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Home My WebLink AboutBLD-23-003712 RECEIVED Office Use Only og'Y'�R JAN 06 2023 Permit# NIr — — Amount W- BUILDING DEPARTMENT Permit expires 180 days from By: issue date su r EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH 66'D .._,2,3�60 j7/2 Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 �(508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: l/nr J 1,/��/� ry. ASSESSOR'S INFORMATION: Map: x Parcel: y 2 �s OWNER: /iL.. 1`�� V, :/i '//j`6' C.r�T NAME� /�,y�,{� J�`y PRESENT ADDRESS r� TEL. # CONTRACTOR: 6'�: /`✓o/r2-- /// CvG�//�/Y/ .._4 �-T, +/ NAME MAILING ADDRESS TEL.# 1 esidential ❑Commercial Est.Cost of Construction$ Home Improvement Contractor Lic.# / L, Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) 0 I am the homeowner (XI am the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# WORK TO BE PERFORMED Tent U Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares (0)Remove existing*(max.2 layers) Insulation El I J Old Kings Highway/Historic Dist. Replacing like for like Pool fencing *The debris will be disposed of at: J i.) /' 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 reyocatioif my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: - Date: ,( a Owners Signature(or attachment) Date: .L b ° / Approved By: AL." Date: / _7 s Building Offi (or sign EMAIL RESS: Zoning District: Historical District: Yes No Flood Plain Zone: Yes C No Water Resource Protection District: Within 100 ft.of Wetlands: Yes No Yes No }.._. }`~_. s a i.A }h"j�Gt:•=j:7 �Je�;I�7 tt g tr- t.. . - 4 . 4 . The Commonwealth of Massachusetts �:IIt ;_,.,�.L Department of Industrial Accidents t ........r .0 " '"'' 1 Congress Street, Suite 100 tki. j viur Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information y �s�,� PPlease Print Legibly Name (Business!Organization/Individual): ' X/"fit i f� / "�I7-. Address: /i'6 (JA(//)X" —cif City/State/Zip: :ix /'D(,77' ?04)/ Phone#: �� `c ? / Are you an employer?Check the appropriate box: Type of project(required): 1.0I am a employer with employees(full and/or part-time).* 7. Ei New construction 2.0I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance./ 14.❑Other 6. We are a corporation and its officers have exercised their right of exemption per MGL c. 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. t Homeowners who submit this affidavit indicating they are doing all work a-id 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 for,arded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify une pains and penalties of perjury that the information provided above is true and correct. ^ / 1 C' Signature: c tr ter.__"y'"— Date: //O ; / ) 7 Phone#: 'j 7 .2 / T , ,7 r' 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 •f;Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards Constctrtqioon1Srvisor CS-112592 ,plres:01/05/2024 GABRIEL I PANAITE 862 QUEEN ANNE RD HARWICH MAC 02645 . /fig tr r(, Commissioner &refki l 4;e )1d THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual GABRIEL IONUT PANAITE Re D/B/A G&R HOME IMPROVEMENT Expiration:p 08/30/2024 Registration: 192964 862 QUEEN ANNE RD HARWICH,MA 02645 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Individual Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 192964 08/30/2024 Boston,MA 02118 GABRIEL IONUT PANAITE DBIA G&R HOME IMPROVEMENT GABRIEL PANAITE 862 QUEEN ANNE RD . se HARWICH.MA 02645 Undersecretary Not valid without signature Bk. 25997 Ps229 �2015 • 01-12-2012 .1 12 =54w NAONT QUITCLAIM DLkT OFFICIAL OFFICIAL I, HARRIS M. SPYLIOS®f AM West 88th Street, Apt.c3k, rreW York, NY 10024 for consideration paid, andvino consideration of ONE ($1.9))0DOLLAR grant to ALEXIS VACCARRJO of 270 West Main Streit, Westborough, Massachusetts 01581 OFFICIAL OFFICIAL COPY COPY with quitclaim covenants, all my right and title and interest in and to my one-half undivided interest in: A certain tract of land, with the buildings thereon, situation on westerly side of Captain Chase Road in South Yarmouth, Barnstable County, Massachusetts, being bounded CD and described as follows: O BEGINNING at the most easterly corner thereof, on the westerly side of Captain Chase Road at Lot 162, on plan hereinafter mentioned; THENCE by said Lot 162 S. 77° 25' 50"W. one hundred twenty (120) feet to Lot 166 on said plan; 0 THENCE by said Lot 166 N. 12° 34' 10"W. one hundred (100) feet to Lot 160 on said 0 plan; THENCE by said Lot 160 N. 77° 25' 50" E. one hundred twenty (120) feet to said Captain Chase Road; THENCE by said Captain Chase Road S. 12° 34' 10" E. one hundred (100) feet to said Lot 162, the place of beginning. The entire parcel of land of which I hold said one-half undivided interest as tenant in Q common with Constance M. Venios: (a) contains approximately 12,000 square feet and being Lot 161 on a plan of a portion of"CAPTAINS VILLAGE" South Yarmouth, Massachusetts. Scale 1" = 100' dated January 1965 by Thomas E. Kelley, Surveyor, a recorded with Barnstable County Registry of Deeds in Plan Book 192, Page 129; and (b) is the same premises described in a deed of William Tourles et ux dated November 9, 1973 and recorded with the Barnstable County Registry of Deeds in Book 1998, Page 226; and is the same premises (and my title being derived from) as described and set forth in a deed of said premises to me and my sister Constance M. Venios, as Tenants in Common, by deed of our mother Despina P. Spylios dated 9 May 2001 and recorded at the Barnstable County Registry of Deeds in Book 13936 Page 42100 on 14 June 2001. 1 Bk 25997 Pg 230 #2015 Witness my hand and dtal)tlifs 3 day of Alt 02711. AN AN OFFICIAL OFFICIAL COPY _ CC� P ` �`_.IL �J t NOT Hz"'s M. SAlliqs AN AN OFFICIAL OFFICIAL At the request of the cruet do title examination wes ee ffocrned prior to the recording of this deed. STATE OF NEW YORK COUNTY OF NEW YORK On this �� day of Q jc , 2011, before me, the undersigned notary public, personally appeared HARRIS M. SPYLIOS, proved to me through satisfactory evidence of identification, which was Pe,,.) Vo 54 k Iv-;,fe.r taccoAc2 to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarily for its stated purpose. ob,af±o C..,k.,°e.,0:,.--L - [SEAL] Notary Public: (print or type name) 1� t ROBERTO C ARA 0 My Commission expires: 4 { lc (WI 1 Notary Public•Stab of Nsw York NO.01CH8238572 Ooattlied in Kings Co ty I My Commission Expires 4 «I 1- 0 1 RETURN TO: Gregory J. Angelini, Esquire 77 Merriam Avenue Leominster, MA 01453 2 BARNSTABLE REGISTRY OF DEEDS