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Home My WebLink AboutBLDX-26-1141 application ,- _RECEIVED g, Y Office Use Only Ql A� i— Q . \• Permit Ji 1�1�-a�-i,yt `3 a4TI %y' 1 AUG 26 2026 O- i Amount D """"`""s` BUILDING DEPARTMENT \'YCORPOR AiEi39r/ By ______ EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 1175 ROUTE 28 SOUTH YARMOUTH OWNER: Town of Yarmouth-Yarmouth Seaside Festival NAME PRESENT ADDRESS TEL. # CONTRACTOR: PO Box 489 Souoth Yarmouth NAME MAILING ADDRESS TEL.# EMAIL: rhonda@yarmouthseasidefestival.com ❑Residential ❑Commercial I] Est.Cost of Construction$ Homeowner is Applicant? Yes No Home Improvement Contractor Lic.# Construction Supervisor Lic.# s . V aoxtinl WORK TO BE PERFORMED Jo'X alb 1 ' Tent 2 Duration 3 days (Fire Retardant Certificate required) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares Insulation Temporary Mobile Home Temporary Construction Trailer Demolition—Interior only *Demolition Raze Structure Solar System ESS System Chimney Fence *Please submit utility disconnect letters for electric&gas—structures over 75 years old require historical review *The debris will be disposed of at: Location of Facility I declare under penalties s 'ury he stat ents 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 • s o to y license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signatur• _ / ^'t - Date: 'i 16/Z i Owners Signature(or attachment) Date: Approved By: Date: Building Official(or designee) Rev 6/24 The Commonwealth of Massachusetts Department of Industrial Accidents 1 P 1 E9 Office of Investigations ' Ittl'- Lafayette City Center • 2 Avenue de Lafayette,Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):Yarmouth Seaside Festival Address:Box 489 South Yarmouth,MA 02664 City/State/Zip: 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 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 g. ❑Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers'comp.insurance comp.insurance.:Aram,p -r required.] 5.® We area r" e"°"ti and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I i.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL I2.❑Roof repairs insurance required.]t c.152,§1(4),and we have no tents employees.[No workers' I3.®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. 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: to be determined 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 hereb fit it.1114ains and penalties of perju that the information provided pbove .�is/true and correct. Signatur 0.4\V Date: �l✓!/`2� 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): 1❑Board of Health 2❑Building Department 31:City/Town Clerk 4.❑Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: ee," c, ISSUED BY: 1/4S.4t. • EUREKA! UREKA! TENTS / a div. of Johnson Outdoors Gear LLC BINGHAMTON, NEW YORK 13902 4410") .C(fi Manufacturers of the Finest •ST 4/7- CC CALF'� 4. .,��'—*1,1*.' OO dent Products Described Herein '�/of �t2 DEALER NAME: CAPE RENTAL WORLD ADDRESS: 8C COMMERCE DR CITY: ORLEANS STATE/ZIP: MA 02653 Q • This is to certify that the products herein have been manufactured from material inherency flame retardant as here after specified by the material supplier. Certification is hereby nude tat: The articles described on this certificate have been manufactured with an approved flame retardant chemical that was tested and passed the foliowing codes: California State Fire Marshal Code, NFPA-701, Underwriters Laboratory of Canada (ULC-S109-M87) and (ULC-S109-2003). DeScrip rim iem c : Traditional Party Canopy WBO 2Qx40 Flame Retardant Process Used Will Not Be Removed By Wasting And Is Effective For The Life Of The Fabric TENT DEPARTMENT JOHNSON S GEAR LW