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Home My WebLink AboutBld-20-001112 ,Og:Y`qR Office Use Only Permit# 3. - C.�J x Amount SD— ''a M",i ATT 1/ S �' - !Permit expires 180 days from ;. Q L)-21) I 1 , 2 =issue date EXPRESS BUILDING PERMIT APPLICATId1 _J CE`' TOWN OF YARMOUTH I I Yarmouth Building Department i 82 1146 Route 28 i v _ a I, r T F,t South Yarmouth, MA 02664 F (508) 398-2231 Ext. 1261 Q ��-_-.192O NSTRUCTION ADDRESS:_O \,Q/Nl ZOL C9* 1 fit- J0 Vl t"A 1 di— ASSESSOR'S INFORMATION: Map:; ,/ QParcel: ✓O WNER: �Qj\ V\Q/ `4 C/V1:: :-‘--_e,6,, RA, 8 ,g2 0`-6(V, AME PRES ADDRESS . TEL. # CONTRACTOR: NAME MAILING ADDRESS TEL.# D0 0 Residential 0 Commercial Est.Cost of Construction$ 60 O 1.--- Home Improvement Contractor Lic.# Construction Supervisor Lic.# Work �m and' Compensation Insurance: (check one) B"I am the homeowner ❑C I am the sole proprietor 0 I have Worker's Compensation Insurance \'`Insurance Company Name: 1 1 ✓ &fr Worker's Comp.Policy# WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # oofmg: #of Squares leA5P ( V)Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at \DW IAGk._ \( 111 -S It)u�i Location of Facility j 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: p (� �ners Signature(or attachment) Date: Q 0 (lh 1 k(9 Approved By: e' Date: 49d�� Building Official(or ign EMAIL ADDRES • Zoning District: Historical District: 0 Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No . . The Commonwealth of Massachusetts —s _ Department oflndustrialAccidents =_n fd_ 1 Congress Street, Suite 100 o _�h�- Boston, MA 02114-2017 -e m 5.•`''� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): A(M J£? V.Q. 1 L P jc , Address: 8 TQ_A- a, i/ City/State/Zip: 551446, YO,CW-0-tATA Phone #: v8 oLgo--O d� Are you an employer?Check the appropriate box: Type of project(required): I.0 I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling y capacity. [No workers'comp.insurance required.] 3. I am a homeowner doing all work myself. 9. ❑ Demolition y [No workers'comp.insurance required.]` 10 E Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑ Electrical repairs or additions proprietors with no employees. 12.E Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.E Other 152,§1(4),and we have no employees. [No workers'comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r 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 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 statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u der the pains and penalties of perjury that the information provided above is true and correct. ..._ Signature: — Date: 0S( �'kq I,/ c a Phone#: b " .o � O' . Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: HAYES & HAYES ATTORNEYS-AT-LAW, P.C. 23 EAST MAIN STREET WEST YARMOUTH, MASSACHUSETTS 02673 Est. 1952 MICHAEI. J. HAYES TELEPHONE (508) 775-0080 STEPHEN P. HAYES TELEFAX (508) 775-0693 FIRM@HAYESANOHAYIES.COM HAROLI) L. HAYES, JR. (1952-2007) August 23, 2019 William Raveis Mortgage, LLC., ISAOA/ATIMA (mortgagee) 7 Trap Falls Road Shelton, CT 06484 and Pavlina llieva 18 Tern Street South Yarmouth, MA 02664 (mortgagor) Property Address: 18 Tern Road, South Yarmouth, MA 02664 Reference is made to a deed from Damilare Oladosu and Oluwatoyin Oladosu, recorded with the Barnstable County Land Court Registry on August 23, 2019 (the Deed), covering the premises described as Lot 8 shown in on PLAN 17392-F, recorded with the Barnstable County Land Court Registry, known as 18 Tern Road, South Yarmouth, Barnstable County, Massachusetts (the Property). Acting solely as counsel for the mortgagee (and as certifying attorney for Stewart Title Guaranty Company), we have caused a mortgage dated August 23, 2019 recorded with the Registry on August 23, 2019 (the mortgage) from the Mortgagor to the Mortgagee covering the Property, recorded at the Registry. We have caused the records of the Registry and the relevant records of the Registries of Probate (collectively, the Records) to be examined through the time and date of recording the Mortgage. We certify that at the time of recording the mortgage, the Mortgagor holds good and sufficient record title to the Property, free from all encumbrances, excepting only matters which are expressly enumerated on Exhibit A attached hereto or otherwise set forth in this certification. We have informed Mortgagor of the matters enumerated on Exhibit A prior to the recording of the Mortgage and notwithstanding, the Mortgagor has instructed us to proceed with the transaction. We further certify that the Mortgagee holds a good and sufficient record first mortgage to the Property, subject only to the matter excepted by this certification. In addition to those exceptions to record title specifically set forth on Exhibit A, this certificate does not certify to or report upon any of the following matters: (1) Those encumbrances referred to in General Laws, Chapter 185, section 46, whether or not title to the Property is registered, if notice of such encumbrance is not recorded or filed with the Registry. (2) Real estate taxes and other municipal liens, except to the extent that the Am-t.AW , i • Certificate of municipal Liens attached hereto as Exhibit B indicates that there are municipal charges presently due and payable; taxes and liens shown on Exhibit B as being due and payable have either been paid or otherwise provided for. (3) Any encroachments, boundary line disputes or other state of physical facts which may be revealed by a personal inspection or accurate survey of the Property (a so-called mortgage plot plan which may have been required by Mortgagee in connection with this transaction provides insufficient data to allow us to remove this exception). (4) Rights or claims of parties in possession not shown by the Records. (5) Easements, or claims of easements, not shown by the Records. (6) Any lien, or right to a.lien, for services, labor or material heretofore or hereafter furnished, imposed by law and not shown by the Records. (7) Any law, ordinance, by-law, or other governmental regulation affecting, restricting, prohibiting, or otherwise regulating the occupancy, use or enjoyment of the Property, the character, dimensions, or location of any present or future improvement now existing or hereafter planned for the Property, or a separation in ownership or change in the dimensions or area of the Property (including, without limiting the generality of the foregoing, Zoning Laws, State Building Code, Wetlands Protection Act, Subdivision Control Law, Lead Paint Law, health laws, sewage disposal laws, historic districts, and pollution control laws). Our liability to the Mortgagor shall be limited to the amount of consideration shown on the Deed. Our liability to the Mortgagee shall be limited to the original principal amount secured by the mortgage. Further, our liability shall otherwise be limited as provided in Massachusetts General Laws, Chapter 93, Section 70. Be advised that this title certification is not intended to replace a policy of owner's title insurance. Sincer , Mi el J. Hayes Hayes & Hayes, Attorneys t-Law, P.C. I HEREBY ACKNOWLEDGE RECEIPT OF THIS TITLE CERTIFICATION. Date: August 23, 2019 Pavlina Ilieva