HomeMy WebLinkAboutBSHD-25-96 YqR j, ® F C D Office Use Only
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Permit expires 180 days from
BUIb RTPAEiJT i;issue date
EXPRESS SHED PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth,MA 02664
aa (508)398--22'' ``31 Ext. 1261 1I {A�
CONSTRUCTION ADDRESS: aS 1 V k,C`1 _ Iv \Na S- J• iva- t y 0 1Y
4_OWNER( 'RJ
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NAME PRESENT ADDRESS TEL y
CONTRACTOR { I_ {X }p ma. ... _
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NAME ,, n—__ MAILING.ADDRESS TEL.e
EMAIL:�111")(✓�,htEAkO rCeleiN
.xResidential _.Commercial
es Est.Cost of Construction S
Home Improvement Contractor Lie.#'3Q�5 /r Construction Supervisor tic.#( .S. 4 — 01 .f)UtS
SHED INFORMATION
New % Size LiC21
x W t:JQQ\ x H I Dt N Corner Lot:1'es_ No
Per Town of Yarmouth Zoning Br-Law Sec 203.5 Note E:
Side and rear card setbacks for accessory huildings containing one hundred filly 1150t square leer or less anal single story.
shall he six tot fret in all districts.hut in no rase shall said accessory buildings he built clesser than Neb.,"r I-'I feet to ant
other building on an adjacent parcel.ill are required to he located third'130)feeiJram e ui freest lot hue
Replace existing*_ Size L_ x II' _x H 11M1
*The debris will be disposed of at: 4J 5 l 10\K.'�.�- ,A-^`c*-r� �1 � 'IA l ` 4S
Location of Facility
I declare under penalties ome
tements herein contained are true and correct to the hest of my Anon ledge and belief.I understand that an false an.wen sl
-will be Just cause tit deniaiy license and for prosecution under M(i.L.Ch.268.Section I. 11 �1,,r''�
Applicant's Signature. _ _ — Dine. 1a1 a 1 1aCJo[a3
Il Owners signature(or�"chmentl Hi."*"-- �� Date: 111
/`Approsed B: Date. _,Building Official 011icial for designee)
Zoning District:
Historical District: Yes No
**Conservation review will be required if shed is placed within 100ft of
wetland.200ft from riverfront,�w or located within a flood cone"
tj-1'nctj! Y 6.24
The Conunonwealtth of Massachusetts
1' `*. �/ Department of Indrrs�l Accidents
SW
_ ` ' 1 Congress Street, Suite 100 .
=. scar .
' '� Boston, MA 02114-2017
. —,.:4- 31�.mass.gov/tom
Workers' Compensation Insurance Affidavit: Builders/Contracton/Electriciaas/Plumbers.
TO BE FILED WITH THE PERMITTdIG AUTHORITY.
f:t,. 4 _ !rhea$ I _ i ' b►
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Name (Business/oiganizatioaJtrtdividual): ,� �, � • le 4 •. +�+ •,
Address: Z 9 C4i),,stsuseliNstsiNe, /1?-(), ___,....................
City/S;tate!Zip- tkse:\n1 i & kS Phone#: wog " it et 0 r.0 Cel IM
Are as employer?Check the appropriate be:: Type of project(required):
I. I am a employer with S. employees(full and/or part-time).* 7. 'New construction
2.0 I am a sok proprietor or partnership and have DO employees walking fox mild: i „ 8. 0 Remodeling
any capacity. [No suckers'comp. insurance required.] d" r
3.�I am iasmeowt r doing all work myself [No waken'comp. insurance required.] 9.., Demolition
4.0t any a homeowner and will be hiring ocatractoars to conduct ail work on my property. I will 00 Building addition
ens=that all coatrac$ots either have workers'compensation iawance er are sole II.fl Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors lined on the attached sheet. I3.D� repairs
rs
These sub-contractors have er Ovens and have workers'comp. :e.:
6.0 We are a cotponatiion and its of icers lave exercised their right of exemption per MGL c. t 4.00thtr
152,¢I(4),and we have no employees. [No workers'comp. insurance required.]
*Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy man
t Horrltowners who submit this affidavit indicating they arc doing all walk and then hire outside caatractats must submit a new affidavit indicating such
tCantractoca that check this box must attached an additional sheet showing the name of the subs and at whether or not those entities have
employees. If the its have employees,they must provide their workers'comp. policy number.
I am an employer that is providing workers'compensation durance for my employees. Below It the policy and Jab site
information. .
Insurance Company Name4440Y0 m ai lw% ,. " 311 1 — la lw. • id •. • ` 1 t 2. VIT15.1
Policy # or Self-ins. Lie. #:t. CC 4 -1- s•I2 4 -i"'2' ZS Expiration Date: 12.$ t26
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 stye I.ent ; forwarded to the Office of Investigations of the DIA 6or insurance
coverage verification. A
I do hereby certify ,,-- the 00, ., ,Opp; . of perjury that the information provided she is true and correct
signature: Date: 5 //o / c
Phone#: r 0 $ q3 b - 7 fi
Official use only. Do not write to this area, to be completed by city or town of lj�icial
City or Town: Permit/License #
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
f
Contact Person: Phone#:
r p .- t --. _ _ .. _. j� - , n_...... - ..�. ._.
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 REAR LOT LINES.
FOR LOT i
Indicate location of garage or accessary building
Additions with dashed lines
Sewerage disposal (cesspool.) 69
I
- - — I (lot ft. rear) b I
Q 1b —
Abutter's I � Abutter's
Name I LL,e.d 1 Name
Lot# I Lot#
If this is a REAR YARD If this is a
corner lot,
write in corner lot,
R• write in
name of street. I name of street.
I'
a
I
4cq
MDR YARD SIDE YARD
HOUSE •
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•
•
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SET BACK •
•
•
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a .,
(lot ft. frontage) 3(
• /
/
\ / (NAME OF STREET)
/ Infisieatlat
`. Supplied by
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itoti 4600WitOni2Mati47i :11191IAta"aalUei444.
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Office of Consumer Affairs and Outiness-Regukti. °at
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10 Park Plazi - Sul, te 5170
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Boston, ' , -- - .. - etts 02116 .
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Home— improvement .•-.41014, • , , .. ., Reparation': •
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• Commonwealth of Massachusetts
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. ' )- .:--airi..._..- --.7.--:::- :----;±--itr---:±:- Division of Occupational Licensure
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__ Board of Building Re ulations and Standards
.1AA=TtI POST & BEAM CO. . ._ .
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Constructio.. • I per1 & 2 Family
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McGliKIN ._. . IP
. 259RW5UEEN ANNE R ). -wr-- .--&- -„-,-..:.,_-: .- _ on i•.-_-._-_:__,-_-„__- • .
CSFA-073865
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p ires 03/14/2(:,
026
HAICH, MA 02645 3 JAMES R MRAii
- RD 3
204 CRANVI- . , :':. , ir, ,.. ..
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BREWSTER .;>. 026 1,
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a alD 41116111410070,06609410 ' . 1.1.1/40‘
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Commissioner
s"........_
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THE COMMONWEALTH OF MASSACHUSETTS
,•
Office of Consumer Affaifs'and Business Regulation
1000 WashingtOti$Ircett - Suite 710
BostonAUSSacilusetts4712__________ 118
_:•,. :. ..._ ... • ....
Home impoven**-- t_ egtstration
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: "7"----•77,,1 • t. i•-'!
"i•-i '.-, • ..-.---,-. .T Type: Corporation
MCGRATH POST& BEAM CORPORATION 1r"", . .......,
C• Yll E0iration: 10/30/2026
D/B/A PINE HARBOR WOOD PROD. 4.::':, '; ... ..0. _ !
259 QUEEN ANNE RD. '1'1; s;:.....-.....44,:i : ......----7----.` :"' •
HARWICH, MA 02645 6,. m-.D..--- .i --' :-
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..... .... Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office oil Consumer Affeins a Business Regulation Registration valid for Individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date if found Mum to:
TYPE:tOrpotation Offlas of Consumer • • • • .• • I • - a Regulation
Bashttamisil .. 111114109.0 1000 werhingt• - • -Sults 710
•
132935' -..--,A.7, 40/30.P2026 Boston,MA - 6
MCGRATH POST&BEAM CORPORATION . 4
DIBIA PINE HARBOR WOOD(PFI ,
CO. - • i
-.• •1::::•',t_i;10.11 if
'•;. .. .t.•:.!...e .
JAMES R.MCGRATH .': •.75:-'7i....!. 4 , . ;;),ic . .
259 QUEEN ANNE RD. ::, '• ....Aao, r
HARWICH, MA 02645 ':, ":„.1
Undersecretary k N t id without sign
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