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HomeMy WebLinkAbout0060 PADLOCK LANE Coo " a.GC �©4:c. � L.,a,r, �. . � � . � . .. , � , .. ,� � - a ' . � � .. ,. i.. .� e 4 � 'a ., � � �t�, ' � � - ° °P - � d e C a ie *�Ot�UC� ( Cp Town of Barnstable ti E:rpires 6 months from issue.date Regulatory Services - Fee BARNSTABLE, • - MASS. v� i639 A /,�� Thomas F. Geiler, Director (2 g113 //0 AlFD MPy Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Off ice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY J Not Valid without Red X-Press Imprint Map/parcel Number —� Properly Address Residential Value of Work Minimum fee of$25.00 for work under$6000.00 t Owner's Name & Address bo P Contractor's Name_ / ' Telephone Number���' � ,3j 9*2 I tome Improvement Contractor License# (if applicable) /s MT Construction Supervisor's License # (if applicable) ` X-PRESS R ❑Workman's Compensation Insurance APR 12 2010 Check one: _�-am a sole proprietor -TOWN OF �f�R�STP►�� ❑ 1 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name .,. ` Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file: . . Permit Request (check box) ,,1Z,Eroof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/"doors/sliders. U-Value (maximum .44) *Where required: Issuance"of this permit does not exempt compliance with other town department regulations,i.e Histdric,Conservation,etc. ***Note: P,ro erty Owner m t sign Property Owner Letter of Permission. A opy of the Hoin Improvement Contractors License is required. SIGNATURE: - Yt i.'\4111-l1.1-.S l OIZMSlhuilding permit fornls\EXPRESS.doC Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents kiOffice 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): III d Address: City/State/Zip: cs��1 LLd` ya��Q� Phone.#: �� - ?J q'l Y� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. El New construction emp pyees(full and/or part-time). Remodelin 2: am a sole proprietor or parttler-' listed on the attached sheet 7• .0. g ship and have no employees These sub-contractors have g_•❑Demolition working for me in any capacity. employees and have workers'comp. ❑BuildinBuilding addition (No workers'..comp.•insurance comp. insurance$ required.] • 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑. I am a homeowner doing all work officers have exercised their 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.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compmsation 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 mployees,they must providt:then• 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.M. - 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 io secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimi ial penalties of a find tip 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` IA for insurance co r a e verification. - I do hereby eerie under the pa' -and enalties ofperjury that the information provided above is true and correct. Signature: Dater Phone# Official use only. Do not write in this area,to be completed by city or town official: City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health'2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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, corporatio/srrein, egal entity, or any two or more --- ofthe fdrregomg-engag in alomt-en rp�u&1dd�mgthe leg represendec�asezi�mpinye�or the--__._._ :~ receiver br tft stee of an individual,partnership,association or other legal entiying employees.'However the owner of i\dwelling house having not more than three apartments and who resin,or the occupant of the dwelling house of another who employs persons to do maintenance,constructiair work on such dwelling house or on the grods or building appurtenant thereto shall not because of such em be deemed to be anemployer." MGL chapter 15\nProd also states that"every state or local licensing age withhold the issuance or renewal of a licit to operate a business or to construct buildi commonwealth for any applicant who huced•acceptable evidence of compliance with a insurancecoverkge required." AdditionaIly,M52 §25C(7)states"Neither the commonwealth or any of its politicalsubdivisions shallenter into any coe performance ofpublic work until acceptableof con mpiiznce aZth the in ice requirements of tave been presented to the contracting authori Applicants Please fill out the workers' compensa 'on affidavit completely,by the ' g the boxes that apply to your situation and, if necessary,supply sub-contiactor(s)nam s),address(es)andphone n er(s) along with their certificates) of insurance. Limited Liability Companies(L C)or Limited Liability erships(LLP)with no employees other than the members or partners,are not required to c orkers°compensati insurance. If an LLC or LL P does have employees,a policy is required Be advised th affidavit may a submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure sign and date the affidavit The affidavit should be returned to the city or town that the application f the permit <r hcense is being requested,not the Department of Industrial Accidents. Should you have any questions 'ardl e law or if you are required to obtain a workers' compensation policy,please call the Department at the n Cr/E* ,,-,d 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 1e y.. e Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of vestig 'ons has to contact you regarding ing the applicant. Please be sure to fill in'the permitflicense number which wi be used a reference number. ]h addition,an applicant that must subunit multiple permitAicense applications in an given year, ed only submit one affidavit indicating current policy information(if necessary)and under"Job Site Ad ass" the appli ' should write"all-locations in (city or town)".A copy of the affidavit that has been officially s - ed or marked by e city or town may be provided to the applicant as proof that a valid affidavit is on file for. r perir ifs or licenses. new affidavit moist be filled out each year.Where a home owner or citizen is obtaining a lice ' or permit not related fo y business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said pens; is NOT required to comp this affidavit. The Office of Investigations would like to.thank you in dvance for your cooperation and s)>ould you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:,,,; ; 11(o C6mmo,iwealth of Massachusetts Deparllnehi of Industrial Accidents O1fftc'e1 of Inlvestigationts 600 Washington Street Boston, MA 02111 TO. # 617-727-4900 ext 406 or 1-877-MASSAFE ;Fax# 617-727-7749 Revised 11-22-06 www.mass_gov/dia 1 David Sawyer Construction 318 Meiggs Backus Rd Sandwich, Ma 02563 508.539.1992 Proposal Submitted To Work Address Mrs. LJ Murphy h same 60 Padlock lane 508.428.4381 Centerville, Ma Work to be Performed: *Strip old roof shingles and replace with new 30 year"AR"Architect CertainTeed Shingles Color:'cobblestone grey *Nail Plywood as needed *Clean Gutters as needed * Install White Aluminum Drip Edge Ice& Water Barrier on all edges of roof and chimney Underlayment Paper System Pipe Flange Ridge-Vent .... _. Hurricane nail roof *Apply,new lead on chimney *Replace"all rake boards,with Pre,prime,wood trim. ,. *Clean& Remove all debris from-.work place after job and take to landfill. Total Investment & Labor: $5,750.00 Payment due in full at time of job completion. All materials guaranteed to be as specific, and work to be performed as stated above. Work to be'completed in a,workmanlike manner. 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. All agreements contingent upon strikes, accidents or delays beyond our control. Please remove and or secure any fragile household items. Not responsible for broken or damage to household items. Five Year Labor Warranty/Plus Manufactures Shingle Warranty. We may withdraw this proposal not acceptl6d within 30 days. Respectfully Submitted Acceptance of Proposal The above prices, specifications and conditions are satisfactory and are hereby accepted. ,You.are autbo"d to.do the,work.as specified. Payment.is due in full at fob completion Da ��. _.. f ,. Signatu Office of Consumer Affairs and Business Regulation. - _ 10 Park Plaza - Suite.5170 Boston, Massachusetts 02116 ` Home Improvement Contractor Registration 1' g Registration: 134313 Type: Individual Expiration: 10l24l2011 Tr# 289550 DAVID SAWYER CONSTRUCTION DAVID SAWYER _ - 318 MEIGGS. BACKUS RD. SANDWICH, MA 02563 --- - --- ------- --- - --- - - -- =- Update Address and return card. Mark reason for change. j Address Renewal Employment Lost Card S-CA1 0 50M-04!04-G101216 - - :/ftP. �Q9JUIJL6Jlll.'P.21{fl. Q�.I�JJ(ZC7CCLJEt�6 � - 1 - Oflice of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation �. '. Registration: 134313 - ..__ IO Park Plaza-Suite�I70 Expiration: -10124/2011 Tr/# 289550 Boston,tVIA 02116 Type: Individual DAVID SAWYER CONSTRUCTION DAVID SAWYER 318 MEIGGS BACKUS RD. SANDWICH,MA 02563 - — Undersecretary ` Not valid I" hout 'gnatur Ol usach1.,Set ts - Departntottt of PIti,Iic S,II'('t� B0 a(I of Buildin Re­(tiation. atul �t:tnd:irti, License: CS SL 98859 Restricted to: RF,WS DAVID- SAWYER 318 MEIGGS BACKUS ROAD SANDWICH, MA 02563 ��- Expiration: 1/27/2011 ( nnini..i ncr Tr 98859 A'Ssessor's map and lot number ...1 .r.. ...: SEPTIC SYSTEM N-1 r � I, STALLED I oF`?"F roe Sewage Permit number .....................................�......�........ /< WITH ARTICLE II T SANITARY n pp II • CODE A t•. 1 N �"MLE, i ` �f> A House number ................................................................:........ REGULATIONS, 900 rb a m� 3e• e 'E0 upi a� TOWN OF BARNSTABLE BUILDING INSPECTOR z APPLICATION FOR PERMIT TO ,,,, Suf folk Rea1tX Trust . ................... .................................................. TYPE OF CONSTRUCTION ........S.ing.le...faMily..zeSidentda1............................................................. Sep.tember...26.:.............19:$... TO THE INSPECTOR. OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Lot # 34 Padlock Lane Centerville ....................................................................................................................................................................................... singlefamily residential Proposed Use ...................................................................................................................................................I..................._...... Zoning District single family residential ,,,Fire District .C.eX1terV.itle...Os.texvill.e.................. Name of Owner ,Suffolk RealtX Trust ...,Address P...O. Box„308 Centerv„il,le Name of Builder ..,•same ..,,..Address same :............ .......................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ................................................................:.Foundation ......I.?ourQ.d...conur ................................ Exterior cedar...shingles.....................................Roofing .......aSP.hal.t...S. ],1aga,��................................... . car etin over underla ment . Floors .......... ..................................Y......................Interior .......S.ka M...QA.at...P.1a.,q.t er................................ Heating ••forced_..hot water by...oil.............. Plumbing .....P.VC..................................................................... Fireplace .......brick..and.,block..................................Approximate Cost .... ,.QOQ...OQ...................................... Definitive Plan Approved by Planning Board -----------_--_-__-----------19--------. Area ..../70../� 9�9RAler Diagram of Lot an , Building with Dimensions - 9 �. 9 Fee ........:.. l..:.'..�................. SUBJECT TO APPROVAL OF BOARD OF HEALTH q60-00 ��Llivo I hereby agree -to conform to all the Rules and Regulations of the Town of.Barnstable regarding the above construction. Name . ... ..... ........... ` ' ' . ` . Suffolk Realty Trust No _.2O025.. pernnh for .................................... single� . oiuglo family dwelling . ---------.—.-----_.—..--.---- . . ' 60 Padlock Laue / Location -----.--_--____-----_. � - Centerville --.--.-----.----.----------.. Suffolk Bealt Troot Owner -----------..��-------.—. . . ` � Type of Construction ...............fra.me_----. .............................. .................... ' Plot ---------. Lot ---- .............. ' . � .. ~ . ' - eodber 28 78 Permit Granted --.����-------.'..l� ~ . ` Date of Inspection ...........................i........l9 ^ ^ Dote| Como��a6� . ' lq ^' r''--- -------. � ' ���@�� ������� ^ . . ` . . lg ` --~~—`-------- ' ---'r—' � ....--.-----...^--------~..^-.-- � _...—~.—....--,--...--------..—..— | ' ' � —..--.,_---_.~.....—~..--...~—,-~—.. � . , . —...'.-~...----.--~....—..—..---.—.. . ` ' ----..-----------. 19 .� . ^ ' ` . -------.�..---.--~..._.—..,~...-- . .' . ~ ----------.---~—.--..,........^. ` ` [ ` ^ r TOWN OF BARNSTABLE �. Permit No. 1 "u Building Inspector Y1L7 L . Cash ------------------------------ 039. oO�O YAY OCCUPANCY PERMIT Bond ----------------_ ------------- "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, 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." Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department 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. .....................................................1 19 ..................................................... 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