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Home My WebLink AboutBLD-23-001615 • �{ YRR fa�/� �/ j Office Use Only 7I Permit# �_"`„ 1 �, Amount /. dd. (�b M\ATTAIN CSf x„��o L�� ,Permit expires 180 days from j issue date 15 EXPRESS BUILDING PERMIT APPLICATION c� _�� Ito TOWN OF YARMOUTH Yarmouth Building Department RECEIVED 1146 Route 28 __.. South Yarmouth, MA 02664 PEP 2 (508) 398-2231 Ext. 1261 7 2�22 �� T l BUILDING DEPARTMENT CONSTRUCTION ADDRESS: v_.___�____,__ _ ASSESSOR'S INFORMATION: //14:5 -- Map: Parcel: OWNER: 6114Ai .`�iA vr\t��)� /19 o! y Q 9L � OPkJ;sENDDRESS TEL. # CONTRACTOR: 6 / /.5�/ - `Y NAME MAILING ADDRESS ( TEL.# ]) Residential ❑Commercial Est. Cost of Construction$ 6---6 0 [ - t9)/ Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workman?-. Insurance: (check one) lKI am the homeowner ❑ 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 JO Replacement windows: # ,f 5 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: c94T, -4 b vr-t 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 ar, r prosecution under M.G.L.Ch.268,Section 1. Zignator a chment)i Date: Vi) Approved By: Date: Bui . a fficial(o designee) EMAIL ADDRESS: Zoning District: Historical District: ❑ Yes 11 No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: Yes 0 No 0 Yes 7 No t �-� The Commonwealth of Massachusetts 140 1 Department of Industrial Accidents t ipt 1i 1 Congress Street, Suite 100 ' 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 Please Print Legibly Name (Business/Organization/Individu I): Address: /4 J Q. , �� Sc,,, \\-,a,s- Ci-ty/State/Zip: r ), fili CI?2-9 Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.0 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 any capacity.[No workers'comp.insurance required.] 3.�am a homeowner doing all work myself. 9. ❑ Demolition y [No workers'comp. insurance required.] 4.0 I am a homeowner and will be hiring contractors to conduct all work on mYP property.e I will 10 ❑ Building addition 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. 13.❑Roof repairs These sub-contractors have employees and have workers'comp. insurance.t • 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.7 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. 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: 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. do hereby certi n er ,ains and pen ' s of perjury that the information provided above is true and correct. Signature: V#2/jDate: 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#: t ' Iv\ 4- P,. 4. , j x k, L____ , X NAS 1 Aft. L___ 01:k" 3 7 R----c-L\e. 1 37L\ e 0\ 1.1)( (4, . i Vvi y s: ''GI i:, ..\ (\440 !',c.... \i... ‘1-- '4 1\ Q., co-,.....IN\\ i''' i S\..) x-ik.../i 01-\41:1 u).s + a".---7 4Pq 7/3 A 9._ 4. f Doc: 1,467 ,804 09-22-2022 12 : 19 Ctf#: 231131 NOT NOT AN AN O F F ' I C I A L OFFICIAL COPY QUITCLAIM DELI/ P Y NOT NOT AN AN OFFICIAL OFFICIAL COPY COPY We, DOUGLAS A. BEECY and PAMELA A. BEECY, being married to each other, with a mailing address of 37 Pebble Beach Way, South Yarmouth,MA 02673, X for consideration paid in the amount of SEVEN HUNDRED TWENTY-SIX THOUSAND AND 00/100 ($726,000.00)DOLLARS, grant to LISA L. DUNDERDALE, individually, of 122 Deerfoot Road, Southborough, MA 01772, 0 cn WITH QUITCLAIM COVENANTS, The land together with the buildings thereon, situated in Yarmouth Port,Barnstable County,Massachusetts,described as follows: es LOT 152 LAND COURT PLAN 28477-F(Sheet 2) The above-described premises are conveyed subject to and together with the benefit of any rights, rights of way,reservations, restrictions,easements and other matters of record, insofar as the same are in force and applicable. d For title,see Certificate of Title No. 107228. aGrantors release any and all homestead rights to the within premises, whether created by declaration or operation of law, and further state under the pains and penalties of perjury that there are no other individuals entitled to homestead rights to the property being conveyed herein. MASSACHUSETPS STATE EXCISE TAX BARNSTABLE COUNTY EXCISE TAX BARNSTABLE LAND COURT REGISTRY BARNSTABLE LAND COURT REGISTRY Date: 09-22-2022 @ 12:19pm Date: 09-22-2022 @ 12:19pm Ct1#: 412 Ct1#: 412 Fee: $2,482.92 Cons: $726,000.00 Fee: $2,221.56 Cons: $726,000.00 1 Doc: 1,467 ,804 09-22-2022 12 : 19 Page 2 of 2 NOT NOT Ex cuted as a sealed'n ru e t r the sins n ti r' this Tday of o L�02R1. �` p °lf COPYP Y COPY NOT NOT AN C> OFF ICIA UG A A. COPY COP • PAMELA A.BEECY COMMONWEALTH OF MASSACHUSETTS Barnstable,ss: , County < -•mot. 2022 On the above date, before me, the undersigned notary public, personally appeared DOUGLAS A. BEECY and PAMELA A. BEECY, who proved to me through satisfactory evidence of identification, which was photographic identification with signature issued by a federal or state governmental agency, ❑ personal knowledge of the undersigned, to be the persons whose names are signed on the preceding Quitclaim Deed, and acknowledged to me that they signed it freely and voluntarily as their free act and deed and hereby certifies that the homestead certifications in the foregoing Quitclaim Deed are true and correct to the best of their knowledge and belief. CSE M. 1 w z= Notary lic: = oy My co ission expires: o•o •1;i4 ,, JOHN F. MEADE, ASSISTANT RECORDER BARNSTABLE REGISTRY LAND COURT DISTRICT RECEIVED & RECORDED ELECTRONICALLY