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HomeMy WebLinkAbout1150 SHOOTFLYING HILL RD �,. . _ . _ . � ;_ , .. .: . r ,, ,. �. � � , . �. s � .. .. ., .. .. .. o - ,. 1: } � � e �. e o �OCb9Kco �oF� ro,,ti Town of Barnstable *Permit# Erpires r r r/rs rorir i�sire(lateRegulatory Services Fee * SARVStABLE. �1SS. Thomas F„Geiler, Director. . A Building PERM Tom Perry, CBD, Building Commissioner 200 Main Street, Hyannis, MA:02601 !)F t r 7 ltiu www:town.barnstable.ma us ro Office: 5.08-862-4038 # t' t„I N OF S R�j ST/� l ,_ Fax: 50 - 0-6230. EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not,Valid tvitliout Red X-Press•Imprint Map/parcel Number . Property Address. 3® NV_pp Z_J 6� residential Value of Work Minimum fee'ofS35.00 for work underS6000.00 Owner's Name & Address 15o 5l-106T �1 o y\v 1-k-M Zb Contractor's Narn Telephone.Number bg' Home Improvement Contractor License#(if applicable) J j® 1 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: - ❑ I am a sole proprietor ❑ am the Homeowner VI have Worker's Compensation Insurance Insurance Company Name GkJA]?-> Workman's Comp. Policy Copy of Insurance Compliance Certificate must.a,ccompany each permit.. r. Permit Request (check box) ❑ Re-roof(hurricane nailed) (stripping old shingles) Adl construction debris will betaken to' ❑ Re-roof(hurricane nailed) (not stripping."Going over existing layers of roof) ❑ Re-side . a of doors ' [Replacement Windows/doors/sliders. U=Value (maximum'.35) # of.windows *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; �AWPFILESVORMSIbuilding permit forrnslEXPRESS.doc tevised-072110, te: 12/14/2010. Time: 8:13 AM To: 0 9,15087906230 Page: 002 S Client#:20662` ` 2COASTALCU ACOR& CERTIFICATE OF LIABILITY INSURANCE ; YYY) 2/14�2O1O PRODUCER z THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. National Grange Mutual Insuranc _ Coastal Custom Woodworks, LLC INSURER B:-Guard Insurance Group RID. Box 102 • 'INSURER C: .. _ Sagamore Beach, MA 02562 INSURER.a .. - - . - - - 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 CONTRACTOR 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. IN ft DD' - POLICY EFFECTIVE POLICY EXPIRATION - - - LTR S . TYPE OF INSURANCE POLICY NUMBER LIMITS A GENERAL LIABILITY MPOS2143' - - - 03/22/10 03/22/11 _ P RRENCE j $2 000 000 X COMMERCIAL GENERAL LIABILITY ^'' _ - RENTED PREMISES o rrence '. $500 OOO CLAIMS MADE OCCUR' nyone person) $10 OQQ .. 8ADV INJURY - $2QOQOQQ GGREGATE $4 OQO000 EN-L AGGREGATE LIMIT APPLIES PER: - COMP/OP AGG s4,000,000 - POLICY E 4 LOC _. . AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ - ANY AUTO (Ea accident) - ALLOWNEDAUTOS - - BODILY INJURY •$ - SCHEDULED AUTOS - - (Per person) HIRED AUTOS - - - ' BODILY INJURY $ NON-OWNED AUTOS - - (Per accident) . PROPERTY DAMAGE $ (Per accident) - GARAGE LIABILITY - r _ AUTO ONLY-£A ACCIDENT•- $ ANY AUTO - OTHER THAN E4 ACC $ AUTO ONLY:. AGG $ EXCESSIUMBRELLA LIABILITY - EACH OCCURRENCE Is OCCUR ❑CLAIMS MADE ' AGGREGATE' Is DEDUCTIBLE $ RETENTION. $ $ .. B WORKERS COMPENSATION AND - ICOWC136. 03-4' <..,,. _ 11h3MO - -11M 3M1 �(. TOR WC Uji STATT OTH- FR EMPLOYERS'LIABILITY - E.L.EACH ACCIDENT. :$5OO OOO ANY PROPRIETOR/PARTNER/EXECUTIVE - OFFICER/MEMBER EXCLUDED? NO _ - DISEASE-EA EMPLOYEE s500 OOO If yes,describe under - E.L.- SPECIAL PROVISfONS below - - - Ft DISEASE-POLICY LIMIT $500 OOO THER - ""a DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS- - Insurance coverage is limited to the terms, conditions, exclusions,other limitations and endorsements.-Nothing contained in the certificate'of - ins.mnce shall be_deemed to have altered,"waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATETHEREOF,THE ISSUING INSURER WILL ENDEAVORTO MAIL 20_ DAYS WRITTEN Attn: Bldg. Dept. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 200 Main Street - IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR HyaAnis, MA 02601 REPRESENTATIVES. AUTHORIZED R PRESENTATIVE ACORD 25(2001108) 1 of,2 #S75579/M75578 CR 0 ACORD CORPORATION 1988 COASTAL CUSTOM WOODWORKS, LLC November 7,2010 Ariane 1150 Shoot Flying Hill Road Centerville, MA Re: Door Replacement Dear Ariane, The following is a breakdown kdown for the repairs to your entry doorwa y. ' •. . Remove existing entry door system. • Prepare opening to receive the new door and sidelight. • Install 3068 RHIS Thermatru Smooth Star o S754A with 14"S716SLA sidelight on strike side. Double bore. • Exterior trim work to be PVC(Azek) • Interior to be Stafford or.1 x 4 flat stock. • Install Baldwin Logan lifetime brass entry set. • Inside know to be egg style 5425.003 • 6 keys x • Dump Run Labor&Materials $3,982.99. Storm door to be Anderson.Full view(CDFV36WH) with brass hardware and toe kick., Labor&Materials 608:89. Total $4,591.88 Not included in the above number: Interior and exterior paintwork Permit to install door. unit If you have any-further questions please do not hesitate to contact'me at 508-776-5988._1 look forward to hearing from you soon. Sincere) Theodore S. Pomeroy Managing Member i Coastal Custom Woodworks, LLC The Commonwealth of Massachusetts . - - Department of Industrial Accidents Office of Investigations 600 Washington Street' Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers APPIicant Information Please Print Legibly Name(Business/Organization/Individual): Cmao_k L. "�O_ \,P00AW04,1C�1 Address: AA Si City/State/Zip. Phone.#: (�'q 1!�;19 Are you n employer? Check the appropriate box: Type of project(required): 1. am a employer with 3 4. ❑ I am a general contractor and I 6. ❑New construction . employees(full and/or part- m.e).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in an capacity. employees and have workers' g Y P tY 9. ❑Building addition [No workers'comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work_ officers have exercised their l l.❑Plumbing repairs or additions myself.[No workers'comp.. right of exemption per MGL 12:❑Ro repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other 'N<_w ►Z 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 anew 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: 6U i ILD Policy#or Self-ins.Lic. #:_.Co '�i� Expiration Date: j Job Site Address: 1 !i)0 -_,,L14,iT i`f`rl V\ t-wA iZ^4rb City/State/Zip: Cti/�i`+:h�� 1M 0 —L 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 tip 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 pain ies of perjury that the information provided above is true and correct. Signafore: Date: r�` 13,2W It'd Phone#: r 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#: i v Informatro�ranrd-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 ente rise and includin the le al re resentatives of a deceased-em-ro er-or the g g _ J rP � g g P P Y , 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 a'license or permit to operate a business or to construct°buildings in;the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall _ enter into any contract for,the performance of public.work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to 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 permiVlicense 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 maybe provided id 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 bum leaves etc.)said persons 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. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia - eNlassachusetts- Department or Public Sarety Board of Buildim- Re�-ulations and Standards Construction Supervisor License License: CS 51311 Restricted to 00. THEODORE S POMEROY ^' f PO BOX 102 r SAGAMORE BEACH;.MA'02562 Expiration: 2/15/2011 ('unanis"imlvl- Tr-,: 10841 ��✓lie i�ompoazu�ea�C a��aaaaelu� � • i License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR i Office of Consumer Affairs and Business Regulation Registration.150297 t a � 10 Park Plaza-Suite 5170 Expirat@tt x 3/ 3/2012 Tr# 292944 Boston,MA 02116 . Type jr'I2tci;L7otlit-.- rpor fr{ COASTAL CUSTOI�+i VIIOODGaIOR.KS LLC THEODORE POIGIERQY ft` fi 2 OCEAN PINES UR SAGAMORE BEACH;MA 02562 Undersecretary Not valid without signatu OF IKE Tp�� • BARNSTABLE, • - Ass. i679• Town of Barnstable �� prFD MA'S a ' Regulatory Servjces Thomas-F. Geiler, Director. Building Division Thomas Perry, CBO Building Commissioner 200 Main.Street, Hyannis, MA 02601 www.town,barnstable.mi.us Office: 508,862-403 8 Fax: 508-790-6230 Property. ®caner Must Complete acid Sign This Section If Using A Builder as Owner of the sublect.property hereby authorize \ QIYA 00 to act on rnY behalf, in all matters relative to work authorized by.this btiilding permit application for: a (Address of Job) <. Si a e caner Date Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILMFORMSIbuilding permit forms TXPRESS.doc Revised 072110 olwT Town of Barnstable Regulatory Services q 'B'pfASS.. " Thomas F. Geiler, Director j a39,. a�0 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 518-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER" name home phone# work phone# CURRENT MAILNG ADDRESS: city/town state zip code The current exetription for"homeowners" was extended to include owner-occupied dwellings of six units or less and 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 permit (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 requirements. 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.12.7.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work fo.r which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing ofconstruction Supervisors):provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(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 form/certification for use in your community. Q:\'NPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 �tME r� Town of Barnstable Permit# Expires 6 months from i ue date Regulatory Services Fee 40 o XThomas F.Geiler,Director O 16 2006 Building Division O l �17�bb Tom Perry,CBO, Building Commissioner p�VN OF BARNS TABLE 200 Main Street,Hyannis,MA 02601 '� www.town.barnstable.ma.us Officer 508-862-4038 . Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number C Property Address //�� �/ �� �• 0 Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name ec Y000 e-!r,.7 Telephone Number Qte77�1- Home Improvement Contractor License#(if applicable) /® a .50-9 Construction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name 0) e Workman's Comp.Policy# ® �9 51-5, 79 Copy of Insurance Compliance Certificate must be on file. r Permit Request(check box) ' ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side R'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 Contr rs License is required. SIGNATU Q:Forms:expmtr Revise071405 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations t '�' �f ' 11 600 Washington Street Boston, MA 02111 r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Mo'W Address: AC170' few "d/ /C, ' City/State/Zip: i ?,L,0�& Phone #: Are yollan employer?Check the appropriate box: Type of project(required): 1.DKarn a employer with 90 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 workingfor me in an capacity. workers' comp.insurance. Y P tY• 9. ❑Building addition [No.workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[]Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL l l.❑Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.5115t'her Lr4dB' 4 comp.insurance required.] *Any applicant that checks box#I 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. tContractors 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.M 0 Vj® Expiration Date: 07 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 ertify u er the pains and pen erj that the information provided above is true and correct Si ature: Date: 42-= 16 --Q Phone#: 47 © — ' y" ,�� 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#: OFFICE: (508)997-1111 ®s MA. Builder's Lic. #021330 FAX: (508) 997-1297 AWRE FREE Home Improvement TOLL FREE: 1-800-407-1111 1 es Inc. Contractor's License WEBSITE: www.carefree(hoomescompany.com 239 HUTTLESTON AVE. (FIT #100503 MA. 6)•FAIRHAVEN, MA 02719 #15179 R.I. NAME 1 IaIr U, DATE 16 4/6(0 ADDRESS 11 ZIP CODE ADDRESS OF JOB TEL d JOB DESCRIPTION a e, '� yapw C , OQ V�h PC r In :S " _ oCJ�?. Ql A Scheduled Start 40 '�"� ® e, � Scheduled Completion t 0 A. Replacement of missing or rotted lumber is not included unless specified. B.All start&completion dates are approximate and could change due to weather conditions. C. Stripping of roof includes removal of up to two(2) layers of shingle e h additional layer to be charged Q _ft2. D. Replacement of rotted roof boards/plywood to be charged Q _ ft2. E. Existing chimney flashings will be reused; replacement, if necessary, is not inc—luded. F. Care Free Homes, Inc. is not responsible for mold/mildew conditions that are pre-existing or result from leaks not brought to the attention of C.F.H., Inc. promptly. The Company hereby proposes to furnish labor and material to complete the above work for the amount herein. Fulfillment of this order is contingent, however, upon the want of strikes, fires and any natural disasters, the ability to obtain materials, or any other conditions beyond the control of the Company. Cost of Project PAYMENT TERMS Date � C (� 1. You,the Owner,may cancel this transaction at anytime prior to midnight of the third business day after the date of this transaction. 2. You,the Owners,agree to pay any and all expenses incurred by Care Free Homes,Inc.in collecting money due under this contract and enforcing the terms of this contract, including but not limited to, reasonable attorney's fees, interest and court costs. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CA FR ES, I C ACC By: Buyer acknowledges Owner CARE EE HOMES,INC. receipt of fully completed copy of this Agreement Ownerlabout _ ,0�;11� — All contractors and subcontractors shall be registered by the director and any inquirientractor or subcontrac r relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 'lie�omrrwm�uea�l! o��/agaaclu�aelta j Board of Building Rcgulations and Standards • Ii t^ HOME IMPROVEMENT CONTRACTOR Regtsivab a008 005(3 Y { on ?� Supplement Card t CARE FREE 11014IS .G �1 1 JESSE MOTTA 239 Hut'tleston ave- '-f II Fairhaven,MA 02719 �µ Administrator J Client#: 50238 CAREFREI -60RUM CERTIFICATE OF LIABILITY INSURANCE 1DATE(MMID 0104/0/04/0 6DIYYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers 8r Gray Ins.Agency, Inc. - ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 341 Court Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.0. Box 3700 Plymouth, MA 02361-3700 - INSURERS AFFORDING COVERAGE NAIC# INSURED [INSURER URERA: National Grange Mutual Ins. Co. Care Free Homes Inc INSURER e: Acadia Insurance 239 Huttleston Avenue C: Fairhaven, MA 02719 URER D: 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. PO ICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE MMIDDIYY LIMITS . A GENERAL LIABILITY MS077983 09/01/06 09/01/07 EACH OCCURRENCE . $1 GOO 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occ 4,ngg, $250 000 CLAIMS MADE 51 OCCUR MED EXP(Any one person) $§000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000.000 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 EA ACC $ - OTHER THAN AUTO ONLY:. AGG $ EXCESWUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WCA019515410 09/01/06 09/01/07 WC STATU- OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500 000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $SOO,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS'I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I`SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S24731/M24699 DAC 0 ACORD CORPORATION 1988