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Home My WebLink AboutBLD-22-006762 ,y~ I / 5 l/�17� 1 Office Use Only R.4 /�VtO (/ 1ti V� ��t PPermit# C r !i. Amount lR. 0 �MATTACM CSE, - - wnc..no`''c� i Permit expires 180 days from j issue date 8&p -0?s -6150702 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department R E C 1146 Route 28 E'�V E D South Yarmouth, MA 02664 MAY (508) 398-2231 Ext. 1261 23 1022 BUILDING D R _!`By: EPA ! CONSTRUCTION ADDRESS: /r V,/ TMEN ASSESSOR'S INFORMATION: Map: '` Parcel: OWNER: At6 6AC 17'7 IJ r_ l PRESENT 2ADD i ( , l TEL. # CONTRACTOR: 1�(\t(A. j i 5 Z'(o 3 rlCcc NAME MAILING ADDREnSS ` 01 � c2'�V0TEL.# _ Residential 0 Commercial Est.Cost of Construction$ O [`�1 t Home Improvement Contractor Lic.# )'7 i 357 Construction Supervisor Lic.# C5- 1` 75 Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor N4ave Worker's Compensation Insurance Insurance Company Name: b.cZ L i `Sy$(c-on L Gro.Y' Worker's Comp.Policy# Lke 99cZ564' _ 1 WORK TO BE PERFORMED .y'^0 Tent Duration (Fire Retardant Certificate attached?) Wood Stove Shei c4 Siding: #of Squares Replacement windows:# Replacement doors: # /d .P OAS 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: Cam;%LC g.)Q6 1 At <Sk ra u‘V'it. MO 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 m . and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: "/ /2o Z Z Owners Signature(or attachment Date: 5jt 3)-ao 36.2 Approved By: Date: ��` Building Official(or bne EMAIL ADDRE — Zoning District: Historical District: 0 Yes ❑ No Flood Plain Zone: a Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: ❑ Yes 0 No 0 Yes 0 No Office of Consumer Affairs& Business Regulation- Mass.Gov Page 1 of 2 Mass.gov • ffice Consumer Affairsd Business ID • ulationOCABR HIC Registration Complaints Registration # 191897 Registrant MATTHEW M FERREIRA Name MATTHEW FERREIRA Address 111 PARK ST City, State Zip NEW BEDFORD, MA 02740 Expiration Date 05/21/2024 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search Site Policies Contact Us https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=191897 5/23/2022 mL�D D m70m m —I 2 -n 3 m O p *-0-� m m 3 mxm > m. 3 O 0 7 ici, � �� v m eat r.1.471ri 4141! o > m ) 55 �a�d ii ii ! I c�^ Q7� N3 yat!' ' �; - ZND Q r, i g N O —h 'r ' c D ^1 ,O CA,' N 2 CD ....... C_ C m XIcm 0 — C7 � (D C. 0 7.t . N _ (� 0 _ to 0 D --. - _.,,...-CO m=4a ai C C 0 a m � ` � 5 D s m I ril, cp 4g a1 o =6 At Z D3. m 3 ;Qit . .�.rL , 1 C O -3 -g c c v�.<d M- � � N C O a7 m v 0. o ov C>1 O C w o� W o O CO3 D o-,g = C a 01 co A.' w `< o. N�a Cn at Xi S. co to = C 3 N N SD w "� . N.) c. c dl C 3 o a Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re•ulations and Standards Cons ,g. . ionr . : - isor 4t1- 05-112275 v empires: 05/27/2024 i '.:1:--..;1...t7•.,..i''4 MATTHEW vE t 111 PARK ST 6 ',t NEW BEDFO MAx f -. _ . ,i. 1 Scanned with CamScanner . AC'o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `....--'-- 1/21/2022 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 rights to the certificate holder in lieu of such endorsement(s). CT PRODUCER CNAME Jay Aquiar Eastern Insurance Group, LLC. PHONEN.e><t►:800-333-7234 FAX No):781-586-8244 233 West Central Street Natick MA 01760 AADDDRESS: laguiar@easteminsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:AMERICAN FIRE&CAS CO 24066 INSURED 181071 INSURER B:Ohio Security Insurance Co 24082 ProGroup Network Inc&J M C F Inc. INSURERC:United States Fire Insurance Company 21113 dba ProGroup&Certa Pro Painters DBA Renovate Residential; ProGroup Contracting INSURER 0:Homeland Insurance Company of New York 34452 1193 Ashley Blvd,Rear INSURER E:Ohio Casualty Insurance Company 24074 New Bedford MA 02745-2419 INSURER F COVERAGES CERTIFICATE NUMBER:2077263764 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR 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. INSR TYPE OF INSURANCE INSOADDL SUER POLICY NUMBER (MMM//DD EFF POUCY EXP LIMITS LTR INSD-y1/YD- 1YYYY)_(MMIDD/YYYY) A 1j COMMERCIAL GENERAL LIABILITY BKA55824277 12/1/2021 12/1/2022 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED j CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $300,000 X I XCU MED EXP(Any one person) $15,000 X I CONTRACTUAL LIAB PERSONAL&ADV INJURY $1,000,000 hGEN'L AGGREGATE LIMIT APPLIES PER: POLICY I X J GENERAL AGGREGATE $2,000,000 PE LOG PRODUCTS-COMP/OP AGG $2,000,000 OTHER: EMPLOYEE BENEFITS $1,000,000 B I AUTOMOBILE LIABILITY BAS55824277 12/1/2021 12/1/2022 (ECOa accMBINEDident)SINGLE LIMIT $1,000,000 X ;ANY AUTO BODILY INJURY(Per person) $ r—OWNED I SCHEDULED BODILY INJURY(Per accident) $ I AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED (Per accident) $ I I AUTOS ONLY AUTOS ONLY $ E X I UMBRELLALIAB X OCCUR US055824277 12/1/2021 12/1/2022 EACH OCCURRENCE $10,000,000 I EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 i DED X I RETENTION$infirm l $ C !WORKERS COMPENSATION 408-742506-9 1/1/2022 1/1/2023 X STATUTE I I ERH AND EMPLOYERS'LIABILITY Y I N I ANYPROPRIETOR/PARTNER/EXECUTIVE N NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? I(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 $1,0 D I CPL PER 0CC&AGG 7930044140006 12/1/2021 12/1/2022 $5000 DERENTEIo MADE $2 000,0 0 A INLAND MARINE BKA55824277 12/1/2021 12/1/2022 I Limit $250,000 Installation Floater DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Additions!Insured coverage is provided with respect to General Liability,for ongoing and completed operations on a primary and non-contributory basis,Auto Liability and Excess Liability where required by written contract. A waiver of Subrogation applies under General Liability,Auto Liability,Workers'Compensation and Excess Liability where required by written contract. EVIDENCE OF INSURANCE CERT1F;CATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE ielliPPlesieg;) 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE „14c Nthed t — Natai_Dir4 votalikisu Vg M21411.VV4 EffirilrAD affigen 'MAW: OIXiMetiffki adAl, 1:1013VIUSIOD 1,011113Aandille anon iumandlaid irmayanau avemiraeleneue*Oe=MO waevirzor-Aeli •itofl # MrN1j, CorenliOtiweaaa Dr MassachuaellS '1111•7 Division of PrOlelsional LICensure BOard of;Wilding Regulations and Slanders% CnSt1134;tibra StiPervisor CS-112275 Eiipires:05127/2022 WirgueW M FERREIRA 111 Ili PARK ST taw BEDFORD MA WAN Commissioner • The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 f = ; Boston,MA 02114-2017 mid" www.mass.gov/dla Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aovlicant Information Please Print Legibly Name (Business/Organization/Individual): re:fab Address: 1193 Ashley Blvd Rear New Bedford, MA 02745 City/State/Zip:New Bedford, MA 02745 Phone#:508-863-5965 Are you an employer?Check the appropriate box: Type of project(required): KrZ 1 am a employer with 10 employees(full and/or part-time).* 7. New construction 20 I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8• ®Remodeling • 3. I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4. Demolition 4.0 lam a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 EIectrical repairs or additions proprietors with no employees. 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.®Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.i 13. Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El 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 workers'compensation policy information. 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. f am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Eastern Insurance Group Policy#or Self-ins.Lic.#: BKA55824277 Expiration Date 12/1/2022 Job Site Address: 174 Bay View Street City/State/Zip: West Yarmouth, MA 02673 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sisnature: f-Wbei)1.4a, Date: 5/10/22 Phone#: 508-863-5965 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.CityiTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone it: or tellsittO rO r' B3. 27515 Ps269 *38952 Robert Weinstein 07-02-2013 0l 02=2713. . • •Attorney at Law Alien Avenue Newton, MA 02468-1720 NAONT N O T A N OFFICIAL OFFICIAL COPY COPY FIDUCIARY DEED N 0 T N O T A N A N I, Roljrt 4. Tat, FeAsoDal Repre lgntxti ve Iotth gsigte of Linda S. Fair (also sometimes knownm a® Ipin la Fair) Middlesex fro raise land Family Court Docket No. 1VII12P5027EA,pursuant to the provisions of the Last Will and Testament of Linda S.Fair,grant to Robert A. Fair of 656 Grove Street,Framingham,Massachusetts An undivided one-third tenant in common interest in and to the land together with the buildings thereon, situated in Yarmouth, Barnstable County, Massachusetts, bounded and described as follows: Commencing at the southeasterly corner of Bayview Street and Windmill Lane, twenty(20) feet wide and running Northerly along the Easterly line of said Bayview Street,Ninety-two(92) feet; Thence running Easterly about Fifty(50)feet; Thence turning and running Southerly about Seventy-five (75)feet to a point Fifty (50)feet from the corner of Bayview Street and Windmill Lane; Thence turning and running Westerly along said Windmill Lane about Fifty(50) feet to the point cr, of beginning,be all of said measurements,more or less. co Also an adjoining parcel of land described as follows: pBeginning at the Southeast corner of the granted Premises; Thence running Northeasterly by land now or formerly of Mabel K. Baker, Seventy-five (75) feet to the Southerly line of Lot 8 on plan hereinafter mentioned; Thence running Southeasterly by Lot 8 Five (5) feet, more or less to land now or formerly of a O Margaret Young; Thence running Southerly by land now or formerly of said Young, Seventy-five (75) feet to Windmill Lane; Thence running Northwesterly by said Windmill Lane,Twenty-five(25)feet,more or less,to the point of beginning. Page 1 of 2 Bk 27515 Pg270 #38952 Being LOT 21 as shown Tn "Plan,of Land, Hyannis oPaTk, belonging to M.E. Sullivan and Clarence Kirkland. AN AN For title referacc sge Lstcte{f`Xh1 a I.JeweleAdgleJexeCoTurity Itobate No. 05P2095EP. See also,Deed of Shawl M? dated June 20,2012 aCncPregorlled with ffMCNSf?1i' Registry of Deeds in Book 26450,Page 205. adWvT N- O T NOT WITNESS my hand ai*&siSal this /'77 day of Mah2113. OFFICIAL OFFICIAL COPY C YY �C GliC� )�O ERT A.FAIR,Personal Representative COMMONWEALTH OF MASSACHUSETTS g100le5e) , ss. On this /7 A day of May, 2013, before me, the undersigned notary public, personally appeared Robert A. Fair proved to me through satisfactory evidence of identification (by presentation of a driver's license) to be the person whose name is signed on this document, and acknowledged to me that he signed it voluntarily in his capacity as Personal Representative of the Estate of Linda S. Fair, for its stated purposes and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of his knowledge and belief. o yPu My Co si Expires: mat, 4 z d ig � ` - - +vim r - BARNSTABLE REGISTRY OF DEEDS Page 2 of 2