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HomeMy WebLinkAbout1120 OLD STAGE ROAD r , a � u Ce P 1 o '-D ,oix, I axe Ilao o ' J / r TOWN OF BARNSTABLEIBUILDING PERMIT APPLICATION Map I !�J Parcel o v Permit Health Division Date Issued 313 6)l 6 Conservation Division Application Fee Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis /J o En PsZI_ Project Street Address ( � bOld �i Village ��� � U(/(,,, Owner Address at, 1(ulf-e U)_"ZL* Telephone Permit Request �2�4­1dr Si< s Si od/' si ter' z /��/��`�C_(f cam.c� �l�itis CAI r S����Sr Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District A C Flood Plain Groundwater Overlay Project Valuation W13660 , -co Construction Type Lot Size Grandfathered' ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (#units) � Age of Existing Structure ([� KS• Historic House: ❑Yes W Ko On Old King's Highway: ❑Yes O'No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Areas .ft. Basement Unfinished Areas .ft ( q ) ( q ) 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 Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new sile Attached garage:❑existing ❑new size Shed:Cl existing ❑new size Other. Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ' Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name O l U sb C4 PC IEOLZelephone Number Address License# t f i /nn 4- DO.( Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO au 14 Q 4 ^ I I SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED y MAP/PARCEL NO. ADDRESS r - VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 'FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 01-27-'16 07:27 FROM- Fuller Electric 5087756977 T-353 P0002/0002 F-094 44. tv Iv I I . IVO. I11U I I Town of Barnstabl Regulatory Services Richard V.Scali,Director Building Division Thomas perry.CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 '%MV.to%Vn.barnsbblo.mA.us Office: 508-862r4038 Fax: 508-790-6230 Property Owner Must Complete.and Sign This Section If Using A Builder as Owner of the etro subject P P tY hereby authorize Nile, --�'dl�. ro act on my behalf, in all matters reladve to work aurhori2ed by this'building permit applic tion for: (Address of Job) Sign a of Owner . b e Print Name If Property Owner is applying for permit,please complete the Homeowners,License Exemption Form oa the reverse side. - t C:\Uscrsl�cconiklAppDstalT.00dlMicrosonlWindowelTempore,y lntemes R�eslCbn[enROaUook�2P101DTIRIGXPR6S$,doc Revised 040215 RECEIVED 01-22= 16 11 :24 FROM- TO- Fuller Electric P0001/0001 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,ALL 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Scott Crosby Builder, Inc Address: 1112 Main Street Unit 7 City/State/Zip: Osterville, MA 02655 Phone #: 508-428-9090 Are you an employer?Check the appropriate box: Type of project(required): , 1. ✓ I am a employer with 5 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. ✓ Remodeling ship and have no employees These sub-contractors have 8. Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. Building addition [No workers' comp. insurance comp.insurance. required.] 5. We are a corporation and its 10. Electrical repairs or.;additions 3. 1 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 13. Other employees. [No workers' 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. tContractors 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: , Hartford Policy#or Self-ins.Lic.#: 4727P23-8-15 Expiration Date: 06/23/16 Job Site Address: 1120 Old Stage City/State/Zip: Centerville, MA 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 h for--insurance coverage verification. I do hereby C,61ikhnder thl pains and enalties�2erjury{iat the information provided above is true and correct. Si ature: Date: [ p' jl Phone#: b' -f.��- qD Q,D 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#: tit Massachusetts -Department of Public Safety 1' f Board of Building Regulations and Standards Construction Supervisor. License: CS-043966 SCOTT E CROSB), �� 62 CROSBY CIR %Ls,�",1JIF �y OSTERVILLE WA .a, J � •��,rtir'`� Expiration Commissioner 12/13/2016 ��e�pa�rz»ea�acuecclC/a��`ccsJccc�utef(it Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration: 151882 Type: Office of Consumer Affairs and Business Regulation Expiration 7l13/2616 Private Corporation 10 Park Plaza-Suite 5170 f_ Boston,MA 02116 SCOTT E CROSBY Bl11tpE"R INC - SCOTT CROSBY x 1112 MAIN ST UNIT#7 g � � OSTERVILLE,MA 02655 Undersecretary Not valid without signature r AC40 CERTIFICATE OF LIABILITY INSURANCE °ATE'MMID°"Y"' 16� 10/08/2015 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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 CONTACT NAME: Germani Insurance Agency PHONE FAX 908 Main Street C o 508 428-9194 A/C No): 508 428-3068 Osterville,MA 02655 ADDRESS:certs@Qermaniinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:SAFETY INS CO INSURED INSURERB:SAFETY IND INS CO Scott E.Crosby Builder,Inc. SAFETY INS CO 1112 Main St.Unit 7 INSURER C Osterville,MA 02655 INSURER D:Hartford 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. INSRLTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDPOLICY EFF POLI MMI CDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY BMA0022636 10/12/2015 10/12/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �X OCCUR DAMAGE TO RENTED PREMISES Ea occu rence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ B AUTOMOBILE LIABILITY 3953278 9/7/2015 9/7/2016 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ A OS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccid.nt C UMBRELLA LIAR HOCCUR CM00001805 10/12/2015 10/12/2016 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED I I RETENTION$ $ D WORKERS COMPENSATION 6S60UB-4727P23-8-15 6/23/2015 6/23/2016 STATUTE OERH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N� N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Scott E.Crosby Builder,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1112 Main St Unit 7 ACCORDANCE WITH THE POLICY PROVISIONS. Osterville,MA 02655 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD d. r r p3 - °FjHt=T Town of Barnstable er � Expires 6 monthsfront issue.date Regulatory Services Fee_ .4r- , t BARNsrABLE, MASS. g Thomas F. Geiler,Director ATE MAIA . 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 EXPRESS PERMIT APPLICATION_ - RESIDENTIAL ONLY Not.Valid without Red X=Press Imprint Map parcel Number Property Address residential Value,of"Wort: Minimum fee of$25.06 for work under$6000.00 Owner's Name&Addressy, j.�F. G_c-/�'dL {___ " --- CC �i1► i�r �' �L' l/>VAJC f Y% CP S C:'ontractor's Name— LZ'"j l}` �` �/ Telephone Nomber I tome Improvement Contractor License#(if applicable) Construction Supervisor's License PP # if applicable ❑Workman's Compensation Insurance -PRESSX . I . Check one: [!'I am a sole proprietor D E C 16 2009 - ❑ I am the Homeowner ❑ 1 have Worker's Compensation Insurance : TOWN OF BARNSTABLE Insurance Company Name. 2 vL /' •,s Workman's Comp. Policy# M � Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) [�j 'Re-roof(stripping old shitigles) All construction debris will be taken to El Re,-roof(not stripping. Going over existing_layers of roof) El 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. ***Note: Property Owner must sign Property Owner Letter of Permission. A the Home Improvement Contractors License is required.- SIGNATURE - O.`U I'I ILEY.FORMS\building permiifomis\EXPRESS.do Revised 100608 ! 1 .. �n R L�l E S C 0 R The Roofer's Roofer", TOTAL INVESTMENT ------------- $ 7995.00 '�g POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Tri Replacement Boards,Plywood L Sheathing,Missing Metal Flashing,Sidi Walling or Any Other Carpentry Neeln will be done and charged for as an Extra:'Materials Plus Labor at the Rate of$6&ooper Hour PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this R(i of Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 30 Days ol Acceptance and Receipt of Deposit providing the Materials are Available. Please Make Checks Payable to: C14ARLES COREY CHARLES COREY Warranties the Shingles and Labor for 5 years. CERTAINTEED Warranties the shingles,�n labor 100% for the First 5 Years 1 and the Shingles your ears if the shingles becomes defectm I CERTAINTEED Warrants the Shingles p t a CATEGORY II CANE-1 10 MPH WIND WARRA,, TY CERTAINTEED Warrants the Shingles tb b�Algae Resistant for a Full 10 Years This Proposal MU Be Withdravin By Us If Not Accepted & Q= sited Received Within Thigy Da Or'Bdfore The Next Price Increase In aterials. I CH�RLES COREY carries Workman's Comyensayo and Public Liability Insurance on thd,above work DATE OF ACCEPTANCE: ACCEPTED BY: SUBMITTED BY: LANCE MacENE CHARLES 4COREY HOMEOWNER ROOFING CONTRACTOR The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 , z � www.mass.gov/did Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Of 40, G Address: �twe u City/State/Zip: Phone #: �7-/4 `p Are you an employer? Check theappropriate box: Type of project(required): 1. am a employer with _4> 4. ❑ I am a general contractor and I 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' 9. ❑ Building addition [No workers' comp. insurance comp. insurance,l required.] 5. ❑ We area corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL' 12. oof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers 13.0 Other, comp, insurance required.] *Any applicant that checks box tf l 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. tContractors 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: S Policy# or Self-ins. Lic.#: Expiration Date: /Vze ` Job Site'Address: ash City/State/Zip: ( '�.a,I U ✓tilt�So 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 crrfy a der the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: m 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 S. 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 o'f another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporatio2,or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal represeptatives of a deceased employer, or the receiver orlrustee of an individual, partnership,association or other legal entity, employing employees. However the owner of a Aelling house having not more than three apartments and who resides therein, or the occupant of the dwelling houses of another who employs persons to do maintenance,cons action or repair work on such dwelling house or on the grounds building appurtenant thereto shall not beca/eptable ch employment be deemed to be an employer." MGL chapter 152, §§2+5C(6)also states that"every state or localg agency shall withhold the issuance or renewal of a.license or permit to operate a business or to conuildings in the commonwealth for any applicant who has not�`roduced acceptable evidence of compwith the insurance coverage required." Additionally,MGL chapter`152, §25C(7)states"Neither the conalth nor any of its political subdivisions shall enter into any contract for.the performance of public work until evidence of compliance with the insurance requirements of this chapterkave been presented to the contractirity." Applicants Please fill out the workers' compe ation affidavifee lete ,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)n�me(s), address(es) n phone number(s)along with their certificate(s) of insurance. Limited Liability Compam\e (LLC)or d iability Partnerships (LLP)with no employees other than the members or partners, are not required toarry worpensation insurance. If an LLC or LLP does have employees, a policy is required. Be advise that thavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application permit or license is being requested,not the Department of Industrial Accidents. Should you have any questiording the law or if you are required to obtain a workers' compensation policy,please call the Departmentatmber listed below. Self-insured companies should enter their self-insurance license number on the appropriate li City or Town Officials Please be sure that the affidavit is complete an rinted gibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event t e Office o Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license nu ber which wi be used as a.reference number. In addition, an applicant that must submit multiple permit/license ap ications in any 'ven 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 be n officially stamped r marked by the city or town may be provided to the applicant as proof that a valid affidavit is n file for future permit or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is taining a license or pe r-A't not related to any business or commercial venture (i.e. a dog license or permit to burn leav s etc.)said person is NOT\quired to complete this affidavit. The Office of Investigations would lik to thank you in advance forooperation and should you have any questions, please do not hesitate to give us a cal The Department's address,telephon and fax number: The Commonwealth of Massachusetts Department of Industrial Accident's Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617427-7749 Revised 4-24-07 www.mass.gov/dia F �1 �ry �1 isy_CERTIFICATE /'�/� C p ®y/y 6p gp �&B����$+► pp�, t7 -OtgD, V��\■ ���L//'��G O� ��H�'L��'■ ■�SURANCE CSRAB - pATElMnwprrrrl . COREC50 09 09/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GOLDMAN & ASSOCIATES INSURANCE ONLY AND CONFERS NO RIGHTSUPON THE CERTIFICATE FINANCIAL SERVICES INC. HOLDEWTHIS CERTIFICATE DOES NOT AMEND,EXTEND OR 933 FALMOUTH RD. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HYANNIS MA 02601 Phone: 508-775-6010 Fax: 508-790-0249 INSURERS AFFORDING COVERAGE NAIC# -- _-- - -- ------........ - ----- -'-- ............ INSURED INSURER A ST PAUL TRAVELERS - INSURER B: CHARLES COREY DHA -_— ---- ,-- -— COREY & COREY HOME IMPROVEMENT - INsuaERc: ___-- 1684 FALMOUTH ROAD #115 INSURERD: CENTERVILLE MA 02632 --- ----- __..__— :_- --.--_-- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ' ANY REOIIIREMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MY 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. - p MR ADDL i �POLICY ATEIMFFECTIVE (POLICY EkPIRATION LTR INSRO TYPE OF INSURANCE POLICY NUMBER pA7E 1MRw01YY) DATEIMMAID I .'I LIMITS GENERAL LIABILITY —_ — i DAMAGE TO RENTED COMMERCIALGENERALLIABILITY ! I - I PREMISES IEaaxurmca) S CLAIMS MADE OCCUR ; MED EXP(Airy ! - - i - �PERSONALB ADV INJURY —I• i GENERAL AGGREGATE 'S_ ,. � . GOTL AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG j POLICY PRO- JECT N^�I LOC AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT ANY AUTO I i !ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS f 4 _(Pg ) HIRED AUTOS - I ! 606LY INJURY {Per acrd. ) i$ ., NOWOWNED AUTOS I j - PROPERTY 3 . (Per accklenl) . GARAGE LIADBITY` - ! AUTO ONLY-FA ACCIDENT S _ ANV AlfTO OTHER THAN EA ACC !3 i AUTO ONLY: AGG I S i EXCESSIUMBRELLA LIABILITY i EACH OCCURRENCE A 1$ OCCUR I i CLAIMS MADE I .. I --f-AGGREGATE _ _ E -- —__ . DEDUCTIBLE RETENTION - WC STATU- DTW 1 WORKERS COMPENSA77 ANO - - TORY LIMITS ER - EMPLOYERS'LAGILRY - - A #D24IM37 09/14/09 09/14/10 ELEaGHAccIDENT 3 100000 _ iANY PROFIT ETOR/P NER/EXECUTIVE `—'� —' OFFICER/MEMBERF UDE09 - E.L.DISEASE-EA EMPLOYEE 3 100000 SPEGIAd LPROVI ONB I. - E-L DISEASE-POLICY LIMIT j 3 SDDDDD OTHER i I• I DESCRIPTION OF OPERATIONS I LOCATIONS I V lGEES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION FOREVID SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION' DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS VDIRTEN FOR EVIDENTIARY PURPOSES ONLY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL.. IMPOSE NO OBLIGATION OR LIABILRY OF ANY KIND UPON THE INSURER ITS AGENTS OR - - REPRESENTATIVES. - .. AUTHORIZED REPRESENTATIVEX)OCucK30OuODODDDD0DD= MA ' ANN LOUISE HEL"..R " ACORD 25(2001/08) CORD CORPORATION 1988 p� �'!eo�nmooulea/i o�✓�caaaaclzuaela Board of Building Regulations and Standards i HOME IMPROVEMENT CONTRACTOR i RegistrAona 136066 E' _Irai6 =6%6/2010 Tr# 268785 COREY&CORE P O I-,J[�JIPRO"EMENTS CHARLES COREY =I 1694 F.ALMOUTH RD,#115'. P, CENTERVILL'E,MA 02632- Administrator _ 4 ✓fze Pomvreo.uueai a�✓�aaaculi.�aea } Board of Building Regulatio sand Standards Construction Supervisor License ° License: CS 2881 Expiration 2_/14/2010' Ti* 18106 _try �! strc ion 00 a. CHARLES E COR Y� I; 1694 FALMOUTH RD#1(5 { CENTRERVILLE,MA 02632" Commissioner n . i I License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 q Boston,Ma.02108 . 1 _. 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