Loading...
HomeMy WebLinkAbout0333 SKUNKNET ROAD o ,. , 4���� _ . °� o ,_ Town of Barnstable Building�, os ThiS Card:S.o Tha it�is S/isible .rom the Street A roved flans° ust be Retained:on Job ands histGard Must be?ICe t � 1rsrABaE i M" Posted Unt11' Ina�1,) spection'Has Been Made. , � ' t ' 4W,here �ficate of Occu an'c; is R u�re�d"such Buildin' sFallNot be Oceu ied until a.F�nal drs ect�on has been made. Permit Permit No. B-17-2052. Applicant Name: todd leduc Approvals Date Issued: 09/06/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 03/06/2018 Foundation: Location: 333 SKUNKNET ROAD,CENTERVILLE Map/tot 170 112 Zoning District: RC Sheathing: T Owner on Record: FULLER,SUSAN R � ..Contractor Name TODD LEDUC Framing' 1 Address: 333 SKUNKNET RD Contractor Ucense CSSL-106019 2 .,,.. CENTERVILLE, MA 02632 `k Est fiProlect Cost: $3,000.00 Chimney. Description: Air sealing and insulation of attic flat,kneewall slope,kneewalls,and Permit fee: $85.00 �f Insulation: ee Patl $85.00 common walls. f Project Review Req: Air sealing and-insulation of attic flat,kneewallll�slope,kneewalls, Da#e 9/6/2017 Final:and common walls. "� 5 Plumbing/Gas � :Rough Plumbing: 4Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by Yhis permit is commenced within siz months Merg issuance. - Rough Gas: All work authorized by this permit shall conform to the approved application and the`approved construction documents-for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by 1avrs and codes. � Final Gas: This permit shall be displayed in a location clearly visible from access street or road�nd shall be.maintained open for publicinspection for the entire duration of the work until the completion of the same. a - : . Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Bui ding andFire OfficialsFareprouidedon°thpermit. Service: Minimum of Five Call Inspections Required for All Construction Work: ` z 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 ofconstruction. 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 final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable �R E�aT 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-2052 Date Recieved: 6/29/2017 Job Location: 333 SKUNKNET ROAD,CENTERVILLE Permit For: Building-Insulation-Residential Contractor's Name: TODD LEDUC State Lic. No: CSSL-106019 Address: East Greenwich, RI 02818 Applicant Phone: (401)965-8578 (Home)Owner's Name: FULLER,SUSAN R Phone: (508)771-9441 (Home)Owner's Address: 333 SKUNKNET RD, CENTERVILLE,MA 02632 " Work Description: Air sealing and insulation of attic flat,kneewall slope,kneewalls,and common walls. Total Value Of Work To Be Performed: $3,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. - I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the ' Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: todd leduc 6/29/2017 (401)965-8578 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $3,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 6/29/2017 $85:00 X30 -7OC-X3�t7{- Credit Card L.. " 8065 ........ .. .. ..... ...... ........ ... ........ ... ..... ... . ....... ......... Total Permit Fee Paid: $85.00 s y ` _ .�uas" �. ,mo. .�:.:. ate• ,. x�a,,.F, .. ....0 . L f �oFINME Town of Barnstable *Permit# P C Expires 6 months from issue date "s &UMsT"LE,s Regulatory Services Fee� S�f 9 � i639•19 0� Thomas F. Geiler,Director p rFDMA�A Building Division X-PRESS PERMIT Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 MAR 5 1003 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number e C Property Address j U N �T 1/ CL W C�11.tJ a�LCf rh 1a Q?_ib 3 Z aca Residential Value of Work �IP9 Owner's Name&Address 505A&3 5Q 4k 333 Contractor's Name hA J C.VtA-eL StyU t lA Telephone Number -SG$' 1 q 1 3 Home Improvement Contractor License#(if applicable) 2 �1 30 y Construction Supervisor's License#(if applicable) OWorkman's Compensation Insurance Ch9k one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 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 ❑ Re'lacement'Windows. U-Value (maximum.44) Other(specify) 3C, 14. PCO PR. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 4- ***Note: Property Own must sign Property Owner Letter of Permission. Signature c' Q:Fomis:expmtrg Revised121901 Town of Barnstable Regulatory Services 9 BA MA� '� Thomas F.Geiler,Director �A i639. �0 rEp,,9. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize /�� p� ,�/�.// /) to act on my behalf, in all matters relative to work authorized by this building permit application for(address of job) p nature of Owner Date LE2- Print Name r fie �ornmzaouaea��z �`�aaeczc�auaelta Board of Building Regulations and Standards HOME IMPRRVEMENT CONTRACTOR RegistrAon `.;,.127304 -.. • 1 � 4,�'icpii[at�c�r< _1�i�12004 Priate Corporation I MICHAELJ.SMITG Y 7._; _s ' ICMA-EL SMITH \ 209 IYANOUGH RD !HYANNIS,MA 02601 - Administrator I l Assessor's -map,and lot number ....o � ... ,............ 1 ,., i" r (�Irk V�:_ - ��F T��♦ T E Sewage Permit number S' S :. �....... } Z BABBSTABLE, i House number ......... - 90 ruse :......f........ .^ ...., O i639 9� '�E0 YAY{►� r y TOWN OF - BARNSTABLE BUIPIN.G INSPECTOR �-- � /aAPPLICATION FOR PERMIT TO ................� ..�../' `J�,:......./.../.•. .,...................,....,......, ....................:.. uv r TYPE OF CONSTRUCTION ..................� ... ....... ....... . . ................................................ ............. .-?,�/.............19...... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following infor ation: Location ..............l .n...1....... '......................... ...i ........ `....... "....... ........:............_............................................... ProposedUse ...........::...... .....�.,...... ......��!,1..............................................................................+... Zoning District ......................................................................• .Fire District ........... ................... Name of Owner ..........`f7 �� 1........Address Name of Builder Address ... .. ............................ .......'.r........... .................. Name of Architect I..i 1, �.>".�:....... � //...Address .r`-.!....C .f..!.../ .f ..................1 / 57— Number of Rooms ...:.......... ......................................Foundation ...(.�,��� ........... ............... ................................ Exterior ,.............I....!� ...Roofing �............................................. . . .;. : ..................................................... r t . Floors �^ 4) ?Xy .....................................Interior ..... !' /. Heating.........!,' /....................................................... .Plumbing .. . !/...� .`� [ .� ................. 'v' Fireplace ......... ...........................................................Approximate. Cost .........a..........J. ...... .................................... Definitive Plan Approved by Planning Board _____ I9��__. Area Diagram of Lot and Building with Dimensions Fee i SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar'�d'ing,,the,"above construction. r r Name ...y !�f:r F �' /. a'r`"_ � oConstruction Supervisor's License ................................,.... S L S TRUST A=170-112 27946 �- Story No .... Permit for ..................................... Single Familylbwelli g .......... ................................ ........... .... ..... Lot 650 , 333 Skun t Road Location ................................................... . .......... Centerville ............................................................................... . S L S Trust ` Owner .................................................................. Type of Construction .....Frame...............„.....„ ................................................................................ Plot ............................ Lot ................................ Permit Granted ..May....31......................19 85 Date of Inspection ....................................19 Date Completed ......................................19 t^. -�-.3'ti'� :;r• w`�—�...-^ .--a•- .,.,s _ :.�.. 7:'.. � . ...•.y., 9/•+i�S _.w..a:'w�;.�.' rst .-w.�r_.,.«tt�[sa�$!.1= �a7ie:Y'iffk .f o TOWN OF BARNSTABLE permit No. ___2794- --------------- Building Inspector 1 U.MAU i =i Cash -------------____-- Bond' - X OCCUPANCY PER iVI(T - ----- Issued to $ L $, Trust Address Lot 650, 333 Skuunknet Road, Cefiterville Wiring Inspector � � � Inspection date ,� r Plumbing Inspector/'//-r .K µ� Inspection date , r �► Gas Inspector ��� ' Inspection date �����,_n� � X Engineering Department's �!? 1' � � � Inspection date/f-/ Board of health l_ Inspection date THIS PERMIT WILL`NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ............... I9_...._ _.... ..__........._....._........._._ Building Inspector ��P,,� •�ew TOWN OF BARNSTABLE BUILDING DEPARTMENT 2 seaaaT TOWN OFFICE BUILDING FAAM b 9• �� HYANNIS, MASS-02601 �o r�r�• MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued' for the building authorized by L u BuildingPermit #._ ............ ... l ........ .............................................. ....:.:.. »....».... ...........» ..»»..». issued .to .............. ».._,. .......». . ,...»........ ........ ........... ............................................................»....»...».....:»» ».........»._.r».».... Please release the performance bond. J t{ 1 /1 S Z3o r N �i 3Z' _. 3l Ex�ST. a GAR•a 1 N �uMO. N 4 is LOT 640 � o h LOT 650 /Z/,78' s 30o i¢� 53• w of �q�ssAc Si�L/�/� /C/� T -e o WILLIAM �s M. WARWICI: No. 13770 � s GISTER`` L Lla��i On the basis of my knowledge, information and *F0L/ND,477O/V CERT/F/CAT/ON belief, I certify to The Town of Barnstable, The Boston Five Cents Savings Bank and Ticor Title Insurance, Co. that as a result of a 'LD7- 5&L/NK/VE'T 1F0 4Q survey made on the ground on 5/Ih , I find that: The structure (s) are located on the site as G'ENTE"if'�//LLE, �•9.55,shown. The title lines and lines of occupation of the site are as shown hereon. The site is situated in .Flood, .Zone�oh- . azXVP ,L Community. -an el .S 20 io. Date: �.oV , /585" .Z'.CILE / =30 Date: 5/Zo William TT. ,,arwick,RLS W�Kwi�K��55oc, 1,VZ . Assessor's map and lot number .:... ..... pFTHETp 5`.5.. ..�.. ... ...�..... Sewage Permit number .......:..... SEPTIC Sy$1'E�Vi ��� �� INSTALLED TITLE yL9Ay a = BAaaSTADLE,,► Housenumber ........................................................................ W 9 MAIL ENV1RONmENTAA.L COD* ° ara`e TOWN OF BARNSTWBtE BUILDMO INSPECTOR APPLICATION FOR PERMIT TO ..�..... .:. � I�. .... ........ . ..... ... ............... ....... ...................... TYPE OF CONSTRUCTION .................. .. ....... ..... ... ........... ....... . ... .................................... TO THE INSPECTOR OF BUILDINGS: The undersigned h eb�plies for a permit accord* g to the following infor ion: Location ............. ... V....�.....CY... ....... � .. ...!...� ..... ....... ................. . ProposedUse .........` &.. .. ..�.�/.... .......................................................................... Zoning. District .......... ............ .......................... ...Fire. District ........... Name of Owner ..........�,�? ....,�... ..,1 .......Address .... ��.. /� ��; ... ,�Q�. .Name of Builder .....� .......Address Name of Architect. !. /. .....V.✓...L..`'� /.!...Address .. G .�l � Number of Rooms ................ ..................................................Foundation ... . .......................................Roofing �j Exterior ......... .. .�1��• ..... ��'/ �•i .C � Floors ....................Interior ......y�,�/' / • ' ................................ Heating g � t�i /�� ......................... ...... Plumbin .... Fireplace ........ . ........ ............. I......................... ......................Approximate' Cost .......... ............................. Definitive Plan Approved by Planning Board ______ �� 4__ C (/ ---------------------19-�--. Area ............ .... ........................ #. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable reg ing the above construction. Name .. .... . .......................... j Construction Su rvisor's License .. ........... ......... ..... L S TRUST y t 2 7946 permit for .l i Story fJo ............. ................... Single Family Dwelling ............................................................................... ; Location Lot 650, 333 Skunknet. . ....Road " ......... Centerville . ....... .. ............ .. Owner ..........I'...5.....Trust............................. Type of Construction .......rame............ ..........? 1 _ � r Plot ................. . ............................ Lot................ � .r• j May 3.1, 85 Permit Granted ................ ....... .19 Date'of Inspection ................................... .19 Date Completed fad r f dr/ e f< .F oF«rT 'own of Barnstable ,L01 161051 Z r *Permit# 0 r E rpires 6 morn!/rs front issue rlafe s -Regulatory r�ervices rp"r � > YFee a Thomas F. Geiler, Director , I� Bit Iding Division Tom Perry,CBO, Building Commissioner. 200 Main Street, Hyannis, 1vfA 02601 Y .p= •.., s4 4_ www.town,barnstable;rna.us ` Office: 508-862-4038 Fax 518 790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL�ONLY, iVof Valid avlthotl RedX-Press Irrrprirt/ 170 2 Map/parcel Number_, J: Pro erty Address Residential Valueof_Work � - ' f' Minimum fee of35.00 foi w"ork'urider S6000.00' Owner's Name �C Address (� B/ e e, w Contractor's Name t ,A/J� ti.�o®/y Tele Flione,Ntimber 9 ° ®= Home I rovement Contractor-License #(if applicable) Cons uction Supervisor's License#'(dapplicable) Workman's Compensation Insurance Chec ne: k " Ej.I m a,solcproprietor am the Homeowner I have Worker'sC.ompensation Insurance` <, Insurance.CompanyName )4co� ' Wo'rkman's Comp, Policy# gJ. Copy of Insurance Compliance Certificate must ad orripany each permit r ¢ - ° " Permit Request (check box) n` t .. •._ .' r a, 5 ,. .. Ej Re-roof(hurricane. nailed) (stripping old shingles) All construction debris will be taken t' •Ej�Re-roof(hurricane n11iled){not stripping. 'Going over, exrsti,ng Jayers of roof) r +~ R side 4, #ofdoorsY Replacement Windows/doors/sliders. U-Val" .�i (nazimum .35)#of windows *Where required: Issuance of this,pwnit does not exempt compliance With other town depa rtment regulations;i e. Historic Conservation,etc ***Note Property:Pwner must sign Property Owner Letter of Permission. 4¢ Y A,copy of the Home improvement Contractors License & Construction 5 required upetvisors License rs a . . i_ YNATURE: V('PILESifORMSIbuildin' pcnriii forrnslEXPRf S.S.rinr "'s 4 r The Commonwealth of Massachusetts .�Department o De art Industrial Accidents P 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 Legibly Name(Business/Organizatio ividual): )) t�� S SOGJ./II G Address: /$ T City/Sate/Zip: kL Phone #: 40I' Are ou an employer?Check the appropriate box: Type of p ject(required): 1. I am a employer with 210 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. VRemodeling ew construction 2.El am a sole proprietor or partner- listed on the attached sheet. 7. ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have-workers' � y p tY comp. insurance.: 9. ❑ Building addition [No workers 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 11.❑"Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs 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. $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: RCt' n l /1/ U U�41 Policy#or Self-ins.Lic.#: 0 Expiration Date. Job Site Address: JIVAIdPof 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: � ^-�.- Date: _ Yd 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#: r CERTIFICATE OF LIABILITY INSURANCE oPID sR :DATE(MWDDNM) MOONA-1 10/05/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A(MATTER OF INFORMATION 1= ► ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old River Road, P'.O. Box'1; ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI. 02$38-00d1 Phone:401-769-9500 Fax:401-769-9502. INSURERS AFFORDING COVERAGE NAIC# INSURED Moon Associates Inc-.: INSURERA: uational Grange.Tnanranae Co, 14788 DBA Gutter Helmet DBA Renewal bar Andersen of RI INSURER B: Beacon Mutual DBA Gutter Helmet Roofing DBA Moon Works INSURERC. . 1137 Park East. Drive INSURERD: Woonsocket RI 0289S INSURER E: COVERAGES THF-POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED.BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH. PQLICIE$.AQ.QRFGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: LTR INSRE TYPE OF INSURANCE POLICY NUMBER. DATE(MMIDDtYYYY) DATE(MM1DDNY)4) LIMITS GENERAL UABIL I TY EACH OCCURRENCE $ 10 0 0 0 0 0 A X COMMERCIAL GENERAL LIABILITY MPS2661:9 09/16/lo 09/16/11 PREMISES(Ea occurence) $500000 . CLAIMS MADE 1XI OCCUR MED ED'P(Any one person) $10 0 0 0 PERSONAL&ADV INJURY $-10 0 0 0 0 0 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 0 0 0 0 0 0 POLICY EC LOC - AUTOMOBILE LIABILITY' COMBINED SINGLE LIMIT $ 10 0 0 0 0 0 A X ANY AUTo BIS26619 09/16/10 09/16/11 (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 OTHER THAN EA ACC $ . AUTO ONLY: AGG $ 10 EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $1000000 A X OCCUR CLAIMS MADE CUS2661'9 69/16/10, .09/16/11 AGGREGATE $' $ DEDUCTIBLE $ X RETENnON $10000 $ WORKERS COMPENSATION - - STAI - AND EMPLOYERS'LIABILITY TORY LIfv1RS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N❑ 28586 1.0/01/1.0 10/01/11 E.L.EACH ACCIDENT $500000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500000 If yes;describe under SPECIAL PROVISIONS below .. E.L.DISEASE-POLICY LIMIT $50 0 0 0 0 OTHER - DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Moov;ASS 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 REPRESENTATIVES ACORD 25(2009101). ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD _ re ~ `or A Won ' ' Te = - - _ '#I. ow . OO .�-c V!- tiEar _ y : aesYkm UMOSS jA PAINNIE ROAD • ' r R!02864 Jan 2311 12.23p dim5U8 fib 3938 P- ::37 Put E=orwe uaq:c tzu9ysAs35t[saaa+usacaenrrci `"",S Mao<usxie:,.Arodetdar047E95 6 W,v.nd:D5427)9iMarnArsoaaRSarW � . 7 •-' tA�tffi a_295t3{Nm•t As�tt:s Vti 1 _ �.r�r:i Pwrdtare rioter S V S N h,g t't^;<T T �=V L €�Z cis) tnstalle.A �z� �i• ;, r� P,.�? C s,�cs @. G�Li Mailing Aedoeas stoma Phone:,boy-771 9r41 Celt Phone: �rrgit tear lfdme fiViR: 6etomer btlHak:4� Teas Paid bt Tawn ef. R4 w kf SZt B' -J—e t/We,the above purdwseris}11tachasei(si.)and the ovmeris)of the property tdcawd at the abw*iasra@azwn adorers,neraby jointly and seaeraihr agree to Cmraact with!,door•Associates,mr.(' oomivorW)to fum.st,deliver,ated irtsto of a4 materials as described in this agreement(`AWeemerit"),t--ne amtebed Spec Sheet(s)artil wragraails)which are ietofobtated here,nby reference one made a putt haeuf.A Compietian CeitiFcate will be exearted for al bos at the end of the iasaliation. Order tr ur bev. �- _ N mber oTYPpre)ectTVpe: P e: AgreemrntArrount 7A�7 OPrrod HTu'mlP� IAR' 61tAtrouoc S Agreemerr.Amount S Less Deposits S ii Less Depodi s S _ tees Omens Balance Die Ore ComPlubw S. `�1 i 8alamte Due On Cotrepledon S eaiarice owe On Comwietksn S I2Nip mum 33YOrP&Remerl AeauNt nw WaM1 mecWa"- iNtin4wn33kd1�RM�MlimGYc�R.6>r tiEunimr- i\wlo.rr 33tdApRenie+tlM�'�t�9m ceeetic4 i,r�catePaynce,tcMethod For ettima mdkaarray,.ds McOWFor0abnm meatodr<oraatance Due at Time of Installation: Due at T'aoe of Installation: Dal at Torte of lnstallatMm v Es:.Start Date: Ea Comp at on Oates Est.Start Date: I Est t orrV etixh Dare: fist.Start Data cA.Completion Date: DEPOSRtPAYMENTOPTIONSI,swWatoturnveritkattwandler�a a4 L Chid tasbie*'s Cheek or i3ilOtrey Otter ate 3 Financing (Made payabte to Moonworks) A=e47Q�606 -V iCy 93i:3 Approval C. 2 Credit Card'icark) Visa MasterCarc D sucver Aect b_--- Approval Code •NweatrrerouroarMoanwrbtoihmPirzrerwmed<rerbt cud txeudrpoci'aemwt Accce Expoate tecarityCode bwwedes+nm acecnysde�c�two wnxcom»ranet:^mamma atw+fs�r. H Is agreed by and between tit Pam tW this Agrrdrnent WnsHtutes tlw Critics understanding betweaft the Partles,and there one no verbal urtderstaadmBi cha prig or tmWftrig arty of tha terms of this Aigmmwm purchase(s)hesebyadawwtedgea thi d Pwdaser(s)1)has read the front land reverse of this AgrWalat acid has received a completed.signed,and dated cM of this Agreenvant,Including the twos aecatrtpr "Olke'el CartoMallon+forms,on the done FYee wAetan above and 2)was orally futormed of hk fher rkht to artoal thk VennacHwt.DO Nor SKIN TM CONTRACT IF THNE a1ANKSP Purdha Purdu err Signature Srgnattre �lore �i�+iAR J�aaaeti77 jr1LL4 4 !s/•r ,�.OSS91Yi 5 L Pr nt Na ne Print Name Print Name YOU,THE BMVgs),MAY CANCEL THIS TRANSACTION AT ANY TINE PRIOR TO NUDNKWT OF THE THIRD WSWESS DAY AFTER THE DATE OF TW TRANSACTION-SEE THE NOTICE(W CANCELIATK W VOW BELOW FOR AN EXPLANATION OF THIS pKaHT. N�tSTICFyO�P�rA/a9�LLaTtON_ � awnnr�ttF CgI�P�.� Date of Trartsinaian_ l= Date of Transaction :a-2 J/ You may Cancel this irartsaction,without any Penalty a obligation,°Ytm may cWel this lransac&N without eny penalty cc obTrgatron, viXlrin three business days ham the above data.d you cancel.any tadtldn three btoltaess days frmne'be above date.B'You cancel,any property traded In,any payments made by You 1"Wer the Contest or property traded in.any Pftwmft rtsade by You tmdae the Contract tar Same,and any negodahte Instrument uscuted by you Will be returned Sale,and any ruble kd&ij anent et ecated by you will be reUarted within 10 ftp fdbWfng secelpt by the Seller of Your cancellation wWa 10 days folloaring receipt by the Seller of Your ca"diebam netke,and any security interest arising out of the transution will be amlae.and any security(ntaxest er gout of the transaction wit►be your canceled if You cancel,you must stake milabie to the Seller at Your en eaWd.if You cgnce.Yet must maW available to Hie Seiler at your residence,in substintlally as good condition as When received,any rgsidagw, in subs>tamillaUy as good condition as when received, any goods deXsrered to you carder rids Contract err Safe;or Y"may,If Yw+I delivered to You under this CUMCt or Sale:;or V-may,it you wish,mm(sy with the irLstructioos Of the seller reptditdg the return whit,comply wish the ImsttveHores Of The SeW regardin8 the rat," dniptmnt of the®Dods at the Sdkn expense and risk.if you do make, s ttl imtrrt of the goods at the SeDes eapetwe and 11sk if you do snake the®Dods available to the Seiler and the Seller do"not Pict them uP the go04b rallahte to the SeOm and the Sekar dons not pkk Hera up wither+20 days of the date of your Notke of Cancellation,You may within ZO days of the date of your Notice at Canceffatinn.You imay retain or disport of the goods without any further obligation.If you retain or dispose Sepik of ose Sep MNhttut any further oftaidon. If You fail to make Me goods available to the Seller,or it you agree to retum tail to make the goods ayaiWbk to the Sadler,Of If ytru agree to rmleen The goo&to Hie Seiler and fay to do so,that You remain mme for the Soles to cite Sdkr and fait to do so,then You remain Gable for PerfWmana of as cbXgatidms under the Contract. To once!dos peff rvnance of all obtigFbona under the Contract. To cancel this transaction, malf or deliver It signed mW dated copy of this taaluaclion, mall or deliver a danto and doted Copy of this eaocellattion notice or any other written notice,or send a telegram to muffiloonnotice or any ofhet caftan siodce,or and a WeVam WandMOOW#IMS, 113J Park East Off", Woomsecltet, Rhode tIWW N►�ntaosita, in? part !Fast Drive, WOMMKIIist, 02✓L05,NOT LATER THAN MIDM IjT OF� --Z C-1/ (Detal• 02�5,NOT lAtER THAN MIONiGHT OF�L 1 (Daft . I HEREBY CANCEL'TFRS TRAWACTION. I HEREBY CANaR Tifo3 r$ARIgAGTfON. Consumees signature Oaet �Contalma/ss Fite-- REP VIER