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Home My WebLink AboutBld-20-4219 ONE &TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling U E U This Section For Official Use Only 20 2 r; Building Permit Number: RL D-4 219 Date Apli �, a BUILDING DEPART ,rom seAc.s 3�'� 8y Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers go 1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 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 0 Private 0 Zone: — Outside Flood Zone? Municipal❑ On site disposal system CI Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: � p��et/y� �� 4s D.c e .447 � FFf 7 1- ( / Name i 1/ (Print) City,State,ZIP . -0 C/wwIs4y L st, Gi 2 3.1 4-7133 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORIC2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied VI Repairs(s) Alteration(s) 0 T Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units.„2.— Other 0 Specify: Brief Description of Proposed Work: ,Qt'i /n 1, i/e'ri, %vL Ja 4✓41e. 4.44% c l~lo6., ✓ y.Zt , -Ai/C. rigs r•p u /1r/c Ad, D TI \O SECTION 4:ESTIMATED CONSTR ION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ ,, , t/ti.0 1. Building Permit Fee:$ a Indicate how fee is determined: Standard City/Town Appl tion Fee 2.Electrical $ ❑Total Project Cost(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount; Cash Amount: 6.Total Project Cost: $ la deo L7 Paid in Full ©Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �s--oq/ /3 tea, r License Number p' 'on Date Name of CSL Bolder 9 7 5 'bL✓✓e' p List CSL Type(see below) No.and Street Type Description /a/yin./d9L /12 o 3-3‘o euR Unrestricted(Buildings up to 35,000 cu.ft.) r{ `It' Restricted 112 Family Dwelling City own,State,ZIP M Masonry RC Roofing Covering • WS Window and Siding /Z ,f9.-- er7/ i'V 1 by I SF Insulation Fuel Burning Appliances . '� �l'it7�f'�t1/LLD/'►. I nsulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) lyQ �,�a�a l 4/0/ /'P'(' HIC Registration Number Expiration Date }IIC Company Name or HIC Registrant Name A2a/e G«sis 1r-G// t t G /)1r p/✓0-pa NC 0/z1 No.and Street /--dcA.Zavb /?)y> a4 366 7f/33r.eono Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION LNSURANCE AFFIDAVIT(I4I.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 la: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize 4.14-Gorti f y/✓U1/7e LLt.-- to act,,on my behalf, in all matters relative to work authorized by this building permit application. 6-4 G Cty, //i)/24" Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. ./0 efl /30001-6 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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 fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.nov/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.) 6 Habitable room count Number of fireplaces ✓ Number of bedrooms y Number of bathrooms ` 3 Number of half/baths / l 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" a The Commonwealth of Massachusetts or ► it Department of Industrial Accidents 1 Congress Street, Suite 100 \I Boston, MA 02114-2017 �.,rumF. ' 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): /' V{ rawrindia, 6&Ci Address: /,q/ //FG✓ ,Ji/J-4-- City/State/Zip: /2O&/ L WA-° Phone #: 7 I) 3 3 S' _Zia 0 0 re you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with,,S employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp. insurance required.) 9. ❑ Demolition 3.0 I am a homeowner doing all work myself. [No workers'comp.insurance required.]t 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance Dr are sole 11.❑ Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑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.❑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. 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: /Q Z,/') /'7 v Y4/AL_ AT (0.) Policy#or Self-ins.Lic.#: t/Gt/G'id 0'GD3Qe71-1'7— . -Oiq 4 Expiration Date.. 5701Dd-3 ' • • Job Site Address: d C/o retVe? ./'Iv-c- ,r ylo9Krili1- 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature:T 4f Date: /A4D0O , . Phone#: ‘-/7) cc_q -- .7-7 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#: §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22P ext.4261 Fix 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 'D C/,aivdr .Aj, - So 2 /hi, 1,i? _ Wok Address Is to be disposed of oat the following location: 1.t'.4- //714,tajefil Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. Oyix97e Signature of pplication Date Permit No. -------- it. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constr tt1rt ltOpervisor CS-091043 . pi res. 08/07/2020 0. i 1 +�Y c MARK P RYAN .-{. ` 97 SANDWICaR, +3 , , a: PLYMOUTH.MA 92360 °"' ��• / t 0/s\,'1 1�1�� • Commissioner ' -7 HOME IMPRITYVEP:ActiaLLcC/°(NTRACTOR B en Re0ulfation IVE ABLE CONSTRUCTI I I : { MARK RYAN 1: aoi VFW ROCKLAN(1.-- . D MA MA 02370 -16"_'lG'__...�y Undersea , • • 1/1 . 1 -.. • .iii„iiii,it....:6;titiiiiiii• -,iii,•• .i,t-••'•::• ...i. — - '''' '' ''''.. .7... :...,::;ONTRACT FOR EMERGENCY SERVICES , .......,,,,,,,,L,;...,....- .:„.._ .--•::-,-:-..:tm .,..-.....:morgency ,SerViceS, / , . fz.i.,_2 ,•'_-•-,,_ i.± ( Customer") autidt)rizes and contract, tAii th t-t.:tr.)h-..t , .. ' .., ...• .:: •,..,...... : ,'.....,,•,•:::::-: , .1: . -3:-,1..•,t,"., ?.,-C...-• ti,,,ii;...-A",.. ,-;t11")et.°er1CV restoration services to repair the struciuretst on Custom ems nrcitterai ayitsiripirri „.••,c . „ ..) ,,• i tog Pciarierin't aft,. wilci resinect to ;reins that need to he clesineci at a remote: lociatton, to intituraate it. .- ri t t• yi .., : . , ,. ,„,,. _r tC.... . ..., , . .1 ,.t. .„, _, . t - ' • -:. • .1,-- • . ...1:••.-:•.. .:,e.• •.:; .t...•,-•, -t- H.,t,* hecorrie necessary due to a fire flood or other disiartei. accident in enitirosincy tate. ' . . •,•••. -..• "ait to• ••-• •• ti•-•• nt:i ••••i', no aittnia insinichisirly descraded in Me scope of services ici he ro-sded in cluxitiocrica. 'cry iii..,oie. ,t5 t'telt '• •. : ••'-.•: t•••....-'''''"-.1-',...', t 1•- rt: -,H::•••'t_ ,--.`V.•-.','t.!.31 ,11 .".t....-.. :,i te (7,.:)nri iti on s,. noriducted a witilk-thrOu,)h itiiiiits Cii;:uistorrer insitiettaux ray •hic Soo sits•on Con) -anti nait determined the moil effective restoration pr•oceiluies to taccorrielish the. Services. root inc lice ordsoisi Fon sant et dos diervices will be cortimercialty reasonable arid will be determineu in accordance with standard . ii-iin oho :nth's:no •••••••trit chi ••••• A concule•rieeci estiatriating S'y....,,t0,11-1 called Xactimate. The (host of the Services will inctude a tee pament . t: tiros-oil tatitrin oho ...i• ten cis:nisi it. triticite criarcie Ica Services performed b•y outside subcontractors. /Additional information regardi.no Wits pricing i- i••nine. mitt.) ta„lin ti, is thi-- t • - i'.iicitsiticei.Atheit Lei:tr....rest Customer agrees to this method of pricing. i taxitsithetaiso .P•....-,,,,F.,...-.;:t.,.'. /).1.-1e ga ti o o s. ittaistomer agrees he is responsible for his insurance de.ductible (if ,artty). litusiondeit Air-idea-stands ... it ...., no .... as:). i: i, y. •• •'' - boy rtniiisictos are noi covered by the Insurance i.2.c., Customer agrees to ttay the total Jr or• irivinicsr..... ... • tr n• ....• darn,- ..".static "it irtcy roxict tocitar-i itat slays of each invoice date regardless of whether his insurancie clairri has been settled. ottani irii•• t. it.••nt.•• ls to bile. th r. cosi' ot: 'sr "-.•••••tridanie ntin tOustorner hereby irrevocably authorizes and directs Inc ihrturatratire Co. to oav Able stalely and Lintt.i.• ri". "ti.•• n••••-•• '''ittitilityri ":" •••-i riot ..xistotir arty In.sortititicc Co it eisk should come to or be made payable to Customer Cristrenireir agrees triiii Firer „-....iiiii iiii iiiiii, iiiaii ... kri order Sc expedite payment to Able, (-Asti-timer hereby appoints l'itible •iiii; isis attohnei.,i-it-ittii)cit :iii••titt•itit iti•••••••i iti i.ittiti tiii.ii iiiitsitiiitii:its 'tit th•••:itiiitit•itti.,tiat•iite.7,73',•f.1 .,'" -.1.eposit.insurance Co,checks or drafts for completed Services. Customer understands thatj: titttitiiiiti...aitifinfvinijit.itit onatsitairt for any and all deductibles,depreciation,and any costs not covered by the insurance Co_ J'itiistitririsietitii rifir di. iii.fa t.'=-Ett rat?ce P roc es d s/Priority of Payments. Customer agrees that immediately Upon recerifti. Of any ;it:air:omit) . tr...x.,:atort: xiiiii•iant shistrin•citytt mons:Ain-sitaii tte-piaici iirsi in f.heir entirety before any other contractors or suppliers are paii. iiii...ritiotritit triet (tityticcatis tintiro•iiiiitti-ttria Costs of Collection. Invoices not paid within 60 days after the invoice date ....sill incur ititepatts, ...••••••mt ity. rot:, it in ant- •-• i •••••- ors- -- ' t 'Ton triti. itaincillii or at the islighest rate allowed by law. Collection attempts ma-,: incisimenice after ih.. 6 i••-ti •.: •.• it: • -tit-hitt tiiiiiitti : eiit ii:t. :ii.: ett.hhiiis ',his achoont for collection, Customer agrees to pay interest at 1,5-llit. per month or at the highest. , it: it"..•-,.....hi to irits ....to' iti inittr•it sit : c:i,••• iiiiiiii itria..in ertislis, rritasonatiler attorneys' fees arid all other costs of collection. CtusiMrrier further agrees to ..•ositonst.Artie tin ninon itittr•ttritintintritio acht tabor costs associated with its collection activities at the rate of$50.00 per hour. A 5i'ert•ii Liability. li•ititttei•ii• H6siiiWiit is ...x.pressiy limited to tne total amount paid by Customer for the Services. Any warranties made friti .t.-•iiiii it•••trittinisticirmi alii tins ••...initticrial shall lite null and."void in the event of a breach by Customer of any of his payment obligations. tasuriance cittci. titriitiiiartiiiiit. J.1iititorriar .atarees that ft) the event his Insurance Co. notifies Customer Mai it plans liti rush ,a Ma ••••••thAtti ii i Listaistraitt trAtii ition0 H'),..- HI:,HT t'11)1e t,.,..".)that it Can be present for such inspection. fiiitji i,.f f.,:...-- ..?,. .,1...8,i:g.,. ,,,:,A enteiti riiibie ti-;3:..t share certain confidential business information with Citslcirrier. nethods This information may not be disclosed to other parties without the advance t.',iritiert. _ht... •-•,-•••• t., snot. Mist 'ono'„a it „tn. „it iiia ase trtia information ONLY to process Customer's claim. It may nOt Cii:SCIOSe any of this litiftirmiatin-ci !O ...•••••,,....-.: •.:..:. •:.,-.:,.',.'..'-''''.••:' ,.-. .,:-•,•.. ....',...-1,...r.r• 'J.f.',.',.':".••,-;';,•-ty fl.,..-JE,.• .?,F'./ f ircunist3nces. Customer is responsible fur any losses or dai•addet.F that tritti.x. int.:unit. ,.-.i.c t..tt.t.tIF:t.' ,t.:-.:.tt f....,:).,,16' .-tt 3.,ftdtttlg 4qteemertr. Custi-tirrier understands that this is, not a contract of insui•ianists. Customer .agrees Mat,itittilis "... xi:ration.: inn ma itinoxichritin sr)..-i. not iiriiiii iiieiiiriamost ciii,io.. insurance Co.'s agent or adjuster, or public.adjuster. Custorner undertiiitands•and sure: ir„to rittairter son lissortnachi °Li nth ,•-ticrit. tot "itts aidents has the right to cancel this contract. This contract is binding and fully enforceable 11;11,-C.:,t't ,t•••.t•t''',.•'tt'Pr• tH'...- C."1, '-,-:%:Y• :','•t'-t•t •-.1..••.''-. .:t•it It e r.'.. :..P Ctt rt....er agreements or understandings(written or oral)made prior to exectition of this contract. Citistotruects 1-?ethesictiptations and Warranties. Customer represents and warrants as follows lat. be is the record owner a noon-en •-iniont •c inn init-.rt..: onithir cii Sae titroperly ark) has full authority to enter into this contract: (b) his honteowiter's aisurance policy was -• hist or.rt ern scent ••••tiiii ...ti rat tosti, cil thia loss and that such policy is adequate to cover the cost of the Services. lict) the norneowitter's sontettax rose not ticen assigned to any other party: (d) he will execute any document's required to cinicess, lire •• ,•• •••sit.it :rattlers •itti...nine, sini int tot 'nom isaad inis contract in its entirety and understands and agrees to its terrain tiltddittioriai Woritt•Ricshi. to ittatcd. •if Cosiorner decides to hire Able for a second construction phase of woit,. v;hixth .!...ene?.*:kt.- frilo--iss no' 'cia• Shame si einictottintito ou' htteiy Loottatitst itriti this contract Customer understands that such work will be covered by a separate cyanid-aid if •i•-r. .):::.•••c••••••..ity• t,..,..Et,'11 t,H, -•'.',rt, '...-ft.t•... •,..-, t.,•:.-tf'...t.'1t! 1;.3.,ittlttiCr',.:d or from another contractor, Customer agrees that Able hias inf.? fic11.11 1-o match the rs:.;eteiiiti tii•tiiii etiititi t• i•i• iiiii hi iiittii•iti•••••••-'6•Tttiiii: iiii• hihi itii•iiii•itiiiit•S':=:•eii i;h:iSi nfini tO match.Customer agrees to award the work to Able :,-,i>.1.1.doec.,e..s.. •:,...s J...,..:,c•, :-' . conftant. •all rirohouns and all defined terms shall be deemed to own to the ntrasculine. .3emir-di-es hi....r.„) th,•eat,"...a, J.:7y alioriti. ric,•• the ntithation• ot ine pecS011, Pe rsons, entity or entities or the circumstances may require it any p.an of this tt/ttnno t'•-•• - t-, :tt..,--:,•e,;,.. t..,,. L. ,?..,-,,,, the rerander of this contract shall not be affected anti .each riarneininq pri11 ;&•! '-• :-,.-.- ' .1--..-.-. t...-. ',.,,, .•-:t.'.1:: .7.n- ,',.'t ".., - t..t11:?s extent permitted by as • ..t.titt C.);St..):,; 1::,,T ED ANT.) ._ Lao :__.cr.,:_.•:.•,.._. ..'_ .. •:••_ •• '":.•:• ...:'".:: •'-' '•'::::••••......... „.:.:,....„:„...„............................_....._........„.........._............:.:„......_...._.........______ ,. .. . : ' ..• ..,,...... .• .. •,. ......„ „......„.„. ... :„., ... . . .......• .. . „...• iiiiP. ••-• ... .... .... ..-• . .. ...... ..............„....• .......................„.._ .,. . . ., • Date:/ • - 0/1. 0 d :l/ ' ii' " .,. Ac R CERTIFICATE OF LIABILITY INSURANCE DATE(M DOrfVYY) 08126/2019 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 06265-001 NAHOMtE�tCT 6265 6265/1 Corcoran&Haviin Insurance Group riUG.i�o:Exti: ice.No.: PO Box 9011 A Wellesley,MA 02482 dtEss, ddonohue@chinsurance.corn INSURERIS)AFFORDING COVERAGE NAIL# INSURER A. A.LM,Mutual Insurance Company 33758 INSURED Able Restoration Inc INSURERS: INSURER C: 401 VFW Drive Rockland, MA 02370 INSURERD: INSURER E *See Additional Named Insured Endorsement 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 ADDLSUBR POLICY NUMBER POLICY EFpp POLICY EXP LIMITS LTR INSR WVD (MM/DDPYYYY) (MM/DD/YYYY). GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ POLICY �jECT LOC — AUTOMOBILE'LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY{Per sodden)) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ pMRR I9NNppLT X *Y LATTU S $ OTH- ER A PROPRIETOR/PARTNER/EXECUTIVE Y(N E.L.EACH ACCIDENT $ 1,000.UOU.00 A OFFICER/MEMBER M�EMM6BEERR N N(A VWC•100-6020297-2019A 8/25/2019 8/25/2020 (MandatoryfY in NH) E.L.DISEASE-EA EMPLOYEE $ q,000,008-00 VIEW On iPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1.000.o09.00 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101 Additional Remarks Schedule,ifmore space Is required) CERTIFICATE HOLDER CANCELLATION Able Construction LLC 401 VFW Drive SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Rockland,MA 02370 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH,THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ACORD CORPORATION.All rights reserved.