HomeMy WebLinkAboutImage_001.pdf - BSHD-23-84 22795o
o\c!o
EXPRESS SHED PERMIT APPLICAT
TOWN OF YARMOUTI]
Yarmouth Building Department
ll46 Route 28
South Yarmouth, MA 02664
(508) 398-2231 Ext. l26l
C('o\s'rRt ( ' o\ .\Dt)RFss,
3u e-e.r$e
NAMI'S+e A
PRE
Aoo 5Ots 78oa ?6+
gResidcntirl O
('ommcrcill
llome lmprotement Contractor Lic. #
Workman's Compcnsation lnsurance: (chcckone)
lam thc homcoNncr I am the solc proprietor
lnsurancc Compan\ Namc
g-
SENT ADDRESS
\-\{-
tFt *
II,\II I\"C.\I)t)RFSS IFI "
Esl. Cosl ofConstruction $
Worker.s (,omfi polir)#
( onstruction Superrisor Lic. H
I hitrc \\'orlcr'r C0mpcnsation lnsurancc
Replace existing* _ Size L
'Ihc dchns rrrll hc dr\rcsed t)l al
rl,
l.orilion ot t.rcilit}
\rill be Just cause lbr dcnaal or revocation ofmy licen.e and tor prnsec,ttioni ra"'lf C f'.n 26E.S€ctmn I
Dale
pn nrrs sign:rture 1or llttachm€rl,$ci Drt(
Pcrnrt c\Irres 180 da\s tiom
Ec
Bal.-
7 32202cT0
PEL)
v ::--
Zoning District
llistorical Districr: yes r'o
Water Rcsourcc Prolection DistrictYes No** *Note: Conscrvation revicrr
Flood Plain Zone: Yes No
Vr'ithin 100 ft. of\4etlands: ***
Yes No
$ithin 100 ft. of Wetlands
.c D.rlc
l/21
5a
OllNER:
( ( )Nl Ri\C I ( )ltr
i.rltt *)
appro'.,rsr${t:rElak
B rldrns Ot'trcl]t ior de\rgflccr I \1.\t-AD-DRLSS -
sHut) I}-[ ()Ri\IA1.to\
,, /\er ,.2' t,,, ,/V ,r, 7 ,tt/u-l (.r.rr(,1 1,,1.1.. \,, >r
/Applicanr's Signarure
Ollice Llsc Onlrmpza
\.-;...
w
Jhe {oamzizM S JfAaaaahzaa@.
Office of Coasumcr Affairs and Bqiocss'I(egulation'I0 Park Plaza - Suitc 5f 70
Boston, IvfassaglPttts O2l 16
Home ftip.rovcmcn @ftor Registration'.
McGRATH POST& BEAI{ CO'
JAI\,iES MC€RATH
259 dUEEN ANNE RD.
HARWCH, f,'tA 02645
Cormonwarlth ol M!.rachuarttr
Dlvlalon ot Occuprllonal Licanrq,eBorrd ot Bulldtng Rd$hlonr rnd ghndordr
construct3yrfrft*Vf,rb;l & 2 Famity
c8FA.073805
JAMES R
&o'a:
E
9,
to
t$i 0311412021
THE COTTIO'{WEALTH OF UASSACHT'SETTS
Orlca ot Conaurrt &l.lrEa R.luLlton
IIOIE
I',ICGFATH POST Eoal P|NE HAnBOfl
204
BREWSIER
,r,a . -l!Ltv.tll'J',
Conmtcttor*rr dvtrp R df-;-t L"
Corpoabn
132905
10t3r)t?024
lrpdrt! Ar'drtaa aird Rdum C.r{.
n gllb.Uoo t dd tor h.lhrldu.l u.. ooly b.toG lrE
axpltr0on arrta. I loui ,*,rn io:
Ottba ol Con.lrnf, Atlrlrt and BurlrE. R.gub0on
1000 Wlthlngton 3lr..l - Sultc 710
Bo.ton, IA Cl|lt
THE COMMONWEALTH OF MASSACHUSEfiS
Office ol Consumer Business Regulation
1000 - Sufte 710
118
Home
TlPo
JAMES R. MCORATH
.I. 59 OUEE}{ ANNE BO
tlARWpH, MA 02645
t
=,
I
'\-:Urxbrs€crslary 3lqnatuI€
M@RATH POST a BE lil CO.
D/B/A PT.IE HARBOR I/V@D PR@UCTS
250 OI'EEN
^I\INE
RO.
HARWCH, MA 02645
d-..ro./.r*
The Commonwealth of Massachusetts
Department oJ I ndustial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www, mass.gov/dia
\\'orkers'Compensatioo losurancc AIIidavit: Buildcrs/Contraclors/Ercctricians/plumbcrs
TO BE FILED !VTTH THE PERMITTINC AUTHORITY.
,{oolicant Iuformation Please Print Lcsibh.
Name ( Business/Orsanizarion4ndividual)
Address: 2..5Q Guet-rrr Annc Q,.\
Arc you eo cmploycr? Ch.cli tt. tppropri.tc bor:
I [t I am a cmployer wi*r ]4 .rptoy... (ful and/or pan-time) .
2 fll am a solc proprictor or panncrship and havc no amployccs wo.kiag for me in
any capacity [No workcrs' comp insurancc rcquircd ]
3 !l am a homeowner dojng all *ork myself [No workcrs'comp insurancc requirad ] i
c!lamahomcownerrnd\arll be hrrrnt contrac@rs lo conduct all lrork on my propcny I will
ansLIIc that all contractors arther havc workcrs' compcnsalton lmurancc or arc solc
proprietors with no cmployees
5 f] I am a gcneral conrracto. and I ha!€ hrred rhe sub-contractors lined on the anached sh€et
Thes€ sub-contractors have employe€s and have workars'colhp insuraDce i
6 ! Wc are a corporation and ats omccrs bav. cxcrcis.d 6cir righl of.xcmption pcr MGL c
152, $l(4). and w. havc no employccs [No wo*ers'comp irLsurancc rcquircd ]
City lState/Zip Hc*rt:itl. , M-t Otbu5 Phone #: 6..,K - q70- a8a0
14 fl 0ther
'An) applrcanr $al checks box 4l must also fill our Uc sectton bctos showhg l})errr Homcoqners *ho submrt rhrs affidavl indrcatrng rhey are dorng all *ork ani theniconkacors thal chcck thrs box must anachcd an iddnional shccishowing thc name
workcrs' compcnsation polrcy information.
hirc oulridc contraclors musl submit a new amda![ andicalnB such
ofthc sub{onltactors and state whefEt or not thosc rotitics havaemployacs If dlc sub-contactors hav. cmplolecs,thcy must providc dEir workcrs'comp policy numb€r
I am an enployer lhal is provitling worken' compensotion insurance lor ny employees. Below is rhe poticy antljob siteinlornfuion
Insurance Company Name .H Lrn lo o.A
Job Site Address City/State/Zip
Attach e copy of thc workers' compcnsatior policy declaration pagr (sho*ing the policy aumber and cxpiration date).
Fatlure to secure coverage as required under MGL c I52, $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 $250 O0 a
day against the violator A copy ofthis stetement may be forwarded to the OfIice of lnvestigations of the DIA for insurance
coverage verification
I do hereby certily u penolties oJpejury that the inlornurion provided above tru and correcL
Date L
OfJiciol use only. Do not wite in thk aret, to be conpleted by ciU^ ot tov,n olficiaL
Citv or Torrn: Permit/Liccose #
Issring Authority (circlc otrc):
l. Board ofHealth 2. Buildiog Departmetrr 3. City/Towr Clerk
6. Othcr
,1. Electrical Inspcctor 5. Plumbiog Inspecror
Phone #:Cotrtact Persoo:
P
hlp,,r
Policy#orSelf-ins Lrc # ECL-GOO -L{(\COqSrl-a0AU4Expirationoate Jv\u\ X, A0ALI
Z3
Typc of projcct (rcquircd)
7 flffiew construction
8 [ Remodeling
9. E Demolition
l0 fl Building addition
I l.E Electrical repairs or additions
l2 fl Plumbing reparrs or addirrons
l3 !Roof repairs
Alov. 7n
326ibmouh Rd. IHyannis,l,tA02601 I508.771.5007 1Far508771.7070 I hyannisotineharbd'com
25S ouoooArne Rd. I Harwi:h, uA 02645 I 508.430.28m lFarS08.430.1115 I inf0@ti0€hato(.com
1.8tr,I6sllEl, I Cuttorn{S.wl..t.ScSlE0lol I uuurtLlt{tor.com
PINE Schedule Dale
.1yz-1vt t
Eranch 0ai€iold
nze E Styh
5
loors
Siding
Rool Shingl€s
Cupola & WeaiErYane
otier
icA Stmail
506'.at-1Lol
Ar Stale fne,@413---"&tl . &.,4' r lr a
Special lnstructions
o
lra 6D
fs
fim
Sub Total
Tax
lnstallation
Delivery
TOTAL
Deposit
EALANCECredit CardCashCheck
b ilo
VOOD PRO DUCTS
I't,
tr
IJL
+
FoR LOr l _-____---__.._..
mffiffi,r--==j::Y
ii!:,i".E3.^'#ti,L'fl 3?$"EE+'.
tr$ J$Fj}:+r i?r b,il ii#i i ",PLOT PLAN
(Jot. . . .,.,,... . .. ..ft- i€E)
(fot. , ... .... . ..,..,. .ft. ftcnbge)
c €
I
I l
I
Abutter's
Name
Lot #
It this is acorner lol,write in
name of street.
Abutter's
Name
Lol #
It this is ocorner lot.\Yrite inname of streel.
AITJ
t
qto
o
o
( NA!{8 OF STREET)
InfumaficnSrppLld by
4
0
a1
rrg
I
I
II
SDB YI.ID
@E YAXD
0--- -xr- 0
?
I
I
s,Et BtcI
G
I
I
I
REIR TARIT
"'-""r:"'o'
I
II
--++-
fr
HOUSE
3t17t13
PINE HARBOR
WOOD PRODUCTs
p
o.CU
q)
A)a
QUIVETT CAPE DIMENSIONS
(\
-\l
(o
6' Gabte g',-11 1t7"6'-4 1t2 6',-4 1t7 6',-0'
6',-4 1t2"8' Gabte 10'-9 1tZ'6'-4 1t2"6'-0"
10' Gabte 11',-7 1t2"6',-4 1t2 6'-4 1t2 6'-0"
12' Gabte 12',-7 1tZ 6',-4 1tZ 6',-4 1t2 6'-0"
INSIDE FRONI
WALL HEIGHT
INSIDT REAR
WALL HEI6HT
OVER,ALL
HEIGHT
DOOR
HEIGHT