HomeMy WebLinkAboutBSHD-26-55 applicaiton oFYq_� RECEIVED
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BUILDING DE ARTMENT Permit expires I80 days from
By issue date
EXPRESS SHED PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261
CONSTRUCTION ADDRESS: 20 Witt/VicAced
OWNER: A c‘ete t H i .3C Wi:CvtPtd41. !�` 04g01/ 41 .203 53-0, '.Z l�
NAME PRI SI N'I-ADDRESS TEL. #
CONTRACTOR NJ ) (:��1C� C\ H';1t � 0 •
NAME MAILING ADDRESS TEL.#
EMAIL: In P,vt.�144bci, C'C
til_Resi den tial 0 Commercial 1 Est.Cost of Construction$ UC )(_ C)C)
Home Improvement Contractor Lic.# %3 j Construction Supervisor Lic.#CS-,j - C31 `m
SHED INFORMATION
New ,k. Size I. x W /( x H " Corner Lot: Yes,X No
Replace existing*_ Size L x W x H
*I he debris will be disposed of at:95 9 r'{1 , n►u ^C �'il„�n�i ta'l(A-)1 niA 0r36 _,3
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 orrevocation of my license and for prosecution under M.G.L.Ch.268•Section I. /� ,/
Applicant's Signature: %a�L,CJ 44 Date: ,,t..)//.�.�/�aZ6•
Owners Signature(or attachment) 1'� / Date: 94//y.,
Approved By: Date: —_ `
Building Official(or designee)
Zoning District:
Historical District: � Yes No
**Conservation review will be required if shed is placed within I00t1 of
wetland.200t1 from riverfront,or located within a flood zone**
6/24
The Com»mmvealth of Massachusetts
n_ _g Department oflndustrlolAceddents
= 1 Canvas Street,Side 100
Boston,MA 02114-2017
www.mass.gov/ifia
Workers'Compensation insurance Affidavit Bailden/Cortractom/Elctfr C alPlambers.
TO BE FILED WIfMTHE PERMITTING AUTHORITY.
Anolicant(nfornation 17ease Print/Le lb4C
Name(Business/Organiudonrtedividual):11 Wt. 40e gY A1000\r9 QAikt, �..1—C
Address: ? R f�
City/State/Zip: 4 `�.1► CR. S Phone#:Cb4 /I-3 0
Are employers Coed as r appropriate boat Type of project(required):
1. lame employe wiNZS employees NO w5'm p tt time).• 7. New construction
1.0 i tom a race proprietor or pedaership and have ram epbten working Come fa, . 8. 0 Remodeling
'
any capacity.No meters'comp.insurance required.] 9...❑Demolition
301 am a homeowner Ming all Pork myself.[No workers'comp.im+ame requited)s
10 0 Building addition
end
4 Di ern a Menem..r d oral ea hiring bunion coconduct all out ea my .propoty t rail
enahae it stall eooaactors eiders ism workers'compensation trial—ace or we sole 11.0 Electrical repairs or additions
proprietors with m employees. 12.0 Plumbing repairs or additions
5❑I sin a general contractor and I have hired the w'o-oonrraclm listed on the attached sheet 13.❑Roof repairs
These sub co oaoors have employees sod lava waters'coop.entrance
6.0 we are a eorpone en and'err officers hove aacised heir right of exemption per MGL 14.ODtller
152.11(4),end no have no employees.[No worsen'camp.mamma tegoned]
'My epplicann that cheeks box a I met also fill of to section below Mowing their workers'compensedoe policy information.
Htamrwncre who submit Nu affidavit iodinating then,are Ming all worm end then hire amide convectors Orman udonit a new anidavo h diertny such
tCormmcmrs that cheek thie box mud enthral en Wilma'sleet Mewing the name of the sob-coniraemrs and stile whether or act time entitles have
employee.If the mb eamucton have employees,they owl • Oda Mir workers'comp.policy mnnba
_._
I sin an employer that 8 providing workers'compensation Insurance for aty employees Below Is the policy mrdJob site
information, �rnC�t
Insurance Company Name:
Policy 0 or Self-ins.Lie.o: Cl �" 12 4 q 202S Expiration Date 2.1213 1-2 7
Job Site Address: City/State/Zip:_
Attach a copy of the workers'compensation policy declaration page(showing the policy clamber and expiration date).
Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine cut to$1,300.00
and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a
day against the violator.A copy of this ent forwarded to the Office of Investigations of the DIA for insurance
coverage verification. p /
J do hereby cdt0 �"' PatWIC."perjury.Met the information provided above is true and comet
$ie nature: /� Dam I l o l
Phones~: 'id $ - Y3 o—7.
Official use only. Do mot write in Litt area,to be ronepleted by tier or area official
City or Town: Permit/Llcaase It
teaming Authority(circle one):
(.Board of Health 2 Midis'Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector
6.
r
Contact ta Person:
Moue N:
— ' —
PLOT PLAN
FOR LOT f
Zndicats
AdditLc*,Sewerage ��wffi�t�h�-�-d��ashed attra of garage or
accessory building
( pool) ED
I
I
Itat O ft. yeah t
'O. �
Abutter's I
' Name Abutter's
Lot# 7 t Name
7
Lot#
If this is a /A' REAR YARD If this is a
corner lot, ,. corner tot,
write in /Or �1 .... � ..ft. write in
name of street. }.• name of street.
t
I. ( a
b
i
4 .1
SIDE YARD
' HOUSE SIDE YARD •
• 0_ 3Q.„...rrr 0 o_3.2 _...cro .
.
.
. 4
f� I
�:
•
•
SET BAQC •
J
It
I
(lOt ft. frontage)
•
/ Wiunnd 4dact
/
/ (NAME OF STREET)
/ Informed= 1�
• Supplied by dokn e c' i�ver
V Commonwealth of Massachusetts
Dision of Occupational Licensure Construction Supervisor 1 & 2 Family
Board of Building Regulations and Standards
A\C F1 [ ,,. . .
CSFA-073865 spires: 03/14/2028
JAMES R MCRATH
204 CRANVIEW RD `"
BREWSTER MA 02631
t.0j,)•\ .1 0 .. Failure to possess a current edition of the Massachusetts State
aim; Building Code is cause for revocation of this license.
Commissioner `�V.s.�__.
Contact OPSI: (617) 727-3200 or visit www.mass.gov/dpl/opsi
C.
•
•
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affaits and Business Regulation
1000 Washington Street-Suite 710
BostonLMassscpusettsA2118
Home improvement Registration
• Type Corporation
.MCGRATH POST&BEAM CORPORATION - - Iron• 1029J5
DB/A PINE HARBOR WOOD PROD - _: �j 7.= ion' 107J012026
259 QUEEN ANNE RD.
HARWICH.MA 02645
UpdM.Address me MoNm Cern.
THE COMMONWEALTH OF ASSACHUS'c i'TS
Mon of Co...,..*Rolm A Mot-,..Ragulevon Rogl.tndm vt116.or Irglvl6ucl ono only 0e1en MA
HOME//sPROVE!IENT CONTRACTOR azplreeon 6.1o.X tau.vuwn,to:
TYPE:Connor/Ron O1flh.d Coo.omo.A M1y•RAguleXon
137905 ExiikIMO/pTo 1300Roston,WoonIngl to •SOW 710
MCGRATHPORT OSEAM CORPORATION
DB/A RINE HARBOR WO D r
14
JAMES R.MCGRATH J
259 QUEEN ANNE RD /
HARWICH MA 02645 `` ¢ -+
Undersecretary Nit valid algno om
1