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19 NICHOLS ST - BUILDING INSPECTION (3) ZS The Commonwealth of Massachusetts ° Board of Building Regulations and Standards FOR Massachusetts State Building Code,780 CMR,7" edition ; '.);' ,;; ; MUNICIPALITY SE Building Permit Application To Construct,Repair,Renovate On Demolish a Revised January One-or Two-Family Dwelling ;. / p;, ,ilq!;, 1, 2008 Tliis'Seution Fof Official UseOnly Building Permit Number. a Applied: Signatur 'Building Corumissroner/ c ings Date S TION 1:SITE INFORMATION 1.1 P'r�erty A��Idrff ss: (� 1 1.2'Assd5sdlrs.lYlaa�Bc I'avcbl?4mnbers F-/ lll/r Tif�d�� 3) _, �W#c .JL mlw. Ii„ i; 1 1.1 a Is this an accepted street?yes no Map Nuntbfr 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❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesO `"=' ^>SECTION=2: PROPERTY OWNERSHIP', 2.1 O r of Recgr4 Name(Print) � ^ Address for Service: Signature Telephone SECTION 3:.DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ eration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other Specify: /S�lays� Brief Description of Proposed Work-2: - SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: official Use Only Labor and Materials 1.Building $ _ 1. Building Permit Fee:$ Indicate.how fee is determined: 2.Electrical $ ClStandard City/rown Application Fee " ❑Total Project Costs(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: $ 07-0- 13Paid in Full ❑Outstanding Balance Due: r SECTION 5: CONSTRUCTION SERVICES - - 5.1 Licensed Construction Supervisor(CSL) License Number Expiration Date Name of CSL-Holder 3 F fi6n Street List CSL Type(see below) LA- Address SalimMA 04970 Type Description : U Unrestricted(up to 35,000 Cu.Ft. Signs V re ` R Restricted 1&2 FamilyDwelling �A-- M Masonry Only RC Residential 5n Resi R Covering d Roofing Co nn Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) J qZ(5 p At{antic Weadleli7atton,LLC l HIC Company Name or HIC Regis' 61 W?Ufffoon AvenueRegistration Number /I / /_ Add re . - Salem MA QI 3 / /z (o Expiration Date Signs 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 Issuan of the building permit. Signed Affidavit Attached? Yes.......... No...........,❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OAR+CONTRACTOR APPLIES FOR BUILDING PERMIT I, Fr,C- G4S�ty/ as Owner of the subject property hereby' authorize y, Q vr1 to act on my behalf,in all matters relative to work kaauthorized "by this building permit application. Signature of Owner Date ' SECTION 7b:,6WNERr OR AUTHORIZED AGENT DECLARATION I, Eric. PC, (pri as Owner or Authorized Agent hereby declare that the statements and information'on the foregoing application are true and accurate,to the best of my knowledge and behalf. C f I Print e • (/ r QI Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of "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 fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 11 O.R6 and I IO.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors 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" Massachusetts Rome Improvement Sannnle Contract This form satisfies alI basic requiremm6 ofthe stores Home Impmtameat Cmuactw law(MGL chapter 1424),but does not include standard Imguogetopmtecthomeonvers. Sceb legal advice ifnecessury.AnypetSan planing home improvements should Just obtain'a copy of"A Massachusetts Consumer Guide to Home Improvement"before terming to O anywndt on yoattesidmce.You may obtain ahee copyby piling theOffice oFConsumvASairs and Business Re atiotis Caasmermfnrmation Hotline=617-973. Mor 1499-293-3757 oroo owwcbsi¢. Homeowner Information - Contractor Information jAdd— .. J('7clE Scdo no[uu Po OtB/�_ 1 Cmmttod - n ,.rYD�LsJ 61 RJefTeYsbnAv S toZiP Cade Butiaes Address(must bttlpdeO 970 11Pi1` Ld�1970 &eating Ph.. Cip?onn Sr1e Ly Cadh �J 6_1 .tleiang Address(f[diffewnt from abosx) Bmivess Phme Federal Employer IDwSS"Numbm .. - t,"ngehelhasr•ntema 'nor=e arum . .nor neartdoecmoean,mr The Commetoragreen to do the lboowing work for the Hommrrner. Inescrihe in detail[hexmkto compined,spmiaing the 6Pe,brand and grade of reannish m be ottd, dd'" 1•h 'r /� (i�XAOZ K i R ah C_ 3� Required Permits-ThefoOorvingbm7dmgpemitsatorequimd Proposed Start and Completion Schedule-Thefo)lmvingachedu)e tvdl and Mill be secured by the wntracor I the homeatnees agent be adhered to unless cimmstaaca beyond the caomemoes cannot miss (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of DateJD.,.witm contractor svt71 begin conaaated Mort:.lIGL chapter 142A) nficn concerted Moir sill be substantially completed. 7oml Contract Prim and Pgvmmt Schedule TheContrectaregrea to perform the Mad;,fattish the material and laborspecified above for the total sum of. �I�a Payments Mill be made according to the following schedule: 5 OD�f7 i upon signing=tom(not to exceed U orthe total contract rice the cost of special gt spedalaNeritaos,Mfiichauisgrearer) 5 by / !_or upon campletion of x S _by +Ll�l—!ar upon completion of iizl Q'gttCPiyr z Sato* upon completion ofthecantraa. (Law forbids demanding Cull paym mil contract is completed ro both patty's satisfaction) The follexitg neamol/egaipmem must be to me spe®I 5 to paid ordendbefm,themmmcttedxorkbed in ordv et thecompletian schedule(••) S o� for ?\OYES:(•1 Mcluding all famnm<harges(••)lau•requims that m6deposit ardona-payment required tr:the room-emar before Mark brim may nat eueN the gemer.f(a)one-thud ofthe[oval wwact pare ar(6)the attual cmr afanrspecial equipmml mcuMom made rtumdal ohich matt bespeeial ordered in eato m to menthe comptatoa schedate E w nnnts brit lied M• h t ' []Y ❑Y r Ir fth S bmotmeta -Theeo tram to a egr n h solelyrn-paomble Forcamplmon oFrhe Mod:desenbedtegardless oftheactiomcfenthird pamisubcannattar mliad by ate eaorrattw. The centac[orfurthwagrees tc be wlclY re P=-ble fwall mat ' I "dl b d th' - ear Paymentstoall subconractors for t.mtrtttattepmnm DPoa agtmq ins doeummtbecomaabmdmg contract order taw.Unless oWm%lw acted within this document,the counsel shall netimplythm my lim or other security interest has ben placed m thcresidmcz Review the following cautions and actica carefully before signing ads contfam ° Don't be presorted into signing the monrou Take time to read and fully understand it Ask questions iEsomUldng is mUw. ° Make sure Ih�coneactm haz a via Haute L ro t Contractor Registration. The Inv requites most home improtmrmt twnttazlws and subcontractors to be neutered oral theDtrectorofHomelmPms mt Contractor Regimavon You may inquire about contractor registmtim by xridag to ale Director m Work plea,Room 5170.Boston,MA 02116 or bycallina 617-973-8787 or S88-283-3757. r Does the contractor hares insumace? Mk the Contractor for hismsemance company information so lhatyou tan confirm covmaee,or ask to see a copy oln praofofinsmmce"dacummr v know•your rights and resPonsbdiaa. Read the lmponmt informed=0 the reverse side olaas farm ad get a copy ofthe Consumer Guide to the Home hgmmammt Contractor Law. WntYou may cancel this agreement if it has been signed at a place oilmrthm the connactoh annual place ufbusiness,provided you aoti&the contractor in waiting at hivber main ot5ce or branch office by ordinary=1 posted,by teleeam seat or by defray,y,not]met than midnight of the third busineudoyfollosling the signingofthisammment See the attached nodes ofedoceaation form form aplasetion ofthis right. DO NOT SIGN THIS CONTRACT IF THERE ARE AIYY BLANK SPACES-M`Tun tl^^^ImP3eflbemvtr>tttmhmcyt-ial cr:'d Cts mP:'r=r�3Eom6eFam c�'-.r all ML-. •Ihc mncene.. 40 O Homeowner s Signature Contractors Stma -5 re SLv � I� 611� Da e Dore Contractor 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 witha coatractor. 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 unless 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 Home improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor maysubmirdid dispute to a private arbitration firm which has been approved by the Secretary of the Execdtive Office of.�pgnsunier Affairs and Business Regulation and the consumer shall be required to submit m such arbitration as.(iro'videA In Massachusetts General Laws,chapter -142A....,:J , i • Off/ ,/AI Homeowvnees Signature J Contrac s NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights - A homeowner's rights under 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 as 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 contractor,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 homeowmer's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in dui 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 signed 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 expired. 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 hiaJherself Lobe 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 contracted 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 Home Improvement" contact: - ConsumerinformationHotline - - - Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170.Boston,MA 02116 617-973.8787.888-283-3757 or visit the OCABR website at If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation - 10 Park Plaza Room 5170,Boson,MA 02116 617-973-9787.888-283-3757 or visit the HIC website at„ctr dvN v:�w:maseovlocabd Go online to view the status of a Home Improvement Contractor's Registration: -:r;d'o.;tate.inn.us':itomeimrrnvanenNliceuszziist.aso .- .. For assistance with informal mediation of disputes or to register formal complaints against a business.call: Consumer Complaint Secdon Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-6524800,508-755-2548 or 413-734-3114 yr aoa 2.1-t tm_n010 The Commonwealth of Massachusetts f PrtntFdr�ny Department oflndustr[al Accidents Office of Investigations Uf I Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Atlantic Weadierization,LLC JetleMn Avenue Address: Salem MA 01970 City/Stat 1p: Phone#: _ q7� 7y�/-P/y Are y an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 2 4. � I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. Demolition working for me in any capacity. employees and have workers' o workers' com comp.insurance.t 9. 0 Building addition (N p.insurance P• required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12,0 Roo airs insurance required.]t c. 152, §I(4),and we have no employees. [No workers' 13. ther �1JS ,[ct�yp�� 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 wort and then hire outside contractors must submit a new affidavit indicating such. tContractors 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. �J / Insurance Company Name: L t t r-,Cam, Policy#or Self-ins. Lic.4:_ Expiration Date: 12011 Job Site Address: Z / / Y� City/State/Zip: a/9'70 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. l do hereby certd2 u r the EgAyl ago2e#giiies oflierjury that the information provided above is true and correct. 11 3i2nature: -- Date 1 'hone 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): i 1.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• `•+e++�+an no—i J/1ZY GU19: "/ :Z"f :t)"1 AM PAVE 55/066 Fax Server AC'c3R d CERTIFICATE OF LIABILITY INSURANCE osE ....a 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. M 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 corder rights to the certificate holder in Tieu of such endorsemem(s). PRODUCER CONTACT EASTERN INS GROUP LLC NAME: - 233WESTCENTRALST PA,CW EM:HONE FAX A/C No: NATICK,MA 01760 EMAIL INSURER(S)AFFORDING COVERAGE NAIC0 INSURER A:AMERICAN ZURICH INSURANCE COMPANY INSURED INSURERS: ATLANTIC FFERS NAVEON LLC 61 REAR JEFFERSON AVE INSuaERc: SALEM, MA 01970 INSURER D: NSURER E INSURER F: REVISION 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. IN TYPE OF INSURANCE A00 SUa POLLW EFF POLICY EXP NSR WVD POUCYNUMBER MINDDtYYYY MM/UDIYYYY LIMITS L LIABILITY EACH OCCURRENCE § MERCIALGENERAL LWaILRY 0AMAGE TO RENTEDLAIMS-MADE❑ OCCUR I rMEDEXP(Artyonepawn)PERSONAL$ADV INJURYGENERALAGGREGATEGGREGATE LIMIT APPLIES PER: PgODUCTS-COMPNP AGG § CY PRO- ECT LOCBILELIABLRY NEDtlem SINGLE LIMIT § ANYAUTO a MBI a ALL OWNED SCHEDULED BODILY IWURY(Pew Pawn) 5 AUTOS AUTOS BODILY INJURY(P.azcdenq 5 HIRED AVT0.R AUTOSNON1 EO AUTOS �10PE Y MAGE § S UMBRELLA Luke OCCUR EACHOCCURRENCE S EXCESSUAS I JCLAIMS-WOE AGGREGATE § DED RETENTION$ S WORKERS COMPENSATgN WC STATU AND EMPLOYERSLIABILnY YN X TORY LIMIT- S OER ANY CERNEETOReP XCLUDEIE%ECUTN $500,000 OFFICERA+EMBER EXCLUDED? NIA 6ZZUB 03-20.2014 03-20-2015 EL.EACH ACCIDENT (Mandatory in NH) 11 ye;tle5pibe roger 5B270121 E.L.DISEASE-EA EMPLOYEE $500,000 D RIPT ON OF OPERATIONS Eebx E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTON OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 1M,AtltlXbnel Remarks Schadula,a more apace Is required) CITY OF SALEM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 93 WASHINGTON ST CANCELLED BEFORE THE EXPIRATION DATE THEREOF, SALEM,MA01970 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESFNTAm1E ACORD 25(2010ro5) The ACORD name and logo are registerredt marks of ACONDCORPORATION.All rights reserved. �4C ROItO p® �--- CERTIFICATE OF LIABILITY INSURANCEDATE THIS CERTIFICATE IS ISSUED qS A MATTER OF INFORNIgT10N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3/10/2014 T�j-Ilg CERTIFICATE GOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED TE 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 li the terms anti conditions of the Policy,certain policies may require an endorsement A statement on this certificate does not confer rights po m: lame) must be endorsed. If SUBROGATION IS WAIVED,subject to certificate holtler in lieu of such endorsemem(s). PRODUCERt0 the Eastern Insurance Group LLC N°ME:°TConstruction 233 West Central Street PHONE . (508)651-7700 F/V( IL Natick MA 01760 INSUR S AFFORDING COVERAGE INSURED INSURER A:Arbella Protection Ins. Co. 1360 HARD Atlantic Weatherization INSURER B:Arbella Indeanit Ins Co, 0017 61 Reaz Jefferson Avenue INSURERCNautilus Insurance Co 0017 INSURER D: Salem MA 01970 INSURER E: COVERAGES INSURER F: THIS IS TO CERTIFY THAT THE POL CIES OFICATE NSURAN COEBL STED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDfT10N OF ANY CONTRACT OR OTHER O�COMIEORT WIT{{ RESPECT TO WHICH THIS NUMBER- 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 PgID ClAiMS. WSR TYPEOFINSURANCE GENERAL LIABILITY POLICY NUMBER MPOCY EFF p EXp LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A CLAIMS-MADE T OCCUR P I ocw m S 50,000 50004281E /20/2014 /20/2015 MED EXP(A—ane Person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LJMR APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X PRO- LOC PRODUCTS-COMPJOPAGG 5 2,000,000 AUTOMOBILE LIABILITY S H ANY AUTO COMB NED INGLE LIMIT Ea a¢oer AALL IUTOS RJED X SSICHHEDULED BODILYINJURY Par 020015871 /20/2014 ( Parson) 5 1 000 000 X HIREDAUTOS X AUTOS /20/2015 BODILY INJURY(Peraceldenl) 5 N EW—aEERtl D MAGE S X UMBRELLA LAB X OCCUR PIP-Basic S A EXCESS LIAR 8 000 CLAIMS-MADE EACH OCCURRENCE $ 2,000,000 DE RETENTIONS 600058654 AGGREGATE S 1,000 000 WORKERS COMPENSATION /20/2014 /20/2015 AND EMPLOYERS•LIABILITY S AONY PROPRIETORJPARTNERIEXECUTNE YINVYC STATU- 01 (MendetondatoryEMSER EXCLUDED, NIA ry In NH) E.L EACH ACCIDENT S If yes,dasm DESC ceRIPTION wrier OF OPERATIONS Delow EL DISEASE-EA EMPLOYE 3 C BOLLOTION LIABILITY E.L DISEASE-POLICY LIMIT S 200378602 0/1/2013 0/1/2014 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION U,000,000 DESCRIPTION OF OPERATIONS ILOCgTONS/VEHICLES(Attach ACORD 101,Additional Rcmadm Schedme,Um n,apace is requlm,q CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SAIZ r THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.93 WASHINGTON STREET CAT.EM, MA 01970 AUTHORQED REPRESENTATRIE Ronald Cleaves/SHE ���� — INsgu ,n,AMJB, en,i Inn ne The A ©198 AM ACORD CORPORATION. All rights reserved. r:flprl rve n aro roni¢fAroA merlr¢Af M Rn Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-087977 a r. ERIC W PALM - 3 RMTON ST _ Salem MA 01970 Expiration Commissioner 04/23/2016 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR - before the expiration date. If found return to: gisbation: 142069 Type: Office of Consumer Affairs and Business Regulation pirdtion: :W1212016 Ltd Liability Corpo- 10 Park Plaza-Suite 5170 Boston,MA 02116 ATLANTIC WEATHERIZATION L.L.C. ERIC PALM 61R JEFFERSON AVE SALEM,MA 01970 - Undersecretary Not valid without signature