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Home My WebLink AboutBLDX-23-15127 • Office Use Only/Pi SiRRma C 1 3-/S/ i$ - c,t; RECEIVED {� ..i, !Amount � MATTACt, ESE _S.. ..00 a. 0 8 2023 `'" AUG „_ ;,:... ;Permit expires 180 days from +issue date BUILDING DEPARTMENT EXPRESS BUILDINGCATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 , I-�-�t(-51 Ext. 1261 CONSTRUCTION ADDRESS: C,U 'g W- 1 V\ IA • 0 J C 43 ASSESSOR'S INFORMATION: �^ Map: / iU ( Parcel: �� OWNER: �D341)\/ Car,TO l q .t.r Qi to. vi etv":4 t 1 -4`jj1 — J aR- ' 3 3�-- NAME PRESENT ADDRESS TEL. # CONTRACTOR: NAME MAILING ADDRESS TEL.# tesidential ❑Commercial Est. Cost of Construction$ /0/ 00 D Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) yam the homeowner ❑ I am the sole proprietor r] 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 1 LI emplacement windows: # Replacement doors: # 1.--- /Roofing: #of Squares -T ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: e&Y1 e,) lekt"AzikATA ig fy,v, a Q O/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 and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: 0 I I(RI OC C2 3 Owners Signature(or attachment) Date: to O 81 b r id 3 Approved By: I Date: z 6 Building Offi (o signe EMAIL ADD Zoning District: Historical District: ❑ Yes ❑ No Flood Plain Zone: a Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes ❑ No ❑ Yes I.11 No The Commonwealth of Massachusetts • Department of Industrial Accidents __=,jOi= 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass aov/dia ow 4 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): al'nni 6 / Address: Cat City/State/Zip: W./A ' ian- 11111 k Oo1C-43 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. 0 Remodeling any capacity.[No workers'comp.insurance required.] am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑ 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. • - 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1 Roof repairs These sub-contractors have employees and have workers'comp. insurance.t 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 1 . OtherU :51 hl.C therval.0 t 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. $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 here. under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 'D N. Phone#: — 4 33� 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#: U-A.CuJ4- ark to w aur Ri , (2,0-66(\%n cow ws 6u, „\i„, W e,e K cwd Loasva- 4 o x rvwv e i n A- 3 ,vac r-H s V\GtSSq atIA sits us+ 202:5 Jt.mail V►SU L S IS Cave.Cod @ smou l .corn Bk 35921 Pg216 #30833 • ' 08-03-2023 @ 10:23a NOT NOT AN AN OFFICIAL OFFICIAL COPY COPY NOT NOT AN AN OFFICIAL OFFICIAL COPY COPY QUITCLAIM DEED AU Realty Corporation, a Massachusetts Corporation with a principal place of business al located at 182 Pitcher's Way,Hyannis,MA 02601, for consideration paid and in full consideration of THREE HUNDRED THOUSAND & 00/100($300,000.00/U.S.)DOLLARS, j. GRANT to Robinson Campos, individually, of 140 Cranberry Lane, South Yarmouth„ Massachusetts 02664, with QUITCLAIM COVENANTS, z The land located in Barnstable, Barnstable County, Commonwealth of Massachusetts, o together with the buildings thereon,described as follows: Being LOT 259 as shown on a plan of land entitled: "Swan Lake Shores, West Yarmouth, U Mass. Donald T. Fenton,Trustee,dated December 1926",which said plan is duly filed in the Barnstable County Registry of Deeds in Plan Book 20,Page 15. Said conveyance is made subject to and together with all rights, easements, restrictions and covenants of record, in so far as the same remain in force and applicable. This transfer does not constitute all or substantially all of the assets owned by the corporation in the Commonwealth of Massachusetts. FOR TITLE,see Deed recorded in Book 35891 Page 89. MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 08-03-2023 @ 10:23am Date: 08-03-2023 8 10:23am ct1#: 138 Doc#: 30833 Ctl#: 138 Doc#: 30833 Fee: $1,026.00 Cons: $300,000.00 Fee: $918.00 Cons: $300,000.00 >Outdoor and Indoor Signs """>Banners [(IL/ >Stickers 74 >Full Wrap >Yard Signs >T-shirts >Hats 1 visualsignscapecod 1)gmail.com Q;781-964-9216 774-327-4337 • Bk 35921 Pg217 430833 NOT NOT AN AN OFFICIAL OFFICIAL COPY COPY WITNESS my hand artd gBallthis{ Zt'' day of August,2429 T AN AN OFFICIAL Ala Marty 1061 p4r Min COPY C O P Y Juan Mcial,Presid nt& Treasurer COMMONWEALTH OF MASSACHUSETTS Barnstable County, ss: On this A day of August, 2023, before me, the undersigned notary public, personally appeared Juan Marichal,President&Treasurer,ALJ Realty Corjoratio ,proved to me through satisfactory evidence of identification, which was a1 to be the person whose name is signed on the preceding document, and acknowledged to me that he signed it voluntarily for its stated purpose as ' - '• -asurer o LJ Corporation. C1111.15FOPSER I.MI MS N6duy Public Cominv_awa lth of Massachuscus a _��w My Goantissioa Expires No • r ' .`'ram" %' sr t,zoa4 r y Co • is 'on Expires: a'y JOHN F. MEADE, REGISTER BARNSTABLE COUNTY REGISTRY OF DEEDS RECEIVED & RECORDED ELECTRONICALLY