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0088 FIVE CORNERS ROAD
a �xAF�Y +I a ei Snct tY typ 10 . � yY .,•.E ..r,.5. ����r:.;1:,_ ,y,. -.•� ..� � .-„. xti,,;i } r. l,.rsX# +' r e ,1r, '.{ {j - r;s: _ i.t .��, y i.. i/ 1.'. f.�•y II :.� I S off" +.UF e,f, J }{ y .. f , r � ..�¢ q�. .,dL •:Tu. �, ��� � '{ :�a}y�. RP'I tPY � � I rfq e. :a _ >}; ++r 'r .v r)�.?' ..G, .-i't^x," ^'!'` Q1 d';:ray, F r.,- •c^ ;Y3�r`?ftVx� _ .,e' M, R + "+q a,:n • ..E,`� „}�t�t• •^S eU,a .:;;� P4 t� 4!i �'.� o a ,. �, ,'. M: iD 41 r � a JAI 41 c r. r c r, � C c • J �O uy o •r a y 1 r n- x u .. o - Te' � e u a - r 1 « m : a 6q s c a ` 6 V . r I - - r r. Y R. ,y .1 ofWE� Town of Barnstable *Permit ,- f `)36 Expires 6 nrout frdni issue dnte Regulatory Services Fee + BARNSrABLE, TM �b1 ,0� Richard V.Scali,Director ,,pfo Q Budding Division Tom'Perry,COO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION = RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 057 Property Address-9 9 rtePS el✓ le C / Residential Value of Work$ 7 y Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 3re.l n el �eit rlyJ i&0171t!'4 Rec�� Contractor's Name %le1b,J tZ{/t ! /Jtsol( Telephone Number.(gO J)q$O C7 Home Improvement Contractor License#(if applicable) 1732 L( 57 Email: Construction Supervisor's License#(if applicable) (26';- 7 07 2Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ m the Homeowner LY I have Worker's Compensation Insurance Insurance Company Name Y(' n Workman's Comp.Policy# WZ A 3 J 5'Y 7A Copy of Insurance Compliance Certificate must Accompany each permit. Ap Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side [Replacement Windows/doors/sliders.U-Value 3 y (maximum 32)#of windows 3 #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit.does not exempt compliance with other town department regulations,i_c_Historic,Conservation,etc. ***Note: Pro a caner must si Pro er[y Owner Letter of Permission. _..._..__._....._._.__P.rh` _..__ P __- _...--Permission.. _-.. _....-.-- . . ..__...._. A copy cKthe Home Improvement Contractors License&Construction Supervisors License is require �— ' � o SIGNATURE: C:\Users\DecollikWppData\Local'uMicrosoft\VVindowsUemporary Internet Files\Content.0utlook\21`10I DHRIEXPRESS.doc Revised 04021 i f r Renewal Agreement Document and Payment-Terms Andersen. dba:Renewal B Andersen of Southern New England Brendan y gl Beatty&-Veronica Reddy Legal Name:Southern New England Windows,LLC 88 Five Corners.Rd RI#36079,MA#173245,CT#0634555,Lead Firm#1237 Centerville MA 02632 winnow PE �a..MEar 26 Albion Rd I Lincoln:,RI 02865 H:(508)776-9012 - Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: Brendan Beatty &Veronica Reddy: Contract Date: 07/12/17 Buyer(s)Street Address: 88 Five Corners Rd, Centerville, MA.02632 Primary Telephone Number: (508)776=9012 Secondary Telephone Number Primary Email: bbeatty@myhomesteadmortgage.eom Secondary Email: Buyer(s)hereby.jointly.and severally agrees to,purchase the products and/or services of Southern New EnglanclWinclows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions;described in this Agreement Document and Payment Terms;any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms,of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s) .hereby agrees to sign a completion certificate after Contractor has completed.all work under this Agreement. Total Job Amount: $5,874 By signing this Agreement;you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit.card,or.cash: Deposit Received: ,$0 Balance Due $5,874 Estimated Start: Estimated Completion:. 8 to 10 weeks 8 to 10.weeks Amount Financed: $5,874 _. Method of Payment. Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we'are providing at this time is only an estimate.We will communicate an official date and time at a later date.Rain and extreme.weather are the most common causes for delay. Notes: Financed via Greensky; Plan #.`2521; -Taxes paid in Barnstable MA. Buyer(s)agrees and understands that this Agreement constitutes:the entire understandings between the parties and that.there are no verbal ' understandings changing or modifying any of the.terms of this Agreement.No alterations to or deviations from this Agreement will:be . valid without the signed,written consent'of both the Buyers) and Contractor.Buyer(s)hereby acknowledges that Buyer(s)1).has read this Agreement, understands the terms Hof this Agreement,and has received a completed,signed,and dated copy of this Agreement,including- the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement: NOTICE TO BUYER.Do'.not sign this contract if blank:You are;entitled to a copy of the,contract at the time you sign r YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 07/15/2017 ORTHE THIRD BUSINESS.DAYAFTER'THE DATE OFITHIS TRANSACTION, WHICHEVER DATE IS LATER:SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name• outhern New England Windows,LLC. dba:Rene al Ander 'of u ern New England Buyers ' Signature of Sales Person: :` Signature Signature Josh Ocharsky Brendan Beatty Veronica Reddy Print Name of.Sales Person Print Name: Print;Name^, UPDATED:.07/12/17.. — Page-2 / 10 �,lassachusetts Department of Public .Safety Board of Building Regulations and Standaris License: CS-095707 a BRIAN D DENNISON 7 LAMBS POND CIRCLE--'_• :^ CHARLTON MA 01507 I-0mmissioner 008,12O18 J;`ce G ._._ J> surner kffaLs j id Business Y �W'ai G = Ibl P ar!r,Plaza -Suite 5'7n i Gston,lA<issachusens +;'_''_IJ ent r o tractor Registration. Home �mprcvem Repistradon: 173245 .. ._:._. Tpe: Supplement Card E-piratlon: 9/19/2018 SOUTHERN NEW ENGLAND WiNDOV 81L = BRIAN DENNISON - p_—_—___--- 25.4LBI0N RD _ ---. LINCOLN, RI 925E5 —— ---- _'odate Addr^ss and renlra'9rd.1'iar c reabon for ahan-,-e. '-Aeidt^sti' _ 3ene•.v31 _Empin}:uent •_ nst Card _. .. .i ....r.: ell— (Tice of(:nasumer:Ufairs Y Ousin�;s Re•;uiatino Rystruriun ialid for individual tot nrtly oefnre the , _. q,: .. :Rpiratian:laic if found;etnra'o: __^HOME IMPROVEMENT CONTRACTOR OtLc;eg i;aosttmer affair;and 3usinus.:te�^t:aCne Regisnadon:,1.73245 Type: 10 Para Place-Suite 5110 ." �.piraticm...9j.19I 013 Supplement Card 34mton.)IN 93i Ili - SOUTHERN-MEIN ENGIANDW_INDONIS L-C. RENE4HAL 3Y ANDER90N' BRIAN OENNISON UMCOLN.R102865 lindersemEarp Nnt va acute e P i The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia IYorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lelzibly Name (Business/Organization/Individual): e �pqlw Address: & Auystoo City/State/Zip: L&1&10 Phone#: 10I - 2�8 Q Are you an employer?Check the appropriate box: Type of project(required): IXI am a employer with ZO 1,employees(full and/or part-time).* 7. D New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.a I am a homeowner doing all work myself[No workers'comp.insurance required.]t ' 9. 0 Demolition 4.F1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition - ensure that all contractors either have workers'compensation insurance or are sole l l.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.F1 I am a general contractor and I have hired the sub-contractors listed on the a . attached sheet 13 ❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. / 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[fOther 0 r n c/ &J 152,§1(4),and we have no employees.[No workers'comp.insurance required.] r P 14 ee,+i e^ 5 *Any applicant that checks box#]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 and job site information.Insurance Company Name: I! Irle s dV Policy#or Self ins. Lic.#: W CA 3l-5_8-_7 Z q Z O I Expiration Date: lh / d Job Site Address: 8f 'R n.. City/State/Zip: ai/kril'lle . MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fuze 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the airs andpenalties ofperjury that the information provided above is true and correct o Si ature: Date: —�lP— / Phone#: Q��- 2�g"� lc• 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#: } f ESLERCO-01 SANDERSO CERTIFICATE OF LIABILITY INSURANCE . DATE 0610 2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE.OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 NAME- CoBiz Insurance,Inc.-CO S"N Ext: )988-0446(303 FA(alcX,No):(303)988-0804 1401 Lawrence St,Ste.1200 Denver,CO 80202 A o SS:COMail@cobWnsurance.com INSURERS AFFORDING COVERAGE NAIC If INSURERA:Acadia Insurance Company 31325 INSURED INSURER B:Firemens Insurance Company of WA D.C. 21784 Southern New England Windows,LLC.dba Renewal by INSURER C:Liberty Surplus Insurance 10725 Andersen of Southern New England 26 Albion Road,Suite 1 INSURER D: Lincoln,RI 02865 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE INSD POLICY NUMBER D MWDD 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S OCCUR0110112018DAMAGE TO RENTED 300,000 CLAIMS-MADE ❑X OCC CPA3158728 01101/2017 pREMI E Ea ocamence 5 MED EXP(Any oneperson) S 5,000 PERSONAL 8 ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PEC- LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER. EBL AGGREGATE S 21000 000 MBINEA AUTOMOBILE LIABILITY (CEO,a..'eeOitSINGLE LIMIT S 1;000 000 X ANY AUTO CPA3158728 01/01/2017 01/01/2018 BODILY INJURY(Per person) 5 OWNOS ONLY AUTOS BODILY AA BODILY INJURY(Per accident) S HIRED NON-OWNEDPerOadenDAMAGE S AUTOS ONLY AUTOS ONLY S A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5 1,000,000 EXCESS LIAB CLAIMS-MADE CPA3158728 01/01/2017 01/0112018 AGGREGATE S FTDED I X I RETENTIONS 0 Aggregate 5 1,000,000 B WORKERS COMPENSATION X IP STATUTE I I ERA AND EMPLOYERS'LIABILITY Y/ry CA3158729-20 0110112017 01101/2018 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EA ACCIDENT 5 %FICER/MEMBER EXCLUDED? N/A 1,000,000 (Mandatory in NH) E.L DISEASE-EA EMPLOYE S If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S B Worker's Compensatio CA3158730-20 01/01/2017 01/01/2018 1,000,000 C Pollution Liability TIEDE654299.117 01/01/2017 0110112018 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 17-18 Workers Compesnation Includes-All states except ND,OH,WA,WV,WY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE PQUC-Y PROVISIONS. AUTHORIZED REPRESENTATIVE IFOR InfoEmational Purposes ACORD 25(2016/03) ©1988-20,15 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Town of Barnstable Regulatory Services �p Richard V. Scali,Director B„MST ", Building Division BARNS MASS M I R AF EN f V L E•fNiT•hY4NN 5 Ja5.::N5 N..S 1."N.xL'f41•ktST NRM.rutBLl • - 1639. �� Paul K. Roma 1639-2014 Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us .. Office: 508-862-4038 -Fax: 508-790-6230 March 31,2017 Mr. Paul Bacher T 88 Five Corners Road Centerville, MA 02632-3126 Re: 108 Cap'n Crosby Road Dear Mr. Bacher, The purpose of this letter is to thank you for helping in a very difficult situation. Our Electrical Inspector, Bill Amara, and our Zoning Officer, Robin Andersen, came back to the office extremely upset about the living conditions they saw at the above address. The police, fire, health, and building departments were wrestling with how to deal with the problem. Your willingness to help a neighbor whom you did not know and to do it at your own expense speaks; to,the very best our community has to offer. Once again,thank you for your kindness and compassion. Sincerely, L Paul Roma Building Commissioner S; - �F11HE ram, Town of Barnstable *Permit# Z d L L� v � Expires 6 nth.r�t iss a Regulatory Services Fees. sniwsrnst.e. 9� MASS.9. Richard V.Scali,Director ® �� RFD Mpl A�0 Building Division Tom Perry,CBO BuildingL Commissioner 2 200 Main Street, Hyannis,MA 0260i 0W/ 0r 8As www.town.bamstable.ma.us f� ' s �� L Office: 508-862-4038 Fax: '-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY � U`13 Not Valid without Red X--Press Imprint Map/parcel Number 1/6 7 Property Address ('br-re�rS Q�u� -&(Residential Value of Work$ 5 S(�, U Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ��►e, To,S ED �ye_ Cnrtn 4 lm )a�0 lle_ d�� Contractor's Name e/ I ssccj c.r, e= Telephone Number Home Improvement Contractor License#(if applicable) 00� 8'� Email: Deoorc&p&0 .4 / C�D"'i Construction Supervisor's License#(if applicable) ID y 3 is— ❑Workman's Compensation Insurance' Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Yl have Worker's Compensation Insurance Insurance Company Name csoC_�ct�eC,p r_,,4 4)Ve(-S Zn s, C y Workman's Comp.Policy# tA)GC fS D o Si)) y6% ` �_ s A Copy of Insurance Compliance Certificate must accompany each permit. Permit Re est(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to aaluer U✓ � ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: ogA C:\Users\Decollik\AppData\Local\Microsoft\Windows\T porary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 CF THE Tp� » BARNSTABLE, MASS.: ,.� Town of Barnstable ACED MA'S A , Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Wa4 e_ PotsLo' , as Owner of the subject property hereby authorize S Q li4M I LA ) '�^�d act on my behalf, in all matters relative to work authorized by this building permit application for: 99 F1 v<?'Coctie rS (Address of Job) Signature of Owner Date/ j te— Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\21`101DMEXPRESS.doc Revised 040215 The Coale moan watth o,f Massachusetts Deparmten t ofInditsoial Accidents Office o,f Investigaations 600 Washington Street Boston,M4 02111 wits"°.nass.goovIdira Workers' Compensation Easurance.Affidavit Builders/Cointractors/EIectiricians/Plumbers A licant Lufar®aation I Nease Print 'b Name.(]ham atnflnalividaaal}_ I-S Q / f?�r I 5t) � 65 Address: I j �&4 cDV f- 101 w . City/StateMp_ Co ll► A/Y�' 0�62 S_ Phone g- SOP Am you an employer?Check the appropriate box: Type of project(rewired): 1.9 I am a employer with 1 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time)-* have hired the sub-cantractors 2.❑ I am a sole proprietor orpartner- lasted on the attached sheet. 7. ❑Reemoodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity- employees and have workers" 9. ❑Building addition [No wo&e s'cam-i„surance comp.insurance.:required-] 5. ❑ €tie.are a corporation and its 1{}.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work. officers have exercised their 11.❑Plumbing repairs or additions myself. [Nay workers'conap. right:of exemption per MGL 12. of repairs insurance require&]1 c. l52, §l(4X andwe have n* employees.fto workers' 13•❑Other comp insurance required.j *Any applicant that checks box#1 mn also fill out the section below shorting their workers'campensaften policy inforzabom Homeowners who submit this affidsvir indicamg they ate,doitU all crack and thm here mnside contrurors mmst submit a new affidavit indicating such. ICarntmcmra that check ck this box must attached Ea addiaional sheet shmiog the ame of the sub-contractors and seine whether or not those eaddi a haee employees. If the sub-contmaors have employees,they must pro de their aro=ken comp.policy number. lain in an employer thaat is pm4diotg workers'congmusation instiranceforutyanydoyea& Below is thepaUcy aand job.site inforaam on. J Insurance,Company Nance: SSDCI e I r'�1�Cr3 S, Policy 4 or Self-ins.Lie.4: WCC,-QQ - 5013 N Y )1b)5A Expiration Date: s Job Site Address: YS7S Five- Cbrt>t c/'s �y4� Qty,/State/Zip ~I Attach a copy of the workers'compensations policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 2.5A of MGl,c.. 152 can lead to the imposition of criminal penalties of a tine up to 1,500.00 and/or one-year imprisonment,as well as civil penalties in Ike,£:aria 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 far warded to the Office,of Investigations of the DIA for insurance coverage v cation- Tdb hereby c under tiros paaihs areal Wallies of pedury that the inforearahon provided aabmw Zsie and correct S' e: � Date: oZ t Phone#: SO��� 1 \Y (Jiciaat aria only. B©arot write in this area,to be completed by city or tar m of ciaaL City or Town: Permitllaicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City1rom►Clerk 4.Electrical.Inspector 5.Plumbing LLVector 6.Odher Contact Person: Phone#: r A•I•�/�• ���ua) A.I.M. Mutual Insurance Company M. Massachusetts Employers Insurance Company i I INSss,�+ --.� New Hampshire Employers Insurance Company URANCE COMPANIES Associated Employers Insurance Company Associated Employers Insurance Company INSURANCE BINDER This binder is a temporary insurance contract subject to the conditions shown below. PRODUCER ISSUE DATE 03/16/2015 EFFECTIVE EXPIRATION Rogers& Gray Insurance Agency Inc DATE TIME DATE TIME 434 Route 134 06/08/2015 12:01 AM 06/08/2016 X 12:01 South Dennis, MA 02660 AM PM noon CODE 4971-1 SUB CODE 197 DESCRIPTION OF OPERATIONS/VEHICLES/PROPERTY(including location) Dennis O'Reilly General residential carpentry, 11 Cotuit Cove Rd Cotuit, MA 02635 INSURED COVERAGES POLICY NUMBER All liability limits in thousands X STATUTORY MA $ 100,000.00 (each accident) WORKERS COMPENSATION To be assigned. $ 500,000.00(policy limit) $ 100,000.00 (each employee) SPECIAL CONDITIONS/RESTRICTIONS/OTHER COVERAGES NAME &ADDRESS P t t 4a�� AUTHORIZED REPRESENTATIVE CONDITIONS This company binds the kind(s) of insurance stipulated. The insurance is subjected to the terms, conditions, limitations of the policy in current use by the company. The binder may be cancelled by the insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If the binder is not replaced by a policy, the Company is entitled to charge a premium for the binder in accordance to the Rules and Rates in use by the company. 54 Third Avenue a P.O. Box 4070 a Burlington, MA 01803-0970 a Tel: 781.221.1600/800.876.2765 a Fax: 781.270.5599 BRIDGEWATER a BURLINGTON *CONCORD, NH a HOLYOKE a MARLBOROUGH sponsored by Associated Industries of Massachusetts &fze cpannaruueu �d�� oac�iuleL Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: :'A6, 842 Type: xpiration:_.:SL?L62046_; DBA O'REILLY&ASSOCIATESB.UILDERS,/DEVELOPERS DENNIS O'REILLY 11 COTUIT COVE RD COTUIT,MA 02635 Undersecretary Massachusetts -Department'of Public Safety `Board of Building Regulations and Standards Construction Supervisor j License: CS-104375 r DENNIS T.OREE,,LY 11 Cotuit Cove Rdr Cotuit MA 02635-7 7.. f Zo_ Expiration Commissioner 05/15/2016 License or registration valid for individul use only before the expiration date. If found return to: Office of.Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170' Boston,MA 02116 i O Not valid without signatu Unresteicted-Buildings of any use group contain less than 35,000 cubic feet(91rn)which enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS licensing information visit: www.Mass.Gov/DPS TOj,rJ OF -ri, f €L ° CAPE SAVEY! Weathefization 508-398-0398 December 14,2011 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application #201006344, Status A, Parcel 168037 at.88 Five Corners Road, Centerville, Permit type: RADD , and issued on 12/03/2010 has been inspected by a certified Building Performance Institute (BPI) Inspector. R-30 Cellulose insulation was added to the attic. R-18 cellulose insulation was added to the slopes and floor. Walls were dense packed with R-13 cellulose insulation. Basement sill was insulated with R- 19 fiberglass batts.All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Cj�/Ih TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel V 13 Application # .Health Division Date Issued 7i ) 1 Conservation Division Application Fee C5 Planning Dept. Permit Fee '7-1 Date Definitive PlanApproved by Planning Board COE) Historic - OKH _ Preservation / Hyannis Project Street Address E) 1 ll(f__ 0-cprnf—S Village \ �/ Owner_ _� �'1 1p_ n,n ) 0 !IL 0 Address _ 1 I-M e--, Telephone LPG- -gn 5 Permit Request Square feet: 1 st floor: existing proposedS1hP 2nd floor: existing 1 11- proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatiof 61 M _Construction Type Lot Size a � aCP�S Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family_ Two Family ❑ Multi-Family (# units) Age of Existing Structure Li Historic House: ❑Yes L9 o On Old King's Highway: ❑Yes a No Basement Type: 2 ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) I�. Number of Baths: Full: existing I new Half: existing new Number of Bedrooms: existing s1new Total Room Count (not including baths): existing ��new First Floor Room Count Heat Type and Fuel: ❑ Gas ®'Oil ❑ Electric ❑Other Central Air: ❑Yes dNo Fireplaces: Existing New _ Existing wood/coal stove: ❑Yes No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑:news--size_ Attached garage: a existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: _ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes Flo If yes, site plan review # =` f r Current Use Proposed Use ;5f' APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number �"I Address ve License# AHome Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE' DATE t. FOR OFFICIAL USE ONLY APPLICATION# ' If _- c DATE ISSUED ,t = ,1 t MAP/PARCEL NO. ADDRESS VILLAGE OWNER 1 - ti DATE OF INSPECTION: ,;:�FOUNDATfON - , 3 FRAME �& S is+J to R i%c-4— 7A6 - INSULATION ' t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i rGAS ^ F ' 'ROUGH FINAL ;-FINAL BUILDING' f _ >ll k r L _ DATE CLOSED OUT ASSOCIATION PLAN NO. r - - l• ` The Commonwealth of Massachusetts: Department of Industrial Accidents Office of Investigations % }• 600 Washington Street v =/ Boston, MA 02111 c www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/In dividual): { 00LA I' Address: g IV his A City/State/Zip: � T e � 1 '� Phone#. Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction . employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner-:. listed on the attached sheet._t Remodeling ship and have no employees These sub-contractors have "8. ❑ Demolition working for me in-any capacity. workers' comp.insurance. 9. ❑ Building addition o workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3. I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. C. 152, §](4),.and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.], 13.❑ Other *Any applicant that checks box#] 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #:_ s 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 violator._Be advised that a copy of this statement may be forwarded.to the Office of Investigations of the DIA for insurance coverage verification: I do hereby certify under the pains-and penalties of perjury that the information provided above is true and correct. Si riatur 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): L6. Board of Health 2. Building Department 3: City/Town Clerk 4: Electrical Inspector-5. Plumbing Inspector Otherntact Person Phone# �w F -Information and Instructions 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;c6n4ruction or repair work on such dwelling house or on the grounds or building appurtenant thereto sliall not because of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency 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-contractor(s)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 carry 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 being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. 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/license 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 future 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 611-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass..gov/dia , 'own of Barnstable THE rpky Regulatory Services t BARNSTABLE, Thomas F. Geilerr, Director. � ' - MASS. - 039. Building Division pIFD '�a Tom Perry,Building Commissioner 200 Main Street,, Hyannis,MA 02601 K,wNv.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ii Please Print DATE: i JOB LOCAT1 N: 1tr V I number street village HOMEOWNER": i i�. name ��J Q h e phone# work phone#: CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelling of six units or less an&. to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER. Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,.attached or detached structures accessory to such use and/or farm structures. A person who constructs more-than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building Pen-nit. (Section 109.1.1) The undersigned`.`homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations, The undersigned "homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and,that he/she will comply with said-procedures and requ' Signature of Homeowner. Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with,the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supenisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supenisbr(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly. when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fomi/certification for use in your community. 1 f �ofrHe Teti Town of Barnstable y� regulatory Services Y Y •' HARNSrABLE MASS. Thomas F.Geiler,Director rfo � BuiIding.Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-62-� Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for.- (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:mRMS:O WNERPERMISSION b �'�'. ►�C�Z Cam. �j o+iP " :. j7 b v ,,1� cScc a ►'v -"� . r ����-{--�.r-�i 1 I,� o CG�o� �S � � t - i` `� I "} --� � l.S�� ;�� �� �:G �. � . ;,�.� C� � { , � , L # : TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I D Parcel' b Application # Health Division Date Issued Conservation Division Application Fee V Planning Dept. Permit Fee. Board -I 1 Date Definitive Plan Approved by Planning oa d � ��/3/jo', Historic - OKH _ Preservation / Hyannis Project Street Address c of-Nx)a S_ Village Owner Address Telephone PRR 3(q ?b5 Permit Request U LO VJ'tj 10 I 0 SU LIST QtJ 6CN_W-dZAL (L�(-A w W10 J Square feet: 1 st floor: existing !{ wproposed 2nd floor: existing — proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 5000• °o Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documention. Dwelling Type: Single Family: Two Family ❑ Multi-Family (# units) -� Age of Existing Structure 0K05' Historic House: ❑Yes ❑fNo On Old Kings Highway: OhY,.es �No Basement Type: 'Full ❑ Crawl ❑Walkout ❑ Other w Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing_ new Half: existing new '`' Y L'9 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas 626il ❑ Electric ❑ Other Central Air: ❑Yes Y� o Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: R(existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes Ul!No If yes, site plan review# Current Use Sit L;(,c(- I�,q Proposed Use Sa E APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name i CC-LQ S 14 C- ,�44ephone Number S©k- N S-03`(8' a Mdress _7C License # O2,T7G �CJ ,> -AA D9 k MA: 0'266' Home Improvement Contractor# �Z Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE i 0 FOR OFFICIAL USE ONLY APPLICATION# ' DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER t DATE OF INSPECTION: LL—FOUNDATION i" FRAME INSULATION_, FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r 'i sGAS - _pfi>' ROUGH°- '4 = _ FINAL :-FINAL BUILDING" €' - :-'_>: DATE CLOSED OUT _,i ASSOCIATION PLAN NO. i u T ZHE rc�,M Town of Barnstable 0 1 Regulatory Services Hax re `J Thomas F. Creiler,Director Bililding Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 N"",.town.harnstahle.ma.us Office: 508-862-1038 Fax: 508-790-6230 Proper---y Owner Mus t Complete and Sign This Section If VsijigA Builder Z, , as Owner of the Subject property hereby authorize P �' je ' to act on my behalf, in all matters relative to.work authori;-ed by this building permit application for: CErj zuI ccc (Address of Job) 4S 1(0 Signa e of Owner — to If Propedty Owner is applying for permit please complete the Homeowners License Exemption Form on the reveise.side. 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Q266 . �:���:�1.�I.�.�I. I .....:.:��..:.:.I;� I . The Commonwealth of Massachusetts Department of Industrial Accidents Office_of Investigations .600 Washington.Street Boston,MA 02111 www.massgov/diia Workers' Compensation Insurance Affidavits Builders/Couttactors/Electrlclans/Plumbers ADulicant Information Please Print Legibly Name(Business/organizatiowinndividual): Address: Ci /State/Zi Phone#: OS, O?A Are you.an employer?Check the appropriate box: , l.12 1 am a employer with 4. I.am a eneral contractor and I Type of project(required): g 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 working for me in any capacity. employees and have workers' g' ❑Demolition [No workers'comp. insurance comp. msuranceJ 9. ❑Building addition required:) 5. We are a corporation and its 10.0 Electrical repairs or additions 1111 am a homeowner doing all work officers have exercised their 11,Q Plumbing repairs or additions myself [No workers:'comp. right of exemption per MGL insurance required.]r . c. 152,§1(4),and we.have no. 12.0 Roof repairs 3a.Q..I am a homeowner acting as a.. employees.[No.workers'. 13. tfitr general contractor(refer to#4) comp..insurance required.] 'Any applicant that checks box#l.must also fill out the section below showing.their.workera'compensadoB�o6cy information t Homeownersorsthat who snbmit.thie affidavit indicating they are doing all work and,then hire outside contractors must submit anew.affidavit indicating such. tContractors that check this box must attached an additional short 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 wortew comp.policy number.. I am an employer that is providing workers compensation Insurance for ary employees. Below is die policy and job site informadon` Insurance Company Name: ` (�J S a �J Policy#or Self-ins. Lic.#: �-� ( S Expiration Date: Job Site Address:_ E Ft 1 CtZYU S (L City/State✓Zp:(i ,Ly t fk (03 Attach a copy of:the.workers'compensation policy declaration.page(showing the,policy number and ex n piratio 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of. Investigations of the DIA for insurance coverage verification. I do hereby eerdo under the nains and a o. informationP P fpedW that the rovided above is drre and correct Date: Ifi I ' 1C) Phone#: O�?cial use only. Do not write in this area,to be.completed by city or town of eia[ City o r Town: Permit/License# Issui ng Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Do.Other Contact Person: Phone#: A�' ® DATE(MM/DD/YYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 11/1/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY,THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Shannon S errazza NAME: P Risk Strategies Company UPHCNE (781)986-4400 FAX,No:(781)963-4420 15 Pacella Park Drive ADDRESS:ssperrazza@risk-strategies.com Spite 240 CRODUCERUST ERID#00018476 Randolph MA 02368 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Seneca Specialty Insurance Co INSURER BAeating Group Ins Services Michael McCluskey, DBA: Cape Save INSURERC:Chartis Insurance 7 C Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER CL1011132675 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE Fx_] OCCUR BAG1002608 10/16/2010 10/16/2011 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ 1,000,000 X POLICY JE� LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB HCLAIMS-MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ B RETENTION $ 023578601 10/16/201010/16/2011 $ C WORKERS COMPENSATION chael McCluskey WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N X ITSI ER ANY PROPRIETOR/PARTNER/EXECUTIVE is excluded from coverage E.L.EACH ACCIDENT $ son 000 OFFICER/MEMBER EXCLUDED? FY—] N/A (Mandatory in NH) 9930951 10/21/2010 10/21/2011 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Issued as evidence of insurance. Contractors-Executive Supervisors or Executive Superintendents. CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Ruth 460 West Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601-3698 Michael Christian/SMS '- ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD f `►:a,sat 11u,a ttr• Department at'PJAI)tic• S,&t. Bri;artl caf'Building ,$„ Itc.�ail,ttioras aaaaat �t.ancl<ar€1ti . C nstr ctio Supervisor Speeia;ty License License: CS.SL 102776 Restricted to:, IC WILLIAM MC CLUSKY 37 NAUSET ROAD ` WEST YARMOUTH;'MA 02673 .,, c— � . Expiration: 6/28/2013 C:��r�ntai�saroaer Tr#: 102776 .. e y� td" `j - — ^ Xe 6wvmowa.1eaa ., Office of Consumer Affai s and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164432 Type: Supplement Card CAPE SAVE Expiration: 10r6l2011 WILLIAM MUCCLUSLEY -- -- --- -- — 8201 S. HOURD CT CHAPEL HILL, NC 275.16 Update Address and return card.Mark reason for change. JPS-cai 0 50ia-04,04-0101216 Address ri Renewal Employment — Lost Card Office of Consumer Affairs&Business Regulation License or registration valid for individul use only 'HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: F, `! Office of Consumer Affairs and Business Regulation r Registration ?64432 Type: 10 Park Plaza-Suite 5170 Expiration 10/672011, Supplement Card Boston,MA 02116 CAPE SAVE WILLIAM MUCCLUSLEY 7C HUNTING AVE S.YARMOUTH>MA 0261i4' Undersecretary Not valid wit ou signature