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Home My WebLink About0462 MAIN ST./RTE 6A(W.BARN.) 1 v a llll a°�"aE°�oy,. No 512543 3LOR '�., '''�� HASTINGS. UN Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 11/3/15 --4 Town of Barnstable '— Thomas Perry CBO :z Building Commissioner 200 Main St. Hyannis,MA 02601 w 03 m RE: Building Permit#201506287 TO: Building Inspector(s), This affidavit is to certify that all work completed for 462 Main Street,West Barnstable has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 133 Parcel jd � (; NSTABLEApplication # Health Division .,� �! JDate Issued (O lS Conservation Division Application Fee _ _t50 -00 Planning Dept. Permit Fee 3 35.00 Date Definitive Plan Approved by Planning Board . :VEi Historic - OKH _ Preservation/ Hyannis Project Street Address 5_+eP,@+ Village we- a n3 4-OL [& Owner S1Gf C�► , Address Telephone 56 3 6 3 55 b Permit Request add ' 3 ase ► '4�C TTiC Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family 0 Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: 0 Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )�(No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name W� t cCt �•G 16F'oe&v& c Telephone Number 28 A48 0 3 18 Address '' License #_ C d -7 7-i Home Improvement Contractor# I Email Worker's Compensation # �J W C 31,1& a*H ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO roU m 0 wi SIGNATURE DATE S' FOR OFFICIAL USE--'ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION y , - FRAME INSULATION 'a' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 1 , GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT - ASSOCIATION PLAN NO, I • r The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Stree4 Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓0 I am a employer with 20 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. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.[—]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 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 I I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 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.❑✓ Other Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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 thepolicy andjob site information. Insurance Company Name:Wesco Insurance Company Policy#or Self-ins.Lic.#:WWC3136274 Expiration Date:04/09/2016 Job Site Address: 462 Main Street APT 6 City/State/Zip: West Barnstable 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 th pains and penalties of perjury that the information provided above is true and correct. Si mature: Date: 9/23/15 Phone#:508-398-0398 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#: 5 ACO DATE(MMiOQIYNYI� �,..� CERTIFICATE OF LIABILITY INSURANCE 3/24/2015 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. 7AWORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 endorsements. PRODUCER CONTACT NAME: ' Colleen Crowley Risk Strategies Company PHorE (781)986-4400 Fa-No•(781)963-4420 15 Patella Park Drive I .ccrowley@risk-strategies.com Suite 240 INSURE S AFFORDING COVERAGE NAIC t Randolph NA023fiS INSURERn:Selective `Ins. or "America INSURED INSURERB AlIMOXica Financial Alliance 0212 Cape Save, Inc INsuRERc T+Tesco Insurance Conipany 7 D Huntington Ave INSURE-RD: INSURERE: South ya=outh 1 INSUPERF: COVERAGES CERTIFICATE NUMBER:CL1532491501 REVISION NUMBER: THIS IS TO,CEftTIFY TI+AT THE POLICIES OF INSURANCE MSTED BELOW-HAVE BEEN'ISSUED TO THE`INSURED'NAMED ABOVE TOWTH'E POLICY-PERIOD INDICATED. NOTWRHSTANDINGANY 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. 0LTIR VSR TYPE OF INSURANCE O ICY EFF TO CY EXP LIMITS POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGELrrl PREMISES fE2 occurrence $ 100,000 A CLAIMS-MADE 10 OCCUR 51994480 0/16/2014 0/16/2025 MED EXP(Any one Person) $ 10,000 PERSONAL 8 ADu INJURY $ 1,000.,QOO GENERAL AGGREGATE $ 2,000,000 GEN POLICY -1 PR IT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X JECT PRO X LOC $ AUTOMOBILE LIABILITY LE LFAIr Ea ccitlert 1,000,000 ANYAUTO BODILY INJURY(Per person} $ AALLL6VMEDESCHEDUITSED 46796600 1/6/2014 1/6/2015BODILY INJURY(Per accided) $ XHIRED AUTOSNON-DNNFD AUTOS P OPERTY DAMfwE $ X X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESSUAB CLAIMSMADE DED RETENTION S 8I 1994480 0/16/2014 0/I6/20I5 AGGREGATE $ 1,000,000$ C WORKERSCOM?9WTION fficers Included for wcsTarii o H AND EMPLOYERS-UA(3a1TY XANY PROPRIETORIPARSNER/E ECUTIVE YIN overage OFFICEW EMBER E)CLL� N/A E.L.EACH ACCIDENT $ 5O0 OOO (Mandatory In NH} 1352'74 /9/201'S /9/201"6 ' If yas•desalbe Calder E.L.DISEASE-EA EMPLOYE $ 500,000 DESCRIPTION OF OPERATIONS below - - E.L.DISEASE-POLICY LIMIT $ 500 OOO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more spats Is roqulrat0 Issued as evidence of insurance, Thielsch Engineering, Inc, is listed as additional insured as respects General Liability as required.by written contract. CERTIFICATE HOLDER CANCELLATION »ng@cape3.ightCtlm4)act.arg SHOULD ANY OF THE ABOVE DESCRIBED POL'ICItEffi BE CANCELLED THE BORE C ACCORDANCE WITH THE POLICY PROVISIONS. E WILL BE DELIVERED IN Cape Light Compact Attn: Margaret Song R0 BOR 427/r9CH AUTHORIZED REPRESENTATIVE - - 3195 Main Street Barnstable, to 02630 Ptichael Christian/CLC ACORD 25(2010/05) @ 192&201aACORD CORPORATION. Ali rights-reserved. INS025(2woo5).ot The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. WILLIAM McCLUSKEY - 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 -- -- - - - - -- Update Address and return card.Mark reason for change. SCA 1 C. 20M-05/1 t Address Renewal Employment Lost Card //rn t�n[ii liuiuuei[�l�o/�.��r�iJSnr�[eJe//' _. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ egistration: 171380 Type: Office of Consumer Affairs and Business Regulation Expiration: 3/14/2016, Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY 7-0 HUNTINGTON AVENUE' gam„ H,py SOUTH YARMOUTH,MA 02664 Undersecretary Not vali ithout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards �.tliutrilC`ui�Ti J`yiiriei r iSOr`;lcCinit'V - '. a License: CSSL-102776 :i•':r i:ti �� WJ LLIAM J MC C9LU 37 NAUSET ROA6 1 West Yarmouth 1VIA ((V Expiration Commissioner 06/28/2017 r HOME OWNER WEATHERIZATION WORK PERMIT: j PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. I I hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: )7�:s 4 t The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic& basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement and give my consent. Home Owner(signature) t � ' -�e ' Home Owner email: Date: Agent:(signature) Date: Weatherization Cont tors: Adam T Inc Cape Save All Cape Energy Frontier Energy Solutions Alternative Weatherization Lohr Home Improvement Building Science Construction Resolution Energy Cape Cod Insulation Tupper Construction Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 9/9/15 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permit#201505367 TO: Building Inspector(s), i This affidavit is to certify that all work completed for 26 Compass Circle,Hyannis has been inspected by a third party Certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey I Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 9/15/15 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St.Hyannis,MA 02601 RE: Building Permit#201505128 TO: Building Inspector(s), This affidavit is to certify that all work completed for 164 Locust Street,Hyannis has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 ' 9/16/15 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 201505201 Dear Mr. Perry This affidavit is to certify that all work completed for 42 Briarcliff Lane, Centerville has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey iI I XopP Town of Barnstable *Permit# &096oa�`7 Expires 6 ontlis jronr issue date BAN �RI`lj/� Regulatory Services Fee off, 1 4 ?008 Thomas F.Geiler,Director 7-O� �OFegRNs Building Division X � 01 7',q�LE 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 X J Not Valid without Red X-Press Imprint Map/parcel Number Property Address y L IV esidential Value of Work �, LI60 :&V Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ,5 t✓� l $ Contractor's Name �� C'I i3✓'Ui'(i Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name A- cA Workman's Comp.Policy# 14 �� `3 1 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side [!]�'1�eplacement Windows/doors/sliders. U-Value a 7 (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pr periy Owner must sign Property Owner Letter of Permission. copy of the a Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg R nv:cell ft any ' ICU ' The Commonwealth of Massachusetts Department of Industrial Accidents Of zce 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/Orga=tion/Individual): . 0 re16s 1� VM Address: UT K3v r C Y City/State/Zip: t-tr' Phone.#: 6 Are you an employer?Check the appropriate bog: :Type of project(required):, i.®I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* , have hired the sub-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ' ship and have no employees. These sub-contractors have g• Demolition employees and have workers' working for me in any capacity. $. 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10.❑Electrical repairs or additions required.] 5. � We are a corporation and its , '3.❑ I am a homeowner doing ill-work . officers have exercised their 11.❑Plumbing repairs or additions ' myself.[No workers' comp. right df 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 aut the section below showing their workers'compensation policy information. t Homeownera.who submit this affidavit indicating they are doing all work and then hire outside contractors mutt submit anew affidavit indicating'such. 3Contractors that check this box mutt attached an additional sheet showing the name of the Sub-contractors and state whether ornot those entities have imployces. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. (� A Insurance Company NMne: •.1-�� / �'`�`✓I Policy#or Self-ins.Lia M. j6 1` -f_ I Expiration Date: lob Site Address• L City/State/Zip: �✓ /d�^zi�r" `'''� Attach a copy of the workers'compensation 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 fine 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 maybe forwarded to the Office of' Investigations of the bIA for insurance coverage verification. _ I do hereby certi der the pain penalties of perjury that the information provided above is true and correct. Si afore: Date: Phone#: TY, `j 71 Official use only. Do not write in this area, tb be completed by city or town.officiaL City or Town: Permit(License# Issuing Authority(circle one): A.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6. Other Contact Person: Phone#: F1HE Tpk, Town of Barnstable Regulatory Services �8e1 MASS. Thomas F.Geiler,Director 4i°rF0 ;A. Building Division Tom Perry,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, Ps t h e r- Childs , as Owner of the subject property herebyauthorize _Rill Cr�stan to act on my behalf, in all matters relative to work authorized by this building permit application for: 462 Rt 6h, West Barnstable Ma (Address of Job) Signature of Owner Date Esther Childs Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&OWNERPERMISSION - L ' Town of Barnstable �OFZHE t, y�P o� Regulatory Services BARNSTABLE, = Thomas F.Geiler,Director y MASS. g 1 19• .0 Building Division A�FD �n Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Officer 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and , requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor.;' ' Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt i - 1 r I ISSUE llATE 0910412007 i THIS CERTIFIC ATF IS ISSUED AS A MA i i'ER OF NFORMATION ONLY AND �Yriller McCzrtin ( C'ONFERS NO J.101-ITS UPON THE CERTIFICATE HOLDER.THiS CERTIFICATE. 1 i FOES NOT ANI :ND,EXTEND OR AL'(ER THE COVERAGE AFFORDED BY THE �.; w., a Dowling&O'Neil Ins A_gcy POLICIES BULS:1V. �21.2 West Main Street 1JJyannis,MIA o2601 COMPANIES AFFORDING COVERAGE � eVilliam W Croston 1 _ I J hi William W Croston Build ingContractor COMPA`1Y A,!-.I.M.l4.u.;tial [nslarans t;Co i O Box 133 LETTER +:I tmille,MA 0265-5 ' ":I S IS TO CERTIFY THAT THE POLICIES Or F!I!St1R.,%NCF LISTED F3F'._OW HA1 ..BEi.N iSSt;ED ICI THE INSUREDNA.MED ABOVE FOR THE POLICY PERIOD rNDIC:ATED,NOTWITHS7•.'l Di'VG A.VY REQUIREMUNT,TF..RM rjR CO'EDITION OF,,NYC ONI RACT OR.OTHER DOCUMENT WiTH RESPECT 1 FO WHICH THIS CERTIFICATE MAYBE ISSUED OR\4AY PERTAIN,THE,iNSI,'P, N(-F--AFF'OFDE1)BY—P(F.POLICIES DESCRIBED HF,REiN IS-SUB IECT I TO ALL_THE TERNIS.EXCLUSIONS A:NU CONDJT:ONS OF SUCH POLICIES. L11A FS SHOdVN MAl'RAVE k1EH1'd ktbiJCED 13Y OAID CLAIMS__] CO iYPF.OF INSURANCE POL1L-V VFPEC IYB I POLICY 7NP(RATION LHf(TS ' UI P,� POl.1CY NUMBER TOATp(MM/DD•YY) i DATE(MMIDD/YV; ! i ICENFRAL-LIABILITY !•_�- f GFNF.RAI.AGGREGATE — PRODUCTS-COMPIOP AGG. I Ir�COMM1IFRCWL GENERAL 11.AR{LITY 1 i I I""" PERSONm.S ADV.INJURY 1 1=9ANtitS =)CLAIMSMADP=CCC'.,R1 A COITI'R ACTORS PROT. EACH OCCURRENCE L•AMAGE!Anyom tire. --------------- 1 —_-.-_�_ _ _ __.��TV •MFU.EXPENSE(Ary,mc ocrs+m) ! 4 C 1 AUTOAtOBILE LIABILITY +i CO46B+ED8D10EE k I I LIMIT r I I I —tl ANV ALTO T f i ALL OH?HD AUTOS I:Y INJURY 6 (Per peiTon? —� II SCiIEDLT.EDAL4'US IHIREDAUTOS I �'—"-- Y" NON-OW'NEU AUTOS RODIL INJURY GARAGE.1.IABILI7Y i I 1;Fe*nc:lArnl) _ I I PROPFR-.-YDAMAGB —_ EACS(OCCUR.CE. P t— �UMBRELLAFORM I AOGREGAn- 6 1 rrr-=]C1THERTHANN;INPRF.I.LAFORM r1X—r1T—UT0 WORKERS COMPENSATIONANp 1 RY'LIMITS HER EMPi_OYERS LIABILITY h HE PROPRIETOR/ EI I F,4C;H ACCIDENT S 1,000,0Q0 j A ARNEASLXf.CU21VE ! �PICIER.S ARE: 1 7013419022007 09,'O8.!2007 09.'08J'?008 i IrNCL ®EXC'[. t EL D!SFASE-•POLICY I,iMiT 1,000,000 ! FL DiSEASE--EA.CH { 1,000,000 _ .:MPLOYFiE --� C'0,MM ENTS'DF,SCRM-IOV OF OPERATIONS OR LOCATiONS:� --�— — — NVII,INIANit W CROSTI ON IS NOT COVERED BY T1Hl:WOi2KERSICOMPENSATIO I,POLICY. RM I i i , yf HOULD ANY OF T H:ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATED } HEREiOF,THE ISSUi JG CO.'APANY WILL ENDEAVOR TO MAIL.12 WRITTEN NOT ICE TO THE CERV*FICATE f OLDER NAMED TO HE LEFT.8L:T FAILURE TO MAjL SUCH NOTICE SH.ALL IMPOSE NO OBLIGATION '( R LIABILITY OF AS KIND UPON THE COMPANY.iTS AGENTS OR REPRESENrA T iVES. �- — lA.LTHORIZEDREF'41iSENTAi'IVI _ _ —� ✓/ze.�oryirzaacuealC! a"�../�ac�auaetY,a---i .� a s. '13l> [J;of. in'Iiling�cgulaUui a�, taudxrd'y' u>Y (dense or regist�'aClu r va I foY mdi e,w y' 4 JIF IA ROVEl1AEKT GON7RACTOR I �cta c:tlic expiration`tat 'q.f foYt turm�o: i. y` A .4i> ? Board of Building R.egul .t►gns- d-Standards RetraTlon M0A. 0023 =��;ar Ex (ration ` One Ashburton Place Rm 1301 Boston,Ala.02108 Type DBA 13U,CR TON®UtLDiNG CONTRACTOR I �c:r:;`.. ;t=. 3•'..! "'' a:1{a WILLff it ROSTON - ' '` :•. II 4 'I d ualid 11 itho�,It sl11$t g q g C 11I�Ad nfValcv i i