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EXPRESS SHED PERMIT APPLICATION
TOWN YARMOUTH
Yarmouth Building Department
• 1146 Route28 RECEIVED
South Yarmouth., MA 02664
15081,398-2231 Ext. 1261 AUG 02 2022
CONSTRICTIO ADDRESS: d'`G�K/tk} e.I e- 1mvi ...__ —
' BUILDING UtY'ARTM`ENT
flo\,...vis0st 3 tv, � d +' By: 1. "`
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A,Nif' SWUNG ADDRESS I, t tt
cptd:not i - C`trmrmmet-t tal II sr tCos;off.ansttuctstrn p f
Dome Improvement Contractor Lie.# Construction Supervisor Lie.t
Vt orkrn, 's Coln-swoon imuraneet ishte one/
i I am the hom etsat rter I am the sole oroprteroi I hose Worker's Compere town Insurasnc
Instrrarts.c Comp4t;t Name: ___V� �. St orker`s Comp trait ce
SHED NFORM TION
New 11 Size L. ) „ ‘Vii I % , 1 t 1,. Corner Lot: Yes..., No
Pet lets or cot arrr:loath/xrt rr i-Lute, r r t .i ,Nith- 1
€, EOtra € irk ;, ssid mnla,dr -'r
9,07-42
Replace existing' Size I t W s tf e�H "'9 I
I€tiehto.saltIledlyt edof al. n ' Lorain*nfkwtii t yei z /itibef., ._. .._�_ //21 /'.:0-
I dcctarc tinder penalties;sink:n m that the statements heron contoured are erne and ammo to the hest rt#mz Idiom ledge and locket I onsierstarott that aMM Wm motems r
toll tre too ranee for dental to res atmctn of m}Mt fro mom.turn undo M G I r.:h roll Seaton I
pplieSe s 4tIna€tor hate
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tl!rtc. � J .-gate
—1--22
Bwidol ofriow tsmrdent t EMAIL ADDRESS
I Zoning District_.
Historical Mundt t Y S NO flood Flamm Lose Yes No 1
Water Rd-source Protection Ds+tri t Within DPI ft of Uctlands ***
Yes No Yes 'atm
***±+ilia Con 'anon res seat mowed d istilttn SO it of Wetlands
1 .
311
1
voidaism
"o. The C.'o n wealth of illaassut h usetts
.. Department of Industrial Accidents
I Congress Street, Suite 100
. *owBoston, MA 11 201
ww.masslovidia
Workers' Compensation Insurance Affidavit: Builders/ContractorslElectriciansgPlumbers.
TO BE FILED WTTht TTBE PERMITTING AC v°,
Applicant information Please Print Intibly
Nam e Busines Or lowindivid d +,1 11.6_ '[s.ur 1II
/ Address: Kt W e. , five PeipAr'
City/State/Zip:: P ne 41 6163e-itior Art 1 '
you as employee!Caeca the appropriate 3aA pats box:
Type of project(required):
0 arn a employer adet employees that me part-drnel 7. New construction
? t errs a tote Apr or ershsp a ha
ve err kkae or°l,°ar for merz S. 0 Remodeling
New
workers'imp.>raeunnce re aced
3 .- ;ass a hor awes -.fe all work m tf No Viers'camp msuurame marred
9. Demolition
11"3 AM a per atr t diOt tunng conennalors to cane=all work ors thy oroporty well E 0 ttiiditt addition
ensure. aia contrathors either have workers'zomOtnnshnt tteunince ora:e c e l 1.Ej Electrical repairs or additions
preen-earswail rtC amployees.
12.0 Plumbing repairs or additions
5 a-These-l sum e mutat connionat and t have he sub-oonts Tors:tined or tax etteoned shod
sub-es is have l a 1 Other rs
p s e t 13 Roof repairs
6 0 We am*corporator)one is officers have exercised theo nine of cameo=Per s+# c '
2,ls(4),and we have no employeestrNoworkers'
*Any applicant that checks costal MI=also fill our the sector below showing taus riee e°r,omgers pokey Infonnation r Homeowners who subout des*davit intimemst theyart doing an work and fir:furs=obi teener=muts s bnxtt a new of day at mthoems such
1,Corresetrirs that check this lox mast ansteriedare addtt crat steal StIOWEng the name of the sub-cerrsea rs and nate whether or not those er bes base
employers If the rs have employees,trey mast pro'aide.heir .4 ws'comp poi number
1 am an employer that is providing workers'compensation truurance for my employees. Below is the policy job site
information_
Insurance Company Name:
Policy a or Self-ins Lic Expiration Date:
;on Site Address; -_ CityiStateZip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MCI c 152, §25A is a criminal violation punishable Oyu a fine up to$LSOO, 0
and or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250 00 a
day against the violator, A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurar, e
coverage verification.
Ala
I do hereby cad- .n<;tlr. ; irrs <> d p 1 ` of perjury that the rnf ormat on provided above is true and correct
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Phone : 403 q V
Official use only. Do not write in this area,to be completed by city or town official
City or Town: PermitfLicense
tIssuing Authority(circle one):
I. Board of Health 2, Building Department 3.City/Town Clerk 4.Electrical Inspector 5, Plumbing Inspector
Other
t. Contact Persons Phone;s
N
Fun PLAN
FOR LO 0 *
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Name atrr's
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Lot 0 41,Nil
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RECEIV 4, TOWN OF YARMOUTH
7-,
Z. 1..-: 63uTh YARt100•tel MA 026636 2,4A
.JUL 2 9 202 ' Te:epr'vpe t508,398-223, Ext 7292-cap ,508i 39r:
l'ARMOU'i I-1
OLD WAPP KING
'S HIGHWAY HISTORIC DISTRICT COMMITTEE
KING'S HIGH
APPLICATION FOR
CERTIFICATE OF EXEMPTION
Application ,s hereoy mace tor vie issuance ol a Ge,10,cate ot Exemption under SectIcns 6 and 7 or Cnapter 47Q o,
Acts of '973 as amended for t'e vaposed wo-l‘ as described below and on plans.drawings or photographs
accompanying this application. ,
Type or mint taaibbr .
1.....-,
A Ti,ons .3'sr,a3se3 feoir 1,.> C ;-\C,141 '-L..;I.) 1 1 b ri t-€ Mar LW
,:ttwx:L. ek. .... 1‘- , s".---,'1, p,,,, LAC 3 •
All applications must 00 submitted b ,s
y wry or eccornpeniee by letter from ,new approving submittal ol application
,
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kia t r,g lkodtess ,;,.. 5-9 64,(,..'. .,14...1 1)-nebe /(e) ig,-.6..../,‘,17 ftliat
_1_ ...) 7,', ' t kit 11"1.,(.44:7 P.4.4-.t-. 3-777,7 7 ,,001 r et'IVI Pro,* Er
Descrlottort of Pr000sed Work(Additional omits maw be_abatbsctif nacassirvi
Shed installation - 10x12 Quivett Cape- Pine Harbor.
Gable end facing street-window on left, single door on right, clapboard house color
Side facing West toward house - 2 windows,clapboard painted hoiuse color
Roof-asphart shingles to match house roof
East and South sides-board and batten-natural;
Existing paving stones in area under shed wi l‘e removed
Si,;,ied Cissna,v apt-1, oati, 7101.111 -
,
[ hvne,c 0,4,30-,ner„t,:await•ra•3 pie-e•T s.te re41,0•ea 1 cry,re ,....air.);Jepartreerti ‘t:teco c•ne,6004111,7Wet Me
••• 'r s reati-:ata s eczi',I.v...e.Ire a ",vr 3C0-).117!aZe c r.te-4We t.t ric,iai-o- _t 1‘.0‘risi;se m4 dale
for Committee use onfx
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TAOLDPKYPARGRMS°
JUL 2 9 2022
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°HUIGTVPHIWAY
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- APPLiCATOs a 2.) E01_01
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Doc: 1, 464 ,099 07-26-2022 2 39
Ctf#:230621
(Space above Chit line reserved for Registry ofDeeds use)
QUITCLAIM DEED
I, Mark A. Spetelunas, an unmarried man, individually, of 1 i Taylor Road,Buzzards
Bay. Barnstable County. Massachusetts, for consideration in the amount of EIGHT
HUNDRED FORTY-ONE THOUSAND and 00400 (S841,000. 1) DOLLARS, do hereby
grant to John and Suzanne Paulson, husband and wife as tenants by the entirety, of 53
Cromwell Drive,Yarmouth Port,MA 02675,
WITH QUITCLAIM COVENANTS
The land with the buildings thereon located in Yarmouth, Barnstable County,Massachusetts,
bounded and described as follows:
8
LOT 54
As shown on Plan 35454-A(Sheet 2)dated July 1970,drawn by Barnstable Survey
Consultants, Inc.,Surveyors,as modified and approved by the Court,and filed in the Land
,,. Registration Office at Boston,a copy of a portion of which is filed in Barnstable County
Registry of Deeds in Land Registration Book 452,Page 82 with Certificate of Title No.
56402.
c.y Said land is subject to an a Mni set limb m a t gran by Peter G. Shaffer et ux to the04-1 .
Town of Yarmouth dated April 16, 1968 duly recorded in Book 1399, Page 647.
Said land is subject to an easement set forth in a grant made by Peter G. Shaffer et ux to
Cape&Vineyard Electric Company dated June 28, 1968,recorded in Book 1407, Page 490.
There is appurtenant to said land a right of way over the ways as shown on said plan,in
common with€thhers who are now or may hereafter be entitled thereto.
Said land is subject to a perpetual right and easement in said roads,shown on said roads,
shown ern said plan,and as set forth in a grant made by Peter G.Shaefflo et ux to John Tracy
Wiggin recorded in Book 1501,Page 806.
asaAcim s!rTI IMAM CZCISE TAX aausrasza coon+ rL ISM TAX
AAaxa°ra<r c LAUD Cover anaztrim BARSITAati XAaD atmrt azaz errer
Data; 07-28- 022 e 02s39pm Mkt* 07-26-2022 t 02: 4pw
Ct.1*: 526
e off: 6116