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10 PICKMAN ST - BUILDING INSPECTION r , �� --- the Commonwealth of Massachusetts al i hoard of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CNIR SALLAI `, 'L'�•• Rerive,1.1Air2 1/ Building Permit Application To Construct, Repair. Renovate Or Demolish a One-or Tuar-Fanfih'Du Ming this Section For Offi i I Use Onl Building Permit Number: _ Da e AApp'ppll ii'e'd:: Ilui ding Ofticial(Print Nmunc) Signature Date SECTION 1: SITE INFORMATION _roly�} ress- M � � 1.2 Assessors Map g Pa el umbersProp 1,la Is this an accepted street?yes no_ Map Number Parcel Nwnher 1.3 Zoning Information: Li Property Dimensions: -Zoning District Proposed U c Lot Area(sq It) Frontage(II) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:( . I.c.qU,§Sq) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check fifes❑ Municipal❑ On site disposal system ❑ SECTION2: PROPERTY OWNERSHIP' 2.1 Ownerl of Record: D Name(Pr m1) U.fJJ /'J/// C'ityt Slate.ZIP r r✓f ( y No.and Street Telephone hmail Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repeirs(s) * Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ INumber of UnitjZ7 Other ❑ Spccity: Brief De_s,c..r�iption of Proposed Work': Kp Prs, SECTION a: ESTIMATED CONSTRUCTION COSTS item Estimated Costs: (Labor and Materials) Official Use Only I. Building S I, Building Permit Fee: S Indicate how fee is determined: '. Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)s multiplier t. Plumbing S 2. Other Fees: S - 4. .Mechanical 111\'A(') S List: (� .Suppression) S Total .\II Fees: S_ I, Total Project Cost: y`9� Check No. _--C'heck Ant.nun: _ ----- C',tsh Amount: Y ❑ Paid in Full 0 Outstanding Bakulce Due: �, SECTION 5: CONSTRUCTION SERVICES 5.1 Cottstructioo Supervisor License`CSI.) 0 ti0 ^' --� --- - Jvl gY. �2- .. Llcensc Numher I.vpuatian Dllle n1c ol'l'SI. Iluldcr rU y� List CSI. 1)(1e Isec hduwl 'I)pc Description -- N . .u1J Street Y 1 l I I Inrc,tnacJ(Buildings an In)S,UIIU eu. Il.) R IteslricteJ III Pamil Dllcllin 'it% r,1 .tilde./ ' NI Nlasunry RC Rot lin C'overin �,/ 0 WS W'indovv:ald Sidin p�G ( QC� av T SF Soli)l'uc113urning Appliances 1�a •1& I I huulalion Talc hone Email address D Demolition 5.2 Registered�hro-�me Improvement Contractor(HIC) r L* Oo �3 h t /� J/J1 (_26dt'd7nt. ✓ri IIIC' Registration Numller If. piratiun Uatc Aon1p 1y Name x I IC Itegislra ame j� r G t id�street alPYZ 03k1aL19(� l:muil aJJnss ow ,State,ZIP Tcle hone J SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c. 152.1 15C(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 of the 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Dale SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION By enteri -try n me below,1 ereby attest un r and penalties of perjury that all of the information contain n thi application ' true, d to t e best f n wledge and understanding. Prim l %ncr' , Aut nlriicd,Ngent's Nano(Hectrunic Signature) Dal NOTES: I. wrier who obtains a building permit to do his.her own wor ,or an owner who hires an unregistered contractor t registered in the Hume Improvement Contractor(HIC) Pro rarnl,will nu have access to the arbitration program or guaranty fund under M.G.L.c. 112A.Other impo nt information on the HIC Program can be found at "�� � n .r•. 11 , ,.I Information on the Construction Supervis r License can be found at I1)s,1.n1:15:�o\ k1p. 2. When substantial work is planned, provide the information b lov: Total Moor area(sy. flat _ ___--_t includil garage, finished basemenCanics,decks or porch) Groii living area(sq. fl.) Habitable room count Numtberof fireplaces.-_ - Numberofbedrooms Vumher of bathrooms __ _ Number of'half'hadis I'y pe of heating sy item _ _ . _. . _ Nunlhcr of•deeks, pordles. _ - I\lie of coallog iy itellt - FncloscJ I 1. ''fatal Project Square Footage" n a: he suhitilutcd for''I'olal Project Cosy' - �� ✓lte T�ar,►2aY:ciYuuea�C� �r' Office of Consumer Affairs and II,YY{{usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration > _ - Re9islration: 1,32701 Type: Private Corporation .. Expiration: 4/6/2013 Tr# 211619 ALL IN ONE CONTRACTING SERVIOES, IN_ DAVID BRADLEY 14 WESTRIDGE DRIVE — _ HAMPTON, NH 03842 i Update Address and return card.Mark reason for change. nPS-0A1 G 50M-04/04G101216 E] Address ❑ Renewal ❑ Employment Lost Card c Office Meoeum�er�A'�{aus&"O o ss egu7e n" License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 1,t Registration: 162701 Type: Office of Consumer Affairs and Business Regulation Expiration; Q.6/2013 Private Corporatic-.1 10 Park Plaxa-Suite 5170 A ONE CONTRACTING SERVICES,INC. Boston,MA 0 111166 DAVID BRADLEYC__f� 14 WESTRIDGE DRIVE HAMPTON, NH 03842' Undersecretary N valid without signature _ .. �l ussachu.a'ttc - nayt:u tincnl of Public .�ufcn 1 Bnard 1d' Buildin-, Rc_ululinn. :tdd i-onstruction Supervisor License -- License: CS 104055 Restricted to: 00 DAVID BRADLEY r� _ 14 WESTRIDGE DR .` 1 HAMPTON, NH 03642 rn` E<puaunn: 12/21/2013 1 ( nnmi..� iurr Tr=: 104055 A11 In OneZ Contracting214 } S E R V I C E S , 14 Westrid a Drive Ham g � ton p NH 03842 Tel 978-378-4778, Cell 978-533-9416 CONTRACTOR AGREEMENT THIS AGREEMENT made this 13th day of September, 2011, by and between All In One Contracting Services, Inc. (Home Improvement Contractor # 162701), hereinafter called the Contractor, and Janet Sherwood, hereinafter called the Owner. WITNESSETH, that the Contractor and the Owner for the considerations named agree as follows: ARTICLE 1. SCOPE OF THE WORK The Contractor shall furnish all of the materials and perform all of the work (per the scope of work listed on the quote dated (September 131h, 2011) on the house located at 10 Pickman Road Salem, MA 01970. ARTICLE 2. TIME OF COMPLETION The work to be performed under this Contract shall be commenced on door delivery and shall be substantially completed within 3-weeks of job start. ARTICLE 3. THE CONTRACT PRICE The Owner shall pay the Contractor for the material and labor to be performed under the Contract the sum of Twenty Three Thousand Four Hundred and Nineteen Dollars ($23,419), subject to additions and deductions pursuant to authorized change orders. ARTICLE 4. PROGRESS PAYMENTS $4,000.00 @ Job Acceptance (to $ 6,419.00 @ Job Start $4,500.00 @ 33% Completion $4,000.00 @ 66% Completion $ 4,500.00 @ 100% Completion ARTICLE 5. GENERAL PROVISIONS 1. All work shall be completed in a workmanship like manner and in compliance with all building codes and other applicable laws. 2. Contractor warrants that workers are insured as required by law. 3. Contractor agrees to remove all construction debris and leave premises in broom clean condition. 4. In ehe event Owner shall fail to pay any periodic or installment payment due hereunder, Contractor may cease work without breach pending payment or resolution of any dispute. 5. Contractor shall not be liable for any delay due to work done by Owner. 6. Contractor shall not be Gable for any delay due to weather. All In One Contracting Services, Inc. 14 Westridge Dr. Hampton, NH 03842 TEL 978-378-4778, CELL 978-633-9416 HardiePlank ColorPlus Quote 9/13/11 Janet Sherwood Back of Home and Rear Addition 10 Pickman Road Salem, MA 01970 All In One C 3ntractinsL Services Inc. is a James Hardie Preferred Contractor $ 16,336 Remove and haul-away existing siding and install Hardiplank brand H25 cement siding (ColorPlus - BOOTHBAY BLUE 15 year paint warranty). Siding will be installed blind-nailed on a 5" lap. Style -6 1/4" Select Cedarmill (cedar-grain appearance). Includes Hardie-house wrap and all flashing. $ 0 Rotted Framing or Substrate Replacement: -$50 per sheet on plywood or OSB, $4 per lineal foot on 2x4, 1x6, or 2x6, $5 per lineal foot for 1x8 or 1x10, $10 per lineal foot on 2x8, $12 per lineal foot on 2x10 and 2x12. This price can vary, depending on the actual amount of rotted framing to be replaced. Rotted framing will be immediately brought to the owners attention and will be handled on a change order as required. The hourly labor rate for replacement of any materials not itemized above Is$32 plus cost of material. Included Install corner trim, rake trim, eave trim, and window/door trim using ColorPlus - ARTIC WHITE HardieTrim. Includes all light blocks and triming around utilities. Included Install crown moulding on the side porch and paint as-required. Included Replacing 1-gable vent. $ 664 New Gutters and Downspouts. $ 0 Does not include the cost of any electrical work. Included Paint all door and window trim, all overhangs,friezes, fascias, and corner trim with 1-additional coat of paint to give a freshly painted look to the home. Repairs and painting of the existing bow windows will be done on a time and material basis. $ 17,000 Sub total $ 6,419 Replace the combination window unit with a Windsor Brand 9' wide patio door unit which will consist of a three -3'sections with the center section operable (3'OF/3'0 Slider/3'OFx6'8Height). The door will be a metal cladded, insulated, wood door unit with traditional grilles. This door is Low e - Energy Star rated. Does not include staining the interior of the door unit. Included Porte Potty Included All James Hardie Siding Products will be installed in accordance with the Best Practices-Installation Guide Version 5.0. $ 23,419 Total By d Bra ey, All In OT ting ervices, Inc. James Hardie Inc. offers a nonI ted 30-year Limiteabl Product Warranty on the HardiPlank Lang and a non-prorr L' itedTransferrable Product Warranty on HardiTrim.All In Onin Services, Inc.gives a product lifetime limited warranty on labor instaa I mited warrantyon other work performed for a period of 5 years followii n. A 1 year warranty is given on painting of existing surfaces. 7. James Hardie Building Products, Inc. offers a 30-Year Express Limited Transferable Product Warranty on the HardiPlank Lap Siding and a 15-Year Express Limited Transferable Product Warranty on HardiTrim. The Contractor gives a transferable product lifetime limited warranty on labor installation and a transferable limited warranty on all painting and other work performed for a period of 5 years following completion. The Contractor guarantees the construction performed to be free of defects in workmanship. The warranty is limited to construction work that has not been subject to accidents, modification, misuse, abuse, material deficiency, and/or had repairs made or attempted by others. 8. Contractor is not liable for any fees that might be incurred by the Owner for any and all consulting with any third party inspection service, the Contractor must be notified of the use of a third party inspection service prior to contract acceptance. The opinion and/or recommendation of the pertinent manufacturer representatives will supersede those made by any and all third party inspection services. 9. Contractor is not responsible for any damage to any items hanging on walls or any delicately placed items on shelves, etc., or any other household items damaged because of the shaking or vibrating that occurs during construction. Owner is urged to safeguard any delicately placed items. ARTICLE 5. OTHER TERMS 1. The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGI,c t42.A. Owner: Contractor: NOTIC.'F.: "lli natures qftheparlies above apply only to the ague ent of the parties to alternate dispute rrsolution initiated by the contractor. The owner ruay initiate alternative dispute rcmluti even where this section is not zgned eparately by the artier." Signed - 131h day of September, 2011. By Da 'd ra ey, All n One Wtracti a ices, Inc. k � / By Janet Sherwood, Owner Date � '� CITY OF SALEiv[ ;;0' PUBLIC PRUPRERTY s' DEPARTMENT Mf 11",NI41"it \Iulw I�: \Vn HrlAl.l U.\ilaEtl' � i•11Fu.M.1\h.\1Jn V I.nyp/y,+� Workers'Ifi,nnalfo I'lu If . t)HIS•If,S • I'ts vIM•!/4'LyM Cumpenaatlon Insuruncro UOddvi1: IluildemcontractorwElectrlcianyP►umbere 1 , cant n f © PI .� fn le 'hl V,Ilno I ILIUItivy v t7ratnnin vinJlvnluull: ,� Nddresa: �� I City,Stacc.lip' I'hone it:_ 6 o y I .tev)ou an valploysr:'Chevlt the apprnyrlut.o••�It r. 1.❑ I and a vmpluyur with 4.V I ;son a gunural cvolraelor and I I')M o(project(rvqulrad): '•❑ mnpluyces(lull anJ/ur purt•linte).• buvu hired thv suh-cunlractun b' ❑New cutsltuelion I.ml a late pmprieur or panner• listed on the inched sheet I.ship and have no uin lu coscontellcrars y ❑Rmnaldins whave orking lir Inv in y jpauily. pork rs'ca rIP6 '"JuranclL tl. ❑llsmolirion I NO workers'cutup. insurance J. ❑ We are a cntporetinn and its 9' ❑OudJind udJitiuln J.❑ nquirvd.) onTeors have uswcisv'd their MC3 Electrical repairs or additions I am a hommlwnur doing all wark right of veemption per MAL I LQ Plumbing re myself. (�'o wnrkun'cum ' Y pairs ur aJditinry p• C. l f7, ¢I(4).and ws hllvu no insurance required.) r ;mployves.(Nb workers' 12.0 Ruul'npairs nmp inwrant.'e squired.) 11.c]Ufller •.�"> agd4'ae Ihvl.•Act1 hua nl nlup.dw Illl,W I 'I'"^""'�^rrr�IIII,IJMuI nit•r11davit i,vrlruwo Illrrr Vauu.lr.luW Jgrina Ilk* Iss'evnrrvNyylyp 'C•.nrrwllln lhM alw.e Ibis Ms nIIW nrih�.In aJJrli,ryt JYiNe.fl,.y,"y IMf hlro oWlide•usrn•rors",.ullw,il a n•,r rinJwil inJlayIn ram"last /run sour avuployrr shut It prvnld/nr IverAey'rump I n/IOe b Yn net jrrr yei np/v,+R I t Bduoms Wivt� VIy /j Me pv//ay unJ/u1�'l� I .IrJwy Infklrnlrin� injururwGrrt Insurance Company Nalnr�__ Policy a Ix.SvIr.ims. Cic.re: — - ------ —'-' Espirinwn )sob Site Addruic D;ar. .yttach J copy of ftts Yorkers'cumpinvation pulley duelarullual pugs(showlnq rhelpellcy uumbur and etplrarlua dole), I;adury w,'cure sow stage as required under Suuiun'L►ul'SIGC e. I SI can lead to rhs son r'mu up nl SI 04.1 n y Nail uns•yesr in,prissnonunr, 4n wc11.la civil lXnulltas in Ihv funs of a STOP WORK ORDER and a Rod r up rn i:1A 9n a Jay ryail»l Ihs via v. I lc 34viwa thin i copy urlhls dulcmunf muy be ttb'rwar.J uSoi011 tthe On ce ,f.q o/7 Iln an�,tuluu ul';6u UTA :or nlsnr.l .s• C,I.�r�,u ,el lllu4un. /,lu h.vrAy„rri/�nn/.v dry p,ri r nrd pry dN u prr/try rh I 16e irr urrnrllon j yrorided sobuce it sour and corevet 1 Ols/I4iu1 alr son/y. /)u.rn Ivrirr in this un•u, ru D y a•runt /•trd by airy ur/olrn sly 1 IVA ' fire or Inwn: _ L.uin -- Panniul.lcvnre a y .l uthnruy (rirclo nnel; I III,rrJ of Ifr.ilth !.6. 1)Ihe♦ Ilnddnr� Ila p,lr hne nl 1. I.il).'lunq Cferk J. Alaal ir.11 lu,pectur i. Phunbin� peetar I rn 1 • a Lrcl 1'a r,u u: -----�.. I'hunv 1• Information and Instructions �Ltasu:huaetts l;:nenl LJws:hJptef I i2 tegwres ulicVery r`inn ,n iheJarvue of Jnod,ereutuler nOy :untnct Of hire. I•ur.u.uu w❑us ,t Jiut°• in emplurre is JctineJ Js b or Jn two Or More ;.press or ❑nphed, oral Or wnuen." or the NA ,onpluyer i+defined as"Jn individual, purtnerill J inst,t auo,eorparauon err other legal ejs, Y al eonly,empluytn{enlployeee. However the t ihu hrteSU,ng enbageJ ,n a Joint told rpnis, Jnd utcluding the legal rcpteseuuuves of a deceased employer, ant ofthe ,ecerver Or uuslee of us individual, pssmanhtp, ,asoot000a ti other leg' owner Of a dwelling house having not more than three Jpamn°nu and who residns therein.Or the Occdto be in atnpluyec" to + Woos tO Jo,naintenunceor"�h amploytncnt be deem CJsuuk dwelling house ,hvelltng house of JnOiher who a urDtt art LheretoLshalliiot because•, , or,,it the .,rounds.Or building app ese rhsU withhold the IssuseCs or any `tGL chapter 152. =lC(6) also slates this"tvsry class or local Ilu- l i $ fabN wldeots of cutnpilaeae with the insurance corers s required."vision of iu'politiC subdivisions 'hall rena•V1.ufa license Or (6) 31it 10 Operate a husinsu or to construct bullik the le sha Commoewssi or typlleant nlie`h'as not pro �'C p)crates"Naiiher the commonwcultb nor any 1JJitiunully, %IGL chapter IS' i- ( ublic walk until acceptable evidence ut untpliattce with the insurance Wier into any contract l'ar the poll, lance of p ,everted to the contracting authority," requirements of this ehJpaer haw bean p' applleaoss checking the boxes that apply to your situation midi if adtbaNas)and phone nuntber(s)along with then camiftwtal4 of Picam till Out the workers' compensation atlldavit completely,by Ponnenhips(LLP)with no employees other than the necessary,supply sub contractcr(s)n ern°(°)• LLP does have required to carry workare' compensatiboenIII at submitted to the Depurobnam off atrial r I Insurma, Limped Liability Compamics(LLC)or Limited Liability member Or partners, Lite not en,pinyeas,a policy is required 13e advised that this alli be s may udst°d. not the t).ipartmcnt of \ceidanu for confirmation of inaurarie0 coverage. Also be sun to sl{r and Jute the ul'lldevll. The ailldavit should Iteuige for the permit or lieenae is being rt q to obtain a workers' he runintaJ to the city or town ou Irthe apPlave any gaeiall .regarding the law Or if you an requiredallies should enter their Industrial t'.euidenu. yhuul call the Oaptsrtmsnl at tha number listed below. S•lf•insurad comp compensation policy.please volf•insureness license number ern the a ro riot°line. (.Iry Of.rowa Offlelale rtritent has provided u space at the buttum rioted legibly. 'The Depa the applicant Mast: he sure that the affidavit is complete ;Ltd p applicants Of the Jfrtdavit tur you to 1111 nut in the avant the C hic will be igati0ms has to contact you In rcn addition, ltcations in any given year, need only submit ern°atlidsvit indicating wrreur I•I:asa be curs to slit in the p,trmii/licensa nwnbOr which will iv used;r�tts,�etehouldrence iwrita'all lucuuuns in n ap (' Y than meat submit multiple pennit"Ilceliwnderv')Ob.cite AJdrass1"the app be provided to the policy information (it.necessary) qd or niarlitd by tits city or town inay town)•"A copy of file ulrldavit that has bent officially sump' business Or commercial venture Jpplicunt Js proof•that a valid Jf idavit is ern rile 1'or iesi n paimia err o,relate Anew Wusine t muss be tilled nut etc a license Or penult oat related to any arson is NOT required to eompleta this Jffidavit. ye•tt. When a hums uwnet err eitiien is obtaining I i c. ,t .log lican.0 it permit 10 burn leaves ese.) said p ussuans. I he )i lice , t Inve,tiyJtiuns wuuld like w thuuk you in JJv;utca fur your:aopention and ehuuld you have'lily 4 please Jo not hesitate to give us a cJll. truncnt'+ JdJra+s, telephunt Jnd riot number. '`•. the uep• The Commonwealth of Massachusetts Depa►ent of InIJustrial Adeidents Otto of fsvesdgadons 600 Washington Street Boston, MA 02111 Tel. N 617.727F�6Cxt 17 102 a71 .877 MASSAFE .,,. s www.tnass.gov/dia LPKtM-1 UP IU:SW . 111.1 �° CERTIFICATE OF LIABILITY INSURANCE DAT09112111 Y) `�' 09/12111 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 policy(iss) 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 lieu of such endorsemen s. PRODUCER CONTACT 978-998$896 NAME: 27 Garde Insurance it 1B s,LLC PHONE FAX 27 Garden Street Unit 16 978-998-6897 MC Na Ext: MC No)- Beverly, MA 01915 n—MAIL s: Genesis Tax House INSURE S AFFORDING COVERAGE NMCd INSURER A:InterGUARD INSURED LP Remodeling, Inc INSURER B:Arbella Mutual 10017 103 Shirley Ave INSURER C: Revere,MA 02151 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR TYPE OF INSURANCE DL SUBR POLICY NUMBER POLICY EFF MPOLIICY EXP LIMITS LTR GENERAL LABILITY EACH OCCURRENCE $ 1,000,08 Reffreu B X COMMERCIAL GENERAL LIABILITY 8500052259 07121/11 07/21/12 PREMISES Ea o=rr roe $ 100,00 CLAIMS-MADE 1XI OCCUR NED EXP(My one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREG7JLIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,0011 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccidenf $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODI LY I NJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS P AUTOS Peraccident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LMB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X WCSTATU I OTH- AND EMPLOYERS'LIIIBIUTYTORY LIMITS PP B ANY PROPRIETOR/PARTNERIEXECUTIVE V� NIA LPWC221023 08/01/11 08101112 E.L.EACH ACCIDENT $ 100,00 OFFICERAAEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if room apace Is required) Evidence of insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN All in One Contracting ACCORDANCE WITH THE POLICY PROVISIONS. 14 West Ridge Drive Hampton,NH 03842 AUTHORQEO REPRESENTATIVE �LceWCar.� /��c.�aar�w ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD PDF created with pdfFactory trial version www.i)dffactory.com CITY OF SM.&NI, Alss.ICHUSETTS BLMDLNC; OEP.IA mNr 120 WASNLYGTON STREET, }ie FLOOA rM (978) 745-9595 KIAMEALEY DRMOLL F.Vt(978) 740-9846 MAYOR niOmu ST.Pffi1As DIAECTOA OP PCBUC PIIOPFATY/8CQ.DLYG COJpnSSIONEA Construction Debris Disposal Atttdavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 11 I.S Debris, and the provisions of MGL a 40, S 54; Building Permit M is issued with the condition that the debris resulting from 111 work shall be disposed of in a properly licensed waste disposal facility as defined by ti1GL c l I I, S 1 SOA. The debris will be transported by: f �S CS l,Sa (nimeofhaul ) The debris will bedisposed of in : (na20tly) (�ddre» of fu6ty) 11M r fpermitJpplicant J.1fa