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BP-54301 Permit No. BP-54301 BUILDING PERMIT. :-. GIS# 4204.00 - t oainxonrueaG l''o/FY/a.uachaeetis Map 0479 TOWN OF-DARTMOUTH 0020 - 0 400 Slocum Road,Dartmouth,-MA 02747 Sub Lot. 0000 Phone:(508)910-1820 • Fax (508).910=1838 Category: TO REPLACE - Project# °JS-2009-000589a, .- PERMISSION IS HEREBY GRANTED TO: Est:Cost.. S20000 00;'; JR "Fee• 75A0 - Contractor: License Phone#: Const Class F_ MICHAEL J NERONHA 111112232 (508)669-6134 Use Group R4 Engineer: License Phone#' Lot Size(sq ft.)- 13{00A Zontng SRB Applicant: # pplicant: New Coast `N/A MICHAEL J NERONHA (508)669-6134 Alt Coast N/A OWNER: Date Typed i 09-09 2008 KONOWSKI BERNA ALT &,JAMES ANTHONYKONOWSKI DATE ISSUED: - ` 1 r TO PERFORM THE FOLLOWING WORK: Strip/re-roof house and garage TO MEET 110 MPH WIND ZONE STANDARDS Project Location: 129 PINE ISLAND RD Approved/Issued By: I UNETTE,LOCA DING INSPECTOR All work shall comply with 780 CMR 71"Ed.(MGL Chap.143)and any other applicable Mass.Laws or Codes and plans on file. SCHEDULE APPROPRIATE INSPECTIONS AS REQUIRED. UPON COMPLETION OF WORK,FINAL INSPECTION IS REQUIRED. THIS PERMIT WILL EXPIRE PER 780 CMR 5110.9(NOT MORE THAN 3 EXTENSIONS WILL BE GRANTED)OR ON ISSUANCE OF A REGULAR OCCUPANCY PERMIT. I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his agent and to receive this permit, I further understand other agencies may have reason to STOP WORK if items under their jurisdiction are not met; not withstanding the issuance of this Building/Zoning Permit. Signature of Owner/Agent: �j��< � . / Comments: PERMIT NUMBER IS REQUIRED WHEN REQUESTING INSPECTIONS/RE-INSPECTION FEES MUST BE PAID BEFORE RECEIVING ANOTHER INSPECTION/REPLACEMENT FERWILLBE REQUIRED Or LOST CARD "Persons contracting with unregistered contractors do not have access to the guaranty fund(as set forth in MGL c.142A)" Inspector of Inspector of D.P.W.Inspector Building Inspector Inspector of Gas Fire Department Plumbing Wiring Water Service#: Footings: Underground: Oil: Underground: Service: Foundation: Rough: Smoke: Rough: Rough: Sewer Service#: Rough Frame: Insulation: Final: Final: Final: Cross Connection Final: Final: _ Treasury: Board of Health E-911 Additional Comments: Planning Board Prior to issuance of Certificate of Occupancy/Completion,this card must be returned to the Building Department with all necessary inspections signed off. Department phone numbers are listed on the white"Required Inspections"document provided with the issuance of the building permit. POST CARD SO IT IS VISIBLE FROM THE STREET TOWN OF DARTMOUTH 54301 BUILpING RECEIPTS COLLECTOR'S OFFICE Name , Property .- Date: ''�` r y� t,f 11:ki ?:.L. Owner:- f.T .�--,,_ ,/;i . _ f Job Location: / "`)(, LITH -- TORN DR'S OF t n mu Copy-Collector's Office Plot: Lot: COLLECT Yellow Copy-Customer's Receipt J/ L) 2 trio ink Copy-File Copy SEP 0 reen Copy-Building Department Phone: 1!0 Description . General Ledger#'s Ref.# s Amount License&Permits-Building 01000-44105 `j di i7 License&Permits-Building Mist. 01000-44105 License&Permits-Electrical 01000-44106 License&Permits-Plumbing&Gas 01000-44107 Other Department Revenue 01000-42420 iL ________ ` o This is not a Permit or License for Building,Plumbing or Gas Received By:_ , ti` 1 r, , Pi./.,/. A RISIDENTIAL 0 FOUNDATION �ONLY qt. 1�t�j` $25.00 APPLICATION FEE IS NON-REFUNDABLE `c NON-i RANSF RABLE U ti r� „,TN DATE RECEIVED t : ft.,,,, DARTMOUTH BUILDING DEPARTMENT '� I� ifilii $' 400 Slocum Road, P.D. Box 79399 � �, .- . :' Dartmouth, MA 02747 `' ' `-'' 508-910-1820 FAX 508-910-18 8 , .--/ APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ,� -jr-, ,'.-,-, .,- r' 4s'a a*. �*a ':,s,!, a k Oist R- +, "a 31- r Vilegg v ,, A _ 1 wart, A" -I x - -N _ +� A5 ate, ° -,• ' � 1 , * -S ma S ' .'I' " -- t'*. '' .i. z '€oia * ''+'.. , ax`+ Mu.' `°; k9fi,ro t � t '�, J h ,+F " ar= M 1`,,._ >g . PS * ¢ �� ^ a . r , e s 4E 3 4 "C� " p , `' :-., x ts4-.- .ZA17 ,%, ,„, " 'a . + r Bud , gg : -i Wi , * F""-s` t .- "-t x v�ar � Lontng Dt5tric ti. p€ised UU /o e : ,1 ij.. >. 4'' dx •e. .4 f 1 fe "'t,: .P s ta' ,,,,,..+ -- ,1 .kt,` F 1 d"`it`A S:'(h '"' vS v { "fa- �,�*? d '& " i"K ¢N't a:�`'..����i * �i zi l .�:', �" fir,Y� -" a® ; y�a � ,ei"�.� yr �,�w.a Q'e _ �., a , �'�ee„" ,a ry6..�, y'�}j f"�,.z+ /-.A {-r�:� Y{-'y "fj f"5s 'sue 'Jn: t 1 _ ... }�� i1� " ,a ✓ .Y- ; gs` :;V-kl.„4: ✓. ;7 r , t ,.A a y ;� :''' Sa g40 ..Q , rd . il d . . A Hth r .. " a „ e aoow , .. pe :t e 5.x e $1, ,ry ' a rr f, ne r. , u o 'F � " *' . Ja`fa ;� " x y e ,,x ',` ;rd ` r-_' s' Y. -a 04 s y , z s 4. ; irk .a e � > ' "y Rt =0�d ,.. ',3 ', 4/,X �z '7' � `. 1Q, ire 0 as *t- I,;lau11nzng Car' -al&e'r Cart.a� .04,4...,.173,01,06.--;.6,. a ram. xs - .- '' . E,t' a ,> I I ,�.: - .��,r "".� � z. 4 tee...; 17 PECTOR, It `�W BEFt i'E T}T[s a i a , Zoning Review: Signature �> e _� 1 Date: 9"?-45 Energy Report: Signature: Date: ,R Fire Chief Signature: Date: Board of Health: Signature: Date: Conservation Commission: Signature: Date: ,r Other: Signature: Date: Description of work being petfortnetlil 1SV r t, �p r, ',� A 0,"'� _a"r�ft" :t r ' 7.c4111 :.':yi. °r'J:s�d x �- ti NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: 0 yes c-rlo n A " 1.2 Assessors Iviap,�&j Lot Number: 1.1 Property Address: 7, 4 ry.J ' Map 1 q Lot A - Nearest Cross Street: 14-1 t f PckA,t. O p `r 9 — t7 p U z 0 Subdivision Name:, __ 1.3 Historical District 0 yes &no Total Land Area Sq. Ft.: Has application been submitted to the Historic Commission? �19 3.._-/ _ AC-IJ`•--es. Q yes .krio Date: — 1 1.4 Water Supply(MGL c 40§ 54):�� I. / 1.5 Sewage Disposal System: t C:\bldg.fornulflidgapp.res.upd Page 1 Rev.January 2005 RESIDENTIAL s y �'d '1"a � 11,77 _',,, . -. x,Y t'� ' l ''�dw+�S,' g "A !C 1:ram '7:,'� .yw oqy iI;Dss .••x.:l 9.i 'dal � �. ��s; s"S°vii:'t> Imdi ffi,4 IrJi@,t�. 39LM� �:c � . 2.1 Owner of Record: ) 1 I 141 A .1 l'411/ tv) R-1� 5 U k 351. -- - ',1 _,t,r/v.4/1.1/ b A v 1\)3 c` A kii, I, 0.7 i/h/01) \'‘/"_4_5,1 4 '44 11 1/1.1 01)) e -2 9 1,) Naitct I Contact Address Phone Number 2.2 Authorized Agent: g-uitf la vv/ / V NPWSlL1 \N-44 1 V PIC,. 0 i))V 7YLI / A It Name(print) Contact.tkddress Phone Number 3.1 Licensed Construction Supervisor: M/ke Ale rdrt hit 6n5 )- II c. Not Applicable C Licensed Construction Supervisor iiiii•c/Re/ - >ve,eo,JI m License Number' 55,5"/ Address 21 W' /I t a.rns .5 D� n 0 Z7/.S' Expiration Date Sinature Telephone, (,7Ia (3` ! / .' 3.2 Registered Home Improvement Contractor: Not Applicable 0 Are you a Home Improvement Contractor subject to(780 CMR-6)? .©;-es L7 no If no,go to the_next section! Are you claiming exemption from the requirement? 0 yes 0 no If yes,submit the required affidavit! Company Name Ai I k ,E©r✓\A C o n„„S"1-. Registration Number(if none,state'`none") Address oZ 9 O 1 v (m i`°t S 5 , i.1,140..) Pi A, c3a 7/1c // o2 oc 3 o� Signatur it./� � 'I'elephane�'D, _(4,jv / j� Expiration Date -.f.- o 3.3 For Residential Remodel Work Only • PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND: QUESTIONS OR COMPLAINTS,call or write: Home Improvement Contractors Registration, One Ashburton Place-Room 1301,Boston,MA 02108, (617) 727-8598 Owners Name(print) Signatur by signing the above,the home owner acknowledges that there will be no eligibilty to the Guaranty Fund Date 3.4 Homeowner Exemption-One&Two Family Only FOR HOMEOWNERS WHO INTEND"TO PERFORM AND BE RESPONSIBLE FORTHEIR OWN PROJECT .109.1.1 Licensing of.Construction Supervisors: Except for those structures governed by Construction Control in Section 116.0,effective July 1,I982,no individual shall be engaged indirecttysupervisingpersousengagedin constmction,reconstruction,alteration,repair,removal or demolition involvingihe struetural elementsof buildings or structures,unless he or sheis licensed in accordance with the rules and regulations promulgated by the BBRS entitled Rules and Regulations for Licensing Construction Supervisors. Exception: Any Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section;provides that ifs Homeowner engages a person(s)for hire to do such work,that.such Homeowner shall act as supervisor. For the purposes of this section only,a"Homeowner"is defined as follows: 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 andlor-farm structures. A person who constructs more than one home in a two-year periodshall not be considered a Homeowner. If you are applying under this section sign below: Signature: Your signature carries certain responsibilities,including but not necessarily limited to,general liability C:lbldgfornrs\Bldgapp.res.wpd Page 2 Rev.January 2005 RESIDENTIAL NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed Construction Supervisor,whether or not they have taken the permit are responsible for code compliance. (see Appendix of 780 CMR R5.2.15) 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: fi'yes ❑ n 4 i lLuiwi ❑ new construction* 0 addition 0 alteration 1pa rs 0 chimney/ 0 woodstove (energy report required) (energy report required) fireplace ❑deck 0 pool 0 accessory bldg. 0 replacement window/door [anther 0 demolition (shed/garage) no. of windows doors (specify below): (specify below): *If new construction,please complete the following: Ce_ C-p ) ✓ r c UPI y-v S.c o A rA Single Family: no. of bedrooms no. of baths ! ✓ZA Two Family: no.of bedrooms unit I no. of baths unit 1 no. of bedrooms unit 2 no. of baths unit 2 • Furnace(hot air)- fuel gas(natural or propane),fuel oil, electricity, other(specify): O Boiler(heating)-fuel gas(natural or propane), fuel oil,electricity, other(specify): ❑ HVAC(combined unit)-primary fuel,natural gas,propane, electricity, other(specify): Air conditioning-(separate unit) , ❑ None of the above to be provided ❑ Hot Water: Gas Electric Fuel Oil Other Brief Description of Proposed Work: 2 r 1,, ,, Q '- tite ;k.,�,a.:2;"r§'z Item Estimated Cost( )to be completed by permit applicant I. Building 2. Electrical 3. Plumbing 4.Mechanical(HVAC) 5. Total =(1 +2+3+4) *Estimated Total (plea print) I, r,J ,,- VV K ,as Owner of the subject property hereby authorize 1 k I'V t 1) I cc,d to ac y behalf,in all matter re to work a • this building permit application. -- (S) a urea wner . Date .. 01%: U x4' {a'`r,i w� jj// ATITilffil i TI �Tf:1 I'[`TTT I kA1 ._ # I,&r/r► --( IV /c 1‹.- ► ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. S'gned under the pains and-penalti ofperjur . a caner/Autho zed Agent ate C:‘bidg.forms\Bidgapp.res.wpd Page 3 Rev.January 2005 RES,!.DENTIAL 1. Date plan reviewed: --- --. 2. DENIED(see project review worksheet): Date: 3. HOLD reason: /t/ Date: 4. HOLD subject to Zoning Board of Appeals action: Date Comments: • Inspector's Sitrnatur ,...11,..,.) Date: r', .: ,, Y> —'*• ` . -i `. . , ..x iv .F 4 c ra' 4-71,--;,.ramwry4.- t om,- , xx. Applicant inform of .•ve Date: �� Time411441.�� ,,���' �/� di Clerk: S Comments: i� V ,`� 'ems 9={� z ° ��� a r...-s �,,,,,� �� . ., $ ._. 1�-= #" �}1 � ':"'�L��7r r -� �� aa1�*-�.» f,-` bm"� aSk"'� ;��"� � +Y' fil �"� €r- .�A a .� � �� 4R_ _ ' ,,,', to Total Permit Fee: $ y (Less Application Fee: $25.00 Remaining Balance: $ --d-- TOTAL FEE: 76-- Gross Area-New Construction total sq. ft. oss Area-Alterati n total sq.ft. �� Jf/` Permit u a T+,' ry�f/ . ---I � �„� ,�, T i / III s L1 p e* ,, sat+A* &' "5i. .,I T y '*a,to e , "' c t i� i_ �. . ,...-,..{�,..4 .y..u..., �F�. y 4,, ,,, C:1bldg.forms\Bldgapp.res.wpd Page 4 Rev.January 2005 permit No. BP-54301 Project Location: 129 PINE ISLAND Commonwealth of Massachusetts TOWN OF DAR TMOUTH IS# 4204.00 �VIap..,� :1H179.. 400 Slocum Road,Dartmouth,MA 02747- Lot• 0020 Phone: (508)910-1820 Fax (508)910-1838 Sublot: BUILDING PERMIT Category vTO REPLAC Project## JS-2009 00058 Est Cost $20000 00" FIELD INSPECTION Fee. � 75.00 Const.Class: Contractor: License: Phone#: Use Group R4 MICHAEL J NERONHA HI-112232 (508) 669-6134 Lot Size:(sq:It: 3,OOA: „ Engineer: License: Phone#: Zoning: SRB New Const.: N/A Applicant: Phone#: Alt.Const: N/A„ Ceiling: MICHAEL J NERONHA (508) 669-6134 Walls, OWNER: Floor KONOWSKI BERNAR ) ,ALT R:&,JAMES ANTHONY KONOWSKI " Glaz�n� DATE ISSUED: TO PERFORM THE FOLLOWING WORK: Strip/re-roof house and garage TO MEET 110 MPH WIND ZONE STANDARDS DATE TIME TYPE OF INSPECTION&REMARKS INITIAL - /00 --tZ,1�,7)°,--CriadftV/(Xkl\ /o� A Sep 02 08 07: 12p Mike Neronha Construction 5086696870 p. 1 r 13 rb of13utZi'g ngufatio4is anii`5fan a1c6 Construction Supervisor License License: CS 5551 Birthdate: 9/17/1963 Expiration: 9/17/2009 Tr# 5216 Restriction: 00 MICHAELJ NERONHA _f 2920 WILLIAMS ST • ci - �'� DIGHTON,MA 02715 Commissioner Ruari{uI 1luif<frn c,vau:mf;nf tirand,uil, HOME IMPROVEMENT CONTRACTOR Registration: 4 12232 i Expiration: 2/11:2009 Tr# 127274 Type: Individual • MICHAEL J NERONHA MICHAEL NERONHA 2920'WILLIAMS ST ,L �...... 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O '••, O) 00 O N O O CO A. 0 The Commonwealth of Massachusetts Department of Industrial Accidents tr— t ;?; ►=. Office of Investigations ` :i-N 600 Washington Street 1 Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Ai; e iota N)il C 0 A. Address: rg (g o l (I 1^Kri5' s l, City/State/Zip: ID.io h-}-Q#:, ,g-, 0, 7/3- Phone #: SO g'-6 C..7 -41.7y Are you an employer?Check the appropriate box: Type of project(required): 1. 1/ I am a employer with _3 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7 ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.1=] 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 2viet Ck" A Aetet 9A.2 i fciS 9Rn;,P °`-,;7 s Policy#or Self-ins. Lic.#: (p 2..Z 0/3- ( I q 9 M 5/q •-., - 0 sF Expiration Date: 4 -<j/-0 9 Job Site Address:a, 9 e. e,s/i9,,i R.. .fw..1M o v-ih M4. City/State/Zip: b A,ejfil o ov X it.m. _ Attach a copy of the • orkers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coy-..ge 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 an. or . - .woIL is 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 and enalties of perjury that the information provided above is true and correct. Signature: r� /�� .!� Date: ''02 7--0`v' • Phone#: L5"0 - (o 6. 9- 6/3 y 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#: V. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/27/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION M.A. GADBOIS FINANCIAL INS DBA CARPENTIER ROSE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GADBOIS INS. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 865 COUNTY ST. ;,,t SOMERSET, MA 02726 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: WESTERN WORLD INS CO. MIKE NERONHA CONSTRUCTION INC. INSURER B: AMERICAN ZURICH INS.CO. 2920 WILLIAMS ST INSURER C: DIGHTON, MA 02715 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. QAE(MM/E�� INSRL WSWRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY)E PDDD/Y))N LIMITS A GENERALLUIBILITY NPP1017462 06/24/2008 06/24/2009 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO(Ra RENTEccD $ 50,000 PREMISEl CLAIMS MADE ❑ OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY n PROJECT n LOC AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR El CLAIMS MADE AGGREGATE $ DEDUCTIBLE 7 ✓ $ % RETENTION $ B EMPLOYERS LMIABIL TYN"D 6ZZUB-01 199M49-2-08 06/04/2 06/04/2009 7 TOR LIMITS n ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? If yes,describe under ..DISEASE-EA EMPLOYEE $ 500,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CARPENTRY ONE AND TWO FAMILY DWELLINGS WORK TO BE PERFORMED AT 129 PINE ISLAND ROAD NO DARTMOUTH,MA CERTIFICATE HOLDER CANCELLATION BARNEY KONOWESKI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 17 HAPPY HOLLOW RD DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN WAYLAND, MA 01778 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABIUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AU REPRESENTA 1 ACORD 25(2001/08) 0 CORD CORPORATION 1988