Loading...
HomeMy WebLinkAbout0053 GLEN ROAD Application number M� Date Issued................... ....................... STABM '16 9. Building Inspectors Initials.......... .�[ FO N;�•`0 APR 2 4 2019 O Y BARNSTABLE ® I�! Map/Parcel................................................................. - TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: NUMBER STREET VILLAGE Owner's Name: Phone Number Email Address: yr;i(:a, ,a r,e I e co�cA 51.Ile-/ Cell Phone Number Project cost$ 15 . & 3 I — Check one Residential Commercial { OWNER'S.AUTHORIZATION As owner of the above property I hereby authorize p to make application for a building permit in accordance with 780 CMR Owner Signature: fee -44,Jy� Date: TYPE OF WORK 0 Siding lz Windows(no header change)# !Z M Insulation/Weatherization 7 Doors (no header change)'# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to w& ae r►�� ,Q��'f= G✓���.fn . r'l./�- CONTRACTOR'S INFORMATION Contractor's namernA o-r s - /J Ora QeQaM,4 c .L L C Home Improvement Contractors Registration(if applicable)# 14(a 5$ 91 (attach copy) Construction Supervisor's License# ([ 0-' (o ? (attach copy) Email of Contractor 6 1"A-& f.con, Phone number_i_A-yo-VZ-LL i! ALL PROPERTIES THAT HAVE STRUCTURES OVE 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a:for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s)of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3:30 pm-4:34pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOWNEWS LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities 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'S SIGNATURE Signature Date Z/-�2. All pe it applications are subject to a building official's approval prior to issuance 4 . . Massachusetts Department of Public Safety Board of Build ng Regulations and Standards License: CS 110763 Construction Supervisor JEFFREYCONNC RS e 64 OLD FIELDS RDAD i SOUTH BERWICK ME 0390E �:1.'.- ;r•• Exprratton- C'ornntiss oner 06FOW2020 'r . '!,v f r.n r,,,..,,+•r�'f��+r/' '(1rr...,,.I n..,'Yl . otrece of Consumer Affairs&Busloess Regulation , HOME IMPROVE)!<fJENT CONTRACTOR Registration vaG for Indtvldual usa only TYPE:Supoletne it Carr) bgigre the expirati date. it found return to: R is tia ' EX13iration ce of Consttm Affairs and Business Regm.dation •'�i`i 146559 05JO442019 Plaza-S'm 5170 l OPERATING,U.C. Eilustor�,NSA 021 tdE-WI FiC C t JEI-FRl•Y CONNO RS zti cea WOBURN,NIA 01801ari s r. —= ' h o �a4id without signature Undersecreta►} I i j I i i �r Y n � !a 8 � �.�r .r^�t ��j'�'1'�'�?'„;r�� yam' •+ ty��'yi�St 5_ e,,. ? •ASS S hLts�- It tr �r rr rt ar`F- s+G�ryt, T 44�5 1 .R'c F r Yt. k��t •y ,�r ���sj�t r .. }15 ..y / }��X r1)r �y r : "'li)�� � h r. J � ���,- Ly��� Tzc� •sv 3,. ,.�- s h to 7� r 1- r t} �f t��--�a t;' .rS ems.. `s� ,s'r;�`F` �7;i. S -�ia�.,`�sn�rr �.l}—- -•�'' ,�re it •�r _F" - i-`�C' k` � h'' r"t� :�'-f-' E Se >, •-,,- s-95 1 5 t ��-r�c•'[� '3� � 'r:4r.�``�� e.. t °�'Xg.1^s,' '� Yrar��# � -.. j --.. ,:ar r u �H S -���„�x"-�, {� mac. ..� �,a�,�`t�„�n ,.� ��a, '1 •r-=��- j-tc'�.3- ..ram > i � u � y-- 4`�{F i �.v-tee* y,> >.• 4 � y3"t ��''''-r:x The Commonwealth of Massachusetts s Depwtnent of Indicsfrid Accidents 1 Congress Street,Suite 100 Boston,MA.02114-2017 wmmass gov/dia Rrarkers'Compensation Insurance Affidavit-Builders/Contractors/Electriciaus/Pinmbem TO BE FMW WIT$THE PERIVUTMG AUTHORrM A iicant Information Please Print Legibly Name pusiness/Omm&ationandividad): t LL Address: .2tv Q r City/State/Zip: WA l'n� �� ©j�i Phone#: % L00 Are you an employer?Check the appropriate box_ Type of project(required): lX am a employer with ALO employees(full and/or part-tame)." 7. ❑New conSllllction 2.Q I am a sole proprietor or partnership and have no employees wonting forme in g_ Remodeling any capacity.[No workers'comp•inumce required.] ❑Demolition IM I am a homeowner doing all work myself No workers'comp.insurance required,]t 1 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property- I will 0 0 addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs.or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-conhacbm listed on the attached sheet 13.❑ .. of repairs These sub-contractors have employees and have worlxrs'comp.insraance.t 6.Q We are a Corporation and iu officers have exercised their right of exemption per MOL c. 14 t?ther (N t nGG9 r✓ 152,§1(4),and we have no employees.(No workers'comp.iosumm requuedl / en e-1 *Any applicant that checks box#l must also fill out the section below showing their workers'compensation policy iaformation- i Homeowners who submit this affidavit indicating they are doing all work and then hire outside coatactors must submit a new aff davit indicatmg such. tCont actors 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 woda ss'comp.policy number. I am an employer'tliat is providing workers'compensation insurance for try employees.: Below is the policy and job site F a r information. n_ Insurance Company Name: �(AQC—A Ins. 00 - Policy#or Self-ins.Lie.#: 7 aJ O U Expiration Date: J� Job Site Address: J? IPn City/Staie/Zip:� iI`-t Attach a copy of the workers'compensation policydeclaration page(showing the policy number and ezp mtion ate). Failiue to secure coverage-as required under MCTL c:'152,§25A is a a6minal viol>ition punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator_A copy of this statement may be forwarded to the Offiee of Investigations of the DIA for insurance coverage vmifi >L I do hereby rtify h the airs mid pena7tis of perjury that the information provided above is true and correct Si a Date: —Z `-/ Phone#: 7 — Z b ' Of{e' use only, Do not write in this area,to be completed by city or town official City or Town: PermitlLicense# )ssuing Aut*rity(circle one):. 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6 Other Contact Person: Phone#: l_ 0 DATE(MM/DD/YYYY) A�/ L> CERTIFICATE OF LIABILITY INSURANCE 12/28/2018 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 Melissa Pflug NAME: Maclantire Insurance Agency Inc C. aC N EtI. (508)388-6161 No: (508)366-5202 11 West Main Street AEDSS: melissap@mackintre.com INSURER(S)AFFORDING COVERAGE NAIC it Westborough MA 01581-1931 INSURER A: Sentry insurance INSURED INSURERS: Guard Insurance Group Newpro Operating LLC INSURERC: Colony Insurance Co 26 Cedar St. INSURER D: INSURER E: Woburn MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19-20 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE 1 p p POLICYNUMBER MOWLDICDY� M1WDDfYYYM LIMITS X COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE ®OCCUR PREMISES occurrence $ 500,000 MED EXP oneperson) $ 15,000 A A0062403003 12/31/2018 12/31/2019 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPUES PER: GENERAL AGGREGATE $ 3,000,000 POLICY F—IECr LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY CCMBINEDSINGLE LIMIT $ 1,000,000 a accident ANY AUTO BODILY INJURY(Per person) $ A OVIINED SCHEDULED A0092403004 12/31/2018 12/31/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY accident Uninsured motorist BI $ 250,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 5,000,000 LA EXCESS LIAB HCLAIMS-MADE A0092403006 12/31/2018 12/31/2019 AGGREGATE $ 5,000,000 DED RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'L Y IABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA NEWC903809 05/01/2018 05/01/2019 E.L.EACH ACCIDENT $ 500,000 OFFlCER/MEMBER EXCLUDED? (MandaWry in NH) E.L DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 Limit $1,000,000 C Pollution Liability CSP304242 12/31/2018 12/31/2019 Aggregate $2,000,000 DED $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS I 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD I Page 1 of 14 MA Reg#146589 CT Reg#0605216 E Federal ID # 20-2625129 Window / Door Contract Customer Information William Ariel (508) 778-6454 ()<br>(508) Date: 04/01/2019 Lisa Ariel 778-6454 () Rep: Kurt Raggio 53 Glen Rd Williamariel@comcast.net Office # 800-242-9974 Hyannis MA 02601 Williamariel@comcast.net Location Agreement NEWPRO hereby agrees that it will, for the consideration hereinafter mentioned, furnish all labor and material necessary to install the goods purchased by Owner in accordance with the terms described on the following pages of this agreement (collectively, this "Agreement") at the premises located at: 53 Glen Rd Hyannis MA 02601 Windows Being Installed: 12 Doors Being Installed: 0 Window Details ElLocation: Kitchen Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None ElLocation: Mudroom Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None Location: Entry Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 .r Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None Location: Den Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None This space intentionally left blank LeapTODigitafxom 1.4.25 Page 2 of 14 Location: Kitchen Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None Location: e Kitchen Series: Ecomax Double Hung ' Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None Location: Kitchen Series: Ecomax Double Hung fi Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None ElLocation: Kitchen Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None Location: Kitchen Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 El Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None Location: Y Kitchen Series:~ s r Ecomax Double Hung ` Interior Color: White Screen Type: 1/2 a Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: None Glass Options: None Location: Living Room Series: Ecomax Double Hung El Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: (Conversion) Glass Options: None Location: Living Room Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 i +. Exterior Color: White Grid Pattern: 6/6 Hardware Finish: White Grid Type: Grids Between Glass Additional Labor: (Conversion) Glass Options: None Window Capping Type Standard Capping Capping Texture Smooth Capping Color Aspen White 27243 J�- This space intentionally left blank LeapToDigital.com 1.4.25 Customer Information Page 14 of 14 William Ariel (508) 778-6454 ()<br>(508) Date: 04/01/2019 Lisa Ariel 778-6454 () Rep: Kurt Raggio 53 Glen Rd Williamariel@comcast.net Hyannis MA 02601 Williamariel@comcast.net Total Price: $151831 Deposit $5,000 Balance Financed $10,831 Amount Financed $10,831 Stage 1 to be processed at order $5,415 /A/SA Stage 2 to be processed upon completion $5,416 Financing terms are subject to change based upon review of customer credit history. Customer Info Last 4 Digits of Social 9533 Account Info Account Number: Exp: CVV: Q� Kurt Raggio William Ariel 04/01/2019 04/01/2019 Date Date Lisa Ariel 04/01/2019 Date This space intentionally left blank LeapToDigital com 1.4.25 Town of Barnstable *Permit# D 0 S S7 Expires 6 months front issue date . Regulatory Services Fee d y Thomas F.Geiler,Director 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 PERNIIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ref f , Property Address �/ r► [Residential Value of Work 3 3 G a0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address R-1 ay Contractor's Name X4-r of yi Y 1/Vc Telephone Number 77� 4MI,f�. Home Improvement Contractor License#(if applicable) / Y 7 /A 4P(, Construction Supervisor's License#(if applicable) [�Jorkman's Compensation Insurance Check one: ® Bess PERMIT ❑ I am a sole proprietor ❑ I am the Homeowner AUG 2 0 2007 ETI have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ffRe-roof(stripping old shingles) All construction debris will be taken to n`�� < ✓ Csf ❑Re-roof(not stripping. Going over existing layers of roof) E?<e-side ❑ Replacement Windows/doors/sliders. U-Value (max 44) ;1�r *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,6on`sdwation,etc. ***Note: Property Owner must sign Property Owner Letter of PerriiiSs on! A QoK of the H Im rovement Contractors License is required.; SIGNATURE: V r Q:Forms:expmtrg Revise061306 IsfandSiding andRoofing �10 N1. E u} a division of RLTConstruction,Inc. Proposal To: July 30, 2007 Richard Taylor 28 Burt St. Acushnet, Ma. 02743 We are pleased to submit the following specifications and estimates. Strip existing cedar shingles on front face of house. Install house wrap and dbl. 4 Cellwood vinyl siding, autumn tan or equal. Install vinyl coil white to front corner boards. Reroof garage roof only removing existing shingles and installing new drip edge,ice shield,tar paper and 30yr. Shingles to match.. Remove and replace existing storm windows on 3 front windows. Install new .032 white seamless gutters,Ipc. To front and back of house,including new downspouts strapped and screwed with stainless screws. Clean up and haul away all debris to landfill We hereby propose to furnish material and labor- complete in accordance with the above specification, for the sum of: THREE THOUSAND THREE HUNDRED DOLLARS $3300.00 PAYMENT TO BE MADE AS FOLLOWS: Payment in full due upon completion. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents,or delays beyond our control. Owners to carry fire,wind damage and other necessary insurance. RLT Construction,Inc.carries General Liability and Workman's Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: 8-`7-0 7 Signature WAC'-;t;— Start Date: Signature .Z�E 31 Manni Circle Centerville, Massachusetts 02632 Telephone 508.420.5243 and 508.833.5249 • Fax 508.420.1776 • Enmi(caperoofer@caperoofer.com 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 Le 'bl NaMe (Business/Organization/Individual):. le,C A4-7- 6elO7 /it✓L , •Address: 3 h /* City/State/Zip: A4• 6V 4e 3 a Phone.#: J 776 k,*/y Are you an employer? Check the appropriate box: ,�,� � 4. I am a general contractor and I 'Type of project(required):. 1.Rl i am a employer with ❑ . 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.$• required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 1.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.[YRoof repairs insurance required.]t c. 152, §1(4),and we have no p employees. [No workers' . •13.❑ Other �l' ro w-d comp. insurance required.] . 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet sbowing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,tbey must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below isthe policy and job site information. Insurance Company Name: 119 Policy##or Self-ins.Lic.M / Expiration Date: Job Site Address: �3 6 I�� �11 iJ City/State/Zip: _ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date),.. Failure., to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine iip 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. Ido hereby certify and epains-a dpenalties ofperjury that the information provided above is true and correct: Signature: Date: Phone#: S-® f —2 7 /y Official use only. Do not write in this area,'to be completed by city or town affciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: RightFax N3-3 8/17/2007 3:36:45 PM PAGE 003/003 Fax Server AC®R®. CERTIFICATE OF INSURANCE DATE(MWDMYY) 08-17-07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE EDWARD A GRAZUL INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO BOX 337 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE MARSTONS MILLS,MA 02648 COMPANY 28Y2K A HARTFORD GROCIP INSURED COMPANY B - R L T CONS TRUCTI ON INC COMPANY 3 MANNI CIRCLE C CENTER-VILLS,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 PITY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTI'O WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, Li MITSSHOWN MAY HAVE BEEN REDUCED BY - PAID CLAIMS. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MWDMYY) DATE(MMMDWY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPlOP AGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTORS PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) 5 MED.EXPENSE(Anyone Person) $ AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(PerAccident) $ HIREDAU70S PROPERTY DAMAGE S NON-OWNED AUTOS GARAGE LIABILITY ANYAUTOS AUTO ONLY-EA ACCIDENT S OTHER.THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE S EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-1051C045-06 12-24-06 12-24-07 STATUTORY LIMITS X THE PROPRIETOR/ EACHACCIDENT $ 100,000 PARTNERS/EXECUTIVE X INCL DISEASE-POLICY LIMIT $ 500,000 OFFiCERSARE: EXCL DISEASE-EACH EMPLOYEE $ 100,000 •S R OTHER ,r< ''. DESCRIPTION OFOPERATIONSILOCATIONSIVEHICLES1RESTRICTIONSISPECIALITEMS I' THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CrERTUTCATE HOLDER AFFECTING WORKERS COS COVERAGE. CERTIFICATE HOLDER CANCELLATION SHOLLD ANY OF'HE ABOVE DESCRt3EL PaICIES 3E CA JCELLED BEFORE THE TOWN OF BARNSTABLE BUILDING DEPT EXPIP A70N CATE THEP.EO°THE ISSUING COM-ANY'WILL ENDEdLVOR TO MAIL 10 Y1f• DAYS WRITTEN NOTICE TO THE OER7t=ICA7E HOLDER NAVED TO THE LEFT BJT JOB:53 GLEN RD HYANNIS FALLP.E 70VAfl SUCH NOT'CE SHALL IMPOSE NO OELIGATION OR LIA3ILITY OFANY 200 MAIN STREET KIND UPON THE COM PANT,IT SAG ENTS OR REPRESENTATIVES. HYANNIS,MA C2601 AUTHORIZED REPRESENTATIVE R-amani Ayer ACORD 25.5(3193) I u-+-�•-S is `Y ,..(fbCh'Y^ y(/IyNY121AJP.(L L 9• ✓ Zlti'tGCG1^c+� - s�`+ '* f �;` _ Bourd o=IIui l�n�Reguta•� ns and Stlndarrl ,M icense or:.regtstrattoi,v1l�c'for mdi�,c a!us �ni��; .. Ogg HOME IM?ROVEP.7ENT CONTRACTOR ��tfore tre,expo�hon date-It fb roil retux � r: tir �So trd of I3w]d�n Re ui Lions :rii Stanch,"U `� PP-, 134286 f3 {2 c Ashburton P!4ce Rnt 1301 a ,- -sow Cxpirzt�on 1+)/2�/2007 ", s �'stan,lala 0214��• DBA h f r MO kP.t7CONS I INC Df3A ISLAND^CUING&ROOFIN \u�fN�T��R�,y��ILLE��4�02�6E , � � ,, ,. Pont vah4�yd�•�+�.ts �ti�v�j.�,a, „�;,;�' `$::�.�§''T.`s-'� t �?i,t £ ..v.E1d,711n1s`1 �i17 �-Y-.+�•�o' ..i.. _ .: y �