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26 MONROE RD - BUILDING INSPECTION & The Commonwealth ofMassachusetts Board of Building Regulations and Standa:rd CITY OF w Massachusetts State Building Code, 780 C SALENI Revised.tlyt�j011 ' Building Permit Application To Construct,Repair, Renovlish a = w r One-or 71vo-Fanily DiveUing (� This SectionFotOfliaiolUseOnt r'. PPro mitNumber Date A` 11W., C' All icial(PrintName) ." - ''_Sig_naturoq Date �ZE2� SECTION I;SIT1;INFOILVIATION- p Address: I I.2 Assessors Map&Parcel Numbers 91or,raccepted street?yes no IAIapNtunbqr, IJ Zoning Information: 1.4 Property,Dimesslpns:t 5a . Zuning District Proposed Use - Lot Area(sq(1) "•'Fhbdtoge(R) -. 1.5 Building Setbacks(R) Front Yard - - Side Paid! Rear Yard - - Required Provided Required ftAded. - .itegoirert Provided 1.6 Water Supply:(tv G.L a 40,§54) 1.7 Flood Zone Information; 1 1.8 Sewage Dhposal System: Public O Private O. Zone: _ Outside Flood ZoneT Munie(pd 0 On site dispos;isystem O .- L�qceoo SECT[ON1: PROPCheck If es0.ERTYOWI4ERS87P4: . 2.1 � gl7f Crd. .Nime(Print) City,State,ZIP . . o.and Slreet Telephone Email Address SECTION 3e DESCRIPTION OF PROPOSED WORK'(ebeek all iii apply) New Construction O Existing Building O Owner-Occupied ❑ -•Repain(s) ❑ (terrtion(s) 17 Addition ❑ Demolition O Accessory Bldg.O Number of Units_ Other eSpecify Brief Description of Proposed o =: SECTION-1-ESTIMATED CONSTRUCTION COSTS : . - Iicm - Estimated Costs: Official Use Onl Labor and Xlaterials) y 1. Building g a �: I. Building Permit Fee:S Indicate how fee is determined: 2. Electrical - S O Standard Citylfown Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2P Qiher Fees: S 4.Mechanical (HVAC) S List: 5.\Icthanieal (Fire Suppression) 3 Total All Fees:S Check . No /W Check Amount mount:Project Cust: 0 Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCT ION SERVICES 53 Construction Supervisor License(CSL) $ 7 2-7 -7 y/Z 3{/ License Number Expiration Date_ Name of CSL holder Erie W. F?Llil ListCSL'fype(see below) I I4,Iton P pd -Type Descrlplioir ._ No:'ajd Street Sales MAL 0070 _ U Unresniaed Duildin-_g u to 35,000 cu. Il. R Restricted 18c2 Famil Dwellin Cityfrown,State,Z1P .M Maso RC Root! cover, %vS \Vindow and Sidi !A SF Solid Fuel Burning Appliances -711Y- 90 0. : 1 Insulation ' Email address D Demolition Tch: hone - 3.2 Registered.Ilome Improvement Contractor� �HiG� t,(Z U SC-�/ - /2 Ll Ell Registration Number Expiration Date 1IIC Company Name �IIBe Email address No.mud Street . City/I own State ZIP Telephone SECTION 6:%VOR[CER$'.COMPENSATION INSURAiHCEAFF7DAVIF(MG.G c:ISX f 2$C(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 Isluance o gilding permit Signed Affidavit Attached? Yes .......... No............0 TION TO BE.COMPLETED.W HENt i- SECi[ON7a:OWNERAUTHOtti?A,. , OWNEII'S AGENT OR COIVTkACTORAPPLIES FOR BU"DiiNG.PERM li 1,as Owner of the subject property,hereby authorize 6 G 1 CL wi t9 act on my behalf,in all matters relative to work authorized by this building permit application. C�s�'i7/D •• - Date Print Owner's Name(Eleenonic Signature) SECTION 7h:OWNEW 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 eccurate to the best of my knowledge and understanding p Date Print Owt er s or r udmriznl c lecuonic Signature) NOTES: I. An Owner who obmins a building permit to do his/her own work,a. an owner who hires an unregistered contractor --- knot registered in the Home.lmprovement Contractor(HIC)Program);will r o have aces to the arbitration d� - program or guaranty fund under M.G.L.c. 1 d2A.Orherimportantinform-a tt an on the H1C'Yrogm—m cao be ou www.mass.eov;•oca Information on the Construction Supervisor License can be found at www.mas,��ovhins . t 2. 1Vlren substantial work is planned,provide the information below: N (including garage, finished basement/attics,decks or porch) Total door area(sq.ft.) Habitable room count (;ross living area(sq. Il.) Number of fireplaces Number of bedrooms Number of bathrooms " Number ofhall7baths Type of heating system Number of decks!porches Type orcooling system t Enclosed Open 1. "Total Project Square Footage"may be substituted fur"'futd Project Cost" ' I �c�ansed�dome m mall basic,¢gau®amisgffbatkirfsixFmeDvemmr b°mGaidats.Sea& Cboaaetoriaw oSaPTQIa2I1).ItatdtresaDtintfadas6adard � C�simarGuideloHotae -A°y'P�ePlana51g1tmteitogroeeaeo��ouldfastobtama O&xofCanstaaarASabsaodBm�essR aaYCo mg Sm°�Batkon yotirres-pov Yon aopyaft How Hadinel Yourredde87 or198B28iA=757��bym Hn&dm rner9BfBTmaffion Waeaiee (aamG COBh9CYOT�BtfOF08tioB LCampaoy ame Sheet Address(do om mea - t� Fart cifmeBosn�n . /sane . ncgi. cDnax m City/1'auv Tap Cade BamvevAddatis :. „N,A{l�/�t L (mat' I97O - 9-7 Cityllerm Sgft Me0 ZAddtey-(hdi0et,of, abm ZPC�e Bminaenem FW n I EmPiwcID gr SS.A'®br vPR�c�ar�:vecast—.e �t���sa-tte� �f Fgccsae rye The Conhvatar,,.,� DdD the foB °i°aRtro-+c.ae..,b- /(��6Ti �j ✓/IL/ U (D�cdhe in@milaMamh meaasptemd,sp��Netype,taand,mam�a� (/ / / 2 maaiats tvbrDcd.�.i9di-mtp���p�) " Mdd%Wtt1 bOOegnftac etruits-7befo8otvnigbm7dmSPmmitsae Glinpmod praPo edStaRaadh (OWBOMW secure their as0lehomeowner'sergent be a& to S S'� e-Tbefop e,Vluded Pasmalswin be to Dtdeascue�aabegAmdthe ale, �edolevn'B '++'B9&e�BivyaBfg,Faod 8 �� goo, bW 655, et>dQ'af e6apter14ZL) �^�71t644oBS of Date nheacmbaaarivdl beer.eonaacmdw ob. Total Coatrec Prim and PnymxotStltedole / Dat0Whea mntrsmad Wmk WM bembs(antiaByaompl�ed.TheCanuamorgg"g,pe:l'm'getheg4 neffule str tbeIDatedal�dlahor Payments WEB be made acm sJ75CWedabgwlbr&ataw�of +dioStoibefoOoWioSscladWe: (') 8upm si�ecoa : S— aact(ootto eaeatx(7/3 ofdmta3l mabaccPtict atbemstof . --/p)�—.by/ I oroomrnmoiedonoF �?edaP arderitems.}t3dcbetais8®ter) S"-"—c-c�•bl' /�!�/�(�arupaa compledm of . '/ Q-2-7 oPm eompleAim ofdievmtovt (fasvfotbidsd g, "bee,e d/a9a+Pmmtmvrt he�e+d S ®�SFt+Bp6Ymeo[® eantra is etedto botltPaay+sm+i�5rlon b meet the m°meted uw-L-h�immv:dc m ! )evvryledmsrhN.t.(es) IVG3'�-S:(°)lndudiog rJl --�'—'-� be ' far vm�cadtM- malru()m./Luvs9vhat>mt _ cvf a m3'den®tors...-- vnichmmteesFsxl ^sbitd arlhetmalrn�Rdcear(p)tha-.�-.-. �1°���-LOp�cmrhefamnad;treginvme}. aniQ,y is adrmmmmemeheemgdadamsahedNe amt oEvvysP�°l °ePSPmmt ar nmvm mach+miaial Gemrs Wr. . m .ten " SnbrontraraR-The cvaaagy. °h'div mvided irveh mvlr P��/_�cont�actorapl�dyY� t��mfnetyr�poasbleFareamaletim oft�ewmLN °tiro., w e rtadroth-m d la6 ri der isa t haGorfm{nera tD lK dgmt diC5ato7essaFiheaedamsofsDyWd Contract Ara¢pmow-Upon si �elFraspms3lefora0 PaYmmty to aB mbmoaamDis far cmhzct sbdl aotim 1 Sm°S.dds dommaat becmiesabin' camFu0y hefore si PYdtat aaY lien arodter� om3lmn(mttmd¢r7 SomS ibis matmet. `Mtn''meit'stbacb�plated®theteddm Rm"ecrthmt��aomdtabfi�Wisdoeomeo;the ot''mSi�7onsandataima ° i�halre sumr�med into signinSOte peaa�r, �bw the toner=ttortta valid Hom `�Umetatrd endfnBy!md¢rstmdit naactors tobe:egisterrd ssdih thaDitectorafHome� o - 1-aelawtegidte, gaundear. xe byuaitioBto WeDiremorat 10 7mPmv¢m®i Canirrctor tmPmvemwt n Does Weevaagatorlarm insutana?q the�F Ranm3170,8as1oq iylg02lJ6 Y, may ingnuaahont eot mab� ctm and sn m, afa`St for ttYaaBmS617973-8787orS88-]83-3757. ° Guif evrightsaod PaQytnfanagdm mdge Guide to titcHmehn��bdides.Read ihebapmtmt y0°�msta'twvga84 orask to Ptos'maetCoaaactarLaty- r'`menon m tbateve>asfdeofthisfmm gad Yau my cancel„s'ais SetapapyofdteCoosnmer cmaactorin tivritin e°msnnmtifitbas been sigaedmaplat�ailter t(tirdbasiaessdayfollow st,main o�cearbmehoiffa.^by 0kv fhetwnaa saotaml P. mafbu90 �'mAiTO> S®Snftbsa5remmtseethe�gaad-dpTRYn ob �eS�seatorbydebvay=Jeur�hma�� rmrnmc—ra:pPcu T �� " �$'gF $� mnanlLtion Fmm forgo eapimalioa ofW2rit t:tofdm �iltlYf"'t -3WKSPACESrvt Dratbmpyt,r��at Homeasraer's Siauatme T /� Conaaam'sS gmimc Dot Contmctor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however The contractor would have to resolve any dispute he/she has with a homeowner in court mdeas both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Hare Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the mrtractorhas a dispute concerning this contact,the co df'e dispute to a private arbitration firm which bus been approved by the Secretary opp�!QEs3gp.ID�'d d Affairs and Business Regulation and the consumer shall be required to submit to such arbilratio ash 141ni4k4kchusetis General Laws,chapter 142A. Homeowner's Signature Coo r atme Bn � NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contactor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties- Homeowner's Rights A homeowners rights order the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered w prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contactor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights_ Ifyou have questions about your cmumm"iliomeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original sipped copy of the contract with attachments is to . _ be given to the owner and the other kept by the contractor Any modification to the original contract must be in writing and agreed to by both parties_Contracted work may not begin until both parties have received a fully executed copy of the contract and the three day rescission period has expiredl Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances}where a contractor deems hbm/lierself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contacted work Withdrawal of funds from said account would require the signatures of both parties. Additional Information - If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Rome hnprovemcnt" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-293-3757 or visit the OCABR website at htto://mvw_mass.-ov/ocabr/ If you want to verify the registration of a contractor or ifyou have questions or need additional information specifically about the contactor registration component of the Home Improvement Contactor law,contact .Director of Home Improvement Contractor Registration . - Office of Consumer Affairs and Business Regulation - 10 Park Plaza,Room 5170,Boston,MA 02116 - 617-973-8787,888-283-3757 or visit the HIC website at htb:/Arwwmass.aov/ocabr/ Go online to viewthe status of a Home Improvement Commctoes Registration:- litm://db.statema.us/homeimnrovemenUlicenseelistaso For assistance with informal mediation of disputes or to register formal complaints against a business,call: �.. Consu-11omplaint Section ^ ;?j OfiteeeW, Attorney General 617-727-8400 AND/OR Better Business Bureau 50"52-4800_.508-755-2548 or 413-734-31I4 vevm zl-lirU?olo The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Atlantic WwLi cnzatiou,LLC e rrscN, Avenue Address: Salem M g 111970 City/State/Zip: Phone #: cJ 7 k- 714V- tF/L/3 Are yo n employer? Check the appropriate box: Type of project(required): 1. I am a employer with Z _5'� 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. 7. ❑ Remodeling shipand have no employees These sub-contractors have g ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. t 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 L❑ Plumbing repairs or additions myself. [No workers' com right of exemption per MGL t P c. 152, 1(4), and we have no 12.❑ Roof r pairs tt insurance required.] § 13. ther 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 most 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 11 Insurance Company Name: Policy#or Self-ins. Lic.#: ::r6 a 7 O /Z / Expiration Date: lb-Oh 7 Job Site Address: d to City/State/Zip: S�4 F,°M Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage 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 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. 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 certih under thepains andpenalties ofperjury that the information provided above is true and correct. Signature: 4 Date: 7/�O Phone#: 1/ - M3 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#: - -- -- .-. oY wo rax Server CEITIVICATE OF LIABILITY INSURANCE DATE(MM/DD/YY1^n T TE DO E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS IIII CERTIFICATE DOES NOY AFFIRMATIVELYIOR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR P O C R T EC UEICATE E O DER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in III of such endorsemen a. LPRODUCERRCONTACT NAME: OUP LLCTREET PHONE FAX (AIC,No,Ext): (AIC,No): 0EHAIL i ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC)f! INSURER A: A&MICANZURICH INSURANCE-CO hIPANY ATLANTIC WEATHER[ZAT(ON LLC i INSURER B: INSURER C: 61 REAR JEFFERSON AVE I INSURER 0: SALEM,MA 01970 i INSURER E: INSURER F: COVERAGES CERTIFId TENUMBER: 0 IFYTHAT THE Pp ICIES OF BISUR LIST BELOW pVEa REVISION NUMBER: AFFORDS IREMEE'OLiM OR CONDn10N OF ANY COf)TRACTOR OTHER DOCUMENT EO TOPECT T UflHIHTH ABDVEFORTHEPOLICYPERIODWDICATED. NOTWRHSTANDI AFFORDED BY THE' DESCRIBED NEREe11S so JECT TOALLTHE 7Tai WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PamI THE INSURANCE PAID CLAIM DESCRIBED I Ms,EXCLUSIONS AND CONDITIONS OF SUCH POLILTEM UMITS SHOWN MAY HAVE BEEN REDUCED BY Man LTR TYPE OF NSURANCE ADD SUB POUCYEFFDATE POLICYEXPDATE GENERAL LIABILITY L R POLICYNUMBER (MJ)N)DIYYYY) (MMDD\YYW) 1-e11175 COMMERCIAL GENERAL LIABILITY ACH OCCURRENCE $ CLAIMS MADE ®OCCUR. DAMAGE TO RENTED $ PREMISES(Eat occurrence) ED EXP(Anyone person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL B ADV INJURY $ POLICY ®PROJECT O LOC I ENERAL AGGREGATE $ AUTOMOBILE UABILI7Y PRODUCTS-COMPIOP AGG S ANYAUTO f I GOWNED SINGLE $ ALL OWNED AUTOS { LIMIT(Ea accident) SCHEDULEAUTOS SODILYWJURY g HIRED AUTOS (Per person) NON-OWNED AUTOS BODILYINJURY g (Per accident ( PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EXCESS UAB CLAIMS-MADE j I EACHOCCURRENCE $ DEDUCTIBLE ' I AGGREGATE $ RETENTION 5 i i $ A WORKER'S COMPENSATION AND !! $ EMPLOYER'S LIABILITY YM N 03/20016 U3r20 2D17x WC PROPERITORIPARMEIVEXECV i1-i6 OTHER OFFICEROAEMBER EXCLUDED? I01 LU(i5 (MandalwylnNHl E.L EACH ACCIDENT $ 500,000 uyesAesaLe unoer E.L DISEASE-EA QNPLOVEE $ 500,000 OESCRIPnCN OF OPERATIONS oeIm DESCRIPTION OF OPERATIONS/LOCATIONSNENICLEBIRESTRICTIONSISPECIAI RENTS E.L.DISEASE-POLICY LM(IT 5 500,000 THIS REPLACES ANY PRIOR CER7TFICATE ISSUED TO 741E CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. I ! i CERTIFICATE HOLDER CITY OF SALEM CANCELLATION ` SHOULD ANY OF THE ABOVE DESCRIBED P OLICIES BE CANCELLED ATION DATE T 93 WASHINGTON ST i BEFORE THE EXPIRHEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SALEM,MA 01990 ` AUTHORIZED REPR - ACORD 25(2070i0S7 The ACORD name and loign are registered marks of ACORD 1985-2010 ACORO CORPORATION. All rights reserved i DATEtMWDD,YYM CERTBI=BCA`I'E OF LIABILITY INSURANCE 3/9/2016 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 Policypes) must be endorsed If SUBROGATION IS WAIVED,subject to the teens 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 endorse�neld(a). PRODUCER CONTACT Conatrnetion Eastern Insurance Group LLC PHONE FAX 233 West Central St ' - (800)333-7234 aC No: EMAIL i A Natick INSURERIal AFFORDING COVERAGE NAIC# INSURED MA 017§0 INSURER A.rbella Protection Ins. Co. 41360 Atlantic Weatherization j INSURERB.Wautilus Insurance Co 61 Rear Jefferson Avenue ! INSURERC: INSURER D: Salem MA 01970 INSURER E: COVERAGES INSURER F: CERTIFICATE NUMBER"BuSter 2016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES UI INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_ NOTWITHSTANDING ANY REOl11REMENIT, 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 L TYPE OFINSURANCE POLICY NUMBER POLIU EFF PO CY EXP GENERAL UABILITY ` LIMITS X COMMERCIAL GENERAL LIABILITY ff EACH OCCURRENCE S 1,000,000 A ClAIM6-MADE ! EMIS O a pence S 50,000 X OCCUR i 500042616 /20/2016 /20/2017 NED EXP ceeperson) S 5,000 X CONTRACTUAL LIABILITY I X CG0001 10/01 FORM I PERSONAL SADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X PRO- LOC PRODUCTS-COMP/OP AGG S 2,000,000 AUTOMOBILE LUIBIUTY j' S A ANY AUTO CEOlaBcl,lenSINGLE LIMIT S 1 ODO 000 ALL OWNED X SCHEDULED j BODILY INJURY(Papenam) S AUTOS AUTOS 020015871 /20/2016 /20/2017 BODILY IWURY Peraocie X HIRED AUTOS X NON-OWNED l enD S AUTOS PROPERTY DAMA0 et M S X UMBRELLA LIAO X OCCUR PIP-Basic S A EXCESS UAS CLAIMS-MADE EACH OCCURRENCE S 1,000,000 I DED RETENTIONS S 11000,000 ONS 10,00 } 600058654 /20/2016 /20/2017 WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY WC STA U- OT ANY PROPRIETOR/PARTNER/EXECUTIE IN If OFFICER/MEMBER e(CWDEDT N/A EL EACH ACCIDENT S (MyyanOaI In NH) DESeGrRIPT10N OF OPERADnN$ENow EL DISEASE-EA EMPLOYE S B POLLUTION E.L DISEASE-POLICY LIMIT S PL200378614 0/1/2015 0/1/2016 EA pOLLUT,N CONDITION $1,000,000 GENERAL AGGREGATE $1,000,000 DESCRIPTION OF OPERATONS/LOCA71pN51VENICLES( ch ACORD 101,Atl4Alonal Remade Schedule,if more space is mquImM CERTIFICATE HOLDER i CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE i THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 93 4g1SHINGTON CITY OF SAT O j ACCORDANCE WITH THE POUCY PROVISIONS. STREET SALEM, MA 01970 I AUTHORIZED REPRESENTATIVE ACORD 25(2090105) John Koegel/SNE INSD2511mnns,n, II ©9988-2090 ACORO CORPORATION. All rights reserved. Massachusetts Department of Public Safety Construction Supervisor Board of Building Regulations and Standards Restricted to: License: CS 087977 j���,000 cubic feet(of 991scubic meters)of hich n Construction Supervisor enclosed Space. ERIC W PALM 3 HILTON ST SALEM MA 01970 - /? Fa'lure to possessacurrent edition offfieMassaeltusetts Expiration: State Building code is cause for revocation a61Sns6cense. Commissioner 0 412 312 019 Dps licensing Information visit:WWW.MASS.GOV/DPS Jar-osnnrnrmc^riffii n! ftrr-r(/a.;sf�- License or registration valid for individul use only _' Ofliee of Consumer Affairs&Business Regulaimn _ before the expiration date, Ulaund return tic . . ME IMPROVEMENT CONTRACTOR - Offlce of Coosmner ASairs and Business Hegniafion a egrstration: 142089 Type: - 10 ParkPiam-§nice 5170 lration: 3/12=18- Ltd Uabalty Corpor - Boston,AtA 02116 EW ATLANTIC WEATHERIZATlOiV-LLC" ERIC PALM 61RJEFFERSONAVE LEM MA 01970 - - Not valid without signature SA Undersecretary