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HomeMy WebLinkAbout0023 NORRIS STREET M� � T � Town of Barnstable Building eRtaysrwet� Post This Card So That it is Visible:Fromthe Street Approved Plans"Must be Retained on Job andathl'Card Must 6e Kept r� Mwsa Posted UntiliFinal Inspection Has Been Made 1Perm° � a Where a Certificat6 of Occupancy;is Required,such Building shall Notbe Occupied until a Einal Inspection has been made i Permit NO. B-20-72 Applicant Name: Henry E Cassidy Approvals Date Issued: 01/13/2020 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 07/13/2020 Foundation: Location: 23 NORRIS STREET, HYANNIS Map/Lot: 306-032 Zoning District: RB . Sheathing: Owner on Record: MARKS,JOHN S&CWYNAR, ELAINE R Contractor,Name-", CAPE COD INSULATION INC Framing: 1 Address: 20 RUSS ST Contractor;,License 153567 2 RANDOLPH, MA 02368 Est Pro1.ject Cost: $2,400.00 Chimney: Description: Insulation , Permit Fee: 85.00 • �-. _. : Insulation. Project Review Req: Fee Paid:' $85.00 Date x 1/13/2020 Final: 4 .; Plumbing/Gas . E ; Rough Plumbing: y ;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 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. p �, Final Gas: This permit shall be displayed in a location clearly visible from access street orroadiand 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 Off,icials are provided"' this permit. Minimum of Five Call Inspections Required for All Construction Work:" Service: 1.Foundation or Footing . Rough: 2.Sheathing Inspection , , .. s 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: " ersons racting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 1 ApplieaSCM Numb .. ` Permit Fee.............:....:... .......01her Fee.. ... 2 Total Fee Paid:......:....... ......... .......................... TOWN OF BARNSTABLE ,t� ,•�i Permit Approval by.......!: `��!"........on.... ............ ........ BUILDING PERMIT APPLICATIONMVQ�5 ..................Fmocc.....aa q.... ......... Section 1 — Owners Information and Project Location Project Address 2� OV Ul S Village NA l� Owners Name rJvA& 6V4YUV Owners Legal Address FWi`_i thJ city State Owners Cell# q l ttiq "4 l7 E-mail �O Section 2—Structural Use _ .. ao F- ShVJe/Two Famil ercial v y Dwelling lhng ❑ Comm Structure o er 35,000 cubic fit ❑ Commercial Structure under 35,000 cubic feet Section 3—Type of Permit ❑ New Construction ❑ . Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool Insulation r Other—Specify Section 4—Detail Cost of Proposed Construction Square Footage of Project Age of Structure Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms (proposed) M 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design I 1AA uPaatcd:1 12017 Section 5 -Work Description AAA11i 14/0 Section 6—Project Specifics ❑ Wiring (l Oil Tank Storage . ❑ Smoke Detectors ❑ Plumbing ❑ Gas Fire Suppression El.Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane C Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ I Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. 1 Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes 0 No Lastupdatea:IIM2017 _............. The Commonwealth vf'Mzissachusem Department of Industrial Accidents OfficeofI'nvestgations 600 Washlrtg ton Street Boston,MA 02111 i www.m sgovIdia rl'orklereCompensation Insurance A.I tdavit. Builders/Contractors/Electricians/Plumbers Aplslican't Information. Please Prints Lezilbly Name i8asines.OJOrganization/Individual): Capp: Cod Insulation Inc. j Address: 18 Reardon Circle l City/State/Zip- South Yarmouth, MA 02664 Phone#: 508-775-1214 Are you an employer?Check the appropriate boxy Type of'project(required): I. 1 am a em to er with 4' 1 am a general contractor and I p y - --_ 6. Q New construction employees(full and/or part-time).e have faired the sub-contractors rs .❑ 1 atrt a sole proprietor or partner- listed can the attached sheet. _ 7. Q Remodeling ship and have no employees These sub-contractors have S. Q Demolition workingfor rate in an capacity. employee's and have workers' y � �Y• t 9. El Building addition tNo workers'comp.insurance comic.insurance. required.) 5. Q We are a corporation and its I{I.Q Electrical repairs or additions officers have exercised their ❑ I am a homeowner doing all work 1 LEI Plumbing repairs or additions myself. o workers'co right of exemption per MGL Y P 12,E]Roof repairs t ' 15. . 1 an we have no insurance required.]t cs 4 t )° d Weatherization empic gees.[No workers' 13. tither r n comp.insurance required.) 'An}applicant that checks box#i must tdso fit)out the sec Lion below showing their workets'contpcnsu on policy intorynation. *Hotncownc:rs who submit this d(lidevit indicating they are doing all wank and then hire outside contractors must submit a new affidavit indicating su& Contracts that check this box mast attached an additional sheet showing the to=o€tht svh caastaacturs and ate whether or not the entities have zmployces. If the sutrc mtactttrs have employees,dwY must provide their workm'camp.policy number. d am an employer dduU is providing wOrttiers'campensatrnn insurance for my employees. Bellow is the policy and job site inyormatia1z. Insurance Company Name: Atlantic Charter _ Policy K or Self-ins.Lic.#: WC1.00136900 Expiration:Date:06/30/20 i Iob site Address: (" City/StateiZip: l G�(ti�l l G7 i. Attach a copy of the workers'compensation policy declaration pa5e(showing the policy number sad expiration date). Failure to secure coverage as required under Section 25A of MGL c. 1.52 can lead to the imposition of criminal penalties of "ine up to Si,500.00 and/or one-year imprisonment,as well as civic penalties in the forts of STOP WORK.ORDEP and a fine of up to S250.0o a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ittvestig ations of the DIA for'insurance coves e verification. I do hereby cenyyr under the/rains and petialliss of perjury that the!n,farrdaiun pravdded ab ve is sir tt�td correct 5iare: Date: Phone#: -77 — tfjseiud stse only. i7®no:write in this urea tb be compldesd by city or lawn Official City or Town: Persmil Licease# Issuing,Authority(circle one): I.Board of Health 2.Building Department 3.Cityffowo Clerk 4.Electrical Inspector 5.Plumbing Inspector-, 6.Other Contact Person: Phone#: ............ e Commonwealth of Massachusetts Division of Professional Licensure 1,•"z Board of Building Regulations and Standards F ' Construe#on°Supervisor CS-100988 � Expires: 11/11/2021 HENRY E CASSIDY 8 SHED ROW; WEST YARMOUTH MA�02673 at' � y t 1 1 Commissioner /L"" ) i Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home I mprovement.Contractor Registration Type: Corporation Registration: 153567 CAPE COD INSULATION,INC Expiration. 12/14/2020 18 REARDON CIRCLE SO.YARMOUTH,MA 02664 !Update Address and Return Card. Office of consumer Affairs&Business Regulation HOME iMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE Corporation before the expiration date. If found return to* RanistrAti an Ex2lratio Office of Consumer Affairs and Business Regulation 153567 12/1412020 1000 Washington Street-Suite 710 CAPE COD INSULATION.INC Boston,MA 02118 HENRY E.CASSIDY '"7 ... I (3;,— 18 REARDON CIRCLE SO,YARMOUTH,MA 02664 Undersecretary B I Ith t Sig c I .. . -�-� CAPEGOD 27' AC+ORCp' DATE IrainroorvwYl CERTIFICATE OF LIABILITY INSURANCE. MM 019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY.ANC3.CCINFERS 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,LAND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies).must have ADDITIONAL INSURED provisions or be endorsed. if SUBROGATION IS WAIVED, subject to the.terns and conditions of the pollcy,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 LWrCT Mood Rogers 8 Gray Insurance Agency,Inc. PHONL ;FAX R RI,134 Atc ,Ext:(800)SSS'1801 Arc Na:(877)815-215fi South Dennis,MA 02660 ' mail roers' .com _ ( IN URERIS)AFFORDjNG GOYERAGE_.,___. NAIC# INSURER A:West American Insurance Company 144393 INSURED INSURER B.Arbelia Protection insurance Company,Inc. `41360. Cape Cad Insulation,Inc. INSURER C;Endurance American Specialty Insurance Company 141719 18 Reardon South Yarmouth Circle,MA 02664 lNsuREaE.INSURER o:Atiantic.Charter Insurance-Cpm an _.. 114326 __.....___ INSURER P COVERAGES CERTIFICATE,NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED.NAMEO 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER, POLICY EFF POU, EXP LIMITS A X ComMpRC[AL GENERAL 1,000,000LL TY CLAIMS-MADE Fx OCCUR LW 53328261 411i2019 41112D20 DAMAGETORENTEDAISES s 100;000 MED EXP'(Ary one WwAl 1 15,000 PERSONAL&ADV INJURY $ 1,000,000 GI=:N'L AGGR .A LIMIT APPLIES PER: GENERAL G A GR. E S 2,000,000 X POuCY�j u LOC PR DUCTS-COMP AGG. S 2,000,000 OTHER: p I C7MBINED SINGLE LIMIT S 1,000,000 B AUTOMOBILE LIABILITY ANY AUTO 107,0081008 41112019 41112020 BODILY INJURY Per mw s OWNED ';�xx SCHEDULED AU��T��OppS ONLY AUTOS. BODILY INJURY Pars de AUTOSOtaIY A A�N q ;. PgOPERI AAdAGE $ V -' X HI { NfNO.'.ON� ' 3 I C UMBRELLALIAS X OCCUR 2;000;ODD EACH 0CCURRENCE $ X EXC10006635004 411/2610 41112020 j 2,000,000 EXCESS LIAR _ CLAIMS-MADE. � AGGRE AT ,�_ DED _a. RETENTION s S D WORKERSCOMPENSAT49 PER DTH•' AND EMPLOYERS'LIABILITY YrN WCI0013fi900 613012019 6I30/2020 1.,000;000 ANY PROPRIETOPJPARTMERIEXECUTNE 't € -E:.L,EACHACCIDENT 5 _ OFFICE�iRaiEMftEXCLUOED7 NIA; 1,00D.000 i an oryln ) - E.L.DISEASE--EAEAjpLOYEI. $ d- bl . ,000 IPTtON E.L..DISEASEPOLICYu T. ,tDESsCROPERATIONSbelow i DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(ACORD tOt,Addlanai Rema*s$rhodule,may Da attached 1f mom space.Is mqufmttI CE IHOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE .EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Information Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016103) 01968-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHE Town of Barnstable �IIAR�iSTAII LE, Building Department Services s •. �nss: o Brian Florence CBO Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1, Elaine Cwynar , as Owner of the subject property hereby authorize C to act on my behalf, in all matters relative to work authorized by this building permit application for: 23 Norris Street Hyannis (Address of Job) Signature of Owner _ S gre 1.01 o App scant E LA ) PI L C. W� -A Print Name Print Na e Date Section 9—Construction Supervisor Name /1 Telephone Number �1 t Address (r Otit, V � U6vmruostt. Zip 0 Z(�lo License Number License Type Expiration Date jtA /-Z/ Contractors UAL V(A hOK Cell# j I understand my responsibilities tinder the rules 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 by T8P CMR and the Town of Barnstable.Attach a copy of your license. t Signature Date dobo Section 10—Home Improvement Contractor Name Telephone Number -7 n Address I® lit- City ' MWU State' Zip 07� Registration Number kpnlon Date 1 Z 1`f / ZO w I understand my responsiib ides under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation by 780 CMR and the Town of Barnstable.Attach a copy of your FLLC... Signature VaW � Date �D Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules 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 IYPC[ documentation requited by 780 CMR and the Town of Barnstable. " Signature Date f ICANT SIGNATURE Signature Date 7 ?� Print Name U l Telephone Number ? 4 E-mail permit to:,Y4 @LueCD 0 f &L- Cam' t, Last update:1012017 Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire deparbnent for approval Section 13— Owner's Authorization I as Owner of the subject property YherebY authorize to.act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner date Print Name 4 { ^' R� o L J Lat updWz&-I1/712017 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION_ Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424 8/19/2017 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.36 HYANNIS BUILDING DEPT. 200 MAIN STREET HYANNIS MA 02601 Re: Insured: ., JOHNS.MARKS&ELAINE R.CWYNAR Property Address: 23 NORRIS,ST., HYANNIS,MA 02601 ; Policy Number: 0965032 Type Loss: Vehicle Damage Date of Loss: 08/17/201 Z Claim Number: 416794 _ Claim has been made involving loss,damage or destruction of the above captioned property,which may either_ exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss ; a$rd claim--or file number. cc ts cars :!= MPIUA Claims Division . Off c Zn- tVr 4 CMA00021 it#�� � Town of Barnstabl ` � t a Pe i Expires 6 months from iss�ldate y3 ~' Regulatory Services Fee t BARNMEM Thomas F.Geiler,Director 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 �3 Properly Address � 2) N OCc-' S 'Residential Value of Work$ j .Od Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address E'IQ � nC,�'. £' y Contractor's Name h Mzg I1;r, I Telephone Number Home Improvement Contractor License#(if applicable) 1337,015� Email: H44 1; le s/ �1Q Constuction Supervisor's License#(if applicable) C —0 7 9 3 0 X-PRESS P if Workman's Compensation Insurance Check one: x O C T"`I 7-2013; ❑ I am a sole proprietor El the Homeowner. I have Worker's Compensation Insurance ,• TOWN OF BARNSTABLE Insurance Company Name .• .SIJf'r.(Jy Workman's Comp.Policy# W C 0(03 5 U3 Copy of Insurance Com Nance Certificate must accompany each permit. . 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) Q'Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#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 signn Prope Owner Letter of Permission. A copy of the Home Impro t Coniractors License&Construction Supervisors License is requi e d.: SIGNATURE: w C:\Users\decollikWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc , Revised 061313 i The Commonweakh of Massachusetts• r Dg9w tnTent o,f Indush al AccillaW O,,Q`ice of Fnvestigations 600 Washogton.Simet Boston,MA 02111 svte*m mass govJdia Workers' Compensation Lm rance Affidavit.Builders/ContractordElectricians/Plumbers Applicant Information " Please Print.Lembh� Name1):V�'1l 1 �, r C�t�; ► ,tic . Z Lc. .. Address. 66 ¢ C3 -(1 v G City/stat/zip: i tf- .0 5- Phone VSDS— 9�- �C� AO Aim you n employer?Chet the appropriate box: Type of project(required): 1.Ly'I am.a employer with 4. I.am a general contactor and I 6. ❑New construction- to full and/or r s ' have sub-cm�c�s tmup fees{ paLt"'tim.B}- • 2.❑ I am.a sole proprietor or partner' listed on the attached sit 7. Remodeling ship and have no employees Theme sub-contractors;have g. Demolition working for me in any capacity., and have workers' 9.. ❑Building addition [No wodam s'comp_insurance. core.insurance ] 5-❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑'I am a htmrhecivner doing all work officers liareseicised their ''� 11-Q Piurmbing.repairs or additions : myself[No workeW comp- right of exemption per MGL. 12.[]Roof repairs insurance required.]! c.152,§1(4 and we have no , employees.jNo workers' I3.�ther -•S ,h comp.insurance required-] 'Any applisaBC that checks box#Y�also fill out dw section below showing dude wo leers'co4ensa�policy marmatia� r 1 Ffameowaets wbo b this affidsait.ia1icatmg:they are doing all writ amlihea bi a ode couuacmrs must submit anew affidavit indicating such. ZConuactm that check this bout must attached an additional simmA showing the name of the sub-ca=acbm and state ubedw ot'not tho;e eatifs bxm employees. If the sab-contrmms have emp�aer s,they mustpmvide th&workers'camp.policy number. Iam.on employer that ispmviduW worirers_'conW asat on insurance for my eazptoya'es Below is titepolicy and job information. Insurance Company Name S Policy#or Self-ins.Lic-#: 0 co 3 a{3 y ExpirationDate: �/J Job Site Addis: 93 lvUr/'a civistateizip: Z�pO Attach a copy of the workers'copensati i `on polcy dedaration'page(showing the policy num m irat on date). . Failure to secure coverage as requuited under.Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one-year imprisoaumsnt,as well as civil penalties in the form.of a STOP WORTS ORDER and a fine_ of up to$250.00 a day against the violator."Be advised that a copy of this statement shay be forwarded to the Office of Investigations of the DIA for insurance coverage verification ' I do hereby cerhfj+under th and parr f perjury that the information prverided ere is and correct si Date:/0// Phone# officid nse only. Do not write in'this arert,to be completed by cif:or town o f cia1 , City or Town Permit/License# Issuing Authority(circle one}: 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5,.Plumbing Inspector 6.Other Contact Person: Phone#:, ,4co CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 9/9/2013 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 - ME CAA CT Kathy Silvia " The Fair Insurance Agency Inca (AIC No PHONE • (508)775-3131 FAX o.(508)790-1677 619 Main Street " " E-MAIL DD ssc kathy@ thefairagency.com e. . . Suite 7 INSURERS AFFORDING COVERAGE' NAIC# Centerville MA , 02632 INSURER A:Western`World HTBO18 INSURED INSURERB:Citation Ins. Co. (MA) 40274 Macallister Building LLC' INSURERC:Star Insurance' Company 18023 64 Ebenezer Road INSURERD:Peerless Insurance 24198 i' INSURER E: Osterville MA 02655 INSURERF: COVERAGES CERTIFICATE NUMBERCL139900587' 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 - TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ . 1,000,000 COMMERCIAL GENERAL LIABILITY t r.= DAMAGE TORE TED 3OO OOO PREMISES Ea occurrence $ A I CLAIMS-MADE OCCUR NPP1318574 /11/2013 /11/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2;000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2',000 i 000 X POLICY PRO- JFCT LOC e $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO : BODILY INJURY'(Perperson) $ B ALL OWNED SCHEDULED X2082- 9/7/2013 /7/2014 AUTOS X AUTOS BODILY INJURY(Peraccident) $ HIRED AUTOS NON-OWNED ` - / ,, PROPERTY DAMAGE $ - AUTOS Per accident r - _ _ $ , UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITYILIMITS ER Y/N ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ lOO OOO OFFICER/MEMBER EXCLUDED? a NIA t C0632030 /1/2013 /1/2014 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100 000 tf yes,describe under '. I. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 D M8492273• 8/11/2013 /11/2014 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 10l,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Bannstable 200 Main Street Hyannis,' MA' 02601, AUTHORIZED REPRESENTATIVE " Jackie Stewart/FAIJS2 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r9Mnnsi nt r Thn Arnan nmma anti Inn^am rnniefcroA rnn#*.4 Ar-non Massacnusetts ,Uepartment of Funiic 5aiety Board of Building Regulations and Standards Construction Supervisor License: CS-0793.58 I IS ��'� LPL.i. ,' � ,•' MARK A MACALXL`ISTER 64 EBENEZER RD s OSTERVILI..E Na 0265�b )IXA Expiation Commissioner 08112J2614 lJ i7.e d'/77/I72Q4ZCUP.CLU�'9 c(� Qc1CI,C�II?BC� r ~\ Office of Consumer Affairs&Business Regulation License or registration valid for ME IMPROVEMENT CONTRACTOR, before the expiration date. If found'return to: to ul use only egistration 133Z44 y xpiration 8/3/2015 Type' Office of Consumer Affairs and Business Regulation DBA # 10 Park Plaza-Suite 5170 ` MACALLISTER BUILDING — ,-` 1 Boston,MA 02116' MARK MACALLISTER 64 EBENEZER ROAD OSTERVILLE,MA 02655 1 Under se cre to ry Not valid without signature ' i -`'THE O + iARNS'fABLF� • MASS.1639. Town-of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street,-Hyannis,MA 02601, ,t . . www.iown.barnstable.ma.us Office: 5084624038 Fax:s508,790-6230 Property Owner Must -Complete'and Sign This Section If Using A Builder Gt�i (� �, _ LA-)ta�(l / ,as Owner of the subject property ,. herebyauthorize/hrT� M�'1 _creL 1 S7"'C! ! ► to act on my behalf, in all matters relative to work authorized by this building permit application_ for: a 3 Norr►s s�G - � r (Address of Job) lv Signature of Owner b.ate Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\8R76BDVA\EXPRESS.doe Revised 061313