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HomeMy WebLinkAboutBld-20-000406 1 94 . ? 6 A .,... , s . ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department or .. 1146 Route 28, South Yarmouth,MA 02664-4492 `' ''� 508-398-2231 ext. 1261 Fax 508-398-0836 tI Massachusetts State Building Code,780 CMR Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number&j•'d{O'tt�'Ydb: ,Date Appli J l !I ''.707 /i ' • q zO ) . 5QArs �� % 61� Building Official. . (Print Name) . store',. : .. . Date. SECTION 1:Sirk INFORMATION . 1.1�Pro Address: )�( f� 1.2 Assessors yap&Parcel Numbers I p e (a n & 1.1 a Is this an edstreet? es Map Number Parcel •um �pt y � nd� 1.3 Zoning Information: 1.4 PropertyRiimeenns I: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owa r'of Re rd; C 4 7)e n g/ r yl Gv, t Cl,r id2 l-, ci vflaz.3 Name(Print) / /n City,State, a_.4'/`2/9 4l E / fit 5$ .?&Q 7 7 'cac No.and Str � Telephone Email Address • ' SECTION 3:.DESCRIPTION OF JROPOSED WORIC2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units , Other ❑ Specify: I14Emei:ic CM-I/02,' Y -I 1-tiPL&9i- , c— tti SV"% A'* pIZ 47i 'j�- kwLiJ c0,G'/1J x c/G/f'/1le . j-r�/J,�►E'/4/ ?).ez-A/�ki; Lae/7 j4 Sii cR'''X - . . : _SECTION4i.ESTIMATED CONSTRUCTION COSTS• • Item Estimated Costs: Oil E 1.) • ... . Of .aallIte � . .-.�..,� 1.Building $ �/i,, 00 :l.:BuildingPeimit'Fee;:$: rb.. ..Indicate how fe is.¢determined: ). a 2.Electrical $ �' !!.Standard City/Town Application fee: '- 'I. ' �7 .2 7 1019 I D.TotalProject Cost.(Item,6)xmultiplier•.. _• . ; x1• 3.Plumbing $ 2. OtherFees: $ � S r u—_ `r' 4.Mechanical (HVAC) $ 66 , L)0 L a '� _ ,k- 5.Mechanical (Fire Suppression) $ Total All Fees:$. - ' . . Checkl�o: Check Amount Cash•Amount: - 6.Total Project Cost: $ .502. C a Paid In Full . 11 Outstanding Balance Due: JI 5-7.- N. SECTION 5:.CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �b 7�r ( License Number Expiration ate Name of CSL Holder ) J List CSL Type(see below) No.and Street �( Type Description „/_// ..`'rJ� �l U Unrestricted(Buildings up to 35,000 cu.ft.) [�(�( Li V a �j R Restricted 1&2 Family Dwelling CitylTown,State,ZIP �a ��` M Masonry • RC Roofing Covering Window and Siding..,1.._^ J SF Solid Fuel Burning Appliances 568' 63g 45 ©e.ocz/I a.Q%L( ,GQJd''JI Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Con ctor(HIC) 40 om an erne or HIC e ' HIC Registration Number Expiration 'ate arfieJr --T�� �fc�� iStreet ce, C7-7/ VIA Email address City/T State,ZIP 26e/ Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes No ❑ • . SECTION 7a:O AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .. I,as Owner of the subject property,hereby authorize 0(9_,OCAJ /[L-L to act on my behalf in all matters relative to work authorized by this building permit application. 4777k eLl Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name ow,I hereby attest under the pains and penalties of perjury that all of the information contained in this appii is true and accurate to the best of my knowledge and understanding. 7/7/9 Print Owner's r Agent's N ectronic Signature) • Date • NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty find under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www,mass.eov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Ak The a> efilessucheeette ''==' _,r Department oflmiustrielAccMests 1 Congress, fee i Suite 100 a4 9111 17 Wean'Compensation laureate Amdavltt Bogdars/C ntra TO BE PILED Willi rim rya AI TBOIRI1Y. , cant ifitibrnuid to Pb.,,Print Leask Name OcEANsi of 7A ('' 1 Address; -r3/7 T 1 j,2 A Tt}/) 'j2/ 0E. Cfty ip:HYAAJAJIS AM 0710O IPhoeu#:_ffi2 7 71 //O ITN eampesyestCaavtt the epprepalatsbut is/am aempioya�wi& if (tidlaotsrpaetdesV TYPO Of Piglet 1 � 7. ❑Nam construction 1 ma a setspsoprletorarp anmehlp sadism en Remodel*El ' ens'ap�9.Plo ibirsoa�p.ioaumaacayabedd.3 Saga 8. 3.01 em ahomesweer dolog ell work myself Deo wmkaa'amp,butanes vagei ed j t 9 ❑Dtetio$bm 4.Qlama homeowner and sill MAl�i Samesemerem aaauecelwokoaa8rptip�y,I� 100 Buda*addition asenediet all ssmea°a eater have woelars'onmpassetims immt=at are sole 11.0 Electrical repairs or additions propeletam wiehm oi$sees Staed IsmsaeeahaolorasdIhaveblsede6esol aometals Ewe ea the atl ebodsheet. 12'0""m" rsmtedditione Thee aebooeiraofwshsve employees sad have wottas•Barge,iaaaeoe t 13.0Rnoftgea 6.QWemeaoomansion sodas cacao have movoiedlimit*Mt afetmpdanperhifiLo. 14.DOfht' 15,11(4),and we have ao employees.LNo amine'aosvp.6rtssaoaras ed] Vann aPpliessit that cheeks hoz M1 most deo fill amuse eeodon Mow dewing tteb waken'asmpeassbaa policyia$aaelisa. rimaeowaaa who eabait this officlevk indicating they me doing all wadi mad t`enhie outside moatmaton meedseboa a new aNidsvlt 6riado=alit. :Commons the duck tlda box mat aaeobeden=Wm=sheet=owing the same&troaitoommotom end stem=whom not those end=he m amPleyeas.Wthesobnontmelose have employees,they=at provide Bear salmi mop.policy ember. lam risprmvl wanton'coad�pam lae�ece +a3' Blow fa Se policy asdJfadu site lnstua000e Company Nar .: `t j l 13. jr L•' 1&)J .._. . (C; / Policy#orSelf ins.Lic.#1. VLA_C 1OO(,, R aI / 34B:ingie Dam I///a6 0 7; Job SheAddzesa: A fir'/✓ ten/ mews/4: ti,WiO W i/ Attach s copy of the workers'oempesaden policy declaration page(shaming the policy number and— , . , data). Failure to same coverage as requited nnderM(L t:.152,.25A is a mindnal violation psmiehsble by a See up to$1,500A0 and/or aamyear imprisonment,as mil as alvllpecaltiea in the alumofa MOP WORK ORDER and a fine ofupto S250.00 a day against the violator.A copy of this statement may be hw.ded to Se Office oflevestigatioas ofthe DIA Sr insurance comma verification. Ili,hereby maw the pans and p aa&+feaefreee ry that die inata4saprov above is t ue ant overact g' p _____ Dote: g'al 9 Pbome#:. SbQ- fl( -3 I t o Official nos only. Do not aa a fit ttkfsarea,to be aoaapktad by thy artamII City or Towrt: . Pe rn sea s 0 Lendgg Authority(drde auk 1.Beard of Baal*2.Building Department 3.Gtyfloaa Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Parson: Phone#;. ;ti. ,z c�'.Y0 o TOWN OF YARMO UTH �' ,she:y c BUILDING DEPARTMENT ' • t. ""I = ,xy 1146 Route 28,South Yarmouth,MA 02664 7, sa' 508-398-2231 ext. 1261 Fax 508-398-0836 BUDDING DEPARTMENT • DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40,Section 54 and 780 CMR,Chapter 1,Section 1113, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at / C1 m/,--) ZJly Work Address Is to be disposed of at the following location: (SrT*00 17n 471� Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Si ature of Application /� � ate Permit No. . gip mmrr a tm=1971 CUm1 Una t answIOSNUMER tot813 7f Restoration 61104714210 104644318 1e a A.O 77447O4311 Pax ASSIONWENT AND ACTION TO PAY The undersigned, herein called claimant, has authorized and ordered from Oceanside, Inc. , the materials and/or services requested. Undersigned hereby assigns to Oceanside, Inc. any unpaid proceeds due or to become due, under the claimant's policy with the insurance company to pay direct to Oceanside, Inc. or to include its name on a check or draft, for all requested work. In the event that Oceanside's claim herein is not covered by, or paid by, an insurance company, claimant agrees to pay Oceanside,, Inc. within sixty (60) days after work has been completed. Claimant understands that Oceanside, Inc. is working for them and not the insurance company or the adjuster: Payments remaining due and payable after the claimant has received payment from the insurance company shall bear interest at one and one- half (1-1/20) percent per month. In the event that there is a breach by the claimant of any of the conditions of this agreement, Oceanside, Inc. shall be entitled to recover, as additional damages, attorneys' fees, costs and any other collection expenses reasonable and attributable to said breach. If payment is not received within 60 days, collection action will commence without further notice to the claimant. 16 Benjamin Way West Yarmouth, MA 02673 Loss/mmax ADDRESS 16 Benjamin Way West Yarmouth, MA 02673 MAILING ADDRNSS (BILLING) CITY STATE ZIP Joshua Dewey, Friedline&Carter Adjustment, Inc Ellis Insurance Natick, MA 01760 INSURANCE ADJUSTER'S NAME/CO. LOCAL INSURANCE AGENCY NAME Massachusetts Property Insurance Underwriting PRINT NAME �.�,. INS. CARRIER/POLICY UNDERWRITER Pfr re* DATE; 12-27-2018 ��¢ 4 g SICOULTURa PRONE: 508-862-6377 ffi+ L: amhigheearthlink_net 0 L i i �Lt, cean idev d $Pa.� Restoration Fire • Water• Soot•Mold 2.1.7 Thornton Dave,Hyannis,MA oa6oi P-508-771-3310/f•774-470-2211 vitesuitsanaidainsasni DATE: 07/02/2019 PROPOSAL SUBMITTED TO: JOB NUMBER:20181377 Denny High Jab Site: 16/Wamtn Way Same West Yarmouth,MA 02673 WE HEREBY PROPOSE TO FURNISH ANY MATERIAL(LISTED BELOW)AND LABOR, COMPLETE AS PROVIDED FOR IN THE SPECIFICATIONS BELOW.ALL MATERIAL IS WARRANTED TO BE FREE OF DEFECTS,AS SPECIFIED AND TO BE WITHIN ACCEPTABLE CONTEMPORARY QUALITY STANDARDS. ALL WORK IS TO BE COMPLETED IN A WORKMANSHIP-LIKE MANNER,ACCORDING TO STANDARD PRACTICES. MATERIAL COVERED UNDER THIS AGREEMENT AND DELIVERED TO THE JOB SITE ARE THE PROPERTY OF THE BUILDING OWNER UNLESS OTHER ARRANGEMENTS ARE MADE IN ADVANCE. OUR WORKERS ARE FULLY COVERED BY WORKERS'COMPENSATION LIABILITY INSURANCE.THIS PROPOSAL MAY BE WITHDRAWN BY US IF NOT ACCEPTED WITHIN TWENTY-ONE(21)DAYS.THIS PROPOSAL SUPERSEDES ANY AND ALL PREVIOUS OFFERS OR ESTIMATES TO PERFORM THIS WORK. NOTHING STATED IN THIS PROPOSAL IS MEANT TO IMPLY THAT THE COST OF COLLECTION OR DISPOSAL OF ANY HAZARDOUS WASTE IS INCLUDED IN THE CONTRACT PRICE. INFRASTRUCTURE COSTS(E.G.HEATING FUEL,ELECTRICITY, PLOWING,ETC.)REMAIN THE RESPONSIBILITY OF THE OWNER AS A PART OF THIS AGREEMENT. WE HEREBY PROPOSE TO FURNISH MATERIAL(AS LISTED BELOW)AND LABOR- COMPLETE IN ACCORDANCE WITH SPECIFICATIONS BELOW,FOR THE SUM OF: $25,529.70 Twenty Five Thousand,Five Hundred Twenty Nine AND 70/100 DOLLARS • PLEASE INITIAL HERE ACCEPTING ALL TERMS AND CONDITIONS SET FORTH ABOVE:x DPI /An M PAYMENT TO BE MADE AS FOLLOWS: $8,509.90 Deposit upon signing,prior to commencenusnt $8,50990 Payable upon 50%completion 58,509.90 Payable upon substantial completion A FINANCE CHARGE WILL BEADDED 219ALL ACCOUMS THAT ARE PAST DUE ACCORDING TV THE TERMS OF THE PAYMENT SCHEDULE. THE RATE IS 11/2%PER MO Pfi1 COMPOUNDED MONIWLY(ANNUAL PERCENTAGE 19.5694).THERE WILL BEA$25.00 CHARGE FOR ANY CHECKS RETURNED TO US UNPAID.THE CUSTOMER AGREES TO PAY ALL REASONABLE COLLECTION COSTS INCLUDIWG ATTORNEY FEES Proposed work: See attached scope-"Exhibit A" Authorized by: Oceanside,lnc.( or Opeadons Mdn ire) Pstimator's Sim ( � .�( .�. sign Not ACCEPTANCE OF PROPOSAL-the above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. DATE OF ACCEPTANCE: 7 "1_ / OWNER/AGENT SIGNATURE: Nally ?1 dit,_OWNER/AGENT SIGNATURE A. ___. _.__....____._._...._...� BATE SIGNED PROPOSAL RCVD BY OCEANSIDE: FOR OFFICE USE ONLY RATE DEPOSIT Itcyp BY%%AMIDE: FOB QFFILB WE ONLY PLEASE INITIAL HERE ACCEPTING ALL TERMS AND CONDITIONS SET FORTH ABOVE:x I l Office of Consumer Matra i eaWnan Rpurtlon HOME IM• - •.,- ENT CONTRACTOR (tigistratlou valid for brdhddruil use only -;.,• • Card beige the erpi dion date. Wfolnd Mum to: Ohio of Consumer Mahe and Business Regulation - 081012020 1000 Washington Sheet-mile 710 OCEANSIDE, ..iKa t t : Boubn,MA a11a ,, .,.._ STEVE TESSIER, 'r- 217 THawrON tilt HYAMIIS,MA 62601 Undersecretary Ot 'd without signature r 1 Commonwealth of Massachusetts Division of Professional Liceeoure �l Board of Bu6dbfp and Standards Conµisor CS-055571 y5'�' # if Ares:OW17/2020 • STEVEN M - , g liko i Commissioner arJ ....._____ 1 k ,. 1 i i • DATE(11M1DINYM) .4 CERTIFICATE OF LIABILITY INSURANCE 01A07/2019 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 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 WCT Linda Sullivan DOWLING&O'NEIL INSURANCE AGENCY PMOrE (508)775.1620 FAX iF,,uc,n x : Isulivan@doins.com RD INEURERts)AFFORDINGcovERAGE NAICS HYANNIS MA 02601 INSURER A: AIM MUTUAL INS CO 33758 swim INSURER B: OCEANSIDE INC MIEURERc: INSURER D: 217 THORNTON DRIVE INSURER E: HYANNIS MA 02801 INSURER F COVERAGES CERTIFICATE NUMBER: 353542 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OP INSURANCE gum vivo POLICY NUMBER fhl p P (IaNIDDlEr 1 LI.UTS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES t aamencel $ MED EXP(My one person) $ N/A PERSONAL it ADV INJURY $ GEM.AGGREGATE UM1I APPLIES PER GENERAL AGGREGATE $ POLICY ,Piker°- LOC ( PRODUCTS-COMP/OPAGO'S -- OTHER: AUTOMOBILE LIABILITY COMBINED1SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED SCHEDULED AUTOS AUTOS i N/A BODILY INJURY(Per accident) $ PROPERTY DAMAGE HIRED AUTOS i�AUTOS (WOWNED f $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAWS-MADE N/A AGGREGATE $ DED RETENTIONS ! $ WORKERS COMPENSATION { X F ATE OTH- AND EMPLOYERS'UMIUIY t. ANYPROPRIEfOR�PARTNER/EXECIJTIVE YJN EL EACH ACCIDENT $ 1,000,000 A OFFICERAMEMBEREXCLUDED? N/A NIA VWC10060198022019A 01/01/2019 01/01/2020 (Myaa,ns arory in NH) EL DISEASE-EA EMPLOYEE$ 1,000,000 ff DE dascrhe under SCWPTION OF OPERATIONS below EL DISEASE-POLICY LBIR 5 1,000,000 N/A t DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Rourke Schedule.may be apeahed II more apace N reMalred) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees In states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-compensatfonMvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH TIE POLICY PROVISIONS. AUAUTHOAUTHORIZEDD REPRESENTATNE Daniel M.�,CPCU,Vice President—Residual Market—WCRIBMA ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • Client#:586925 20CEANSIDEIN ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(YWDDA'YYY) 1/06/2019 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 certl8csta holder Is an ADDITIONAL INSURED,the policy(tes)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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER Dowling&O'Neil Insurance Agy a ma 508 775-1620 ,No);5087781218 tAlC 973 lyannough Road P.O.Box 1990 ADDRESS: Hyannis,MA 02601 INSURERS) COVERAGE NALC Baum A:Arbelia Mutual Insurance Company 17000 INSURED BABB'B B,Arbeile Protection Insurance Co 41360 Oceanside,Inc. INSURER C: 217 Thornton Drive MUREX D: Hyannis,MA 02601 NBLNa R E: NSURERF: 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tiV TYPE OF INSURANCE SISR YrVBR POLICY NUMBeR EMMIOD/YYYFY)palleidgMI UNITS A X COMMERCIAL GENERAL LABILITY 8500066712 D1101/2019 01/01/202Q EACH OCCURRENCE $1.000,000 CLAIMS-MADE X OCCUR oxurenue) 8100,000 X PD Ded:250 MED D CP(Any one person) $5.000 PERSONAL s ADV INJURY $1,000,000 GEM_AGGREGAia UNIT APPUESPER: GENERAL AGGREGATE s2,000,000 POLICY[ ^!! LOC PRODUCTS-COfiWIOP AGO a2,000,000 OTHER $ B AUTOMOBILE LIABILnY 102006166603 01/01/2019 01/01/2028 ter, LE um 51,000,000 ANY AUTO BODILY INJURY(Per person)— OWNED $ wros ONLY X AU D BODILY INJURY(Per accident) $ PROPERTY DAMAGE X HANGS OHLY X AUTOS MY IPerP r scddent) __ s $ A X UMBRELLA LAB X OCCUR 4600066716 01/01/2019 01/01/2020 EACH OCCURRENCE s5,000,000 EXCESSLUB CLAIMS-MADE AGGREGATE 0,000,000 DED X RETENTLONs10000 ! $ WORKERS COMPENSATION i PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER OFF CERSEMB OFFICER/MEMBER RI�ECt1nNEr� EL EACH ACCIDENT S OFFPROPRIM ORIPARLUD®4 i ) PI (ysn(1 InN� EL.DISEASE-EA EMPLOYEE$ DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LINT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101.AddfuomI RneoAs Schedule,nay be sEadred If more space le metered) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR REPRESENTATIVE I G 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD 85227036/M226890 RPSW1 Oceanside ahoy' Recap by Category O&P Items Total •/. GENERAL DEMOLITION 2,50131 9.80% DRYWALL 342.72 134% FLOOR COVERING-WOOD 1,036.73 4.06% PERMITS AND FEES 350.00 137% FINISH CARPENTRY/TRIMWORK 217.08 0.85% FRAMING&ROUGH CARPENTRY 2,192.56 8.59% HEAT, VENT&AIR CONDITIONING 1,707.65 6.69% INSULATION 260.40 1.02% LABOR ONLY 692.80 2.71% MASONRY 6,100.00 23.89% INTERIOR LATH&PLASTER 272.12 1.07% ROOFING 841.26 330% SIDING 4,270.79 16.73% O&P Items Subtotal 20,785.42 81.42% Material Sales Tax 313.48 1.23% Overhead 2,109.94 836% Profit 2,320.86 929% Total 25,529.70 100.00% 20181377 REPAIRS_1 R 7/1/2019 Page:6 Main Level 1 19'3" i 1 I I _ 18'7" z I 6' 5" , EN in in en .� 0 0 Living Room 25' r 25►8" a Main Level 20181377 REPAIRS 1 R 7/1/2019 Page:7 A Imo A 00 ♦ 12' -, • 12`g" $ e „: i• ''' I r S i Ltd. A q 5h, f u >: tom - ,.;�� y 4' x , '.Y E hxy5 a x ,'ice"'” 3;. 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