HomeMy WebLinkAboutBSHD-25-75 application fr -''Ili. `-. i I A,':F. FiE I
i Petntit#314 --;1._.55-
1..41t441_1M OF f., Fc7:127 FROM IDEz.-I Ator)
-Permit expires ISO days from
MIMI date
EXPRESS SHED PERMIT APPLICATION E I V E D
TOWN OF YARivIOUTH (
Yarmouth Building Department SEP 02 2025
1146 Route 28
South Yarmouth,MA 02664 BUILDING CrEPARTMENT
_
(508)398-2231 Ext. 1261 By
*ONSTRUCTION ADDRESS:
ASSESSOR'S INFORMATION:
Parcel:
i —
NAME .
PRESENT ADDRESS
TEL. #
p
CONTRACTOR. •
e4 15C I). 8a)
NAME
MAILING ADDRESS
eilesidential 0 Commerciale,. C...)
Est.Cost of Construction
Home Improvement Contractor Lie.Nil'5 2a5Construction Supervisor Lit.ALCffill 1Lc
Woricman's Compensation Insurance; (check one)
0 lam the homeowner 0 I am the sole proprietor I Worker's Compensation Insurance
insurance Company Namef:l it , (:'(IOU 4);\(-4. :if• ' Worker's Comp.Policy! C.C. - bete, i:)._.....L.. ...._....g...._t OOt it? &6015
SHED INFORMATION
1,
New .4X__ Size LIZ__z W /(..J1 z NIL r Corner Lot: Yes
Per Town of Yarmouth Law Sec 2035. E:
Side and rear setbacks for accessory buildings less than ISO square feet and single story, shall be 6 feet in all districts, but
in no case built closer than 12 feet to any other building.
Replace existing* Size L a W z H ;
_
*The debris mit be disposed of It k'I .4(vv--
Location of Facility
I declare under penalties of 'ury tbat i statements herein contained me true and correct to the best of my biowiedge and belief I andetstiod that any false aninver(s)
deaf
will be jest=se Er in. of my license and for prosecution node:M.G.L.Ch.268,Section I.
/
Applicent's Signature: ,
Data SI k Cl\g9 ')v-threas&Vulture(or ,..
Oale:—_ailLX______________
Aoorowd BY:
Building Official(or designee) EMAIL ADDRESS:
Zoning District:
Historical District: 0 Yes D No Flood Plain Zone: 0 Yes Li No
Water Resource Protection District: Within 100 ft.of Wetlands:***
n Yes 0 No 0 Yes C No
***Note:Conservation review required if within 100 ft.of Wethinds
9/13
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_ The Commonwealth of Massachusetts
1}.-,--'N Department of Industrial Accidents
1 Congress Sbxel,Saite 100
r:_7i -= Boston, MA 02114-2017
www.rnass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
k1.no icant information Print Let ibl v
Name Business/Organizatioo/Individual):9i *VI tA/A:U `(' A4 T�C7►1ri �LC_C.
Address: -2-S 9 clt1/49,_ 4 e,.. a
Gityistate/Zip-" 'QY`iW 1 v`^:i k 42ih'S Phone"#: g'C$ " t '3 0 Z$ M
Arei as employee Check the appropriate hex: Type of project(required):
I. m a employer wit i TS. employees(full and/or part-time).• I
7.` New construction
2.0 lam a sole proprietor or partnership and have no employees working for me'iti: : „ 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.) to
301 sin a a hoc ner doing all work myself.[No workers'comp.insurance required.]r 9.,❑Demolition
4.01 am a homeowner and wall bo hiring contractors to conduct all work on my property. t will it)a Building addition
MUM that all corttracbrs either him workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5.0 I am a general contractor and 1 have hired the sub-contractors listed co the attached sheet
These sub-contractors have employees and have workers'comp.insurance.:
13.ORoof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MU c. 14. Other
152,11(41 and we have no employees.[No workers'comp.inswance required.]
•Any applicant that checks box#1 must also till out the section below showing their workers'eompensatioa policy information
t 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
ru '° ompany
Name: a ttrl
Policy#or Self-iris.Lie.#: CC-400— 12 4 p t 2o)S' Expiration Date:1Z•$ 12.V
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$250.00 a
day against the violator.A copy of this state eat t. forwarded to the Office of Investigations of the DIA for insurance
coverage verification. 4
I do hereby certify ,14 , r. ., , % ,."•ref perjury that the information provided above is true and correct
Signature: �. 'W Date: 5/( 0/
Phone#; c a ^ c(3 h, — 7.'i
r _ ..„... .....,
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
ir.
:;� /l) :
. '. Office of Consumer Albin and Bupinesssiteguiati®n •
+ 10 Part Plain-Suite 5170
Boston, •
0Z116 3
Homo Improvement Registration, .
• — Commonwealth of Massachusetts
. Ted `' =v _ _ Division of Occupational Licensure
.`s POST a BEAM CO 1—__ Board of Building Regulations and Standards
•
-. •t -- CAC
�uq� TM ` = Constructio perJti1 8 2 Family
zss t1EEN A RD. ° 1 d
-}-- CSFA-073885 A'
HAMAA H. 02645. •! _ _�: Plres:03/1d/2026
-._-_.:�— � JAMES R MCJDRATH -
=_-_ 204 CRANVI¢W RD
' .yh. -- '�� BREWSTER tMA 02031 , '
• l�A{V ,
?6 so`
n nuaw..nva..»w • hOl,l.V.1.11.
Commissioner S.,,,L2vat.,.t.__
•
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THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington$trget-Suite 710
BostonnMassachusetts,-02118
Home improvement ' . Registration
i~l _. '" Type: Corporation
MCGRATH POST&BEAM CORPORATION I,' ion: 102835
- ion: 10/JO/2026
2U9/QPINE HARBOR WOOD PROD. w5
HA WICHNANN2RD. �ti', '"
HARWICH,MA 02615 T
Update Address end%rum Cord.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Afraao a Bus...Regulation Rsglrr•tIon valk it indleMasl Asa only Wore the
HOME IMPROVEMENT CONTRACTOR sandonlon dell.n twtq;amen to:
TYPE:LurieiMbn colic.m'Consumer A •Ra9ulaaon
HegelElipB :.ULM40 1000 Washing! ..SAH.710
132935- -104 2026 Boman,MA la
MOGRPTH POST A BEAN CORORA
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PINE HARBORE :
T
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C
O.- - /
JAMES R.MCGRATH ��f,aAJv^
259 QUEEN ANNE RD.-. 466r4 G,
HARWICH.MA 02645
Undersecretary Id without sign
PLOT PLAN
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FOR LOT #
Indicate location of garage or accessory
Additions with dashed lines building
Sewerage disposal (cesspool) e
Well gig
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�. *MOOR. ...WAWAOW... rear) I
Name406
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Lot # I Abertt�or
Name
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Lot #
'f this a ` REAR YARD
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name f • • • • • ! • • • • •ft
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t s reet, corner,.. . I tribe in
write,... name of
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5 street.
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SIDE YARD ••
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SET BACK •
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S (NAME OF STREET)
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® Information
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ARK NORTH POINT