., 3r2020 • . PLOT PLAN i FOR LOT # --Z----,,,___ c 0 Irkticate iccatzlal ct wras9e ar acr:easory bttilding Sow.• . • • • •.... * (cesspool) GSt Well xi I c• 4 0,75 . 0 I (lat...., --- ---ft. rear) I , —...... .C1- I gyp, Abutter's Abutter's l 35-1 Name Lot* Name Lot ft If this is a REAR YARD 4, if this is a its corner lot, write in ........r...ft. .51/eci f corner lot, if, -1 L2€: write in name of street. ---> —..-1 ..tis„,740,.,,) name of street. 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