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HomeMy WebLinkAboutBLD-23-000351 yr a-NA(5 f 9 n o Fr ol'YaR� C��',,„ -1 I Z'�CL �l- /n� t� ^ '� " �, �,.� Office Use Only �y G(JIJu N _ Permit# 130 O O*riii;\ ya ngttn �st� Amount 3 S.Ob kcaoo..n^�c �C ' Permit expires 180 days from issue date 6 —623— 60035/ EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH RECEIVED Yarmouth Building Department �` 1146 Route 28 JUL 2 0 2022 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 BUILDING DEPARTMENT G� `t—ou� ckv r�9, �, �. _ 8 Z CONSTRUCTION ADDRESS: ��� cA / \. OWNER: %re.,I I1 , n 32 lJp'i- ( /Y) clove bed 508 3600280._ NAME PRE ENT ADDRESS TEL. # CONTRACTOR: NAME MAILING ADDRESS TEL.# ki Residential D Commercial Est.Cost of Construction$ e 2 OO, C.) 0 1.---"" Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. Policy# ,� SHED INFORMATION v New( Size L O x W i tt x H - Corner Lot: Y No Per Town of Yarmouth Zoning 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* �Siizee L�` x W x H n �(J� ��Q,�'� *The debris will be disposed of at: r(�w fl cc- 'ai` it -`�" f 1 DI S L Axe, 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 revocati of my license and for prosecution under M.G.L.Ch.268,Section I. Applicant's Signature:\ I01/4• Date: Owners Signature(or attachment .0":1 -3e--- Date: ��f Approved By: Date: ter"—2Z Building Official(or designee) EMAIL ADDRESS: Zoning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands:*** Yes No Yes No I ***Note:Conservation review required if within 100 ft.of Wetlands 3/22 _ The Commonwealth of Massachusetts o= /, Department of Industrial Accidents 4 11= 1 Congress Street, Suite 100 _J -' Boston, MA 02114-2017 '•, `5.'' www.mass.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): I...e._►1 ," J-1 s\ C.c 1 r C% -S Address: 3 g Co. +cLv c o City/State/Zip: .Y0 (YrrA.417 0 66 11 Phone #:( so ' ) a b c 23 O Are you an employer?Check the appropriate box: Type of project(required): I._I am a employer with employees(full and/or part-time).* 7. E New construction 2.E1 I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity. [No workers'comp. insurance required.] 3.y I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 9. C Demolition 10 n Building addition 4.C 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.E 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.El Roof repairs These sub-contractors have employees and have workers'comp. insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.7 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. 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. A r�- Signature: -t-t. Date: Phone#: S v S' .4 .0 O02 3 CAA 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 SQ. 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 i Additions. with dashed lines ccr accessory budding Sewerage disposal (cesspool) 69 figi 1 I — _ _ I (lot ft. rear) I Abutters Name - Abutter's Name Lot# ` Lot# If this is a REAR YARD 9 /- t z • If this is a corner lot, corner lot, write in , ft. write in name of street. ti name of street. • • SIDE YARD SIDE YARD HOUSE • • • • • • SST BACK • • ' ft • (lot ft. frontage) CPO' et—Ct4 C)011/U` CC.) 5:XCe/V))/ri \\ / (NAME OF STREET) / Informatirn \. Supplied by _ 1' , i • i I , ; z 0 o t 100.00' ILI" 37.25 —1• .4. • i 1 . -t 1 .,....1:-.,,,...;-.. • ..--).,t,:. ---""`7`:°- -. .. N9J f k 1 , , .1 .,.._:, '. ..1.,:j.-..,•-• I 11::"..- --,1..c: ' t....1 Pk" •: T-• I • _ . ' '....' •s...- -,..-=,.- ,.: z.: •-•, .. ,.- • 'i,1. ,•••• ,. --_—_..._ --,:_--4.4.44.--r---, t-71t 1I z . I TEST HOLE ELEV.= qg 00 ' FL FAILED Ili F. • c) i t ACHING FIFA n 1 i -- / C , LOT #379 EXIST. 100C •qc11. 1 I )1( Septic lank 00 ,.- 1 !I f7 7'r' DECK . I ' - 1 1 ..------ I \ , • , (:::, . , I 4 „ . i 6 -- ' ..._ .1,_ 7 Z Z Z...21.;i:2",C 2 111,27..Z.72:27ZY.-...'.I_...7z.-....n a, 1 CV e v.- ' . k.• EXISTING (..) • 2 BEDROOM HOUSE17 4 fy #38 11 .t z_zz-r.z .z:Lv , Iz z_z 2-z_z-_27., I . . a., OPNI-WA‘r 1 ' LOT #378 12.000 Squarr Feet 4/- 9 9 1 . _ 100.0 0' -4F ' PI - . 4 - -- I 1 1 ii_..) iir -,.., I "7 .....\- 1-} r) 1-\,.). ..irt-c ."7,- (). --1, ./) 100 40 i-(i.,i i-104.1- ,_)i WA) " , 1 di 7.)\-c), 2(--/ t.1 •- - • I ,A%"444441 TOWN OF YARMOUTH ;rA HEALTH DEPARTMENT 1/4.`;� .2 TRANSMITTAL SHEET PERMIT APPLICATION SIGN OFF To he completed by Applicant: n ,r Building Site Location: . 8 Cot-P-IC.. 1\ Dore re i-o d o c4-+ /c> f0 0 f-h Proposed Improvement: (© X" 14 b U�}I / a5 a Skid Applicant: k AJQ /// Y)r V) doct C1 7 Tel. No.:(S ? 1 , 0o 3Q Address: 3-y C fcf-kJ do re infect Date Filed: **/f you would like e-mail notification of sign off please provide e-mail address:' tJ ov2A4 gC, .f�ai 1, Cor"r Owner Name: ' ,e JJ.t'0/7 ot..9 ZA Ccow r .S Owner Address: 3 g C'.,÷tcu Owner Tel. No.:Cco8) .-6C),-2-3 0 RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, � T +y and septic system location; (2.) Floor plan labeling ALL rooms within building t 6 Zf?Z2 (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; HEALTH DEPT (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: DATE: ?^ I ( PLEASE NOTE COMMENTS/CONDITIONS: n,v•1/4: OF NAR tOr 44 of*Y-44 WATER DEPARTMENT 99 131/416 Wand R.r rad 'Yarmouth, MA 026 lilvphont,. ,.7itPn 71-7921 • Cw/P-Net C c BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM BUILDING SITE LOCATION: ) O C...-CAL,P:11—C' • 4? rt., CiD P- ' d6.3/ • PROPOSED WORK: APPLICANT: 1 I 6'40 IP\ C p•-•-7 ADDRESS: C2...77C,„ cicr-e 14 III PHONE: 3 cd RESIDENTIAL AND OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availabilit) and or existing location Ingineering Department: 1)1/4:ternaries Compliance for Parking and Dr on Conservation Commission: Determines Compliance to Wetlands Act. c, If Ions)border an type of wetlands.ht reit ms.ponds.rivers.ocean, bogs, boys. marshland. ETC... I lealth Department: I)etennines Compliance to State and Town Regulations. i.e. requirements for Septage Disposal and other Public I leal th Activates Fire Department: Determines Compliance to State and Town Requirements for Personal Safety. Property Protections. i.e. Smoke ()electors.Sprinkler Systems,etc APP CANT SIGNATURE )VIE OFFICE USE: COMMENTS ON PERMIT APPROVAL OR DENIA I 2 z REN E ED BY WATER DIVISION(SIGNATURE) DATE %BO Irk • , , i ,,. i to 6' 3 — 9 8 t1' -- iaau5r6e3 L nce E Daley ,, NAME 9—l0-9 7 STREET •-• 7 ( _, r j... M , ,,, ,_,, ./C:c) ..... , , ? VILLAGE (5't) L SERVICE NO. — C5 IS P***,....._) ria , , ',t METER NO. -, --,--,..y •'> , ., , _ C.7:'" 4....,:••44-. 1 ,-;!-.: ifoe,Lr\ 6 P.s.f., . ... , „....„t / . ' 1 g...j, / . . r,-.7 t oil Lla 0 \ - / / / / / / .. , ' \ , . , / s LI p'" / f , (...) '15'01(z. v.4 F F f 1 i YL I, OR/K MUST 100.00' ii , Ti-� v........� J } ._•' t 's L.*., p } Ft • y . ... TF zT HOLE. #t i I _ACHING TIE(.O --d b i ... ZExIST, SO00 •4(1L LOT #379 -,: i Septic Tank jp® If rz .r 0 DECK ,. .........� PI-, ,.zZ,' l-:.��1:zz2—..[.:1.rz...t r,.z.�:l:tzrC-L:r: yw i Q r I EXIST! \ G 2 BEDROOM , HOUSE ., #38 c . ' 9 '' , , , ,.rr.rxa: / r� .. # i • i 1 i 'L r L . A,Sf'HAt.I t, GLOT #'378 : !) IL`.WAY JULi ,? �JL S EALTH D PT. t2.D00 Square Feet t; * : yy w to ` _ t ! el .-. 1 f 7 1 1 N- .... B 0 14.~ i 1 A L 40 F0•`.i PK.41T ;-;. WtA I I .t" tt CI V t