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0021 KNOTTY PINE LANE
.. . �� �� � ;, �_. �. w _� � � . _ } ' _s _ ., °" I r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application .4 Health Division Date Issued /'Z_7 1(0 Conservation Division Application Fee Planning Dept. Permit Fee . Date Definitive Plan Approved by Planning Board ; Historic - OKH _ Preservation/ Hyannis Project Street Address Village ;,: Owner�, i�i _ l� y�� Address—T 4 ' Telephone Z)J Permit Request � � Square feet: 1 st floor: existing proposed 2nd floor: existing proposed_ Total new Zoning District Flood Plain Groundwater Overlay Project Valuation O Construction Type_ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family )S` Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ,&No On Old King's Highway: ❑Yes SO-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: y, r s Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ BUILDING DEPT Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use DEC 02 2016 - Tnuuni(11: . a APPLICANT INFORMATION (BUILDER OR HOMEOWNER) F� Name /' ��? Gn i rl� Telephone Number 07� 1 - Address Jt 2wmazezo G'o License# Home Improvement Contractor# / s'3 Email L0,6, Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO a4e& e SIGNATURE DATE / FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL I FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. i t The Con `athonwealth Of Massa chusetts Department of In(luslrz(ll Accidents a 1 Congress Street, Suite 100 Boston, MA 02114-2017 4 ww,mass,gov/(lire VVw—kersl Compensation Insurance Affidavit, Builders/Contractors/Electricians/Plumbers, Applicant Informati on TO BE FILED WITH THE PERMITTING AUTHORITY, ' Please Lc iblt Name(Business/Organization/Individual); . _ Prin� . Address:_/_ City/State/Zip: .", e 2 Phone #; Are you an employer? C eck the appropriate box; _ I.C�-1 am a employer withemployees(f Type of project (required):ull and/or part.time),' 2.�l am a sole proprietor or partnership and have no employees working for me in 7' ❑ New construction any capacity.(No workers'comp. insurance required.) 8."Fl Remodeling 101 am a homeowner doing all work myself. (No workers'comp. insurance required.)t 9. ❑ Demolition i i 4. 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 [] Building addition ensure that all contractors either have workers'compensation insurance or are sole i proprietors with no employees: I I,[] Electrical repairs or additions S.Q 1 am a general contractor and l have hired the subcontractors listed on the attached sheet, 12.Q Plumbing repairs or additions These subcontractors have employees and have workers'comp, insurance.t 13.aRoof repairs 6.[]We are a corporal'on and its officers have exercised their right of exemption per MGL Q. 14'([9 152,§1(4),and we have no employees.(No workers'comp,insurance required,) ,Other_ Any applicant that check box NI must also fill out the section below showing Chair workers'com eenaaIIon policy information, r Homeowners who submiP4his affidavit indicating they are doing all work and then hire outside contractors must-submit a now affidavit indicating such.T' 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, l am an employer that is provlrling workers' compensation insurance for my employees. Below is the policy and 'ob site information. Insurance Company Name: �2 Policy#or Self ins. Lic. #; , Expiration Date:. Job Site Address:� / - I� - ity/sta� Attaclra copy of the workers' compensatlon policy declaration page (showing the Policy number-and expiration atio. P n d�tc). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of u to 7. day against the violator. A copy o�'.,this statement may be forwarded to the Office of Investigations of the p $ 5a ce coverage verification. QIA for insurance I rlo hereby certify under the pains and pertaltles of per City that the lnformation provided abov ' e lS true and correct, Signature: i Phone#: S� Dat Z 4 Official use only, Do,Aot write In this area, to be completed by city or town official City or Town: Permit/License # Issuiag Authority (circle oat;); 1, Board of Health 2, Building Department 3. City/Town Clerk 4, Electrical Inspector S, Plumbing Inspector 6, Other p Contact Person; Phone#; �--- �. Massachusetts Department of Public Safety Board of Building Regulatlons and Standards License: CS•100988 Construction Supervisor. HENRY E CASSIDY. I. 8 SHED ROW4.1N WEST YARMOU-YH `�L` +�.�i rl1' ;: clq Explration: Commissioner 11/1112017 � j Office of Consumer Affairs and Business Regulation 10 Park Plaza ' Suite 5170 Boston, Maab usetts 02116 Home Improvemer3 - @-,tractor Registration �� Type: Corporation tin ' �T Registration: 153567 wN -_ Cape Cod Insulation, Inc Expiration: 12/14/2018 18 Reardon Circle So. Yarmouth, MA 02664 Al,/ r Sv/Z Update Address and return card. Mark reason for change. 3CA 1 0 2OM-05/11 -.._—.------- --------- --..----- --- L� A� -, s n - de%7"twuoeatl,olbAwdacliaaetta P 4y Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only ,h Type, Corporation before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation =_== "Registration Ex iron 9 — 10 Park Plaza•Suite 5170 � 1E�P- 12/14/2018 yik Boston MA 02116 Cape Cod Insulat`_J Henry Cassidy`�A7 F 18 Reardon So.Yarmouth, - '' Undersecretary Not valid without signature f CAPECOD-27 DEATON CERTIFICATE OF LIABILITY INSURANCE . 7/2 / "Y' /292012016 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 poiicy(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 CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 c o E A/c No:(877)816-2156 South Dennis,MA 02660 nI DRess:mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company INSURED I NSURER 9:SafetyInsurance Company 39454 Cape Cod Insulation,Inc. INSURER c:Endurance American Specialty Insurance Company 41718 18 Reardon.Circle INSURER D:Atlantic Charter Insurance Complain 44326 South Yarmouth,MA 02664 INSURER E: INSURER F: 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. INSR I ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FRI OCCUR CBP8263063 04/01/2016 04/0112017 DAMAGE TO PREMISES RENT rrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY D PRO � JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B ANY AUTO 6232707COM01 04/01/2016 04/01/2017 BODILY INJURY(Per person) $ ALL OWNED AUTOS AUTOS M SCHEDULEDBODILY INJURY(Per accident) $ X HIREDAUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 C EXCESS LIAB CLAIMS-MADE EXCI0006635001 04/01/2016 04/01/2017 AGGREGATE $ DED I X I RETENTION$ 10,000 Aggregate $ 2,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE WCE00431902 06130/2016 06/30/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED9 NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,600,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CLEAResult,Eversource and National Grid are listed as Additional Insureds on this policy on a primary,non-contributory basis. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED-REPPRIESSEENTATIVE ©1988-2014 ACORD CORPORATION. All rinhtsn racarvad Housing ,assistance --- cape cod HOME OWNER WEAaTHERIZA710N WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. I hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation ( herein after referred as "Agency" ) on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping & caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the "Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement as .listed and freely give my consent. Home Owner: (Signature) LLAI Date: F j Agent: (signature) a - Date: Assessor's map and lot number, ' To • w of Swage^ Permit number ' .. . ........... { �' d``P�� ..�y°ft * i i. = 33AUSTADLE, i House number .............................. ..................... .... .......... 9� mum O t639. 6� ; o MAY a` 'ON ®E `�BARNSTABLE �, BUKDIHG ` INSPECTOR .` . APPLICATION FOR PERMIT TO .. ®.:? 7.a'c]� `�' . .' TYPE OF CONSTRUCTION ... CtnQ..all ..........a..: ............................19. ar . TO THE INSPECTOR OF BUILDINGS: The' undersigned hereby applies for a permit according to the following information: Location ....9�/...`Z!V .t1�y F'e L , L 7,r✓��c ................................................. . .. ................. . ......... .... ...................................................................... ProposedUse ... ��?.��N,.. .�!Q. ........... .................................................................................................I......................... Zoning District ...........12............... .........Fire District ....r1n0. iJS�zr�..'� .� .:......................... Nameof Owner ........ .Address .........6Y! e.................................................................... � f / ti SName of .........Address ..... ... ..•.................. Nameof Architect ............. 4.......................................Address .....................:.............................................................. Number of. Rooms / ..Foundation ...�U Av(ecl C°on,e ...................nn...``....................................... ........................................................ Exterior ... !7.� 5.. ....�l.F.!?�^ f ��' (�1�`1 5.... Roofing ...... ...x...........j............................................................ Floors wva ...Interior .<�f. ................................................................................... ............... ............................................................. l Heating o�XlO !6 D .C. Plumbing ......./v�./..!¢....:.............................................. . Fireplace .:......, ............................................................Approximate Cost ....0....v v..`............................... .... Definitive Plan Approved by Planning Board ________________________________19________: Area S` , Diagram of `Lot and Building with Dimensions Fee G} / ............................. F ! SUBJECT TO.APPROVAL OF BOARD OF HEALTH 7 1 / �4n V t Q), t ' r O 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 ....1/�..L..t.... � - ............. Richards, Mr. & Mrs. F. t No .. 3801 Permit for ...••add to dwelling &' remodel •garage to family room.......... t Location 21 Knotty...Pine Lane ..... .,Centerville. F...... .......... Owner Mr . & Mrs FRichards.. ................................................. " Typetof Construction ..frame ................. . .. ............................... . . ..... ... .......... . Io Plot ... ............. ...... Lot ............................... Permit Granted February 9 19 82 • ,. Date of Inspectiory`??.:';-9 . ................... 19 _k '• Date Completed �p..n .. . .. : ..Y;19 1-7 r v., Assessor's map and lot number ,.., .... ./. i .. ........ THE waV Permit number ..............!..:+ i� BAHHSTADLE. • House number ....................... ..................f.:.......................'�..- , 90 mum ��. po,1639: \00 �Ea VAR,*. TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... �•�r,.�. / gr47 ........ TYPE OF CONSTRUCTION ...M e� � .... .� !??Z. !?:�5...... /uT .......................................................... .......... ..:. ............................19 Via.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...!V.. �t1r�f �....A: N.`.. �........F.r,q-ki✓ l�t................................................................ r' !! ProposedUse .. J��?.. �?'�...�?r!`..?c :...............................................................................................................I......................... 12 ZoningDistrict ..................................+......................................Fire District ........................................................................... q ,�� ff Name of Owner ,0.? ! ntvS lC.;A $r)4............Address �+ P .................... ............ .................................................................................... Name of Builder" m .: ?yt� -,` c, s..........Address a ...:"Alr`J..!�..�v`'t /`......!? :...� a.AtaN:s..:.................. Q J' Nameof Architect .............. / ..:....................................Address .................................................................................... Number of Rooms .Foundation 10 Au!"d Exierior ..�Y!??pn (��'I� - xf lU !.:................................Roofing ..............sr..................................................................... Floors .Interior?�s.f3'.{............................................................. ............1'C'U. ........................................................ Heating o7x/C? 1G... �:.�...............................................Plumbing ..........i.-. I Fireplace ..................Approximate Cost o2: v v Definitive Plan Approved by Planning Board ---------------____-----------19________. Area / Diagram of Lot and Building with Dimensions Fee ............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 19711 f,51 I�p 1-4 d - - - - Qe �f : s 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. /; f Name ... �1�...` .c YJ; /„ Sri .. ................... f� Richards, Mr. & Mrs. F. A=191-22 No ..23801 80? ... Permit for add to dwelling & "remodel garage to family room . ............................................................................... Location ........21. .. ... .. Knotty Pine Lane................ .. ............. ........ ......... Centerville ............................................................................... Owner ......Mr• & Mrs. F. Richards ........................................................... Type of Construction frame ................................................................................ Plot ........................ Lot ................................ I Permit Granted February 9 82 .......................................19 Date of Inspection ....................................19 Date Completed ......................................19 I 0/o 6ree441.e dog a?/oo 0 ►-)e.er�q�zra�le Q�ofTHEro�� TOWN OF BAR.NSTABLE f0� ti O� • BARNSTABLE, i ° aMYa�e�� BUILDING INSPECTOR APPLICATION FOR PERMIT TO Construct newhome TYPE OF CONSTRUCTION ....S�.ng1e..�a.m ..1 r.. ,rGod.. s.ar ...c�:uella rig........................................................ Novembr................................................19...69. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Lot.12...Kn.Q.ti4Y....P.ipe..Laneo... enterville. ...P2assachusetts....................................................................... Sin le Earn 1 tivood frame dwellin Proposed Use ......... dwelli��g..................................................................................... ................................................................................................. Zoning District . --1........................................................Fire District ..Centerville,,,- Osterville Name of Owner ..... A�LD ✓2�(�,�.rr� . `.. Address .................................................................................... Name of Builder . Z�t'�ED ...................................................................Address .......................:......................................................... ... Nameof Architect ....E �1. ...........................................Address :................................................................................... Number of Rooms Foundation .....1011 Poured concrete wall .... ............................................................ ...................... Exterior ....IA.Thite...redar...shingles....................................Roofing ..P;sphalt spangles............................................... Oak - 2'; sheet rock Floors ......................................................................................Interior .................................................................................... Heating Oas — l treed warm air Plumbing, .,,1-opper Fireplace ..............................Approximate Cost ......t19.a 000.................................... Difinitive Plan Approved by Planning Board ________________________________19________ . Diagram of Lot and Building with Dimensions f3Lu se (D _-iLd Ao Z co U) J D I C-r' � p° > W My O QD < _ LL Ld CL O to >-LJj Ld LA ,.A W o < < w ¢ /6 Z U 0 n, CLQ w CC d SU 1— Q ► ~ < Q hereby agree to conform to all the Rules and Regulations of the o Barnstable regarding the lbove construction. Nam .. ...... :....... Dacey, William E. ® C 3 19710 n No ,,,12740._. Permit for ..........one stor t single family dwelling.................. ........................................................... .. Location ;R 1 Knotty Pine Lane Centerville ............................................................................... Owner ........... illiam E. Dacey..................... .................. Type of Construction ......frame ................................................................................ IL Plot II ............................ Lot ............:................... Permit Granted ......November 13..........19 69 .............. Date of Inspection .. �` .. ... .........19 s Date Completed ......................................19 PERMIT REFUSED ........................................................ .... 19 ................................................................................ ............................................................................... ............................................................................... Approved .,,............................................. 19 ............................................................................... ............................................................................... . :gam .. .�: ,,,, , _ .,�•, , � : r , .y i, • i 5. y , r r f , .. .. ,ern..-�w•wvv�.--rt....v+.�W»... .�w.-...,....srx6,. ....... -w.:...... ..i>.,.,.:.w. ,«..p .,:. a • • , tlov Aw go t e , a w , s , 1 . i r • , IN f 6 S` �f1 " 4'T QOC 1 p _., . , i , , 3 'a ,., � �- pp,.•� ;w. ,.«.«... �--�. �r� 5� �TJ.:�C.wd� .- �'i.# ��'r G S { AM ILL t 41014, 0,E rC ` a . A u