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HomeMy WebLinkAbout0111 POPONESSETT ROAD !�� AO Po, ) CAPE COS -= INSULATION 11111 OLAi1 '11AMLi 11 111.ICAM 111111N010 IATTS OUTTIAI INSULATION CIILINOI 1-800-696-6611 �-- M Town of Barnstable Regulatory Services Building.Division 200 Main St Hyannis, MA 02601 Date: I kb � ?.A k ja Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc, performed & completed the insulation and weatherization work at the property listed below:Cape Cod Insulation did this in accordance to the specifications listed on the building permit application, All work has been inspected by a certified Building Performance.Institute '(BPI) inspector. All work preformed meets or exceeds Federal & State Reduirements• Property Owner . Property Address Village S�ePr OCohr0<- 111 ToPoresse mac,u\t �d- Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) (x ) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ) Walls ( ) ( ) ( ) ) ( ) cN2r"1 Gvor k F,9r�70r,oje0l Air 'e GA Sincerely H ry E ssi r, President pe C Ins ation, Inc, q . f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION , Map D 19 Parcel Application # C2 6/ S j Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 2S 0a Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Al sr 7;r- �✓ Village Owner�Z%�yfs �,% Address [ss Telephone 9, ��' D5�- Permit Request o!9 772� oa�2 G��.� !�✓`� c," Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /boo. Construction Type fla�/��7�6� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family J Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes 3;�o On Old King's Highway: ❑Yes No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat.Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other CD Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove:`0 Yes ❑ No CD Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existinT ❑ new size_ CO J"D Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: C_0 a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# M r�r Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �"/�i�� C�' `��U/r��o� Telephone Number �-- Address /r gawg 411, -lg License # L a �!d Home Improvement Contractor# Email Worker's Compensation #,/�CE�J,/1 ALL CONSTRUCTION DEBRIS RESULTING ROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE J Z r� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED -MAP/PARCEL NO. ADDRESS VILLAGE ' OWNER f DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE -` ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL s` GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. Uwe Permit Authorization A'°�� � mass Save form PANntrMO SWWW f+ouo enww of ewneN Site ID: S00002307067 Customer: RANDY JUSSEAUME I, RANDY IUSSEAUME ,owner of the property located at: (Owner's Name,printed) 111 Poponessett Rd C07UI7 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. 4 Owner's Signature: 2 Date: FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Dke _ Os•0 Conservation Services Group • 50 Washington Street,Suite 3000 • Westborough,MA 01581 • 1800-480-7472 For Office Use Only Rev.102015 Details Page 1 of 1 Licensee Details Demographic Information Full Name: HENRY E CASSIDY Gender: Owner Name: License Address Information Address: Address 2: City: WEST YARMOUTH State: MA ipcode: 02673 Country: United States License Information License No: CS-100988 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 10/8/2015 Issue Date: Expiration Date: 11/11/2017 License Status: Active Today's Date: 1/11/2016 Secondary License: Doing Business As: Status Change: Prerequisite Information No Prerequisite Information Discipline No Discipline Information Documentum } http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=289986& 1/11/2016 . 1 1;�t Massachusetts Department of Public Safety; 1 Board of Building Regulations and Standards p License: CS-100988 Construction Supervisor. HENRY E CASSIDY, `I 8 SHED ROW �.l,r �• .:�r =:s?<' �'F�1 WEST YARNIOU iH 2' ` .r `y yaa Expiration: Commissioner 11/11/2017 Commissioner 1111112015 Offioe of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C6.'-�t.rktor Registration Registration: 153567 r ^z, Type: Private Corporation Expiration: 12I15/2016 Tru 259168 CAPE COD INSU'LAT,10N, INC HENRY CASSIDY 18 REARDON CIRCLE ,I -- SO, YARMOUTH, MA 02664 Update Address and return card, Mark reason for ch91l SCA I Address Renewal Employment Lost ;'� 20M•05�11 C�J/!0 �p6'J7Y4tLP')LGUaC6GC�L P�(%GG6UJdt!bPIllJ6G�1 Of(lce of Consumer AffRlrs & 5uslncss RcgulRlion License or reglstratlon vaild for Indlvidul use only OME IMPROVI&ENT CONTRACTOR before the expiration date, If found return to egistratlon: Type, Office of Consumer Affairs and Business Regulation j xplration;-,,.12115120,16 ^, Private Corporallon 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSUTA?:I;t7N°;;;1NC HENRY CASSIDY 18 REARDON CIRCLE'"', S0.YARMOUTH,MA 02664• ' — Undersecretnry Tynild e ' r 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, 3M 02111 www.mass.gov/dia r Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 1 i�lrr City/State/Zip: + Phone #: Are you an employer? Check th appropriate box: Type of project (required): 1. _I am a employer with '3_ �5 4. ❑ I am a general contractor and ] employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' " insurance.$ 9. ❑ Building addition [No workers comp,comp. insurance required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 1 l.❑ Plumbing re 3,❑ I am a homeowner doing all work gairs or additions P myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no r; employees. [No workers' 13. Other mu la�vy� comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ♦Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: fir , �l�(,KbVA V 'I v rm - '✓ Policy # or Self-ins. Lie. #: Expiration Date: b i Ito IT Job Site Address: &Z[ 20 r"d1V e ?3 ,Czr- ,� g:::;�!U/91- City/State/Zip: eo Z•G v�.s 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 insuraW coverage verification. I do hereby certify d the pai an penalties of perjury that the information provided above is true and correct. Si nature: ` Date: Z _ 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 Cnntn&Percnn: Phone#: CAPECOD•27 BDELAWRENCE ACORO`" CERTIFICATE OF LIABILITY INSURANCE DATE 1 630/230/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND; EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN.THE ISSUING INSURER(S),AUTHORIZED i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT; If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc, PHONE FAX 434 Rte 134 C Arc No:(877)816.2156 South Dennis,MA 02660 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC 0 INSURER A:Peerless Insurance Company•see LIBERTY MUTUAL INSURED INSURERB:ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulation,Inc. INSURER C; 18 Reardon Circle INSURER D; South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER; REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE:INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY'CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY YE LTR POLICY NUMBER MM/DD/YYYY PMIDD/YY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE M OCCUR CBP8263063 04/01/2016 04101/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JEC XT LOC CPRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY a COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ g UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE EERH B ANY PROPRIETORIPARTNERIEXECUTIVE WCE00431901 06/30/2015 06/30/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In If a E.L.DISEASE•EA EMPLOYEE $ 1,000,000 e DES under s,describe nder CRIPTION OF OPERATIONS below L E.L.DISEASE-POLICY LIMIT I$ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES ( CORD 101,Additional Remarks Schedule,may be attached It more space Is required) Workers Compensation Includes Officers or Proprietors, Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation, Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS, South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION, All rights reserved. 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S�6L�91�C . •t•''®••� - 1p see the preweous'parrel disp4ye6 door on Previous.f To view an absVact,:d rk an the:da&ument e&nn,with:'ABS`: p• ( o view an image dirk on the document iron,0h OOC'. -, 3ii9ii`"i• -'-" r Please note that if the ewn DOE- nat stwwnj:that means-t)ie document Image u ner4 available- V 3 ....••,� o vie an abstract of a referenced documeht,.dick ds hyperlink f `' 4.t7'!iM - Sta ✓ ;,- ,.s a✓.; y<q TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map y � 9 Parcel 0 7� Application 0 Health Division Date Issued 45T r Conservation Division Application Fe { Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village COT-of l Owner STePAe- i 0'C-@1v cAe - Address GO& �3 60-ru1 i MA bXsi Telephone 6'0t� q aO 3-a D :3 Permit Request 1;JTerL.'otz .1414 -it,. R.C;F lns -s laor—In-rC(l q�b I m 5 v L A-r,'�,� �� I(o�.E�. A L AOL m I-VLO C- IFA R L!!v, car- TAe t4jjSF Square feet: 1 st floor: existing 11 A'proposed 2nd floor: existing proposed''. 'Total neyv Zoning District Flood Plain A c�aL 6-6' Groundwater Overlay (X1 �? Project Valuation 3® -Construction Type Lot Size X-1' Grandfathered: ❑Yes 5No If yes, attach supportingdocum�ntation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 4 y f&s Historic House: ❑Yes I*No On Old King's Highway: ❑Yes XNo Basement Type: AFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) ,S b® s Q Basement Unfinished Area (sq.ft) -3 bO sow Number of Baths: Full: existing a. new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: CC Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing i New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: *existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 1kJ AIc A%&e, WkAo.���I Telephone Number Address )�) F)*kaW1L C_W" WA-4 Dc I-yye 5 License# `�9 t,y I P LaN V�e—s-ra.--LAT,�nl Te&U1ce-s Home Improvement Contractor# Worker's Compensation # TA �=� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO '7''0wN o )(Al,nactuI-14 bpspoSA L Ae2r-n- SIGNATURE e �'" DATE F` 3 `/ FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED .S MAP PARCEL NO. j ADDRESS VILLAGE. OWNER DATE OF INSPECTION: ` FOUNDATION FRAME f / INSULATION O f6(f, r a FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL . FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLANNO., ` l ^ .t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 l+,h .mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizationMdividual): Whalen Restoration Services Address: 22 American Way City/State/Zip: South Dennis, MA 02660 Phone #: 508 760 1911 Are you an employer? Check the appropriate box: Type of project(required): 1. [ 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached. sheet. I 7 ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 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.❑ 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 12.❑ Roof repairs insurance required.] t employees.tNo workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#r must also till out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they ate 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 w-the rub-contractors and their workers'comp.policy information. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Arbella Protection Co. Policy#or Self-ins.Lic. #: 9091320408 Expiration Date: 4/1/12 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.his statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification.' 3 1 do hereby certify under the pains and penalties of perjury that the a:formadon provided above is true and correct Silknature: 16,.J ka,. - Date: 0c, Phone#: '7 6 0 t 41,t , 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#: Restoration Services Inc Fire, Smoke,Soot,Water Damage&Mold Remediation Services Cleaning Deodorization Reconstruction Specializing in Fire Restoration All Work Guaranteed Access, Authorization and Direct Payment Request Fora I (we) authorize WHALEN RESTORATION SERVICES to perform work. as per estimate at property located at 111! Poponessett Road, Cotuit, MA"02635 to repair damage caused by tree on 8/15/11 As owner(s) of this property, I (we) understand that I (we) must authorize this work. I (we) hereby authorize WHALEN RESTORATION SERVICES to perform this work." and accept responsibility for payment upon completion. I (we) authorize and direct my Insurance Company Narragansett Bay Policy No. 3H2O020709 , ,to make payments directly to WHALEN RESTORATION SERVICES, Insurance Claim Specialists, for doing this work and to that extent I (we) assign the benefits applicable to this loss to WHALEN RESTORATION SERVICES. I (we) acknowledge receipt of a copy hereof: J OWNER �— DATED _ SIGNED OWNER wH ESTO y TION REP. SIGNED 22 American Way, South Dennis,MA 02660 Phone: (508)760-1911 Fax: (508)760-9995 • 1-800-244-2598®E-Mail: restore@whalenrestorations.com Web Page: http://www.whalenrestorations.com • OFFICE COPY Date: 8/31/2011 Time: 11:10 AM To: 9,15087609995 Rogers 6 Gray Ins. Page: 004 Client#:32193 WHALRES sr 4COR& CERTIFICATE OF LIABILITY INSURANCE -DATE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the Certificate holder is an ADDITIONAL INSURED,the po Icy ies must be endorsed.If SUBROGATION IS WAIVED,—subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Ann Pell - Rogers&Gray Ins.-So.Dennis PHONE 508-398-7917 508-258-2177 434 Route 134 A/C No Ee: JC No: P.0.Box 1601 ADDRESS: pellan@rogersgray.com South Dennis,MA 02660-1601 CUSTOMER IDS, INSURERS AFFORDING COVERAGE NAIL 0 INSURED Whalen Restoration Services Inc INSURER A:Arbella Protection Co 17000 22 American Way INSURER B: South Dennis,MA 02660 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP / LIMITS A GENERAL LIABILITY 8500040398 4/01/2011 04101/2012 EACH OCCURRENCE $10000DD X COMMERCIAL GENERAL LIABILITY PREMISES a ocanenoa $100,000 CLAIMS-MADE ❑X OCCUR MED EXP(Any are person) $5 000 X PC Ded:250 - PERSONAL 8 ADV INJURY $1 000 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000 000 POLICY PRO- LOC $ A AUTOMOBILE uABLM 58243400004 4/01/2011 04/01/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $, DIX1 000 ALL OWNED AUTOS BODILY INJURY(Per person) $ X SCHEDULEOAUTOS BODILY INJURY(Per accident) $ PROPERTYDAMAGE X HIREOAUTOS (Par accident) $ X NON-OWNED AUTOS $ $ A UMBRELLA LUIB X OCCUR 4600021586 4/01/2011 04101/2012 EACH OCCURRENCE $ EXCESSLL CLAIMS-MADE AGGREGATE $1,000,000 DEDUCTIBLE $ X RETENTION 10000 $ A WORKERS COMPENSATION 9091320411 410112011 04/01201 X We STATU- ER AND EMPLOYERS'LIABLMY Y 1 N AICERWMEIM13EREXXC 0 DXCUTIVEF 1A E.L.EACH ACCIDENT $500,000 (Mandatory in NN) E.L.DISEASE-EA EMPLOYEE s500,000 If s,desaibe under OE SCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT s500.00O DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Addhional Remarks Schedule,Y more space Is required) Workers Comp Information Included Officers or Proprietors Project Address:111 Poponessett Road,Cotuit,MA 02635 CERTIFICATE HOLDER CANCELLATION Stephen O'Connor SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE r P.0. Box 63 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ` Cotuit,MA 02635 AUTHORIZED REPRESENTATIVE ©198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S70720/M69147 MEE Nla sachuseits -;Dcpa rtnient of Public Safc,: Board of Building,, Rec,�tilations and Standards — Construction Supervisor License License: CS 74928 a _ WILLIAM WHALEN 122 POND STREET BREWSTER, MA 02631 Expiration: 8/10/2012 ( .n��u�issinner Tr=: 70 �e C(,noszaavno�rnecrl��.oC'/j�cr�:�cre�cc�el�:i _ . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ egistration: 129244 Type: Office of Consumer Affairs and Business Regulation xpiration 7/30/2013 Private Corporation 10 Park Plaza-Suite 5170 , Boston,MA 02116 Whalen Restoration Services lnc; William Whalen 22 American Way �a South Dennis,MA 02660 lJ z - —- - --' -- ndersecretary Not valid without signature G .k • F Page 1 of 1 777 p t d: 't � i�:.�._ .i ,oYiM�T��� t /`, . .st # . ..r • pi+�°y�V8„• 1 V� �::1 .NL�'iFd`�fJ�LL, *' l d.:,sf .. � 5 � a air- Jo s o � 0 / file://\\isvisions\images\00\00\22\52.jpg 8/16/2011 _ ! 1 L i ' { f �#-- � f I - - _ 4 aj ,IYL Ltv i ► t �--�- 1 4 .._ i. -�.• -'-`+-- -�__-'�_---�.—,, -l--- � ---+--.._.}..._.u..-w.-.-: - -.,..-.. ( +��— - ._l.._ .0 � �.�_� � J^r .r � '_„�_ ....y._.�r C � L1."- �f✓U t �{_.,, _�.,.-_.,a_. ( �. 1 ' -�' �4-�:' � L- -� `3�1?C�Ca6rvti 1-4 u NJ i 2 t I " 1 I { l I i I L-74, - T 1 _:_. _f " _ F _ I _ �_ r �. 4. 1 i ..� ..� _ _ �. _}. _ .I. 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