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HomeMy WebLinkAbout0046 THIRD AVENUE .--.. �� � � �'� o n o �� ^s^.s��nr� s�;�-C't,E'^+".`.F-_-P'e'w '��Rdr_�C�! �w.i�'..:?�,.�. ---rn-:�r.�"!'l�_'r"!.f��.e'�+'-"'^ti _ .f,Y�e'r+. - ,^....���«�..t-,�.�'. .. ^.n_ _ ._....-«..,.���....w�*..._ _- 1... ....._�+..L�'`.,...:.5'w.�,'^'^--- �_..... .. — r.. Town of Barnstable *Permit#:i�: Regulatory Services Fee 6 mont/is jroni issue date seartsrneM • 9eb s MASS, ,0$ Richard V.Scali,Director o� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 3 O www.town.bamstable.ma.us Office: 508-862-4038 Fax: ' ���0 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number /zf0 003 Property Address '7 J_Aj1-j -&e a4_�_V i (/e_ PR sidential Value of Work$ /(oTI6 3(,o Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address S.Nt-e c (�0 U24 IS K y ;ref/ Ave- os4ev-✓� i ( MA Z(oS� Contractor's Name E A&elbJs ✓l ()9W//rso/( Telephone Ntunber NO r)R�o Q Home Improvement Contractor License#(if applicable)__/ 73 2 L/ S Email: Construction Supervisor's License#(if applicable) (ICI'4 7 D 7 �Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ JA6 the Homeowner ET'I have Worker's Compensation Insurance Insurance Company Name (20Y7 f' Vftd Workman's Comp.Policy# WIZ 6 S f 5400 F 1 Copy of Insurance Compliance Certificate must accompany each permit. y Permit Request(check box) ❑ Re-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) ❑ side / Replacement Windows/doors/sliders.U-Value . ?jo (maximum.32)#of windows fo #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 wrier must sign Property Owner Letter of Permission. A copy the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\DecollikWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\2P101DHR\EXPRESS.doc Revised 040215 Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal B Andersen of Southern New England Y g James Kowalski' M.M.C.M.1 Legal Name:Southern New England Windows,LLC 46 3rd Ave RI#36079, MA#173245,CT#0634555, Lead Firm #1237 Osterville,MA 02655 26 Albion Rd I Lincoln,RI 02865 H:5084281854 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: James Kowalski' Contract Date: 04/05/17 Buyer(s)Street Address: 46 3rd Ave, Osterville, MA 02655 Primary Telephone Number: 5084281854 Secondary Telephone Number: Primary Email: shopnet@comcast.net Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $16,636 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $5,544 Balance Due: $11,092 Estimated Start: Estimated Completion: Amount Financed: $0 6 to 8 weeks 6 to 8 weeks Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: Taxes paid in Barnstable deposit of$5544 up front balance due upon install Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there r n Y g � g p e are o verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyers) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 04/08/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal BMAnjersen of ou ern New England Buyer(s) Signature of Sales Person Signature Signature Paul Conboy James Kowalski' Print Name of Sales Person Print Name Print Name UPDATED: 04/05/17 Page 2 / 10 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-095707 ionstruc?ian SuJer'viso., yr, S - BRIAN D DENNISON 7 LAM13S POND CIRCLES­� CHARLTON MA 01507� r'1*"'tZU Expiration: Commissioner 09/08t2018 44, �'�fr {L=ryi:'�'Y!f=�'[.Li=PI�t.'`"•.�'. n.-:f��:�lsC:Y.1EiG.dZ-C,;:s•2�� Office of Consumer Affairs d Business Regulation ' 10 Park Plaza -Suite 5170 Boston,Ma.ssachusetts 03116 Hone Improvement.Coutractor Registration -—-_ Reglstradon: 173245 Type: Supplement Card Expiration: 9/19/2ols SOUTHERN NEW ENGLAND WINDQIJVSY_L BRIAN DENNISON 26 ALBION RD LINCOLN,RI 02865 `=• T '+ --- Update Address and return card.Marla reason For change. Address t I Renewal Employment L Lost Card fGcc oT Caosumer.VTairs Wuiners RT L doo Registration valid Forindividoal use only Ware the ? ROME IMPROVEMENT CONTRACTOR espirrtion date It found return to: Once of Consumer Airairs.and Business Regulation 3 u i Registratlon_c..1732+15:. Type: 10 Park Plum-Smte 5170 y4-. -' ExpiraUons9k19Ym78.. Supplement Card Boston.iwLaO'3116 SOUTHERN NEW ENGL'A.ND'WINDOWS LLC. RENEWAL BY ANOERSON:: BRIAN DENNISON ? - - 26 ALBION P.D -- UNCOLN.RI 02865 C-Uhdersecre 4 Not valid without signature V I The Commonwealth of Massachusetts Department of lndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia AVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERWFMG AUTHORITY. Applicant Information p r Please Print Leeibly Name (Business/Orgaaization/Individual): Jpf}��n �e�J Erlr,14r),� Address: cUo Al b i o rN 244- - - City/State/Zip: 1-:11 it r Phone#: (40) Z)& _ 9 8 C)O Are you an employer?Check the appropriate box: Type of project(required): I.cil am a employer with LO employees(full and/or part-time)-* 7. ❑New construction 2.O I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required] 9. ❑Demolition 3.F�I am a homeowner doing all work myself[No workers'comp.insurance required]t 10[]Building addition . 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and bave wodcers'comp.insurance T 6.[:]we are a corporation and its officers have exercised their right of exemption per MGL c 14.Other w 152,§1(4),and we have no employees.[No workers'comp.insurance required.] n'els-ce,, e n I *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 bave 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 informatiom Insurance Company Name: -47"Ie'l-4 1 Ins• —C — Policy#or Self-ins.Lic.#: InkC- /A 313160k l Expiration Date: II'z Job Site Address: y T O rd St• City/State/Zip: 0StPw;11 C M ✓� Attach a copy of the workers' compensation 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 fii a 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I:,hereby certifyunder the*p andpenaldes ofperjury that the information provided above is true and correct Sie: Date: �— 9 Phone#: 04 01 ) 1- 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#: SOUTNEW-01 CZOWNGER ACOKO' �� CERTIFICATE OF LIABILITY INSURANCE DATEs�PAMIDW291M s 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 ISSUINGINSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONALINSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,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 CONfACT NAME: CoBiz Insurance,Inc.-CO PHONE Fax 821 17.tk St AI N (3Q3)988-OW I WC.No (303)988-0804 Denver,CO 80202 "um.ADDRESS:,CoBizlnsuran obWnsumnce.com INSURER( AFFORDINGCOVERAGE NAIC# iNsuRmA!Contindhtel Westem Insurance Compwy 110804 INSURED INSURERS• Southem New England Windows LLC INSURERC: D1B/A Renewal by Andersen 26 Albion Road INSURER D: Lincoln,RI 02865 aSURERE: INSURERF COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED—ABOVE—TOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR.CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE.POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.'LIMITS SHOWN MAY HAVE BEEN REDUCED'Bi PAID CLAIMS. I�TR TYPE OF INSURANCE INSD W VD POLICY NUMBER PC EFF LILY FJO? LJIm A X COMMERCIAL GENERAL LIABILITY I { EACH OCCURRENCE 'S 1,000,000 LLJ CLAIMS-MADE OCCUR I I CPA3136080 1 0710112016I 07/01/2017 p=Ea0cmInence I S 100,000 I I I !MED IXP(Any one ) S 10,00 I ! ! PERSONAL&ACV INJURY S 1,000,000 'L AGGREGATE LIMIT APPLIES PER: I I! I ! GENERAL AGGREGATE2,000,00 POLICY❑ET OC J PRODUCTS S 2DOO,000 0 OTHER: EMPLOYEE BENEFI s 2000,0X 0 aUTOMOBME UA13UW I I � ! � COMBINED SINGLE LWT j S 1,000,00 (Ea accfdwffi A ANY A11T0 CPA3136080 _ 07l01/2016%0710112017 GODLY INJURY(Pa person)._.S- II—II 1 BODILY ALL OWNED SCHEDULED LBODI r,AUTOS NON OWNED f LY INJURY(Peracdder� S t f ! PROPERTY DAMAGE S HIRED AUTOS AUTOS ! % I i Perartiderd X UMBRELLA LIAB X OCCUR I I EACH OCCURRENCE Is 5,000,000 A EXCESS LIAB CLAIMS4kADE I CPA3136080 07101120161 07/01/2017 AGGREGATE I s DED I X I RETENTIONS 0 I { Aggregate Is 5,e00,000 WORKERS COMPENSATION I STATUTE ER T14- AND EMPLOYERS'LIABILITY A ANYPROPRIETORIPARTNERIEXECUTIVE YIN I �CA3136081 1 07/01/2016 0710112017 EL EACH-ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? NIA I - I 1 000 OOO (Mandatory In NH) I + E.L.DISEASE If yes,describe under DESCRIPTION OF OPERATIONS below i E.L.DISEASE-POLICY LIMrr S 1,000,000 f DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Add9ronel Remarks Schedule,may be athcbee H mom space is regcdred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE %MR.L BE DELLUERED IN ACCORDANCEYYrrH THE POLICY PROVISIONS- AUTHORIZED REFRES@ITAWRIE ©1988-2014ACORD CORPORATION- All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD -z3 41111 oFtKE ray, Town of Barnstable *Permit# Expires 6 months from issue date C [fir—pgulatory Services Fee �— * BARNSTABLE, 9� 1639n. `0� JA�1 1 g 2017 Richard V.Scali,Director RFD MA'IA if 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 PERMIT APPLICATION - RESIDENTIAL. ONLY I u 0 /00 3 Not Valid without Red X-Press Imprint Map/parcel Number r Property Address i jl(e 3" AVaA)U E OS T V 1 c�C esidential Value of Work$ ,5, Q�75- Minimum fee of$35.00 for work under$6000.00. Owner's Name&Address w A L_ S e- t c f(o T7h(1 #N tJ O S tZ�✓i LCr E 0'Z6 S s, Contractor's Name P L?vL C/+ L i f Sous, -41 .Telephone Number S�y —�(Z -ll Home Improvement Contractor License#(if applicable) 71 Email: 0��CG�Cle Ze at.0 7" C db`� Construction Supervisor's License#(if applicable) l09 S-4 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name L-IV( co le-P Workman's Comp.Policy# yv G S 3 1 5 3 :a 4( ZBcs 2� Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) 112,Re-roof(hurricane nailed)(stripping old shingles) All construction elebris 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: ❑ 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 required. SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Te orary Internet Files\Content.Outlook\2PIOl DHR\EXPRESS.doc Revised 040215 fir C�— Office of Con Affairs sumer A siness Regulation Il MW" _2 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 103714 Type: Supplement Card PAUL J. CAZEAULT & SONS, INC. Expiration: 7/9/2018 RUSSELL CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card.Mark reason for change. SCA 1 ro 20MI-05/1-1 E] Address [] Renewal [] Employment Lost Card —5-Lhffice of Consumer Affairs&Business Regulation License or registration valid for individual use only 1§65ft�1WOOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:. IC&14. Type: Office of Consumer Affairs and Business Regulation WN-0- 7-� -.- ..:. 10 Park Plaza-Suite 5170 Expirati6-fi: ' " -­­ 7/972.0.18 Supplement Card Boston,MA 02116 PAUL J.CAZEAULT&SbNs,INC. RUSSELL CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02658 Undersecretary Not valid withoutaii-ature Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction supervisor xy License: CS-108157 RUSSELL CAZEAULT.-., 2071 MAIN STREET Brewster MA 0201 0 Commissioner 11123/2018 Property Owner Must Complete &,Sign This Form If Using a Roofer I Builder. I(pint) e5 as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for. Address of Job Signature of Owner Mailing Addres f Owners elk C) ����� _ Telephone #_ -Q-zz,<2. 4 ri- S? Date Please return this form to Paul J. Cazeault Rooting along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com 1 The Commonwealth of Massachusetts E ;z Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 ` www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): PhyL �' �� zV OrvL_- + sbiV Address: /O 3 / 14 4 ,/V 5 i City/State/Zip: O 5 a_-ie v!t-,-L. G Phone#: 43 Are you an employer?Check the appropriate box: Type of project(required): l.�a employer with /S employees(full and/or part-time).' 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.E]I am a homeowner doing all work myself.[No worker'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole I I.0 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.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.k30ther lea—poe-f- 152,§1(4),and we have no employees.(No workers'comp.insurance required.] ���aea_ '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: L M C v R P Policy#or Self-ins.Lic.M (/V C 5 31 S 3 a 6 6 700 2,6 Expiration Date: U /b Job Site Address: �� 3ad"" City/State/Zip: QsAeP"' /Ile 11�/14 6a�b' Attach a copy of the workers'compensation 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: yZ8— A, Official use only. Do not write in this area,to be completed by city or town official A City or Town: . PermittLicense# Issuing Authority circle oo>>e): 1. Board of Heattk 2.11 uilding(Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CER u ll���iATE OF �OQLoU II II �IIrISIJJL'1l/r=�1NCE DATE(MMIDD/YYYY) 08/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Linda Sullivan DOWLING &O'NEIL INSURANCE AGENCY IAI ,PHONN Exfl• (508)775-1620 FAX No: ADDRESS: Iullivan@doins.com 973 IYANNOUGH RD. INSURERS AFFORDING COVERAGE NAIC$ HYANNIS MA 02601 INSURER A: LM INS CORP 33600 INSURED INSURER B: PAUL J CAZEAULT& SONS INC INSURERC: INSURER D: 1031 MAIN ST INSURERE: OSTERVILLE MA 02655 INSURERF: COVERAGES CERTIFICATE NUMBER: 76558 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 CONTRACT OR 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 1INSD WVO POLICY NUMBER (MM/DD/YYYY) (MMIDDNYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE DOCCUR PREMI ES(RENTED PREMISES/Ea occurrence $ MED EXP(Any one person) $. N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JECTPRO- ❑LOG PRODUCTS-COMP/OPAGG $ OTHER: 1$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO 1 BODILY INJURY(Per person) Is ALL OWNED SCHEDULED AUTOS" AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WIRKERSCOMPENSATION X SPE TATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDEDI N/A NIA N/A WC531S386670026 08/10/2016 08/10/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/Workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO14 DATE THEREOF, NOTICE WILL BE DELIVERED IN Paul Cazeault ACCORDANCE WITH THE POLICY PROVISIONS. 1031 Main Street AUTHORIZED REPRESENTATIVE Osterville MA 02655 Daniel M.Cro ey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD THE TOWN TOWN OF BARNSTABLE i BAHH9TADL$ i 9 a Y BUILDING INSPECTOR �FPY a' APPLICATION - r FOR PERMIT TO .. .................. ...���.. Q.................. TYPE OF CONSTRUCTION ....... ........ ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........�6........ ..... .. ...... ................................... ProposedUse ....... -tie- ....? " .. .................................................................................:.............. Zoning District .......... .......: .:.........................................Fire District .... . ..... ..... Name of Owner .� ��9�„ t�te.Address v....,/' LG ......................... ..../ Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... P / y Number of Rooms 0�fl �... =�7�1::..��P..�\.........Foundation �. � �. �:............/ �./6,1.��C' Exterior .......!' 0`'aT........<y ...............Roofing .&%C':!....' .... ..... .... .. .... Floors ��.11../a..` ti� l�.� terior l ....................................................... Heating � .. r�UG ...................................Plumbing ........................................................:......................... Fireplace x. ..� I�4�?Y3!.!!1�. ..a. J ' . ...... 7�wpproximatt- Cost ... Xz2a!!�.................................... Difinitive Plan Approved by Planning Board -----------------------19 Diagram of Lot and Building with Dimensions S� THE PROPOSED METHOD OF PROVIDING FOR SANITARY WATER SUPPLY, SEWAGE DISPOSAL AND DRAINAGE IS,,HEREBY APPRGV D �C - a-3 7 X TOW OF BARNS`I'ABLE, BOARD OF K,,AJ.616 MENSED INSTALLER PERMIT. AND INSTAL MUST OBTAIN SE�V�}G S 60 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. i, Name . ............... ............ ... ....... ...... queroni, Cesare | � ' . = . . � | ' 14850 add to single .................. Permit for .................................... z� ! ----fao---��-'''������ ��� ----.------'. ' / � 46 Third Avenue Location ---------------------- ` ~ wutexno-clo --------.,..---.-.----------.. . . ~ - Cesare �uw�mo�l uvvner - � ---,.-----.--.--.-------. Type of [mnm frameConstruction ............... . ' . . -----.^--.------.-----------.. . . ' / plot ............................ Lot ----------' Permit Granted ........Har.ch-.22...............lA 72 Date of | ' . Date Comple/eo - - PERMIT REFUSED -.---,_-.---..-.-------.. 19 __________________________. ] � - � � ----'--^^'---^~''`''~^-^^~''-~~'~--'' ' . -.-.-.--------.--.----.-.-.-..-.. , '--~-^-----------'--'`—^~'-^-^^ ! ` Approved `S .............................................. l9 � ------------------------.-.. ' --------------'---'---^^^^^'-^' � � O fn1'4 /.y lvt 05 0,4 / 7 261, . :f �� -- ..t . rL 4_ T _ t -s+j � I � �•� .tea ( . I � � tj_,. 1 rr i .'y .....:................................... ................................................................................................................. ................... ........................•ON 80r . ........................................................ ............."'.40':.....i...........ON 133HS ...........................................................................................1O3rens ....................31VO..................................19 1.7 LL AilW fey! wco »' M �� _ 1...�-- _-'^• � / j �! � ! � ' I .. 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