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19 CEDARCREST ROAD - BUILDING JACKET The Commonwealth of Massachusetts RF�T`,bf7D Qx Board of Building Regulations and Standards MSP CTI SXLENPc"VICES { � Massachusetts State Building Code, 780 CMR Revised b%ur 201/ Building Permit Application To Construct,Repair, Renovate Or Demolish 101 DEC 8 A 20 n One-or Two-Fmnily Dwelling (✓(� This Section For Official Use Ont U ' Building Permit Number. Da .Applied ` Buildmg Otlicud(Print Name) Sigaalure'. Date t� SECTION 1.SITE INFORNIATIOW I.1 Proper y Address: 1.2 Assessors hlnp Fr Parcel Numbers Cc� C('C.SE �� I.1a Is this an acre ted street9 yes no Mop Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning DistrictProposedUseEat Area(sq ft) Frontage(11) 1.5 Building Setbacks(R) Front Yard - - sw Yor711' - Msystem Reyuired Provided RequiredProvided.. . . Requited1.6 Water Supply:(M.G.L c.40,§5d) 1.7 Flood Zone Information: 1.8 Sewage DZone: _ Outside Flood Zone? Municipal O O Public Private O Check If`aa SEt T[ONZ: PROPEIRTY:OWNERSHIPt 2.1 Ownert o Recoc'.rd: �. . 1Lc Po'. � N�mc(Print) City",State,ZIP - I? cam„r re 5 F No.and Street - Telephone Email Addreat; SECTION 3:DESCRIPTION OF PROPOSED WORK](check oil that apply) New Construction O Existing Building O Owner-Occupied aItepairs(s) Cl Alteration(s) G Addition O Demolition Accessory B,Idg.O Number of Units 11 Other O Specify: Brief Description of Proposed Work-: — r / SECTION 4:ESTIMATED CONSTRUCTION COSTS Itcm Estimra - - Ofltcirl Use Only Labor aI Building SBuilding Permit Fee:S Indicate how fee is determined: tandard Citylfown Application Fee 2. Electrical - Sotal Project Cost'(Item 6)x multiplier x3. Plumbing Sther Fees: S4.Mechanical (tIVAC) S5.i\lechanieal (Fire Sal All Fees:SSu ression) ck No.��Check Amount: Cash Amount: 6.Total Project Cost: 3 �� aid in Full ❑Outstanding Balance Due: 5EtJT t YJ SAs-F —' 12- SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) g 6) +I -�7 License Number ExpirationDate - Name of CSL Holder List CSLType below � H; IF•-�) s� yPe(see )—sem No.-,aid Street - Type, _„,` Description UnreslticIled(Buildings UPI to 35,000 cu.it. 5/JLk4/i Restricted 1&2 Family Dwelling City/Town,Stat M Wind �_ M may RC Floating Covering WS Window and Siding SF Solid Fuel Burning Appliances RY ivy- 9'1 Y3 1 I Insulation Telephone Email address D I Demolition 5.2 Registered Home Improvement Contractor(HIC) /,'yor� y �� /Q}1e+,,,,, 4y W le--kn Loy HIC Registration Number Expiraltan Date HIC C mpan Name or HIC Registrant Name ry No.acrd SEmail address S�cr.r.. 47zr- 7YY—B”? Ci /town State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURAWCE AFFIDAVIT(M:G,I C.152. 25C(6)), Workers Compensation insurance affidavit must be comp) and submitted with this application. Failure to provide this affidavit will result in the denial of the Isivance a building permit Signed Affidavit Attached? Yes .......... No...........O SECTION 7a:.OWNER AUTHORIZATIONTOBECOMPLETED,WHEN? OWNER'S AGENT OR CONTRACTOR APPLIES FOB`BUILDING PERMIT 1,as Owner of the subject property,hereby authorize �' (2- t9 act on my behalf,in all matters relative to vork authorized by this building permit application. Print Owner's Name(Electronic Signature) - eDate 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 this application is true and accurate to the best �of my knowledge and understanding. / Print Owner's or Authorized Agent's Nome(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 n have access to the arbitration program or guaranty fund under M.G.L.c. 1142A.Otherimportbnl mfoim on on the HiCYrogram can end at— — +vrvw.m;rss.urv'oca Information on the Construction Supervisor License can be found at www•.nrass.eov.'dns 2. When substantial work is planned,provide the information below: Total floor area(sq. R.) 't ,(including garage, finished basemenVattics,decks or porch) Gross living area(sq. tl.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halffbaths 'type of heating system Number of decks/porches Type of cooling system Enclosed Open .l. —rotal Project Square Footage"may be substituted i'ur"Total Project Cost" Mass$ebvmtts Home Im rOvement Sam le Contract wagmage to hada l�mvemmt tB9ohafibeaataae Conueamlaw Cann d toHmm�tadvnsifineesruy. gay p�gb®es'�)4b botdnrs oetiododeamad a -wk am ShOWd fmt Ohtmim a COPY Of'A r D>RmofCoammtr � tea) ibaa®eral owmasimessro Hodmem6ly� �57 ace Wbcar .,,,, the xame CoatraCUMrinformation Street Address(do oat use a Fhst 09rm gQ�) �ry p CL zipcde � � WEATHERIZATIOH', LLC atm: aasmess ndmers coma or.Ede e naydme Fhooe fi ll L w( M, MA 01970 c y�� 978) 744-8143 s ah Mvigvg Addrss(11digeey,6��re) - aatineoPhooe Fedval lmplgerIDar38 NmSv r••'4amoa eoet® ���48 t•erb they .vmgee� dO The Coahectoragreea m do the�a%gworhltrthe H /� (Uombe in demil the weer meomp(etad,'�rYirs the type,prm4�of S('rtP (Z, P T !oatmidamheasrd. 36,yr plsnti. t� d4- 410•,.., ce (le•teae_ i¢Ffee 8� $ 2_ ry eL � " n a vdwia6eP�b_Ihef gPcmbm .- r.-�i-�C he, !/ c�/ s bythe hm�hamman d he,-t- Comp7eh®ydtadofe_1Le5tgowm (Owners who Secure their ownpermjtaw�be be�'Odmmdasmc��h�d�� g�andew,lt etciuded from the Guaranty Fuud mnhol arise MGLchapter142&) Prnvisiotaa of Ix / Dam when moh'aeemwA aomacttd wmk. Tohl Contract PdmandPa9m®tSrhMole � �QkweM hem6gaatiapYmmPlrird The Cwb-ammagtmsmperform drowm—[maishthemal®sl ad)aborypecissdahow Paymeoh will betaedeammdatg mthefff,,,a fmthea>m)®of 000 _'�-----_� CO gschedOlr. $---= Won mgainga®tractnotm ( esmad 113 ofPoe[oral conh�tdCe 0t/p/[_� $ ad ,I ora h➢ ��pleimof J'/ `tial-d-6-4 whie6everiagrc>ft') a q06•� 65 L1/�b/ �apaonamp)care of �la Q®✓C (e upon comPlm®Ofthe 76e6gawiag (fawgoyidsdmmdmgdfotlpa➢mm[ I nata cmtrdGisoomP�lm bmh O �speeisl mmeaftph k 1. t to heyeiefor P�Y's oo) . �) t to be Paid fm clog ag fat®m ehvga('•)law which r�mot hPo`e�of(e)aw.Pokd MV�d--r d4mdtma_-Ymem to9u•red dm sP�do,dened madvanamm�tye.nngem'm@pahedNe dam ofmy�aotlyrviPamtaraogam6�`rmoY medemeteiy Sobmahnttors-Tbe moo'dD`��mhesold th v Party/submntrzgmmiliad by theme Thecmify�tr wmkdecmLodsegydt®ofrheattiam of Coatmm Aecepmace-Upon ageing 0ds dY raPoosbblefmdl PaYmmtty mau wlaaoh�alahed for amefully hefinesi�ga� •°rOstYhtea�has 6e®P�ed�the� Ualasmhawixa�dwithm Pols deuce ReriewPonfo0tgvhg�p��d� the • DmYhepresaued Tatos fravL TaLx ' • Mn1ew gamg PoC� ocoamactorsmhea �yAsk9aeati®sifa�ethmgis®dear. • �nrananhywnOogmthaDhaemrat l0 `Fmkr`t�U`m`fmprermmt Coaaacmyr�Re re9mtY�homne, emtpmvemem mahamors and seeampyofa•proof 'the Co'b'Ctr,has,melaam?Ask the�Rmm5170 MA02116mhycellYoura inquajeam8 maamm^daetavwt .arnese-ooml�Y WbalaIJOa so thatyoo tea eoaGrmm • Qddcmth,H(saadtespooshdi,,,Read Poehnpmtant welge,maskm (lddem WeBeme lmPmw<meat IWbmdonmthe resmseside Coatrartmlaw. ofthis form and getampyaf&e Coasuma Yumraas agrm third basin mWmgathiamlbemrtMrafigi,t t6inags�bem sgata[aphanmhat mftfogowiogthes � m� byanfieghyan[he po tde�� than midm'gytrd'am 11bNOTSIGNTffiSCO dmchedautimofcavcrylahpafmmtoran mofPoisrgbt ran wmdw,w�•rtmw,a�,�,w �ntemaad d���TH1i1tE`�C' �Y BL/1NK SpACESrrr m Wom'a ry/a li s >aoaa °` One 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 clam would give the contractor the some 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 Office of Consumer Affairs and Business Regulation and the consumer shall be required �to submit to such arbitration arbitration as provided In Massachusetts General Laws,chapter 142A. Homeomer•s Signature Contractor's Signabue 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 act 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 mane. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides anexpress 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 maters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. 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 patties.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 imsccure. Howcve,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of fiords not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted wodc Withdrawal of fiords 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: Constimer 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 httn://www.mass.goy/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 htto://% w .mm.goN,/ombr/ Go online to view the status of a Home Improvement Contractor's Registration, httv://db.state.ma.us/homeimt)rovement/licenseelist ml) For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 50"524800,508-755-2548 or 413-734-3114 version 2.1-I1/2=10 1'iZe E6ir2:,zdaurenl_tz or!v<-�ssecl�zrei`=S ! _r�.'"e77�t iffZei2e djF£�'= . �•= =1 �����-r��j'��i.=./ d 55i_rie tif# { J t d5i6r2r lis' OZI -f-20 t 7 VvOrKe:SM1.ICaSas 03_--az56F'2eeCe 3i3L-t-vit' t3'c➢)deFSI�'J_rS`s-aCiC35/ElNcti ciao 1iLit"JE:S. "=O s3E.s NIL0DT"FITH `IE=L_Rb•HTTR4G no)icant3afo_12ltMR "Ut--TZ ®�-Y. ?lase ;Int rLeFiSiY iVaine(BnsinesslOrganizatitinllndi:•iduap: (z 'c':"•�t� v City/State/Zip: Phone : �', e tQ _ �' .`� .Are roo ag employer?ched;the=propriate bo= i. (gm a employer with =yae of Faro" .; P _ reel - ._`a _ at employees .. C -red). - es lull _ _ 3 ( and/or art[i - � I P me)= �1 an a sole pmpnetoror partnership and have no employees norkine for mein 7' O Naw construction Feagt[Aoatvrkers'cp' P.Insurance required.) o- C Remodeling am a hamemvner doing ail wort;myself[No worker tomo.insurance required.] � 9. ❑Demolition I am a homeowner and vitt bellhiring contractors to conduct all Ivor:;on rat•pmoercp. t•.till -10 C Building addition ensure th=_c all contractors either have worker-compensation insurance or am sole Proprietor with no vnpioyces.I 1 L�Electrical repairs or additions s.I I am a general contractor and!have hired rhesub-contractor listed on the=rzched sheat 17'❑Plumbing repairs or additions Tnesesab-contractor ha:•e employees and have worker,'comp.insurance r iIEDRoo•repairs 6.t (tile a§44).and we nand its officer have esemised their rieht ofesemption per NIGLcOther�J�J 153,kl(9),and Iva have no emplloyees.[No workers camp.insurance required) A . tan th t I L I ustIiso ll out die section below shonvne their a•orkers'compensation policy information. T Homeowners wito submit this aiiidavilirditxEng they are doing all:%ark and then hire ouCside contactors must submit a newaffidavit inuin;ina sucb. =Contractors that check this bosmost anached an additional sheetshou`ine the ngme of the subcontractorsand SEs whetherwnotthoseendue;have employees. If the sub-contractors have employees.they must provide their workere comp_policy number_ or put en eizzploywr flz[t is provldiirg Ivo:itefa'cpity�er , [i j orfiteffoit. satmzizts[trcrce-orinpezzzplopees. Be[o!visthepolicpendjobsif2 Insurance Companv Arame: [rt(rL Policy=cr Self-ins.Lia - b /a Expiration Date: 31 —��-;'rl` !r Job Site Address:_ /A - -_ttrich: capY of E.__ ao,vers compensa_,on poise i City/Statelzip: s/l.(y /j'�/� Y deC.2.2tien pale(sharvl the p(tficy nrtmb°s Failure to secure coverage as required under MCL c. 152, egg; s a al violation P enc'e:_pir-2:'o- dayandagainst onetyear imprisonment.as well as civil penalties in the form of STOP WORIC ORDER punishable fine of up to 32fine un to 30.00 a day asainst the violator.A copy of this statement may be forwarded to the Office coverage verification. of investigations of the DlA ,for insur2nce I do Itezrbn cert] de-the s cr 6 / z fires o4�e,-, �t7�tlzer the iz orzzzotior provided above is tae andSiettature- r u Correct Phone= C? 7424 rnQ` i 6tf i Date: 5 - �rT�t w � - iiffzeicl use cal}: De zzot tv;tie in Jzis or ,ee,fa be coin zefed b y c P ) chl;OP IOiVi.pf IClt!1. Per:nitrlicense -5s_i=g:inti?s^'= ,{tree one): -.. s. Snateofc7eaa_� 2.3+�€id:cg Dena.-tment 3.- i- I� ^. the; _ . - I �_�/TOi•:'-pie_ti ._ lecE`rLc2[ 'nspeci�' 5.'lnrabia-Ig_nspectar ��antact;:✓ersan: Phone r A c._ C)h?tzO" CERTWIC ;TE OF �,�QMUTY Q SSURANCE 313/20i5 runnmwj THIS CL-P.T fFfCATE IS ISSUEQ RS A ILRATTER OF iNF01W1A i C1 I ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS •CERTIFICATE DOES NOT ii :I INSIVELY OR NEGATIVELY A-1WEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS GER7lFICATE1OF INSURANCE DOES NOT CONSMUTc A CONTIRAGT Bit WEEN THE ISSUINC INSURER(SJ, AUTHORIZED REPRESENTATIVE OP,PRGQUCER,ANQ THE CERT)FICATa HOLDER. IMPORTANT. It the cewfcatel holder is Bn ADDI I)ONAL INSURED,the po)tcy(ies)muse he endorsed. F SUBROGATION iS WAIVED,subject to the ificat and conditions of the policy,certain policies may require an endorsement. A staiemert on this certificate dos not confer rights to the Certificate holder in tion Ci such en60rscertaisj. PRODUCER BMCONTACConst=cItion P1a25i:GrLa _•a�_SL•Tau7.CE: G-.-Opp NAME.-NAMEE.- 233 sates Cap- S PHONE EL• (600)333-7234 c.NA1: Ey.7A L ADDRESS:Natick 2n 01760 INSURERS)AFFORONGCO/ERACE MAIC: WsuReD INSURERA-'a-=be21z p=otectyon Ins. Co. 1360 Ater tie L•,rez-t�E=_,z it INSURERS: 1L* auti5 !nS:i,1nce Co G= Rear 6e'_ferso,, agnea INSURERC: INSURER D: 9e L ea i 01970 INSURERE- COVERA,GES INSURER F. CERTIFICATE NUII!)gER7)ASTE12 2015 THIS IS TO CERTIFY THAT THE POLICIES OF IN REVISION NUMBER: SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING-ANY Y PERTAIN, THE TERM OR COPlDITLON OF ANY CONTRACT OR OTHER DOCUMENT VWTH RESPECT TO WHICH THIS CERTIFICATE MAYO ISSUED OR MAY PERTp)N THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERIIWS. EXCLUSIONS AND CONDI T)ONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN R rusR I q ueR EDUCED BY PAID CLAIMS. LTR TYPE OFINSURAIQCE IIN$RIWp PODGY EFF POLICY Esl GENERAL UABIDTY POLICY MUMaER MMIpD Mp.7JpO LFu11T$ FTEI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I S 1,000,000 PREMISESEa ueeuaan� $ 50,000 CLAIMS?uiADE DUG UR 9500042816 8_6 /20/2015 /20/2016 MEDSTIAnJonapamm.) Is 5,000 I PERSONALSADVINJURY Is 1,000,000 CEN'L ACGRE1�GAT7E Dti1TAPPLICS PER: C-ENFI2gLAGGREGATE TS=-21 2,000,000 POLICY 1 = 1�RQ' ��LDC PRODUCTS-COMPIOPAGG I s 2,000,000 0.0 TOMOEIL'c LIABILITY: S _ Ay aui0 COidBINEO SINGLE MM a aamaant5 Z 000 000 ALL OSWi Ep SCHEDULED BODILY INJURY(Perpasoa ®AUTOS Alros 020015871 /20/2015 ) s HIREO AUTOS AUTOS ED / /20/2016 BODILYWJURYIPe,zcedan1) S PROPERTY DAMAC-E M.,. Ftlant S " WWRELLA UAB zOCCUR I PIP-Basic S EXCESS UAB I I CLAIMS.i=E I EACH OCCURRENCE Is 1,000,000 I DEO I IRETENTIONS 6000586sa AGGREGATE S 1,000,000 4llORKERS COUPENSATID.^i /20/20:u /20/2016 I s AND e§iPLO:EP.S'DABILIT". 'NY PRGPRI'TpF2/PARTNcZi/`^.,(EClmtc 1/N I WC BrATU-I I OTH-I DF=(GE Jk in N )EXCLUDE 07 a MIA T Y IX. IIBenNSMeyin NH} I E.L.EACH ACCIDENT U =Abe untle:10-SCRIPrion,OF OPFAgTIONS bait.:• E.L DISEASE-EA ii9JPLOY $ POJ,_UTZODT L=ASZZl'TF I EL DISEASE-POLICY UMIr $ ' n&200378613 �O/1/2014 0/1/2015 - GENERALAGeREGATE S1,000,000 ORI-rTION OF QPc' EA POLLUTION CONDMON $1,000,000 RATIONS/LOCATIONSJVEIIICLE3(gltaph ACOl2D 701,Atltli6oml RmAaPrts$ehetlule,'r'moPa space7srapunxu) '.TIFICA I u NOLDE;2 ieavG-L7ea?!TION SHOULD ANY OF THE ABOVE OESCRISED POLICIES BE CANCELLED BEFORE C... OF $aT.r,C THE EXPIRATION DATE THEREOF, NOTICE 9`+ 1N)LL u7ASFiI316=ODT n ACCORDANCE WITH THE POLICY PROVISIONS. BE OELIVERED IN S0RJ!,C,J. SA-jSvr 11cm 02970 AUTIiORLEp REPRESLWTATVE w 25(2010105) Jo=n 3oegel/V%A BJomnrts)n' 02988-ZO?O.AOUKU CORPO e'er C 'fan L['.ARi7 n�nyo aril Fac-.•a�+�-�nie�ca•'�,�p1�,y-L'!'lSQI R(3.?L�N. A!_itFS.FS Pe52,1.•2v 1"tsa If�Ql�i�1�� '� n y I •I.`S=" 5'tP1Ct?iE:S)55UED ASAO.Va?x�, L L�Q'' 7QLI"Q QIgQUpAMCL. DAZE flflCt7lDD/YYYti7 �I CEO%=IFICP.T'c DGES NOZ:SF c'A GF iNFO$yC3,ON ONL'-'AND CONFERS id@ RiGH'uS UPGN ZF7E CEP.TSFI + r •s I �y- ELYOR NEGATIVEL`.t AKWEND,E{TEiUD OR aL_ r_ Ca-E HOLOER. 'HfS 5;5C:ERTIFEC.BTE OF JNSURANCE DOES NOT CONS TI+ i PCI,PP:ODL EN SRr.E iSSUAlG NSUFER(S)RAGE �ALrI}YOPig�IS REPR SENpLC1)V. 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( L'B:BZ70121q� 012NZC15 .SYC STATIC j ill CFRICc�R.9EG13"eR eXCLU0=03 03(20/2016 °=> ' O.W (i::zrdatoryi3 NH) VAi I Iul If DESCRIFTICA rci:eerde: ! j E.L EACH ACCIDEIS• S 3CccCROc OFEFAT10KStalc.•i ) 500,00 ES0 i i sEL DISEASE-EA Elf CRIPF(OIU OF OoERATi06!Sr °'�- : SDD,DDD r7i R_rC.CE3 ANYPRiOP•^? WCAhM EVER)CLESIRES7R1 m EJ-DISEASE-POLICY U%46 e �-TIRC.ATE 65 FO TO q- �OnJSPEC/AL Iic6.,y ` 500,00° t �TXWCAiEHOLOER AF-BbC NG WOR 105 CONJP COVERAGE• 1 IRZ;FICA!I MOLDcP,. C_ri'. OF SAi-Ed4 CANGELL<i)16iJ - 4=?'✓ASfi III�G' ON S? i sHGULD ANY . DFr EABCVEDEscRISEDrOLICIESSECANGELLEO F EEFOP.E✓T.7E E:(P)RAT,ON DATEZ9EREOF,ND7CE'I2ICL BEDELNERED t t FPy - IN ACCORDANGev�,. THE POLICY PROVf90Td5_ -n_.1,IMA 014ip 'ACItt- RIZE0 REP P,D 25(2010105) TF.e?CORD n_nte aitl logo ar=, ' •`•✓" ".Z:`� -� 'H9Iti2:Hd Tales n' PD+:L`D . .95a=2CAU.s.CQAD COP.POF.,Ai70PS Ai1:Ignm:zwO,ep Vlassacnusetts -Depar nent cf?u4iic Safety Board of Building aaguia-HOns and Standards Construction Supervisor `+ L%cense: CS-087977 ERIC W PALM _- 3 HILTON ST z Salem MA 019 W ?'i: iPa'iiCn Commissioner 04123/2016 nice of CoosamerAtfairs&Business Regulation MEIMPROVEMENT CONTRACTOR ist2tion: 142089 Type iretion: ',3M2l2016 LM Liability Colpo ATLANTIC WEATHERIZATIONLLC. ERIC PALM 61RJEFFERSON AVE - - - SALEM,MA 01970 Uadcr rotary -PL*NS1AUST13EfiLfD-1ND APPROVED BY T44E .I wfxTDB PRIDR TD.A PERMIT BEING GRANTED CITY OF SALEM Date it Is Property Located in Location of the Historic District? Yes NoleZ Building CCao5AMIe64--ram Is Property Located in the Conservation Area? Yes No_ BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Instal Siding, onstruct Deck, Shed, Pool, Repair/Replace, Other: PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: Owner's Name �vc i [,t F A/ Address & Phone l9 12d-) CIF�? Architect's Name Address & Phone ) Mechanics Name IA. C- 4 `�fry/LtZ c C' i�� tJG Address & Phone /Q Whet Is the purpose of building? ,Sle.�o t'`/-9 Material of building? Le )ac)h If a dwelling,for how many families? 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C*K To 010dsU am dot t opleaseti.asQdrt►an�i<i������' TY�����s:i��IWbottna re tisvk�7oa b®out is aw evert as eNeoa otbdpdoss hb n aoatsd you>�dr<aPP>�� of a ba to n f!is the pwsdNbaM>�d vM&wM be rated m a rslmeaoe mmbr Is add"m ap P iks•t that met submit m ltbla pamiNMoase typtieadcos is aW lives yar.need a*mbsrk om atsdsvb led CAft tartest Doty iaf><mad0a(Vwcumy)and=M"Jab Stb Ad&ue ft WHeast sbald wrfis"a9 k m&m is_Jd*err nsys�"A gory oitie ssldavis that bee bee omeialbr sts®9ed or mwkd by tbs eiL err bwa may bs provided b err mpaso m pendant a vam addavie i as del far fame pem b a lfemsa A acre aElsdovk mwtbs®eel oat eamb yet Wbas i boss oasat q eldm i obdiiq i"--a po mk set rabbi toaq bodom of aasmrmoial vabw (ia.a dog&cW a peom k a blue laves der.)slid PMM is NOT ragdd n amgkb ail afldavt The O®os of taveadpdm waald as n&mk yos is abmos!m yaw asopaaeim and sbodd yos bays aaW*mdm% p lass do sstbeft"b Swim s aaL The Depwtiorat s addsar.oekPlost d AN masbt Thee C mmoaweilft dMtwfcbselif DgwUmd o(hW th'ial Acddealf Offin d bnvd4pdm 600 wnbiloaa Street Bofto%MA 0211 f TaL 0 617-7274900 at 406 or 1-877-MASSAFE Fai 0 617-n7-7749 ttavviraa s-2d-OQ ww�v masf.8ov/fie " 19 CEDARCREST ROAD f { I. �owik BOARD of ASSESSORS v 93 WASHINGTON STREET, CITY HALL, SALEM, MASSACHUSETTS 01970 (617)745-9595 Ext.261 (+r 3 •�/1 rn January 19, 1988 Mrs. Josephine R. Fusco City Clerk City of Salem Salem, MA 01970 Dear Mrs. Fusco: Please be advised that the new single family house to be con- structed on the newly subdivided portion of the lot located at 1112 Cedarcrest Avenue (Assessors' Parcel 1121-0051) has been assigned the street address of 19 Cedarcrest Road. , r yours, Peter M. Caron Chief Assessor PMC:mjg cc: Postmaster Joseph J. Leccese Chief Joseph F. Sullivan, Fire Department Margaret R. Hagerty, Principal Clerk, Water Dept. `William H. Munroe, Inspector of Buildings Engineering Dept. , City of Salem Jean and Lucille Poirier, 19 Nichols St. , Salem