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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 1 r 1 Parcel - Application # "_k& d
Health Division _ Date Issued
Conservation Division s'. Application Fee
Planning Dept. Permit Fee OZ 00
Date Definitive Plan Approved by Planning Board l307/Uio`_
Historic'- OKH Preservation / Hyannis
Project Street Address eCl
Village O sk"/
/ TG2" #l// �!
Owner I�,I 11 q 9 S N1Z�!G��%j') Address 9 ,
Telephone
Permit Request In's-tX! 9) nevi Gy/td WS
11 'lain O1— W iv& - Al of Fln
Square feet: Ist floor: existing proposed 2nd floor:.existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation f Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family-.-Er' Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full d"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 0 Oil ❑ Electric ❑ Other
Central Air: ❑Yes 0 No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No
ti
Detached garage: 0 existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing DiAw (size_
Attached garage: ❑existing ❑ new size _Shed: ❑ existing O new size _ Other: c/
Zoning Board of Appeals Authorization ❑ Appeal # Recorded L3,
j
Commercial ❑Yes ❑ No If yes, site plan review # co
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name Telephone Number
Address /`os�21 l--�G�Q_ License # 0 0 3dls
Home Improvement Contractor#
Worker's Compensation # SOOQ 6�02 Q 020 0
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
l q�LGOYII.,C2 r,,SP�
SIGNATURE DATE 7//0 O
a
FOR OFFICIAL USE ONLY
f APPLICATION# -
DATE ISSUED
MAP[PARCEL NO.
.ADDRESS VILLAGE
OWNER
. 1
DATE OF INSPECTION:
FOUNDATION
a
` FRAME
INSULATION
3
1
FIREPLACE
,. ELECTRICAL: ROUGH -FINAL '
PLUMBING: ROUGH FINAL _
GAS: ROUGH FINAL
� FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN:NO.
Department of Industrial Accidents
Office of Investigations
' 600 Washington Street
o,M yV'Jy
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
applicant Information Please Print Legibly
•Jame (Business/Orpnization/Individud 0 ' J . 4CL__ l nu,-r , C
address: `8SGC� (l��
�ity/State/Zip: a an S /W � � /
Phone #: � ( I .
re you an employer? Check the-appropriate box:. Type of project(required):
am a employer with 3C7 . 4. ❑ I am a general contractor and I
6. El New construction
employees (full and/or part-time).* have hired the sub-contractors
I am a sole proprietor or partner-
ship listed on the attached sheet $ ❑ Rem_odeling
and have no employees These sub-contractors have 8. ❑ Demolition
working forme in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.]
officers have exercised their 10.❑ Electrical repairs or additions
I'am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself.'[No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13.❑ Other
comp. insurance required.]
ry applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information:
)meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
m an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
vrmation. �� f
'.trance Company Name: / 1
1.cy..#or Self-ins.Lic. #: U/ � (�I d 12d o 12 Expiration Date: .61L01
d J
i Site Address: -< I ��� -��1 /�L�C ..City/State/Zip: U �i� N4 ,Q o-V.,
:ach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
lure to secure coverage.as.required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a -
up to$1,500..00 and/or one-year imprisonment, as well as.civil penalties in the form of a STOP WORD ORDER and a fine
ap to$250.00 a day against the violator. Be advised that a copy of this statement may fonmvarded to the Office of
.estigations of the DIA for insurance coverage verification.
9,hereby c ;fy and t pains a d penalties of perjury that the information provided above.' true andd correct
Mature. Date: 0
one#:
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#.:
I '
Client#-.2093 2JAXTIMEREJ
} ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE,M°"'°D'YYYY'
03/17/08
i PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Agency HOLDER-THIS CERTIFICATE DOES NOT AMEND, (TEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICCIES BELOW.
973 Iyanough Rd., PO Box 1990
i Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC 0
INSURED INSURER A. Acadia Insurance
i E.J.Jaxtimer Builder, Inc.
i Ernest J.&Marie T.Jaxtimer INSURER B:
INSURER C:
48 Rosary Lane
INSURER D:
Hyannis,MA 02601
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES_AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LTR DATE YMIDD DATE(MMMIDIM LIMITS
A GENERAL LUMUTY CPA010264814 01/01/08 01/01/09 EACH OCCURRENCE $1 000 000
X N1.AMES2CWl.GENERAL LIABILITY DAMAGE TO RENTED
M a e $250 000
CLAIMS MADE 51 OCCUR MED EXP(Any one person) $5 000
PERSONAL&ADV INJURY $1 000 000
GENERAL AGGREGATE $2 OOO OOO
GENL AGGREGATE UWT APPLES PER PRODUCTS-COMP/OP AGG E 00O 000
PQUCY JET LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY. AGG $
A EXCESSAWBRIELLA LIABILITY CUA010264914 01/01/08 01/01/09 EACH OCCURRENCE $2 000 000
X1 OCCUR CLAIMS MADE AGGREGATE $2 OOO 000
$
HDEDUCTIBLE
$
X RETENTION $O $
A WORKERS COMPENSATION AND WC�A020455011 01/01/08 01/01/09 T✓C STATU- OTH-
EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000
OFFICER/MEMBER EXCLUDED? NO EL DISEASE-EA EMPLOYEE $500,000
If yes.describe raider
SPECIAL PROVISIONS bebw EJ_DISEASE-POLICY LIMIT $500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Operations performed by the named insured subject to policy conditions and exclusions.
E.J.and Marie Jaxtimer are included under the workers compensation policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Town Of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 n DAYS WRITTEN
200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES,
AUTHORIZED REPRESENTATIVE
ACORD 25(2001108)1 of 2 #51277 LS1 0 ACORD CORPORATION 1988
AL
Board of Building Regula/ios and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
_ -= — Registration: 110609
Type: Private Corporation
�- ���' poration
L� -�- Expiration: 11/3/2008 Tr# 124739
E J JAXTIMER, BUILDER, INC. �'Gi =- �.. �' •
ERNEST JAXTIMERM( _=
48 ROSARY LN
' t
HYANNIS, MA 02601
Xf �; Update Address and return card. Mark reason for change.
DPS-CAI Co 50M•05/06-PC8490 j _ i Address :_ Renewal : Employment Lost Card
,
tie 1�om��zaizusea a o�./ aaoacf uaeQ2 1 f
Bdad{of Bulld9ng�Regulatlons'nnd Stantlarlisr;t
ydrstructlon 3upervisor,License
aiJ, f i
1 t { t' Llse i CS 3251
1 H x Ida i fi 1 14/2010 Tr# 13629 =�
ERNT JI JAX Enq
;i 48 RSA�YlLAN � /� .
is
i f HYANNIS'MA 0 01
coiilniissloner
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- Town of Barnstable
Regulatory Services
s $ Thomas F:Geiler,Director
6 9.Qop�ED►+9.° Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
ffice:. 508=862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I , as O4twner of the subject property
h4Cir'eb7V2.UthO-U*ze ! AtCto act on my behalf
in all matters relative to work authorized b7 this building p e=3it application for:
(Address of Job)
Si e of Owner Dat
Print N e
Q:FORMS:OWN-ERPERMBSION
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All dimensions_size designations given are This is an on final design and must not be Designed: 1/26/20f
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subject to verification on job site and , released or copied uriless applicable fee Printed: 1/26/2008
adjustment to fit job conditions. has been paid or job order placed.
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BRB FND
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N 735 N/ 80y�
710` W C ..
163 54, h -�
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TO BE REMOVED
_Z 77' 0 1WF S77NG
ox PROPOSED NEW 26.
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$ ASSESSORS MAP 117
PARCEL 156
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29,255 SF t o m
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CERTIFIED PLOT PLAN
I CERTIFY THAT THE EXISTING
STRUCTURES SHOWN HEREON COMPLY LOCATION: #91 TOYER HILL ROAD, 0STERVILI.E, MA.
WITH THE SIDELINE AND SETBACK
REQUIREMENTS OF THE TOWN OF SCALE: 1" s 40' DATE: 04-12-96
BARNSTABLE "D IS NOT LOCATED
IN. THE FL"PLAPn
'F i2
PLAN REFERENCE: PL 8K 106 PG 37
DATE:
THIS PLAN NOT BASED ON AN BAXTER & NYE, INC.
INSTRUMENT SU AND THE OFFSETS REGISTERED LAND SURVEYORS
SHOWN HEREON SHOULD NOT BE & CIVIL ENGINEERS
USED TO DETERMINE PROPERTY-LINES.' . 812 MAIN STREET
OSTERVILLE, MASS., 02655
APPUCANT: JAXTIMER/VIHIGHAM
96038 (CPP01)
_ Assessor's Office(1st floor) Map �� Parcel �� Peinut# ?�
Conservation Office(4th floor)(8:30-9:30/ 1:00--2:00) Date Issued 7 9b
Board of Health(3rd floor)(8:15 -9:30/1:00-4:45)9 G y F' 4 oZ/ 'J g(�
Engineering Dept. (3rd floor) House# 9/ �i'G � v►.1IKE
Planning Dept. (1st floor/School Admin. Bldg.)
t;��m�1"�d:\✓ t.i)N .y>gAHNSTABLE. .J
h1ASS"
Definitive Plan Appro by lanning Board 19 6NS EALLED
TOWN OF BARNSTABL&RON.MENTAL CODE AND
Building Permit Application '�OW4 iREGULATIO'NM
Project Street Ad 1 Tower Hill Road , it
Village Osterv; 1 1 f
Mr . & Mrs . Ji g i '
Owner ggs Whi ham Address 91 Tower Hi 1 Road , nst-prv; 1 1 P
Telephone
Permit Request Build new family room .with closet & Screen porch ( 252 sq/ft )
First Floor 650 square feet
Second Floor -- square feet
Estimated Project Cost $ 69 ,000 .00
Zoning District RC Flood Plain -- Water Protection --
Lot Size 29 , 255 s q. f t . Grandfathered ? --
Zoning Board of Appeals Authorization -- Recorded --
Current Use Residential Proposed Use Residential
Construction Type Wood
Commercial Residential vFS
Dwelling Type: Single Family X Two Family Multi-Family
.Age of Existing Structure Basement Type: Finished
Historic House Unfinished XX
Old King's Highway
Number of Baths No.of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name E . J . Jaxtimer , Builder Telephone Number 778-4911
Address 48 Rosary Lane , Hyannis License# nnnAgr;i
Home Improvement Contractor# 1 10 h n A
Worker's Compensation# W C 1—312—2 0 4 2 3 9—0 2 3
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
Barnstable Landfill
SIGNATURE DATE April 15 , 1996
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
i
* FOR OFFICIAL USE ONLY
PERMIT NO. 1 "'C I/ v
DATE ISSUED
MAP/PARCEL NO.
ADDRESS _ VILLAGE
OWNER ;
DATE OF INSPECTION:
FOUNDATION
FRAME.
INSULATION
FIREPLACE '��
ELECTRICAL: ROUGH FINAL `
PLUMBING: ROUGH FINAL
GAS: ROUGH :: ` FINAL
FINAL BUILDING
DATE CLOSED OUT I ram"
ASSOCIATION PLAN NO. 5.4 '
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DEPARTMENT OF PUBLIC SAFETY 40742
ONE ASHBURTON PLACE , RM 1301
BOSTON ,. MA 02108-1618
CONSTRUCTION SUPERVISOR LICENSE•
p F i 2 1996
Number: Expires;
Restricted To: 00 ?. ;:`:•.
ERNEST J JAXTIMER Detach bottom, fold , sign on
48 ROSARY LANE back, and laminate license card.
HYANNIS , MA 02601 Keep top for receipt and change
of address notification.
- �ttte
: - - The Town of Barnstable
'� �0g Department of Health Safety and Environmental Services
ate" Building Division
367 Main Street,Hyannis MA 02601
Office: 508 790-62.27 Ralph Crossen
Fax: - 8 77 3344 :::
mmisst Building once .
For office use only
Permit no.
r
Date
AFFIDAVIT -
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
r MGL c_ 142A requires that the"reconstruction,alterations,renovation,t7epair,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
regaiiements.
Type of Work: AM,1IL y 9OOM &tJ5TlZ"T1 bll) Est.Cost194 08a /
Address of Work: q l Tb t,tJ2 K. f 61 l � , (j s,�e ry I (t°e
Owner Name: ro ct h is ,qCiS wk;6. L w
Date of Permit Application: AQILi�L�S
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S 1.000
Building not owner-oocupied
Owner pulling own permit
Nniioe is hereby given lbm-
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS
FOR APPLICABLE HOME TWROVEIENT 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 owner:
Date Contractor name Registration No.
vn
Date Owner's name
r= _ ---- ----�.. -�-� --
C(DN1'/jO-NTWF-JAJTl- OF
000 V,-'/SI13T�'CI-01, STI LT
�amcs.`Ca-t�oe� :30ST0,N, )\4ASSACHUSL—J-1-5 O lI l
Vic.--+:ss•o�e•
IVORKERS'COMPENSATION INSURANCE AFFIDAVIT
�)LIC I L-D G2 , I N..0 .
(Qiccnscc/permincc)
with a principal place of busincu/residcnec sc
(City/s ta(dzip)
do hercby ccrzifj•, under the pains and pensJties of perjury, rhar:
[ am an cmpiovcr providing ncc following workers'compensation.coverage for mycmployccs working on ihic i
job.
i
3 1Z 2,0y2 3q
Insur2ncc Com ny Policy Numbcr .
[ ) l am z sole proprietor and have no one working for m`
H 1 am z sole prcprictor,gencr-1 cone.-aor or horneownr-r (eirde one) and h:vc hired the c-ontraaors listed below
�c-ho hzve the following workers oampc=aon hwuranec policies:
?mmc ofConrraaor Insurance Comp=y/Policp Numbcr
^amc ofContraaor Insurance Comp:nylPoliey Number
12mc ofConusaor lnn=ncc Cemp=yRolicyNumbu
0 I am a homcownct performing:ll the work my:c1L.
NOTE. Please be awzic tb:z-.&6r—co-zaiwtocrpplorpcesoot to do rotiotcoaacc,coottrvctioaorrcpsir—orkon s
�••cltinS of not more tbxn three uoiu is ti<boraco+,ocr alto ruidcs or oo the Frvuods appurtcm=t tbc(cto arc loot Fcocrall)•
eens:dcr<d to be employers t=ezrtb<,Vjo?xr+'Corpc s:1tioo Act(GL C 152.teet. 1(5)),appliutioo by a bora<owoer for a lieeose
or permit r.-:y cricrccc< the lcFJ sums c(L----loycr uodcr TIc'Workcrs*Compcosatioa Act.
i cn«nt:nc tn.t a copy or tint urtcn<u wii a icr-•uc',cd to 6,c tJcpa.rt::cnt of IndvstriJ Aco&nu'Orrcc of 1asc:ancc for.co-,cra;c
�rrif+cation�,sd thct f ilurc to secure co—zz<::rcSuired under Section 25A cf MGI_152 can kid to the imposition aWr:+ina1 penJucs
f+nc o ccnsf S 100.00 s day a ag ons of a fi nd of to 5 3 500.QQ�.11ct i arri;onr�cnt of up to onc yar d anz C,;Q pcnaltics in the fonn or;Stop Vorl:Ordcr and a
• or rnc..
si;necl this d2y of . l9
Uccns d r !tact Licensor/Pcrmiaor
T
o-V� r
1�
k Cc- C55 TO
�-rTc
x ssessor'sOffice 1st floor Ma �, Permit# .3 7 �� O
qA
• onservation Office Oth floor ll(1..�,�1� --A Date Issued d- s—
Board of Health 3rd floor
J °°"�'"
XEngineering Dept. Ord floor) House# � �
Planning Dept. (1st floor/School Admin.Bldg.): . �, AHM t
..�MAW
Dcfinitive Plan Approved by Planning Board 19 SEPTIC
(Applications processed 8:30-9:30 a.m. & 1:00-2:00 m.) INSTALLE09 IN UST BE
p p OMPLIANCE
WITN TITLE 5
' 'Ji"" VSgENTAL CODE AND
TOWN OF BARNSTABLE.
Building Permit Application
Proiect Street Address cl)
C47 Village Fire District Z 7I f
Owncr h Q Address 9 C3. YI/�
Tcic honc ' 3
Permit Request: t 11 ! ( e�-o r bo st/
o R, 1 � ,!j
Zoning District Flood Plain Water Protection
Lot Size ISO /(f-Z Grandfathered
Zoning Board of Appggjs Authorization Recorded
Current Use (Ea►'a 9-e, . Proposed Use �cc e S�/�4�•«�4 ��ao�,
Construction Type a-r q hQ 1tic eo',
Eaistin2 Information
Dwelling Tyne: Single Family Two family Multi-family
Age of structure Basement bN ed Qo.h cr jr-e
Historic House Finished
Old King's Highway Unfinished 1n
Number of baths No. of Bedrooms
Total Room Count(not including baths) First Floor /lYc
Heat Type and Fuel Central Air Fireplaces A/25
Garage: Detached Other Detached Structures: Pool �c
Attached Barn ,rrJr
None Sheds ,lie
Other
Builder Information
Name go L e-V--t /4, fact " Telephone number c'p q
Address E Q:e / License# 0
C�S-�-e r a `�,? Hef _ Home Improvement Contractor# /!P 0 Xs--
Worker's Compensation #
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 BETAKEN TO E a F vI S �a 6 /--c
Project Cost 41r�
Fee
SIGNATURE DATE_
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
e
BPERM T
FO$OFT-ICE USE ONLY
2/8/95 37 0 F.
17. 156
ADDRESS 91 Tower Hill Road VII,LAGE Osterville
Jiggs Whigham
OWNER
DATE OF INSPECTION: ti
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
S
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING:
DATE CLOSED OUT: `,'n -7,
ASSOCIATE PLAN NO. � _
C ., „
I`ALTH DEPARTMENT OF PUBLIC SAFETY =�
OF 'I ONE ASHBORTON PLACE I j,
MASSACHUSETTS it BOSTON,MA 02108
EXPIRATION DATE 1 1/:;_
4/i:_•��_, Cl—INS R. _'!IF" RV I:=:I_(R CAUTION
RESTRICTIONS EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST
I G 1 & 2 FAMILY HOMES • . THEFT, PUT RIGHT THUMB
12/1 /1 ?=�� i�5•=849 PRINT IN APPROPRIATE
- ° BOX ON LICENSE.
F:C jERFERT A LAL(Li
_ # z BLASTING OPERATORS
!-lLLIHAr I :=;T F•EI -BC IX 4� MUST INCLUDE PHOTO.
PHOTO(BLASTING OPR ONLY) FEE: i EE-TERVILLE MA 0-2655
NOT VALID UNTIL SIGNED By LICENSEE AND OFFIggLLy
HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER
THIS DOCUMENT MUST BE I
CARRIEDONTHE PERSON OF !p SI RE F « SIGN NAME IN FULL ABOVE SIGNATURE LINE
THE HOLDER WHEN EN-
OTHERS-RIGHT THUMB PRINT GAGED INTHISOCCUPATION.
x ! 1QaEg
,AF?F'RCIV._._•AUT'H^�______
HONE IMPROVEMENT CONTRACTOR
Registration: 118075
Type - DBA
Expiration 01/25/97
SHUTTERS
ROBERT A. LADD
� �o 7i &r.0 BOX 133 - 188 WAStiii;v'•
ADMINISTRATOR OSTERVILLE MA 02655
I
Tli c Tow T I (I
c; !•:L-Sum i;Nawl,s MA 02001
Office: 5N-79"227
F= 508 775 3344 Ralph a
For off oc use only
�� oner
Permit no-
Date
AFFIDAVIT
HOME DWRO TCONTRACPORL&W
SUPPIEMENTTO PERTflTAPPUC+liZI )N
M<;L c.142A requires that the--reooustructioq aItaa oas,><raocaLi a
: .
zomo«I.&=Ution,or ootunuction of an additadditionto
any pre-existing
building containing at least one but not motz than four der
io such rdenoe or buildingbt done clIittg units or to strums Vvhich ait�j2�
b} � contractors,a�ih oettaia excx�$ot�,along with other
. �I�z�s.
Tjpe of Nvork Est.Cost �,�
Address of Work:
OK�er Tame: '
-------------
Date of Permit Application: �-
I hartm cal fv that
Registration is not required for the follo�in€rcmn(sy
Work<xcludcd br l2w
Sob under S I,Ooo
Building not<mT+cr-occ upicd
O�ncr pulling o%%m pernvt
hotioc is hcrcbv gi\cn t12t:
O«^ITP S PULLTI,,G T-r—mIR O\i'h PEF,% T OR DEAUNG VTr,,,U:,'REGISTEF2i=D Co-
FOR POR /tiFPL3Chl;LE HON�"i I'�°FO�i'•�;`i i:'OFj: DO 11 T F-A\'E ACCESS TO Ti'.t
i I7R�T10'`'PROG ,t;OP GUI c�?�7� f1-�D L�JSF.1;GL c. 1<2E,
SIG.NED UNDER Pr-NALTIES OF PEF.RII;j'
2::Y1v io'2 j Cr't➢I. 2_is C 2LCe;C",.0
Conte ca;r�r P.cginracioa No.
OR
Datc
OA•ncr's nzmc
11/02/94 17:02 V6177277122 DEPT IND ACCID Q 001
(fomrunoluuea[tlz o/ MaJJac1utJettJ
aLJoPartmen�o�.9ndu�frictl,_/dccidenf�
James J.Campbell 0 .4ton, MamizcLinthl 02 f f f
Commissioner
Workers' Compensation Insurance Affidavit
with a principal place of business at:
(�nr�srxe�zEv)
do hereby certify under the pains and penalties of perjury, that:
() I am an employer providing workers' compensation coverage for my employees working on
this job.
Insurance Company Policy Number
1 am a sole proprietor and have no one working for me in any capacity.
() 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the
contractors listed below who have the following workers' compensation policies:
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
() I am a homeowner performing all the work myself.
I understand that a copy of this statement will be forwarded to the Office of investigations of the DIA for coverage verification and that f,ilure to secure
coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisdriz of a fine of up to 51,500.00 and/or one
years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.00 a day against me.
Signed this day of ��
Licensee/Permittee Building Department
Licensing Board
Selectmens Office
Health Department
TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375
TOWN OF BARNSTABLE BUILDING PERMIT #
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$
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Assessor's office(1st Floor):
Assessor's map and lot number, j `o SEPTIC SYSTEM MUST rJ nor:THE�O1
Conservation •—� Co — / — INSTALL0 IN C®MPLIA Q- •�
"Board of Health(3rd floor): q� WITH TITLE 5
/ 3— 2 2 i t Dsaa3r�at
Sewage Permit number 7
ENVIRONMENTAL CODE r•.a
Engineering Department(3rd floor): �/ TOM REGULATION'S °moo
House number I ,LI
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN, OF - BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO Build a two—car garage
TYPE OF CONSTRUCTION Wood Residential '
�-. June 8 1993
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the followininformation:
Location
91 Tower Hill Road Osterville
Proposed Use Garage
Zoning District RC Fire District C/O/MM
Name of Owner Jiggs Whigham Address 91 Tower Hill Road, Osterville
NameofBuilder E. J . Jaxtimer Address 48 Rosary Lane , Hyannis
Northside Desin Yarmouth port
Name of Architect g Address p
Number of Rooms One -Foundation Poured concrete
Exterior Wood SHingle Roofing Asphalt Shingle
Floors Poured concrete Interior Unfinished
r
Heating None Plumbing None 1
Fireplace None Approximate Cost $30,000
Area 24 x 28 672
--::p da
Diagram of Lot and Building with Dimensions Fee
�
go r
Zr
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name - E. J . Jaxtimer
Construction Supervisor's License 103251
WHIGHAM, JIGGS
No 35'979 Permit For Build Garage
Accessory to Dwelling
Location 91 Tower Hill Road
Osterville
Owner J,iggs Whigham
Type of,Construction Frame
Plot Lot
Permit Granted Julie 19 93 ,
t
Date of Inspection 19
Date Completed 19
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(508)362-2210 (508)362.9802 ` { ' ,C R A,
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1-iOME IMPROVEMENT CONTRACTORS REGISTRATION
Board of Building Regulations and Standards
One Ashburton Place --- Room 1301
Boston , Massachusetts 02108
1-i'OME IMPROVEMENT CONTRACTOR
Registration 110609 Expiration 11/03/94
Type - INDIVIDUAL � /�a�✓G «�wr��
HOME IMPROVEMENT CONTRACTOR
Registration 110609
E J JAXTIMER 5 Type - INDIVIDUAL
ERNEST J . JAXTIMER t Expiration 11/03/94
.B ROSARY LANE
1 IYANNI S MA 02601 E J JAXTIMER
ERNEST J. JAXTIMER
48 ROSARY LANE
ADMINISTRATOF7 HYANNIS MA 02601
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