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HomeMy WebLinkAbout0345 HOLLY POINT ROAD � 1 4 �Q���,�t!��1 11 _ u z v � �,' xc i . a. � i � ,,. � M �� � �• Oro � E},+ _., ... .. .� � , n y 4 ` ..� • }. t � g �. .. � '�` � o . o � ,. - a � � � � s - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION MapParcel— l/ Application # d l30 746 b S Health Division " Date Issued Conservation Division Application Fee Planning Dept. Permit Fee * Date Definitive Plan Approved by Planning Board Ok 13 Historic - OKH _ Preservation / Hyannis Project Street Address _3 WJ d d N Village cpepte,e (/`/* P Owner -:T e-"L a Cq /'`C!)i C Address Sa*41 t9 Telephone Lp��) CT IF 0?IF Permit Request 1, see a)�/c lo`1 P Y-- bfS(,44e,- S!� 6c/ �'. ��tlf l A4� ills u Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio OL9 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes; attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ 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 nM Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor F@in Count i -' Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other =_7E Central Air: ❑Yes ❑ No. Fireplaces: Existing New Existing wood/Goal stove?❑1Ce ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ listing CYnew`''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' CJV OR HOMEOWNER) r,1 Name �V® I' L �I �v�-- r1C- Telephone Number v 3` S ~ 1oa Address C �� ✓� License # f) �✓ '�^ ' rt►'I Home Improvement Contractor# / ! U o Worker's Compensation #T w 708 . ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ct SIGNATURE DATE/C, FOR OFFICIAL USE ONLY J APPLICATION# 4" t• DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ` FOUNDATION e k FRAME t INSULATION FIREPLACE ,s ELECTRICAL: ROUGH FINAL 4 PLUMBING: ROUGH FINAL k: GAS: ROUGH FINAL k. FINAL BUILDING E P G DATE CLOSED OUT C #` ASSOCIATION PLAN NO.. ' A `f '��Pnnt FoFrn�� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations i, I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Legibly Name (Business/Organization/individual): Cape Save,Inc. • Address: 7D Huntington Avenue City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 1.2 I am a employer with 17 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a 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' 9 ❑ Building addition Electrical repairs required.] workers comp. insurance.+ comp. insurance irs or additions required.] 5. ❑ We are a corporation and its 10.❑ p_ 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers right of exemption per MGL comp. 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑✓ Other Insulation employees. [No workers' 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 and job site information. Insurance Company Name: Technology Insurance Company Policy#or Self-ins. Lic.#: TWC 3353968 Expiration Date: 04/09/2014 Job Site Address:c.� ` J4r / z 0 ` d- iU67 City/State/Zip:601fy()jWe V Attach a copy of the workers' comp nsation 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of erjury t at the information provided above is true a►d correct Date -- `— Signature: --- -.__ - Phone#: 508-398-0398 . Official use only. Do not write in this area,to be completed by city or town offciat - City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• g AP CERTIFICATE OF LIABILITY INSURANCE DATE{ 3�' /9/201 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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 ME^CT Colleen Crowley Risk Strategies Company , AHON . (781)986-4400 FAC No:(781)963-4420 15 Pacella Park Drive EMAIL Ss- Suite 240 _ INSURER(S)AFFORDING COVERAGE NAIC$ Randolph M7L 02368 INSURERA:Selective Insurance INSURED msuRms:Safetv Insurance Commany 33618 Cape Save, Inc INsuRERc:Technolo Insurance any' 7 D Huntington Ave INsuRERD: INSURERE South Yarmouth M 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL134960509 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 POLICY LTR TYPE OF INSURANCE ADDL S POLICY NUMBER Mwoo EFF MMI ICY E)(PDAYM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY AMAG-TO KtNTtU PREMISES Ea ocalrrence $ 100,000 A CLAIMS-MADE Q OCCUR S199448001 0/16/2012 0/16/2013 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO- ,ECT LOC $ AUTOMOBILE LIABILITY _ CO BNED SING LIMIT $ 1 000 000 B ANY AUTO • - BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 6208200 • 1/6/2012 1/6/2013 BODILY INJURY(Per acciderd) $ AUTOS AUTOS NON-01ANED PrROPERTY DAMAGE $ X HIREDAUTOS X AUTOS (Per acdd:.rG X Undednsuredmoton;t8lsput $ 100,000 A X UMBRELLA uAB X OCCUR S199448001 0/16/2012 0/16/2013 EACH OCCURRENCE $ 1,000,000 XCESSLIAB CLAIMS-MADE - AGGREGATE $ 1,000,000 EXCESS RETENTION$ $ C WORKERSCOMPENSATION Officers Excluded,from X NRST.4MUS OTR- AND EMPLOYERS'LIABILITY ANY PROPRIETORfPARTNERc:)ECUTIVE - NIA overage EL EACH ACCIDENT $ 500 000 OFFICERWEMBER EXCLUDEO? (Mandatory In NH) 3353968 /9/2013 /9/2014 EL"DISEASE-EA EMPLOYEE $ 500,000 Ilya s,describe under ' DESCRIPTION OF OPERATIONS below ' E-L.DISEASE-POLICY LMIT $ 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS U VEHICLES(Altach ACORD 101,Additional Remarks Schedule,it mere space is required) Issued as evidence of insurance. Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a/ National Grid, Action Inc.,, Colonial Gas Company and NStar Electric are listed as additional insureds as respects General Liability as required by written contract_ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 427/SCH 3195 Main Street AUTHORIZED REPRESENTATIVE Barnstable, Bpi 02630 114ichael Christian/CLC �- �' '���=^ ACORD 25(2010105) 01988-2010 ACORD CORPORATION. All rights reserved. 'INS025(20)o0s).0) The ACORD name and logo are registered marks of ACORD t f4 Nlassachuse is -Cegartnen o; ublic Salet Board of Suilding Regulations and Standards Construction Sullen isur S1lecialty icense: CSSL-102776 ;` a WILLIAM J MC%USX EY 37 NAUSET ROAD West Yarmouth NA 02673 Commissioner 06/28/2015 ti Office of Consumer Affairs andeness Regulation ,o=J 10 Park Plaza Suite 5170 t� Boston, Massachusetts 02116 " Home Improvement Contractor Registration' Registration: 171380 Tvpe: Corporation Expiration: 3/14/2014 Tr# V2184 . CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. i Address -] Renewal Employment Lost Card OPS-CAt'as 5OM-04/04-GlOI216 — 37f16 i?697L1RdI2f,IfP.CLGLit. G�vf�G461(bC1LCCaeL24 License or registration valid for ind Office of Consumer Affairs&Business Regulation ividul use only si _ ?HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: . rt ' r? Registration: .171380 Type:' Office of Consumer Affairs and Business Regulation �~ 10 Park Plaza-Suite 5170 Expiration: 3/14/2014 Corporation - ' _ Boston,MA 02116 CAPE•SAVE INC.:`_ __. . WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH,MA 02664' Undersecretary Not valid wit d sii-ni 1417Y.- SET Town of Barnstable ° Regulatory Services DARNMBLF, ' Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,Mk 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Properly Owner Must Complete and Sign This Section If Using A Builder as Ovaner of tine subject property hereby authorize �AV'+! �,J to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and'accepted. r7 v Signature of Owner Signature of p r an Print Name Print Name Date Q:FORMM:OV N-=RPE12M MSIONPool:S 62012 Cape Save Inc. _ e In 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-39&0399 11/11/2014 Y Thomas Perry CBO Town of Barnstable E - - Building Division 200 Main St. Y Hyannis,MA 02601 RE: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for 345 Holly Point Road(#201307005) has been inspected by a third party Certified Building Performance'Institute(BPI) Inspector. All work performed meets or exceeds'Federal and State Requirements.. 9 m Sincerely, Al f' {• 9q�p a • r ' -William McCluske O S A a V� 3'IStl1SN ode �O NM Own ®f Barnstable *Permit# Expires 6 r� nihs from issue dale 90OZ 5 0 R" Regulatory Services Fee � ��� ������h�tas F.Geiler,Director 11M wilding Division / Tom Perry,CBO, Building Commissioner `0 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint l Map/parcel Number 0 .Property Address C 71 C_E 0 tEf,Q` LL ®Residential Value of Work _rj ©►S�, Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 76 D Q V i V 61� S kc>o LEI l �� 1A M; Ek. CC M I EEO Contractor's Name P CA d 0 .r Ic Telephone Number �B 4)0 q' qQ Home Improvement Contractor License#(if applicable) ( �� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner y I have Worker's Compensation Insurance Insurance Company Name T ON f h U 1 Q A L T>j IR R Nr4-- C✓r). Workman's Comp.Policy# 09 W263 — �� f Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) &rRe-roof(stripping old shingles) All construction debris will be taken to -S+`5 (C_ru zC c)n Lt3 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *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. Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 The Commonwealth ofMassachusetts { Department of Industrial Accidents .., Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pla>+.m hers ApD11cant Information Please Print Lei ibly Name(Business/organization/Individual): t 9c�CknC UCH M E IM PR n d Address: D L WE LOY0 P City/State/Zip: D) Z( ; \4-' ' Phone t 5n8 "E2�' tf ' 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 I 6. ❑New construction employees (fall and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or pander- listed on the attached sheet# �. ❑ Remodeling ship and have no employees These sub-contractors have g: Demolition working for mein any capacity. workers' comp.insurance. 9. ❑ Bu:Uding addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required,] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp, c. 152, §1(4),and we have no 12.[4 Roof repairs insurance required.] t , employees. [No workers' 13.❑ Other comp.insurance required.] ''Any applicant that checks box#I rnust also Clout the section below showing their workers'oampensation policy information' t Homeowners who submit this affidavit indicating they are doing all work andthea hire outside cofactors must submit anew affidavit indicating such ZContractors that check this box must attached ea additional sheet showing the name of the sub-contractors sad their workers'ecmrp,policy inforrnatian. 1 am an employer that is providing workers'compensation Insurance for my employees. Below is the policy and job site information. Inslzrance Company Name: Pr>i (� �1C)TU)M_ R n Pal O Policy#or Self-ins.Lic, #: &0 `U b�3 `76 913 Expiration Date: Job Site Address: 'M S la-u_A" Pr! ft,t� fir\.• City/State/Zip:G1,Lge nnL4& J)J 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$1,500.90 and/or one-year in;Nisonmen% as well as civil penalties in the form oi'a STOP WORK ORDER and a fine of up to S 50.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLk for insurance coverage verification. 1 do herehy certify under the pains and penalties of perjury that the information provided above is true and correct Sienature: ?if (PnL k Date: �-, --os•-D69 Phone#: Orb'y � —�N b� Official use only. Do not write in this area,to be completed by city or town of icial City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building DepartmenL' 3.City/T17own Clerk e.Elect 1cai Inspector 5.Plumbing Inspector 6. Other Contact Persona: Phone#: inioninata®n ana imstructiuns 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 life', express or implied,.6ial or written." An employer is defined as-"an individual,partnership, association, corporation 6r 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 bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of it 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 co-Verage 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 ofpublic 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 numbers) along with their certificate(s) of insurance. Limited Liability Companies.(LLQ 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' compensationpolicy,please call the Department at the number listed below. Self-insured companies thould tinter heir 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 is the pern*/Iicense number which will be used as a reference number. In addition;an applicant that mast submit multiple permMicens a 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. Anew 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 Massachuset m ts ~ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel..-617-727-4900 ext 406 or 1-877-MASSAFE ' Revised 5-26-05 Fax�617-727-7749 VWWW.Mass.gov/dia - — y ---------- ac/u�aelta �sxratton vSl►d tormdrv>Id�l yse bn7�� i �anznuynuz �` °° „ License or reg } Bgacd of Building RRgulahons and Standas 4 before the exptrat►o°autat�ous and st$naa�ds CTOI ° e_ HOME.IMPROVEME CONTRA , Board of uildl°g R� 1301 O.ne AshbuKtod dace Rm Registfatk 121.967 1 r. a t iration` 312006 Boston,Ma.03108 EA YI?�- �liyiduat �M~� BRADLEY A fx C BRADLEY PADDQ.CI, signattir�. 24 DEBBIES LANES Id[ARSTONS MLt,$_ A p2648 3 Administrator 6 L f t�. 1' °FISE,p town of Barnstable Regulatory Services � a 9 LA MAC $` Thomas F.Geiler,Director �pTE 6yq. s Building]Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable..xna.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Y as Owner of the subject property hereby authorize �1Z �p- _�� to act on my behalf, in an matters relative to work authorized by this building permit application for. (Address o Job) Signature 94ier Date Print Name B{'p -A rn ot& Fa 6 s Q TO RM S:O WN ERP ERM B S ION ISSUE DATE CERTIFICATE OF INSURANCE03/29/2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Miller McCartin DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. dba Dowling &O'Neil Ins Agcy 222 West Main Street COMPANIES AFFORDING COVERAGE Hyannis, MA 02601 INSURED Bradley A Paddock COMPANY A.I.M. Mutual Insurance Co dba Paddock Home Improvement LETTER A 24 Debbie's Lane Marstons Mills, MA 02648 063 1 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIO LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ LAIMS MADEEDDCCUR PERSONAL&ADV.INJURY $ OWNER'S&CONTRACrOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABLLI I Y EACH OCCURRENCE $ MBRELLA FORM AGGREGATE $ THER THAN UMBRELLA FORM WORKER'S COMPENSATION AND }L' WC STATU- OTH- EMPLOYERS'LIABILITY TORY LIMITS 7019403012005 05/27/2005 05/27/2006 EL EACH A $ A THE PROPRIETOR/ INCL EL DISEASE—POLICY LIMIT $ 500,000 PARTNERS/EXECUTI V E OFFICERS ARE: X EXCL EL DISEASE--EA EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEIUCLES/SPECIAL,ITEMS i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E. B Norris & Son Inc. EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR P.O. Box 486 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Hyannisport, Ma 02647 �° �b E2`va' Nvrr�•7'�"' �,�v .v�vir;S'1�' - T��in b7a' mar �Nr/�✓�7 � , '�, 13 n 2i� a3� w oa► � d � l � -���- c wco�o�� yo a►�a wn/y � � _ � � . r R.I I e -_ . \ 4 (� �D,�y,Jp ray •A � y / tea C � ovoo� %,a y 1 7 1� �0 07'dog. '/YZifrrFJ IVrr ••�C9 sn�oilvr y��90 411u/1 Z = 31 V 0 r OV ff70- 1`: ?3a1 i^ � .1�1�t� /.� x•wL id3S cl"37JJ�^�3�! \ �i1�� /YouVA 90 ,yt� cx,Sf afrY ,ci7Q1 rvll�i:11:. Q. �,(ti ' ` . 11 �1