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Home My WebLink AboutBSHD-26-70 application Office Use Only • IUL 212026 Permit# n wcCsE '`� Amount 35 L` I -t'ARTMENT i ffy -- Permit expires 180 days from issue date EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 ry�/� (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: �c.Jf //[4 Xt i0--t c( G / o5 �iJ 37 OWNER: �Lt G/ Keh.. !3/Y q & lJ-e Y C AJ- NAME PRESENT ADDRESS ,q O TEL. # CONTRACTOR:_�u'(1 6 R - J /777 5 h4 rit.co-n ,/. O g j 7J g 3 - 3 7q3 NAME n ._ �r(r� MAILING ADDRESS TEL.# EMAIL: rc m I"/ G 9� . CO-11�1 ''V o�/O ` 3— t, J_k 7 t!(4 )S8 C nO aq I I L SbCgt0bai. ne4-- ,esidential ❑Commeercia I I Est.Cost of Construction$ ` r� / Home Improvement Contractor Lie.# l7& '9/ / Construction Supervisor Lic.# t .. FA-/0 . `5 SHED INFORMATION New 7 Size L t, x W -Jr"- x H 7 Corner Lot: Yes_ 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 an adjacent parcel.All sheds are required to be located thirty(30)feet from any front lot line Replace existing* Size L x W x H( *The debris will be disposed of at: 'J y 7K J £h e 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 or r ocation y license for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature Date: 7//f L�4 Owners Signature or attachment Date: /7 lV.Z.Z9Z.0 Approved By: UQ 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** 6/24 . The Commonwealth of Massachusetts — Department of Industrial Accidents M r,. ,'t 1 Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston, MA 02111-1750 ' ', wwx.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Tuff Shed,InC Address: 1777 South Harrison ST#660 City/State/Zip: Denver, CO 80210 Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 employees (full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. n Demolition ' working for me in any capacity. employees and have workers 9. El Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.C I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] .l, c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box Al must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 job site information. Insurance Company Name: IMA, Inc Colorado Division Policy#or Self-ins. Lie.#: MWC31257226 Expiration Date: 3/1/2027 Job Site Address: Argel ge--freac e L A) City/State/Zip: L at'/Y _liest.1,02 4 73 Attach a copyof the workers' compensation policy declaration page(showing he policy n mber 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3ECity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affaii't atwl Business Regulation 1000 Washing ea "t- Suite 710 Bosto , . . , :, ,-- -a��,.. 0, 118 aHome Im ro .-..I + - a+ { " e9istration �'` ' tilt poi •'"-` t Type: Out of State Corporation R�e• ation: 192914 TUFF SHED, INC. E, ,ation: 08/27/2026 1777 SOUTH HARRISON, SUITE 600 DENVER, CO 80210 � I'' Asilsomeisow > . Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affa &Business Regulation Registration valid for individual use only before the HOME IMPROVE I, ONTRACTOR expiration date. If found return to: TYPE:Out;4 <7 it01eoration Office of Consumer Affairs and Business Regulation ., .''=,Q , ," •I 1000 Washington Street -Suite 710 -f9 s Boston,MA 02118 TUFF SHED, INC. t.,„ ,•=it ii rifw t K �,pp f TOM SAUREY "`"" a-Jt t ttt f`Ht- "`'"' 1777 SOUTH HARRIS• Se •_ DENVER,CO 80210 -i� 7. 0 Undersecretary Not valid witho Lure Commonwealth of Massachusetts Construction Supervisor 1&2 Family Division of Occupational Licensure Board of Building ReggulationsII� and Standards CF Constructiog, 6 ,1 &2 Family / // CSFA-106751 /, iatptres i 1/12/2028 TOM SAURE$ T CARRIAGES N %• 0 LITTLETON f %, 4f,)t l.`ft'I ) Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner e.,k1, *s.._ Contact OPSI:(617)727.3200 or visit www.mass.govldpitopsi PLOT PLAN FOR LOT f Indicate 1ccatIce of garage or accessory Additions w dashed building Well. �1�1 (cesspool) ED ra — — —— coot i v 3 it. rear) I Abutter's a Q Name I Abutter's Lot# Name ( Lot# If this is a 1 REAR YARD corner lot, �� 4 p If this is a write in t O �, corner lot, name of street. k write in i • I name of street. ' ri ,yf b Iid - i SIDE YMD Q ,J HOUSE SIDE YARD 9 r b---em s a-oaf-Er0 .: I SET RACE • 33i ft. -a (tat I d-2 ft. frontage) • / /PctXe p4ace LAl \ / \ / (NAME OF STREET) / \ IrtEurrnatinn \. Supplied by 4