HomeMy WebLinkAboutBSHD-26-63 applicaton •
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Permita
Amount J 1\,/1►�fl
Ogpi:r•i EOi BY _ _ f't .__ —__._.___
Permit expires 180 days from
issue date
EXPRESS SHED PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1 146 Route 28
South Yarmouth, MA 02664
X (508) 398-2231 Ext. 1261
CONSTRUCTION ADDRESS: £a Y[_d 1 L / '121Are... JLISL_ /
_rI a fit (1 L3
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OWNER: =�a / _e. 2_[-Jt✓t Y _A ✓1 —� � , /e%
\VF PRISE\ DRESS TEL. u
CONTRACTORP1 U krIZA P ILt 5 Ri59 A3rL
TF:L. G�4c3o '08�L'
N \\IF IX
kEMAIL:1 \ C P -PkeIr t C r eN R
I nXRestdenhtal Commercial x Est.Cost of Construction S /3 `�6
dome Improvement Contractor Lic.# 13 135 Construction Supervisor Lic.# CS PA r 61386.5
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SHED INFORMATION `
Xr t WI. r t "
New X. Size L 15 x��' W t T� x H ill 7 Corner Lot: Yes No x k
Per Town of Yarmouth%utrinn Br-Law Sec 2113.5 Note E:
.Si,le and rear nit.,st'thert k.s for tk'(es.sort buildings containing only hundred fifty i 150t.square feet or less and single start.
shall be sty (6i leer in Lill t/lslrlt ts. but in no t ose shall said acres sari buildings br built closer than to else r/2, leer to ant
other building on ern all/ca enn lrureet'l. All%he'is art. reyriire'cl to_be/ut treed thins 13llt kelp,WI ins Irani lai line
Replace existing* Sire L s II s //
*The debris will he disposed of at: 02 SQ l O00 a Rc), - W 1-LA 1 t .m( 'f c-
Location of Facility
- I declare under penalise of perjury that the statements herein contained are true and correct to the hest 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:
��j� Date: �j�
A Owners Signature Ior attachgtenly�'��� p , :.... C�� Date: 1//3/( Y
\pprosed By: Date
Building Official(or designee t
Zoning District:
Historical District: Ycs No
i
••Conservation review will be required if shed is placed within It/Oft of
wetland.200ft from riverfront,or located within a flood zone**
6 24
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SHEDS LESS THAN 150 SQ FT SHALL
RE PLACED A MINIMUM OF 30 FEET
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FROM THE FRONT LOT LINE AND A
PLOT PLAN MINIMUM OF 6 FEET FROM SIDES AND
kEAR LOT LINES.
FOR LOT i
indicate loCation of garage Additions withdashed °_ accessory building
�W� � (Unposed (cesspool) ®
ca
I I
— — — —I G (.tit pro ft. rear) I
Abutter's l 16 r T .i
Name ,C^ Abutter's
Lot A _ ()'{^ I Lot Me
If this is a ( REAR YARD
corner lot, r It this is a
write in t?4.• ft. corner lot,
name of street. write in
g I' name of street.
8 a
1
4 1
STDR YARD •
HOOSS SIDE YARD •
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. I
SET BACK •
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I
I
8
3 C (]at �13 ft. frontage) •
(NAME OF STREET)
In6smatiat
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The Commonwealth of Massaehiaetts
i'777-- d Department of Industrial Accidents
=n=i I Congress Street Sure J00
_ =""t—:= Boston,MA 021II-2017
www massgov/rfa
Workers'Compensation Insurance Affidavit Bnildeta&Cortractas/Eleettic(aea/Plumbers.
TO BE FILED WITH THE PERMUTING AUTHORITY.
Applicant Information ry i f�- ` ss Print/Leelbly
Name(Business/Organaation4ndivieuall: 1 I T1�.MAj4Y \ A r�("e A1� U..1.
Address: j`tl G-(1,
City/State/Zip: 4 d1 OZ S Phone#:&—.aB.' Crt 0 -Z.415 M
Are ra as amp ayee Cheek the appointor Can
Type of project(required):
lit I am a employer walk?S. nnployeee(full andrr pate-umo).' 7.laNew construction
2.01 an a sore peptide!at pannenhip and have ea employes normal.forewz 4i, 8.El Remodeling
any capacity.(No waters'camp immure.required) :•
3CI I am a homeowner doing ad work myself:trio wwk tamp.mainarre required]eril i 9; ❑Demolition
4.01 am a homeowner aid will be bring caimans to �eanet all work on my property I vial 10 a Building addition
mare that all eanuartas rimer Ora workers'campenseem imurame Or as sole 11.0 Electrical repairs or additions
propemmes with m employes. 12.Q Plumbing repairs or additions
50:am a anneal ronoacwr and I hove hired the nub-oouvactors listed on the attached sheet.
Irmosubcoeo.naes have employees and have sonars'
camp.insurr : 13.❑Roof repairs
6.Qwe area enrpmwmn and its officers raveeamcixdey thrigidofexemptionperNOLc 14-QUbier
52.I1(4),end we have no employers No workers'coop.Mosinee requited]
'Any appliraiu the Met boreal scar alw 00 an the sermon Mlow showing erir workers'.compensator pokey information.
Hon a arc arm submit this dedorir indioriag day arc doing al work and men hire euuida contractors mutt a>mnit a taw emdavn atdieghng arch
TCmuanors that check this box must attached an additional shot dvwiog to coma oldie tubcmtmcton end arse whether ee not those entities have
employes.If the sub-cadtacmn bare employees.they mutt b ovdo their workers'comp.policy cumber
want an employer that Ls providing workers'compensation insurance for n employees. Below Is take policy aadJob site
Insurance Company Name: tp Qjhc
� 1
Policy erg or Self-ins.Lic.ifCC'—loop— 12 4 9?0215 Expiration Date:21Z$ 1"Z 7
lob Site Address: City/State/Zip: l
Attach a copy of the workers'compensation policy declaration page(showing the policy member and expiration date).
Failure to secure coverage as required under MOL c.152,§25A is a criminal violation punishable by a fine up to 51.500.00
and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER end a fins of up to 3250.00 a
day against the violator.A copy of this •ant..:..• forwarded to the Office of Investigations of the DIA for insurance
coverage vacation. d a 11
I do hereby certify . •iiii anofperjuly that tke information provided above Is rrre and correct
Sianatwe_
�f��oily, Date: 3/l0/�6'
Phone#: S Q 'e - Y3 b—7.'3 L-0
Official one may. Die was matte In skis area,be be roayobeand by city or awn offload
City or Town: Permit/License#
Isswug Authority(circle one): _r
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector
6.Oth
er
Contactact Pea rson: norm g;
Commonwealth of Massachusetts ig Division of Occupational Licensure Construction Supervisor 1&2 Family
Board of Building Regulations and Standards
Constructioq".-8uipeC Hnfis ,1 &2 Family
CSFA-073865 spires: 03/14/2028
JAMES R MCPRATH , , :.f
204 CRANVIRSV RD O lik
BREWSTER IiiA 02631
O
�b�0I LvdN3 Failure to possess a current edition of the Massachusetts State
C Building Code is cause for revocation of this license.
Commissioner 1 2Ir t.,-- Contact OPSI:(617)727-3200 or visit www.mass.govldpl/opsi
,
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THE COMMONWEALTH OF MASSACHUSETTS
Office of'Consurner Affaltiand Business Regulation
egWration
259 QUEEN ANNE RD.
THE COMMONWEALTH OF WASSACHLISEM
TYPE-WPaMon Offlos of Conn~
MCGRATH POST 8 BEAM CORPORATION
0181A FINE HARBOR WOOOpRDD.
259 GUM ANNE RD.
19
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