HomeMy WebLinkAbout0700 MAIN STREET (COTUIT) �� ��;,v 7
� \
Town of Barnstable Building
t nn>x re Post This Card So That it is Visible From the Street-Approved`Plans•Must be Retained on Job and this Card Must'be Kept
M^� Posted Until`Final Inspection Has Been Made.
�� ��
k F y 's Required,such Building shall Not:be Occupied until a Final Inspection has been made.
Where a Certificate of Occupancy i
Permit NO. B-20-2039 Applicant Name: Warren Reid
Approvals
Date issued: 08/06/2020 Current Use: Structure
Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/06/2021 Foundation:
Location: 700'MAIN STREET(COTUIT),COTUIT, Map/Lot _036-049 wg Zoning District: RF Sheathing:
Owner on Record: HINES, BRENDAN&SOMOGIE,SARAH ; Contractor:Nametl'-,,Warren F Reid Framing: 1
Address: 93 MONUMENT STREET Contractor License:-. CS-076198 2
CONCORD, MA 01742 ; ~ . " " ,. Est Project Cost: $4,200.00 Chimney:
r Y:
Description: install two replacement windows, no frame change, no header Permit Fee: $35.00
change. Remove and replace 7 square white cedar sidewall shingle. " Insulation:
t i Fee Paid:" $ 35.00
Project Review Req: GLAZING REPLACED IN HAZARDOUS-LOCATIONS AS DEFINED Date: 8/6/2020 Final:
1N 780 CMR MUST BE TEMPERED OR EQUAL.:
j Plumbing/Gas
„y
Rough Plumbing:
" - .. ',:;Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afterissuance.
All work authorized by this permit shall conform to the approved application and the`approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures 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 maintained open for,public inspection for the entire duration of the Final Gas:
work until the completion of the same.
`1 Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are;provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: •. x Service:
1.Foundation or Footing - ..''' Rough:
2.Sheathing Inspection -
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
IHerOhPrintedOn
Complaint Call�"Report ,,. A,. ,,.. . .
' �a 700 `MAIN STREET (�GOTUIT); OTUIT �
a6 9• 0
°rEOMmam e,;�s � ;d , . .. �. s,� �,s , Case# C-99.556 ,
.: �..... ,... :e;;. �.,,r,,• „-, ..,R;. =' ,f`�+ «:;: ,......,'".. .7'inv;�""�,:k.,- '. .,.«,.. ..?,.M.�._Mka:aw �ate.,-..,�..
Case#: C-19-556 Address: 700 MAIN STREET(COTUIT), Date: 7/9I2019
COTUIT
Owner Info: Property Info:
BRANDT, URSULA C D ESTATE MBL:
OF
734 FOX HOLLOW DRIVE 036-049
HUDSON NH 03051
r
Owner Notified?:
Complaint Details:
Type of Complaint Classification of Complaint Method of Complaint
Zoning No Violation Phone
Complaint Summary:
Caller states property has a new owner and is now being used as a business -Air BnB. Caller stated
multiple cars are coming and going all day and night and the dwelling is over crowed (5 cars at 4 bedroom
home). Explained that most bedrooms allow 2 people so 5 cars does not necessarily make the house
over-crowed. Health will seek registration and an inspection will identify how many people can sleep there.
Also explained that language is currently being considered to address and regulate these uses but
currently we do not regulate the duration of a lease. It's a SF use in a SF zone. Caller was satisfied with
this information and share with others the neighborhood:
Action History.
Action Taken Date Description Fee Inspector
Close Case 7I9/2019 $0.00 andersor
Inspector Assigned to Complaint: andersor Filed by: andersor
Comments:
Comment Date Commenter Comment
7/9/2019 andersor Referred to Health for rental registration and inspection to determine
number of.bedrooms and capacity of each bedroom.
lo Date: 7I9/2019�� � �� �,��� � d Town of Barnstable
k ,... - a: .... .�, a e :.# s, n '"C�«t: y..r�. • � .�.,+*.,-'•' "w^*"a€x�.�' .J. +N e"f re' ! r
1 x ° a.�x,: 4- 41 lr•x ..if.• �. piG.+r �,^! ".«�«�� s fi.* ,� � e,� $.r� •.•
.I
a
4 -.,�..: t X� 4- •�n #, y a 4 J `� r "'"�. ..q.__.:5..�' b '"�' ^4i' '..•x a`;r° t X r '�� ..,P �.�«&z"` � x#
oll
u,
xm�M1 p.`•J,• �:4a1, � t, �.. �,4 •:., .. q � t�`L � .t x ,t' s W.;a.� ',L + rvrd., ;,a.•°-' .��,„y s« '�., at'«. ^.«� a � y , �.
x }I
" '�•'M '. `, .♦ .. - .. � t' ,.. '.Y ''r...+.,.- ` ~- x�,j. d .& sue•" r ,s:�.a
r•�a! s• ,n I "' „„"":»> ,..Y..r•... :� .�+' t±�.:6 •"' ! .�. M.�'� of.:�i '.
t .t • ��,� ,p .xis � t".:
:t/ ♦ t a 'r,:.-"r*w. �, «' ,ra^"". �'y°srw" ,f r`r�,"`A«�.,�, :.' a`+sr 1 .: � *'�`-w. ,,,..� '`m•-�'�«. x,.. � k.
pc
rt 9
!� Y ..; t.. :.f.t� 1 xY '-`•' .:Y��•-",tom--' -.':rj, ,.w'.�"' xa:. �, �.. '�. � �� , ., •. �f
.s',v. a *4 ,,. . t! r5,'',• 4 r s�';„^. y�• ,,. ',:ram,, "'T• rjA` n .mo `.+�' «�;a^'w.s'. c�, ,w+r ��"� �'"p n� wxe •i /I ,xwm."""w.`y^^r.„�-":
�r
,x.... f �• .,.�.���,,: r�. ""w- ram"*": .as+r Ewa a 'f w * r : .«�' „�"„x. "wx , «Y+ `» ,m
.� } W..�� � .r�v^� �� �.• a � >+ a-� a+as' '. s�'t 4 �x::3.,�y,rv` 'fir .wit .® ro�
" ^ 4a`, , ,+,� '^'�. ri.�"` �^'"""m~�x«`"� .asp �.,. ^asxa"".. ..p"N• + .r.®'' �+ ``zR. { a�"�.x-" �..'+ .�kv»x m:f.., "F<...�€ro"*` ., ram.`` a
.- >:.....,- �.. y w✓ y x" y.G/ ,/sue„. # � »..
« r dPb.S«"R.' m "".w r,a� ^w A.:�;:` � �' "` .ss,`:�l�cf...e..i:✓�<[� a."a�rN "" x�*y ,S sv� " ram, f.e.+� �W. �`; t
r'.r*" ox. ...•f'.+-F..^.ry .:.ram' ,e�ym« ✓, *, xa 'm.� ..wwa "ae
,x
.. & „ ...•,«:�«. .*'.......r� ,w. �^w tea. *- *' ^ ,ram"
i .. .' :.�• , `" «ate"- <*,xi� ,*....:. .�.:: s -�` b�' �xyr "; -'^7 ,�-
,. _.ors*": ,.r• r .r." -a, - Ma °. _••" aT «x•.• v -Ht ; ,... • .a
,1 ,w- ^�`.^x'.... .�- �• r�-'�a✓.. ^,y. :r,:+fm� ..... -'.-rr-.r J:z�«,+,cx•s a,m yM. � .. , �, t+F"'A I SY.^'°
` �„ �!'` r+� :�±= .,:�"' �..�. x>x^« s vr, '''=,�` ', ,-yam; � $�.a �� �.� ,a�. "�, ..�':«�,� � •�,� �' ,i.*
y. r:�.�"r,�'«.a�1,;::�` .w»•,. - .�'`. �.�"*'e�r+.'� *'mar" ..'•.�r..+,v,y�,..��,�`,r �-� 3 r, �`; $:r, ,�„�. .: ^���� �" � `«� .„9°-� �„� �a*-"
x, « ,� ,�r,v -. -„ ^,; °ar'- ,=,.� ,n,' ..''k.�;p�vr-i.rr�.. ..M W y®�►'. :-`'�a;�"•�.��:ate ";�,
.�a" MN*
*.: ;.. ;....� - �;
- _ f �6/'�`� � r ,.,. "` #i:..mxt'� x , �s,r8".*5' ��,+•:.'.r� � _ � ; as t°:'sn' �= Y,�
Irvi
s'i .n€K ., .''#'. ` w'„ ^'°°�^;w..s't `> 'yy,'`$: ,.9a'+w" +'" �.a',.. ,: :,J,. � •".L„s` �" �' ` ° .• •,x f.. y ...!
a
e
v
x•.r - x roc, �t
,
>
r
d
,
F
54
� .�3.�, ,x Sr,,. ,� ,.r: ��� ram.-'°` '�'� �# ��• P -T :..� - t �'�. .. � � ':.,Y �� v
�
- AW
14
7 �
t
,
s
^ a
r v 1
n
� ^:, x w a •, ..-+ : `:yam
i x�» � +f t•»�``ti II» we JL 2�'sYy�T" '�.�"� `�Vx' r:3t 1� �7�# 'r� �� � s
� " ... �Mc �. `�� �,�=`i#. �tom, r at•`r i �* r '""$t � r� ��,e i,. �tiit t �� x .a t.r ���"�r
.A*�' '_ � u '1V "R.•u� a ��iit`t y~ ¢A � Y; _ '� l�Ft'�'.Yi t. a �'}�#4+��' '�» d; ,� L„gip. i
s y4 f
. tit '�i"+ ; pia +r wt!n a � • � V r.:
a' "',-� r p ♦�''4°• 1`.. 3»,� a��Sa i' s �n'�='e�. � »�i 4r d Y �kl d'q;�..� w,�".a '.�'��"'f,� 'rt,.J�y,"t� :;
'S� c
1,.�+•'�� . 'y-,.., t# K° �,�.' ��:'�t., r, '"e}y� fw ". 14.. f��p 1 �. ��`... �:�,"s r.il s,x �,°� t aw..Fyii: ,t,..
k ♦ ti.4'+ . ,'',E.y r ,,' t.. +s +'^°'.t3i:.� "+ : 04
it.t+.».. 'TW. C 4�.7,•:.'� .4',3���"''v�iai:' If, F•;C`°;'b'C;fi' xt�� ,� +vf,"i :a''V e�� •S. `"'',
pp ' '<'�
y# ' � .gyp � vi•.x..1 ,feik� g+r s � YP•_ .�; � k�' ° -��°` ,».. '� ro �� ," � ,
�,�+ "4' t f,. ...'$A {T{ .. � �t rtU" ae� .��q•a If yyf:.rN' �s�y � .'�.ii •� rc s P f
I
..,� e�..�'w�AL, � L "�%� '+vS•Gb. � `s� » �ia � ra * i...c«�+ -'"K #� �' - ^t �
',* � �_±,d°, """,. "�";�'s, `.,crY. .. g y e� s-•'�'"tP �#TC"1'+v Y,t".5 �c �T �%:r.�u r� :de+ '' _ S,..., ..
^ , C
... ..h- .:.. �, .,�. .t•'6t ®. � .,�, �.:." k� � rat
' aa.. r a� _$.. :: •#;. ..y* � -=„?*"ate .*+� �'� �aa. .. w�,s...a,� � a.i: �"��"xr.w � t .�.*.. � ,�€ " ,y.r `: y..r��:3'
�*
x.
.,�„. '�-+,s«�._w... ., .^ ,. ,w� �. k "�. ..,�" a". Y"c•`�..E. ^fro' ��,"` �a,_ u �.e��.� �'^�'' �'° �'w" ��
#' •,.".�'. i...k -�,- 'da-' ;i+'' '.i'r .m ="`.� ?.. '� ..ec... .ro:
a'7�
�'. ^^ $ k° = a' ",�x <' .^s.a..4;P":.. y r,, ,, a:'-c..<'6 f3`s-'-t'r'•w -
.✓'x,•'�"' .za .r� »�,+'�s� � .✓uu�.r a�y�,.'':;`�3".Hx' sw+..ra,.i ''a�-r..:.. r 'r �,'"��'�` n*a` ;� �.atia'• ". � s,.ei � ,,.mx> '
^m ,x r _' a+' ...2.� '� -"a+c..,-` r ,-. s� ,+tr:9 fA.a' $•4 .4�" $+aA.Ya^ 'Y, Y �'.��f^'T`..�. R'�-`.� r .Y".�
rrzp
r
F f�
w
Y'
'
-' ii + ,•fit,"; is "'C ''. 'x -»c. �a.,raa" Ilk
MCI,
g � � '� � vv.��', � � ,J°?•sue ►r?„ � � � ' ci; m�*xaw�,;.�.,, rX �� t".`,�` ".�`�" ',» � ,� ,"`,t
tl
Town.of Barnstable *Permit �D v �
Expires 6 Q moryrhs from issue date n A
Regulatory Services Fee
Thomas F.Geiler,Director
�- Building Division
2006
S�P O 6 Tom Perry,CBO, Building Commissioner
(�� 01F BARt4S_Vp,BLF_ 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 0 3 (�T9
Property Address 0 Q\ Y� CQ`�' 1 �' M d 2(Q 3 S
Residential Value of Work Z t Q OO•-- Minimum fee of$25.00 for work under$6000.60
Owner's Name&Address��
�Px7 N1�L
Contractor's Name_ ao C A ze Telephone Number
Home Improvement Contractor License#(if applicable) f
Construction Supervisor's License#(if applicable) (' Z.(j 3 25
�Sworkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name I yr71e s
Workman's Comp.Policy#_ y FjD Act'5 Ej G y At L0
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
I
Re-roof(stripping old shingles) All construction debris will be taken to ar mo V Lka
I
4
❑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,ctc.
***Note: Property Owner must sign Property Owner Letter of Permission.
Home Imp vement Contra tors License is required.
SIGNATURE:
Q:Forms:cxpmtrg
Revisc07140S
Department of Industrial Accidents
►� Office of Investigations
' a 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers .
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
L
1J .
Address: ��3 t Co l In
City/State/Zip: otkC'V (5l�hone#: �-�.�—� 1 1
0
Are you an employer? Check the-appropriate box: Type of project(required):
1.XI am a employer with�� 4. El 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.1 7• ❑ Remodeling
ship and have no employees 'These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. g, .❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.]
officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work. right of exemption per MGL ;11.❑ Plumbing repairs or additions
myself.[No workers' comp: c. 152, §1(4), and we have no 1;,KRoof repairs .
insurance required.]:t 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 hue outside contractors must submit a new affidavit indicating such
tcontractors that check this box must attached an additional sheet showing the name of the subcontractors 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: `(� &-a-5 71'IJ S
Policy#or Self-ins.Lie.#:�� ►�pha E2 b tJ Y PC(e Expiration Date: 1 r
t
Job Site Address: City/State/Zip:__,&LA (D 2(p ?j Gj
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 cati 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi der the pains and penalties of perjury that the information provided above is true and correct
Sizaafore: Dater !�r -2 9. O
Phone#: Z ( 1 '1�`7
E
only. Do not write in this area,to be completed by city,or town officialn: Permit/License#
hority (circle one):
Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
rson: Phone#:
F
Town of Barnsta• ble
3AEN37ABLE,
MASS.
� 0.39. ,0� Regulatory Services
�FD MA'S A
Thomas F.Geiler,Director
Building Division
Tom Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign;This Section
If Using A Builder
P A ,as Owner of the subject
1 property
authorize I
` L to act on my behalf,
hereby
in all matters relative to work authorized by this building permit application for:
O MCA ' ST
(Ad res ob)
t
i
qSiature of Own r Date
Print Name
Q:Forms:expmtrg
Rcvisc071405
Client#•19989 2CAZEAULTPA
`AC,ORD,. CERTIFICATE OF LIABILITY INSURANCE' 0 190°' "'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dowling$O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
222 West Main St.PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA: Western World
Paul J.Cazeault&Sons Roofing,Inc.
1031 Main Street INSURER B:
Osterville,MA 02655 INSURER C:
INSURER 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.
LTR NSR UDA TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
DATE MMIDD DATE MM/DD LIMITS
A GENERAL LIABILITY NPP1012091 04/30/06 04/30/07 EACH OCCURRENCE $1 000 000
X COMMERCIAL GENERAL LIABILITY .. DAMAGE TO RENTEDPREMISES fEa occurrence) $5O OOO
CLAIMS MADE FX-1 OCCUR MED EXP(Any one person) $2 500
X BIlPD Ded:1.000 PERSONAL SADVINJURY $1 OOOOOO
GENERAL AGGREGATE s2,000.000 ..
GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $1 000 000 .
POLICY PST LOC
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 $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE
RETENTION $ $
WORKERS COMPENSATION AND WC STATU- OTH-
EMPLOYERS'LIABILITY.
ANY PROPRIETOWPARTNER/EXECUTIVE E.L.EACH ACCIDENT Is
OFFICER/MEMBER EXCLUDED?
If yes,describe under E.L.DISEASE.EA EMPLOYEE $ +p
SPECIAL PROVISIONS below E.L.DISEASE-.POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate of insurance will be issued directly by the insurance carrier.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Infoffnatlonal purposes only DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL __Ja_ 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
C.
ACORD 25(2001108)1 of 2 #42866 LS1 O ACORD CORPORATION 1988
i
i
RD =aF1`� l Ule� GE
£�+• afr yt s 1 3 o
! GATE(MI141DD1YY °f
Il'. Mv*�%•t4M ^e�? Lf :#a. a >.q s...a..as 1 J........e .,?.a....
"aP .
4, q ?RooucER THIS GERTIFICATE IS ISSUED AS A MATTER: i►�-tF.cr�ucx,uaa.,
DOWLING & O:NE,IL INS AGC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE:
222 wE$•T ttAIN .STREET. HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND"OR.
IiO{r''1996.�` ALTER THE COVERAGE AFFORDED BY THE POUCIE.`ti 9ELGW-.
i t ��HYANNISi +
t-IA 02601 COMPANIES AFFORDING COVERAGE
cGUPA„r,
rbt,e, t '2�LGR "
+,s A TItAVh;LbRS PROPERTY CASUALTY COMPANY OF AMERICA
}§z INSURED COMPANY
>yy`rfiapAUL J,'C4ZEAULT 6 SONS INC. ET
lr �1J n t r {a uO5TEiYVSL.LE:STREET
MA-02655 COMPANY
C
r
COMPANY
4 wxrrwa�n'.,. a£'re %w"r`:'G:Y•. ':?'• tii:","
�:.ni• ::7.177777
Ga, t
.:TELLS` /x:..::^ t.•' ;Y:;.o..,
,•t ?HAT THE nba�;c. a.t::c .,: ;aa...aa:"•':i13:.;ta..,:,•t,=,; ,!x� .Y., E POL)CIES•'OF INSURANC '.:s>ca:�.;c;.;.:�:igz'•.;....::, Cr
INDICATED °NOTVIITHSTANDING ANY REOUIREtdENT,TERM OR CONDITION OF ANYCONTRACT OTHER DOCUMENT NAMED*ME ABOVE FOR THE POLICY PERIO.CrI h
k t+ p CERTIFICATE MAY BE ISSUED OR MAY PERTAIN•`THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB SUBJECT TO ALL THE TER,nA 4'£XCLUSIONSANDCONDITION30P•3UCHPOLICIES.LIMITS'SHOWMMAWHAVEBEENREOUCEdBYPA1DCl''AIMS:
rTYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION,
POLICY NUMBER LIMITS
DATE.(MMDa%YY).•
e ht I rYz+l.I'OENEFAL UABIUTY• .
GENERAL AGGREGATE g t} { fi��,yUfi� LUMMtH(.lAI.GtNtHALiIAklII.IIY' .:. .. - .
u '' _ MHUUUC I`J-WmYJUW kid. '
CLAIMS MADE OCCUR. PERSONAL IL ADV.INJURY
l 3
tSWNEH 5 a uJN7RA07iiR$pHOT.• �►cn occuRrtcNce (
FIRE.DAMAGE(Any one fire) g
"�a R AUTOMOBILE LIABILITY MED..EXPENSE.(Any one person) S.
1
f n ',4� i /�NY AUTO COMBINED SINGLE
f
r(} S AIL OWNED AUTOS LIMIT
r{# 1 SCHEDULED AUTOS BODI6Y INJURY
d
(Per Person) i -
6A HIREDAUTOS
r4ti t a I. NON•OWNCO AUTOS BODILY INJURY 3
Ifr (Per Accident)
+htt+4
to PROPERTY DAMAGE g
GARAGE UADIUTY' .. .
�if4'1Iw� Rq L•e� - .. •
CIOEN►'AUTO.ONLY:EA AC ' 3
ANY AUTO'
r ?r+ C)WR THAN AUTO OktY: °t
t4� ,
s EACH ACCIDENT, S .
n AGGREGATE g
EXCESS UABIUTY
�1 EACH OCCURRENCE . g
UMBRELLA FORM
AGGREGATE g
OTHER THANUMBRELUIFOHM -
Ji, A , ,
t ,+ ER'S COMPENSATION AND. -'
rt41t twr{ .THE
gYEASL1AB1uTY.'' (LIB-0095II69-A-06 " 08-10-06 08-10-07 STATUTORY LIMITS
r t; r WORK
S J: d
OPRIETORr
U.
llfi Z +'' EACH ACCIDENT
PARTNERSIEXECUTIVE v INCL f
A fyC rFa ra. 'OFFICERS ARE: EXCL DISEASE-POLICY LIMIT gRD
'
DISEASE-EACH EMPLOYEE g
4� < 1 TtiI:, REFLjiCCS ANY PRIOR CZRTII ICATG ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKER" COMP COVL+ItAGL�.
r C aF�,�LOI R` .
FICA
t : r
b 3 a•
��tii. esf r••W+:a•rl,. Za. +,•..,.•i�ev:,...cyi,�r.•r/.:•Ti+%.t::=: :,t;,v.:`Y.Y.f;r.y •.$9.,"19t:: i•'f'.'<'..ii i.%:�i%<%r.,:.:.' 3i7:si>, t�', '�•�/�•l
J 7• ""��-.�-�._�, �_� �••• h^. v.4,v .. ,;4vf,• ,va:f.fe t �N4{v,�.Lr.il4 f.eV1�.�.i #if'$.i�jr i:'.:f'SK:�l.•. �. ',t•:.:•:•r.•::R:.
� L•3.•� x `.`•,r:Mlw•rxMa.A •..vM<':)�fiiM1b�:,a'.v.v�en:+•i = ' .:.<:� ,<'`�`'�%.;, . .absew3 (... d f' t
, �f ft `--�.-�-__ �_ .. .. '' : :,,a'v,».:'.i l,�, nvlev;�:.°rjtf, 1aT L,�.�Jf J`v:♦a S ..
- 9AOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE",
. r
Paul J,Cazeault&SOnS . EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
xl
'' Roofing,l;1C. 10 DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDERNAMED TO THE
LEFT, BUT FAILURE-TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR
1031 M -I Street`, UAWUTYOFAMY.KIND.UPuNTjiECAfWAiLY,ITSAGii1TSGggGp /sly
Its; Ostervil.lt:, MA 02655
AUTHORIZED REPRESENTATIVE
%2714.,63$3,.e ip i i=a'n r'bs i�a/. i kf c gg��>:.:t.;ytaFr 1"L:tiU:i< •:c> ✓ - .
y.( Nv
ASp{iANtd.a. c r•:�.::•Y'.:':':�Y'.5::,....ati:::fL:< ":(:' hK �p�,f,M�� :.
r� t ro-^..,•:y:{•yC:i•iy. i ..y �K1i11�W1••
— _ Board of Building Regulati ns and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Reqistration: 103714
Type: Private Corporation
Expiration: 7/9/2008
PAUL J. CAZEAULT & SONS, INC.
Paul Cazeault
1031 MAIN ST
OSTERVILLE, MA 02658 - ..
Update Address and return card. Mark reason for change.
[�)PS-CA7 Ca Address .F] Renewal I J Employment Lost Card
50M-OS/O6-P�CT8�490p
,Z ✓/ce -Vanvawouup� o�./�aaaac��zuaeU4 ...._
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Reg istration:,;j03714 Board of Building Regulations and Standards
One Ashburton Place Rnt 1301
Expiration7J9/2008lug
Boston,Ma.02108
Type:!Private,Corporation
PAUL J.CAZEAULT-:'&SONS,;INC`. '?J:
Paul Cazeault
1031 MAIN ST
OSTERVILLE, MA 02658 " Deputy Administrator Not valid without signature
tA
-�
Board of Building egulations
One Ashburton Place, Rm 1301
Boston, Ma.x02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959
Number: CS 026325 Expires: 10/20/2007:,. Restricted To: 00
PAUL J CAZEAULT
1034 MAIN ST
OSTERVILLE, MA 02655
Tr.no: 7696.0
Keep top for receipt and change of address notification.
PS-CA1 CJ SOM-04/05-PC8698
012.
--_------------ -�---�- -
✓12. l>OOJt/lto02Cf/eILG[�L o�✓!(�taaaC�iuJelt6
i
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
( Number .CS, 026325
i B00date 10/20/1959
Ex ires� 10/20/2007
1,P 1_�., Tr.no: 7696.0
Restricted--'00::
PAUL J CAZEAULT :;:, :, i._..
1031-MAIN RT
PERMIT PAYMENT RECEIPT
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
200 MAIN STREET
HYANNIS, MA. 02601
DATE: 09/06/06
TIME: 16:08
------------------TOTALS----, - -.L-----
PERMIT $ PAID 85.00
a
AMT TENDERED: 85.00
AMT APPLIED: 85.00
CHANGE: .00
APPLICATION NUMBER:, 20063035
.a •PAYMENT METH: CHECK
PAYMENT REF: 19505
P
TM
' 3 �►,�, ofBarnstable *Permit# �;?D
Expires 6 months from issue date
jOe UTAtory:Services Fee O
0MASS.39.
,0� SEP 06 Th& F.Ceiler,Director
AlED A V T D
�.gp,R�s �'u>< ding Division
YV pp
-TQWN Tom Perry,CBO, Building Commissioner o GvDr
200 Main Street,Hyannis,MA 0260'1
www.town.barnstable.ma.us 'A
Office: 508-862-4038 Fax: 508-790-6230
`Q1
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
- ( Not Valid witljout Red X-Press Imprint
Map/parcel Number a ul
Property Address-1tJd m a i ek S-�
Residential Value of Work Minimum fee of$25.00.for work under$6000.00
Owner's Name&'Address . , 1 I A `
700 S+ a
T
Contractor's Name zg� Telephone Number
Home Improvement Contractor License#(if applicable)ZI37
Construction Supervisor's License#(if applicable)
�orkman's.Compensation Insurance .
Check one:
I
❑ I am a sole proprietor,
❑ I the Homeowner a
I have Worker's Compensation Insurance `
Insurance Company Name �,��/Q (�/r
Workman's Comp.Policy# v 23 a D q,�Z & 1 /T U 6e
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
❑Re-roof.(not stripping. Going over existing layers of roof)
'�&Re-side q s�J
❑ Replacement Windows. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
Home Improvement Contractors License is required.
SIGNATURE:
Q:Forms:cxpmtrg
Revisc071405
,1 R."\ J
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 .
Applicant Information Please Print Lef ibly
r
Name (Business/Organization/Individual): Po o/— /v e
Address: f
City/State/Zip: j�5±�r V e A hr Phone
Are you an employer? Check the-appropriate box: . Type of project(required):
1. am a employer with ��� 4. ❑ I am a general contractor and I .
Y * have hired the sub-contractors 6. ❑New construction
employees (full and/or part-time).
2.❑ 1 am a sole proprietor or pier- listed on the attached sheet. 1 ?• ❑ 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 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers' comp.' c. 152, §1(4),and we have no 12.❑ Roof repairs
insurancerequired.]:t employees. [No workers'
comp.insurance required.] 13. eroMrV L
•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 o f the subcontractors and their workers'comp._policy_inforn.Jation.
I am an employer that is providing workers'compensation insurance for my employees. Below is the Policy_and job site
information.
Insurance Company Name: 1 ( 1 S
Policy#or Self-ins.Lic.M. Expiration Date: ti
Job Site Address: — I0n City/State/Zip: AA-.62(Q3
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 ce nder the pains andpenalties of per' that the information provided above is true and correct:
Si a e: Dater a
Phone#:
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#:
- ` 91te -0ammonweald
- - Board of Building Regulati ns and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Registration: 103714
Type: Private Corporation
Expiration: 7/9/2008
PAUL J. CAZEAULT & SONS, INC.'
Paul Cazeault
1031 MAIN ST
OSTERVILLE, MA 02658 - -
Update Address and return card. Mark reason for change.
Address ,CJ Renewal .. I Employment ! Lost Card
)PS-CAI it 50M-05106-PC8490 /
✓1w -C7NI�L!)tlYlulIP,C6IA/t o�✓ 2Gif[dP.�G •._
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:
Registration,,-103714 Board of Building Regulations and Standards
Expiration:'-7/g/2008 One Ashburton Place Rm 1301
Boston,Ma.02108
Type:,Private.Corporation
PAUL J.CAZEAULT B=,SONS IN,C
Paul Cazeault
1031:MAIN ST ,.
1 .-� - _ .. ---._ ._...._... .___....... ._..._. _. . -
OSTERVILLE,MA 02658 '`` Deputy Administrator Not valid without signature
Board of BuildiMace
egulations
One Ashburton , Rm 1301
Boston, Ma::02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959
Number: CS 026325 Expires: 10/20/2007. Restricted To: 00
PAULJ CAZEAULT
1031 MAIN ST
OSTERVILLE, MA 02655
Tr.no: 7696.0
Keep top for receipt and change of address notification.
PS•CA1 0 5OM-04105-PC8698
i ✓die V�o�iv»zao O�✓UGadaac�iuorl�4
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Num*,-.-C.S. 026325
B;[t�tdate 10/20/:1959
`Expires 10/20/2007 Tr.no: 7696.0
Restricted:;- 0.
PAUL J CAZEAULT ,,.-.::;;,
_ _ 1031 MAIN ST
y Client#:19989 2CAZEAULTPA
ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE(M I DIYYYY)
PRODUCER 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
222 West Main St. PO Box 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC#
INSURED EINSURERA: Western World
Paul J.Cazeault$Sons Roofing,Inc, S:
1031 Main Street
C:
Osterville,MA 02655D:
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.
TM 001 LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
DATE MM/DD DATEIMMMDrCn LIMITS
A GENERAL LIABILITY NPP1012091 04/30/06 04/30/07 EACH OCCURRENCE $1 OOO 000
X COMMERCIAL GENERAL LIABILITY DAMAGES RENTED nce $50 000
PREMISEa occurre
CLAIMS MADE 51 OCCUR MED EXP(Any one person) $2 500
X BI/PD Ded:1,000 PERSONAL&ADV INJURY $1 00O 000
GENERAL AGGREGATE. $2 00O 000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1 00O 000
POLICY PRO-
JECT LOG
AUTOMOBILE LIABILMY
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-FA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR ❑CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND WC STATU- O R
EMPLOYERS'LIABILITY
ANY PROPRIETOWPARTNERIEXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $
If yes,describe under -
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate of insurance will be issued directly by the insurance carrier.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Informational purposes only 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 R RESENTATNEE
ACORD 25(2001/08)1 of 2 #32866 LS1 0 ACORD CORPORATION 1988
I
..,.:f•n.........:.,.:
as > OATE(MM
s s DD1YY)
PRODUCER THIS CERTIFICATE IS ISSUED.AS A«LATTER F INNLF.tlrrcltKwr,`
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE:
�!DOWLING & 0 NEIL INS AGC HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND'OR
222:WEST,1990''t+tAI1d .STRaET•
�PO. BO:< ALTER THE COVERAGE AFFORDED HYTHE POLICIES QELQW_.
�
i'HYANNIS I-tA 02601 COMPANIES AFFORDING COVERAGE
COMFAh"L
27LGR' A TItnVELEIiS )?ROPER.TY CASUALTY Cc)hipnN'r OFnr9F;li[Cn
INSURED
COMPANY
PAUL J CAZEAULT & SONS INC. g
1031'NA.IN STREET
O5TERVILLE MA•'02655 COMPANY
C
COMPANY
D
`CO V E G S--
..hs.
.n� ..Y 2.. 6:5 4
':h..
••THIS IS* C•• .y.
TO CERTI FY THAT THE POLICI .,�' :asF
E OF INSURANCE LISTED + ��'��� �'"�'
•::INDICATED NOTWITHSTANDING D BELOW'HAVEBEEN I,SUEO„TO'THE IN„UREDrNAMED'AUOVE FOR THEPOL'ICYaPER)OU' '
I.'CERTIFICATE MAY BE ISSUED OR MAYS PERTAIN,HE INSURANCE AFIFORDED 13Y THE TION OF ANY �POLICIES DESCRIBED ACT OR OTHER O HEREIN IS SUBJECT TO ALL THE CUMENT WITH RESPECT TO CTERMS'
,
EXCLUSIONS AND-CONDITIONS OF SUCH POLICIES.LIMITS'SHOWNMAY'HAVE BEEN REDUCE LyBY PAID CLAIMS. '
CO TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION'
LTR POLICY NUMBER DATE(ISADII\YY) . DATE(MU\DD\YY).• LIMITS
GENERAL LIABILITY
GENERAL AGGIILGATL S
CUMMhH(:IALGLNEHALiIAkiIL11Y' I+WUUUI:Iy-{;IX.�VII)I"AUI:'. '
CLAIMS MADE a OCCUR. PERSDNAI.R ADV.INJURY 3
OYrNWS a 4 iONIAM�1 ifis PR01. FAGIt OCCunT1GNCC S
FIRE DAMAGE(Any one tire) $
MED,.EXPENSE.(Arq ono peroon) _.
AUTOMOBILE LIABILITY
ANY AUTO COMBINED SINGLE S
LIMIT
ALL OWNED AUTOS
SCHEDULED AUTOS BADII Y INJURY(Per Person) S
HIRED AUTOS
NON-OWNED AUTOS BODILY INJURY 3
(Per Accidem)
rj
:•,'. '
PROPERTY DAMAGE S
' ;.GARAGE LIABILITY'
AUTO ONLY'EA ACCIDENT' S
ANY AUTO'
OTHER TkAN AUTO ONLY.
EACH ACCIDL?NT, q .
AGGItEGAIE _
FA
ABILITY EACH OCCURRENCE
.
1
' RELIA FORM '
AGGREGATE ;
ER THAN UMOHELL. FORM .
'S COMPENSATION AND. - )
ERSLIABwTY' (LIB-0095B69—A-06 OB-10-06 Oft-10-07 STATUTORYLUrrsEACH ACCIDENT
PRIETOR! v INCL L_ SfEXECUTIVE DISEASE—POLICY LIM[rS
SAREt EXCL
DISEASE—EACH EMPI.OYEE g
THIS REPLACE:, A14Y PRIOR CERTII'ICATG ISSUED TO THE CERTIFICATE KOLDER AFFECTING WORKER:, COMP COVERAGE.
C�,a: TIES :�, QL R`�`>• .:;^s:::'.: ��.. .:, ;.,.
,....,:w,.., ,. a, .,x::, ...r•: :IGA\NCEI:LATl4 a..;., a::;::;
--��...... .... •n ,.ram„•,:::. .:.: 4.i.,:v ..•: •.:'`'l�"' E ?'.i'.f r� ..,. `.�bS,L,....�.;.a.,•.,..,,;,,.
SHOULD ANY OF THEABOVE DESCRIBED POLICIES'BE CANCELLED BEFORE THE r
Paul J•Cazeault&Sons EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Roofing,l,Tc. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR
1031 Mai:1SiCeet LIAWLITYOFA)iY)i{N0.UPONTHEG7iW/iYi,LTSAGiIiTSGiiRGi�isF.�EyLSbT1YE5..
Ostervillu, MA 02655
AUTHORIZED REPRESENTATIVE
OECi�CdliPdl�ATJQt[i�9a';