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Home My WebLink AboutBSHD-26-85 appliction og A RECEIVED r/Z Office Use Only ! s �5 Permit#3StT V'WGP- O • �� AUG 24 2026 Amount �S �.cONPORA�E0�6;ly BU1I1tFG „sI 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) 3988-22,3, ( 1,Ext., 1261 CONSTRUCTION ADDRESS: � 0 I w�S cki c `o (.d' OWNER: `i l (/ L QWt•k W6J1&C t/ U ( l(-ty 7ofve m! /i' ,t OZ (; 6 NAME PRESENT ADDRESS TEL. # (*7— L-(/ (p _ 75 45 CONTRACTOR: NAME MAILING ADDRESS TEL.# EMAIL: (nYC. pWLIll \-tCcOf ) 'Residential ❑Commercial I I Est.Cost of Construction$ (0 6Z Home Improvement Contractor Lie.# Construction Supervisor Lic.# SHED INFORMATION ` / New Size L x W 16 x H Corner Lot: Yes No V 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: \n-e a c----'O r 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 revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: f Owners Signature(or attachment)j> .t).. _44_QJQ11t!� (If Date: r _ C Approved By: 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 Cortunontvealth of Mrtssachwsetts >`s DePrrrtmentojlJrdWsfrjalAretdents 1 Congress Streefy Smite 100 t"='� Boston,MA 02114-2017 tvww.tnassgov/data Workers'Compensation Insurance Affidavit:BoilderslContractaaa/ElectricfaTTtstPlumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. AoolicantInformation y i �} "ease Print fcetbiv Name Buslnesstoratnizatiomaei.�uat): {i IA,"t 1 r�4Y �oo_, A%,,C LL C. Address:-2--S tt C410.1h t ►-i1\ CitylStatelZip: 4 CA IZZ S Phone 4:''b 8^ r-r3 0 Z S M Aiju es employer!Caeek W appeeprhat ee:: �. Tam a empkryer wkl�S` a+ptaYem(fW1 soNor Type of project(required): icon umr)'� 7.` New construction 20 fen a sole proprietor apermeabip sod hereto employers trotting tor m,fd. : any capacity.[No aortas'camp.inaneoe required.) ;?•r S.Q Remodeling 301 an c ho wve:*line as snit mysrtf.04o waken'comp tuners molten]t 9. 0 Demolition a. :ern a homeowner mtd+ be Janine contactors m conduct ell work cm my property.I wai 10 Q Building addition male that ell cot acmeseitherhumwomen'cvmpmmeionuurraoeca.eaote 11.0 Electrical repairs or additions proprietors with m employed. SQ 1 em a general contractor and I have hired Ne wb.00n"amoa lien on the attached shed. 12.❑ umbipa repairs a'addition Thesesubooemsnos hove employeeaand hen wakes'comp.umaeme: 13.QRoofteirs i 6.0we neacorporation end ins officers have exacted Thou risk ofexemption Per WIG a 14.QOtlher 152,DM,end we have tic employee.No workers'amp.Umtata reguued.) *My eplivaathat dent beset rawer also fin eta the sectionbelow Mot:Asir,c rken'compecaeeoe volley iorormaeon. ,Hamew,00n coin eubmr a,.cindav,,iodic..,racy arc doing.107 mart coal alma hoe owtde egMcta oral autapit a tewaffidavn tadicping aurh k.aarauon deo cluck this box nun attached an additional sheet show4q the came of the sobeontraeon end stele whetter nit those entities have was.If the subanracton have employees.they aunt provide their wafters'amp.policy weber. I am an r employes that Erprovlr worterr'etnnpeosatIon itunn we foray employees. Below is the policy attljob siteMfo �,Insurance Company Naarsc jh 'a 1��T.:Shi 1'L"'4f1�1t�'(y� �f�.Gl i 1�{LA1('4 1 � Policy dorSelf-ins.Lic.a. C '^-CD00- t249?o" "ExpirationDate.21442"t.,-27 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the polity aamberand expirsdon date). Failure to secure coverage as required under MOL c.152,125A is a criminal violation punishable by a fine 141 to S 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 forwarded to the Office of Investigations of the DIA for insurance coverage verification. f do hereby ceayy fine o perjury that fits infonnatlen provided above is emu madcemKx Sianatom Date: //0!/t.6.- Phone tt: c Q _ Y3 b`a.i ........ 0.0..r/reel aerate Des ator.n.Otis vs4 ore fie.6466.4 cry eat a...,grin2 City or Town: Permit/Ltcease li loaning Authority(circle one): t.Board oilest&2.Baildieg Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.OtherPhone Ceataet Person: #: r� The Commonwealth of Massachusetts Department of Industrial Accidents w -�? Office of Investigations =. _ Lafayette City Center ilk MO -- my 2 Avenue de Lafayette, Boston, MA 02111-1750 ,� /44 `, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project (required): l . ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 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. ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11 .❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box #1 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. :Contractors 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: 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. 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): tEl of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 511:1Plumbing Inspector 6.0Other Contact Person: Phone #: PLOT PLAN FOR LOT # Indicate local:1m of garage Additions with dashed lines building Seweragedisposal (cesspool) ED I I _I—I (lot ft. rear) I 4 Abutter's / Name I �l Abutter's Lot# I Name Lot# If this is a REAR YARD corner lot, 6O cIf this a t write in corner lot, I ft. write in name of street. name of street. • b SIDE YARD SIDE YARD HOME • d---_-.Er.,.0 p------III • • • • • •• • • • SET BRCS • • ft 4 1 a (tat ft. frontage) , • / / / (NAME OF STREET) / ' Information / Supplied by Commonwealth of Massachusetts Construction Supervisor 1&2 Family IF' Division of Occupational Licensure Board of Building Regulations and Standards ConstructioeuppeerVis 1 &2 Family CSFA-073865 * rip 4pires: 03/14/2028 JAMES R M( a 204 CRANViic I5. BREWSTER ?b • br.v a; `ICI LVdit34 Failure to possess a current edition of the Massachusetts State Building Code Is cause for revocation of this license. Commissioner Contact OPSI:(617)727-3200 or visit www.mass.govldpllopsi THE COMMONWEALTH OF MASSACHUSETTS , Office of Consumer Ana's and Business Regulation 1000 Washingt $ -Suite 710 BostonrAAassoclaus .412118 Home impro*ti!enE :'4:1egistration «. • �.. tom. r-- ,•a • • Type: Corporation MCGRATH POST d BEANii CORPORATION 11% •• :1 ~ 132995 D/B/A PINE HARBOR WOOD PROD. `a+ - -: 10/3Q+2Q26 259 QUEEN ANNE RD. \,;;.,t..• HARWICH,MA 02645 ti 'x• A T=3 Update Aridness and Return Card. THE COMMONWEALTH OF MAI$ACHIM eTTE O4Roe of Consumer Afters&Resinous Regulation Rpls*ation valid tor individual use only Wens the HOME IMPMOVBt NT CONTRACTOR sxPMeeon dole.11 found return to: TYPE:Col y, m n Oasis of Consunwr Alm a Regulation Eaten 1000 WaArnOte etW •Sults 710 132035-.- 90402026 Boston,MA I MCGRATH POST A BEAM CORPORATION 7 DANA PINE HARBOR WOOOPRtb. ti(jijO ter, I JAMES R.MCGRATH.� 259 QUEEN ANNE RD.. ,'°i:. j x ?&.il.t HAPWICN,MA 0264S Undersecretary id Rig NI C 14 l . a q 35