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HomeMy WebLinkAboutBSHD-25-12 applicationb OF YA.14 . Office Use Only 41 . ' , f Perm it$ ,? <.;,,c t« 4r./ Amount 35 f6V- 0`ao, ..E Permit expires 180 days from issue date EXPRESS SHED PERMIT APPLICATION ei8Mb-c2$-1°)` TOWN OF YARMOUTH RECEIVED Yarmouth Building Department -1146 Route 28 MAR 18 2025 t South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 i � �,�,�� �/� �/� BUILDING DEPARTMENT CONSTRUCTION ADDRESS: SP. S 1t ei_ V4�-/n,/ H'./ITT � � — — OWNER: VIZ cWL'�J z L4/rigin dNfi M-a2-671- P - 547"Aia/ NIA PRESENT ADDRESS TEL. d� CONTRACTOR: pAvelf i�. MV�1i-fi�ti1,i a f`'//fm 02 1 "-77/ i/ NAME/� �j' !I �jT� MAILING ADDRESS ` TEL. EMAIL: y�A I. W CO IA.hW.C-041 JfResidential -'Commercial Est.Cost of Construction S Home Improsement Contractor Lic.# . f, 7 f J _ Construction Supervisor Lic.# CSfA- (�3 owl SHED INFORMATION / New / Size LE x W /6 x H `Q/9 iv Corner Lot: Yes No Per Town of Yarmouth Zonin,' By-Law Sec 203.5 Note E: .Side and rear Lard.setbacks fin.accessory huildings containing, one hundred fifty (150) ,square feet or less and single story. .shall he six (6) feet in all districts, hut in no arse shall said accessory buildings he built closer than twelve (12)feet to any other building oil an adjacent parcel All.sheds are required to be located thirty (30L eei front tun:front lot line Replace existing* Size L x II x H*The debris gill be disposed of at: Removed ,b 1i ne 4a(b i/ I. cation 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 answerls) will be just cause for denial or revocation of my license and for prosecution under\LG.L.Ch.268.Section I. A, tcant's Si_nau j Date: wners Signature .r attachment) � ^� , C Date: 3 J-20 /2 5 Approved By: Date Building Official(or designee) Zoning District: Historical District: Yes No **Conservation review will be required if shed is placed within I OOft of wetland,200ft from riverfront.or located within a flood zone** 6 24 The Commonwealth of Massachusetts l b,—_- ,�_•e Department of industrial Accidents — " 1 Congress Street,Suite 106—_: := '� Boston,MA 02114-2017 �_— www.mass.govidia jr'' . Workers' Compensation Insurance Affidavit:Builders/Contractors/Ekctriclaaa/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Informstio>w Priest Leeibly Name(Business/Orgsnizatioatindividual):91 'ax Aiot .12$4Y \14QAPTel7►vj��LL C. Address: 2 J t C .ciM l\- . S-Al City/state/Zip'' cve\A i N dZ6hS Phone#: g'l7$ " it3 © -Z S CX`f dAre as employer®Cheek the appropriate has: Type of project(required): t. 1 am a employer with'?5 employees(full and/or part-tinier • 7.laNew construction 2.01am a sole proprietor or partnership and have no employees working for milli. r> 8. ®Remodeling any amity.[No workers'comp.insurance required.] ff 3_0 ram a homeowner doing all work myself.No workers'comp.insurance required.]t 9. 0 Demolition 4.01 am a homeowner and will be hiring COMMON,to conduct all work on my property. 1 w ill 10 El Building addition ensure that all crosaiaors either have worker,'compensation in s rance or are sole 11.❑Electrical repairs or additions proprietors 'A0 employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs These have employees and have workers'gyp.isamrn rx.: 6.[3 We are a corporation and its offers have exercised their right of exemption per MGL c. 14.®()they 152,§1(4).and we have no employees.(No workers'comp.insurance required.] *Any applicant that checks box#1 roust also fill out the section below hollowing their workers'compensation policy information_ *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-cottractors have employees,they must provide their 'comp.policy amber. I am an employer that is providing workers'compensation insurance for nw employees. Below is the policy and*ob site information. Insurance Company Name: ' %cU .., Policy#or Self-ins.Lic.#: CC" o3_ 12 4 9 262S Expiration Date:2 12°a, 1'z Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number aid 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 rent , .• forwarded to the Office of Investigations of the DIA for insurance coverage verification. / je I do hereby certsfy ?W*�Ir , ; . Fofperjury thos the information provided above is tare and correct Signature: /7 Date. 5/t o l t-if Phone#: 3 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.Citylfown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: . Office of Consumer Affairs and SufinessAegulation •% 1 :;, 10 Park PIada•- Suite 5170 . Boston, • •e>tts 02116 b Home Improvement w+!!t .-or Resistrati on. e _� _ Commonwealth of Massachusetts if - _ t it Division of Occupational Licensure !L �J Board of Building Rego lions and Standards iCHr I c4 l i PQ' 7 BUJ C. r S 1 nstructluq,.►ttprrv�la 1 2 Family Dg3i� 1r 1 e ' t = `' a+ F to ' CSFA-073865 ` ` p►res:03N4/202 • '� ,_ JAMES R M ;s .,tTil #., HARWICH, 64�a ! 204.CRANV ,: 4 - c 1, • /`. BREWSTER `'� tt ,' ,x; `+'' :c i - xdv v� yea `) Commissioner (t /Aih.t THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affait'sand Business Regulation 1000 WashingtQD Street-Suite 710 BostonLAAasQ husetts 02118 Home CtrritraOtotRegistration r "i i •— , • Type: Corporation Iwr t 5 ; 4 B tretion: 132935 MCGRATH POST R BEAM CORPORATION I_ c-- soirattori10/30/2026 DB/A PINE HARBOR WOOD PROD. �.r 259 QUEEN ANNE RD. • 'rK',, ,o ""—`• ''?•• HARWICH,MA 02645 .d' -7r.. ti-.:W_ 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. M found return to: TYPE:Corpo:alion Office of Consumer A s Regulation EfkigitLaift EigittlakIl 1000 W»hingt -Suite 710 132935 - - 10,302026 Boston,MA 18 MCGRATH POST 8 BEAM CORPORA-MN D/B/A PINE HARBOR WOOQPROD. . 3 e f k 7 JAMES R.MCGRATH _+_ r f•.�/�- ue �' 259 QUEEN ANNE AD. ., Jlaya i"i0s HARWICH,MA 02645 Undersecretary V�( IN - 5b ACR 0 E ! ' _ 2,S9 , 3,e LAB . .. ll . Z- .i ,,44,4 m jico. ,\ a4 A‘ -7,7:4 ' 12:17 % o PoNQT� G. , 1 iif 41 a63 H / 0 r \ , Lo`r 20, ) I 12G.�� o ai - f x r h-_ ��� � _otp tg / • • I - / l.-/ �`r l I1 ` CE-,eT/Pz -Z' 4 a7 _ P.G.AAA i LOcg7/OA./: LOT 7n {-Inr lc n.•• L?•_-:: .... Yrr_r:•.,.rou'r r-. I C.41,_ -: Ill= • i7A7-4-:- ' - r " kc'P;Zr STD` - . T..l.0z1 i, JOB 85-1�Z tW I 2 / e '- CE'CT/FY TN< TL 7T' IE a ESCI L /.VF ° �1 ' Ss/olv.V O.V TiY/S P.L AA.J AS LOCATE 0 OA/ Tz/E11 - i= I yeou c/a sas �,�a w.v .ar�ceca./ 1 It II ,H of I '�� ARNE y 4 H. 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