The URL can be used to link to this page

Home My WebLink AboutBLD-23-000348 CwituX 0/ -j( . o `�, . Slit/ Office Use Only .i Permit# l - 1 61, ,„„;TAG, L)E/ ,/ " , ,,, Amounts—.C Permit expires 180 days from issue date EXPRESS SHED PERMIT AP . LICATION-a 3-4�03y� TOWN OF YARMOUTH RECEIVED Yarmouth Building Department __._._____.._._ 1146 Route 28 r JUL19 South Yarmouth, MA 02664 2022 (508) 398-2231 Ext. 1261 __------ BUILDING DEPARTMENT CONSTRUCTION ADDRESS: 121 On l tlY1 r 1.744f,4x j al, t0 A" 4 OWNER Jil -13.5- &Ark' /2/ 0(41014- t- 174 2It., 174S NAME PRESENT ADDRI:'SS TEL ft CONTRACTOR: /1d4les L 0 A 19,04,104 id 5. x► S Eb•�.6 i+_ 170' Z/ /ZZZ, NAME M 4 LING ADDRESS TEL<# esidentiai ❑Commercial Est.Cost of Construction$,_ ,,,61000 _ Home Improvement Contractor Lie.# Construction Supervisor Lie.# Workman's Compensation Insurance: (check one) t)iorn the homeowner , I am the sole proprietor , I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# ._... SHED INFORMATION New Size L # x w /6 x H -[ Corner Lot:Yes No 1/' gcxitny eet it/e`tGkb01 Per Town of Yarmouth Zoning By-Law Sec .,5 Note E: .Side and rear yard.setbacks,for accessory builclin s containing one hundred fifty(LSO)square feet or less and single story, shall he six(6),f{et in all districts, but in no case shall said accessory buildings he built closer than twelve t"1 .;feet to any other building on an adjacent parcel. .All sheds are required to he located thirty(30 Beat rearm an • karat let line Replace existing* Size L x W x H /w l - 6 i&l e9 219 `° *The debris will be disposed of at: §' /ft ,- Location ofFacility I declare under penalties of perjury that the statements he 7 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 revocation of my 'e and ti pros cation under M.D.L.Ch.268,Section 1. Applicant's Signature: _ eS � �Z.Z -- Date' q ({ t14�'ners Signature(or attar ` ¢i''II Date: `1 b 1 7i Approved By. Date< g- n•-ate- Building Official(or designee) EMAIL ADDRESS: Zoning District: I listorical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wetlands:*** i Yes No Yes No ***Note: Conservation review required if within 100 ft.of Wetlands 3122 \ The Commonwealth of Massachusetts __�. _ Department of Industrial Accidents �,A,, I� 1 Congress Street, Suite 100 • it ' Boston, M4 02114-2017 ''�- 5•`' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information 1 Please Print Legibly Name (Business/Organization/Individual). NJ ►A ;y•d s--At Address: /Z( Vi4 icy-) <S l`', J City/State/Zip: m z„u/(� �- Phone #: `1711 2/4- 77 8 Are you an employer?Che k the appropriate box: _ Type of project(required): I. I am a employer with employees(full and/or part-time).* _ 7. _ New construction 2.E I am a sole proprietor or partnership and have no employees working for me in 8. n Remodeling any capacity. [No workers'comp. insurance required.] 3. am a homeowner doing all work myself. 9. C Demolition y [No workers'comp. insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on mYProPrtY e I will 10 Building addition . ensure that all contractors either have workers'compensation insurance or are sole 11.[ Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.11 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp. insurance.: 13.E Roof repairs 6.111 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. I.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 ies of perjury that the information provided above is true'and correct. Signature: c�c.,�s, ��s�4t� Date: ZZ Z q 7/ 1 z Phone#: ''17q 2t4,- 6 7418 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 Contact Person: Phone#: • PLOT PLAN FOR LOT # Indicatte 1DCatjc3 cat garage or accessory building Additions- with dashed lines Seweragedisposal: (cesaponl-) 69 Well igi 1 ___ _ — _ 1 ( ................ft. ) 1 Abutter's Abutter's 4 1 } { Name I !ice ` Lot# I Name If this is a , Lot# corner lot, REAR YARD If this is a write in G ' corner lot, name of street. "'- "ft' write in .I.. _ (' - name of street. I a .o I cq SIDE YARD • HOUSE SIDE YARD • • • • • SET BACK • • • • ft. I I . (lot ft. frontage) \ I / (NAME OF STREET) / \ Information / `• Suppliedby . - TOWN OF YARMOUTH 1146 ROUTE 28,SOUTH YARMOUTH,MA 026644451 Telephone(508)398-2231 Ext. 1292-Fax(508)398-0836 LD KING'S HIGHWAY HISTORIC DISTRICT COMMITTEE ,pii)KiNGS HIGHWAY_j APPLICATION FOR CERTIFICATE OF APPROPRIATENESS Application is hereby made for issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts of 1973 as amended,for proposed work as described below&on plans,drawings, photographs, &other supplemental info accompanying this application. PLEASE SUBMIT 4 copies OF SPEC SHEET(S), ELEVATIONS PHOTOS,&SUPPLEMENTAL INFORMATION. Check All Categories That Apply' Indicate type of Building: Commercial Residential 1)EApi:r BuilerksConstruction: New Building ri Addition iterations Reroof FIGarage i VI Shed LIScilar Panels I Other: El RECEIVED 2)Exterior Painting: [—biding Shutters [1 Doors aim Other: 3)Signs/Billboards: ri New Sin 'ti Change to Existing Sign AUG 1 0 2022 4)Miscellaneous Structures: Fence Wall LIFIegpole 11,Pool 1:10ther: Please type or print legibly: BUILDING DEPA-R;NiENT Address of proposed work: 17_,I (-10-160, 6r, Map/Lot Owner(s): JIMA-Us-5 Phone#: -1'74 Zi6 I/48 All applications must be submitted by owner or accompanied by letter from owner approving submittal of application. Mailing address: i Z/1 L,2ittetOt4 r Year built: 1 Tat S Email: _SP,. r06 a.b)eca..4.00..6...4.4..- Preferred notification method: El Phone [ Email Agent/contractor: gt.414.4t , i-JA-64-0 5---A.Pl inct Phone#: --r-te4 --zo,,,, I zzz. Mailing Address: CrAA Email: al-geStigt t440 P glitAA4 t 1 f Preferred notification method: El Phone Email Description of Proposed Work: 43 inck)49. t1/4-61-141 cieW AMA' Ae Sh /0Kii,/ 640 ), xs,b(1, -00 is , ealiait- Sit- ,PI te 40 e5 .12,142 6" z49 An° 6,744'0 /11214Eit- (LA if sife,C- be at,.c i bc, a wt. Jet' Signed(Owner or agent): -•.„ -- 4 4-- Date: liti 6 > Ownericontractortagenb's aware hat a permit is required from the Building Department.(Check other departments,also.) > If application is approve appro al is subject to a 10-day appeal period required by the Act. > This certificate is good for oTrear from approval date or upon date of expiration of Building Permit,whichever date shall be later. > All new construction will be subject to inspection by OKH.OKH-approved plans MUST be available on-site for framing&final inspections. For Committee use only: 1/Approved Approved with Modifications _ Denied Rcvd Date: 7111192 Reason for Denial:, Amount Cash/CK#: Allte 4) .7 ej r Signed: ---Irm A, PIT-N Rcvd by: 45 Days: ... , ....... ._ Date Signed: el/81202z_ ,,,e LD KIN 'S HIGHWAY 1 APPLICATION#: 2?-'"A3411