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HomeMy WebLinkAbout0012 ARROWHEAD DRIVE �a I�RRoc�.)H[R� �R i vc- Town of Barnstable �P �` Building t Post This Ca"rd So?Thatit°is 1/is�ble"From theStreet Approved Plans Must be;Retained on°Job and;this Card Must+be Kept ;' e -� a Posted Until,Final Ins ection Has Been Made � � Permit loll p' r'' "' `', .: .' s '' eY ili t Where a GertificateMof Oc upancy.is Required,suchBuildmg shall Not beOceupied until a Final Inspection hates been made r.� Permit NO. B-20-713 Applicant Name: William McCluskey Approvals Date Issued: 03/05/2020 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 09/05/2020 Foundation: Location: 12 ARROWHEAD DRIVE, HYANNIS Map/Lot: 271 049 002 Zoning District: RB Sheathing: Owner on Record: HICKEY, PATRICK F Contractor Name William J McGluskley Framing: 1 Address 12 ARROWHEAD DR Contractor License:•41 102776 2 '. HYANNIS, MA 02601' Est Project Cost:= $5,000.00. Chimney: »' - Description: Add R-30 fiberglass,and R-19 fiberglass to the att6c Dense pack the Permit Fee: $85.00 Insulation: walls with R-13 cellulose.Add R-19 fiberglass to theibasement.Air Fee Paid: 5 85.00 seal the attic plane`and basement'with'exp�anding foam General = Final:, weathehzation. Date 3/5/2020 ev Project Review Req: _' Plumbing as e Rough Plumbing r g ; Building Official. Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All workauthoriied by this permit shall conform to the approved applacation�and the approved construction documents for which this permit has been granted. ough G , 3 P ,g Y R as`. All construction,alterations and changes of use of any building and structures shall be in compliance ' open foo ubl b,ms ect on fordthe entire duration.of the 'Final Gas: This permit shall be displayed in'a location clearly visible from access s reet or road and shall be maintainedp p l pe, r „ work until the completion.of the same. ' p Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire`Offcials areprovided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing'. max. Rough: 2.Sheathing Inspection 3.All fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable Building ' B g , S Post This Card So.That�it is.VisibleFrom the Street-Approved Plans Must be Retained"on-Job and this Card Must beKept , Sd ._ amass Posted Until'Fina1-Inspection Has Been Made. �ey�1111t 11 111 Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-360 Applicant Name: MICHAEL SILVA Approvals Date Issued: 02/05/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 08/05/2020 Foundation: Location: 12 ARROWHEAD DRIVE, HYANNIS Map/Lot: 271-049-002 _ Zoning District: RB Sheathing: Owner on Record: HICKEY,PATRICK F Cont F77ractoriName �MICHAEL SILVA Framing: 1 - Address: 12 ARROWHEAD DR Contractor License: CSFA-106219 2 HYANNIS, MA.02601 Est Project Cost: $ 1,800.00 Chimney: Description: windows-doors Permit Fee: $35.00 Insulation: i ! Fee Paid: $35.00 Project Review Req: i P' Final: 1 - Date: " _ 2/5/2020 Plumbing/Gas " Rough Plumbing:_ Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by_ths permit is commenced within six months after;issuance. All work authorized by this permit shall conform to the approved application and the'.approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by=laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or`road:and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this.,permit. Service: Minimum of Five Call Inspections Required for All Construction Work:t' 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" M(as set forth in GL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT r ` , 6• A 1 /� ` Application number...6 ...�L�/•. duia wEFk s: Fee ........... •/ o.......... ................... FEB 09 Building Inspectors Initials..........s .. .................... KAM DateIssued............. "((w ................................... s Map/Parcel..C�,.a ® .............. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: f t.Q 2YAU NUMBER s STREET VHI GE Owner's Name: Phone Number �d� 7 o0 Email Address: Cell Phone Number SCANNED s Project cost$ �l7 Check one • Residential Commercial FFR 0 6 2020 OWNER'S AUTHORIZATION ° As owner of the above'-property I hereby authorize to make application for a building permit in accordance with 780 CMR/ Owner Signature: Z Date: y 3 zvZo TYPE OF WORK F_l, SS gn Windows (no header change)# Insulation/Weatherization LL'J Doors(no header change)# Commercial Doors require an inspector's review 13 Roof(not applying more than I,layer of s. '' gles C nstruction Debris will going to, iC /'1C'lde4_1 CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# I 70 (attach copy) . Construction Supervisor's License# ��� M6 2/l (attach'copy). Email of Contractor t[. T 04V Phone number ALL PROPERTIES THAT HAVE ST UCTURES OVER 7S YEARS OLD OR IF THE SUBJECT PROPERTY.IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ p 'tEP *For Tents Only* Date Tent(s)will be erected Removed on' number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X 4 Additional tent dimensions can be attached on a separate piece of paper. \ Purpose of Event Check one: this event is a: for profit non-profit event ' Check one: Food served Yes No i Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or> Yes Noe , if yes, a gas permit is required. Natural Gas Yes No ,,if yes, a gas permit-is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am 4.30 am or 3.30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing L °b Offsets from combustibles: front back left side right side r HOMEOWNER'S LICENSE EXEMPTION Homeowners Name: r Telephone Number Cell or Work number • 3 i i I understand my responsibilities under the rues and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date f' APPLICANT' SIGNATURE Signature y Date All permit applications are subject to a building official's approval prior to issuance. r r: 3' The Commonwealth of Massachusetts Department of Industrial Accidents. Office 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 .t Name(Business/Organization/Individual): dZ" i Address: City/State/Zip: t ` t�Z��/Phone#: ZX S� Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I 71--employer with 4. 4. ❑ I am a general contractor and I ❑ ployees(full and/or part-time).* have hired the sub-contractors .6. New construction 2. am a sole proprietor or partner- . listed on the attached sheet.r 7. ❑ Remodeling ship and have no employees These sub-contractors have `` g, ❑Demolition'' working for in an capacity. employees and have workers' g Y P ty. S 9. ❑Building 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'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: Policy#or Self-ins.Lic.#: 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 to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ins coverage verification. I do hereby certify-underthe�p' pena ties of perlu that the fnformation provided above is true and orrect'` Si afore: Date: 41 �2 G Phone#: - Official use only. Do not write in this area, to_be completed by city.or town offrciaL 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#: Y 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,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed 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 legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit(license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations . 600 Washington.Street, Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia v Commonweatth'of Massachusetts } Division of Professional Licensure Board of Building Regulations and Standards Consfruio #oe { 1 8 2 Family CSFA-106219 y� �pires:06128/2021 ' MICHAEL SI 82 WALTON/I1y/EN s HYANNIS MA-02601 'Commissioner (01 C�sirrirlo2Grea -��as�pc�i�ed✓i (Y Office of Consumer Affairs 8:13usiness•Regulation ' HOMEIMPROVEM ENT 1CONTRACTOR T ..;Individual e it tion =_ 06/03/2021 MICHAEL SILYA� € fix71 MIChIAEL O.SiL A — 1 82 WALTON AVE�_ Y=' HYANNNIS,MA 02601 i Undersecretary I ,1 , } f t Y Construction Supervisor 18 2 Family Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license For information about this license Call(617)727-3200 or visit VAVW.mass.gov/dpi Registration valid,for individual use only before the expiration date. If=found return to: Office of Cgnsumer Affairs and•Business Regulatio 1000 Washington Street -Suite 710 Boston,,MA 11.8 ; t i i Not valid without signature r' `oh.), t V Y 'Town of Barnstable Building Department Services _ Ott Brian Florence,CBO �QWa BuildingCommissioner �QF MASS. "+"►/�p' 1639. . 200 Main Street, Hyannis,MA 02601 s SST www.town.barnstable.ma.us Office: 508-862-4038 j Fax: 508-790-6230 PERMIT FEE: $ 0 0 SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less J f Id,X/LFLp Cv2%V rJ ®✓� ��bfi/� S Location of shed(address) Village 1190 - 3�as Property owner's name r Telephone number ct Size of Shed Map/Parcel# E-Mail 1101VI04? AZ ignature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? You must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. Y r ' THIS FORM MUST BE ACCOMPANIED BY A ' PLOT PLAN Q-forms-shedreg REV:08/6/17 Legend a K N, = - a Parcels � Town Boundary d ary Railroad Tracks #9 33 - y27tQ4aQ Buildings #4 .1 Approx.Building € � � *� �5 t• �> Buildings - - r Painted Lines w Parking Lots i a,.. . d ;.•�� Paved 7 �� •.. - _ r 271133 ..- Unpaved x J Driveways 619 .0 Paved Unpaved . a . Roads 8 Paved Road - - •. � ,�• Unpaved Road R Bridge E Paved Median - Se� = Streams *•, r 27�t11 6 Marsh Water Bodies • 2=7tQ 02 271R8.7 3a- #22 Map printed on: 10/10/20i8 This map is for illustration purposes only.It is not Parcel lines shown on this map are only graphic Town of Barnstable GIS Unit adequate for legal boundary determination or representations of Assessor's tax parcels.They are Feet regulatory interpretation.This map does not represent not true property boundaries and do not represent .367 Main Street,Hyannis,MA 026ot O 21 42 an on-the-ground survey.it may be generalized,may not. accurate relationships to physical objects on the map 568-862-4624 reflect current conditions,and may contain such as building locations. Approx.Scale: I.inch= 21 feet cartographic errors or omissions. gis@town.bamstable.ma.us f �0*1KETowti Town of Barnstable *Permit 13 � Expires 6 montl fr m iss a date Regulatory Services Fee • aARNSUBLE, " Thomas.F.Geiler,Director 039. prED N►p't A 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 Not Valid without Red X-Press Imprint Map/parcel Number V�� ®�� Property Address. Residential Value of Work �. tD Minimum fee of$25.00 for work under$6000.00 n Owner's Name&Address F&Wl CA UA e- Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) / U Workman's Compensation Insurance - RESS PERMIT Check one: ❑ I am a sole proprietor JAN 19 2010 ❑ m the Homeowner I have Worker's Compensation Insurance TOWN OF BA,RNSTABL Insurance Company Name 8CAC'UA Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. 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 i #of doors Replacement Windows/doors/sliders.U-Value (,, (maximum.44)#of windows *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: ' dyv. �-,--- Q:\WPFILES\FORMS\building permit.forms\EXPRESS.doc- Revised,090809 - t~x The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 4Please Print Le "ibl Name (Business/Organization/I "vidual): m.eS Address: hC . City/State/Zip: WOart> Phone#: A,re an employer?Chec the appropriate box: Type of project(required): 1.U 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 �onstrucfion . 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition (No workers'comp.insurance comp. insurance.# required.] •5. ❑ We area corporation and its 10.❑ Electrical repairs or additions . officers have exercised their 3.❑ I am a homeowner doing all work o 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t e. 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'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 ployees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: ✓� 10 Expiration Date: ®r/ 0' Job Site Address: /City/State/Zip: .� [ Attach a copy of the workers'compensation policy declaration page(showing the policy,nurriber 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 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby.certify under thepains andpenalties ofperjury that the information provided above is true and correct Signature: yv,r. 'i.. ' ` Date: Phone#: 71' 7�V Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2..Building Department I City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: p Phone#: ������ ���� � �� _.. -`�_ •�����'�n��z�i�.�. aa�-s•���asiizcss�i�gulai��� � s R. mwwa Di, p�F34f2i fit#=:2$ 438 MOONAS g 1137AM - VY Q f 9C} fi+;.R y Undersecretary 4tVKMx"�01a ' Jul ta{.JZ Moe ry Su IA wimio�� �$ Pad - �t �; �y DI INNS MD MIF for CUM s MOM m of ft, s. ry # a.# ia�.dnt=rP• :.ram �? From:Shaunna Robinson,Hunter Insurance At'.Hunter Insurance,Inc: FaxID: To:Denise Glade Date:9/23109 09:45 AM Page:2 of x A00RD CERTIFICATE OF.LIABIL_ITY INSURANCE, OP ID S DATE(MM/DD/YYYY) MOONA-1 PRODUCER- 09 2309 O THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION / ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old. River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001; , Phone: 401-769-9500 Fax:401-769-95Q2 INSURERS AFFORDING COVERAGE NAIC9 INSURED Moon AS50C1atE'S InC DBA Gutter Helmet INSURER A: National orange insurance co 14788 DBA Renewal by Andersen Of, RI INSURERS; Beacon Mutual insurance co,-. DBA Gutter Helmet Roofing DBA Moon Works INSURER C; 1137 Park East Drive wsuRERo: Woonsocket.RI 02895 ' I COVERAGES NSURERE: 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,CONTR cT OR OTHER DOCUMENT_WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH - POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID'CLAIMS. LTR INSRE TYPE-OF INSURANCE POLICY NUMBER .DATE(MMlDD/YY) DATE(MM/DD/YY) _ LIMITS ' GENERAL LIABILITY ' _ - EACH OCCURRENCE A -X COMMERCIAL GENERAL LIABILITY, MPS26619 ..0.9�16,�09 .'.09116116. PREMISE S(Ea occurence), $500000 :. M1' CLAIMS MADEOCCUR - _ _ ' _ MED EXP(Any one person) - $-1 Q 0 O Q _ - - PERSONAL&'ADV INJURY $ 1000000 GENERAL AGGREGATE $2.0 0 0 0 0 Q GEN'L AGGREGATE LIMIT APPLIES_ PER: PRODUCTS-COMP/OP AGG $2 0 0 0 0 0 O" POLICY . PELT LOC AUTOMOBILE LIABILITY A. X ANY Auto B1S26619:'.: 09/16/09 09/16/10 (aaccideDnt) $1000000, LE LIMIT ALL OWNED AUTOS SCHEDULED AUTOS; BODILY INJURY $ (Per person) HIREDAUTOS •" - .. BODILY INJURY. $ NON-OWNED AUTOS - - (Per accident) _ PROPERTY DAMAGE - (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ . ANY AUTO - OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 A X OCCUR ❑ CLAIMS MADE CUS26619 - 09�16�09 09116110` AGGREGATE' 1 $ - $ DEDUCTIBLE X RETENTION $10 0 0 0 R $ WORKERS COMPENSATION AND b - BEMPLOYERS'LIABILITY - X TORY LIMITS -ER .'ANY PROPRIETOR/PARTNER/EXECUTIVE 28.586 - 10/01/09 10/011/10 EL EACHACCIDENT $5000Q0 OFFICERWEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $500000 SPECIAL PROVISIONS below - --OTHER E.L.DISEASE-POLICYLIMIT $500000 - - DESCRIPTION OF OPERATIONS/LOCATIONS/_VEHICLES/EXCLUSIONS ADDED.BY ENDORSEMENT!SPECIAL PROVISIONS - CERTIFICATE HOLDER CANCELLATION BUILDIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Bu ilding o Cont. Reg. Board, NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Dept. .- of f Administration ` One Capitol Hill IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Providence RI 02968 REPRESENTATIVES. AU D REPRESENTATIVES ACORD 25(2001/08) ©ACORD CORPORATION 1988 • • ��° RCS � i :� /-���o cam'1��`�v�� � (� !)IA AZ C G a CGum�v to .r&Tiy z� /�.l' /iP 1Ftit_ Yeyr Baits Ra.eo.l M of Rhode�laad er Q , `•- �.J v Addfem 02 d owdVA Z A4 Cnrmaow MO. C y Sales Agroet e ckv�$am. Ovder 1Wwo6w. ]IT 0lak Eau hive h Woomwgba,RI029" P6oartioa A� �q aes..e, vWp%m4wf4m Ardawncbwpp rboow-wa& r es Tf c— Pale!of Dow Lk ficnwc O Rl-30839 R1-12259 MA- Ene& 119535 C!-562M IIORIS. 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