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HomeMy WebLinkAbout0094 CARLOTTA AVENUE II I I SCANNED Application number..., .:{ �...-.a.�g�... �► --azw Fee ................................u. s........... BUILDING DEPT. Building Inspectors Initials-...1~..3........................... 1�2 2020 I`1 I�o AUG Date-Issued........ J.....1 TOWN U BARNSTABLE Map/Parcel........�e(l ................... TOWN OF BARNSTABLE` EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOW S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: / ��t"I1} y�(r (��M 44Lr v j f le- NUMBER TREET VILLAGE Owner's Name: �� Phone Number �� (�� g Email Address: Cell Phone Number ---_; Project cost $ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building a accordance with 780 CMR Owner Signature: Dater TYPE OF WORK 12'Siding ❑ Windows (no header change) # Doors (no header change)# CInsulation/Weatherization EJ Roof(not applying more than I layer of shingles) © Commercial Doors require an inspector's review_ Construction Debris will be going to © Certificate of occupancy with no construction(complete below) Occupant/family relationship or business name or Existing amnesty apartment (attach a copy of recorded comprehensive permit) CONTRACTOR'S INFORMATION Contractor's name -¢R&II Home Improvement Contractors Registration(if applicable) # (attach copy) Construction Supervisor's License# C S d y C I (attach copy) Email of Contractor PLC.G7 G sw�ca�l Phone number 5b6- .3�- 616 ` 0 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR/F THE SUBJECT PROPERTY IS IN If/11/w/ nrr/l nr w nrnw w/T -A Al nr.f"f".#r F% APPLICATION NUMBER............................................................ *For Tents Onlyt* ate Tent (s)will be erected Removed'on`_ .s number of tents total Does a tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensi ns of each Tent X X y X Additional to t dimensions can be attached on a separate piece of p. er. Purpose of Eve Check one: this a nt is a: for profit non-profit event Check one: Food se ed Yes No Flame Spread Sheet of ea tent must be attached. Pro de a site plan with the location(s) of each tent Fuel source being used LP 201bs. or> Yes No , if yes, a gas permit is.required. Natural Gas Yes "No , if yes, a gas ermit is required. If food is being served at your even lease o in a Health Department approval between the hours of 8:00am-9.30 am or 3:30 pm-4:30p C mercial events may require Fire Department approval. "*WOOD/C A" /PELLET STOVES Manufacturer# / Model/I.D. Fuel TYp e ' " Testing Lab Offsets from combustibles:Ynt back left side right side H MEOWNER'S LICENSE E MPTION /truction r's N e: er Cell or Work num r d my responsibilities under the rules and regulations for Licen d Construction in accordance with 780 CMR the Massachusetts State Building Co e. I understand ction inspection procedures, specific inspections and documentation uired by 780 he Town of Barnstable. Date APPLICANT'S SIGNATURE Signature. Date do All permit applications are subject to a building official's approval prior to issuance. 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 -t Please Print Legibly Name(Business/Organization/Individual): 1�,��U b(rai� Address:_©�{ � � � City/State/Zip: a(�O Phone#: Are you an employer. Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hived the sub-contractors 6. ❑New construction 2.$j am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' t 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 insurance coverage verification. I do hereby certi under a pains an enalties of perjury that the information provided above is true and correct Si afore: � Date: Phone#: G .� d/oo Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation.for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,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-contractors)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 permittlicense 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 burn 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 Offlee 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.maw.gov/dia IV *+ n�.v= mra r'�r iaraaagt.=usFc povision of Profession ns al Llceure Board la Boa of Butlding Regu bons and 56nifards C6nstru_ctid.rf`Sitpgvksor - ;E'�pires: 10/28/2021 CS-U91391' FRANK'DONOVAN r I 104 C.ARLOTTA;AVEM1IUE f . FOYAFIIVIS MA Commissioner f ie tpariUriwauaPall�.o ' �gvrae/uc�elta.., .. .. '_. Office of Consuer Affairs&Business Regulation m HOME IMPROVEMENT CONTRACTOR Regisiration'valid for individual use only a, TYPE IndMdual before the expiration date: If found return to:.. r Registratkon�S Expiration Office of Consumer:Affairs and Business Regulation #64521 r =10/18/2021 1000 Washm on:Street -Suite 710 } 1? Boston,MA 02118 FRANK DONOVONZ i.. FRANK J.DONOVAN +f - .104 CARLOTTA AVER �rN No v8 1 8 HYANNIS,MA 0260.1 - tUCB t I d without:sigh Undees6beeta 4. .. k i � f i . .... .. . . .... . " 2 II { -2-1 Town-of Barnstable *Permit# F�gyres 6 months from issue date Regulatory Services Fee snuvsxesi s n�sa Richard V.Scali,Director Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA R5681 1 6 2017 www.town.barnstable.ma.us Office: 508-862-4038 TOWN 0 bAR N STABLE Fax: 508-790-6230 EXPRESS PERAUT APPLICATION - RESIDENTIAL. ONLY. _ Not Valid without Red X-Press Imprint Map/parcel Number o� 6 Property Address , Ll 4 ❑Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address f6(i(a.— I-5 a a Contractor's Name l S Telephone Number v yj 'i y� Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor Pam the Homeowner 2-1-have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) // g Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to,&4 A l f%i2d �d LJ xe-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: .Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. j ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: a Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 01/25/17 i 27z-a Commompealilt ofAfassachusetts Departne utof1mizrslrialAcridents - Office of.£nw gadons 600 Washington&treet Gaston,AL 402111 i-miunlass govIdia Grkers' Camp ens3f an Insm-ance Af Hdavit Bu1dex-lContrahrsMeclricianslPhmzbers AppIicamtInfwmaiian . �.-P�'lenasePlintf&zffi N1IIIB�BncinRcclC�satpi�ua� l/�-(' Address: • �ifgf�fatef�ip= • ,,-" - - Phaae�• Are you an employer?:Checkthe appropriate bow T of project r I asn a Qeaeral conirsctrFr anc€I Yl� p 1 ( ���'= I-❑ I am a employer with � ° 6- ❑New construction employees(fizll anslfor part limed*— base-lliretie-slr-corik�ats---= --- --- ---------------- °----, 2.❑ I am a sale propiietos arpaftaw- Tisfed au the.attached sheet. 7 ❑R,emodahng slip and have no emplayees These=b-condractors have $-,0 Demolifioa wading form is any capacity employees audhave wodcers' 9. 0 Building addition. INo wp&E& comp.fi mmznce comp-k=1ran{e-I required .5- We are a corposafi-an.and its 100 McEttical repairs or addifr-aus 3. I ama homeowner doing all work ofticess have exrcised fir 1L0 Plumbingrepaim or additions " myseY-[No woikere _ might of exempfion per MGL fra li� in �cereSuiLed]Y c-152,§1(4kandwebaveno uL"" epasrs � employees_[Na woAess' 13.0 wier camp-m.sarmce mquired_I •Aay apgg�t�at chedshasl mad also 511a�the sectioaheTmvsbus�ing itieaworicers'evmpeosatiaupnIiegisdormae`eam #ffamevwagrs wl�o sabot dvs affida<ss inc caIIag they ase�m slE urudc sub tfieai xe outfld��aat _h+*znms#snf:mit a neW affi& itt indieaba-Md7L + fCaafsactors�st ehwItU&[tmx nmst attache$=sdditinnsl sneer showing themme of the sob-camtrxckrm=d sutp-wheAm ornaMose enli&slive emplwjees.if the StJt{oaimctneshaFeempIq W-%they -pmsmi&&ek w°orkea'tomp.pormynaabez lam an emprrysr diatis pmVurg workers'co csrdian inmirance for erry wrprq zes $elow is Aarpviicy ar d job St& hiforma67m Insanmce:Couxpauy-Nt ache: L- Po-fiCy 44 or set fILS lic- ` pIf3 TOQDate: Job Sim Address City/Sp: A Uch a copy of the workers'comapensationpolicydeclaration page(showing the policy number and expiration date). i Fa&m to serum coverage as requiredundejr Section 25A of MGL c-15,72 can lead to the inipos tioa of crin hld penalties of a fine up to$1,5ab as andfor one-year imprisonmeT,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250-00 a day abaaiud the violater. Be ad;dsed fat a copy of this statemetsmy,be£arwarded to the Office of Imtestrgadom of the DIA for insimmee coverage mr ication. I do Iferehy cefi6 ,aatder Mh�W9 6fFMjrry ihatAe azfornuff rpm,-id,ed a boiw is bars wi d carre-t sionatar•Iff- Date= Phone 0fi7ZiaL uss arrfj. Da irat Writs in trdS area,ter be cmupfeteri by ebp artOMI ojj`aeiat City or Tazru: PernF9 ff&ense# Lruing A.n9rar€ty(circle one): L Board of Health 7.Building Department 3.City1rown,Clerk 4.Electrical Inspector S.Plurribing Inspector 6.Other Contact Person: Phone#: 6 formation an' d TnS C ons • T r 7Vl�ccarhys�fS�).�Laws�tr 152 r�=�`�i°�to�ide GPdT S'GQ� OII for t�1eIL�II1plUyeeS. pBrsoantin this sfai�,an�Ioye�is defined as.¢.every Pe<son ih t3ie service of another under any��'�°f� wpress or m3plie4 oral or W�" An err�Toyer 3s defined as=aa mdiyiffiA paxin�,asso crn,coxparation or other Iegat e�tly,or any two or more andme the 1 senta&w of a deceased employer,or the Of.the foregoing m a joint=tMpi=, � e HOWevcr the rmeiv=or trastee:of an mil,partamsbip,msociafion or other legal entity, °Ymg�P y - ovzneT of a dwellmghouse�gnotmoretbaati�ree apmtra nts andwho residEs therein,or the occupant offiie- dw fling house of anDffim who employs pca=s to do maim ce,conefmct is n.or repair work on such dwelling house tntenaotthereto shallnotbecanse of such employment be deemed to be an employer" or on.the gro�ds or building app MGL chapter 152,§25C(6)also SAS that¢everystate or local licensing agencyshall�itblioIcl f6ie hzgnance or renewal of a Ticease or permit to Dperafe a Imsin ess or to construct bindings is the commonwealth for any aPglicant-?Fho has notprodnced acceptable evidence of compl=m wUh the h=ran�coverage regan e " Additionally,MGL cbapter 152,§25C()states-Neither the cDr=oaweahh nor aay,ofits political sobdiivi rims shaIl eater faro any contract fpr the performance ofpublic wmkuntil acceptable evidence of compliancewhh the msar''ace.. eafr oftiais chaptlxave-teen pres hented.in the cantr�l��.anfholify:' regmm-m _ . AgPlicaxrLs • Please f jl Dist the worb=,compeasation affidavit completely,by g the boxes�t applY i o your srfnatton and,if s nam s , es and a namber(s)along With f m��-(s)of UDDessalL�Pfy�) �� ) - s with.no employees o 7 tip the msniance L=it�d.LiabOy ComPemes(LLC)orUontcdLiabitityPazinership (LIP) . members or partneas,are not rbgoiredto-cauy workers'compensation ms=ance. If an.LLC or LLP does have employees,apolicy fs required- Be advisedfizatfhis afFidayitmaybe mhmittnd to tine Depa-invent of Tndusfial AccideEds fur confirmation of fnsu m=coverage Also be see to sign and date-Ole affidavit The affidavit should bez�t need to the city or townti�the applicalim for the permit or license is being requested,not the Depaztmeof of Ilasirial A cd&mts- nouldyou haQe any questions regarding the Iaw or ffyon are required to obtain a workers' compensationpolicy,pleasecaafiieDepartmea3tofthenumberlisfEd.beInw: Self-insured companies shouldent�xtjiefr s elf fijsM=ce license amber on the appropriaf,line. City or Town Of El als Please be sm�tip the affidavit is complete amdpr!3ted legibly- The Departmemthas provided a space at the bot[mn flat affidav>t for you to fn71 out m fire event the Office ofInvestigafi�has to coact you:regazdmg the applicant- of Please be sure t o f17. is f.,a pe�Iliceose ntrnba Which vM be used as a refr-=ce�mbrr. In addition,an applicant app need only submit one affida-it M iir2t g G� that must sabmt mubiple penIIitllicense Iiions in any given y ear, policy infomatioa Cif necessmy)and under"Job Site Address"the applicant should Writr=-aII Iocaticns in (Cit3'°r town)--A copy of the.affidavit that has been officially sided or marked by the city or town maybe provided to the - applicant as proofthat a valid affidavit is on file for Rite permits or licenses- Anew affidavits=the fMed Dint eiarh year.There a home awner or citizen is obfiaming a license or perm¢not related in any business or Mnro.ercial vie (ie.a dog license or permit to bTun leaves etc.)said pegson is NOT req�ed to complete this affidavit nhave aay4 The Offie oflnvesfigaii=Wouldhkatothankyoninadvanco for your cooperatimaacl sbouldyo O�• please do nothes to give Ms a CA The Dgep o trnenf address,telephone and fax ntxmbet Deparbment ofladugtialAo--identa ( CM OfInveStgtiow -Tf,-1.:t f i'-' -d- Qit 406 car 1-9 MA K,'� Fax#617` 277749 Revised4-24-0TZr� Town of Barnstable Regulatory Services oFsrE Richard V.Scali,Director Building Division * sAiexsxAsr.�. ' Paul Roma,Building Commissioner MAW - �es� �m 200 Main Street, Hyannis,MA 02601 ED www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print JOB LOCATION: C f C-664-11-d-Y��A �.0 eta_ Y -fil Aj number f street v' age "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 4-t- c4.� Cc.>1i-<J)� 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) ' t 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 proced an a uir nts a/she will comply with said procedures and requirements. Si 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Town of Barnstable Regulatory Services ` Richard V.Scab,DirectorNIAM " Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towmbarnstable-maus Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder IIII kAL /�uS ,as Owner of the subject property hereby authorize w to act on my bebA in all matters relative to work authorized by this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections erformed and accepted. S' tore of Signature of Applicant Print Name Print Name Date QYORMS:OWNERPERNSSIONPOOI S OATE(MMIDDlYYYY) CERTIFICATE OF LIABILITY INSURANCE ' PRODUCER 8115J17 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION Cowan Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 359 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Haverhill MA 01830 INSURERS AFFORDING COVERAGE NAIC# INSURED Stephen Duff IN ERA: Associated Employers Insurance Com_ afn 7 158E Hyannis Road INSURER B: — INS RER C! Barnstable MA 02630 - INSURER D: COVERAGES INSUPZA E: — THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTW17HSTANDING 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER �� GENERAL LIABILITY LIMITS EA C OCCUR NCE g COMMERCIAL GENERAL LABILITY DAMAGE TO RENTED CLAIMS MADE Ej OCCUR USES(EA —- ED EXP orro raan S PERSON L 8 AOV INJURY' S GFN'L AGG ATE LIMIT APPLIES PER: GENERA AGGRE TE g POLICY PR LOC PROD CTS•CO PIOP ACG S AUYOMOBILE LJABIIJTY . 7'"� ANY AUTO COMBINEDEaISINGLE LIMB $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY ,- (Per parson) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Par aociddra) S, PROPERTY DAMAGE ffi(Per acradanq GARAGE LIABILITY AUTO ON Y-EA AC DENT ANY AUTO OTMERTHAN AACC AUTO ONLY: AGG s EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE ffi OCCUR 17 CLAIMS MADE AGGREGATE S DEDUCTIBLE RETENTION S WORKERS COMPENSATION AND EMPLOYERS,LIABILITY )< WC STATU- OTH- A ANY PROPRIETOR/PARTNER/EXE'CUTIV Y'" WCC5009775012017 02I10117 02110118 E. EACH A CIDENT S 1O0 OOO OFFICER/MEMBER EACLUDED9 N� (Mandatory In NH) If ee,dt*vW®under F .DISEASE-EA EMPL YE 100,000 ECIAL PROVISIONS boln OTNER F L DISEASE-POLICY LIMIT s 300.000 r RIPTION OF OPERATIONS I LOCAMON51 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Carpentry contractor. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Barnstable Building Depertrtlertt DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 0 DAYS WRITTEN ZOO Main Street NOTICE TO THE CERTIFICATE HOLDER NAMEDTO THE LP-FY,BUT FAILURETO DO SO SHALL y.,� IMPpSE plp 0 OF ANY KIND UPON THE INSURER ITS AGENTS OR ll�ldllrlrS' REPRESENTA ES.' AFC�IIPENTA ACORD 25(2009/01) -2nOO9 ACORD ORPORATION, AllAts The ACORD name and logo a regi red marks of ACORD