HomeMy WebLinkAboutBSHD-25-104 c
�: Office Use Only
O
O _ � Hi Prrmn=Y�NccO�-d—S—id
`.F,.- u �. Amount 7L
_.. Perri espirrs 180 days from
issue date
EXPRESS SHED PERMIT APPLICATION—
1
TOWN OF YARMOUTH 1< F. 1...9 E: 1 >%
Yarmouth Building Department r
1146 Route 28 NOV 20 2025 1
South Yarmouth,MA 02664
(508)398-2231 Ext. 1261 B ,Lr,uac;cl R1t1 NIT
CONSTRUCTION ADDRESS: c C V 6-_A.
OWNER: �+d O IG , �yr�,�, ,
NAME� PRESENT ADD I::SS - - - -- TEL e
CONTRACTOR: _ S r t r✓1_�� _
-}-//�� NAME ^,�) u.M ,�f MAILING ADDRESS TEL
EMAIL: V De c&^e. ~G �0 r
esidenlial -Commercial v Est.Cost of Construction S
Home Improvement Contractor I.ic.# Construction Supersisor Lic.#
SHI-.I)INFORMATION Leg. a O�Y iLi
Ness Size L 8 x W x H ,5e,5 Corner Lot:Yes_ 'so_ / c
Per Town of Yarmouth Zoning BF-Low Sec 203.5 Note E: b
Sider am!rear curd.setbacks for accessory'buildings containing one hundred fifty t I Sat square feet or less and single story.
shall he six Mt lief in all districts.hut in no case shall said eucessort'buildings he built closer than twelve(12)feel to any
Al-building on an aaljacent parcel.All sheds are required to he located thirty L401 feetfrrm ant front lot line
�. it.19ce existing* Size L q.4j_x 11 j % x H +4 7 1 i" 6'S b 4
'The debris will he disposed of at _ _
Location 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 arm false answensl
will be just cause for denial or resocatio. I my tense and for prosecution under M.G.L.Ch.2(.8.Section I. ,s
Spplicane.Signature , r r Date: N Q V_20/ Wa
Owners Signature for'ehment) Date:
Appmsed By: _ Date-
Budding Official I or designee
Zoning District: _
Historical District: Yes No
**Conservation review will be required if shed is placed within lOOft of
wetland.200ft from riverfront.or located within a flood zone'
6.24
The Commonwealth of Massachusetts
Department of Industrial Accidents
l Office of Investigations
( Lafayette City Center
;
/ 2 Avenue de Lafayette, Boston, MA 02111-1750
=/ www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): 7.�,,n (�.% -e ep _
Address:
City/State/Zip: Phone #:
Are you an employer? Check the appropriate box: Type of project (required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
listed on the attached sheet. 7. ❑ Remodeling
2.0 I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
9. ❑ Building addition
[N workers' comp. insurance comp. insurance.+
r quired.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no �� a 0��t k,
employees. [No workers' 13.[a'fither ( . "1 Sf'�,_
comp. insurance required.] i ) pI ctCe g i ea R S
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation 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
information.
Insurance Company Name:
Policy#or Self-ins. Lic. #: Expiration Date:
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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under t ain and penalties of perjury that the information provided above is true and correct.
Signature: tA) Date: Art)-'
Y''v v A- V
Phone#:
S o8335 - iC3.' I
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(check one):
10Board of Health 20 Building Department 31:City/Town Clerk 4.1:Electrical Inspector 50Plumbing
Inspector 6.0Other
Contact Person: Phone#:
8 dg` '::myx g w
u r
11•41,11143
.V`T :''*' •. mdf R '�°, •e ✓ 'fir ,l P ., S
:..,. ..,.:,: i..,,,:„ ,..,.:,,,...,..,... . .
:'7'
'r
4
Top i'2: ' - . .. . ... . . A
4c
k
-.,.c.. .,.,„„-.-„,:,:„....„„,„..„..,..,,ot e..0 , 1., .,:k.7.0,, -,,,,,-„,_..„.. ... . . -„,.... ..,. ., „,........._ : .:. . ..... :,.., . .. . . . .,. ... ....... .. ......... ...., ..„„,
• •• --- -••••••••,••••••••• CO it2.1rC3° 11)7P%.) -- .-.: •-- _ •
Z 2
,4.Vl�}ey
x
V
ISH;:::•:,-•... l• • el6=‘. •- •.:
/ ,
1 - -
A
Ili A
w
i -ig,g
: t!,...,.1„... „5::':55 ": '''' : ,.
LORI I.��y.�y� L� ,.,,ag u
��., ro zs tisk3`�F 4 ,y��� F' z" __ 4ea3.#" f C29° a. .i4L 6'�*r. -
3# a F's; F.s eA .Yp roc g(
ta. '
yyaak� .
i lAR
�S ,., 'Hs...i.c.,
.ti....-:......:.,.....e.. L.201. :T4.
.4B ,
. C.7 ......-- • ::
c.
'V--
..,....i.,...:.. .,....,..
•
£ • z z.
.
R
t
k
1 :e
u$31$.1
lf .. .... ,.... ..,. ..,
.. ..... . ,
. r. -- -. ..1.4srA� ... ,. ...... ,......„,.
.. .,. . ....... ..
' r
,_. �,
SHEDS LESS THAN 150 SQ FT SHALL
RE PLACED A MINIMUM OF 30 FEET
FROM THE FRONT LOT LINE AND A
PLOT PLAN MINIMUM OF 6 FEET FROM SIDES ANC
REAR LOT LINES.
FOR LOT tt
fidicate location of garage or any building
Additions with dashed lines
Sewerage disposal (cesspool) ®
co
I I
— — — — (lot tt. soar) I
4 _
Abutter's I
Name I Abutter's
Lot I 1(� Name
Lot A
If this is a REAR YARD
corner lot, If this is a
write in ft comer lot,
name of street. write in
name of street.
Ij
SIDE YARD •
•
V--— HOt E SID8 YARD •
•
_ yCs p-----n't>
•
•
••
•
I •
•
SET BADE
•
•
a
(lot ft. )
/
\ / (NAME OF STREET)
/ Informatics
/ \• Supplied by