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HomeMy WebLinkAboutBSHD-26-48 a RECEIVED 1I1�� Office Use Only �4 JUN 02 2026 Permit# 1D (0-4 1 tO Amount )13 .� MAt'AiorCSE •,•NCORPORATE�,09" BUILDING DEPARTMENT BY ---_ Permit expires 180 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. 12611 , CONSTRUCTION ADDRESS: J\JO..y‘�: s W R7 W r l yet r Yn b U t-41_ OWNER: 30 h h A v` Ma Yi 4 , /'Ty10 log Q S I- S N a n et t s l)ety 5 o ' (04 $'4 7 6? NAME l PRESEN.ADDRESS T_L. # CONTRACTOR:Ff hr HCc rlav r a6—q Q UervI IL 6 bps -L4 3O• ,S-11) NAME MAILING ADDRESS TEL.# do cu.)t C-1r) EMAIL:J '(IOD Co nncccS{- ne f W esidential _J Commercial Est.Cost of Construction$ 3 3o U •00 Home Improvement Contractor Lic.# Construction Supervisor Lic.# SHED INFORMATION New V Size L x w 10 x H (. 5 Corner Lot: Yes V. No Per Town of Yarmouth Zoning By-Law Sec 203.5 Note E: Side and rear yard setbacks for accessory buildings containing one hundred fifty(150)square feet or less and single story, shall be six(6)feet in all districts, but in no case shall said accessory buildings be built closer than twelve(12)feet to any other building on ant adjacenta parcel. All sheds are required to be located thirty(30)feet from any front lot line Replace existing* Size L Q' x W () x H *The debris will be disposed of at: 1 V)r. '��sr- cD 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 any false answer(s) will be just cause for denial or revocation of my license and for prosecution under M.G.L.Ch.268,Section I. Applicant's Signature: Date: CO/11/ Owners Signature(or attachment) A. - Date: f/ Approved By: Date: Building Official(or designee) Zoning District: Historical District: Yes No **Conservation review will be required if shed is placed within 100ft of wetland,200ft from riverfront,or located within a flood zone** 624 4 , The Commonwealth of Massachusetts t' a_110_:'/ Department of Industrial Auiderts :ii _ - 1 Congers Street,Stale 100 —:ki— Boston, MA 02114-2017 � .tom 7, �; w'vw mass.gov/dia Workers'Compensation Wars act,r(davit: Builder/CortractorsiEketricuas/Plambas. TO BE FILED WITH THE PERMUTING AUT ORTTY. Annlicaut Information 7easc(Print i,eeiblY Name(BusinesslOrganization/Ir�dividual):7i V. N QY tlete\Pr Lt.C. Address: ZS CI akiaklINN N e._ �—t), City/staterZip' {-cy,Y'�1 & ©'ZV'A' Phone#: •Cp?) '3 0 — $ Are as employer?Carek eke appropriate boil Type of project(required): I. I am a employer witft anptoyxs(full aredtot p.rt rime).• 7. New construction 2.01 am a sole proprietor or partnership and never no employees working for me'i , r: S m Reodeling d any capacity.[No waiters'camp,insurance required.] 9.., 0 Demolition J. I am a homeowner doingall work myself.(No workers'camp,insurance reuired)'4.01 an a homeowner and will be hiring common to conduct ail week on my property. 1 wit ID Building addition enure that all contrairtors either haw a cabsts'compensation Mamma or are sole I i.0 Electrical repairs or additions proprietors with no employes. 12.❑Pi umbing repairs or additions s a lam a general contractor aria I have hued the sub-oont actors listed on tine attached sheet These sub-coca-actors have employees and have workers'comp insurance: l3.Q RDo f repairs 6.fl we are a corporation and its officers termexercised their right of exemption per MM.c. 14.OOther — t52,f i(4),end we have no employees.[No workers'comp.insurance required.] 'Any applicant that checia box al muse also fill out the section below stowing their musters'cornpenxcoe policy information. t Homeowners who submit this affdevit indicating they art doing all work and then hire*inside contractors must submit a new affidavit tndiesaing such :Contractors that check this box mua attached an national sheet stowing the name of the sub-contractors and aete whether or rot those entitim have eraplcyees. if the sub-contractors hart employees,they must. • ide their workers'come.policy number. I am an employer that is providing workers'compensation Iasi ounce for eery employees. Below is the policy msdlob site informationInsurance Company Name: a MC Policy if or Self-ins.Lie.#:a'C(` oa- tz 4 1'0.2S' Expiration Date:2 125 1'2 7 Job Site Address: City/Stst&Zip: Attach a copy of the workers'compensation polity declaration page(showing the polity 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250-00 a day against the violator.A copy of this a •eat . a,. . forwarded to the Office of Investigations of the DIA for insurance coverage verification , . f do hereby certify , '• Mel'f perjlay that the information provided above is t►ue and correctigna r _ fri , _ 0 s' - -- Phone.#: S'�Q 'F — c(3 b — 7.` lase. Official use only. Do not write in this area, to be completed try city or town officialCity or Town: PermitiLlcatsse# ^_ Isaniag Authority(circle oat): I.Board of Health 2.Building Deportment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Letterntact Person: Phone is _ Commonwealth of Massachusetts Canetructl.n B .,Isar f P.2 Family vua i °lemon of Occupational Ucensore Board of Burkling R.AuV?Oons and Standards ac++,as GSFA-071865 g4'r 1f{tNm'03,1472028 CR AN RVIIW /C`204 BREANSTER AA O? - . t; ��' Fawn,to passe..a aan.at Aldan of tO.M..e.chw.rt.OW. Building Cede Is coo.for n ud weon of We Oconoo Commntab rner \ .P r Y.__ ^.. Cont..opa:(en)1274200 or',It awcr.ma...a.O.P.l HTC THE COMMONWEALTH OF MASSACHUSETTS -----_. Office of Consumer Aflaltiand Bushes;Regufatbn 1000 Westing •Suite 710 118 Home 1 "�. _ __ ration r 11IL 14 ~rypr It MOO MT POSTE BEAM CORPORATION 07, ' 1080202e MBA PINE MAIIOR V4000 PROD. BSO QUEEN ANNE KA . . MARWICK AN OdlAt I, t. Y.:. "tea!}::;- I. .1"�1 Ware AARr rBwl fool rat CA11111e11teALTR O wwcMwme OM.NICANAmo Aatga bow..Me.. By1f4MM.W Mr WOW am md,ttd.nho NOM Oe1RRACTpt ��PeYY��daRRrflim■amilmmo tE TTR OQrelOrw� Rgddlaa arlrr .t M.P uete- u.rww MCORATN POSTS DOM., bee ME HARBOR ;d .a RATON-, ftpplmf owe fM.w IAM r et.d. t MMWpt,MA WU ., IAAiRt.......— 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 # Indicate Additions. with �of garage or accessory building Sewerage disputed (cesspool) I I _ __ _ I (lit , I Abutter's & I L �r Abutter's Name 4'0" S hem t Lot# If this is a REAR YARD corner lot, If this is a write in ft. corner lot, name of street. write in f` name of street. I • . .0. •o8 4 SIDE YARD • HOUSE SIDE YARD ,.. .�. .0__ _.Erb • • • I • I • • SET RACE : • 4 ft. I (lot ft. frantage) , \ /� (NAME OF STREET) / Fnfurmatiain • Supplied by