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HomeMy WebLinkAbout0009 EDGEHILL ROAD ��1" � I �, i row Town of Barnstable_ Building Post` So That it is Visible.From the Street-Approved,Plans Must be Retained on Job and,this Card Must be Kept i fpcisted'Until Final Inspection Has BeeiI Made. Permit o Awe Where a..Certificate"of Occupancy is Required,such.Build�ng shallrNot be Occupied until a Einal Inspection has beenrma ._ .c -,M_ •_,���_.,. •, O c ie - ,Fi_al Insp..ction de Permit No. B-19-2984 Applicant Name: Michael Mailloux Approvals Date Issued: 10/28/2019 Current Use: Structure Permit Type: Building-Demolition Expiration Date: .04/28/2020 Foundation: Location: 9 EDGEHILL ROAD,HYANNIS Map/Lott/ 287-111 Zoning District: RF-1 Sheathing: Owner on Record: SAIDNAWEY,JOHN R& PAMELA B Contractor Name: MICHAEL MAILLOUX Framing: 1 Address: 11 ADAMS STREET Contractor License: &106420 2 BELMONT, MA 02478 - -_ Est. Project Cost: $20,000.00 Chimney: Description: Demo rear portion of existing home in preparation to lift douse for Permit,Fee: $ 125.00 " new foundation. Demo interior plaster and masonry., ;! Insulation: Fee Paid: $ 125.00 ° Date: 10/28/2019 Final: Reviewers Note:This is the demo. Rebuild on'B-19 2816. RMCK Plumbing/Gas. Project Review Req: Rough Plumbing: i: A - -•t ',..,Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within'six months aften'issuance. All work authorized by this permit shall conform to the approved application and'the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for 'public inspection for the entire duration of the Final Gas: A work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: r Service: 1.Foundation or Footing $ Rough: 2.Sheathing Inspection - 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). � Building plans are to be available on site Fire Department Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable Building + �nRctSTwBL Post This Card So That it is Visible From the Street-Approved'Plans°Must be Retained on Job and'this Card Must be Kept "'^ $ Posted Until Final lnspection_Has Been Made.W er1111t DMP�P~a here a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-2816 Applicant Name: Michael Mailloux Approvals Date Issued: 10/28/2019 Current Use: Structure Permit Type: Building-New Construction Rebuild After Expiration Date: 04/28/2020 Foundation: Teardown Map/Lot: 287-111 Zoning District: RF-1 Sheathing: Location: 9 EDGEHILL ROAD, HYANNIS Contractor Name'- MICHAEL MAILLOUX Framing: 1 Owner on Record: SAIDNAWEY,JOHN R&PAMELA B Contracto.rLicense: CS-106420 2 Address: 11 ADAMS STREET Est. Project Cost: $1,700,000.00 Chimney: Y BELMONT, MA 02478 Permit Fee: $8,720.00 Description: Demo/rebuild Insulation: Fee Paid;f $8,720.00 Elevate Existing home to excavate for new foundation. Place ' existing home on new foundation with new addition added Date: ?` 10/28/2019 Final: Reviewers Note:This is the rebuild,demo on permit B-19-2984. c `. �r �!�� Plumbing/Gas RMCK '" _ Rough Plumbing: Building Official Project Review Req: PROJECT AS SUBMITTED IS CONSIDERED A DEMO REBUILD Final Plumbing: AND SUBJECT TO THAT ORDINANCE CHAPTER 240-91. Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within siz months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents.for which this permit has been granted. Final Gas: . All construction,alterations and changes of use of any building and structures shall-be'in compliance with the local zoning bylaws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall.be maintained open for public inspecti`n for the entire duration of the Electrical work until the completion of the same. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:L Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall no roceed until the Inspector has approved the various stages of construction. Fire Department "Pers ns contracti with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: c� Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �THe Town of Barnstable Ei.oPM,eNr •� Planning&Development DeparfR%W QF; &�o o snRMNsTns Barnstable Historical Commission y Mnss.I E$ 200 Main Street,Hyannis,Massachusetts %AMR 27 Will: .' 1639' A10 Phone(508)862-4787 Fax(508)862-4784 0 s / erin.loganatown:bamstable.ma.us OF 8010� Elizabeth.Jenkins,Director COMMISSION MEMBERS: Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA W Elizabeth Mumford. C) Cheryl Powell Frances Parks N . c; M CO DECISION Summary: Demolition Delay Not Imposed Pursuant to Chapter 112 Historic Properties,'' Section 112-3 F Applicant/Property Owner:. John and Pamela Saidnawey Subject Property: 9 Edge Hill Road,Hyannis Port Assessor's Map/Parcel: 287/011/000 Hearing Date: March 19,2019 Pursuant to the Barnstable Historical Commission receiving your notice of intent on February 22, 2019, a duly advertised and noticed public hearing was held on March 19,2019 to determine whether the significant structures identified as a single family structure on this property is a preferably preserved_ significant building and whether demolition delay would be imposed for the partial demolition of this structure on the parcel addressed as 9 Edge Hi11 Road,Hyannis Port. After review and consideration of public testimony, application and record file, the Commission by a unanimous vote, found that in accordance with Chapter 112F the partial demolition of the single family structure is not a preferably preserved significant building In accordance with Chapter 112-3 F,the Commission determined by a unanimous vote that the partial demolition of the single family dwelling would not be detrimental to the historical,cultural or architectural heritage or resources of the Town. This decision applies only to the demolition described in the notice of intent submitted on February 22, 2019 No future demolition shall be permitted without application and approval from the Barnstable Historical Commission. _ Nancy Clark,Chair s Date cc: Brian Florence,Building Commissioner_ Ann Quirk,Town Clerk 200 Main Street,Hyannis,MA 02601(p)508-862-4787(f)508-862-4784 367 Main Street,Hyannis,MA 02601 (p)508-862-4678(f)508-862-47.82 s � $ Town of Barnstable Planning & Development Department m Barnstable Historical Commission www.town.barnstable.minus/historicalcommission rn co COMMISSION MEMBERS: %.n Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Elizabeth Mumford Cheryl Powell Frances Parks February 22, 2019 Re: Notice of Intent to Demolish Structure &Relocate 9 Edgehill Road, Hyannis Port, Map 287, Parcel 011 LDa Architects c/o John Day, 222 Third Street Cambridge, MA 02142 Ann Quick, 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 partial demolition of the single family structure, on March 19, 2019 at 4:00pm, 367 Main Street, Hyannis, 2nd.Floor, Selectmen's.Conference Room. 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, Nancy Clark, Chair { i Planning&Development Department,Elizabeth Jenkins-Director 200 Main Street,Hyannis,MA 02601 r Town of Barnstable ... Planning & Development Department --+ s,Rvarneu . CD> NAM Barnstable Historical Commission www.town.barnstable.ma.us/historicalcommission +x� N COMMISSION MEMBERS: un Nancy Clark,Chair Nancy Shoemaker,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Elizabeth Mumford Cheryl Powell Frances Parks Chapter 112 Historic Properties, Section 112-3 D. DETERMINATION of SIGNIFICANT BUILDING 9 Edgehill Road, Hyannis Port, Map 287, Parcel 011 Pursuant to.Intent to Demolish Structure The property located at 9 Edgehill Road, Hyannis Port, Map 287, Parcel 011 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 this structure is a significant building. This determination applies only. to the demolition described in the notice of intent submitted on March 1% 2019. Any future"demolition shall require a new determination from the Barnstable Historical Commission. I Planning&Development Department,Elizabeth Jenkins,Director Erin K.Logan,Administrative Assistant 200 Main Street,Hyannis,MA 02601,508.862.4787 r Town of Barnstable *Fermi .# Expires 6 months from issue date Regulatory Services Fee Thomas F.Geiler,Director R Building Division Tom Perry,CBO, Building Commissioner. 200 Main Street,Hyannis,MA 02601 Www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address � � l�� t �Cl n n S reK Residential Value of Work 5;00(D Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �ic � llc Contractor's Name L 'i l'C 1 (mL r Telephone Number•�')[��) U S i I/ Home Improvement Contractor License#(if applicable)__ I 10 609 Construction Supervisor's License#(if applicable) 00 3 c� . vorkman's Compensation Insurance Check one: X-PRESS PERMIT I am a sole proprietor ❑ I am the Homeowner O C T 2 ® 2008 [g-I have Worker's Compensation Insurance 1t T C Insurance Company Name /� - TOWN O BARNSTABLE Workman's Comp.Policy# `�� � / Q D / (=2 DQ Copy of Insurance.Compliance Certificate must be on file. Permit Request(check box) w ❑ Re-roof(stripping old shingles) All construction debris will be taken to Re-roof not stripping. Going over existing layers of roo N ET-Re-side o � Replacement Windows/doors/sliders. U-Value (maximum.44) r *Where required: Issuance of this permit does not exempt.compliance with other town department regulations,i.e.Histori Conserva$on,etc. ' � f" ***Note: Property Owner must sign Property Owner Letter of Permission. A copy:of.the Home Improvement Contractors License is required. SIGNATURE: Q:Fomis:expmtrg Revise061306 Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111' www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers applicant Information ( Please Print Legibly fame (Business/Organization/Individual): �J • �L�.���(.Q��' � �� .ddress: 6sG(� � NRPhone ✓'ity/State/Zip: G�, �d�, � #: - t •e you an employer? Check the-appropriate box:. Type of project{required): Q'I'am a employer with �'C� . 4. ❑ I am a general contractor and I 6• ❑New construction employees(full and/or part-time).* have hired the sub-contractors ] I am a sole proprietor or partner- listed on the attached sheet.$ ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein 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.❑ Phunbing repairs or.additions myself. [.No workers' comp. c. 152,§1(4),and we have no 110 Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] . applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: neowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site rmation. rance Company Name: ,y#or Self-ins.Lie.#: Expiration Date: .01 O/ /09 iite Address: rGtG/P I�IY fit'nf�l Tity/StateJZip y 7 ch a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ire to secure coverage as required under Section 25A of MGL c. 15.2 can lead to the imposition of criminal penalties of a ip 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 to$250.00.a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of aigations of the DIA for insurance coverage verification. hereby certi u t pains and penalties ofpedury that the information provided above is wandcorrect iture: Dater pr 911cial use only. Do not write in this area,to be completed by city,or town official. ity or Town: PermitUcense# wing Authority(circle one): Board of Health 2.Building Department 3.City/Town.Clerk 4.Electrical Inspector 5.Plumbing Inspector. Other intact Person: Phone#.: Date: 2/20/2008 Time: 4:04 PM TO: R 9,15087754909 Page: 002 Client#:2093 2JA"MEREJ ACORD,.. CERTIFICATE OF LIABILITY INSURANCE 2=iM8MM Pr�oucN3l THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling A O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyanough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC#. NSA Acadia Insurance E.J.Jaxtimer Builder, Inc. INSURER g Fireman's Companies Ernest J.&Marie T.Jaxtimer NsuNTNR c. 48 Rosary Lane INSURER D: Hyannis,MA 02601 INSURERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQuffa3 ENT.TERRA 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 POLICES 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 OF POLICY TR TYPE N p�ATEEFFECTIIVE DDAATEE EXPIRATION L LIIIBTS A G9NEPAL LEAS UrY CPA010264814 01/01/08 01/01/09 EACH Oc cE. $1 000 000 COMWERCIAk _ _ DAMAt-1TORENTED --------- HAB —-------------------- -- --- ---- -- - - r , -$25 ---------- --- -- r.:..:. :ca nlMs MADE CUR _ t ane_peaon 4$5 gyp.--..... PERSONAL aADV RCIURY $1000 000 GENERAL AGGREGATE $2 00D 000 GENL AGGREGATE LUIT APPLIES PER: PRODUCrS-COMPIOP AGG s2,000,000. POLICY LOC B AUTOMOBILE LIABILITY MAA010395014 01/01108 01101109 COMB24ED SINGE LIMIT ANYAW0 (Emma) $1,000,000 ALL OWNED AUTOS BODILY IWURY X SCHEDULED AUTOS �p-) $ X HIREDAUTOS BWLYMURY X AUTOS � I) $ PROPE TY AMAGE $ C-ARAGE LUU LITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A MY CUA010264914 01/01/08 01/01/09 EACH WZE RRENCE $2 000 000 R1 OCCUR ❑CUMMS MADE AGGREGATE s2,000,000 $ DEDUCTIBLE $ X RETENrI0N $D $ A womom cowEmATIO N AND WCA02D455011 01101108, 01101109 wC STATLF fN44JOYERVLIABILITY E.L.EACHACCIDENT $500,000 ANY PROPRlEr0RlPAR NERIIXECUrtVE OffiCHtlAAEMBER EXCLUDED? NO EL DISEASE-EA EMPL $SOD DOD 8 ���� E.L DISEASE-POLICY LIMR $50000D SPECIAL PROVISIONS below OTHER TDN OF OFMTDNS I LOCATIONS I VBUMM I EXMM W ADDED BY BMD SBIW I SPECIAL PROVMM - Certificate holder Is named additional insured for general liability. E.J.and Marie Jaxtimer are included under the workers compensation policy. Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DF.SCRBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE TH BMF.TM sSIING HMMM VML ENWAVOR TT)MAL III) VMTTE a 200 Main.Street NOTICE ToTm CERTFDATE HOLM mmm TD THE LN_FT,BUT FALURE TO DO sO SHALL Hyannis,MA 02601 No OBLIGATION oR LIABTLRY of AW KIND UPON THE INSURER,ITS AGEWTS OR REPRESENTATIVES. AUnWRl2» NTA O ACORD 25(2001108)1 of 2 #S509951M50595 LS1 ®ACORD CORPORATION 1988 10i20/2008 14:19 BANK OF AMERICA 401-278-5590 4 915087754909 NO.050 9001 5087754909 E PAGE 01/01 j 10/20/2008 03:06 5087754909 JJAXTIMER egal toa Serdee Toza�Paxry, vaudtg Com &.-Sic= . . M•A 02601 � 200 a Straet, l FOE: DB=� •M 5pg'8624058 Property der must d ample a MI Tli$•Sectxo� If Using A Bi il,dct ; as Qanet o£rhe subJect ps POrLT . �. • • •. - '�,. •� �Wi.�-- - to act on C3a�ive to tv0A a ! d this b,,,"irt petit app eatioa£ox•, ddm$ of•Job) e.Of pwn�x ti Name �= Board of Building Regula Ions and Standards One Ashburton Place - Room 1301 " Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 110609 t _ r Type: Private Corporation Y jh t1 a.t Expiration: 11/3/2008 Tr# 124739 E.J JAXTIMER BUILDER, INC `, Y ERNEST. JAXTIMER M� F � 48 ROSARY LN - -- L HYANNIS, MA 0260.1 Update Address and return card.-Mark reason for.change. . —? Address i Renewal Employment Lost Card DPS-CAI 0 5OM-05/06-PC8490 - --- - a j � I '� ✓fze >°aninxa� o�../G�z�a�uaet�.a i . Boa d of Budd ho mgRegulans and Standards t I Construction Supervisor License ` t + �+ I O nse. CS 3251 i � xpr�Ciin 11g14/2010, Tr# 13629 tit estridtion QQE' - 1 � s 1 @ i ERNPST J JAXTI(viER; t 48 ROSARY LANE r J �/_ HYA02601. dx yti, i NNIS,MA Commissioner r �� -3-13 a1 �� yoFz T Town of Barnstable Permit#. Expires 6 m9nth om issue date Regulatory Services Feeo • BARNSIASLE + 9eb 16 9. ,�� Thomas F. Geiler,Director pTEp MP't� , Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 _ www.town.bamstab le.ma.us Office: .508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - .RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address / �� ado ['Residential Value of Work. / Minimum fee.of$35.00 for work under$6000.00 Owner's Name &Address l/ 0, ), Contractor's Name 1 Telephone Number - Home Improvement Contractor License#(if applicable) Q Q Construction Supervisor's License#(if applicable) /X-If"RESS PERMIT INWorkman's Compensation Insurance Check one: MAY 0 2 2013 ❑ I am a sole proprietor ❑ I am the Homeowner �have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. - Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to IY46O I&6 ",1 ❑ Re-roof(not stripping. Going over existing layers of roof) Ej Re-side #of doors ❑ Replacement Windo.ws/doors/sliders. U-Value (maximum .44)#of windows 1 *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission: . A py of the Home provement Contractors License & Construction Supervisors License is it . SIGNATURE: Q:\WPFILES\FORMSIbuil1 permit formsTXPRESSADC Revised 070110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant A Please Print I,e�ibiy � PP Information NaMe(Business/Organization/Individual): EJ JAY_ntn�X, Address: 0�4 8 City/State/Zip: �an At S PM OZ(pU 1 Phone.#: C_QB) 17179' iell Are you an employer? Check the appropriate box: Type of project(required): I. I am a employer with .3L 4. ❑ Lam a general contractor and I 6. ❑New construction employees(full and/or part-tim.e).* have hired the sub-contractors 2:.❑ I am a'sole proprietor or partner listed on the attached sheet. 7...❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.-insurance comp. insurance.$ required.] - 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3. doing all work officers have exercised their 11.❑Plumbing repairs or additions ❑ I am a homeowner d g [11 P. 12. Roof repairs myself. o workers'coin right of exemption per MGL airs Y insurance required.] t 152, §1(4),and we have no c. ❑ Other employees. [No workers' 13. . 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. lContractors 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: AJS LCZ_ A1 Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: / (I I City/State/Zip: +�4414 n l S I QK+ A Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). da_'(,P 7 Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of.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. Be advised that 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 penalties ofperjury that the information provided above is true and correct Signature: Date: /124 113 _ Phone 4: Offccial 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#: Acc^RO® CERTIFICATE OF LIABILITY INSURANCE 71/1(M4/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the. certificate holder in lieu of such endorsement(s). PRODUCER NAM , Erica H.'O'Ctinnor HART INSURANCE AGENCY,INC. 243 MAIN STREET mc.PHONNo.E , (508)759-7326 . Fax (508)75.9-7366 . -. A!C No PO BOX 700 E-MAI L ADDRESS: BUZZARDS BAY,MA 025320700 INSURERS AFFORDING COVERAGE NAIL>i msURERA: ARBELLA PROTECTION INS CO 4.1360 INSURED EJ Jaxtimer Builder,Inc ARBELLA PROTECTION INS CO 41360 Hyannis,MA 02601 Rosary Lane INSURER B INsuRER C: ARBELLA PROTECTION INS CO 41360 H INSURERD: ARBELLA INDEMNITY INSURANCE COMPANY 10017 INSURER E: INSURER F: ..:.. .... I . . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:. THIS IS TO CERTIFY THAT 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,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR TYPE OF INSURANCE INSR WVQ SUER POLICY NUMBER POLICY EFF POLICMMIDDY� LIMITS: A. GENERAL LIABILITY 8500042039 01/01/2013 01/01/2014 EACH OCCURRENCE S_ 1000000 COMMERCIAL GENERAL LIABILITY DAMAG TO RENTED PREMISES(Ea a rrence S 300000 CLAIMS-MADE OCCUR MED EXP(Any oneperson) E 5000 - PERSONALBADVINJURY S 100000 GENERAL AGGREGATE E 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG E 2000000 POLICY PRO- LOC B .AUTOMOBILE LIABILITY 21662400004, 01/01/2013 01/01/2014 CEO eBINED SINGLE LIMIT. 1000000 S _ • ANY AUTO BODILY INJURY(Per person) S, ALL OWNED SCHEDULED BODILY INJURY(Per accident .E AUTOS AUTOS ) NON-OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Pera 'dent) $ $ C UMBRELLA LIAO OCCUR 4600042040 01/01/2013 01/01/2014 EACH OCCURRENCE .E 2,000.000 EXCESS LIAR CLAIMS-MADE AGGREGATE .y 2,000;000 DED RETENTION E E D WORKERS COMPENSATION 0053890111 01/01/2013 01/01/2014 WCSTATUT I I OTH- AND EMPLOYERS'LIABILITY YIN — FR ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT - SOO,000 OFFICER/MEMBER EXCLUDED? �. N I A S (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE E 500,000 If yes,describe under - - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT. E .500,000 - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additlonal Remarks Schedule,If more space Is required) Faxed to(508)790-6230 CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 MAIN STREET THE EXPIRATION .DATE THEREOF, NOTICE WILL BE DELIVERED IN HYANNIS,MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD r i v 91te &wunowawald p i Office of Consumer Affairs and vuusiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 # Home Improvement Contractor Registration Y ' Registration: - 110609 == Type: Private Corpor"ation j - +---- Expiration: 11/3/2014 Trt/ 233027 E J JAXTIMER, BUILDER, INC. b ERNEST JAXTIMER . m 48 ROSARY LN =� HYANNIS, MA 02601 w Update Address and return card.Mark reason for change. t..t _ Address Renewal Employment ❑ Lost Card DPS-CA1 is 50M-04/04-G101216 G- 09JYA➢ZNJZf.I/P,fG Office of Consumer Affairs&B°fines gn�ltgetla License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: F Registration: 1,10609 Type: Office of Consumer Affairs and Business Regulation s Expiration: . 1/3/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 E JJAXTIMER,BUILDER I_NC - ERNEST JAXTIMERiff- — �= 48 ROSARY LN k HYANNIS,MA 02601 M ,x Y Undersecretary a'lid without signature 3 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Ciui:,tructiun Super� License: CS-003251 ; +>t"I,S �Jlf A ERNEST J JAXTIMER 48 ROSARY WE' I HYANNIS 1l1 02601 I -yr i Expiration commissioner 01/14&14 Y-01-2013 14:00 From:WHALEROCK 4012287648 To:15087754909 Pa9e:1,'1 t , 1 i "t'M 1679. Town of Barnstable A�� Regulatory Services Thomas F.Ccilcr,Director Building Division Thomas Perry,CBo Building Commissioner 200 Main Street, I lyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax- 509-790-6230 Property Owner Must Complete and Sign. This Section. If Using A Builder as Owner of the subject property hereby authorize �, �'ef l _ 6 t-L " to act oil my hehalf, in all matters relative lu work authorized hV rhis httiiding pe.nnit application (Address of Job) �0/3 Sig tore of Owner 17a.1c Print Name If Property Owner is applying for pertnit.please complete the Homeowners License Exemption Form on the reverse.side. :r C:1tI.cCnldecollik\AppUala\LocallMicrosoRlWindow.r•17'emporary Internet FileACvnlent,OutJook\DDVR7AA7.1PXPRESSAm Revised 072110 Town of Barnstable *Permit# 00(0 �} Expires 6 mi o the from issue date Regulatory Services Fee JW/� Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 DFEx 08-79 - jr EXPRESS PERMIT APPLICATION - RESIDENTI �' ® 1006 Not Valid without Red X-Press Imprint ®� b III BARNST�BLF Number—Mar/parcel 7� 7 Property Address lo- [ sidential Value of Wor Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address t C WJ��,j'3t T 1 Sf(?!rV VU1�' O z%t5 Contractor's Name /�/oC�A✓I`n /� 5`t��/Yst.(tiJ Telephone Number Home Improvement.Contractor License#(if applicable) I SD Oil Iq Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner &?I have Worker's Compensation Insurance Insurance Company Name -->t�'A j Workman's Comp;Policy# ?fir 5 —7A1��s 5-� P t,) Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ["Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign'Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents ;� �• r Office oflnvestigations 600 Washington Street Boston,MA 02111 www.Mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 2p City/State/Zip.2X— C,(�7 �yy 6U3 l Phone #:. — >S5_�3(lA Are you an employer? Check the appropriate bog: Type of proj ect(required): 1-❑ I am a employer with 4, ❑ I am a general contractor and I employees(full and/or part-time).*- - have hired the'sub-contractors 6. ❑New construction 2.YI am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling ship and have no employees ' These sub-contractors have 8. ❑Demolition working for me in any capacity, workers' comp.insurance, 9. ❑Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its requiied,] officers have exercised their 10.❑Electrical repairs or additions 3,❑ I am a homeowner doing all work right of exemption per MGL 11,0 Plumbing repairs or additions myself, [No workers' Comp, e. 152, §IN, and we have no 12.❑Roof repairs insurance required.] t employees, [No workers' comp.insurance required.] 13.�ther 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such, :Contradtors that check this box must attached an additional sheet showing the name of the sub-contractors and then workers'comp,policy information. am an employer that is providing workers compensation insurance for-my employees. Below is the policy and job site . nformation. nsurance Company Name: 'olicy#or Self-ins.Lic:#: Expiration Date: 'ob Site Address: City/State/Zip; attach a copy of the workers' compensation policy declaration page (showing the-policy number and expiration date). l ailure to.secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a ine up to$1,500,00 and/or ono-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the office.of nvestigations of the DIA for insurance coverage verification. •do hereby certi under the pai and penalties of perjury that the information provided above b true and correct li afore: 1 Date: Z� 2oeCo 'hone#: �, 353 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.BuiIding Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b. Other Contact Person: Phone#: -Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. - Firsuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a j oint enterprise,and including the Iegal representatives of a deceased employer,or the receiver or trustee of an individual•;partnership,association or other legal entity,employing employees.•However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." .MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance_with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any pf its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants ?lease fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necess.a y,supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s),of insurance. Limited Liability Companies(LLC)or.Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance, If an LLC or LLP does have employees,a policy.is required. Be advised that this affidavit may be submitted to.the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if youare required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of luvestigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that-must submit multiple permitllicense applications in any given year,need only submit one affidavit indicating current policy.information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number; The Co=mmalth of Massachusetts Departmtrnt o€lndwt rial A.ecidents Of riee of InveWgations 600 Washington Street Bostcb,IAA 02111 T�.l. #-617-727,4900-ext 40.6 or 1-977-MASSAFE Fax.#�f�l'�-727-'�749 Revised 5-26-OS wwwmass.govidia r { - rr • r �ofz►�t Town of Barnstable ° regulatory Services BARNSTABM ` Thomas F. Geller,Director - 9 MASS. `gyp,i6.19' ► Building Division fc rug+ Tom Perry,.Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-79076230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property ize hereby author to act on my behalf, in all matters relative to work authorized by this building permit application for: IV A (Address of Job) Signature of Owner Date Print Name Q:FORMS:oWNERPERM1SS10N THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) m DATA paga;soj ❑ ;uatu,Coldma lumauag [] ssa.appd 8698Dd-40/VO-NOS Q [Vasda •38usy3.ao1 uosea.t 31aeH•p.1e3 ulnlaa pun ssajppd aaepdn LE9Z0 VVY 'H31SAI 'db 1013VNV0 09 NOSNVMS M1111M ]13CIOVYDN 5? cwimina / KI1 1w.. ,MS 1118 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return s Board of Building Regulations and Standards Registration: 150919 One Ashburton Place Rm 1301 Expiration��`5l8/2008 Boston,Ma.02108 .Type DBA' N/BUILDING&'REMODELING WILLIAM SW SONS 50 CA D. Nov id ithout signature BREWSTER,MA 02631 Deputy Administrator t Town of Barnstable *Permit# ;9ODI?,Q�6g Expires 6 months from issue date RegulatoU Services XsP Fee 00 Thomas F.Geiler,Director PERMIT Building Division MAY 212006 Tom Perry,CBO, Building Commissioner 2006 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLE www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ( ' Not Valid wit/tout Red X-Press Imprint Map/parcel Number Z8 7 1 if Property Address Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address O C Contractor's Name Number , -�^ Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) bf!L � E�orkman's Compensation Insurance c { , Check one:. ❑ I am a sole proprietor ❑ I am the Homeowner y (2rI have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) [�Re-side ❑ Replacement Windows. U-Value (ma_ximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvem 'Contractors License is required. n SIGNATURE: Q:Forms:expmtrg Revise071405 Town of Barnstable �P °^ Regulatory Services t vMAss. $` Thomas F.Geller,Director 1639. Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 --- - ---�- -:__ _Property_Owner Must - Complete and Sign This Section. If Using A Builder as Owner of the subject property hereby authorize �ri ( G�-ci to act on my behalf, in all matters relative to work authorized by this building permit application for. J 'ad ra k -tS I�iv1' CY1 A 0---2(o y 7 (Address of Job) Signature cTmer ate aVLa • Ta Print NaE& Q TO RM S:O W NERPERMIS S ION 5 ' X__ I Flu ti(i r 1PG111!,15& ''115 Jl� 13 ulat ons and Standards oaxd o w. on Place - Room 1301 A�hU . Ong'° a{ 'Massachusetts 02108 B ent Contractor R provem F 140111 - Registration: 1509 ly e s �y `' Type: DBA Expiration: 5/8/200 w K.k BUI LpING & REM DELI ,�{ BILL SWANS NSON e � F� WILLIAM OR T p, 50 CAMEL A 0 631 Update Address and return card.Mark reason for change. BREWSTER, M Address Ej Renewal 0 Employment Lost Card DPS-CA1 0 50M-04/05-PC8698 i qr. v. i� o.n *i �r ER' _19 _ jy/ 6 FOUNDATION CERTIFICATION PLAN tAT 112 DISTRICT: RF-1 ZONING DATA Ap Zg� NUE EN SOLE SOURCE AQUIFER PROTECTION OVERLAY DISTRICT — MASS GIS FRS N1 AVE TtJ`t �sf'ss 1N15 Gp�ETGE�p 0, DESCRIPTION: REQUIRED: EXISTING: FOUNDATION AS—BUILT CNN ao K�605 PA p LOT AREA 43,560 S.F. 19,320 S.F. NO CHANGE NSF J DEED B g 4 RpPE 20.5 FT NO CHANGE LOT WIDTH LOT AGE 125 FT 20 FT 2187 FT NO CHANGE ND P FRONT YARD 30 FT 32.5 FT 31.9 FT SIDE YARD 15 FT 59.2 FT 56.9 FT REAR YARD 15 FT 11.6 FT 16.9 FT BUILDING HEIGHT 30 FT 25t FT N/A 1 FLOOD NOTE: BY GRAPHIC PLOTTING ONLY, THIS PROPERTY IS LOCATED IN ZONE Y OF THE FLOOD INSURANCE RATE MAP, AS SHOWN ON COMMUNITY MAP No. 25001 CO568J, WHICH BEARS AN EFFECTIVE DATE OF JULY 16, 2014, AND IS NOT IN A 1 p SPECIAL FLOOD HAZARD AREA CD co PREPARED FOR: I \ 1 25.0' \ JOHN do PAMELA SAIDNAWEY I GARAGE \ 11 ADAMS STREET FOUNDATION w \ BELMONT, MA 02478 obo \ N f 1.5' 2.8' z rr .9, 16.9' 10 15.1' 12.8 2.0' o y 1 0 m 1.3' N N D Z 71� J all AS—BUILT C� FOUNDATION 1. I Z o T.O.F.=30.9f J 1 1.5' oo #9 1.4 3.9' .4.0' I O 0 1� Z I Dorrnn L4 1 v W m O O Z Z Ico V w 23.0'1 8.4' 40.0' 1 cn 38.6' M z L - - - — — — — — — — — — — — — Jo ASSESSORS MAP 287 LOT I I I 19,320t S.F. OR 0.44± ACRES (LOT Z) (frid) 110.00 S10'50'37V 4 8 20 H Y A N N I S N PUBLIC — 40' WIDE N AVENUE DOU IAS . AABERG, P. .S. DATE 9 E DGE H I LL ROAD - HYANN I S, MA I certify that the foundation shown on this plan has been located on the ground and conforms to approved o DOUGLA3 design plans for the town of HYANNIS, MA with respect L. to horizontal dimensional requirements. AABERG NO. 35382 `• �q�'�F SS\ P'k • `` UR a v e LL ri 9 Engineers and Land Surveyors SCALE: 1 =20 427 COLUMBIA ROAD, HANOVER, MA 02339 / T. (781) 826-9200 DATE: 4 8/2020 26 UNION STREET, PLYMOUTH MA 02360 / T: (508) 746-6060 JOB N0: 19-271 r WWW.MERRILLINC.COM