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Home My WebLink About0359 SEAPUIT ROAD 0 v; e, °o c ° ° °x ° ° ° o ° 0 ° 0 a ° o n ° n s „ ° R ° u ' ° ' R ° ° o , en a c° , ° 0 � r of ,� 0 n �I , I i ° ° o ° r ti r� p ° ° r " °� II e n , If If ap If IN 9 r a a ° r, ° ° V 0 pt, ° r. n ° r ° ° ° o °, ° o o, i o 0 o c ° r P ° 0 Engineering Dept. (3rd floor) Map (� S Parcel �� 9Peimit#' �3 73 House Date Jssued Board of Health(3rd floor)(8:15 -9:30/1:00- —ti 00 Fee 3 , (p Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) ,�, •a , - t, Definitive Plan Approved b Planning Board 1911��TALLED lid CC PP Y g �+a 1 �d1T� Y A�nL9 : BARNS'[pBLE. r TAIL C ... ,� °�s,� TOWN OF BARNS' . �y � y : Building Permit Application Project Street Address 359 Seapuit Road Village Osterville , Owner Mr. , Jack 'Fallon Address 359 Se'apuit Road , Ostervil'-e Telephone Permit Request 1 f A D D I T ION ; First Floor 504 square feet Second Floor square feet Construction Type Wood Residential. Estimated Project Cost $ 107 ,635 .00 Zoning District R F 1 Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 0 Two Family p Multi-Family(#units) Age of Existing Structure 56 years Historic House ❑Yes ®No On Old King's Highway ❑Yes ®No Basement Type: ®Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) X Number of Baths: Full: Existing 1 New 1 Half: Existing 1 New No.of Bedrooms: Existing 1 New 1 Total Room Count(not including baths): Existing New 4 First Floor Room Count Heat Type and Fuel: ❑Gas ®Oil ❑Electric p Other _ FHw Central Air ❑Yes ®No Fireplaces: Existing 1 New Existing wood/coal stove ❑Yes ®No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) p Other(size) Zoning Board of Appeals Authorization p Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Residential Proposed Use Residential — Handicap Accessible Builder Information Name E . J . Jaxtimer , Builder , Inc . Telephone Number 778-4911 Address 48 Rosary Lane Hyannis License# 003251 Home Improvement Contractor# 110 6 09 Worker's Compensation# W C 9 7—6 9 5 0 2 8 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO M ber ' s Dumpster SIGNATURE 5 DATE BUILDING PERMIT D FOR THE FOLLOWING REASON(S) --� r _ FOR OFFICIAL USE ONLY 4 - PERMIT NO. 3 �3Ir \ DATE ISSUED _ �C MAP/PARCEL NO. ? r- ADDRESS VILLAGE �. ` ' OWNER DATE OF`INSPECTION: . FOUNDATION FRAME t INSULATION FIREPLACE' t , ELECTRICAL:: ROUGH FINAL ' PLUMBING: ROUGH FINAL ,GAS: ROUGH FINAL . _ FINAL BUILDING , DATE CLOSED OUT _ ASSOCIATION PLAN NO. f• The Town of Barnstable 19 ,e�' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Com issione For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization. conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: ADDITION Est. Cost $107 ,000 .00 ` Address of Work: 359 Seapuit Road Osterville Mr . Jack Fallon Owner's Name 7/2/98 Date of Permit Application: I hereby certify that: iRegistration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the 7/2/98 E . J . Jaxtimer 110609 Date Contra t ame Registration No. OR Date Owner's Name 06!16/98 02:57 FAX @J 01 �.t1GlJ 1frC►fRA�i1 i wwa+v*+.ftdngm tech.ad Trw• pum"b ah obw Bomw via 1ema fta . 1KA>mMl1M '('xD QWdN cown aar,�c 1Lb ati+r�l�r' ta�4� 9131 N iip Q trs oso u 13 I! to i tia®U a e=!i a!z ao s 11 k to ! d/a" T f111 t1.76 sf fi !! tbA FCA �bavri . V 13% aA6 Yi 1t Yt T• i 11o1�a1 V ls% Oval >s is ?! H/A WA H ARZ v • 111i I L52 10 It Ty 10 f WAS A Im ox 31 19 Z5 NdYA WA . fi6n�t d42 m 1f 1 $ W,4 WA $ It 10 i "Arm AA ItIKMO }p w Is f1Q I. ADDRESS OF PROPERTY: 35541 mpu rr 0 STURV 1 LL.E . A/1 &Smg S. SQUARE FOOTAGE OF ALL Ec'xMUOJL WALL4: �(00S. . I SQUARE FOOTAGE OF ALL OLAZM: 4. %GL+ZIMG AR$A(N3 DWOED 8Y IIZ): �"� Z 'o S. SECT PACKAGE(Q�AA•sw am ebmy NaM: OTHER MORE INVOLVED METHODS OF I)E RMFMG ENFRGX REQUMENMNTS ARE AVAILABL L ASK US FOR THIS 1NFQLMATION. BU=INQ R4SFFr=R APPROVAL: Y'ES: l9fdf W s � i ' _I �; �s . . a�' i -�--- � �, P %' . , .:' / • � • ' � /, / I � I �� / /, /• � ' i / / i� ' ` l %. .) �� • . � ,/. .,. i � I ` � ��, ., . �i-� ,, • a� j � ;• :�� i ;;, . . i I r . �� iI •' ' ,�; . � �� , ' — -J ;� ,� ;: . � -�- r �� t� � �a, 'E-• it n;• f M r, a 'ice �KF i' ; .t � r ``'� C+J� � �y. _ ,F y. }, • k2 r�i Y •,, t F Yyt I •�� 1Fd � ,r• � .. ,� � , i4 �G>{��r.. 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NIN 7r�1•CtL4Y9 � `--------------- i, •7 0 7 a:' 6 x T.� MN►OiSCb9 / tau_ •n;islu�F+�iarr - -� wt.�= �o119^x»c`e o4•��{: '� `•pQ01 n r ,n vri�n�s'�►�M�l : • �---,-aQ�''?11'b zlxz 1 _i x", � Ul •I ''YTOI f1•C lS.{�f�KA i• „gb QL 3]ILL.GtY= A: 'hKdO4.X OfM� I I , MIS Yl -r_•ww��.r � ' , •7.O I��I'J 9X7r� �` I i -11 v"A", Mo•Irz, --- ------ �6� . r .x 1 '•.:E-Fes''•' is � °:t'`M .�•. i Q L4f zArIQ - � � g N .oQ 7� a r A nc f—t ll 70 glo Q O .� d ?Cfl Oc�INCt ---- r• _#—FC,nZ3�1E1C-tf�IT IME t Town of Barnstable �JEIOPMFhr Planning & Development Department �10 0�9 Barnstable Historical Commission BARNSTABLE, *' 200&367 Main Street, Hyannis, Massachusetts 02601 3 9�A 6 SS. Phone (508)862-4787 ro` 0�� rFp MpH p erin.loran@town.barnstable.ma.us OF BARt6 Commission Members Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Cheryl Powell Frances Parks Jack Kay April 1, 2021 Re: Notice of Intent to Demolish Structure & Relocate 359 Seapuit Road, Osterville, Map 095, Parcel 009/000 Ford & Ford Attorneys at Law C/o Jeff Ford 72 Main Street PO Box 485 West Harwich, MA 02671 Ann Quirk, Town Clerk 367 Main Street, Hyannis, MA 02601 Brian Florence, Building Commissioner 200 Main Street, Hyannis, MA 02601 Pursuant to the attached . decision, please be advised that the Barnstable Historical Commission will hold a public hearing on the full demolition of the single family dwelling structure, cottage structure, and detached garage structure, on April 20, 2021 at 3:00pm, and will be held by remote participation methods as a result of the COVID-19 state of emergency in the Commonwealth of Massachusetts. This public hearing will be advertised, notices sent to abutters and a notice form will be posted on the building or other visible site on the property. Please contact Erin Logan at 508.862.4787 or erin.logan@town.barnstable.ma.us for processing information. Sincerely, l Ira 'ci" C+�liJl.�, Nancy Clark, Chair Plannine&Develooment Deoartment-Elizabeth Jenkins.Director oFTr T Town of Barnstable �JE`aPMfNT Planning & Development Department Barnstable Historical Commission BARNSTABLE, 200 Main Street, Hyannis, Massachusetts 02601 5 9� 16 SS. �0 (508)862-4787 Fax(508)862-4784 iOtED 39. A erin.logan@town.barnstable.ma.us `Y^ofsaaNSSP Commission Members Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Cheryl Powell Frances Parks Jack Kay 1 APR'21 Pm12:26 BARNSTABLE TOWN CLERK Chapter 112 Historic Properties, Section 112-3 D. DETERMINATION of SIGNIFICANT BUILDING 359 Seapuit Road, Osterville, Map 095, Parcel 009/000 Pursuant to Intent to Demolish Structure The property located at 359 Seapuit Road, Osterville, Map 095, Parcel 009/000, is associated with the broad architectural and cultural history of this area. In accordance with Chapters 112-2 and 112-3 (D), the Barnstable Historical Commission Chair has determined that the single family dwelling structure, cottage structure, and detached garage structure are significant buildings. This determination applies only to the demolition described in the notice of intent submitted on March 11, 2021. Any future demolition shall require a new determination from the Barnstable Historical Commission. I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0109 Permit# $41 3 Health Division ` , ' i5� �Xf Date Issued FS Conservation Division J G Fee Tax Collecto "" lEP�`iC SYSTEM MUST BE - Treasurer �_�i_� INSTALLED IN COMPLIANCEWITH TITLE 5 ` Planning Dept. , ENVIRONMENTAL CODE AND TOWN REGULATION'S Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 359 Seapuit Road Village Os tervi l le Owner Mr . -Jack Fallon Address 359 Seapuit Road, Osterville Telephone 4 2 8-8 015 Permit Request 20 ' x 40 ' Inground Pool Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost $60,000 Zoning District RF-1 Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No • On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded 0 Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER.INFORMATION ' Name E. J. Jaxtimer, Builder, Inc. Telephone Number 778-4911 Address 48 Rosary Lane , Hyannis License# 003251 Home Improvement Contractor# 110609 Worker's Compensation-4 WC 9 7-6 9 5 0 2 8 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Macomber ' s Dumpster SIGNATURE DATE U� ti FOR OFFICIAL USE ONLY - PERMIT NO. A DATE ISSUED 46-- MAP/PARCEL-NO. • ,gig ' `_, _f - i ADDRESS 'k VILLAGE - OWNER ,, , r DATE OF INSPECTIOIe r FOUNDATION ` FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH.. s- FINAL 'PLUMBING: ROUGLJ4 ? FINALir ` GAS: ROUGIK FINAL � A kx :� FINAL BUILDING F t _ _ r_; nsr,, t , � r DATE CLOSED•OUT r t e ASSOCIATION PLAN NO. "r-!McHtl POOL-S TEL 5Ja-31-.6—��-79cp P. 74 lit In LJ tix x % lu, 7,1 gum LIA Q nv` th 6L lag LOT 13 at;8t' 1 30.33, c rr a 2'33'4.4- N ' � � s � 1 , N 1 ' r t ' T• �v ' LOT ss 2 ~� V O �� • 1 r 1 t t J�e� � , ;,. a_ Re loos v e 0 r1 { -NfeRV6 O a e Ot.sDER ecov.GttSR owEtLARD 1 w i qo t ENSR H tL i tot ;, I t to lte� ophr . o A11 1 N � `• .a .. 3 N 37'43'03- W J� 1 1D_Bo: ram. f y.,� ` A- cto of ?9 ' 1 � , MIN. s�:e •` / { i0B ZONE:. 1 / t sty 1 134C { 1 Sr! JtF-1 l �� gtistNEER TO VERtFy AT T1VIB Or- Arm (rt17N. �,560 SF f6i' �. , I �'�St/,PJtc jm%T L-LArt0% THE SLJrTAOtLT4 of Front (min) 20' tri CSTIA%ftt.t t.MA TNe Sots t 1 •t t 1Go a� W,dtA Thin) 125' Front 30' 1 tl1 ASSt`---0ORS R¢F. Side 15' i 1 f �1 ` / WlAP 95,rwRLS%-4 Rear 15' 1 + 1 1 4•S s 12' �ie r n 37'4 3'03' W 325.78' LOT fd PLAN VI EW Scale: I"=60' SITE PLAN PROPOSED SEPTIC SYSTEM aF UPGRADE PE$fi AT 359 SEAPUIT ROAD For property line Information please see H OSTERVILLE, NIA LCCS725-16 FOR The proposed addition Complies with the JOHN Si ANTOINETTE FALLON sideline and set back requirements for O SCALE: 111=60' DATE:JUNE 30,1998 the Town of Barnstable and Is not located SULLIVAN ENGINEERING INC. within the fioodplain. OSTERVILLE, MA SHEET Iof2 i of rnt:r� The Town of Barnstable mpuxsnknm MASS. � Department of. Health Safety and Environmental Services Grua" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790,-6227 Ralph Crossen Fax: Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME UN4PROVEN ENT CONTRACTOR LA'4V SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renrnation,repair, modernization,conversion, improvement, rcmo%al, demolition, or construction of an addition to arty pre-existing owner oc upied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: 20' x4O ' Inground Pool �.Cost $60,000. 00 Address of Work: 359 Seapuit Road, Osterville OwnerNamc: Mr. Jack Fallon Date of Permit Appl ication: 5/2 0/9 9 I herein•cer ifv that: Registration is not required for the.following reason(s): Work excluded by law Job under$1,000 Building not owner-occupied 01%mcr pulling own permit Nnlim is herehv givcn that- OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBFFRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owncr: 5/20/99 E.J. Jaxtimer 110609 Date Contractor name Registration No. vrc Date Owncr's name r Town of Barnstable r�,� - F 1►+e IpjY "o Regulatory Services Thomas F. Geiler,Director �axsrABM MASS. Building Division ��Eo►�`� Tom Perry,Building Commissioner 200 Main Street, Hyannis,M.A.02601 www,town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623( 0 6�� PERMIT# �� ? �Z FEE: r� SHED REGISTRATION 120 square feet or less Location of shed(address) Village Property owner's name Telephone number Size of Shed Map/Parcel# . /d Q 7 gnatur Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WPIEIIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FOR . MUST BE ACCOMPANIED BY�A M --------- PLOT PLAN Q-forms-shedreg REV:042506 1 ----- -- -_- _- - _... .. rq -PALRRcT OFA4 ' q�}rt..ia�se ma-a a. ,. 4 : Bog Pond �✓ >: awzm�a� w� weorrra;� , �„�• � _ _• �� yvo rvs+ nvcxaroysa�rpx�tr^�- °may` ,ro- ,•� 1"^ LT1 Tcuunys r�ec .'y'•L I'1 � \ tea,�� •ram- - .�l': 1• l!!-'4.; 7 . � -° :- 4 �� - - - _ ' _ - Y/ iv NN pp� Skettcft�lrr� RM OF lAtO BARNSTABLF- � \WL lq p3T0?wxCl c� „a1.A \t S?'Jf+r oe ilp'mi^a'.�Ba:M m S.9 old MASSACHUSETTS ° Auausl 2W7 SCALE 1-40' CapeSury OCT - 9W07 BARNSTABLE CONSERVATION A 1 Town of Barnstable oFVe r ° 4 Regulatory Services s Thomas F.Geller,Director • s�uuvsT�Le, 9� MASS �m Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 PERAM#O �5 Z FEE: $ SHED REGISTRATION t 120 square feet or less Location of shed(address) Village ZtP CLOT✓ 65-o S7 r po/s F Property owner's name Telephone number o A9 x Size of Shed Map/Parcel# r\% , Signature Date r7l, Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District-Commission jurisdiction? ) y, Conservation Commission(signature is required) �� /a �� a�� 1�7�11fe PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE �Z/6 COMNIISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN - CUcirLv— N4/4-nu j ��• C/;�d�,�wvod S?',2 s- I ( s�iect• I/ 79 3- o� i —• _�� loe loe 00 .ol Q6 r— —0 0 • \, O N o C z Ca 325.78 • o � o- "� 'mac+ ••t . S �7' 49' 0 3 -• E 0 p L , Vim• ` � Ci. `� • o 1 -�1 • i:fit `• `� •�4p 1 fA .� � •�-y 07 ` 43 � • ✓ -P .HOME IMPROVEMENT CONTRACTORS -REGISTRATION Board of Building Regulations and Standards ,t One Ashburton Place - ,Room 1301 o . Boston , Massachusetts-021:08 I t• •I ------------------------- HOME- -IMPROVEMENT CONTRACTOR' �- ---- =--- Registr.at"ion 110609 Expiration 11%03%98 Type PRIVATE CORPORATION r HOME IMPROVEMENT CONTRACTOR I' Registration 110609 J JAXTIMER , BUILDER , INC . G . Type - PRIVATE CORPORATION i --SANEST:, J,. JAXTIMER t EzPiration 11/03/98 ROSAf2Yw:,LN. i ANaIS�:MA 02601 E J JAXTIMER, BUILDER, INC. RNEST J. JAXTIMER �.�ce�. co•• $a' ..� ; ROSARY LN• ADMINISTRATOR HYANNIS MA 02601 i 5J 123 DEPARTMENT OF PUBLIC SAFETY 153423 ONE ASHBURTON PLACE, RM 1301 BOSTONT.MA 02108-1618 CONSTRUCTION SUPERVISOR LICENSE �5 :� Number: Expires: - .— Restricted To: 00 ERNEST J JAXTIMER 48 ROSARY LANE HYANNIS, MA 02601 Keep top for receipt and change .r_ of address notification. -_...-. �w..`w wV�ti JJ •1�v.':..-::?.'..':��__.-_..'_—_mow titi\?_`:T�J_\VV\>1_ICi�U�:4�:Lti`VLl_\�\.ZV:A��:.. .".....��-�_::____.�...�:.��.�_._�+a.'i�._��..�•..`�iti.J.t�:�v\\1`�\•�1\.�\\U.. `.J.�V�V��\y:X\I��JL\.�Y�\l'�1�k�'.ti\��.�tii�ti�i:�'__..-... . � 1 The Commonwealth of Massach usetts -- -- Depdhnient of Industrial Accidents Office nf1,7Y9SL[g2110ns 600 Washington Street 1 i A P PARCEL Boston,Mass. 02111 'Workers' Compensation Insurance Affidavit m•atf n''t-`V.i:.` �c+ti:P'z' � �"^"� -,a:A.-irc,:C-a s-"a-...='..r_,;>.�,.;,ti —_�'3Ci, �.-t TVsl�le �I li,4;.:�,e� .a, � .-r.£a,>.3..._ t}:_..�'-ti:�+°`.a nt�:�2.c1;: �.:�-�•, E.J. Jaxtimer, Builder, Inc. - name: 48 .Rosary Lane. cation' �� Hyannis, MA 02601 phon (508)778-4911 ❑ 1 am a homeowner performing all work myself. O I am a sole proprietor and have no one working in any capacity �..s'.""..".::<-..i".:2.��a�+/iTi'.::•.>T k'�-X;..cf_.•s. 9 Y �r...r _ -.+-�,�}_�...�Li- �'.a['ia-.�_ �,iax�•'_�.r:.��":S. ,�-.i:{:^ii:'.�-`;-.w�:�..c. :f{�r�::k'�.:.�:r-.: �'-�,.. �v.L"j'gTcyt�^"m �j I am an employer providing workers' compensation for my employees working on this job. :...:::. ..:.Lane add c_s. %:,. a............... ,..'.j.MA``..`.asU.< `6'Q':>l` .... {>''5 i:0.'.. `. <'<> E`F`' _ 9 7. . . ..::.(. . 8� hone rY ;n Frraoce:,. .........seer-... a5u`aaa>::<:':>' rivaiice<Co' :>': >`>>:::<::>::::::;;::::<:>:::>::>::>::.::::: ::::>:>::>::..:WC9...b9 _028::: ':::<::;::; '.;::<:.>',:: ::::<::>:>;::. .:..... oltc i/ P 1 I a.m a sc!--,proprietor,general contractor,or hou�eo�yner(circle one)and have hired the contractors listed below who have the following woikers'•compensationpolices: ' e ' t c tv a:ar: �a ss: :i n'- sura nee co� _.... Eff Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/ors one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement ma*,be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify the pains and penallies of perjury that the information provided above is.erue and correct. Signature Date Print name Jaxtimer, Builder, Inc.. Phone k 778-4911 official use only do not write in this area to be completed by city or town official city or town: permit/license N -Building Department O check 0Licensing Board if response is required 'OSelectmens Office l - contact person: (Health Department' phone q; -Other (raised 3/95 P1A) j R y C'4)1 fc'r o I Id c-1 I,::I I(I ✓fie "-�a��r:o�u�seur.� o��/ a�eC>ta ; o HOME IMPROVEMENT CONTRACTORS REGISTRATION I Board of Building Regulations and Standards One Ashburto,fi, Place - Room 1301 Boston , .-Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR -------- --------------------- Registration 110609 .'.'E cpiration ..11/03/00 Type PRIVATE CORPOROTI64._ HOME IMPROVEMENT CONTRACTOR Registration 110609 Type - PRIVATE CORPORATION J JAXTIMER , BUILDER INC . RNEST. J . JAXTIMER: i Expiration 11/03/00 i-8 ROSARY LN I.IYANNIS MA E J JAXTIMER, BUILDER, INC. S i 4 _�4r'ROSARY' LN T J AXTIMER ADMINISTRATOR- HYANNIS MA 02601 ....—_...___._ _�_.__._:.._r.:__�_�:=_._rr'._��:vr\�:��1�i:�`ti�1��\\»:�r'.•_r��i��»�`:[.\�\.:,—� ��\ V�—ti err —L--__ y The Co/:t//romvealfh of Afnssnch uscits =—=-'�r-_--��^ De ariz ie;tl of Iudtulrial Accidents •=__1 � OfTce a1lrl�esUgaUons __ w MAP PARCEL 600 l3ashitt�to�t Street Boston �, 11�nss. 0..111 �------ Workers' Compensation Insurance Affidavit -��7)..1.:[rl�:, 1 ,l.'..,r:....rG.:::.�c�.:�-:..` '•f..:1''.f�S:,{, _ �) ..fir -::4::. - _ -_ - ---------'�_-------- ---_---1.1sc„ .i��ljNnclCi]'I;tit�%�':__ iJ:;r:=': - _-_ •��,:-:i- _ _•� ��'�•a`<=':�'" � ,�. E.J. Jaxtimer, Builder, Inc. n P.MC:locaiinn• - 48 Rosary Lane. Hyannis, MA 02601 ri:•� (SOS)778-.a 911 ❑ 1 rn n homcow-ncr perfo'MIing all work n?ysclf. ❑ 1 am a sole proprietor and have no one working in any capacity' I am an employer providing workers' co;i}pcnsation for my emplovices worl:ing—on this job. y JzxUIM . .. ........:... v n ( ) . — P to t c n 1-• 7. 0 [ns[[ :.......:::::: P::::::;::.:..::.:::.::::...:.::..:. Y tl 0 C. 1 _ _ 1 r - I am.a sc'<,proprietor,general contractor,or hon�eo�yner(circle one)and have hired the contractors listed below who have the Following workers':compensation polices: :. :'�:'• _ <:a> ion: `. a' � . dd"re C 1 MMK n L ra s n c< C; :::; an o n a rri" P Y c '•`oiir`-� it.c v: :insura n�� ..........:..:..... .........:..... --r' oars .. ................. ........................................ Failure to secure coverage as required under cc on 25A of MGL 152 eats lead to the imposition of criminal penalties of a fine up to SI,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine orsioull a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify unde rhepainsand�nalties of perjury that the information provided above is true and correct. Signature Date Print name E•- Jaxtimer, Builder, Inc. Phone k 778-4911 4 offcial use only do not write in this area to be completed by city or town official city or town: µ permit/license M Building,Department 0Licensing Board p check if immediate response is required �Scicctmcn's O(Tiec oHcalth Department contact person: phone d; nOther (revised 3,95 PIA) Ci _5 G _r:w fir; Gtd - �- -_ till�7z � + 1 n NI r GQJG I I 1vr�--!kx * zr�Yes#h%tlla: WJLLgvl •��to 1N��•. i �A�LD.��*L�Y Y 1 � •7, 1 � v ' 2X12 R-►M%r_-t>9. �L�sP►�l�-7 s+Un�t�S �+o 10 k Cv tnycu�.a-ftON Mau �/ 6�1?f201NCW.c V 12 xB t)?Lo• 1- ` o e�� ! :i i}: '^ "�'T1MC gust eu�Ica r JDNJ 17 a o I Pit ' r � i N _ o LA hY •r+ i��F `{ - 0 f I I r. 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