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0106 KNOTTY PINE LANE
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I :v ti I !� ;' drs, b '.,. .I . r f r,n.,� � tY '^',,. w ,t#• ;,� . r f ,a; ��1 r,,,� r r ,;{, ric r�ti .,�t} r. r '' f� J q I,. ' .r_ ;f $, n'. .,� .M ,.. Sv,. .�.'4:i/ #tn.. ...:,' l:.., .t .1w ,,,.[ °b,: �t.. ,,r,rt.r ,H 4r. ri.. s, u c f r 007 (0 C12 1HE ro Town of Barnstable *Permit#� NAP ti� Expires 6 i nth om�e date Regulatory Services Fee r ti BARNSf @,a,ABLE, • "�+ q y mass. � k homas F. Geiler, Director / �AJFD MA'S ADO.,EB 2 � C 0 � O K 2.G G 9 �� 0,9 Building Division N OF BAR/V Tom Perry,CBO, Building Commissioner STABLE 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Maprparcel Number V� Property Address .104 Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owncr's Name& Address 4�A1i � C f Ufll ci2 Contractor's Name Telephone Number I lomc Improvement Contractor License#(if applicable) Construction Supervisor's License# (if applicable) ❑Workman's Compensation'lnsurance Check one: ❑ I am a sole proprietor M I am the Homeowner ❑ 1 have Worker's Compensation Insurance Insurance Company Name �/J /2 -.14 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/doors/sliders. U-Value (maximum .44) 4^AeWQ1t- G140t-40el -• *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. SIGMA"I'L'RE: (Y^\k-PI-II.kMI:0RMS\building permit forms\EXPRESS.doc Revised 100608 �A 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 Please Print Legibly Name(Business/Organization/Individual):_ _e,1A4,'Q 0#&U,4 lL2 Address: 77Y City/State/Zip: C&,,JZ5y2U L A44 Phone.#: 2 S c y90 Are you an employer?Check the appropriate box: Type of project(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 listed on the attached sheet 7. .❑Remodeling El I am a sole proprietor or partner- ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P t}'• � 9. El Building addition [No workers' comp.insurance comp. insurance. '10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3. I 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.❑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 subcontractors and state whether or not those entities have employees. If the subcontractors 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: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip: 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 tip 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 p ' sand penald of perjury that the information provided above is true and correct. Si ture. — Date: S Phone k 4- V5;�C2 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#: Information and Instructions �! Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant 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 foregoingg-engag to a joinven ipprisei.iM m&ludin`g:the legal representati deceased empio3�er,orthe- --:_._.. :: _----.. 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 be an 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 of 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 Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)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 you are 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 Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license 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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit crust 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 bum 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 TO. #617-727-4900 e:xt 406 or 1-977-MASSAFE Fax# 617-727-770 i.. Revised 11-22-06 www.mass.gov/dia GI _ Town of Barn-stable Regulatory Services • iaxxsres[.e, • r NAas �, Thomas F.Geiler,Director 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 ABuilder as Owner of the subject property hereby authorize, . to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FOR MS:OWNERPERMISSION m� Town of Barnstable - Regulatory Services atitrxsrwste, Thomas F.Geiler,Director MASS. �''°rfo amp Building Division Tom Perry,Building Commissioner _.._..... .________ ___.:._200Main=Street,—Hyannis,-MA026-01 vt'ww.town.b arnstable_ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: ,2 b.S/D!q JOB LOCATION: I(�Cv �n.d P,&e L•n J CG/V ��IC� number streets village •.HOMEOWNER':Q,_A 4IQ C lVzEEL 6 6:/ A � name home phone# work phone# CURRENT MAILING ADDRESS: I U'�v `n o 7T- rn�2-�U it/� 6y► � �a`C�3� city) wn state rip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned."homeowner"certifies that.he/she understands the.Town of Barnstable,Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and ents Sijnatizrc of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.I.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall ad as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of s supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed priori as it Would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her respmmbilities,many communities require,as part of the permit application, that the homeowner certify that helshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may can t amend and adopt such a formIcertification for use in your community. Q:forms:homeexempt Txr to�ye� TOWN OF BARNSTABLE Z DAD39TADL i r6 9• MASSACHUSETTS 1 Solid Fuel Stove Permit G r� P DATE OF APPLICATION ...... �rr�...:... ......�./..a�.�f-: ISSUING PERMIT ................ 7.............. �....... �� 1 A NAME (owner) Q1A'!-St....a ...............C.h.. .....!�'�1F .. NAME (Installer) 5 !111..C..�...... .1... ti ...SeliC- -� ftfi� Lyric ADDRESS ....I..�..C�........���.T.�`........ ...r..."..N....�=.......�........... ADDRESS .��...a�.::...�a...C?..X......��..C?...........1............�.�..........:....�,..................... STOVE TYPE f1/1... .........C'.:..15 CHIMNEY: NEW ........................ EXISTING ; Manufacturer o........................................................................... CHIMNEY: Masonry .. `` .............................. ............... S� Mass. Approval ............................................................................................................... CHIMNEY: Metal ................................................................................................... This is to certify that the above installer has permission to install a solid fuel burning appliance at the listed address in accordance with an application on file with the .............................................................................................. �P* and subject` to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made under the authority thereof. Issued By: / ...:. .(�'S.�.....................Title .....9L14 ........ :V S.................... Date .. 1..... ..... /— Permit to install expires 60 days after issue date Stove Ll�i S ,el... e"' / 0 G�G. .............................................................. . ................................................................ '..y................ .. , .... "', Stove Clearance c5�t�+� f© G�� ... ............ ...................r/......................... ............................................ .. ..... Floor �...?...............................................................:................................................................................................................................................. SmokePipe ................................................................1P.L.14............................................................................................................................................................................................................ SmokePipe Clearance .......................................... ......�.............................................................................................................................................................................................. Chimney "14 s®�d'y SmokeDetector .....................................:....................... .e 5.................................................................................................................................................................................................... The undersigned hereby certifies that the installation of solid fuel burning stove and equipment made under au- thority of permit dated ...................................................... has been made in accordance with provisions of the Commonwealth of Massachusetts State Building Code now currently in effect and pertaining thereto ........................................................................ Installer /��°�� By:. J /:v�...............Z...`........... �.Title: .....INSTALLATION APPROVED .....................................(.... ...... ...... -��� ............... date WHITE: FIRE DEPARTMENT - CANARY: BUILDING INSPECTOR - PINK: APPLICANT d O Assessor's map and lof'`number .. x ' SEPTIC SYSTEM MUST BE 4 Ir4STALLED IN COMPLIANCE Sewage Permit number /1•r••• I R •• � WITH ARTICLE I! STATE' . t!t ' :? y ,. SANITARY CODE AND T01�fN . . ofYNETo� TOWN ' -OF .BARNS I` �eALB le N C Z MRSTALLE Omum �Ye�� k BUILDING } INSPECTOR APPLICATION FOR:PERMIT TO J......... ...................... ........................... . ...... .......................... TYPE 'OF•CONSTRUCTION ..............�n ........ ..................... ....................... ............................... t ................................................19..�.. TO_THE INSPECTOR OF BUILDINGS:, The undersigneed� hereby applies for a permit according to the following information: Location ...r(=.,!"1...�Z l!. .<1b....................:....................................................................................................:..................... ProposedUse �� �................................................................................................................................................ ZoningDistrict ....::.... ............................/..............................Fire District .................................................I.............................. Name of Owner �0/N �... .... ,('1. � 1/.G :...Address ..l��P.:...14/! ®� .... lfY ......!�/?.�. ..... Name of Builder /V/Y�/�/ d� �/� 27 /'/l 4. .V2. Gv �/�/� �vW// :. ............... ... .......................Address ................ : ....:.................................. �'?.. .... Nameof Architect ..................................................................Address. .................................................................................... Numberof Rooms ..................................................................Foundation ......................................................:. ....................... Exlerior` ......................:..............................:..............................Roofing .......("'. 1��T.L�................................................ Floors CF/yl G�/dT ........................Interior Heating ..................................................................................Plumbing ................................................................................... �I%D d 0.p o Fireplace ....Approximate Cost ..............................................: 19_____--. Area Definitive Plan Approved by Planning Board ____________________________ ...... .'�a.o... � ........... Diagram of Lot and Building with Dimensions / Fee ...... ...................... SUBJECT TO APPROVAL. OF BOARD OF HEALTH 1 hereby agree to•conform to all the Rules and Regulations of the Town of Barns re r ing the ve ` construction. Name ............ ............ Chevalier, Ronald N. 18682'- '�:`". `.. Permit for garage No ............... .................................... - ......................................................... ..................... e. a - `. 106 Knotty One Lane Location ...........ti.................................................... UMM Centerville - ............................................................................... Ronald N. Chevalier r Owner ..................................................... .. ., frame Type of Construction '........................................... ,. Plot ............................. Lot ................................ ' September 21 Permit Granted ...................................... .19 76. " Date of Inspection .......... ...................... :..19 .n Date Completed ..`.�. .........19 PERMIT REFUSED = ......................................................:...... ..................... •........................... ................... .................................... ..................................... r{ f w ........................... .................................... ........ rr - Approved ................................................ 19 Assessor's ma and lot.-number ..........................................r ? � p r < < Sewage Permit number ..................:...:...._........ ..v �FTNETD�y TOWN OF 'BARNSTABLE Ii BAHBSTABLE, i M6 9 ,e��a BUILDING . INSPECTOR • ��0 war ' ' APPLICATION FOR PERMIT TO .......:....... .' t� t . " TYPE OF CONSTRUCTION ........................................................................................................... ............................. ..............19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........................................................................................................................................................................................ ProposedUse ............................................................................................................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ...a A/............... GAR /......Address ..fi r...... ./l.1 T ..... /.7.i=......L'/............. Name of Builder .��.......:.�7.......L f'P L.�a.......Address �1..7....'.f.�: (/� �� fJir' F ✓ . . .,r(.:.�.`. ...�... ......... ............................................... Nameof Architect ..................................................................Address ..................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior Roofing !� .............................................. ................ ............................................................. Floors �' ��' ��'�� .........Interior Heating ..................................................................................Plumbing .................................................................................. Fireplace Approximate Cost .........'.l.-.v v " e .................................................................................. ................................................... Definitive Plan Approved by Planning Board --------------------------------19--------. , Area !i..n.::'.17............. Diagram of Lot and Building with Dimensions Fee .....� .. :r� SUBJECT TO APPROVAL OF BOARD OF HEALTH I r r r-- I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r Name ....... ... ..................................................... ......... Chevalier, Ronald N. A=191~97 ` l86Q2 No ------ Permit for ....��Fa.g.e.................. - � . ----'--.--^-----r----------''' �»� 106 �ine ' Centerville� ' ............. . . . . Ronald � ^ ~~..~ � Type or Consnucn ^ ' ' � ^ ..................................... ..... Plot . Lptember Permit Granted~ ` 19 ' . -_- of --,--_. ------ Pate Completed ' ' PERMIT 14EFUSED , ` . ` ~ ,�� � ........................ ............................. ....................... . '----''^^~' -------^-^----^' .-.----.-. .-.-...-..-----~... � . � A ................................................. 19 ^ ---------------~--------.-- - ---- .............................................................. | °FT"Er°�� TOWN OF BARNSTABLE BAHHSTAIILE, 9° "° 9 awr a' BUILDING INSPEC TOR� cf'D`ts ors - APPLICATION FOR PERMIT TO ... ..1 ......... .......Zl, ...... ................................................ .... TYPE OF CONSTRUCTION .. �� .. ...... ..... .... . ............ ......... :... .......:. .. . ...... .......................................... .19........ .. TO THE INSPECTOR OF BUILDINGS: ; ! The undersigned hereby applies for a permit according to the following information: Location .. .Q../.. ` �n0 hCYin-/ �,� .�......... ��� ' .... ....`.......+................ .art...... + !v?r .......... ..................................... Proposed Use ..... ... .... . .. . ....... !.....,.... ........... .... . . ... C.0 Zoning District v............. ,� ...........................................................Fire District .. ... ... . .............. .. ....."''..:�!� ............ Name of Owner ..�..6.6.7.................................................Address ..... .....`:�.....� +.......�/� .... .............. Name of Builder .." ..................................................Address Nameof Architect ..((,/.�!�`. ..............................................Address ............:....................................................................... Number of Rooms ..........:�A ...Foundation ....#4i`°t-� Exterior ................. .... � Roofing /�•'� .n... ..... Floors '.. .....................................................................Interior ....Z:.� ���/ / ............................ Heating .. ....... .......... ../.`3...�.................Plumbing ..........:.. .................................................................... Fireplace ..........??.........................................................•......... .....Approximate Cost .............� o ........................... Difinitive Plan Approved by Planning Board _______________________________19_,______ . .0 Diagram of Lot and Building with Dimensions /3 1� r! w w LL r . O J m < � �� wow , y yS� o� � `n = � U)~ mow "—' `� z t J,w _ Loq (II o0� Q z cr, Cif Cr Uj O Z z Q a. o Ni s �A I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..411JR Dacey, William E. pEC 3.1 ' 70 No ...�3224... Permit for .two..storyl............. single family dwelling ............................................. ............................. (o Knott P1ne Lane Location ��............... '..... ..................................... Centerville ............................................................................... Owner William E. D. .cey Type of Construction frame .......................................... ................................................................................ Plot ............................ Lot ......... 8............... Permit Granted .......jay..14.................19 70 • 1 Date of Inspection-..��� .. :1.9 .70 Date Completed ......................................19 PERMIT REFUSED, 1 . ................................................................ 19 ............................................................................... I ............................................................................... t ............................................................................... Approved ................................................. 19 ............................................................................... , i ............................................................................... }