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22 OSBORNE ST - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date lied: Building Official(Print Name) Signature tPate —1 SECTION 1:SITE INFORMATION tJ z 1.1 Plnperty Ad ress• 1.2 Assessors Map&Parcel Numbers r— OS_ rot L l a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Ln a V ) rn :�— Zoning District Proposed Use - Lot Area(sq ft) Frontage(11) rn 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 yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: i K, , +�� fa✓aI 7 ,7 �t Ie" G7970 Name(Print) City,State,ZIP d.�L OAorwel Sf1 97sr S9y- fr No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other Specify: Brief Description of Proposed ork2: Gcl, t SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I.Building $ I5L70 : 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application 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: $ /SQQ . ❑Paid in Full ❑Outstanding Balance Due: cs�-T It(Z'k Qb Pc S t_, We_7pt-ta SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) S /5-7—7 tf h,3 6? License Number Expiration Date Name of CSL Holder f,I1C W. 1':dIIl List CSL Type(see below)---(A-- No.and Street 3 Hilton Street Type Description Salem MA 0fi970 U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 0 o I I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ' Li 210" f2 /r Atla ntk weat1er1Z8tinn HEHIC Registration Number Expiration Date HIC Company Name or HICRrgi e Nam m=U_ e SalemNo.and Street Ol Salem MA 01970 Email address City/Town,State,ZIP 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 Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT C_I,as Owner of the subject property,hereby authorize rl G Ca IVY to act on Imyy�behalf,ink all matters relative to work authorized by this building permit application. LI 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 kis applicaf n is tru� accurate to the best of my knowledge and understanding. *<i l zz�iL-4 Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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 can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 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.) 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"maybe substituted for"Total Project Cost" �c �seS ®gaa� ibis Fmmsa[is6eaeli baste ' BO�rt+:,8@i3effi$�'�Fffi Ile C®9Ei'H'aC$ fa" raNtnememsottheaates i Aome ImPmvameot Cmaeaor3an.�Dy'�'["ssacnuxt sro��0f9Op'��alaaaicoffa�ty..paYPWson ptm"d"Snoma- ��1�)•Imrdaesaormdadasmadntd - O�ceoFConamnerCo�erGoide to AatnbFatProvanmt'before a2eSWatioob °�e'v"Em Nad'me®az6i� ytoY�®v88'"a-e6tmnaGeew ay COPY OF Sine - 4lomaa CaaSti®erFnfaaaat°n Contrattor;'Info73+stmana Y rmatiou i Sfi a ✓ Cam-°any '.^- S�AddRs ld"notomaP®06mxaaeadd�? Za it t ,. � _ QS�J�-ti J CaavaGor/$ah$Praay •t_s,_` � t l. i • Gnffann T Avenue�` s m 74Cadn 3" `- q EceoiagPnei !'7 Ciry:Tmm '.NoiGng+tddtasfnd-airentfmm% tt) o Store -P Cede�� 8atemPhom >ar _ �4�5"Dta3sIDorSS..tumha 7ha Canaac[oragteeemdo thetoU taesenbe 7n daalj3oavtl:meompteed,"a'"GttarltforttteFFomaatvner. . �� Oa:tFP40mad aMma+.yaatntalsmbemW„prnnaa.:meli yam } - lb and will ba cantor-7hetonodagbn3�SPe am rmim . (Owners who See the wnnaetoras thahmnemtn�a_ecac ne 8osed Startapd Campletian 5rheddo_ eseludedfro at'etheiroxnpettidistsilibe Ieszchamtstaaaasbelod ao mnaSor's eudll ildGLchapteri42 tYFundpmvsiansof Z utlmire Datetdtmcoab'uYornill fiegin mntmelad male Toml ContragPriw �Dn"ltwmanaeted rmntnllbe nm Coaoagoragtaesa ptrfo®tna�dWe� SobstantiallYmmpkted. mdt tanlsh theomtaidleodlobortpecifldabovelb tkul ntm OP. Payments nill6emadeagord;agto theFWfmv S upon aaaingcoaoaa bat tP j . ( l/3 ofthe toml amtlraet— Won gr thecoaof — —'i=�aPm i mpl�oa d sPaaial otd¢hs em S tciddtnerisgteater) S / of 'b< /1l✓ Ilis or upon completion of l upuM cacampletionn a=fttl e. I l C�Lv ( 'lbtbidsd=mtrm & 76andbeam - 3 UPaymm until aonnact is . �teram �� s�ro tmd� �Pnsedmnatnparq•'s�[is{aedaa) thecama riansdadate(°•) ( S r VOTES:PJ lecladrag yt finance Paidm not eaczdtbegeatvo�!(a)t••)t3t` d�ua'deradtma"'-__ f aidchmaa fiespeelatoWvwm Wiaam+a a°°°azeWiaaarliathWcMWcnu r`W8ytheaenuaeror0rramaajebc u tt _� neejthe®Ptatanshedula e4°jP al egWpnum mam°mtaadamateial Sanwa/ttaots_ c""vaaor - Rmt}/sa6wnoaaorbmiliad bytnemunccoc rye,��bleforemaPled000ftnetttand�rnbd vtht wttaavarfether regaiaeo oPWe CanhactAceeptaaca_ Ystees robesWdyacdresPoaa'nletorell payme,ns to oasareny tnbd wnimu shall not nopb.thx[w aEnm3,this doevmvithemmmancWat subcootmctemtor tareEdh•herom sg,dogads� �oraatersea"[6'IDtenllufusbea pl nca d®tna>m- Lthdrn�law. iamothe nhmnoo tvhltintnisdocnmeat,the tamtiaasandnell ptt�taad o,m Bening We - ° kt� aaaoa to 6e " l'dwNaaac'lnkedmetonadand fulkYM&rmnd h.Asn4aestionsifsom gisulbt anmmW�t'ithtII a .The Lnv dtio3ismclear. na Sm the13haorat ittaaorntAomehapmvemtuu CIUMMarR �ltnt2smdsthawe imiIIOt'm+en[wntra Daesthpyo aactornateinstuanty�Asl.Ni C,w'pact farnis1mapooms7iasnnmca�M402116m'by tapffm Yg bjmajYA 3 labor 8& � and tea a copyofa•pmafoFWotzoce•doco>naas lri-3757. Khotv)vurd ra�"Yiai'otatan®mtnat mtaseo 'arage,ora,$-to l�GandtxsPana3t7ttier Rezddlevmcot Guide to thetien"holan"MentCoattacta tkbmadonontherat 'aside oFthis tbtm;adget a copy oFthe Coo on, wnoaaorhtnritivg zt W�'sln®t¢ithas beenaiSod m placaotheratan third 6uyittm dat•foamting the utE braycy"�tr�byotdinarymaan pan yp otmal placeofbusioea3•Ptovidd povaotify the DO NOT SIGN TAUS eO em smtheatxdted awl on jmm fo}ran erpja 6�m off®a"da Sht orth. Taa i3ea^7 mp�arde�y�G CT IF T$$g, ,-4hE AAt-Y$ "'e =, o.�c-b;-Hvem�-- ,� EANKSPACESl;I aescv:•msatrieptbraeama...x [imtrontus'sStgnanoue� 'f af.� t3% Eli O�a1 Iil Caatmamrs ll 5ignaaue .'•"-:`:�,: Date Date If ContractorArbitration : The Home ImprovementContractorioavprovideshomeownerswiththerighttoNr� r�aabtninatice113affordedtoa aitemativetowurtacdon)ifti,havaadisPt"evidtacontracter- The ainh rig.Milli ahomeoRmer in c°utuntess contractor .however The contractorn'ould have to twelve any dispute both parties agree ID opidnn d claeseprovidedbelow. This clanse would give the contractor the see riehtm arbitration as is affordedto thehome6tvnerbv the Home hnproemem Coatrarm' The contractor and the homeowner hereby mutually agree in advance that in the eveni The contractor has a diJ'�7 concerning this contract:theconmactormay submit the dispute to a private miitvstion Sim`which has been athe Secretary•ofthe F�ecutveOfftoe!ofCott' naerAf ihs andBusiness Rem iladon aa d theconsmnersball lei 1to submit to suck arbitratimn-aspFotndted In Massachusetts General Laws,chap OTICL:The sigrtuurrs ofthe pattes aboveapply oniv to the aaeemem of the pal les to altemadwe dispuresoiunoninitiatedbythecontractor The bomeovnermayinnate altemanve dispu i Moludon even NAM section is not separately sighed by the ptoties- Homeownees Rights A homeovwmees rights tinder the Home hnprovemeat Contractor Law(MGL chapter Id?A)°°d other Consumer protection laws(i.e.MGL chapter 93A)mom'not be tAaived in any nay,even by agreement. howeve'bed bY r:homeowner may be excluded from certain rights ifthe contractor they choose ficallY Bred from registered m�Fund provisions of Homeowner who secure their own buiidht�p the Home Improvement Contractor Law. The contractor is responsible for completing the Wort as Contractor in a timely and nodtmanNU manner. Hmneovner may be entitled to other specific legal rights if the contractor guarantees orprovides an express Warranty for vvorlananship or materials. In addition to guarantees or wananties provided by the contractor alt goods sold in Massachusetts ram ao implied vwarrarty ofinerchatdabilrty and tiros''for a panicular pwpose An enumemdon of othermamers on which the homeowner and contractor latvfidly agree may be added to the terms of the contract as,long as they do not restrict a hamcowvner'sbasic cot'umer n"—kts'ffyouhave rigktS,comactthe Cm sneer information hotline(listed below). questions aboutyour co»smner/hotueowner Execution of Contract v of all exhibits and referenced documents haveeenThe contract must be atttached. Parfies are also advised not to sign thcuted in b6i=oad should not be signed edocument until all blanksections have been filled in ormarked as void,deleted ur not applicable. One original signed cagy of the contrammith ataclunents is 10 be given to the ov6mer and the otherkeptby the contractor. Arty modffitation to the original contract m»stbe in n'ritmg and agreed to by both parties.Contracted workmay notbegim until both parties h;v'a received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractarmay not demand payments in advance of the dates specified on the payment schedule in cases where the homecumerdeemshmt/herselftobefinancia0vinsec�the balance over.in ff funds vetduebepie¢edor amaomtescrowlf to be financially insecure,the contractormay require account as a prerequisite to continuing the commcted worn- Vilthdratval of fun i from said accotmtwould require the signatures of both parties. Additional information if you have general questions orneed additional information about the Home Improvement Contractor Law or other consumer lights,orif you wishto obtain srreecopyof "A_MassachusettsConsimer Guide to Home Improvement' contact - . Consumer InformationHmUne Office of Consumer Affairs mid Business Re_p?afion 10 ParkPlele,Room 5170,Boston:MA 02116 617-9r.9787,888-283-3757orvisittheOCABR%'ebsiteat'-"''° lfyou twant to verify the registration of a contractor or if you have questions biased additional information specifically about the comractor�aisaation component of the Rome Improvement Contrae i r Late contael: Director of Home Imurew®ment ConrractorRegtstradon Office of Consumer Affairs and Business 11e_�tlation 10 ParkPlam,Room 5170,BOSIOT MA 021t6 6I7-973-8787,8B8 283 3757 or visit the HIC website at=nn-%•`:�h:v-r^"-`::" Go online m view the s-mius of altame Improvement Cuntractoes Regis.tietfo '- -''-'t.^a c:•i....-�i,-,r-..•,=.,;tticzn>z=ii>—..:�<p Forasshsmce whhinfomrai mediation of dispmw orto register ibr-mal compl is again''.a business,ca11: Consumer Complaint Section Of'nce of the Attoroey°General 617-727-8400 ANDIOR Better Business Bureau I, 508-6531800,508-75542548or4I3 T �114 v ,,-ironing The I!Commonwealths ofMassaclzusetis Deparftent ofllzduattialAcerdents -J Office oflnvestlgations I Congress Street,Suite 100 Boston,MA 02114-2017 www.. mass ov/ 'Workers, g dra rs Compensation lausnrance Affidavit: l3 ' A lkcant lnf waders/Contra o ct rmation ors/lt lec 'trlcians/pl�Le -bl name(Businesyor , ��] �/ 11 'e Please Prin Sazrizahon/Individual): -✓-�h lyC. WGQ Address: Ca< R J- Qy ' CiTy/State/Zi : -i, Are yo e vLh4 Q!of O Phone#; COP. mplayer. Check the a r 7y� /r7 3�,�� PP opriate bog: 1•t�I ant a employer with�_ 4. ❑ i a general contra Type of project r employees contractor and I (required): Pees full and/ a 2 I ( orpart-time), have hired the sub-contractors 6• New c❑ am ❑ construction a sole proprietor ction P etor P or partner fisted on the attached sheet ship and have no employees These sub contractors have 7- 7�—] ❑Remodeling working fo r me i g n any capacity employees to • $• ❑Demolition ty P 3 ees and have workers a(No workers' com .insurance nsurance i comp.insurance t 9. ❑.Buildin required, g addition l 5. We 3. ❑ are a corporation and i _❑ I am a hom 10•❑Electra homeowner doing all work officers have exercised their cal repairs or additions myself. [No workers' comp. right of exemption per MGL 11 0 Plumb' re rng pairs or additions itrsurancerequired.j t c. 152,§1(4),and we have no 12•0 R/oofrepairs employees. (No workers' 13.0 pier iv comp. insurance required *Any app eowj ant that checks box R]must also fit'out the sectioa�below A wm t Flomeowmrs who submit this affidavit'ndi g theyare doin all work g their worker'compensatim policy hdarnation.tContraotors that check thus box must etmehed�g the are d eegehowo and then hate outside contractors most submit anew employees. If the su g the name oft sub-contrecmrs and state davit indicating such. bconaractors have employees,they ruustprovide thatr workers, whether or not those entities hava I am an employer that Ls providing workers'co C0p p'policy number. fnforrnr UOI mpensadalf Insurance for my employees Below is the policy artd jpb site Insurance Company Name:ame• •��tt,r, c�, Policy#or Self-ins.Lic.#: 70! Expiration Date: Job site Address es Gs6 t-N t, s' , Attach a co City/State/Zip: Sa I•e�, COPY of the workers compensation policy declaration page(showing the policy number and Failure to 1,500 coverage as required under Sectioni25A ofMGL c. 152 can lead to the imposition fine up to$1,500.00 and/or one- expiration date). Of up to$250.00 a da Yeaz im imprisonment as well as civil penalties in the form of a STOP WOcR�K nQg j�fies of a Pri t y against the violator. Be advised that a copy ofthis statement may be forwarded to the Office and a fine &rvestigations of the DIA for insurance coverage verification. rdo hereb a certl der she apses o er my that the Information provided above is true and correct Si ature: -. yr . - ---- Date: .. Phone=Other 9 7 F 7yy �,y 3 I only. Do not write in this area,to be cam feted b P y city or town official n: hors Permit/License# Authority(circle one). f Aeaith 2.BuUding Department 3, Ciiy/TOwnClerk 4.EIectrical Inspector 5.Plumb'son �inspector Phone#: --- • u� vca-ver .4StC®� i HOLOERRTHISACEBTIFICATE DOES NOT�AFFlRRSATIVE YAOprNEGATIANFl�I IS AFFORDED BY THE R(S),POLI Es ORI. THIS CERTIFICATE OF INSURANCE a ' NOT CONEND OR ALTER STITUTE$POD CONTRACT ON 'HE CERTIFICATE I VELY r iTHE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. SHE COVERAGE gublcIMPOr tO th It the cert c ndate holder is a ADDITIONAL INSURED,thetwticy(es)mustbe aado sed. If SUBROGATION iS WAIVEpN I sub)EcttoihetermsandcortdfiDnsafthe olic 1 P Y.certain policies may require an i dcrssmait A statement on this certificate doss j not confer fights tD the certificate holder in fish of such endorsemam(s). II PRODUCv� f _EASTERN INS GROUP LLC ..Der,.er 1233 M NAV h'A71CK, 01760 L ST j MA 07760 � I lar:Ny I A t E.asn i b ,•m- I sn dE c- - I INSUR A($)AFMROV40 COVERAGE I INSURED I INBL'RERA:AL!ERICANZUmCHINS11agNDv CCLVANY N41Ga I ATLANTIC'NEATHERIZATION LLC msuRER a:61 REARJEI•rERSONAVE SALEM,MA 01970. INSUREa C: INSAIRER D: iNSDRER E. I I I CO R Es NSURER P: I Trlls Is C IC — BE . ABOVE TO CERTIFY P THAI THE POLICIES OF INSURANCE LISTED B 1 I REV 10 FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN REQUIREMENT, T R INSURT•At,i OR OTHER D c VE BEEN ISSUED TO THE INSURED NAMED I i\'SURANCE AFFORD SUM-�w�RF�^PECi'TO W1i7CH THIS CERTIFICATE MAY g TERM OR CONDITION OF ANY CONDITIONS OF BY T7iE POUCIES DESCRIBED HEREIN IS SUBJECT 7p AI E ISSUED OR IA PERTAIN,SUCH POLICIES.UM1'f5 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A S THE UtSA AI THE TERMS, EXCLUSIONS Atdp TYPEOPINSURANCE III 1 B GENERAL L1A81LITY III 4 D POUCYNUNgEA'!POLICY EFr, POLICYE)OJ I L!H/D AUi C0='h.!c7.CIAL OeVERAL Ug9Ir LUdINS I =ImS-_rADCM OCCUR ' EACH OCcuRR::NCE S If j )AGE 70 HE.\TEa n S TIED IMP. gle S G_T+7AGOREGATELAda I PERSONALBApyiN.NRY S POLICY I� PR0. APP JES PER: GENERALAGGRSOATc A O'^OBAEUABB.ITY LOC 1 PRODUCS-CwM ,np GG 8 ANY AUTO I s I ASS:EO AS OOUL-e➢ i {f i ,E-N � IVGCe UNr 5 HRED AUTOS Ab.VCNAeD I EL^.DILY tN1URY(Pe,PCJ:+nJ 15 A!JfOS i I EODILYPUURY(,p,a M,) 8 1ltdmEXCE mu LUIS ?PRO�ERry' )=AGE I ! OCCIR � S IDEDURB NT.0 CL:4L5tApOE i I EACH OCCURRENCE 5 1 T AGGR_=GATE i I AND Et!PL CO, ATiON 1 5 OYEflS'LIABILITY I i5 Ow:ERM13c R�PARTNEW=_JtECUiNEY�R: I .• I YJCSTATU_ FJ'ST-T EXCLUDEDT !NI N:A iTORYLYT �• !yin eaV ••. 'I"'•='��nn.�r 1 � 6Z2U8 03-20-201c D 03-20.207b E'L E:.CH ACCIDENT t IP P P AT } i III 56270127 I ELOISEASE• 5600.000 EA iuftoYEE $500,000 I EiL 06CASE-P LICYLUJR $500,001) DESCRIPTION OF OPERATIONS!LOCATIONS)VENICLe$(All aeIIACDR01➢f,AdEU6"in mschaduW,Umom �Ig ruqt�d) I i I Cc TIFICA Lp i CITY OF SALEM CANCEL ON i i S3WASHINCTON ST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BEI SALEM.MAQT970 CANCELLED BEFORE THE EnpIRATiON NOTICE PALL BE DELIVERED IN A DATE THEREOF,' I I POLICY PROVISIONS. ACCORDANCE N7TH THEj . AL'THO- IREPRESENTA-n ACORD 25(2079N7 ` ©7988.2pt0 ACORD C�RPORAT1pN,All rights The ACORD name antl logo era registered marks Gf ACORD 1 reserved.. REV i CERTIRCATE OF HUrr URA THIS CERTIFICATE IS OSUED'AS A MATTER IIF INFORMA710N ONLY�AND CONFERSe�p H e�� CER771-ryCATE HD � CERTIFICATE DOES NOT11 DAn I6f0 PJO UPON THE BEL06R/, THIS CERTIFICATEINSURANCE DOES OR CONSTITUTE q CONTRACT g 3/10/201d REPRESENTATIVE OR PRODUCE �)t7'END OR AL'fBRi THIS —1� IMPORTANT: If the ce R AND THE CERTIFICATE HOLDER THE COVERAGE AFFORDED BY THE POLICIES the to rhftcate holder is an ADDITIO COVERAGE THE ISSUING INSURER(S), AUTHORIZED rms and Fondftl3ns of the y NAL INSURED, the poficy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to certificate holder in lieu of such endorsetne olicies may require an endorsement IA s FR00ucER tetement on this Cartlflcate does not confer O Eastern Insurance jMstothe 233 West Group LLC y CO°°ME Cofistrlletioa Central gtr@@t PHONE (SOB)651-7700 IL FH XaticL AD S. I a: INSURED ` 01760i I INSURER INSURER A Y�r AFFDR00-tG COVERAGE Atlantic Aeatherization ella Protection Ins. Co. NAICa 61 Rear RISURERB-AZ IndeJaIIi 1360 Jefferson Avenue 0077 wsurtERcNalitilus Ins Ins Co. prance Co Sal DISURERD: COVERAGES id2L' 01970 ! INSURER E: THIS IS TO CERTIFY CERTfFICATENUMBER34aster 201 NSURERP: INDICATED NO TMAT THE POLICIES OF INSURANCE LISTED BELpW HAVE BEEN ISSUED CERTIFICATE TH0JPOIDING ANY REpU1REMEPIT, REVISION NUMBER: ISSUED OR mAyIXCLUSIDNS AND CODITIONS OF SUCH pOUCjES.LIMIT OR CONDITION OF ANY CO -ro TH bTHER E INSURED NAMED gBOVE FOR THE POLICY PERIOD IL THE INSURANCE AFFORDED BY THE pPTOLLIICCiES DRESCR 8ED HEVREI "TH RESPECT TO q TYPE OFixsultANCe WN MAY HAVE BEEN REDUCED;BY PAID CLAIMS. RESPECT LL THE WHICH THIS GENERAL UABILIiY PopDYTERRA NU)ABER PO ERP S. X Coy I PoucY aL+ERc1AL A GEN°RlLUABILi1Y Ucvrs CLAIMSJJADE ®OCCUR j EACH OCCURRENCE S 1,000 500042816 /20/2014Ii/20/203_5 L115 ,000 s mr'D exp( me S 5,000 GeNi AGGREGATE UMIT I PERSONAL 3 ADV INJURY APPLIES PER I S 1,000,000 Pouw X PRO GENeRALaGGREGATe s 2,000,000 auro)60e1(E UABIIItt Loc PRODUCTS aNraUTo COMPIOP AGG S 2,006,000 g � S ALLosm"a" INED 3IN UNIT AUTOS X K6N&,Ep� Ea 1 000 DOD ^ HIREDAUTOS X NAO�N,�RI i 020015871 /20/2014 /20/2015 BODILY INJURY IPerP= oa) S BODILY INJURY(Pmagy,l S X D-SRELLA Ltgg PROP E EXCESS LIAS ^ OCCUR maci4 S FP-eg11� S 8 D00 BED R EACH OCC AND IN Pell NNS 60ODS8654 aGGReCA URRENCE S 1,000,00D ANYANY ELIPLOYERg•LU1BILnY !20/2014 /20/2015 S 1,000,000 WPM PROP Ill�TQR?ARiNERfr7@CUpyE YIN 1' 'S OFFICEeLIAE, NJ EICCLUDEI)T I i NCSiATU- Ug".�4ry)ANH) Q NIA I OTH- If a5,4esal�e umkr i D CRIPTI0 OP OPERATONS palm, el EACH ACCID is C POLLDTIom L286ILITY EL DISEASE-EAEUROY S 00378602 S EL DISEASE-POLICY UNIT 0/1/2013 0/1/2014 DESCRIPTION OFOP GENERALAGGREGATE eRATIONS/LOCATIONS/VpeCLE4 I EA POLLUTION CONDITION51.000,000 (All ik 101.A4NH0n81 Remakes $1,000,000 ��°�0in�ePaee mlrequfred) I ERTIFICATE HOLDER CANCELLATION CITY OF SHOULD ANY OF THEABOVE DESCRIBED POLICIES Be CANCE SAT,EM THE EXPIRATION DATE THEREOF, NOTICE WILL gE p 0 BEFORE scar-u INGT01 70 ACCORDANCE WITH THE POLICY pROy(SIONS. ELNERED IN MA 01970 AUT/OR¢EO REPRESENTATVe t ORD 25 Ronal (2040/05) d Cleaoes/Sil Th.dP.r1Rf1 n�rne� ) O'988.2010 ACORD CORP M1�""•mtefnrn,#11�r4e of pf:AOn ORATION. All rights reserved. 1 Massachusetts-Department-zf Public Safety Board of Building Regulations and Standards Cnnstrucdon Supervisor License: CS-087977 '' - rr ERIC W PALM - 3 H I TON ST Salem MA 01970-f - Jam.+�tl�GLe�..a �:.�� FxplraT.ion Cammissioner 04/23/2016 &7w`�ouuur+urnen�l�o`C'knurrc/rrrrJh 06 ice afConsamer Aifa'us&Bovness Regulation ME WIPROVEMENT CONTRACTOR istrdtion: 142089 piration. ;3112l2o16 Lid Liabigly Coryo': . ATLANTIC WEATHERI7ATIONL.L.C. - - ERIC PALM 61RJEFFERSONAVE - - SALEM,MA01970- - Undersecretary