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HomeMy WebLinkAbout0033 SIXTH AVENUE (HYANNIS) 33 Six-i1�, -Avg -- --� - - - Application umber.. I I O�tMEt -y� 1� � O� PR3 0 � 9 Fee....................................................... � MAaARNSS , t OWN I Building Inspectors Initials......... HHA18I B �FDMA'� Date Issued..............V.5. � IF...................... Map/Parcel....... . .."'.......I.................................. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION, PROPERTY INFORMATION Address of Project: _'�3 SIXTH AVE- H YAN N I S , I1 P NUMBER STREET VILLAGE Owner's Name: k)U IV L s P f[-R S PE I CV1 E Phone Number-2 10 Email Address: 0t SS a`tX i? Gi�COm Cell Phone Number Project cost$ 6, 35V Check one Residential i/ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 786 CMR Owner Signature: Date: TYPE OF WORK F-1 Siding 0 Windows (no header change)# 0 Insulation/Weatherization ED Doors(no header change)# Commercial Doors require an inspector's review ED Roof(not applying more than 1 layer of shingles) Construction Debris will be going to a(M0 OLUIr'1 CONTRACTOR'S INFORMATION Contractor's name /}�nI L-V S Home Improvement Contractors Registration(if applicable)# 1$3 2 0 2 (attach copy) .. Construction Supervisor's License# O 6 10 2 (attach copy) Email of Contractor w rz q a4ndcDr"roa, ,P_r e U'J m Phone number 5O S- 7 76 - Z9 0 0 ALL PROPERTIES THAT HAVE STRUCtURd OV 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............................................................ *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. Purpose of Event f 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. E *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: 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 documentation required by 780 CMR and the Town of Barnstable. Signature Date PLICANT'S SIGNATURE Signature Date All permit applications are suhject to a building official's approval prior to issuance. Office of Consumer� irs and Business Regulation One Ashb on Place-Suite 1301 Boston, Ili - achusetls 02108 tz Home Improve , nt•Contractor Registration i Type: Individual ARMEN SAFARYAN - Registration. 183202. 67 SEA ST APT A4 - 6Piratiom 09/13/2019 HYANNIS, MA 02601 `4 a 20M.W17 update Address and return card. Office of consumer Affairsg a Business Ration HOME IMPROVEMENT CONTRACTOR R istrgUOn valid for individual use only TtrPE;Indnndual b fore the epiration date. if found return to: E—m�ion _ er ace of Consum Affairs and Regulation 1832p2>==___. 09/13i2019 1 t'ark Plaza-Suite 51 ARMEN SAFgi3�G1k11( B n,119A 02118 OB/A COREYAND COS!_Y f ARMEN SAFARYANI iILI 67SEASTHYANNIS,MA Undee�eiary Not valid without drqnVure Massachus, Department of Public.Safety } ' Berard of`Buii�ing Regulations and Standards •License: 106102 Consviruction Sug6 isorSpacialiy ARMEN SAFARI s. 6T SEA STREET ' iiVANMS MA 02 q01 A Comrnlssi•Tier Expiration: 1010=020 a ACCWL?® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY() 09/13/2018 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 have ADDITIONAL INSURED provisions or 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 Ashley Paiva NAME: Eastern Insurance Group PHONE (508)997-6061 FAX (508)990-2731 C No.Ext: (AIC,No): 439 State Rd. E-MAIL a aiva easterninsurance.com ADDRESS: P P.O.BOX 79398 INSURER(S)AFFORDING COVERAGE NAIC V North Dartmouth MA 02747 INSURER A: Arbella Protection Insurance 41360 INSURED INSURER B: Armen Sataryan INSURER C: DBA:Corey and Corey INSURER D: 67 Sea Street Unit A4 INSURER E: Hyannis MA 02601 INSURER F: COVERAGES CERTIFICATE NUMBER: 2018-2019 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DO MM/DD LIMITS COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 3E TO RENTED CLAIMS-MADE ®OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 .. A 952004644104 09/18/2018 09/18/2019 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 T ❑LOC , PRODUCTS $POLICY❑PE 2,000,000 OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per.ccident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE - AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1.000,000 A OFFICER/MEMBEREXCLUDED? ❑ NIA 952004644104 09/18/2018 09/18/2019 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L:DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Display Purposes Only , ACCORDANCE WITH THE POLICY PROVISIONS. i - AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved.` ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual):ARMEN SAFARYAN Address:67 SEA ST APT.A4 City/State/Zip:HYANNIS, MA 02601 Phone#:(508)776 2900 Are u an employer?Check the appropriate box: Type of project(required): l I�l am a employer with employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition In I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10[]Building addition 4.[:]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.�Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify er the in n e It" of perjury that the information provided above istrue and correct Si ature: 11 Date: Phone#:(508)776 260 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1 1 / 4rrE " The hoofers 67 SEA STREET APT#A4, HYANNIS MA 02601 PHONE 1 - 508 - 775 - 8240 I� CERTAINTEED LANDMARK LIFETIME; - ALGAE RESISTANT ARCHITECTURAL STYLE RE - ROOFING PROPOSAL March 29,2019 ANNE AND PETER SPEICHER 33 SIXTH AVENUE I,M: ssatx PJ @gmail.com HYANNIS,MA Tel: 210-843-2020/210-654-7328 COREY & COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles (Both Layers)from the Whole House and the Shed.Re Nail All Plywood Sheathing)as needed. Supply and Install CERTAINTEED LANDMARK AR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTIO; , CLASS A FIRE RATED, COPPER/CERA11IC STONES for a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT,235:POUND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY, CATEGORY III HURRICANE STORM IHURICANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED,LAMINATED ARCHITEC AURAL STYLE,FIBERGLASS BASED ASPHALT SHINGLES. Supply and Install 8"WHITE ALUMINUM HICK'SVENTED DRIP EDGE on All of the Eaves. Supply and Install 8" WHITE ALUMINUM DRIP EDGE on All of the Rake Boards. Supply and Install CERTAINTEED WINTER-GUARD (Ice & Water Shield)WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves &Valleys ,Under the Step Flashings,on the Skylights and Chimneys. Supply and Install CERTAINTEED'S "ROOF RUNNER" SYNTHETIC ROOFING PAPER Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on the Entire Ridge. Supply and Install"' ALUMINUM& NEOPRENE SOIL.PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. a TO TAL INVESTMENT _-----__---- $69350.00 i ,rc t he hoofers " POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deterio rated Trim Boards, Sheathing,Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement od will be done and charged for as an Extra: Materials Plus Labor at the Rate of$60.00 per Hour(For Each Laborer Involved). PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Sci�eduled for Completion Within 90 Days of Acceptance and Deposits Received are Non-Refundable After a Three Day Cooling Off Period from the Date of signing. Please Make Checks Payable to: COR�EY & COREY COREY & COREY Warranties the Shingles and Labor for 5 years. CERTAINTEE D Warranties the shingles and(labor 100% for the First 10 Years and the Shingles.your LIF TIME if the shingles becomes defective. CERTAINTEED Warranties the Shingles up io a CATEGORY III HURRICANE-130 MPH WIND WARRANTY, CERTAINTEED Warranties the Shingles to bl Algae Resistant for a Full 10 Years. COREY & COR EY carries Workman's Compensation land Public Liability Insurance on the above work DATE OF ACCEPTANCE: ACCEPTED BY: SUBMITTED BY: j A NE AND R SPEICHER ARMEN SAFARYAN HOMED ER COREY & COREY H I C # 183202 r CSSL# 106102 i I �S[HE Town of Barnstable *Permi # Exp'es m is Erato issue date Regulatory Services Fe MAS&' Thomas F. Geiler,Director , D MP't 201t Building Division &,,BEE Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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�U (4 Property Address 33 S inn MVe-- W&S i- nt\i Crt JjResidential Value of Work �� t Minimum fee of$35.00 for work under$6000.00 ' Owner's Name&Address e. + 1"1 Vt pl atq � r Contractor's Name 1., ✓r Telephone Number Home Improvement Contractor License#(if applicable) /'9 3 5-3 7 Construction Supervisor's License#(if applicable)f S g ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner. I have Worker's C - Im—ranrP Insurance Co: Zurich American Insurance Company Name._ Policy#: 6ZZUB-92lX274-4-02 Workman's Comp. Policy#_ Copy of Insurance Compliance uertuicate must accompany each per1111u. Permit Request(check box) ZRe-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ���S' ✓ ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.,U-Value (maximum .44)#of windows *Where required: Issuance of this.permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contrac r License & on ruction'Supervisors License is required. I SIGNATURE: Q:IWPFILES\FORMS\build; ermit forms\EXPRESS.doc Revised 070110 CI 11HE l Town of Barnstable J Regulatory Services y MASS. Thomas F.Geiler,Director 1639. Tec �s Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: .508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder r 1114r -�f f p r (fL t Y� as Owner of the subject property. here b authorize 3d(A y �.�g°trr:e���t� to act on my behalf, in all matters relative to work authorized by this building permit application'for. 5�al' P (Adares f Jo 1. z ii Signa e o Owner D to Print Nime If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q TORM&O WNERPERMISSION 1 Town of Barnstable P��t�TOwti o Regulatory Services BARNSTABLE, Thomas F.Geiler,Director y ?A Ass. t6g9• A,� Building Division TfD MA'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# ti work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"-was extended to include owner-occupied dwellings of six units or less and. to allow homeowners to engage an individual for hire who does not possess a license,provided_ that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) . 1 The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. \ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be;required to comply with the. State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed. Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt rvrassacnusetts- oepartmentof ruuuc 3dieiv Board of Building Regulations and St'--- ads Construction Supervisor License Failure topossess a current edition of the Massachusetts State Building Code, License: CS 15649 is cause for revocation.of this license. ROBERTtKk8TiELLOg', Refer to: W'WW.1VIass.Gov/DPS PO BOX 77fi ,, S CHATHAM +MA`,02'59 Expiration: 6/9/2012j Conunissiuner Tr#: 27911 - ✓�ze U/G�7'2�72072CIJP,2L(�L �,/�,aaaacliuoelta� office of Consumer-Affairs&B siness Regulation HOME IMPROVEMENT CONTRACTOR . Reg istratio n:,,5M,03537 Type: Expiration: -*8/2012 DBA ROBERT K.STELLO CONSTUCTZN 'I fr '' License or registration valid for individul"use only x G before the expiration date. If found return to: Robert Stello ,Office of Consumer Affairs and Business Regulation 310 COMMERCE PARK r 4 yE��P 10 Park Plaza-Suite 5170 S.Chatham, MA 02659 Undersecretary Boston,MA 02116 j } Not valid without signature i 3 1. , ?7ae Commronwealth of Mossach users Deparbnent of Industrial Aeeiderr c O., e of Invesfigadons Boston,MA,,02111 . nw-mina--mgr/diu �T I� , cnrs�aro_ i.�-,.x:�• A.-:T.7.....,1 .�+1�.._=1_�. /Ci_ _ •__._Inv-, x�orkE s Compensa im lip_.__ _a _ _.L . .+.: ,r. _.�:ws G .a rw. ae.s -sa .a"mbers AapntInformation ;-Name:•Stello-Construction-Company-` Name )Location: 310 Commerce Park City: South Chatham, MA 02659 4 Address: Telephone; 508-432-2218 city/state/zip- Are i you an employer?Check the appropriate box: Type of project(rejaired). 4. I am.a contractor and I l_El I am a employer with _ New construction employees(full an&,orpart_tinne).* , have Hired the sub--ccvntzactors 2.❑ I am a sole proprietor or part= listed on the attached sheet 7. ❑Remodeling shipand have no employees These sub-contrwiors have �P 8_ I}eQwlitsan wodrang for mein any capacity- employees and have wars' o vrorkers'comp_++�a�++ce comp-i+,M,•��X 9. El Spalding.addition rewired] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions officers live exercised tlpeir 3.❑ I am a ho>7a�wner doing all wrarlr l l_❑Plumbing repairs or additions Myself. NO worl=s'comp- right of exemption per MGL 12 Roof repairs instuaace required,]T c. 152,y 1(4),and we have no employees.[No workers' 13.❑Other camp.insrzramcemptired. - *Any appEcii t that checks boa#1:nwst also fill root the section below showing dheir waakes'c—pensat w.policy infiRlOi O Y Hawemners who submit this affidavit indicatdng they ase•daigg 9lFwnat_¢ad.dh ea hitE_arotsidse cantsactors roost suuirmit anew affidavit indicating each . Crs that check fhis'boac mast rttach sm addi�vaal sheet shoaPing the pions a#the sale camaaefiars and sure arhether-ar_natboSE enoities harms----7 the s_b ntmctcrs bass - --If _—._�_�_-�..._._�emplayses,they'anssrPnTnde�th�eu�w�arksts'':caaap:palicFatnaber.^"��� ' I am rut employer that is providing_ w rkers'coatpsr�`arr i ratzce for mp.sn T Belnwr is they vvWr �crud job site infornQrrhan. � Insurance Company Nam_ Insurance Co: Zurich American . _._..�..._._ ._.... _._.- �_Policy#:6ZZUB=921X274-4-02 � Policy i or Self ins.Lie. Job Site Address: �®th �t//J� � - Cityfstateiz p-IWA Attach a copy of the woz leers'campensa hiau policy decLaration page(showing the policy member and expiration date). Failure to secure coverage.as required under Section 25A of MGL c. In.cam lead to the impositiosr of criminal pertalties of a fine up to SI-500-00 andfor 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 statetneut may be forwarded to the Office of Investigations of the.DIA for insurance co-o-mage verifiratiarz ' I dv herebY c carder In pe abyss orfpedn'ry that the information prodmided afire cs bw and corm aLvagg a: 06-tad' Daate: Phone Q�rial nee only. Do not write in flits exert,to be courpteEed by city or hvnsrr r, icciri! City or Town: PermdbUcense# Bluing Authority(circle one): . 1.Board:of Health 3.BuRding Department S.Cityffmm Clerk 4-Electrical Inspector 5.Ph=biug Inspector . 6.Other Contact Person: Phone#:' 6 n - - Dec. 12.'' 7011' 12: 03PM No, 2442 P, 1 STELLO CONSTRUCTIONjINCE Additions, Sunrooms, Remodeling P,O, Box 776 South Chatham, MA 02659 (508) 432-2218 www.stelloconstructlon.com December 12,2011 Barnstable Building Department 200 Main Street Hyannis,NIA 02601 RE;33 0 AVENUE To Whom It May Concern: P1eAse be advised that Stello Construction Company has designated Casto Construction Company as the subcontractor on record for the roof replacement work to be completed at 33 6a Avenue, Hyannis,M.A. S' cerely, Robert Stello ' Stello Construction Company ' 1 rn if 12/12/201`1 ll:d� Bryden and Sullivan Donna Seviour-> 1/1 OP ID: DS co�za CERTIFICATE OF LIABILITY INSURANCE DAT 12/1212/12D/YYW) � /11 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), AUTHORI2ED 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 endorsements. Bryden&Sullivan Ins Agency 506-790-141 —PHONE FAX 88 Falmouth Road Arc Nc Ext: (A/C,No): Hyannis,MA02601 E- A Hyannis Office PRODUCER CASTE) 1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED DennlsCasto INSURERA:NGM Insurance Company 14788 P.O.Box 571 INSURER B:Associated Employers Insurance So.Chatham,MA 02659 INSURERC: INSURER D INSURER E INSURER F THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 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 NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A COMMERCIAL GENERAL LIABILITY M:P061072. 05/09/11 05/09/12 PREMISES Ea occurrence $ .500,00 CLAIMS-MADE DOCCUR" MED EXP(Any one person) $ 10,00 X Business Owners PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY F Ra LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION . $ WO KERS COMPENSATION WC STA - 0 H- EMPLOYERS'LIABILITY - TORY LIMITS ER - B PROPRIETORPARTNER/EXECUTIVE Y!" WCC5006316012011 06/20/11 06/20/12 E.L.EACH ACCIDENT $` 100,00 OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory in NH) E.L.DISEASE-Fes,EMPLOYEE $• 100,00 If yes,describe under «-a " DESCRIPTION OF OPERATIONS below E.L:DISEASE"-POCICY LIMIT $' s �" 0 600'00 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) - arpentry-Residential less than three stories;less than 5%roofing r - --- BARNS-1 � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C CELLED 1BEFORE Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis,MA02601 Hyannis Office ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The-ACORD name and logo a registered marks of ACORD