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HomeMy WebLinkAboutB-14-1542TOWN OF YARMOUTH Building Department BUILDING _ _ - _ _ - _ - _ _ (508) 398-2231 ext.1261 PERMIT NO � _ B-14-1542----- ------ ---------- _ PERMIT ISSUE DATE ; _ 5/16/2014 PROPOSED USE ---------- - - e ur - s --------- JOB WEATHER CARD APPLICANT Yarmouth Restaurant Association ----------------------------- ___ ___ PERMIT TO Misc./temt AT (LOCATION) 10220SOUTH ST ZONING DISTRICT R-40 Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK 1026.115.1 BUILDING IS TO BE: CONST TYPE USE GROUP LOT SIZE erect temporary tent - Summer Kick Off - 6/22/14 - 6/28/14 REMARKS 1% AREA (SQ FT) EST COST ($ $0.00 PERMIT FEE ($) OWNER ITown of Yarmouth/Bass River Beach BUILDING DEPT BY ADDRESS 11146Route28 South Yarmouth I Ma 102664 CONTRACTOR LICENSE Bamstable County Sheriff's De 600 Sheriff's Place Bourne MA 02532 PHONE 15083982231 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector "a+cs�fL�;Q office Zk—lle �,�"Permit / Amount Permit expires 180 days from EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 1? �4 S 5 WK_;Ekcu —WEST �Ehl b Pn JAI C- LOT ASSESSOR'S INFORMATION: ��tQ 50i4rif 5T Map: Parcel: Ilk OWNER: t2i4d Q d NAME P ENT ADD SS TEL. # CONTRACTOR: TR ON N G ADDRE S TEL. # (� Residential Commercial Est. Cost of Construction $ Rome Improvement Contractor Lic. # Construction Supervisor Lic. # Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp. Policy# R `�/ K TO BE PERFORMED Tent Duration (Fire eta7ant Certificate attached?) Wood Stove Siding: # of Squares Replacement windows: # Replacement doors: # Roofing: # of Squares ( ) Remove existing* (max. 2 layers) Insulation Old Kings Highway/Historic Dist. ( ) Replacing like for like *The debris will be disposed of at: UR 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 revocation my li ense d for prosecution under M.G.L. Ch. 268, Secti n 1. r Applicant's Signature: _ Date: �J f Owners Signature (or attachment) Date: " Approved By: Date: Building Official (or d rgnee) Zoning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft. of Wetlands: Yes No Yes No y The Commonwealth of Massachusetts - Department oflndustrial Accidents ®f_ice of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers Applicant Information Please Print Legiblh Name (Business/Organization/Individual): Address: Ci Phone #: Are you an employer? Check the appropriate box: 1 • ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t required:] 5. [] We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' camp. right of exemption per MGL 3a. E]insurance required.] t I am a homeowner acting c. 152, § 1(4), and we have no as a general contractor (refer to #4) employees. [No workers' comp. insurance required.] Type of project (required): 6. (I New construction 7. (] Remodeling 8. Demolition 9. C] Building addition 10.C] Electrical repairs or additions I LO Plumbing repairs or additions 12. C] Roof repairs 13.[] Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensati l t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. oa`policy information. tContsactors 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 information. employees. Below isthe policy and jab site 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Of eial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board, of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5, Plumbing Inspector 6. Other Contact Person: Phoue 4: CAPE COD BAY DENNIS TOWN OF YARMOUTH ' BASS RIVER BEACH A APRI L 2014 2 a U" JAG Q LEWIS BAYS BASS RIVER BEACH NANTUCKET SOUND YARMOUTH LOCUS MAP AERIAL IMAGERY ACQUIRED FROM GOOGLE EARTH. © 2014 GOOGLE INC. ALL RIGHTS RESERVED. REPRODUCED HERE FOR EDUCATIONAL PURPOSES ONLY. �$ c N � H H, W E `\ AT CH [3 !��RROQppiCO S APR-16-2014 01:44 From:5085634574 Page:5/5 NlAY. 4.200b IG:16AM BCCF K.6755 �• � �` IMPORTANT DOCUME- L Certif icate of 'Flame 'Registanee Ef "ONION ISSUED BY Date of Shipment 1;ta. ,70IV ��' oeiot�rca EVANSVI"Fn INDIANA 47725 lent Itlentl>icalion F12I.41 0 MANUFACTURERS OF THE FINISHED oa9DVWq TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and wera supplied to: 76980 sARNSZAats COUMY CORRECTION 6000 SHERIFF'S PLACE BOURNE MA 02532 Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was darts in conformance with California Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. Serially 4002100(►) ,ription of item oerbilied. META Tor 20WXAO WH 8 VVn Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The- Life of The Fabric i MN BOYLE STAVSVILLE NC Si ned• � lv 1 SPz L EVENTS 01MON-ANC1109 flDUtMMS IM a•d 0EZS-SG£-S0S—Y-6 33oa9 eLe 411 90 1+0 mew