Loading...
HomeMy WebLinkAbout0243 OLD STRAWBERRY HILL ROAD ti f Town of Barnstable Building . _ ;.sA,F...W� ,,, .. � '"''" ,R 3 °fi"z _i ` ,; '"*;•,fie- � '$\ Post,This Card So.That it is:Uisibl'e From ith Street-�i4 rovedPlans Must.be Retained on Joband this CardMust be Ke t .ARxf3r r Sz;_ '�£ ,�^'.h� Y esg�pp i u w 2 s >,... , p �.s mxsSPost d lJnti1 Final;I'jX ., S ' � , " nspection,Has Been Made w Where a Certificate of Occupancy�s Required,such Buildmgshall Not be Occupiedunt�l a fmal,lnspection has been made, Permit No. B-18-1673 Applicant Name: LUCIO, RAFAELA ORTEGA Approvals Date Issued: 06/08/2018 Current Use: Structure Permit Type:• Building-Siding/Windows/Roof/Doors Expiration Date: 12/08/2018 Foundation: Location: 243 OLD STRAWBERRY HILL ROAD, HYANNIS Map/Lot 250-088 Zoning District: RC-1 Sheathing: Owner on Record: LUCIO, RAFAELA ORTEGA f , Contractor Name< Framing: 1 Address: 9 243 OLD STRAWBERRY HILL ROAD A, Contractor License 2 HYANNIS, MA 02601 Est Project Cost: $850.00 Chimney: rmit Fe'e:Pe $35.00 Description: replace 3 windows �� F �� Insulation: Fee Paid:' $35.00 Project Review Req: 6/8/2018 Final: Date Y axi ; # ram:., Plumbing/Gas Rough Plumbing: a 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. Rough Gas: All work authorized by this permit shall conform to the approved application and thapproved construction documentfowhieh is permit has been granted. All construction,alterations and changes of use of any building and structur es 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. e Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are prodded 'tfiis permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing � s� Rough: 4_ - 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" (as set 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 Blilldlilg '. Past This Gard;So"That�t:�s Visible From,:the Str""eet,-A,,, roved,-Plans Must be,Retai"ned on Job andthis,Card�Must be Kept ; :. eA1FaT27rAe1.C. • � � ,:�, • Po11 sted Until Final.Jns ectton HasBeen,Madez Where a Certificateof Occu ands Re umed,such Buildm shall Not beOccu ied`until a F.malrins ection hasbeen made Permit PermitNo. B-18-1673 Applicant Name: LUCIO, RAFAELA ORTEGA Approvals Date Issued: 06/08/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 12/08/2018 Foundation: Location: 243 OLD STRAWBERRY HILL ROAD, HYANNIS Map/Lot 250 088 Zoning District: RC-1 Sheathing: Owner on Record: LUCIO, RAFAELA ORTEGA Contractor Name Framing: 1 �Cotractor Licen d 2 Address: 243 OLD STRAWBERRY"HILL ROAD ." 6y : .,_ HYANNIS, MA 02601 r Est Protect Cost: $850.00 Chimney: Description: replace 3 windows PermitFee: $35.00 Insulation: Fee'Paid> $35.00 Project Review Re L 1 q ' Final: Dante 6/8/2018 h Plumbing/Gas � s Rough Plumbing: Building Official Final Plumbing: p y p Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized�b this permit is commenced within six months after-issuance. All work authorized by this permit shall conform to the approved applicationand the=approved construction documents%for whichthis permit has been granted. 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, 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 B ding,an f're Officials arre pr y ded on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: a 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" (as set forth in MGL c.142A). Fire Department G Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application number. DateIssued...........` . .......... .................... Building tors Initials 16 250 MAYMap/Parcel...............................()............................. 2 4 2010 TOOV'TOIAIN ,( ( ' TABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: a(43 f d SbQa;Wb6M 61 z) 14 Ate;rn 4 od Go I NUMBER STREET VILLAGE Owner's Name: C,i iy)&22? � Phone Number-5� 360'-C650 Email Address:`RprFA(-,t4 W CZO_�- Q6,nat,wrl? Cell Phone Number Project cost$ 'SO .�_� Check one Residential Commercial 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: Date: TYPE OF WORK ❑ Siding Windows(no header change)e # . E` Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to s CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 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 ...........................................9...........x.. *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 Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 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 Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: '1fiG Telephone Number 13 �O 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 documentation required by 780 CMR and the To of Ba able. Signature Date Mq,& - APPLICANT'S SIGNATURE Signature aaj Date r1'1 - ). - All permit applic r-onsre subject to a building official's approval prior to issuance. r it •' The Commonwealth of Massachusetts. Department of IndustrialAccidenis Office of Investigations 600 Washington-Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/orguiza iombdividual): Address: o24; O r!.cf. S Ea2-,v b6ow h M 2 c4, City/State/Zip: 1A Nabitu i 5 rnA 1 Phone#: uoz) 3(oo- a8so Areyoun an employer?theck the appropriate bog: Type of project(required): l.❑ I am.a employer with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These es a d have have . g• Demolition working for me in any capacity. employees and have workers' 9• Building addition [No workers'comp.insurance comp.inSnran�P,� • ed.] 5. We are a corporation and its 10.[]Electrical repairs or additions 3. rIam homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions f:[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#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 contactors most submit a new affidavit indicating such. Contractors that check this box must attached an additional sbeet 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'compensadon 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' ce coverage verification. I do hereby c , ' under the p ' and penalties of perjury that the information provided above is true and correct Si e: Date: — .a Lj i S Phone#: Official use only. Do not write in this area,to be completed b1'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.EIectrical Inspector.5.Plumbing Inspector 6.Other Contact Person: Phone#: i Information and Instructions r 'V, 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 budding 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 I52,§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 brat this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and dat6 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"ail 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 homeowner 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 t . Department of Industdal Accidents Office of luvestigaftu 600 Wasbington greet Bow,MA 02111 Td.#617-727-4900 ext 406 or 1-877-MASSAFE - Fax#617 727-7749 Revised 4-24-07 www.mass.gDvIdla TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION kc BA NSTABLE —� J Map Parcel Application # Health Division i1t L` t ' 1L: 04 Date Issued Conservation Division Application Fee Planning Dept. — - Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Str et Address \ Village Owner pp �i �i� Address Telephone 5b� ` '3� 0 - Cl -rib Permit Request l t u �l ' GPIQ6'e7t I e; ne Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation UOO*n Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑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 YNO If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name t Telephone Number Z5 • 2� Address OlVdb License# Jo6 U 'u ` AV Mf4_ Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJ CT WILL BETAKEN TO SIGNATURE DATE L6 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: , FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r Massachusetts Department of Public Safety Board o'f Building Regulations and Standards 5 9 License; CS•100988 l Cohstruction Supervisor HENRY E CASSID-Y,\ 8 SHED ROW ri?2-,'fit . WEST YARMOUTH t Expiration; ' Commissioner ' 11/11/2017 - COMIssioner. 1111.112015: Office of Consumer Affairs and.Business Regulation l0 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement CO:h�t.ra'ctor Registration Registration; 153567 Type; Private Corporation i Expiration:on: 12/15/2 16 .rr u z59i s 8 CAPE COD INSULATION, INC i I 'r. I• . ' HENRY CASSIDY ( ' ; ,.I ,• . --._ 18 REARDON CIRCLE LL SO, YARMOUTHI MA M64 _ Update Address.and return card,Mark reason for clijngc, KA i NM•05nr [] Address 0 Renewal Employment Lost C9 _. ...... OfilceofConsumrAffalrs& BuslncssRcguletion �LImse • V/ce O'J7N7L672GU6�6 C�PC✓���oJDG'6o�ttJeG�J or registration valid forrindivldul use only OME IMPROVEMENT CONTRACTOR before the explratlon'date, If found return to; eglslratlon; '1'53567 Type,. ` Offlce of Consumer Affalrs.and Business Regulation j xplratlon; Private Corporatlon 10 Park Plazii:-Sulte,5170 �.. Boston;MA 02I 16 CAPE C00IN8ULAt�.' HENRY CASSIDY 18 REARDON CIRCLE`-' S0, YARMOUTH,MA 02664 ' ' Undersecretnry N' ,valid wl ut sign e I lie Uotramonwea.lth of Massachusetts t} �" Department of Industrial Accidents Tom. :..'j Offce of Investigations 600 Washington Street Boston MA 02111 wfvw,mass.gov/dia Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/OrganizatioriAndividual); Address; �Gr�'1�� ;' / ✓ City/State/Zip; _ V-A-, '1�a4� 1[�► �f�b Phone #; /, w .yet •' �V 1 ! jam ' I ?,Iv, Are you an employer? Check th- appropriate box: l. ,I am a employer with I _ 4. ❑ 1 am a general contractor and I Type of project (required): employees full and/or part-time),-" have hired the sub 6, New c( p ) sub-contractors Q,;,, onstrucaon 2,❑ 1 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,a [No workers' comp, insurance comp, insurance.t 9, ❑ Building addition 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 I l- Plumbing repairs or additions myself, [No workers' comp, right of exemption per MOL insurance required,) t c. 152, §l(4), and we have no 12.❑ Roof repairs employees, [No workers' 13V 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 alTiciavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attaphed an additional sheet showing the name of the sub-conb•actors 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. ,,info.rmation, Insurance Company Name; y �, r� �� Policy # or Self-ins, Lic, 4: t C,ell00 Expiration Date; Job Site Address: lar City/State/Zip; Attach a copy of the workers' compensation policy d laration page (showing the policy numbe and expiration date Failure to secure coverage as required under Section 25A of MOL 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 insura covera e verification. I do hereby certify d t/te pai an penalties of perjury that the information provided dbove is true and correct, Si nature; ° Date: 21 Phone#, Official use only. Do not write in this area, to be completed by city or town offf.cial City or Town; Permit/License# Issuing Authority (circle one): 1, Board of Health 2, Buiiding Department .3, City/Town Clerk 4, Electrical Inspector 5, Plumbing Inspector 6, Other Contact Person: CAPECOD-27 BDELAWRENCE ACORO" CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDD/YYYY) 6/30/2015 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, IMPORTANT; 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 endorsement(s). PRODUCER CONTACT NAME; Rogers&Gray Insurance Agency,Inc, PHONNQ E E WC No): ('877)816.2156 434 Rte 134 EMAIL South Dennis,MA 02660 ADDRESS; INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURERS:ATLANTIC.CHARTER INSURANCE GROUP Cape Cod Insulation,Inc, IN SURER C: 18 Reardon Circle INSURER D: South Yarmouth,MA 02664 INSURERE: INSURER F: 7o COVERAGES CERTIFICATE NUMBER. 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. ILTR TYPE OF INSURANCE POLICY NUMBER ADDLISUBR MM/ODY� MM/DD�YY LIMITS. A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADEFR OCCUR CBP8263063 04/0112015 0410112016 PREMISES Ea occurrence $ 100,000 DAMAGE TO RENTE - MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I $ 2,000,000 X POLICY D j CT LOC PRODUCTS•COMP/DP AGG $ 2,000,000 OTHER: !$ AUTOMOBILE LIABILITY o COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PRO RT tDAMAGE $ HIRED AUTOS AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAS HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH• AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Ya - WCE00431901 06/3012015 06130/2016 OFFICER/MEMBER EXCLUDE( NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) ifs,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000;000 n DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is requlred) Workers Compensation includes Officers or Proprietors, Additional Insured status is provided under the General Liability and Auto Liability when required by written contractor agreement with the Certificate Holder. I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS, South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Town..-of Barnstable Regulatory Services s�u+gsr�. � ltichard''V".$cali;:Director. 161 Tom ferry,Buiiding.p6mmissioner 200 Main Street,H*iuis;MA 02601 www.towa.barnstable.ma.us Office: 508-862-4038 1W 508-90-6230 Propexty der Must Complete:and:S.itg Tlus Section. If U.sxn,,.g; ._BWW :77777L LA i a g:5 Crier pf the Subjec7. t pnapctty Hereby audiorize.�Cct tf 0,i1 0 3�C ou n�p'oehalf in all matters relative to work.aurhoriaed by this but&g permit application.for. {Address afjo Pool fenc e-S and alarms aim the i espor8lltty o:f the apphcan Poc 15 ate Rbt.:to be fil d 61 ut.d=: d Before fence-s instAkd and.all fli l Ja. b 'ons are performed and accepted S Bna of Owner Sipature:of Applicant �1 Print dame PLinc Name AW � ` Date Q;F0 MS:0WNF_"ERJ.SJ5S10NF00LS TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 250 088 GEOBASE ID 16004 ADDRESS 243 OLD STRAWBERRY HILL PHONE . Hyannis ZIP - LOT 83 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 11930 DESCRIPTION RESINGLE PERMIT TYPE BROOF TITLE BUILDING PERMIT ROOFING CONTRACTORS: MAIN HOME IMPROVEMENT Department of Health, Safety zxITECTs: and Environmental Services TOTAL FEES: $50. 00 BOND $ . 00 CONSTRUCTION. COSTS $1, 200 . 00 �TME 750 ROOFING AND SIDING 1 PRIVATE PROPERTY e 4 + ER RNSTABI.E. i OWNER HILL, DOROTHY E ADDRESS OLD STRAWBERRY HILL RD16 HYANNIS MA ED ► s: DATE ISSUED 11/29/1995 EXPIRATION DATE x BUILD DIV IO BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR r ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- r 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS is P ti 3 2 2 u' 2 1! 5 .s 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT Ilk 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL i WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY _ VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS IFTELEPHONE OR WRITTEN NOTIFICA- .-2<s"essor's Office lst floor) Map Parcel Permit# 1 �� Date Issued f �� Fee �U r� V �ngineering Dept. (3rd floo House# c; 3 FJS �.TME D ammng Board .19 b 9. r TOWN OF BARNSTABLE Building Permit Application ,roject Street Address r 'aye ® e 'Aillage �wner 1 Address ��elephone ,;�Oermit Request 9►' — ' First Floor square feet Second Floor square feet V/Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths''.. No. of Bedrooms ~ - Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information r Name —Telephone Number6Xd dress cZR License# 0 (, ) ��°✓ i� Y►� f,� l� j Home Improve nt Contractor# / Worker's Compensation#5ge 42A"LZ NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE / 02 h BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) a FOR OFFICIAL USE ONLY PERM NO - � - -. -. _ ;- - , • ' DATE MAP/ AR EL NO. ?, ' ! • } ' ADDR S ` ' VILLAGE OWNS , DATE F ISPECTION: c FOUN ATION E = - •s FRAME INSULATION ! - FIREPLACE ELECTRICAL: ROUGH FINAL - - PLUMBING: ROUGH ' FINAL } + GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. E t' i S i t } I t 12/19/95 TOWN OF BARNSTABLE PAGE 1 PERMITS ISSUED BY TYPE SELECTION CRITERIA: permit.permit_type matches 'B*' and permit.stat='A' contracts.contractor id='061621' PERMIT PERMIT MASTER TYPE TITLE ISSUED NUMBER EXPIRED PERMIT FEE PARCEL ID ADDRESS BROOF BUILDING PERMIT ROOF 11/29/95 11930 50.00 250 088 243 OLD STRAWBERRY HILL TOTAL REPORT 1 50.00 RUN DATE 12/19/95 TIME 13:32:32 PENTAMATION - PERMITS MANAGER The Commotrivealth of Alassachusetts Depart►ne»t of Ltditstrial Accidents ' l office o 10=1192118ns 600 If uci►ington Street Boston,Alas. 02111 Workers' Compensation Insurance Affidavit 7A-nMlicaa nformation-- Pleace PR1NT`hibly a� ,�', _ name: locition• city phone# 1 am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity L..=..t :` P."nC.:;,ur[•1+7??T.v . . •:.T' , '!r!e!N'..wTe�"..+.w'�'"'.'°' I am an empiover providing workers' compensation for my employees working on this job. compiny name' t address: ,City: ohnne#: insurance co fiolicy# .fir.... a+..►-�.aer;vAe^`., ++..e..r�..r.r� .�...r....�...s.. 1 am a sole proprietor, eral contractor omeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: ne• �.1�/� `TV (5�'L_� / WL am •ttldress• �i7� w L^�-t G �� •�p VA VA-LA - 70 79 'T7 , >insur.qnCC co ( A . 7.1 _ -____ 'T�!iFf3!r47°�4''R_1._��:R:!!rprSR ��' .�'•�'.'sS company name: dress: city phone#• insurance co policy 0 :Atiachh additional sheet if aecessary,;r•,:,+K.:::�:;wrs-�.r:�t�ry.•+r.�r.•F„t,,�::7-777 =�_►-R___.--Zte_;,._��-�_�-- Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification. !do hereby cerrifj,under time pains and penait' -o perjuq•that the infornwtion provided above is true and correct. Si_naturev Date Print name Yl i e—Yvv vy�- \ JCe e2'e C—\- Phone tr official use onlw do not write in this area to be completed by city or town oMcial city or town: permit/license# riBuildi7DepartmentOLicenD check if immediate response is required C3Select�Hcaltcontact person: phone q;, Imiscd 3M" PJA) : The Town of Barnstable $ Department of Health Safety and Environmental Services i619. - Building Division 367 Main Street,Hyannis MA 02601 Ralph Ciossen Office: 508 790-6227 Building Commissions F= 508775-3344 For office use only Permit no. Date AFFIDAVIT HOME E"ROVEMENT CONTRACTOR LAW- SUPPLEMENT TO PERMIT APPLICATION n,conversi MGL c. 142A requires that the-reconstruction,alterations,renovation,repair,moderai=tio o n,e improvement,.removal, demolition, or constriction of an addition to any pre adsting owner �P id building containing at least one but not more than four dwelling units or to structures which are adjacent ' to such residence or building be done by registered contractors,with certain accepuons, along with other tequirera its. v Type of Work: LA A- Est.Cost l AkA AU r/ Address of Work: y �Oarer.Name: ✓Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work occluded by law Job under S1,000 Building not Dames-occupied Owner pulling own permit Notice is hereby given that: CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING DSO NOLNOT HAVE CESS TO THE APPLICABLE HOME IMPROVEMENT WORK ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the ov►-ner. Date Contractor name Registration No. z OR ' Date Owner's name . x � 5 � t. +r' .• p� - `� ONE;IMPROVEMENT RACtQR i�iAak maw e r Regl<stratiolr:A 5 ' .yp ., _k�; Ezp>trat5, A7 f � r-� R99 .Nain�Hooe�I�pcov''p , Dav�idM�tat n. G� �o 7��E'V 0`Boz 04 5tree ADMINISTFiA70R �• ��`?�^ �� F �} �{ Onn>,s MA 02638 Pt mz Av COMMOPIWEALTH ,51� Y *} e 1 I'?ARTMIEN� PUBLIC SAFETY OF AS TiBQRTANPLACE BQSTON,MA 02108 MASSACHUSETTS r CAUTION :� L TOEhJf__17 EXPIRATION DATE. �> r?`'�e'�m R `-}��RV I'S0R � FOR PROTECTION AGAINST FFECTIVE DATE. 41C N¢. THEFT, PUT RIGHT THUMB RESTRICTIONS , a PRINT IN APPROPRIATE s BOX ON LICENSE. 0m r BLASTING OPERATORS pflll £D ILL MA£N � � MUST INCLUDE PHOTO. DUX 404% GJFiIu I Palloretopasssssaofff"t k PHOTO(BLASTING OPR ONLY) FEE: .ENtJ NOT VALID UNJ1L SIGNED BY LICENSEE AND OFFICIALLY ~ Massaobasstts state BIIldlao iA { HEIGHT: $?AMPED OR-SIGNATURE OF THE COMMISSIONER., ( �t1 QaI���OI/I/OOINOA lfAlallaanaa. DOB: I ' 5 21 9/ I c2tir7.�'J' 31GNN,dME IN FULL ABOVE SIGNATURE LINE .THIS DOCUMENT MUST B TjjRSE u CARRIEDON THEPERSON - - . THE HOLDER WHEN TMom � i. k 5 OTHERS-RIGHT THUMB PRINT GAGEDINTHISOCCUPA 1 .�� � .r L: w. -..s.+rr. ..,;"� t.y•i.Y a '.'dcufr• r..d ... . LP v 3 2 'E? IssUE DATE (MM/DD/YY) �CA� )F JfSCI ..... . .. 11 28 95 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, RYDEN & SULLIVAN INS EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 8 FALMOUTH ROAD COMPANIES AFFORDING COVERAGE YANNIS MA 02601 COMPANY A TRAVELERS INSURANCE CO LETTER COMPANY B INSURED LETTER AVID MAIN COMPANY C BA MAIN HOME LETTER IMPROVEMENT COMPANY D P.O. BOX 404 LETTER DENNIS, MA 02638 COMPANY E LETTER COVERAGES .. ... ....................... ... ... .. ..... .. .. .. ......... .. 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. CO POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER LIMITS TR DATE (MM/DDNY) DATE (MM/DDNY) GENERAL LIABILITY 6 8 0 3 0 6 W 3 6 6 0 COF %2/0 3/9 5 12/0 3/9 6 GENERAL AGGREGATE $ 600 , 00 O COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ 600 , 00 CLAIMS MADE OCCUR. PERSONAL&ADV.INJURY $ 300 , 000 OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ 3 O O 000 FIRE DAMAGE(Any one fire:, $ 5 O 000 MED.EXP.(Anyone person) $ 5 00 O AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ F1 GARAGE LIABILITY PROPERTY DAMAGE EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ ..................... .............._.......................... .....,,........ .........._........ ..........._........................... ......._..._. ._..__.......................__. _..._._........ .................._.. OTHER THAN UMBRELLA FORM STATUTORY LIMITS . WORKER'S COMPENSATION EACH ACCIDENT $ AND EMPLOYERS'LIABILITY DISEASE-POLICY LIMIT $ DISEASE-EACH EMPLOYEE $ OTH• PROPERTY DESK CRIPTION OF OPERATIONS/LOCATIONS/VEHICL-MISPECIAL ITEMS OTE: STATE LAW NOW—PROHIBITS US FROM DOING CERT, OF INS ON WORKERS COMA f `OLICIES. THESE MUST BE OBTAINED DIRECTLY FROM THE INSURANCE CO. WE 'HAVE� 4E. UESTED THAT THEY SEND YOU A CERTIFICATE ASAP—�_ -- -- CERTIFICATE Ht)LDER ­11 CAAICELLA FIQN;._.. .... ...... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO TOWN OF BARNSTAB LE hg�@ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE BLDG D I V, ATT• LOU I S E LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR MAIN STREET LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. HYANN I S MA 02601 AUTHORIZED REPRESENTATIVE INS[tR1NET 25-5(7I9U) INSURNET INC.. 940 AGENT 1heTravelers'j'' WORKERS COMPENSATION AND The Travelers Insurance Companies EMPLOYERS LIABILITY POLICY (Each A Stock Insurance Company) Hartford, CT 06183-4040 TYPE AR INFORMATION PAGE WC 00 00 Ol ( A) POLICY NUMBER (6N-UB-704K459-2-95) NEW-95 INSURER: THE PHOENIX INSURANCE COMPANY NCCI- CO CODE:. 12610 1 . INSURED: PRODUCER: MAIN, DAVID DBA BRYDEN & SULLIVAN INS AG MAIN HOME IMPROVEMENT 88 FALMOUTH RD P 0 BOX 404 PO BOX P DENNIS MA 02638 HYANNIS MA 02601 Insured is AN INDIVIDUAL Other work places and identification numbers are shown on the schedule(s) attached. 2. The policy period is from 03-23-95 to 03-10-96 12:01 A.M. at the Insureds mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state (s) listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: 100,000 Each Accident Bodily Injury by Disease: 500,000 Policy Limit Bodily Injury by Disease: 100,000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy appplies to the states, if any, listed here: SEE ENDORSEMENT WC 20 03 06 a d� D. This policy includes these endorsements and schedules: ,—_ SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE a= 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating. Plans. All required information is subject to verification and change by audit to be made ANNUALLY DATE OF ISSUE: 03-27-95 GL RECEIVEDST ASSIGN: MA OFFICE: GRIND 161 DISTRICT: C-09 i PRODUCER: BRYDEN & SULLIVAN INS AG 232MY MAR 3 0 1995 FOR DEPOSIT ONLY ............................... .......................................................................... . ISSUE DATE '((v1M/bD/YY) a1:ORIP® C RT F A 0 �1 1JR�4I E ,1-29-95 PRODUCER:.::.::........................................................................................................ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE BRYDEN & SULLIVAN INS AG DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 88 FALMOUTH RD POLICIES BELOW. Po Box P HYANNIS MA 02601 COMPANIES AFFORDING COVERAGE COMPANY LETTER A THE PHOENIX INSURANCE COMPANY 232MY COMPANY B INSURED LETTER MAIN, DAVID DBA COMPANY C LETTER MAIN HOME IMPROVEMENT P 0 BOX 404 COMPANY D LETTER DENNIS MA 02638 COMPANY E LETTER Q.... ... ............................................................................................................................................................................................................................................................................... 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. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE 71 OCCUR. PERSONAL&ADV.INJURY $ OWNER'S&CONTRACTOR'S PROT. S EACH OCCURRENCE FIRE DAMAGE(Any one(Ire) S MED.EXPENSE(Any one person) S AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS I R E C E I V ® BODILY INJURY $ SCHEDULED AUTOS L (Per Person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS DEC 111995 (Per Accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM STATUTORY LIMITS A WORKER'S COMPENSATION 7041<4592 03-23-95 03-10-96 EACH ACCIDENT S 000100000 AND DISEASE—POLICY LIMIT S 000500000 EMPLOYER'S LIABILITY DISEASE—EACH EMPLOYEE S 000100000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. .............. ................................................................. ...................................................................................................................................................................................................................................................................................................... . TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BUILDING DIVISION/ATTN: LOUISE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO 367 MAIN STREET MAIL 10 DAYS WRITTEN NOTICETOTHE CERTIFICATE HOLDER NAMEDTOTHE ` HYANNIS MA 02601 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE AEO :CORPR?RATION:181f:> Rf..... ........................................................................................................... .......... . ....... ... .. ..... ....... .... ..... ............. ... ...... .............................. THE TRAVELERS CL RESIDUAL MARKET P.0 BOX 3556 ORLANDO, FL 32802-3556 f ` + I"1i fr : r + f BRYDEN & SULLIVAN INS AG 88 FALMOUTH RD PO BOX P HYANNIS MA 02601