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HomeMy WebLinkAbout0316 SEA STREET (2) 3 J to S �.�. S=f� TM ._ r i J 9 L ___ rti Town of Barnstable �~ �\ Post This Card So That it is Visible From the Street;Approved-Plans Must be Retained on Job andahis Card Must be Kept Posted Until Final Inspection Has Been Made. e Where a Certificate of Occupancy is Required,such.Building shall Not:be Occupied until a Final Inspection has been made. " Permit No. B-17-3519 Applicant Name: Approvals Datelssued: 11/02/2017 Current Use:. Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: - 05/02/2018 Foundations Location: .316 UNIT D SEA STREET, HYANNIS Map/Lot: 306-241-OOD Zoning District: RB 'Sheathing: Owner on Record: COLON,WANDA&THORPE, ROBERT Contractor Name: PAUL M DOWNING Framing: 1 Address: 14 COOPER RD Contractor License: CS-074247 2 7 t Cost: 0.00 NATICK MA Ol 60 Est. Project C $ Chimney : Patio Door No Structural Permit Fee: 160.00 Replacement ment at o Description: p $ Insulation:. Project,Review Re Fee Paid; $ 160.00 Pro J q: . Date: 11/2/2017 Final: -. Plumbing/Gas Rough Plumbing: 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 the approved construction documents for which this 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 or road and shall,be.maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Ins:-lation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 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 BUILDING PERMIT APPLICATIO Map J012 LZql Parcel O O J� Applic Qa Health Division Date Issued �17 Conservation Division Application Fee Planning Dept. Permit Fee ` Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project SW�Zvks ress 3�� c�� Sr LIiU�J"� Village Owner C040,I) o6er DN dress3l6 Nutt' /17 ez4o r Telephon4 $ 333-Y7 7 9 Permit Request ? / (� kb Square feet: 1 st floo xi 'ng proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio � Type Construction T e Lot Size Grandfathered: ❑Yes 16d bf1 ,� h.supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family n(# units) ��qq�� Age of Existing Structure Historic House: ❑Yes ❑ T Wing's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other TOWN OF BARNISTABI_E Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name rau I ,0(��1�4! Telephone Number 66 - �Z7— Address / w 1 License# 0 71 Z 57 AA Home Improvement Contractor# ` Email Worker's Compensation # Y)&_ 4456/60782D/6,4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 1 DATE i 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 k DATE CLOSED OUT ASSOCIATION PLAN NO. i _ w �taE tqy, BAIMSTASLB +� MASS. ,�� Town of Barnstable Arf° �A Building Department Services Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us s Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder h ' as Owner of the subject property hereby authorize -PI,VJhbu-Jol na to act on my behalf, T- in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner • Date Print Name if Property Owner is applying for permit,please complete the Homeowners License Exemption:Form on the reverse side. QAWPHLESTORWbuilding permit formsTYPRESS.doc 08/16/17 SPECIAL SERVICES CUSTOMER INVOICE Page 1 of 14 NO. H2612-51602 Store 2612 HYANNIS Phone:(508)778-8948 :- - - — ------- - 65 INDEPENDENCE DRIVE Salesperson:AMR5697 HYANNIS,MA 02601 Reviewer::VXG1123 Nerve REPRINT COLON WANDA (»4)308-3103 i o •, e' 316 SEA ST UNIT D rnmx x (508)333.4779 CAY HYANNIS JaeO "°" patio door install, 201740-061004: smt. MA 02601 O0 fitly BARNSTABLE CtJSTOIVIRdtCKl #1ky; MERCHANDISE AND SERVICE SUMMARY o�d`�Amershttolimitthequantitiesotmerd�andise REF#W1'1 SKU#0000515-664 Customer Picku I Will Call S.O.MERCHANDISE TO BE PICKED UP: S/O SILVER LINE BLDG REF#S09 ESTIMATED ARRIVAL DATE. 09/27/2017 12724 PRD �. S0909 0000-268=837 1.00 EA NA l SOS BUCK WITH INSTALLATION FLANGE PD 2 P!50S-BUCK WITH A $572.21 $572.21' INSTALLATION FLANGE PD 2'PANEL-5502#1 S0910 0000-268-837 1.00 EA NA/(CONTINUED)/50S BUCK WITH INSTALLATION FLANGE.PD 2PAN Y $0.00 $0.00 5502(CONTINUED)RLEADTIME=NW$SU$=LEFT SLAB$$3A$WPROP$=A$WDIM$=ASLAB WIDTH=29.4995ASLA�� HEIGHT 75.75A$WQ$=A$SU$=LEFT GLASS$$JA$WPROP$=A$WDIM$=AGLASS O WIDTH=28.3125ADISPLAYGLASS WIDTH=28.31 A EIGHT=77 SCHEDULED PICKUP DATE:10/12/2017 • 572.21 �=E'NO, F.CU TOMER-PICKUi =REF INST-ALLO WL' I Y REF#101 s STOCK MERCHANDISE TO BE DELIVERED: ESCRI�TIOM1t.''" ,,� - .�:�. .x�i :TAX sP �C ..EkCH� - NSION R03 1001-361-475 1.0 4-1/2"72"WW412 OAK SADDLE 1A Y 22.98 22.98 � `"'.C�N'Fl UEdONfIEXT�PA WILL.CALLMERCHA P Will•Callitems nthestore;for7daysonly. ; Ai R{", Cheek your current order status online at tr>YtOf' � � 0%SILLAL 'x SERUICE'.DESK AREA a j www.homedepot.eomlorderstatus l Ica es I em ma owli� .• - Page 1 of 14 NO H2612-51602. Customer Copy zfy • I . i SPECIAL SERVICES CUSTOMER INVOICE-Continued Name:COLON Page 3 of 14 NO. H2612-51.602 REF tM01. INSTALLATION,SIT NAME- COLON WANDA INSTALL LABOR CHARGE: $569.00 ADDRESS- 316 SEA ST UNIT D TRIP CHARGE: $0.00 CITY: HYANNIS STATE: MA Zip:02601 CREDIT FOR DEPOSITIMEASURE: 30.00 COUNTY: BARNSTABLE SALES TAX RATE:6.250 TAX:Merchandise,Y LABOR-N $539.00 PHONE: 508 3334779 ALTERNATE PHONE: 774 3083103 BASIC INSTALLATION LABOR INCLUDES: PRE-INSTALLATION JOBSITE INSPECTION EXISTING DOOR DELIVERY WITHIN 30 MILE RADIUS OF STORE , a INSTALL NEW CUSTOMER PROVIDED INTERIOR CASING AND REMOVAL OF EXISTING DOOR UNIT EXTERIOR TRIMBRICKMOLD OF THE NEW DOOR WHEN THE INSTALL NEW PATIO DOOR UNIT CASINGITRIM IS THE SAME SIZE OR WIDER 'INSTALLER TO PROVIDE NECESSARY FASTENERS,SHIMS AND 'INCLUDE NON-COLORED STUCCO PATCH UP TO 4•FROM JAMB AFTER CAULKING EXTERIOR MOULDING IS INSTALLED,WHEN APPLICABLE •INSTALL EXISTING OR NEW CUSTOMER_PROVIDED DEADBOLT, 'FINAL CLEAN UP OF ALL DEBRIS RELATED TO INSTALLATION' LOCKSET AND KICK PLATE(IF APPLICABLE)ON NEW DOOR 'FINAL INSPECTION WITH CUSTOMER INCLUDING INSTRUCTIONS ON •ADJUST DOOR TO ENSURE'PRO PER OPERATION a CARE OF PRODUCT TO ENSURE,PROPER OPERATION `DRILL HOLE IN JAMB.FOR ALARM WIRING IN SAME LOCATION AS ` UNLESS STATED ABOVE THIS INSTALLATION DOES NOT.INCLUDE: INSTALL DOORS OVER 96X96 STUCCO PATCH GREATER-THAN 4-,PAINT AND STAINING INSTALL FIXED ARCH TRANSOM LITE IN EXISTING OPENING DISCONNECT AND RECONNECT OF SECURITY SYSTEMSIWIRING REPAIR CARPENTRY TO EXISTING OPENING ` PLASTER,DRYWALL OR SIDING WORK: SPECIAL NOTES: IT MAY BE NOISY DURING YOUR.'INSTALLATION THE INSTALLER WILL BROOM CLEAN THE IMMEDIATE WORK AREA BEFORE COMPLETING THE INSTALLATION..AIRBORNE.DUST IN OTHER PARTS OF THE HOME IS A NATURAL OCCURRENCE AND IS THE RESPONSIBILITY OF THE CUSTOMER. AN ADULT OVER 18 YEARS OF AGE WITH THE AUTHORITY TO MAKE DECISIONS ABOUT YOUR INSTALLATION MUST BE PRESENT DURING THE INSPECTION(WHEN APPLICABLE),DELIVERY AND INSTALLATION - ', •�aoirTlrlaeo`�N`NEiC`aac� Page 3:of 14 NO. H2612-51602 Customer Copy SPECIAL SERVICES CUSTOMER INVOICE-Continued Name:COLON Page 5 of 14 NO. H2612-51602 s 1NS1'AIr t,AYiaN#Z f �} REF M02 PICK UP FROM THAT MUNICIPALITYAND DELIVER TO EITHER JOBSITE 'ALL FEES ASSOCIATED WITHOBTAINING PERMIT(MUNICIPALITY DELIVER COMPLETED PERMIT PACKAGE TO PROPER.MUNICIPALITY, SPECIAL NOTES: CUSTOMER IS RESPONSIBLE FOR PAYMENT OF THE PERMIT.ONCE IN FULL.NO REFUNDS ON PERMIT FEES AFTER 72 HRS.OF PAYMENT. THE PERMIT IS PAID FOR,WORK ON THE PERMIT ASSEMBLY BEGINS IMMEDIATELY.CANCELLATIONS WITHIN 72 HRS.WILL BE REFUNDED •7 ; .ENO OF 1NS'EALL#2 4' 'ZI fir TOTAL CHARGES OF ALL MERCHANDISE & SERVICES Policy Id(PI): $1,355.75 A:90 DAYS DEFAULT POLICY; SALES TAX $46.86 TOTAL $1,402.61 BALANCE DUE $950.74 PAYMENTTERMS Refer to the Home Improvement Agreement for payment terms - The Home Depot reserves the right to limit/deny returns.Please seethe return policy sign in stores for details.'' - � �:��s _` `� ��`� .,s �; _�, t.'.,END OF-ORDEItNo.H262ti516D2 m- �• :' �. �"<`w '•� =� _��'���`�� ,,,� s 3 Customer's Signature Date oZ r Page 5 of 14 NO. i2612-51602 customer copy > From: Kerry McNamara[mailto:kerrymcnamara52@yaho6:c6mj Sent:Wednesday,September 27,2017 8:01 AM To: Rob Thorpe<rob.thorpe@rossmorteageco.com> Cc:Robert Thorpe<rithorpe@comcast.net> Subject: Re:Assessment 9/25/17 Robert Thorpe Cape Mariner condominiums 316 Sea st Hyannis, Ma Dear Rob You have the association permission to install a new slider. Call if you have any other questions Thank you r Kerry McNamara, Manager Cape Mariner Condominiums Cape Cod and Islands Property Management, Putting Greens & Versacourts of CapeCod Real Estate rentals and broker ' Po Box 1144 Osterville, Mass 02655 508-428-0503 office 508-428-1949 fax ` vwwd.capecod-greens.com . On Monday, September 25,2017, 100;40 PM EDT, Rob Thorpe <rob.thorpeca-)rossmougageco.com>wrote, Hi Kerry, I have been meaning to email you but got sidetracked with an emergency work project at my house in'Natick. Over the Labor Day weekend, I took some new photos(see attached) of the corner of my back deck where the wood shingles were replaced. It had been raining over the first part.of the Labor Day weekend and it was quite evident that the gutter that was repaired is leaking again in the exact same.place and.causing the same dampness on the same section of shingles. The water drips down missing the higher shingles and splashes off the domed light fixture dissipating the water over the _bottom corner shingles and deck. ! also have been asked by Home Depot to request.a letter from the Cape Mariner Condo Association.giving them permission to install.the new sliding door to the deck to replace the old one now that the rotten framework ; has been replaced. I look forward to hearing from you. Regards, A • , - 2 The Commonwealth of Massachusetts Department of Industrial Accidents 7 Office of Investigations l Congress Street, Suite 100 Boston,MA 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): �,�� I,�>�Ui Address:_L Kj�,SU)(td1_ — City/State/Zip: _ _r h Q �> � - Phone#: Are you an employer?Check the appropriate bc. Type of project(required): L❑ I am a employer with 4- f2lm a general contractor and I Cam Wearn, mployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction a sole proprietor or partner-. `` listed on the attached sheet. 7. ❑ Remodeling shipand have no employees These sub-contractors have 8. n Demolition working for me in any capacity. employees and have workers' insurance. 9. Building.addition comp. [No workers' comp. insurance P- required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 atn 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 till 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. TContraclors 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 isproviding workers'compensation insurance for my employees Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins. Lie.•#: Expiration Date: Y . 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 c! under the pains and penalties of perjury that the information provided above is rue and correct Si ature _. — - Date: Phone#: Official use only. Do not write in this area,to be completed by city or town offzciaL 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#: j= The Commonwealth of Massachusetts Department of IndustriatAccidents Office of Investigations +� ) 1 Congress Street, Suite 100 . Boston,IVA 02114-2017 wl11Bl.mass.gov/dia ' Workers' Compensation Insurance davit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le6ibly Name (Business/Organization/Individual): The Home Depot At-Home Services' Address: 908 BOSTON TPK City/State • SHREWSBURY. MA 01545 Phone-4. (508)942-6942 Xemployees a o heck the appropriat bo Type of project(required): 200= ' 4� - neral contractor and I ploverwith 6. ❑New construction (full and/or part-time).x have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition employees and have workers working for me in any capacity. 9. ❑ Building addition " comp. insurance [No workers comp. insurance m � I0. Electrical repairs or additions required.] 5. Q We are a corporation and its 3.[] I am a homeowner doing all work officers have exercised'their I I-[(Plumbing repairs or additions myself. [No workers` comp. right of exemption per MGL 12.E] Roof repairs insurance required.]T c. 152;y 1(4),and we have no employees. [No workers' 13•[YOther f� comp. insurance required.] o Y� - *.4nv applicant that checks box=l must also fill out the section below sho++ing their workers'compensation policy information. r t►-iotneotivners who submit this affidavit indicating they are doing-all work and then hire outside contractors must submit a new affidavit indicatinesuch. 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,tilev must provide their workers'comp_police number. I am an etnpl6yer t11at is providing workers'compensation insurance for my employees. Below is the policy mid job site information. ` Insurance Company Name:NATIONAL UNION FIRE INSURANCE COMPANY — 03/01/2018 Policv f or Self-ins. Lic.r: XWC 65831 45(QSI) Expiration Date: ' Job Site Address: C7�io Sat 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,Section25A 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 ci-61 penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day a6a a violator. Be advised that a copy of this statement may be forwarded to the Office of,. Investigations of the Dit r in4irance coverage verification. I do hereby certify un f e lie sins a d f pry r erju that the information provided ab ove /f 7 tru and correct. Date: /6 7 Sianature: + Phone 9: O fficialonly_ Do not write in this area,to be completed by city,or rotdii off eial. - r n: Permit/License# hority(circle one):Health 2.Building Department 3.City/'Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: ACCOltt�RLIF CERTIFICATE OF LIAEILITY INSld1�i4N�CE D02i72MIODIYYY1i FTHIS 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 1 BELOW_. THIS CERTIFICATE.OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(% AUTHORIZED J{ REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(jes)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 Ileu of such endorsement(s). PP.ODUCER CONTACT .. MARSH USA,INC. NAME T'AO ALLIANCE CENTER wDNr o I ac No. 3560 LENOX ROAD,SUITE 2400 E-mA11 A T LANTA,GA 3D326 ADDRE55: INSURERIS)AFFORDING COVERAGE. I NAIC a 100492-HOmeD•GAW%17-18 INSURER A•Ora-REpUbNC InsUtanM CO 124147 INSURED I THE HOME DEPOT,INC. INSURER e:Agri Cmeral Insum,rce Company 142757 HOME DEPOT U.S.A.,INC. INSURER C:New Hampshire Ins Co 123841 2455 PACES FERRY ROAD BUILDING C-20 INSURER D: I ATLANTA,GA°.0339 INSURERE: j ` INSURER F.• I COVERAGES CERTIFICATE NUMBER: ATL-OD3746387-14 REVISION NUMBER-2 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 CONTRACTOR 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. iLTRR I TYPE OF INSURANCE (INSDAD B + POLICY NUMBER j 61M CCY EFF PMOCLI I UMRS A COMMERCIAL GENERAL LIABILITY MLV7_`f 310022 EACH OCCURRENCE I S 9,000,00D I^- �- - + 03101/2017 0310112018 I I CLivMS,`JiDE I X i OCCUR PAMAGE 5 I RENTED RcwSES Eacmdrence s 1,00:7,1p1D i jMMITS OF POLICY XS I >, MEDEXPIArWwea=son) i S EXCLUDED IOF SIR S1 M PER OCC $.RSONAL&ADV INJURY IS 9,00D,OOD i NrIENOTHER LAGGREGATE UKTAPPUES PER: t CENERAL AGGREGATE j S 9,60D0C'Gi PRO- POLICY .� LOC i PRODUCTS-COMPIOPAGG S I f - � I I S A AUTOMOBILE UAeILrrY M1'VTB310021 01701r2017 03/012 LI 018 COMBINED SINGLE MIT (Ea accident) I S .1.000,DD0 4 X ANY AUTO I I ` - BODILY INJURY(Pe-peison) 15 ALL OVWED scriEDULED III SELF INSURED AUTO PHY[LAG " I AUTOS AUTOS j eomLYINJUPY(per­a-ern)j S Oy. I I fP�-ERTY�5At HIRED AUTOS aedetd 15 UMBRELLA UA HCCc,,':-MA,._ EACH OCCURRENCE SExcess LU1B B c. ` I AGGREGATE I S DED I RETENTIONS I I I S 8 (1VORKEPSCOMPENSATION V&RC491123MMi 0310i2017 D31012D1B X PER OTH- e AND EMPLOYERS'LIABILITY I I STATUTE I I EP. C Y I N WC 023102423(AK,NH,NJA 0310112017 JU310VZOID ANY CERIM MSEPIPARTNDED7ECUT1� a ' I OFFlCE(LMErttBER ExcLwEoz � NIA I EL Eaa-t ACI:D3JT I S I(Mandatory in NH) WC Oa,02424(WI) I031D12D17 031D12018 E L:DISEASE EA EMPLOYEE s 1,000,GOD IOIf yas.Il-TIONdescfta undo CmIlin0ed an Add60rd Pme I DESCRIPTIDN OFO.�cRATlOf75bdow I :EL DISEASE-POLICY LIMIT I S 1,000,C� '- DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may he attached U more apace is required) - - EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,ING 2455 PACES FERRY ROAD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE ,DELIVERED IN ATLANTA,GA 34339 ACCORDANCE WITH THE POLICY PROVISIONS. AUTrIORIZED REPRESENTATIVE of Marsh USA lnc i Masashi Mukherjee __31uoowtu 0 1988-2014 ACORD CORPORATION. All rights reserved ACORD 25(2014/01) The ACORD name and l000 are registered marks of ACORD I AGENCY CUSTOMER ID: 100492 LOC#: Atlanta �1 AC4 RV ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED MARSH USA,INC. HOME DEPOT U.SA,INC. DIWA THE HOME DEPOT POLICY NUMBER 2455 PACES FERRY ROAD BUILDING C-20 CARRIER NAIC CODE ATLANTA GA 30339 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate Of Liability Insurance Workers Compensation Confined: Cartier.Indemnity Insurance Company of Narth Arte Aca Pofxy Number.WLR C49112294(AL,ARFL,ID,IA,KS,KY.LA,MS,MO,NE NKND.OK SC,SD,WV,WY) Effective Date:03 IW7 Expiration Date:03101018 (EL)Limit S1,000,00D r • Cartier:New Hampshire Insurance Company Policy Number WC WM02422(DC.DE,HUN.MD.MN.MT,NY,RI) E((et five Date:03101W7 Expiration Date:O 12018 (EL)Limit S1,01AM0 r , Carrier:ACE American Insurare a Company Policy Number.WCU C49112282(OSI)(AZ,CA,IL NC,ORVA,WA). EffecM Date:031D112D17 Expiration Date:03IM12018 , (EL}Limit S1,000,01X) SIR:S1,0W,0W SIR for the states of AZ,CA,IL NC ORVA WA Carrier.National Union Fire Insurance Company Policy Number.XWC 6%3144(OSQ(CO,CT,GA,ME,MI,NV,OH,PAUT) Effective Date:0310112017 Expiration Date:0310112018 (EL)lfint$1.000,000 r` S1,0D0,00D SIR for Me states of CO,ME.NV,MI,OKPA,UT , S750.000 SIR for the stale of GA S350,0W SIR for the s13Ie of CT Cartier.National Union Fire Insurance Company Policy Nranber.XV1'C 6583145(OSI)(MA). EflectiueDate:O'J01=7 Expiration Data:03101R018 (EL)Umit 51,00D,00D Slit 550D.00D TX Employers XS indemnity: _ ,• . Camerl1ri ilos Union Insurance Company Policy Number.TNS C48613202{T)C) Effective Date:WA1112017 ' e Fxpi.stion Date.03101/2018 (EQ Umit S10,000,001) SIR SLOW.00D, I ACORD 101(2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD g `` rMg n it al,iBb.t33?4 4 w 1 PAUL M DOWNING 1$0 KESWfCK ROAD SROCKTON MA 023 Commss: ion;,er M $201 19 gym € Y C 4p