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Home My WebLink About0259 STEVENS STREET asg s�e.,� sr t j TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ��d Parcel; S Application#�y U� f 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 Village h�y >r Owner Address Telephone &:;!�7 3/Z ,�7 Y-"3 Permit Request yj?ia 2�� 1�� f`a �� /�/ei��c� �/l L,) l:e f/v/� ,s� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Ad4g B ' Construction Type /"s d Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sn orting cl&me tion. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes XNo On Old King's ighway:<U Yese XNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other _ -y Basement Finished Area (sq.ft.) Basement Unfinished Area (sq. ) � z I— IL m 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 �� l�/��yJ�, ,ram Telephone Number O-Or. Address 1/�L� �l�l✓!!®,� � License # /p® � ,�i/1J11U Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE KEN TO azzOLre '1Z,/ SIGNATURE DATE 9 f 9 FOR OFFICIAL USE ONLY " APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER J DATE OF INSPECTION: y u FO.UNDATI0Mu.�*fic,mil,itP MIANQAHQku, FRAME —. — — - INSULATION..=� .- _ L FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 3 FINAL BUILDING DATE CLOSED OUT _ ASSOCIATION PLAN NO: r 08/18/2014 11:31 508775G52G PAGE 03/07 08/17/2014 22:04 95687906a67 PAGE93 460 WOM Main Strut Hyan iffi,N1A 02841-3698 775-'7434,) � Tat:PS)T71-54M F6►7t(508) Housing � Tan all 1in1§9 Assistance r CorpO ration Cage cod F henZatip%n! } Free .7 uested and is eligible for weatherizatlon of your rental. home Your tenant has rreq vPded at no + to YOu. Prog a through government funding. This twrill be regulations permit us; to spend arc,and $2,50(? $7,500 in materials. and,labor per dwelling.unit. K (Program regulations require us tow ath®r-strlp and caulk doors and windows; ansula hed private attics, sidewalls and floors: All work is professionally rryake suite that ill v+�done bytoCki4ss completed _ contractors. ..We will conduct a final inspection to , to Specifications.- It Y ou request, you 411 be informe ' of the estimated measures before they arQL d e . and provided with a list of the actual measures aria ,costs #allowlrrg the com p , . the work. We also need proof that you own the property. A copy of a CURR T TAX._B114 AR, DgE listing you as the owner will sausfy this requirement. A of h( enclosed a,greernent and return with the proof of . t�lease fill to all blank areas t , ownership as soon as posslbie. , If we do not receive`tha enclo ed lform within two weeks, ,we will do a 'basic energy audit of the home, but o weather! ation work Garr be recommended or done. If you have any questions please call uzln"O Smith at 508.771»5400,'�Xt. 123 of email her 0 pamlthQh eoncaperod.4_g ' [r + / LAN 9.OR V�11 TENANT! ®lilfp h�t I �Vl e0 i v►Ie hor �jpone:(11"Q) Plane: { 08/18/2014 11:31 5087756526 PAGE 04/07 -- — ._ — . PAGE 04 08/17/2U14 22:04 95087905367 . , I& The Parties acknowledge treat this Agreement is under seat. it is intended by the Paftlas that the Tensrnt or Any successor Tenant is the intended beneficiary of the Agreement and shall have a right at en#dreemant. Date Property Owner's Slgrteture: �- — g - 131 Phone: 0 Addr®as: ' , t Date Tenant Signature t Agency Approved Weatherizattan Company All Cape Energy I 'Adam T. Incorporate ! :Cape Cod Insulatio /'Cape Save 1 Frontier Energy Solutions / Lehr&Sons Inc. I Resolution Energy i r Agency Signature, 08/18/2014 11:31 5087756526 PAGE 05/07 PAGE 05 08/17/2el4 22:04 950B7906367 W TENANTIPROII OWNERIAGENOY WEATHEFitZATtON AGR'E't VtENT t. Th arties c this rnent fol ovn _(hereafter known as Tenant), (print your t nant's ame) On Lfi( (hereafter known R8,Praperty Owner).., (print a your m ) and F1oou n 14ssi�ten�ce carpora Con (hereafter known as Agermr<y):. In considemlion of 049 mutuat prr�miaos hereafter stateo.the parties agree as folidiNs 2. The date of Agency's signature will be the effective date ofthis Agreement. 3, Property owner and Tenant consent and agree that the Agency may 60 the fallowing with respect to the rpr'operty located at(s reet,town) _, . unit# end currently leased or rented to tile' Tenant: . ; ry. . A. •- . a} Enter the Rremises far the purpose of performing a Weatherizativn inspection b) Enter the premises to perform Weatherization work which the Agency determines in Its discretion is necessary and appropriate as a result of the Agency's inspectlan of the property and in accordance with tha appropriate priority list for the type of dwelling. The Agency and the Agency's contractors ray al®o enter the appropriate cornmon areas of the building for the purpose of accomplishing the Weatherization work.•The AgencY and representatives of the commonwealth of Massachusetts, Department of Housing further enter the proporty to inspect any and ail work, & Cornmunfty Development (DHCDy may hereunder, The Agency will provide reasonable notice Of the timing of the Weatherlration work and ation work will be performed in a0cordance with the Property Owner's inspections, The Weatheria ; consent as Further specified below: INITIAL{}rVLy oNE OF THE FOLL,OWINO I consent to'performance by the Agency and Its caritractora of any Weathsrizetlon'workr ned necessary and appropriate by the Agency as a result of its inspection of the property. understand tftst- the Agency will provide a detailed statement of the actual work performed and tho associated value at the compietion of work. _ f will provide a separate consent to performance Agencynsp by the Agency and its contractors of Weatherization work following se receipt of the 's inspection report and a statement Df the eatimated'work and associated value. This additional consent will be sent under separate cover as,Attachment A. l understand that the Agency will provide a detailed statement of the actual work performed and the associated value at the completion of the work. d. The Property Owner undarstands and 'agrees that any and all work, including related repairs for,which the Property may also be eligible,will be performed at the Agency's discretion. The Agency estimatAd completion of the 1Weatherixatlan work by the and of t. 2013, 5- If the property Owner is required to make repajr�syte the property prior to the commencement of Weatherization work by the Agency,the.property Owner wlll be notified by the Agency and will required tt7 make the repairs as soon as possible, yExcapt where the Property Owner receives a written extension from the Agency, time is of the essence in the performance of repairs by the Property Owner. 6, The property Owner and Tarrant authorize the Agency to receive a statement frCm the fuel supplier/utility supplier as to the quantity of fuelfutUlties used at the above address In each of the past three years and the future three' years. Tf1a.information is to be used only ,to determine the cost effectiveness of the Weatherizatlon improvernente. 7. The Property Ovrner,agrees tat the rent for the dwelling unit will not be raised because Of any increase_in the value thereof due sptely to the WOatherizetian work performed: 08/18/2014 11:31 5067756526 _ PAGE 06/07 PAGE 06 08/17/2014 22:04 95087906367 201312014, appraxlmately We fs. in consideration of the Weatherizatlon worts hereunder,the Property Owner further agrees that upon the eifeGtive 11 date of this Agreement and during a perlod extending thraug year from the time the work is completed, sent rent ,a `par montll will not b$raised for any reason. {Tht3 rent amount must be a) The pre . filled in).Heat included in rent?Yee_, No h t3si will bte waived try the Agency,in w'rttiing it,and only It,th®premises How6ver,this Paregr� ( a in are leaned under a state ar federal VON to the standards of the rent stibei�y p ogram the aorusl rent charged by ti5®Owner$boil conform Please state which Housing$ubaidy program your t®nant is On and trrrough which Agency: b Thu property owner wiii not lnstltvte any summary praTenant flOn or anfor ucce soQ�enan 1t in the case of non-payment of rent or other good cause relate d to the e Y . ` remises,property Owner shall abmply with pn9 of c) In the event the Property Owner decides to sell the p oP Y the two requirements below: `. . , ..The Property Owner shalt not sell the premises unless the buyer agrees(Witha copy forwarded to ills assume all obligations of the Property Owner set oust in this Agency) in writing prior to sale to Agreement;or .. - � .,, .. _ e Property Owner shall pay the Agency an amount.equal to the cost,as certified by the Agency, of Agr the Weatherization materials installed and Tabor performed to the premises as of the date of Balm. Sold amount shall be paid to the Agency inImediatety upon sale. Of he g, (Appticalble Only if Tenant's heat is included In shall not be ais d more nt and thanblanks are MOO pe in) A y for an period set forth in Paragraph 5 above,the rent additional period of one year, and the provisions mabbe waived by the o above aAg Agency in writing f,{and Only It, However, the rent prov� bhs of this Parag p Y premises are leased under a stale or federal rent subsidy program, in which case the aactuai rant charged by the Owner shell conform to the standards of the rent subsidy program. 10: The Parties agree that the terms of this Agreement are incorporated into any other lease or agreement betwoAn successor TOMM,and it there is the Property Owner and the Tenant sorts of.this Agreement and the provisions Of Owner and su h other lease or agreement,the x any iaiosconflict between the pnnr provisions of this Agreement shalt govern. However,If such,ether lease or agreement, ;nciuding without limitation, a lease or agreement under state or federal rent subsidy program, contains stronger prateCtiona for the tenant, such stronger protgctlons shall apply- 11. For preach of this Agreement by the ProRe4 owner, the Property Owner shall reimburse the Agency iri an amount equal to the cost, as certified by the Agency, of the Weatherizatian materials installed and labor performed on the premises,a$well as attorney'$tee and court costs. The Property Owner may also be liaple for damages to tho Tenant In accordance with applicable law; in such instance, fhe Property Owner shall refttirso the Tenant for attorneys fleas and court costs. WIt17W limiting the foregoing, the Agency may'"at'b notion terminate this Agreement,by providing written notice to the Property Owner and Tenant,In the event at breach by the Property Owner or Tenant,:` r Performance of the Waatheriizatlon work hereunder by the Agency is.contingent.upon the availability of funds to the Agency fmm the cgmmonw9altri Of Massachusetts and the federal government,as well as thereligibility of the , wren Tenant under WAP program requirements. The Agency may terminate una Agreement, by p g notice to the Property"Owner and Tenant,if the Agency determines that the navafls�iility of funds or ineligibility of the Tenant warrants termination. ' 08/18/2014 11:31 5087756526 PAGE 07/07 . - .' � - 11 f/f:r:Rlfl of Hll�V:A(I'L1f M1l VS I'°.I'1NFI"11f(=J::MV1; . I ilUrn'.411i f♦t;c1ilR SEE REVE1 RSE SIDE FOR IMPOPTANT INF'ORMAT10N1 * r.d4r.c4a(+i+mul I HE GOMllvlOs`niVEnl_TH OF r1ASSAC}-II1SF_77✓ r Taxpayer Copy Town of sarnstable Ascai YeAr 2014 gilt No. 21070 Actual Real Estate TaX 1311i' l qX W $77,328,82 SLIMMARY Real Estate Y'ax $1,805.23 specialASSeswent9 =8RI-1RTY iOG 1PTft ON CPA 577,328,82 HYGONf $1,175.60 Total TaxfSpez,Aasass. NS STREET 0112 HYRES $14.070,55 Prellminarytax3.86 AC TAXCOM $ , . Custom Credits ExemptlonslAbatement6 %0,00 30$258 TAXRES S57,S44,5BC,37748 Past Du@, $0.0tl $77,328,82 $0,00 07l1 bM 995 Land Value $g50,200 3rd Quarter.Due 02J0312014 $Zd,3iS.t6 Asteeaed owner as of,lanaarl 1,2013: 6ulldino Value $8'191'600 " 41:11 Warter,Due 11510412014 $24131d•16 ONE VILLAGE MARKET PLACE LP Exempt vat u� ,Taxabl0 Value $6,641,300 Close 7 �Class 6 Glace 3 Glass 4 ONE VILLAGE MARKET{�LAGE LP Rg>{LdendeI Pere.Aro Cotq:r0 spa IntltlfSCl21 297 NORTH STREET S SeIALASS SMEtVIs General 9,12 B,Z2 B.12 6 -22 HYANNIS,MA 02601 Total pistrlctT6x Rate P8r ffi1,000 ' a 8arnat0Hlo FD Catalt FD COMM PD I1N.Ownstablo FD $0.00 Z.7D 2.02 1.51 12.59 YOD012��00016 - - H.Anni,F61 ;Irlpnt1AIrnrhar rk7", F; _ Y00642.00Q016 Qhr 3:;9f7>:smnntp aB of,la !i0.fv `. fiscal Year 2014 Ent ),u P.aaf Ys(ala Tax Ill Ands 1WIn'f •�O1Mn O �srrlstable F r - . Return this portion with paym - . 9c1in01ny,Iq(y 1,20^.5�n(t-and+ny JrmI 70 13t11 0.!4 on th q pafce!cf(10 rai-n(a c!ascrih�.!rl Actual Real Estate Tax Btl Da a 1114 1 01 .,vl4w fie zA fc(bw:: .. MMsko Checks Pa ante 1o:7own df68rrt8tabto Maureen E.Nlam" p0 I30X 742 0 31B,16 Golloctor of Tax®a 4th(Otr.RE.TOWSpac.A$s0w' , . heading,MA 416S7-d405 $ROPERTY GE$CRIPTION ColleatoeA t7lflce' W6 862.4054; AMOUNT DUE $20,318. 16 Y 223 STEVENS STitEE7 , . Q�i�Q'1�ZQ�4 Parzel IQ 348.258. et in d:e malt. Maka this t1Ce last ptll you g VolUntary Soholalrship y a E 1,1,mi at the rate of 146/6 Per annual w01 aearue $19n up.iar Paperfess W1109•r10da on aver due paY^� �Om the due date un01 TTIeT 1# poi ntismade_ WWW.TOWNi0ARN'51A8� A,lJ 4Cx V I ry nr+ payrnents made after 12110013 will not CASH "Ede soled he reflected on thia bill. MAY -- nt v+ . AsaeaAad.4+Nner as or January 1,3013: `l} ONE VILLAGE MARKET PLACE LP Total Paid ONE VILLAGE MARKET PLACE LP You have a prioryaarb8lan E ram, 297 NORTH STREET Taw Ccrlecto�s Onfce far rot, !n tlu Iday 8:30 AM to 4:30 PM .WANNIS,MA 02601 * f, COLLECTOR C) 02-1182UA20l49000210708000203181, 8 Dae«(d ch b88925menIB 9a nt Jangar4 1.2011. ynUrpellEBtBt"'rnxlerthgflscalY09T J� Qtl811'�t'��ilYl2flt, b13g(nninp JUIy 1,2n13 and mr!dinp JUI'>t3 10. Town of(Barnstable FISCal Year 2014 '" • . 201 d on the parcel of rnel t>9tat?tle�trlbBo b91ov1 is 02 fa w% A•ctUal Real Estate Tax Will Return this portion with payment F Maureen E.Nielnt, Blll Date 1213t12093 Ma a Maureen of Taxe§ Make Checks Pa phte To,Yown of Barnstable 0 PO BOX 742 PROPERTY DESCRIPTION Reading,MA 011367.0405. 3rd Qtr,RE TaxlSpec.Assess. $20,318.16 223 STEVENS STREET' Past Due }� Abatement Applications are due in the Interest parcai ID 308.258 Anerosor's Office by 02103i2014_ nn $0,00 lntarcst at tS1e raze at 14°k per annum wni accrue Maka this the last bill ou et In the mall AMOUNT U2 V 31J..1 A an aver-due payments from the due Gate untl y 02103/201 a ' R. payment Is made. Sign up for Paperless Billing Ynddy Y- " Assessed awberAs*1 January 1,2013: WWW.T0WN.a.ARNSTA9Lt=:MA.1 9 Voluntary SCf1018r31iip „. -• 4 - ONE VILLAGE MARKET PLACE LP Payment ONt=VILLAGE MARKET PLACE LP Voluntary — R° 297 NORTH STREET' Elderly/Disabled � HYA,NNIS,MA 02601 L Payment Total € aicl T 02082138>2014900021070800020315164 The Commonwealth of Massachusetts - Department of Industrial Accidents ' Office of Investigations .. 600 Washington Street F Boston, MA 02111 •www,mass.gov/dia Workers' Compensa9 tion Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A Ucant Information Please Print Legibly Name (Business/Organizadowbdividual): Address: � � ' - . • ,� _ City/State/Zi 2 T� t� o : Phone #: Are you an employer? Check the appropriate box: . 1. I am a employer with 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 working for me in any capacity, employees and have workers' 8• ❑ Demolition [No workers' comp. insurance comp. insuranceJ 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 t 1.❑ Plumbing repairs or additions y [No workers' camp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we' have no '12•❑ Roof"repairs 3a.11 I am a homeowner acting as a employees. [No workers' 13.(� Other�,�/';,� general contractor(refer to #4) comp.insurance required,]._ Any applicant that checks box#1 must also fill out the section below showing their workers'co satiod= li reformation" t Homeowners who submit this affidavit indicating they are doing-all work and then hire outside contractors trust submit a new affidavit indicating such. tContractors that check,this box trust attached an additional sheet showing the name of the sub-contractor and state whether or not those entities have etnployecs. If the sub-contractors have employees,they trust provide their workers'comp,policy number. r i I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site information, r Insurance Company Name: ------------ r . Policy#or Self-ins. Lic.#: /2`;,�o�� Expiration Date: Job Site Address:aP�r R � �¢` > ZYr�gt_ S' . City/State/Zip: _� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. i as hereby certify un the pares and penalties of perjury that the Information provided above is true and correct Siba Date:' Phone Ofcial use only. Do not write in this area, to be completed by city or town official . City or Town: PermitUcense# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk �4• Electrical Inspector:5. Plumbing Inspector 6. Other p Contact Person: Phone#: r { I CAPECOO.27 KLIG -' CERTIFICATE OF LIABILITY INSURANCEETT �DATEMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND 00 :ER S Np 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 Ilea of such endorsement 5 , PRODUCER ;ogers Gray Insurance Agency, Inc, FN NA E T PHONE Barbara DeLawrenc_ e Sot Rte IA/C IL _ Al 877 iouth Dennis,on MA 02660 E•MAII ^� No, 816r2156 AU E bdelawrence ro ers ra ,cam — b INSURER 3 AFFORDING COVERAGE _^_ NAtC N LRED INSURERAPeerless Insurance CompanyINSURER8:COMMERCEINSURANCE COMPANY -Cod Insulation Inc INSURERc;EVanston Insurance Company ardon Circle INSURER D;ATLANTIC CHACHARTER INSURANCE GROUP Yarmouth, MA 02864 - —"INSURER E;INSURERF; ^— _ CERTIFICATE NUMBER;, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEp BELOW HAVE BEEN ISSUED TO THE INSURED NR, EVIA Q D At3pMBEpR THE POLICY PERT D Ir�DICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 'R C R;TIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEp HEREIN IS SUBJECT TO ALL THE TERMS, C�USIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, TYPE OF INSURANCEADM POTIC Epp POI EIM X COMMERCIAL GENERAL LIABILITY POLICY NUMBER MIDD Y M I D Y LIMITS _ _, l CLAIMS-MADE I X1 OCCUR CBP8263063 EACH OCCURRENCE $ 1,000,000 04/01/2014 04/01/2015 �qO�F ^'- PREMISES(Ea occurrence) _ $ 100,000 MEO EXP(Any on�(jrson) $ _— - 61000 O,N L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ 11000,000 _ POLICY PRO' GENERAL AGGREGATE T $ 2,QO.0,O00 � �JECT ` J LOC OTHER PRODUCTS,COMP/OP AGG 2 AUTOMOBILE LIABILITY $ ____ ,000,000 AUTOC a accident E ING E LIMIT $ALL OWNS 14MMBCKVMK 04/01/2014 04/01/2016 8001LY INJURY(Per $ 1,000,000 ALL OWNED X SCHEDULED --- AUTOS AUTOS _ n) HIRED AUTOS X UTO$WNEp A r BODILY INJURY(Par accident) $s, AUTOS PROPERTY DAMAQE- Per acciU nl $ X UMBRELLA LIAR X OCCUR $ — EXCESS LIAR CLAIN1s•h1ADE XONJ_453514 EACH OCCURRENCE: $ 11000,000 DED X RCTENTION$ 10,000 04/01/2014 04/01/2016 AGGREGATE WQRKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Aggregate $ 1,000,000 ANY PROPRIEI.OR/PARTNERIEXECUTIVE YIN/MSWCA00525904 STR TE OTH _ OFFICERry InN R EXCLUDEp9 .NIA 06/30/2014 06/30/2015 E•L^EACH ACCIDENT (Mandatory In NH) $__ 1,000,000 II-yes,describe under' -• DESCRIPTION F OPERATIONS below E.L.DISEASE•EA EMPLOYEE_$ l I E.L.DISEASE•POLICY LIMIT. $ 1.,000,000 SergiRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1ol,Additional Remarks Schedule,may be attached It more apace Is required) Compensation Includes Officers or Proprietors, to al Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, ITIFICATE HOLDER —" CANCFI I QTInW a Massachusetts -1)epaftni'a'nt of Robliic Safety - ,'06prd of Building Re ulalforis p.nU Staridarcis Consti-ltfion Supervisor tfU;K License: CS-10098$ . .I•I Is k.11i;.NRY R CASS11)V 8 SHED.ROW W EST Y AIM LFn-T •.,/ ` 1, , ✓.�.» Ja..cSt �.« �� I,I Expiration CommisStoller 11/1112015 �N�_, �E� Ci1 y?/yyLt;LYliGl12Gr'C/��L C� C?�G/GGY;l 1 Gr c/liGGJ e, �/ 1 Office of Consumer Affairs and Business Regulation' ` 10 Park Plaza Suite 5170. Boston, MassachLisetts 02116 v I Iom' e Improveliier Cqg raa for Registration .;i Registration: 153507 - : Type, -Private,Corporation Expiration; 12/15/2014 " I'M,, 233631' r,• � I p CAPE COD INSULATION, INC HENRY CASaIDY 18 REARDON CIRCLE ---- SO. YARMOUTH, MA 02664 Update Address rind return Lilrfl. Mill k run.lon for cliollge. i. .... [ Address Renewal Uj Employment (,I Lost Cord . Muni uo,i� , '�iCo-s`f(�r..rir.�ir.u��.taatrll� c�J62��u,Jfic6°tadttlt '. - ' Ulficc ui•l'unsunuu•At•fnir•s& Business RQV4111tiou License or registration valid tbr'it dividul usa ortly OME IMPROVEMENT CONTRACTOR before the expiration date, 1f found return W. egistration: 153�67 Type; office of Consumer Affairs and Business Ttvbulafio,n expiration; 1V1:5/?014 Private Corporation 10 Park Plazri-Suite 5170 ` Hostoo,NIA 02116 r D INSULA'I'IQN Y CASSIDY ` kROON CIRCLE t NIOU1•-1, MA 02664 [ludcrsecccfarY of Val' witho t lint re , 261-263 STEVENS ST E6\ CWT f u P _ b , e 0 0 ° o sr-I Pi E Ek\ MUL I I L--cy �Tl -fc�, I I- �E- so i ' t