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HomeMy WebLinkAbout0061 BAY LANE .. _ .� �� a ., � _ F - .� �� .. � o .. � � C 0 _. ".Y O o ,. II u P, - Assessor's map and lot nu erE T�p T p '� °�/ }* Sewage Permit number ... .. ......... .��. ....................... EP C "YSxALLEO 11v Cf BSTABLLE; i House number ...... .......... .......... i ` rpe9JeSt H TT� a war a� T TOWN OF BARN$TABLEt r,-A�-! . BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........4a7h ��r�� .................................... :L:S......... ............................. TYPE OF CONSTRUCTION .....4f/Z.1...wo1, 1L'<.............................................:.............................................. ..........'Cie .........................19ty? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... /...... i� ........(..�°I.TGl'f�!` ..1 ' .c.... / 7.......t���� .... ............ Proposed Use :,.,)!!?. .,(�. .: ?'1.�• l�G je7 �........... .. Zoning District ...........................................................Fire District .... I ... ?r�� �11/d.�.�..i�='............. Name of Owner . .....;2?16 ..................Address .....l _41. Vale, .4.f- Name of Builder l'Y�sa�..� . 46,,,Address . .lot1��:...�f...�5'f�. ..� Name of 1_ ��Ckh . !+a.n!7......;.41 . .............Address ......`.............�............�...............��............................ Number of Rooms ...............................:..................................Foundation ... ��'!c � � .................. Exterior ...,'.!!.1.41 � 5 ..........................Roofing ....A '' •••••.................................................... Floors ........................Interior ....r "/ .................................................... -Heating. � .................Plumbing ....�j�J....- .. . ll...r........................................... Fireplace 1- 46........................................................................Approximate. Cost ..... .Q. ................................... Definitive Plan Approved by Planning Board�1l ---------19_;0_ Area !�.... . ....�........ of Lot and Building with Dimensions G �� -Ple `� Diagram g Fee ..........( `........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 45 `3� 4 Ivl ��/a 0( OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name J;Q nstruction Supervisor's L' ense ............ -.BAY LANE TRUST No`25 53 f�ermit for 1 2 Story ................................... L it .......Single...F'.ami.ly....RWellixlg.............. _ y Location ..Lat...4.0......Fxl..Hay....Lane............ - 1' _ V F —Centery I.Le................................. - � �� � 4IV i Owner ....dayl-Laae...T.xus.t...... .................... Type of Construction .•••• Frame • L i � ........................ . .... � .........................................................Lot ................. Plot ......... tPermit Granted ...O�.kObexF..l.4.,.: .. .19 83 Date of Inspection .............`.............. • 19 ! '' k. Date Complet l� (o,/ ....... .. 19 _ r^ t' s �. si j' 7 ,..ems ✓ V This Determination is negative 1. ❑ The area described in your request is not an Area Subject to Protection Under the Act. 2. U TThe work described in your request is within an Area Subject to Protection Under the Act, but will not remove,fill,dredge,or alter that area.Therefore, said work does not require the filing of a Notice of Intent —— provided that the following conditions are met; 3. ❑ The work described in your request is within the Buffer Zone, as defined in the regulations, but will not alter an Area Subject to Protection Under the Act. Therefore, said work does not require the filing of - a Notice of Intent provided that the following conditions are met; . Construction is in _conformance with Town of Barnstable Flood Zoning rf , Regulations, and the foundation is as shown on "Sketch Plan of Land in Centerville, Mass. for Robert Shields" by Low &Weller, Inc. , 477 Main Street, Yarmouth, Mass. Dated July 1983 MOTE; Any variance from herein-cited plan shall require another Request for Determination. 4. EX The area described in your request is Subject to Protection Under the Act, but since the work described . therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of Intent is required: provided that the above conditions are met: Issued by the Town of Barnstable Conservation Comm nissssion Signature(s) - l This Determination must be signed by a majority of the Conservation Commission. . ............. _ On this �o� day of 19 �'-� before me personally appeared 'e�� , to me known to be the person described in,and who executed,the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed Notary Public My commission expires This Determination does not relieve the applicant from complying with all other applicable federal state or local statutes,ordinances,by-laws or regulations This Determination ar shall be valid for three yes from the date of issuance 71e applicant,the owner•any person aggrieved by this Determination.any owner of land abutting the land upon which the proposed work is to be done,or any ten 9 residents of the city or town in which such land is located,are hereby notified of their right to request the Department of Environmental Quality Engineering to issue a Superseding Determination of Applicability,providing the request is made by certified mail or hand delivery to the Department within ten days from the date of ce issuan of this Determination.A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and the applicant. { _ 'THETO Commonwealth a of Massachusetts .:__. -�_•_ __ �'... :� �'._*-:�,- ._ .j� �C: .._ a . _mac�aY�' .,}_ _ . _. ._.....�- ='� --- ._ Determination of Applicability - _1_1 Massachusetts Wetlands Protection Act, G.L.c. 131, .§40 TOWN OF BARNSTABLE BY-LAWS,'.-CH. 3, ARTICLE XXVII From Town of Barnstable Conservation Commission Issuing Authority To Robert Shields, Jr. (Name of person making request) (Name of property owner) Address 351 Mai-n St. , Centerville, Ma. " Address This determination is issued and delivered as follows: i by hand delivery to person making request on - August 32; 1983 — — --— (date) U A by certified mail, return receipt requested on (date) Pursuant to the aui:hority of u Jd c. 131, § 40 wi d Chap. 3 Article XXVII of the Town of Barnstable By-Laws,. the Barnstable Conservation Commission has considered your request for a Determination of Applicabiiity and its supporting documentation, and has made the following determination (check whichever is applicable): O This Determination is positive 1. 0 The area described below,which includes all/part of the area described in your request,is an Area Subject --- to Protection Under the Act.Therefore,any removing,filling,or dredging or altering of that area requires the filing of a Notice of Intent 2. O The work described below,which includes alUpart of the work described in your request,is within an Area Subject to Protection Under the Act and will remove, fill,dredge or alter that area.Therefore, said work requires the filing of a Notice of Intent 3. 0 -h The work described below, which includes all/part of the workTdescnbed in your request, is within the Buffer Zone as defined in the regulations, and will alter an Area Subject to Protection Under the Act. Therefore, said work4requires the filing of a Notice of Intent - F Assessor's map and lot numlie�l .+! �' THE T�1` t Sewage Permit number j.................. .1............ .... ' 0B�as`°0 MSTA Ya a'\ Ee�, House number ....... , M6... q TOWN Di OF BARNSTABLE A BUILDING INSPECTOR _ APPLICATION FOR PERMIT TO �h,s??'?!c ......................... Lam- �d` _ �� TYPE OF CONSTRUCTION .....'`r,Jrvle,.�... s'� .✓. ............................................................................................ .........................19.;� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby/applies for/a permit according to the following information: Location ......�P1�'S�.....I.*4.�1..� t...P..�f.J frsil.:� % ...... �U7•'�•� .. .` ��..�'�a��a 4�r�. 2............ Proposed Use 1?r.Al.... �y. !/�..`� ...............`......................................... J .. /............. Zoning District . ................/.......................//........Fire District ...r � s� ?v>r„�Y/Jg .rid/�„ti'°............. Name of Owner / ......... //5./....................Address ... �!! .... s`r!xl..:.41.� .. �7 P!!/1. .<. •`� Name of Builder .t....;:� �'°`s' t :... r 'r' : ! 5.,.Af :Address ... ......'?A, Nameof A,rc11-RL-t .... ..............4.... 1:........... ..../.......,..............Address ................................................................................... Number of Rooms ..................................................................Foundation ..... y„ - ...a-�tml.xn'. .....................: Exterior .. 4!],/.rr�s ,�, d ��f!.. .. *: ................................... ...... ra2<✓ .........:.......................................... Floors �r.��'/./.../���!✓7........ ..........Interior ......-4AleWrv. . .................................................. Heating f:9- :�� , 'rim,• /ssdf4'.................Plumbing .: . j..�ny, r�✓,a;:;.... ......................:........... Fireplace rah................` ..... .........................._...............Approximate. Cost ......... n Definitive Plan Approved by Planning BoardArea Diagram of Lot and Buildingwith Dimensions 6,ee, %c�f't � ';i . Fee .......... .` SUBJECT TO APPROVAL OF BOARD OF HEALTH i i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......... Construction Supervisor's License ............. f BAY LANE TRUST A=186-74 00[ No Permit for ...V2...,9.tQXy. ............ Single„ Amily..D..... Mellizg............ Location Jigt...4.0..&.......6.1...B.a.y...-L a ne.......... ................qg)1AjtQxai11.e.................................. ll Owner ...BEjY..LATI.P...T.U,9.t.......................... Type of Construction ...Frame.......................... ............................................................................... Plot ............................ Lot ................................. Permit Granted ....October...14 .........19 83 .. .... .. .. Date of Inspection ....................................19 Date Completed ......................................19 i .. _----- I i ' 1,7r7POF wAt[ 64EV. /2•07 7S/t"57EP/H WALL.: L __J TOP Of LWW L EGEK ASO r0P Of WALL ELF_V./Q S7 y i �iAAMG .10/475TDS/OEOfBEgMIY/flAN6ER'S I �r A•-._ �STfP/N FLOOR �� I �_z;/a••�' s^�/D"�/z'o.c M.•sawr� �r E i SyssrEELCOL. w//2VZ%-Ya�'C4 A A ( I DECK I o.e.� OPEN/N6 FOR it zi/oc�/6'o.0 ! 1 i (AsOVA I r =L-� { '4"�o�vC.�f�w/ ,o. �` -' -:_ Fes;E./sgTT'--- -- r'�-��', ':.-,-:.•=_."�x.G:_'. , 6�y�G, 3t roEwnMAAlC L. II \ I 7%s"STEP -- --"-= /N WW[ I ' I 17OPOFIY.Ou 1 1 I ELEW./�.So 9 - " l BU/LO UP ?N,E-CLCLSGT ANA II 1 ' • 3'P"/O"� 300KCA TO 54 AREA [EYEL Of .,fAM/LY ROOM I I z~t/D" .*ten rel.'eoG . � i`� I 2'a:0"E°/Z"O•G.-� l y G ONCKE7E @ Z O.C. I I I I if-414"BOLTS _:___ ._..___ .. ...._.---__.._.__.-.I 2�6"r 2'6 x/O'•FDo7/N65�TrPJ '�, I - I� III • • I • —-�_--•�-- ���<Ni V O E[ ,:.�'dIGRO�ftrT/E5 t4 FOR- P-47M064Z r4 �W�STFfCT6/ST • ( '� � I I.K ELEV.6.8 t . J Of As GDL2NERSTO.ME :EA1T4A'R1$Z5 Ah CEc/TERVIGGE AM NLJ F/.?5T FLOOR FRAM/N6 "FLAN JOHAN KOIVA $CAL.,E. /14"e/-'0" No.29126�� . er: - urNorcn aciut::AS..:.S �.--. owwner.. , IDATL 4,dLG t!/M86R 7G HAVE AMER STRESS -ZOT 40 . :BRAY G ENE GEhITERVIL L Ey Lid_ / 7 ,70h'AN'Kd/V,9� Ei46lAlE£R' .i F ' b1111WINa NUYlE9 i. &"B.6£LDAA/ L4Mf,C6NhLRV/LLE..Mdd: QP:OF JVA[L,ELEY•!2 8Y II I-- -- -- - = - 14, ToPor)VALL ELEVV/r 50 �. i I I _ k I I 3�i:�57E6L.CDL.K/I/P I I .GAPf� ¢"EO,VCRETE FLOOR I I I sTEP/NFLDOR I I pp a' W,41PACT£D 6RASIBL -.I I -- — — — —I- rill jI I } SLOPE FDP oRQ7NAbR I _ -_ - i I .TOP°f/YAGG ..ELfiT7/ V./P•BT I I I tl;I I�G�Y 3A54 I I I r I 22=4" I a 2%/0"6/2"O.6,i BOLTS STEEL Jo/sr NANBERS - . •-., , I C I y/UND/sTLMBF_D 50/L(M/N./B"BEL OW SEC T1ON _R:. GE A :Xf73l7GAT/7J�/6£7iYEF11.1�5t5 P 2"/o' Joist HAN6EK a -- :gvi q srnF4 -6LVMN Jy�l2 K�/8"GAP it FOU IDATIO/�. NOTES: T /Bi ' w` p l7 or x dv WiILGS..ATTJ'%E.SQMEDfM lOEN 3 DA5 NECE� TOBE �FEEf. dW PESv l66yeR. Foe, F2QSl PROTECTIC/J. A!/O/D/J,NB,LAV c' S' 40 17 31, ���.c.�:_:.. " � o� a•4 ram•:�G•7--:��37 . 40 + '�'-'� .V�P Ce ©r+$i a��?�� ;�35 S l-f to r.•.��..t Q�.a ¢:.._,:e-r. i�, 88f3'¢ wX. -• aweG �ti% ,C�?GTiF.y rN�a:T T,w evicza��vrUN "S fV.V OA./ }ri l�3 FAG�:cl✓ IS 40C,97 "� �'�% TiN • t` "ia 167 `s �Ce�{,✓:t:/.L9 ��'.�'�:N%.�! 'NE,'GB�o!>�✓_ .RevL7 • �iiT iT ��.�'C�" �`"� ' ff FROM n R 'TOWN OF BAR STABLE x BUILDING'DEPARTMENT Rrancis Lahteine 367 MA 'STREET HYANNIS, t+AA 02601 Town Cleric Phone: 775-1120 SUBJECT: FOLD HERE DATE _ - MESSAGE ' Work has been cxxr leted under Permit � 2 653, bane Trust Please release-Bond.- DATE 1 REPLY­ SIGNED I SIGNED Ne7•Rml RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY ' PRINTED IN U.S.A: SENDER: SNAP OUT YELLOW"COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. i pT TYtr TOWN OF BARNSTABLE �5653 Permit No. ------ Building Inspector cash OCCUPANCY PERMIT Bond __ __ 7_ Issued to Bay Lane 33� Address lot #40 61 Bay Lane, Centerville Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector iL %�""'^} Inspection date Engineering Department ,f �' Inspection date .X Board of Health �+. . . d Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. y ................. .. 19 L .................................................................................................................. Building Inspector 1HE Town of Barnstable *Permit# ' E.XPir 6 months(rnm' rrr rlatr (: tta Regulatory Services >I• � � - 639. Thomas F.Geiler,Director Building Division r 7/231orc�*- �b Tom Perry,CBO, Building Commissioner +' ? ®�0 Main Street,Hyannis,MA 02601 �FB �0�� 6, www.town.barnstable.ma.us Office: 508-862-403�RjVs, j' Fax: 508-790-6230 EXPRES T rA P PLYCA RESEDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number l g� 06 Property Address Residential Value of Work ' Q Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 61 -------------------- Contractor's Name ♦� icy S vcllll�r� �ti,z��� Telephone Number -5-4-51 FS - :PL6`3 Home Improvement Contractor License#(if applicable)_ r-S70 S 6 7 Construction Supervisor's License#(if applicable) / �O ❑Workman's Compensation Insurance Check one; ❑ f am a sole proprietor ❑ I am the Homeowner 6E[4 have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) `R_C_Toof(stripping old shingles) All construction debris will betaken.to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) °Where required: Issuance of this permit d s not exempt compliance with other town department regulations;i.e.Historic,Conservation,etc. ***Note: pert- er must sign Property Owner Letter of Permission. Hom m ovement Contractors License is required. - SIGNATURE: , Q:Fonns:expmtrg Revisc071405 Y A » Mma Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www town-barestable-ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject.property hereby authorize-� 1��a�� to.act on my behalf m all matters relative to work authorized by this building permit application for. (Address of Job) Sa tore oa Date At PAY Y-AACI�LCKSSfL Print Name Q:Fonw:expmftg Revise071405 F . The Commonwealth of Massachusetts Department oflndustrial d ecidents Office oflnveszhgations 600 Washington Street Boston,M4 02111 www.rnassgov/dia Workers'Conipensation Insurance.Affidavit,,Builders/Confractors/Electricians/PIumbers Applicant Information Please Print l& 'bl Nam6'(Business/Organization/IndMduat): i .Address: /v e_ City/State/Zip:! yc, .��'1 �`7,}U 260/ Phone.#: �= �-•���3 Are you an employer? Check the appropriate box: eM I am a employer with�_ 4. E]I am a general contractor andl 'Type ofjh (required):. employees(full and/or pad-time). have hired the sUb-contractors 6• ❑Nuction .2.❑ I am a'soleproprietor orpartner- listed on the attached sheet. 7. ❑Reg.ship and have no employees These sub-contractors have g, Q Deworking for me in any capacity. emplo a and have workers' 9. Q Buridition[No workers'comp.insurance �• ' urance. required] 5. Q We are a corporation and its 10.0 Eleepairs or additions3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plmepairs or additionsmyself [No workers'comp. right of exemption per MGL 1? ooainsurance segnirrA]t c.152, §10),and we have noemployees.[No workers' 13.❑Oth comp.insurance required•] !Any applicant that checks box#I must also fill out the section belowshowmg their workers'compensation policy information. t Hameowners who subrot this affidavit indicating they are doing all work and then him outside contactors must subnit a new affidavit indicating such. tContmctors 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. rf the sub-contactors lrave employexa,they must pmvieb their workae comp•policy nurnbccr. I ant an employer that is providing workers'compensation insurance for my employees Below islhe policy and,/ob site information. Insurance Company Name:, Ce , Policy#or Self-ins,Lic.#: Expiration Date: Job Site Address• vl�� /� CityiStatrizip: Attach a copy of the workers'comgensatlon policy declaration page(showing the policy number and expiration date), Failure•to secure coverage as required muder Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a fine lip to$1,500.00 and/or one-year impris(Mnent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to V.50.00 a day against 'olatoL Be advised that a copy of this statement may be forwarded to the Office of luvestigrations of e t)IA for' urance covers a verification. :-rdher certify xn r epains•andpenal&s ofperyury that the informationprovided above is true arid colrg t Da6e: — 2 3 Z r��— S _ 3 — nlx Do not write this area,Yb be completed city or town offu ial : PermiMeense# rity(circle one): ealth 2.Building Department 3.City/Town CIerk 4.Electrical Inspector S.Plumbinglnspector Jle �azio wouvea�a o�' umetd License or registration valid for individul use only Board of Building Reguiations and Standards before the expiration data If found return to: -_� HOME PAPROVENim CcmTRACTOR Board of Building Regulations and Standards One Ashburton Place Rm 1301 Re®latratioai;-158587 Hostan,Ma.OZI08 •2WZ110 � 2264153 �+pe: Private Corporation T.�.HrCCHCOCK Sakvi ES:INC. TED HITCHCOCK 105 FERNDOC RD �� Not with signature HYANNIS,MA 02668 Administrator _- BParffoffluoifflmW6Aa ns an U -- One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 158587 Type: Private Corporation Expiration: 2/8/2010 Tr# 264153 T.L. HITCHCOCK SERVICES INC. TED HITCHCOCK 105 FERNDOC RD HYANNIS, MA 02668 Update Address and return card.Mark reason for change. Address 0 Renewal Employment Lost Card 04/14/2008 15:15 508-790-0249 GOLDMAN & ASSOC. PAGE BZ/e:l C-080 CERTIFICATE OF LIABILITY INSU EIIS'C CE � %—v 11g0- 041$ 0 OaTL111NN410Y► .�' 8 PROD=eR THIS CERTIFICATE IS ISSUED AS t 014TTER OF DI 'ORIVATION GOLDmw i ASSOCIATES INSURMCE OAILY AHD CONMRS NO R1G}fiS WM TK5 C1rR WICATE FINANCYALL MRV:ECES INC. HOLDER.THIS CER nFiCATE DOE NOT AUEND,M END OR 933 rALmum RD. ALTER THE COVERAGE AFFORDED MY THE POLICIES 6Et_O1i1J. 02601 .— Phone:5013—7 T5-8010 raz:508-790-0249 INSURERS AFFORDING COVERAGE _ NAIC iB INSURED BiSUAERA. ESSEA INS5RANC@ CO BtbVRER Pi case :m CO. 3EHiV=C�Hsgs pp COCK CONS CbIObd nsaURe�c nic E�PIMTE MTS E?' upi dm co 105 FBRNDRCO2601 INSURERO: HYAMIX Rye COVERAGES r THE POLICIES OF INSURANCE LLSTFA BELOW HAVE BEEP!t$Sm IO THE nsuRm NATEO ARaw FDR THE POUCY POKW ff=CATM NOT'BflBTAHDWG ANY REOUIREE Mr.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUUMT WRH RESPECT TO WHICH THIS CERTIFICATE MAY BE C MA D OR MAY PERTAIN,THE AXIIRAKaE AFFORDED BYW POLICIES 05VORWED HEREIN 0 BUBJECTTO ALLTH$TERM EXCUMM AND COX= NS OPSIIC:H POLICIES AGGREGATELP=$HOWN UXV K4VE BEEN REDUCEDBY PAID CLANS. I — VIR NSR TYPBOFINBURANCB POIICYNUNIBER CwTe DA E 161�1i8 GENERAL LIABILITY EAC Hs CCJRRENCE 11000000 I� Ili A mul uA mm a3CP2332 07/28/07 07/29/08 PROD 4-@T $50000 CLAR98 MADS ®OCCUR N&D E P(vq am vote" S 5000 PERsc•ML B ADV mwRY $1000000 _ GSdIS: TE 32000000 COIL AGRBREMWEUNTAPPLIESPER: Pam:TB-COm10?Aw 92000000 POLICY Fl jE� F-I LOC AUTOMOBILEUARRM t•�B IFt9MiT $ B ANYAUTO P=10008214230. 12/20/07 12/20/08 ALL OWNED AUTOS BOOT INJURY 8250000 SCHEOULEDAUTOS 1parPs Ion' x RmAme BMW MAW X NON-0WNEDAUTOB IP-- d-A $5000®O PROPI fn DAMAGE 4250000 GARAGEWRBLITY AUiO(7!--EAACCjDE7T 3 ANY AUTO i O ft EAACC 3 Au .Nt•: aoG s a:SCs 6ORMNLOAIJA81LffV EACH4 CCIATREKCE S 7 OCCUR M CLAIMSMAOE AGGRI3ATE $ oEmxrmm RETENTION b 3 UmIXERSCOMMMA110MANb -TvcwI,IM(CS ER Lmom C ANYPR�DPR1E11- 2246868 03/29/08 03/28/09 ER.FAsliceDENT a500000 OFFICI&IUMEMBERELCLUINM ELCNI AE-EAEf! 8500000 Iryyaee aaeumeunaer — IslirA LPROVIStONSOMflw ELDL•A.E-M=YLWT S 500000 OTHER 0@SO OI.OPERATIONStCOC2STlVEP6CtFSIFAp.USBON6 BY />�EGAt.PROVt&QNS -` M CSMFZCJM HOLDER ES LXSTLD AS ADDITIOM MRSDRED ATIM AC.00RDnic; :O THE POLICY PROVISIONS CERTIFICATE HOLDER CANCELLATION _ Capa=T SHO"ANYOFTHEABMMSCRIBSIPM-CESBEUMYCELLEDBMVRI!WMMXPMATRIN OATS.1tl=w.ibm t r wc;ur,wmRvaLL ► Ewjoaso ww_ 30 PAvo w m w NOTICE TO THE CERTWCCATE HOLDER MOM TO THE LEFT.BUT FAILURE TO DO 50 SHALL MOSENOMMIM OR LIA811M CF AIT'MID UPON THE(VIsUUREI,ITS AGENTS OR 7NE4. ATR/E IAM ACORD 2S(2MM % OACM CC RPOPATION 190