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9 MAY ST - BUILDING INSPECTION (2) J fL��MNr�E#�NO AP�PIIOViD aY ZiIE ��l1>D A'.>1EEwT�E+10 �YIANT�D \ , C CITY OF SALEM Mara rM FMdk grMol7h YM�No f� I�NAlaa G M Poopmly Lao"in : b CO MM&M AM? Ym!_Ns Pam1R 1D: ELBLMO PowAp""Tm PORE (Cifala Mf111o11aYar appy) CoffWW Do* god. Pool. PLEABE FILL OUr L.EMLY A COMPLETELY TO AV=DEL AVB M PII �O TO THE INSPECTOR OF BULDROW ' The undwsoW hasty apples for a pww* to bold a000rditto ft.lolo mb 1P - Fml & 0M1 8 Nana Addmss A Ph" y ST 5;1 C? �� w73t '7��—C��9� Amhh@Ws Name Aditn d Phals ( 1 M olm-1 Name AddressA Phone wal is is pop m of b~ 1d "d, I 1 01 1 a diwi I for how wily ow ma? t r M bAq owdM to fowl ye� A1bNW, C/�/``l/v a Cy/v fllawaw aoa 4,�X0, airuos.• Nw uoaw.s� 8 4 �/ 136 6ftm , Lfa. � 139w�cv 8gffrffw.of AppYorfl Ml �in MNALTr' Op powm DIBCWI N OF wralMc TO EE DONE ?/ c e�/ � . �� ,� �:� �.� � �� ,{ �h Y .,� .Y. . • �-. • • � - I• 20799 , fi gada9 v�d - t-- ,-ham IV P✓n-7 09 . r. -lr7 421' ;7�1�761 2s w -o W ZiN7}9mU 1,yi�S�x1J tq 16 r 4-' A .LY COw ; CERTIFICATE OF LIABILITY INSURANCE OF ID S DATE IMMIDDNYYY) SILVA-1 10 21 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dan Hurley Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Chestnut Green, Suite 24 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Seven Federal Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Danvers MA 01923-3620 Phone: 978-777-9394 Fax:978-777-3306 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. Preferred Mutual 15024 Silva Remodeling INSURER B. Granite State Insurance Orlando Silva DBA INSURER c: 19 Rollins St INSURER D Groveland MA 01834 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. POLICY EFFECTIVE POLICY-EXPIRATION I I TYPE OF INSURANCE POLICY NUMBER DATE M-EFFECTIVE GATE MMIDDI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 300000 AG TILETTEl A X COMMERCIAL GENERAL LIABILITY CPP0110564397 10/23/03 10/23/04 PREMISES Fir occurence) $ 50000 CLAIMS MADE 7X OCCUR MED I(Any one person) $ 500,01 PERSONAL&ADV INJURY $ 300000 GENERAL AGGREGATE $ 600000 GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGG $ IPOLICY PRO In JEGT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILYINJURY $ SCHEDULED AUTOS (Perrper person) HIRED AUTOS BODILY accident) $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GAR AGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHETHAN EA ACC $ AUTO O AUTO ONLY: AGO $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ 1f. RETENTION $ g WORKERS COMPENSATION AND X TORY LIMITS ER B EMPLOYERS'LIABILITY WC6805769 09/20/04 09/20/05 E.L.EACH ACCIDENT $ 100000 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED' SEE ATTACHED NOTE E.L.oisEASE-EA EMPLOYEE $ 100000 If yes,describe under SPECIAL PROVSONS below EL DISEASE-POLICY LIMIT S 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Carpentry - less than three stories CERTIFICATE HOLDER CANCELLATION CITYOFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL City of Salem IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 93 Washington Street REPRESENTATIVES. Salem MA 01970 AUTHORIZED REPRESENTATIVE Daniel J Hurley ACORD 25 (2001/08) ©ACORD CORPORATION 1 NQTEIPAM::�':�:: :1NSUREVS,:NAME: SYlvaI Remodeling 0 P.I D. SR DATE 10121/04:::: As required by Massachusetts Workers' Compensation Rating and Inspection Bureau: All requests for (workers' compensation) Certificates of Insurance must be submitted to the servicing carrier or voluntary direct assignment carrier. A request has been faxed to Insurer B named on page 1. f-._ _.' "�' ✓/ee 1°iomvrnreo�,¢C(/i �✓�aouar%uoe!!d BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR ., Number: CS 084761 i Birthdate: 05/18/1969 1 Expires: 05/18/2007 Tr.no: 84761 ` ` Restricted: 00 ORLANDO YST SILVA. 11 11 MAY ST SALEM, MA 01970 Administrator I ✓fee �a�ivneao:eae¢�e o�'./�luuac%uaa,<� 1 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 139424 -..+ Expiration: 7/16/2005 Type: DBA SILVA REMODELING ORLANDO SILVA 11 MAY ST. SALEM,MA 01970 Administrator rvouc rPIOP=ff e7QAWNDfr ML M.11A O1 i Ted.(alp 7u-MM ar.*so PAX (OM 7404M" STANLEYM�Aran tNOV1C?, DLSPOSAL dr D1�APFIDAVlI' In amr&nos via the peovidm atom a 4%SK I ecly *iWp that ae a a No= al>]bift Pamit r .an&b&raeoft iham as aem*"=mddb p c"by this Bnildbr8 Pa n&Ad be d qcW a[ia a*gpwlbr nomeed eond wsft diipoal heft.m&dmd by)=s IQ SIftt ThsdebdswrIDbsdi9o"octet: �!J!�/ ffS'/�6c9� s� ZiLL. 'SAGc�/'IT�,9A/51 2;=r Iaeadoa a[Feotl�► 57'.sTio�� awwom a[Pamn APPglow Date M MY aampleb Ow b3o hiS bftmsdm MZASB PjlW CLSARLY) Nem.a[Pamdt AppnoW �thm%ifm /9- fen ll, ;� S -5% Ad&oa,OW&fhb 'Ar above smuts:egoira that&bdo Am the demolition,rmovaoao6 mbab or other altwW=of bml&g or*ocoas be dkpwW in a p mpaly-Hound soli&swb diepoal fic ft r dedoed by lam,cam,SIX&,od the buff ft pamih or boo m most io&O the bad=ofdw heft.