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Home My WebLink About0155 KNOTTY PINE LANE Tq TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map• ��l Parcel Permit# l r Health Division Date Issued Conservation Division Fee Tax Collect Treasurer Planning De Date Definitive Plan Approved by Planning Board Historic-OKH' Preservation/Hyannis Project Street Address �� fr o f�� 1P Lr p`a i;rl e! Village ( eP4 )1_4I'd 4o, , Owner f v�v� T -e�faws Address J S Y'�,Ow Telephone ;2;7-5 � Permit Request 1.2e —51Wir�� U� f 9 ��/ r �� Square feet: 1st floor: existing . proposed 2nd floor: existing proposed Total new Estimated Project Cost !!''OU Zoning District Flood Plain Groundwater Overlay Construction Type { Lot Size Grandfathered: ❑Yes .❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No -V 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: Zoning Board of Appeals Authorization ❑ Appeal#- Recorded❑ Commercial ❑Yes . ❑No If yes;site plan review#. Current Use Proposed Use BUILDER INFORMATION Name �!ti'�2 Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO- 0 4 SIGNATURE DATE • ;.. FOR OFFICIAL-USE ONLY. < • j PERMIT NO. - DATE ISSUED r MAP/PARCEL NO. -ADDRESS ,. J'� VILLAGE OWNER' DATE OF INSPECTIO FOUNDATION rfi r T FRAME 'Y INSULATION '-., •_ r � � .T " � `. .. ', `• ; r, FIREPLACE ELECTRICAL: =ROUGH : FINAL t PLUMBING: ROUGH FINAL j'f(f GAS: ROUGH ' - ° FINAL FINAL BUILDING r . • - " DATE CLOSED OUT L t { M S r t i • t ASSOCIATION PLAN NO. • , The Commonwealth of Massachusetts r --••_ Department o Industrial Accidents Office 8110e5ti MIARs 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name _location: ��5 /�rs <� y "� .7 rZ e 2.5 one# I am a homeowner performing all work myself. I am a sole ropnetor and have no one wor kin in anv ca achy address ................:.. .. :...::: .....: ............ city bhona. e#- insurance co. :....:........;. : :.:;;:,...:. %/ ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: aav ram .....: .:....:.....:..::::...... ...... com address. :..::.: :.::..::..;'.:;............ ....:::.:::..}:•':;.:... ....::::::::::::.:...............:::w:::•.................................... t..... v:::::::::•: ... ..... ......................................:•:::•:.�: ::•}......::::::. i•:•i:r:i•:-:}:•::•:}}}::i•}:?;;;} r sir;:>5;;J.i iii^::is?:iii::!:?i:ii}:ijYv:iiiFi-.�::.;::}ri}:•}}}i}}::•i:}}i::-:}:i::.:':::: ''fj�.iilj?::{::`Y:�iii:S}:i: :::{:ii:!:i}};ii'Y:>ii::isiisvii`::iiY:ii`i:i4:iiY::iti::i:i: <b ition e a... .................................................. ............................................ .................:::::::::.. ::::::::::::::•.:...................................................................... ....................................... ..............:::.............................................:........:..........r...............................:..................................................... •:::........ -:.. ................ ....................... .................................. ..i..r.........5............:•:::::::::: ... ..:. ::...........:..........................:......v....... ..::::::.::::..:...:::.:.�::i:}.:i:}:i::•;�}}}:ii^;i'i::::::::iiii:i:^:P:Si•};•::•}}:•h}:•}}:'-}:•i::}:+:v1:;}:i?^:;}:i::iiji:.}}?}?::^:h}};^_:.:.::;:'i:;Y,.:.;:.}::!:::: ��'#.isi:!.:::::::::}y:'':ii:;i:!;:':.i::::isi:::::::::'i::i:::i:::i}::•%-:{xi:•:r.:.i:•.;:.::::::::::.:.;::::ii:.i::•:�' address:. _. :.::::;::...::...::....::::::.:::::r::::..:::::::..::::;.:::;.:.:.._::.:::.:::.:.::::.:.......citV. ,>`ito>ze .........:...... ...............................:..::..::.::::::.:::.:::::.:..:. >::>< Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years,imprisonment as weii as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the Oince of investigations of the DIA for coverage veriflcstion Ldo hereby certify under the pains and Pen of erjury that the injorniation provided above is trw and coned Signature Date Print name �/'JP2 � � ��l lG�j offlcW use only do not write in this area to be completed by city or town offlcisl city or town: permdtAicensq# L❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's otnce ❑Health Department contact person: Phone#; ❑Other_ (tevaed 9195 PJA) THE �.�► The Town of Barnstable MAE&• �vsr�sre. • �0 Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMUT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: &16 Estimated Cost �7" Address of Work: Owner's Name: Date of Application: d' I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied `Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE OR GUARANTY FUND UNDER MGL c. 142A. ACCESS TO THE ARBITRATION PROGRAM SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Date Owner's Name q:forms:Affidav Department of Healtha and Environmental ,ervices Building Division BARPMAJtr c 367 Main Street,Hyannis MA 02601 KASS. y 161q• ��rEO MA'i A Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissi HOMEOWNER LICENSE EXEMPTION Please Print '3 �� -a O DATE: JOB LOCATION: t �1'�!' '/i ` °e num�beri street village "HOMEOWNER":- home phone# work phone# CURRENT MAILING ADDRESS: city/town 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 d r uirements. 4 e_v 7) Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger wiil be required to compiv with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMEMON 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 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many.homeowners who use this exemption are unaware that they are assuming the responsibilities of a 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 person 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 responsibilities.many communities require.as part of the permit application.that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:,FORMS:EXEMML' Q��f7HEt0�♦ TOWN OF BARNSTABLE i 89HBSTOIIL$, i M°9 BUILDING INSPECTOR °�p MAY Or APPLICATION FOR PERMIT TO ... d........T.. . .... ................. TYPE OF CONSTRUCTION (!' .... t..... . ....�� ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following informatio Location ./>.O..T..�. ....�Ylrk y!.:.. ..... ' '-`ate` �1 fir ,� ....el ...... ....... ....... .......sue...... .... . ...... ProposedUse !ter. ... h. .... ................................................................................................................. ZoningDistrict .. .. ..... .....................................................Fire District .............................................................................. Name of Owner � �bsc�o.. . . j.....Address Name of Builder ......................................................................Address Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .......�........................................................Foundation ... ::�..sa.-:-......� �..�.�.�!.�........... .................. iP Exterior .... .. � � P Roofing ..a ....... 9 ,tea , Floors .................................................................Interior .... �.. ff' ...:.:...........: Heating ......ra,....9..lf..yj.................................................Plumbing ..... ,-&....................................................................... Fireplace ... .........................................................................Approximate Cost ..... 1?0..i ... .................................... Difinitive Plan Approved by Planning Board -------------------------- Diagram of Lot and Building with Dimensions v !� of lti! �y V) O < . U) L_ 0 0 z � LLJ Ld , 3Im ti Cl O O LL LLI 0 I_ ocn �C� � � �- a_ 'jJ O'O �. w ;D w ; rz �� Q ¢ nw Ld > 02. t OQ V -- n Z 0 � d '� = ~ O\ v Q I �v q Pjwc I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Names .. .�/�?'.. ..(✓.... �'4! ............ William E. Jr. � DEC 3 1971 ' one atoz3r No -----.— Permit for .................................... | � ' single family dwelling .-.---..'..— --_...'..—..--...^r..—.—.---- �/�/) - ' ."~ Pine ]�ano � � Location ---'��.��--.--.^-------.— ContemrviIIe � ~—~~—'-----''^'^---^---~—'—'--'—`' Owner ...............William ..��_.. | Type of Construction —.--..�ruzue_.__.�__ ^ . ` . _.---,^--.-.------.---.—.—,.,—..- / Plot ............................. Lot ......... ................ ' !� Rarnnh Granted .....April.�------]g 71 \ � � Dows of Inspection —l9 �~�r � ( Date Completed ---.--.—.----..—l9 ( ` | PERMIT REFUSED > --~—...--,'--~.--..------. 19 ( ^^^--'----'^-----'~^^^—^—`^~---'''' ' ~ ~''---^'--`—'---'---'^^'`~'----'`~—^~' \ � -.',—...^..--~..~.,..—.—..—~--._,,—.—, ` .---.-.---.....--.~.....-....-.—.----.,' . �_._____________... l� } . Approved \ . � | ^ —..--..----.----~...—.----~.—..— ' , .................... . � �- \ .