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Home My WebLink AboutBld-20-003469 O YRR Office Use Only Permit# yy CtJ 0 H Amount 'Y MATT M[f( , **roam•4 �`• Permit expires 180 days from : :;'••' cD lJ 3( (01 issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth,MA 02664 (508) 398-2231 Ext. 1261 06-44-1(--13 CONSTRUCTION ADDRESS:61 Helmsman Dr Yarmouth Port , MA 02675 ASSESSOR'S INFORMATION: Map: Parcel: OWNER:JGS Realty Corporation 767 Independence Dr Unit D309 Hyannis ,MA 02601 (603)315-6285 NAME PRESENT ADDRESS TEL. # CONTRACTOR:Excel Building Systems Co Inc PO BOX 436 Forestdale ,MA 02644 (508)901-0143 NAME MAILING ADDRESS TEL.# l4 Residential ❑Commercial Est.Cost of Construction$3,200.00 Home Improvement Contractor Lie.#182094 Construction Supervisor Lic.#CS-0c8849 Workman's Compensation Insurance: (check one) ❑ I am the homeowner E I am the sole proprietor X I have Worker's Compensation Insurance Insurance Company Name: Associated Employers Insurance Company Worker's Comp.Policy#WCC50050098182019A WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares 16sq ( 1 )Remove existing*(max.2 layers) Insulation Old Kings HighwayfHistoric Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: Yarmouth Disposal Area 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 d..�. sr revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. Qom/ (Q Applicant's Signatu Date: // ACV�q(f�(J Owners Signature(or attachmen Date ( tg 1- Approved By: Date: / %9 Bui 0 al(or esignee) EMA ADDRESS: Zoning District: Historical District: I Yes No Flood Plain Zone: C_ Yes No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No The Commonwealth of Massachusetts iR=1 Department of Industrial Accidents 'a1— a 1 Congress Street,Suite 100 Boston, MA 02114-2017 .00e www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leziblv Name (Business/Organization/Individual): Excel Building Systems Co Inc Address: 8 Jan Sebastian Dr Unit 9 City/State/Zip:Sandwich , MA 02563 Phone#:(508)901 -0143 Are you an employer?Cheek the appropriate box: Type of project(required): l.®I am a employer with 4 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ®Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. El Demolition 10 ❑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 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance? 13.El Roof repairs 6.❑We area corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(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 workraa'compensation policy information. f 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:1gssociated Employers Insurance Company Policy#or Self-ins.Lic.#:W CC50050098182019A Expiration Date: 03/05/2020 Job Site Address:61 Helmsman Dr City/State/Zip:Yarmouth Port, MA 02675 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 S250.00 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 --% under the pains and penalties ofperjury that the information provided above is truetr�/ and correct Si natur Date4 'i /c� C7 Phone#:(508)901-0143 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: .. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards C onstruction`Supervisar CS-098849 E3tpires:06/20/2021 RENATO SILVA PO.BOX 438' FORESTDALE MA 028A4 Commissioner , G--f1c/ /fii- 1��frra�riiuv rf/f r/'. .i sr�/ii�i//: Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Reaistratiott Expiration Office of Consumer Affai and Business Regulation 182094 05/25/2021 1000 Washington Str - uite 710 EXCEL BUILDING SYSTEMS COMPANY INC. Boston,MA 02118 RENATO DA SILVA -7 8 JAN SEBASTIAN DR.STE 9 SANDWICH,MA 02563 Undersecretary Not Vat out signature Client#:38860 2EXCELBU ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PROLWCFR 'CONTACT NAME: The Hiib Groupof N.E.dba PHONE —_-. FAx (AA:,No,Ein) 5D8 775-1620 .Ic,Noy 5087781218 Dowling&O'Neil Insurance Agy E-MAIL P.O.Box 1990 4 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL e Hyannis,MA 02601 N INSURER A. GM Insurance Company 14788 INSURED I INSURER B:Associated Employers Insurance Company 111104 Excel Building Systems Company,Inc (INSURER C: PO Box 436 INSURER D_ Forestdale,MA 02644 r— - 1 INSURER E. —_- I INSURER F: COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OH MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR --_. _._. _.__.__ 'ADOI'SUBRI _..__ POLICY EFF POLICY E1CP LTR TYPE OF INSURANCE 'I R IWM POLICY NUMBER MWD _ LIMITS IIN$ r (MM,DOlYYVYi� orYvyYi A X COMMERCIAL GENERAL LIABILITY X X MP02774T 2/22/2019IO2/22/2020 EACH OCCURRENCE $1,000,000 i !!! I DAMAGE TO RENTED 1 ;CLANS-MADE , f I OCCUR i I PREMISES(Ea occurrence) $5000 000 MED EXP{Any one person) S 10,000 . PERSONAL&ADV INJURY $1,000,000 GENt AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE ,32,000,000 -PRO t PRODUCTS-COMPOPAGG S2,000,000 .POLICY X .R0- _X LCC -... . _. ....__ _.._ I $ OTHER: — 44 COMBINED SINGLE LIMIT i A FAUTOMOBA E UAB�m M102774T 12/09/2018 12/09/2019�(Ea accident) $1,000,000 ANY AUTO - 1 BODILY INJURY(Per person) $ Ail OS ONLY XX � AUTOS 1 I i dOGs�i iNd R v Per e�c oer > 1 HIRED C NON-OWNED I PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY , (Per accident) $ I it 1 $ UMBRELLA LIAR 1 OCCUR I EACH OCCURRENCE $ I ,EXCESS UAB -.-j CLAIMS-MADE i I AGGREGATE ,$ WORKERS COMPENSATION SANTION $ Y!N $ B lANDY EMPLOYERS'LABILITYFXECUT;VE �WCC50050098182019A D3/05/2O19I03/05/2020 X {STAT rE �RH _-- i AND EMPLOYERS'LIABILITY T I(Mandaory in N , LUDE9 N/A' L 4_Q✓EN, $500,000 (Mandatory in NH) N I I E L.DISEASE EA EMPLOYEE$500�000 II yes,describe under -- - — --- DESCRIPTION OF OPERATIONS i 1 E.L.DISEASE-POLICY LIMIT ,S500,000 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule may be attached H more space is required) The following coverages applying in the favor of The Valle Group,Valle Redbrook,LLC,&John Parker Road, LLC:Additional insured status on the General Liability;Waiver of Subrogation on the General Liability,as well as other parties as required by contract.General Liability is Primary and Non-contributory for premises,products and completed operations. (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES.BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD *5230329/111230326 RPJX1 Doc: 1 , 385 , 759 12-12-2019 12 : 52 Ctf#: 221369 Return to/Mail tax statements to: Law Office of Stanley P.Nowak, Esq. 1550 Falmouth Road,Suite 6 Centerville,MA 02632 File#:TCEL-197 SPECIAL WARRANTY DEED This indenture made and entered into on this the 211 day of November,2019,by and between WILMINGTON SAVINGS FUND SOCIETY,FSB,DB/A CHRISTIANA TRUST,NOT INDIVIDUALLY BUT AS TRUSTEE FOR HILLDALE TRUST,whose address is 440 South LaSalle Street,#2000,Chicago IL 60605,Grantor,and JGS REALTY CORPORATION,whose post office address is 767 Independence Drive Apt.D309,Hyannis,MA 02601,Grantee. W itnesseth: That for and in consideration of the sum of TWO HUNDRED FORTY TWO THOUSAND and 00/100 DOLLARS($242,000.00),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: THE LAND WITH BUILDINGS THEREON IN YARMOUTH, BARNSTABLE COUNTY, MASSACHUSETTS BEING SHOWN AS LOT 9 ON SUBDIVISION PLAN 36472-B (SHEET 1)DATED MAY 4, 1977,DRAWN BY CMS ASSOCIATES INC.,SURVEYORS, AND FILED IN THE LAND REGISTRATION OFFICE AT BOSTON,A COPY OF WHICH IS FILED IN BARNSTABLE COUNTY REGISTRY OF DEEDS IN LAND REGISTRATION BOOK 518, PAGE 14 WITH CERTIFICATE OF TITLE NO.64254. BEING the same premises conveyed to the grantors herein by deed filed on 03/06/2019 with the Barnstable County Registry District of the Land Court as Document No. 1365366. Property Tax ID#: YARM-0001 I6-000069 Property Address: 61 Helmsman Drive,Yamouth, MA 02675 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. MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY EXCISE TAX BARNSTABLE LAND COURT REGISTRY BARNSTABLE LAND COURT REGISTRY Date: 12-12-2019 @ 12:52pm Date: 12-12-2019 @ 12:52pm Ct1#: 982 Ct1#: 982 Fee: $827.64 Cons: $242,000.00 Fee: $740.52 Cons: $242,000.00 Doc: 1,385 ,759 12-12-2019 12 : 52 Page 2 of ' 2 WITNESS my hand and seal this 21st day of November, 2019. WILMINGTON SAVINGS FUND SOCIETY, FSB, DB/A CHRISTIANA TRUST,NOT INDIVIDUALLY BUT AS TRUSTEE FOR HILLDALE TRUST By: FAY SERVICING LLC, as attorney in fact .rr► By: ,45/0 . Name: Michael Brooks For Signat1re Authority,See Limited Power of Authority filed as Document NO. 1 , 382,411 . Title:REO Closing Coordinator.Fay Servicing, LLC,Attorney-in-Fact State of FLORIDA HILLSBOROUGH County Dated November 21 , 2019 On This 21st day of November, 2019,before me, the undersigned notary public,personally appeared Michael Brooks its RHO Closing Coordinator of FAY SERVICING LLC as attorney in fact for WILMINGTON SAVINGS FUND SOCIETY,FSB,D/B/A CHRISTIANA TRUST,NOT INDIVIDUALLY BUT AS TRUSTEE FOR HILLDALE TRUST, 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 gam°;, , acknowledged said instrument to be the free act deed of said corporation(or association). MY CtyCe�OMrMtISSIONttea mom . Bondedmoumowrocwigwams otary 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 for 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 JOHN F. MEADE, ASSISTANT RECORDER BARNSTABLE REGISTRY LAND COURT DISTRICT RECEIVED & RECORDED ELECTRONICALLY