HomeMy WebLinkAbout0030 WACHUSETT AVENUE w..
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°f1HE 'Town of Barnstable Permit#
Expires 6 months frorn issue date
Regulatory Services Fee 02,s'
awxrtS BLE,
MASS. a
v� i639•
p ,�� Thomas F. Geiler,Director
Al f Building Division -PRESSPERMIT
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis,'MA 02601 APR 2 0 2010
ww-%v.town.barnstable.ma.us ` OWN OF
Office: 508-862-4038 � ai , 30
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address -T QV� N`tW�NlS ?(}LT 1`l UZ�,��
M/Residential Value of Work V700 00 Minimum fee of$25.00 for work under$6000.00 .
Owner's Name&Address L VVTr
3v WACHU 5PT AVt 0YAIV 15 P0a:T rA 06-7 01t'5`t
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#.(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
I am the Homeowner -
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to _
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
#of doors
Replacement Windowsldoors/sliders:U Value (maximum .44)#of windows_
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
'Note: Property Owner must sign Property Owner 'Letter of Permission.
A copy of the Home Improvement Contractors License & Construction Supervisors License is
required.
SIGNATURE:
j�
1
The Commonwealth ofMassachusetts
Departrnent of Industrial Accidents
r' Office of Investigations
is 600 Washington Street
' Boston, MA 02111
w3vw.fnass.gov/dia
Workers' Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/Plumbers
Applicant Information - Please Print Legibly
Name (Business/Organization/Individu 'al): LV9 `-7 kE
Address: 30 WACH V 5P-71 AV
City/State/Zip: poI;gWls' 1poRT CIA 020 Phone
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. 1 am a general contractor and I 6. ❑ New construction
have hired the sub-contractors
employees(full and/or part-time).*
listed on the attached sheet. 7. ❑Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have g, [] Demolition
working for me in any capacity, employees and have workers' 9 Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions
__myself,_[N.o_Worlce.Is'comp, right of exemption per MGL 12.D..Roof.repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 131:1 Other
comp. insurance required.]
*Any applicant that chccks box#I 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.
#Contractors 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 thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic. #: 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 yip 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 verifi'cation.
I do hereby certify under the pains andpenalties ofperjury that the information provided above is trite and correct.
Signature: Date: 20 �� IV
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#: I
r
J
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 foregoing engaged in a joint enterprise,and including the legal 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 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- LC 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 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 Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 4-24-07
www.mass.gov/dia
i�
OFIKE Tp� Town of Barnstable
Regulatory Services
BARNSTABU, ' Thomas F..Geiler,Director
1639.RFD 3� Building Division
Tom Perry,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
I
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Usina A Builder
1, ;.as Owner'of the subject property
hereby authorize to act on my behalf, ,
in all matters relative to work authorized by this building pernit 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:FORIvIS:OWNERPERMISSION
S
Town ®f Barnstable
�0V trte ro `d
�P o Regulatory Services
> xxszns Thomas F. Geiler,Director
BA
Mass.
Wig, 039. ��� Building Division
AlfD �a Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
pp Please Print
DATE: �� �® �y;
JOB LOCATION: �o W NCA U '�- � A V R(ANN 15 TV�T r� . 02�4
number y t street village
"HOMEOWNER": VETN LVV vE 506 -7-75 _4945
lY#X
name home phone# work phone !
CURRENT MAILING ADDRESS:
O` A N�IIs 0264' b� q
city/town state zip 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
require ent
Signature of omeowner
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 109.1.1 -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 t amend and adopt such a form/certification for use in your community.
Q:\WPFILES\FORMS\hometxempt.DOC
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 Leizibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: d�l — d Phone
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 1 6. ❑New construction
employees(fiill and/or part=time).
* 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 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9 Building addition
[No workers comp. insurance.$comp. insurance p
required.] `
5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions
myself [No workers' comp. right of exemption per MOL 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.
=Contractors 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:
Policy#or Self-ins.Lic.#: 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 MOL 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 and the pain rndpenalties of perjury that the information providee/d above is true and correct.
Si nature: Date: Z 2- ` 0
Phone#: _rv�o_ q_ Jo
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 rnstruc[tons
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 foregoing engaged in a joint enterprise, and including the legal 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, constniction 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:muked 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
mercial venture
year. Where a home owner or citizen is obtaining a license or permit not related to any business or corn
(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
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617427-7749
Revised 4-24-07 www.mass.gov/dia
Town of Barnstable *Permit#
Expires 6 months from issue date
Regulatory Services Fee C . Uc
Thomas F.Geller,Director
X-PRESS PERMIT Building Division PIf
Tom Perry,CBO, Building Commissioner
FEB 2 0 2007 260 Main Street,Hyannis,MA 02601
www.townbarnstable.ma.us
�' ( �F8 STABLE Fax: 508-790-6230
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
Not Valid without Red XF Press Imprint
[ap/parcel Number
roperty Address
]Residential Value of Work Z�mc�•e�o Minimum fee of$25.00 for work under$6000.00
owner's Name&Address TOt'll1 &M LU
!ontractor's Name �(J` �" C40Q-K SV& Telephone Number 9 /C Z
[ome pniprovement Contractor License#(if applicable)
, 's-License#(-ifappiieable)
]Workman's Compensation Insurance
Cheyk one;
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's/Compensation Insurance
isurance Company Name awywt,
Vorkman's Comp.Policy#
:opy of Insurance Compliance Certificate must be on file.
emit Request(check box) -
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping, Going over existing layers of roof)
Z Re-side
Rr Replacement Windows/doors/sliders. U-Value. (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e,Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home rovement Contractors License is required.
;IGNATURE:
I:Fon=:expmtrg
.evise061306
f
The Commonwealth ofMassachusetts
Department oflndustrial Accidents
tl
Office of Invesfigations
' 600 Washington Street
Boston,MA 02111,
wyvw.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electzicians/Plumbers
APPHeant. Information Please Print
Name(Business/organization/Individual): .
Address:
City/State/Zip: D6Vbls AW-A Phonet- f 0Lr->>�
Are you an employer? Check the appropriate boa: ;Type of pi oject(required);
.
l;❑ I a employer with 4. ❑ I am a general contractor and I
•employees(full and/or part-time).*• have hired the stab-contractors 6. ❑New construction .
2. I am a'sole.proprietor orpartner= listed onlhe'attached sheet 7. ❑Remodeling
ship,andhave no employees These sub-contractors have g• ❑Demolition
-�yorking for me in any capacity, employees and have workers'
(No workers' comp,insuiance comp, insurance$' 9. []Building addition .
required] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner-doingill-work officers have exercised their ,
11:❑Plumbing repairs or additions
myself,[No workers'comp, right bf exemption per MGL
insurance.required.]t c. 152, §1(4), and we have no 12.❑Roof repairs . .
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 anew affidavit indicating such,
:Contractors that check this box must attached an additional sheet showing the name of the Sub-contractors and state whether ornot those entities have
employees. Ifthe sub-contractors have employees,they must provide their workers'comp,policy number.
lam an employer.that is providing workers'compensativn insurance for my employees. Below is.the policy and job site''
information.
Insurance Company Name:
Policy#or Self-ins.Lie,# 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 ofMGL c. 152 can lead to the imposition of criminal penalties of a
fine up tb$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 copyof this statement maybe forwarded to the-Office of
Investigations of the WA for insurance coverage verification, '
.1 do hereby certify,undisr th pains•and ppennalti�es of perjury that the information pravided above•is true and correct.
Signature: dip (b
Date:
Phone#:
Officiai use only. Do not write in this area,tb be completed by ctiy or town off ciaL
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
ti. Other
Contact Person: Phone#:
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 foregoing engaged in a joint enterprise,and including the legal 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 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.".
AdditiomaIly,MGL ehapter.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 i#b the insutance•
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,it
necessary,supply sub-contiactor(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 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 onthe 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 Sire Address"the applicant should write"all-locations in (c%ror
town)."A cb of the davit that has been officially stamped or marked by the city or town may be provided to the
PY � Y P
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 homeowner or citizen is obtaining a license or permit not related fo 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:,
Thy COMMODWWth of ma 0huse"tts
Dvt~nt Of lrt:dusta1 Accidents
Of fico of fnVe lagat olk's
' • ' �44� g�aa het •
RQ4tan,.MA 02111
TO.#617-727-400 ext 406 a 1- 7-1'vTASSAFE
Fax#617-727-77-49
Revised I1-22,06. w .ma;ss g 6v7dia
Town'.of Barnstable
Regulatory Services
sres�e, + Thomas F. Geller,Director .
0. Building Division
o
TomPerry, 'Building Commissioner
,
200 Main Street, Hyannis,MA 02601
Fax: 509-790-6230
Office: 508-862-403 8
Property Owner Must
Complete and-Sign This Section
if.Using .A.Builder
as Ownet of the subject ptop etty
--�--- W ( L S to act on xny behalf
hereby authorize,
i a all,taagets relative to work authorized by this building p ermit application fot:
(Addtess of job)
6-7
gurOwner Date
print Name
A
QFORMS:OWNER?ERMISSIOId
�i �/ze -�omv�naiasea� o��/�ea�ivaet�
�\ Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only
Registratidn
before the expiration date. If found return to:
,_ 4258 Board of Building Regulations and Standards
/2008 One Ashburton Place Rm 1301
0,
)'Ph DBA Boston,Ma.02108 `
�; 1
W.D.CARPENTRY.�SER�I :.
WILSON DE SOYA t%
56 DELTA ST /
HYANNIS,MA 02601 /c
Deputy Administrator Not alid with ut signature
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application # d
Health Division Date Issued
Conservation Divisions Application Fee J "
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _Preservation / Hyannis
Project Street Address 10 WP►CHU59-r1C ANE
Village 14YA W41S ?6F,7
Owner .JEP 'N 4 t3l_=m LVVTI F Address 'M WAC14U,%TT ? 'V .
Telephone '508 7-7 5--7846
Permit Request C6NS1i2u(T AN ACCCS5 TRW? -TO GET IN'rO AN9 OUT O'F T4-W HOW%-
VVIT40VT HAVING -TO USE 5-INR5
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Z is00. Ott Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family 21 Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes A No On Old King's Highway: ❑Yes 0 No
Basement Type: A 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: A Gas ❑Oil ❑ Electric ❑ Other
Central Air: ❑Yes m 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 ZI No If yes, site plan review #
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER) - - - - -
Name 0F_TT Y l_U P"tl-vt Telephone Number
Address ,30 License #
W�A1J NIS Q62T T'i A 02644 Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
-W WTAFV- - LAN1 9r-I L i l-r2p\j, ra sTA-n 6-N
SIGNATURE DATE 26 t
FOR OFFICIAL USE ONLY
APPLICATION#
DATE,ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER!
i
DATE OF INSPECTION:
FOUNDATION
+. FRAME
.t
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
�s The Commonwealth of Massachusetts
Department of Industrial Accidents
t y. t. 1 . Office of Investigations
.f
600 Washington Street ;
" Boston, MA 02111
c www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): V? C L U'D_TkF
Address: '36 W N-CV4 V StTT AVK_
City/State/Zip:WAN NK FOP--' Ma 02694 Phone #:
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 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. I . ❑ 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
officers have exercised their 10..❑ Electrical repairs or additions
required.]
3.`1 I am a homeowner doing all work right of exemption per MGL 1 LEI Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.]t employees. [No workers'
comp. insurance required.] 13.❑Other
*Any applicant that checks box it l 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 their workers'comp.policy information.
1'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. #: 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 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.
[do hereby certify under the pa' sand penalties of perjury that the information provided above is true and correct.
Signature: C Dater JAM . 11
Phone#: 77
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 foregoing engaged in a joint enterprise, and including the legal 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 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 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 riot 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 Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass..gov/dia
- 1
i
Town of Barnstable
�ofYHE ray
Regulatory Services
j "
- -
EA,RN�� Thomas F. Geiler,Director
htwss. $
t63q Building Division
PrED '�s Tom Perry,Building Commissioner
200 Main Street, Hyannis, MA.02601
www.town-barnstable.ma.us
Offi6e: 508-862-403 8 Fax: 508-.790-6230
HOhIFOWNER LICENSE EXEMPTION
r Please Print'
DATE: �b AN 91
JOB LOCATION: US'u—'T AW 1-yYAMNIS ?ow- ' VA 0264
number t( street village
"HOMEOWNER": PC TT` LUP7-KF 79L5 �
name, home phone# work phone.#
CURRENT MAILING ADDRESS: lao)( 4134
NY�N NI S Ro►�-r� fi�� �6��_8���
city/town state zip 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.
DEMMON OF BOMEOWNER
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.construlcts 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 pmfonned under the building permti. (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 tbat,he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
.y� L
Signature of Homeowner.
Approval of Building Official .
Note: Three-family dwellings containing35,000 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.homcowner performing work for which a building pcnrit is required shall be cxm-npi from the provisions
of this section
.(Sccticin 109.1.1 -Licensing of construction Superyisors);proyidcd 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 arc unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q
Rules&Regulations for Licensing Construction Supervisors,Scction 2.15) This lack ofawarrness 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 ultirnatelyresponsible.
To enure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that hc/sbe understands the msponsibilitics of a Supervisor. On the last page of this issue is a.form currendy used by
several towns. You may care t amend and adopt such a form/certification for use in your community,
r ,
r ,
VEr Town of Barnstable
o
Regulatory Services
r
r s
yM sS. Thomas F. Geiler,Director
1639- J�6�� 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
Prop e rtY Owne r Must
Complete and Sign This Section
if Using A Builder
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 pleas e complete. the
Homeowners_License Exemption Form on the reverse side.
Map Page 1 of 1
Town of Barnstable Geographic Information System New search Home Help
` Parcel ViewerIF
Custom Map Abutters Map Size ® Zoom Out M 1 j M fl M. jIn -
............ . .......... . .-...,.... ,......:...
JPG Map: 287 Parcel: 053 Full
Property
287050 '^' Location: 30 WACHUSETT AVENUE Info
N to
j(1 " '![ s� •„k. � ° `r" Owner: LUDTKE,JEAN E&BETTY C
287133
%32 m
g Location Information
t _ .... .. ......... . ............
Map&Parcel 287053
Location 30 WACHUSETT AVENUE y z
I 287054 Acreage 0.08 acres
046 '
m _._... .................. ........-..,_
v{ Current Owner _
287043 Mailing Address LUDTKE,JEAN E&BETTY C
q0 l w PO B0X 484 -
• w 287053 - HYANNISPORT,MA 02647
- raised Value(FY 2011)
... ........ .........
s- Extra Features $10,800
Out Buildings $0
M .,. Land $615,200
i
j Buildings $172,800
Total Appraised $798,800
i
0"*k0SeTT AVe _ Assessed Value(FV 2011) j
. Extra Features $10,800 -
0 34 Feet 287057 — out Buildings $o
� �^'"" 2g3g7 Land. $615,200
w, Buildings $172,800
Total Assessed $798,800 -
Set Scale 1" = 34 - I Aerial Photos I MAP DISCLAIMER -
Copyright 2005-2010 Town of Barnstable,MA All tghts reserved.Send questions or comments to GIS -
BarnstableMA v1.2..4015(praductionl
I
http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=287053 1/21/2011
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Sewage Permit number ......: ::....... 11,!S(AL LED IN COM-PL'ANC d``Q
1011TH TITLE 5 2 BA"STALLE, i
House number � .�.. 4'.�'. .41..<: .^ NTAL �� .� , aea
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TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ..` . .,.. .........................................
TYPE OF CONSTRUCTION ...... ��...................................
.' .11..................................
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
J
Location �..d...... ................ ... .11..??: : ':.i��d.. !............................................
Proposed' Use h. �� G4../�'t.�.. .
Zoning District /�r.. .....................:......................................Fire District ... ...... . ldd./..` .......`...(.`:�..........................
Name of Own
......Address Q..4YrXU.c�'C✓f., ... ......................
Name of Builder E... Q..l>�� .. .1.!.2.l..vPly....Address 9 �.• . �m . ►., �C. rn� .6..;t.
Name of Architect ...1..`,,Address .. �..�i.?1... .1..�.. h!/.�..5. .:.
Number of Rooms .....b.........................................................Foundation . ..ka.r.....4.yy... �.........................
Exterior l!l..a..Y......s /....?? ..........Roofing ....A.'51 /7.�s..�
........................... .... .................................................
Floors ....................Interior ....................................................................................
� � I
Heating �.``...��� .........................................Plumbing
Fireplace ..................................................................................Approximate. Cost ..... ................... .................
Definitive Plan Approved by Planning Board ________________________________19________. Areal?. ... .. ..................
Diagram of Lot and Building with Dimensions Fee ......
..... ..............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH u ��
y
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 /C. I. .Ld.�Z.....`........................................
Construction Supervisor's License aj1.7:?A ..........
11 , JAMES & JEAN
' 'l ^^
. �1 ./ 27347 ' A� TO &--M—Y�—D—E.L
m -----.. Permit for ...................
.^'
^ |
" 1 Fam ily Dwel 1 ing
-- ........ — ...... ...... ........ ......
--^-----. .
Location _]0__— _ Avenue__`___
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.. .--.^—.��..� ��.�-----___---_.�
Owner .....JaooeS..8i.J.eao'.Iazd±]me------
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Frame '
Type of, Construction ..........................................
_--- ..................................................................
lot /!
, ~* _--................ �t ----------'
. . -
.2O._........ q '84
.� ^^�x� �-^� ^ '
Date of '�,^u� '^.�9�[�`^ '
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7-�ote Completed Z%���]�--.�..'=���--.l9�}�
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4sgesSocss map and lot number ..... ................ l THE
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....... ...........
Sewage Permit number ........ . ............................
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j ts f Z MARNSTODLE, i
House number .. ..°j. '.�' ._ fit• r 9 Mae&
............•..........N........ 16 00
1 oE11AYa�
TOWN ,,OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO !!?:. �t , ��?:'�:... .. ? '.:'� r c .!f.... .....................................
TYPE OF CONSTRUCTION a`' ...............................
r.:..:7.:!/ ............................19.: t`
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies .for a permit according to the following information:
Location ..1•�..U" .�. 1.�J. '. .. ............................. .�1...... ?.. ?.!. . .. ..!�............................................
ProposedUse :>.✓.j. !.. ?lJ%%. .........1. ............! �f ..........................................r.......................................
Zoning District �� ............................................................Fire District ... .............
Name of Owner /i!'?t ...: /D, i� !!./ sK., Address '., ..1-�.....�......................
........ .
'Name of Builder (�L� ..?// �/J..l �. j'. / �....Address .�`9..�.../.ej .'.`:f!. ?-'#..h,
Name of Architect '. s` j r
�I�.... � / ✓ r�-�..::" " .Address ........:..... ...... �...............
Number of Rooms ...... .........................................................Foundation 11!���U.J ...../ 6 �i f 1?" e
Exterior f f .,.. ........... ...................................................
..�........fi....�!l ..................Roofng ..A.�
Floors ....................Interior .............................................................................
Heating.T .:..-.. :-.h�.......................................................Plumbing ..................................................................................
J.J.
Fireplace ........................................................................,.........Approximate. Cost ......:........J..............................:..................
Definitive Plan Approved by Planning Board ________________________________19________. s Area F'?. .. .....`..............
Diagram of Lot and Building with Dimensions _ Fee �.. r .........
SUBJECT TO APPROVAL OF BOARD OF HEALTH u �`
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 IC:,l1\� .......................
Construction Supervisor's License 4�11 X.: ..I ..........
1
LUDTKE, JAMES & � M A=287-53
No ...27347 Permit forZ?..� & REMODEL
:: Single Family..Dwelling t
Location ...30 Wachusetts. ...Avenue
.................
........ ........ .............
.................HyY nnis2o .....................................
Owner ...,James & Jean Ludtke
.................................................
Type of Construction ....Frame..........................
...............................................................................
Plot ............................ Lot ................................
Permit Granted ..,December 20, 19 84
Date of Inspection ....................................19
Date Completed ......................................19
tcol 1 —�
I
l �
• //� �U
' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
f
Map Parcel3 Permit#
Health Division .c;20 OP -Leze ���y�� �� Date Issued
Conservation Division I I Application Fee 01 DO
Tax Collector 111 t7 Permit Fee o ��
Treasurer C) fC — NL — u , ORBERTIC SYSTEM MUST BE
Planning Dept.614 INSTALLED IN COMPLIANCE
t� No bewa�ltk.� WITH TITLE 5
Date Definitive Plan Approved by Planning Board IJ� eF rtiKsp Ei�VlOfi�is7i��dTAI.CODE AIdG
Historic-OKH vA tt.e1 6Preservation/Hyannis 'V3N A��a'Z Tf.1911H REGULA"riONS
Project Street Address 30 W AC HV S E T'j AV
Village 4-1YA Iv ,&))S PO R T
Owner E-/-))V S, L.Z/,bT/(C Address 30 r 7 AV 04�y
Telephone U B�7 7 7
Permit Request _ 11 SUSS`_ L > 1)/V -GJGTml J E PZA el-/AJ G- r'01//V 0/11 LOAI
Square feet: 1st floor: existing 6 proposed 120 Z 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation -7 5-0 U 0 Construction Type fl(fV.-lem 11
Lot Size S V-44-0 s�r/1�D, D�u0Cs Grandfathered: ❑Yes No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure j Z q 0 Historic House: ❑Yes 0 No On Old King's Highway: ❑Yes ONo
Basement Type: ❑Full ❑Crawl ❑Walkout Other /Y► N k CA����� i�c Z2
i
Basement Finished Area(sq.ft.) ��' fi Basement Unfinished Area(sq.ft) V-3 f
Number of Baths: Full: existing new Half:existing new
Number of Bedrooms: existing new J�-
Total Room Count(not including baths): existing new First Floor Room Count 17 VA a
sv
Heat Type and Fuel: N Gas ❑Oil ❑ Electric ❑Other ,
Central Air: ❑Yes rd No Fireplaces: Existing New Existing wood/coal stove: ❑Yes No
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size 0
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: O
. Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes A No If yes,site plan review#
Current Use ta 0 Proposed Use -faL,4 C
BUILDER INFORMATION
Name JE A lU L Ut)T KE Telephone Number
Address 0 4/7 6 D W N E9 License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE 7 /V oil 2 U.0Z
FOR OFFICIAL USE ONLY i
PEIjMIT NO.
+ DATE ISSUED
+ MAP/PARCEL NO.
ADDRESS. - VILLAGE '
OWNER '
DATE OF INSPECTION:
FOUNDATION 6 Fy O 71810 3 ,,/)A
FRAME Fie h? r it L0
INSULATION _,�r'�'�'S U /LI �
i -
FIREPLACE
ELECTRICAL: ROUGH FINAL j
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
1
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
r
t
TheTown
ow of.Barnstable
Regulatory Services
Thomas F. Geiler, Director
Building Division
Tom Perry, Building Commissioner 0
200 Main Street,Hyannis MA 02601
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
i DATE: 7 o I/ Z o D i
JOB LOCATION:
number street village
"HOMEOWNER,- �E�4)N I)T SO,?/ 7 7 7844
name p/ home phone# work phone#,
CURRENT MAILING ADDRESS:
city/town state zip code
t
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 requir eats.
Signature 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 109.1.1-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 t amend and adopt such a form/certification for use in your community.
Q:FORMS:EXEMPTN
The Commonwealth of Massachusetts
Department of Industrial Accidents
=- = Office 911HY85MOO ANS
600 Washington Street
Boston,Mass. 02111
Workers' Com e�ti�Imu%%ance Affidavit
name: EA'Y L v I/T K C
location VS E % l l�
city /J/ �l /V A) I.S !` o�% ��� Q 2/ 4-7 phone# 5o f1'�7 7 S -70 Lk-5
I am a homeowner performing all work myself.
❑ I am a sole netor and have no one worldn in ca achy
%%%///%/l%%%/%/%% % %%%%O%%%/%%%%%%%%%/%%%%%%/ %%%%%/%%%%%%%%/G%/%/��/%%%%%/%%///%///%%/%%/%%%�%�%%%%/G%��/%%////%%�%
I am an employer roviding workers' compensation for my employees working on this job. ... :: ::: :: :::::: :;::::: : :
sbmrs v
agar . : ::•:>:».<:<>.: :>::.:::: :.. .
..........:;...-::....... :<::.:'.:>:..;....::. ;.»'>::::.;.;.:,:.::::::.;<:.<::...lion
A
'::>::: `::::::: :: oil
insurance t:o.:::.:;,::.:..':.:::<;::;;;::>;;;.:,;,:::;.;•..:.: .:.::::.;":
❑ 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;
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11
' ities
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:.......................:......:....:.. boa :.:.:.........
city` :................. .....................................:..:.......,.::::::::p
L:ii$iii%�+rill?:i:iir:�:'i:}�:;:{i:;iy�:;i:i;:; ;:;:Ji"iiFi^:i:4 iiiiii:: ::'iil T'?:j;}iiiiiFti^:i^:!Jiiii:::•iiiii:4i::;+.•i?'+i:S:•ii:�:-:::.�::.
j�i?::..:
... ::w:.�.... :4i::•:i}Ji:ryii:•::^iii:•:::?:ii::::ii:<!i:ii:ji:vi:i:J$ii;:i:iiii;i{Oi::i::::::::.:�:: •� ,::....:
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine to$1,500.00 and/
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true.and correct
Signature b`��"h /► /'/ Date /D�/ Z D D
Print name J N L v b / /(E- phone# u 0 7 7 Sr-— S
official use only do not write in this area to be completed by city or town official
city or town: permitilicense# ❑Building Department
❑Licensing Board
❑checkif immediate response is required ❑Selectmen's Office
❑Health Department
contact person• phone#; 0�er
0evued 9195 PJA
Infor
mation and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", 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 joint enterprise, and including the legal 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 be an employer.
MGL chapter 152 section 25 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,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
4ry please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and
supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
if 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.
RX
City or Towns
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 permitllicense number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
FEE
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
y Oltice of inyestlgatloos
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone#: (617) 727-4900 ext. 406, 409 or 375
c
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ffective Date: November 19, 2002
u
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Western Suret om any
u '
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P 9
G LICENSE AND PERMIT BOND
F 9
tl
W, KNOW ALL PERSONS BY THESE PRESENTS: Bond No. 69432806 ;
P
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That we, Jean Ludtke
n
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of the City of Hyannis Port State of Massachusetts as Principal,
and WESTERN SURETY COMPANY, a corporation duly licensed to do surety business in the State of
Massachusetts as Surety, are held and firmly bound unto the
Town of Barnstable State of Massachusetts as Obligee, in the penal
sum of Five Hundred and 00/100 DOLLARS ( $500.00 )
lawful money of the United States, to be paid to the Obligee, for which payment well and truly to be made,
we bind ourselves and our legal representatives, firmly by these presents.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the Principal has been
licensed Road Bond
by the Obligee.
NOW THEREFORE, if the Principal shall faithfully perform the duties and in all things comply with the
Taws and ordinances, including all amendments thereto, pertaining to the license or permit .applied
for, .then this obligation to be void, otherwise.to remain in full force and effect until
November 19th 2003 unless renewed by Continuation Certificate.
This.bond may be terminated at any time by the Surety upon sending notice in writing, by First Class
U.S. Mail to.the Obligee and to the Principal at the address last known to the Surety, and at the expiration
of th r °� 'ii:& trays from the mailing of said notice, this bond shall ipso facto terminate and the Surety
,she4 efeupon beer�lieved from any liability-for any acts or omissions of the Principal subsequent to said
. v
dale> `°�, ��=i ep 'df e number of years this bond shall cor_tinu- in force, the number of claims made
asttlus bonadatdthe number of premiums which shall be payable or paid, the Surety's total limit of
lxaity all not be"ulative from.year to year or period to period, and in no event shall the Surety's total
lia rlit o aft U404si exceed the amount set forth above. Any revision of the bond amount shall not be
cution
zl � �
G Dated this 19th day of November 2002
P F
, n
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Principal
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e Principal '
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Countersigned(where required) WEST E S U R E T COMPANY
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By By c.�
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F
esident Agent Paul T.Bruflat,Se for Vice President
n Form 532-5-2002
r "
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F '
ACKNOWLEDGMENT OF SURETY .
STATE OF SOUTH DAKOTA ss (Corporate Officer) -
COUNTY OF MINNEHAHA
h
On this 19th day of November _ 2002 before me, the undersigned officer,
personally appeared Paul T.Bruflat ' ''r "` = �'-° who acknowledged himself to be the aforesaid
officer of WESTERN SURETY COMPANY, a corporation, and that he as such officer,being authorized so to do, executed
the foregoing instrument for the purposes therein contained, by signing the`name of the corporation by himself as such
officer i r:_ ._t . . , , i- i q.., 1; ..a _ _
t n, �" _
IN,WITNESS WHEREOF,I have hereunto set my hand-and official seal: ., -
.*44bbbb4bbbbS444bbbb4%%%% ,{
` D. KRELL ;
s S AE L NOTARY PUBLIC SE�A� +y
+RSOUTH DAKOTA�I A P
r a I I » • . Notary Public—South Dakota
. . �bbbbb44444b44bb4444444b
My Commission Expires November 30,2006
ACKNOWLEDGMENT OF PRINCIPAL
STATE OF ss
(Individual or Partners)
- -
COUNTY OF
On this day of before me personally appeared
known to me to be the individual _ described in and who executed the foregoing instrument and acknowledged to me
that—he executed the same.
My commission expires
Notary Public
.,,;..,.xt. . t . . .. <:,y c . ,: �x,e'' t, .U:;.c •:. b:. ACKNOWLEDGMENT OF PRINCIPAL,,
(Corporate Officer)
STATE OFCOUNTYSSI
i .. ,,.. e. _ . '3'�."`f .. fie;. ,...., .. •. . ., , ,. .. .. ..,. �'
On this day of before me personally appeared
who acknowledged himself/herself to be the
of a corporation, and that he/she as
such officer being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing
the name of the corporation by himself/herself as such officer.
My commission expires
Notary Public
E-
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i
y Western Surety Compan
y
POWER OF ATTORNEY,
KNOW ALL MEN BY THESE.PRESENTS: "
That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota,
and authorized and licensed to do business,in-the•States of Alabama;'Alaska,'Arizona, Arkansas, California; Colorado,
Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois", Indiana, Iowa, Kansas, Kentucky,
Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New
Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania,
Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia,
Wisconsin,Wyoming, and the United States of America, does hereby make, constitute and appoint
Patel L BruTat of Sioux Falls
State of. S #h�akoL __-___ , its regularly elected Senior Vice President. .. . , _
as Attorney-in-Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and deliver for
and on its behalf as Surety and as its act and deed, all of the following classes of documents to-wit:
Indemnity, Surety and Undertakings that may be desired by contract, or may be given in any action or proceeding in any court of law or
equity, poIi�ci%es$ r��,mnifying employers against loss or damage caused by the misconduct of their employees; dfficial, bail, and surety and
fidelity1bon s fcnpi `M#y�in all cases where indemnity may lawfully given; and with full power and authority to execute consents and
waiO to modify o cl ge�or extend any bond or document executed for this Company,and to compromise and settle any and all claims or
demands°m�qe or exist+ against said Company.
estern Surety Compi�j further certifies that the following is a true and exact copy of Section 7 of the by-laws of Western Surety
C 0m any duly adopted arad Aft in force,to-wit:
S"e on 7V Ail bo•ds policies, b fide rtak'irigs, Powers of Attorney, or other obligations of the corporation shall be executed in the
core e me.of tt1e,%Mpany by the President, Secretary, any Assistant Secretary;Treasurer, or any Vice President, or by such other
°n ��
officersea ttr e�6oardunftlbirectors may authorize. The President,any Vice President,Secretary,any Assistant Secretary,or the Treasurer may
appoint Attomes-matt or.agents who shall have authority to issue bonds, policies,or undertakings in the name of the,Company.- 'The
corporate seal is not necessary for the validity of any bonds, policies, undertakings,Powers of Attorney or other obligations of the corporation.
The signature of any such officer and the corporate seal may be printed by facsimile.
In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its
Senior Vice President with the corporate seal affixed this 19th __--day of November , 2002
ATTEST WEST N URETY OMPANY
_ By , e _
Assistant Secretary Paul T. Bruflatnior Vice President
STATE OF SOUTH DAKOTA
ss
COUNTY OF MINNEHAHA
On this 19th day of November 2002 before me,a Notary Public, personally appeared
_ Paul T. Bruflat and L. Nelson '
Who, being by me duly sworn, acknowledged that they signed the above Power of Attorney as Senior Vice President
and Assistant Secretary,!respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be
the voluntary pact and deed of said Corporation. a i » i
y t�yy55yyyyhhhy�,hhhhh�hhyh t :r ;
P i i, s D. KRELL
r' s S L NOTARY PUBLICQSE��L :
SOUTH' DAKOTA
My Commission Expires November 30,2006 Notary Public
tic
Form F1975-4-2002 ��M
Addendum to BUILDING PERMIT for Jean Ludtke,30 Wachusett Av,Hyannis
Pont '7 7 � �5
LISTING OF SUB-CONTRACTORS
Allenby Tree movers and Tree Farm,Hatchville
Cape Cod Mechanical Systems—plumbing(Glenn Boudreau)
John P. Clancy—masonry (brick facing on foundation)
Co;mcast Cable Communications—cable connections
Hayden Building Movers—raising/shoring house,foundation
Robert B. Our, Co.,N. Harwich--septic,basement floor
Michele C. Tudor,P.E.—Consulting Structural Engineer
W D Carpentry Service Co.--framing,finish carpentry
E.F.Winslow,Electrical, S. Yarmouth (Don Cook)
COVER TO BE WITHIN
' 9" MIN. COVER TYP 6" OF FINISHED GRADE
TOFR 31.9'
F.G. - 30.2'+/- COVER TO BE WITHIN
., 6" OF FINISHED GRADE
'; SCtiEUULE% MIN ELEV 30.25'
4" SCHE . 41
.i PVC PIPE
28.8T 'off S-.02 FTO
1 +/-
GAS BAFFLE \28.OV
28.0
PLACE.SEPTIC
DIST. BOX ON
EXISTING OR MECHANICA
BUILDING ."—SOIL
PROPOSED 1500 GALLON
SEPTIC TANK
H-1O
SEPTIC SYSTEM
LAUNDRY
BATH KITCH"ININ BATH
BED
BED BEp
UWNG
BED
FIRST FLOOR PLAN SECOND FLOOR PLAN
m
14 �24. 00L
OF q
ro dO • shy`1 _ _
s n
c R. N
n- 873J�n"J W M
EGim A
4,Vq *AZ �
;n
0 3,440+/- SQ. FT.
W z 0.08+/— ACRES
Z CBAM FND S 83'05'00" E
W 50.00'
LA,�ID�NG
GAS GALE ® PROPOSEDSEMENT BA pK �h
Lu
1:9 S 4DP7:
EXISTING FOUNDATION WALL NEEDS
FULL BASEMENT m TO BE REPLACED WITH REINFORCED
�- PR CONCRETE WALL PROPOSED WALL,
WA U FND EL=31.9' TO BE WATERPROOFED MATH CARUSLE
g 701 MEMBRANE.
LA N I lI G �_.,, PROPOSED BASEMENT
M TOF 10 n/f DIONISI
"i 3.0' PORCH = 31.9 - o
EwsnNc iaoo ,`�° N DB 2859 Pg 233
GAL TANK
O SSPOOL
.PROPOSED 1500 �
GAL TANK C OLLY
n 1
CB/SEAL FM 195.95' n 11' X 37'
t 50.07 co 3.5'LEACHING
AREA
EL/bH FN ' 6'0
i .N 85'28 W 346.16' TD 100.14'
NM WAIM GATE EXISTING ,
BRICK WALK I
W A C H U S E T T A V E N U E
PI A REFERENCE: EXISTING STRUCTURE LOCATION IN HYANNISPORT MA ELEV. =27A6'-
PREPARED FOR JEAN S. LUDTKE BY BAXTER. NYE & HO IVIGREN INC. 6/03/02
S
S ITE P LAN
1 " = 20'
HYANNISPORT
W MAIN ST MAIN ST
N
COVER TO BE WITHIN
6" OF FINISHED GRADE
9" MIN. COVER TYP. m
TOF- 31.9' COVER TO BE WITHIN Q
F.G. - 30.2'+/- " O
6 OF FINISHED GRADE WATER TESTED FOR LEVEL 6 0�" w
t " P P MIN ELEV 30.25' 2' LEVEL ` Ffc ��
4SC LEA f0 3 MAX. COVER '� m
4" SCHE 30. - a
t ;., PVC PIPE t' MIN. COVZ ROE MIIN 28.06 D =
01p ».
S-.02„FT/FT S=.02 FT/FT 77N
2&6 1O' 14' 1 +/ if. 30 +/- Lf. LAFAYETTE LOCUS
LESS 2' LEVEL 0 0AVE
CHUSETT A
' 0 0 C3 ar-31-3
4' GAS BAFFLE �-� 27.90
PLACE SEPTIC TANK ,AND 26.56' . _ ( 24.56'
Y bIST. BOX ON 6" OF STONE 2.5 '
EXISTING �_SORI MECHANICALLY COMPACTED I I 32 I 3/4" TO 1 1/2" LOCUS MAP
BUILDING DISTRIBUTION -4-FLOWDIFFUSORS H-20 DOUBLE WASHED STONE NOT TO SCALE
PROPOSED 1500 GALLON BOX +�'X�' 5'MIN
SEPTIC TANK H-10
H-1 Q BOTTOM OF TEST HOLE OR
SEPTIC SYSTEM PROFILE -
LAUNDRy NOT TO SCALE
BATH
KITCH�
/bININ BATH NOTES:
1. SEPTIC SYSTEM SHALL BE INSTALLED ACCORDING TO
BED 310 CMR 15.00 (TITLE 5)AND THE TOWN OF - HYANNISPORT DESIGN :CALCULATIONS:
------
BEp BEp BOARD OF HEALTH REGULATIONS.
UWNG 2. ALL PIPES SHALL BE 4" SCHEDULE 40 PVC NUMBER OF BEDROOMS: 4__
3. THE DISTRIBUTION BOX SHALL BE WATER TESTED TO GARBAGE DISPOSAL UNIT: NONE
BED INSURE -LEVELNESS AND EQUAL FLOW. TOTAL ESTIMATED FLOWN
* 4. THE INSTALLER IS TO VERIFY THE LOCATION OF UTILITIES ( 110 GAL./BEDROOM/DAY X 4 BEDROOMS = 440 GPD )
FIRST FLOOR PLAN SECOND FLOOR PLAN AND SEWER LINE ELEVATIONS PRIOR TO INSTALLATION.
5. EXCAVATION FOR AREA WHERE FILL IS REQUIRED SHALL REQUIRED SEPTIC TANK CAPACITY= (200%) = 880 GAL.
EXTEND '5' LATERALLY BEYOND S.A.S. ACTUAL TANK SIZE: 1500_ GAL.
6. VERTICAL DATUM - T.O.F. = 31.9
-7. SYSTEM IS NOT DESIGNED FOR GARBAGE GRINDER. '
8. ALL PRE CAST UNITS ARE TO BE PLACED ON 6 MIN. LEACHING AREA REQUIRED:
�y,24, ®,� CRUSHED `STONE, MECHANICALLY COMPACTED. SOIL CLASS 1
PER RATE - Ste_ MIN/IN.
"
9. MIN: PIPE SLOPE 1/8 IN/FT. 1/4 IN/FT--PREFERRED-,
LTAR 0.7-4- GPD/FT
= 10. ALL CONSTRUCTION DETAILS ARE TO CONFORM TO
440 _ GPD / ���4 GPD/S.F. _ _ 594.59 _SF USE 595____ SF
-- - STATE OF MASS. ENVIRONMENTAL CODE (TITLE 5) AND
of LOCAL REGULATIONS.
Romljo . ��' one' . 11. ALL MANHOLE COVERS< ARE TO BE WITHIN 6" OF LEACHING CAPACITY:
- a FINISHED GRADE. 4 FLOW DIFFUSERS WITH 3.5' OF STONE ON SIDES
29874 I W r^, 12. SEPTIC TANK TEES SHALL CONFORM TO MASS & LOCAL
'� 2.5' STONE ON ENDS AND 1' STONE UNDER
REGULATIONS. ,
Fci 13. ALL STONE IS TO BE DOUBLE WASHED ACCORDING TO SIDES= [�� x 2_ ] _ _192 _ SF
�aQ _
MASS. & LOCAL.•REGULATIONS. BOTTOM= [ 11_' x 37_'] __40Z_ SF
0 3,440+/- SQ. FT. 14. GROUND COVER OVER SYSTEM COMPONENTS SHALL NOT TOTAL AREA = __5R9__ SF
0.08+/- ACRES EXCEED 3'. .. * ,
TOTAL CAPACITY = 599 SF 74 GPD/SF = 443 GPD
15. EXISTING LEACHING PIT, SHALL BE REMOVED ACCORDING
2 CB/bH FN0 S 83.05.00" E TO LOCAL REGULATIONS
w 50.000 16. LOCAL UPGRADE VARIANCES REQUESTED ACCORDING TO F '
15.405 (1)(o) REDUCTION OF S.A.S FROM EAST PROPERTY
,Q r LINE FROM 10' 'TO 3.5'; FROM SOUTH PROPERTY LINE FROM A.
10' TO 4.6'; FROM WEST PROPERTY LINE FROM 10' TO 9'.
GAS GATE ® BASEMEN 0 REDUCTION OF SEPTIC TANK SETBACK FROM WEST
No.3
w ,.. PROPERTY LINE FROM 10' TO 3'; FROM SOUTH PROPERTY
LINE FROM 10' TO 7'.. ACCORDING 'TO 15.405(1)(b)
EXISTING FOUNDATION WALL NEEDS REDUCTION OF S.A.S FROM PROPOSED CELLAR WALL FROM
~
w m TO BE REPLACED WITH REINFORCED 20' TO 5'. REDUCTION OF SEPTIC TANK SETBACK FROM APPROVAL ENT R AMP
FULL BASEM04T CONCRETE WALL PROPOSED WALL
"A
TO BE WATERPROOFED WITH CARUSLE CELLAR WALL FROM 10' TO 5'.
uN FlVD EL-31.9' . 701 MEMBRANE.
vQ
PROPOSED BASEMENT 10
Q M TOF V) n/f DIONISI Date DESCRIPTION Drawn Checked
J 3.0' PORCH �= 31.9 R E V I S I O N S
EXISTING 1000 DB 2859 Pg 233
GAL TANK DATE: 7/23/02
GAL TANK OLLy TEST HOLE 1 GSE� 30. HEALTH DEPT.: DAVID STANTON
ABARG
PROPOSED, 06. SOIL EVALUATOR: TODD LABARGE SEPTIC SYSTEM UPGRADE DESIGN
1 DEPTH FROM SOIL HORIZON SOILTEXTURE SOIL COLOR SOIL MOTTLING OTHER
CB/SEAL FND 195.95' BETTY LUDTKE
n 11' X 37' SURFACE (STRUCTURE. AT
1 50.07 co 3.5'LEACHING (INCHES) (USDA) (MUNSELL) STONES. EfC)
N
AREA 10014' 30 WACHUSETT AVE
CB/bH FND 86'05 28 W 346.16' TD 0-1.2 FILL IN
EL - 29.76
NGVD WA70 GATE EXISTING
eRlac WALK 1.2-2.0 A LIMY IOYR 4/3 - HYANNISPORT
W A C H U S E T T 2.0-3.0 B LOAMY
DY 10YR 5/8 -
AVE ,
NUE SCALE. 1 = 20 DATE: JULY 23, 2002
ELEV. =27.06'-- 3.0-11.0 C SAND 1OYR 5/8 FINE -
PLAN REFERENCE: EXISTING STRUCTURE LOCATION IN-HYANNISPORT, MA LA BARGE
PREPARED�FOR JEAN S. LUDTKE BY BAXTER. NYE & HOLMGREN INC. 6,/03/02
NIX o+oo rrm ING1NEDgUgNG`&ppCO�NTrRAnCTING,INC.
11.0' r PER2C A�•7�'� LL IMIOJS KL RD.
BOTTOM OF TEST HOLE AT ELEV. 19.06
SITE PLAN- 6" 0 7:00 MIN IIARWIGZI,MA 02645
(508)4324360
1 " = 20' DRAWN BY: SEM
0238
CHECKED BY: TAL SHEET 1 OF 1
�
v O FOUNDATIONS: j
1. All workmanship to conform to the requirements of the
V.
270- 7„ Massachusetts State Building Code, latest edition.
1`� - ., For site
location and aradrng information, see Site Plan, by others.
a ,
3. Soils Assumed net allowable soil bearing capacity, 3000 psi,
fora sand/gravel composition. Other soils encountered, contact the
Engineer of Record. Compact bockfill soils around perimeter with a
n rcv l rnix of s required
Portable vibratory compactor. Add _.a d/ e soil, a
>rta atory -gym a q
it in umpaction to provide final grading.
dur g c c e dinc,�.
4. Concrete: Minimum 28 day strength, f'c - 3000 psi, 3/4"
f,ggregate, designed per American Concrete Institute Code, latest i
;_,sue, max. slump = 4'. h
� ¢ + a.) Steel reinforcing bars: New billet steel, ASTM A-1515, Grade
_ 5 --0 60_
❑D DECK A galvanized, 1 t diameter x 2"
5 Anchor bolts: ASTM A3 7 /`'�' 1
FUTURE REBUILT W❑ b.) n h C
ion w 2" hook, spaced at 4'-0" o.c. max., max. V-0" from
TO MATCH EXISTING i g
2 jogs, unless otherwise noted.
sive CC
") MASONRY: -
C1500
--' 2. Reinforcement:re Unless otherw seand prisnsshown,l verticol re nrforcement
- - shall be #`' 0 48 o/c., and horizontai reinforcement sho!1 be
"X �----- _ - '
c�
"Durowoll" wire truss type reinforcement 0 8" o/c horizontally.
FRAMING:
PORCH 3 l
f I i. All workmanship to conform to the requirements of the
Z � Main accordancte withAppendix
Building Code,A andnx C unle unlessst edition. Al nailing
noted herein ; ficafl shall bury I
t x S- ( Z pF v pi!c Y
V d 2. Timber Framing:
NJ L - z i- a. All new timber framing: Spruce-Pine-Fir No. 2 with Fb=1000
--- - NEB G1Rj (4) 1.75` .X,_18'�V.� . — . f - —4
psi, E=1,300,000 psi, or better.
b. Pressure treated timber (P.T.): Southern Pine with Fb=1300 psi,
' E=1,600,000 psi, or better. (Deck nailing shall be stainless steel,
ap and may use screws to attach decking.
° 1 c. Laminated Vereer Lumber ASI L.V'.L. shall be 1.9 E S P.
x
MICRO=LAM LVL (M.L.) with Fb-2925 psi,
UNFINISHED BASEMENT N` 1 E=2,000 ksi, Fv=285 psi, Fc-_per =750 psi, Fc--por =3035 psi.
4' SLAB-ON--GRADE _y� --------- I Metal Connectors
3 is As manufactured by Simpson Strong-Tie Co. shall be handled and
installed per manufacturer requirements, with all nail holes filled, with
O
II x the size noil as specified herein.
I 0 4. Bolts: (AS REQUIRED)
D10 t Bolts in wood framing shall be standard
DN RISERS AS REQUIRED machine bolts unless noted
110' DEEP X 16' otherwise. Bolt holes in wood shall be 1 '32" larger than bolt
! _
WIDE FOOTING diameter. Bolt heads and nuts shall bear on standard malleable iron
CHIMNEY �- _-- - ) NEW 2 X 4 BEARING WALL (2) 135 X 9.25 L.V.L_,
TO BE washers, or square plate washers. All nuts shall be retightened at
__.._._ _.________. _-- __-- _ ____._____ _._________,___- _.. ___w_
REMOVED `- -- �_ \ 1 h' completion of job. Minimum of 2" wood edge distance is required 0!1
-- around bolts.
-------
- / 5. Header < 4' - 0" use 3-2X6, all others leer MA State Building
_ _ ` ! i Code Table 3606.2.6
ALIGN IT
�I y�� \ �y-__J 6. Structural Design Loads:
CB) J W/WINDOWS ) �__^_ -� a�..,l Dead Loads: Weight of Building Components
ABOVE Q
_ Live Loads: Snow Load - 25 psf plus drift
I 3 {
p „ -1 m- FINISHED BA LI` ENNT REPLACES,: Wind Load 21 psf
M I 10 -6 - -� - 3 _4- LCC CA) First Floor = 40 psf
I _ _____� __�_ ___. x CLEAR � Q� 4' SLAB-ON-GRADE WIND[JW I f
-- -_
N CL AR ' d Second Floor = 30 psf
S_Z Lj
Z1 1 ti�/2 XS-2 i
`bd, �L n�
- 3- X . _ . _._ �• UP i �____ �' NEW GIRT (3) 1.75' X 16" L.V.L" *
' r
2 SPAN f I f{
__j + }
ci
A!-IGN �
W/WINDOWS _j
ABOVE `i Cu
(3sw_
WINDOWS TO MATCH �WINDOWS ABOVE_x - --
t11
-
-'! AREINFORCE LEDGER NAILING
1°ANGLE
EXISTING PORCH
AL_IGN ALIGN 1
W/WINDOWS W/WINDOWS j
ABOVE. qSf i _ ABOVE. 3,
>—
d,
FRONT
Y
I DESCRIPTION I M.O. (WIDTH X HEIGHT) FOUNDATION PLAN_ SHOWING FIRST FLOOR _FRAMING
r
_f --
`. - - - - ----- -- ---- -- - --- _ SCALE: 1/4' - 1 0
" DOUBLE GLIDER UNIT 5'-7' X 2'-0'
^- - --- - 00 INITIAL ISSUE i C1/29/03
B FIXED TRANSOM BY MFGR. N0. DESCRIPTION DATE
EXISTING BASEMENT WINDOW
- 2'--6' X i`_4.
------�__---- ---__-_-- — —_-- - -__---- _-- 71 TL t _ PROPOSED FOUNDATION PLAN
- INTERIOR DOOR BY OWNER Q�
4, . `� AND STRUCTURAL MODIFICATIONS
(EXTERIOR GRADE)
� o T,r� �, i�RoJECT, PROPOSED LUDTKE RESIDENCE
U No 3�./74 At,
Slil�r�.f' � 30 WACHUSETT AVENUE, HYANNISPOR7, MA
JEAN LUDTKE
R
ALL EXISTING BUILDING DIMENSIONS 30 WACHUSETT AVENUE, NrANNISPORT, MA 02ti47-w'484
DIMENSIONS N S I O N S � � E
� - - - -
, ONTRACTOR SHALL VERIFY ALL D E M I C I -I �_-_ E �___, � U _D Ll R � �' , E ,
PRIOR TO CONSTRUCTION . Consi,_,IL of-ig_ Struc taro L Engin _. erg
1?3 COTTONWOOD LANE, CENTERVILLE, MASSACHUSETTS 02632 (508)771-7601
JOB NUMBER: 2_UO2--137 DRAWN BY:MC?-/BCW�"- !I DRAWING NUMBER:
r SC ALE
AS NOTED DATE: JAN. 29, 2003 -
a
,. Ai,, •, wk ARP '�h,'}.
a ,
Y 'J
r r
4a
1
SHEATHING -- - I
i SHEATHING - --
j w^:s
E W P T. (2) 2 X 10 EXISTING 2 X 6 JOIST
` /,lit Q�, ay . WUt � ��, 4-j ��;- — i
EXIST. 2 X 6 JOIST
T [1, F O U N D EL, 32.9
_ PROVIDE BATT BEAM PER PLAN
INSULATION
I— STR GYP. I X 3 SISTER W/2 X 8 JOISTS FOR INSULATION
- �.. STRAPS "�---- -
OPTIONAL: SISTER JOIST SPANS > 8`0'
4' #5 @ 48' D.C.1 4 W/1.75' X 5.5' MICROLAM. USE RIGID I
BRICK —#5 @ 48' ❑.0 _ REGRADE BRICK
�,
-- . INSULATION BETWEEN. FOR 3 COURSES
# 6' CONCRETE BLOCK
POSITIVE
j EXIST, 2 X 6
GRADE VARi `.�.�.—,. .,r I � _.�..� PITCH ,
URSES
E:S I (T �_._ I !�_. - 6" COQNCRETE ''� � _ _— —`— � ,-� i 1=Ti 2 #5 TOP (TYP. k _----_—
BLOCK I Q i___. I I_. I I--I _ �, ALL AROUND) cv I
Aa z
• SISTERED 2 X 8µ2 RIGID _.._____ _ ____ _._� I i —— - ___ —INSULATION UJ
001
SIMPSON
10" �w N \: LU—SERIES
00
y
x PROPOSED
0 HAUNCH @ REAR 6" 10" #3 @ 16 0.C.
. I
R.H.S. ONLY k-- — -- I
I INSULATED 2 X 4 WALL
ALL AROUND PERIMETER
OF BASEMENT I ; '
BITUMINOUS
DAMPPROOFING
4°
4' SLAB—ON—GRADE 4' SLAB—ON—GRADE ~�
3 NEW GIRT
I � ,
I SCALE: 1' = 1'-0'
gF
- HAUNCH FOUNDATION SECTION
M TYPICAL FOUNDATION SECTION 2
1 — SCALE: 3/4' = V-0'
SCALEi 3/4' = 1'-0'
t
i 9
;N
I .
x
o�
i
{ BASED ON
4' WALL
r--
_CC SIMPSON STRONG — TIE
I NOT TO SCALE
16" O.C.
INFILL WITH
CUT IN NEW BEAM
j W0CID WEDGE FLUSH WITH L'W BEAM
f Ct ..
TOP OF CONCRETE EXISTING 2 X 8
2 X 6 @ 16' O.C.
A
__.
2 X 4 Vs/ - - (MAX (8`-0' TO FRONT) � 2 X 6
----- (2) 1.75 X 6.5' L.V.L.
-- -- _. {@ STAIR ❑PENING }
71 16'
} 2 X 6 i I O C SISTERED 2 X B
3 1/2' DIAMETER
00 — — ----- INITIAL ISSUE 01/29/0,3
LALLY COLUMN
NO. —� DESCRIPTION MATE .
-E:
PROPOSED DETAILS
- A STAIR OPENING DETAIL E T I � � _�_� U T\I T LAM o� M«HE�E `� PROJECT: PROPOSED LUDTKE RESIDENCE
04 I AIL 1- O R _ _ o C.
� s 30 WACHUSETT AVENUE, HYANNISPORT, MA
WINDOW D E - TUDOR m
SCALE: 1" = P-0' SCALE: 1 = P-0 0 No.34774 r„
SCALE: V 1'-0' STRUCTURAL
k
FOR: JEAN LUDTKE
i► /ONAI F — 30 WACHUSETT AVENUE, HYANNISPORT, MA 02647-0484
►Vwv
C , T
M1 CHELE UDFIR PIE
31103 Conc_-; u � tang S -truc -turaL Er krZo,4� ,
123 COTTONWOOD LANE, CENTERVILLE, MASSACHUSETTS 02632 (50iw,71.7a1
A�
JOB NUMBER: 2002-137 DRAWN BY:MCT/BCW/SJ* DRAWING t41
SCALE. AS NOTED DATE: JAN. 29, 2003
i
i ,