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HomeMy WebLinkAboutBLD-93-672 _ j '4:: �' . TOWN OF YARMOUTH Q Oven /n o Vii. y 5""..T".„,ss $JApplication for a Permit to Build No. 1D7& ,,��,�,,,,e.r�, UPON FINAL APPROVAL c1 g . q3 MAP 76 LOT V y FEE MUST ACCOMPANY THIS APPLICATION. DATE C2151/24te,019 53 The undersigned hereby applies for a permit to build �q according to the following specifications / a 3 1. Name of property owner (e yintrd q �Ic einCa-- / Tel. da a43/ Address 79 lin/ fzem aiamsu,Se .ya t mn eth ,/r/a 2.Name of Architect(if any) Tel. 3. Name of builder 42+t tl T P Ct 1-1- Address /I S hAc(cfarct Rd ?e6, j11d_ 4. License No.044/ 365 ; Tel. / -t/7-:q4i/-o2a-7 oiuG7 5. Name of Mason .E a-E le/4w/.pvie. Address 3 ne'a.0 ' l ,&C. 6. License No. Tel. 3 99' 9016 &.as , ,nA 7. Construction address '7f' 97scictecil/,444x-2 , so. a nee4 Flood District - 8. Date of subdivision Approval plain zone Zone I?-y0 9. Private dwelling ® Estimated Cost (16-;, DO NOT WRITE IN THIS SPACE o b to aa) 0 .°n3,Ft; Type of room m No. 10. Multi family 0 �'��©6 oO , : ., Z • 11. Commercial 0 -1' �` Kitchen REAM -' 71 Dining Rm. 12. Other 0 g0Rooit. 13. No. of stories / BedinR PI 3 . sr Rm. 14. Foundation — Full ® Half 0 Crawl 0 Slab GAJ ,AS” Bath 15. Materials — Wood li Cement 0 Other ❑ •�-3•?- Deck 16.Type of heat — Oil 0 Gas LT Electric 0 Other 0 ,b�� 7�P Closed porch 17. Garage — 1 0 2 rt.3"` ,a"SPaL' Family Rm. Sun room 18. Swimming pool - Size Garaged 1 19. Storage shed.- Size• I A. 1—, '41 -f., • i'. .•" F ,Shed: . 20. Stove — Wood 0 Coal 0 Alterations 21. Size of lot: No. of feet front /A6 No. of feet rear //1/35/ No. of feet deep /S/, 66 22. Size of building. No. of feet front 023 No.of feet side /a No. of feet rear a3 23. Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street From rear lot line 97 5' Side line /5. t- 25. H.I.C.R. No. LOT RELEASED BY Signature r?-1 4fl -ef (�94/1/ J c % -e-cl- PLANNING BOARD Address 7 2zeu%J S-x.c) Date . VItetn-144,?h? 4,261/ • � - BUILDING/// PERMIT APPLICATION SIGN OFF APPLICANT: ��,��n�ou j 0j rn Iti GA, BUILDING PERMIT it: ADDRESS: 79 27(2,14 .L[-_c„ X TELE. NO. : 76.0 0 t 7 / DATE FILED: BLDG. SITE LOCATION: �_t.,�,-,ti_2_ MAPA: LOT/l: THE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD, ALTER, OR ADD TO A STRUCTURE WITHIN THE TOWN OF YARMOUTH. THE BUILDING DEPARTMENT WILL DETER- MINE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGH THE FOLLOWING DEPARTMENTS: RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: DETERMINES COMPLIANCE OF WATER AVAILABILITY. ENGINEERING DEPARTMENT: DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE. CONSERVATION COMMISSION: DETERMINES COMPLIANCE TO WETLANDS ACTS, I.E. : IF LOT(S) BORDER ANY TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH LAND, ETC. HEALTH DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E.: REQUIRE- MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES. FIRE DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REQUIREMENTS FOR PERSONAL SAFETY, PROPERTY PROTECTION, I.E., SMOKE DETECTORS, SPRINKLER SYSTEMS, ETC. THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR ` ISSUING THE REQUIRED BUILDING PERMIT: REVIEWED BY: \I. WATER DEPARTMENT `,- 4,, ,,,_,I (, Ch, , DATE: •0,2- 9 '3 N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: /'. DATE: N/A: 4. HEALTH DEPARTMENT /N. DATE: @a-I:7-13 N/A: UGI INDUSTR /OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE ALL STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING PERMIT. COMMENTS: i 1 ,Z.-r ,,, - ,n vc -C-0) '._ A`h-r)rr i,-,ii Ut) cy_. o F 4 an r4 ai -3C-b6- tear7my- ,c) et 0leDen.- r" u"flL /17,N. ,�ovxcD - 1ftt- $tori-c ' ' g -ev e " /'�$ �nc- f/ oPe F-iCanac ft "g ` $c-.q-g /O O ill�M P"el 2 S%,gce�Pnopeg rratr ' Ontvn-c. 0t.)z-N/ c sa n y aot=,-i r {ia%e�res A febrY r fir IvP ah— Cu r £'c ro ,lye s Mee- 11-o-t 3r 771,9tr la wde f`-,c'n p r C ,C /,,) Sta Al tX t 12Fe M Q1YC Coat 4. Foam. M, A /1 ��t J//,1. . t 9j o'2 . .ice-,,/,r.-- BIM/89 ' _ COMMONWEALTH OF MASSACHUSETTS • . DEPARTMENT MENT OF INDUSTRIAL ACCIDENTS • -.i � 600 WASHINGTON STREET James CampbellBOSTON, MASSACHUSETTS 02111 • ,",pmmrssroner WORKERS'/� COMPENSATION INSURANCE AFFIDAVIT • Pa_vfrtoree (licensee/pc/mince) (/ • with a principal place of busines idence an 7 V ® e-ji- 'oLg 0-4r-2, /,;, G4 (City/ tate/Zip) do hereby certify, under the pains and penalties of perjury,that: [] 1 am an employer providing the following workers' compensation coverage for my employees working on this job. • Insurance Company Policy Number [] 1 am a sole proprietor and have no one working for me. I am a sole proprietor. general contractor oromeo (drde one)and have hired the contractors listed below who have the following workers' compensation insurance policies: •-:•,..., - . Name of Contractor . Insurance Company/Policy Number /J ..-. Name of Contractor - Insurance Company/Policy Number • -.,• - • Name of Contractor Insurance Company/Policy Number I am a homeowner performing all the work myself. NOTE.Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)),application by a homeowner for a license or permit may evidence the legal status of an employer under the Workers'Compensation Act.. I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of lnsurance for coverage verification and that failure to secure coverage as required under Section 25A'of MGL 152 can lead to the imposition of criminal penalties • consisting of a fine of up to 31500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day against me. Signed this day of , 19 License ermirte- LicensoriPermirtor 'kis NQgolcpC ' !ZS o 0 0 /i1ITj i -- v .. • ... 0.q. LAT 3 _,* , -,....______ ...... ----„,„.....„ -- LOT 4 y0 COO. ��a•a4 --f owN of -YAI2MOuTH LOT S -----N l ,J i • 11 FNP, t"1_, = 39.6 ( N.G.V. DI HIGH PT IN 20 = 37.4 NOTES FNS 13_2_411 A(30VI= HIGH PT IN 21). LTHIS PLAN IS VALID ONLY IF IT IS STAMPED AND ' D IN RED. THIS OFFICE ASSUMES NO FOR INFORMATION CONTAINED ON 7 r ,,// OT HAVE ORIGINAL STAMPS r�,�, 3 � //Z.7 "AS- BUILT" PLOT PLAN t ET CMRSEC ION 6.04 Y/-AP_Mou -I ,MASS. USED FOR Lot 4 WA uTCA L LA$J E • LAND USE TECHNOLOGY, Inc. 1 ( v. a•,.a..'"Cr........•_•. ...",r.rtn"�?..i:.Try ,:"0'7 ..," :7..7-•'.^.S..v.r n7..'Twp.........-t.77.._ . 7:2—e—e7..M 1 P'eP•°'72"•.,::.'T.0--2114va.�.,7..'r . -,....., TO -eR}/m0ND w 0itsr4rNe 7 DATE `f/ A--;1,437 I' 79 Na y7iQA �. rL.sm .. SUBJECT tii . 1{ _ .1 S .. )4c"tnto 4-PH Ad,�_sq_ fire,g/AAi /new /j?pL7 'A r . _ •• w�`.dn, x^'+7!r*:w"nna��. rw»r'.n, :+w. zpvay.m`.�n�st".npR +y±mrre•n••vbz..Rrnnnu.w.,7.r „; MESSAGE FRa.v7 of Hops ti (t., Rt, 1 t‘‘ - t' is I \` ' r \\ /cel .` t, i tt),‘. 9," g A li 41 1 \ I ,' , , 4I ,,t) 1 / "*. r" f, 1 / i i rY .. . ..n ..wrmm. SIGNED ;, REPLY it i iel i. 11 f4 L } o Pc S} i 1 V.. a wSIGNED DATE P...,t...ac.itn� i..', ,..3'.".."..'R'.•....^'!'°,','..ra` v."'w'.a".7lfa•^.^.'."ra;•�s,-if F—°,".-sre;.,}�`»;: e r ... y �•I EDIPoRM 45 475 SEND PARTS 1 AND 3 INTACT•PART 3 WILL BE RETURNED WITH REPLY. carbon/r» •1 MK(50 SETS)4P475 Suggested Affidavit for Home Improvement Contractor Permit Application For Mee Use Only NAME OF CITY/TOWN Permit No. Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the"reconstruction.alteration,renovation,repair.modernization.conversion.inprovement,removal.demolition. or construction of an addition to any pre-existing owner-occunicd building containing at least one but not more than.four dwelling units....or • to structures which arc adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other requirements. • Type of Work:0_0(AP Lchl. QJ .LG'-e nip , Est. Cost?'�J�I i. oc Address of Work 7 9 e .e.aA %aico, -J•2,� ) 'WA Owner Name: AyMernd 8' e nco-- Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): ' _Work excluded by law Job under 51,000 _Building not owner-occupied Owner pulling own permit _Other (specify) Notice is hereby given that: • OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ' ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. - Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a .ermit as the owner of the above property: 093 �� �� D. to Owner 'Name • TOWN OF YAMOUTII - BUILDING DEPARTMENT -_- HOMEOWNER LICENSE a I TION PLEASE PRINT: DATE amidst 620) / 793 JOB LOCATIONJ/ 77 Wau2&i &t( Lane , t1/annoc.tI , mA ✓� NUMBER STREET ADDRESS SECTION OF,TOWN "HOMEOWNER" iCuc mont( �oir�ev eci - 7/& -2t 3/ 4i7-ns-road NAME - HOME PHONE WORK PHONE • PRESENT MAILING ADRESS 79 - ///aehLi 7 etrmca ._ . la/4 CITY 0 _. . . TOWN STATE ZIP CODE THE CURRENT EXEMPTION FOR "HOMEOWNER" WAS EXTENDED TO INCLUDE OWNER-OCCUPIED DWELLINGS OF SIX UNITS OR LESS AND TO ALLOW SUCH HOMEOWNERS TO ENGAGE AN IN- • • DIVIDUAL FOR HIRE WHO DOES NOT POSSESS A LICENSE, PROVIDED THAT THE OWNER ACTS AS SUPERVISOR. (STATE BUILDING CODE SECTION 109.1.1) DEFINITION OF HOMEOWNER: PERSON(S) WHO OWNS A PARCEL' OF LAND ON WHICH HE/SUE RESIDES OR INTENDS TO RE- SIDE, ON WHICH THERE IS, OR IS INTENDED TO BE A ONE TO SIX 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 TUE BUILDING OFFICIAL, ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HE/SHE SHALL BE RESPONSIBLE FOR ALL SUCH WORK PERFORMED UNDER TUE BUILDING PERMIT. (SECTION 109.1.1) THE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH TUE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGULATIONS. • TUE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE ' WILL COMPLY WITH SAID PROCEDURES AND REQUI• ai TS. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL NOTE: THREE FAMILY DWELLINGS 35,000 CUBIC FEET, OR LARGER, WILL BE REQUIRED TO COMPLY WITH STATE BUILDING CODE SECTION 127.0, CONSTRUCTION CONTROL. • INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL Ch. 142. Yes 0 No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 0 Other type of indemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Lows, and that my signature cn this permit application waives this requirement. Check one: Owner cir Agent 0 Signa:e:, or O*ter or +Tres Agent --- -.-- - • • 08/19/1993 09152 FROM MAHONEVtWRIGHT READING TO 2371532 P.02 c._ ,. :d,:!O,.i^.i4n' .•' _',n: N'� ,, k,,..,,,,5,.;'„0. „fi.Y.�•�MM/DDrYY .t ... :,,,:,. : .e,sits},A.,r.'W;fi^.i. .'� _ gig;.',J'k! ,. ,5,.;''„0.ziiiUEDATEf 1 FICA •:r^ AC/11.11. ''f.CER` .,. ;C F= ,VSt ANGE,, ;.,;.:,,,,,. , !)::4:. . . ,., ' :°��5;, .'v�:.� �: � •n:�r • u: 8/19/033 ►ROD CEfi.,:•:., v �i,. y!:.:V . r: ::;.' ;.,".:;!.:yla.'. 4!'`;,t, :airy,•,,:,i may,THIS T. ..I.. ,y. / ucER CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND & Wr ht Ins. Agency,Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE Mahoney y 1 POLICIESSNOT BAMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 100 Main St. Reading, MA 01867 j COMPANIES AFFORDING COVERAGE LETTER NY A Worcester Ins. Co. ,. ..,, ...,..._ ........__.. LETTER COMPANY B Aetna Casualty & Surety INSU ED Martin J. Butt Contracting COMPANY`+ 11 Shackford Rd. I LETTER Reading, MA 01867 ; LETTER Le n • , COMPANY E LETTER ,.J:••iirtiV.:-,:I7i •''•1Trl�`)!' t�!'. Ft:M ;I;',IIhI:iisig? `'_: ^�_}':.. .:':4 `",...'':.i 11,1.5::, ;r';"aLIPII“.: '=&*.Y`,4:1 -,.y jItitcitI4: °1:1I,II Vt:titg�.S�,,•a.'i4' .COVERAGES: ;';;a:l�'r.•�v..�•._:.f-�Yt:.am..,,• :,F.,,, ...�..�. .,:„�. ':'„ •. .: x:".r.! ,,'. THIS IS TO CERTIFY THAT THE POLICIES OP INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD r 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, 1 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ _ „_,,,_• „-,_ O TYPE OF INSURANCE POLICY NUMBER I POLICY EFFECTIVE POLICY EXPIRATIOPJ LIMITS LIR . OATS(MM/DONY) • DATE(MM'DDMY) • r GENERAL AGGREGATE I f 'j 0003000...... :GENERAL LIABILITY • , . . ....._........._ !,..._„ 7 1 X�COMMERCIAL GENERAL LIABILITY I i PRODUCTS-COMP/OP AGS I 24000,000 • A .;4: 'CLAIMS MADE ...XOCCUR., �O86H1 10/20/92 ' 10/20/93 t PERSONAL,f ADV.INJURY_..;$ 1,000,000— r I ^ EACH OCCURRENCE f .. OWNEP'Sf CONTMCTOA'S►ROT: I :.. ...... ......._ ..,.. . .H. ..1} .} '- •- j FIRE DAMAGE(Ant Ons Pr}) I f 1009 ODD__ . 5.000 I I NE:O E%PENSE OM w Oexm) f AUTOMOBILE LIABILITY ' COMBINED SINGLE t ANY AVIV . • LIMIT , •ALL OWNED AUTOS BODILY INJURY t I 1 (P"prwn) : ;SChIEDVLKD AUTOS .. .. ...._.__. .._.__.... 'MIRED AUTOS • BODILY INJURY Mir uddinli : $ •• ,NON-OWNED AUTOS OARAGELMiaITY • ;PROPERTY DAMAGE If gyms LIABILITY , EACH OCCURRENCE-.. ......i•,,.....•... ..•_. .... ..._ •UMBRELLA FORM • AGGREGATE . S OTHER THAN UMBRELLAFORM j ' - --+i.;.:'�;,; "4`ri •:hyo: .r.,. 1 ' WORKER'S COMPENSATION . LSTATUTORY LIMITS • .';r, ., .._ ... i.:.:..,..',.:.x._:......,.:= II B: AND 006C0022917643 11/13/92 11/13/93 i _..EACHACCIDENT • ..... 00,000.__._. ' DISEASFAOLICY UMI • f 500, (! EMPLOYERS'LIABILITY • r 1 i , DISEASE—EACH EMPLOYEE f 00.000 OTHER i I VII DESCRIPTIO I • N OF O►ERATlONS,LOCATIONSIYEHICLES/SPECIAL ITEMS 'r ,..,J r"' . 4r r : ;$y' ^yy� ';.S.C: "^c'+-:'m,xt9ir,:,"„o.: i;,•. x� ,��4f.ryr 1', •� •CERTIEICATE.NOII.DEii;r',��.l,.;li;•.��'.t,.w��;N,:;e"',:a:?'-. �u:;:134,. ���L�1T10ftl:;i�:: ,`•'''J :.`t�".:rY � n:l. �.'r'.,...1. yl), F�' 1• I Ray Border ..,�'I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Twitchell Rd. s~1 EXPIRAT7IO�N DATE THEREOF, THE ISSUING,COMPANY WILL ENDEAVOR TO f e 02181 4 MAIL. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE c 23 Ft.existing structure rear of garage 3' 12' i /SY 4 / 11'6' Y/ ,r 4' /— — 2' High Sliding Window_, I � Lot#4 79 Nautical Lane South Yarmouth, MA • AC014D ISSUE fl000R(MM MYYY) CERTIFICATE OF INSURANCE • • n 08/18/93 PRODUCa • • • THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Rogers & Gray Ins. Agency CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE 640 Iyanough Rd Rte 132 DOES NOT AMEND, EN,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Hyannis, MA 02601 COMPANIES AFFORDING COVERAGE CCOAPANY LETTER A Wausau Insurance Company COMPANY E INSURED LETTER • A & E Forms, Inc. _ COMPANY c 32 General Holway Road LETTER South Yarmouth, MA 02664 COMPANY D LETTER COMPANY E LETTER COVERAGES,:..., t. - ..._. .. ..... 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. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE Of INSURANCE POLICY NUMBER DATE pm/DDMY) DATE(MWDDA,Y) UNITS GENERAL UABIUTY GENERK AGGREGATE S COMMERCIAL GENERAL LABILITY PRCOIJCT&COMP/OP AGI. $ • ICLAIMS MADE pi OCCUR PERSONAL&ADV.INJURY $ OWNERS&CONIRACTERS PROT. EACH OCCURRENCE B RAE DAMAGE(My ons Ms) $ MEA EXPENSE(My we penon) $ AUTOMOBILE UABU TY COMBINED SINGLE ANY MO UUNITR ALL OWNED AUTOS BODILY INJURY SCHEDULED AURIS ON Pim* S HIRED AUTOS BOOBY INJURY ldoNON-OWNED AUTOS �•� S _ GARAGE LIABILITY PROPERTY DAMAGE S EXCESS LIABILITY EACH OCCURRENCE -UMBRELLA FORM AGGREGATE S OTHER TNN UMBRELLA FORM ..... WORKER'S COMPENSATION / STATUTORY UNITS ., . . . ... EACHAr..TENT • 100,000 A MD 1514-00-075985 06/03/93 06/03/94 DISEASE-POUCYUMR I 500,000 EMPLOYERS'LIABILITY DISEASE-EACH EMPLOYEE S 100,000 OTHER DESCRIPTION OF OPERATORS/LOCATIONS/VEHICLES/SPECIAL ITEMS • ..• SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO Ray Bordenca : MAIL 10 DAYS WRITTEN NOTICE TO THECERRFICATE HOLDER NAMED TO THE 79 Nautical Lane LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABIIITYOF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. South Yarmouth MA 02664 AUni DREPR ESEMjATIVE c KYAY INSURANCEEf�AAGJENCY,INC. . -. . ' •B9• .=3d'n«�1 ` ���.r DACORD CORPORATION 1990' ACORD 25-S(TM) .. • \ \r 2 x 10 Rafters `"�E--Asphault Shingles 9" Inwlationl ''..N. 1 ....„.....„..s.„,...: v , 1/2 Sheetrock 4"/ ' T • ' I 31/2 Fiberglass Insulation I Wood Shingles ir ; Ii1/2 Plywood • IL . • • S/8 Plywood I � 1 x 3 Treated Sleeper I ' , • Y 'i 1"Inwiation \ ) j 2 x 8 Treated • ;� i v • .fi^r.4�1F�i Caulking' . ' i..:• under plate • ( t *'7 8" • ' Concrete.--- 4"Concrete slab � t� ! 1I Foundation 1 i t .-�- _ — '' :` -- •-- _ . _ - cif-7. •-_-: ;� , L • I i • __ _ -•y. - - - -- — — --- 1 --------- . - - .-... _. i -- --- --- -- --. --= -- - - - .�— � � / - 1 - -- .— - ---- !— _ , gyp ------ ------- - il --r I--' - - - -- ---- - -- -- - --- -LT- -- --I 'r -_ - ,T..__ - ._ - _- --_.___...._. - _. - • • - t----, [i _ i _ I -__. - iI I - I .r__- 1 I • • • • ey i.�... • _4 `j t "` side , back angular side — 1 t._ , i? • • ft I ,-- - I. • ,Lot#4 79 Nautical Lane South Yarmouth, MA • .