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Home My WebLink AboutBLD-23-003491 �i•1'q4- Office Use Only permit# O C a j� /J ,t4 mArii. PI '� Amount [1 f G{ ` d Permit expires 180 days from issue date bc,4 z.3 003lice EXPRESS BUILDING PERMIT APPLICATM)N TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 DEC 2 7 2022 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 II ) �,� ,J/ f � l�� BUILDING DEPARTMENT CONSTRUCTION ADDRESS: O`02 idA/i—� c' "r 1 ' - By: — ASSESSOR'S INFORMATION: Map: q? Parcel: /3 j Z Dp — 3&. 9_- 02 gj II OWNER:ad UUktes4'' Po1•k iLlt. Oir) w414-1. )"'t IN S V64...4k T0k-)(y-04ZS by NAME/ PRESENT ADDRESS (�/ TEL. # U��I & ® 'j CONTRACTOR: • , NARD6A �j 9• Lc A to,. tt ir`/ NAME MAILING ADDRESS TEL.# ❑Residential %Commercial Est.Cost of Construction$ /rderj l Home Improvement Contractor Lic.# /35-'r7 7 Construction Supervisor Lic.# ei,s/9 '' Workman's Compensation Insurance: (check one) ❑ I am the homeowner//�� 0 I am the sole proprietor 4 I have Worker's Compensation Insurance Insurance Company Name: /r/i•7 /7f6//1 r/ Worker's Comp.PolicylN� 5bg 1u3�� a7 * WORK TO BE PERFORMED /, G2/e,e 0 6 Tent Duration (Fire Retardant Certificate attached?) Wood Stove n Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares (n)Remove existing*(max.2 layers) Insulation L I -1 Old Kings Highway/Historic Dist. ()Replacing like for like Pool fencing *The debris will be disposed of at: Xirs/fe�';% rn�p Location of Facility I declare under penalties of perjury that the st ments 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 y license and fo prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: / r2•r ,c, Date: Ci Owners Signature(or attachmen /� �� ,/ Date: /7''" '1 / "` Approved By: �� — .� Building Off... (or• signee) EMAIL AD S: Date. Zoning District: Historical District: :- Yes ' No Flood Plain Zone: Yes r No Water Resource Protection District: Within 100 ft.of Wetlands: Yes 1 No r. Yes No di. The Commonwealth of Massachusetts hi 11, • Department of Industrial.Accidents 1 I Congress Street,Suite 100 er t Boston,MA 02114-2017 .4..-:''''''' www?nassgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers, TO BE FILED WITH TEE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Alt7 Address: 029 9 v/<°}irie, --A-A • City/State/Zip: 8 //,{Y v14 444_ (3ek`/ Phone#: ` .-77/ e:i; -7 / Are you an employer? Cheek the appropriate box: Type of project(required): i.pfI am a employer with / employees(full and/or part-time).* 2.-1 am a sole proprietor or partnership and have no employees working for me in 8.. ❑Remw construction any capacity.[No workers'comp.insurance required.) Remodeling 3.E I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9 .IuDemolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees, 11.E0 1•t��Electrical repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet l2.1_f Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.t 13. Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL e. 14• Other 152,§1(4),and we have no employees.[No workers'comp.insurance required,] • *Any applicant that checle 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 jab site information. Insurance Company Name: 4J/�j "or it ii— r Policy#or Sel.-ins.Lic.#: 4-eve- 51,64-203 W2 --....o.-ii,4 Expiration Date: 3- JZ-23 Job Site Address: 497 1 Mi W9-T4 Attach a copy of the workers' compensation policy declaration page(showing the policy number expirationdate). 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 p�' s and penalties of perjury that the information provided above is true and correct. Signature: Mdil Date: /Z;2/a2 2 Phone#: tO g-r' 77/ —ffs' 27 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#: 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: `(I?E LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 1,35887— H.08/14/2024 Boston, MA 02118 Al J NARDONE CARPENTRY LLC. AICHAEL J.NARDONE-, ''99 WHITES PATH Ai( SOUTH YARMOUTH, MA 02664 ' Undersecretary 6 of valid without signature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Const tAi isor CS-081139 ; Ettpires:09/16/2023 MICHAEL J NARDONE 299 WHITES PATH ,.; SOUTH YARMOUTH MA 02664 Commissioner da k�a Bk 35557 Pg135 #62761 12-22-2022 @ 12 : 53p NOT NOT AN AN OFFICIAL OFFICIAL COPY COPY NO 2QUITCLAIM D LIB AN ��,,__ AN KNOW ALL M) 1 IF3l,TtliP W ENTS that DN OFFICIAL Ni'OR'1', as 'Trustee of the DAVENPORT R1E�ALT RUST, u/d/t dated June Y), 19)6, recorded in the I3arnstahle oCounty Registry of Deeds in Book 945, Page 7, as amended and restated by Amended and First Restated Declaration of Trust of Davenport Realty Trust dated June 18, 2013 and recorded in the Barnstable County Registry of Deeds in Book 27475 Page 35, having a mailing address of 20 North Main Street, South Yarmouth, Massachusetts 02664, z for consideration paid and in full consideration of Seven I lundred Fifty Thousand and 00/100 Dollars($750,000.00), o grant to 22 Whites Path, LLC, a Massachusetts limited liability company with an address of 22 Whites Path, South Yarmouth, MA 02664 with OWTCLAIMCOJEM.p'TS a+ The land in Yarmouth (South), Barnstable County, Massachusetts,together with any buildings and improvements thereon, bounded and described as follows: NORTHEASTERLY by Lot 4,as shown on hereinafter-mentioned plan, two hundred thirty-one and 16/100 (231.16) feet; SOUTHEASTERLY by White's Path, as shown on said plan,one hundred twenty-five (125.00) feet: SOUTHWESTERLY by Lot 2 as shown on said plan,one hundred eighty-nine and 69/100(189.69) feet; and NORTHWESTERLY by Mid-Cape Highway—Union Street Interchange as shown on said plan, one hundred thirty-one and 70/100 (131.70) feet. Containing 26,303 square feet, more or less,and being shown as LOT 3 on plan entitled "Subdivision Plan of Land in South Yarmouth, Mass. for P. W. McAbee et al, Scale 1"=40' March 16, 1972, Barnstable Survey Consultants, Inc., West Yarmouth, Mass."duly recorded with Barnstable County Registry of Deeds in Plan Book 256,Page 85. MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 12-22-2022 @ 12:53pm Date: 12-22-2022 @ 12:53pm Ctl#: 335 Doc#: 62761 Ctl#: 335 Doc#: 62761 Fee: $2,565.00 Cons: $750,000.00 Fee: $2,295.00 Cons: $750,000.00 Bk 35557 Pg136 #62761 NOT NOT The grantor hereby certilieila;Wollows: AN OFFICIAL OFFICIAL COPY COPY 1. I am one of the Trustees of the Davenport Realty 'Trust, a/d/t dated June 9. 1956; N 0 T NOT 2. Said trust has not bdt,:nJ ltered or amended other Ihaiilasl&ct forth herein. Said trust has not been roolrectaantl icstill in MI force andieffecR; ICIAL COPY COPY 3. All of the beneficiaries of the Davenport Realty Trust, u✓d/t dated June 9, 1956 are of lull age and legal capacity and none of the beneficiaries is a corporation; 4. 1, as Trustee, acting singly, have been directed by said beneficiaries to transfer the property at 22 White's Path, South Yarmouth, MA 02664 for$750,000.00, the consideration recited in this deed. I, DeWitt P. Davenport,Trustee of the Davenport Realty Trust, u/d/t dated June 9, 1956; the Grantor 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. Being the same premises conveyed to Grantor by deed dated March 1, 1976 and recorded in the Barnstable County Registry of Deeds in Book 2305, Page 185. 2 Bk 35557 Pg137 #62761 N O T N 0 T A Executed as a, .nl f,�d 'nsu Nen o ti}r's thc� I6 tti Va A N • F 8 w, rl l rilLCZ(Ii2'A L COPY Davenport I.caRy N 0 T N O T A N A OFFICIAL F 'FI I A L COPY 13y: )cWitl t nrt. Trustee STATE OF FLORIDA f County of__/ _ Q, T`T/t/ March , 2022 Before me, the undersigned notary public, personally appeared DeWitt P. Davenport, Trustee of Davenport Realty Trust, and proved to me through satisfactory evidence of identification, being (check whichever applies): ' i driver's license or other stale or federal governmental document bearing a photograph image, o oath or affirmation pf a credible witness known to me who knows the above signatory, or o my oWH 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 of his own free act and deed and the free act and deed of the Davenport Realty Trust. Notary Public state ot nava SEAL Joshua Bien cry Public- my commute('NH 024624 11, 4 ExgRs 09t2TY2024 My commission expires: I 2 7 2c>. � JOHN F. MEADE, REGISTER BARNSTABLE COUNTY REGISTRY OF DEEDS RECEIVED & RECORDED ELECTRONICALLLI