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HomeMy WebLinkAboutBSHD-26-73 application g A RECEIVED ' . Y o z Z � �Office Use Only 0 _ ;44 ,)LII 2r�tiA 2026 Permit#(-Jl,ar0'p�d �,`pe', ,4) Amount �) �Za.,•: rE��b' BUI ING pE � (�T �y J ate. Permit expires 180 days from issue date EXPRESS SHED PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 J� CONSTRUCTION ADDRESS: ! 37 I O 1 iG— ?f A Of ? )AtPA A OWNER: --�0 1 \ 5P 6nesec ,,3y Jon G 8410/ 77 y z6 i2O? NAME n ,� PRESENT ADDRESS 1-#4.2S tf TEL. # p ) CONTRACTOR: A'111ec (GrA-i'Y.( l ?ay C Vl-u.) roA.OZlo?1 car (/,) 7 Qom/ l NAME MAILING ADDRESS TEL.# EMAIL: `ohii,, ;g( St Efrr i L 4'v-A Residential 0 Commercial ❑Est.Cost of Construction$ / //1 ` 9 5- Home Improvement Contractor Lic.# /3Z q3 c Construction Supervisor Lit.#_Cri (as SHED INFORMATION New // Size L x W x H 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 LJ J x W / 2_`x H *The debris will be disposed of at: dl( lit A( ` o( 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 i of my'. „se and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: G Owners Signature(or att hment) Date: Approved By: Date: Building Official(or designee) Zoning District: Historical District: 0 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 • " l Department of IndustrialAccidenes _t=n- 1 CongrersSires%Susie 100 Boston MA 02114-2017 www.mass.gov/ilia Workers'Compeaso ion Insurance Affidavit:Ballderv/CertractonJEle trkiana/Plambera. TO DE FILED WITH THE PERMITTING AUTHORITY. ,00licant Information t i P,e/at Print I.ed ly Name(BusinessIOrganvaboMndi nauap: ' `f�t 1�41Y)::144 f -Y iV eX5A, re:A r,ETS. LL C Address:ZSJ Ghi,Q4rn City/StatetZip: 4 d1 ©Z 5 Phone#:5C$ y'3 0 -Z S 44 Are as emptereel Cint tie appropriate derType of project(required): • I. am a employer with 6 5 an ployeee(full and/or pat-time)" 7.UNew construction 201am a sole proprietor orprome elapsed have no employees wadies for me'fp, : 8. Remodel' ng any=peaty.Igo workers'comp intones inquired] .•' ❑ 3.01 am a homeowner doing ail work myself.(Na micas' r 9..❑Demolition comp.iosurare tequindJ 4.01 em s homeowner nod will be hiring contractors toconduct ail work on my property haul 10❑Building addition mane the at co raisors either hoe workers'compauation insurarte m are sole 1 in Electrical repairs or additions proprietors with memployees 12.0 Plumbing repairs or additions 5.aI am a amoral contractor and I have hind the aab-eonoacton tired oo the attached sheet These subwommemer have employees and have workers'coop.imucene: lip Roof repairs 6.0 We are■eorpmeumf.od ra officers leave exorcised their right old/rapid's per MGL 14_DOther 152,)1(4).end we haw no employees(No waters'tromp room=required.) 'Any sepptirantthat arch box el inner also fill om the section below Mowing their workers'cowpenwioo polity informerioo Hmnmwrcrs wbo submit this affidavit indicating they are doing as wok rod then him outside correctors must nmasit■newamdavit todicring each :Correctors that cheek this box must atorhed n additional dm0 stewing the name oath sub.mrtraetas and gtle whetter a ea dose entices here employees.If the sat.oamatmn have employees.May met provide that workers'map.policy mother l am an employer that is providing workers'ron peasadon insarance for cry employees Below is she policy asdjob site JnAmadora Insurance Company Name: �r v11� Policy d or Self-ins Lie0: CC--ip(�Q-- 12 4'202E Expiration Date:2 j28`2 7 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the pokey camber and expiration date). Failure to secure coverage as requited under MGL c.152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this ,.. .ant r, t•, forwarded to the Office of Investigations of the DIA for insurance coverage verification 4 a l do hereby cerlfy '!' �'• , �nfpm'jury that tke info as lion provided above is true and eos�e Signature: `� 7/ Date. /l a Phone#: Q - 1 7i b-411 Official use only. Do not write in this Brea,to be completed by city or tows official City or Town:_ Permit/Lkense# Iaaaiag Authority(circle oat): t.Board of Heath 2.Building Department 3.City/Town Clerk 4,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: `_.___ Phone#: PLOT PLAN FOR LOT # Indicate location of garage or accessory building Additions' with dashed lines Sewerage disposal (cesspool) 69 Well of I I 4 Abutter's ( ! Name _ I Abutter's Lot* ( Name L # REAR YARD If ot this is a If this is a corner lot, corner lot, write in ..._,...j...,ft• write in name of street. name of street. . 'a 8 i To 4 •: SIDE YARD SIDB YARD • `-- • HOUSE - • • • • • • • • SET BACX • . ft. • I . I (lot ft. frontage) , • \ / \ / (NAME OF STREET) / \ Information \ \. > by J �� c�Q -��L'�� Commonwealth of Massachusetts Construction Supervisor 1 & 2 Family g/ Division of Occupational Licensure Board of Building Regulations and Standards Construucfio ti enfCH ri&f ,,, i t 2 Family 47, CSFA-073865 cq I spires: 03/14/2028 JAMES R MCi;RATH U, 204 CRANVI-- RD , / ,' BREWSTER ' 02631 ' 3: V Failure to possess a current edition of the Massachusetts State ` ;z ._ , - Building Code is cause for revocation of this license. Commissioner c . s� elz Contact OPSI: (617) 727-3200 or visit www.mass.gov/dpl/opsi • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingtgti$trget-Suite 710 Boston MassscJ!t .0211g Home improvement rt`iegistration +. • ;." TYPO: Co �iCGRATH PAST g BEAM CORPORATION ir• 1325 n DB/A PINE HARBOR WOOD PROD. ; -: ,Wr ! 10/30/2026 259 QUEEN ANNE RD. ,� r+ , HARWICH,MA 02645 Update Address end RMum Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affalro 8 Business ReguIstlon Registration vend'for Indlvlduel use only before the HOME if`RPROVEMENT CONTRACTOR anpNation dots. If found return to: TYPE: ce-iatbn Moo of Consumer A so Raguletion 132935 i,'.7040/2026 Roston,MA 18 Sutta 710 MCGRATH POST&BEAM CORPORATION N D/0/A PINE HARBOR WOOQPROD. _ - )1iL/W" ` r JAMES R.MCGRATH .` 259 QUEEN ANNE RD. ::, ' HARWICH,MA 02645 , ' Undersecretary 6V1 t v id%Pittman sigma 0-�1.C_ 4 ( 3a Q ® Commonwealth of Massachusetts Division of Occupational Licensure Construction Supervisor 1&2 Family Board of Building Re ulations and Standards Constructio 'IQOpeerJTiv&2 Family CSFA-073865 ti - Spires:03/14/2028 JAMES R MCICaRATH 204 CRANVIEW RD BREWSTER 18A 02631 rb O ! MUIyYdi1J� y Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Commissioner z1/ r�___ Contact OPSI:(617)727-3200 or visit www.mass.govldpIlopsi • • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affa!Fs'and Business Regulation 1000 WashingtQti$tri�t - Suite 710 Bostortcusetts42118 Home improverrent°w: : .- s •tom • ' Type: Corporation MCGRATH POST&BEAM CORPORATION ..... ,:1� D/B/A PINE HARBOR WOOD PROD. , ration:: tOr30V2132935 t?28 259 QUEEN ANNE RD. • �.c ' HARWICH, AAA • t ,• •' ::_. '� • - �i T • • • Update Address and Return Cani. THE COMMONWEALTH OF MASSACHUSETTS Moe of Consumer Mains A Business Reputation Registration valid for Individual use only before the HOME IMPROVEMENT, ACTOR expiration date. If found MUM to: TYPE Mee of Consumer A • •. - , a Reputation andraysio D 1000 Wash -Suite 710 132935- - -.,.; -10402026 Boston.MA ,. 1 tl MCGRATH POST d BEAM CORPORATION 0/8/A PINE HARBOR WOOC4p Oo. : • - T ' .t JAMES R. MCGRATH • 259 QUEEN ANNE RD. . flv/f r,•wL HARWICH, MA 02645 '•, Undersecretary t id without sign k C- 4 13q35 .£-iD (- tl)kSLAaP