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56D PICKMAN RD - BUILDING INSPECTION o The Culnmunmealth ut ,Massachusells t Board of Buildm: Regulations and Standards FS tit r \II \I( II' \I III- ' hlassachuscits State Building Code. 7St1 CMR 7"' cdhiott r Building PeIIiIII Application Tu Construct. Repau. Re o\a t e Or I)emolislI a t (hu•- or Tlru-Fionih Du riling n°v �— This Sec!ion For Otticial Use Only Bulldinp Permit Number- uPlied. _ — -- -- Bwlding Cunvnis,lonei/ In.pc< r of Ifuddwes Date SECTION 1: SITE INFORMATION 1.1 I',o crty A 4 lssessors '\' t Y Pu ccl .n 's .Coted �%C tr •; •,_..—° m,_— Property Lo !'mix»ed Use !_ol Area Isy It) i i in g Dt,or i Ll Rouw !1L —� 1 5 SuildMg Setbacks (it) 'I Front Yard S!de Yards Rear Yard I Rryulred Provided Rcyuned T pnrvidnl Keyuurd ?— Pro,IJed t.b SVstcr Supply: tM.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: s,ca, Zone: _ Outside FWd Zone'' Municipal ❑ On site dis l mil 0 h!ic ❑ Pri�ute a Check it yes❑ P I 15 SECTION 2: PROPERTY OWNERSi1 I" p N,ur,c�.`P^�nnU�j`r}�yrt' Address lot Service: /--3 v(, SEC:TIS.)N J: DESCRIP'Tit?N Oi� F'RC�P08Gi: ,VC:::Nz(e:::;k all that ar:}±.lyl T _ 1,4ew CuIisaructwn ❑ 1 ExisunL •;dim ,� ., nr O wpieI .1 p r v \hcr:.t ,I tsi�i ,J '--iu1El IUenluli un IJ . 0 � iVt ether ct Unns _.,� O her 0 Spec:!y: SECTION 4: ESTIMATED CONSTRUCTION COSTS ❑ens T Fsumated Cults I — —Official Use Only -- lia:iur:md aleria Is) r -�— I. Building Permit Fee: $ Indicate how tee a dvtermincd: I. Building ❑ Standard City/;own Application Free 6 ❑ Total Project Cost (Item 6) s mulupl �C i. PlumbIn � $ 2. Other Fees: S____-_ 1. bleehnnical !ilk \CI $ —� _- 5. !\lechanieal (Fire — total All Fees: S I Suppression) I -- I ,, heek No. Check :\mount _ Ca.,h \nwun! ._._.._ . o Total Project Cost S �?j 0 Paid in Full 0 OUISemdine Balance Uue:_____ - SECTION 5: CONSTRUCTION SERVICES A 5.1 Licensed Construction Supervisor (CSI'1 1 7_.\'u!nbrr I�\pi/r.u!�/m D:uw , r \dine ul C JL- IIuIJer V hnl C'SI_ ilpe Lee hcluw I I a Desrrl man f fire?IiIi ICJ ll lu `�.lN ll)C'u I'1 -- -- R Rcsvlcicd I&2 F.mnl\ D,,rllinc . n_n:uure _ r/ \I \I:uonn Onlc Rc>!Jennal Raul in e lu,:un__ TC epl - \\'S RCNiJrnli�I \\u,Ju,, .md ..siduwc Sh RCSIJeunal Solid Furl Roo nue \I+ph.m. Iu�Lil Lnini D Rr.!Jenli.il DC111111tion 5.2 Registered llome Im roven: t Contructor(111C) IZ7 _ HIC Company Nanre or HIC Reui)arallt Nainc, Rrgutrauun ::\umhcr Add rrm 6/0r Expr-auon Date signalulk 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 pro%!de this affidavit will result in the denial of the Issuance of the building.permit. Signed Attidavit Attached'? Yes ........ . No ......... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 as Owner of the subject property hereby authorize to act on my behalf, in all m.mefs relative to wot k ed by this bw gg permit :application. j Si nature of Owner Date �SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION 1 / � ��f(�Ls LC� , as Owner or Authorized Agent hereby Jeclaie that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and nenalf. Print.—_-'e Signat O tic or A r- ent Date - (Si ed under and nalties of er... NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregi,leted :ontia,toi (nut registered in the Home Improvement Contractor (HIC) Program). will not have access to the mbitiation program or guaranty fund under M.G.L. c. I12A. Other important information on the HIC Progrun and Construction Supervisor Licensing (CSL)can be found in 780 CMR Regulations I IO.R6 and 1 I0.R5. respecu\ch' _ ' When substantial work is planned. plov!de the mtirmanon below: Total flours area(Sq. Ft.) (including garage. finished hasement/attics. Jerks ur pofch, Gross living area ISq. Ft.) Habitable room count Number of t!replaces Number of hednxnns Nun)ber of h:uhruorns Number of hallibaths l\'pe kit healing Nvstem _ _--- Number kit deck,/ p''It-hes Type of<nol!ng Sy,lem -- 3. `Toed Project Square Footage- may be ,llbsll[ntCJ tor "f,,1:11 PfUICr! C,rNI J CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT ,. \I.\ it 12: A.\,I li!:I;:,f�Siiil l-1 Hill l'rl: ')'`J.?15-'r5v; 1'vs; 978-';= 'IRir, Workers' Compensation Insurance :Affildacit: 13uilders/Contractors/E:lectricians/Plumbers Applicant Information /�/�)y Please Print LeaiblV N nnic IRu.anr,,.l h'eamcu:,ni ln1J/n�,I,lu.d l:��G lr'/r'�. , y / r/r j, 0 :Address: '23�.1 /✓'"rl-L."P YJ Ii'/tC UN l� L.K✓.' b,". City:State/'Zip: L `4 Phone : �7 2--nZ- 6 Are sou an employer:' Check the appropriate box: 7).pe of project (required): Li :tnru employer with_ _7 _ 4. ElI am :t general contractor and I h. ❑ New construction employees (full and/or part-time).` have hired the sub-contractors 2.❑ I :un a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling Ship and have no employees These sub-contractors have 8. ❑ Demolition working fur me in anv capacity. workers' comp. insurance. y. Building addition No workers' coo insurance 5. ❑ We are :t corporation and its i P 10.0 Electrical repairs or additions rcyuircd.J officers have exercised their 3.❑ I am it homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself. (No workers' comp. - . c. 152, §1(4), and we have no 1_'.❑ Roof repairs insurance required.] t employees..[No workers' 13.0 Other comp. insurance required.I ':any appheant that checks box HI must also till our the section below showing their workers'commensal ion policy information. t Homeowners Who submit this affidavit indicating they are doing all work and then hire outside contr800r5 must submit anew affidavit Indicating such. I Cnnvoctors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp, policy information. !ant an employer that i.c providing workers'enntpen.salion irt,sarancefar my employees. Bela iv is the policy and job .sire information. Insurance Company Name:-- !lC?/�l✓G ??l✓yS `fie°. .�{C Policy #or Self-ins. Lie. /� U� �.J lJOU '� Expiration Date: Z .Inb Site Address: :5 ./ '0 P lck-A4�4 ' - /Q,�q City/State/Z.ip: !�;rjLrh, :Attach a copy of the workers' compensation policy declaration page (showingthe policy number and expiration date). Failure to secure cuccrage as required under Section 25A of NiGL c. 152 can lead to the imposition of criminal penalties of a line up to S I.i00.00 ;md�or one-year imprisonment, as well as civil penalties in the torn of it STOP WORK ORDER and a tine oI up to 1.-250.00 ;t day against the violator. Be advised that it copy of this statement may be forwarded to the Office of Im.c>ii,;moos of the DIA for insurance iovaragc ccrific:uion. !de, hereby rerli/i' under the curd per tw t DrJimnurion provided above i.c tore and correct. Sittimiure: Date: D/Jieial use arrly. Do nut n•rite in this area, to he completed by city or ton'n o.lihial City or Tow n: .. _._-__ _....----- ------___— Permit/License 9--- Issuing Authority (circle one): I. Iluard of Ifealth 2. Building Department 3. CityiTowm Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person ----.--------_--__.___.-- Phone k:_.----__ . - -.DrREET SMCE 1a63 230 Ballardyale.Street SW 7 teB -` FACTORY W>rmuagton .MA 0488 se./y ' „r/m s"I` 'HfC 127772/YIN 58244 2642 a 8. 7846 3699•978 284 6115 " ra Phone°' "" f �M>� �t" �'a�X 6tate yf+ 2ip"..�� aesmess:Phona;(MciYNhs) C '� E1e�6aoer enR Wrntl4Ws',- 4fMndows 8�'.floors` VInyLStlmg irlm&Shutters cifass&Scjeea,Patlo(dooms ;Entry&Eatlo,;Dnortrs< anA,r. •vc+ n'r'og*" 4 .zxv of o" t fl SA &;fiE A14G11 N00W CQ AC7, c+�An4F. A#�+ +�1aIN� szonmEAsuR�„ntrA��€A� rEton FUBtms�i.a�xr '` 41N$�A�LIS,FNE�F�Ok.$'OMYit�7�a,�tYSTAAab•fGf'ADE V�Nl7DOMiS,rF(�i?FF�^�4117,0}JT1T6714ULATEDi9'EL01N� r � "- �� ALLEHAMPIOMY✓NJD01N , 'iAl',Q 65 GLASSV✓IA'[AR60M FOAh4ENkIANCE„D,�S�tiS fk kME)WyTd;F„F1Si0N.jNEL'gED COflME1dS�N ' . IN3£illOaYEXTE9YO�B�IF7}roW GIR'EpN re. �Tamw't,ehoosm olor8or✓d 1[`o`luhii,"e er�wa's hl[•selectaa: ,. � '�'"` _, u< s ,.. CBL4�eDNIX$bP ON �� exfay(nGwaly em.iL]}eAck�ed-i©Bmnxe, II�6aknul BlE� �.,�(¢,gpagg�Ggayy„'�#merald;Gieep_ ;jams':�,°+YlhrM ;:... ...'�:��#e -OBSCt7REjG1A5S "" 'y' QYES -N0 ""-ouANnN ,YYC+LO Tf1tNN r .. 'S= . y -� aIALFSCREEN) 1 ,.. 9ASEMENTj y��( 1 (FULLSCREEN)' A DODBLl`CASEMENT `4(PNO'FULLSCREENSt j r M 1 1N0• CREE<,J)°� ' r ,, i n W NTEA Lesmv+Fsz'E¢gGera ms j f - '121p 9P eM.vBr av lb 181 wialli' 91 ro 'enmb.ere 22'pwgN FOE Ji+€SCREEN$) n" `a .. . ,�a<�PrICTdIRF�WAµNDOWa r t > y,Lwa EE{31 { ae I r• pe P+t SCR .s`3 ;P t '" R .1017,6L`�137}A1[JGS'i ,s. a "^,W'iA9EMENTBAY'WhxN' a,. .•7 W '?WPICA F-S TJj,iE�,V7H4DOW � � ® xFWO RALFSC`REENg)+y1. e v d 1 ro Mha M1ya19Ra Aaaetl. =a' 4VI dh 11ILA`I�n`(a�e ml MOC xiT:vyY al.ai e t4 m '` 'P \ �; 'S .A3iebA WIJ�4 faadeY.>•^�Wox' y y�ln,� � � (IwOftlLLSCREENSf i N3"aR' .� �G3fapEN WIN©©W�u�irY+ - r '-0`"t'dca3a[E Fib1AlG eAr u3rr+5 � -•, A r r s4„ NkT`E(�a�SE[x Y 'r"" � E Id'Dokf s G ssr� rs FLU wl , 1 rN. t° S '' H, "J`nrea woad isRo�s lea« wmea ''°imwopmtl orommeawrs�aurea - -1 _ krc +ryWn Ftl1(ySCR Nal3 �!"�� Mo44' IF ry I p�'c� - �� vti•.wLsa�..I .' F G _ u ♦�"".YSWO.NhLESSvREEHS) � � +Y A me 7"waws mea ssnM . aK a rx -}�B'd'S£' EN�W1C�OyY r s -o- x f<'�kSnwmyYi nbymw 6Ee'°,or aeinmr .: r 4M'i:Fh REEN[.. ^u y ♦. Z .. ; :Hpe la S INtl II!`P%TNaSfiC[m v4wgBP LEREENS W� w �5 25 a25. .ems i �rT 3a✓1 ' z.3Y2 .sa `s`Ya s ru ora4 a a:.n, ,a i uE 4w• "erS as"„+.ac e o ewn e��>$faLSFzdEl Il"iu J:. !"" ^-kOTY� MaER M4 ;S';c� MS,pF(Sb�3A�39p0Rt?Ef1 }- r07+1[il F r•�`� [i' k3' .E�I�� ' fy J'.A"T r •, ..�" YY" I T y rr - ` -total prYrise for above - $ u - �E4Y�f� MAY CA�N[CEL iliiS GQ�J7�Af� ERING WpRITiEN Foll [ ©Nmpayf '�^wa aSpf' {�fiF' dJ9��1*�5 ` w'� kBalenseyaa'y�aUte'elY� �jf S,Qi 4 !]dF).tl= }AOafl'a�fl0.G1/®8f1YQ6�'y.-, k $ b.7' �� QRfS$ TH,f:ZaIQL�QtA�N'S�' n� Sf�L A �: r x+sasc,z nrhr"Y" "P' � _:fSSAS}1Q�t��VE a,- - ee�s�� ,, *�•��tl�'`o- i . , P'F7r Eaa{c.'FHaa��aYg,w. .tl.a,Cash on Co�rnplet�oN • .� IY.a�FJNP8181WIJa'gf19YMRBtlapbb'a8W¢Nth/bl �m_ave_"pWOIXIR04kCnlaN(IBSaJAN O&. ItlCIpH9 vbhIS.WI1VdgS4wdrq ygM1am IIIa6f1811pr0¢16M r• 'QalYMbyupef res?Gbe Sespenslb1¢Ya7lsreenammeilal aelaYs?amkes.aarpl MEW Is", rhgreesihm ilw.eqn nNrt aYYe 8Cx1 ball¢ronczd E—�mraa+�lls �grnad artlerygoatls Asndl.md KaeCeYetlomn n �4'+ ��° A �Hri° ectao 4 wlaUasls0ledabm�52AM�IIa00o on¢reoo�+ weela'kam¢�o e"rSaOayEsl rearePtlatgo'lielbmaWatmmpkn m !barges allo'+m�bemyuMa relnava¢ndwaov eP�ob wl8�i�e'N�-�Nsal° eVbeae6al¢r¢aIG48ha EoalmormwNirg'R¢yuwmnsa a'senwaz 7klro'£Jan i' ilea,�23c.. .„ � ""4""" •`a'19C°"ulsa�` aee nSrmmrectowan4slmmmrxmgwlA Y atrn ,� ,reUeYaJo}NIVa{,e9 mrmloa�sEall obta!rvanY aPtlbl4nemasar.+�pgmn(rasalbPp li rs n'kssbtlwwu"E`®reaedb 6oYe'�I euye seauesPa ma 9M.fife,.maYeb¢.extluaedJmrPAEagoeReltilnnApiovavoido`I�E�4d�LCM1amPlo sml�„NWrsu¢°Bu�•¢r`G�all'W`enM�amoJn6 aAOve�{&IYsr Atbey,IlaEk hcGllamPbn.s+eaW��eGe teeaal�ms6 �%.ntluO�Ktlomey¢kes+A FINANEECEoCalaled��} ate)' bro¢�aid'�t glrenl'auaums NM xIDAalbn amFoomgaAon � esare',appo,�I�mta,aW slAtfeyl°¢rLenpgwMo�IsetVe®¢I�romkeslrartrz�¢raon'm4suisi aav�igs`C uewlore'a�Ymr�ra�U'mraNWres Ma¢mm�u�iAaM .' dru. -'' �r- n 9Po�l�ie carlles:aM 4o mnacwtlareh�mlg o.YJatarei+veNelauo@erxaa:mellbedMlgq Iakanag e.T46OtPo�P¢Rres^Lin�{YAn Yor youuora¢r. rllodiormesrnn etixfYM¢a¢IeRlmmFeknUspaSas- Is Buyer sSlpRaWre ' � u' " "" " Socn'S Se No Chaglplon�,iepygsn e e - ��-..; _ j ,��uXe�„S19nalure > +Aw�'k'x•�Sosla4Sewr HNo ,a z ., .. q' aty Ofizmpronhl'ep`resentaave • ? FACTORY DIRECT* INCE 19521 WINDOWS SIDING PATIO ROOMS AFFIDAVIT 1, the undersigned, being the owner of the property at hereby verify that I have authorized Champion Window, Siding and Patio Rooms and its agents to )1apply to the Building Department of the City of �ih• �Pl.� to act as representatives in obtaining a building permit. Signature o Date: Owner: n Address of Owner: // 1- - City & State: QC�f /�/f. Zip: F 7o Champion Window, Siding and Patio Rooms "Tel. No. (9?8) 284-6108 Fax (998) 284-6115 PATIO -JD oo,Q v C`+A?�iP{ON `YINDOW MFG. P(mieg � JllJL)Ol,l/ a CHAMPION WINDOW MFG. 31 CC SERIES PATIO DOOR Too SEFUEs RtCyURE WINDOW NFAC CPC�B-A-Ml CaGtlJ-Sa-A-0D4 . NFRC RIGID VINYL FRAME I-ASH • - RIGID VINYL FOAM ENHANCED FRAME DOUBLE GLAZE-ARGON FILLLGW E @ DGUB�'CE Gu1L-�F1GON Flu1GW E r 'I� '� .liar n;arnlw,l �n�`.v4+,tiees•tM9.v^ .4' ra+'u#fryduwi ,. to s-n i + ez•lf-'i�. a*�'.r,., a r 9" t� y�. :v� ✓•�8�-w,.a.Gs, .a..wt��F•�S.�k�x ate. ca� r i �irIMAMAk� w dF vA '!e >tOKMk��AetN"Md �" ary ��;C.� mow" '�S•�`a'�`,'a "A��"� I,+ait�r ttiY7xSt7. �y..Cie�t.�M�. T'rtuWd�,S'Y.W4/ELwTdr++k sf " a9? ,yr.t� ryr M�(�Iptt10I1 YGt4�aIt hCA/i�•••�l'1 1 ��? .f?�1.10bilSd6'7!'s kNFRC'�twlbrt 9'' .a a. aten � oB id00.a�i-0l7Sa WRNFAC�naE altar rirehcn9..... ..:3b tetra" 52 ` .59 arr. .......... ................ ....:32aw .32 WeAnaat ath/aa�As data eaaroarncmnaarm.rlt'S�anxm kz'-+«T�n'V ur,�,- -r-;-=,r„r 1•.,.ie-a .�ae•F�,.rsr .:��m+J SL 1 DE12 I,.3lN DC) W l�aUT3L� 14ul I a CHAMPION WINDOW MFG. a CHAMPION WINDOW MFG. aimSERtE5 sL-,DeR ® BCD SERIES COUeLP HUNG �RC C➢t256-As105 CROiC158-?.-0C6 NFRC R1G0 vINYLFOAM ENHPNCEC FP.?FA£ RIG:C VINYL F,-Th12NH?NCEC F?T:1E Naborml F CCUDLE GLAZE-NRGCN F!LL-LOW E DCUSLE CLA=-- FGON F:LL10W'c Fatrng eund Pmn9 Ccut� Nad Jfr Cx ncf rn • Eietpy urai9•Ma d.pand on rnur ,e fk dtmab,tvm and Iasalylo ; Enwr Mr a qa ad11 da C:.renr 1p,,41,cIn iwmr anc .•r<a:y'. For men'nfa kn,.1114�,5-1-"gMait NFRC'...b wife al J F«mon infortnaafon,oll t.d�d'S-S-S dnot HFiC'a.eb aNa� ww"a.tdre.arq want-�..� r7 - apa ,.49 40. , d, a 5=5L 4 o P�.eraerc.urs uanbear aWiom b 1ene:arg�.:lm a ncacb!F.0:caalaaa L ieemrq 'L atCla PeetC eRT Pak�a;FHC ryq se ad.�.d b a.bd vl d an.m,wa ,droll Rase tn*S7�er:aawm fFi:C%hP an ga.�rm , a d arnmrurJ ab aoz4 P.Be fma .ae'm ani seCe aoC•t ms CASEMET(T W ( QDoUJ a CHAMPION WINDOW MFG. Ina SERIES CASEMENT WINDCW- NFAC cpc;*3s6+\-0C2 RIGID VINY',..=CXM ENHANCED FRAME NatiwAl F COUELE G4L_-ARGON=LL-LO`n E Ratlng Camd ® a • E181Qy aa"hp"'a dapw+d an your a",hU dlmabt,twuea and Itfeatyl° • F«mon hkr:r_•nn,d tdW-etyn377 q Hvt NFRCaw ars>ty rA.n(!e qd321� .3 �.1� Ivant port .52 321 .47 .55 / 11Uamdr afnita qw Sew ndytatamn a wFt�t VFaL Pma.a tr,ib"iti9 �O CERTIFICATE OF L�ABILITY INSURANCE OF ID T1 DATE CH r curse -- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION _ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE -i� 'ai!'.. g, in�ur-ance .Agency HOLDER. 7"HIS CERTIFICATE DOES NOT AMEND, EXTEND OR C:!,ancellor. Dr. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Cr a:,,r.view lull.. HY 41017 Fax 869-241 3709 INSURERS AFFORDING COVERAGE NAIC:7 nl,ureR r,: uI I;ul Co. of TND CANA INSURANCE COMPANY 22659 PI 'mriun Y7nuloe: .__ _ -- Ul9tnn lara rth LLC IN mvux r,' CHU73B TNSURANCD GROUP rr InIngt on MA 01987 urLr,-D unary Insurance n +,ulxnrr[: COVIF.i2AGE5 -^ .—_ ---- I� I. uR,.na I � ulil_ov unr r�- m .v u-n-ro mEua ma .;vul lom-urlln IoucY rERlou lrlolcven.no-rw1l+GrnnlumrG fill IIIT. -1d.10 W➢ArrIOY OI 111),COtr'r lA1.l UR OTHER o06uLIF.Itlr4ii[il L'I'E(.Trr)1mhlC1t TIIISCrMW1CATL t AY OF ISSUED nit IIIl1t ❑ NI .PIr r ll UFl.l 1.r LI(ILiS Ill I IUI(ill xf IN l SUtliSC MAL 1711 Rr l P'r.l UlilOrh NO I,GNOli to l f PSUU 13 r I l TIT IL a III f I L n Rl-p0(I'D I l I ID�I II Ir Y/II , IN lli nNC nl It YnU a13[1 16 fYITI Icf 11/ IG('II IfY -- _ nrTl wwflDI'rri i Tr_MMIII DIYYI IIAlI1S t,zrr nlun°r- L""c1focc:upliENei T 900 , 000 IIII L,L IY 'fi ll,ill1- IDAi1V11(]R ur LD - — 07/G1 0 / I 04/O1/OII tr[I nl a au cI 300 000 I •.n_NI rl Ir��..,n sol � : 5 000 I i I l U'EI mll.acva nn'Y _ 1, 000, 00o �cl II ' cdaur vl rrRec n _� 000, 000 rlxr u�tl cul.lr of ,c .. 2,000 , oO0 1 I OltDll 11-I. }I'lil.;vll II _ � rI(lrll V IIJ III,'! I I. li.fp Ll rl rl'1 � IP<:I:;r u l I o0Dl1 YIr!.IUi:'i Jr..fl-(1v:ME❑nIITOS � U�a+nooQonp � j I I I .ra; -I-I lll.rrr I ;.urn oOl cAA GU UTrlpel .._ _ �-10 000 000 I,a. Ltnu ICIJ F3319330 ! O'7/01./07 Ord/O1/081 +i,fm c,n, r10, o00, 000 I I i n u ' rt I + lrrtr=rN lGunlr — I RnI rr ar eil ilunve 90] 623?0100061 12101/07 _ 1.2101/013 I.eunr u9Or 1 ,000, 000 rI_DII }L -•,rl.rlor 1 ,000 , 000 --------- -ill 1.1C will 1 , 1, 000,000 79I360822 04/01/00 ! Excess 5 , 000, o00 = II . I c:rr 'dIIDHSI� T Leslvrlw 11 rr%cLuslGH,:qumnvl NuaR>EFlel rvsvru,v rRovltiloR; - -"—� . -- r ): --ic > s Liali ifl :;2 , 000, 000/92, 000,000 Einplo ment Pra ctices c?s Li 000 w 'th On 0001 deductible per clairrl CCP 1IFICATE BOLDER --1 CANCELLATION _ FOR PRE SHOULO FlNY OF TII![.:NOVF OESCIx113 F_o POUCTES GE Cn NGELLF_D GEI°ORE THE iiXPIRA i101 DATE THEREOF,'nlE ISSUING IN IRGG WILL END[AVOR TO MAil. 30 DAYS wRIT1'ia: F+D P_ PiiI:SEbI'P]A2IDia USE GHLy NOTICE TO'O IE cERTIriCATE i orom NA/ArO TO THE U FT.our FAILURE TO 00 50 SIIAL, 'fuL',i. YiiCY✓:Y;h7"_Xl:L-.l'}�[XXJ�LSC}G�.SJ(Y.-{ II.IPOS[PO 013LI iAl'ION OR UADO.IrY or ANY KIND UPON THE INSLIRRR,ITS AGENTS 0rY — YJ�:f}',..v.3:,JLY.7(X:Ci3:XX}'yy�}',gy,}{�+�,}{y� REPRE59NiAnvfa 4Sa2 r_ 7`�r=. e7. _sJ ACORD CORPORATION ID&J •• ,_r 07zA 6'0 .... ..... .CLIC� P�✓�'^4dIP(.'l[UJP-�A Board of Building Regulations and Standards Construction Supervisor License License: CS 72772 p Tr# 24354 .Exiration:. 4f7/20 10 _ ,* Restriction: ,00 JEFF C STEELE 24 SHERWOOD AVE DANVERS, MA01923 Commissioner .r. `Jl(; -�1n01)!.)RI✓/P60n!/.��/!. Ofc✓('/li:L(¢r�i41i;L�J m \ Board of Building legulations and Standards rJ� R HOMEIMPROVEMENT CONTRACTOR Registration: 127172 �.rT Expiration: 9/15/2008 Type: Supplement Card CHAMPION WINDOW.,,,&PATIO 230 BALLARDVALE ST SUITE B ��_�� ✓ WILMINGTON, MA 01887 Administrator