HomeMy WebLinkAboutBLD-23-002212 .Yam
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�,Oiioc RECEIVED Office Use Only
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�� U D P � Permit# VIA-'TrG-�—!✓
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r� MATTACM ESEi$ i OCT 19 ;221 Amount 6`-C.J
' RT NT Permit expires 180 days from •
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issue date
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EXPRESS SHED PERMIT APPLICATION
TOWN OF YARMOUTH Clotf ZZ I 1,0
Yarmouth Building Department
1146 Route 28 41 SAD
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South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261 /
CONSTRUCTION ADDRESS: 5-1 (3 ( FA-rC.A go S • +'(f72MOcir4A,U 44l.4 07675 V
OWNER: Pt?tn kilt r i ILA S( 241 rAveM F10 c. (61-4 uatdtr-e-10/1 r; ;OA 6 267 s
NAME PRESENT ADDRESS TEL. #
CONTRACTOR:
NAME MAILING ADDRESS TEL.#
Residential Commercial Est.Cost of Construction$ 5UGG ✓
El 0
Home Improvement Contractor Lic.# Construction Supervisor Lic.#
Workman's Compensation Insurance: (check one)
I am the homeowner I am the sole proprietor I have Worker's Compensation Insurance 0
Insurance Company Name: Worker's Comp.Policy#
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SHED INFORMATION
New Size L �L x W f�i x H � Corner Lot: Yes No � ��
Per Town of Yarmouth Zoning By-Law Sec 203.5 Note E:
Side and rear yard setbacks for accessory buildings containing one hundred fifty(150)square. , 'i ess and single story,
shall be six (6)feet in all districts, but in no case shall said accessory buildings he built closer than twelve (12)feet to any
other building on an adjacent parcel. All sheds are required to be located thirty(30)feet from anyJi•ont lot line
O 0-1 pr6V
Replace existing* Size L x W x H i� 11 za
/
*The debris will be disposed of at.
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 I.
Applicant's Signature: Date: t'd (i(ZZ-
IOwners Signature(or attachment) Date:
Approved By: Date:
Building Official des e) EMAIL ADD
Zoning District:
• Historical District: Yes No Flood Plain Zone: Yes No
Water Resource Protection District: Within 100 ft.of Wetlands:***
Yes No Yes No
***Note:Conservation review required if within 100 ft.of Wetlands ,77
The Commonwealth of Massachusetts
=i = /, Department of Industrial Accidents
_ = 1 Congress Street, Suite 100
.%ME _ 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 Lezibly
t..' Name (Business/Organization/Individual): P 71iz AAA i T( LA
✓Address: S I (3i.4-( FmAA 40. 5
V City/State/Zip: V.,‘2'v1c 'rtz'P 'z AAA 02c'Tc Phone #: Co ( 7•- lc,`(S - 5 3(Z
Are you an employer?Check the appropriate box: Type of project(required):
1.E I am a employer with employees(full and/or part-time).* 7. New construction
2.E I am a sole proprietor or partnership and have no employees working for me in 8. E Remodeling
any capacity. [No workers'comp. insurance required.]
9. E Demolition
3. I am a homeowner doing all work myself. [No workers'comp. insurance required.]
10 7 Building addition
4. ,1rn 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.E Plumbing repairs or additions
5.11 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.El Roof repairs
These sub-contractors have employees and have workers'comp. insurance.(
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. 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.
(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 hereby certi under the pains nd putties of perjury that the information provided above is true and correct.
Agnature: Date: Z all`(I aZ-
Phone#: 431 7 6 cl S 362
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
Phone#:
Contact Person:
•
PLOT PLAN
FOR LOT I
Indicate Additiaa with of garage
or �' building
Sewerage disposal (cesspool) ED
Well aig
I I
AbAbutter's
Name ! f Name
Lot# I
Lot#
If this is a REAR YARD Lad If this is a
corner lot, coer lot,
write in ff. write
rn in
name of street. 1, name of street.
_ f
• � `-�
I1
SIDE YARD y6,
HORSE SIDE YARD
•
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SET BACX
ft
(/at ft. frontage)
•
/ (NAME OF STREET)
In£nrTnatirr
Supplied by
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TOWN OF YARMOUTH
1146 ROUTE 28,SOUTH YARMOUTH,MA 02664-4451
1 ,:-7:E :. IV E:',4'44-ii.,-,:-,:•,,, Telephone(508)398-2231 Ext, 1292-Fax(508)398-0836
on 2 0 ?P`I.' C#LD KING'S HIGHWAY HISTORIC DISTRICT COMMITTee. .7"F: C -F- VED., . •-•
... ..
APPLICATION FOR t
I)KIN 'S ill 40N,0' I.
CERTIFICATE OF EXEMPTION OC 2 0 222
/--- h,1,-,1` f-P RT M ENT
Application is hereby made for the issuance of a Certificate of Exemption under Sections 6 and 7 of hMet_gave-- A
Acts of 1973, as amended, far the proposed work as described below and on plans, drawings,a photo! ; i.ii- ---------
accompanying this application.
Type.or print lerilbly:
Address of proposed work: 1.51 ORA1 F;t444 rzo 5:, `iri /ret P41/27 C.;'a,'cm /It# i 511
Owner(s): PC,TETZ iii-J0 j-cm-", mAT ric A Phone#. 01-6 4S--
'
All applications must be submitted by owner or accompanied by letter from owner approving submittal of application.
Mailing address: 5-1 tWAY rtezm iza s Yittzkicirdeun..,---AA-4 02{,elc Year built /182?
Email: PE:7-02 Ail 4 r rt LA 1 e 641A it-•Z"41 Preferred notification method• Phone 't Erna4
A9entiContracigr r ..s P/24 1 S tiED S Phone#', 5-6(31c18:1q cr)
Mailing Address _ Z 35 6-aavr:4A4-511:tiNi itZ0 .124.--:-&I Nit c /41 A . .
Email: 5,44_74;rr24,15 fl CDS 1,44--Q(2.0.44.04 sr, r4 L-7-- Preferred notification method: V Phone gmail
Description of Proposed Work(Additional panes may be attached if necessary):
COAJSraverio-f kkit,iNST'..tt if/0.3 6t.xi C i FC Ci-- A le 'x tzi ci,f4ocA) 5 HO?
13 Y 54t r St/A4'i 541(..12S OF 5. 004/31‘. WO) k.'t Lk.044 LE.T"ht L RIC
c Az-cif/T.1-r!c....,,i ,21Eesb./14-c 1-1(-?-ir A ,i--eht S.t-f CD S A °cirri dati) 1...1
17-ec u/4 I-I H PC c.vt Ft F ice-Fr e.)i-- CX"cx(driciAi PecLME.4,7"-.
COCA ro if,t-fr co t.:xstsrfric,.. HO.)Si:,
Signed(Owner Of agent): ,,,,"(-06 Date. i 6 I(fire
1> own.kwractoeagent is aware that a permit may be required from the Building Department(Check other departments,also.)
This certificate is good far one year from approval date or upon date of expiration of Budding Permit,whichever date shall be later.
..__—.
For Committee use only:
Date lti A))2.1 /Approved _Approved with changes
i ' *PrilOVE-7—
Amount
?a C4 Reason for denial. -
;
Cash/CK#:-
)1q
Date Signed: _ Signed :
APPLICATION#
v6.2c,I
Bk 35082 Pg80 #22091
MASSACHUSETTS STATE EXCISE TAX 04-28-2022 @ 02 : 26p
BARNSTABLE COUNTY REGISTRY OF DEEDS
Date: 04-28-2022 @ 02:26pm
Ctl#: 763 Doc#: 22Q21-Ai T N O T BARNSTABLE COUNTY EXCISE TAX
Fee: $2,479.50 Cons: $725,0uu
AN AN BARNSTABLE COUNTY REGISTRY OF DEEDS
OFFICIAL O F F I C I ADate: 04-28-2022 @ 02:26pm
CtLl#: 763 Doc#: 22091
COPY COPY Fee: $2,218.50 Cons: $725,000.00
NO QUITCLAIM DT EED
AN AN
KNOW ALL MEN IlYFTliEREIPItEkENTS that W ,I EiEft AI. eAf1PBELL and LAURIE
A. CAMPBELL n/k/a GOULET,being u tm2rrdedIof 51 Bray Farm Road South,
Yarmouth Port, MA 02675,
for consideration paid and in full consideration of Seven Hundred Twenty-Five Thousand and
00/100 Dollars($725,000.00),
O
grant to PETER R. MATTILA and JOAN T.MATTILA,husband and wife, as tenants by the
entirety,of 3 Pierce Avenue,Westford, MA 01886
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with QUITCLAIM COVENANTS
The following property and land in Yarmouth Port, Barnstable County, Massachusetts, bounded
and described as follows:
Lot 8 shown on a plan entitled"PLAN OF LAND IN YARMOUTH, MASSACHUSETTS FOR
FLENN HALEY, Scale 1"=40',May 7, 1986, R.J.O'HEARN, INC. SWAN RIVER PLAZA 35
`^ Route 134,Unit 2,POST OFFICE BOX 237, SOUTH DENNIS,MASS. 02660"duly recorded in
the Barnstable County Registry of Deeds in Plan Book 420 Page 79.
U
0 Parcel is subject to and has the benefit of those matters of record, including Common Driveway
Agreement recorded with said Deeds at Book 31312,Page 99.
We,Peter A.Campbell and Laurie A. Campbell n/k/a Laurie A.Goulet,the Grantors named herein
do hereby voluntarily release all our rights of Homestead as set forth in M.G.L. Chapter 188, if
any,and there are no other persons entitled to any such rights.
For title see deed recorded in the Barnstable County Registry of Deeds in Book 13778,Page 327
1
Bk 35082 Pg81 #22091
NOT NOT
AN N
SIGNED under thopi id nFa p n�ltivs Df perjury this I dIty I�f ``,/ , 2022.
COPY COPY
NOT NOT
AN
PA-710-
OFFICIAL Peter A. tarpplpelb I AL
COPY COPY
COMMONWEALTH OF MASSACHUSETTS
Barnstable,ss
On this 2c, day of ► I ,2022,before me,the undersigned notary public,
A.Cam bell andproved to me through satisfactoryevidence of
personally appeared Peterp g
identification,being(check whichever applies): river's license or other state or federal
governmental document bearing a photograph i age, o oath or affirmation of a credible witness
known to me who knows the above signatory,or o my own personal knowledge of the identity
of the signatory,to be the person whose name is signed above, and acknowledged to me that he
signed the foregoing instrument voluntarily for its stated purpose and who swore or affirmed to
me that the contents of this document are truthful and accurate to the best of his knowledge and
belief.
.ubs, 'b o,=nd .w•rn -for me
`t,`'`tµtluiuPt,f'�i I
. Notary Public
•S>;�A;
t3. My commission expires:
•
2er '
Bk 35082 Pg82 #22091
NOT SIGNED under the pains mkt penalties of perjury this m A dayT of H ) , 2022.
OFFICIAL OFFICIAL
COPY C O P
NOT Cam
AN Laurie A. Campbell n/k/a Laurie A. Goulet
OFFICIAL OFFICIAL
COPY COPY
COMMONWEALTH OF MASSACHUSETTS
Barnstable,e ss
On this 4" day of { 1 ,2022,before me,the undersigned notary public,
personally appeared Laurie .Campbell n/k/a Laurie A. Goulet and p ed to me through
satisfactory evidence of identification,being(check whichever applies): driver's license or
other state or federal governmental document bearing a photograph ima e, ❑ oath or affirmation
of a credible witness known to me who knows the above signatory,or❑ my own personal
knowledge of the identity of the signatory,to be the person whose name is signed above,and
acknowledged to me that she signed the foregoing instrument voluntarily for its stated purpose
and who swore or affirmed to me that the contents of this document are truthful and accurate to
the best of her knowledge and belief.
Sub , ibed El + swo I ere me
/Li/ /i . i '
4, 20a0 ":%
e 1y t: - otary Public—
SEAL ; 67,,j
�rri of ^ My commission expires: c `f"
3
•
JOHN F. MEADE, REGISTER
BARNSTABLE COUNTY REGISTRY OF DEEDS
RECEIVED & RECORDED ELECTRONICALLY