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Home My WebLink AboutBLD-23-003555 I $ Pemiitil ovt a p C► v/CJ Office Use Only Cy ,,, _ ,,\ Amount,3 5.G.) Permit expires 180 days from issue date EXPRESS SHED PERMIT APPLICAT ON � - 3 �0�3s3s TOWN OF YARMOUTH EYarmouth Building Department R --G^ _.�--V E D 1146 Route 28 South Yarmouth, MA 02664 SEC 2 9 2022 j . (508) 398-2231 Ext. 1261 sun_DING DEPgj M ENT CONSTRUCTION ADDRESS: 13 Webster Rd., West Yarmouth —___________ OWNER: Timothy Norton 7 Sewall St., Somerville, MA 617 365 0736 NAME — _... _.... PRESENT 1 ADDRESS TEI:.. CONTRACTOR: Owner NAME MAILING ADDRESS TEL.# Residential Commercial CK Est.Cost of Construction$ $7500 Home Improvement Contractor Lie.# Construction Supervisor Lie.# Workman's Compensation Insurance: (check one) X I am the homeowner I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. Polio i SHED INFORMATION ��'� lr'T� � t!` (, nr� New X Size t. 16 x W 9 x H Single Story Corner Lot: Yes No X 1 I 1-1 Per Thwn of Yarmouth T.aninj tar-Law See 203.5 Note E. Side and rear turd sethac:°hs fi)r accessory buildings containing one hundred fifty(150i square feet or less and single story, shall he siv (fi)f ee t in all districts, but in no case shall said accessory buildings be built closer than twelve (12) fE et to auv other building on an adjacent parcel. All sheds are required to be located thirty(30)feet flour anv front lot line Replace existing* Size L x W x H 'The debris will he disposed of at: Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the bestof my knowledge and belief I understand that any false answer(s) will be just cause for denial or matron of and for prosecution under M.G.L.,Ch,268,Section I. Applicant's Signature: , �'' � _ ....._._ ___.... Date / / Owners Signature(or attachment) J Date Approved By: Date: L/ -- Ruildina Official dew, EMAIL ADORE:S, - , 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 Property Description (Lot and Block Numbers,Tax Parcel Number, Legal Description, etc.) AM 29, parcel 151, being lot 104(Plan Book 36, pg. PLOT PLAN 63)& lot 106(Plan book 47, pg. 113)at Barnstable Co. Registry of Deeds FOR LOT W 151 °r accessary bAdditlime with ica unding sereraga dig l (c � - -------- • eWel isj • Lot#145 I Andrew Leighton Lot#144 1 �.. (exit......... •120� rear) Ronald Cadillac t Abutter's �" 6'to 7`setback Name from lot#144 V Lot# I 3 Abutter's 1 9.1 SHED Name If this is a - ! Lot# corner lot, REAR YARD -16'- Write in 55' 14'to 16'setback If this is a name of street. ........ •••ft. from Lot#152 corner lot, • }, write in .- name of street. I �. si 8 Septic in side yard 90 ft: �g YARDta deep IOW 90 feet IMF :9 p 12.7" H�?t75E SIDE YARD deep �].,..�..��.FT.a. 79.2' Lot#150 13 Webster Rd. o West Yarmouth ��W- Fred&Carrie • Lot#152 Delfino ; Joe&Carolyn • . O'Reilly • • • • I ; • SET BAClt • .4 w. 14.7' • 4• I 40. ...ft. £xtnt mge) ‘ / Webster Road, West Yarmouth \ f 7 (NAME OF STR$RT) // 1\4:4 lam-maticn SUp by Timothy J. Norton North The Commonwealth of Massachusetts ro--.r�1►�� Department of Industrial Accidents S %Vel: ; 1 Congress Street, Suite 100 e ' ti Boston, MA 02114-2017 syy, www.mass aov/dia \Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information PIease Print Legibly Name (Business/Organization/Individual): Timothy J. Norton Address: 13 Webster Rd. City/State/Zip: West Yarmouth Phone #: 617 365 0736 Are you an employer?Check the appropriate box: Type of project(required): l.❑I am a employer with employees(full and/or part-time).* 7. Qx New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] $• Remodeling 3.0 I am a homeowner doing all work myself. [No workers'comp.insurance required.] 9. ❑ Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work on property.my 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. • 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. I2.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.t 13.❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other 152,§1(4),and we have no employees. [No workers'comp.insurance required.] *Any applicant that checks box 41 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 DR for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 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#: