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Home My WebLink About0096 STONEY CLIFF ROAD 9'(0 � Shonet� CI �' '77 _ � _.z J . r � ,, Y � o � .. .. j n n o ... � � ., Iwo 24911 # �l TOWN OF BARNSTABLE Permit No. _.. . : { !� Bwldin g, Wpector ter. t. I �Wn I l`. �. ✓ , !• .. .�' ...r< ' Cash 9 .. OCCUPANCY PERMIT Bond Issued to James K. Smith Address ` Lot C)l'96 "Stoney Cliff ' Road, Centerville Wiring Inspector / '..�� f "- Inspection date Plumbing Inspecto�ft �u�C � Inspection date V Gas Inspector C_�,_ ! f/� ��,� -� f� Inspection date Z . �. ,.r _.�.., .e..Tit_ uQn •t 83 Engineering Department Inspection date - Q Board of Health7. y Inspection date /� 3 THIS PERMIT WILL NOTBE 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. /�...t3!:�'.......�� ... 19_ ..3� ............... _;..1..................................... i!_`._- _ V Building Inspector - j coltG a cep f � O - r 1 P �sy.j3 voc wruiaM yG�,ti, g C. o N Y E �. �' '' CERTIFIED P1.0'T' PL-•Q�+!. N w+ No. 19334 0 � LoCATI Ot ANT-Ei2 Yl t-c. Z ND SU PL A►J RE EiZE_►J GE. ., ' cr.ZTIFY NE�TNAT T Fc+�N�PT�c�5� 1J NEQ GAS C" COAAp .%eg WITH TWG= SIVE.LIWE-- REQ ANC BACK UIREkt�WTS of THE v►�ZAP( Tab 1 �'� ;. s T s-rp-1XL.,� I ^[oWN otr C3A�N• A►.lD 1S i`loT� , - LOGA'TSO WIT" l D R.AtM i3aXTCI12. Nyrz ING. aAT� 3 1 B3 REGtSt G.0 1.�lIJD SuevaYolzc THIS p�.AN IS LdOT lbASE'G . C)"4 oSTE1ZV%..Lr= o mASS►. Iwy'Tw.V%F_W.iT �Qv�Y T�{L ot+�S�T'S Sdowuo APPW_IGA4-JT' hlGl" gCz u5tc To om:rc WNW L.pY' u�t`S ;� Assessor's map and lot number ...�.1�� - Sewage Permit number . . .—. ^' !='�6C sT INSTALLED IN TAE H use number ....................................! .e .........................: -/ iwl'�IT � � +� L ENVIRONMENTAL C TORN ®F r BAIL NSTA , #LIIE`W�ATIONS i BUILDING 'AASPECTOR Construct Dwelling s� APPLICATION FOR PERMIT,TO ........................................................................... ........................... ....................... TYPE OF CONSTRUCTION Wood• frame . ...... . ........... ............. .................................... ..................................,..... Mar.,.......... 2q..?........... 19.$3.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the :following information: Lot 9 Stoney Cliff Road, Ce.nteruille Location ................ .......................................,........................................................:.......................... ..:........................::. Proposed Use .......Single. family ...................... :..... .... Zoning District ...,•Residential ..........R...... ...........fire District ...,,C8rit-0St James K Smith Barnstable ' Nameof Owner .................................................. .Address ............................... _ ................... ...... ............. Name of.Builder- ,James K°. Smith Address ......Barnstab`le............................................... Name of. Architect ............ .........Address Number of Rooms. ........... ..4...................................... Foundation .....P; U:Eed...Concrete . Exterior .....•Cla,Aboard...&..tlll.......................... ...... .Roofng ...... asphalt........................ :. Floors wall to wall................................. :,. .Interior ...........dr rall.. ................................................ Heating -� hot air 1 bath .................. ......... Plumbing .................. ......... ... ....: .. .... Fireplace. . OTle.............................................................. . .........Approximate. Cost .....45.�000............... ,. ...... ... .. H Definitive Plan Approved by Planning Board _______ ______-----------19_______. Area ..... .. .......................... Diagram of'Lot and Building with Dimensions Fee �... ..... ... SUBJECT TO .APPROVAL OF BOARD ,OF HEALTH 24y34 la stories OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the- Rules and Regulations of the Town of Barnstable regarding the above construction. • Name ...vr- ..... w....S.-.:.`...:.. `.....:................ . #5 190 `�. SMITH, JAMES K. i ` 24911 112 Story , �la . J"c:.... Permit for ................................. ,..: Single Fami1 ...Dwelling............... T Location .Lot...9.r.......96...Stoney...CJ.. .. Road Centervil .................................le.................................. Owner ...James K....Smith.............:............ 'r i i Type of Construction ........F:KAMe..................... E ..................................................... .... { Plot ...................... ..... Lot ................................ Permit'Granted Apr11 :4 1..:. ....19 83 ! Date of Inspection .fv.o IIg�.�.....19 ' Date Completed ..........P�.�?/lp.'...........19 c y r r .✓A.^.M Assessor's map and lot number ... ....... r T E T0� Sewage Permit number �' —' !��/ dWQ��°.► MMSTAU Hotise number ...............................,....... .................. .....:....:. rAsa �b t639. TOWN OF BARNSTABLE BUILDING INSPECTOR, APPLICATION FOR PERMIT TO Construct Dwelling; Z ....... .... ..... ......... .................... . . ..... ..�. ..................... TYPE OF CONSTRUCTION Wood...frame.:........................................................................................ 1 Isar. 24 j, 83 .......................................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location I,. .... ... ot q St. o.ney. ...Cl.i.ff Road, Centerville .. .... .. .. .... .. ..... .... .. ................................................................................................................................... Proposed Use .......Single family ...................................................................................................................................................................... Residential � �i Cent--ast ZoningDistrict ...................................................:...................Fire District .............................................................................. Name of Owner Jdi11eS.. .... SDll..rl..............................Address ...........Barnstable. .......... ................................ Name of Builder' .Jame.s..K......STTI1 11..............................Addres ...........B.arn5table..........................I......................s Nameof Architect .............................................. ...............Address ............... .. ..... . ................... ........................... Number of Rooms .................4.............................. .. .Foundation ......�.oured e.o.n.trete.................................. Exterior ......C1a Aboard................ ... ..............................................&...tlll Roofing .. ........as-ohalt......... Floors ........wall to Mall........................... ..............Interior ...........dr ral:1,.................. .............................. Heating .... a ..r.................................................Plumbing . .�...bat ...................................... Fireplace ....2TKq......................................................... .........Approximate Cost .....r`-.+NCO...:.......:...{ Definitive Plan Approved by Planning Board -----------_----__-----------19 __. Area i ..!. ...I...................... Diagram of Lot and Building with Dimensions Fee ' C4 . .................... ........................ J.r SUBJECT TO APPROVAL OF BOARD_OF HEALTH 24x34 1� stories t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of.Barnstable regarding the above construction. 4 Name CI ;Y...I......�...... ................ #5190 SMITH, JAMES K. A=190-39 � | Permit for ..l;5_Story____.. . ° '-+— —Sio�le ]�^--.~~. *v�-�'- ---..— Location .Lot_9�__..9.S.. St ..CIi.f.f...Road � Centerville —'—'—'~----------'------------' � James K. Smith Owner- ----'---'—^'------'---'—^'- ' I�z Type of Construction —..�l��.—.------ . ' _..—.^......,..,.-......_----.—~_.~—' Plot' ............................. Lot -..—.-------- ' ' Permit Granted .......----��il--4—'—'-- 83 ..lg . Date of |nxpection ....................................l9 Ooio Completed ---_—._.................... , . ` ' . ` �- ' . . ^ - \ � �� ss s or's map.and lot number ............ ..............`............ � PTIC SY ,,o�STEM MUST S THE .s (� INSTAL LED P COMPLIANCE ewage Permit number .....::.:.......:......................�:,..�... � IN t WITH TITLES i BaEB9TYDLE, Fdouse number .... :.................................................................. UIRONM 90o rasa ENTAL CODE AND t639. \0� TOWN REGULATIONS ''�OypYa BARNSTABLE TOWN' OF 1 BUILDING . INSPECTOR t : APPLICATION FOR PERMIT TO ..............:..... TYPE OF CONSTRUCTION .......... ...Y\.,,5. -.................................\.............................................. . .......�.�...�J.b.......................19... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location��Q. ..TIU. M ..... 1 ... .)..............� P............................................................... ProposedUse ......5. 61IR.....�,.C•.Tm- ........................................................ ....................................:........................ Zoning District .........\............................................................Fire District �y`� ,... ... S� � V. �.�.. ................... Name of Owner . .......Address ...... (3 . ............................................................... Nameof Builder ....... .... ..........................................Address ......5. 1- ...................................................... Nameof Architect .................. ................Address................................ .................................................................................... Numberof Rooms ......... .....................................................Foundation .,1.��.1.C_......�.:�.._............................................. Exterior „\ 5............:.................................Roofing .. ... .................................................... Floors ..... ........................................................................Interior ..... e9 ........ . ...................................... Heating ......!0 ...............................................................Plumbing ........�.................................................................. Fireplace .........\..........................................................................Approximate'Cost ..........`...�...�.0..�.:........................... Definitive Plan Approved by Planning Board ________________________________19________. Area '.�!.�..tj . ....... ... ktr Diagram of Lot and Building with Dimensions F AD 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 regarding the above construction. 0 Name ..!..... �. . 1C� �.i........... . �� Construction Supervisor's License ...... ,.;j......... WILSON, BARbara P. 28615 �n�j9§9A................. Permit for ... j . .. rcgz.eway� _ Single Family Dwel 9..... .......................... ........... ............. ........... 96 Location .... f...Raa a................ Centerville ............................................................................... Owner ...Barbara..P.....Wilson.............. ...... ........... .. k Type of Construction ....)EKM................ ........... ............................................................ .. .......... ............................. Lot ................................ October Permit Granted ................................... 85 Date of Inspection .............................:......19 Date ;Com Plete d *.............19, Nf !T M (V '— S i.- M C) F.) ei ? � BUILDING INSPECTOR �� N �� 0� 0NN �� °� �� APPLICATION FOR PERMIT TO —.\ . '��z~~ �-..( '.} .............................................. r -'' TYPE OF CONSTRUCTION ........... ___________\._.__.___________ � .��..--.—.--]9'��- ^ ---l'' — —'— TO THE INSPECTOR OF BUILDINGS: � The undersigned hereby applies for o permit according to the following information: Location \ |- � \�k � �_^�:^.v» �-u`��.^—.��.� --`�--`~a`��..`.�� -----.--.^----.--.----- Proposed Use -- " . mx --.—.—..-----------.. ----------.------.--. ' ` ( Zoning District --.J...=-------. --..Rve Dixh�� l`�l��— [�.�)-�.�.:�=------. V . >. c�n Nome of Dv,nor '\��.�/DL�\��.��—\/u,L --..A66reo --/�ul��lL,.-------------.----.. Nome of Builder .......r:;XTj,.{.............................. ---'Address ....... ..................................................... Nome of Architect --..-------------------'A66reo ---------------------------- \ � Number of Rooms --'�p.-----------------.Foun6otion �.----.----------- Exterior \«l�� \ Roofing . ......................................................... ,Floors ..... ) --------------------..|ntericv \ .—'.... ...'~ K ................................... ' ^ �L Heating --� ��--------------------'�um6ing --'`==, -----------------___.__ | \ - \ � � 0Fi,epoce --' ------------------------Approximote Cost .^--.�'\----.---_,________. Definitive Plan Approved by Planning 8nov6 lV---- ' 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 regarding the above � � . � � ' Al m� oI286^~- Permit for �� ay� Single ................ ........... Location —. .. ------� — '. � BARBARA wuLSvm ~_.~ ...... ................................ � Frame Type of Construction -------__----- � ----.-------------------'—' Plot ............................ Lot ................................ ' 0cto6er 30, 85 Permit Granted ------------_lg � Dote of Inspection ------------lg ` Dote Completed ...................................... � ` � ' _ - � - ^ . . . / ` | n Z J r S� (70 � � I O _ rb tD F' f -y t .. F f k..- Town of Barnstable *Permit#r� 07D /� Expires 6 mondks from issue date g Regulatory Services Fee PERMIT X-PRESS �`" RMIT Thomas F.Geiler,Director Z� 6 0 0 C T - Building Division ZOO7 Tom Perry,CBO, Building Commissioner TOWN OF BARNSTASLE 200 Main Street,Hyannis,MA 02601 www.town.barmtable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint. Map/parcel Number ` Y Property Address esidential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address R's r.4 z ✓r k1 Y S G N. , r Contractor's Name ✓ Telephone Number `7 Home Improvement Contractor License#(if applicable) DI Construction Supervisor's License#(if applicable) "oran's Compensation Insurance Check one: ` ❑ I am a-sole proprietor ❑ I am the Homeowner . ❑ I have Worker's Compensation Insurance Insurance Company Name ?t/V L V v Workman's Comp.Policy# �7f��v 6 Copy of Insurance Compliance eertificate must be on file. Permit Request(check box) [�RE r of(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. ***Note: Property Owner must sign Property Owner Letter of Permisiion. A opy of e H e Improvement Contractors License is required. SIGNATURE: - Q:Forms:expmtrg Revise061306 v CORE, Y &, .: COREY - r The: Rkgofers, Roofing Cape Cvd S sqe 1g70, 1694 Falmouth Rd. #115, Centerville, MA 02632 GERTAINT EE AR30 RE - ROOFING PROPa. SAL September 13, 2007 BARBARA WILSON 96 STONEY CLIFF RD. P�G L`p t7 y- Y 9 7^ a l5q N l/ CENTERVILLE, MA 02632 Phone: 1-508-775-3365- C®IZEY & COIaEY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturers specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles. Supply and Install ONE APPROV V°AZEK TRIM BOARD in the Left Rear Window Area. Supply and Install CERTAINTEED LANDMARK AR 30: 30 YEAR WARRANTY, 10 YEAR SURE START PROTECTION, CLASS A FIRE RATED, ALGAE RESISTANT, 245 POUND HEAVY WEIGHT, SELF-SEALING, 70 MPH WIND WARRANTY MULTI-LAYERED, LAMINATED ARCHITECTURAL STYLE, FIBERGLASS BASED ASPHALT SHINGLE with COPPER/CERAMIC STONES with a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT COLOR: WEATHERED WOOD { Supply and Install 8" WHITE ALUMINUM DRIP EDGE on All of the Eaves. j Supply and Install CERTAINTEED WINTER-GUARD ( Ice & Water Shield )WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves, 100% Total Coverage on the Shallow Pitched Rear Window Section and the Breezeway/Chimney Area. Supply and Install ALPHAPROTECTOR-SUL REX SYNTHETIC UNDERLAYME'NT http://W".permarproducts com/onUnefonns/alphaprotector pdf Supply and Install ALUMINUM & NEOPRENE SOIL PIPE FLASHING Clean and Remove . Debris from work area after job is completed. With No Added Ventilation: , TOTAL, INVESTMENT 6850.00 I1 Page 1 of 2 Pages i ILATION OPTIONS: y and Install AIR VENT SHINGLE VENT II RIDGE VENT on the Three Main Ridges. TOTAL INVESTMENT $ 7250.00 Supply and Install SMART SOFFIT VENT SYSTEM on Both of the House Eaves. http://w-,vw.dciproducts.comlhtml/smartvent.htm TOTAL INVESTMENT $ • 4 7SCO ►- C° � POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing, Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Materials Plus Labor at the Rate of$60.00 per Hour. PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORD SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 30 Days of Acceptance and Receipt of Deposit providing the Materials are Available. Please Make Checks Payable to: CHARLES COREY . CORE' & COREY Warranties the Shingles and Labor for 5 years. CERTAINTEED Warranties the shingles and labor 100% for the First 5 Yearn and then on a pro-rated basis for 30 Years Total if the shingles becomes defective. CERTAINTEED Warrants the Shingles up to a 70 MPH WIND WARRANTY. CERTAINTEED Warrants the Shingles to be Algae Resistant for a Full 10 Years. Any alteration or deviation from above specifications,will be executed only upon written orders and will become an extra, charge,over and above the estimate. Owner to carry fire,tornado,and other necessary insurance upon the above work This proposal may be withdrawn by us if not accepted within thirty days.1HC LIC# 136066 COLEY & COREY carries Workman's Compensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE: ACCEPTED BY: SUBMITTED BY: BARBARA WILSON ChARYES COR. Y HOMEOWNER COREY EY Page 2 or2 Pages CSC VA, Y lie a4G�' �K 44 The Commonwealth ofMassaehusetts Department oflndustrialAecidents Offee of Investigations 600 Washington Street Boston,MA 02111 www.m ass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name(Business/Organizstion/Individual):, •Address: C , City/State/Zip: %evilJly Phone.#: 7 "7 S [�' K4 Are you an employer? Check the appropriat�e b.,og• -Type of project(required):, 1.❑ I am a employer with 4. L`I 1 am a general contractor and I 6 ❑New. employees(full and/or part.time).'" have hired the sttb-contractors . . 2.❑ I am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'comp.insurance comp. insurance.# required.] 5• ❑ We are a corporation and its I0.❑Elec 'cal repairs or additions 3.El am a homeowner doing all work officers have exercised their 11.❑P Bing 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.❑ Other . wrap. insurance required.] , *Any applicant that checks box#1 must also fill out the section below showing their warkers'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 ornot those entities have employees. If the sub-contractors have employees,they must providb their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information Insurance Company Name: V %J V x Policy,#or Self-ins.Lic.M 7&2C'Vi& "7 '19 Q �0-. Expiration Date: lob Site Address: Q(e yrn Qelr CL l F F City/State/Zip Vv� Attach a copy of the workers' compensation policy declaration page(shoes ing the policy number and expiration date),., Failure,to secure coverage as required under Section 25A of MGL 6. 152 can lead to the imposition of criminal penalties of a fine tip 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce thFes-anapenaines of perjury that the information provided above is true and correct Sit>_nature: Date: • Phone#: - - — Official use only. Do not write in this area,'fo be completed by city or town official City'or Town: Permit/License# 6 Issuing Authority(circle one): 1.Board of Health 2.BuildiugDepartment 3. City/Town CIerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone M °F1HE'okti Town of Barnstable Regulatory Services s iAk114M3LZ, • 9 MASS. $ Thomas F. Geller,Director, �AIEor.�b� Building]division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ",w.town.barnstable.ma.us Office: 508-862403 8 Fax: 508-790-6230 A Property Owner Must Complete and Sign This Section If Using A Builder I, ,as Owner of the subject property " hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: , (Address of Job) Signature of Owner Date Print Name Q:FOR.MS:0WNERPERM1SS10N ,i• use istration valid for in d�T�duu n to n1y If foun License or reg�ration date. �o before the exP and Standards g¢gufat►ons and Standards wilding Regulations Board otBuilding ONTRACTOR - € Boar of$rton Ylace Rm 1301 i rP 0VEMENT C one Ashb HOME IMPR iVla,02108 Reg istration_1�36066 $oston,- �,. Expirat►on fif612008 U j TVP I � MOVEMENTS 'IMPR nature COREY&COREY�H�ME J '' ` valid without sig , R� �y CHARLES CO � UTH Administrator 1684 FALMO DepntY CENTERVILLE,MA 02632 CORD a CERTIFICATE OF LIABILITY INSURANCE 04/09/2007 . ,?Dum THIS CERT11FICATE IS ISSUED AS A MATTER OF INFORMATION l;c8Lrj=L xxsuahum ONLY AND CONFERS NO ROM UPON THE CERTfflCATE BOLDER TKS CERTFICATE DOES NOT AMEND, EXTEND OR 34 UK= ST ALTER THE COVERAGE AFFORDED BY THE POLKNES BELOW. fa9T. , MA 02673 S AFFORDING COVERAGE NAIL# NIAI®- 6VBURlS4 A' ?anl Snekmiller voumst a TRAVSLMS MR NBUNR C IN8 im Ik 3yannis, H& 02601 COVERAGES THE POLICIES OF WSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE fit THE POLICY PEMW WDICATM' NOTIMT WANDING ANY REOUREMENT, TERM OR CONDTIION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WWCH THIS CERTIFICATE MAY BE iSSLIED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS "MAMONS AND CWMITIONS OF SUCH POL K2ES.AGGREGATE LISTS SHOWN MAY HAVE BEEN REDUCED BY PAR)CLAIMS. TWN LTR 61M TYPE OF YS 10 POt NummBt DAU DATE Lam A amorALLMALPY CP46OS9303 OS/15/2006 05/15/2007 FAc10 s1,000,000 8 I COMMEtCULMMRALUAGRHY PRE W=(EantaneMe) s 50,000 CLAMffiMAOE. a.occuR_._..._ sXllD PEFacNAtaADV ftL>rr 51,000,000 6q*mAOOREQATB s2,000,000 GB&Aa6REGATEUSSTAPPUESPER: - _ PRwLcm-oowwrAw 12,000,000 POLICY LOO - AUTONOBLL@LW&LRY COMOR ONGLELMff 1 AWAttro (EaaWdem) ALL OWNW AUTOS ewtLY MUM s ,. tPd Pam) SCNS£OLA.EDAUTOS NNW ALA= S=Y NAW l�fU s NON•OYYIM�AUTOS - . RA)PPRTYDAMAM s OARAOMWORM - - - - AUTOONLY-EAACCMMT E ._ ANY AUTO - omaR if m EAACC i AMOW.Y: AM E EI ESM I DREUAUMM - , EACHOCCURREHM 3 OCCUR CLAWS MADE AOaREOATE E I OEDUCTME -. E RETEHTIOH s i WOW0000WOMTMAM 7PJUS-743OA7-06 04/11/2007 04/11/2009 % �y . r.R Bsmovew LLOALrTY E.L.EACH ACCREW $100,000 PROPMETORNORTNERmscunVE - -._... O o EzauoED? __.._...._....-._-_-.- sL o�sEAse o►EMPlor� 00;0OD- - _ YES • EJ..DISFJIEE-MUCYI.WIT, 3 500,000 OnM sEsaraTTON aP CPeunow r uoa►►noNs r vP�Les r e>otx�NONS Aoo®s+r HNDoamrENr r sPeaa.PRora�oNs< P= BucmaLt.BR IS zzcitmd 8'ROM.NIS woldow cmaum 1TIOM C3tT94CATE HOLDER CANCELLATION :;O= a OORBY 4"o" ANY OF THE ADM DEOMM POLICErrB BE CANCELLED SEPDAE THE E7IPSIATtON 1694 BAIbMUTH YtD VAN TIOMF IM MUM DWAM VKL EMDUV R To MAL 21 DAYS NmTm f NOTICE TO IM CWMFXATE OMM NAMED To TM LEFT, WT PAYLRE TO 00 80 WMLL MNTERVILLE, NA 02632 INPDos No oaualmoN OR ululrsTY OF tPoN TIN: erstlrMs+. rTs ACENTs OR ItSP r^ i JAWNORMD7777i� , \CORD 25(2MMB) _ _ 0 ACORO CORPORATION i9B