Loading...
HomeMy WebLinkAbout0029 PHINNEY'S LANE - ,+.�: "�1. � I j+ Pa brit .+. � th•., R. „# r.: �, •.....S•,t. .#s, ?. a. --'7, i,y' 1' g' �r5{ 3``i'fy,,f ;y' `•5 i,y° .t ..r. • 1Y :, t,ya -.� � � r � � rr a ``_= '�'d' �Fis:a r '.r'.,a+; �p s. ,.pp I K5 f , � O , c A 5 C r a ' i. R s a e t' a .L in , v m .y V A Town of Barnstable /�J� ,.7 ;�. '" *:- arr�,,:� x �- r £ -, r„� �Bung t Post`°Th�s`Cad SoLThat tt is Visible Frorn the Street Approved P1ansaMust be'Reteined on,Job and this Card Must be Kept �7 Post d'Until`Final Inspection Has Been Made. '' " " e s r -a, Permit Where a Certficate'of Occupancy is Required,such Buildmg;shall Not be Occupied until a Final Inspection has been made a : - - Permit NO. B-17-4115 Applicant Name: SPRINKLE HOME IMPROVEMENT, INC. Approvals Date Issued: 11/30/2017 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 05/30/2018 foundation: . Location: 29 PHINNEY'S LANE,CENTERVILLE Map/Lots 209 049 Zon(ng District: .SPLIT Sheathing:. Owner on Record: MINK,CLIFFORD E&LOIS C Contractor NameSPRLNKLE HOME IMPROVEMENT,_ Framing: ,1 INC. Address: PO BOX 1120 r '- `.. g 2 . Cortractorlicense 103757 CENTERVILE, MA 02632 Chimney: Description: RE-ROOF STRIPPING OLD SHINGLES-YARMOUTH _ Est Protect Cost: $ 10,940.00 $ Permit Fee: : $55.79 :Insulation: Project Review Req: F Fee Paid: S 55.79 Final: '#"Date ` 11/30/2017 . o Plumbing/Gas g , � -f�n""�i^✓ Rough Plumbing: k -� Building Official Final Plumbing: r Rough Gas: This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within sN'months after issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents#or which this permit has been granted. Final Gas: All construction,alterations and changes of use of-any building and st Iuctures shall be in compliance with the local zoning by-laws"and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintaine&open for public inspection forthe entire duration of the Electrical; work until the completion of the same. Service: "The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work:Ut , 1.foundation or Footing _ 'Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection. 5 Prior to Covering Structural Members(Frame Inspection} Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 'Final: Work shall not proceed until the Inspector has approved the various stages of construction: Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT V _ Town of Barnstable *Permit# 'j 7-1-1 /�S Ex Tres 6 months from issue date Building Department ee S nnartsrnsie, : Brian Florence,CBO 6 A�� Building CommissIt' .('��� 200 Main Street,Hyannis, 1 r� -_ www.town.barn stab l e.ma.us Office: 508-862-4038 NOV 3 0 2017 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RRO EROW RE Not Valid without Red X-Press Imprint Map/parcel Number 2091049 Property Address 29 Phinney's Lnnp. Centerville, MA 02632 gResidential Value of Work$ 10,940.00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Mink_ Clifford & I nw 29 Phinney'G Lane, Centerville, MA 02632 Contractor's Name Sprinkle Home Improvement Telephone Number 508-775-1778 Home Improvement Contractor License#(if applicable) 103757 Email: S rq ink&comeaSt net Construction Supervisor's License#(if applicable) CS-006643 [TWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner E7 I have Worker's Compensation Insurance Insurance Company Name AIM Mutual Workman's Comp.Policy# WCC50050167472017A Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to OA,, ❑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: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Ofwnern Property Owner Letter of Permission. opyprovement Contractors License&Construction Supervisors License is r u' d. SIGNATURE: C:\Users\deco)I ikWppData\Local\Microsoft\Windows\rNetCache\Content.Outlook\9NNOKXYW\RESIDENTILONLYEXPRES S.doc 09/26/17 Note: Any changes in the contract during the duration of the project which results in additional monies ' due will be paid in full to the contractor at the time of the change. 1 authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be performed on this job (i.e. permits, applications etc.) if necessary. Homeowner'Signature Date Contractor S'Igh—atur6N Date Clifford Mink Brad Sprinkle - Registration number: 103757 29 Phinney's Lane, Centerville, MA 02632 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 z� www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):SPRINKLE HOME IMPROVEMENT, INC. Address: 199 Barnstable Rd. City/State/Zip: Hyannis, MA 02601 Phone#:508 775-1778 Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with 10 employees(full and/or part-time).* 7. ❑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.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.❑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 11.❑Electrical repairs Or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12 umoof airs These sub-contractors have employees and have workers'comp.insurance.t 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other rep 152,§1(4),and we have no 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: A.I.M.Mutual Policy#or Self-ins.Lic.#:WCC50050167472017A Expiration Date: 1/1/2018 Job Site Address: Zi Phi I f Y)f lLN City/State/Zip: �j�L I l�p ( 3� 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 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.A copy of this stat ent may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify er t ai nd penalties of perjury that the information provided above is true and correct. Signature: Date: I Phone#: 508 775-1778 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#: SPRIN-1 OP ID:DS A.CORO" DD/YYYY)TE(MMI CERTIFICATE OF LIABILITY INSURANCE DATE 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 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 endorsements. PRODUCER CONTACT Bryden&Sullivan Ins Agency PHONE Kelley A.Sullivan FAX 88 Falmouth Road AIC No Ext:508-775-6060 luc NI I:508-790-1414 Hyannis,MA 02601 E-MAIL Kelley A.Sullivan ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:NGM Insurance Company 14788 INSURED Sprinkle Home Improvement Inc. INSURER B:Associated Employers Insurance 199 Barnstable Rd Hyannis,MA 02601 1 SURERC: INSURER D: 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. I�TR TYPE OF INSURANCE D WVD POLICY NUMBER MMIIDDYIYEYW MM/DDIIYYYY LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR MPT2640X 07/01/2017 07/01/2018 DAMAGE TO TED PREMISES(Ea occurrence) $ 500,00 X BUSIneSS Owners MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JET LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINEaacciEDdentS INGLE LIMIT $ 1,000,00 A ANY AUTO M1T2640X 07/2712017 07/27/2018 BODILY INJURY(Per person) $ ALL OWNED X AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident) $ X X NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Peraccidenl $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE CUT2640X 07/01/2017 07/01/2018 AGGREGATE $ 1,000,000 FT DED I X I RETENTION$ 10000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WCC50050167472017A 01/01/2017 01/01/2018 E.L.EACH ACCIDENT $ 500,00. OFFICER/MEMBER EXCLUDED? N❑N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Certificate issued for insurance verification CERTIFICATE HOLDER CANCELLATION SPRNKHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sprinkle Home Improvement,Inc ACCORDANCE WITH THE POLICY PROVISIONS. 199 Barnstable Rd. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE Kelley A.Sullivan ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i Construction Supervisor Commonwealth of Massachusetts Unrestricted-Buildings of any use group which contain Division of Professional Licensure less than 35,000 cubic feet(991 cubic meters)of enclose! 0 Board of Building Regulations and-Standards Space. ConstrjGtilliri l§bpgrvisor CS-006643 *' ; spites: 1010812019 BRAD K SPRINKLE ' p fi 199'BARNSTABLE HYANNIS MA 0260 - � Failure to possess:a current edition of the Massachusetts State Building Code is.cause for revocation of this license. For information about this Ocense. CaO.(917)7V41M�visit www.m w gov/dpl CommissioneF — KY ` 1'l Q 7�?/I72 4/Ylit'U t 04'Gf 4 Z Office of Consumer Affalrs.and Business Regulation 10 Park Plaza-.Suite.5.1.70 Boston,Massachusetts 021.16 Home Improvement Cont r.Registration Registration: '103757 Vie: .Private'Coroombbri- sr" Expiration: 719f2018. Teti.419291. SPRINKLE HOME IMPROVEMENT,;( ,._, A'�=' Brad. Sprinkle 199 Barnstable Rd. Hyannis, MA 02601 ,} -- -- — --- TUpdate Address and return card:Mark reason for change.. 1"I Address Renewal. F .Employment �lost.Card, SCA 1 Q 20M-05171 L. - - �/Ic.11:rin9lroniaii/fll.or�:IF`�n.iJt<C/ttlJr,(/J (initeof cousumerAMIrs&Business Regulation. Licenie or registration valid for individual use only. ME MWROVdNENT,CONTRACTOR before the expiration date. It 0nand return to; Registration: 'AW67. Type: Office of Consumer Affairs and Business Regulation.. Expiration i72g18.: Private Corporation 10 Paris Piers-Suite 3170 v # Boston,MA 02116 SPRINKLE HOME 1MRR014EMENT;INC. Brad Sprinkle Hyannis,MA 02601, Underxrretary. Not valid without s ture ------- oFt"E° Town•of Barnstable *Permit# Expires 6 m s f iss a to r Regulatory Services Fee. ThomasF Geiler,Director` 09 Building� Division. = Tom Per CBO Buildin Commissioner rY�.. g, : 200 Main Street;-Hyannis,MA 02601 {`" www.town.barnstable.ma.us } -Office: 508-8624038 Fax_ 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 4 _ c. Not Valid without Red X-Press Imprint. ' Map/parcel Number- )0 p 1 t6 1 ' Property`Address `a"t P h i .n n Q v. L: A (Residential Value lof Work�g Minimum fee of$25.00 for work under$6000 00 . Owner's Name&Address Cl � � c Lats n� rr Contractor'sxName: r°A�� y M`(L �� ' ►'►�E. T Telephone Numbei 5 , V 7�.S l.l 9 8, HomIm rovement.Contractor L e p icense#.(if applicable) Construction Supervisor's License#.(if applicable) 0,5 CP,Uy 2-e e% ARIT VorkmanIs Compensation Insurance 20 jQ Check one:', A G yrt I am a sole proprietor ' `I am the Homeowner I �`p�.BAR(VT�B � p. w haves Worker's Com ensation Insurance Insurance Conip any yName � �d uS 'es tr A Worrkman's�Comp.Policy# copy' of Insurance Compliance Certificate must accompany,each permit. " Permit Reguesf(check box) El Re-roof_'(stripping old shingles) All,construction debris will be taken to ❑Re-roof(not stripping.;Gomg'over existing layers of roof) ' F Re side;. s �j #oftldoors 'Replacement Wmdows/doors/slider-s. U-Value. J o� (maximum 44)#of windows i *Where required: Issuance of this permit'does not exempt compliance with other town department regulations, .e Historic,Conservation,etc ' ***Note: Property Owner in A` sign Property Ow'ner,Letter of Permission co a Improvement Contractors License&Construction Supervisors License is e uire ist SIG�lATURE: QAWPFILEST0RMSIbuilding permit forms\EXPRESS.doC Revised 090809 . The Commonwealth of Massachusetts- Department Accidents P Offtee of Invesdgations 600 Washington Street • Boston,MA 02111 . www.mass.gov/did Workers' Compensation,Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please,Print Legibly Name(Business/Organizatioi✓lndividual): ri t; IG �� Nth c�ri 11 fbVe.MP�n•�' Address• ��` �i�' arr<S 6A �c City/State/Zip:s t� i5 - od(00 Phone#: .�501f' 7,5' U 7 73 Are you an employer?Check the appropriate box: Type of project(required): ,� 4. I am a general contractor and I I� 1. i am a employer with- - 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 workingfor mein any capacity. employees and have workers' Y P tY _ 9. Q Building addition [No workers'comp.insurance comp.insurance. 5. Q We are a corporation and its 10.Q Electrical repairs or additions required.] - 3.0 I am a homeowner doing all work officers have`exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per,MGL .. 12.Q Roof repairs insurance required:]f c. 152,§l(4),and we have no: employees.[No workers' 13 :Other t 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 andivit indicating such. tContractors that check this box must'attached an additional sheet showing the name of the sub�onu=tors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number: ` I am an employer that.is provlding workers'compensation Insurance for my employees. Below is the policy and Job site information. Insurance Company Name: W SS0C. Policy#or Self ins..Lid.#:AEG 700 L4 9 q 3t)l o2b its Expiration Date: Job Site Address:A Ph t n n Pals City/State/Zip: Gen W, 3a Attach a copy-of the workers'compensation policy declaration page(showing the policy number,and expiration date). Failure to setuie coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$i500.00 and/or'one-year imprisonment,as well as civil penalties in the form"of a STOP WORK ORDER and a fine.. of up to$250.00 a day against the,violator. Be advised that a copy of this statement may be'forwai-ded to the.Office of Investigations of the DIA for ins . ce coverage verification. I do herebyc and �and o er u that the in ormation rovided above is true and correctof l T. .f P. . _ Si nature: Date: Phone#: . . Offlcial use only. Do not write in this area,to be completed by city or town offlciaL City or Town: Permit/License.# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town.Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . Contact Person: Phone#: . p cHero�ti Town of Barnstable .. Regulatory-Services uxx is• Thomas F.Geller,Director �Eo16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towfi.barnstableima.us Office: 508-862-403$ Fax:. 508-790-6230 Property Owner.Must Complete and Sign This Section If Using A Builder as Owner of the subject rope LC5 ES M��lL 1 P p rI7 hereby authorize t ILl e. � to act on my behalf, in all mntters relative to work authorized by this building permit application for. P nr�ew� CQo�e�� lrn� .(Addrdss of Job) Signature of Owner. 1?ate t Print Name If Property Owner is applying for permit pleas e complete the Homeowners License Exemption Lorin on the reverse side. ry r),I;nRM.q-nWNF.RPF.RMi.QR1nN ''.` DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE OP ID DS SPRIN-1 01/05 10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden & Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-775-6060 Fax:508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Associated.Industries of MA INSURER B: Sprinkle Home Improvement Ind. INSURER C: 199 Barnstable Rd INSURER o: Hyannis MA 02601 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY FF TIVE POLII Y EXPIRATI N LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YYYY DATE MWODIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAULPREMI3E I(Ea u ee $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY I$ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMPIOP AGG •$ 71 POLICY PRO-CT LOC JE AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO - (Ea accident) ALL OWNED AUTOS'. ; BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $- (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ • ANY AUTO _ I OTHER THAN EA ACC $ AUTO ONLY: AGG .$ EXCESS I UMBRELLA LIABILITY ` EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ g WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER A ANY PROPRIETORIPARTNERIEXECUTIV4­1 AWC7004943012010 01/01/10 01/01/11 E.L.EACH ACCIDENT $500000 OFFICER/M(Mandatory In NH) EXCLUDED? LJ E.L.DISEASE-EA EMPLOYE $500000- (Mandatory in NH) If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES i EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION SPRNKHD DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Sprinkle Home Improvement, Inc IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Fax #508-775-1350 REPRESENTATIVES. M3T J0 Mack AUTHORIZED REPRESENTATIVE 199 Barnstable Rd. Kelley A.Sullivan annis MA 02601 ACORD 26(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. . The ACORD name and logo are registered marks of ACORD Offi+cetoumeiairirdnes" o License or registration valid for individul use only Liee HOME MP ROW CONTRACTOR before the expiration date. if found return to: Registration. ^103157 Type Office of Consumer Affairs and"Business Regulation Expiration: �12 Private Corporatic 1 i� 10.Park Plaza Suite 5170 - Boston,MA 02116' OSKLE`HQM E T'(�NC. Brad Spnitkie i 99 l artista"i Rd 1:f Hyannis,:Id1026i % � UnBersecF.etiiv y Not valid without sign tur;.e is Mdtis.ichu:setts Dep:u-tment of Puhlic $lfetN Restricted to: 00 Board of Building Re.i;ulatioitti a6d Staindards 00- Unrestricted Construction Supervisor License j 1G-1 2 Family Homes License: cS 6643 Restricted to: 00 BRAD.K SPRINKLE:: ^ j Failure to.possess a current edition of the '` ' Massachusetts State Building 1; Code L THROPS LAN 190 Q i W BARNSTtkBLE, MA 02668 is cause for revocation of this license. K; Refer to! WWW.Mass.Gov/DPS Expiration: 10/8/2011 ('unnuissiuner Tr#: 5478 I'