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10 PHELPS ST - BUILDING INSPECTION (2) ZS CK t11S2 The Commonwealth of Massachusetts RECEIVED a_ Board of Building Regulations and�t mchasAL SERVICE CITY OF Massachusetts State Building Code S CMR SALEM �i Revised Mar 2011 Building Permit Application To Construct,Repair,R1"&APrl3enRo isll P One-or Two-Family Dwelling -. This Section For Officia -se Only tom+ Building Permit Number: Date plied: 1^ Building Official(Print Name) , Signature . Date J 1 SECTION 1:SITE INFORMATION 1 1.1 Property ress• 1.2 Assessors Map&Parcel Numbers i 1.1a Is this an accepted street?yes no Map Number Parcel Number {l— 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(In 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' Q 2.1 Ow �rd- C Name(Print) City,State,ZIP ?A-ell s Sf No.and Street f Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed World: 1T SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: ; ,- _ Official Use Only Labor and Materials 1. Building $ 30'1V • 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x - 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (IIVAC) $ List:. - 5. Mechanical (Fire Suppression) $ Total All Fees:$ Check No.{I ,5$.Check Amount: Cash Amount " 6.Total Project Cost: $ ❑.paid in Full ❑Outstanding Balance Due: m 4y,Ta t L_e:-r) q_�� r' SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) n 7 -7 —7 11h 3 License Number Expiration Date Name of CSL Holder List CSL Type(see below)--m—L No.and Street Ericr.MR Type Description 3 Hilton Street U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City1Town,State,ZIP M Maxonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /YZ U S�I / 3 / Atlantic Weatheti7atiou, I.l k, HIC Registration Number Expiration Date HIC Company N :11 I �ra�t Nam e No.and Street SelemMA 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 compjcted 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 rczc, Pa /11-11'7 to act on my behalf,in all matters relative to work authorized by this building permit application. k. A— 41, Ahia"i 3/3 I Print Owner's Name(Ele nic tgnature) 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 'this appli ation i e d accurate to the best of my knowledge and understanding. � eh 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.eov/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"may be substituted for"Total Project Cost" Massachusetts Home hul I0eutSam le Contract 76ivfom a�afiesaS(tee mlwememsofthe mP,�dh�Wp�S�l�dady��OV�eo`Cm°arlmlaa'(MQ.�la�,mrdoe,varmdode ��� CntideloEvme 'A°y�°Phllll>mghome- e(aodard uoprovemeots shodd fuS o6mm a°OPY of"p ONceofC®erAffausavdBvsiaessBegdaCmkCo �m��®yo�resideace YmmaY o6te;oa&ee toPYby ' H°IDCOwne�Informgtiep Botlmeat677A73-8787or 1-BBB-283-3737ar®°orb the Name /^ - CDOtt9eter lLfOrdDBttOp Baeat Addr (dam a med•Ba: ) Atlantic Wcathefuaiioi), ,LC �/ S Cmaaaodsabspm®/ ciyrr f • ffetson Avenue zip Cde Daytime Ai(ovye'W��T+,y+2'// .{p Ea9/Pww Bfam Lp Cade Mai Bvg Addtna(h di6ment f=�1G) Bwinmepbme F•deal D'aml9'erID ar SS Nm„hQ The Caana<toragsea to de the fob � � I yr��`• (Ddaibe is detail the peke, awsngw dbrthe Aomeowuer. �pl�' the��bmvd,md&adea f m°aialsmhva¢d• edd-���) �1�• wQ-e� ,e-�� andwillfbeseemedyy�°Oe"Ob.0dmBP�daareaag®ed 1'+apmedStattaed aonaa(larmthebneeowners ehOn beymdthe OD s .0 (Owners who secure their Pn'mits win be beadhered m unless esvluded from the Gtmrau Food auw MGL chapter142A•) prDvW m of 9 7G Daaewhmmnhatdvr�� � 9 /o Dffiawh® wmdc wdl he Total CoatrattPrimand PaYm®tS%edule sm�O°Hy�°Pt�ed. TAc Coavactorm��, kj�me� ®dLWOrryuoifiedabove �. payments wlLbemade a-.dig to lhefallowmgsduyole. fmPoebhl aom of. �--C) S 'enl r upm sig°mgamhact(nm m exceed 1!3�thetoml mnvactprice gr tbecosiofayac d oNerimm;whichescisg�) S by q_/L/ / ,(yam Completion of yo by.1 mopm comp eu®of upov motPletim offhemnhact(fswfoebids The e�Uwtmeotoam heapeaal $ g:f0➢paym umlm0 ismmph9adtoboWpmry•asa.&cio0) CmbBMndvmk6egnpmwder be 'd m - mnnotd.e®rphtiW-jwda(«) _ In far NOT". P')law saydW®hm udtid� � amded m"bbd maaaC p,;ma.ro)tLaa eqmmdby Weaaea'mhrrort®mtb..mar ad•maemmeetmecomPlmmsdmdda aaY�l`9°iPmmt memtom avdeaWejal Snbroetyamon_Tha�� th ❑Y 1 /subcon Id111� 4gmbm6e5a1 1mnY sao Mthecmaactor 7h�e l a&aesmbbe Mind far Contract AexePmvee-U YIeforaBl�rabma8-• far mahact shag votimplyS�q$°tng tldsdommept bemmesabmdmeamtrmxmda cetofidly before aB®gthis ooay °10 (bivtee&has 6eeaPlaOMmthored Unhsvathemaaenomdwahm Wtsdornmaot,the dorm.IteriewthtpfoBowiog®bmsand notiexs DmY 6e preswmrd ivN sigtivgthe ': • snob sae ttr cea�„ehasaaalid�efeeige"dufth theym��mmdandfvlly undasrmdit Asle .4aesdoavifa® � wr'mg the eI)ireoorat leavOtOfamft�m� �IheLtwn amschome-g�tovnmcetmnvaam.smd Men • Does We cmm4orhave ce7 .iZeom 517q B0.5!m.MAO2116c6crbyna YOomaymyameahmt� seeacopyofa-profofmuvmQ�dm�®t�°tr or forhismsmmOmoompmyrotmpapm Q1Ung617A73-8787 MSB&7.g3_3757. • Rud,yonrriglvsand thatym rmeo0fnmmm (hddetotheHomo te.P...t C. Readdtelmpo,�tlnfonnmim mtlm �C. araskto �Pt°wmmtCmvacor)aw: rcaetseaideoFthisfom anda�acopyof�e Cmsomer you cmvantori1e C ntm8aga:mtmtit'ithas bem agvad atePlatto/hatha I theamvacm smrmal .thirdbusmess � �mb=cteffmbytadhlerymm7 p° (..hY ldaceofbosm�Plouidedymnotifythe 1)DNOTSIGNTffiSa���Scethemadnedw fceoadem;av�far satIaeathmnodmghtofhe •rao•�®em TRERE ARE mmRlm0 ofthisri ran ld� NET CIF A14VBIAW SPACESrrr � Je �• be Hom Sinn.. 8/3 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 my 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 hnprovement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contras. tthelconttactormay!sul>'mi[the dispute to a private arbimmon firm which has been approved by the Secretary of thJ'E'Xecuhve O Q.�-Lo��CCQQgqss�ummmmer Affairs and Business Regulation and the consumer shall be required to submit to mctl0i0u�tioldl VPdeG1 1vlassaohusetts General Laws,ch ter 142A. J,ee Sign ure F Homeowner's Signature � Contractors 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 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 my 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 Ford provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as desm'bed,in a timely and workmanlike mamer. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as tong as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner tights,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 most be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a frilly executed copy of the contract,and the three day rescission period has expiredf Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems himNerself to be financially insecure,the contractor may require that the balance of finds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of finds 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 ifyou 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 htto://w .mass oov/orabr/ 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 b aprovement 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 H1C website at hlur://w v.mass.aov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration htto://db.state.ma.uslh meimprovement/licenseelistasn For assistance with informal mediation of disputes or to register formal complaints against a business,call: 4 Cofis omplaint Section _ ••v,,,,y� 8.• 0 Attorney General 617-727-8400 AND/OR Better Business Bureau 508-6524800,508-755 2548 or 413-734-3114 vadw 2.1-1 lr2=10 The Commonwealth ofMassac,111setts Department ofludasirialAccfdenis = 1 Congress Street,Suite 100 -80"0",194 02114-2017 it lNorkers'Compensation Insura }: ice Affidavit.Bui dens/Contractors/Electricians/Ptumbers TO BE FII.Fn WITH THE PE%WITTiNG AUTDORiT A licantlnformation Name(Business/ Please Print Le 'bl Otganimtiott/Inditidual): r�I�8lll£tC ����xraatSi.).l.l: Address: Rt R 7e£�ea r`WMW City/State/Zip: Phone#: C7g _ 7�fGl _ Arc you a employer?Check the appropriate box: r-�a employerwith��emPlayees(full and/or part-time).• Type of Project(required): 2❑l am a sole Proprietor W pamtership and have no ere 1 7. ©New construction any capacity- [No wod ets'comp.insurance uired°rees nrorking for in 'art J 8- Remodeling 3.01 am a homeowner doing all work myself[No workers'comp-insurance required-]t 9- ❑Demolition 4-❑1 am a hamemimerand unll be hiring conuamors to conduct all work on my .pmperq•, I wifl 10 ensure that all contractorseither have workers•compensation l%vork on m are sole Building addition proprietors with no employ". 11-Q Electrical repairs or additions 5.�1 am a general contractor and t have Fired the sub-contractors listed on the�atpched sheet 12-❑Plumbing repairs or additions These sub-contracmts have employees and have workers'comp-listed oniw,m h e a ,13_❑Ro .repairs 6.❑We are a cotpomtion and its officers have ecercised their right of ex ti m 13. t 1S—'.§I(?),and wx have no employees. mOP P=r h•1GLc then No workers'comp-insmanee requited] 'Any applicant that checks box�I must also fill out the section below showing theirworkem,core t Homaonsrers who submit this affidavit indicatingtheyPensation policy infonnmion- 'Contramors drat are d°'°gall wink and then hire outside contractors must submit a new affidavit indipiine such. check this box must attached employees- additions)sheet. a the a[hename of fhesub-contractors and slate whedheror notthose entities have employeeS. If the subcontractors have employees,they mutt Provide their wodters'comp.policy number. I our an employer that is providIng tporkers'campensadon I "ancej lrrformadmr. or tnv employees Below is the police andjob site Insurance Company Name:_ 2=g1rick Policy#or Self-ins.Lic_#---_ S 0�70 f' /Q ��e City/Sb Expiration Date: ,3 6 Job Site Address: - Attach a copy of the workers'rnmpens tion policy declaration p mg the policyt au��d expiration date). Failure to secure coverage as required under MGL c. 152,§Z25A is a criminal violation punishable by a free 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify underthe naiA- e :Ire fnjonnatian provided above is S' ue and correct Signature. � �-. — Phone -7 Date: g j rcd,anly- Do not sprite in ibis area,to be completed by cis),or torpn offrclaL • Permit/License# ority(circle one): ealth 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspectorn Phone#• CERTIFICATE OF LIABILITY INSURANCE IFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS te» CERTIFlCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING RAGE AFFORDED AUTHORIZED REPRESENTATIVE 0 DU CE TI IC 0 DE IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the p011Cy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and entlas certificate holder in lieu Tf such endorsemen s. me^L A statement on this certificate does not confer rights to the PRODUCER CONTACT EASTERN INS GROUP LLC NAME: 233 W CENTRAL STREET PHONE PAX INC,No,Ext): NATICK.MA 01760 E-MAIL 22MLW ADDRESS: INSURED INSURER(5)AFFpROINGCOVERAGE INSURER A: AMERICANyUR[CR INSORANCB COMPANY NAICB ATLANTIC WEATHER[ZATlON LLC INSURER S. INSURER C: 61 REAR JEFFERSON AVE INSURER D: SALEM.MA 01970 INSURER E: COVERAGES INSURER F: CMRANCE NUMBER: T T T NE POLICNao e13URM10E B 110. REVISION NUMBER: ANYBEQUIREMENT TERN OR CTNORNIN OF ANYCONTRACr OR OTHER EEN TO THENSUR®NAMED ABOVE FOR THE POLICY AFFORDED eY THE POLICIES DESCRIBED HEREIN 65UBJECr TOALL THE TCUM@JT WRN RESPECT TO WNCN THIS MDICATFD.NOTWRNG{ANOWG PAD CLAa15. ERNS,IXCLU9IONS AND CONDn10N$OFSUU pp IC1EEL YLO ISSUED MM OR NAY PERfML THE INSURANCE arSR OWN MAYHAVE BEEN REDUCED BY LTR TYPE OF INSURANCE ADD MR POUCYEFFDATE POLICVExPDATE L R POLICY HUM BER (IJBIMMYY GENERAL LIABILITYYY) (NMODTYYYY) LDTn6 COMMERCIAL GENERAL LIABILITY CH OCCURRENCE CLAIMSMADE 13 $ OCCUR. AMAGETORENTED REMISES(Ea atturrence) $ EDEXP(Anyonepmsm,) S GENT-AGGREGATE LIMIT APPLIES PER: ERSONALa A INJURY POLICY ®PROJECT❑LOC $ ENERAL AGGREGATE $ AUTOMOBILE LIABILITY RDOUCTS-COMPTOPAGG $ ANY AUTO COMBINED SINGLE ALL OWNED AUTOSLIMIT(Eaaccitlern) $ SC14EDULEAUTOS - BODILY PNURy $ HIRED AUTOS (Pe'parson) NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Pm acciders) UMBRELLA LIAR OCCUR EXCESS LIAS CLAIMS-MADE EACH OCCURRENCE $ DEDUCTIBLE AGGREGATE S RETENTION $ $ A WORKERSCOMPENSATION AND $ EMPLOYER S UA81 SA WIN U838270121-15 031ZOQ0T5 J( wC STa ANY PROPER ITOR?ARTNEFVE%ECUTryE 03rL0/2076 LIMITS MDRY OTHER OFFICEFL"EMBER EXCLUDED? El N/A III, dt .to NH) E.L EACH ACCIDENT $ 500,OD0 ayes.R1pnC a miler E.L.DISEASE-EA EMPLOYEE OESCgIPnON OF ppEAAT10N5 Aelow $ 500,000 DESCRIPTION OF OPERATIONS/LOCAllot4WEHICLES/RESTAICnoN E.L.DISEASE-POLICY OMIT $ 5D0,000 THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CFR7M SlSPECIAL ITEMS CATS HOLDER AFFECIpTG WORRBRS COMP COVERACH CERTIFICATE HOLDER CITY OF SALEM CANCELLATION . 93 WASHINGTON ST SHOULDANY OF THE ABOyE DESCRIBED POUgES BE CANCELLED HEREOF.EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WrM THE POLICY PROVISIONS. SALEM,MA 01970 AITTNORI2ED '.- ACORD25 ?O70/0 The ACORD creme and logo are registered marks of ACORD Te 2D10 ACOITD CORPORATION. Ail r ..i8hts reserved. A��®® CERTIFICATE OF LIABILITY INSURANCE DATE IlfmmDnrm THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO13/3/2015 N ONLY AND C6NFERS NO RIGHTS UPON THE CERTIFlCATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the Policy(tes)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 certlFicate holder in lieu of such endorsement(s). PRODUCER CONTACT Eastern Insurance GroupLLC NAM - Construction PHONE (800)333-7234 a 233 West Central St E-MAIL ss- ,Nisk Natick MA 01760 INSURER AFFORDING COVERAGE Nplcp INSURED INSURERAAPbella PSOteOtiOA Ins. Co. 1360 Atlantic Weatherization INSURER aNautilus Insurance Co 61 Rear Jefferson Avenue INSURE INSURER D; Salem MA 01970 INSURER E: COVERAGES CERTIFICATE NU TER 2015 NNUMBINSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED vNAMED ABOVE FOR THE POLICY PERICHTHOD INDICATED. NOTWITHSTANDING ANV REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIIS 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 A LTR TYPE OFINSURANCE N�EFF LIO EXP GENERAL LIABILIN POLICY NUMBER MID LIMITS X COMMERCULL GENERAL UABILRV EACH OCCURRENCE $ 1,000,000 A CLgIM51NADE ®OCCUR 500042816 P EMSEa 0 S 50,000 /20/2015 2016 MED EP(AW we S 5,000 PERSONAL a ADV INJURY S 1,000,000 GEML AGGREGATE LUMITAPPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X PRO LOC PRODUCTS-COMP/OP AGG S 2,000,000 AUTOMOBILE LIABILITY S A Eaa1.entSO TLUlai ANY OWNED S 1 000 000 AUTOS OOSJNED X SCHEDULED BODILY INJURY(Psrparsan) $ AUTOS 020015671 /20/2015 ( S X HIRED AUTOS X AUTO MED /20/2016 BODaYINJDRY Peractitl PPRerOam TYIDAMAGE S X UMBRELLA LIAB X OCCUR PIP-Basic S A EXCESS UAB CLAIMS41ADE EACH OCCURRENCE S 1,000,000 DED RETENTIONS 600058654 AGGREGATE S 1.000,000 WORKER$COMPENSATION /20/2015 /20/2016 AND EMPLOYERS•LIABILITY $ ANY PROPRIETOR/PARTNERIEXECUNVE Y/N STA OTH- OFFICER/MEMBER EXCLUDED7 ❑ N!A (MYYanC 'V In NH) E.L EACH ACCIDENT $ DESCRIP ON OF OPERATIONS belmv EL DISEASE-FA EMPLO $ 3 POLLUTION LIABILITY EL DISEASE-POLICY UMrr S L200378613 0/1/2014 0/1/2015 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION $1,OOO,OOO :SCRIPTON OF OPERATIONS/LOCATION$/VEHICLES IABach ACORD 11H.Addillwal Remedm Schedula.Bmme space Is rewrarp (RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SALEM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WRH THE POLICY PROVISIONS. 93 WAS$INGTON STREET 3ALEM, MA 01970 AUTHORO:ED REPRESENTATIVE John 1KOe9e1/P24A �RD 25(2010lOB) D25 mm�Oal m The Ar:rTRn name nn,l Rnnn an ronicfnnarl m 1Le2d nRn6RD CORPORATION. All rights rese nF rved. erved. 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenimr AML_ License: CS-087977 G ' ,�. SSIC W PALM ! 3 HILTON ST 9 s Salem MA 0197OF y Commissioner 04/23f2016 Urtrestricted-Buildings of any use group which contact less than 35,000 cubic feet(991m')of enclosed solace. 0 I Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS ticerarng Informatronvistt w -Ma -Gov/DPS - .Jrc`�rovrrironrnrn/!/or/iil�auoc/rre//t . Office of Consumer Affairs&Business Regulation -_ ME IMPROVEMENT CONTRACTOR istretion: 142089 Type: tration: 311=016- Ltd Liability Corpo ATLANTIC WEATHERIZATION LLC. ERIC PALM 61 R JEFFERSON AVE SALEM,MA 01970 Undersecretary T License or registration valid for individul use only before the expiration date. Iffound return to:Office of Consumer Affairs and Business Regulation i 10 Park Plaza-Suite 5170 Boston,MA 02116 N�Ijd wrthont stgnatore •