The URL can be used to link to this page

Home My WebLink AboutBld-20-001847 !_! c, as �8= 0 'l '� L7 .N !Amount c:c $. Ems' i Permit expires 180 days from '' „_.:... +issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 G (508) 398-2231 Ext. 1261 C16 - (3 L CONSTRUCTION ADDRESS: /5. 1-/e r(i L,',n( ? S . / by ASSESSOR'S INFORMATION: f Map: Parcel:r o p / (� (� OWNER: triILSOI& Alves PRESENT ile,ADDRESS 1 N � y—O (...QA _� -I NAME TEL. # CONTRACTOR: NAME MAILING ADDRESS TEL.# P Residential ❑Commercial Est.Cost of Construction$ jr3.003. Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) X I am the homeowner I I am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares 15 Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: 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: I Date: Owners Signature(or attachment) .s` "D Date: i 0 _0 Approved By: Date: � 7 77 Building ici des' ee) E ADDRESS: Zoning District: Historical District: D Yes ^ No Flood Plain Zone: a Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No ❑ Yes 0 No _ The Commonwealth of Massachusetts _+�, = Department of Industrial Accidents _=,%"Il_ 1 Congress Street, Suite 100 _ �= Boston, MA 02114-2017 0, ;: ..•-• 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): Eel (2,50h/ A Lo>ti S Address: t S. Nt r Py-1, i fn(. S. l h1 City/State/Zip: 50011-\ y,} 1„, ' . Phone 4: . y_ 3 L_2Li _2 Li Are you an employer?Check the approp ate box: Type of project(required): 1.E l 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 any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doing all work myself. 9. ❑ Demolition y [No workers'comp. insurance required.]t l0 ❑ Building addition 4._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 11.❑ Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E Roof repairs These sub-contractors have employees and have workers'comp. insurance.: 6.❑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 under the pains and penalti of perjury that the information provided above is true and correct. iQnature: cll Date: n r- _ 1 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 (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Return to/Mail tax statements to: Edilson Alves 141 Clifton Lane Centerville,MA 02664 File#: TCEL-498 SPECIAL WARRANTY DEED This indenture made and entered into on this the 25th day of June,2019,by and between PROF- 2013-S3 LEGAL TITLE TRUST II,BY U.S.BANK NATIONAL ASSOCIATION,AS LEGAL TITLE TRUSTEE,whose address is 440 South LaSalle Street,#2000,Chicago IL 60605,Grantor,and EDILSON ALVES and THELMA R.ALVES,husband and wife as tenants by the entirety,whose post office address is 141 Clifton Lane,Centerville,Massachusetts 02664,Grantee. Witnesseth: That for and in consideration of the sum of TWO HUNDRED FIFTY-FIVE THOUSAND and 00/100 DOLLARS($255,000.00),cash in hand paid,receipt of which is hereby acknowledged,the Grantor has this day bargained and sold,and by these presents,does hereby sell,transfer and convey unto the said Grantee,Grantee's successors and assigns in fee simple,the following described real estate: SEE COMPLETE LEGAL ATTACHED AS EXHIBIT"A" Property Tax ID#: YARM-000059-000014 Property Address: 15 Hervey Lines Lane,Yarmouth,MA 02664 Being the same premises conveyed to the grantor herein by deed filed on 05/09/2018 with the Barnstable County Division of the Land Court as Document No. 1345826; Certificate of Title No. 216121. Grantor to convey the title by special warranty deed without any other covenants of the title or the equivalent for the state the property is located. Grantor makes no representations or warranties,of any kind or nature whatsoever,whether expressed,implied, implied by law,or otherwise,concerning the condition of the property. • WITNESS my hand and seal this 2 5 th day of June ,2019. • PROF-2013-S3 LEGAL TITLE TRUST II,BY U.S. BANK NATIONAL ASSOCIATION, AS LEGAL TITLE TRUSTEE By: FAY SERV CING LLC s attorney in fact By' Daren Perez EO VP State of Florida Hillsborough June 25 County Dated , 2019 On This 2 5 th day of June ,2019,before me,the undersigned notary public,personally appeared Daren Perez its REO VP of FAY SERVICING LLC as attorney in fact for PROF-2013-53 LEGAL TITLE TRUST II,BY U.S. BANK NATIONAL ASSOCIATION,AS LEGAL TITLE TRUSTEE,and that the seal affixed to said instrument is the corporate seal of said corporation(or association), and that said instrument was signed and sealed on behalf of said corporation(or association)by authority of its board of directors (or trustees),and said Daren Perez acknowledged said instrument to be the free act and deed of said corporation(or associ t' l ,�t nrro•.; MICHELE.ANN BOYD 1 1 ,i> 4:`., MY COMMISSION#GG 050699 Ft f " * EXPIRES:November 20,2020 /LI ek! /1Y 14— 7 'Ao r?P Bonded Tin Notary Public Underwriters (� Notary Public -` My commission expires: No title search was performed on the subject property by the preparer. The preparer of this deed makes neither representation as to the status of the title nor property use or any zoning regulations concerning described property herein conveyed nor any matter except the validity of the form of this instrument. Information herein was provided to preparer by Grantors/Grantees and/or their agents;no boundary survey was made at the time of this conveyance. This Instrument Reviewed By: Dmitry Kirzner,Esq. 1674 Beacon Street Brookline,MA 02445