The URL can be used to link to this page

Home My WebLink AboutBLD-23-000706 of 1AL 8l i iizZ 'YARD Office Use �Onnlly�. ,�r� . �R RECEIVED Permit# l..b=� V ►01 C MATE,�S[!/H, ` 5OU ^�,� Amount ak «°'° a AUG 0 8 2022 - Permit expires 180 days from issue date 8 UI E---� NT 46vv—A.---dd aia EXPRESS SHED YL� 4�C1'i APPLICATION TOWN OF YARMQUTH Yarmouth Building Department 1146 Route 28 4 - South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 1, CONSTRUCTION ADDRESS:_ 'S F--t 0 CS`E rPo 1 rP�) `AST- YA M°u'1-j IAA a Z-4 7 3 OWNER: 1EV('V+' 'f (Zry S 9 A 5 MMG co/tiT/A.3 b n • 617 346 S C'AC NAMI ! C PRESENT ADDRESS TEL. CONTRACTOR: �''I�S rear U1 Jfl1 1L 6vioN yS int, 3 1 1'4 y 14 lhi&Q,A /V NAME MAILING ADDRESS TEL.# pi 1cr due l v. eArlefbA, sidential D Commercial Est.Cost of Construction$ (1,6 �+ 2 Home Improvement Contractor Lic.# it 7 O3 Construction Supervisor Lic.# C J- g 9s."V$5 1v 1C i c L AIfl e- J+1- Workman's Compensation Insurance: (check one) 2� Ir-A O y S 1� Du`i1 Col C 4-7I am the homeowner I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: 1 ,rrYlSUIk/' —Worker's Comp.Policy#W il SHED INFORMATION New Size L Ltd x W /if x H 11 Corner Lot: Yes 7/ No • Per Town of Yarmouth Zonini.'Br-Law Sec 203.5 Note E: Side and rear yard setbacks for accessory buildings containing one hundred filly(1 50)square feel or less and single story, shall be six (6)feet in all districts, but in no case shall said accessory'buildings he built closer than twelve (12)feet to any other building on an adjacent parcel. All sheds are required to be located thirty(30) legit j-orn am front lot line Replace existing*1)�i- Size L x W x H *The debris will be disposed of at: Location of Facility I declare under penalties of perjury that a 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 rev c `n of my license and for prosecution under M.G.L.Ch.268,Section 1. f^t Applicant's Signature: Date: ``Ip`L�l`a 414 Owners Signature(or attachment) Date: 1,14 61 ,- Approved By: 4-/�� Date: 1 ''C'' Building Official(or designee) EMAIL ADDRESS: Zoning District: • s Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft.of Wet s:*** Yes No Yes No ***Note:Conservation review required it within 100 ft.of We ds - Workers' Compensation Insurance Affidavit: Builders/ContractorsiEtectriciansrIL/IIIRPL-17, TO BE FILED WITH tHE PERMUIT INC AL'f1-101411'1, Applicant Information Please Print Legibh Reeds Ferry Srnall BldgS. Name t Bik;iness Or!!!aramon Indioati: Addresvz• 3 Tracy Lang CitviStatelZip:Hudson NH 03051 Phone 603-883-1362 -----. Are you an employer?Check the appropriate IMPS: 1 I Type of project (required 90 1 . LE]I am a employer with employees irull fald'or part-um:J.'. 1 ' " 0 New construction . i I '. 212 I ant a S01::pmprictot-or parmership and havte no emolover,•woo.;;;t1 to;voz 1,1 1 I S. D RelilOdel in,' , any capacity.[No..vorkers'c011ip, insat-ancc rerlimcd 1 I 1 9. D Dem,ii,i,„, 3.ri 1 ain a horneowroc'r doini a vt ork hv,-st.'l r l'..,-,Vk6i,-- -..,...: ,,,Op,i,,`,•-,;iv;:,;,.:,.: i to [ Buildow addimr-: 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I wilt ensure that all contractors either have writ-kers'compensation insurance or arc sole I 1 I 1.n Electrical repairs or additior.! - prynnewrs with no employees. I 1 12.n Planfoiricz repairs or ad:litior.., ! ! ..... stj i am a'general c onmactor and I have hired the sub-t:ontractors iliteri o Lt n the allaia sheet. i I I 3.1-1Roof remit-, I-hese sub-contractors h".1`C..aNTIC,:.;...;:,;at.,i h.-.. 1 i 14 Snec- , - — 6.0 I.A c arc a corporation and its officers have exercised then.right of exemption pc;N It.i I,.-,: ' 152.§It 4 .and we have no employees.;No workers comp insurance=tared.' t : l *Any applicant that checks box=ti must 3150 till our Me section nelow snowip, meir Workcrs comocnsanon nottc.: it'-a ) ' Homeowners who submit this affidavit indicating they arc doing all WOrk and then hire outside contractors must unmet a new affidavit muicaurtt: i 4.'ontractors that check this box must attached an addition:1i sheet showlne the name of Inc sub-contractors and state it Settler ttr not those I cmpioyces it tnc sun-contractors has c emplo\ees.tnev must provide their workers ,:otrin rop.:v ttalttr:. I ant an employer that is providing workers'compensation insurance for my employees. Below i.s-the policy and crib sitc i information, 1 Utica Mutual iris ! Insurance Companv Nart-!..- 517c/A Policy or#or Self-ins. Etc. #: '''' Expiration Da': __ ___ . _55 Horse Pond Road _citv.statetzir,West Yarmouth MA Job Site Address: . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date't, Failure to secure eoverafie as required under NICil_ c, 152. zl25A is a criminal violation punishable by a fine on to$I.501)iv' and or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER.and a fine olup to S250.0.,.: day avainst the violator.A copy of this statement may he forwarded to the Office of Ins estigations of the DIA for insuraricc: cov•.L.raisze \erittcati,..i7. I do hereby certify undeythe pains and penalties of perjury that the information provided above is true and correcl, _ 603-883-1362 — ---- 1 i Official use only. Do not write in this urea,to he completed by city or town official , ii ! , L 1 it City or Town: Permit:Licensi2= ......_. . .. 1'1 Issuing Authority(circle one r , 1 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector 1 6.Other Contact Person: i:. 11 Phone#: . ....._________.._ .,....._ i ., 4, , Al . , . . • \k\:\ jjik PLOT PLAN 5T M9 f`i,,..PA Q5s a . FOR LOT rstlemp. Cti to t cf ~ bIzati- ?'3 Addirlmer with dashed linenWe Sewerage dispceal: (cesspool) EH l fig/ j ( ..ft. rear) -1...i' 3 ...... ...�,. . Abutter's Abutter's Name \D t9 Name Lot# /5'7 0 k a ,._ . ' Lot# If this is a REAR YARD If this is a corner lot, corner lot, . write in ft. write in name of street. �, name of street. t n C (7111--° 4--- • SIDE YARD SIDE YARD = - • SET Back ,V ft. i .4„. clot f ftt ) • hbiteei q 0-A,k ( & e / 1\ / (NAME OF STREET) — - r ` Informat it n J J I I) 5 c�n Supplied by The Commonwealth of Massachusetts Department of Industrial Accidents 'tll -� 1 Congress Street, Suite 100 Boston, MA 02114-2017 -�' www.mass.gov/dia rr Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): {<E vie f t y s'4 Address: 55 Mo-5.6 ro,'ld r City/State/Zip: tile il- niAki tit Phone#: I ? 3i Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with employees(full and/or part-time).* 7. IeW construction 114 61) 2.0 i am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling t d F l ` any capacity.[No workers'comp.insurance required.) 9. L Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑ Building addition 4.l1 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. - 12.Q 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.1 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14 ❑Other i 52,§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. . ?- eJc Insurance Company Name: .0e- X C• fr , IItt — 2 � Policy#or Self-ins.Lic. #: V" 4I 2- ��a �" �S �'2/ 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 Iv1GL 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. 1 do hereby certin) u d t pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 6/..LY'/Z2 Phone#: 7 JPO SLY) 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#: Sincerely, Diane Diane Clifford Operations Analyst Reeds Ferry Small Buildings,Inc. 3 Tracy Lane-Hudson NH 03051 603.883.136Z I 888.85.SHEDS www.reedsferry.com Please Check Our Link for Site Prep:http://www.reedsfelry.com/Site-preparation • Intl us on Faceboot I Follow us on Twitter —— t'"77-7'4e F0-712/220-/M1 10//) Office of Consumer Affairs and Busir 1000 Washington Street - Su Boston, Massachusetts 02 Home Improvement Contractor R REEDS FERRY SMALL BUILDINGS INC 3 TRACY LANE HUDSON, NH 03051 SCA 1 0 20M-05/17 ZoirtesifotRoanswooto 104009F*A0000°n HOME IMPROVEMENT CONTRACTOR Registration valid for ir TYPE: Corporation before the expiration d; Registreion Expiration Office of Consumer Aft 119903 09/16/2023 1000 Washington Stree REEDS FERRY SMALL BUILDINGS INC Boston, MA 02118 MICHAEL D. CARLETON 3 TRACY LANE ,;4.7t4of a. HUDSON, NH 03051 Not valid v Undersecretary ` From: Kevin F Bryson kevinbryson@comcast.net Subject: Re: Sales Order 34810 from Reeds Ferry Small Buildings, Inc. Date: Jun 24, 2022 at 12:37:59 PM o, Diane Clifford dclifford@reedsferry,corn Hi Dianne, im going to the town for the permit., Two q quick questions -the insurance workmens comp on the page below expired 6/20/22 can you send a new one,and whats the LENGTHx WIDTH xHeight, Thanks Kevin Sent from my iPad On Apr 18, 2022,at1:18.PM, Kevin F Bryson<kevinbryson_fcomcast et>wrote: Ok thanks Dianne, ill let you know on the workers comp-much appreciated Sent from my iPad On Apr 18, 2022,at 1:17 PM, Diane Clifford<dclifford_fteedsfrrry,com>wrote: Hi Kevin, I forgot the permit forms we talked about.Let me know if you will also need a Workers'Comp affidavit. Best, Diane Diane Clifford Operations Analyst Reeds Ferry Small Buildings,Inc. 3 Tracy Lane-Hudson NH 03051 603.883.1 62 1888.85.S H E DS www.r- eedsf yc_oi Please Check Our Link for Site Prep:httpww.r Arisfa. -----��°v.com2Le r ti n '4....°) alloW New Pnglane Join us on Far h k I Follow us on Twitter From:Kevin F Bryson<k vinbrysinacom a t n t> Sent:Monday,April 18,2022 1.13 PM To:Diane Clifford<dclifford r d f rry.com> Subject:Re:Sales Order 34810 from Reeds Ferry Small Buildings,Inc. CAUTION:This email originated from outside of the organization.Do not dick links or open attachments unless you recognize the sender and know the content is safe Thank you Dianne.looks awesome-very excited Have a great day All the best Kevin Sent from my iPad On Apr 18,2022,at 12:52 PM,Diane Clifford<dclifford@r edsfp >wrote: Dear KEVIN BRYSON: Your sales order is attached.Please review the list of items on order. Thank you for your business-we appreciate it very much.