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Home My WebLink About0039 OTIS ROAD � p Otis �n .- - - J - - �J a.,--(`� Page 5 of 5 fl .�3 R Official Website of The Town of Barnstable -Property Lookup Page 1 of 4 Select Language[ Assessing Division Property Lookup Results - 2015 367 Main Street,Hyannis,MA.02601 <<BACK TO SEARCH<< Print Friendly Owner Information - Map/Block/Lot: 311 /060/ - Use Code: 1010 Owner Owner Name as of 1/1/15 JEAN,ANDREW M Map/Block/Lot G/S MAPS 39 OTIS ROAD 311 /060/ Property Address HYANNIS,MA.02601 39 OTIS ROAD Co-Owner Name Village:Hyannis Town Sewer At Address:No GIS Zoning Value:RB Assessed Values 2015 - Map/Block/Lot: 311 / 060/ - Use Code: 1010 2015 Appraised Value 2015 Assessed Value Past Comparisons Building Value: $45,200 $45,200 Year Total Assessed Value Extra Features: $3,200 $3,200 2014-$112,000 2013-$112,000 Outbuildings: so so 2012-$111,800 Land Value: $63,600 $63,600 2011 -$122,600 2010-$156,900 2009-$186,100 2015 Totals $112,000 $112,000 2008-$199,700 2007-$199,700 Residential Exemption Received=$87,192 Tax Information 2015 - Map/Block/Lot: 311 / 060/ - Use Code: 1010 Taxes Hyannis FD Tax(Residential) $254.24 Community Preservation Act Tax $6.92 Fiscal Year 2015 TAX RATES HERE Town Tax(Residential) $230.71 $491.87 Sales History-Map/Block/Lot: 311 /060/ - Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: JEAN,ANDREW M 2012-03-26 C196628 $73250 SECRETARY DEPT OF VA 2011-06-17 C194519 $211000 CONVERSE,JARED W 2004-05-24 C173112 $212000 SANDIS,ISMAELA 2003-11-17 C171268 $181600 TOMKINSON,CATHERINEJ 2001-11-30 C163544 $130000 BERRIOS,MARIOJR 2000-11-28 C159878 $94000 ALMQUIST,ROBERT H 1985-01-15 C99745 $42500 OLKKOLA,ALFRED E 1979-12-31 C80513 $0 Photos 311 / 060/ - Use Code: 1010 -____-_-_________ There are not any photos for this parcel Sketches- Map/Block/Lot: 311 /060/ -Use Code: 1010 http://www.townofbamstable.us/Assessing/propertydisplayscreen 15.asp?ap=0&searchpar... 11/20/2015 1 Official Website of The Town of Barnstable -Property Lookup Page 2 of 4 As Built Card s:Click card#to view:Card #1 1 _____._.._.. .......... Constructions Details- Map/Block/Lot: 311 / 060/ - Use Code: 1010 Building Details Land Building value $45,200 Bedrooms 2 Bedrooms USE CODE 1010 Replacement Cost $57,250 Bathrooms 1 Full Lot Size(Acres) 0.18 Model Residential Total Rooms 5 Rooms Appraised Value $63,600 Style Ranch Heat Fuel Gas Assessed Value $63,600 Grade Below Average Heat Type Hot Air Year Built 1950 AC Type None Effective depreciation 21 Interior Floors Carpet Stories 1 Story Interior Walls Drywall Living Area sq/ft 684 Exterior Walls Wood Shingle Gross Area sq/ft 684 Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp Outbuildings& Extra Features— Map/Block/Lot: 311 /060/ — Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value WW FPLI Fireplace 1 story 1 $3,200 $3,200 Sketch Legend Property Sketch Legend 132N Bam-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor,Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished)FUS Second Story Living Area SPE Pool Enclosure (Finished) BRN Barn GAR Garage TQS Three Quarters Story(Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine,Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in Porch PRT Portico WDK Wood Deck PTO Patio http://www.townofbamstable.us/Assessing/propertydisplayscreen l 5.asp?ap=0&searchpar... 11/20/2015 r •� ao � 3o8Sya �t 1r Town of Barnstable *Permit# Expires 6 months from issue date `7 Regulatory Services Fee 3 anarts ABM 9� MA89, Richard V.Scali,Interim Director PERMIT QED MA't� Building Division , X-PRESS Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 N 0 V 19 2013 www.town.barnstable.ma.us Office: 508-862-4038 0L-6230 EXPRESS PERMIT APPLICATION - RESID � 1.F r l b / Not Valid without Red X-Press Imprint Map/parcel Number �o Property Address 'Residential Value 6f Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address A&jt--,R C� Contractor's Name Telephone Number LLB (p Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ® I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ® Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 copy of the Home Improvement.Contractors License&Construction Supervisors License is required. SIGNATURE: Q:IWPFILESTORMSUilding permit formS\EXPRESS.doc Revised 061313 ,r _ i \t� Hie CommoyncteaUh ojfMassaeliuseas Deparhnmt of liuksaial Accidents Office-o •Inve•tikadons 600 Washington meet Bostarj,MA 02LII wmv.masmgovIdia Worket-s' Compensatianivsurance affidavit:BudIders/ContractorsTlectriciansMumbers Applicant Infarm•atiaim Please Print Lep_ibTy :Name(BusinesslOFganirationfindivictvai): �,iV'� �, �'�,�, Address: Gityf tateliip: 2 v Phone#: ` Are you an employer"dheckthe appropriate box: Type of project ,r A-. I atxui a cxrntractor and I I� � l ��- L❑ I am a employer with a1 6_ ❑New won employees(full andlorpart-time).* have hired the subcontractors. I El am a sole proprietor or partner- listed on the attached sheet �- ❑Remodeling slop and have no employees These sub-contractors have g- ❑Demolition woriring for me in any capacity employees and have woslcers' q. ❑Building addition [No worlmrs'comp.insurance comp.incuMM 5. ❑ ate area corporation and its 10..❑Electrical repairs or additions 114 I am a homeowner doing all words officers have exercised their 1I..❑Plumbing repairs or additions myself [No warkers'comp- right of exerTtion per MGL 12..❑I.Zoof repairs - , ,{, and we have no � 4 insurance required.] c 152L 1 -[ 1j fv 1 employees.[Na workers' 131§kQther comp.insurance required.] *Any appEctat that chedts box 91most also fill out th•e section below showing Theirwoadsen'compensad-policy, nfrrmatian t Homeowners who submit ibis affidavit indi cst arg they.sse doing all tom[and then hire o=de contractors last submit anew affidavit inX�such- =Contrectors that rhxk this boot must attached an additional sheet showing the name of the�and state urhethw ornot these emmes Lase! employees. If the snb-contmcrom hose employees,they nurst provide their workers'comp.policy number. I am an employer that is ptmddbV workers'compensation insurance for my employees Belau is thego7icy and job site in formatioiL Insurance Company Name: Policy#our Self-ins-Lic.4: Expiration Date: '-Job Sife Address: e3 l �&-4lS0—� City/StatelZtp: Ai#ach a copy of the workers'compensation policy declaration page(showing the policy number And mqiwation date). Failure to secure coverage as requimdunder Section 25A of MGL c. 152 can lead to the imposition ofcriminal penalties of a fine up to S 1,500.00 andlor one-year imprisonments as well as civil penalties in the farm of a STOP WORK ORDER and a fine. ofup to$250-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Imestigations of the DI1A fior insurance coverage verificatitn- I do hereby certify under thapains andpenakies of pedury that f)te ire fotmaikn prmtiderl aLtoue is true and carrsct Simature: Date: - ` Phone#: ©jEcial use only. Da not write in this area,to be cautpieted by city or town ofjiciaL City or Town: Permi Mcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cifyffown Cleric 4.Electrical Inspector 5.Plumbing Iusgector 6.Other_ _.. '4. haformation and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,-or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." s . MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to eonstruct'buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political ftibdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,i£ necessary,supply sub-coatract:or(s)name(s),address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)writhno employees other than the members or partners, are not required to cant'workers' compensation inenrarnce. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insura oce coverage. Also be sure to sign and date the affidavit. ne affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to a out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one ai�davit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marled by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be milled out each year.Where a home' wger or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. ' `�t The Co mrmanwealth of Massachusetts Depai meat of bid al Accidents Office of kvestipfio is 600 Washingtaa Street Boston,MA 02111 T(IL#617-727-4 ext 4-06 or 14 MAS E Revised 4 24-07 F�# 617-727-7749 • •�_�ass,�n�fdia I � °FmE Tgt, Town of Barnstable ti °t Regulatory Services �=axxwMASS. Thomas F.Geiler,Director i639• Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section , If Using A Builder. Owner of the subject property hereby authorize A to act on my behalf, m all matters relative to work autho ' d b this building permit (A ess of Job) **Pool fences and ala ms are the responsibility of the applicant-Tools r are not to be filled or 'zed before fence is installed and all final inspections are perfo d d accepted. Signature of Owner Signa pplicant Print Name Print Name Date Q:FORMS:OWNEUERMISSIONPOOLS 62012 ° 1 NKME Town of Barnstable Regulatory Services '"m SrAlIM Thomas F.Geller,Director Mnss. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION _ Please Print ~DATE: ; V eey ".JOB LOCATION: . N" number street village Q ,,HOMEOWNER!': Aflj�DS 1 N S J I �d name• h e phone# work phone# ..se CURRENT MAILING ADDRESS: UT �.� M 2Ca1 ty/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license;provided that the owner acts as'supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner'assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature ofHomeo r Approval of Building Official + Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Constructidn.Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who 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 proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the Iast page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRF-6ZUBNIEXPRESS.doc Revised 053012 F�tt> r Town of Barnstable *permit Expires 6�ranths roar issue. Regulatory Services Fe rBARNST�IH1 E, �$ 639'r,05 20�� Thomas F.Geiler,Director Building Division r- RNsTABL6 To Perry, CBO, Building Commissioner 200 Main'Street, Hyannis, MA 02601 www.town.b arnstab le,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_J_ Q C� 0C r Property Address / �!S /d�✓V11 l V /✓T U co ZResidential Value of Wort._ 7,� �C) Minimum fee of$25.00 for work under 6000.00 n o Cali � 'sL n 0��-ner`s Name&Address � "�'( � ��1 Contractor's Name ' , /^ ! v ; Q Telephone Number ��Z7 /��L 7� I Ionic Improvement Contractor License#(if applicable 1261 23 Construction Supervisor's License# (if applicable) V 9 ❑Workman's Compensation Insurance Check one: ❑ 1 am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name �� >� i '� IN-S CO —V— �- Workman's Comp. Policy# ,, Copy of Insurance�Compliance Certificate must be on file. Permit Request Keck box) Re-roof(stripping old shingles) All construction debris will be taken to VI/IJvc.- r- Vy/F; 1 r! / e17" ❑ Re-roof(not stripping. Going over existing layers of roof) [1 Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE 1VYFU.E.S\J:0lZMS\building permit forms\EXPRESS.doc Revised 100608 I - You can do it. We can help., September 21, 2009 Barnstable Building Department Re: Home Depot Installer Jasmany Guillermo Naranjo is an approved installer for The Home Depot. CS License # 93783 Exp: 5/10/2010 HIC # 163124 Exp: 5/11/2011 If you have any further questions please contact Mike Bedard, our permitting coordinator at 508-962-6942 or I at 508-756-4105. Sincerely, r r Rus$dl Johnstone New ngland Region Installation Manager THD At-Home Services,Inc. 345 A Greenwood Street•Worcester, MA 01067 508-756-6686•Fax 508-756-8823•Toll Free 800-657-5182 Board of smalft)lndaddtns"Id Sstadas* 14 M 001ROVENENT CONTRACEOft 126e93 v a' Estes= &312010 Type: Supplement Gard The Moore DeW At-home Sor'" DARREN DEMERS 3200 COBB GALLERIA PKWY#20 ATLANTA,GA 30339 Administrator License or regiStration valid for iud"al M only r before the expiration date. If found return to: Board of Building Replatious and Standards One Ashburton Place Ras 1301 Boston,Ms.02109 Not valid witboat siguatu" il. 09/21/2009 11: 1J 7813411444 NARANJO CONS PAGE 01 R g)��BfrTorBuoi'-;I�dmingR�egiilatoo�r;s anal Standards On.e Ashburton Place o Room 1301 Boston. Massachusetts 02108 Horne Improvem,eut.6ntra,ctor Registration 7 Registration: 163124 'Type: Individual Expiration: 5/11/2011 Tr# 284065 GUILLERMO NARANJO GUILLERMO NARANJO _-- 187 STATION ST, STOUGHTON, MA 02072 '' r Update Address and return card.Marls reason.for change._ ["I Address i__] Renewal n Employment I' I Lost Card 0PS•CA1 0 4nM•08m8•Da81JRORMCAt0a2t2One FICA 'I!�U.?N/At!!O➢I/JP�.I�� / i/✓�.I7AA(l.P ,d . Board of building RepOrttions and Srnndards Litenae or registration valid for individul use Wily HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Registratiioti:- 16317.4 Board of Building Regulations and Standards jj. 1/2011 TO 284085 One Ashburton Place Rm 1.301, =--0—.:.:fntlluiduai Boston,Me.02108 GUILLERMO NARANJO:-= GUILLERMO NARR�d--- : •:' 187 STATION ST. s' STOUGHTON,MA 02072 Administrator Not valid without signatu i i BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number-.CS 093783 Birthdate: 05/10/1987 Expires 05/10/2010 Tr.no: 93783 Restricted 00 JASMANY G NARANJO STATION ST G STOUGHTON, MA 02072 - Commissioner 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 / I t Please Print Legibly V Name (Business/Organization/Itidividual): l M—N 0O COI &4 Nil Address:/ 7 SM raN St - City/State/Zip: Sl0 /V I 007ol�, Phone#: E09-9GO'1-01111\ Are ou an employer? Check the appropriate box: Type of project(required): 1.L=1 1 atn a employer with 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 S. ❑ Demolition workin6 for me in an capacity. employees and have workers' Y P Y r 9. ❑ Building addition [No workers' comp.insurance comp.insurance.= required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ P1 ibing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.]' c.152, `1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.. 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. n I n .� Insurance Company Name: !VA- I mild Ow 1td/U �i�'e- ILy s Co, 07 Policy#or Self-ins.Lic.#: w c / 65 It t� / Expiration Date: �3r✓—/D Job Site Address: / Nis 1( City/State/Zip: /T 4 N/Vi • A 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 certify under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: 3 _� Phone#: 0�5 Official rise only. Do not write in this area,to be completed by cite 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#: f -A-QRA. CERTIFICATE OF LIABILITY INSURANCE 20/092a/D9PROOVCER 1-404-995-3000 THIS CERTIFICATE IIS ISSUED AS A MA;E� OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homadepot.certrequest@marsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 347S Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 INSURERS AFFORDING COVERAGE 'NAIC# Fax (212) 948-0902 INSURED INSURERA Steadfast Ins Co 16387 THD At-Rome Services, Inc. INSURER B:Zurich American Ins Co 16535 269D Cumberland Parkway INSURER C:NATIONAL UNION FIRE INS CO OF PITTS 19445 Suite 300 23841 Atlanta GA 30339 iINSURER O:Now 8 hire Ins Co n45URERE:Illinois Natl Ins Co 23817 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWCfHSTANDiNG 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR N00'y TYPE OF INSUFt&NC POLICY NUMBER POLICY EFFECTNE POLK:YEXPIRATIOM LOUTS LT.A GENERAlLIA81LITY IPR 3757 608-02 1 03/01/09 03/01/10_DATE fMM1=nM EACH OCCURRENCE $4,000,000 RENTED X COMMERCIAL GENERALL"ILITY 1 LIKITS OF POLICY ARE EXC$SS IPR MIE"u r +te S 1,000,000 4 i J CLAIMS MADE 1 OCCUR J"OF SIR: $1,000,000 PER OCC" ;MEDEXP'Any on,penonl [$EXCLDDEp ! ' I 4,000,000 I I 1 PERSONAL 6 ADV INJURY 3 i ; (GENERALAGGREGATE $4,000,000 r'� I PRODUCTS•COMPfOP AGG S 4,000,000 GEN L AGGREGATE LIMIT APPLIES PER: j I X,POLICY PRIEC LOC 03/01J10 B AUTOMOBILE LIABILITY 1BAP 2938863-06 1 03/01/09 I COMBINED SINGLE LIMIT $1,000,000 i X�ANY AUTO j ALL OWNED AUTOS BODILY INJURY $ (Per person) I SCHEDULED AUTOS j f1 HIRED AUTOS I t j BODILY INJURY S { ;(Per accident) !NON-OWNED AUTOS `Xi SELF INSURED AUTO i i PROPERTY DAMAGE [$ i tPe:accide++:) ;PHYSICAL DAMAGE I.GARAGE LIABILITYI j AUTO ONLY-EA ACCIDENT is .`1 ANY AUTO ! t OTHER THAN EA ACC'$ . AUTOONLYt AGG I.S p �f IPA 3"57 608-02 03/41/09 03/O1/10 tEACHOCCURRENCE 55,000,000 EXCESSiUM8RELLA LIABILITY ; ; �? 'AGGREGATE g5,000,000 'X I OCCUR I�—S CLAIMS MADE ? 1 ^i DEDUCTIBLE --i RETENTION $ ) I 3566916 (CA) 03J01/09 03/01/10 X i WCSTATU- $ S OTH- C WORKERS COMPENSATION AND ITOLIMITS E� N $1,000,000 EMPLOYERS'LIABILITY i3566g15(AOS) 03/01/09 03/ E.L.EACH ACCID D i' i ANY PROPRIETCR/PARTNERIEXECUTI'VE 03/01/10 'E.L.DISEASE•EA EMPLOYEE!S1,000,000 E OFFICE"Eh18EREXCLUDEO? 35.66917 (FL) t 03/01/09 ,If yes.Llescr'.be uncle. Sx EC1Al PROVt IONSberow + f E.L.OLSEASE-POL.IOY LIMIT 'S1,000,0-00 OTHER } 1 D ;Workers Compensation i3566918 (KY, MO, NY, WI,r) 03/01/09 i 03/01/10 F '.TX Employers Excess TNSC45694421 (TX} t 03/01/09 1 03/O1/I0 (Occurrence/SIR 25K/2M C 1workers Compensation :4801323(QSI) 01/01/09 03/01/10 i DESCRIPTION OF OPERATIONS,'LOCATIONS I VEHICLES;EXCLUSIONS ADDED By ENDORSEMENT I SP ECtAL PROVISIONS ;RE: EVIDENCE OF INSURANCE I i I I i (;ERTIFICATE HOLDER CANCELLATION ! -^� SHOULD ANY OF rHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPt1'tATiON DATE THEREOF,THE tSSUlNG tNSURER WILL ENDEAVOR TO MAIL—30—DAYS WRITTEN lTHD AT-HOME SERVICE'S, INC. NOTtCc TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,RUT FAILURE TO 00$0 SHALL ;tdPOEE NO p„LY;A'1:04 OR L1A,;iUP(OF ANY XU::)UPON iI1E I&SURER,ITS AGENrS OR 211 Su CLT!01t:2LAIHID PAk'Y'4.,'f _-- ISUI'.':: 3D0 REPRESENTATIVES. { AUTtlORKEa REPRESENTATIVE JaTL.:,,27TA, GA 30339 USA L___ __ -- CcACORD CORPORATION 1988 ACORD 25(2001!08)ckomrauo hc' 111721a0" I. lU :aVV% 11 L/ 1JVI I.Ii vV�I.. 11 . . JV�i� .. Jl'lil 1..•L 1,1 ,1:1I LIV1'JYY L`1�1 1 • UU 1;' UU:+ DATE C-0-RP CERTIFICATE OF LIABILITY INSURANCE o6/16/2009' PRODUCER (781)344-3200_ FAX (781)344-142r' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Malcolm & Parsons Ins. Agcy. Inc. 'ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6 Freeman St. - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 527 Stoughton, MA 02072 __�— INSURERS AFFORDING COVERAGE NAIC# INSURED Naranjo Construction Inc. INSURE4 A: Northland Insurance Company 3.87 Station Street INSU<ERE: Hanover Insurance 22292 Stoughton, MA 02072-1664 r:IsuREgc National Union Fire Ins Co INSURER D. INSURER E: COVERAGES 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 DESCF:IBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE -POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CP-574340 06/15/2009 06/15/2010 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S 100,000 CLAIMS MADE D OCCUR MED EXP{Any one persmj S 5,000 A _ PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S 1,000,000 POLICY JET LOC AUTOMOBILE LIABILITY AMN-2318565-!01 12/07/2009 12/07/2009 COMBINED SINGLE LIMIT (Ea accident) S ANY AUTO ALL OWNED AUTOS BODILY INJURY S i (Per person) _ 000 X SCHEDULED AUTOS 100,000 B X HIRED AUTOS - - BODILY INJURY S X NON-OWNED AUTOS (Per accident) 300,000 PROPERTY DAMAGE S - (Per accident) 100,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO .. OTHER THAN EA.ACC S AUTO ONLY: AGG S EXCESSIU MBR ELLA LIABI LITY EACH OCCURRENCE S OCCUR CLAIMS MADE - =( - I.. - AGGREGATE S S DEDUCTIBLE S S RETENTION S • i/ _i _ _ WORKERS COMPENSATION AND WC6765497 04/.30/2009 04/30/2010 X r�YTATT- vTR- EMPLOYERS'LIABILITY - E.L.EACH ACCIDENT SOO,OOO C ANY PROPRIETOR/PARTNER/EXECUTIVE — OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under -SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES)EXCLUSIONS ADDED.BY ENDORSEE LENT/ZPECIAL PROVISIONS - Residential carpentry, siding 8, roofing contractor. HD at Home Services, Inc. and the Home Depot Are included as Additional Insured with espects to General Liability Insurance. CERTIFICATE HOLDER CANCELLATION f�ULb ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1 5XPiRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL THD At-Home Services, Inc. I 10�. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ciba: The Home Depot at Home services BU 2690 Cumberland Parkway T FgILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Suite 300 CF ANYXIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Atlanta, GA 30339 AUTHOf RJR REPRESENTATIVE Davin arsons ACORD 25(2001108) FAX: (508)756-8823 " ©ACORD CORPORATION 1989 i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): - Address: v G� City/State/Zip: G S ly Phone#: " 657 Are you an employer?Check the appropriate b . Type of project(required): I am a employer with "'> 4. I am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g: ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp. insurance comp, insurance.t required.] 5. ❑ We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plu ing 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 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. $Contractors 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: �Je S Policy#or Self-ins.Lie.#: 3 . tom' l l Expiration Date: `j 1 U Job Site Address: 3✓ 0T'S P4 __City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy num er 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance covera e verification. I do hereby certif r the pains and penalties of perjury that the information provided above is true and orrect. nature: Date: Si _ < — Phone# EOther only. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspectd'r 5.Plumbing inspector rson: Phone#: 1 SEP-02-2009 07:52 FROM-HM DEPOT T-691 P.001/006 F-334 DOME IMPROVEMENT CONTRACT PLEASE.READ THIS Sold,furnished and Installed by: Branch Name: Boston Date: ?��_ THD At-Home Services,Inc, d/b/a The Home Depot At-Home Services Branch Number:31 345A Greenwood Sareot,Unit 2,Worcester,MA 01607 Toll Free(800)657-5182; Fax(508)756-8823 J Federal ID#75-269846o;ME Lie#C 02439;Rt Cont.Lie#16,427 CT Lic#565522;MA Home Improvement Contractor Rcg.#126893 E Installation Address: � -f �C� t) " ,C aA" 0.2(01 ' i? City State Zip Purchaser($): Work Phone: Howie Phone: Cell Phone: [»v] 31"�- 7 t77y7 s7rs" - �y [ Rome Address: ,Vj (If different from Installation Address) City State Zip Email Address(to receive project communications and Home Depot updates); ❑1 DO NOT wish to receive any marketing emails from The Home Depot MP feet i formation: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, and THD At-Home Services, fnc.("The Home Depot")agrees to furtush,deliver and arrange for the installation("Installation')of all materials described on the below and on the referenced Spec Sheet(s), all of which am incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job Products: Spec Sheet(s)#: Pro'ect Amount oofing Siding Windows C3 insulation�6 ❑Gutters I Covers []Entry Door; ❑ 9 6 l y�"Z3 Roofing ❑Siding ❑Windows ❑'insulation ❑Gutters/Covcrs []Entry moors ❑ $ Roofing ElSiding ❑Windows ❑Insulation ❑Gutters/Covers []Entry Doors❑ -CIRoofing ElSiding ❑Windows ❑Insulation ❑Gutters/Covcrs ❑Entry Moors ❑ $ Minimum 25%Deposit of Contract Arlmuot due upon execution of this contract. Total Contract Amount $Maine Purchasers may not deposit more than one-third of the Contract Amount Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificau (one for each Product as defined by an individual Spec Sheet) and pay any balance due. As applicable,each Customer under this COnlraet agrees to be jointly and severally obligated and liable hereunder, The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary # -yQ j, L. , included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pry The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed tinder applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acce lance and Authorization: Customer agrees and understands that tins Agreement is the entire agreement between Customer an 7Yie Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to Said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. Aecepte Submitted b Cus mcr s are Date Sales Consultants Signature Datc X Telephone No. r('71 P Customer's Signature Date Sales Consultant License No. O 4". CANCELLATION: CUSTOMER MAY CANCEL 'PHIS I (as applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE.PART OF TWS CONTRACT 3-3-09 C-SC White-Branch File Yellow-Customer Pink-Sales Consultant