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29 OSBORNE ST - BUILDING INSPECTION tt39s to RECEIuts VED The Commonwealth of Massachusetts INSPECTIONAL Stld Board of Building Regulations and Standards CTT�IYOF Massachusetts State Building Code, 780 CMR 1015 OCT 19vlsd 2011 G Building Permit Application To Construct,Repair, Renovate Or Demolish a f One-or Two-Family Dwelling This Section For Official Use Only_ V/ Building Permit Number. - Date Applied: - .Building Official(Print Name) - - Signature - - - SECTION 1:SITE INFORMATION t.l Pr�erty ��s: 1.2 Assessors Map&Parcel Numbers `j IXJrN� Sfi. L l a Is this an accepted street?yes_ no Map Number 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 yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Oym; of Record:y t�7 N(7,z ISO Z Name(Print) 1 City,State,ZIP �9 (95bo -n� I 770-S-q77 No.andStreet Telephone Email Address .SECTION 3:DESCRIPTION OF PROPOSED WORK''(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work-2: - SECTION 4:ESTIMATED CONSTRUCTION COSTS - - - Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ a 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ' ❑Total Project Costr(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: $ a,, 0 Paid in Full 0 Outstanding Balance Due: - SECTIONS: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Y7177 y/7,3//(y License Number Expiration Date Name of CSL Holder Eric W.Palm List CSL Type(see below) t, KL No.and Street 3 Hilton Stmet Type Description Salem MA 01970 U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted I&2 Family Dwelling City Fown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 9N �,A/A G/� SF Solid Fuel Burning Appliances '�!r'! O ! I IInsulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Atlantic WeatheriratioB LLC l Re is U /ti //r HIC Registration Number Expiration Date HIC Com ppgy.Al AN"FAV Name No.and Strereeetulem MA 019,11J 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 o e building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize_ _�i C f 4/P7--1 to act on m behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Sign. e) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARAT7iON By entering my name below,I hereby attest under the pains and penalties of petjury that all of the information contain d in this a�cati * c and accurate to the best of my knowledge and understanding. /U fo Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: i. 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 v:ww.,nasc.•_o=.-;'oca Information on the Construction Supervisor License can be found at r�•_ay.ntass.��o�ddos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,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" Ilb ���9u fpsKo me �ov�ffi��t��ffi ➢� �oa� ` ihisfotm sadsEesall bmicr¢ytdtemnolsofthemm's • tmtg°agem ptaRtp h-...--oes sea& HamelmPm+aaeorC°°frd#ortaw M��° C°anwarCnridemHameadvimifnmanrY.Anypetsnn p2vvaeg®eit�rov�eotssbouldfia[obtmme standa.d OtSeeofCvavmer �dBn;innsR t}ab r��� gtO wYasmkwya�tesidta�Y°u of"A mayobtama5ccopY bymal is�t1D7@fINBe[�fo[®2tspu °w`40°gotlineat627-973-8787 ar 1••SB&283-37S7 orwom by Ce. 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PmNlsoacantr+,.#orntifiz;d 6y oe eontmeta7 Thewnb,�.ory�h eamptdion ofine- m¢cthe ehatmthemalza ateriaJs mmdlabartmderrhis eemea ^O'Tcd�#r7udregmrpess a£tfieaatiat¢afmmY dmd Cantrct Arrepmnrp- tT°22mmsto beadetYaespcnnblefaraH paymcets mall •- r,fbr canhact shd)notim I.Uoan sigoog;this document beeomesabind-m cuefnlly hafare si Py drat wy7ien aratberse:n,-ityu>(e�hysb HConttscronderLavc Unlat going[his cannaat. C®PLtcedw meresi °metwisnoted within Phis decpmeo. dmtce.BevievrthefoDowmgtantioosandoodees the ° Mal:esmetfi�d�r8°2ogtbetanbeaL Take " ='h:aonactMlobe erbas cmtbth. a eattCa bnbmmetofipYrmdeataad it Ad:queationsifeame[itmgism#ea ` OII gR�eDDainxtorme[i orof23omofmproae:o®[`Csr�dnn.,fir. "holaw�nmthm°atmptoaement wntra#on and , byn ev ° Ders th,tmvtrdcmrlmremnoaoce?q{s a iiwi�om�3s17tl,Bos+ngtl9A0221Re600rrb o. ou may y,"b,SEBmn�,cor s_:aco `r4mofof' the C� Knor,3z rrights2o3 �,a.�aCT �IIL mR1m°Ce ,,,,pally ofmmation so[Latyoo rao wn5tmw ge ora's,rto GuidemtheHmeicTFovementConaa#ori2vr. Pmtmd2°f°T°tat2aa mthete thisfatm and rrerse side of Yau m geta'mPYafWeCaosrmtQ s]'aanceltbis ngtt•�m®Fifithssbe®9 ed or contractor N writing uhi° Wird business -�tarmain ofiieenrbrancho$ce ardba hat oecon day followingthe stgmngofmisagreemanG de, Gnu poinetbYtdegrsm Pizuoaby I Yoaaodfythe liT mC aaachcdnbticeof,,,,loni®far tbl"idmgotafdte- . Tvn' att�.c� ev�'®T '�Lq L`T Hf" aaPlmmaaov oFtbisrigo[ —tisL�BE �231�2LAp2g{SPA m3k^avia-"Y�mP➢eaW�omtb � t�c't/{�� �:i 0 $, 2'lO.Te°imee,Stmryary DoleCwYrdctces S gaaaae Contractor Arbitration The Home Improvement Contractor Law.provides homeawners 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 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 homem%%er hereby mutually agree in advance that in the event the contractor bas a dispute concerning this coatracS the conhactof!ItaXMbpI Mhe dispute to a private arbitration firm which has been approved by the Secretary of the Execa'W":0t'fice of o�psq�m�er Affairs and Business Regulation and the consumer shall be required to submit' such arbitratipdi.as3pYo'Gr 'Ivlassachusetts General Laws,cha er 1,2A. u Homeowner's Signature Contractor's Signature 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 homeowners 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 ofother matters on which the homeowner and contractor lawfiilly agree may be added to the terns of the contract as long as they do not restrict a homeowner's basic consumer rights. Ifyou have questions about your consumer/homeowner 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 notto sign the document until all blank sections have been filled in ormarked 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/louself to be financially insecure. However,in instances where a contractor deems him/herself 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 contracted work_ Withdrawal of fiords from said aecountwould require the signatures ofboth 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: Consumer Information Hotline 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 htro://umiv.mass.2ov/ocabd 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 Lava,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 htm://wwnv.mass arv/ocabd Go online to view the status of a Home Improvement Contractor`s Registration: - htto-//db state ma.usihomeim»rovement/limnseelistaso For assistance with informal mediation of disputes or to register formal complaints against a business,call: a - onsufner plaint Section orney General - " 617-727-8400 AND/OR Better Business Bureau 509-652-4800.508-755-2548 or 413-734-3114 verstaa zt-t trlroto i E 77re Commonwealth ofmassacliusens Department oflndustrfalAccidents I 1 Congress.Street,Sttite 100 . BOStOn, M4 02114--2017 wwtv.m ass. ov/die Tworkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plum rs be I TO BE FILED�i YITH THE PERibIITTING AUTHORITY.. pP A licantinformation _ Please Print Le btv Name(Busmess/Oreanvahon/Individual): Atfaattc K +to. aaNytgl,LLC, Address: ^( R .leflym,4vaIle City/State/Zip: Phone#:_ ? [4-f-1 re youa employer?Check the appropriate Doze Type of project(required)- 1 am a employer with employees(full and/or part-time).* 7. ❑New construction! ❑1 am a sole proprietor or partnership and have no employees working forme in any capacity.IIJo workers'comp.insurance required.] - 8- Remodeling ®i am a homeowner doingall work myself ys [No workers comp.insurance required.]t 9. Demolition ' I am a homeowner end will be hiring contractors to conduct all work on my popery. l uin 1�❑Building addition ensure that all contractors either have workers•compensation insurance or are sole proprietors with no employees. I 1-Q Electrical repairs or additions 5.®I am a general contractor and i have hired the subcontractors listed on the attached sheet- 0 Pitunbin_repairs Or additions These sub-contmetot have employees and have workers'comp.imumnc;r 1 d-❑Ro repairs / )6.0 We are a corporation and its officers have exercised their right ofexemption per MGL c. 14- therm 152,§1(4),and wx have no employees.(No workers'comp.insurance required.] 'Arty applicant that checks box Kl must also rill out the section below shoving 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 anached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp,policy number. i I am an employer that is providing workers'cmnpensaHon tan,;ancefor ny employees Below is the policy and job site information. Insurance Company Name:_ J'utri Gk Policy#or Self-ins.Lic.#:_ J 2-70 a i n q I (�L Expiration Date: ,� 6414 Job Site Address—._ d / d5bei J / City/State/Zip lCt+— Attach a copy.of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. i I do hereby certify umder the perms and peiraljtes o-�per'rry that the information provided above is trite and correcti Siart ant J N Date /d�(p Phone#: q7Qr_ 9LILT—R1 41 $ 77ContactPerson: on1J: Do not write in this area,to be completed by city or town official. Town: Permit/License# ority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son• Phone#• r t CER I�BG�B�a�M �g�Ba�bBLB B�f 8Nl9S4��i\9CE DATE(MMmDJvwn �CERTIFICATE D EIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RtU as UPON THE CERTIFICATE HOLDEP31J PM Is R. PHIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALA ER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 0I:IS CERTIFICATE OF INSURANCE DOES NOT CONS IME A CONTRACT BETWEEN SHE lSSWNG INSURER(S),AUTHORIZED REPRESENTATIVE O'?PRODUCE AND THE CERi4FIC T HOLDER. IMPORTANT:If'He certificate holder is an ADDITIONAL INSURED,the policy(iss)must be endorsed. If SUSROGAYIDN IS WAIVED,subJectto the 'terms and colder i nH T]the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER CONTACT EASTERN INS GROUP LLC - NAME: 233 W CENTRAL STREET PRONE FAX (AtC,No,E;t)_ (A/C,No): NATICK,MA 01760 E-MAIL 221V/LW ADDRESS: INSURED INSURE R(S)AFFORDING COVERAGE NAICa ATLANTLC WEATHERIZATLON LLC INSURER A: AMERtCANZURICNINSURANCSODMPANY I' r'INSURER B. _ �I INSURER C. II tFFF of REAR JEFFERSON AVE `INSURER D. f f SALEA11,MA 01970 'INSURER E. 1 !F#} COVERAGES INSURER F. CERTIFICATE NUMBER: T^-11, C1 EY THATTHE POLICC-S PF IN6UggPICe REVISION NUMBER: ANY REOUIRERfENi,TERN OR COMMON OF ANYCONTRACTOR 007HIIM DOp)MENTWITH IC1'T0REDU�MEDABORS ATE NAYRELYSUEDOR LAn==TrgN,THE HEIR NCE 4FORDEQ eYTHE POLICIES DESCRISEO HEREIN IS SUBJECT TOALLTHETERMS,E#CLUSIHMPE TTGWHIGHTMSDCON"TIONSOF SUCH POLICIES. SELSTRHDORYVM AYNAVEQEENREINSURUCED N PAID CLNt,SS. I LTAI ADO SUS LTR TYPE GF,h'SURANCE L R I— POLICY rs'F pATE POLICY E%P QgTE— POLICYRU)ASER Hann IYYYY) PRA00\VYYY) GENEgAL LIABILITY t LGtRs COMM,ERCIALGENERALLIASILHY 3 = CH OCCURRENCE S CLANS MADE (�OCCUR. S I.�t yy'DAMAGET EirocRENTED i 4?REMISES(Ea owrtrence) -ad - Mr EXP(Anyone person) S GEN'L AGGREGATE LIMIT APPLIES PER: � PPERSONAL a ADV RYJURY g 9 POLICY OPROJECTC]LOC( v^ENERAL AGGAEGATE S I 1 AUTOMOBILE LIABILITY PRODUCS-COMP/Op qGG S �I ANY AlfTO COMSINEDSINGLE f AL LEDUEAUTOSS WNIr(Ea accidPnl) S JI SCHEDULE AUTOS BODILY INJURY IS f HIRED ALMOS (Per Penton) I 'NON.ON.rNEDAUTpS 8001LY INJURY S f (Per acdden0 PROPERTY DAMAGE S (Per acciden!) UAIBRELLA LIAR rOCCUR r _ J EXCESS LIAO _(i CL40ASMA S EACHOCCURRENCE 5 Ig DEDUCTIBLE AGGREGATE S =11 RETENTION S S A WORIfER'E COMPENSATION AND S ANY PRO EER'S RIPARTry Y/N DS120/2015 i� ,WCSTAMORY"OTHER PNYPROPERROR EXCLUDED,CSULIVE ��p UR-a8270)21-15 03/pO/aQi6 (OFRCEP.RAEM1IBEA EXCLUDED, i"" S UA 'U:ARS i I $pdesdatory NNH) ELEACHACCDENT(!�a yes.JnTION OF r S 500,060 OESCRIPnCY OF OPEMTIDNSIzimv E.L DISEASE-EA EMPLOYEE S SDD,000 DESCRIP17ON OF OPERA"BONS/LOCATIONSNEHICLESMES-,-Al ()Ijg SPECIAL ITEMS E.L.DISEASE-POLICY LIMIT g BUO.ODO THIS REPLACES ANY PRIOR CERTIFICATE LsSUED TO THE CERTFICATEHOLDER AFFECT"HG WORKERS COMP COVERAGE i CERFiFIC IT HOLDER CITY OF SALEV7 CANCELLATION . 93 WASHINGCON ST ! SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED i BEFORE DANS0XPIRATION DATE 7HEREOR NO170E MLL BE DELIVERED RJ ACCORDANCE VJlTH THE POLICY PROVISIONS SALEM,MA 01970 AUTHORIZED REAR V S) The ACORD name and IOgo are registared mart=Of ACORD T98a'=20T D ACORD CORPORATION. Ail rights resnsvad. CERTHFICA E OF LIABILITYINSURANCE GATE(NIBIDOIY" 3/3/2015 THIS CERTIFICATE IS ISSUED A3 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXPEND OR ALTER THE COVERAGE AFFORDED BY THE POLICE= BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR2ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPOP.TANT. if the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certfficate holder in lieu of such endorsement(s). PRODUCER CONT OtlonACT COaStrO N ME Easters Insurance Group ISC PHONE (800)333-7234 FAX 233 West Central St E-Ib1AIL ADDR Natick INSURERS AFFORDING COVERAGE HAIGS LIA 01760 INSURED INSURERA-AMbella Protection Ins. Co. 141360 Atlantic Weatherization INSURER B RTautilus Insurance Co 61 Rear JeffersonINsu1TERc- INS U Avenue RERD- INSURERS.Salem i� lr 01970 INSURER F, COVERAGES CERTIFICATE NUMBERMsTER 2015 REVISION NUMBER: 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. I1NSR LTR TYPEOFINSURANCE AS POLICY NUMBER MS. PONIIJC LIMITS GENERAL LIABILITY Mfl3 EACH OCCURRENCE S 1,000,000 4i COMMERCIAL GENERAL LIABILITY A 65 TO E nee HEATED PR S 50,0001 A CLAIMSr ADE a OCCUR 8500042816 /20/2015 /20/2016 MEDEXP(kwwep n) Is 5,000 PERSONALS ADV INJURY S 1,000,000 GENERALAGGREGATE 5 2,000,000 GEN'POLICY GATE LAAtTAPPUES PER: PRODUCTS-COMPIOP AGG S 2,000,000 POLICY n PRO- C LOC S AUTOMOBILE UABIUT' COIN INED SING R Eaamdenl S 1.000.000 A ANY AUTO BODILY INJURY(Perpe ) S ALL OlNVEO n SCHEDULED 020015871 AUTOS AUTOS /20/2015 /20/2016 BODILYIWURY(Peraceden0 S HIRED AUTOS NON-0WNED " AUTOS P.r. .TYDAh1AGE S era UMBRELLA LIAB - OCCUR PP-Baste S .1 EXCESS UAB ' CLAIMS-MADE EACH OCCURRENCE S 1,000,000 DEO RETENTIONS 60005865A /20/2015 /20/2016 AGGREGATE S 1,000,000 VVOAND EMPBCOMPENSA710N S AND EMPLOYERS' AKINE Y WC 5TI r oni. R ANY PROPRIETOR/EXCLUDED? YIN I O Mandatary in N R IXCLUDEO? ❑ NIA E.L.EACH ACCIDENT S (Mandatary in NH) - If yes.descdba under EL DISEASE-FA EhiPLO S DESCRIPTION OF OPERATIONS be -, POLLUTION LIASILITF EL DISEASE-POLICY UMR S Z.200378613 0/1/2014 0/1/2015 GENERALAGGREGAfE $1,000,000 EA POLLUTION CONDITION $1,000,000 SCRIPTION OPOPERAnON"LOCATION'" MCLE.4(ARach ACORD.Ipr Ady-Umra)Rema*SScbedule itmomspomism[p imd) RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SATEM_ THE EXPIRATION DATE THEP HEREOF,LICY NOTICE U18LL BE DELIVERED IN 93 WASHINGTON STREET SALEM, DIi . 01970 AUTHOROW REPRESENTATNE >RD 25(20'10/06) ®1888-2040.ACORD CORPORATION. All right reserved. 12.5 f>n1d(LSI M 7Tae ArTrTRiT some en,9 Innn e;e reniermerr rrmrx nF AL:RRrT 9�t .Massachusetts -Department of Pubic Safety f Board of Building Regulations and Standards Construction Supenisor Y License: CS-087977- ERIC W PALM 3 H LTON ST f Salem MA 01970- Commissiaaer 04/M016 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(99111113)Of: enclosed space. 1 failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. w ripSucemingirdarmationvisic t -Mass-Gov/tiI - ��c Yonl/uasarenll��ni('�ni3ti(YI?ie//1 . _Office of Consumer Again&Business Regulation MEIMPROVEMENTCONTRACTOR _ eguutration: 149089 Type- it.31,1212016 Ltd Liability Corpo� ATLANTIC WEATHERIZAnON LLC. ERIC PALM 61R JEFFERSON AVE - �-a- SALEM,MA 01970 _ Undersecretary License or registration valid for individul use only _ before the expiration date. if found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valid withOnt stgnamre