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Home My WebLink About0086 PUTNAM AVENUE Town of Barnstable .. .P ,,.,,..;.. ......,. -T""¢a w.• ' " w�; +»r. ..,. ,...„.nw • :.w. , .,.*r�.*vud uw,r-+- Frei^«»..v+"•. ..rti Building e ,n + oe ard So'ThatritisVisxi ler omhS reert +Appr o MstbReiyF,en Jobandthis Car, Pst This C Must be Kept b' s,�$ #Posted Until Final59. Inspection Has Been Made . ;, Where a Certificate of Occupancy is Required,such Building shaII,Not'be Occupied until a Final Inspection has Geen made PeY'I111 Permit No. B-18-3945 Applicant Name: Howard W Woollard Approvals Date Issued: 12/04/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 06/04/2019 Foundation: Residential -Map/Lot 036-037 Zoning District: RF Sheathing: Location: 86 PUTNAM AVENUE,COTUIT Contractor Name.,, Howard W Woollard Framing: 1 Owner on Record: ZAIS,CAROL D&ADAM S TRS •j Contractor License. CS-015834 2 Address: 86 PUTNAM AVENUE " '» Est Project Cost: $30,000.00 s }s 1 � Chimney: COTUIT, MA 02635 �. Permit Fee: $203.00 Description:' Remove Linen Closet-Relocate Bathroom#3 Enlarge Bedroom. �" x' Insulation: i , Fee Paid:, $ 203.00 6, Date: F� 12/4/2018 Final: o Project Review Req: s` Plumbing/Gas k � Rough Plumbing: 7,Building Official Final Plumbing: f Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six month's afie- issuance. All work authorized by this permit shall conform to the approved application and the tapproved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall-be incompliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Electrical work until the completion of the same. _- s Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final:' 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application Numb a . + + BARNBTASLE, + MAS& Permit Fee.......................................Other Fee........................ 26396 Total Fee Paid. . TOWN OF BARNSTABLE Permit Approval by........ .... .... ............on.....�. �..:.1.�..� BUILDING PERAUT Map .. .. .....................Parcel.............03.�.T......... APPLICATION Section 1 - Owner's Information and Project Location i i Project Address_ U/%�/�/1� L� Village Owners Name Owners Legal Address (J�G (�l�/✓0� ��f✓� '� : Cil y/ ' State G�� W t3' / Z� W a 110 M Owners Cell# G/, ` S /3 E-mail Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3—Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment Sprinkler.System ❑ Addition ❑ Retaining wall ❑ Solar 2 Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description Last updated. 11/152018 Application Number.................................................... Section 5—Detail Cost of Proposed Construction 3� Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing S e Total#Of Bedrooms (proposed) S 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics 211(viring ❑ Oil Tank Storage ❑ Smoke Detectors [3'flumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney relocate bedroom i Water Supply Imo'Public ❑ Private - i Sewage Disposal ❑ Municipal U On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes 0'90 Section 7=Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes D No Last updated: 11/15/2018 Application Number. ......................................... Section 9-Construction Supervisor Name Telephone Number �� 2-Z Address ,O;�Y City AWV,ri 4/ ' State Zip e,�2 License Number � S `� License Type �S' Expiration Date , Z9 Contractors Email �Z�y�J Q � � ��,-Cell# I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor.in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature ��`/�� Gam/ Date Section 10-Home Improvement Contractor Name_z��&may (� �C-C � Telephone Number Address City State OVO` Zip O a-,6' Registration Number le-e/��49 Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780/CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature `' y ^J��-( Date r/- 2- Section 11 -Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date IL e Print Name %7�eVlzfz� e�Z? Telephone Number E-mail permit to: Last updated: 11/15/2018 Section 12—Department Sign-Offs + Health Department ❑ Zoning Board(if required) Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ { Conservation For commercial work,please take your plans directly to the fire department for approval, Section 13—Owner's Authorization I, o L I.S , as Owner of the subject property hereby authorize /�® � j l r��a�� -s `to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) gnature o weer date C Z197l S Print Name ' Last updated. 11/15/2018 r ------------------- Barnstable Bldg. Dept. l ,f Approved by: Permit #:'� -ZC —( S MSTR. BEDROOM '------------' m M ewe eoacs eaac9 ;------------------------------------------- - - ce LL- CHANGING O e � - ------- BATH.- ■ r BATH�2 LINEN BATH. 3 I_ 1Q _....,.-. Fr """U, BEDROOM 2 BEDRM. �i -- - HALL el SCREEN PORCH i I - {� HALLR B r BEDROOM 4 BEDROOM 3 C) i 4 mavta j i DOM f �H� AN&N6 !i ----- BATH I BATH. 7 f i! BEDROOM 2 ._.�_..._ ......c�.. HAL�.� 1. �. t HAL�� 2 .t9EGR40M Q',. i ;.s Btirnstable Bldg. Dept. -------------------7 Approved by:— Permit#t: 11,�1 MSTR. BEDROOM CIDca.W 0 J �- eoacs ooace ----------------------------------- f wave ------ -- ------ 1 Cq ts. ON !i .-.O CHANGING + 00, m /1 BATH, 2 LINEN BATH. 3 HALL j BEDROOM 2 BEDRM. -=- =---- .:: HALL SCREEN PORCH T _ems BEDROOM 3 T BEDROOM 4 r, �0 1r l ✓�0.v�. �v� Ca'� r� I vc 1 I MSTR. SEPROOM i 1 1 a®.vte 1 j �SHANCi1NEs � II ..... BATH.. _ 110 BATH. 2 • ," ' ►+_...A ,4, ........... 1 I Lt I t,i'{1 jf�L, R 1 I pED�RQOM 4 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual): ®�s/�` /�, z_ Address: 7i el, City/State/Zip: ��/� /T/fl /�GU - Phone#: -�`®X l_2 Rio Are you an employer?Check the appropriate bog: Type of project(required): 1.ElI am a employer with- 4. C3 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.Ell am a sole proprietor or partner- listed on the attached sheet. 7. E-Mc odeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.: 9. Building addition required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.El officers have exercised their I am a homeowner doing all work 11.E]Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance Leguired,],t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp:insurance required] {Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the 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.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 of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and Penalties of er' that the information provided above is true and correct Signstore: z ( Date: r 2—f Phone#: G� Z Z_% — �✓6/ 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:EIectrical 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 cant'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 member 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 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 1,nvestigatlow 600 Washington Street Boston,MA 02111 Tel.#617-727-4400 ext 406 or 1-877-MASSAM Fax#617-727-7749 Revised 42407 www.maw.gov/dia Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constr�Ctil tt`��b rvisor . p r f, CS-015834 Eires: 10/30/2019 In f +i � HOWARD W WOOLLAR4 `" M.. PO BOX 263 i � BARNSTABLE MA 02630 tl`�IcS 13ON, Commissioner Co•suction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts ^ State Building Code is cause for revocation of this license. t For information about this license Call(617)727-3200 or visit www.rnass,gov/dpl 14 I dj�72-�o�aiiiycaruueal�a�C�/ CiaSrcc/uueCtb OBce of Consumer Affairs&Business Regulation' HOME IMPROVEMENT CONTRACTOR TYPE:Individuals _ Registration i n e BUM 05/17/2019 F HOWARD WOOLL9R �t'I� HOWARD WOOLLARD 3219 MAIN ST _ : BARNSTABLE,MA 02�f> 0 Undersecretan ..l �� ,��. �� _�, i _- I�- -- � - - -- i �- -- . ,;:33•r.. i ice: F: :J' �f•r•• . .:.t +.4'4' fi'ii \>>, rINSULATION CO. November 20, 2018 Job Location: Woollard Builders, LLC P O Box 1143 86-Putnam Ave Barnstable, MA 02630 Cotuit F Insulation installed to specifications below: Area R value Manufacturer ?ype Comment ... ... . Exterior Walls (2x4) R-15/2.25" Gaco One Pass Closed Cell Spray Foam Insulation Interior Walls R-13 3-112" Owens Corning Unfaced For foam specifications see attached documents. I hereby certify he insulation p ucts have been installed in accordance to the specifications stated abov . 1 All Timothy T/tt Summit Insulation Co., Inc. P.O. Box 1337 Harwich, MA 02645 (508)430-8144 , | / ' Liaco Western S / wuG 1oes -------------------------------------------- ------------ '--------- --------------- ------------- -------' Product Data Sheet: GacoOnePass F1850 June 2017 Supersedes 3/17 GacoOnePass F1860 . CLOSED CELL SPRAY FOAM INSULATION DESCRIPTION GaooOnaPaoeF185Oisa two component HFC'blown (zero nzone-deploting) liquid spray system that cures hoamedium- density rigid cellular polyurethane insulation material. GaooDnoPann F1850oontaino po|yols derived from naturally � renewable oils, poot'oonoumereoyc|ed plastics, and pre-consumer � � � GacoOnePass F1850 is a Class A(Class 1)fire rated foam that meets or exceeds the requirements of ICC-ES AC377 Acceptance Criteria for Foam Plastic Insulation. See |ntertek Code Compliance Research Report CCRR-YO43 for code compliant application information. GacoOnePass F1850 is a Type 11 foam in accordance with ASTM C1029. GaooOnePane F1850 is designed to be installed in uptofive and one half inch(5Y2^) passes when installation instructions are followed. This closed cell foam is designed to provide: excellent thermal performance; air impermeable insulation; and, an integral part ofon air barrier assembly. RECOMMENDED USES GacnOnoPano F1850wiU provide excellent performance in awide range ofresidential, commercial and industrial applications where in service temperatures are between'40~F and 200"Fino|uding: vvo/o *u|oo Concrete Slabs Cold Storage Storage Tanks comnnx Crawlopaoeo Residential Ducts Freezers Flotation Floors Foundations Plenums Piping Industrial Applications . 8anoOnoP000 is FEMAC|aon 5, the highest rating forf|ond'reoiotant materials. PHYSICAL PROPERTIES ' The following physical property tests were conducted by independent certified laboratories with traceable samples in accordance ICC-ES AC377 and ASTM C1029 for Type 11 foam and ABAA D-1 15-010 for Air Barrier Materials and Assemblies. PROPERTY* ASTM TEST VALUE UNIT Compressive Strength (Parallel to D1621 28.5 psi Tensile Strength D1623 39.7 psi Water Vapor Permeance E96—Method A 0.44 perm-in Dimensional Stability Crack Bridging @-150F(-260 C1305 Pass No-cracking Water Absorption (96 hours, D2842 2.76 % by volume Made in the USA| - GacoOnePass F1850 Page 2 Water Absorption C1763 0.21 % by volume Water Resistive Barrier ICC-ES AC71, Pass AATCC Method 127 UV Weathering AC71 Pass No blistering or delamination Accelerated Aging AC71 Pass No blistering or delamination Hydrostatic Pressure—55 cm AATCC Method 127 Pass No water leakage 21.6" water column Pull Adhesion DensDeck D4541 39 psi Concrete D4541 48 psi OSB D4541 43 psi Fungi Resistance C1338 Pass no growth Hot Surface Performance C411 Pass No flaming, charring, or smoldering UL GREENGUARD Pass No harmful effects VOC Emissions UL GREENGUARD Pass No harmful effects Gold *These items are provided for general information. **Federal Trade Commission regulations published in the Federal Register 16 CFR Part 460 require that R value testing of polyurethane foam insulation must be conducted on aged samples at a 75°F mean test temperature.Failure to comply can result in substantial fines by the FTC. ***To determine R values for thickness not listed: a. between 1 inch and 3.5 inch can be determined through linear interpolation;or, b.greater than 3.5 inches can be calculated based on R 7.2/inch SURFACE BURNING CHARACTERISTICS GacoOnePass F1850 meets Class A(Class 1) requirements when tested in accordance with ASTM E84 (UL 723) as defined in NFPA 101 and Section 803 of the International Building Code (2009, 2012, 2015). SYSTEM FLAME SPREAD INDEX SMOKE DEVELOPED INDEX GacoOnePass F1850' 5 350 Sample tested at 4"(10.2 cm)thickness. May be installed at unlimited thicknesses when covered with'/"gypsum board. LARGE SCALE FIRE TESTING TEST PERFORMANCE LOCATION FOAM THICKNESS/COATING Vertical surfaces Up to 8.0" (20.3 cm)/No Coating Required AC377 Ignition Barrier Horizontal or sloped surfaces Up to 10.0"(25.4 cm)/No Coating Required NFPA 286 Thermal Barrier Vertical surfaces Up to 7.5"(19.1 cm)/DC315- 18 mil wet Horizontal or sloped surfaces Up to 9.5"(24.1 cm)/DC315- 18 mil wet Vertical surfaces Up to 7.5"(19.1 cm)/TPR2 Fireshell NFPA 286 Thermal Barrier F1OE/TB- 18 mil wet Horizontal or sloped surfaces Up to 11.25" (24.1 cm)/TPR2 Fireshell F10E/TB- 18 mil wet GacoOnePass F1850 meets or exceeds the IBC requirements for exterior walls in type I, II, III, IV and V construction. This includes NFPA 285 and NFPA 259 testing with Intertek Listings(GWUFIP 30-02, GWUFIP 30-01). VAPOR RETARDER GacoOnePass F1850 meets the requirement of one perm or less for a Class II vapor retarder per the International Code Council and ASHRAE when installed at 0.44 inches in depth. However, minimum installed thickness recommended by Gaco Western is 0.75 inches. Water vapor permeability at various thicknesses is provided below: Thickness WVP Thickness WVP 0.44" 1.00 perms 3" 0.15 perms 1.0" 0.44 perms 4" 0.11 perms 2" 0.22 perms Made in the USA . gaco{com . 877.699.4226 I GacoOnePass F1850 Page 3 AIR BARRIER PERFORMANCE GacoOnePass F1850 is an air impermeable insulation and an air barrier material based on testing in accordance with ASTM E2178 at one-inch depth or more and has passed air barrier assembly testing in accordance with ASTM E2357 and has been evaluated by the Air Barrier Association of America in accordance with ABAA D-115-010. INDOOR AIR QUALITY GacoOnePass F1850 is a low VOC emitting material and is GREENGUARD Gold Certified(29167-410, 29167-420) (formerly known as GREENGUARD Children &Schools Certification) by UL Environment. This program demands strict certification criteria and considers safety factors to account for sensitive individuals(such as children and the elderly), and ensures that a product is acceptable for use in environments such as schools and healthcare facilities. It is referenced by both the Collaborative for High Performance Schools(CHPS) and the Leadership in Energy and Environmental Design (LEED) Building Rating System. FLOTATION PERFORMANCE GacoOnePass F1850 meets the requirements of US Coast Guard requirement for flotation materials for both bilge and engine room applications in accordance with Code of US Regulations, Navigation and Navigable Waters Article§183.114 by testing from an independent laboratory. LEED INFORMATION GacoOnePass F1850 has a minimum of 9.7% recycled content based on weight, including 1.8% pre-consumer material and 7.9% post-consumer material. It contains 8.5% rapidly renewable content. GacoOnePass F1850 raw materials are blended in Waukesha,WI. Actual polyurethane foam end product production is done on-site by the applicator. TYPICAL LIQUID CHEMICAL PROPERTIES "A" Component contains polymeric isocyanate. "B" Component contains polyol, catalysts, fire retardants, surfactants and blowing agents. PROPERTY TEST ASTM TEST VALUE UNIT TEMPERATURE Viscosity—"A" Component: 770F (25°C) D2196 200 t 50 cps Viscosity—"B" Component: 1080 t 100 cps Specific Gravity—"A" Component: 77°F (25°C) D1638 1.24 S.G. Specific Gravity—"B" Component: 1.235 S.G. Weight/Gallon—"A" Component: 77°F (25°C) 10.34 Ibs/gal Weight/Gallon—°B" Component: 10.3 Ibs/ al Mixing Ratio—"A" &"B" Component: 1:1 By volume Stability When Stored at 50OF to 70OF A Component— 12 Months 10°C to 21°C : B Component—5 Months APPLICATION To ensure optimum performance, a minimum pass thickness of 3/4" (1.9 cm) is recommended with the maximum not to exceed 5'/2" (13.97 cm) per pass. To obtain optimum results substrate temperature should be within the ranges as stated below. All substrates must be dry at the time of application. Do not apply to wood surfaces with a moisture content of above 18%. Material Substrate Temperature GacoOnePass F1850R 30°F to 120°F -1°C to 49°C GacoOnePass F1850W 20OF to 80°F -7°C to 27°C EQUIPMENT SETTINGS REACTIVITY TIME Pre-Heaters - Iso(A): 105°F to 135°F(41°C to 57°C) Cream Time: 1 second Pre-Heaters-Poly(B): 1050F to 135°F (41°C to 57°C) Rise Time: 3-6 seconds Hose Heat: 105OF to 135°F(41°C to 57°C) Tack Free Time: 4-8 seconds Recommended Spray Pressure: 1,000 to 1,200 psi(dynamic) Cure Time: 24 hours The information herein is believed to be reliable but unknown risks may be present.ALL WARRANTIES OF ANY KIND,EXPRESSED OR IMPLIED, INCLUDING WARRANTIES OF FITNESS FOR A PARTICULAR PURPOSE AND THAT GOODS ARE OF MERCHANTABLE QUALITY,ARE SPECIFICALLY DISCLAIMED.See Gaco Western for information concerning its limited warranty and its availability. For specific Safety and Health information please refer to Safety Data Sheet.©Gaco Western 2017 Made in the USA . gaco.com 0 877.699.4226 Town of Barnstable Buildiri g � oet Teh�is Ceartrd Mb�° nScaoa lt TeInhzsa�pt ertcc ticsio 1np/I aSHInbaclsye BFsereonme q Mtharede eSt,rse;e ct,-Awppro�nvgeAxsd Pala�nso Muest b�eM uRq�pe tained on JFoib anrd.pthis Card Muni be Kept , Permit dUt FenPtos Psr Permit No. B-18-201 Applicant Name: HOWARD WOOLLARD Approvals Date Issued: 01/23/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 07/23/2018 Foundation: Location: 86 PUTNAM AVENUE,COTUIT Map/Lot 036 037 Zoning District: RF Sheathing: t ? Contr ctor Name '�.HOWARD WOOLLARD Framing: Owner on Record: ZAIS,CAROL D&ADAM S TRS , Address: 86 PUTNAM AVENUE "� �ContractorLcense 181970 2 .., COTUIT, MA 02635 Est Project Cost: $200,000.00 Chimney: Description: Remodel Mudroom, Kitchen and Living room�Relate 1/2 Bath and Permit�Fee: $ 1,070.00 FALaundry, remove two chimmneys. relocate entry door ass windowin Insulation: Fee Paid $ 1,070.00 living room. Replace all windows ' z Final: Date ` 1/23/2018 Project Review Req: Smoke permit on related permit B-17-4239 M Ldts��crn. Plumbing/Gas . P �� cj Rough Plumbing: _ --- - 41 Building Official final Plumbing: h Gas: This permit shall be deemed abandoned and invalid unless the work authonied by,'this permit is commenced within six o�nth °after issuance. Rough All work authorized by this permit shall conform to the approved applicationla i the approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shae in compliance with the local zoning by laws-and codes. ll b This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for publicinspection for the entire duration of the work until the completion of the same. ,� Electrical szti 3 " Service: The Certificate of Occupancy will not be issued until all applicable signatures bthe Build O hy Ffi o permit. Minimum of Five Call Inspections Required for All Construction Work 's114111 Rough: 1.Foundation or Footing �- 2.�heathing Inspection .Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6�Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechapical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Appiicatioa Nzmmber...... ......................................... Pe.�rtFee....... D 7 0 0.0....01grF=....................... T9P1........... ................................................... TOWN OF BARNSTABLE JA# mgvy .................. BUILDING PERMIT Town►OF BAR, ` ��!BLE APPLICATION ........... � ' ........................... ..�. - { Section 1— Owners Information and Project Location Project Address Owners Name C412-ffe- Owners Legal Address City C yi State zip Owners cell# h/� f��3 -J�yD/- E-mail X",07 Z15""f Section 2—Structural Use f E Single/Two Family Dwelling ❑ Commercial Structare over 35,000 cubic feet i ❑ Commercial Structure under 35,000 cubic feet Section 3-Type of Permit ❑ New Construction ❑ .Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire stru�) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler Sy stem . i. ❑ Addition ❑ Ret fining wall ❑ Solar Renovation ❑ Pool ❑ Insulation Other-Specify Section 4-Detail Cost of Proposed Cbnsftuctik�o,azio Square Footage of Project Age of Structure /(/V f Dig Safe Number #Of Bedrooms Existing 5,- Total#Of Bedrooms(proposed) y 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design 129updaxa:i72017 M ' Section 5 -Work Description le��Ipoo G£C W-l"doAn �i �fI`6� G/U/"n l2t5 Loci Te 7w O �.j��1/1��'�j � �/Z GAL o C-/f jG' ��i�� aV� - ��✓� w��o�,� Section 6-Project Specifics Wiring Oil Tank Storage ErSmoke Detectors Plumbing Gas Fire Suppression O Heating System ❑ Masonry Chimney ❑Add/relocate bedroom ----------Water SupplyPublic--- --❑_Private _. Sewage Disposal ❑ Municipal L"J On Site Historic District ❑ Hyannis ITistoric District ❑ Old Kings I•iighway Debris Disposal Facility: I am using a crane C Yes ❑N Section 7-Flood Zone Flood Zone Designation /0-/P- j Within or adjacent to a wetland,coastal bank? Yes ❑ No u Section 8—Zoning Information Zoning District Proposed Lot Area Sq.Ft Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past'? ❑ Yes El No i I Last updates 11=17 Section 9—Construction Supervisor . Name �fo��2� Gr, �✓oO�C�zI�Telephone Number 5 c2l^ Z Z/ -710 Address State 4V<f- Zip oZ, 3 y 4 License Number.(!5/5 8 -z- Y License Type s Expiration Date le2 - 30 �l9 r Contractois Ema3ll?Go�� f i "`� �" �' ' Cell# 'vim-Z-Z� - Flo F I understand my responsibilities under the rules and regulations for Licensed Con tmcdon Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I d the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature ' �l/1��' Date Section 10—Home Improvement Contractor Name l�o�J�'`'� �Joo�61f7t,0 Telephone Number Address 3 Z�� 1� s� f�Oti s�i�« StateAV, Zip �2 Z- er 3 r� Egpsatioa Date - - � Registration Numb ' �/�7 0 -- ---------- 4 I understand my responsbilities under the rules and regulations for Home Improvement Contractors in accordance with 780 { CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your FL LC... Side V(" Date Section 11—Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the roles and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachuseas State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 ChdR and the Town of Barnstable. Signa tine Date APPLICANT SIGNATURE Signature �� `�� Date Print Name &601,175W G�- G•�ov a�`�� Telephone Number E-mail permit to:—h(,ow o o «.1`4,0 6e Last updftd:1 12017 i Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required} ❑ Historic District ❑ Site Plan Review Cif required) ❑ Fire Department ❑ Conservation ❑ J For commercial work,please take your plans&ecdy to the f re deparbnent for approval Section 13—Owners Authorization I, as Owner of the subject property hereby authorize /-'oA>1;AV to.act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Si a of er date Print Name r r UrUpaatma:I V712017 i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name(Business/Organization/Individual): l�b�l�/L/� (��p Gz--Ifley Address: IY�-K // l_7 City/State/Zip: /��it�Yr`/fj�Gu— u Phone#: D Z I'c2 Are you an employer?Check the appropriate bog: Type of project(required}: 1.El am a employer with 4. 0 I am a general contractor and I e4aloyees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.K11 am a sole proprietor or partner- listed on the attached sheet. 7. EMemodeling 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.t 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 11.❑Plumbing repairs or additions myself[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑Other employees. [No workers' 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.Lie.#: ` Expiration Date: Job Site Address: �c� y�� l/�l/G' 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. I do hereby certi^under t�he�pai)ns/and p�enalties�ofp/�e.7y that the information provided above is true and correct afore ' T '�C/ �/(/ �� —�f Sign Date: Phone#: > OR Z-2 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-contractor(s)name(s),address(es)and phone numbers)along with their certificates)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 permitilicense 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 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 Gammcnwealth of Massachusetts Dopartment of Industrial Accidents Office of Investigations 600 Washington Sh=t Bostan,MA 02111 TeL#617-727-4900 ext 406 or 1-877-MASSAFE Fax##617-727-7749 Revised 4-24-07 VVWW.M=,gov/dia Town of Barnstable Geographic Information System August 28,2006 036038 # 10 036039 # 0 0 Cp # 658 w�<<AVZNVE - 036041002 # 0. CD 036052 036031 # 33 # 674 036037 # 86 036032 #688 $Z # 59 41 # tn. -- �� W a �►,� z 036036 LU 36013 036049 # 58 #689 # 700 a Z 44 eetVu\n F 0 010 d 036041001 # # 51 DISCLAIMERS:This map is for planning purposes only._It is not adequate for legal Map:036 Parcel:037 - N boundary determination or regulatory interpretation. Enlargements beyond a scale of -Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:ZAIS,CAROL D TR Total Assessed Value:$852700 are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:1.60 acres Abutters E - boundaries and do not represent accurate relationships to physical features on the map Location:86 PUTNAM AVENUE such as building locations. Buffet Commonwealth of Massachusetts Division of Professional Licensurelug F Board of Building Regulations and Standards ! Constrqj6tMi j�rvisor CS U15834 P�pires: 10/30/2019 F HOWARD W WOOLLARD " PO BOX 263 f ;' BARNSTABLE MAO 630 W�0U,1, i Commissioner Cor struction Supervisor 4 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed< i space. i t F Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. I For information about this license i Call(617)727-3200 or visit www.mass.gov/dpl �ze rOoa��oJruuae�cClf a�C��cLu�aeCt'< Office of Consumer Affairs&Business Regulation"I HOME IMPROVEMENT CONTRACTOR N. TYPE:Individual Registration Expiration 15 181970_ 05/17/2019 HOWARD WOOLIARD:,,-E HOWARD WOOLLARD_—_ 3219 MAIN ST "�- BARNSTABLE,MA 02(i30' Undersecretary i Registration valid for individual use only ! 1 before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation { 10 Park Plaza-Suite 5170 { Boston,MA 02116 / Not valid without signature {a r � , �y 1 INSULATION CO. February 26, 2018 Job Location: Woollard Builders, LLC __ _ _ P O Box 1143 C86 Putnam Ave Barnstable, MA 02630 t-1 Cotuit,� Insulation installed to specifications below: ti N.N c:::: :::: .0 ... ...:::... tA22[ aGlZt ....... TYp : .. ammat Exterior Walls (2x4) R-2113" Gaco One Pass Closed Cell Spray Foam Insulation Bath Walls R-13 3-112" Owens Corning Unfaced 1st. Floor Ceiling R-19 6-114" Owens Corning Unfaced Crawlspace Floor R-2113" Gaco One Pass Closed Cell Spray Foam Insulation For foam specifications see attached documents. I hereby certify the insulation products have been installed in accordance to the specifications stated abo , Timothy. ott Summit Insulation Co., Inc. P.O. Box 1337 Harwich, MA 02645 (508)430-8144 Gaco Western . S I N C E 1 9 5 5 Product Data Sheet: GacoOnePass F1850 June 2017 Supersedes 3/17 GacoOnePass F1850 CLOSED CELL SPRAY FOAM INSULATION DESCRIPTION GacoOnePass F1850 is a two component HFC-blown (zero ozone-depleting) liquid spray system that cures to a medium- density rigid cellular polyurethane insulation material. GacoOnePass F1850 contains polyols derived from naturally renewable oils, post-consumer recycled plastics, and pre-consumer recycled materials. GacoOnePass F1850 is a Class A(Class 1)fire rated foam that meets or exceeds the requirements of[CC-ES AC377 Acceptance Criteria for Foam Plastic Insulation. See Intertek Code Compliance Research Report CCRR-1043 for code compliant application information. GacoOnePass F1850 is a Type II foam in accordance with ASTM C1029. GacoOnePass F1850 is designed to be installed in up to five and one half inch (51/") passes when installation instructions are followed. This closed cell foam is designed to provide: excellent thermal performance; air impermeable insulation; and, an integral part of an air barrier assembly. RECOMMENDED USES GacoOnePass F1850 will provide excellent performance in a wide range of residential, commercial and industrial applications where in service temperatures are between -40°F and 200°F including: Walls Attics Concrete Slabs Cold Storage Storage Tanks Ceilings Crawlspaces Residential Ducts Freezers Flotation Floors Foundations Plenums Piping Industrial Applications GacoOnePass is FEMA Class 5,the highest rating for flood-resistant materials. PHYSICAL PROPERTIES The following physical property tests were conducted by independent certified laboratories with traceable samples in accordance ICC-ES AC377 and ASTM C1029 for Type II foam and ABAA D-115-010 for Air Barrier Materials and Assemblies. PROPERTY* ASTM TEST VALUE UNIT Core Density D1622 2.1 t 10% Ibs/ft3 Aged R-Value** C518 R 6.5 at 1""" h.ft2.°F/Btu C518 R 25 at 3.5"*** h.ft2.°F/Btu Compressive Strength (Parallel to Rise): D1621 28.5 psi Tensile Strength D1623 39.7 psi Water Vapor Permeance E96—Method A 0.44perm-in Dimensional Stability At 1580E 70°C and 97% RH D2126 L=5.2%,W=1.1%, T=8.5% % linear change At 1760E 80°C and ambient RH L=-0.3%, W=-0.2%, T=45% % linear change At-40F -20°C and ambient RH L=0.2%, W=0.2%, T=1.7% % linear change Open Cell Content D6226 4.4 % Air Permeance @ 75Pa E2178 0.00 at 1" L/s.M2 Infiltration/Exfiltration Air Barrier Assembly @ 75Pa E2357 0.007 at 1" L/s-M2 Infiltration/Exfiltration Crack Bridging -15°F -26°C C1305 Pass No-cracking Water Absorption (96 hours, 2" D2842 2.76 % by volume .. head, 70-740F 21-230C Made in the USA • gaco.com • 877.699.4226 y ' GacoCinePass F1850 1,_', Page 2 Water Absorption C1763 0.21 % by volume Water Resistive Barrier ICC-ES AC71, Pass AATCC Method 127 UV Weathering AC71 Pass No blistering or delamination -Accelerated Aging AC71 Pass No blistering or delamination Hydrostatic Pressure—55 cm AATCC Method 127 Pass No water leakage 21.6" water column Pull Adhesion DensDeck D4541 39 psi Concrete D4541 48 psi OSB D4541 43 psi Fungi Resistance C1338 Pass no growth Hot Surface Performance C411 Pass No flaming, charring, or smoldering UL GREENGUARD Pass No harmful effects VOC Emissions UL GREENGUARD Pass No harmful effects Gold *These items are provided for general information. **Federal Trade Commission regulations published in the Federal Register 16 CFR Part 460 require that R value testing of polyurethane foam insulation must be conducted on aged samples at a 75*F mean test temperature.Failure to comply can result in substantial fines by the FTC. ***To determine R values for thickness not listed: a. between 1 inch and 3.5 inch can be determined through linear interpolation;or, b.greater than 3.5 inches can be calculated based on R 7.2/inch SURFACE BURNING CHARACTERISTICS GacoOnePass F1850 meets Class A(Class 1) requirements when tested in accordance with ASTM E84 (UL 723) as defined in NFPA 101 and Section 803 of the International Building Code(2009, 2012, 2015). SYSTEM FLAME SPREAD INDEX SMOKE DEVELOPED INDEX GacoOnePass F1850' 5 350 'Sample tested at 4"(10.2 cm)thickness.May be installed at unlimited thicknesses when covered with''/z"gypsum board. LARGE SCALE FIRE TESTING TEST PERFORMANCE LOCATION FOAM THICKNESS/COATING AC377 Ignition Barrier Vertical surfaces Up to 8.0" (20.3 cm)/No Coating Required Horizontal or sloped surfaces Up to 10.0" (25.4 cm)/No Coating Required NFPA 286 Thermal Barrier Vertical surfaces Up to 7.5" (19.1 cm)/DC315- 18 mil wet Horizontal or sloped surfaces Up to 9.5" (24.1 cm)/DC315- 18 mil wet Vertical surfaces Up to 7.5" (19.1 cm)/TPR2 Fireshell NFPA 286 Thermal Barrier F10E/TB- 18 mil wet Horizontal or sloped surfaces Up to 11.25" (24.1 cm)/TPR2 Fireshell F10E/TB- 18 mil wet GacoOnePass F1850 meets or exceeds the IBC requirements for exterior walls in type I, II, III, IV and V construction. . This includes NFPA 285 and NFPA 259 testing with Intertek Listings (GWL/FIP 30-02, GWL/FIP 30-01). VAPOR RETARDER GacoOnePass F1850 meets the requirement of one perm or less for a Class II vapor retarder per the International Code Council and ASHRAE when installed at 0.44 inches in depth. However, minimum installed thickness recommended by Gaco Western is 0.75 inches. Water vapor permeability at various thicknesses is provided below: Thickness WVP Thickness WVP 0.44" 1.00 perms 3" 0.15 perms 1.0" 0.44 perms 4" 0.11 perms 2" 0.22 perms Made in the USA . gaco.com . 877.699.4226 GacoOnePass F1850 Page 3 AIR BARRIER PERFORMANCE GacoOnePass F1850 is an air impermeable insulation and an air barrier material based on testing in accordance with ASTM E2178 at one-inch depth or more and has passed air barrier assembly testing in accordance with ASTM E2357 and has been evaluated by the Air Barrier Association of America in accordance with ABAA D-115-010. INDOOR AIR QUALITY GacoOnePass F1850 is a low VOC emitting material and is GREENGUARD Gold Certified (29167-410, 29167-420) (formerly known as GREENGUARD Children & Schools Certification) by UL Environment. This program demands strict certification criteria and considers safety factors to account for sensitive individuals(such as children and the elderly), and ensures that a product is acceptable for use in environments such as schools and healthcare facilities. It is referenced by both the Collaborative for High Performance Schools (CHPS) and the Leadership in Energy and Environmental Design (LEED) Building Rating System. FLOTATION PERFORMANCE GacoOnePass F1850 meets the requirements of US Coast Guard requirement for flotation materials for both bilge and engine room applications in accordance with Code of US Regulations, Navigation and Navigable Waters Article§183.114 by testing from an independent laboratory. LEED INFORMATION GacoOnePass F1850 has a minimum of 9.7% recycled content based on weight, including 1.8% pre-consumer material and 7.9% post-consumer material. It contains 8.5% rapidly renewable content. GacoOnePass F1850 raw materials are blended in Waukesha,WI.Actual polyurethane foam end product production is done on-site by the applicator. TYPICAL LIQUID CHEMICAL PROPERTIES "A" Component contains polymeric isocyanate. "B"Component contains polyol, catalysts, fire retardants, surfactants and blowing agents. PROPERTY TEST ASTM TEST VALUE UNIT TEMPERATURE Viscosity—"A"Component: 77°F (25°C) D2196 200 t 50 cps Viscosity—"B"Component: 1080 t 100 cps Specific Gravity—"A" Component: 77°F (25°C) D1638 1.24 S.G. Specific Gravity—"B" Component: 1.235 S.G. Weight/Gallon—"A" Component: 77°F (25°C) 10.34 Ibs/gal Weight/Gallon—"B" Component: 10.3 Ibs/ al —Mixing Ratio—"A"&"B" Component: 1:1 By volume Stability When Stored at 50°F to 70OF A Component— 12 Months 10'C to 21°C : B Component—5 Months APPLICATION To ensure optimum performance, a minimum pass thickness of 3/4" (1.9 cm) is recommended with the maximum not to exceed 5'/2" (13.97 cm) per pass. To obtain optimum results substrate temperature should be within the ranges as stated below. All substrates must be dry at the time of application. Do not apply to wood surfaces with a moisture content of above 18%. Material Substrate Temperature GacoOnePass F1850R 30OF to 120OF -1°C to 49°C - GacoOnePass F1850W 20OF to 80°F -7°C to 27°C EQUIPMENT SETTINGS REACTIVITY TIME Pre-Heaters- Iso (A): 105OF to 135°F (41°C to 57°C)_ Cream Time: 1 second Pre-Heaters- Poly(B): 105OF to 1350F (41°C to 57°C) Rise Time: 3-6 seconds Hose Heat: 105°F to 135°F (41°C to 57°C) .` Tack Free Time: 4-8 seconds Recommended Spray Pressure: 1,000 to 1,200 psi (dynamic) Cure Time: 24 hours The information herein is believed to be reliable but unknown risks may be present.ALL WARRANTIES OF ANY KIND,EXPRESSED OR IMPLIED, INCLUDING WARRANTIES OF FITNESS FOR A PARTICULAR PURPOSE AND THAT GOODS ARE OF MERCHANTABLE QUALITY,ARE SPECIFICALLY DISCLAIMED.See Gaco Western for information concerning its limited warranty and its availability. For specific Safety and Health information please refer to Safety Data Sheet.©Gaco Western 2017 Made in the USA • gaco.com • 877.699.4226 '71 I ®Bohm Cascade Triple 1-3/4" x 9-1/2" VERSA-LAM® 2.0 3100 SP Floor Beam1F1301 Dry 1 span f No cantilevers 1 0/12 slope December 8,2017 08:09:19 BC CALC®Design Report Build 6080 File Name: H Woollard_86 Putnam —6 3— Job Name: Description: Designs\FBO1 Address: 86'Putnam'Road� Specifier: jlm City, State, Zip,Cotuit, MA- / Designer: Customer: Howard Woollard Company: Shepley Wood Products Code reports: ESR-1040 Misc: I I I ! I ! 1 1 1 i l i l i f f I I l i l l 16-08-00 BO B1 Total Horizontal Product Length=16-08-00 Reaction Summary(Down/Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 1,500/0 495/0 B1, 3-1/2" 1,500/0 495/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf.Area(lb/ft"2) L 00-00-00 16-08-00 40 10 04-06-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 7,863 ft-Ibs 37.6% 100% 1 08-04-00 End Shear 1,736 Ibs 18.3% 100% 1 01-01-00 Total Load Defl. U392(0.496") 61.2% n/a 1 08-04-00 Live Load Defl. U522(0.373") 69% n/a 2 08-04-00 Max Defl. 0.496" 49.6% n/a 1 08-04-00 Span/Depth 20.5 n/a n/a 0 00-00-00 Squash Blocks Valid %Allow %Allow Bearing Supports Dim.(L x W) Value Support Member Material BO Post 3-1/2"x 5-1/4" 1,995 Ibs n/a 14.5% Unspecified B1 Post 3-1/2"x 5-1/4" 1,995 Ibs n/a 14.5% Unspecified Notes Design meets Code minimum(U240)Total load deflection criteria. Design meets Code minimum(L1360) Live load deflection criteria. Design meets arbitrary(1") Maximum Total load deflection criteria. Calculations assume member is fully braced. Design based on Dry Service Condition. Fastener Manufacturer.TrussLok(tm) r Page 1 of 2 r Balm Cascade Triple 1-3/4" x 9-1/2" VERSA-LAM@ 2.0 3100 SP Floor Beam\F1301 Dry I 1 span No cantilevers 1 0/12 slope December 8,2017 08:09:19 BC CALC®Design Report Build 6080 File Name: H Woollard 86 Putnam Job Name: Description: Designs\FB01 Address: 86 Putnam Road Specifier: jlm City, State,Zip:Cotuit, MA Designer: Customer: Howard Woollard Company: Shepley Wood Products Code reports: ESR-1040 Misc: Connection Diagram Disclosure .i b d Completeness and accuracy of input must L I be verged by anyone who would rely on a output as evidence of suitability for • 4-• • particular application.Output here based c on building code-accepted design properties and analysis methods. • • • Installation of Boise Cascade engineered wood products must be in accordance with e current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call a minimum=2" c=5-1/2" (800)232-0788 before installation. b minimum=4" d=24" e minimum= 1" BC CALC®,BC FRAMER®,AJS- ALLJOISTO,BC RIM BOARD-,BCI®, BOISE GLULAM- SIMPLE FRAMING Calculated Side Load=225.0 lb/ft SYSTEM®,VERSA-LAW,VERSA-RIM All TrussLok screws may be installed from one side of multiple I VERSA-LAM beams. PLUS®,VERSA-RIM®, Y P ply VERSA-STRAND®,VERSA-STUDS are All TrussLok screws may be installed from one side of multiply Versa-Lam beams. trademarks of Boise Cascade wood Connectors are: FMTSL005 Products L.L.C. r ®Sollpe Ca=de Double 1-3/4" x 7-1/4" VERSA-LAM® 2.0 3100 SP Wall Header1F1302 Dry 11 span I No cantilevers 1 0/12 slope December 8,2017 08:09:20 BC CALC®Design Report Build 6080 File Name: H Woollard_86 Putnam Job Name: Description: Designs\FB02 Address: 86 Putnam Road Specifier: jim City, State, Zip:Cotuit, MA Designer: Customer: Howard Woollard Company: Shepley Wood Products Code reports: ESR-1040 Misc: 1 1 1 1 1 1 ! I ! I l l l l l ! I I I Isl I I I I I i l I V I i l I 1 1 1 i l l 1 1 05-00-00 BO 61 Total Horizontal Product Length=05-00-00 Reaction Summary(Down/Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 1,407/0 543/0 675/0 B1, 3-1/2" 943/0 427/0 675/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf.Area(Ib/ft^2) L 00-00-00 02-06-00 40 10 08-06-00 2 Reaction from Desi... Conc. Pt. (Ibs) L 02-06-00 02-06-00 1,500 495 n/a 3 Unf.Area(lb/ft^2) L 00-00-00 05-00-00 5 30 09-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 2,948 ft-Ibs 35.2% 100% 1 02-06-00 End Shear 1,522 Ibs 31.6% 100% 1 00-10-12 Total Load Defl. U999(0.043") n/a n/a 3 02-05-06 Live Load Defl. U999(0.031") n/a n/a 6 02-05-06 Max Defl. 0.043" n/a n/a 3 02-05-06 Span/Depth 7.5 n/a n/a 0 00-00-00 Squash Blocks Valid %Allow %Allow Bearing Supports Dim.(L x W) Value Support Member Material BO Post 3-1/2"x 3-1/2" 2,104 Ibs n/a 22.9% Unspecified B1 Post 3-1/2"x 3-1/2" 1,640 Ibs n/a 17.9% Unspecified Notes Design meets Code minimum (U240)Total load deflection criteria. Design meets Code minimum (U360)Live load deflection criteria. Design meets arbitrary(1") Maximum Total load deflection criteria. Calculations assume member is fully braced. Design based on Dry Service Condition. Fastener Manufacturer:TrussLok(tm) Page 1 of 2 ®Boise Cascade Double 1-3/4" x 7-1/4" VERSA-LAM® 2.0 3100 SP Wall HeaderT1302 y Dry 1 span I No cantilevers 1 0/12 slope December 8, 2017 08:09:20 BC CALC®Design Report Build 6080 File Name: H Woollard_86 Putnam Job Name: Description: Designs\FB02 Address: 86 Putnam Road Specifier: jim City, State, Zip:Cotuit, MA Designer: Customer: Howard Woollard Company: Shepley Wood Products Code reports: ESR-1040 Misc: Connection Diagram Disclosure �.I b a Completeness and accuracy of input must L I be verified by anyone who would rely on a output as evidence of suitability for particular application.Output here based on building code-accepted design properties and analysis methods. • • • Installation of Boise Cascade engineered wood products must be in accordance with e current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call a minimum=2" c=3-1/4" (800)232-0788 before installation. b minimum=4" d=24" e minimum= 1" BC CALC®,BC FRAMER®,AJSTM' ALLJOISTV,BC RIM BOARD-,BCIO, Connection design assumes point load is top-loaded. For connection design of side-loaded BOISE GLULAM- SIMPLE FRAMING point loads, please consult a technical representative or professional of Record. SYSTEM®,VERSA-LAM®,VERSA-RIM PLUS®,VERSA-RIM®, All TrussLok screws may be installed from one side of multiple ply VERSA-LAM beams. VERSA-STRAND®,VERSA-STUD®are All TrussLok screws may be installed from one side of multiply Versa-Lam beams. trademarks of Boise Cascade wood Member has no side loads. Products L.L.C. Connectors are: FMTSL338 BelmCascade Quadruple 2 x 4 SPF #2 CL01 ' Dry 1 8'0"Column Freestanding December 8,2017 08:09:11 BC CALC®Design Report Build 6080 File Name: H Woollard_86 Putnam Job Name: Description: Designs\CL01 Address: 86 Putnam Road Specifier: jlm City, State, Zip:Cotuit, MA Designer: Customer: Howard Woollard Company: Shepley Wood Products Code reports: NLGA Misc: Live Dead Snow Wind Roof Livi 6.. Load Summary Freestanding Column �° 3.5^Tag Description Load Type Start End 100% 90% 115% 160% 125%E(left-Right)=1.002" 1 Conc. Pt. (lbs) 00-00-00 00-00-00 1,500 495 E(Front-Back)=0.585" Bracing Elevation Sheathing Top 08-00-00 Base 00-00-00 Load Controls Summary value %Allowable Duration Case Axial Compression n/a 19.5% 100% 1 0„ Axial Compression and Bending Front-Back n/a 13.2% 100% 1 Axial Compression and Bending Left-Right n/a 11% 100% 1 Slenderness Ratio 27.43 54.9% n/a 0 Cautions Design does not consider perpendicular to grain stress on the sill plate or other supporting member. Notes Allowable loads are based on a minimum eccentricity of 0.167 multiplied by the column thickness or width(worst case). BC Calc does not perform shear wall or connection design for in-plane load transfer. The analysis of solid sawn wood members is in accordance with the NDS and is limited to the output shown above. All other support and design for these products, including but not limited to notching, connections, installation, and engineer/architect certification is the responsibility of the project's design professional of record. Disclosure Completeness and accuracy of input must be verified by anyone who would rely on output as evidence of suitability for particular application.Output here based on building code-accepted design properties and analysis methods.Installation of Boise Cascade engineered wood products must be in accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call(800)232-0788 before installation. BC CALC®,BC FRAMER®,AJS- ALLJOISTO,BC RIM BOARD- BCI®,BOISE GLULAM- SIMPLE FRAMING SYSTEM®,VERSA-LAMO,VERSA-RIM PLUS®,VERSA-RIM®,VERSA-STRAND®,VERSA-STUDS are trademarks of Boise Cascade Wood Products L.L.C. �€ II Not to scale Page 1 of 1 �i_ INSULATION CO. January 08, 2018 .Job Location Woollard Builders, LLC P O Box 114385 Putnam.Ave R Barnstable, MA 02630 l�Cotuit," Insulation installed to specifications below: ............................ ::: . ::::::::::::::............::. ; ::::::: E:a:::::::::::::::::::::::::::: ::: t�lx :::::::h�lanu}ac ur.er::: .............�a �rz.:�.:::..:::..:.:......................... Crawlspace Floor R-21/3" Gaco One Pass Closed Cell Spray Foam Insulation For foam specifications see attached documents. I hereby certify the insulation products have been installed in accordance to the specifications stated abov Timothy T ott Summit Insulation Co., Inc. P.O. Box 1337 Harwich,MA 02645 (508)430-8144 4 } 4 e { Town of Barnstable TMI rpv _+Y Planning&Development Department 40 Barnstable Historical Commission z 9� BAM ssBM * 200 Main Street,Hyannis,Massachusetts 02601 ' v� 1639. `0�' (508)862-4787 Fax(508)862-4784 / �Eo s erin.logangtown.bamstable.ma.us ��`�OF BAR COMMISSION MEMBERS: Elizabeth Jenkins,Director Laurie Young,Chair Nancy Clark,Vice Chair Marilyn Fifield,Clerk w 0 George Jessop,ALA .� Nancy Shoemaker Elizabeth Mumford n Cheryl Powell d co DECISION - c Nrn Summary: Demolition Delay Not Imposed Pursuant to Chapter 112 Historic Properties, Section 112-3 F Applicant/Property Owner: Carol Zais Subject Property: 86 Putnam Avenue,Cotuit Assessor's Map/Parcel: 036/037 Hearing Date: January 16,2018 Pursuant to the Barnstable Historical Commission receiving your notice of intent on December 19, 2017, a duly advertised and noticed public hearing was held on January 16, 2018 to determine whether the significant structure identified as a single family structure on this property is preferably preserved significant building and whether demolition delay would be imposed for the partial demolition of this structure on the parcel addressed as 86 Putnam Avenue,Cotuit. After review and consideration of public testimony, application and record file, the Commission by a unanimous vote, found that in accordance with Chapter 112F the partial demolition of the single family structure is not a preferably preserved significant building. In accordance with Chapter 112-3 F,the Commission determined by a unanimous vote that the partial demolition of the single family dwelling would not be detrimental to the historical,cultural or architectural heritage or resources of the Town,noting the grill pattern of the four replacement windows on the left elevation will be eight over one. Nancy Claz Vice Chair ate cc: Brian Florence,Building Commissioner Ann Quirk,Town Clerk 200 Main Street,Hyannis,MA 02601 (p)508-862-4787(f)508-862-4784 367 Main Street,Hyannis,MA 02601 (p)508-862-4678(f)508-862-4782 Town of Barnstable Building t °¢,',c. ' ,...q"'�'4"} ;:� � ,`%-';� n ^ hr>y�; x € xv.. `a, °�".'" a3,,:.::#.. .,. ,:,..�. .� •�.. . �c �, - xa' ,... #R2 Post°This Card So',That rt�s Visible From thezStreet App�overtl P«Ians Must be,Retained orr`Job and this Card Must'be Kept 0 �h • BAPOWAau r a n � z Posted Until Final Inspeetion�Has Been Made � �` ,� � �� ,' �, � �x � � � � 1639.R f �� Permit Where a Certificate of Occupancy,�s Required,such Bwldmgshall Notbe Occupied until a F'rnal Inspectionhas been made ¢ ' Permit No. B-17-4239 Applicant Name: HOWARD WOOLLARD Approvals Current Use: Structure Date Issued: 12/15/2017 Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 06/15/2018 Foundation: Residential Map/Lot: 036-037 Zoning District: RF Sheathing: Location: 86 PUTNAM AVENUE,COTUIT % Q' ' 5 Co�ntractor,Name -4 HOWARD WOOLLARD Framing: 1 Owner on Record: ZAIS ADAM&CAROL Contractor License 181970 2 Address: CAROL D ZAIS 2017 TRUST - � � •- ,,,� Est Project Cost: $30,000.00 Chimney: COTUIT, MA 02635 Permit Fee: $203.00 Description: Living Room, Mudroom, Kitchen renovation intenor nl Insulation: p g y Fee Paid f. $203.00 Project Review Req: Date 12/15/2017 Final: 3 r t, +' s Plumbing/Gas c Rough Plumbing: Building Official Final Plumbing: This permit shall be.deemed abandoned and invalid unless the work author¢ed\by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved a pplicationkand�the=approved construction documents for which this permit has been granted. g All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning.by laws and codes. This permit shall be displayed in a location clearly visible from access street oc road and shall be maintained open for public irispection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this;permit. Minimum of Five Call Inspections Required for All Construction Work:. ' Service: 1.Foundation or Footingc✓ Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ApplicationN=ber.. .! .:... ..? _ Z".3BAMM .. ....�. t PeamFee...��..... .�.O .f....®...0@►eaFee........................ TotalFee Paid..................................................................... TOWN OF BARNSTABLE PemitApXovalby.................................on........................... BUILDING PERMIT APPLICATION .................. ..Pa0a.. .�. ..........:........ 2— Section 1—Owners Information and Project Location Project Address _� j _ Owners Name Owners Legal Address City �y�% State 101-fl,�10 Zip Owners Cell# y%� "f 3 �/� j E-mail Section 2—Structural Use atingle/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3—Type of Permit ❑ New Construction ❑ . Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(ewe stmctm e) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar renovation ❑ Pool ❑ Insulation r _ Other Specify - Section 4—Detail Cost of Proposed Construction 3Z evv Square Footage of Project ge,;t) -T Age of Structure �/DLt;> Dig Safe Number #Of Bedrooms Existing S_ Total#Of Bedrooms (proposed) I 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Last updated:I V7/2017 J Section 5 -Work Description /�/V/✓ S�LGf li(.�1��-G� /�'G'G�I�Cr� - �/j'��1(�2 l�/U�� PJ/?/L� Section 6—Project Specifics ❑ Wiring [] Oil Tank Storage . ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑.Heating System ❑ Masonry Chimney 0 Addhrelocate bedroom ----- —Water-Supply— —Public_ ❑_Private Sewage Disposal ❑ Municipal 0-6�site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane C Yes ❑N Section 7—Flood Zone Flood Zone Designation 20/,'d ,� Within or adjacent to a wetland,coastal bank? Yes ❑ /No u Section 8—Zoning Information Zoning District Proposed Use/Zef Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) i Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed .._ Has this properly had relief from the Zoning Board in the past? ❑ Yes . R- No 1&M3Pdsz&11n2017 r ' Section 9-Construction Supervisor Name_,Lo6,>elic Telephone Number L z-/ Address 2 Z-/9 City AeI6'Zsr�isue-State Zip c'zG. �?O License Number- 0l5 F 3 y License Type C s Expiration Date /f- 3,-? / Contractors Email L(cJvc��G2 Y�� Cell# 2 I understand my responsibMes under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and docmmentaiion required by 780 CM`R and the Town of Barnstable.Attach a copy of your license. Signzattne Date /L - - Section 10-Home Improvement Contractor Nameo��n� GJ �G��zo Telephone Number Address Zip //*f/'Y State,,,V-'�- Zip c2Z43 Registration N—umber if-I f - - - Erman Date - �- -- --- :- - - ---T - I understand my regxnsibiilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the canstractim inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C.- Signature �--�-� �� Date 12 Y 7 Section 11-Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I I understand my responsrbrlities under the rules and regulations for Licensed Contraction Supervisor in accordance with 780 CMR the Mww1 usetts State Building Code. I understand the c onstrvcti,on inspection procedures,speck inspections and docinnentatioa required by 780 CMR and the Town of Barnstable. Signature Date F, APPLICANT SIGNATURE Signature �� G�� Date i Print Name GJoDC�i110 Telephone Number E- E-mail permit to: Last updated:11112017 Section 12—Department Sign-Offs " Health Department ❑ Zoning Board(if required) El Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ i Conservation ❑ e For commercial world please take your plans duec dy to the fire depwftent for approval Section 13— Owner's Authorization as Owner of the subject property hereby authorize /-/o V/,4 :�10 to.act on my behalf, in all matters relative to,work authorized by this building permit application for: (Address of job) /Z - r j e of4Kmer date ' 17WYL 7,61 S Print Name j .i i i I i i Last updated 11M2017 Commonwealth of Massachusetts Vfze Wo„vna......... d��sac/u�ae ` Division of Professional Licensure Board of Building Regulations and Standards Office of Consumer Affairs&Business Regulation g g, HOME IMPROVEMENT CONTRACTOR ' Constrgjct��r� b rvisor } TYPE:Individual -` �S R`eg strationExpiration CS-015834 _�' `pires: 10/30/2019 _ �,18t970 05/17/2019 i VDWOOLLARD;- r HOWARD W WOA D ~ PO BOX 263 i Y BARNSTABLE MA 02630 HOWARD WOOL L Ml 3219 MAIN ST BARNSTABLE,MA 02630 Undersecretary: Commissioner CIL Co•struction Supervisor unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 c-,-� Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Not valid Without Signature For information about this license Call(617)727-3200 or visit www.mass.gov/dpi t _, ------ - --. - 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 Le>?ibly Name(Business/Organization/Individual): C/V p 0 Address: City/State/Zip: / i�/�i�f��j3LC' r , Poe#: Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I e ployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have .g• ❑Demolition workingfor me in an capacity. employees and have workers' y � t3'• 9. El Building addition [No workers'comp.insurance comp.insurance t 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 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *My applicant that checks box#]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-.yhether 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.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 of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penaa ties of perjury that the information provided above is true and correct Sign e• `^y' 7 Date: �Z 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.EIectrical 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 nam s ,address(es)and phone number(s)along with their certificate(s)of PP Y O �) in chance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cagy 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 citizen is obtaining a license or permit not related to any business or commercial venture year.Where a home owner or tannin (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 Massachusotts Dgpmt ment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,4 617-7274900 ext 406 or 1-977-MASSAFE Fax##617-727-7749 Revised 4-24-07 www.MM'govkha Town uf;Barnstable: Planning&Development Department: :Barnstable:Historical Commission w►owtown.barna1ab1e.m&4s/hisrtnricaleomn .gsiott COMMISSION MEMBERS: \ f. Laurie Young.Chair Nancy Clark,Vice Chair FHP"JSZ;RE E T 131A,'d s �C '. . Marilyn FificK Clerk 1 George lessop,AIA _10'.17 DPC Lu orf2:0 t Nancy Shoemaker, Elizabeth Mumfoid Cheryl Powell . December 27 2017 Re. "i4otice of Intent to Parblally Demolish Structure,'Relocate.::-. i86 Putnam Avenue;C6tuit,Map 036,Parcei:037' 1 _ Woollard Builders LLC: °v. c/o Howard:Woollard'. P4 Box.1143; -r Barnstable;MA 02630 . k- � Ann Quirk,Town Clerk.. 367•Main Street,Hyannis,MA 02601 Brian Florence,;Building Cotnmtssioner 200 Main Stieef,Hyatuus;MA:02601 Pursuant to the,attached decision,please'be advised that the Barnstable Historical Commission will_hold a public hearing on this matter on January.i,6,:2q 18 at,4OOpm,,£367 Main Street;Hyannis,2"d Floor,Selectmen's, Conference Room.: This public hearth will be adverttsed noticessent to::;abutters and a notice.form willbe.posfed onthe buildug.or. P g f, other visible site on the:property,: Please,contact:,Erin Logan at 3U8 862;4787 or erin.lo� a�town barn table.ta l.us-for:processing information: . Sincerely, f LaurieK.Young, , t r Planning Development DOmttrnent,:Elizabeth flans,Director } 200 Main Strxt;Hyannis,MA 02601,367 Main Street,Hyannis,MA 02641 .: - \� FJ It'•.itl�Ii IL�LL. i ' Itl L .. . Town of Barnstable Planning & Development Department �'='BAWWABM jr.� ?R "�" y I 3 9. Barnstable Historical Commission www'town.barnstable.ma:us/historicalcommission I COMMISSION MEMBERS: Laurie Young,Chair Nancy Clark,Vice Chair Marilyn Fifield,Clerk George Jessop,AIA Nancy Shoemaker Elizabeth Mumford Cheryl Powell Chapter 112 Historic Properties, Section 112-3 D. DETERMINATION of SIGNIFICANT BUILDING 86 Putnam Avenue, Cotuit, Map 036, Parcel 037 Pursuant to Intent to Demolish Structure The property, located at, 86 Putnam Avenue, Cotuit, Map 036, Parcel 037, is associated with the broad architectural and cultural history of this area. In accordance with Chapters 112-2 and 112-3 (D), Barnstable Historical Commission Chair has determined that this structure is a significant building. Planning&Development Department,Elizabeth Jenkins,Director Erin K.Logan,Administrative Assistant 200 Main Street,Hyannis,MA 02601 M7 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION Map �D Parcel O rJ 4n t3= s � � r I' Application v s �, AB L L l Health Division Date Issued _ V Conservation Division - �. Application Fee Planning Dept. Permit Fee •dc) Date Definitive Plan Approved by Planning Board" ,t 't`,f,-Ir.1 Historic - OKH— _ Preservation / Hyannis Project Street Address �,� Village Owner Address V Telephone Permit Request �KtC'1 Gil Whi , �V cA -od ROE Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation V1 — _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 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�,�LJ N�+on If yes, site plan review# t Current Use Proposed Use C�Q 1� %W)AA APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Addresst—VO& \NW License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTIQN DEBRIS RESULTING FRO THIP PROJ CT WILL BE TAKEN TO W ®ATE SIGNATURE t__� s`'� i' FOR OFFICIAL USE ONLY APPLICATION# =% �. DATE ISSUED ,, �-r, - ,ems -• _ �--�" .-,v..,. � - ��.'.� '�. , MAP/PARCEL N0: ADDRESS VILLAGE OWNER s •t ~ m..4 '1.. J li DATE OF INSPECTION: FOUNDATION: FRAME INSULATION ; Iv FIREPLACE ELECTRICAL: ROUGH -' � FINAL ... PLUMBING: ROUGH -=:" FINAL GAS: - ,.•,.. ROUGH r: FINAL r-, "` E vF-INAL BUILDING y DATE CLOSED OUT ..� ASSOCIATION PLAN NO. �" Y 11t Federal ID#064MS629 RISE Engineering RI Contractor Registration No alas MA Contractor Registration No 120979 A division orThieisch Engineering CT Contractor Registration Noa20120 5 Dupont Avenue,South Yarmouth,MA 02664 CONTRACT 508-568-1926 FAX 508-568-1933 ` Page 1 PROGRAM CLC-RCS ENGINEERING AND TTHHE CUSTOMEBETWEEN F K ns ENGINEERING DESCRIBED BELOW CUSTOMER ,'�-� •�� PHONE DATE CLIENT d WORN ORDER Carol Zais (508)561-2935 07/29/2015 198579 00002 SERVICE STREET BILLNG STREET - .... 86 Putnam Avenue 36 Old Coach Road SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Cotuit,MA 02635 Sudbury,MA 01776 JOB"DESCRIPTION AIR SEALING`.Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed) (1.6)working hours. A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. $1,232.00 AIR SEALING:Provide labor and materials to install Q-Inn weatherstripping and a doorsweep to(9)door(s)to restrict air leakage. $693.00 ATTIC FLAT:Provide labor and materials to install a.6"layer of R-22 Class I Cellulose added to(1780)square feet of floored attic space. $3,524.40 ATTIC ACCESS:Provide labor and materials to insulate the back of the attic door with 2 rigid Thermax board and seal the door's edge with weatherstripping to restrict air leakage, $73.91 VENTILATION:Provide labor and materials to install 18)8ydiameter roof vents)to increase ventilation in attic areas, The vent can be supplitl"in(circle color)brick,brown,gray or mill flnish. _TI �-� -�— — - $697.20 VENTILATION:Provide.labor and materials to install ventilation chutes in(101)rafter bays to maintain air flow. $352.49 COMMON WALLS:Provide labor and materials to install2"FSK faced semi-rigid fiberglass board insulation to(50)square feet of common wall area. $165.50 INCENTIVE:RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible measures,the Cape Light Compact offers 75%incentive,not to exceed$4,000 per calendar year,and an incentive of 100%for the Air Sealing measures. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the available airflow in your home both before the work is begun,and after the weatherization work is complete.We will also conduct a full assessment of the combustion safety of your heating system and water heater.This has a value of$90 and is at no cost •you,- �': f $90.00 S E P '2015: 1 Federal ID#06-0406629 RISE Engineering MA Contractor Registration No 8186 MA Contractor Registration No 120979 A division of Thielseh Engineering CT Contractor Registration No 620120 5 Dupont Avenue,South Yarmouth,MA 02664 CONTRACT 508-568-1926 VAX 508-5684933 I J Page 2 PROGRAM TN18 CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERINGCLC-RCS ENGINEERING AND E CUSTOMER FOR WORK AS IBED OW CUSTOMER PHONE _ DATE CLIENTO WORKOROFA Carol Zais (508)561-2935. 07/29/2015 198579 00002 SERVICE STREET BILLING STREET '-"-- 86 Putnam Avenue 36 Old Coach Road SERVICE CITY,STATE,ZIP — BILLING CITY,STATE,ZIP Cotuit,MA 02635 Sudbury,MA 01776 JOD'DESCRIPTION Total: $6,828.60 Program Incentive: $61626.13 Customer Total: $19203.37 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ""One Thousand Two Hundred Three&371100 Dollars $1,203.37 UPON FINAL INSPECTION AND APPR7OVAL BY RISE ENOINEERINO,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALTCF ]0 DAYS.SEER E FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. � DO NOT SIGN THIS CONTRACT IF THERE ARE ANY B _ SPACES AUTHORIZED SIGNATURE•RISE Enghwring Cug76g_ACCEPTANCE - 1 NOTE;THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 3D. DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED TO DO THE WORK A8 8PECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE • 1 . � T To:wm-of Barnstable °-' Regul'atory Services Richalyd'V.StA niirector. � 1 ;�►`0� 13u �iing�Dfvsiva Torn Perry,Bvhding Commissioner 200 Main Street Hyannis;MA 02601 www.town.baenstabie:.ma.as Office: 50M62-4038 Fax: 508-790-6230 Property Owner Must oxpp:lete and,Sign TI-ds Section If Us, ng A uIder t- Z ; S ,'as Owner of the subject pmpen y nn kereby:authorize !I� T MC-PI CA) iJ3 - co act ou.inybelYaJf, m aI matters.reln.6m to.workauthorized bythis,building,pennit application for. (Ad.i�ss ol"�oli *- Pool fences and Lu= are the respons b&j of the-apph=t. Pools are-notto be.`filled orutililed-befor-&fence is installed and all final inspections are performed and accepted.. 97\, S' o er• Signat=of Applicant 4iut:.Name Priat Name d 3► !S Date Q;r•ORMS:oWNWF M3SSJ..or,?00IS The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): M.T. McMahon and Son, Inc Address: 19 Fieldstone Way City/State/Zip: Plymouth , Ma 02360 Phone #:781-831-1234 Are you an employer?Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 9 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 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' [No workers' comp. insurance comp. insurance.: 9. ❑ Building addition 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 MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.❑� Other Weatherization employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Aim Insurance Policy#or Self-ins. Lic. #:VCW-100-6014109-201 Expiration Date: 12/08/2015 Job Site Address: 86 Putnam Ave City/State/Zip:Cotuit, MA 02635 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date 9/15/2015 Phone#: 7818311234 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#: o 3�1 Massachusetts-Department of Public Safety �eiyr�ai tracal�a�C�illruar�iiaeitJ i Office of Consumer Affain,&0usries�;tegu;at;uu 1 N` � Board of Building Regulations and Standards WE OME IMPROVEMENT CONTRACTOR t •' Construction Supumisor e istration:961816 Type: ' License:CS-068111xpiration: 11 4112016 Private.Corporatic f;1 t NUCHAEL T MC AH4 MICHAEL T.MCMAHON 8 SON=,ANC,. 191FIELDSTONE.'WA;Y� ' y: k PLYMOUTH MA 023�6'0 ' MICHAEL MCMAHON' /,t ��,� , 19 FIELDSTONE WAY`' ,. ! f �c,�� 'r. .-• o-* �i°iu.� f`Expirationt:.. PL'YMOUTH,MA 02360 Undersecretary ' �'�"" 08/17/2016,• I �•"- ,, Commissioner Unrestricted-Buildings•of any-use group whtc}i - r. L6,_asp nr reg►strat}ion valid for indiv�dul use.oniy:: n 1'�-ntaitt.less".35,000 cubic feet(991m3) before the ex iratiu.t r r e; enclosed space.' `` ; P� date.- ,.:and return to: � Office of Consumer Affairs and Busines '2ev,1Iation 1 ' 10 Park Plaza-Suite Boston,NIA 02116 ' R Failure to possess a current edition of the Massachusetts E State Building.Code is cause for revocation of this license. Not valid without Signature 4" For DPS Ucensing Information visit: www.Mass4ov/DPS DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit # was issued with the condition that all debris resultin from this work shall be disposed of in a Properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: ABC Disposal Name of Waste Facility 1245 Shawmut Ave, New Bedford, MA 02746 Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L. c.40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. I I I s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official,in writing,as to the location where the debris will be disposed. 780 CMR—6`h Edition Signature of Permit Applicant Date DATnlr�enroavrrv) ,aCORH CERTIF ICATE OF LIABILITY INSURANCE 9 is TE 13 ISSUED AS A MATTER OF INFORMATION ONLY AUPON ME ND CON AS R R HE COVERA©AFFORDEDABy THE POLICIE$ TFQS CBRTIFICA OR CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, 15XTEND THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S);AUTHORIZEDto SLOW. CATION 19 D,subject REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLD ppRTANT: the certificate ho der IS an AD. OINAL INSURED,the poilcy(les) must IrI endorse , fi the terl and cond ftlons Of the policy,certain policies mey roqulre an endorsement. A statement on thl$cartlilcate.does not conf9r rights 401hA certificate holder In lieu of such endorsemen s. , (7t)1) 335-9782 PRODUCER PHONE78�� -1890 ' ThOmgson Insurance �yI ns JJTi@Com oast.net and Financial Services O 8i NAIC9 389 Union $t!?AAt _ INSURE 6 Al FPORDIN6 COVERA08 _ Weymouth, MA 02190-316 _ SURERA;Travelers — _ INSURER B PTM Mutual INSURED !6Tenti�zm w'Or1d O MT McMahon and Son Zac. INsuRER =118uranCAa _Ce 19 Fieldstone Way Jill ER O Plymouth, MA .02360 Owna E: INSURER P REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTI! H THIS TMKAT THE ANYIREQUIREMENTNTERM 0�CONDI i0N OF NY CONTRACT OR OTHER DOCUMENT WITH RE -C�TOL mr INDICATED. NOTVVI CERTIFIGITE cONdS O®0 SUCH PERTAIN. RT ES.LIM Ts s ANC MAY HAVES BEEN RED BY PAID�CI�AIMBD HEREIN IS SUBJECT TO ALI THE TERMS, EXCLUSION SAND c LIMTe TYPE OF INSURANCE OUCYN ER MMIDDN. 1,000-000 9/16/14 9/16/15 EA-HOCCURRENCE S C :GENERALUABILrry NPP8202484 OA 100,000 COMMERCIAL GENERAL LIABILITY MEDEXP1AtNOne Q1011 9 5,0 CLAIMS-MADE OCCUR PERSON4L&ADVINJURY S 0 GENERAL AGGREGATE S 0 PROOUGT8-COMP10PAGG S 1,00g,000_ GEN'LAGGREGATE LIMIT APPLIES PER S: POLICY LOC a AUTOMOBILE LIABILITY BA 2CS92729 8/31/14 8/31/13 ead n[ � BODILY INJURY(Per p018Dr1) S ANY AUTO BODILY INJURY(Per eoaldent) ALTOS nee X SCHEDULED pgR�1T�i�ICG $ AUNON- TOS X HIRED AUTOS X AUTOSWNED SRBLLALIM oacuR 80313L140ALY 11/24/1a 11/MI. ERCHOCCURRENCE' 8 1,000,000 D AGGREGATE S 1 000 000' EXCEBBLIAB. CLAIM8•MA� . . & - . 8 ERS OMPBNBATION vWC-100-6014109-201 12/9/14 12/e/SS �y A X ANDEMPLOYERS'LIABILITY_ YIN S.L.EACH S 0 6O0 ANY PROPRIETO)WARTNERIEXECUTIVE NIA & 300 00.1 CERMEMB R EXCLc DEW (Meal E.L.Pla EASE-PO I v LIM • 500 000 Ifvas.dee�IDaundON OF o 9141QRATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS f VCLES (A=Ch ACORD 101,AmDlonel RoneritD Wedule,If more space le leQUrdtl) EHI CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE OF SCRIBED POLICIES BE CANCELLED-BLPORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W $T+ANK ACCORDANCE WPM THE POLICY PROVISIONS. AU' Mol REPRESENTATIVE - —- John J. Thom son - __ 0.1988 2010 ACCIRD CORPORATION. All 019hte reeerved. ^f ACORD TME Town of Barnstable ` 4- 't' * ermit# Expires 6 mou jro r iss(re date • Regulatory Services t t u A.% l, ; Fee Mass. V 16yg. � Thomas F.Geiler,Director Building Division //3 Cve Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 5087862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Fax: 508-790-6230 Not Valid without Rerl X-Press Imprint Map/parcel Number Property Address residential Value of Work Minimum fee of fo� r work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number�6� Home �— Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) X"P ❑Workman's Compensation Insurance Check one: MAR 2 9 2013 ❑ I am a sole proprietor 1 arryt-he Homeowner ❑_ a ave Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit.. - Permit Request(check box)' y VIre-roof(stripping old shingles) All construction debris will be taken toI' ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value #of doors (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 a Improvement Contractors License& Construction Supervisors License is r uire . GNATURE: � The T C's,_•� ommonwealth of Massachusetts f ! Department oflndustrial Accidents Office of Investigations 600 Washington Street 1 tlrrl� Boston, MA 02111 { www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 7�j Address: Aa City/State/Zip: l Phone #: d'e'l ka Are y9dan employer?Check the appropriate box: Type of project(required): I. I am a employer with l 4. ❑ I am a general contractor and I employees(full and/or part-time).* . have hired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7 emod'eling ship and have no employees These sub-contractors have 8. .E] Demolition working for me in any capacity. workers' comp.insurance. 9• ❑ Building addition [No workers' comp, insurance 5• ❑ We are a corporation and its required.] officers have exercised their I O•❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work -right of exemption per MGL l I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4),and we have no 12•� Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13•❑Other *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 their workers'comp.policy information. 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: 10, Job Site Address: City/State/Zipzll % 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage Verification. I do hereby certify,under t pai and p nalties of perjury that the information provided above is true and correct Si ature: Date: 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 , ��11 TRAV L �. E ERS WORKERS COMPENSATION AND.. t. EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6KUB-4861 P48-8-12) RENEWAL OF (6KUB-4861P48-8-11 ) INSURER: THE TRAVELERS INDEMNITY COMPANY NCCI CO CODE: 11347 INSURED: PRODUCER: DANFORTH, JAMES DBA PAUL PETERS AGENCY INC . JAMES DANFORTH REMODELING- 680 FALMOUTH ROAD PO 'BOX 973 MASHPEE MA 02649 C.OTUIT MA 02635 Insured Is AN INDIVIDUAL Other work places and Identification numbers are shown In the schedule(s) attached: 2. The policy period Is from 09-2971f2,to. . '09-29-13 12:01.A.M. at the insured's mailing address. -3. A. WORK.ERS-COMPENSATION JNSURANCE: Part One of the policy applies to the Workers Compensation Law of the states) listed'here: MA -B. EMPLOYERS-LIABILITY.INSURANCE: -Part.Two of,the.poilcy applles to work iri e`acti state fisted in item 3.A. The limits of our liability under Part Two are: Bodii.y Injury by Accident: 1,00000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the state§, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A D. This policy Includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS, - EXTENSION OF INFO PAGE `•T . , 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is sub)ect'td verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 08-23-12 CP ST ASSIGN: 'MA OFFICE: ORLANDO INDUS AFF 161 oonnl IP=12- oni 11 0PT1ZPc er.FWV TKir - 28LBR � `T ✓ nsuntenon• 3 a�2c euct Oiiicc.o �onsurtc c �c`•,!S s ,es, r�U,at,ar, + Department E3 Y Massachuse##s - d�Zar#rr rat of Public�afet Roche imO�s vErR'c�?�CONTcYACT i�z-, t�, r d Standards Board of Building RecJul�ti�ar�s�r , Registration 1 t4S1 Ty�E ' t+r - Construction Super isor ^y_. J Exptra lo;z x License CS-008267 ..; ,-;l,r( '- av! JAMES D DANFOHTH h S 14NFC:r'`�rtr < � PO BOX 973` s COTUIT MA`026M' Uf 1 Gb -,LD POST RL COTJI'r; IA 0283c i Uncrcrs cear,a ,c Expiration F .. Comm /2014 .Oai3'4€'E"+iSS-QIngr. r yry .,�•sm�s..:...s.a.-m++>....w�mc-ar�%�".�m.>ecroi� w. �,�. '� sa ,tt -:k �. 3..w, ly, �p,�a•:..Y + I.his., errlrlcaze t.S�Q.JC�infeU. a )R al x at ,w� ^w v , �c plc rtaaVck i3elth nssttior ' t For compietfon of, xceilence( Safety s _ x ° ,�- jam, `: ., 5 ' �'AL VP 6OCli�S #' `g . Y� �< t t�fT�� Hall CT1 Y' e ` held at Shepley WooF?rvcrActsAHyanniMA � s.. • r r r n 4 " z aS at��eu ti if ear f i2d x - sac+r Cie uq a i,nat. ana itlatti% sl tF bran ng Uause t W� �{K �• �z? e 'y •� ..� S'.tea M A 2 - i ��a�� F` � ik , ` � A� � e�w-sXtt rnf9C5 etc» Tratnrng=Dateagc s €_ r w a." � �� ' rcTia*e� � .� i x Construction Supervisor Home Improvement License,Number#008267 Contractor Registration#114813 OSHA Approved Member of the Better Business Bureau Home Phone#508 420-5131 CELL PHONE#508 280-0802 ESTIMATE JAMES DANFORTH P.O.BOX 973 COTUIT, MA. 02635 Carol Zais 36 Old Coach Road Sudbury MA. 01776 March 12, 2013 Job location 86 Putnam Ave. Cotuit, MA: ' Work to be completed as follows. , Remove the existing roofing shingles from two section of the roof on the left side of house. Install 8" aluminum drip edge at the roof eaves. Install ice and water shield 3ft. up onto the roof and in all valleys. Install a 151b. felt paper over the remaining roof sheathing, from the top of the ice and water shield to the roof ridge. Install.a 30-yea r-Arch itectu ra I type roofing shingle, using CertainTeed Landmark Woodscapes, which are algae resistant shingles. Shingle weight is 240lbs. per square. The standard wind warranty is 110M.P.H. I will use 6 nails per shingle instead of the standard 4 nails per shingles. This will increase the standard wind warranty to 130 M.P.H. I will use CertainTeed starter shingles along the roof eaves and rakes,- This process will increase the wind warranty to 130M.P.H. House and shrubs to be covered with tarps while work is in progress. Removal of rubbish. Material and labor $3,580.00 This price includes the building permit. Insurance certificate will be issued prior to the start of the job. There is a limited lifetime manufactures warranty on the shingles. I will provide a seven year warranty against any roof leaks. All materials are guaranteed to be as specified.All work to be completed in a workmanlike manner according to standards practice.Any alteration or deviation from above specifications involving extra cost will become a' extra charge above the estimate. Our workers are fully covered by orkman's Compensation Insurance. s + CUSTOMER SIGNATU Er,/y '✓✓' CONTRACTOR SIGNATURE DATE OFaACCEP.TANCEj-Z6 • Assessors map and lot number .:............. ........• • . .. AZ Ive i. Sew a a e r m i t number ,S'Li�,� . C, s 'THE HE TOWN' OF -BARNSTABLE BJSHSTADLE, � y ♦ # - UM&L. Cb GUsILDING INSPECTOR Op 1639.,`00 'FD M {r• c d. • ¢ APPLICATION FOR PERMIT TO .. .Q..!!.Y..........XX.L. .. ..N. ...........................................D•F ( 9W 1. , + TYPE OF CONSTRUCTION .......11—0.0,1). _ " ......,5••H•. .N�i L.J�................................................................. c CC .f...................3.........19.7 4 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... ....PU.T.N.r M.......4. 11�f.........:,j•..4r.Q.(/.,I..T.................•.......................................................... ProposedUse ....To-OL,......SWE-D........." .•6-A.:R,A,-6E. ....................................................... ........................ Zoning District . .......Fire District ....'......G� e? U f T Name of Owner .....�..�. �..�. �..(D••1P�Y••..Address ....:.......... .................................................................... ... ,,�� ddress .................................................................................... Name of Builder .. 0.&Aj.....• ••&.ale Name of Architect ..................................................................Address ............. ®�....... . Number of o s �- ,n...................... ..........................................Foun Foundation ...............•..... ... ............ Exterior ...::. ...U.. ... ....!.... . . .... .......................Roofing ................. ..........................................:...................... Floors ...... .Interior .................................................................................... ...... ....... ............... Heating ..................................................................................Plumbing ..................................................0-01......................... Sao Fireplace ..... ...........................................................................Approximate Cost ..............ell.... ........................ . . .. . Definitive Plan Approved by Planning Board ---------------____-----------19________. Area, .......2. .0 . ............ Diagram of Lot and Building with Dimensions ' Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH QCn 3,� V 1 ' I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... ... ...0..4- - - Dietzgao° J. E. . ' . 18856 - moveWlazno Post No ................. �ermit for ------------ . Office building'- . ` ` ----'r--^��~—�-- ..................................... ' . . Avenue Location— —'^—T^--'---^—^--------'' � -- . � . co�tolt �---.--------------�---.. ......... J. Di ��Owner -----� E. �--'��^`-------' . Type of Construction --. �rama ` ------- ----.' _---'—'--...�----.-----.l.�—�---.. . . Plot --- .................. Lot ........... December 3 . 76 Permit Granted ..--��....--...—.;]V - Date of| ................................... lg . Date Comp|e�e6�—/�1 ��''�----lg .PERMIT REFUSED . ................................. . ---'.—.---^''r---'—'---^------''�' ` ' ~ —_~,.--...—.--.-----.-------- .-..~—..—..�.------,—~---.~----.. . ` '------.-�.`.---.---...^�-.--.~.— ' ~ Approved ' ' A ^ ------------._—''' ' � _______.__________,_.__.,__,._ -« p. � ^ ' . . �. -------`------------~---..—.. . ' | � - ,,...-, T - • � .. -.f'• .._'T�.•T` A.'F' ., �.. c.�,-r�•�S Sr �v. -•� ... .. ^ f.,• M_- .../.....w� •1�r r.. ._. � ..?t. i ♦ f _+ Assessor's map and lot. number ........ �....�.�...�:........ � � , �l Sewage Permit,number ` 1� v % - �t. 7NEtpo.. TOWN OF 'BARNSTABLE SS .s B8HB9TOF{LE, i "6 •�cb =� BUILDING INSPECTOR • �'0 NPY�`• - APPLICATION FOR PERMIT TO ...11.P.V. .........Q. /A.VAI POST . ". . . . .... .......... TYPE OF CONSTRUCTION ......W.0.Q)....... ...,SAI../tQ-6j,P,............:......................:.................................. ......Q..i C...........3...............19.76. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Locatick.. ..O../..../Y.AH...........AVE............ .�/. ....C.O.T. ./..T.............................................................................. ProposedUse ..�.Q.&L.........S..H..F,z.............. ......................................................I......................... Zoning District ..........'? . .. .............. ..........Fire District .......... .t....... .1.. ............................................ ET Name of- Owner .... . .. . . �, ,T"�, .......................Address ........ .�A ....Av....................................... r Nameof Builder ....................................:...............................Address .................................................................................... Name of Architect .................... Address �'.......... ................. ......................................... ..... ........... Number of Rooms Foundation �. °� ' �K .............•••••••...................................... •............. .......................................................... 1� Exterior ......_,,..:......................d..................._.............................. g .................................................................................... r Floors ,.. .. -...............................................................Interior Heating ....................................:. ........................................Plumbing ...... �....... ........................... .............. .... .. ..::. .......... Fireplace `` 4 --..----.....................................................Approximate Cost ...............: j t..L........ ; �.f{....� Definitive Plan Approved by Planning Board -------------------_--------E__19________. Area ,2.7..K.. �................. Diagram of Lot and Building with Dimensions Fee .................. ........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH , � trl v� J • - f 3 t= � ,r t- 1r . P t/ 33 • a 4 I"hereby agree to conform to all the Rules and Reg ulations•of'the Town of Barnstable regarding the above construction. Z Name ................................ . .......... C`� Dietzgen, J. E. A=36-37 18856 move Wiarno No ................. Permit for .............. ............. Post office building ............................................................................... 86 Putnam Avenue Location ................................................................ Cotuit - ............................................................................... J. E/ Dietzgen ,- Owner ............................................; I ,0 1 frame Type of Construction ........................................... ................................................................................ Plot .......................... Lot ................................ Permit Granted ......... .D ber 3.........19 76.... .............. Date of Inspection ....................................19 Date Completed ......................................19 P ILIMIT REFUSED ............................. . .................... 19 ..................... ..................7............................. ............................. ............................................. ................................... .............. ......... ................. ......ep; ........ ......... Approved .................... ........... .............. 19 ............................................................................... ............................................................................... Assessor's O "Lot O'? 7 Permit#� Conservation Office(4th floor) Date Issued ,PP - 96 j Board of Health(3rd floor)(8:30-9:30/1:00- 2:00) Fee ` Engineering Dept.'(3rd-floor) House#1 P 4 : BAR D I 19 `.. o 9. `�� TOWN OVtARNSTABLE Building Permit Application Pr ct tr tAddress �� L(.��ct�� l� Z�e� a Owner / Address ��e _� a7[-& Telephone t Permit Request ev e6 l -Total 1 Story Area(include 1 story garages&decks) square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ L4, pap . D Zoning District Flood Plain Water Protection Lot Size Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name Q�� li(J, (;t lephone Number Address �� License# C S_ D/ (-/7 7 Home Improvement Contractor# /0l Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE l � / BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. �3 D 'TE ISSUED MAP/PARCEL NO's ADDRESS k= fi+ VILLAGE OWNER •— DATE OF INSPECTION: • s FOUNDATION , FRAME INSULATION y — FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL — .• — - GAS: ROUGH FINAL — FINAL BUILDING DATE CLOSED OUT i , ASSOCIATION PLAN NO. ; Cittne . • °: The Town of Barnstable " KAM Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508 790-6n7 Ralph Cry F= 508 775-33" Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,nnnoval, demolition, or construction of an addition to any pre-adsting Owner occupied building containing at least one but not mote than four dwelling units or to structures which are adjaeeat to such residence or building be done by registered contractors,with attain exceptions, along with other requirements. Type of Work: Est. Cost p,�ti , o-Z Address of Work: O%mer.Name• / Date of Permit Application: I hereby certify that: Registration is not required for the follo%%ing reason(s): Work excluded by law _ _ob under S1,000 Building not owner-occupied Owner pulling own perm# Notice is hereby given that: CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING WITHL�NREGISTFRED FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor a Registration No. OR ' Hate Owner's name , r TIC Commonwealth of Afassachusem Department. partmu�t of Industrial Accidents ` -. ,i Officeof/nyesUgallons !; _ 600 H'ashittrlon Street Boston.Mass. 02111 `- Workers' Compensation Insurance Affidavit �--:ZU I��.,..t m f . M....�.:,.... ease PRINT le tbl ,. nam • Z, F G N Cit U �L� ! phone# rl I am a homeowner performing all work myself. 0 1 am a sole proprietor and have no-one working in any capacity -...if[+..,*,rp.�.+�a-.,+f�sr.T'-. :.'.7�'!'1JYM!.._�._�__- _:'k,: .. _....... ..•.;_ :::. -. --. ,....; ..._. •... .4:r..�.�•�e-+t-.+-earn' am an employer providing workers' compensation for my employees working on this job. campany name �� l cJ �C' i /l� �T L E address: r city: _S�' N Phone#: insurin e o �l am a sole proprieto . general contractor r homeowner(circle one)and have hired the contractors listed below who have the following workers compensation-polices: comlianyn•tmc. address• l Sz - City. S I�F/,L-) 4e-) / )k phone#: -5-6) sun lJolicy# /� 2, -1 _•.�._.{w. .._�e3.., - _... 71t.7:Y;�i:-.�.a:74�pT _ •y f.T;".i... LL+� gompam•name• - - address: city: phone#• ipcur•tncc co T o� lice# _ :Attach edditional'shiii if* ..C_ _�. FuHare to secure coverage as required under Section 25A of A1GL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the D1A for coverage verification I do hereAr certify under the pains and penalties of perjun•that lite information provided above is true and correct. Sianature Date v Print name 5-L �� . N� L Phone# �y� f / S oRcial use oniv do not write in this area to be completed by city or town official * _ cit. or town: permit/license# nBuilding Department Licensing Board check irimmediate response is required [3Selectmen's Office �liealth Department '= contact person: phone#• n0thcr (revised V95 P1A) information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their employees. As quoted from the "law", an emplt tvee is defined as every person in the service ofanother under any contract of hire, express or implied, oral or written. An cmrpIttver 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 emplover, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dweiling house having not more than three apartments and who resides therein, or the occupant of the dwcllin�,, house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the -rounds 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 anv 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. ~ . • .. .:` t%:. t ..}... nY��.�.� 'P' Jl:+.. •i V'4. S ..tAi w.fT':;^ ♦.L:,. _Applicants 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 as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 17he 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. .k 7777 s_ 77-7770 Cit• 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 permit/license 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. Y.. 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 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 i ISSUING OFFICE 181 LIBERTY Workers Compensation and INFORMATION PAGE MUTUAL Employers Liability Policy ACCOUNT NO. SUB ACCT NO. Liberty Mutual Insurance Group/Boston 47 49 63 10000 LIBERTY MUTUAL INSURANCE COMPANY 15628 POLICY NO. TD/CD SALES OFFICE CODE SALES REPRESENTATIVE CODE N/R 1ST YEAR C1-312-474963-02591/2WESTWOOD 1101 ASSIGNED 3000 2 94 Item 1. Name of E D W A R D W D I N G L E Y Insured PO B O X 665 SANDWICH, MA 02563 FEIN 042642496 Address Status INDIVIDUAL Other workplaces not shown above: 14 C R O W E L L R D, SANDWICH Mo. Day Year Mo. Day Year Item 2. Policy Period: From 07 02 95 to 07 .0 2 96 12: 01 AM standard time at the address of the insured as stated herein. Item 3.Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liabilit Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 10 0 , 0 0 0 each accident Bodily Injury by Disease $ 5 0 0 , 0 0 0 policy limit Bodily Injury by Disease $ 10 0 , 0 0 0 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT WC 20 03 06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE Item 4. Premium— The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rates LINE 110 Estimated Per$100 Estimated Code Total Annual of Re- -Annual Classifications No. Remuneration muneration Premiums SEE EXTENSION OF . INFORMATION PAGE MA ASSESSMENT S 88 Minimum Premium $ 5 0 0 (MA) Total Estimated Annual Premium $ 2,899 Interim adjustment of premium shall be made: ANNUALLY Deposit Premium $ 2,899 *N*9N00* ARC 177 tV This policy, including all endorsements issued therewith, is hereby countersigned Authorized Representative Date 05/18/95 THIS PROPOSED RENEWAL POLICY WILL NOT TAKE EFFECT UNLESS THE POLICY PREMIUM IS PAID BY 07/02/95 Loc.Cod Term.Oper. M A T Audit Basis Periodic Payment Rating Basis Pol.H.G. Home State Dividend RENEWAL OF 1 5/18/95 1 1 NR I I MA I IWC1-312-474963-024 GPO 4030 RI WC 00 00 01 A Copyright 1987 National Council on Compensation Insurance ✓KgQQQpJ weM IMRROVE ENT NTRACiOR = YRegistrlton 1695 � IType'E ItIDIV �UAI� _ � Ezpiratton s0 /29/96 .$ s *r' � i,,yEdward"Y Dingley Carpentry � :�f;� sl�".i'Y,�S.F §.7�YID •I&`^4� h4rq° -i 1° �. 4' ; xa ;Edward Y Dingley _� � fro"Nell Rd/:Boz 665� { �`s-ADMINISTRATOR SndwlCh MA 02563 r s' SG G ; Ge2 : L�ll � f N. Ali -BAR.,ISTALc t;iJ,:_Dii:..1-D4 P:. DATE C^: 3 , .!'i9�J�✓_A-�ir�r/ _ fie!/_5/zc.1.7 FI-EE DFE.PARt 141- •T DATE 'BOTH SIGI AITJRESA1::. ,,';�.�-, F.';R ERMITTIP,IG 5 --------- ---------- ------------------------------------------- r�Xt9 a - - I SttttnQ• Imo./ l mstr. bedroom sto ® --------------- - - _ I , book book o 9 -- books ----------------------------------------------------- patioItVfn D I I I if IT -�� II I I— III 9tOr6 a} an - /, , �ctrlc , 11 , I o bath. I j �! p �I Flo. Flo. IA 'I 7 r K_ �` n• bath. 2 linen I bath. 3 dnr z � II hall J n9 -- bedroom 2 / --- dint j bedrm. 5 ,. �I - mud_room _.. P i `> wLAS bur ® m -------------- hall i� 9FLL -.CIF up �' .% �� /jup- cov: or d p -- - - 6 Screen porch mlcr c I I II -- �ia`�Ir i I � � ❑ I � 6 I II bedroom 4 I den I'n office e ------L---- bedroom 3 I i II 11 y: h c JCIk� s \ --- -to r p / BULDERS Box 1143 cov'd porch Howard R.Wool lard Barnstable, Ya. 02630 h-oollard®Yahoo.coo 508-221-7101 OL90N DE9IGN ASSOCIATES DENN19 PORT,MA 0263E --T------------��---- - - - � - - ---F'�: 508-I15-4300 email- oleondeeigrwverizon.net ZAIS RESIDENCE B6 PUTNAM AVENUE COTUIT, MA. EXISTING SECOND FLOOR PLAN EXISTING FIRST FLOOR PLAN First F!OO1 habitable area= 1.725 sc;, Ft. second floor habitable area 1,�25'eq.Ft, storage and ext,bath area 252 eq, Ft. REMODEL SCALE I/4 = I'-O SCALE I/4 I�-O EXISTING FIRST FLOOR PLAN i a EXISTING SECOND FLOOR PLAN Ia.."�• D.O.I r 1 R S �I FOK DETECT(FRS REVIEeRE6 BAR11STABLE BJILVi 113 DEFT. DATE FIRE DEPARiTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING - —---------------------------------------------------- V(.Aso c%Olt- ' I I ba' 8lttin, mstr, bedroom \ I� I ----------- ------------- book book o s - ��, books - ______________________________________________________. I i livi D i patio ' shelve - �\ ' store e ch - ii shelve bath. 0 D �� o. c o °, -----.-----� i� to � > �1 bath. 2 linen bath. 3 dn� \ hall --------LNv u kitchen P__ u i bedroom 2 0 �� bedrm. 5 �. mud room ahely O I > O �` dime 4% w Pay ill P o f l 9 =—�- -------- w bur =-------------- up- -a 6 COV'd port14 screen porch 0 �t� - a � bedroom 4 den i office 6-------R-------n-------fbedroom 3 i i lfo r 0!�� oollar BULDERS COV'd porch O.Box 1143 Honsrd W.Wool lard Barnstable. Wa. 02630 fh-mlla 221-7101 I/�y O PORT, SSO ACIATES DEN I [u� DENNIS5 PORT,HA 01639 -------------' --g-------------------------------�----------------- _ ------- 508-TI5-4300 email- oleordeelglWyerizon.net ZAI5 RESIDENCE Or.PUTNAM AVENUE COTUIT,MA, EXISTING SECOND FLOOR PLAN second floor habitable area.1,,25 sq.fi. EXISTING FIRST FLOOR PLAN ;Itofloor n�itablet1 meal;252egegf Ft, REMODEL SCALE I/4" 1'-O° � SCALE: I/4" I'-O " EXISTING FIRST FLOOR PLAN EXISTING SECOND FLOOR PLAN D'O. NG'v. 6,ZC ems..I/4'-I'-0° BUILDING DFPN. .�- �v�L� fehe find floor — -- JAN 2 2 2013 of ahc ® ® ® ® TOWN OF BAH1\j A.3 I ,,++\\finished floor o saoon�Fl000 —. _.—._.—.—. _. —.—._._._.— _._.—.—.—._. I ` ter, d�Flnlehed floor ___,_ ._,_._._. _._._._ _._,_._._._,___,_ _,_,_ __ cFr o flrst floor Y"a f .F oor'— EXISTING FRONT ELEVATION SCALE: 1/4" - I '-O" 1 � . dl"sacodn3Tloo_ —'—'—•—'—'—' '—'— I —'— — i. .I ' �1 t! I ! BUULDERS P.O.Box 1143 Hoard W.Wool lard Barnstable, Me. 02630 i I 508-221-7101 hwxool lerdCS'ahoo.con I it I I OLSON DESIGN ASSOCIATES - - POR7,MA I DENNIS 02639 Flnlshed Floor_ 508-175-4300 omell- olsondeel9nAverizon.not tL C flfstf roro 1 'y h I/- ZaIS RESIDENCE 86 CO UN AVENUE IT,MA i REMODEL EXISTING RIGHT ELEVATION SCALE: 1/4" 1 ' O " EXISTING FRONT E RICzNT EXTERIOR ELEVATIONS hUV.6,201' �3 t I I I finlehed Floor . —.—.— El G I I I I th.Finlehed floor .._.—. _. I—. ® I ��II m ref o or L— — I j! EXISTING REAR ELEVATION ' SCALE, 1/4" 1'-O" Ll Ll i I 1 I 1 i I finlehed floor 4w, HHHBox Hard 1 0161430 hwola z21 �0 AT S OLSON DESIGN ASSOCIATES L50NIS PORT, SS 07AT 508-115-4300 email- oleondealynwerizon.net o F(rel'Foor — ZAI5 RESIDENCE 06 PUTNAM AVENUE COTUIT,MA. EXISTING LEr-t ELEVATION REMODEL SCALE: 1/4" I -O" E><ISTINCz REAR 4 LEFT EXTERIOR ELEVATIONS oy D.O. 2 �ft'Ae floor `P a effTc floor. .r,.finlehed floor V7 ai eecbn3Tloo� —.—.—.—.—.—.—.—.— —._..—._ —. _.—.—.—.—.—.—.—.—. - - I - ffi - - ;--......._ Eg 1i ® C2J NEW WINDOWS ,, , H •� a NEW DOOR A flntehed floor 'YoE'et foor.—. '—'— —' '—'—'—'—'—'—'—' —•— NEW WINDOW PR®P®SED FRONT ELEVATION SCALE, 1/4" 1'-O " I oollar �y 44 p f Inlehed floor —. —.—.—.—.—.—.. —'—' I —'— BULDERS o eecona-floor i' } P.O.Box 1143 Howard k.woolhoo. Bernst .5 _2 02830 hww�ool la�rd0yahoo.com 508-221-7101 e I I I ILr�r•a I OL50N DESIGN ASSOCIATES I ��S��j DENNI5 PORT,MA 0263E 505-115-4300 email- oleondealgnaverizoana �d`flrllehed qlour I ZAIS RESIDENCE �'o fist£o'— —•—•—• —'—'—.—.—.—. —.—._.—. _.—.— .—.—.—I —. —.— 86 PUTNAM AVENUE COTUIT,MA. I REMODEL i PROPOSED FRONT 8 RIGPT PROPOSED RIGHT ELEVATION EXTERIOR ELEVATIONS SCALE: 1/4" . 1'-0" D.®. A©3 f NOV.6 2011 -..ter ....,.__--c...--s...-�.�:.�_�..:.y, Y Ut _I Cinlehed Floor I i I rr�flnlehed floor NEW PATIO (3)REPLACEMENT —REPLACEMENT DOOR DOOR WINDOWS <WINDOW r (9 a r a l a v a t i o n l S C A L E: 1/4" = 1'-O" I I -- iF J®RT 4m, flnlehed floor � .Box 2 643 ho"wwardool 1Y.17oo1lard Barnstable, Na. -1111 _ H hmcool lardByehoo.cam 508-221-TI01 I O C4)REPLACEMENT , I DN15 PORT, 026395 N WINDOWS s 506-115-4300 awil- oleondeelgnoverizon.n J ZAI5 RESIDENCE "Cl nlehed floor—. i 86 PUTNAM AVENUE Fy.fir —.—.—.—._._._.—. .—._. I GOTUIT,MA. CU REMODEL REPLACEMENT ° WINDOW q F'ROP08ED REAR b LEFT PROPOSED LEFT" ELEVATION EXTERIOR ELEVATIONS SCALE : 1/4" - 1' 0 " I r D.O. ------------------------------------------------- ---------------- - d bU�. dn, wn $$ie Sittln .j mstr, bedroom ............. ---------------------------------- F sto. i book book oo e books _______________________________________________;______, Ifvfn shelve i / I Chan 9toraCle • et'—d f\ dn. I i _ p p - ----------- • shelve O bath.�1� �O G o to o -----, � D.. : dn. v linen bath. 3 m kitchen v at hall P u bedroom 2 ° d(nin shely bedrm. 5 �, mud room _---- P 4 draweirsE�e : pa7I:r—:s - / bur w hall 9 P u 6 CIO. d u cov'd port _ screen porch ; I micr o fiajfr o bedroom 4 i / den office bedroom 3 foger a001 ar ILBUI_DERS '— eno le rdeynhooacom e5.o.BM I'll a Ma.covd 21-71001 a OL90N DESIGN A550 DENNi9 PORT,MA O2635ZG39 _ _______________________LF_______ ____-___n________._______ SOE-lT-4:00 cmail- olaordealensverizon.net ZAIS RESIDENCE 86 PUTNAM AVENUE COTUIT,MA. EXISTING SECOND FLOOR PLAN EXISTING FIRST FLOOR PLAN First floor hdbitable area=1125 eq ft second Floor habitable area=I,125 eq.ft. storage and ext.bath area=252 eel. Ft. REMODEL EXISTING FIRST FLOOR PLAN d EXISTING SECOND FLOOR PLAN ' NOV.6,2011 (3) NEW ba un -tec� WINDOWS dn. slttin `v/ U i (4) NEW WINDOWS StO. living / I1vin y .... patio NEW i DOOR;\ store e s Dra�L -------------------- 1--'------------ NEW d Li d. WINDOW � eiectrl elec t NEW PATIO pane s pane a, �w DOOR d� i-- ------------------ l o EL o � w kitchen �� a' dinin � ----- � mud room Ll _# ', -6 drsweree9be w pantry /j% '- I / - oc . : d q new kitchen — _ r mud � I w a �wder Id u -------------- g.p:: cov'd�porc _ -_ i i cov'd port -m cr ------- ----- - ------- h�ndlar o pantry ----- NEW WINDOW— NEW DOOR 4 d ci WINDOWS den office 9`r„ ` ! ii office foyer foyer m r - � hwwaorol 4w, 8aox cov'd porch cov'd orcIn Na. 2630 DEMOLITION LEDE ND -221-7101 1143 01-5011 ESIGN A550CIA7E5 ___________________ _ I EXIST. STUD WALL REMOVED I _ ® DENNID5 PORT,MA 02639 -Q_ tT -� 508-115-4300 email- oteondeelgnoverizoane EXIST. STUD WALL W/ ZAIS RESIDENCE EXISTING FIRST FLOOR WINDOWS < DOORS REMOVED LEDGEND 86 PUTNAM AVENUE DEMOLITION PLAN PROPOSED FIiPZST FLOOR PLAN COTUIT,MA. SCALE : 1/4" - 1 ' -o " EXIST. STUD WALL NEW 2X4 STUD WALL REMODEL TO REMAIN \\\\\\ NEW DOORS @WINDOWS First floor habitable area=1,123 a ft. n=� EXIST. STUD WALL W/ lretptor Floor e andextbbath a-1,�75eq,f. FROPOSED FIRST FLOOR PLAN storage and ext.bath area-2S2 sq. ft, DOORS C WINDOWS TO 9 q FIRST FLOOR DEMOLITION PLAN REMAIN EXIST. STUD WALL o TO REMAIN D•®• EXIST. STUD WALL W/ DOORS & WINDOWS TO 1;V,6,20n REMAIN "'1/4"-r-I"