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39 OSBORNE ST - BUILDING INSPECTION .r . c<< 9 2y S 2S°z7 e Commonwealth of Massachusetts ly i OF ° Bo of Building Regulations and Standards 1NSPEC TI Boar L Mass chusetts State Building Code,780 CMR Building Pei Rev$rseTY F011 it Ap lication To Construct,Repair,Renovate Or EJgAhpj 9 P ' t One-or Two-Family Dwelling 02 This Section For Official Use Only Building Permit Number: Date ied: Building Official(Print.Name)- Signature SECTION 1:SITE INFORMATION 1.1 P pe A%Iress: 1.2 Assessors Map&Parcel Numbers L la Is this an accepted s4eet?yes no Map Number Parcel Number 13 Zoning Information!: 1.4 Property Dimensions: Zoning District Proposed Us Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yazd Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G!Y,c.40,§ 4) 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 &4 ecord MA ( e 14 Sa/-eh-, �W Q/q 7 0 Name(Print) City,State,ZIP No.and Street I Telephone Email Address SECTIONS:ID ESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ 1 E. isting B jilding❑ Owner-Occupied ❑ 1 Repairs(s) ❑ eration(s) ❑ Addition ❑ Demolition ❑ Accessory,Bldg.❑ Number of Units_ Other Specify: Brief Description of proposed Wo kz: SECTION 4:ESTIMATED CONSTRUCTION COSTS Item I Est mated Costs: Official Use Only Labo and Materials 1.Building $ '� 1. Building Permit Fee: $ - Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ i ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC)I $ List: 5.Mechanical (Fire $ Total All Fees: $ Suppression) Check No, Check Amount: Cash Amount: 6.Total Project Cost: $ / 0 p Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTAUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Name of CSL Holder -�- EIIC W.Pd1R1 Expiration Date Hilton Stlut List CSL Type(see below) CA. No.and Street SlIfelln MA 01970 Type Description U Unrestricted(Buildin s u to 35,000 cu.ft. City/Town,State,ZIP R Restricted M2 Famil DWellin M Maso RC Roo fin Coverin WS Window and Swin SF Solid Fuel Burning Appliances D I Insulation Telephone Email address D Demolition 5.2 Registered Homei Improvi ment Contractor(HIC) IC HIC Company Name or . C eggg �g`e T HIC Registration Number Expiration Date b� p1Gi1CISbfi Avenue 4 0.and.Street I lem MA,01970 �(�y.�/� Email address Ci /Town,State,ZIP Telephone SECTION 6:WPRKE 'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c.152.§25C(6)). Workers Compensation Insuran a affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the de iial of the Issuan of the building permit. Signed Affidavit AttacAed? es ..........2f No...........❑ SE ION 7 :OWNER AUTHORIZATION TO BE COMPLETED WHEN OWN R'S A ENT OR CONTRACTOR APPLI E S FOR BUILDING PERMIT 1,as Owner of the subj Ict proper ,hereby authorize Z(r C PGt,/VT✓n to act on my behalf,in all matter relative to work authorized by this building permit application. Olkliq Print Owner's Name(Electronic Signature) Date SECTION b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name b low,I hereby attest under the pains and penalties of pedury that all of the information contained in this application is a and accurate to the best of my knowledge and understanding. o d Fruit Owner's or Authorized Agent' Name lectronic Signature g Il o I Date NOTES: 1. An Owner who obtains a bui ding permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home I provement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund un er M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass,gov/oca lnformat on on the Construction Supervisor License can be found at www mass eov/dos [2.:W:hen substantial work is pl ned,provide the information below: or area(sq.ft.) (including garage,finished basementlattics,decks or porch) ing area(sq.ft. Habitable room count of fireplaces Number of bedrooms of bathrooms Number ofhalflbaths eating systemNumber ofdecks/porches ooling system Enclosed "Total Project Square Footag "may be substituted for"Total Project Cost" Massachusetts Home Improvement Sample Contract This form satisfies all basic requhemmts of the scale's Home Improvemmt Contractor Law(MGL chapter 142A),but does not iaGudesmndard language m protect homeowners. Seek legal advice if neeess,�ry,any parson planning home improvements should first obtain a copy of"A Massachusetts Czt Guide to Home Impmvemant"before agreeing to any workonyamresidence.You may obtain afire copy by ca0in the Office of Consumer Affairs and Business Regulation's Consumer lnformmion Hotline m617-973-8787 or 1-888-283-357 or on ow websiteg Homeowner Information Contractor Information Name ,r .. .ompmy Name //�J. -`I_ u.rttic Waattiaization. I T V Sam Addrestdormt a Past Offimnozaddres)11 Contramud Sal Ciry?oxn —jarfew-Avy"M State Zip Cade Business Address(roust" -ei�vt Y�'l9 ol9�a ' Daytime Phone Evening Phone Ciry?own stem Zip Code Melbas Address(It difFerent farm above) Busies Phone FedemlEmployermor SS.Number .. raw rtpvW W�mva6me Ilaverv{�®C®u®m&a.numb [yvN�Nrt - �.. s. ImPmnme ,a®nhtrt v,watl mehrnavv vvmEer The Can tractor agrees to do the following work for the Homemvuer. (Describe'"detail the work to completed,specifying me type,brand.and grade of materials to be used, Regmred Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowoers agent be adh to Unless circumstances beyond the contractors mount arise (Owners who secure their own permits will be Q "Ouded from the Guaranty Fund provisions of v Z.7gtawhencontraator will begin contracted wnrk. MGL chapter 142A.) n Z 1j Date-lam contracted work will be substantially completed. Total Card Td Price and Payment Schedule /��JJ�� The Contractor agrees to perform the wmk,famish the material add labor specified above for the total Burn ofi. -5 J�1 (•) Payments /will be made according to the following schedule: s13/1/_'uPor,sigoingcontram(mottb,excead 1/3 of the total contract rice or the cost ofs "P pedal order items,whichevm is greater) s by!qr1�1 m upon completion of Q s - i by-tit //�m upon completion of ,!C/TQ,, (yh/ e(/)y)'n/2fi f�1"✓ S ✓pQv� upon completion of the contract (Law forbids demanding full Payment until contract is completed to both.: pl parry's satisfaction) , The following meurittMequipment must be special S to ordered 66{{//pehd fat ordered before the conment nectedle(*o)gin in order ` orto meet the foreth connctedulmkb S to NOTES:(-)Ineludiogall hence charges(••)taw requires that any deposit mdawo-psym e, mquired by thecommmm before work begle may not exceed the greater of(a)meihird ofthe total contract price or(b)the acmal cast ofaoy special equipmem ormutom made materiel whicbm .hespecialwderedinadm.tommtheoompledmuhedute - Lulaullw I were®waist,being trowidedb h at rT No 13 fall rl f6ermched fah s S bmutra<tors The contractor agrees to be solely responsible fat completion ofher work described regardless ofthc actions ofany third party/mbmatmUor utilized by the contractor. The continuum further agrees to be solely responsible for all payments to all subcom actors for g t als lmdlabor under ibis ilpoemmt - Contract Acceptance Upon signing,this document becomesabUrhdUmg contract order law. Unlessotherwisen mad within this document,the contract shall not imply that any lien at other security interest ban been placed oa the residence. Review the following cautions and notices carefully before signing this contract • Don't be pressured into signing the contract.Take time to read and fully understand it Ask qumdoas ifsomething is unclear. • Mak �relh fat tat 6e oval"d Home lea rnt Co trac+on-Repastottion. The lawrequires most home impmvmmtcoamactors and subeantiaGors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Rom 5170,Boston,MA 02116 m by calling.617-973-8787 or 888-283-3757. • Doesthematfdetorhaveinsumam? Ask the Conlrectorforhisiasurm"companymf an so dam you can confirm coverage,or ask to ee S a copy Of"proof of insurance'document • Know your rights and responsibilities. Read thelmponantlnfommion on the revmsesideofthis form nudger a copyof the Consumer Guide to the Home IMProvement Contractor Law- You may pncel this agreement ifit has been signed of a place other than the contractors normal place of business,provided you notify the conaanmrin writing at his/her main 011100 or branch office by ordinary mail posted,by telegram seat or by delivery,not later than midnight of the Third business day following the siguing of this agreement. Sm the attached notion ofmncellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Twe vimdcal copies ofdmma u®at beuuvpktW mOsia�m pne wpyshwWgomtbo Mmroouu.ThcoWaaapy should be keprby Wp mmrxms. LAA HommsYlr '.Sr)ptmure --_ - Contractor s Signature - Date Date 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 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 homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive.Officeof Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as pmwed d Iamaissachusetts General Laws,chapter 142A. n, ' ad o4 1 Homeowners Signature r - Co tat e 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(Le.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 property 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 warrant.ies 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 homeovner'and contractor lawfidly agree may be added to the terms of the contract as long as they do not restrict a homeowner'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 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 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 himtherself 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 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: 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 han:lAc;+n.mass.uoe/ocabr` 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.Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at nitl:lh;�;�ranass.acv/ocabrf Go online to view the status of a Home Improvement Contractor's Registration: htto://db.statc.mausgtomeinn>rovemen`vlimnseelist vn - For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General ' 617-727-9400 AND/OR Better Business Bureau 508 6524800,508-755-2548 or 413-734-3114 Version 2.1-I trmn_a1a �. CITY OF Sr1T:E;A iA' SSACHUSMTS Bt1tLDP.1G DEPAR'ISIEDiT 130 WASHINGTON STREET,3!D FLOOR TEL (978)745-959.5 Fix(978)740 9846 (Cj\t$RRr EEY DRISCOLL "j'HphL1S SLPtERRB MAYOR'. DIRECTOR OF PUBLIC PROPSRTY/HL'I[DL*IGC03Ltit15StONER Workers`Compensation Insurance Affidavit: Builders/Cont"riCtors/Electricians/Plumbers Anniicant information Please Print Legibly Atlantic �Veat6rization,LLC NatnC(nusiitesti0iganiratioN lndividuaq: vetlue Address: Salem MA 01970 City/State/z PhoneM: Are yo a cmptoygr?.Check the appropriate bozo Type of project(required): 1. .1 stir o�mploycr with 'a.5�' 4. (] 1 am a general contractor and,l d. C],New construction employees(i'ull Snd/or part-time).' have hired the sub-onaactors ' 2 ❑ Pam prop a solo rietor or partner- listed on the attached sheaf i 7• ❑Remodeling ship'and have no employee�.::: Thtse-sub-contractors have , .. 8. ❑Dernolition workin for me in an ca aci workers'comp insurance ' g• g addition g . Y P ry. ❑Building INo workers comp.insurance' S. We are a corporation and its'. 10.❑Electrical repairs or additions squired J . ' officers have exarcised their, 3.0 [am ahotneowner.doing all work right of exemption per MGL , I I.Q Plumbing repairs or additions, myself [No workers:comp, c l52 §1(4),and we have no I2.©R repairs insurance regwrid j employees.[No workers'', 13. Other Y�� t tlg/tY/*� comp:insurance required) ` 'Any appllaM that ch%XM b=41 mtutahiii rill out the section below showing their wodeni'mmpeention polity inhumation. - t 1 woownms who submit fhb ifndavh indicuing they atedoing all work aria than hiro outiido contractors must submits now,affidavit indinving,wch :Commotonthatcheck this box must aeachedand"tiatalsheel showing rho gum ofIdasu&copingoa and lhelr'wonmi comp.policyinfoaoation. !am an.eingloyer Marls:provldl�rg workers'aompensaton btsurance jar aty empinyeei Below/s the poJ14 and Job site 3njormatioiri, ' InsumnceCompany Name: _ Paliry N,urSelf ins.Lie.itq ��J U 1 (�1 Expiration Date: 3 -1d l — Cob Sire Address; ty/State/Zip:5 Attach a copy of the.1vorkers'compensation:poliey,declaration:page.(showing the policy number and expiration date). Failure to-sc urc coverage as required under Secdo,25A of MOL c.,152 can lead to the imposition of criminal penalties of a fine unto§1.500.00 and/or one•year.imprisonmeni,as well as civil penalties in the form`of a STOP WORK ORDER and a fine of up to$250:00'aJayagainst the violator. 13eadytved that a copy uCthisstatcment may ba forwarded to the Office of Investigations or.the DIA for insurance coverage vcniication. 4 do hereby ern 1.uhr{ar the y�p lNes ojperJury that the injonngtCol,apuavldrd above i9 true u�rd correct II/ fdV�e s-ll il/L-1 Phone 9,) _2 ���� Official u"ady:::Da nor wrjte in this area,fo be abarpleled by el yar-fawn 10clal City or"fawn: Permititaccnse fi _ Issuing,authority(circle one): 1.nourd of licrlih 2.milting Department 3.Cityffown,Clerk 3.Electrical Inspector 5.Plumbing Inspector 6.Other -- Contact 1!crson: Phone ff: +sib++-1.f 6A 1TJ—f J/ 1L/ LV,lY l :L! : J l Hl•! YtlVL'. OJ/ VOO C0.A OOf VGf I a ® CERTIFICATE OF LIABILITY INSURANCE 0ATE 3-12-2014 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 poficy(ies)must be endorsed. If 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 confer rights to the certificate holder in fieu of such endorsemerd(s). PRODUCER CONTACT NAME: EASTERN INS GROUP LLC } PHONE FAX 233 WEST CENTRAL ST r No. M: No: NATICK,MA 01760 i E-MAIL INSURER(S)APFOROING COVERAGE NAICA INSURER A;AMERICAN ZURICH INSURANCE COMPANY INSURED ! INSURERS: ATLANTIC WEATHERIZATION LLC I ` INSURER C: 61 REAR JEFFERSON AVE SALEM,MA 01970 I INSURER D: INSURERE: INSURER F: COVERAGES C 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. INSR TYPE OF INSURANCE ADD SUB pOMCY NUMBER POLICY EFF POLICYEXP LIMITS LTR INSR WVO (MM4)O/YYYY) MMMDNYYY GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY ( DAMAGE TO RENTED S CLAIMS-MADE❑ OCCUR I MEDEXP(AWmepnsW S PERSONAL B AOV INJURY 5 GENERALAGGREGATE S GENL AGGREGATE LIMB APPLIES PER: i. PRODUCTS-COMP,OP AGO S POLICY j� LOG f j S A MOBILE LIABRRY ar'ecoHdeD SLUGLE LIMIT S ANY AUTO BODILY IWURY(Pei peiwn) B ALL O'NNED SCHEDULED I AUTOS AUTOS NONOME0 �• BODILY INJURY(Ptt a¢4en1) S FPO AMAGE HIRED AUTOS AUTOS f S S UMBRELLA UAB OCCUR EACH OCCURRENCE 5 EXCESS DAa LLAIMSMADE AGGREGATE S pSo RETEMIONS WORKERS COMPENSATION Y/CSTATU- AND EMPLOYERS`LIABILITY YM X TORYL.TS OETMR ANYPROPRIETORNARTNERSXECUTN NIA I E.L.EACH ACCIDENT $500,000 OFFICERILIEMBER EXCLUDED? 6ZZUS 03.20-2014 03-20-2015 (AlflndalNyin NH) ( I 5B270121 E.L.DISEASE-EA EMPLOYEE $500.000 11 Tax desoYe umer I DESCRIPTION OF O RATI NSEelory I I EL.DISEASE-POLICY LIMIT $500,000 I i � DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(At tai h ACORD 1M.Addilbnai Remuks Schedule,H more apace Is requlied) i it � I ERTIRCATIE HOLDERCANCELLATION 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. I AUTHORIZED REPRESENTATIVE ACORD 25(2010106) The ACORD name and logo are registeredgmarksfof ACORD CORPORATION.All rights reserved. A CERTIFICATE OF, LIABILITY IN SURANCE DATE(MM DO YYYy) THIS CERTIFICATE IS iSSUEDgS q MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS 3/10/2014 CERTIFlCATE DOES NOT AFFlRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER 711E COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSU NICE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE 71 PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate Holder is an ADDITIONAL INSURED,the p1:li1:I':I'll I must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and cond(tions s 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 endorsement(s). PRODUCER Eastern Insurance Gro I I,I.0 CONTACT Construction NAME: 233 West Central PHONE . (5O8)651-7700 FAX Street E-MAIL NI D s. Natick iNA 01760 INSURERS AFFORDING COVERAGE INSURED INSURER A Arbella Protection Ins• (�`o, NAIC# Atlantic Weatherizatioi NsuRERB ASbella Indemnity 1360 Ins Co. 61 Rear Jefferson Avenue INSURER CN.11 ills Insurance Co 0017 INSURER D: Salem MAI 01970 INSURER E: COVERAGES INSURER F: ICERTIFICATENUMBER3laater 2014 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED : REVISION NUMBER: BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING glJY 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 EC ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Ri R TYPE OF INSURANCE I NUM Si t 1P UUDCY EFF G LIABILITY R pCY EXP uMrrs X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 11000,000 A CWMSMADE OCCUR 500042836 P MIS E omnre S 50,000 /20/2014 /20/201s MED EXP(Any ona rson) S 5,000 PERSONAL&ADV INJURY S 1 QO0,Q00 GENL AGGREGATE LIMIT APPUES PER:I GENERAL AGGREGATE S 2,,000,NO POLICY X PRO- PRODUCTS-COMP/OPAGG S 2,000,000 LOC AUTOMOBILE LIA&CITY S ANY AUTO COMBINED SINGLE UNIT B alxlaen S 1 000 000 AAA ED x AUTOS SCHEDULED 020015871 BODILY INJURY(Perpe,s,n) S X HIRED AUTOS X ��WNED /20/2014 /20/2015 BODILY INJURY(Per aciuenU S PROPERTY DAMAGE Peractid nI S X UMBRELLA UAB X OCCUR I PIP-Basic S e 000 A EXCESS LIAB CLAIM6•MADE - EACH OCCURRENCE S 1,000,000 DE RETENTIONS 600058654 /20/2014 /20/2015 AGGREGATE S 1,000,000 WORKERS COMPENSATION ANO EMPLOYERS'UgBIUTY S ANY PROPRIETOR/PARTNERIEXECUTIVE YIN V.o BTATU- TM- OFFICE(Mandatory in R (Mandatorybe NMI EXCLUOED7 NIA - E.L.EACH ACCIDENT S vyyu,aesrriea wltler DESCRIPTION OF OPERATIONS Me,, E.L DISEASE-EA EMPLOYE S C POLLDTION LIABILITY ELDISEASE-POLICY OMIT 5 L200378602 0/1/2013 0/1/2014 GENERALAGGREGATE $1,000,000 EA POLLUTION CONDRION $1,0OO,OQQ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEj11CLES(Attach ACORD 101,Addidunal Remadd%Schedule,It more$ ace is P requhed) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SALEM THE EXPIRATION DATE THEREOF, NOTICE WILL HE DELIVERED IN 93 WASHINGTON STREET ACCORDANCE WITH THE POLICY PROVISIONS. SA EM, MA 01970 AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) Ronald Cleaves/SHE INS025noin,nlm Th.Annan o,„o, I ,r,na.atv�mike,^f A(InRnORD CORPORATION. All rights reserved. 9 t Massachusetts-Department-*f public Safety J Board of Building Regulations and Standards Omoructinn Supen iiar License: CS-087977 rj rr ERIC W PALM 3 HMTON ST 2 ` Salem MA 01970; Expiration . Commissioner 04MI2016 PolruirNrrrKYrl��.ofC�i�'tcu;nc�nic/(J _ -0flice arConsumer Affairs&Busroess Regulafioo MEIMPROVEMENTCONTRACTOR gistratlon: 142089 TYPe- . xpiration. 311212016.. Ltd Liability Coryo - ATLANTIC WEATHERIZATIONiL:L.C. , ERIC PALM 61RJEFFERSONAVE' Q s SALEM,MA 01970- Undersecretary r it