The URL can be used to link to this page

Home My WebLink AboutBLD-22-007509 e_ttitALk / 17)—Z.-- SHEDS LESS THAN 150 SC FT SHALL EE I ()Hr,..,:,ils4.,..r)nl:, ACED iVINIMUM OF 30 EET FROM THE P,111 I!.;._._eXsit.L,(411 P'11 41!4Yil- 1 .:1. FR CNT LOT ',—NE AND -4 M'N,IMUM CF 6 FF,=T , Am ,„,..a.s:ob 40,:..„,,,_- „._,,i;-.,,,-,i 7POM 17,-4..= sln=s . \47' RF AP CT Ni'=''S 1 Piainit irTirt..ai 1%dayi tnun 6 1.,D--4 -?- -04 '7561 EXP:;"ESS S'.,-;:-.Ei- ', PERMIT APPLICATITE C E IV E D TOWN OF YARMOUTI l Yarmouth Building Department JUN 30 2022 1146 Route 28 South Yarmouth. MA 02664 BUILDING DEPARTMENT ( y 508) 398-2231 E.I.Ext 1261 coNsTRucTioN ADDREss:_zci .1\1461c,\„/_ u.c•AQ..., .„ .. _ \ssus,0,, ,,:,„,„„.„, ,: Map: I Parcel: OWN11:: QS:(SSIAO,o,k um _ s 4 _losh„....kkiVittlin _01,0X72 - a60.-164.11-_, rvizsr-ii-i-DDRIL,-3 TEL :!.- • CONTRACTOR: V% G S ccf.11 U3-iktii.P-ci.&)41111A6 110L--Q a)NANtU NIAIL INC!ADDRLSS TEL. 7- Ictst.csidential D Commercial Ft. Cost or Construction$ q 9)9 . 00 i Horne Improvement Contractor Lie.ti Construction Supervisor Lie. Workman's Compensation Insurance: lleek 011Q) X ain the lionieowricc - I am the soIe proprieior I have Worker's Compensation Insurance Insurance Compan Name, Worker's Comp, Polics-, SHED INFORMATION _ _ New Size L V N iV11 X fi Corner Lot: Yes _ No Per Town of Yarmouth ZonitN'By-Law Sec 203.5 E: Sick and rear setbacks to;'accessory buildings less than 150 square leer and single stot:),, shall be 61M in oil(fisirias, btu ill no ease built closer than 12 li,et to any other builcling, Replace existing* MI Size t fbe debri3 win tiC disposed _ Locatiu a til Facilitv 1 dQulitre Undir 1),:ilalti'.!S Or per-jury that the statzments lierein contained itre true tint!coneet to the best of my knotvIeL,e and belief I tar lei-A=1 that any false anstverts; cc/I!be just cause t'r denial or rev,\-ation of my licent aml Ca pm cetaion and \Lai,.Cl "2.0,Secooti Appiicant's Signaturc:_C_LitStl - On tiers Signature tor Alt:Himont) Daft,: nproVk'd 13;y-: —7.".....2.7.2.-- , Buildino(miej, ,,r d. g.,;„, EMAIL AD lt,S: Zoning District: I I listorienl District: \-es , - No Flood Plain Zone: 0 Yes : Ni i 1 I •tvtier Resource Protection 1)/ore.. Within I')0 IT,0 r\Vet lond,;: Yes : Ni I Note: Con5ervation review required iftvithin 100 R. of Wetlands PLOT PLAN , FOR LOT k Indicate location of garage or accessory building Additions with dashed .lines Sewerage disposal (cesspool) ED Well t I I I (lot ft. rear) I Abuttor's 4 -- -- _._. _ Name I (p'4 Lot Abuttor' I Name f this is a REAR YARD to L (2� Lot M acirner lot, �� vrite in name ft. If corner If street. : write i name of o, I ti .a other ,o• street. 4 ; SIDE YARD HOUSE SIDE YARD : . • • • I . SET BACK ' . I `� v \ 6-8 , \Cur a (NAME OF STREET) / \ / \ Information Supplied by (ARK NORTH POINT The Commonwealth of Massachusetts ' IN� Department of Industrial Accidents G 1 Congress Street, Suite 100 Boston, MA 02114-2017 4�'� www.mass.gov/dia vow Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/organization/Individual):Salt Spray Sheds Address:235 Great Western Road City/State/Zip:South Dennis, MA 02660 Phone #: 508-398-1900 Are you an employer?Check the appropriate box: Type of project(required): I.® I am a employer with 4 employees(full and/or part-time).* 7. E New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. EI Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. 0 Demolition I Li Building addition 4.❑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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 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.* 13.0Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other shed construction 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: Travelers Insurance — Policy#or Self-ins.Lic. #: UB 4N913088 Expiration Date: 05/12/2023 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 perjuly that the information provided above is true and correct. Signature: ""— Date: 06/20/2022 Phone#:508-398-1900 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#: 1 es` <i.ItfcYl ,.. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:°Corporation Registration Expiration 188352 07/20/2023 SALT SPRAY SHEDS,INC. ANDREW WARBURTON __- 235 GREAT WESTERN ROAD SOUTH DENNIS,MA 02660 Undersecretary • The Commonwealth of Massachusetts Department of Industrial Accidents A4 Fr.lio'c= I Congress Street, Suite 100 Boston, MA 02114-2017 — „ ww;v.mass.gov/dia . ,. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information , Plea e Print egibly Name (Business/Organization/individual): N.) ((Ife ..,, ' kird [.,1 7(J\1104 Kluirlam r Address: Q City/Statelip: \(0,MA Rp, 0,.,N3Phone 4: S_A - 6.3&._______ Are you an employer?Check the appropriate box: Type of project (required): 1.0 I am a employer with employees(full and/or part-time).' ' 7. X New construction 2. I 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.] 9. E Demolition 3.0 I am a homeowner doing all work myself. [No workers'comp. insurance required.]I 10 Ei Building addition 4. am a homeowner and will be hiring contractors to conduct all work on my property. I will ns,:ro that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.D Plumbing repairs or additions 5,D I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp, insurance.: 14.D Other 6.D We are a corporation and its oft-kers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] I l *Any applicant that checks box#1 roust also fill Cu:the section below showing their workers'compensation policy information. I t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors 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 andjob site information. Insurance Company Name: 0 CT Q,c) cis aobcc)..1) ., C-)(4. Policy 4 or Self-ins. Lic. 4: t a I, 6 o„, av Expiration Date:q \ \ a a. Job Site Address: 81-1 h66\( (w\c, ty& City/State/Zip: wz.1. (k,r(11,4).-\ 01 ()c14-73 Attach a copy of the workers' compdnsation policy declaration page(showing the policy number anà 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. Sianature: Date: Phone#: -1 Official use only. Do nor 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#: I