HomeMy WebLinkAboutBSHD-25-32 application fYA~'=a
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L. Permit expires 180 days from
issue date
185k1J -9532_
EXPRESS SHED PERMIT APPLICATIIR C E I V E D
TOWN OF YARMOUTH r
Yarmouth Building Department
1146 Route 28 MAY 0 5 2025
South Yarmouth, MA 02664 ,
(508) 398-2231 Ext. 1261 BUILDING DEPARTMENT
By:
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CONSTRUCTION ADDRESS:310 U Oct brc I e, `1 C fl �'nth C p o rt t M c U Zc4 is
OWNER: k hO. Ferret rtu csa-)34 4 1
NAME PRESENT ADDRESS T #
CONTRACTORQI�Q 4 IO� Pis a39 Ac ecS - i c h 5o& .
NAME ` MAILING ADDRESS TEL.#
Al, EMAIL: Q\ '\-<"CZ P / ^ , C4 C•\
C 2esidential 0 Commercial ❑Est.Cost of Construction$ 5500
Home Improvement Contractor Lic.# 13a9cS 5 Construction Supervisor Lic.#C S. A ^ 61 8.jj
SHED INFORMATION
( t t �t V
New � Size L ��, x W � x H /D Q-1 Corner Lot: Yes No
Per Town of Yarmouth Zoning 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) feetfrom any front lot line
Replace existing* Size L p /x
W x H �;� ( /�� n
*The debris will be disposed of at: n t C;rpcc.r 4 • ` R('i ^((-c 1.. t t� 1 r t A
Location of Facility i
I declare under penalt' of rjury that e 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 enial r ev cation f my license and for prosecution under M.G.L.Ch.268,Section 1.
pplicant's Signature: Date: S\5\a -
/�
Owners Signature( tachment) Date: ()61 05 i 2-025
Approved By: Date:
Building Official(or designee)
Zoning District:
Historical District: ❑ Yes ❑ No
**Conservation review will be required if shed is placed within 100ft of
wetland,200ft from riverfront,or located within a flood zone**
6/24
esus `(A
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"_ The Commonwealth of Massachusetts
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!- �ti Department oflndustrialAccidents
1/44.,).: = 1 Congress Street,Suite 100' Boston,MA 02114-2017
'•..,,� www mass.govidia
Workers'Compensation Insurance Affidavit:Buildera/Coatractors/Ekctrieiaas/Plumbers.
TO BE FILED WITH THE'EMITTING AUTHORITY.
Applicant Informs lion i,1 'se jriat Leeibiv_
Name (Business/Orgsnizatioallndividaal):9; Ai gtrAJ4Y Ag 9r 1 '' LL C.
Address: 2S 9 ,„se4. 1 t'C c e.,)l
City/StateiZip"Md+Y'e\rS 1 NA Qa.61As phone#: s-b ) " �'`S 0 —Z S
1 Are employer?e .yer?Creek ne appr.priete bee: Type of project(required):
t I am a employer with ?with?S. employees(hal and/or part time).' 7.UNew construction
2.01 am a sole proprietor or partnership and have no employees working for me , > „ 8. c3Remodeling
any capacity.[No workers'comp.msw a required.] '
3.01 am a homeowner doing all work myself(No workers'coup.insurance required.)t 9.,D Demolition
4 al am a homeowner and will be hiring cowacton to conduct all work oo my property I will 10 0 Building addition
ensure that all contrectora either have workers'compensation insurance or ars sole 11.0 Electrical repairs or additions
proprietors with no employees
12.0 Plumbing repairs or additions
S D I am a general contactor and I have hired the subcontractors listed on the attached sheet. 13.DRoof repairs
These sub-cootractors have employees and have workers'comp.insurance t
6 D We art a corporation and as officers have exetsised their right of exemption per MGL e. 14.Dothan
152,11(4).and we have no employees.[No workers'comp.instaance required.)
*Any applicant that checks box it i must also fill out the section below showing their workers'compensation policy information.
t ilaneowners who submit this affidavit indicating they are doing ail work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an add/nowt sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the ors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation eensation insurance for my employees. Below is die policy and job site information. ��4
Insurance Company Name:
Policy#or Self-iris.Lie.# �'_p(xi— 121}9 262S Expiration Date IZ$ 1215"
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 state •ant '`• . forwarded to the Office of Investigations of the DIA for insurance
coverage verification. d . , ,
I dO hereby certify thatthe infarnneiion provided above La isn't wad correct
Signature. / Date. //C l 6—
Phone#; C D 3' - (73 t — 7.
rOf-use oraty. Do not write in his area,jto be completed by thy or town o ficial ,
i
City or Town: Permit/License#
Issuing Authority(circle one): ,
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector e
6.Other
Contact Person: Phone#: :i
PLOT PLAN
FOR LOT t
Indicate Location of garage or accessory building
Additicos with dashed lines
Sewerags disposal. (cesspooL) ED
well (g
1 I
1 (irt ft. near) I
._. -- -- --- )- 4
Abutter's Abutter's
Name I Name
Lot# i Lot#
If this is a fps 5 �p REAR YARD If this is a
corner lot, corner lot,
„ft write in
wrna�mein of street. 1 name of street.
SIDE YARD SIDE YARD
HOUSE
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SET BACK
•
.Q.
(lot ft. titnth)
• r ? \U0A C►rr 1 e
(NAME OF STREET)
/ Infarmaticin
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of Consumer Affairs and 1 uijiness.Regulation
10 Part '- Suite 5170 .
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_Boston, MI 16 .L: ,
Home Improvear nt •,* ' ''•' Registration
• • _- Commonwealth of Massachusetts
. pli _•* _ _ / ,, Division of Occupational ircensure
Board of BuildingR utations and Standards
. � <t as ��s�.ria +tr 1 R 2F3mrIY
'MCGRATH & BEAM" _ filial _ ,,. om_ r
=MEN*ANNE . - _ =F� — ' tSFA-073865 :• I , pires:03H4J202
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HAR1AIcHa 11A 45- i 7 JAMES Rits RAf
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•• ^ BREWSTER Taos: ''
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l�f�+ ?h N.:dy, O�
Commissionereit/..LL:,„___
THE COMMONWEALTH OF MASSACHUSE I I S
Office of Consumer Affairs and Business Regulation
1000 Washington Street-Suite 710
Boston us.ts.i12118
Home improvement E pfttrRegistration
r -i, 41
t - Type: Corporation
2935
MCGRATH POST d BEAM CORPORATION ,7t,,,.. an /310230/2026
0/B/A PINE HARBOR WOOD PROD ✓t ---
259 QUEEN ANNE RD. - il= ;'
HARWICH,MA 02645 ��'= r •••-
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._._ Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for Individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date, If found return to:
TYPE:Co:poratim Omos of Consumer A Ustrmos Rsgutanoo
tulitelsn 1000 wowing'. -Suite T10 \
132935 - 10M02026 Boston,MA 18
MCGRATH POST 6 BEAM CORPQRATION
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DOA PINE HARBOR WOOGPROI : - ��
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JAMES R.MCGRATH �
259 QUEEN ANNE RD . ' t t y /
HARWICH,MA 02645
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