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HomeMy WebLinkAboutBSHD-24-125- r. 'f- —� 0Al£-/rv6— 1//.1-/ ,tz YA Office Use Onl �f y - • P4lSalt O /. 5 Ar Amount OR— . `z Permit expires 180 days from issue date EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 18 Carver Road West Yarmouth MA 02673 0 L0ZI OWNER: John-and Jacqueline Lodge ds gogersc" (2 Cun-he+-, tit A- G¢ I i 33SSr5� NAME PRESENT ADDRESS TEL. # CONTRACTOR: NA NAME MAILING ADDRESS TEL.# EMAIL:lackielodge86©gmaU.com Co Residential 0 Commercial ❑Est.Cost of Construction$`p 12,749 Home Improvement Contractor Lic.#NA Construction Supervisor Lic.#NA SHED INFORMATION New X Size L 12 x W 12 x H 10 Corner Lot:Yes NoX Per Town of Yarmouth Zoninx 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* Size L x W x H *The debris will be disposed of at: 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 revocation of my license and for prosecution under M.G.L.Ch 26/1.Section 1. Applicant's Signature: Date: Owners Signature(or attachment) QE�(�*C'`�� Date:November 15, 2024 Approved By: (1 Date: Building Official(or designee) Zoning district: Historical District: 0 Yes ❑ No **Conservation review will be required if shed is placed within 100ft of wetland,200ft from riverfront,or located within a flood zone** — br24 _ The Commonwealth of Massachusetts Department of Industrial Accidents _.,,, Office of Investigations ( _ -- ni= Lafayette City Center Pr , ,) \; "L- • 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): N/A Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. %. ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no Shed Install employees. [No workers' 13.� Other comp. insurance required.] *My 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. I City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5i:Plumbing Inspector 6.0Other 11 Contact Person: Phone#: __- li A !1 T1 '1. A !-`/IT 1 11 1 C~(�VI�L T'1 r 1 1� 1 PLAN irklU IINrEL T� Ti"1I ...) I. N H r4pplicant: Ldqe, I=ocation: Oar mD u fGc Z " • \:" 6 2 L'o t 184-- tot Jibe Uot too �. 1.----±,/ / "-SYIe1 9e taxia- Coy I'18 ocxxx tOt le 1 --- ICI f_ ____� _L_-_- I tot rock I 2 story LOt Aro. /5 -,---- GlitAM,1114441 Got ift7 povth ovr'v eir itZ0 Ca treJlsed • *V1444 /OV ASS lignS �0 • •u� ti\ Title ref__9'6_?2.�9:3._____ Mood Panel: 2. 4 01.a_0_5�3..J_71ood Zone: _X__ S GAO - ,71 �J hereby certify that this mortgage inspection was prepared for ' "g'3' IIeC -1_ 0114.. _l- '91(7__ 4 ldl eUs_.Ekt/..g Q_1olin .,.\1,1.,1t.r _0._cLc so.0 .- ---._____ `ifs T E;. of , T he dwelling shown hereon..sitta.w.lfall in a special ), Mt1 6. . . flood lone -01 "fl"or"V", with an effective date of .,5^.16,-.3_,__.and the location of the dwelling V _ _ ._conforwr to the local zoning by-laws in effect at the time of Scale: 1•'= __ .Q......._...___..__ construction with respect to horizontal dimensional setback requirements Date:__6__.11:.?. _____._._ or is exempt from violation enforcement action under M.G.L. eh. 4074, sect.?. 3ile No....?o-1012.4-_- 1 icasc nvtc. D��� Sv✓+i..v+reS =n ivvrl uri Inc; flirjriguye lrl><7Nl UUY7 Um' yrrVWn U/jr/rvXlmUle Uili6J, rlri iri>iru rrierri>Nr VCy i� iit'Ce?S(.iry i0 i determine a precise location of structures and properly tines.This mortgage inspection must not he used for recording purposes or for use in preparing deed descriptions and must!of he used for variance Or building department purposes.Verification of building locations. propery line dimensions.fences or lot i on figuration can only he accomplished by an accurate instrument-survey which may reltect different ferent information than what'IS Shown hereon. NOTE: THIS 15 NOT A BOUNDARY SURVEY AND IS FOR MOR rc AOE PURPOSES ONLY. COLONIAL LAND SURVEYING COMPANY, INC. ►'osT OFFICE BOX 350 - KLIMA ROCK,MA 02047 ' !':781-826-7186 F;781.826-4823 - C•.C01.0NIALSURVEYOGMAILCOM .�I