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Home My WebLink About0048 SPRUCE STREET S�p°ru.Ce 1 Town of Barnstable ��Il��Il� Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept sex.�•suecs. � Permit M'� Posted Until Final Inspection Has Been Made. t0}¢ 1� ' nMxc` lWhere a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final inspection has been made. Permit No. B-20-1036 Applicant Name: Thomas Capizzi Approvals Date Issued: 04/17/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/17/2020 Foundation: Location: 48 SPRUCE STREET, HYANNIS Map/Lot: 310-224 Zoning District: RB Sheathing: Owner on Record: BRIGGS,DEREK STEPHEN Contractor Name: CAPIZZI HOME IMPROVEMENT Framing: 1 INC. Address: 48 SPRUCE STREET 2 HYANNIS, MA 02601 rContractor License: 100740 Chimney: Description: New roofing-strip off existing of roof of main house and right side Est. Project Cost: $ 24,000.00 e I Insulation: building CertainTeed landmark Pro asphalt 14 square same color as Permit Fee:` $ 122.40 exising I Fee Paid $ 122.40 Final: Replace white cedar shingles 5.5 square Front and back of house Dater 4/17/2020 Project Review Req: - 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 thetapproved construction documents for which this permit has been granted. M k s Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. 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: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 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: c All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable Permit6--f� Regulatory Services ate: I t 0 0)j oFTME' � Richard V. Scali, Interim Director ee: Building Division annN&MBi>; ' Tom Perry, Building Commissioner MAss. 1639. a1� 200 Main Street, Hyannis,MA 02601 -� www.town.barnstable.ma.us Office: 508-862-4038 �� ax: 508 190 623p TOWN OF BARNSTABLE SOLID FUEL STOVE PERMITZE ca Owner: �� Plt F/V ri—(9V Phone: / C/ � /2) Install at: �{�'5��.�C� ST�CT Village: /-�J��9 411 S � 0401 Map/Parcel: f G 4 y. �� Date: o'G7'-w Stove A. Ne /Used B. Type: adi /Circulating C. Manufacturer: uZ Lab.No. D. Model No.: Chimney A. New/, xist` (If existing,please_ note date of last cleaning B. Flue Size 6 Ialc k a s C. Are other appliances attached to Flue?�t/� D. Pre-fab Type and Manufacturer E. Masonry: ine nlined Hearth A. Materials: �2 B. Sub Floor Construction: Installer _ Name: S .e ' '2& ,$ Address: S uc eI der =+ �iviv,S Phone: 99 /`t/1 '714 61 Location of Installation: H.I.0 Registration# Construction SWervisor# t OR check v Homeowner Installing, no license required LICENSED INSTALLERS SIGN T APPLICANTS SIG T APPROVED BY!. Please make chec s -a able to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 11/4/13 ; Town of Barnstable Regulatory Services ; 'r d Richard V.Scali,Director l - Building Division ARM ' Paul Roma,Building Commissioner &639. �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ' Please Print DATE: JOB LOCATION: �j7pact �t /e . number / - street 3 village -HOMEOWNER": S D�II�?% name home phone# work phone# CURRENT MAILING ADDRESS: fit 9 Cei rye cit3&wn 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) 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 p7mcedIM and re . ements and that he/she will comply with said procedures and requirements. Siignaft6 of Homeowner s Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or Iarger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S MMP'ITON The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such-work,that such Homeowner shall act as supervisor.." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form'currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FOR,MS\building permit fomislEXPRESS.doc 06/20/16- e ToWn of Barnstable Regulatory Services ` Richard V.Scab,Director Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maus Office: 509-862-4038 Fax: 8-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1 , as of the subject property hereby authorize to act on my behalf in all matters relative to.work authorized by this b ' ' permit application for: (Addres f Job) 'k'kPool fences and:a= e the responsibility of the applicant Pools are not to be filld utilized before fence is installed and all final inspections are erformed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNMU'EPMI SIONPOOIS r ?lie Commomveakh o, -Waysodiuseffs Department ofrudush ial Acddim& Ojfce of1mwfigadam 600 Wasikhwon Street Boston,MA 02111 r tnx masmgowfdia Workers' CainpensafianInsumnceAffidavit:Builders/ContractursMecfticiansfPhunbers Applicant Infarm2afian Please Print Lem 1IY Nam weztag - 71 Are you an employe . Check th appropriate bow Type of project(required): 1.❑ I am a employer with j 4. ❑I am a general contractor and I 6. ❑New construction employees(fall an&or part-ime)-* have hired the sutratractors 2.[3 I am a sole proprietor or partner- listed-on the attached sheet 7. ❑Remodeling slip and have no employees . . These sob-contractors have g.,❑Demolition wonting foime in any capacity. employees andh-ae wodl m' 9. ❑Builcliag addition, 1[No micem2 camp.i'amz nce cam-insurt!n i • . 5. ❑ We are a wrpomfim and its 10-❑Electrical repairs or additions 3.� I ama homecuner doing all work officers have exercised their 1L❑FIumbingrepaiss ar additions myself[No workers'camp- of exemption1(4). per 1rve n 12.0 Roofrepairs insuramre req ire&]i C. §1{ ,and we have IIL7 employees.[No •s' 13_❑flame[ camp-insurance,mquired-] 'Aay appiicmt Hhat dLeft boa iR1— I also fMc=the sectionbeTowsbowiag du&v odsere mmpensafian policy inf mush= Hnnim rners who submit skis dfidzv&=fficsting they axe damg Oval l and&yea hoe outside C0nI)3c=s— MIMIC a new affidseid iadicatiag SUCK-- fCanuactats ffiat dart tags box mast attsrhed sa addit;aaal sheet showing the name of&a Sdb-00=NdM and state whether ar wt(hose eadtieshme emplmyees.Iftheml-caa==rs base employ,they 'P e&c=p.pohu.nt®bm -Tam an errrployer fliatis prfnzd&g t warkers'coerlrerisattart hmzrauce jbr my eRW1&jvm Below is fTie paUcy anti job srte irz�ot-rrrrstiars - » - P. . - L Insurance Company Name: Policy i or Self-ins-Lic- - Expiration Date: Job Site Addzess CitytStatedzi�: Attach a of the awarkers'c ensation oli declaration a she the fi number and expiration date). J copy �P P � Fag t �� Po c3' �P ) Failure to secure coverage as required.undes Section?SA of MCL c- 1572 can lead to the imposition of criminal penalties-of a fine up to$15-O0 OD andlor one-yeasimgrison:neut,as well as ciT.,d penalties.in$re fozm of a STOP WORK ORDERand a Effie of up to$2.5O.DO a day against the vzolatur. Be advised&at a copy of this statemed maybe forwarded to the Office of Invesfigations of the DIE,for insurance coverage v on. - I*hengbp'c thBpQirzSandpaialges ofpalwy fhatthir informatkupropkWabmw igyhm and carrel p-3 2-Pilaus 7 Il 02kial wo only. Do not write in this area,to be campletced by city artotm oficiat . City or Town: Permiff&ense; Issuing Authority(drde one): L Board of Health 2.BurTtfmg Department 3.C tylrown Clerk 4.Etechical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 formation and Instructions Massa�husetfs Ge��aal Laws cb�I52 recces all�Ioyets'Fn provide Wormers'compensation far they employees.+ ParsaEDtto this sty,an errplvyee is defined as-"-.every person in the service of another under any contract ofline, �• express or implied,oral or wiftbma." An,employer is defined as'2n inffi idnal,partnership,association,corporation or other Iegal entry,or any two or more of the foregoing engaged in a Joint m tespII.se,and including the legal representatives of a deceased employer,or the receives or trast=of an m dividnal,partnership,associafi or other legal entity,employing employees. However the owner of a dwelling hooe having not more than three apartments and who resides therein,or the occupant of the - dwelIiag house of another who employs persons to do marts,caastraction or repair woik on such dwelling house or on the grounds or bunZdmg appurteoznt thereto shall not becanse of such employment be deemed to be an employer." MOL chapter I52,§25C(6)also sues that"every sib or local licensing agency shall WithhoId fhe issuance or renewal of a license or permit to operate a business or to contract bufldiags in the commonwealth for any applicant who has not produced acceptable evidence of cumplii=ce With the inset-ance.coverage requir•ed." Additionally,MCrL chapter 152,§25C(7)states"Nefther the caromcawealth nor a'ay of its political subdivisions shall enter mtn any cont:mat for the perfotDnaace ofpublic watic u atil acceptable evidaace of compliance with tine fi=an= requ�eats of this chapter have been pre-sented to the contacting a afb onty." Applicants Please fiZI oht the wozkers'compensation affidavit completely,by checlang the boxes that apply to yoTs siination and,if necess sob-conacta n , address(es)and phone numbers) along with their cert�cate(s)of �Y,SWPIY �s) n.�s) • �pI other no o than the ;,,cr�nce. Limited Liability Companies(LLC)or Limited Liability Parfnetsships(LIT)with Ye�es members or partners,are not required to cry Workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidayitmaybe submiffed to the Depa-tment of Industrial Accidents for confaMation of msurmce coverage. Also be sure to sigh and date the affidavit The affidavit should be-retvmed to the city or town that the application for the permit or license is being regnested,not the Department of i ions fine law or if n are to obtam a workers' ri,rinafi-iai�.rcicl�a��_ Shonldyon have nay gnrsla regarding yo req�ed compensation policy,please call the Department at the amber listed below Self-i mzrd companies shou ld enLrx their self-insm-ance license number on the appropriate line. City or Town Officials Please be sine that the affidavit is complete and priatrd.legibly. The Department has provided a space at the bottom of the affidavit for you to fM out in the event the Office of Investigations has to contact you regal ding tile.applicant Please be sine to fill in the permidliceose will mnnber which w be used as a reference number. In addition, an applicant em year;need o sabnnt one affidavit indicaf„�T�nt multiple e�itllicense Ii�aiions in y �Y that must submit uzmp P �P my 1� p olicy infoaaation(if necessary)and under'Job Site Ad&ess"the applicant should write"aII locations ia (city or town)."A copy of the•a$davit that has been officially s anped or marked by tit e city or town maybe provided to the applicant as proofthat a valid affidavit is on file for fdiure peanits or licenses_ Anew aff davitmvst be tilled of t each year.Where a hflme owner or niiizen is obtaimmg a li tense or permit not related to any business or commercial veatcre Ci-e. a dog license or peanit to bunn leaves etc.)said person is NOT xtqoired 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 Departm mf's address,telephone and fax mmmberr Degariment cifhidasfdalAocideat! � zl�fA E�lIF Tf,-L 4 6I7' -4900 e t 406 w I-a77 1_�A&4FE � Fax#6I7 727 7M Revised 4-24-07 .mag�gfd�a C�1 ��A1STAIL" CAPEC 1NSULAT1`Qj[ge1 t ' 74i- BA • C¢OEASa SOy""' 9USVfNOEO ie TTS �+ryi a+:+ iNSUEAT•ON 1-80i" 696-661 I 30 '1own of Barnstable Regulatory Services Building Division 200'Main St Hyannis, MA 0260$1 DateW--/.-7�=1 Dear Building Inspector t p Please accept this Affidavit as documentulion that Cape Cod Insulation, Inc. performed & completed the insulation and weatheriza(ion work at the property listed below. Cape Cod Insulation did this in accordance to the spu,_ihcations listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements- Property Owner a 3. 1Property.--k,dress Village Insulation Installed: Fiberglass- Cellulu�, R-Value Rzstricted Unrestricted Ceilings Slopes Floors Walls L 2� w er- S�.`t' u o r-..5 f �(��r• ,t { t •4 c�r ).ems Sincerely r ; 'He y`E Ca sidy r, President " Ca e Cod sulation, Inca - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � ► LI 0 (Q-?e`2. Map 310 Parcel Z Application # Health Division Date Issued - Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address eq �f Village 4,C/& S Owner Z le Address Telephone7J Permit Request D �� '�/,� gd f2 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation SPOLi O Construction Type A�fz-J � o 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 A No On Old King's Highway: ❑Yes 3(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 ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) -- Name y� lo� Telephone Number Address License # Home Improvement Contractor# Worker's Compensation #/�,2 4x--2' � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO D SIGNATURE DATE /U� / ,t. r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED k' MAP/PARCELNO. rs^. a '. ADDRESS VILLAGE OWNER DATE OF INSPECTION: u�FOUNDATI.ON:s;�!..,_:t+l4 FRAME 1INSULATION 4. FIREPLACE ELECTRICAL: ROUGH FINAL j3 I{+ PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING n DATE CLOSED OUT ASSOCIATION PLAN NO. 1 Y Housing Assistance A Corporation Cwe Cad HOME OWNER WEATHERiZATION WORK PERMIIT&I UEL RELEASE: PLEASI=FILL OUT AND SIGN THISFORM IFYOU ARE THEAPPLICANT HOMEOWNER. hereby consent to and agree that weetherization work may be - done by the Weather!zation Program of Housing Assistance Corporation ( herein after referred as Agee)on the property located at: ` 4 , Theweatherization work done will be based on programmatic prioritiesand availability of funding and it may Include all or some of the following measures: Weather-stripping& caulking of windowsand doors, insulation of attics, sidewalls& basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of theweatherizationpwork to bedoneat my home agreetothefollowing: 1. 1 give permission to the"Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weetherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect thefud or utility bill for the - weetherized unit on an ongoing basisfor no morethan five(5)yearsafter theweatherization work is completed. ' I have read the provisions of rt listed and freely give my consent. HomeOwner: (Signature) �'' Q - : ,. Dater ` �Ct, Agent: (signature) V{{ Date HAC approved Weetherization Company cam_ ., live learn work grow 460 West Main St. Hyannis, MA 02601 hac@haconcapecod.ora 508-771-5400 Jax: 508-775-7434 The Commonwealth of.Massachusetts .:> Department of Industrial Accidents .-'Office of Investigations.— 600 Washington Street Boston, MA 02111 •www,mass,gov/dia; Workers' Compensation Insurance Affidavit: Builders/ Analicant Information Contractors/Electricians/Plumbers Please Print Le—e Name (Business/Qrganizaaon/Individual): k-/ ------------ Address; 4 . City/State/Zip: 2 1.)14 o ,Rhone #: ;:7 ��- Are you an employer? Check the appropriate box: 1.� I am a employer with 4, 4, I am a general contractor and I Type'of project(required); employees (full and/or part-time).** have hired the sub-contractors . 6.. [] New construction 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' [No workers' comp, insurance comp, ins urance,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 myself, 11.[] Plumbing repairs or additions y [No workers comp, right of exemption per MGL I required.] t c, 152, §1(4), and we have no 12,[] Roof repairs 3a.❑ I am a hotneowmr acting" a employees. [No workers 13, Other/,t'./��,b� general contractor(refer to #4) comp.insurance -' �.].. "Any applicant that checks box#1 must also au out the section below showing their workers'compensation poucy information, t Homeowners who submit this affidavit indicating they are doing-aA work and then hire outside contracton must submit a new affidavit indicating such, tContracwrs that check this box must attached an addidonal sheet showing the name of the sub-contractors and state whether or not those entities have eotployeea. If the sub-contractors have employees,they must provide their workers comp.policy olic number. i I am an employer that is providing workers,compensation insurance for my information. enrployees ;Below is the policy and Job site Insurance Company Name: Policy#or Self-ins. Lic.#; 15� Expiration Date: 10 Job Site Address: ��/Z�� ' .� / City/State/Zip; O y1j1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and e'#htion 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 WORD 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, do hereby cernJy u,n#r the pains and penalties of penury that the information provided above is trace and correct• Signa Dat 11 G pbon r Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitfUcense# Issuing Authority (circle one): -------7 1. Board of Health 2. Building Department 3. City/Town Clerk 4• Electrical Inspector,5. Plumbing Inspector 6. Other Contact Person: Phone#: a Massachusetts -Departm'a'nt of Public Safety. : , '.!�6?trd of Buildi6g Regula;tons pltl Standards Consintction Supervisor License; CS-100988 1-.IR.N-RY.R CASSI0 8 SHED.ROW "^ { W R ST Y A 11K 0 UP111.1 11 uv�l Expiration w GonmisStoner 11/1112015 h,r. ice. 1 � � Oflice.of Consumer AffairsI and Business Regulation 10 Park Plaza - Suite 5170 Boston:, MassachLjsetts 02116 I IO.me Improvement C ratgtor Registratibri - ::- a Registration: 153507 Type: F'rinle Corporation ' A I.,t•r .- I Expiration: 12/15/2014 I'll 233831 CAPE COD INSULATION,-INC HENRY CASSIDY 18 REARDON CIRCLE '::Ik ` .:.:: -- _ _ ' S0. YARMOUTH, MA 02664 -_ �__._... _.:_ .._._....._... . __ Update Address and rutut'tl card. Mnt'k ruasun for change, �' Address butt will U�rn lu mt nt lost Gard [� LJ p y. C:.l '��rs`((lt.rrr.��air•tturtrl�� c��C?'��tddttG6tG�lal�3 � . 1. nicc ur consunmr Arl'nirs& Business 12vbulnti0n Llcenae ur registrotloo valid for individtll use ottly OME IMPROVEMENT CONTRACTOR Ware the expiration(into, if found return to; ogistration: 153.�67 Type; Office of Consumer Affairs and Business ltobulation xplratlon; 12/1v5/2014 Private Corporaliol'I , ' 10 Park Plaza-Suite 5170 Boston,MA 02116 (OD INSULA'I`1.01\1 Y L\WON CIRCLE , \ MOUTN, MA 02664 llllticrsccrctar — ' 4, 207 Y of Val' ` 1 CAPECOD-27 KLIGETT + -- CERTIFICATE OF LIABILITY INSURANCE ' $ ,• =,,,mm1,u,[ /YYYY) 14 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 Ileu of such endorsement(s). PRODUCER CONTACT Rogers&Gray Insurance Agency, Inc. NAME: Barbara DeLawrence, _ 434 Rte 134 PHONE South Dennis, MA 02660 __._. Ext)�_ FA/C No; 877 811J•2156 — (A/C.No. ADOREss:bclelawrence@rogersgray.com INSURERS AFFORDING COVERAGE _ NAIC N ------- INSURERA:Peerless Insurance Company INS RED _ { INSURERS:COMMERCE INSURANCE COMPANY _- Cape Cod Insulation Inc INsuRERc:Evanston Insurance Company 18 Reardon Circle South Yarmouth, MA 02664 INSURER D:ATLANTIC CHARTER INSURANCE GROUP t INSURER E; INSURER F 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 C-RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E Cl-USIONS AND CONDITIONS OF SUC__H POLICIES.LIMITS SHOWN MAY-HAVE BEEN REDUCED BY PAID CLAIMS. NSR ._.-._..------ ----- LTR TYPE OF INSURANCE _ POLICY NUMBER MM DDNYFF MM D YEXP X COMMERCIAL GENERAL LIABILITY LIMITS l EACH OCCURRENCE 1000+000 -1 CLAIMS-MADE L X] OCCUR CBP8263063 04/01/2014 04/01I2015 D IFTO ENi' -- $ _— PREMISES(Ea occurrencel _ $ _ 100,000 ({ ,, ME EXP(Any one person) $ 5,000 — PERSONAL'&ADVINJURY _ $ 1,000,QOO G N'L AGGREGATE LIMIT APPLIES PER: t � ^ - « � GENERAL AGGREGATE — $ 2,00.0,000 POLICY I—.I JEOCT LOC 110THER PRODUCTS_COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY „ COMBINED SINGLE LIMIT $Ea accident 11000,000 3 ANYAuro (Ea 04/01/2014 04/01/2016, BODILY INJURY(Per f ALL OWNED X SCHEDULEDperson) , $ _ - AUTOS AUTOS ; BODILY INJURY(Per accident) $ HIRED AUTOS X NON•OWNED — AUTOS Pe�ac ae DAMAGE $ )(- UMBRELLA LIAR X OCCUR $ ' EXCESS LIAR EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE XONJ453514 04101/2014 O4I01/2015 AGGREGATE - --- $ ---- F1D X RETENTION 10,000 Aggregate WORKERS COMPENSATION $ 11000,000 LOYERS'LIABILITY SEA UTE ETH.RIEI'ORIPARTNERIEXECUTIVE YIN WCAOO525904. 06130I2014 O6/3OI2015 .E.L,EACH ACCIDENT $ 1,000,000 EMBER EXCLUDED? N/A in NH)ribe underE.L.DISEASE•EA EMPLOYEE $ 1,000,00 ION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 11000,000 • ES OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)orkert Compensation includes Officers or Proprietors. idl to al Insured status is provided under the General.Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. - ERTIFICATE HOLDER r+Alklr+C1 I A'r1^&.1