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La_L_ -11__�L"I., _�_, _�"._,___�,� � ,_ � '_ - - ,,­,,�,,, ,,,, - �, c, -. 0 Town of Barnstable Building 3 Post This Card So That it is Visible;From the Street Approved'Plans Must be Retained orrJob and'this Card.Must be Kept ena�ra�rt s es (Posted Until Final Inspection Has"Been Made Permit Where a CextificateN-ofvOccupancy:is Required,such Building shall Nof-be-0kccupied.'intil a-F nal Inspection has.been made ) �.. - _ ._ ._. Permit No. B-20-116 Applicant Name: DEREK MULLIKIN Approvals Date Issued: 01/29/2020 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 07/29/2020 Foundation: Residential Map/Lot: 193-017 Zoning District: SPLIT Sheathing: Location: 139 HILLSIDE DRIVE,CENTERVILLE - Contractor Name.:-,DEREK MULLIKIN Framing: 1 b 2-0 Owner on Record: HODNIK,CHRISTOPHER&CROSBY,SANDRA � � Contractors License: 172972 I 2 Address: 167 WICKS LANE -- Est. Project Cost: $ Z0,000.00 Chimney: �- Y: - MALVERNE, NY 11565 Permit Fee: $ 152.00 Insulation: / Description: remodel bathroom in basement. new flooring coretex, new fixtures Fee Paid:." $ 152.00 -shower, pedestal,sink,toilet. +" Date. r' 1/29/2020 Final: Add.lights � ' _ - ~'�^ . Project Review Req: Plumbing/Gas . 'Rough Plumbing: Building Official' Final Plumbing: m i nThs'aftersissuance. This permit shall be deemed abandoned and invalid unless the work authorized by thislpermit is commenced with "'six mo . All work authorized by this permit shall conform to the approved application andthe`iapproved construction documents�for which Rough Gas: All permit has been granted, i; All construction,alterations and changes of use of any building and st`uctures 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. { 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: . Service: 1.Foundation or Footing ' 2.Sheathing Inspection _w _ « TM 3 Rough: 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 Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 1 S� ta7�a� . Town of Barnstable Buildifig. yPostTh�s Card So;That rt is Uis�ble,FromtheStreet Appcoued PlanskMust be Retained on.Job andthis,Card",Must;be Kept + AABi.E. $ 'z:`5.`� ', "°� ','. »; P ;.t fi`. 3� r v iPosted UntilFinal InspectionHas✓Been:Matle " Where a Certificate of Occ'upancy�is Regwred;such Building shall Not be OccupiecJ until a Final In pe�ctionyhas been made Permit tea. 3�s.....,,x 2�..�,..,,, ...w "._-aa«"a' �,..,.,...�k'. r �,�,.a.. >r"-,.�...,.. ,. w.��.,.,,� .:d2a.>.......�-�..,_�_.. �.. a:.::�.... - ...'as,�a..� ..�... ,..� „_. .:,.,,.,.w,..�.s..-„ ,=.a...,�,-sue t .,f.. .........,Ma, .1 Permit No. B-18-3503 Applicant Name: ROBERT K BOUCHER Approvals Date Issued: 10/25/2018 Current Use: Structure Permit Type: Building-Smoke Detector-Fire Alarm Dection Expiration Dater 04/25/2019 Foundation: System Map/Lot: 193-017 Zoning District: SPLIT, Sheathing: Location: 139 HILLSIDE DRIVE,CENTERVILLE ' Contractor Name: ROBERT K BOUCHER Framing: 1 Owner on Record: CROWELL, BEVERLY M Contractor License:" 1317 2 Address: 139 HILLSIDE DRIVE Es't Project Cost: $2,000.00 Chimney: CENTERVILLE, MA 02632 Permit Fee: $35.00 Description: INSTALL FIRE AND CARBON MONOXIDE TO CURRENT-CODE AS PART Insulation: OF NEW SECURITY SYSTEM. "SEE PLAN" Fee Paid:' $35.00 Final: Date: 10/25/2018 Project Review Req: ` Plumbing/Gas } . l�u i Rough Plumbing: Building Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six,months afier':issuance. Final Gas: All work authorized by this permit shall conform to the approved application'and the`approved construction documents#or 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 zoningby Iaws and codes. This permit shall be displayed in a location clearly visible from access st�eetaor road and'shall be maintairied operi"for public inspection for the entire duration of the Electrical y work until the completion of the same. s x Service: The Certificate of Occupancy will not be issued until all applicable signatures by;the Building and Fire Officials,are•provided on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work:'' 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Final: Whereapplicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with unregistered contractors do not have access to theme guaranty fund" (as set forth in MGL c.142A). Final: Application N=ber..g....LU......... QQ ELAFM . . c�3 2®�u Permit Fee ......:.....................®�� ...........OtheaFve........................ KASEL TOWN OF B RNSTp,�LE - ATotal Fee Paid..................................................................... Permit Approval by... ....Aa....!.o�Zs�i 8..w TOWN OF BARNSTABLE ..........._......... BUILDING PERMIT :.........:� . :..........Parea..:........ ...................... APPLICATION ,, s S� - Section 1 —Owner's Information and Project Location Project Address 1 /T/ a Vie Owners Name Ce 6 S 19' em ��- owners Legal Address k-1A State /�'l/ Zip 07s&-3z Owners Cell# E-mail Section 2 Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet e/Two Family Dwelling Section 3—Type of Permit ❑ New Construction ❑, Move/Relocate ❑ Accessory Structure . ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty --Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System t ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 -Work Description e-s e, w T-90 imp:2192Ol R Application Number..................................................... Section 5—Detail Cost of Proposed Construction Square Footage of Project /JO Age of Stvcture �{� Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) Z 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics Wiring ❑ Oil Tank Storage Smoke Detectors ❑ Plumbing ❑ Gas ' 0 Fire Suppression ❑ Heating System ❑ Masonry Chimney ' ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway i Debris Disposal Facility: I an using a crane ❑ Yes ❑ No J Section 7—Flood Zone 1 Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ Section 8—Zoning Information a Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required -Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No r astimant-4 2/9rz019 g L f c S REVIEWED y G C.- ri A UI I EPT. DATE car FIRE DEPA EN DATE BOTH SIGNATURES ARE RE UIRED�FOR WIZING 11t j-- Barnstable Bld .Dept. r T oil. , Approved by: Permit :. ti p 0 VIA- r Pm Or TNT ,�FT Gfl ow amma f T'be Commonwealth ofMassachusetts. Department of InduMial Accidents 1 Congress Street,Suite 100 Boston,MA 02114 2017 wwly mass gov/dla Markers'Compensation Insurance AMdavit.Builders/Contmctorsalectriclans/Plumbers. TO BE FILER WITH THE PERMTnNG AUTHORITY. Apniicant Information Please Print I.el>ably Name(BusineworganizationMdividtw): amide Alarms Inc Address: 1265 Route 28 City/State/Zip: South Yarmouth,MA 02664 phone#: 508-394-0599 Are you an employer':Cbeck the appropriate box: Type of project(required);. I.2 1 am a employer with 19 employees(full and/orpart time).= 7. ®New construction 2.FJ I am a sole proprietor or partnership andhavemo employees working for me in any capacity.[No worke comp.insurance required.] 8. 0 Remodeling rs' 3Q 1 am a homeowner doing all work myself[No workers'comp.insurance required.]It9• Q Demolition . 4.M1am a hameoivner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.®I am a general contractor and I have hired the sub-contractors listed on the attached sheet ❑ These sub-contractors have employees and have workers'comp.insurance? 13. Roof repairs 6.Q we are a corporation and its officers have exercised their right of exemption per MGL c. 14.MOther alarms 152,§1(4);and we-have-no employees.[No workers'comp:insurance required.] CAny applicant that checks box#]must also fill out the section Flow showing their workers'compensation policy inforatation. t Homeowners who subunit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, rContractors that check this box must attached an additional sheet showing-the name ofthe sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide.their workers'comp,policy numbm I am an employer that isprouldi gworkers'compmadon Insuranceformy eWlayees Below is tlaepoilcy undjob site information. Insurance Company Name:Associated Employers Policy#or Self-ins.Lic.#: WCC50050128332018A Expiration Date: 2125119 Job Site Address: All sites in �u��c City/State/Lip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to S 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.A copy ofthis_ statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cei*under thee pains mrdpenalties ofpegury thattlte information provided above is t rue and coral Signature: 044,31 �`�1 f� 3 r�O� Date.• Phone#: 508-3944=0599 Official use only. Do not write in dds 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/Towne-Clerk '4.Electrical ksspector. 5.Plumbing Inspector 6.Other Contact Person: Phone k Fold,Than Detach Along All Perforations _; tC3MM®NIIUEATH 4F 1Ul, a^SA •3ES t = =ISSUES TEiE�OU_OWII+IG UCE�ISEAS A �a ��' ' r _. REGF`ySVT�REl7 SYS i EM�CO� �. ,� . r E QBERT K BOUCHEi " I SIDE ALA INC r 1266 ROB :a: z S YARD OUTH,MA zih Zk — i s kl'D is im Commonwealth of Massachusetts Department of Public Safety License:SSCO-000046 r � Security Systems-S-License ' . ROBERT K ROUGHER =� Employer'.., " • ,_.. _ SEASIDE ALARMS INC'. Expiration: Commissioner 01/06/2019 - - - L o COMMONWEALTH OF MAMA HUSETTS BOAF40 OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A REGISTERED SYSTEM CONTRACTOR ROBERT K BOUCHER _ SEASIDE ALARMS INCZU W 1265 ROUTE 28 2 W S YARMOUTH,MA 02664-4455 � f �J 1317 07131/2019 117771. ' ------------ Application Number........................................... Section 9—.Construction Supervisor Name_ S / ram. Telephone Number 3 - oS' Address City. �•^v State /fut Tap License Number 7 License Type Expiration Date z --,r t Ll Contractors Email Cell# I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CUR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature h �,. s-4 p 1�c; 04", 1— Date Section-16'=Home Iniprovement Contractor Name Telephone Number Address City State Zip } Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780_ CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town ofBarnstable.Attach a copy of your EUC..., Signature Date Section 11—Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsrbrlities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and. documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature /_a(fG�. i'� (��ts, ,�'� Date it Print Name Ro 3,4,.'A-I �if� �,� Telephone Number E-mail permit to: n in nm o Section 127 Department Sign-Offs Health Department ® Zoning Board Cif required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ - Conservation ❑ ' For commercial work,please take your plans directly to the fire depofta t for approval i Section 13—Owner's Authorization I, J_*"kC-EXI 620_sd)/ , as Owner of the-subject property hereby authorize se50-s'rac to act on my behalf, in all matters relative to work.authorized by this building permit application for: /3 9 /fiL_S E Ae-1UF 6EL-,7,F;r_V 1U_,G- , Ms� DL63Z (Address of j ob) eT. /7/ / Si a of Owner date Print Name Last=dat:a:7J92018 Town of Barnstable *Permit# 63� � Expires 6 months ront issue date Regulatory Services Fee Thomas F.Geiler,Director Building Division 0 (ollgto� Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint [ap/parcel Number \,Ck'S •- ( roperty Address rj i} s� ��- U (( w .Residential Value of Work Jk000 Minimum fee of$25.00 for work under$6000.00 1wner's Name&Address A .ontractor's Name �,orr� �\ 6���'e tA Telephone Number [ome Improvement Contractor License#(if applicable) 0+"S `< � « �\ S.. • Hl .� - -• -- - 'sor'-s-L�cerrse-#-(�appiieable)_ ]Workman's Compensation Insurance Check one: PERMIT ❑ I am a sole proprietor ❑ I am the Homeowner JUN 1. 2 2008 bg I have Worker's Compensation Insurance rsurance Company Name � `�F'�V 2.�'-�'+P� TOWN OF BARNSTABLE Vorkman's Comp.Policy# �� .opy of Insurance Compliance Certificate must be on file. ermit Request(check box) M—Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. YGQA! l ***Note: ^perty Owner ust sign Property Owner Letter of Permission. A py of the o prove ent Contractors License is required. SIGNATURE: - OS 8 ��' � Qt' i:Forms:expmtrg g�a{� f'ZjV .evise061306 = The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): . �n ^� Address: -6SON City/State/Zip: C! xk�� A- Phone.#: 5�0�-�'lc�-�` 3-�E(o C Are you an employer?Check the appropriate box: Type of project(required):. 1.M-I am a employer with _ 4. ❑ I am a general contractor and I * _ have hired the sub-contractors 6. New construction . employees(full and/or part-time). 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers'$ 9 ❑Building addition [No workers comp. insurance. comp.insurance 10.0 Electrical repairs or additions required.] 5. We are a corporation and its 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•N-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. lContractors 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 insurancefor my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M -Ica!�" YJ " C z:- Expiration Date: ^®�6 Job Site Address: A, r �' Q-- City/State/Zip: i-21Aet/U�\��t G`1 C..3 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 Investi ations of the DIA for insurance coverage verification. I do hereby rti under tl -and enalties of perjury that the information provideVaboveistrue and correct: Si ature: Date: Phone#: rOffficial use only. Do not write in this area, to be completed by city or town official 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#: 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 local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter...152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with'the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the 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 to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number:. The Commonwealth of Massachusetts Npartment of Industrial Accidents Office of Investigations 600 Washington Street Boston,.IOTA 02111 Tel. ##617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 w .mass.gov/dia ofIVHGE � Town'.of Barnstable Regulatory Services , _ �wxxsres=e, ' Thomas F. Geiler,Director MASS. 9�p�En ►`�� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 S Fax: 508-790-6230 Property Owner Must . Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize S to act on my behalf, in all matters relative to work authorized by this building pe=mit application for: ke '�)\c (Address of Job) a � Signa e of Owner Date Print Name Q:F0RMS:0WNERPERM1SSI0N RightFax N3-3 9/7/2007 1 : 32 : 06 PM PAGE 003/003 Fax Server ACORD.., CERTIFICATE OF INSURANCE DATE(MM\DDWY) 09-07-07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE TD BANKNORTH INS AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 14 LOTS HOLLOW RD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE ORLEANS,MA 02653 COMPANY 26T7F A TRAVELERS DIRECT ASSIGNMENT INSURED COMPANY B STANLEY DEAN COMPANY 359 CAPTAIN LIJAH ROAD C CENTERVILLE,MA 02632 COMPANY D COVERAGE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MWDMYY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTORS, EACH OCCURRENCE $ FIRE DAMAGE(Any one Fire) $ MED.EXPENSE(Any one $ AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANYAUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY f UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY U13-769913142-07 08-31-07 08-31-08 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT.;_; I.,$ 100,000 PARTNERS/EXECUTIVE INCL DISEASE-POLICYLIMIT, $ - '900,000 OFFICERS ARE: X EXCL DISEASE-EACH')=MPLOYEE $ 100,000 OTHER ` ...... DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/RESTRICTIONSISPECIAL ITEMS t :; THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. r f a THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR STANLEY,DEAN. Cl i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF BARNSTABLE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO C/O SALLY MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 367 MAIN ST COMPANY,ITS AGENTS OR REPRESENTATIVES, HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE Charles J Clark ACORD 25.5(3193) i I . .i Gl ✓lie -�o�.v%rwricuealC/ o�.///la.�:rac�accael�a�r —--=------------------- _ Board a;13uildiub l.eeu and Standard License or Hgistration valid;or individul use only HOME IMPROVEMENT CONTRACTOR before the e.0ieation date. If found return to: Ragistratioh:-.132149 Board.of Building Regulations rt=d Standards Lxpiratiorii 11/28l2008' Tr# 125453 One Aslihurton Place Rtn 130 i'. Type: iridividual Boston M.a.02108 DEAN F.STANLEY DEAN STANLEY 359 CAPT.LIJAH RD CENTERVILLE, MA 02632 Adroinietrst;,r Not valid withcut:signatur l