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HomeMy WebLinkAbout0750 ATTUCKS LANE (4) 15P fll14-1.1111.11.1111111n.#3 � 71 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Z9S" Parcel 0/ B ;6)1Application # Health Division 414 Date Issued '- l':1 I f Conservation Division Application Fee ` Planning Dept. Permit Fee �• Date Definitive Plan Approved by Planning Board 1 . Historic - OKH _ Preservation I Hyannis Project Street Address 7s v /-L777-t ks Z ) Village "j4 4✓ldl /Siiuis / �//_ n / Lie... Address / . 3 .14Y1 // Owner �/1�1, 2��� � �la � � GL �� Telephone ,5 0E. 37r oc.) e 1 014- Permit Request z > 1-e►-,0( A✓-1tl-/64.f /-1 9-4 eA-i iri I3(//64,1pi, ' Rir- L,t..itc 1-4Utit it--2,r Zs'-icAA. /vvse5 Square feet: 1st floor: existing 3O4broposed 0 2nd floor: existing 0 proposed 0 Total new 0 Zoning District Flood Plain Groundwater Overlay Project Valuatiog 43445toeu0 Construction Type / e q15 0:0,i75 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: 0 Yes 0 No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) fi Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new 6 Half: existing 0 new C) Number of Bedrooms: 0 existing Onew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: C 'Yes ❑ No Fireplaces: Existing b New c' Existing wood/coal stove: ❑Yes a1'No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size Barn: Cl existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing U new size Other: --1 Zoning Board of A peals Authorization ❑ Appeal # Recorded CIs 4r Commercial es ❑ No If yes, site plan review# : . Current Use D.0 'c Proposed Use Of 1 e-. `-'• L APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameAt-�et,c-e_ Dad-i..4-tei - Telephone Number (E; `7,G a7 . Address 7 a f SIB A. s t',r,..4.r c 1 ...P License # C s 'j `Lr 7 ce I of ,S 40 i4 Zcac,F 9 Home Improvement Contractor# /66'/f46 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO gccrt,L / SIGNATURE ���C�" _ _ - ' DATE 2. FOR OFFICIAL USE ONLY rq t •APPLICATION# - i y .i DATE ISSUED -•— _1 , — . , -MAP/PARCEL NO. . • s _ . `. ADDRESS - VILLAGE . OWNER DATE OF INSPECTION: t =:LFOUNDATIONI. .• - . 1 _, FRAME - : INSULATION•L ' ",.� { FIREPLACE , I -( , t } ELECTRICAL: ROUGH FINAL . .ti .i e �i PLUMBING: ROUGH FINAL _ t ' • r GAS: r°' ROUGH FiC' F " FINAL ' 11 •-•e ._ sF:INAL B_U_I_L_DING.L •,-.`;° -- r`: . 1 . DATE•CLO$ED OUT . -.: t , ASSOCIATION PLAN NO. • • . , } Foundation Certification in Hyannis, Ma. Prepared For : Silvia & Silvia Inc. Assessor's Map : MAP:295 Lot:18—B02 & 18—H02 Baxter Nye & Holmgren Community Panel Number 250001 0005 C Registered Professional F.I.R.M. Map Zone: Zone 'C' Engineers and Land Surveyors Plan Reference : Book: 469 Page: 018 812 Main Street Owner : Silvia Sc Silvia Inc. 0sterville, MA 02655 Tel 508-428-9131 Fax 508-428-3750 98-0127 Scale: 1" = 100' Date: September 5, 2000 9 6, BARNSTABLE MUNICIPAL AIRPORT COMMISSION ti7,,L S 8712'00" E 238.89' 02•\ Sc�� TOTAL PARCEL \ CD 90,331 sq.ft. tiT r7 2.07 acres kL42 121. 8' ' o 5 vi o ce ce le\ EXISTING j o w FOUNDATfoN o EL: 3 7 4 c J d N \ in U M 1,j Q M IAo \ LOCATED '' , a 10 ' 8/5/00 A (a3 M 4 in Z d �p 0 0 Q V1 w Z 42.0 \ z Z co BM cc \ Q ELM 60 60' m \�10.54' R303. 59' W 241.21' m L. 44. 02' S 86 02'02' C.B. R53 59' "E 175.00' C.B. FWD. L=167. 4 C.B. N8602'02 FND. FNDT7TrKC+ LANE �� OWN �YouT-5' ow T WIDE) I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE FOUNDATION SHOWN HEREON IS i,i : IN COMPLIANCE WITH THE APPLICABLE BARNSTABLE ZONING DISTRICT SIDELINE AND ", ``r ;-:,`' SETBACK REQUIREMENTS, IS LOCATED IN RELATION TO THE MONUMENTS SHOWN, AND -?' t '- IS NOT LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA. ;i 1 REGISTERE PROFESSIONAL [AND SURVEYOR DATE -'�" ''"'-'"�� `` 9.7•oe • Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 100120130 111 �, BWP AQ 06 Decal Number Notification Prior to Construction or Demolition Important: A. Applicability When filling out PP tY forms on the computer,use ' only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building,or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection us -do not use (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of the return key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10)days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. 46 . iFP/AI B. General Project Description 1. a. Is this facility fee exempt-city, town, dist • t, municipal housing authority, owner-occupied Instructions residence of four units or less?❑Yes [No 1.All sections of b. Provide blanket decal number if applicable: Blanket Decal Number this form must be • completed in order to comply with the 2. Facility Information: Department Environmental Ie�.91 'c elCe c • Environmental �7 ��, �� Protection a.Name notification '7 5-7) 4-1 Ue1c s X c.i requirements of b.Address 310 CMR 7.09 ii—1, `� MA c.Citv/T wn d.State e.Zip Code f.Telephone Number(area code and extension) q.E-mail- Addresss(0 tional 3 aor". Mgr Lc j1 deed : cot-A- . h.Size of Facility in Square Feet i.Number qffloors j. Was the facility built prior to 1980? ❑ Yes No k. Describe the current or prior fuse of the facility: 1_4 �i'� ""s .6 t'' C c7 al✓4-y /e?"•'i-e4-i- j e I. Is the facility a residential facility? El Yes E No _o m. If yes, how many units? Number of Units _o 3. Facility Owner: N �o a.Name6 o `4,36 r 4,..t n c.24.)(s A • A.R. b.Address fil fri Vi ✓,. 17 014. ileilA _o c;Citv/Tovfn d.State e.Zip Code �o �� of 3 7s- cj 3 eV /'2 p,-` Q � /erlec c, .tc:-�, f.Te hone Number(area nd extension) a.E-mail Ac ess( s .Q h.Onsite Manager Name U ag06.doc•10/02 BWP AQ 06•Page 1 of 3 II I Massachusetts Department of Environmental Protection `i Bureau of Waste Prevention • Air Quality 100120130 1111 It BWP AQ 06 Decal Number Notification Prior to Construction or Demolition General Statement:If B. General Project Description (cont.) asbestos is found during a 4. General Contractor. Construction or ._ Demolition Zo,..,,,,r.i^,L e`it�f,-ro' operation,all a.Name L� responsible parties y �) must comply with '2)O I S'1,.a.ti ems,.•..> /lJC✓/b .JJ /Z.t'- 310 CMR 7.00, b.Address 7.09,7.15,and ,� � _ UZZ C- 7- Chapter 21E of the /'/1L ?$ke—e-'e- f/-� (7 General Laws of c.City/Town d.State e.Zip Code the Commonwealth. v -2 - 0 2 2 ,...,•�`lam v,w,� 62 s e_ . 6,..)_-.. This would include, f.Tele hone Number(area code and extension) q.E-mail Address(optional) but would not be limited to,filing an Q—/L',l_o / e.0.Z? asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of C. General Construction or Demolition Description release of a hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. 1 Q•-v/�ti1 c,c i e-v r�L a.Name b.Address rtitc.?j4 p 11-i/1 a'LGer ry. c.City/Town d.State e.Zip Code S?' 7 2 6. G 26 z. _ ec,,.s,r- iJ- -, tP �� ? 0 4,Gam,.,-7 f.Tele hone Number(area code and extension) g.E-mail Address(optional) Q�✓ C.✓L�-e' d GcJ c --I..-tb h.On-site Manager Name 2. On-Site Supervisor: !..--C w✓LA. c.e /]- - , ter' On-Site Supervisor Name 3. Is the entire facility to be demolished? ® Yes EK‘lo N _0 4. Describe the area(s)to be demolished: �N �0 -0 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: .1:4 s 1-e l/ 4-0. to _0 =c =Q U ag06.doc•10/02 BWP AQ 06•Page 2 of 3 U - Massachusetts Department of Environmental Protection •■ I i Bureau of Waste Prevention • Air Quality 100120130 (\ BWP AQ 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project,were the structure(s)surveyed for the presence of asbestos containing maten I (ACM)? ❑ Yes No If yes,who conducted the survey? b.Surveyor Name c.Division of Occupational Safety Certification Number 7. Construction or Demolition: La ate Ore/ a.S art ate(mm/dd/yyyy) b. (mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving b. If other, please specify: ❑ tting ❑ shrouding covering ❑ other 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Date(mm/dd/yyyy)of Authorization d.DEP Waiver Number D. Certification I certify that I have examined the above and that to the best of my a.Print ame ✓ _o knowledge it is true and complete. The signature below subjects the b.A orized Signature �N signer to the general statutes -o regarding a false and misleading c. ston itle =o statement(s). vtg d. epre entin � �// e.Date(mm/ d/yyyy) • ag06.doc•10/02 BWP AQ 06•Page 3 of 3 eDEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System Usemame:LAWRDEVINE Nickname:LARRR LOG OFF GT7 eDEP Forms III Gary Profile '11 Ca213 My eDEP I Show Filter Last Download Trans# ID Transaction Private Note Status Update. to Print 362632 100119907 AQ 06- Add Note WORK IN PROGRESS 01/25/2011 Download Construction/Demolition Notification 362863 100119965 AQ 06- Add Note WORK IN PROGRESS 01/26/2011 Download Construction/Demolition Notification 362768 100119943 AQ 06- Add Note WORK IN PROGRESS 01/26/2011 Download Construction/Demolition Notification 363700 100120130 AQ 06- the building was built in 2000 there WORK IN PROGRESS 01/31/2011 Download Construction/Demolition is no hazardous materials Notification Edit/Delete Number of records found: 4 First Prey 1 of 1 Next Last MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.10.0.12.0©2010 MassDEP https://edep.dep.mass.gov/Pages/MyHomePage.aspx 2/8/2011 eDEP-MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact I Feedback I Tour I Privacy Policy ' I MassDEP's Online Filing System Usemame:LAWRDEVINE Nickname:LARRR LOG OFF, 1n7 eDEP G Forms 3 Di Profile w'I� } My eDEP Show Filter Last Download Trans# ID Transaction Private Note Status Update. to Print 362632 100119907 AQ 06- Add Note WORK IN PROGRESS 01/25/2011 Download Construction/Demolition Notification 362863 100119965 AQ 06- Add Note WORK IN PROGRESS 01/26/2011 Download Construction/Demolition Notification 362768 100119943 AQ 06- Add Note WORK IN PROGRESS 01/26/2011 Download Construction/Demolition Notification 363700 100120130 AQ 06- the building was built in 2000 there WORK IN PROGRESS 01/31/2011 Download Construction/Demolition is no hazardous materials Notification Edit/Delete Number of records found: 4 First Prey 1 of 1 Next Last MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System stem ver.10.0.12.0©2010 MassDEP https://edep.dep.mass.gov/Pages/MyHomePage.aspx 2/8/2011 of THE � RARNSBLE, "�TA � Town of Barnstable i6J9• � Regulatory Services Thomas F. Geller, Director Building Division Thomas Perry, CB0 Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us 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 a ('f I /t hereby authorize � att.)�%Z/u _ to act on my behalf, in all matters relative to work authorized by this building permit application for: 1st aS e (Address of job) �i4f 5 ( /16 ®Z6® Z/S 1, • Signature of Owner azpouat Date UVl k U� 2l .O i Print Name . rf Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. Qs\WPFILESIFORMSIbuilding permit forms\EXPRESS.doc REVised 072110 • ry Town of Barnstable .st Regulatory Services )3AI-6TABLE, Thomas F. Geiler, Director lass. -.°1� ,�a`' Building Division • Tom Perry, Building Commission!r 200 Main Street, Hyannis, MA 026 I www.town.barnstable.rna.us • Office: 518 862 4038 _ Fax: 508-790-6230 • HOMEOWNER LICENSE EXEMI' ION Please Print • DATE: JOB LOCATION: number street village "HOMEOWNER" name home phone N work phone Il CURRENT MAILNG ADDRESS: city/town state zip code The current exemption for "homeowners" was extended to i lud-,owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not po'. e:s a license, provided that the owner acts as supervisor. DEFINITIO ,, OP HOMEOWNER Person(s) who owns a parcel of land on which he/she resides • I`,tends to reside, on r'hich there is, or is intended to be, a one or two- • family dwelling,attached or detached structures accessory to 'uch se and/or farm structures, A person who constructs more than one home in a two-year period shall not be considered a homeo ner. St. h "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be re•.onsible fo all such work performed under the building permit. (Section 109.1.1) • The undersign ed"homeowner"assumes responsibilir for compliance wit' the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned"homeowner"certifies that he/.he understands,the Town ofBsrnstable Building Department minimum inspection procedures and requirements and that he/she ill comply with said procedures.a'd requirements, • Signature of Homeowner • Approval of Building Official • Note: Three-family dwell':gs containing 35,000 cubic fee or larger will be requirecLto comply with the State Building Code" Section 127.0 Construction Contr.,• \,a IIOMEOWNER'S EXEMPTION The Code states that: "Any,omeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing o(construction S.,.ervisors);provided that if the homeowner engages a•person(s)for hire to do such wd'rk, that such Homeowner shall act as supervisor." • Many homeowners wh' use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot p occed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately - responsible. ' To ensure that II homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner • certify that he/she'underst; ds the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several tons. You may care amend and adopt such a form/certiri,.tion for use in your community. • • • Q:IWPFILESIFORMSlbuilding permit formslEXPRESS.doc Revised 072110 • ,......„--,40 i • c)/ I • .......,, I .TII 1 mit , . , - , 1 J SN . 4 T 1,.,):. a,d .,..)9.s.f. e ea.4 siezolilai(12( \ ..1•••••• * Ai :1 js \ i-lijc, rr,.?0 4 q oe T- ., . , , ,----- NI I* Z 1 e , ler t -)(9 ,s,-) •AN.'— , "P— CPc) .. / _ ...---....." ;. ...., —.... .;._-* _ _ ---- ..- tUF..... ..- -., ..- . L Ell ri 1 h . 1 , . . . /',-di ., ,,, Ao 34jo 15, 40a r 1111 Alleigirr41.1"-- ,..5-1 I] 0 :no d 0V d 0. ...]Sh 66c „.. ifT., 4 f 1 Am , I o g . Aiares ,S2(10-1.2400// e7., ..,,t , '''17 Si. fir / L 1 ,04,!';. ••,..' c, -, 3 ••• ,, !,-7,- , •-•„•,,,,,,,,,,„„:„.„.„ .: . • -". ., le 1 I,,d ec,.,) -,--)"1.--- -"1?----2 iq/ g3 I. • Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the ninth edition of the ..s'° Massachusetts State Building Code, 780 CMR, Section 107 pAyA Project Title; Date: ` Property Address: 757) 47 q s fil6Wft5i Project: Check(x) one or both as applica le: .New construction X, Existing Construction • Project description:L d©� l 15T, '1N LlJ�cry., o 7vt/J& if oC?' t _ I MA Registratibrl i\lumber: Expiration date: /zZ ,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerningl: Architectural Structural Mechanical Fire Protection Electrical Other: Y I for the above named project and that to the best of my knowledge, information,and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my. designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the dutic fo registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports (see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work, I shall submit tote= - e.F= �' ial a'Final Construction Control Document'. • o? MICHELE yc Enter in the space to the right a"wet" or o CUOILO a ,' '� P g ` STRUCTURAL in fc�lyA ' electronic signature and seal: No 34774 Ado 9FGisTER�4„ l -ess,oNAL eG. Phone number: Email:itvi (Lit. pei,,otweet Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised. If'other' is chosen,provide a description. • Version 01 01 2018 1 e........, /l/ 6'3/ Commonwealth of Massachusetts • 74 f Division of Professional Licensure Board of Building Regulations and Standards Constri tronfSdpgrvisor CS-054081 ;r" t. ires: 09/20/2019 LAWRENCE SlDEVINE LI a f 1 P.O.BOX 431 41 `� t ,c •1. , CENTERVILLE MAI 02632 J` i �' .`gej s •cCommissioner . 7 ®A9RD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) `�- 12/03/2020 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 have ADDITIONAL INSURED provisions or 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 Emily A.Montgomery Dowling&O'Neil Insurance Agency PHONE (800)640-1620 FAX (A/C,No,Ext): - (A/C,No): 973 lyannough Road E-MAIL emontgomery@doins.com ADDRESS: INSURER(S)AFFORDING COVERAGE - NAIC# Hyannis MA 02601 INSURER A: NGM Insurance Company 14788 INSURED - INSURER B: Lawrence Devine Carpentry INSURER C: PO Box 431 INSURER D: INSURER E: Centerville MA 02632 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN SD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDM/YY) LIMITS X COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE - - $ 1,000,000 DAMAGE TO RENTED 50,000 CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A TBD 12/02/2020 12/02/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE - $ 2,000,000 POLICY n POT- nILOC OTHER: PRODUCTS-COMP/OPAGG $$ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ I ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $-AUTOS ONLY _AUTOS ONLY - (Per accident) UMBRELLA LIAB ^_ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - ,$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE n N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) _ E.L.DISEASE-EA EMPLOYEE $ If yes,describe under ' DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations,and endorsements.Nothing contained in the Certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Barnstable Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 s �—�a41.1. I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORD DATE(MM/DD/YYYY) ACO. CERTIFICATE OF LIABILITY INSURANCE. 12/03/2020 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 have ADDITIONAL INSURED provisions or 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 Emily A.Montgomery NAME: Dowling&O'Neil Insurance Agency PHONE (800)640-1620 FAX IA/C,No.Extl: (A/C,No): 973 lyannough Road E-MAIL emontgomery@doins.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Hyannis MA 02601 INSURERA: NGM Insurance Company 14788 INSURED INSURERS: Lawrence Devine Carpentry INSURER C: PO Box 431 INSURER D:INSURER E: Centerville MA 02632 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE CLAIMS-MADE N OCCUR PREMISES(Ea occur ence) $ 50,000 MED EXP(Any one person) $ 5,000 A TBD 12/02/2020 12/02/2021 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n PRCTO 2,000,000 (JE n LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO - BODILY INJURY(Per person) $ - OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED - PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per accident) $ I UMBRELLA LIAB _ OCCUR - EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? n N/A (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations,and endorsements.Nothing contained in the Certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Joseph P Keller ACCORDANCE WITH THE POLICY PROVISIONS. 750 Attucks Lane AUTHORIZED REPRESENTATIVE Hyannis MA 02601 ` ,... 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