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0007 EBENEZER ROAD
. �' ,���! ., s -� . . � �. �. . .. . 0 . _ _ � �, n �� I ' Application number....... Fee......................... .................................... AM Building Inspectors Initials.-.-... ..... MOs16 i Date Issued...............3.1h�.. .:A.:............... ..... j f- Map/Parcel............:.......�. �._......,:��.......�..... TOWN OF BARNSTABLE wt EXPEDITED PERMIT APPLICATION: z ROOF/SIDING/WINDOWS/DOORSfIT NTS/STOVES/WEATHERIZA PROPERTY INFORMATION Address of Project: i!�-8 OIL. -2 C- NUMBPR STREET VII:LAGE Owner's.Name: �1,p Phone Number S-0 8 ,, L�S-63 q Email Address: �` l�-S( l�-Vi't L Cell Phone Number Project cost$C)�r>n Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize o +(` to make application fors building TH=Mit in actor with 780 CMR Owner Signature: Dom• Z, TYPE OF WORK Siding U Windows(no header change)# L y E3 Insulation/Weatherization Doors(no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# f � (attach copy) Construction Supervisor's License#. �, 7 I (attach copy) Email of Contractor ti] L�-S 6� �kAy L Phone number 7 3 E �9 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN w urrri►nSr nie rnirr vnr 1 200 le-r^nrw to r.ne•rIftnfb" •nnnr.l iw. sr-110111• 1 11-1..�...■...� APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one:this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or>Yes No ,if yes,a gas permit is required Natural Gas Yes No ,if yes,a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APP IC 'S SIGNATURE Signature Date ` T,/ Q All permit app . ations are ject to a building offxivl's approval prior to issuances ., The Commonwealth of Massachusetts Department of IndustrialAccidents — = Office of Investigations 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Vl Phone#: 1S O 6 Are you an employer?Check the appropriate bow Type of project(required): 1.7Iampla employer with 4. ❑ I am a general contractor and Iyees(full and/or part-time).* have hired the sub-contractors6. ❑New constriction 2. sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.ir=ance comp.insurance. $ 9. ❑Building addition required.] � 5. W oration and its 10.0 Electrical repairs or additions ❑ e are a co 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑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. .$Contractors 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 andjob site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 for advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA fo msur e over e verification. I do hereby certify nder t pain pe alties of perjury that the information provided above is true and correct. sign a Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical.Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions v Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged 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 dwelling 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 grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every 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,MGL chapter 152,§25C(7)states"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 have been presented to the contracting authority.- Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to-your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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 beingrequested,pot the Department of _1:___ -A' -4kl 1„r...,,�4F-0-are re—ir-1�o obtain I WQr1CeTq' �i t$L'�C7al f!Ccidents. Should,you nave auy cjuc�uv,c,raga=!5���u R �. -��, • �•�t _r -- compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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(licease number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for firture permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number- The CommonweaM of Massachusetts Department of 1dustdal Aeddents Office of Investigations 600 Washington street Boston,MA 02111 Tel,##617-727-49GO ext 406 or 1-977-MASSAFE Fax##617-727-7749 Revised 4-24-07 wanass,gov/dia Commonwealth of.Massachusetts t Division of Professional Licensure Board of Building Regulations and Standards ConstructibrySilpervisor CS-048971 E'i r es: 06/05/2020 THOMAS J DRISCOLL.-�i f 73 AGAWAM FAKE SHORE'DR ?_ WAREHAM MA A2571 ` Commissioner =` Construction Supervisor Unrestricted-Buildings of any use group which contai less than 35,000 cubic feet(991 n space.cubic meters)of enclosed l Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www,mass.gov/dpl Office of Consumer Affairs & Business Regulation - Mass.Gov Page 2 of 2 Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Tuesday, February 26, 2019. Search Results Registrant am ESP® SI 1311. EGISTR T ESS ( EXPIRAT IJI INDIVIDUAL NU BE DATE .......... ..................w ... . ..., _......._r............ .__ .. __�v_ � . .. ...... .� . _.... .__ ._ _. ..... � THOMAS J. iDRISCOLL, 178907 73 AGAWAM 02/02/2021 ;Current �DRISCOLL THOMAS ILAKE SHORE DR. I WAREHAM, MA I 02571 I � Site Policies Contact Us ©2018 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. https:Hservices.oca.state.ma.us/hic/licenseelist.aspx 2/27/2019 Office of Consumer Affairs& Business Regulation- Mass.Gov Page 2 of 2 Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Tuesday;February 26, 2019. Search Results RegistrantNamdtESPONSIBLEREGISTRATV=RESS EXPIRATUMATU INDIVIDUAL : NUMBER DATE i.._....................................... ._._.................__.._...._._:..........._.__,_._...._...__......_.__........................._.._.:_.__......_.........._.._......._......_...._....__. ...............__.__..._............,..._.,....._... _......_,..........._._.._ ;THOMAS J. DRISCOLL, 178907 73 AGAWAM 02/02/2021 ;Current tDRISCOLL THOMAS FLAKE SHORE f 'DR. � F WAREHAM,-MA _...._._._..._.__..._...._......... ........ _. .........:........._.. ....... .. __...__.......... 02571 Site Policies Contact Us ©2018 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. https:Hservices'.oca.state.ma.us/hic/licenseelist.aspx 2/27/2019 i My File Edit Tools Help Sig YearjTypejBill No. - - Customer Account Information — History 2018 RE-R 418 C 461418 Detail l Property Information ALDEN, SELMA 7 EBENEZER ROAD Parcel ID 147=078 OSTERVILLE, MA 02655 ' Alt Parc _ 3 Apply Pmt Prop Loc 7 EBENEZER ROAD 23 Special Conditions jNotes 1 Scan Bill � Quick Entry Installment Information Int Dt Billed Abt jAdj Pmt jCrd Interest Unpaid bal Effective Date 08j02j17 354,09 0.00 354,09 0.00 0,00 11 j02j17 354.09 0.00 _ �354.09 0,00 0,00 Utility Acct - - — "-- — 02j02j18 j 967.72 0.00 967.72 0 Oi7 0,00 Customer 05j02j18 967.72 0. 00 967 72 0.00 0.00 Name ! FeesjPen 0.00 mo �0,00 _ 0,00 �u 0,00 Totals 2,643.62 0,00 2,643.62 0.00 0100 Parcel i Prop ID i -Notes/Alerts Due 03105/2019 0.00 Per,Diem 0.00 Misc Receipt JAN 1 Owner: ALDEN; JACOB C&SEL Int Paid 400.90 =ViewRev _ _ _._v_._ —. Total Paid 3,044.52 1120 V1 p1 'wvaid Ulk a3 view WIMAW ow Bill Dates 3 Bill Audits ! Bill Events Reprint Preferences � , Diagnostics l TAX COLLECTOR'S OFFICE j TOWN OF BARNSTABLE P.O. BOX 40 HYANNIS, MA 02601 3 508-862-4054 Batch Information Batch# 67674 Department ;3302. Batch Total 0.00 I , Deposit Current Receipt 0100 Receipt Count 0 EI Lij 1 o f 1 LE 1E, Attachments(0) Display transaction history For the current bill. FOVR I - ❑ X My 'File Edit Tools Help Year/Type jBill No. Customer Account Information - History • 2019 ; RE-R 442 471501 Detail Property Information ALDEN, SELMA %HOUSING AND URBAN DEVELOPMENT Parcel ID 147 078 _ 451 7TH ST SW Alt Parc j WASHINGTON, DC 20410 Apply Pmt Prop Loc 7 EBENEZER ROAD — — - -- i 90 Special Conditions/Notes � . Scan Bill Quick Entry Installment Information - Int Dt Billed AbtjAdj PmtjCrd 'Interest Unpaid bal Effective Date 08j02j18� — 660,91 0.00 — 660.91 0.00 _ 0;00 -- _... .. _ ...... 11j02j18 660.91 0.00 660,91 0 00] 0.00 =UtilityAcct i . . 1 02j02j19 { 793,13 — ..- �.00 793;^13 _.. .m .000. m0.00 Customer 05j02J19 793.13 0.00 0 79 0.00 792.34 Name 3 FeesjPen 0.00 0.00 0.00 0,00 0.00 j Totals2,115.�74 0.00. 79234 Parcel j Prop ID —Notes/Alerts Due 0310512019 0.00 3 Per Diem 0.00 Misc Receipt ]AN 1 Owner: ALDEN,SELMA Int Paid 91.07 View-Rev Total Paid , 2,206,81 view pf ul a€ estw PfW mpaid bilk .� Bill Audits 3 =Events Reprint PreFerences l Diagnostics TAX COLLECTOR'S OFFICE ! TOWN OF BARNSTABLE P.O. BOX 40 HYANNIS, MA 02601 I 508-862®4054 ......_ Batch Information Batch# 67674 Department 3302 Batch Total 0.00 , Deposit Current Receipt 0.00 Receipt Count 0, LIEEKI 1 of 1—__ __ 1� y Attachments(0) ------ Display transaction history for the current bill. VR b � 17 E-11 CAPE COD INSULATION TIBIA GLASS 79AMli 33 SPRAY FOAM SUSVIN 7lV IATTS OUITIp3 INSULATION CI ISIN03 1-800-696-6611 si 3 Town of Barnstable Regulatory Services Building Division 200 Main St ' Hyannis, MA 02601 Date, Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod. Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute ,(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village J AZDb AU11 7 r,Oe4 e 2 c z Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Cna&JL ( X-) ( ) ( 3c9) ( ) X) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( ) ( ) ( ) ( ) (.VOr ll pwr , � Sincerely 2CHrE ssi r, President Ins ation, Inc, J " w�„��•Y`'.e" ;. TOWN OF BARNSTABLE Permit No. q__-2 3.2 i Building Inspector cash " OCCUPANCY - PERMIT Bond _ "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building•shall be occupied until a certificate of occupancy has been issued by the Building Inspector." ' Issued to Greeenbrier Corp., Address Centerville Lot #41 7 Ebenezer Road Centerville Wiring Inspector Y r �!l .d. �•+ X Inspection date Plumbing Inspector `! , t! �'� Inspection date ,! Gras Inspectorh �. � s;- tt .,, Inspection date bEngineering Department Inspection date e 3 c) r 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. 19 ai /� �, v Building Inspector 1 a �. 4 �... * �tJ• �, 1 3h I. Tom- X ,' 1 -- 7 �� � 1 CERTIFIED PLOT PLAW ME11Il .00NSTRUCTION ONLY : 0 OF FOUNDATION 1S 3,a FEET r IN LOWPOINT OF ADJACENT SCALE = C, DATE : 1 U rc E�®GE ENGINEERING CO.IN I CERTIFY THAT THE CLIENT SHOWN ON THIS PLAN 13 LOCATED. 901STERED REGlSTER.ED k'� �l"�� , CIVIL .- LAND JOB N0. ON THE GROUND INDICATE® A `. �, ,;� r),? CONFORMS TO 'THE- YONiNG LA gb , EN®INFER S4RV..YOR DR BY� OF ®ARNSJAB6�eE , MASS. , w 7I2 MAIN ST. Cli.BY: .f� r�y 't`f- ! • ,° , , � 1 r . H'YANNIS, .MASS. BH:EE C "T OF _, . DATE 'REG. LAND SURV. ; Ass is map and lot numb ..�./...,�1 .:-.! .ems.... FTNE T -6� SEPTIC SYSTEM MUST Sewage Permit number . . ..1 .7........................:...... INSTALLED IN COMPLI u H Z BARNSTADLE, • . ...... E WITH L O a TITLE 5' House number ......:............................ :...... ENVIRONMENTAL CODE o = 39- 0� ax 7 TOWN REGULATIONS TOWN OF BARNSTABLE .�. F BUILDING INSPECTOR { ' APPLICATION FOR PERMIT TO ........ /►!��!�L !l� � :......................................... �f TYPE OF CONSTRUCTION ................ p-/...�`�I, .i..................................................................................... ....... ,/ .................19W TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according/t'o the f Ilowing information: ,, / Location ............................................. � �21/....���-M,...��.•.......................................... Proposed Use .............. 1 1.. ... .°r!�li�.X ......................... ............ ........................................... Zoning District �✓ Fire District �4 ''!� ��l...... ...... ...... .. . .. .. ........... .. .... ............. ........................................... Name of Owner .lC[. r`* i .... .�Y{.-.................Address .. .1��... /G✓. ..� � � �I�/�t✓............. !(�� � Name of Builder ... ���..rC/���L .. ..........Address �/.... .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...................... ..........................................Foundation ..... . ... ................................................... Exterior ......L�(V.. /..{ ..... .............. ...............................Roofing ...... � ,�i' ./l ........................ � . .......... �:..... Floors .........................................Interior .............. i.:r`:................................................. Heating �r/�". .. /................................................Plumbing ......'�1/ � ................................. Fireplace ......... ....................................Approximate Cost ....... lea... �........................ ...... Definitive Plan Approved by Planning Board ___ 0/_______________191!l__. Area ......... ..1.......-5........... Diagram of Lot and Building with Dimensions <ee Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH d; I hereby agree to conform to all the Rules and Regulations of the Town o arnstable a arding the above construction. Name ............................... .......... .:....... ............................ . P,GREENBRIER CORP. Permit for .......................One S to..r..y........ • Sinale Famil .................................... a=6i•.�oad Locati6n -Lgt...4.41............................................ .............. .................................. Owner Greenbrier...Corp.,.................. . ........................ ........ . ...... Type of Construction ...k:rAma......................... ................................................................................. Plot ......................... Lot ................................ Permit Granted ........:April 23, 81 ............ .......... Date of Inspection ............................. ......19 Date Co leted ... 19 0/ j f PERMIT REFUSED vo > 4...........IFZ�-..".;...................... ............... .19 .. ........................................................ ................................................ ................................................... IM ..... ...... .4z;................................................... W Approved 19 ........................................... F ............................................................................... ........................................................................ � a._ ..•..,.=.-i;.."v^t�,L"S4» .e�,`.+r'`-A ...;:r=w`-w<:�w+,�r�-e,..`a�»a tits�%���. - A:. 2 42 EMI Tz' EiN pkl Z�' STA LEA cvree 0 O zo 13� 00 `\ x• Lc 7- / 7 / �2 �l'IOR AC7 PU2 Pa D IL Y L L l 4 TF!> iN T�/t /vo yF� �z. LooD CERTIFIED PLOT PLAN _ .,/ _ =f i.c%^..� 6 Y ?•,/� U D, LOT -�/ ,F. c'. c% �''R . .�2Di4'J L RA 7-F IN { 11:5117E — - �5 vrzv_-VC)AQ SCALE / = 6O �DATEI IWXI'�� I CERTIFY THAT THE GLICMT SHOWW ON THIS PLAN' IS LOCATED E913TERED REGISTERED B/023- ON THE GROUND AS INDICATED AAtO CIVIL LAND 408 NO. """ ENGINEER SURVEYOR D9R.8Y� ,,,;� COPdF4RE�IS TO THE ZONING. LA1y8 Tz �. Of ®ARNSTAO E 7715 . ` 712 MAIN S T R E E.T -' "«$Y� •�.• s S`&6 N YA N r� l S, MASS. $HEET�OF�, ATE REG. LAND SURVEYOW Assessor's office (1st floor): THE, Assessor's map and lot number :. .y�....� .� ..:`. �; �•. �o� o� ..CP"C SY T� Q M4al�tT P � Board of Health'4(3rd floor): d� Sewage -Permit. number ......7.6.77.). ,. ..... a� O P Z BARISTADLE, Engineering Department (3rd floor): K Kr�< � �o rb s - House number.: :....... .... . ... E3ir,5 ��: a�.&ii,;Alo. . �r� :" x. o,,� 39 C Nay a. Definitive'Plan`Approved by Planning Board ,__- __________________:____l d R.EGUL ATIONS APPLICATIONS •PROCESSED'�8:30-9:30 A.M. 'and"1:00:2:00- P.M. only' TOWN OF BARNSTAB'LE .: - BUILDING " INSPECTOR k APPLICATION FOR PERMIT TO :!... ....... ................. ! .11v...........:...... ..[:iD....X. ..1.'G"............ .r� - TYPE OF CONSTRUCTION .. . ......:.:....... . ........ .....................:.................:................. .. ...... .-- --.19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following informal ......,.. SST q Location ......r�........ ... . . Q ....... ............ ...... Proposed Use ......:: lY.49RC.4—............... \...... Zoning District ................. ................................ Fire. District ................................ MM ...... . ...........l...0 ........................ 5�4�fi.... .....��:U..,��'Name of Owner .. Address n............... ......... ......... ......... . ........ ............... Name of Builder: .. ....A....JA0� . . .:.:.....Address :...!.�P}C......1�J... ........ Name. of Architect � Address ....Foundation '1.../.... Number of Rooms :....... c` .. Er r............... ..................................:... Exterior" ..GU rI.P......�...11/Y Le ......... ...... . o . .......................Roofing ...:........5 .. ......T ........ .. h/ �./? 1::;PWM4 ........ ...... ... ..�/t Floors .... ........ Y Lv/�L Interior ..................... Heating :.��G�.. ...���...:.............. _........ ...:.....Plumbin g ............... ....... ....... Fireplace ...: ......Approximate„Cost ..... y!✓�oo .... .......... . . • .. ,. Area .�"./"...... ................... •r Dia am of Lot and Building. with ,Dimensions 9. 9 ., .. • Fee,..........�o/..................... x 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 ....aw c- •.�. ....... . . ....... ... .............. Construction.Supervisor's License 6,j......... ALDEN, SALMA No ••32215•• Permit for .,ADDITION _ Single. Family Dwelling LocatlOn 7 Ebenezer Road y �....( ...... 1 t % f Owner. Salina Alden - Type of Construction Frame............................ , .......... .............................'.......... ................ i , Plot .................. .... Lot .. ........................... Au ust .,3'0' `a, 88 Permit Gran,ed .........9.........-:..................19 - Date of Inspection t' .... 19 Date Compleytf d .................. F. MI rQ - , /Tf/ Y& 2_ 7D 610 /� lz Ts 4, O 0 � � v T 4 d:rri:u; �,► -vT o RQvr� .2,;3 �..o SD, 171-API p Z-T to i !a ROBERT BRUCE EIDR p SON �v 2 r1V 'v- ✓ CERTIFIED PLOT PLAN NEW CONSTRUCTION ONLY CEAI7_Er,' 4 .L If TOP OF FOUNDATION IS 3.5 FEET IN RQADE LOW POINT OF ADJACENT aA qhS tAa v .,,�, � 7 ,lv.5�7� 7$ SCALE, 60 DATE, q i9 k (ELDRACDOE. E Q/NEE'R/NG CO.IN ��cEiya.e�� fo v>yo�t r/o CLIENT-CB.�-I�'�. ...-I CERTIFY THAT .-THE - EGISTERED REDSHOWN 0N TH13 PLAN I3: �.00.ATEO.JOB N0: �CIVIL ON THE GROUND-A9 INOtCATEO ANQ:CONFORM& 'T0- HE ZONING LAWS... -ENGINEER - (�REGISTE SURVEYOR. OR.BY� A-. - O.F 1lARlV : A9' E� MA8. AIE ' �1- = ` -71 712 MAIN ST. _ HYANNIS MASS. 8HEET.�OF / D TE RES. LAND sUR 'Assessor's office (1st floor): �/�— 7 � SEPTIC SYSTEM MUST HE ro Assessor's map and Jot number .....................:..........:... INSTALLED 0 CM �o Board of Health (3rd floor): fO 0 F s Wl�i TITLE 5 . Sewage Permit.number .................................................. . LB LE, ENVIRONMENTAL CO LE, i Engineering Department (3rd floor): y a House number ....................................�..� � ............ .... MOWN REGU�'TI®► OYpr.�`0�° APPLICATIONS PROCESSED 8:30=9:30 A.M. and` 1:00-2:00 P.M. only t TOWN "OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........ E !. ...` T!4 ✓...................................................................... TYPEOF CONSTRUCTION ................................................. ..... ..................................................................... CP TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following-information: Location ✓. .. .+�i0 ......IC..C.w7- 1'LIJ.f...(.�L.. 7 ......�.... ....................... ................... ........�Gf y ProposedUse .............. yf?1. �...../. lt( .M................................................................................................................... ..Fire District ...C��Z�41 �.I ,/ • 1 Zoning District .......... .l .v.. ............................................. 'Ks......le. �,�...T..!rtG.(d�..... Name of Ownerlvhn/.../j,..�} +, / .t ........)F,).L.An.Y.........Address �y go h nI /*), AN� A elo y p Name of Builder (1�/� ... ! !7...! /r�. ..'�!J�� � 'A�dress f a�, /3Y Nb�Aed +/b° Cvur.. ...... /r:1/ h 1 Name of Architect 1-:�ro q ......Address o.yt.,.f, 7.7.40C.4G � ..............W......................................,.. Number of Rooms Foundation ..3/ 9 �'� �o��C,-t.4f .................................................... ............................. ...........I.......................... Exterior ....... i .....(.: .4!'/... ....... ..!7/.fG�G.Ic/'f.....Roofing .......... J/ .�li�. .. ...,S i,rl�i.A J............ Floors j oZ Q ... .� �?.D...Q'.........Interior .............`t% I..�`!S'.../P�A1/r� .................................. .............. .......................... Heating ............... ........................................Plumbing ................/'2�P../�!�G...............................:.............. r Fireplace ....................../ 64.........................................Approximate Cost ........... �P�..Q.��.U...�..............�........ ,... Definitive Plan Approved by Planning Board __________________________ -----19--------. Area 4/ X Z y Diagram of Lot and Building with Dimensions S.�W /91000A ,� �� Z�� Fee ........... ...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH ff rg f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to.oll the Rules and Regulations of the Town of Barnstable regarding the above construction. k Name ... ....... ..... .... . _r........ Construction Supervisor's License ............................. ALDEN, JOHN 29462 No ....... Permit for ....APP�T 0)V/ ...................... Single Family DwelliNi.. ........... ...... ................................. .................... Location . ................................................................7 benezer R . ad Centerville .............................................................. Owner ...................J 6 John .A.I.......den......................................Frame Type of Construction .......................................... . .......................................................................;........ Plot ............................. Lot ................................ June 5, 86 - Permit Granted ........................................19 Date of Inspection .......... ...................19 Pa/te Completed ............ ............... I- MW f Assessor's office (1st floor): �L/7— , / ' o�THEt0 Assessor's map and lot number ... ........................... ..... Board of Health (3rd floor): Sewage; Permit number o�..N.5 (J Z 33AHH9TLBLE ✓ Engineering Department (3rd floor): •-7 � 5 '°o Mb 9• ems House number .........;f.':... ......: �Fo MAY a, APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ................................. ..............!.✓........................................................................ TYPE OF CONSTRUCTION ......................If-.00.c✓ �ZX ! i .............'A...�................................................. ..................C..•l+/. ..:..•c .....19........ G.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 7 0 42 % ,� ...... � �� 121,+� .�L... .............................................................. ................ ........................ 1 ........�G f .... ProposedUse i f�e. a.....1•c�ial . `?............................................^......................................................................... Zoning District ....Fire District ...``..+ .h(. : .^.:.::.P Ih.......��C........................... Name of Owner ........�i...k.�.)(... ...Address �r a G h nt n-r A'FV i�P4/I Name of Builder (,..�i l�!z ! ra.... i.? ...... 9 �Pi,�r/r'al.�Address ...... � !%...a .... `1�.�'O�bIJlC'�J�c„d r' t"uu�t t dKIIAI(JA� .... ............... Name of Architect(: =?I�S .!?.�'.... !!( '.!?! !4�'�!�!!'� ......Address �..? ...`?l.' .7.!PUu?�z 0o/7 ............................................ Number of Rooms ...........� ...........!Foundation ..' ./. 9 ............................................. Exterior ....... i ...... /......��..�7iw1,/.f'./......Roofing .......... f/! /?G... .....�� �•cld. J............ tr �/ �... Floors ..................X..........y!... �.S). ...( .......Interior .............%:.. ,.? �/A/ 5r Heating //cr /7!.. :........................................Plumbing . Fireplace ......................:..V4.A 4................................. ...........Approximate Cost ...........Z-1,; OU U ................'i............................. Definitive Plan Approved by Planning Board --------------------------------19-------- . Area �{ ` . ... ................. Diagram of Lot and Building with Dimensions ,Sfk 10V h/ c Ares Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 .... ....... Q �?;r .,... �......... Construction Supervisor's License -P- ALDEN, JOHN A=147-78 No ..:,�9462 permit for ....ADDITION Single Family Dwelling ......... ................................................................... 7 Ebenezer Road Location ................................................................ Centerville ..........-................................................................... Owner John Alden .............................................................. Type of Construction ..Frame . ............................. .............................................:.................................. Plot ............................ Lot .......:........................ Permit Granted June 5; 86 ................................19 Date of Inspection ....................................19 Date Completed .............19 Lit ... .. _ u. .�r..+r: '.i..o.,4i.:f.'= 'w..'rswy„-i.f'C.°„��+y 4S,�.`� .. s♦...« �c'r ``'�Sz:s*:,,:^s>:�:fac .,..�+�� i.. -��.:. r z ... Assessor's office (1st floor):. I / Assessor's map. and lot number / Board of Health Ord floor): a Sewage Permit number ...... PAUSTAMLE. Z v-K . K�� rasa Engineering Department (3rd floor): 'oo 1639- \0� Housenumber ........................:.......... .........:....................... �0 mo Definitive Plan Approved by Planning Board ----------------------------------19________ . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN. OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....x`?�� ....... �E1.....` '! .�,lI�I .............../0 x-/�V 1 `ram .. .. . .. TYPE OF CONSTRUCTION ....................1, ./.0.0'.D................: 1. -T ...................................................... ? 0-----..19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: n OSIZ Location ��� ..2.4:-/�..............P ....................... ....,......... ...... .... ..7...........`.q.�. �..................... Proposed Use .........E/.f.44t? .1; ................ .��.�",?.....�i?!X?N? 1........................................................................................ .... .................................... ................. Zoning District .............................. Fire District -.- ................ Name of Owner fi .41-124..1?!.................Address ....1................................................................................ Name of Builder ......io11. .....4..../-,;AU.wls?A-/.`//.:!..............Address ....j.�,-%�.........1�,3............. .,z`�....1.7�"'7.Y/.`/ic.....f.�1.f?....�o'G�o Nameof Architect .............. . .........................................Address ..................................................................................... Number of Rooms ........................................................>..........Foundation ' ` ?'1f_./1.1�....................................................... Exterior ...G.I�.S eW47......5'14ur.14 ...........................................Roofing .......��.5.� �i��.T........................... ......................... Floors .... ......... li�s.'/.'b"?! ..........................................Interior ....... ................................................. i Heating ......../2:C.?..................................................Plumbing ..............-...•---.. -::........ Fireplace ..................................................................................Approximate Cost ....... ,..j ?.G........... ..//...��...... ............. Area ......../ ..................... Diagram of Lot and Building with Dimensions Fee .........�.7..�p.. ............ 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 /..,..., .�6" .Y.". .��..r ................................. , Construction Supervisor's License oa.r,,��..,1.......... ALDEN, SALMA A=147-078 No 32215 Permit for ..ADDITION ....................... .....Single....F.am.i.l.y.. .......... .. .... .. . .... Location ...Road....................... ............>.. .......... Owner .......Salma Alden ........................................................... Type of Construction ......Frame ......................... .. ....... .......................................................................... Plot ............................ Lot ................................ Permit Granted .....AIA .........19 88 Date of Inspection .....................................19 Date Completed ......................................19 Assessor's map and `lot number .. .-... . ,.?s'....... ypi TM E TO Sewage Perrrait, number ........: .....:....................................... BARNSTABLE, i House number / 9�C "6 9• I 9 OR a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......... ...�.. ..:...... I 7 . TYPE OF CONSTRUCTION .......... .:...:............../...................................................... ....... ;;f. .......................19.1;/.;', TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according tothe following information: Location ................. .:....... ... ...... .... . ........ ....................... ......... ..,.. ProposedUse ......... J.......i./(`; `....l;./ .._�.,f%1................... ................................... .. ........................................ s Zoning District -- --� ........... ....... ......... .,.r..�.... ...................Ffre District ...r r.I�•-:..':�...:.. J .. Name of Owner ... ..... ./.?t /°t `...fry!,tt✓ '...............Address t "`....Jx/.......................... '.::.I :............. Name of Builder ... ... .....?.. ....:.... -`.`................Address ......... Nameof Architect ..................................................................Address .................................................................................... �� Number of Rooms ...... - Y ........Foundation . d�-•� .:....................................................... Exterior ..........Roofin .........!. ? b� Floors ...........................................................Interior ....... :,. . :!r! Heating �i r rz:....................................Plumbing .....! ? /`r''° �1 Y. .. r Fireplace ......... '. Approximate Cost ..... 4 :::..................... %... .................. Definitive Plan Approved by Planning Board _ / -------------------l9 _ . Area cr tf.....r.i......... rs= Diagram of Lot and Building with Dimensions Fee ................../ (?,- ............ ............... SUBJECT TO APPROVAL OF BOARD OF HEALTH f s I I hereby agree to conform to all the Rules and Regulations of the Town of'Barnstable,regarding the above construction. --tee .,,;Fx Name ............... r ......... .......... '.............................. � ) . GREE08RZEIl CORP. rA=147-78 � 23037 One Story � No ................. Permit for ------------ ' Single FamilyDwelling . �-------------' Lot #41 Il Rd. Locoho6 --------.�.....-...................-...... ' Centerville ' ---'" .....----� / ` Greenbrier Cr, Owner Frame T',- of Construction --.. ` 23, l Permit cnumeu ' ' uo'e of Inspection 19 Date Completed PERMIT REFUSED -----,--.-.----------- 19 '---'' ---''^----- ' --.., .�~ ----.-----.. . Como � . -.----.-..^-----.-.-..-.---.---.~ . '---'-----^~-^^^^-^'----~'~~'^-^'' Approved ................................................ lg ' � ^ -------'------''---^--^^-^^^^'-'' ----..,----------.-..---'.--..... � ~ � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I7 Parcel 078 Application Health Division Date Issue — ' Conservation Division Application Fee Planning Dept. Permit Fee (h Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis s6116� Project Street Addressf" ��� G� Village Owner `r4ro A-.942_1e-v Address /�y ?f Telephones Z 02't,Z/n Permit Request /a✓Z s /�� /✓r�/Q ie Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �!,g,6 ,d, pConstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family A Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes iNo On Old King's Highway: ❑Yes O'No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new BUILDING DEPT. Total Room Count (not including baths): existing new First Flor. � 2Bo�om Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other IWA2016 TOWN OF gARPo�T Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coa`sto"A-E❑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 .��U � �f� Telephone Number Address lB.A � t!� License # /� 7 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 0' - L- ro� � g oar. 4ffce. 50$'$62 Ta�c: 50$7Q-6? 0 iga jo :rela,�ive to. .pe sa�,p a for, Wtesi 001 W—es. is Daie. - Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-100988 Construction Supervisor HENRY E CASSIDY 8 SHED ROW WEST YARMOU•`'H 2, Expiration: Commissioner 11/1112017 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, •INC HENRY CASSIDY - 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 'Update,Address and return card, Mark reason for change. scn i zom-osi>> I] Address 0 Renewal Employment Lost Card --... ...... V/ee�ai�r��zooacve�r./G�o�C�/T/lrwaac%uaeGti _ -Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: UV ' egistration: '153567 Type: Office of Consumer Affairs and Business Regulation xpiration; :;121:9:5/20.1.6 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATIO ;.INC HENRY CASSIDY 18 REARDON CIRCLE` SO. YARMOUTH, MA 02564 T� — Undersecretary N• valid wi tit sign e The Commonwealth of Massachusetts Department of Industrial Accidents r Office of Investigations 600 Washington Street 4?.. ;; Boston, MA 02111 �..` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: � l r ��� City/State/Zip: . �. ' ,a '' AA Phone #; � ���tom' �'�1U' Are you an employer? Check the-appropriate box: Type of project.(required): l. _1 am a employer with l'j 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, ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity, employees and have workers' 9, ❑ Building addition [No workers' comp. insurance comp, insurance, , ] .re uired 5.. ❑ We are a corporation and its 10,❑ Electrical repairs or additions required.] 3:❑ I am a homeowner doing all work officers have exercised their l l,❑ Plumbing repairs or additions myself. [No workers' comp: right of exemption per MGL 12,❑ Roof repairs insurance required.] t c: 152, §1(4), and we have no employees. [No workers' 13.� Other comp, insurance required,] J *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affid%`�it indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors 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. ��Rt Insurance Company Name: t V,/LAw z' . Policy # or Self-ins, Lic: 4: �r 0�' ' Expiration Date: 1 Job Site Address:�` �,��" t��'Ala— Attach City/State/Zip:��� Tj/,fQ �2 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 irnp.risonment, 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 insura coverage verification, I do hereby certify, d the pai an penalties of perjury that the information provided above is true and correct. f Si nature: Date: Phone 9: Official use only, Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2, Building Department 3. City/Town Clerk 4. Electrical Inspector 5, Plumbing Inspector 6. Other Contact Person: Phone#: CAPECOD-27 BDELAWRENCE CERTIFICATE OF LIABILITY INSURANCE °ATE`MM'°°"YYY' 6/30/2016 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 pollcy(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 lieu of such endorsement(s), PRODUCER CONTACT Rogers&Gray Insurance Agency, Inc. PHONE 434 Rte 134 A/c e c; A/C No; (877)816.2156 South Dennis,MA 02660 E-MAIL -- ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC q INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED - INSURER B:ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulation, Inc,_ INSURER C 18 Reardon Circle INSURER 0: South Yarmouth,MA 02664 INSURER E; INSURER F; COVERAGES CERTIFICATE NUMBER; REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT QR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEF EIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE D POLICY NUMBER MM/DDY EFT MMIDOmYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR CBP8263063 04101/2016 04/01/2016 EACH OCCUR $ 1,000,000 PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:PR GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT LOC OTHER: PRODUCTS-COMP/OPAGG $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ - Ea accident ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ - WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY YIN STATUTE ER B ANY PROPRIETOR/PARTNER OFFICERMEMe RExc uDE/E ECUTIVE a N/A WCE00431901 06/3012.015 0613012016 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) I(,yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ .1 000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ( CORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors, Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS, South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE � 7 _ ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD