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Home My WebLink AboutBLD-22-007503 #6 CB �, C/a t it to I j✓ice f2(14 0.1 p)L d acp A Office Use Only pfo' RD l�V` I !!! O }Permit# �j o `1H RECEIVED ,Amount /OMATZ "�'^^- ^'�—"'^ 1�, o 1 Permit expires 180 days from JUN N 29 2022 ;issue date B ILD ' l� C6 7:�13 EXPRES S U INq M PPLI f ATION TOWN O ' YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: /v' ` (A C k Ts lad o c c1 LV r C. k \f r a i MA 02673 ASSESSOR'S INFORMATION: Map: Parcel: yy OWNER: .1.:�w •_1±00 çc1&icQ_ d1Jnn `, / 773 --if/6 TAME RESENT ADDRESS TEL. # CONTRACTOR: NAME MAILING ADDRESS TEL.# CI-sidential 0 Commercial Est.Cost of Construction$ TQ 0 Home Improvement Contractor Lic.# Construction Supervisor Lie.# Workman's Compensation Insurance: (check one) ❑ I am the homeowner 0 I am the sole proprietor ❑ 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 Replacement windows: # Replacement doors: # 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: 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 lice d for cutionunder M.G.L.Ch.268,Section 1. �/ Applicant's Signature: /i f Date: ),-I - .,--.0, :)_ Owners Signature(or attachment) Date: Approved By: Date: .2/..... ma Ici (or designee) EMAIL ADDRESS: Zoning District: Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No Water Resource Protection District: Within 100 ft.of Wetlands: ❑ Yes ❑ No ❑ Yes ❑ No -,11\n() : Lopz-s--Q_ �-,1 00 1,^ The Commonwealth of Massachusetts Department oflndustrialAccidents =I/11= 1 Congress Street, Suite 100 =lir Boston, MA 02114-2017 5 www.mass aov/dia IMP Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: • City/State/Zip: 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.E I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity. [No workers'comp. insurance required.] 9. ❑ Demolition 3. a homeowner doing all work myself. [No workers'comp. insurance required.]t 10 7 Building addition 4.0I 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 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp. insurance.1 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 certify under the pains and penalties of perjury that the information provided above is true'and correct. %gnature: Date: — Phone#: 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#: BUCK ISLAND VILLAGE CONDOMINIUM UNIT DEED I, Constance M. Baldman, of West Yarmouth,Barnstable County, Massachusetts, 02673, for consideration paid of One Dollar ($1.00), hereby convey to Anthony A. Baldman, of 3022 Larkin Place, San Diego, California, 92123, with Quitclaim Covenants: Unit 6CB in the condominium known as "Buck Island Village Condominium", which condominium is located in West Yarmouth, Barnstable County, Massachusetts. The Unit is conveyed along with a 1.6277 percent undivided interest in the Common Elements appurtenant thereto, subject, however, to the exercise by the Sponsor of the Expansion Rights and a recomputation thereof according to the calculation formula. A copy of the Floor Plans are filed with the Barnstable County Registry of Deeds Book 3116, Page 171, and also filed with the amended and restated Master Deed in Plan Book 335, Pages 1 through 8, of the Barnstable County Registry of Deeds, which depicts the Unit being conveyed hereby. Such copy contains the verified statement of a registered professional land surveyor, as required by the Condominium Statute, that such copy shows the designation of such Unit and of the immediately adjoining Units and fully and accurately depicts the layout of the Unit, its location, dimensions, approximate area, main entrance and immediate common area to which it has access, as built. The Floor Plan referred to herein is contained on a plan captioned "Buck Island Village Condominium," which plan was prepared by Frank M. Russell, Registered Professional Engineer, and is recorded in the Barnstable County Registry of Deeds, in said Pi an Book 335, Page 2. Reference is made to the Master Deed filed by the Sponsor on November 29, 1977, and recorded in Book 2624, Page 101, of the Barnstable County Registry of Deeds as amended and restated by an instrument recorded in Book 2949,Page 328, of said Deeds. Terms defined in or by reference in the Master Deed which are not otherwise defined herein shall have the same meanings herein as therein. The Condominium is located on the Land, as described in the Master Deed, and has a post office address of Buck Island Road, West Yarmouth, Massachusetts, 02673. The Unit may be used for residential purposes only,as described in Article V of the Master Deed. The Unit is further conveyed subject to and with the benefit of the following: (a) The terms and provisions of the Condominium Documents. (b) The Title Conditions, all as described in Exhibit IA to the Master Deed. (c) Taxes for the current fiscal year which are assessed but not yet due and payable. (d) The terms and provisions of the Condominium Statute (M.G.L., Ch. 183A). (e) Such other easements in, on, over or in respect of the Land which may be granted by y ;3 the Board pursuant to the By-Laws. Po IH!of 1 Gm o dco m ainU�o Property address: 6CB Buck Island Village Condominium, West Yarmouth, Massachusetts, 02673. For title see deed dated June 13th 1980 and recorded in the Barnstable County Registry of Deeds Book 3116, Page 168. For death certificate of Constantine A. Baldman see Book 3116,Page 168 recorded in said deeds. The Grantor, Constance M. Baldman, hereby retains a life estate in the above described premises. Witness my hand and seal this 12th day of July, 2021. 0(AA � r \i\\ onstance M. Baldman COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. July 12, 2021 NOW BEFORE ME, personally appeared the above-named Constance M. Baldman, who proved to me though satisfactory evidence of identification, which is a valid Massachusetts driver's license, and who acknowledged the foregoing quitclaim deed to be her free and voluntary 4:91/ 0‘ MICHAEL L. LAVENDER ( Michael L. Lavender NotaryPublic Notary Public COMMONWEALTH OFMASSACHUSETtS, My Commission Expires: My Commission Expires / Au ust 17, 2023 2