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Home My WebLink About0210 NOTTINGHAM DRIVE � - I'. � , O'll z . . :1 ; . ;:�x -11 . .� � . � . . I . . I I I . . - ___ r . I . .. . . .. 1, 1. I I 11 I I .'� . a 4- l \, f.i Q r. { e'. .' .'1 .. '" I g 13 r-1 � Town of Barnstal *Permit# & - a� Regulatory Services ires 6 montlis from issue date Q * snaNSTABLE.MASS. Richard V.Scali,Director AUG n i6g9. a` 6 1J Building Divisi(WN/nj , 2d,g Paul Roma,Building Commissioner �� 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number / 7�— �o� S Property Address / i esidential Value of Work$ ; 0. Minimum fee of$35.06 for work under$6000.00 Q Owner's Name&Address D !�1 Contractor's Name i Telephone Number A Home Improvement Contractor License#(if applicable) ,a,Q Email: . Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance h ck one: am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance / Insurance Company Name6a�04(b Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompan each permit. Permit Re nest(check box) -roof(hurricane nailed)(stripping old shingles) All"construction debris will be taken to / ❑Re-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: *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 c of the Home Improvement Contractors License&Construction Supervisors License is r red. s•. r.x > SIGNATURE: / C:\Users\decollik\AppData\Local\Microsoft\Windows\lNetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 5 F Office of Consumer Affairs and Business Regulation J One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home ImprovemeCantractor Registration Type: Individual 77) RZz ,/ Registration: 134313 DAVID SAWYER , Expiration: 10/23/2019 318 MEIGGS BACKUS RD. SANDWICH, MA 02563 _ Update Address and return card. SCA 1 0 2007MMpp-05/17 ✓2G �M1/7?.P2CllrlG��O�✓OU'2l'1ll,Ul.CCdE/.l{1' _. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:IndMdual before the expiration date If found return to: Office of Consumer Affairs and Business Regulation Recu °r+ Exo1rati� 0n 10 Park Plaza-Suite 5170 Tom.• l23/2'0:-10 19 _ Boston,MA 02116 DAVID SA ' DAVID SAWYERS 318 MEIGGS BAC€C1�5D_ �= --— SANDWICH,MA 02583 -- Undersecretary Not valid without signature 4� Massachusetts Department of Public Safety Board of Building Regulations and-Standards License:CSSL-098859 Construction-Supervisor Specialty DAVID R SAWYER 319 MEIGGS BACKuSy CUAD44. SANDWICH MA 0259V��I`- Expiration: (Commissioner 01/2712019 Ir Q �4 r WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY , INFORMATION PAGE 9FFarm Family Casualty insurance Company AGENT N03020 OFFICE NO 3020 Glanrnont-N-YOrk MARK SYLVIA INSURANCE AGENCY LLC Farm Family Casualty Ins.Co. 404 MAIN ST CENTERVILLE MA,02632-2916 NCCI COMPANY NO. 16721 508-428-0440 POLICY NO 2001 W6406 NSURED AND MAILING ADDRESS: RenewConversion DAVID SAWYER EFFECTIVE o3ro5nola SEE EXTENSION SCH U E SAWYER CONSTRLICT N 318 11EIGGS BACKL R SANDWICH,MA 2563- 31 THE INSURED Indi idual Workplaces cove d It this po`cy: ST P N ';A RESS OF WORKPLACE � R'fG.BUR NO. INTRASTATE NO. MA 1 318 MELGGS BACKUS RD 'SAND1*1*'1CH MA 02563-3131 The policy period is fro 3/05/2018 to 03/05/2019 12:01 A.M.Standard meat the insured's maili g address. A. Workers Compensa n Insurance:Part One of the policy a plies to the Workers Co pensation Law of the state listed here:Mn B. Employers Liabilitc In ranee: Part Twq of the polio-aptlies to work in each Is ate li ted in item 3.A.The limits of our liabilih under Part Two are: Ilodil%Injun Bl Accident t(1.1000 j njuBi VaeuseBodi Injun 8�Meuse 1110.000 each accident polio'limit S 1 0.000 each employee C. Other States Insurance:Part T ee of the polio•applie to the st tes,if and-,listed here: All st tes xcept the states designated in item 3.A.of the information pag nd N D,OH,NVA,and "Y D. This policy includes these endorsem is and schedules: X49710416 X30781208 %vC,75050 202 X43320216 X2 9 X3632 ` 560 13 N'COOOOOIA %VC0080ooC0115 NC0003150985 N'C0004140 WC00042280115 WC 003010484 NC-200302A0908 NC 0 03D0810 WC'2004030191 NC'2004050601 1*1000601A0708 , NC20060411 Cop.right 1987%atiunal council PROCESSED 01/12/2018 on Compenwtion Inwmnee Issuing Office-PO Box656-ALBANY,NEWYORK12201-0656 2oo1 W6406 01-12-2D18 19:39:12.Dt The Commonwealth of Massachusetts Department oflndustrialAccidents I Congress Street, Suite 100 , Boston, MA 02114-2017 ' ,r• ' www mass.gov/dia NGorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information P�ase Print Le 'bl Name (Business/Organization/Individual): S1111zf J1nfjQ1tk& Address: t City/State/Zip: Phone#: � cJ Are you an employer?Check the appropriate box: Type Of project(required): - I.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction I a sole proprietor or partnership and have no employees working for me in. 8. Remodeling y capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp_insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. oof repairs These sub-contractors have employees and have workers'comp.insurance. 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 15Z§1(4),and we have no 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 subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'co ensation insurance for my employees Below is the policy and job site information. r Insurance Company Name: Policy#or Self-ins.Lic.#: o W Expiration Date: Job Site Address: City/Statelzip: ti Attach a copy of the workers' compens n policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement ma forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the p ' and penalties perjury that th o Lion provided above is true and correct Sig unature: r Date: �- Phone#: Official use only. Do not write in this area,to belcompleted by city or town official ' City or Town: Permit/License# Issuing Authority(circle one): L.Board of Health 2. Building Department 3.City/Town Clerk, 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: y.� r Property Owner to complete and sign if using a builder/contractor I LlL-(1jeq g4 SUZ4L-V✓A , as owner of this property �R Hereby authorize 'G To act on my behalf, in all matters relative to work authorized by the building permit for address: e(17 kifA v'��/l e AA DLL 3 � Address of work) Signature of Owner Date Print Name R 3'13 C41 David Sawy6r Construction 318 Meiggs Backus Road Sandwich,MA 02563 508-539-190 Proposal Submitted To , Work Address: Mr&Mrs.Sullivan 210 Nottingham Dr Centerville,MA 508-428-3841 Worked to be Performed: *Strip Roof--Replace with CertainTeed AR Architect Landmark Shingles Shingle Color-Customer to choose *Nail Plywood as needed *Clean gutters as needed *Install: White Aluminum Drip Edge Ice&Water barrier on all edges of roof,two chimneys and one cheek Underlayment Paper System Pipe Flange Hurricane nail shingles :. Ridge Vent Totai Mateh6l,Labor&Investment $7,800.00 seven thousand eight hundred dollars Payment dtie 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 responsible for broken or damage to household items. Five year Labor Warranty/Plus Mapufactur warranty. Contract may be withdrawn if not accepted within 30 days. Please se�i back f additioy�l terms. �--_ f / Respectfully Submitted ,/,u�,uj Lid o,GL� G; l Date Acceptance of Proposal -1Z The above prices,specifications and conditions are satisfactory and'hereby accepted. You are authorized to do the work.. Owner signature: Dat