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Home My WebLink AboutBLD-23-000737 ''O1.Y`4R n /�a 1 „/ �//Z Office Use Only e G,(�t/f e (/L f� ,' J. ! 0 it 2, Pennit# C%` ita2.43 0 ,1,,� LIV,C10 µ '� - '� �-'Amount MATTAcn LU ,j 'r`....10�.a 6t� !Permit expires 180 days from Q��j issue date 46 — 3—D®d'737 EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH RECEIVED Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 AUG 12 2022 (508) 398-2231 Ext. 1261 ___ BUILDING DEPARTMENT CONSTRUCTION ADDRESS: f R� �1�71J[� By: ASSESSOR'S INFORMATION: =�� Map: 6143 ,-1 Parcel: p r� "OWNER: e3 `1 J Ai 6"v * twat L yd vn CP S�Z NAME PRESENT ADDRE TEL. # CONTRACTOR: [0/7- 7 sS- 3o/.3 y NAME MAILING ADDRESS /TEL.# I4idential ❑Commercial Est.Cost of Construction$ I '0(000 Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workmanf Compensation Insurance: (check one) Lilt am the homeowner ❑ 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]o . ( )Remove existing* (max.2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing /The debris will be disposed of at: 1 8:A) iti/ (y%,--dti 1)w. 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 .rosecution under M.G.L.Ch.268,Section 1. pplicant's Signature: Id. O �wuers Signature(or attachment . Date: / ' ' /? -P" Approved By: Date: U'')h' Building 0-icial(or designee) EMAIL ADDRESS: 61_) 'S 04 (21-amitd L4 Co r.— Zoning District: Historical District: 0 Yes ❑ No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: ❑ Yes ❑ No 0 Yes D No The Commonwealth of Massachusetts A,. Department of Industrial Accidents 1 Congress Street, Suite 100 4 Boston, MA 02114-2017 ,., 5's„ www.mass.z-,uov/dia MP \Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly ame (Business/Organization/Individual): --60.. .0,.."J /N -1 ?SC,J Address: 33 C j A) � ?_ j City/State/Zip: S 0.)(L vC Phone #: 0 I -' ` 7— (¢ (a 7 Y 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.Ell I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling y capacity. [No workers'comp.insurance required.] 9. _ Demolition 3. I am a homeowner doing all work myself. [No workers'comp. insurance required.]t i — 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.❑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.E We are a corporation and its officers have exercised their right of exemption per MGL c. 14.E 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 cop • his statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verific. 'on. I do her-.y certi% under he pains And penalties of perjury that the information provided abo e is tr e'and correct. /io.nature: I AMA& 1 Date: .9--4")---'_ 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#: Clarke, Kristin From: Nancy Alexson <nancy.alexson1227@gmail.com> Sent: Friday, August 12, 2022 10:12 AM To: Clarke, Kristin; Brian Alexson Subject: 33 Captain Daniel Rd. Attachments: Michael Brady death cert and authority.pdf Attention!:This email originates outside of the organization. Do not open attachments or click links unless you are sure this email is from a known sender and you know the content is safe. Call the sender to verify if unsure. Otherwise delete this email. Hi Kristen, Attached is the death certificate and letter of personal representative for me.We inherited the house via the will. Please let me know if you need a copy of that. It is our primary residence. Please call me if you have any questions. Thank you. Nancy Alexson 617-755-3093 1 Docket No. Commonwealth of Massachusetts LETTERS OF AUTHORITY FOR The Trial Court PERSONAL REPRESENTATIVE BA22P0446EA Probate and Family Court Barnstable Probate and Family Court Estate of: 3195 Main Street Michael John Brady PO Box 346 Barnstable, MA 02630 (508)375-6710 Date of Death: 01/20/2022 To: Nancy Alexson 89 Country Club Road Dedham,MA 02026 You have been appointed and qualified as Personal Representative in ❑ Supervised CK Unsupervised administration of this estate on Apr:./ Z 9) 2.o Z...� (date) These letters are proof of your authority to act pursuant to G. L. c. 190B, except for the following restrictions if any: ❑ Pursuant to G. L. c. 190B, §3-108(4),the Personal Representative shall have no right to possess estate assets as provided in§ 3-709 beyond that necessary to confirm title thereto in the successors to the estate and claims, other than expenses of administration, if any, shall not be paid. ❑ The Personal Representative was appointed before March 31, 2012 as Executor or Administrator of the estate. (Do Not Write Below This Line-For Court Use Only) CERTIFICATION I certify that it appears by the records of this Court that said appointment remains.in full force and effect. IN TESTIMONY WHEREOF I have hereunto set my hand and affixed the seal of said Court. --- - y� Date/ / l � 2�t7 2. / - Anastasia'N Perrino, Register of Probate MPC 751 (4/15/16) _ - � 41 ```