Loading...
HomeMy WebLinkAbout0031 LAKE STREET V-3 a i own oI lsarnsiaDie Building Department Services .� 4ZKe TOwq, Brian Florence,CBO o� Building Commissioner sAaxsrAIME, = 200 Main Street,Hyannis,MA 02601 y Mass. 1639. Www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: 1 \ l S Phone#: U b Address: UL Village: l�J Name of Business: O Type of Business: INTENT: It is the intent of this section to allow the residents of the To of Barnstable to operate a home occupation within single family dwellings,'subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the.dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • ' Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residentiaf buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing-the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall bg employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant. 8 Date: 3) 2-9 I Q(� Homeoc.doc Rev.06/20/16 YOU WISH TO OPEN A BUSINESS? For Your lnormation: Business.certifcates(coat`t?40.00 for 4 years); A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does,not give you.per to operate.) You must first obtain;the necessary signatures on this form at 200 Main St., Hyannis. ' 7 Town Hall and et the Business Ce rtificate that is Take the completed foram to the Town Clerk s Of`fice; 1st FI., 367-Main St., Hyannis- MA 0260 ( ? g required by law. rr DATE-3 I Fill in please: APPLICANT'S YOUR NAME/S: E G1 YOUR HOME ADDRESS: C� -"upia (Aj S4fx; TELEPHlSN Home Telephone Number o 1(J • ..:•. �tt.a•rr-.� E I N #: 5� E-MAIL:; NAME OF CORPORATION: NAME OF NEW BUSINESS ( TYPE OF BUSINESS Cla IS THIS A HOME OCCUPATION? YES NO y� �V� ADDRESS OF BUSINESS. I � MAP/PARCEL NUMBER ✓2� -1 [Assessing) When starting a riaw business there ar`e several things you rnustdo...in orde��to be.in compliance•with.the rules,and regulations of the Town of Barnstable. This form is intended to assist.you,in obtaining-the information you may need. You MUST GO.TO 20..0 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate Your business in this. town. 1. BUILDING COM IS 10 ER'S OFFI -, , T are u"rement>;that el'tainto Vhis e uf6usness. MUST COMPLY Wi T H HOVE 0�.;�,., i f rm This indlvidu l'h e yP type 1 r,,_,. RULES, 1 �L AND REGULATIONS. F:Ai.�Urfl~ TO uth ri Si natui-VK CXWPLY MAY RESULT IN FINES. F MMENW"4)4P1-)V I,"- I r CY 2. BOARD OF ILTH) �y This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature COMMENTS: 3. CONSUMER AFFAIRS (LICENSING.AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: R 1 's Town of Barnst.�lible `Yerinittt Expires 6 irior+i rfis from issr le UARN!MBLF d Regulatory So VIC1"ws Nee 5 Thomas F. Geiler, Direc l}otr Building 'DivisorL � Tom Perry, CBO, Buildirng C0011711issioner yI 200 Main Street,Hyannis, M[A 01M I le 0�� www.town.barnstable•rna.to, Office: 508-862-4038 Fax: 508-7S-0-6230 EXPRESS PERMIT APPLICATION - R-ESIDEINTIAL,,OI''=dLY Not Valid without Red X-Pres•srw:,y1'rriW Map/parcel Number C(Z ��� � - Property Address oG 9 � Residential Value of Work `— — 3SP 0 ° 1Vlinimumfee af$25..op0 for work under $600100 Owner's Name&Address I � bC��1"�: C_ Ao c� f OA k S Contractor's Name 4�M Telephone Number Home Improvement Contractor License #(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance -PRESS l"" W Check one: ❑_ I am a sole proprietor JOL - 12009 I am the Homeowner ❑ I have Worker's Compensation Insurance -TOWN OF BARNSTAKE Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) - ❑ Re-roof(stripping old shingles) All construction debris will be taken tto__ [].Re-roof(not stripping. Going over existing layers of roolj Re-side v4 vf- tA 'ReplacementWindows: U-Value (maximum M) *Where required: Issuance of this permit does not exempt compliance with other town regulations,i.e.1-ristoric.Conservaleon,etc. ***Note: Pro rty w mus sign Pr erty Owner Letter-of P,e�rnmission, Ho, e I p . eme V.rContra ors License& Construct Su pei:arvisors License is required. SIGNATURE: Q:\WPFILES\FORMS\Express\EXPR PERMIT.DOC Revise06O4O9 41 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + d 600 Washington Street Boston, MA 02111 s�•y`� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information r Please Print Le�ib� /l Name (Business/Organization/Individual): �©�1"e Q ft_AM./(1 Address: j lle S r City/State/Zip: CC U+l 41/1 (,�Z� Phone.#: 2 Are you an employer? Check the appropriate box: Type of project(required):' L El I am a employer with 4. 1 am a general contractor and I 6. ❑New construction employees(full and/or part-tim.e).* have hired the sub-contractors. 2.[] I am a sole proprietor or partner-' listed on the attached sheet. T. 0 Remodeling ship.and have no employees These sub-contractors have g. `E]Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.$ 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 I LF1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs x insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑Other 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. xContractors that check this box in 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: Policy#or Self-ins. Lic. M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine rip 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 WA for insurance coverage verification I do hereby certify under the pains edenies of erjury that the information provided above is true and correct., Si ature: �� Date:Phone#: .s7 Fca only. Do not write in this area,to be completed by city or town officiaL n: Permit/License# hority(circle one): Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in.the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs.persons to do maintenance,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 be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal 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 �-t employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial . Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete•and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating.current policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in__(city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. Tue Office of investigations woulld lake 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 r sTo�, Town of Barn-stable Regulatory Services BARN'? �sEm�; Thomas F. Geiler,Director oa�� Building Division e . Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: S08-862-4038 Fax: S08-790-6230 Property.,Ovvner Must e ►'` , .; CYmplete and Sigma This S'ectio' If Using ABuilder as Owner of the subject property hereby authorize to act on my behalf, r m all matters relative to work authorized by this building permit application for. ' (Address of Job) Signature of Owner Date t a Print Name If Proped y Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side.' Town of Barnstable iHE Regulatory Services Thomas F. Geiler,Director Building Division prED A Tom Perry,Building Commissioner 200 Mairi=Street,—Hyannis,MA 02601 Yr".town.b arnsfable_ma.us Office: S09-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE b JOB LOCATION:_ y I L., number ,�1 J street village HOMEOWNER": 1 e �w_ A4d-�ciJt� name home phone# work phone# CURRE : qyNT MAILING ADDRESS ( etr! E 6>� city/town sta zip code The current exemption 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 Persons)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$arnstable,BuildingDepartment rmmmnm inspection procedures and requirements and that he/she will comply with said procedures and requireme 5igna of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any ha w meooer performing work for which a building permit is required shall be exempt from the provisions of this section(Section 1 o9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall od as supervisor." Many homeowners who use this exemption are unaware that they an assuming the responsibilities of a supervisor(sex 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 uniiccnscd 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 bis/hcr 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 sorb a f6mrVicertifi cation.for use in your community. Assessors map and lot number Ok c !� /'"a'YS/44 SL�Gajf7 �W dIJLG� ' Sewage Permit number ' ,yl % M F?HET ° TOWN OF BARNSTABLE i BAHHSTULL BUILDING INSPECTOR L APPLICATION FOR PERMIT TO .................... ... .. ......1../...................................................................................... .1 TYPEOF CONSTRUCTION ............Yv...�...... .............................................../....................................... ............. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r Location ` ProposedUse ... f�7 f/ ........../...... /rl�./j.. ..................................................................................................... ZoningDistrict ....... ...!.s..........................................................Fire District .............................................................................. Name of Owner 7 7.`'�k1. ..... !/ .. nPN.....:........Address .............. r' . I.C' ".. ........(. Name of Builder t ... :... ✓.. Address ... ✓7.�0/1... �1:.."..... .................................. ...... Nameof Architect ............�..,,.w...�-f ..................................Address .................................................................................... Number of Rooms ..................... ....................................::...Foundation ............. ....................... .. ................ ... ........... .... Exterior .... .....�............. ... . ............................................Roofing ...........`.... .. ... / `...................................... Floors / ............Interior ...X C e Heating Plumbingd Fireplace ..........................Y...d.................................................Approximate Cost ....... Definitive Plan Approved by Planning Board ________________________________19_______. Area ..........T..!.. r...:........... Diagram of Lot and Building with Dimensions � / Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH -13 -- - -- -- _ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarcLiAg the above construction. 9 .... ............... Christensen, John 16747 Permit for .....,add to single No .............. ....................... i family dwelling � .............................................................I.................. Location fake Street ............................................................ Cotuit ............................................:.................................. Owner John Christensen . .................................................................. Type of Construction frame ....................... .............................................................................. Plot ........................ Lot ................................ , Permit Granted .....AQ.VQ .QX..2l ..........19 73 , Date of Inspection Date Completed 19 ' ' 4 PERMIT REFUSED ................................................................ 19 ' ............................................................................... ................................................................................ .............................................. ............................... t { Approved ................................................ 19 ............................................................................... .................... .......................................................... /Y FEE (Y� aab 10"7 47 TOWN OF BARNSTABLE, MASS. bcc pb�� 1s 0 to ✓ �•� THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO O� > O V _.........................................................................._......................................................................_......................... .................................................................................._........._..... _.� (PROPERTY OWNER) (ADDRESS) 03 CD D.by w Is TO ............................................................................................_........................_..____._............................................................................................................................... _.. Er b (BUILD) (ALTER) (REPAIR) 'a y N (TYPE OF BUILDING) (APPROXIMATE SIZE) O O \ M oc LOCATION ........................_............................_....................................._........._..... ..._........................................................................_................................. _ y )STREET AND NUMBER) IV ILLA6E) NAME OF BUILDER OR CONTRACTOR __.... ..._.._.._........__............_..................._....._.........................__..._.__.__.. _ A APPROXIMATE COST ..................... _._....._.._...._.._....._.............................._._..._....._.................................... ___.....�._.__._ AGREE ALL THE RULES TO REGULATIONS OF THE TOWN OF BARNSTABE, REGARDING THE ABOVE CONSTRUCTION.(D o PO 0 v in N Ce V1 (OWNER) (CONTRACTOR) B O � 00 ... O _.........�.._....._......._..... ........_..._....._............................................................................... (D a ABUILDING INSPECTOR Subject to Approval of Board of Health. SENIOR CENTER TOURS AND TRIPS FLOWER SHOW -- Thursday, March 18. Cost: $10.50 ( includes bus and admission . Bus leaves West End Municipal Parking Lot) corner of Forth Street and Bassett Lane, promptly at 9:00 A.M. Standby reser- vations only. WASHINGTON D. C . CHERRY BLOSSOM SPECIAL -- April 1, - 4. Cost $189.00 double occupancy, includes 6 meals and sightseeing. Standby reserva- tions only. BOSTON BUS TRIP Tuesday, April 20, 1982. Cost: $7.25 . Bus leaves West End Municipal Parking Lot promptly at :(9 ;0 A.M. Leaves Boston at 4:00 P.M. (Please note change in time due : o Bridge repair) . Call Center for reservations. Tickets must be paid one week in advance. MAPhT4R5UUFtnRAYuWP, JAFFREY NEW HAMPSHIRE -- Thluq CAI rN �H Cos�lxd q& iaS � es us, guided tour of historic visit tq nX Rhnson s Sugar House and luncheon at 01 HMNgs'IICNIloo Woodboun nn -- choice of Yankee Pot Roast or Bak �;991W HAQ[dMkl) All taxes and gratuities included. Call Center for reservations. TEN-DAY CRUISE -- S .S .ROTTERDAM -- May 4, 1982 to Charlotte Amalie, St. Thomas, Philipsburg, St. Maarten and Bermuda. Cost: $1425.00 per person. Brochure available at the Center. STURBRIDGE VILLAGE -- Thursday, May 20. Cost: $24.50 (includes full course buffet, admission and bus) . Call Center for reservations. WORLD'S FAIR KNOXVILLE TENNESSEE -- June 7. Cost $499.00 double occupancy; $449.00 triple; and 6 9.00 single. At this time, standby reservations only. NEWPORT, RHODE ISLAND -- Tuesday, June 22. Details next bulletin. NOVA SCOTIA AND PRINCE EDWARD ISLAND -- June 27. Six days. Cost: � '349.00 double occupancy; $319.75 triple; $449.00 single. Deposit of $25 .00 per person due March 12. Standby reservations only. Due to the tremendous response, there is the possibility of a second bus. FUTURE TRIPS are being planned to the ISLAND OF HAWAII and to IRELAND provided enough interest is shown. `J � } �� �� � � '. _� 1 � ` � , _ 1 � `_ V� � � - ,. �� � � _ ., i � ,. .. .. � � s�4f _.I .. ... ' - - q - \ � .. � - � _ � _ _ - P S ` - /d1we �pF(HEToy� Town of Barnstable *Permit# 79 ' Expires 6 utooths front issue date y Regulatory Services Fee )ARNSTABI.& i r MASS. Thomas F.Geiler,Director �A 0 9. a�0 TFDNta�` Building Division X-PRESS PERMIT Tom Perry, Building Commissioner OCT 5 - 200 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 -OWN OF BARNSTABLE Fax: 508-790-6230 EXPRESS PERNHT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ®23 S O Property Address)2�� 1 1ZT t ���✓�-� Residential ^ Value of Work (�f�� --� Owner's Name&Address La Contractor's Name P���iJ�� Telephone Number_ 50e—V.?J Home Improvement Contractor License#(if applicable) 103 7 l Y Construction Supervisor's License#(if applicable) 02 (p A PW orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Comp Jany Name T� A�:C L/P/� A �_ Workman,s Comp.Policy# P � � ` L 7 s �d Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) / Re-roof(stripping old shingles) All construction debris will be taken to C y� ❑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. Hom Improvement Contractors License is required. Signature Q:Forms:expmtrg Revise053003 . Town of Barnstable ' °{ Regulatory Sen ces ' _ BAMSTABLF, ' Thomas F.Geiler,Director unss. g .. A, �a Building Division FD MA ; Tom Ferry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ina.us Fax: 508-790-6230 Office: 508-862-4038 Property Owner Must Complete and SignThis Section If Using A Builder I, x` as Owner of the subject property , here y authorize �- ,0` to act on my behalf, in all inatters relative to work authorized by this building permit application for: r (Address of Job) S" n tore of Owner ate Print Name 1 _ a Q:FORMS-.o'vW MRPERMISSI0N _ Board of Building Regulat�ons an =anar s One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement,Contractor Registration Reqistration: 103714 Type: Private Corporation �r Expiration: 7/9/2006 PAUL J. CAZEAULT & SONS, INC Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card.Mark reason for chang Address M Renewal Employment Lost Card DP8-CAI C! SOM-04/04-G1oi216 Board or Building Regulations and standards HOME IMPROVEMENT CONTRACTOR License or registration valid for iudividal use only Registration:,lS' . 103714 belore the expiration dale. if round relu U ro ,: Board of Building Regulations and Slautla ds Expiratlom:7/9/2006 one/%shl urwn Place Rin 1301 ;;Types`Private Corporation Bust uu, Nia.02 108 PAUL J.CAZEAULT;&.SONS,INC' Paul Cazeault 1031 MAIN ST OSTERVILLE,MA 02658 Administrator I��Ir 1 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 026325 Expires: 10/20/2005 Tr.no: 8603.0 Restricted: 00 PAUL J CAZEAULT 1031 MAIN ST ,p y- OSTERVILLE, MA 02655 Administrator Board of BuildinP eRM ulations f =, P One Ashburton ace, 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Number: CS 026325 Expires: 10/20/2005 Restricted To: 00 PAUL J CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 Tr.no: 8603.0 Keep top for receipt and change of address notification. ACORD�, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNY) PRODUCER /2004 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McShea Insurance Agency, Inc. THIS CERTIFICATE DOES AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BYTTHE POLICIES BELOW. Osterville, Ma. 02655 ---508-420-2011 INSURERS AFFORDING COVERAGE INSURED Paul J Cazeault & Sons INSURER A: Lloyd's Roofing Inc. INSURERB: r s Insurance 1031 Main Street INSURERC: Osterville, Ma 02655 INSURERD: 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION GENERAL LIABILITY DATE MM/DD/YY DATE(MM/DD/YYj LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $1 ,000 ,000 FIRE DAMAGE(Any one fire) $ CLAIMS MADE ®OCCUR MED EXP(Any one person) $ ti LGL034776 04/30/04 04/30/05 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: . 000 ,000 POLICY PRO" PRODUCTS-COMP/OP AGG $ JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY �I EACH OCCURRENCE $ U OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ - $ WORKERS COMPENSATION AND W TATU- TH- EMPLOYERS'LIABILITY TORY LIMITS ER B 7PJUB-0095864AO4 08/13/04 08/10/05 E.L.EACH ACCIDENT $ 100 ,000 E.L.DISEASE-EA EMPLOYEE $ OTHER E.L.DISEASE-POLICY LIMIT .000 $ DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL n 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 FtEfga, A I ACORD 25-S(7/97) Jj 0 ACORD CORPORATION 1988