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HomeMy WebLinkAboutBSHD-25-70- i Office Use Only RECEIVED ; c rl O • -fey V� ic�N�' ;.....�.. � • ' AU6 12 2025 Amount !✓+r►J/J Permit expires 180 days from BUILDING DEPAR T issue date By' EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1 146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: G AL)a_ki, �_ G_ (1 /akag,61-e.-fo;.\---- 78 14,40- 0 8F� NAML PRESENT1 ADDRESSh n TEL. n CONTRACTORTfnP 1 Q-,sbb._ \DoA �RUc1�1C oI63 Ll if — � UDfCh Sog_�I3c ? NAME MAILING ADDRESS TEL.B EMAiLT i0 S a i 4ml•c-om 'Residential 3 Commercial Est.Cost of Construction S t � ^ • ) 3 Home Improvement Contractor l.ie.# /22---•N • _Construction Supervisor Lic.# SHIA) INFORMATION TION New 1/ Size L x W 11Z) x H to �(' Corner Lot: Yes No Per Town of Yarmouth Zoning By-Law See 203.5 Note E: Side am!rear yarn!setbacks for accessory buildings routainmg one hundred filly 1150b square feet or less and single story. shall he six (61 feet in all districts. but in no rase shall said accessory buildi►tgs he built closer than twelve t 12) feet to any other building on an adjacent parcel. All sheds are required to he located thirty t30)feet from any front lot line Replace existing* Size L 'The debris will be disposed of at:(IPS? Q0e.a0 nc { -tC IC-3Th Location of f-acilit) 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 at» false answerts► will be just cause for denial o vocation of my cerise and for prosecution under M.G.L.Ch.268•Section I. Applicant's Signature: 401 // ! • . Date: v) Owners Signature for attachment► Id( ` Date: Approved By: _ Date Building Official for designee) Zoning District: Historical District: No **Conservation review will be required if shed is placed within I00ft of wetland.200ft from riverfront.or located within a flood zone" 6.24 • The Commonwealth of Massachusetts lb_=_'( Department ojlttdusblalAceidents �`-, -1 Congress Street,Slate 100 ,;_Ii� Boston,MA02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit Bailden1CoatractorslEleetrlciaulPlulaberl. TO BE FILED WITH THE PERMITTING AUTHORITY. iannlicant information x Print l eelbh Name(Bluinessiorganitratiodi divid�p:7 �1 orb� AY N � � LL C Address:Z)J�+q Ci 1�QC F-01 City/State/Zip:`T O,Y"�r1 i Uh Ml'c�2(p4'�j Ptwne#:�e 3© � O M An as employee?check the epprepee bee Type of project(required): h.1een tae a employe with?5. employees(full and/or part-time)' 7.`iNew construction 2❑lam a sole proprietor or pwmmhip and have no employees working for nee ld, : .. 8.0 Remodeling any catmint_[No workers'romp.uuan.rce required.] y 9...0 Demolition Tat am a homeowner doing all work myself(No waken'comp.innrame required.]t 10[I Building addition 4.01 am a homeowner and will he hiring contractors to conduct all wort on my property.I will emote that all warraiaon tot,have woken'compemtion insurance Or are sole 11.0 Electrical repairs or additions proprietors with m employees. 12.❑s. contractorlama general contractor and I have hued the subcontractors listed cm the attached sheet oofr repairs or additions These sub-contractors have employees ed have workers'comp.awaarwe.: 13.❑RDof repairsa 60 we area corporation ad ro officers have exercised their right of exemption per MGL e. I4.Dothan 152,41(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that ou et checks bil crust also fill ow the section below meters'eters'eoema mpwn policy information. Homeowners who submit this affidavit indicating they are doing all week and Wen hire amide wemacmrs must submit a new affidavit indicating sock. iCouraclora that cheek this box mutt attached en additional sheet showing the name of the sub-come es and sae whether or not those muties have employees.If the submedracmrs bane employees.they moat provide their workers'amp.policy comber. l am an employer that is providing workers'compensation insararacefor rely employees Below Is the policy met job site injormaryoet Insurance Company Name: 331 �� Policy 0 or Self.ins.Lk.0: CC--lo00— tz 4 9?CZS Expiration Date:2 12.13 126 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number sad expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to S1,500.00 end/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this ant forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify the of perjury that the information provided above it Thar and correct sitmature: Date: 5//o/Ir t Phone k: C o 7 Y3 b—L Zl Official ruse only. Do not write in this area,to be completed by clay or(awn official City or Town: Permit/License k Lansing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone k: • ...._ _,••___,„ ::._, e. f.A,,, . , c 51,14 -6awviitoiteimiierizxp 0 ,,-, ,/,ii Of c of ee s Affairs and tgine ss-Regulation a -'% 1 ' , � 1 C) Park -- &Aft 5170 .- e - . Bolton, itr �4. • _a . , 02116 .,? i3 o ,- • L. CM , • `1 — -_'. _ Commonwealth of Massachusetts • 117 . tin _ - Ailt- -- �_ • Division of Occupational Licensure �• �CO. _ '= Board of Building Regulations and Standards 111ZRATti POST is r — COnstructio 4 perrilrigt 1 & 2 Family 259 ( ' � NNS `� _ __ _t, --- CSFA-073865 lac,� -F� .� ` '�_ _ �, t- _ empires: 03/14/2026 HAMMCHI O t`6. - _— . JAMES R MQGRAI H T^ �, __ - _ �� 204 CRANVt W RD i� • Liy.llk ' BREWSTER MA 02631 ; i ; fi Commissioner a THE COMMONWEALTH OF MASSACHUSETTS r. Office of Consumer Affairs and Business Regulation 1000 Washington..$trl t - Suite 710 BostonL Massar.husetts-.d12118 Home improvemer t°� nt or-fiegistration i1 r^-- • . -f .+ ` ., - Type: Corporation MCGRATH POST& BEAM CORPORATION I r.- -= '., •---. a isfration: 132935 �_ , -ntif �-- E rasion: 10/30/2026 D1B/A PINE HARBOR WOOD PROD. ..+• i -�� 259 QUEEN ANNE RD. �' :;, :.�, HARWICH, MA 02645 �,� •i .1 :. - _. t r .' ,r' , 'Ian .,y' ,��.� 4: . _: ' M i F • Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affalru 8, Business Regulation Registration valid or Individual use only before Me HOME IMPROVEMENT CONTRACTOR xapkatfon date. If found ratum to: ata �•Corporation Office of Consumer A ss Regulation . folialdi2n 1000 Wsshingt -Suite 710 132935 - 10430/2026 Boston,MA 18 MCGRATH POS CORPORATION .o D/B/A PINE HARBOR WOOgPft)D. �..+:.,. JAMES R. MCGRATH ,'•' �.' , 259 QUEEN ANNE RD. •, - f �f r,{id� HARWICH, MA 02645 '-, - - - . _ �-- , .- `• Undersecretar y N it a id without s9gItm • SHEDS LESS THAN 150 SQ FT SHALL. RE PLACED A MINIMUM OF 30 FEET • • FROM THE FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM SIDES AND PLOT PLAN kEAR LOT LINES. FOR LOT / • Indicate location of garb or accessory building Additions with dashed lines Sewerage diapoeai (cesspool) ®Well co I — — ——I (le*. rear) I (_ I 4 Abutter's Name L Abutter's Lot# Name I Lot# If this is a REAR YARD corner lot, If this is a write in ft. corner lot, name of street. I write in name of street. I3. SIDE YARD `___�zrr Co • • HOUSE �_MR YARD • • I • • • • • • SET BACK • • A. • a (lot ft. frontage) (NAME OF STREET) Information \• Supplied by