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HomeMy WebLinkAboutBLD-19-003133 I'Mit A tce Use On, O ,,i,i"'� N Amount /D i :-+nau^'g.' Permit expires 180 days from g ..' issue date i EXPRESS BUILDING PERMIT APPLICATI S N.--------,C E I V E U~ TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 NOV 16 2018 South Yarmouth, MA 02664 /(508)3988-2231 Ext. 1261 Buy • (' r'EP' RTMENT CONSTRUCTION ADDRESS: , V-1 /-/I�1 h A et`t (LI ' ajaillaya,ASSESSOR'S INFORMATION: Map: / Parcel: s le /97- 7 7/- 4 OWNER: ( Weal Veldt wh' tt. LLC /t S1ocbtI dap t 6Aacat' AA- Gal aS NAME PRESENT ADDRESS TEL. # CONTRACTOR: De O 7 0 A Ass0 JAres LLC /°? i necr- Oats Drttu! 4,17-14 `.l.—'16 P NAME MAILING ADDRESS TEL.# I Residential ❑Commercial Est Cost of Construction$ a 01 WI) Home Improvement Contractor Lic.# 117( I3 / €2/6/ i ? Construction Supervisor Lic.#CS-Ott',I,yj 2/yl!7 Workman's Compensation Insurance• (sheek one) 0 I am the homeownermil am the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # Roofing: #of Squares ( )Remove existing* (max 2 layers) Insulation Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing ! /� k ban i 0 r r / / t Qd Jo Ik `reftcpiA - , 'The debris will be disposed of at ^a e J EKe° - JOo gr-e4 Cve4 NNi I £y fth NAA Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or revocation of my lic se or prosecution under M.G.L.Ch.268,Section 1. Applicant's Signa Si_: Me " Date:__ to pv [ i- (} Owners Signature(or attachment) ( k i \ Date: /I /'. )er- Approved By: C s_.,�i;— Date: AZ-026-1716 B ::g 1, cial(o designee) .mom I ADDRESS: - Zoning District: Historical District: 0 Yes 0 No Flood Plain Zone:, 0 Yes 0 No Water Resource Protection District: Within 100 R of Wetlands: 0 Yes 0 No 0 Yes 0 No • do,' ' The Commonwealth ofMassadhusetts ►6=_ _f/ Department oflndustrialAccidents 1 Suite 4r7 BostonSMA 021 100 14 2017 .�• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): ,l Mn vlo A ,SCI A-5-tet. GL C Address: I o 2 t„ a Qire /i- City/State/Zip: S. O.NN+ a Phone #: di7- ala - Y676 Are you an employer?Check the appropriate box: Type of project(required): l.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doingall work myself t 9. ❑Demolition ❑ ys [No workers'comp.insurance required.] 4.❑I am a homeowner and will be hiring contractors to conduct all work on m property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.11,1-'‘a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information- ?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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 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 MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby at" nder the pains and • aloes of perjury that the information provided above is true and correct Sienatu,-: A Al? t " e& /� AS?— Date: l� `�`/�� Phone#re I-In - 76,Fo Official use only. Do not write in this area, to be completed by city 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#: • Information 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 ajoint 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." MOL chapter 152, §250(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 construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §250(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any cont-act 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,if necessary, supply sub-contractor(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)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industial • Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The 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 fill 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 affidavit 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 marked 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 filled out each year. Where a home owner 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia • �oF YgRG TOWN OF YARMOUTH BUILDING DEPARTMENT F 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 261 BUILDING DEPARTMENT TOTAL DEMOLITION SIGN-OFF FORM State Building Code(780 CMR) Chapter 33, Section 3303.6-Service Connections "Before a building or structure is demolished or removed, the owner or agent shall notify all utilities having service connections within the structure, such as water, electric, gas sewer and other connections. A permit to demolish or remove a building or structure shall not be issued until a release is obtained from the utilities, stating that their respective service connections and appurtenant equipment, such as meter and regulators, have been removed or sealed and plugged in a safe manner." "All debris shall be disposed of in accordance with 780CMR 111.5." Building or Structure Location: tf o e /fati /34. k Map: Lot: Owner's Name:20(45s tt -e,n- L U-Address: Phone: Contractor's Name: Address: Phone: Eversource: Date: ' I BY: See A 14utclwci Title: National Grid: DaBy: JPe A+L4CLe I Title: Water Dept.: Date: A/114-14 By: Seec6 Title: Board of Health: Date: el— l 0— t8 By: R4 Title: 'If t4 Condition: p4 ,--r1 ov - Sz!)h c Fire Dept.: Date: //b4 9 By: dt Title: be eta - Historic Commission: Date: BY: SeeA1l4ck+kzc Title: Conservation: Date: t3 b s By: Me.. / / Comcast: Date: rG n/�Ac oc 3/15 EVERSa One NSTAR Way vURCE Westwood,MA 02090 ENERGY September 5, 2018 Thomas Lambert 20 Edgewater LLC 85 E India Row 39E Boston, MA 02110 RE: 402 High Bank Rd., S Yarmouth MA Dear Owner. At Eversource Energy, we're committed to delivering great service. This letter serves as confirmation that, as of 08/21/18, the electric service to 402 High Bank Rd., S Yarmouth MA has been removed. Based on this information, there Is no electric power at this address and you may proceed with the demolition. Sincerely, Mu Mrs. M. Feeney New Customer Connects { 4f • nationaigrid November 8,2018 Tom Lambert 402 Highbank Rd. South Yarmouth,MA 02664 To Whom It May Concern: RE: 402 Highbank Rd.,South Yarmouth, MA 02664 This letter is to confirm that there is no live gas service to the above property. I can be reached directly at 508-760-7439 should there be any further questions. Sincerely, Q� 10411044 ,( 41/j Ellen Whelan Gas Connections Rep National Grid 127 Whites Path S.Yarmouth,MA 02664 (T)508-760-7439 1 ) ) i ) J TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 Ph.: 508-398-2231 ext. 261 BUILDING DEPARTMENT TOTAL DEMOLITION SIGN-OFF FORM State Building Code (780 CMR) Chapter 1, Section 112.1-Service Connections "Before a building or structure is demolished or removed, the owner or agent shall notify all utilities having service connedions within the structure,such as water, electric,gas, sewer and other oonnedions.A permit to demolish or remove a building or structure shall not be Issued until a release Is obtained from the utilities, stating their respective service connections and appurtenant equipment, such as meter and regulators, have been removed or sealed and plugged in a safe manner." "All debris shall be disposed of in accordance with 780CMR 111.5." Building or Structure Location: '(1)2 /�7.` AA4t MAP: 9/ _; LOT: J Owner's Name: /&64g/ 4Ibo,c I• .dpest fiCS y7r/ /S$i o rc— o2/c9 Contractor's Name: Ceep7.13 r-. Address: /S°Ia,vr h A Phone: 3-6/r39118 I/ Stennis o.2C c, NSTAR: DATE: BY: TITLE: KEYSPAN: DATE: BY: TITLE: WATER DEPARTMENT: DATE: Viaj3'1 BY: Tom' Assisi -CI BOARD OF HEALTH DATE: BY: TITLE: CONDMON: FIRE DEPARTMENT DATE: BY: TIRE: HISTORIC COMMISSION: DATE: BY: TITLE: VERIZON:- .... DATE: BY: . TIRE: • �f YqR. TOWN OF YARMOUTH • { �o WATER DEPARTMENT t • & . C y ' y: 99 Buck Island Road N� }• West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET • Bldg. Site Location ifoa /-115h earl. k Map #: Lot #: Proposed Improvement: IQtA,2R. • actAC.0 Applicant: O/-v,Aaoh_ C.ns� . Address gi fns L Cs (-1%4+\ Loh_ 070—'--Tel. #: 78 1.171 -` U. Date Filed: Sr 3 1 - ( &S a,sdoto 1'1'V\ Oa /to RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location 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, Ocean, Bogs, Bays, Marshland, Etc... Health Department: Determines Compliance to State and Town Regulations, i.e., Requirements 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... 4Alt A24- 3 ( - I l Signature o ant Date • PLEASE NOTE: COMMENTS: ' • ._..�� . [ 3 / ; Re ewe. by: Water Divisi, Date a • ILO :-Ci k TOWN OF YARMOUTH *- ° HEALTH DEPARTMENT Oz ''� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant:,1 1-1 .j ),Building Site Location: T d 6.-k 6'/d1 Proposed Improvement: �ea q 8.-.) t y ra ri t to_u c04'ite l Applicant: 001 it,en 6h4 # Tel. No.: 7ti1.. 771- 5/71 C 1 G{uuMit( f Address: ' IJli 1—ti�,k ) 3iIt 0cis.run) Date Filed: 9/ ( 0bS **Ifyou would like e-mail notification of sign off please provide e-mail address: Owner Name: .t) U g city -t lie,t- L L C ^ 1 Owner Address: 65 17. 071 2' A ,1 Z-.,) 3 i ri (tea 4„4)OwneMnr Tel.No.: 71/- 7 7 l- Y 74 RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note:Floor plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. COAREVIEWED BY: DATE: 7//n//6 PLEASE NOTE COMMENTS/CONDITIONS: Seritc, IV ts'L tV te.. C'f' AG wtVve 4 - , flc TOWN OF YARMOUTH 0 Mil 1146 ROUTE 28,SOUTH YARMOUTH,MASSACHUSETTS 02664-4451 Y8' Telephone(508)398-2231 Ext. 1292 Fax(508)398-0836 HISTORICAL COMMISSION November 8,2018 CERTIFIED MAIL#7016 1370 0001 6401 4052 RETURN RECEIPT#9590 9402 2096 6132 2644 32 Mr.Tom Lambert 85 East India Row#39E Boston,MA 02110 Email: lambertneed@aol.com RE: 402 Highbank Rd., South Yarmouth-Demolition Request Dear Mr.Lambert, On September 13, 2018, the Historical Commission received request for the full demolition of the house located at 402 Highbank Rd. As the structure is over 75 years old, this request was automatically subject to the provisions of the Yarmouth Town By-Law,Chapter 92: Historic Properties. On Tuesday, September 25, 2018, the Commission met in quorum on site at 402 Highbank Rd. and unanimously voted that despite its deteriorating condition the original portion of the building being proposed for demolition (herein referred to as the"main house") is a "significant building" as defined in Chapter 92-2. They determined the"main house"to be significant to the town of Yarmouth, where it has resided since approximately 1825,not only from an architectural standpoint,but also in large part because this home was once owned by a sea Captain whose industry was a significant part of the Town's heritage. On Thursday, October 25, 2018 a public hearing was held, in accordance to Chapter 92-3, to gather information in order to make a determination whether or not demolition of the "main house" would be detrimental to the historical, cultural or architectural heritage of Yarmouth. At this hearing, you expressed that as much as you would like to preserve the main portion of.the house, it would be cost prohibitive based on the cost of the work needed to bring it to code verses what it would sell for based on the market price of other homes in the area. In addition, several abutters appeared and spoke in support of the full demolition. While they understand the historical significance of the house, they are extremely concerned about the hazardous conditions resulting from the house and land having been abandoned and neglected for the last 15-20 years. They also expressed a safety concern about people walking through the property late at night because of the lack of fencing along Highbank Rd. All agreed that it is quite a shame that the property has been left to deteriorate to this extent. On Thursday, November 8, 2018, the Commission met in quorum and voted unanimously on the following items: 1. The demolition of the"main house"located at 402 Highbank Rd. S. Yarmouth, would be detrimental to the historical, cultural or architectural heritage or resources of the Town of Yarmouth based on the fact that it was once owned by a sea Captain whose industry was a significant part of the Town's heritage. 2. The Commission waives the 180 day delay period in its entirety allowing the demolition permit to be issued. This decision was made after taking into consideration, a) the unlikelihood that another person or group would be willing to purchase, preserve, rehabilitate or restore the "main house", b) the fact that the house cannot be seen from a public way and therefore does not add to the visual historic appeal of the area and c) that delaying until spring will only prolong the neglect, the deterioration and further blight of the property, The Yarmouth Historical Commission,thanks you for your due diligence in this matter. Sincerely, pa 71faeleaZee Julie Mockabee, Chairman,Yarmouth Historical Commission CC: Yarmouth Town Clerk,Yarmouth Building Commissioner,YHC File . ot'Y`�R } :Q Town of Yarmouth �� . yl; $ Conservation Commission "," .o 6CF, Building Permit Sign-off Application TO BE FILLED OUT BY APPLICANT: Building Site Location: 'ID d 14 t h% II evt 65 ea Map# edae # Property Owner: aC 6 dae t%.4'"/*".. L L.C. Applicant: o oil 04 6-vt f Applicant Address: cc £j.t II A.4;4 Al al 31C j&o 6f, > 14 ow, Telephone: 711-71 ( '`Y764 Date Filed ` b3bE Proposed Project Description: s CZ Simc-{-t•AP ' ae t' �1kce exlsri•e Plans: StOA/avl ©l 97402. fhrh&rid /Co6 Si. YQYn4otelt, eh,eh TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: Do You Have A Valid Permit From The Conservation Commission For The Proposed Project? Comments from Conserva ' n Commission: Approved Conditionally Approv Rejected All work related debris shall be taken offsite or disposed in a legal upland location At the end of each day, the area shall be clean and no debris shall be in the Resource Area Refer to: SE83- or DOA permit Ah) j u it t.s ectc &We" . Conservation Commission Sign-off Signature: Date:9/n//d, cIPP COMCAST . Memo To: Whom it may concern Front Matt Martin Date: 11/15/18 Subject Drop removal To whom it may concern, The Comcast lines have been disconnected from the pole to the building at 402 High Bank Rd, South Yarmouth MA.Any further questions,please feel free to call. Matthew Martin Technical Operations Supervisor Comcast Business Services Cape Cod and The Islands Office: 508-630-8847 1 CCCONST-02 MVERTENTES ACOizo" CERTIFICATE OF LIABILITY INSURANCE DATE DDmm `—'� - 11/16/2018 ' 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(les)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 License#1780862 jrcatherine Lawrence HUB International New England - jPHOO,NN.o,Eci):(508)235-2207 I FAX No): 222 Milliken Boulevard E-MAI .Fall River,MA 02721 AOORhss•catherine.lawrence@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIL$ INSURER A:Firemen's Insurance Company of Washington,D.C. 21784 INSURED INSURER B:St. Paul Fire&Marine Insurance Company 24767 C.C.Construction,Inc. INSURERC:Acadia Insurance Company 31325 15 Diamond's Path P.O. Box 1493 INSURER D:Markel Insurance Company 38970 South Dennis,MA 02660 INSURER E: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS I TR INSD WVD (MMIDD/YYYY1 (MMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _§ . 1,000,000 I ^ CLAIMS-MADE OCCUR CPA509678515 07/01/2018 07/01/2019 DAMAGE TO RENTED 250,000 PREMISES IFe occurrence) $ _ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LqGTIMpIT APPLIES PER: GENERAL AGGREGATE § 2,000,000 1 POLICY X • JELOC PRODUCTS-COMP/OP AGO __§ 2,000,000 OTHER: EBL AGG $ 2,000,000 A AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT 1,000,000 IEa accident) $ X ANY AUTO MAA5096788-15 07/01/2018 07/01/2019 BODILY INJURY(Per person) $ - OWNED SCHEDULED _ AUTOSg�� ONLY _ AUTOS W ED BODILY INJURY(Per accident) § AUTOS ONLY _ AUTOS ONLY ler aci Cent)AMAGE $ — $ --- -B X UMBRELLA LIAB X OCCUR . EACH OCCURRENCE j 10,000,000 EXCESS LIAB CLAIMS-MADE ZUP15P1771518NF _ 07/01/2018 07/01/2019 AGGREGATE - $ 10,000,000 DED X RETENTIONS 10,000 $ . A WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER WPA509679215 07/01/2018 07/01/2019 1,000,000 OFFFICEERR/MEMBER PROPRIETOR/PARTNER/EXECUTIVE N N/A - - E.L EACH ACCIDENT $ (Mandatory n NH) E.L DISEASE•EA EMPLOYEE $ 1,000,000 II yea,describe under 1,000,000 DESCRIPTION OF OPERATIONS below - E.L DISEASE-POLICY LIMIT $ C Equipment Floater CIM5101396.15 07/01/2018 07/01/2019 leased/rented 325,000 D Pollution/Environm MKLV7ENV100244 07/01/2018 07/01/2019 Each occ/agg 5,000,000 • DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Addklonal Remarks Schedule,may be attached If more space Is required) Project:402 Highbank Road,Yarmouth MA Twenty Edgewater LLC Is named as additional Insured for the project referenced as required by written contract. CERTIFICATE HOLDER CANCELLATION - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE . THE DATETwenty Edgewater LLC ACCO DANCEIWITH THE POUCYREOFP OVISIONS.E WILL BE DELIVERED IN 16 Stockbridge Street . . 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