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HomeMy WebLinkAboutB-14-1543of TOWN OF YARMOUTH Building Department BUILDING _ _ _ _ _ _ _ _ _ _ (508) 398-2231 ext.1261 PERMIT NO ' _ B-14-1543 PERMIT ISSUE DATE 5/16/2014 PROPOSED USE ---------- ou ------ APPLICANT Yarmth Restaurant Association JOB WEATHER CARD ----------------------------- ___ ___ PERMIT TO Misc./tent AT (LOCATION) 10220SOUTH ST ZONING DISTRICT R-40 Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK 1026.116 BUILDING IS TO BE: CONST TYPE USE GROUP= LOT SIZE erect temporary tent - Summer Kick -Off - 6/22/14 - 6/28/14 REMARKS kP AREA (SQ FT) EST COST ($ 1$0.00 PERMIT FEE ($) OWNER ITown of Yarmouth/Bass River Beach BUILDING DEPT BY ADDRESS 11146 Route 28 South Yarmouth I MA 102664 INSPECTION RECORD CONTRACTOR LICENSE Bamstable County Sheriff's De 6000 Sheriff's Place Bourne MA 02532 PHONE 15083982231 FIELD COPY Date I Note Progress - Corrections and Remarks I Inspector O' - �5 "n MATi'A M EbF✓� EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 Officr; U Amount Permit expires 180 days from issue date CONSTRUCTION ADDRESS: I' !T 5 5 R( V k K. E K-k('N WEST S T f:4 P ft K k LQ r— a' a O S 1 iA -li S r- S. I A P— MO L( 11f MR o -4FG� ASSESSOR'S INFORMATION: ( I Map: aL Parcel: `�' I OWNER: 1 a i4 9 me A 7 TIA ��A(D-- 066 4 <6 91 J ( v — a a 31 WM� DRESS ' ' T-0 CONTRACTOR: 7 M(i KE �� 1I P A-K V /'i'mn tow N F6 X 16 5. YA MtIAr14 - HA 0266 y NAME ING _T ,rr XDDRVS8 TEL. # +rr Residential Commercial Est. Cost of Construction $ Home 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# / 6--1Z2-/Ll WORK TO BE PERFORMED ✓ / e Tent Duration (Fire et�dant 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: N A 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 evocati f my 'cense d for prosecution under M.G.L. Ch. 2669, Sec 'on I. Applicant's Signature: 1 Date: AlLl _� Owners Signature (or attachment) Date: ! Approved By: Date: Building Official (or ignee) Zoning District: Historical District: Yes No Flood Plain Zone: Yes No Water Resource Protection District: Within 100 ft. of Wetlands: Yes No Yes No 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigadons 600 Washington Street Boston, MA 02111 Workers' Compensation Insurance www.mass gov/dia Affidavit: Builders/Contractors/Electricians/Plumbers Anolicant Information Please Print Legibly Name (Business/Qrganizadon/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. [] I am a general contractor and I Type of project (required): employees (full and/or part-time) .* 2. ❑ I am a sole have hired the sub -contractors listed the 6. New construction proprietor or partner- on attached sheet. 7. Remodeling ship and have no employees These sub -contractors have g_ Demolition working for in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition required.] 3. ❑ I am a homeowner doing all work 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions myself. [No workers' camp. in t right of exemption per MGL 11. Plumbing re ❑ g pairs or additions 12.0 Roof repairs required.] 3a. ❑ I atn a homeowner acting as a c. 152, § 1(4), and we have no employees. [No workers' 13.❑ Other general contractor (refer to #4) comp. insurance required 1 Any applicant that checks box #1 must also fill out the section below showing their workers' co J sation`,h information. ' t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. rContractors 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 jab site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: 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 imprisonmentz 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 certsfy under the pains and penalties of perjury that the information provided above is true and correct Siznature: Date Phone #: OfflCial use onlyy. Do not write in this area, to be completed by city or town offrciad City or Town: Issuing Authority (circle one): Permit/License # I. Boarol of Health 2. Building Department 3. City/Town Clerk 4: L'lectrical Inspector 5, Plumbing Inspector 6. Other Contact Person: Phone #: CAPE COD BAY TOWN OF YARMOUTH DENNIS BASS RIVER BEACH APRIL 2014 l f7 0 LEWIS BAY BASS RIVER BEACH YARMOUTH NANTUCKET SOUND LOCUS MAP AERIAL IMAGERYACQUIRED FROM GOGGLE EARTH. © 2014 GOOGLE INC. ALL RIGHTS RESERVED. REPRODUCED HERE FOR EDUCATIONAL PURPOSES ONLY. A OF Y O N `.. AT W E OROppg0 S s t mmw 3 C 5 Y 150 1 Feet APR-16-2014 01:44 From:50e5634574 Page:2/5 ` IMPORTANT DOCUMENT Certi Ovate of Flame &sistance ISSUED BY Date of Shipment 07/07/10 .gistration Number Off CHORINDUSTRIES INC. Tent Identification 140.1 14a77530 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable) and were supplied to: BARNSTABLE COUNTY CORRECTIONAL. FACILITY 5000 SHERIFF'S PLACE BOURNE, MA 02532 (7Certification is hereby made that: 1 The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric has been tested and passes NFPA 701, CPAI 84. Serial # 8105985 (1) Description of item certified: O i r� CENTURY MATE EXPANDABLE END tl� 40WX20 SNYDER WHITE VINYL Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDER MFG NEW PHILADELPHIA.OH Name of Applicator of Flame Resistant Finish Signed: A"iN AL C >AN CTRIES INC