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HomeMy WebLinkAboutBLDX-25-48 , Y VED AR.,, R on--Use Only o- y; JUN 231025 Pent. X-2s ,fe—P". ".. 4'', I AmouAmount'� `..,'s,:. ass, Br UILDING DEP MENT Permit expires ISO 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 CONSTRICTION ADDRESS: 2. f-°2 ASot-as .RIU£ S. 1.4/2.40,-*/,-A__02(-(-47‘OWNER: 'KIJAC 4n1 Ea &4S -El 5O ?, /, ^/ J �J, I SS l .�/ tiAMF. r� PRFSfST ADDRE TEL.a CONTRACTOR: -i4 saG i S (G� TE�/�_..S Ili oA- -c' I>'11_...__ .J 5. '(,.tfao .AME- - MAILING ADDRESS - -a- EMAIL: O /Residential _Commercial Est.Cost of Construction StC�27�_4� Home Improvement Contractor Lic.# Construction Supervisor Lic.it ??ICE. r A B Ki fT SHED INFORMATION :YPh ferry. `� ( verr ZeN./I e f Ness ✓ Size L/Z x N' /6 x H ? ?' Corner Lot:Yes No ✓ Per loan of Yarmouth Lanier(Bf-Lan Sec 2//3.5;Vote E: �i,lr,tn,/rr,u t,,,.d si t/'n,Ai I,u',6,rssnn huiltlin>!s,nnlstittliii,nn•hunJn¢l fill, ,151),symnr Irrt,n.less till tingle sl,a-r. s/ndl br sit,6,/rrt lit sill Jnn,ts n lira to tit,s sits sh,t/l%stir),n t cssors htahligtin he butt/,Inser t/,ut melee,12,l,•,t ln,ult „flier hill/s/iu,l,nt silt udlurrnt laurel -1/1 Slut/%cll."( legilliVtllit lit''Wales,Nnrn t 3lhwq jrunt<m)lr,NnJta Line Replace existing* r[O Size L _x II' x H 'The debris still he disposed of at: Location of runic) I declare under penalties of perjury that the statements herein contained are true and correct to the hest of my knowledge and belief I understand that any false amscerlsl will he Just cause for denial or resecation of ins licyrS25ttd litr prosecution under M.(I L.('h.260.Section I Applicant's Signature. r�L/C J `iN-� _ Date. �o(z 3(zoZ� Owners Signature par attachment) Date: Ce /Z / 26Z0 Appn.,ed Its Dale B udding Official for designee l -- -- Zoning District: i Historical District: Yes No ...Conservation review will he required if shed is placed within 10)11 of wetland.200ft from riscrfront.or located within a flood tune" 6 24 it • • SHEDS LESS THAN 150 SQ FT. SHALL z� �.` k; RE PLACE-f) A MINIMUM OF 30 FEET FROM THE FRONT LOT LINE AND A PLOT PLAN kEAR OF 6 FEET FROM SIDS AND kEAR LOT LINES. FOR LOT i Dxdicatae location of gacese or accessory building Addidoner with dashed lines Seweragede l (ceaspooJ.) 6 Well gg _ _ 1 (lit................i't. rear) I Q Abutter's Name I r_ Abutter's Lot j i.^`-"-r- Name SH - If this is a REAR YARD I�0 Lout corner lot, - ' ` If this is a write in ft. corner lot, name of street. I write in _ �' name of street. (E!2Ac') I a 813 Gtj-eRRstirZ t i --- ;1::- smE YARD 3�— q-- • xot SIDE YARD • • • • • • • • • • SST SACK • • .ft. a . (lot ft. frontage) (NAME OF STREET) / Informatfnn / `• Supplied by C�-y" AC�® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 03/31/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Sheila Lemmen NAME: Lighthouse,an Alera Group Company (A/c,No,Eat): (800)344-3531 FAX,No): (616)455-9489 56 Cesar E Chavez Ave SW E-MAIL ADDRESS: slemmen@lighthousegroup.com Ste 300 INSURER(S)AFFORDING COVERAGE NAIL N Grand Rapids MI 49503 INSURER A: National Union Fire Inurances Company of Pittsburgh PA 19445 INSURED INSURER B: Commerce&Industry Ins Co 19140 Backyard Products LLC;Packyard Planation;Backyard Storage INSURER C: Solutions LLC;Backyard Lawn Master LLC;Lawn Master Outdoor INSURER D: 1000 Ternes Dr INSURER E Monroe MI 48162 INSURER F: COVERAGES CERTIFICATE NUMBER: 24-25 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL-SUBR POUCY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DDIYYYY) UMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE 10 RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ NOT WRITTEN WITH AGENCY PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ POUCY JPER� LOC PRODUCTS•COMP/OP AGG $ OTHER: • AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A ^' OWNED SCHEDULED CA 4489736 06/30/2024 06/30/2025 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Trailer Interchange $ 50,000 Occ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION XI PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA WC015-89-3866 06/30/2024 06/30/2025 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I J (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ , , EL Each Accident 1,000,000 Workers Compenation(for CA only)-WC B Limits apply per Statute WC 015-89-3865 06/30/2024 06/30/2025 EL Disease-Ea Empl 1,000,000 EL Disease-Policy Limit 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) Named Insured Include:Backyard Storage Solutions,LLC;Backyard Storage Solutions,LLC dba Heartland Industries;Backyard Storage Solutions,LLC dba Handy Home Products;Backyard Construction,Inc.;Backyard Storage Solutions,LLC dba Backyard Buildings&More;Backyard Services LLC;Backyard Play Systems,LLC;Backyard DISC Company Inc.;Planet Playgrounds/Backyard PlayNation Backyard,Backyard Kids LLC;Studio Shed Acquisition LLC CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE ) South Yarmouth MA 02664 ', 1 ._ r-�,/1/IY�p ' aC 11 I Jiar.ti ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD