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Home My WebLink About0130 HORSESHOE LANE a f , , ► :. o �' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # NZ07 l l Health Division - Date Issued r Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board $►c l /��-. Historic - OKH _ Preservation / Hyannis Project Street Address A-1 c) \6o c fie.Sh o . \...,u ng Village Owner S&wcwzA N. Address \30 Telephone Permit Request cx-\N\L, /©::c SQtAN g,, \C_ cxsSQ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation \nOO 4®° Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) a a Age of Existing Structure Historic House: ❑Yes ❑ No On Old King';Wghway: �Ej Ye6F9LJ No I CD Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other CDI ' Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) ; Number of Baths: Full: existing new Half: existing new ; -' Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size = Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION �3 (BUILDER OR HOMEOWNER) ` Name c3iNoC' C,\(ko-,C,INP J." Telephone Number 'SU5'S33`S3`9 Address 3r ZckXm- \-'�.O License # NOSR`lS AnA O-o�-(-G3 Home Improvement Contractor# Worker's Compensation # �� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 12,11111 IL - r } • FOR OFFICIAL USE ONLY 3' APPLICATION# DATE ISSUED S MAP PARCEL NO. ' a ADDRESS VILLAGE OWNER { r' is 1 DATE OF INSPECTION: FOUNDATION j , FRAME INSULATION j � s' FIREPLACE ELECTRICAL: ROUGH FINAL , r PLUMBING: ROUGH FINAL 1 GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT i` ASSOCIATION PLAN NO'. r, The Commonwealth of Massachusetts Prmi Form. +' Department of Industrial Accidents Office of'Investigations .1 Congress Sir-eel, 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/lndividual):CONSERVE ENERGY INC. d.b.a CONSERVISION ENERGY Address: 376 ROUTE 130, SUITE C City/State/Zip:SANDWICH, MA 02563 phone/#: 508-833-8384 Are you an employer?Check the appropriate box: 'Type of project(required): 1.® I am a employer with 6 4. 1 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 8. ❑Demolition working for me in any capacity. employees and have workers' 9 ® $wilding addition [No workers'comp. insurance comp. insurance. required.] 5. We are a corporation and its 10.7 Electrical repairs.or additions q � 3.❑ I am a homeowner doing all work officers have exercised their 1 1.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12,0 Roof repairs insurance required.]t c. 152)§1(4),and we have no employees.[No workers' 13.®OtherWEATHERIZATION 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,aredoing all work and then hire outside contractors must submita 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: SELECTIVE INSURANCE COMPANY OF THE SOUTH Policy#or Self-ins.Lic.#:WC7956539 Expiration Date:3/15/13 Job Site Address: City/State/Zip: _ Attach,a copy of the workers'compensation policy declaration page(showing the pokey 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 certi under the pains and penalties geerLu2 that the in orrnation,provided above is true and correct. Sign - Date, i j 0 Vt Phone M 508-833-8384 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 i 6;Other Contact Person: - Phone M f 1 Client#:68880 CONSER ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYY" 03/15/2012 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 BOLDER. IMPORTANT:N the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,Subjecito 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. Rogers&Gray Insurance Agency,Inc. FPRONE En)-508 398-7980 _LAIC No): 434 Route 134 E MfUL South Dennis,MA 02660 aoDREss: _508 398-7980 INSURER( S)AFFORDING COVERAGE_ NAIC B INSURER A:Selective Ins.Co.of the South INSURED . . -_y INSURER e: Con-Serve Energy,Inc. 376 Route 130.STE C i INSURER C: i Sandwich,MA 02563 �INs� URER°-- .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 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, IN R TYPE OF INSURANCE AODLSUSR - POLICY EFF POLICY EX--X—�-- —�- ---- — .,�.INSR WVp ,,,,,,—; _POLICYNUMBER_ - _ MMIDO/YVYYl.fl�(MMIDO`ryy�yy'��I _ LIMITS A GENERAL LIABILITY )( 52011299 3/1412012 i 03114/2f)1 EACH OCCURRENCE — .i$1 000 000 X COMMERCIAL GENERAL LIABILITY - (DAMp�g TO ENTED�I- PREMISES IEa oCCurre $100 000 CLAIMSMAOE OCCUR .MMEED EXP(Any one parson) )'$10, 00 PERSONAL&ADV INJURY l—§1 LOo0,000 GENERAL AGGREGATE ' $3Z000,O00. r GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG 0000,000 X POLICY PRO- LOC $ �... . AUTOMOBILE LIABILITY 1 CA 88nI�N�ED nt)SINGLEttMIT $ - ANY AUTO j BODILY INJURY(Per parson) S Y� ALL OWNED SCHEDULED AUTOS AUTOS 1 +l BODILY INJURY(Per accident). —, NON-OWNED - PROPERTY DAMAGE HIRED AUTOS - AUTOS � � � I pdr accident) .$ A UMBRELLA LIAB- A OCCUR I X S2019299 3/14/2012 03/1412013�EACH OCCURRENCE $1 OQa 000____ X EXCESS LIAB CLAIMS-MADE , AGGREGATE I s3,000,000 DED X RETENTION$0 { $ A AND EMPLOYERS'LIABILIITY j WC7956539 311412012 03/1412013 X I WC SRV AMIT �r�H- ANY PROPRIETORMARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT $100 000 OFFICERIMEMBER EXCLUDED? E.L.NIA I (Mandatory In NH) t E.L.DISEASE-EA EMPLOYEE'$100.000 if yes.doscribe under f -- DESCRIPTION OF OPERATIONS below ..— _ ___.._._..._ I E.L.DISEASE•POLICY LIMIT $500t000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule,if more space Is required) - Excluded officers under workers'comp-Conor and Courtney McInerney. Blanket additonal insured coverage applies under CGL. CERTIFICATE HOLDER CANCELLATION Thielsch Engineering,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g g, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 Francis Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Cranston;RI 02910 ' AUTHORIZED REPRESENTATIVE ©198 -2010 ACORD CORPORATION.All rights reserved. ACORD:26(2010105) 1 of 1 The.ACORD name and logo are registered marks of ACORD #S788991M78896 DDR • Massachusetts-Department of Public Safety Saari#of Building Reguiations and Standards C'r7n,Cructit3n:`�up;r3�ic7ir 4�aeclalt� License:CSSL-102778 �itY ty CONOR D MCiNERNEY 39 SIASCONSET DRIVL', SACAMORE BEACH MA$0262 I ',f r Expiratton Cxirraessioner 08119/2014• .a .J Lt'09Y24uIrr.Ltf. lt6,[f lStl[ti ACI t[ t Office o oosumer airs mess egu a ion License or registration valid for individul use only FIRHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to; i�Registration: ,171251, Type: Office of Consumer Affairs and Business.Re utatiori - e = Expiration: ,311/2014 Partnership 10 Park Plaza-Suite 5170 g M ,!� _ Boston,MA 02I'16 C01�=SERVE ENERGY CONOR MCINERNEY 376 ROUTE 130 SUITE C SANDWICH,MA 02563 — Undersecretary ,� Not valid without signature e 4 OWNER AUTHORIZATION FORM (Owner's Name) ' owner of the property located at (PropertyAddress) L��f rv,•/�P. /�,9 G 263 Z (Property Address) hereby authorize Co`fls e� v l (Subcontractor)L ' an authorized subcontractor for RISE Engineering,to act on my behalf to obtai building permit and to perform work on my property. Owner's Signature i Date ,• 4 i Town of Barnstable Regulatory Services . "T W �, � Thomas F.Geiler,Director EMW„�M `" Building Division IV SEP 25 AM $- 25 1639. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us. -- DIV SION Office: 508-862-4038 Fax: 508-790-6230 PERMIT#��O l ��S� FEE. $ SHED REGISTRATION 120 square feet or less Location of shed(address) Village Property owner's name Tee hone number p x ,Size of Shed Map/Parcel# C) Signature Date �— Hyannis Main Street Waterfr4 istoric District? r b Old King''s Highway Historic District Commission jurisdiction? A 16 Conservation Commission(signature is required) /2-( _ Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A• a PLOT PLAN �. ON r Town of Barnstable Geographic Information System September 25,2009 C207,128. 207,125 #152Jr 11�137 INNN 207111y #6 CIO 207127 #144 207079 #128 p 1, t15 207126 x Nx #130 11 207140 #110 207091002 #40 207141 #108 207100 ". #105 21 Feet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:207 Parcel:126 1. boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:KILROY,EDWARD A& Total Assessed Value:$266400 are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner:KILROY,MARY ANN Acreage:0.25 acres Abutters E boundaries and do not represent accurate relationships to physical features on the map Location:130 HORSESHOE LANE such as building locations. Buffer Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee SEP 17 2007 Thomas F.Geiler,Director TOWN Oi BARNSTABLE Building Division Tom Perry,CBO, 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 D-0 7 Property Address Z3 0 [9'gesidential Value of Work � �_ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address f/dam C�cv - c%✓-sl�li�ci�� !/��. Contractor's Name ,eL_r Telephone Number 7 76 1Y Home Improvement Contractor License#(if applicable) �/ Construction Supervisor's License#(if applicable) [�orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Lain the Homeowner I have Worker's Compensation Insurance Insurance Company Name U � Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(c eck box) Re-roof(stripping old shingles) All construction debris will be taken to t stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance.of this pemilt does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A of the Ho a Improvement Contractors License is required. SIGNAT 7' Q:Forms:expmtrg Revise061306 w ' - The Commonwealth ofMassaehusetts Department of Industrial Aecidents Office of Investigations d 600 Washington Street Boston,MA 02111 . www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/Organization/Individual):. /ewe Address: 31 G /I el C-6 City/State/Zip: releeli,-,I� � - Phone.#: Are you an employer? Check the appropriate bog: Type of project(required):. 1.L3 1 am a employer with_ 4. I am a general contractor and I . employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.❑ I am a•sole proprietor or partner- listed on•the'attached sheet. 7. ❑Remodeling These sub-contractors have ship and have no employees 8. Demolition working for me in any capacity. employees and have workers' 9 .r�j Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 1.❑ I am ahomeowner doing all work officers have exercised their 11.❑PI bing 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 employees. [No workers' _ .131j Other comp.insurance required.] , *Any applicant that checks box#1 must also fin 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. rContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. rf the sub-contractor frave employees,they must provide their workers'comp,policy number. lam an employer that is providing workers'compensation insurance far my employees Below isihe policy and job site information. J�167 � - Insurance Company Name: Policy#or Self-ins.Lic.#: // / Expiration Date: Job Site Address: ��O Ave J' Z n 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 iip 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the IDIA for insurance coverage verification. Ida hereby certify jun er he pains d penalties ofperjury that the information provided aabovg is true and correct; Sienature; Date: / —(? —e ? _ Phone#: 776 T/ /Y Official use only. Da not write in this area, be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: K ' Of f HE�°�y Town of Barnstable. Regulatory Services nmiNS a ILZ, • ,e MASS. Thomas F.Geiler,Director A )Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,-Na 02601 "w.town.barnstable.maxs Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and'Sign This Section If Using ABuilder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to.work authorized by this building permit application for: . (Address of Job) Signature of Owner Date Print Name Q:FORMS:OWNERPERMISSION �b ` t , 81 rh y I u Fy g E ra xs f'� y ' �i. 4, t { � r u` ''`,,�' t ` /Ze: 9t Y/�01$CC'gQLGiL r2�✓'�s�c�7CGr�LGC:kO' t ..r— {i Board o `$4t dm�E` gutations and Standat rfy ' { FiO67 lcense oeg rorE IMPROVEMENTC r r imcli�, ul us , CTOIP e 1' •+ ` . f fi p before the expo? f Registration tion date.<lr rtl�rii i etwr 134�86 4ard of Rnildmg Rego, Lions srrl'Stand,rcls e �CFpiration 1012�/2007 C2VC Ashburton pi "ee Rm he'd a � c D[3A It stun,A[a 02100'� f' nfi< CGNST INC DBA:lSt AND:lUING&ROOFINZZ f BONNIE TAYLOR = a lgOt V 114 .... d 4 din a 0 oing i g nd1-- Edward A. Kilroy 1 sfand S R f 7 Linkside Court Northbridge? v .i Massachusetts 01534 a division of RLTConstruction,Inc. August 29, 2007 Proposal to: dward Kilroy 25 fig„41/ E Y 130 Horseshoe Ln.. Centerville,Ma 0263.2 We are pleased to submit the following specifications and estimates for re-roofing. Remove existing asphalt shingles and flashings. Install aluminum vented drip edge and copper pipe flashings. Install 3 ft. ice shield to eaves and chimney. Install 151b. paper to remaining roof. Install 30yr. Certainteed architectural grade shingles. Install cobra ridge vent and ridge caps. Clean up and haul away all debris to landfill. We hereby propose to furnish material and labor- complete in accordance with the above specification, for the sum of: $3500.00 For 1 pc gutters front and back add $400.00 For trim replacement of facias and rakeboards with Azek pvc trim add $1000.00 Gutter guard installation and shed removal no charge. No deposit, Payment in full due upon completion. All material is guaranteed to be as specified. All work.to be completed in a workmanlike manner according to standard practices: Any alterations or deviations from the above specifications involving extra costs will be executed onlyupon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents,or delays beyond our control. Owners to carry fire,wind damage and other necessary insurance. RLT Construction,Inc. carries General Liability and Workman's Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specifie . ( car i Payment will be made as outlined above. �� Date of Acceptance: e� Signature g Signature Start Date: 31 Manni Circle Centerville, Massachusetts 02632 7efephone 508.42a5243 and 508.833.5249 - Fax 508.420.1776 • Enwdcaperoofer@caperoofer.com I RightFax H1-1 9/17/2007 4 : 03 : 03 PM PAGE 003/003 Fax Server ACORD. CERTIFICATE OF INSURANCE DATE(MMI)DIYY) 09-17-07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE EDWARD A GRAZUL INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO BOX 337 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE MARSTONS MILLS,MA 02648 COMPANY 28Y2IC A HARTFORD GROUP INSURED COMPANY B R L T CONSTRUCTION INC COMPANY 31 MANNI CIRCLE IC CENTERVILLE,MA 02632 COMPANY D COVERAGE 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 SUBJECTTO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDDWY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Anyone fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULEAUTOS BODILY INJURY(PerAccident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'SLIABILITY U13-1051C045-06 12-24-06 12-24-07 STATUTORYLIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 100000 PARTNERS/EXECUTIVE X INCL DISEASE-POLICY LIMIT $ 500:000 OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. PHYSICAL LOCATION:54 HYANNIS ROAD HYANNISPORT MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF BARNSTABLE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT ATTN:BUILDING DEPARTMENT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OFANY 200 MAIN STREET KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES, HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE Ramani Ayer ACORD 25-5(3193)