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HomeMy WebLinkAbout0041 STETSON STREET �/ ��� � � `� �� ; � i ' i �' i i TOWN OF BARNSTABLE r BUILDING PERMIT t 1 4 PARCEL ID 306 :234 GEOBASE .ID • 21640 ADDRESS 41 STETSON STREET PHONE Hyannis ZIP LOT '4 BLOCK '" LOT SIZE DBA r DEVELOPMENT DISTRICT HY PERMIT 10686 DESCRIPTION REMOD_FR.ENM,�3 X 19" ADD TO GARAGE PERMIT TYPE BREMOD TITLE i RESIDENTIAL ELT/CDT�artment of Health, Safety CONTRACTORS,: GUNDAL, WILLIAM C. and Environmental Services ARCHITECTS.# CERTIFIED "AS BUI T'.' REQUIRED . TOTAL FEES � � $50.00' �TME BOND $.00" CONSTRUCTION COSTS., $2,700.00y 434 RESID ADD/ALT/CONV r 1 PRIVATE P:CIHAR1vsTABLE. ' MASB. , OWNER ANDERSON, HELENA ADDRESS ANDERSON MARJORIE RAE } 41 STETSON \'' HYANN I S, MA BUIIL,b;. VISION'S. DATE ISSUED 09/2d/�',1995 EXPIRATION DATE BY"' i • DIVISION APPROVALS FOR ` CERTIFICATE OF OCCUPANCY TO BE SIGNED BY EACH DIVISION HEAD UPON COMPLETION s BUILDING:,' •= - DATE: i COMMENTS: i i PLUMBING: ! DATE: + COMMENTS: r ELECTRICAL: <.,. DATE: COMMENTS: GAS: DATE: COMMENTS: CONSERVATION: DATE: COMMENTS: OKH: DATE: COMMENTS: HISTORIC: DATE: COMMENTS: FIRE DEPT.: DATE: COMMENTS: OTHER: DATE: COMMENTS: y TURN THIS IN TO THE BUILDING COMMISSIONER AFTER ALL SIGN—OFFS' COMPLETED.A CERTIFICATE OF OCCUPANCY WILL BE ISSUED AT THAT TIME. �r ri TOWN OF BtNS�'ABILE A. WILDING 'PFMIT: ' PARCEL JD 306 234 GEC:SASE ,X D 21640 ADDRESS ,. 4-1 STETSON STREET PHONE Hyann,is ZIP ITT ALOCK LOT SIZE' DBA r3 DEVELOPMENT DISTRICT HY, PERMIT 10555 DE9CBIPT.ION REMCD.ER.ENTR ,a X 19` ADD To GARAGE PERMIT TYPE BREMOD TITLE, RESIDENTIAL AI /CDVpartment of Health, Safety CONTRACTOTZS: GUNDAL, WILLIAM. C and Environmental Services ARCHITECTS:M 1) ��A BU'ILT!' ,-REQUIRED EKTI IE TOTAL FEES: .0C BOND $.00 CONSTRUCTION COSTS $2,700.00 4 /ALT/CON�d .M`' 1 PRT SATE . 4 , STABLE. MAS& s6gq. 10 I OWNER ANDER ON n HELENA ED MIS A ADDRESS ANDERSON . MA JORI RAE _. 41 STETSON ST HYIANN 18 MA � �- BUILIA`" VI N .: 'SATE 7`SSUE t7 /25� J 6 EXPIRATION. DATE Bey," 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 ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS 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-. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY POST THIS CARD • IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS` ELECTRICAL INSPECTION APPROVALS i 1 1 r 0. 2 2 2 . 3 1 :. HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I 21 BOARD OF HEALTH li OTHER: SITE PLAN REVIEW APPROVAL I 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 TELEPHONE OR WRITTEN NOTIFICA TION. NOTED ABOVE. -TION. 508-790-6227- i BUILDING - PERMIT, j TOWN OF BARNSTABLE BUILDING.PERMIT APPLICATION + .;MI Map Parcel Z 3y Applrcatit # Health Division �'D4tejsued 1 13 0 L Conservation Division .�' Application Fe Planning Dept. `*,Permit Fee "; Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address y/ SA6Tf 50i✓ Sfeac- Village Owner jOIJAIII J `/fA J 4114V Address /ar; Telephone (a03) -YZ/-yr Z 9 (2a3) -Y890 Permit Request 44_4obee. 1,kmJ td#f9/1 New ������►��N�'' krft�� C�d�, � /,l�a i4�CY� 6-1L Na , 7a Al., x G,) .Square feet: 1 st floor: existing YZO proposed 2nd floor: existing SZv proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation v I ddd _Construction Type Lot Size Grandfathered:- ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family RI Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ZNo On Old King's Highway: ❑Yes ❑ No ©Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) /69 Basement Unfinished Area (sq.ft) 'jag. Number of Baths: Full: existing' Z new Half: existing / new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing 5— new First Floor Room Count 3 Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes /r�o Fireplaces: Existing_I New Existing wood/coal stove: ❑Yes ErNo Detached garage: Q 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 �r9Vl-� ��ME Telephone Number S0f cZ37-a7yJ6 Address /°f 1W141i &J License # 5 6 bSq q9 ,AA-. Home Improvement Contractor# Worker's Compensation # 2 oo l LJ IP3 5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO /�R�'�Zvv�I SIGNATURE DATE Z �/ r FOR OFFICIAL USE ONLY APPLICATION# v DATE ISSUED s ' MAP/PARCEL NO. ADDRESS VILLAGE OWNER F i DATE OF INSPECTION: ?FOUNDATION . FRAME INSULATION 1 FIREPLACE ' ELECTRICAL: ROUGH FINAL '.� PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL ` FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. . The Commonwealth of Massachusetts Department of Indushial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciaas/Plumbers Applicant Information Please Print Legibly 'Name (Business/Organization/Individual) Q.S e.-) ✓ ,/`�d �a+�� LAMS /QeJ1b/d!/9J o 1 Address:-5,117 /rI'4� 5�. : 4114 W 17, City/State/Zip: 114/&Jlc /a Phone#: Are you an employer?Check the appropriate IK: Type of project(required); 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet._ 7. EjrRemodeling shipand have no employees These subntractors have P Yees -co 8. �Demolition working for me in any capacity. employees and have workers' comp. msurance.t .9. Q Building addition [No workers' comp.insurance P• required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs.or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.Q Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c..152, §1(4), and we have.no employees. [No workers' 13.0 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 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: 1AM1L Policy#or Self-ins. Lic.#: ZOO/ 01635/ Expiration Date: Job Site Address: City/State/Zip: /�YA�W/1 , rK✓Jz Attach a copy of the workers' compensation policy declaration page(showing the policy n.umb�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 car ti under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: / Phone#; �a� Ll 7 3���I o a Lei ✓ 057 0746 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 Cont#ct Person: Phone#: E,�yti Town of Barnstable Regulatory Services RARNMBIEMass, g, Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must i Complete and Sign This Section If Using A Builder I, 'kMtA— V—iki Lk-11 , as Owner of the subject property J P 1' riY hereby authorize wLl,'.GQ R-0 IM.'o to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms.are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. e of Owner Signature of plicant h V Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS 6/2012 Town of Barnstable Regulatory Services snxxsrns , ; Thomas F.Geiler,Director Mass Ar1639. �A � 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: . JOB LOCATION: number street village "HOMEOWNER": name home phone# 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) 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 our community. Y P Y Q:forms:homeexempt . r OF THE rti * BARNSrABLE. ' i6ss ��$ . Town of Barnstable n: rED Mp'I A - Regulatory'Services Thomas.F. Geiler,Director Building Division Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:,.508-790 6230'`, �.� A: Pro er O tY p . wner Must r Complete and Sign This Section If Using A Builder I, � a ; as Owner of the P per subject property ty hereby authorize lJ l to act on my behalf, in all matters relative to work authorized by this building permit application for:.. (Address of Job) /Yz attire of Owner to Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on:the .reverse side. O'\WPFTI.F.S\FnRMS\hnilriinv ne.rmit fnrnS\FXPRFSR tine . Town of Barnstable Regulatory Service's snt Thomas F. Geiler, Director 9 n'^ss. MASS. �' 1659. 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 HOMEOWNER LICENSE EXEMPTION PleasePriot- DATE: !� Zo�� JOB LOC TIO : � a AA nu ber I, stteet A / village 9 "HOMEOWNER": name h phone# work phone# CURRENT MAILING ADDRESS: V 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 riot 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 "homeo er"certifies a/she understands the Town of Barnstable Building,Department minimum inspection proced res an .require e s and tha / will comply with said procedures.and requirements. . Si nature 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. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor .! License: CS-065949 O + DAVED ROME�� d� PO BOX 138z^ South Denni9lMA 026'60; I s .�... 14�n Expiration .Commissioner 1 010 5/2 0 1 3 -. !ze -Fomvr�zaizurecr�C! o �//�craaaclzuaella Office of Consumer Affairs&Bu mess Regulation License or registration valid for individul use`only HOME IMPROVEMENT CONTRACTOR. before the expiration date. If found return to: R Registration: A17515 Type: i Office of Consumer Affairs and Business Regulation Expiration 10/b13/2014. . Private Corporatiopi 10 Park Plaza-Suite 5170 PA DAVIS SYSTJF CAPE CO�&ISLAN 1 Boston,IVlA 02116 DAVID ROME \ F x 108 Susan Lane t Brewster,MA _• Undersecretary r Not valid ithout signature PAUL DAVIS RESTORATION ® When Minutes Count And Quality Matters. P14 ems► r��►es �c,�s����t� /ma's����<�,� i FwSteptan1bfilwWa.14UBC3t&national Tot:Aa(IPtMRestorgt7aMfl5g8lM07E9KiF 21002 . Fax c 1Mfi '/02/12 EST Pg 4-4 CERTIFICATE OF LIABILITY INSURANCE DATE(MNU/201' YY) R7IFICATE 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 INSU RER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the poiicy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to he certificate holder in lieu of such endorsement(s). J PRODUCER CONTACT NAME: . HUB INTERNATIONAL NEWEN' t PHONE` " FAX 222 MILLIKEN:3L VL) I " (A/C,No,Ext): (A/C,NO): M EMAIL s' FALL RIVER,CIA 02722 `, ADDRESS: .',D6P • INSURER(S)AFFORDING COVERAGE NAIC# . INSURED INSURER A: TRAV3LERS DJDENNI"Y CO. R:CHIES INST-1ATION INC' f INSURER B: INSURER C: £ INSURER D: I I I OLD BEDFORD ROAD e INSURER E. ' y, �k-ESTPORT,NIA 02790 INSURER F. COVERAGES CERTIFICATE NUMBER: x REVISION NUMBER; ' THIS 5 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.THEINSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN_IS SUBJECT TO ALL THE TERNS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.,LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: INSR " *.P ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE. L R POLICY NUMBER (MMTIMYYYY) (MMADIYYYY) LIMITS• GENERAL LIABILITY -ACH OCCURRENCE. $ COMMERCIAL GENERAL LIABILITY ' NIAGE TO RENTED CLAIMS MADE Q OCCUR ` r KENISE (Ea xcurrenc ), t . MED EXP(And url�_parsurn $ ERSCNAL&ADV INJURY $ e GEN'L AGGREGATE LiNI APPLES FER � a' ,. ENERALAGGREGATE $ POLICY ❑PROJECT LOC; N r ' RODUCTS-COMP/OP ACC' $ a AUTOMOBILE LIABILITY "+ COMBINED SINGLE ANY AU-0 LIMIT(Ea accident)'. ALL OWNED AUTOS D LY INJU RY' UR' $ .. (Per person) s , SCHFDUI.F AUTOS HIRED AUTOS BODILY INJURY $ a. - (Per accident) _ NON-OWNED AUTOS PROPERTY DAVAGE $ h: (Par accident), 0MBRFI:1,A I IAB O,ccuR " EACH OCCURRENCE. !$ EXCESS LIAB CLAIIJS-MADE AGGREGATE 1$ DEDUCTIBLE REIENION $ 't I A WORKER'S COMPENSATION AND AC STATUTOR •-OTHER, EMPLOYER'S LIABILITY YIN" UB-5039P403-12 02/1012012, 0 211 012 01 3 uMTc E ANY PROPERITORIPARTNER EXECUTUE M N/A s E.L.EACH ACCIDEN, $ 100 000 OFFICERMEMBER EXCLUDED,? ` (Mandatory in NH) c' t L'[JISEASE-EA EMFLOYI E $ 100 000 r. Ilyes ria;criba imrei r ,.y •r a :.. ' E L DISEASE-FOLIO-Y LMI $ 1,003 030 DESCRIPTION OF OPERATIO^J°be;Po r �: � DESCRIPTION OF OPERATIONStLOCATIONSIVEHICLESIRESTRICTIONS!SPECIAL ITEMS TH_S REPLACES ANY F?IOR E2_1_LTC 1"E ISSUED TC THE r EE:I ICATE HOLDER AFFECTING,WORKERS COW COVERAGE... CERTIFICATE HOLDER CANCELLATION FAUL DAVIS RESTORATION&REMODEL, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED FO BOX 1382 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTO VE Z SOUTHDENN;S,NIA 02660 ;l ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1W-2010 ACORD CORPORATION. All rights reserved. �' ' --.......... . . .. DATE(MM/DDMIYY) Ate,. CERTIFI ATE OF LIABILITY INSURANCE 11 Ol 2012 PRODUCER (lei) 3aa-8578 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER$ NO RIGHTS UPON THE CERTIFICATE C.L. Hollis Insurance Agony Inc I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 27 Glen Strut ALTER THE COVERA(3 AFFORDED BY THE POLICIES, BELOW. Stoughton MA Q2�72- INSURERS AFFORDING COVERAGE NAIC INlIlI11P0 INSURER A'.SENTINEL INSURANCE CO LT 1.1000 EUROP>ZAN MASTER FLOORING DOA INSURER B:TWIN CITY FIRE 201 Lakeside Dr, �kI I INSURERS: _ II INSURER D: Malrstons Mills MA 2 48—. INSURERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELQ HAVE B EN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF A CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POL IES DES RIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE B E REDUCE BY PAID CLAIMS. INSR ADIYL POLICY EFFECTIVE POucY lzPIRAnoN - LIMITS, TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE MfDDVW A GENERAL LIABILITY 977 12/15/2011 12/15/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY ! DAMAGE TO RENTED $ 1,000,000 PREMISES Ea oocurcence CLAIMS MADE EOCCWR 12/15/2012 12/15/2013 MEDEXP one arson $ 10,000 PERSONAL Q ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 OEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000 X POLICY PE(t LO / / EPLI 10,000 tl _ AUTOMOBILE LIABILITY / / COMBINED SINGLE LIMIT' (Ea eo WeM) ANY AUTO ALL OWNED AUTOS / / BODILY INJURY $ (Per Person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY Y • $ (Per®addenl) NON OWNED AUTOS �I PROPERTY DAMAGE ' $ (Per amderd) ' GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT $ ANY AUTO I / / / / OTHER THAN EA ACC $. AUTO ONLY: AGc $ EXCEMMMBLLA LIABILITY I _ EACH OCCURRENCE $ OCCUR CLAIMS MADE I I AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND IOBWIICLC�785 04/08/2012 04/08/2013 X T YLIMITS I IER BYPLOYERS'LUIBILITY E.L.EACH ACCIDENT $ 100,000 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? I r / / / / E.L.DISEASE-EA EMPLOYEE$ 100,000 If yes,deacHbe under 500 000 SPECIAL PROVISIONS blow E.L.DISEASE-POLICY LIMIT $ r OTHER DESCRIPTION OF OPERATIONSILOCATIONONEHICL4"XCLUSI"ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER ' ''A CANCELLATION " (508) '430-7800 SHOULD ANY OF THE ABOVE ESCRIBED POLICIES BE CANCELLED BEFORE THE it I EXPIRATION D ERE , HE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 D WRITT N C THE CERTIFICATE OLDER NAMED TO THE LEFT,BUT PAUI+ DAVIB RESTORATION FAIL TO 00 N POSE NO OSLIGA N LI ILI OF ANY KIND UPON THE 527 MAIN STREET UNITP 12 I INS GEN REP NTA - � AU ORI,T,ED REP TATIV HAMICH 02 45- ACORD 25(2001/08) V ACORD CORPORATION 1208 . Papa I of IN3028(olo8).06 10/25/2012 08: 13 Bryden and Sullivan Donna Seviour-*David Rome 1/1 WOODBA OP ID: DS ,a►coRc� CERTIFICATE OF LIABILITY INSURANCE DAT10/25DI11 1 r�1111 I��Ir�iiiiri�I ti 1 5 lL;QNI-IzK5 NO IRIG.HTS UPON THE C-ERT11JTE HOLDER.Mr ,0I25112 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT- If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. Bryden&Sullivan Ins Agency PHONE FAX 88 Falmouth Road Fax: 508-790-141 Arc No Ext: (arc,No): Hyannis,MA02601 E-MAIL Hyannis Office INSURER A:Associated Employerslnsurance l INSURED Brian WOOdillDBA INSURER B:NGM Insurance Company - 14788 BW Construction ; INSURER C PO BOX 1538 Brewster,MA 02631 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 - LIMITS - L POLICY NUMBER MMI NYYY MMlDDlYYW GENERAL LIABILITY EACH,),-1_URRENCE 6 1,000,00 X X COMMERCIAL GENERAL LIABILITY MPT199OG - 10/22/12 10/22/13 PREIvnoEs;Ea����.currencei � 500,00 CLAIMS-MADE •aX ccu: • } MED=_'•= r n l rson) $ 10,00 ' • PERSONAL;'-P.DV 1,000,00 . .. iEfdEF'ALA.GGR=hATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER r PkCDUCTS-I_CMP OP AGG $ - 2,000,00 Rv j- - POLICY P - LID,-' AUTOMOBILE LIABILITY ,Ea accident) $ _ ANY AUTO $ODIL'r'IN:IUR 1,*(Per personf $ ALL OWNED SCHEDULED AUTOS AUTOS BODiL'r INJUF'i(F'er accident) $ NCIIJ OVVNED .r - .. - F'F P DAMAGE $ HIRED AUTOS AI IT,_�S ` Per a lent UMBRELLA LIAR Cu_CIJR r EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE 4 ASr,REGATE $° DED RETENTI t W ANO ERS COMPENSATI EMPL TER 'LIABILITY T i LIMITS 77 A PROPF /PAP.TNERIE>IECUTIVE YIN BINDER' 1012211.2 10/22/13 EL EA N C .IDENT $_ 500,00C - OFFICER/MEMBER EXCLUDEDN> N r A (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 500,00( If yes,describe under -- DESCRIPTION OF OPERATI'DNS belr;N, * E L DISEASE-F'JLICY LIMIT $ 500 00 DESCRIPTION OF OPERATIONS r LOCATIONS r VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) ' perations performed by the named insured as provided for by the terms and onditions in the,policy PAUL DA SHOULD ANY'OF THE ABOVE DESCRIBED'POLICIES BE CANCELLED BEFORE Paul Davis Restroration ACCORDANCE WITH THE POLICY PROVISIONS. 4 of Cape Cod&The Islands David Rome AUTHORIZED REPRESENTATIVE PO Box 1382 Hyannis Office (South Dennis,MA 02660 ©1988-2010 ACORD CORPORATION. All rights reserved. ' ACORD 25(2010105) The ACORD name and logo a registered marks of ACORD 2/7/2012 9 : 41 : 51 AM '8935 0 02/ U2 (MM/DD/YYY) -"``' CERTIFICATE OF LIABILITY INSURANCE DATE 02i07 zoi2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE _ISSUING,INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain.policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Passaro Leverone & Buckley I NAME PHONE Insurance Agency Inc "�` " E"t'` PAY AY "°'' E-NAIL � P O Box 160 F .ADDRESS: i •• PRODUCER Dennisport, MA 02639 CUSTOMER IDR. INSUREDS) AFFORDING COVERAGE HAIL A INSURED Kenneth N Fletcher III INSURER A: A.I.M. Mutual Insurance CC 33758- INSURER B:... ' dba Cape Custom Plastering INSURER C: " P O Box 1389 INSURER D: South Dennis, MA 02660 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 REQUIRFSENT, 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 TIME: POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SO" POLICY NUME IN POLICY EFF 'POLICY EXP L3I4ITS Y Ltr TYPE OF INSURANCE IwroDmwt " (m1NDAIYYYr GENERAL LIABILITY - - - EACH OCCURANCE S ❑COMMEAC IAL GENERAL LIABILITY ` . - • ° .. DAMAGE TO RENTED - '- PRENISES(Ea. —rrence) S ❑❑CLAMMS MADE ❑OCCUR - i. NED EXP (Any Une person) S El •. ' PERSONAL G ADV INJURY S GENERAL AGGREGATE S' GEN'L AGGREGATE LIMIT APPLIES ER: []POLICY ❑PROJECT ❑LOC • ' PRODUCTS- COMP/OP AGG S S. AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT - aC ❑ANY AUTO • ' BODILY INJURY (per Perem.) S ❑ALL OWNED AUTO` - y .. - ❑SCHEDULED AUTOS BODILY INJURY(per accidmt) S •t PROPERTY DAMAGE ❑HIRED AUT11E - �a (Per a cident) S a } , ❑NON-OWNED AUTOS ❑UMBRELLA LIAB ❑ OCCUR' - ' ' ' _? EACH OCCURRENCE : S ❑EXCESS LIAB -❑ CLAIM MADE AGGREGATE � � Sw ❑DEDUCTIBLE - - S ❑RETENTION 5 ' -S ilC SrWU- �• WO[DQ:RS COMPENSATIONOTH-M. � _* - . AND EMPLOYEES LIABILITY ° , , TDBY LINT E„ THE PROPRIETOR/PARTNERS/ - 8 100,000 EXECUTIVE OFFICERS ARE E.L. EACH ACCIDENT' A •I •1 ® 1ncl ❑ eXCI • 601499ZO12O12 E.L. DISEASE -POLICY LIMIT S 500,000 02/02/2012 02/02/2013 E.L. DISEASE -EA EMPLOYEE S 100,000 COMMENTS DESCRIPTION OF OPERATIONS OR LOCATIONS: v - - KENNETH N FLETCHER III IS COVERED BY THE WORKERS' COMPENSATION POLICY r 4 CERTIFICATE HOLDER CANCELLATION , PAUL DAVIS RESTORATION '• , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED,IN ACCORDANCE WITH THE , 527 MAIN STREET UNIT 12 POLICY PROVISIONS. HARWICH, MA 02645 AUTHORIZED REPRESENTATIVE '.a :1 9743 4 s Mar-30-11 02:29pm From- T-932 P.001/002 F-329 CERTIFICATE OF INSURANCE w o3/sarzoll HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN HE ISSUING INSURERS , AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require and endorsement. A statement n this certificate does not confer rights to the certificate holder in lieu of such endorsement. PRODUCER Passaro Leverone&Buckley Ins Agency r 239 Rt 28'Box 160 Dennisport, MA 02630 `x~ COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Kenneth N Fletcher IIII DBA Cape Custom Plastering PO Box 1389 South Dennis,MA 02660 . . 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,NOT WITHSTANDING 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 THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIR CLAIMS. Co LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY LIMITS , HE PROPRIETOR/ PARTNERS/EXECUTIVE. ' OFFICERS ARE: STATUTORY LIMITS INCL a EXCL o 994.7289 1 3/18/2011 - 3/18/2012 OTHER Coverage Appllee to MA Operations Only. ' �• $ 100,000 EACH ACCIDENT r DISEASE POLICY LIMIT $ 500,000 DISEASE-EACH EMP40YEE $ 100,000 DESCRIPTION OF OPERATIONSIVEHICLES/SPECIAL ITEMS RE:KENNETH N FLETCHER III IS COVERED BY THE WORKERS COMPENSATION POLICY, CERTIFICATE HOLDER CANCELLATION PAUL DAVIS RESTORATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE . 527 MAIN ST, UNIT 12 EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE HARWICH, MA 02645 'WIHTE THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i ^ { CERTIFICATE OF LIABILITY INSURANCE DATE(MMMWrf"' 111/22/2011 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: the ceRificate h6lder is an 1 e po cy(w) must an oraetl. su )act 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($). PRODUCER - NAME: HLAIR AGENCY, INC. 508-866-9150 52B-866-5334 AFC No,I-): 145 SOUTH t9►IN ST annREsa: CARVER, MA 02330 CUSTOMERIDN;' _ --.......... -._.._..�..--...--- ........._ 508-9 6 6-9150 INSURERS)AFFORDING COVERAGE NAIL a INSURED INSURER ASARM FAMILY CSUALTY INSURANCE COMPANY 16721 JOSABEN, INC, wsuRenmAMRICAN SAFETY INSURANCE CODdPANY DRA PAUL DAVIS RESTORATION OF CAPE COD 4 THE ISLANDS INSURERC; PO BOX 1382 INeuReRD: SOUTH DBNNXS, MA 02660 INBURERE: 11,18URER 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. NOTWfTHSTANDINO 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. ll�R f. _._ --..._..__......_.......... — LTR t TYPE OF INSURANCE IN3R WwVD POLICY NUMBER (MMtbD1YYYY) (MMfDOdYYTY) LIMITS GENERAL LIABILITY . _. EACH OCCURRENCE - - $1,ODD,OOO X 'COMMERCIAL GENERAL LIABILITY X ENV030453-11-01 11/17/201111/17/2012 PREMISES(Ed omunenm) $ S I CLAIMS-MADE �X OCCUR MED EXP(Any one oatson) i 5,000 PERSONAL R ADV INJURY $1,000,000 GENERALAOOREGATE 52,000,000 OEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS_COMPIOP AGG $2,00,0,000 —I PRO, X I POLICY JECY LOC f AUTOMOBILE LIABILITY X COMBINED SINOLE LIMIT 8 - , (EA 00cident) ANY AUTO 2001C38363A 11/17/201111/17/2012-__..._.--'_-... ...------._. ' _............... L.._ BODILY INJURY(Per Farm on) 8 1,000,000. A ALL OWNED AUTOS BODILY INJURY(Pet axidem) E 1,000,000 X{SCHEDULFDAUTOS PROPERTY DAMAGE $ 1,000,000 JC HIREDAUTOB (Paraaldent) X NON-OWNED AUTOS X UMBR'LLALAe X OCCUR X ENU030454-11-01 11/17/201111/17/2032 EACH OCCURRENCE s 2,000,000 B EYCESS U1 !.CLAIMS-MADE -° - AGGREGATE v s 2,000,000 DEDUCTIBLE c X RETENTIONi- WORRERBCOMPENSATION - - AND EMPLOYERS'LABILITY TORY uMITa X I ER A ANY PROPRIETORIPARTNER/EXECUTIVE Y I N I 2001W6351 11/17/201111/17/2012 E.L.EACH ACCIDENT 3 500,000 000 OFFICERIMEMBER EXCLUDED? ❑ NIA .._.__.... .:_...._...__..._.....__...._.._..._._.__. ....--. (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 It yea,describe under - E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS below )B CONTRACTORS POLLUTION LIM X �ENV030453-11-01 11/17/201111/17/2012 SEE DESCRIPTION 8 BAILEES COVERAGE ENU030454-11-01 11/17/201111/17/2012 AGGREGATE LIMIT $250,000 DCSCRIPTION.OF.OPeRATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Ramarks SchodUW,a more space If raqulrod) $XE ATTACHED DESCRIPTION OF`OPERATIONS OVERFLOW CERTIFICATE HOLDER CANCELLATION CRAWFORD CONTRACTORS CONNECTION SHOULD ANY OF THE A®OVE DESCRIBED,POLICIES BE CANCELLED BEFORE 5022 GATE PARKWAY, SUITE 304 ' THE EXPIRATION DATE THEREOF, NOTICE WILL .8E DELIVERED IN JACRCSONVILLE, FL 32256 ACCORDANCE WITH THE POLICY PROVISIONS. . , AUTHOR D REPREBENTATIVE FAX# 904-224-6457 ''ATTN- STEF'ANIA,,PINION r igas-20WACORD CORPORATION. All rights neserft ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD 2nd floor 2'11" { 3'6' [r.. walk-in 0,4 L ft MtR .E klant n.th t yRR m. 'a I_-2'4' met(z1 iu t 1. T 1 ����`�'? "• �` o,�,;;�.t.ram'""'.. T �„`;•sy`r�w '�' �. ...�-ram:,'" -, _ - - rnimrn;trm, .wantned" r®Taeeeraom 5tatr hdl - lout I • . 2nd floor Main Level i Odd • l ,0'9• - �5.2' ti .. 1 2KRchm ,.z M. Y � w j _ - 3 --- 3110' 3 4 3'3 2'9° `..u.k,aoom I rhall [msetg2, r t • Main Level I'i Basement 20'B- _ - - t, 20' K B'4" , ,j �6 7 work Rrea/Romn - ' Y 29 Ell * �6' 6' F ld�LL ` Cedar cbset , 70'11' 8'9- T9.4- Basement TOWN OF 9ARNST,A®L, 5 . Aso ASSEBSOR 2.33 AG s�' • a�0 TT-1' 76 t�•� .4L.c 75 5e AC 71 72 73 74 .50AC 3 70 zy AC .21 6 u .26 AC26 ABC w w 2 � i 196 J 6) 03 ul 54 S T E T 30 N 58JSAC 34AG 'tip 5B 60 59 .50 AC' �e O 6 2 25 ABC a u .29 AC 7 O ^ !6 i zL� tc.9 Z70 Lis `as 9 Of AC Z`� so ov goo - HJ iim soiP� �I cflsoIII le I-'/rrIi �zellk, Al I i r- OA/ -4-7 ..� D O k) - Qj N40- 7-41 JN t � il/o w O,e /�O,e 41ERE L Y W Y v/[.L F- .� /(E VC Al Y Assessor's Office(1st floor) Map , Y2 (� Lot 4 -. iit# Conservation Office(4th floor) , Date Issued q-�02(, Board of Health(3rd floor)(8:30-9:30/1:00- 2:00) ti t "S T BE .Engineering Dept. (3rd floor) House#1 IN$�I � ������ Pla (1st flo ool 'ri'Bl IN E Is oop-�� CODE AN finiti pproved Ian "M 1 TOWN OF BARNSTABLE, Building Permit Application Project Street Address `Z r J /-- ���� " Village �Ac`LcA/VAI1--5* Owner / i Address 5 �"/.= T-�/% s'`7 Telephone Sf 7 7 oZ 73 `IN, Permit Request F6-1 N r /� /Y 1 eA�/�-_ Total 1 Story Area(include 1 story garages&decks),, square feet Total 2 Story Area(total of 1st&2nd stories) <f`' l'"'"` square feet Estimated Project Cost $ Zoning District Flood Plain~ Water Protection Lot Size Grandfa'thered ? Zoning Board of Appeals Authorization '` '' " Recorded Current Use r` A Proposed Use Construction Type Commercial Residential Alwelling Type: Single Family %l 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 Name l/1//L.C.//� G �!�%`/J�/� Telephone Number Address .� �i'i� -%S License# 0 �/�j—Ll � Home Improvement Contractor# 8/7 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ,p ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I (/7/✓� f SIGNATURE DATE 154 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. 1058.E DATE ISSUED 09/26�/95 f MAP/PARCEL NO../ 306.234 41 Stetson Street;t S Hyannis, MA 02601 : ADDRESS .� VILLAGE OWNER M. R. Anderson DATE OF INSPECTION' E �� FOUNDATION' , � M. t ., rF ON FRAME INSULATION ' FIREPLACE - ELECTRICAL: ROUGH FINAL ,1- PLUMBING: ROUGH FINAL GAS: ROUGH FINAL yyr� K Yk • : b-� FINAL BUIL''bl9k «r iIt'u�`%:n�^ �' Ei•'Y�'�d4 DATE CLOS t; v, ASSOCIATIQPIEtfi N{J L; r ' The Cminnon►realth of Afassachusetty Depart►nent of hidustrial Accidents office-of/nYBSUya1180S 600 fl ashhtgton Street Y , n - .,+ Boston,Mass. 02111 �- Workers' Compensation Insurance Affidavit -Ali can nformati�i'.- - Please PRINT legibly �, _ •` '�� (/t name location. 12�—o � 1 am a homeowner performing all worf.•myself. I am a sole proprietor and have no one working in any capacity t.....:ai�:. : •6r' .a[.""' 'a"' T..aaawss.7.v�'''^�.�. �.�__�_.._.� :',�, -..ram�,�^.. `��r�,;��ur ;¢, :•�- .�7 !? +..+.�.e--r-.-..T�e-_x••..+-e.,.,o� .1 am an employer providing workers' compensation for my employees working on this job. comply name: address: - city: phone#• insurance co policy# 1 am a sole ro rietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company nnme- address• citx• phone#• insurance co poluw# 1.�. .�i,.::.....ac� - _.•..:� i.7:.;•,,-•.naorarrr•s.'-•T«'t�i eaeV'.•.�s•--�ae�r�4 -rJ4E�a+J1�j++yv�t'37*OM1f• P�.�`�"�:1�rtir'� company name: — address: city phone#: insurance co. polia# .Atiach idditional'shcei if tiecessa .. ._.�'.::;...z — -.i1:.. ..� ! a. • ,late w•syiu: Failure to secure coverage as required under Section 25A of A1GL 152 can lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NYORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forward to the Office of Investigations o e DIA for coverage verification. I do herehr c rtify and t • and penaltl j th tl rotation provided above is true and rrect. Si-n, Date Print name "v r / C y� y / Phone# 7 official use onh• do not write in this area to be completed by city or town official city or town• permitAicense# nBuilding Department OLicensing Board check if immediate response is required 0Selectmen's Office �I1ealth Department L contact person: phone#• r'lOther :.�--:ate--•-.•�,:� .,.:.,�.,......-....•,,.. (revised V95 PJA) : 4 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an enrphr wee is defined as every person in the service ofanother under any contract of hire, express or implied, oral or written. An cmp/orer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing enga-ed 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 dweilinu 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 arounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that even,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, 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 haver been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date 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. .77 Cit• or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. .. ,. .. . , +vim p ..... , The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 i ;,� yr ►� !=o ° � � C '�� `x� �x�", .a:, �an ������ �a: ;� � :1 .� s� � _ v �k C(` a'a . " .t - , . ,t. yF , r . x 't,', _ _' I, x ti .� P '1 I I t `i t �(: ' , :. J .. , - 1' , ) , t I �.. t .i P < .c -- ' f," 6 11 i r `r 4.,,i q'ile;i r. _t !, I-♦ _y �...,- - x: r 1 r1.. ^ te, i y �"':} i xx .,,+�3.,kr�^ ,1. 4 s _ (y r ,:t +.. ..Yt J I. <, >s�. II I' t 1 3 .:# II .^.. i .l - ( ♦ l I t ,l 1 +,. r �. t Is ``) .� ( ' s r Ij f t T 4 l t - _ r'r _ , . J r a. S I 1 ,' ( ,'t / t .. J y,. y" .rl. s C.j k /1 ;J+ .t; i t I - .. :5 I I ' , f t. + / s e . .. ; I i'. r) l i .. t, 'lr it ., - - I r ti x 5 s t � r 1 .i t t t ` + i } I II J I r t 1 I t !. 1- t I ` I i j i!A y I+ - t I k t c *, t `I d !r I o t b y,p.q wrw qqr .+a`a J j.r + kV y.( ` .,% , ,' ?. _,' a Q ry .� tolfir#topOatsesa ,Vi6va _ .5.K h. '' COMMONWEALTH t I$ 3 DEPARTMENT OF'PUBLIC SAFET�1f; to oMw>rte+Stab8dM.. aar OF.' ; , 1,t 1"° � .ONEASHBORTON PLACE w. • 3`' Rib ��/pr OR TT ;x_ 4 .. _ i 1l'' - . •y ir1 14 { ` `� r:. S08TON,MA 02108 ,1x d j i I. I'l ,` z MASSACHUSETTS y,�� lr,• - ,.�t �.' ':' ,, t. rr x, 1 .�/t }^e a ,},, �7! d- t Y. Y r t i < r:'sa.x�""',,yy--. `* r C,.:,.sa l 'roi a: .i M1/_ 4/ '�4?;L ,r '..�t - nt ° .—'' dy -�:.-K-h 1 n.. EXPIRATION DATE ,,k ,.. rt_S SUPERVISOR 1. ; t ��r,1, FO�i.PROTECTION AGAINST, •. 07/19/1946 Fft CONSTR. " THFFf,PUT RIGHTTHUM6-, s "�; EFFECTIVE DATE LIC-NO RESTRICTIONS. `faf , ? + t ;� i f.: k PRINT INAPPROPRIATE 4 r I + j t ¢ � BOX ON L,ICEN$E ' ` t ;,ems�UF . 07/31/1993 048546 r 3 Lt by + t � .,: j '• ..I LIAM 'CL GUNDAL BLASTING OPERATORS MUST INCLUDE PHOTO I f y 1 15 0 REGI6 RD � `� "' " x7` PAD 3 'r '` PHOTO(BLASTING OPR ONL of ,. ,,,:MARSHFIELD MA 0�050 fK�. �. 4� . n FEE �'* ^ K. ' ' ® �I/� 4 OT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY r P v c R- ''S'.l.as r L , ` L t '? 10 •rf 6 �Y+�' STAMPED OR SIGNATURE OF THE COMMISSIO .;e I r i'a N r j� ar I HEIGHT. t k�� S a Q���t�7 3 �'` - ' + rS NAME IN FUG.P}IOV�,tyG- LINE 4 t d ���y/,//, r ,_,, `TMS DOCUh1FJ%IT�M�ST BF! GNATUREOF LICENSEE t rn r� - • • i- l - f} '$ x CARRIEDONTHE pERSONO - pd w ' �- .'' + 's; - THE HOLDER WHEN EN I , -_ ISSIONER �j�'��y m u i- , vc, �r.2 ,'-u GAGEDINTHI$OCCUPATWN - OTHERS-RIGHT THUMB PRINT l - - .. -s it ap .l t 'is - t y Y` n.r;� ..*.', .�.�.+..e t 'a .,.�'vrl Jii"y, ( .,r� ecv f'cNYf ( t.t r ' 1 t ( til I 1 a \ r t I I •1 I t y - Yt ,? 4 r It I r -,:1 I t t. , I Irt,. 11 `. I t I. t t , p ,.•' f: t. 1♦ J.V ' ,, I 0.. ( d q, /qx 4r+t''rn y f Iq P .1•.j3i I i , I I i J`��)J s a` (, hd 'y d 4;a x. �!: i it L .. - Y-er0 Gr rs:.: .S ,-tiy 4.;V s4 4 4 f� V - (L ti 4j r �>a.a grI a. urn( r :}� '1 1 l i Y rr�t a:A�y ir:.�i ��trn d sty'-5 �' iiA. ,f yr k y dt: i •. r i,' ,�. 'tic h i r 1t,. .,,.--. t . ,t rkI.t I t 1 L + di ,,,� j.F ai} qti Z t..` ,Y p S ,k 9 s 1 -I I I ai "+I - . 'I t t i o t t .I +. P Ir I r t { I I I 1 " 1 +.. r ` LI 1 l` II t q1 } I 'y.�4F I ♦, 1i C .o1,"} i\i C�f ♦ ,;` �. t trt.,.,\, ,, . . , ... .;l'.. . . .r. < .'I GUNDAL CONSTRUCTION 50 REGIS ROAD MARSHFIELD MA. 020500 TEL (617) 834 9558 MA. CONSTRUCTION SUPERVISOR LICENCE#048548 MA. HOME IMPROVEMENT CONTRACTOR LICENCE#108177 COMPLETE HOME REMODEL NEW CONSTRUCTION HOME INSPECTIONS SEPTEMBER 24, 1995 CONTRACT AGREEMENT AND SPECIFICATION SHEET BETWEEN GUNDAL CONSTRUCTION AND M.R.ANDERSON OF 41 STETSON STREET HYANISS,MA.02601 TEL. (508) 7751293 JOB DESCRIPTION: FRONT ENTRANCE. TO SUPPLY AND INSTALL NEW FRONT ENTRANCE WITH GABLE ROOF,BARREL STYLE CEILING,TWO SQUARE COLUMNS AND TWO 12"%4'FOOTINGS. CLOSE TO ATTACHED PICTURE. COST OF ABOVE WORK $2,700.00 NO.OF PAYMENTS 3 PAYMENT#1 $1,500.00 UPON SIGING OF CONTRACT. PAYMENT#2 $ 700.00 UPON INSTALLATION OF ROOF. PAYMENT#3 $ 600.00 UPON COMPLETION OF CONTRACT AND CUSTOMER SATISFACTION. I ACCEPTED AL I Y. i .. ��'= .. _.�,...- --'''"■,.,.-tea; ,,,� � 1 J . _ —sue 1►� � � , � ;,� 1 - �� �++' jIMMIA % •