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HomeMy WebLinkAbout0045 SMOKE VALLEY ROAD 1. Assessor's office(1st Floor): r Assessors map and to um O P' BEM MUo T SE `�{THE Tp` ConservationSTAL1 IN COMPLIANCE Board of Health(3rd floor): VATH°nTLE 5 Sewag a - 1tsIR®N MENTAL CODE AND { ssa»r�ntt e Permit number . y rua Engineering Department(3rd floor): �WN REGULATIONS Y��' House number '7 - �� lb Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.,and 1:00-2:00 P.M.only: TOWN OF , BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 7��!� ��0.(�OU'n�fl ZJ I M Iry Qn pl, TYPE OF CONSTRUCTION C.0 ��e t V 1 °I -172-1 G Z 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Lk Location E)M o)Ck J C-I\\-e`t R O �'�rum ��a �s �' i \2`7 Proposed Use w A o L. Zoning District- Fire District /V/Ad Name of Owner (a cM Address o 2 Q sTe D\\ Name of Builder_ c D 600gZ Q 0C3 Address\-Lk-l-N CGo,..� �sj 'CY ,�� Name of Architect TO Address Number of Rooms � Foundation C CsoC R- -C -P Exterior Roofing Floors Nt Interior Heating Plumbing Fireplace "�\ Approximate Cost \O 00 C., Area Diagram of Lot and Building with Dimensions Fee QJv/`� ,y OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the rTown of Barnstable r gar in th above construction. r. . Name- Construction Supervisor's License C ArJ fl•�}2�c�, `� K.{.,EIN, ADAM .,� No 35389 Permit*or Build Inground Pool v Accessory to Dwelling Location " 45 Smoke Valley Road (Lot #127) Marstons Mills Owner -Adam Klein Type of Construction concrete/Vyna1 i G Plot Lot Permit Granted September 22 19 92 Date R.lnsp8ction,"0'N'`!9? 19 _ u Date Compl@te r �19 /J3 . ex Qi`J HOMEOWNER RECORDS SEPTIC TAN, MAINTENANCE dgt LZ _ Sketch house, septic tank, leaching facility and show distances from septic tank cover to nearest �IrOUC l house corners. q TANK SERVICE RECORD Approximately 90% of Cape Cod's population Date contractor Service Performed disposes of its wastewater through individual G on-site sewage disposal systems. If properly rJ operated and maintained, an on-site system can provide many years of trouble free service. If neglected, however, the system is likely to fail, creating public health hazards and expensive (!, repairs for the homeowner. This pamphlet describes the principles of septic system operation and explains the maintenance pro- �— cedures, necessary to insure long life for the system. A homeowner's maintenance record is provided on the back. Prepared by: Qr Cape Cod Planning&Economic Development C> Commission 1 st District Court House If you have problems, contact your local board of �—' Barnstable,MA 02630 health or health agent. Tel.362-2511 Ext.477 I B 'i . 1..�:�._t�:.+; .. .: . ..., . - --1:}. = -�•_�-,.`� � . ' VF - ulcer ,_r is I _ i I 1 ti 4 , -i- i , 1 t. : i 3 I SPL sti : 7•Y �# \ f p _ a , ILI _ -- Ar da ELz . r 1 ol IA , : .fir'!.,{•,�:� ! � � f � _.i- (..1 � � � _ � _' : • -RSo FIv�1ZcGccS -2-x'4-.� _TwSS:�uo- . , S. to 40ytQ �a 1= . u SUTTT ElZ _LEAt7 EJ2-S 11L.►:_'G LO$L'T - r Er->2Oo�/�_._. ._ -- 3F-rF-t,T..-%VI.TN VENTS .tG WIT" rENTIL. ,_)'J,1�_J��>�� .1(...1`�}.��i��,v".�t.J :_�2xtix�?-Iy:' � �.. ':2Ktr•�@t2^ off.. . LISJINS IZOO//\ `65 P� = Fn//LILY 200/A, I. i' IN$U"TION ,. 9b 4•I T.0 Oi 2x to Q 16•• o•c, t2 - - - - - - r ZL�. Ax ti (7 ° I ° ", o U 14N-,I s, LA .=17 -� { X J= I 0 , r qIP ��l J I K 1 c 1r V zr In V--f� FF L -J 4- 1 F'.: 'i3O- ....... .. . zft>? Coe Ft-= 11-z 7 -0) > PT o 21 P- r qr q F --1 I Ca tv L— J I—J y -9 Pr hh 1�0 I I $� ` i 4to'_' o() fq I �i1I I —— � � j r 4,u, � �� I i� I I•j r as I soar-T I I I L -- / _arz t)C/n Ga2pE�:__ OsHo,,ca � _CAR,pjCT Llh� ry /.Prt.AR.IN,Ca.'W A1.1.._fO Q..�J.grT66 I I �i Hon1E_ _-._. _.. __..,.._•..-._._... -- q q�� __. i PS QOm�I�1 i ..�•\V ALK-IN I. ' I j 0 T 'CAVA. ou n I �CAM Lr i �9 BAkL'o11Y as 91•x 1-. d - I SToliA4L OPEN TO —' I i -PLYwoap - I I O pwwooTa. --�--' I I i LZ 9'-. %'-O` O.W. i 00 r Z z .I p 'L 49 m � I I 501 z I c r l l 61 I 1%D Z 'L..� i� 711� N I L m z r i O PI 1 6i A or n 4 `.kLH. P;. D �,vi � a � � I w u a I f —-- ---_----------- ' 1 --- V G- F O z 1 II i r n n ,a. r GD -C D� of i e'•»Irol.o � � aN rim 10-0� 12'-U., 20.�0•. . 13 m 0I a .V, I a r f. ,------ - Z� I m • o ` I � d ; � i--,J 7-1 r: I ! P -`tj i I i I _ �- >{ r i RM9 � I c r ,, 1 J I � i o i r-} - T - --=- -_- L --- 1 i o n I � � z I-- I iI n m v � I I /�/ •f�/ o f 0 ; y i• a 1 •• 1 i ; V tA IA i zr nr Z n 00 M1r r An 1 r I i J ii n a � L =75 ❑Il0D y I� QDIEl . 0 F1j� G I i i } . � . | | / . | / i ! / | / | ' | --_�� . . � . / � . . . . . � . � � . . . . . ` | | . y . . . . . . ' � . . / . � � ' ! ! / ! � 1 710 im TIM!!Ti'I's,11 ii, IF ! �-- - - - FF[11 1!1 '' 1 | . . � i ' ' | / / | � i / / . � TOWN OF BARNSTABLE, MASSACHUSETTS B U 1 L D i N .. PE RM At-%7-'37 , DATE September 17, 19 92 P R IT NO. Nv '1353 2 APPLICANT_ Bayside Bldg. CO. ADDRESS en ery l @ _ 1 (NO.) (STREET) (CONTR'S LICENSEI PERMIT TO Build Dwelling (11 ) STORY Single .Family Dwelling NUMBER OF •• (TYPE OF IMPROVEMENT) NO. DWELLING UNITS - (PROPOSED USE) AT (LOCATION) Lot #IV 127, 45 Smoke Valley Road, O&tervllle ZONING 'RC IND.) (STREET) DISTRICT BETWEEN AND (CROSS STREET) (CROSS STREET) _ SUBDIVISION LOT BLOCK SLOT IZE BUILDING IS TO BE FT.; WIDE BY FT. LONG BY FT. IN HEIGHT ANO.SHALL:CONFORM-IN CONSTR.UCTI r TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION REMARKS: Sewage #92-372 (TYPE) Bond VOLUME 2901 $C;. ft. X32921 270�000. FEE $232. 25 EE (CUBIC/SQUARE FEET) ESTIMATED COST OWNER Adam Klein ADDRESS C OX 7j, en @rvl @ BUILDING DEPT. BY THIS PERMIT CONVEYS RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK'OR ANY PART THEREOF. EITHER TEMPORARILY C Oy- 0. PERMANENTLY. ENCROACC HMEN TS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE A PROVED BY THE JURISDICTION. STREET S. ALL. Y GRADES AS WELL AS DEPT,,��AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINE FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DO NOT Rj�iLEASE THE APPLICANT FROM THE CONDITIOI OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. INSPECTIONS MINIMUM OF THREE CALL -APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE ( ALL CONSTRUCT OIONRWO R K:R CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I. FOUNDATIONS OR FOOTINGS. MADE. WHERE ,A,CERTIFICATE OF OCCUPANCY IS RE- MECHANELECTRIC ALAI NSTALB PLUMBING • 2. PRIOR TO COVERING STRUCTURAL MEMBERSIREADY TO LATH). QUIRED,SUCH BUI ' ING' HALL NOT"BE OCCUPIED UNTIL iii 3. FINAL INSPECTION BEFORE FINAL INSPECTIOtVS BEEN MADE. OCCUPANCY. P®ST TINS CARD SO MIS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPEC N APPROVALS ELECTRICAL INSPECTION APPROVALS 2j��� s ��►;1 Plg �1 tg— ►3—5 3 2 3 .'Hc: •� I /_'� HEATING INSPECTION APPROVALS (� EN EERING pE�MNT 4, k. w Y., )3— @AARD OF HEALTH OTHER I SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDICATED ON THIS CARD CAN E CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITTE NOTIFICATION. i 4.. ��..°�z °•.w TOWN OF BARNSTABLE _ BUILDING DEPARTMENT 7°H1°r TOWN OFFICE BUILDING rua HYANNIS, MASS. 02601 �o r�r►• MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit $� _3 ��, ...__ ....................................................................................... _ .»...... __ issuedto ...... ... ! 5i..........................._............. .............................................. Please release the performance bond. c vyi. +�. "•" ,(�"'°"af.�: r- .-..t a.� . y.. .t•"-rs y.-....-...'r, w *+.`..:.: '++."�'w..iC" i.� _. .'�... Y���r. 4.r S.-.. ,,.-`f.!r .r. TOWN OF BARNSTABLE Permit No. .....35372 . BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash 7 Yl p 6SV. X uY HYANNIS.MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to ADAM KEEIN Address Lot #127 45 Smoke Valley Road Osterville USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID. AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. January 15 .. . .... . . 19. 93 '� ���2�. .. ... ... .. .. .. .. .. ................ ..!..............-&-� Building Inspector OT 1 P-OAp T , -_ r -�-r9 _. l -- ,��T � T-t ' • � � �, 12`l t--t 7 + �T ; ;_� - r`'o p r -; c 3�• ohA. IWT O Y l r +- rT • r V �-t '- - ,2T/,4=-y_.�7;, IA7 T.1 > ��v,�pAr�o�J LCc,4Tio.C/ os w�cE/di1A/c'SJ�D41S M�GLS Sc,4 / q .0 EQY//,eE�s'lEit%TSWA l : r32N6TgaL 77 ;4"Lio,�/S No77- - LOT /Z7— �: - �_, y. 47 SAXT.E.C?E tic/ AV i2EG/STE,2E1�.%NST,elU��G}{jX,$'!/.2YEY OSTE.eIi/.C.,C�a O�,5S E'TS syvLt/y Sh/�UG.a ,(/p)- g� . �'l.4SS. USE10 7a OET��-mil/�E .�-UT G/�t/�.S .4F��.L. 0?37D OW As$gssor's o1¢ce(1st Floor): Assessor s map and to umber Conservation ` ice- SEPTIC SYSTEM MIDST Board of Health rd f oor): INSTALLED IN COMPLIAN ' Sewage Permit number - 37 �- + WITH TITLE 5 Engineering Department(3rd floor): ENVIRONMENTAL CODE A 0 MAI House number Definitive Plan Approved by Planning qVh, of /'-J-1 T0WN RErR wfl,-mTIONS APPLICATIONS PROCESSED 8:30-9.30 A.M.and 1:00-2:00 P.M.only TOWN OF BARfNSTABLE BUILDING INSPECTOR IM APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: sf Location l o� ! 1! G�/ 1 l of/ j Proposed Use �— Zoning District Fire District a Name of Owner ae,&4w Address !v Name of Builder Address Name of Architect � � Address Number of Rooms Foundation QQ Exterior ¢ �ir-� Roofing Floors zl4r %C�. LC44 . �t:e f' � l u Interior Heating Plumbing � a Fireplace aw-,A 3W04 Approximate Cost O—zy c d-o-y Area 02/0 Z CL Diagram of Lot and Building with Dimensions �D� Fee o2.3 Z ?5 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ' Construction Supervisor's License P KLEIN, ADAM No 35372 Permit For 1 z Story i Single Family Dwell Location Lot #127, 45 Smoke Valley Road Osterville Owner. Adam Klein , Type of Construction ` Frame Plot, Lot Permit Granted September 17 , 19 92 Date of Inspection 19 Date Completed 19 ooMMONWEALTN t. D jET 'OF ENT OF PUBLIC, � -• ---•.:;-�.....__._.�„�.. MA33ACNU9 10EP 10 COMMONWEALTH AVE, s 1 ETTS BOSTON,MASS,02215 EXPIRATION DATE L I C ENS E. �l�ll ENCLOSE CHECK OR MONEY ORDEF 06/3Q/199 CONSTR. SUPERVISOR: i. a RESTRICTION§ 3. ��- c 3 "r:: :. FOR REQUIRED FEE; r. NONE: EFFECTIVE DATE •• UC�v ADE PAYABLE Ob/ 01199�•:.. :005� M LE,TO 5, 6:45 "COMMISSIONER' F p.. SS 027� eVAN .T= DAC t:,., , f? UBLICSAFETY 46 S9S6 - 62; FE RB EY ' ROOK .LANE ►NOfO(SLASiNO•pvN ON-") FEE: CENTERVILL :MA.. 02632 ....:: � 1....�' . r' :rtz„'p l00.00 P EASE..NO ..hNCREASE' '•f'•t'Liftsi +y�e• �(yr EIGHT: YA NOT VVALIDYNUNTILEIONEO EY E•••'. .,.v'• �• "��gy��j.ly r :� DOB: STAMPED .OR IICENBEF AND E f E C T I �xy sy 1(d w y• 'SIGNATURE COMM .t.. y i. Ij...f�.',• TURF OF THE IALLV ' . 04/19 1 56. y8 9•.. OTNE• ';v�1•���.r''�:Y I t Y�� • DOC3T all M 2w8 7•BRtG12iI0{+ � TNE RE . �"� •D D E PIS& CARREO ONFIN Is OCCUPATION «NOT.:, CEN SC i'STU9 NS"SNOLOENR WNNOO/ NAME IN FULL COMMISSIONER ABOVE SIG' NATURE UNE ' -- i Town of Barnstable *Permit - "1�7R Expires 6 mon i f r. n e d �7 Regulatory Services . Fee r • • BAMSTABLE. • iaass. $i639. Richard V.Scali,Director ♦0 �D MA'1 A I Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY er Map/parcel Numb Y O C.(/�Valid without Red X-Press Imprint i / , Property Address �� G t' o K� V U,l l e-j R Residential Value of Work$ Jul 0 0 o Minimum fee of/$35.00 for work under$6000.00 Owner's Name&Address Nd rH^ �'1�-lG��vC, I -&4� j l rz.,j4 j y►L. 16 Contractor's Name Dove n�5 KwK..yi �0 Telephone Number Home Improvement Contractor License#(if applicable) , I 1 I Email: (J K.fG✓��� y1�Cci f ( ��. Construction Supervisor's License#(if applicable) -" -I 1 •� AM t9 ss PWorkman's Compensation Insurance EI �'� Check one: MAR O 9 El am a sole proprietor 1016 ❑ I am the Homeowner TO '•I ►1 WN OF B I have Worker's Compensation Insurance I- A"STABLE Insurance Company Name fJat_W A(,( Gm nC iti't✓dv�,t` �t15 Workman's Comp.Policy# WCC.wv S b o 7&5­9190)6 PI Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to [z--Ie-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Fa-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. A copy of the Home Improvement Contractors License&Construction Supervisors License is r SIGNATURE: C:\Users\Decollik\AppData\Loca icroso ows\Temporary Internet Files\Content.0utlook\21`10I DHR\EXPRESS.doc Revised 040215 I r r 1ARN3rAB1.F. � Town of Barnstable RFD MA'1 A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I DP.nr S ke�kudo l kkA pf14�rir- &4� �� as Owner of the subject property hereby authorized 5 ��lU'tGt to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signa e o caner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\WppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.0utlookUP101 DHR\EXPRESS.doc Revised 040215 The Cornmonweakh of Massachusetts Department of Inrlrrsh ial Accidents Office of Imwstigations 600 Washuigton,Street Boston:,MA 02111 www.mass,gov/dia Workers' Compensation Insurance Affidavit--Builders/Contractors/Bkctricians/Ph tubers Applicant Information Please Print Legibly Name(Bust easlOrganrzatiaa/Individual). 1)oki'l S Address: k e7 U- City/State/Zip: /n 1� Ga 1, l Phone## Are you an employer?Check the appropriate boa: T r 4. am a. etseral contractor and i }�of project(required): L El I am.a employer with �I g 6. ❑New construction employees(full andfor part-ime)_* have hired the stib-contractors 2.❑ I am a sole prior or partner listed on the attached sheet ?. 5�R�e ling ship and have no employees These smb-contractors have 8. ❑Demolition. have wotlters' working forme in any capacity. employees and h 1 9_ ❑Building addition workers'comp.insurance Comp.msurance required.] 5 ❑ Ale 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- rightof exemption per MGL 12.❑Roof repairs insrvannP ram]i c. 152, §1(4),and we ham no employees-[No workers' 13_0 Other comp.insurance required_] `A applicaat that checks boa#1 nmst also fill out the section below shooting their woofers'compensation policy infnrmatim i. i Hameaanffis orlro submit this af5da It iniicamig they are doing all woof and then hoe outside contractors Est submit a new affidavit indicating such- sContractors that check this boa must attached as additional sheet shoving the name of the sub-cantroctars and state whether is not those entities have employees. If the sub-contractats base employees,they mush provide their workers'comp.policy number. lam an employer that is providiw workkers'conWansadon insurance for my enyAo; m Below is the policy and job site information. Insurance Company Dame: „ l!U a Policy#or Self-ins.Lic_#: (N[_IC,�;�5bL)7637 o??�O JJ)(I A Expiration Date: / Job Site Address: . h'Y��C�- U << y2 City/Statet7ap: ^3 hco5 kW 602 5 Attach a copy of the workers'compensation pc ' y declaration page(showing the policy number and expiration date). Failure to secure coverage as rem under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andlor one-year imprisormumt,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 vacation. I do hereby cerh y under the and penalties of pedury that the information prmided above is true and correct Date: Phone#: tfl,(jlcial arse only. Do not write in this area,to be completed by city or town officdaL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ti I I i - Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-093445 Construction Supervisor DENNIS KERKADO y 16 KINGS HYANNIS MAA 02601 Expiration: Commissioner 02/26/2018 Construction Supervisor Restricted to: 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. DPS Licensing information visit: %VWW.MASS.GOV/DPS ie CC oou1V1101rrurea�a/i�/vLa�aac`Uwelyd . Office of Consumer Affairs&Business Regulation -- ME IMPROVEMENT CONTRACTOR gistration: ,1J79.19 Type: expiration: ,2[ 4f2(118;_; LLC BAYRIDGE REALTY"LLG DENNIS KERKADO 16 KINGS WAY HYANNIS,MA 02601 Undersecretary License or registration valid for individul 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 Not valid without signature i Client#:36429 2BASSETTJO ACORDT., CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDD/YYYY) 2/03/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Dowling&O'Neil Insurance Ag PHONE (n No.EY1:508 775-1620 FA No: 5087781218 973 lyannough Rd, PO Box 1990 Hyannis,MA 02601 ADDRESS: 508 775-1620 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Grange Mutual Insuranc INSURED Joshua B.Bassett INSURER B:Associated Employers Insurance P.O.Box 128 INSURER C: West Hyannisport,MA 02672 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY'THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED'ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY MPJ2966M 3/11/2016 03/1112017.EACH OCCURRENCE $1 OOO 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Eaocourrenca $500 000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PRO- JEC LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AOTOAWNED PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE TAGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCC50050078582016A 1/04/2016 01/04/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY OFFICERIMEMBER EXCLUDED?ECUTIVE] N/A E.L.EACH ACCIDENT $500 OOO Mandatory in If yes,describe under E.L.DISEASE-EA EMPLOYEE $500 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 7 -T DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Bayridge Realty LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 16 Kings Way ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE I ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S164599/M164595 CBD r Mass. Corporations, external master page Page 1 of 2 + r William Francis Galvin Secretary S} J of • • of s rev a O Corporations Division Business Entity Summary ID Number: 205281783 Request certificate New search Summary for: NORTH ATLANTIC REALTY GROUP INC. The exact name of the Domestic Profit Corporation: NORTH ATLANTIC REALTY GROUP INC. The name was changed from: KERKADO REALTY INC. on 07-01-2009 The name was changed from: DKST CORP. on 11-26-2007 Entity type: Domestic Profit Corporation Identification Number: 205281783 Date of Organization in Massachusetts: 11-13-2007 Last date certain: Current Fiscal Month/Day: 12/31 The location of the Principal Office: Address: 16 KINGS WAY City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and address of the Registered Agent: i Name: DENNIS KERKADO Address: 184 CAPTAINS ROW City or town, State, Zip code, MASHPEE, MA 02649 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT DENNIS KERKADO 16 KINGS WAY HYANNIS, MA 02601 USA TREASURER DENNIS KERKADO 16 KINGS WAY HYANNIS, MA 02601 USA SECRETARY JENNIFER CAMPBELL 16 KINGS WAY HYANNIS, MA 02601 USA VICE PRESIDENT JENNIFER CAMPBELL 16 KINGS WAY HYANNIS, MA 02601 USA DIRECTOR DENNIS KERKADO 16 KINGS WAY HYANNIS, MA 02601 USA Business entity stock is publicly traded: ❑ http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=205281783&S... 3/9/2016 Mass. Corporations, external master page Page 2 of 2 The total number of shares and the par value, if any, of each class of stock which this business entity is authorized to issue: Total Authorized Total issued and outstanding Class of Stock Par value per share No. of shares Total par No.of shares value CNP $ 0.00 275,000 $ 0.00 0 ❑ ❑Confidential ❑Merger ❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Administrative Dissolution : Annual Report Application For Revival !f Articles of Amendment v View filings Comments or notes associated with this business entity: A I New search http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=205281783&S... 3/9/2016