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Home My WebLink About0253 GREEN DUNES DRIVE �. � .. �x .�, _ � o .. e r. , � , ,. �. ,� ti ' r .. _ .. ,: ,� - �,,. ,. ;, q�... a. _. ,. .. .. - � '. za o ri - � ,. a ... �� .. ,6 t - .. � '� Y 4 �. �- p.a, ..,. __ '... x� �; � .-. �.. .. ,. � '� a .,; -.. - - .. .. _. ..- u. - � �. ,.� _. , _ e n� �. ' oWn of Barnstable 'Perm t Expires 6 months from issue date Regulatory Services Fee -7(e ' ) Thomas F.Geiler,Director �. Building Division yf I�lol/ 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 PERMIT APPLICATION,— RESIDENTIAL ONLY. T. Not Valid without Red X-Press Imprint a 5 o5J Map/parcel Number -- = --= - Property Address a�� r�� ptCi ['Residential Value of Work (fir O00 Minimum fee of S25.00 for work unde'r.S6000.00. .. Owner's Name&Address ma now ' �53 6ae4n- t bans "'A kn l'S Fd C�� .d'�cY-1 l I V ey. &i� tN(, .Telephone Number Contractor's Name � . Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable).—�5 <. NKorkman's Compensation Insurance .p , S ', a Check one: ,. .., ❑ tarn a sole proprietor, APR 2010 ❑ I am the Homeowner ; [U�I have Worker's Compensation Insurance bW �� BAkNSTABLe Insurance Company Name , 1 ►`��% 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 _ [7 Ke-roof(not stripping. Going over existing layers of roof) [/Re-side [Replacement Wuidows/doo sliders. -Value t ma_ximuri144) *Where required: Issuance of this permit does not exempt compliance with other town department regulations i.e.Historic,Conservation etc ***Note: Property,OwnermustsignPropertyOwner'Letter':ofPermission. c y of the Hoine.Improvement Contractors License is required. SIGNATURE: . Q:Fanns:expmtrg f Revise061306 I : 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 Information L r Please Print Legibly v Name (Business/Organization/Individual): r•J. y Q Y_/ /w c If>�/ 1 GIB/fir /`f(f . Address: G -- City/State/Zip: QIL fu 5 /77l9 02&0 / Phone #: (5-02) 1711 • t l Are yyoou an employer? eck the appropriate box: Type of project(required): 1.IJ I am a employer with a0 4. ❑ I am a general contractor and I * have hired the sub-contractors 6 ❑New construction employees(full and/or part-time). . 2.❑ l am a sole proprietor or partner- listed on the attached sheet. 7. [jRemodeling 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.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing.repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other .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.' tContractors 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; M 72KROAr I& s co Policy#or Self-ins.Lic.#: . 9< 01009 Expiration Date: Job Site Address: OIZZI3 � n sjewFt�S Ci /State/Zi �S ri p: W �a nru Po r'f' Attach a copy of the workers':compensation policy declaration page(showing the policy number and expiration date). 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 the pains and penalties of perjury that the information provided above is true and correc4 Si ature: Date: 2>130116 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: A•COfeD„ CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYY) 01/20/2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HART INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 243 MAIN STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO,BOX 700 BUZZARDS BAY,MA 02532-0700 INSURERS AFFORDING COVERAGE NAIC# INSURED EJ Jaxbmer Builder,Inc INSURER A: ARBELLA PROTECTION INS CO 41360 48 Rosary Lane INSURER B. ARBELLA PROTECTION INS CO 41360 Hyannis,MA 02601 INSURER c: ARBELLA PROTECTION INS CO 41360 INSURER D: ARBELLA PROTECTION INS CO 141360 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 CLAW. NSR ADDL POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIODATE IMMODOrfYiNLIL am TYPE OF INSURANCE _ A GENERALLIABILJTY 8500042039 01/01/10 01/01111 EACH OCCURRENCE S 1.000.000 COMMERCIAL GENERAL LIABILITY PREMISES Ea oxutance S 300 000 CLAIMS MADE ®OCCUR - - MED EXP(Any one person) $ 5,000 PERSONAL&AOV INJURY $ 1 ODO OOO GENERAL AGGREGATE S 2,000,000 GEN•L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2.000.000 POLICY PRO• LOC JECT B AUTOMOBILE LIABILITY. 21662400004 01/01/10 01/01/11 COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accident) X ALL OWNED AUTOS - BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS - - BODILY INJURY S . NON-OWNED AUTOS (Per accident)- PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY ,. AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S (� EXCESSIUMBRELLALIABILITY 4600042040 - 01/01/10, -01/01/11 EACH OCCURRENCE $ 2,000,000 X OCCUR M CLAIMS MADE _ _ - AGGREGATE S E DEDUCTIBLE - S RETENTION S S WORKERS COMPENSATION AND 9111010109. ' 01/01110 .01/01/11 C w STATU- 'Fg' - EMPLOYERS'LIABILITY - - ANY PROPRIETOR/PARTNER/EXECUTNE - - E.L.EACH ACCIDENT S 500 000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S'-- 500.000 if Yes.deacrdre I'der - SPECIAL PROVISIONS Dabw E.L.DISEASE•POLICY LIMB S 500 OOO OTHER RIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town Of BarnstableDATE THEREOF,THE ISSUINGINSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 2OO Maul 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 REP ORD 26(2001108) 0 ACORD CORPORATION 1988. g g License or registration valid for indiv ,per ✓fze �ar,vnzonu�eall`i a��/laaaaclu�aet(a' �\ Board of Building Re ulati6ns and Standards idul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: �< Board of Building Regulations and Standards Registrataom 110609 One Ashburton Place Rm 1301 Expiration 111/3/2010 Tr# 276582 Boston,Ma.02108 Type Pate Corporation E J JAXTIMER 8011-DER'INC' . I t k ERNEST JAXTIMER-= _ 48 ROSARY LN HYANNIS,MA 02601 - Administrator t valid wit out signature Massachusetts- DeNartment oC Public SufetN UVBoard of Building Regulations and Standards n y Construction.Supervisor License s License CS 3251 r s Restncted to: 00 - 4 �ERNEST J "JAXTIMER _ I a-48 ROSARY LANE. ?HYANNISMA`02601` Expiration: 1/14/2012 Conunissioner Tr#: 131.22 THErq Town of Barnstable Y Reg ulatoServices r « « snxxsrwsr..e, « r Mwe $ Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner' 200 Main Street,Hyannis,MA 02601 www.towmbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Properly Owner Must Complete and Sign This Section If Using ABuilder .r as Owner of the ro subject e l property riY hereby autho E�. dvt m,P''. B( (d f—, ( to act on my behalf, 4 in all matters relative to work authorized by this building permit'application for: DUACZ (Address of Job) Signature gofer Date Print Name If Property Owner is applying for permit please complete the . Homeowners License Exemption Form on the reverse side. Q:FORMS 0VtWERPERMISSION f v Town of Barns k S ° °FTME Tph� ARNSTABLE Regulatory Services g Y Thomas F.Geiler,Dir�t9� 't�2r MAY 10 PM 2: 50 * BARNSTABLE, MASS.9� ; ��$ Building Division pjFD MP'�A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 026CR I V I S I O N — Office: 508-862-4038 Fax: 508-790-6230 a � � PERMIT#. �✓ 76 FEE: $ SHED REGISTRATION 120 square feet or less Location of shed(address) Village f Property owner's name Telephone number Size of Shed Map/Parcel# 6 l0 O Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? /� C Conservation Commission(signature required) f � PLEASE NOTE: IF YOU ARE WITHIN 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 FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 P�0*1HE r Town of Barnstable Department of Health,Safety,and Environmental Services BARYSTABIX ' MASS. s63q•. Conservation Division �0 ATF°r^p� 367 Main Street,Hyannis MA 02601 Office: 503-862-4093 Robert W.Gate%vood FAX: 508-790-6230 Conservation Administrator MINOR ACTIVITY REGISTRATION 6-1 Property Owner Telephone number Mailing address (� Project location Map/Parcel# X Project description The following minor activities will reviewed,under Art.27,by Conservation staff instead of the Conservation Commission,as long as they are constructed at least 60' from a wetland resource area or top of a coastal bank. * Pathways 4' in width * Fencing that does not create a barrier to wildlife movement, 6"above grade * Conversion of lawns to decks,sheds,patios that are accessory to single family homes,as long as: -house existed prior to August 7, 1996 - alteration within the buffer zone is less then 250 sq. feet. -sedimentation and erosion controls are used during construction * Stonewalls(this does not include stonewalls for retaining wall purposes, grading and/or fill) Signature Date 611 C_ Reviewed by Date XGIS Plan Attached(fee charged for plan) minoract.doc �.� o y � 4i f STANDARD LEGEND - ,.� A !41 ir'x f$1.t f F tV ;.. ' Y F ! ..tF t k.: ( ,'r, k L is fr eyl li y i 'r"•t''. —^// 7 NOTE:not all symbols will appear on a map L / F t 2 GOLF COURSE FAIRWAY -c+ { EDGE OF DECIDUOUS TREES 2 1(ik t r r 1 tz r 14 t! -ls i` it€ r R t r' Pk, i .P1 tV `'• EDGE OF BRUSH Int 1z y a e ORCHARD OR NURSERY rat Vf �1 1 It k t 1 *d � P V-V-v-P EDGE OF CONIFEROUS TREES ks Pr h3 MARSH AREA EDGE OF WATER DIRT ROAD t ;.'s �,d,. ^" DRIVEWAY - } 'ttk�" PARKING LOT j,. 7 t s < k ) X a- tit tt i A z� 6� u,� PAVED ROAD a it ? DRAINAGE DITCH PATH/TRAIL PARCEL LINE** IAAP 110 E----MAP#' 21 F—PARCEL NUMBER #1e60—HOUSE NUMBER 2 FOOT CONTOUR LINE t rs 10 FOOT CONTOUR LINE Elevation based on NGVD29 SPOT ELEVATION 4 st STONE WALL \\ > 1 -X—X- FENCE RETAININGWALL RAIL ROAD TRACK STONE JETTY. SWIMMING POOL. PORCH%DECK F BUILDING/STRUCTURE HAP DOCK/PIER HYDRANT t r� r s aF a VALVE O MANHOLE POST Qp'' FLAGPOLE T O W N O F B A R N S T A B L E 0 E 0 0 R A P H I C 1 N F O R M A T 1 O N S Y S T E M S U N I T p SIGN ®. STORM DRAIN !r w PRINTED XME IN FEET *NOTE:This map a on enlargement of a **NOTE:The parcel B�me only graphic representation DATA SOURCES:Plonimetria(man-made features)were interpreted from 1995 aerial photographs by The James p TOWER il 1'=IW sale map and may NOT meet of property boundaries.They are not true location,and W.Sewall Company.Topography and vegetation were interpreted from 1989 Oermi phat"mphs by GEOD � UTILITY POLE 0 20 =40 National Map Acmmcy Standards at this do not represent actual relationships to physical obWft Corporation. Pianimetriq topography,and vegetation were mapped 1 0 mat National MapZoo'Standmds : t INCH=40 FEET* enlarged sale. on the map. at o sale of 1"=100'.Parcel lines were digitized from FY2002 Town of BOmctable Assessors tmc maps ¢ LIGHT POLE O. ELLCfRK BOJL f:ldglMoonservation.dgn 05/10/02 02:48:19 PM