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HomeMy WebLinkAbout0140 CAP'N SAMADRUS ROAD /� �`... � /� F � ` i J � .� Town of Barnstable Building ? Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept °1M Posted Until Final Inspection Has Been Made. Permit 059. �� t• Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-419 Applicant Name: Jason Chretien Approvals Date Issued: 03/06/2020 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 09/06/2020 Foundation: Location: 140 CAP'N SAMADRUS ROAD,COTUIT Map/Lot: 038-045 Zoning District: RF Sheathing: Owner on Record: KOHUT, KATHLEEN L _ _ Contractor Nam�JASON M CHRETIEN Framing: 1 Address: 140 CAP'N SAMADRUS ROAD Contractor License: CS-103004 2 COTUIT, MA 02635 Est. Project Cost: $33,546.00 Chimney: Description: INSTALL 9.3KW(30 PANEL) ROOFTOP SOLAR ARRAY Permit Fee: $221.08 Insulation: Fee Paid: $221.08 Project Review Req: Final: Date: 3/6/2020 Plumbing/Gas Rough Plumbing: 4- �----- \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within'six months after issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: 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 or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. i Electrical I The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing 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 / r Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ? � S � wry T ... .. ram-_•' 4_�. �� �•- TOWN OF BARNSTABLE Permit No.• . •• 4 Building Inspector l Cash AU sSTAn _ 1 fk'�n tlft lrr.il 7 '� . � . - ""Y� 1 OCCUPANCY ' PERMIT Bond. . "No building nor structure shall be erected, and-no land, building or structure shall be used for a new, different,1 changed, or enlarged use without a Building Permit therefor. 'first having been obtained from the Building Inspector.,No building shall be occupied until_ a_ - certificate of occupancy has been issued by the Building Inspector.91 Issued to - $011t1 RO�JEr 8 Add ess Rd*xL=it; - .- - - 0 I-*. Anz 14(,, ^�y�hn+.. ��r1TnrT•Ain T?^. A l�nM►;i- { Wiring Inspector Inspection date Plumbing Inspector �r �,t- Inspection date Gas Inspector v 07 Inspection date , Engineering Department ' ✓ f .�� f� .1Z/qo ,jY Inspection date THIS PERMIT WILL-NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR,UPON SATISFACTORY COMPLIANCE .WITH TOWN REQUIREMENTS. w, _ f Building, Inspector Assessor's map and-lot number ...... a.....�...7/J� .,.., ��, ' SEPTIC SYSTEM ,(MUSTS `,OF?NE toy♦ . o Sewage Permit number .CQI. ....3.6.d............................... � INSTALLED IN COIVIPLIA .� WITH TITLE 5 = BARNSTABLE, I House number ...... ,........ ,.................:...................... ; ENVIRONMENTAL CODE M639 TOWN REGULATION �`0 NAY d� TOWN OF BA`RN�STABLE BUILDING .INSPECTOR APPLICATION FOR PERMIT TO ............... C.r...... IXJ L nl.Ac, <.. .. . ... ........... TYPE OF CONSTRUCTION OPOD.. .... ...Map...........NJ��.......................................... cc ......du L^.y.....Cqq.................19k 1 OO 4T�/E'�I?,NdSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �D.........C..6...r ..CF........................... Proposed Use ....... ot.h?.�?.�.�L..... A.�!►.I..L�.. .R: 4..1..i�..�y................................................................. Zoning District .R E...... ....."...7............Fire District ....C.G'..�T...�.A r ........................................... Name of Owner R�B. .R..1+ . .... !.Q.H.. ................Address CON's� 1. �s Name of Builder ..................................1...... .N ................Address .�... ...!!1�......�. ..N �r`l�.IJTH.. Name of Architect G...i.T!.1. A.!mg.0)4jxS..®e.X...Ldress .....1)W$.HU.P..1:......N. . :i t...®3©lp.o............... Number of Rooms ......6.......................................................Foundation .YvL. .... �Z.�e Q........................... A�n �3 r i Exierior ...4�'(.�. d.A�� . r..... . .��h L.,OK................Roofing ...CN.. ...`1- ......A� t H�LL..�........................ .. . ........ Floors 13 , .FLTf...Y...... ..lN.yL.......................Interior ..�J.: '� � .® ........................................... Heating ...../.� ..L-.. = /C�./..�3.. .......Plumbing 1/^ .. �L � p" ,T '� P................................. Fireplace ..� J .............M. , C./<..............................Approximate Cost ....... .2-7� .......................................... Definitive Plan Approved by Planning Board -------------------_-----------19 . Area ... . ..V...................... Diagram of Lot and Building with Dimensions Fee ..........I......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ($100 0 . 0 0) Send to 140 Captain Samadrus Rd. ! Cotuit, Ma. I hereby agree to conform to all the Rules and Regulations of a 'own of Bar le r arding the above construction. o Nam .. ... ...... ... ..~....... . ....... ....................... f ,-, ROBERTS, JOHN tvo 23327 Permit for One...Story t Single Family Dwellin j Location ..Lot 25 ,., 4,0__,C ....................t n iad us1 T Cotuit c l ` ti• 3. "� i ... ......_ ..Jonn...Roberts...................,........... r� ♦� .,,,, " �� � ,♦ �l ? +� �' . _ Owner ................:.... .................... .. ................. N Type of•Construcfon ..........................................rame r'za .c Plot ...t%........................ Lot .................... ......... :........... j Is July,!.-2 9 Permit Granted y ' 19 81 + �r y ✓ �"�...............................`r— w _ Date of Inspection Date C plete .......... ��. . '•� 7 '-J-=} ...... . .. r PERMIT REFUSED117 r .... . •.?,'i.. r: r: . ...... , ........ �. ~ ' a- c �`. ,� i *�•. _ . t i . .... • • ......... i 4 '�• ` � • 4♦ y `Y e + l ,'` ' �..L�y. .tit � _ r} .. _ .-� • rnr. Approved ............................................... 19 s — _ r7 ............................................................................... — ~• ..................... ......................................................... `�' i `,� Rj J N t i j I S l--L } 4 0 � � s�sz � R 14 �+ •V,V �•,4 \ •, 74"e15", ROSER� , LUND P. MV b\ BUNIKIS vi lF• o K \ Nu.2216'L �1 , It 11 rf 4 EXISTING SPOT ELEVATION OxO CERTIFIED PLOT PLAN EXISTING CONTOUR --- O --- L-o 7- FINISHED SPO:T,:EL.EVATION FINISHED CONTOUR 0 IN APPROVED BOARD OF HEALTH �•l J •ill DATE AGENT --SCALEt / �=4d DATE16 124, 91 L DREDGE ENG/NEER/NG Co IN Gv ciZ T"1�/ • CLIENT_ . I CERTIFY THAT THE - PROPOSED , REGISTER E REGISTERED JOB NO. J /v 2-- BUILDING SHOWN ON THIS PLAN, CIVIL LAND CONFORMS TO THE ZONING LAWS DR.BY:. � . � ./2" ENGINEER SURVEYOR OF BARNSTAB,,�..E, /MASS. 712 MAIN ST. . CH. BY: HYANNIS MASS. � �� 3 SHEET._L OF DATE. REG., LAND SURVEYOR r /YOTL� /F -17WeR Ts,�E SEPT/C TAN/C OR ?O FT. M/N. r�,-E.4CH11V0 O/T ARE MORE TNA/V /2.,QELOW /O PT. AN/N. :iRAOEI A P4 rp/AN1 ETER C'oNCRET� COPPER' !� SWALL 4PE ,g;W04/6N7- TO4,TAD=.Ci4N .-X7-A-A CONCRCTE 4~PYC P/PE �EAYY CA ST IRON COVER .S//ALL !3E USEV E�✓. / O•D COYERS MIN. ?/TGN /�'/N GR/VEN/A y - p•��J•MIN. CO/VC&Aco P,4=10lr TE / CLEAN .SANG ' •- 6ACXF/LL ' .•q, L/QV/O LEVEL _ ' ,� �:. a= - z LAYER/e r C.�IST _ IRON P/PE /00 0 GAL. o •. o • • • • •• • o• OF I� 3 - 0 M/N.P/TCN o • • • ; Vq'PEI�IT. SEPTIC TANK • • • • • • • , WASHF,D S72�NE BOX • � • • •• •EFFECrrrA-- . 314 • • 1 • • pEPTt/ • •• • • WASNEP STONE • • PRECAS T SEEPAGE IN{iCRT ELE✓AT/o�vs • ••• � + • • •• • 1 • • ,•Q o P/7 OR EQU/✓ 9 . 8 .- INYERT AT 04//LD/N6 97.97 FT. INLET .SEPT/C TANK 3�r FT, �D FT. VIA 4 C(5EE 72W41/-'4TJON> Ot/7LET SEPTIC TANK 9b.3 FT. //VLET•O/STR/8!/T/ON BOX 96.0 FT. SECT/ON OF GROUND W,47',CN TAQLE OVTLETDi STRwDIIT/ON BQX 9 S 9 FT. INLET L.CACII/N6 IC'/T FT. SEWAGE Q/SP05At SYSTEM TAQULAT/ON• LEACH//VG P/T. DES/ON CRITERIA SCALE : %~ s /=O� 0/MAWS 10 N NVAJOER OF A6,0M00A!S 3 DIMENSION C T.M/N cv+Ra•aEo/5P05A4 u/v/r- Q SOIL LOG t TOTAL EST/MA•TED Fz.o ev - 33 0 G,4L.�DAY SOI L. TEST At/ SO/L 71r57-02 SOIL TEST J kuMBER aFE,o tcIVING �o/T,S_ -ELEK 9 EcA'✓. 9`S• PATE OF SOIL TEST /�' S/DE L EACH/AW PER PIT SQ, wr At_ ItES�/LTS ICl/TNESSED .dYL r OOTTOM LFr�ICN/NG PER PIT 7 SQ. pT. L-OAAJ $ QpA• /H AE,ICOLAT/ON MATE,*/ !wtv�hNCH TOTAL LEACH//vG AREA 26 L SQ. Fr. S0/3S0/l. P&1eCO3LA7-/ON R.,TEA2 7MIN.//NCN RESERVE LEACN//VG AREA Z� b SQ. FT. 2 Z I 2-0 O TH OF MASs9 SAy-*-AO NO / Lt) 7 o ROBERT P. E3 BUNIKIS H o p No.22162�0 Q ELOREDGE E/Vr'/JV6ER/JVIC' GO,INC.f� 90 FGIST�P 'c, ELF gSi D U CL.. A 1Y . NTEREO NYANN , MASS.ON .GtO UNO i�// EATFLL�/. k Z JOD /VD. V-/IIJ S/IEET 2-Of d- 7°` z�p� ' Assessor's map and lot number .....�.. .4.... �` ......� *THE T ......,.. Sewage Permit number d�Q� ♦�' 0 0 9 e 19% ....ti .��.......................... L t,� E9HH9TAMLE, i House number .... "��..........:.....n....................................... q MA86• — 00 t 63 9• . •° �'0 YPY y. TORN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO c.T.. ... 1 .�- -.i. ��...^(....... TYPE OF CONSTRUCTION ..�!�tC�O1� ,,.L...I .. ....,`...aR�. .xa. .t q ..................... .... ............ _tk,u TO Tr INSPECTOR OF BUILDINGS: e un�deigned hereby applies for a permit according to the following information: Location . a`T... ..... .Ae�$ .r. �.....,..1. �!1 .A.,��u. '.,. ,K,a7..........>.......®' 'L1..�. ...................................... Proposed Use ....... I,,, I. ,L �,.... .. ..!..�.!`�. ...a,��. .F°.�-.f...!..!��.r*................................................................. 'Zoning District .. .�....... r.!.l�1 ... .. ............Fire District C T lJ 1... ........................................... ............................. Nameof Owner .......c)RF......e.. . . ..�1.( . .. . ................Address .............................. .............................................. Name 'of Builder )-or.................Address Am..Wm.rr.o I.0...�-?,•.. I I�i2�P�1)�W t EL- W 1;.3STf 2 1-1 IGNWvV Name of Architect r,.,P1)T!.OE:MTAII7..O.OM.F.A.-PP.A.:FAddress .....IMP�S.Ial}fl...... ............... !!� Foundation a.a�1,. cs.4 t F A Number of Rooms ...... ................................................... ........................... Exierior MA,,c,W1T A, � ...Roofing ...Dad . �B k..P.H.#L 1 .� I� 0 �(, ..........Interior f..,.. ... ... T �,Qe—K Floors ......1.. ,.,�i.��.,,�.�,.T...................:.....�....................... ..�� �.. ....................................................... Heating ....... - �". ��.1...,. Plumbing /. 1�, C.:... ..... ®...................................... ..... . �.... �, Fireplace C ............. JC. .........................Approximate Cost .6.4rik ................. Definitive Plan Approved by Planning Board ------------------ ---_------19--------. Area ..._____ �i / SW ......., .. .._rJ....................... Diagram of Lot and Building with Dimensions Fees � � SUBJECT TO APPROVAL OF BOARD OF HEALTH ($1000: 00) Send to 140 Captain Samadrus Rd. Cotuit, Ma. r � . e � � Y J I hereby agree to conform to all theJ Rules and Regulations of fheTown of Barnstable regarding the above construction. , t` Name ... ......... .�.,� !!P '1................. ,....r ROBERTS, JOBN � No .3332 . Permit for -.Ooe..Stm.............. ' .�_� ..�amilv_Dy��llig�.____.. , . Lot t io Samadroo 8d. Location --.---�25--�--l40---C�.. _-- Cotoit '---------------------�---'. John Roberts Ovvne, _-----------------'---'' � � I7zauxa Type of Construction -------------- - ...................................... . np/ . , ' ' - lPermit Granted ... 19 � k -~~- � . . Date of Inspection � . uooe Completed - . ` . . ~ ` ` . ' PERMIT /EFUSED � lV ' -------------�--`....---�-. . ............... .................. .. -. ............................. ' ........... ............................... -,-------------------.----. . . . ----.--------------'-.---~.. ^' � . Approved '--.-------------.. lq , ` --------------------------. ` ' . , --.-------------------~~.... . . - I 2 Town of Barnstable *PermiExpV; rqy Regulatory Services FeeSARNSTABLE, Mass.1639. Richard V.Scali,Director �� ��ED MA'I to Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS E,E T APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number()7 Property Address I residential Value of Wo/rk�$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name C,Q/��-- Telephone Number �— Home Improvement Contractor License#(if applicable)J y3�ql Email: Construction Supervisor's License#(if applicable) 0 4 QWWorkman's Compensation Insurance Check one: a lei am a sole proprietor ❑ I am the Homeowner Sip 4 ❑ I have Worker's Compensation Insurance 2015 N OF Insurance Company Name TO y u DA R I V ry BLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) �U2 4EI$k-toof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ��❑11Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. '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. copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: C:\Users\Decollik\App \Local\Microsoft\Windows\Tempo Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 The Commonwealth of Massachuseft Department of Industrial Accidents Office of Investigations IF 600 Washington Street Boston,MA 02111 fwvw.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organinhon&*Yidn D: Address: 31 GICi City/State/Zip: Phone#_ ���'S 3?q �� ! <—L Are you an employer?Check the appropriate box: T of project e rJ'am a employer with 4. ❑ I am a general contractor and 1 YID e J (required): }: : have hired the sub-contractorsel* 6- ❑New construction employees(full and/or part-time). 2_�J am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity- employees and have wod=s' 9. ❑Building addition [No workers'comp.insurance comp.insurance I mod_] 5. ❑ We are a corporation and its 1G.❑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 cs insurance regained.]Y c.152,§1(4),and we have no employees-[No workers' 13. Other comp.insurance required.] *Amy applicant that checks box#1 most also fill out the section below showing their workers'compenu=n policy information- 1 Homeouinm who submit this affidavit fmdiratmg they aie doing,all work and them hire outside contractors mmu submit a new affidavit indicating such TCantractars that check this box must attached au additional sheet showing the name of the sub-caamamis and state whether or not those entities have employees. If the sub-comt w rs have employees,they must provide their workers'comp.policy mmiber. lain an employer that is providing workers'coolpensaffor insurance for my emplayem Below is the panty and job site information. Insurance Company Name: D=4�gL n Policy#or Self-ins.Le.#: �O(r) I �p �l (n Expiration Date: 3 Job Site Address: md tu, City/State zip: Attach a copy of the workers'colipensation 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 line 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 Otffice of Investigations of the DIA for insurance coverage verification. I do hereby c �y under t epains and penalties of perjury that the information provided above //is t ns and correct Si Date: _l� Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: PermiVUcense Issuing Authority(edrde one): 1.Board of Health 2.Building Department 3.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: David`Sawyer Construction 318 Meiggs Backus Road Sandwich,MA 02563 508-539-1992 Proposal Submitted To: Work Address: Lisa Cooper 50&5664962 140 Captain Samadrus 02635 Worked to be Performed: Strip Roof--Replace with CertainTeed AR Landmark Architect Shingles— Color-customer to choose {. Cbi "*,Z, *Nail Plywood and.replace as needed *Clean Cutters as needed *Install:::;WhikAluminum:Drip Edge on edges of roof Ice&Water barrier on all edges of roof Underlayment Paper System Pipe Flange Ridge Vent ,Hurricane nail shingles *Clean&Remove all debris-from workplace,take to landfill Total Labor&Investment:9,000.00 nine thousand.dollars Deposit to.begin work:3,00000 and balance.due..at.completion of job. . All materials guaranteed to be.as_specific,.and-work to__,be,performed.as_stated above.in a workmanlike manner. Please remove.and/or secure any fragile household items. Not respbnsible.for..broken or damage to-household items. Five year Labor..Warranty/PI Manuf res Lifetime warranty. Contract may;be.withdrawn if not accepted within 30 days lease se back for ad nal term_ s Respectfully Submitted JVJZ1 Date ZY Acceptance of Proposa The above prices,specifications and conditions.are satisfactory and hereby.accepted. You are authorized to do the work. Pay ut due as shown.''_ Ownerfsignature 'D. LQ 5" a Ld 'o'ZOIS� Property Owner Must Complete and Sign This Section If Using A Builder I, �.�� - l.�n ,as Owner ofthe subject property hereby authorize to act on my behalf., in all matters relative to work authorized by this building permit application for: 1 (Ad Ass of Job) fgnature of Owner Date P t Name If Property Owner is applying for.permit,please complete the Homeowners License Exemption Form on the reverse side. Y 1 Y17=4 Office of Consume PMrs&Business Regulation-Mass_Gov The Official website of the Office of Consumer Affairs&Business Regulation(OCABR) r Consumer-Affairs and Business Regulation ;n - -r Home Consumer Rights and Resources Home hriprovement Contracting Home Improvement Contraaor'Registration Lookup You can search/fiter the regstration..M..,by any of the criteria below. Search by Registration Number f 313 i'Searc Search by Registrant Name -�� Search by City �. Zip Code Search Registrants Click on the registration number to view complaint history.You can also view arbitration and Guaranty Fund history. The ist is current as of Sunday, March 16, 2014. Search Results RESPONSIBLE . REGISTRATION EXPIRATION REGISTRANT NAME ADDRESS STATUS INDIVIDUAL NUMBER ' DATE MAV&6s r' = ZA1IUY R,xDA�U�Q 134313 3'1.8 M_EIGGS.BACKUS;, 10/24/2015:: ;,Current ... CONSTRUCTION r=.,RD=' SANDUU,ICH. MA.02563' ©2012 Comnonwealth.of Massachusetts_ Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. Massachusetts -Department of Public Safety Board of Building Regulations-and Standards Construction,Supervisor spedWte -License: CSSL-098859,. -VTT''S 1 DAVID R SAWYE�__ 318 MEIGGS BA_ SANDWICH MA2O?S 4 r .1 0 Massac _"cells :+�epar#men€'o tiblic safety Expiration i. B_oafd:of itding Re4plat_ s and Standards Commissioner 0112712017. Constructio up e iso' peci:ilty License: S 8659 DAVID R '318 MEIGG A s .SANDWI 2Vfq=0251 g .• �J' s l,i}`'• Expiration apJ/serucesocastate.mats/hicAitenseelistaspoc Commissio�r t 01/47f2015 - 't WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION-PAGE Alk AGENT N0 .3020 OFFICE N0,3020 �.. . MARK,SYLVIA INSURANCE AGENCY LLC 404 MAIN STI.: CENTERVILLE MA.02632-2916 FARM FAMILY CASUALTY INSURANCE COMPANY 5O8y428-0440 *.. NCCI COMPANY NO. 16721 PoucY No 200*1W6406 EWIjAL`p ' 1W6406 . D AND MAILING ADDR ESS: REN F'NO 20 0 INSURED EFFECTIVE 3/05/15 DAVID SAWYER DBA SAWYER CONSTRUCTION 318 MEIGGS BACKUS RD SANDWICH, MA 02563-3131 THE INSURED IS INDIVIDUAL Workplaces covered by this policy: RTG.BUR NO. INTRASTATE NO. ST WP.NO. . ADDRESS OF WORKPLACE MA 01 318 MEIGGS BACKUS RD 210677 SANDWICH MA i??T:......fit v.......x:r::.}::{:r{n:`?•v..v.:??•::v..,r.}..y:::::.::r::.:::::j i:::{{.:n:?.?jj::}{•:}?: ...........::v::::::r•:Y•?:<:-i:•:Y.ji%•vv:i::vi:.?y}x}:::v'vv:{v.?•:i}:::r..::}...:..:::::..xv::•i?:•?%::::::{:w;?}:::vny}}:r:iiii}}{:{•}}:rf.::n.. .- ,-.. .v '• ��:4•?:?•??}}::Ci::.?}:?:?:•:::...,.:... .:•:rv•.:..n...........n.:..r..;.-::.:is`l�:ii}::::r::xr.... • -�. �•A.M. Standard Time at the insdred's mailing-'address. 1S from 3/05/15 t0 3/05/16 12:01 The policy period , } :::} :::: .:. n:Law of ::� ��. .}:::. ...... o e Workers Co pensat><o ......:...... ...... ...... ..... ......:............:.... ..... ....... xr....:::: : ensation Insurance: Part One of the policy applies t th W k m A. Workers Com the estate list here: MA . ' ers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. B. he Employers under Part Two are: The limits of our liability Disease Bodily Injury By Disease B Accident Bodily Injury By to ee' Bodily Injury Y $ 100,000.each emp Y $ 100,000 each accident $ 500,000 policy,limit applies to the states, if any,' listed here: All states C. Other States Insurance: a Three 3.A. of the information page and ND, OH, WA, and WY except the states designs ted D. This policy includes these endorsements and schedules:vvc o0 03 15 We o0 oa'1a vvc'oo 04 22A WC 00 00 00C We 00 00 016 vac o0 01 14 WC 20 03 01 WC 20.04 05 WC 20 06 01A WC 20 03 02A. WC 20 03 03D - PROCESSED 01/29/15 INSURED COPY Copyri&t:1987 National Council on Compansation Insurance WC 00 00 01 s Issuing Office - PO Box 656 • ALBANY, NEW YORK 12201-0656 David Sawyer Construction 318 Meiggs Backus Road Sandwich,MA 02563 508-539-1992 Proposal Submitted To: Work Address: Lisa Cooper 508-566-1962 140 Captain Samadrus 02635 Worked to be Performed: Strip Roof---Replace with CertainTeed AR Landmark Architect Shingles= Color-customer to choose *Nail Plywood and replace as needed *Clean Cutters as needed *Install: White Aluminum Drip Edge on edges of roof Ice.&Water barrier on all edges of roof Underlayment Paper System Pipe Flange Ridge Vent Hurricane nail shingles *Clean &Remove all debris from workplace,take to landfill Total Labor&Investment: 9,000.00 nine thousand dollars Deposit to begin work:3,O00.40 and balance due at completion of job. All materials guaranteed to-be as specif c,.and_work.;to be_performed.as_stated above in a workmanlike manner. Please remove.and/or-secure any fragile household items. Not responsible.for.broken or damage to household items. Five year Labor Warranty/PI s Manuf ures Lifetime warranty. Contract maybe withdrawn if not accepted within 30 days lease se back for ad ' 'onal terms Respectfully Submitted Date—0 Acceptance of Proposa "( The above prices,specifications and conditions are satisfactory and hereby.accepted. You are authorized to do the work. Pay nt due as shown. Owner;signature ' D' e° I r �� -lv LQ, 5 UU a01s r , i TERMS AND CONDITIONS CHANGE IN THE WORK Any alteration or deviation from the work specifications involving extra costs will be executed only upon written order,and will become an extra charge over and above the estimate. ]DELAYS Contractor agrees to start and diligently pursue work through to completion,but shall not be responsible for delays. All agreements contingent upon strikes,accidents or delays beyond our control. COMPILANCE WITH LAWS Contactor shall be licensed and Insured. ft In connection with-the performance by Contractor of duties pursuant to this Agreement, t Contractor shall obtain and pay for all permits and comply with all federal,state,1countyPr.- and local laws,ordinances and regulations. ARBITRATION,VALIDITY,AND DAMAGES Any controversy or claim arising out of or related to this contract,or the breach thereof, shall be settled by arbitration in accordance with the Construction Industry Arbitration Rules of the American Arbitration Association,and judgment upon the award rendered by Arbitrator(s)may be entered in any court having jurisdiction thereof. ATTORNEY FEES In the event legal action or arbitration instituted for the enforcement of any term or condition of this contract,the prevailing party shall be entitled to an award of reasonable attorneys fees in said action or arbitration,in addition to costs and-reasonable expenses incurred in the prosecution or defense of said action or arbitration. ASBESTOS AND HAZARDOUS WASTE If contractor encounters such substances stated above,Contractor will stop work and,allow the owner to obtain a duly qualified asbestos and/or hazardous material contractor to: perform the work. ' Satu ignr" � . D IS Page 2 i