5 PYBURN AVE - BUILDING INSPECTION (2) lie
2g °°
v
L The Commonwealth of Maffll; l[u>tJHN AL S ERV ICE
Board of Building Regulations and Standards CITY OF
� SALEM
Massachusetts State Building Co(�g 7gp, ,Q
LU(5 Ul.�" Is P 1' RevisedMar2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
- -This Section For Official Use Only - -
Building Permit Number: Date plied:
Building Official(Print Name) - Signature V Date
I SECTION 1:SITE INFORMATION
1.1 Prope dress: ,� � 1.2 Assessors Map&Parcel Numbers
1.1 a Is this an Iccepted street9 yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
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.402§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yesO
SECTION 2: PROPERTY OWNERSHIP'
2.1 OrynrX'of Record: i _ 2 2
keriAn. }rnan» SCi�GH2 /AVT
Name(Print I City,State,ZIP
�1 �N bKl 978- CIS-(- s3&
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ 1 Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work :
->— 3 O- / Nac M4 61-70 WY-
SECTION
4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials -
1. Building S Lf7a_ 1. Building Permit Fee:$ - Indicate how fee is determined:
2.Electrical $ ❑Standard CiVaown Application Fee
❑Total Project Cosr'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire _
Su ression) $ Total All Fees:S
Check No.113JA_Check Amount: Cash Amount:
6.Total Project Cost: S 1470 ❑Paid in Full ❑Outstanding Balance Due:
StTAsC-_ to �ZZ
t
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) Y7 G 7-7 y/Z3
License Number Expiration Date
Name of CSL Holder
Eric W.Palm List CSL Type(see below)
No.and Street 3 Hilton Street Type - -Description
Salem MA 01970 U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Atlantic Weatheri ation,LLC ��12 U k� i 2 /(r
HIC Registration Number Expiration Date
HIC Comgy ppkala�,t,LjI,C,RO Name
No.and Strreeell em MA Email address
Cityfrown,State,ZIP 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 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 /f FOR BUILDING PERMIT
G
I,as Owner of the subject property,hereby authorize s 4/P-;-W
to act on my behalf,in all matters relative to work authorized by this building permit application.
I6,a.;e1,,,.,r,,. Ci w A,,, ) 16114
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contai din this a�cat a and accurate to the best of my knowledge and understanding.
G
Print Owners 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
t','%v acmass._u,•Ioca Information on the Construction Supervisor License can be found at�r..:v.r�ass.•=uv,dus
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"
mP+ohr26�e��drementsaftheaaieYHomelmP+av®at •'�
O&ce ofCi°'dBto�faegoaemea[be Any PPasm ( d ehap4.r 192A),6atdasaotmdadnsmad2rd
CwsemaAfjabsmdBasinessR a °S to aaYramkm3'e�rea'denra Y�ea155hauldfiC¢abh�aCOPY af^A
e�1ffim'sCoamnerfafamC•tionEnNaeffi677A73�')87 art�Yoh�mafreocpP9byaaDmg the
�omEpyi'aeCt4tfOYmatihn 3757 armaewebsite.
Name �OnfpaeRoelnfoematioa
P I C11 11 1 n comparyName
Street Addres(dovat use Pint Difica)eoz nr7 AtWtie W"he(•iLdllU(i, L.Lt,.
cayfrawn - Avenue
_i. scu��T.�P cae.,., ,.
nr�ea Addr¢s(nmt'
Dayrfine Phone"' •��._��' '
Ere+vogPhme Cityffawo S3 - s�
�} � Z de
Plr�c / Fc�
Mailing Address(hdi eant8omabava) 9 /yy— O p 41
$nsm�
. Feud&apt icIDmaS.Nwtba
The Con acto. ➢tea1V! P7 /I
"a!`Tfido Hre griarietartlreA
(Dx°,ibe in deyliAeemktom mae,,,,,
specifyingme"-bead,and Bade eF
d wdl'ee-sec�m "ft7
rmadiogpnm;Ls D13L i C/� uT /. e 7ras tbehomeawae's t ('+opased Startand C°mPleffan Sffiedde-71m5rG
(�wnets vaGo sE®t bea�etedtowless ce" d �gsxbew.e aexcluded fsamar>a Bt:rmits welt bo _ I'm the caonaaoes conaot ariaMIGL ChapterP Fond PIUVs§ons O; " Datelle
' watraaorwdl begin contracted wodcTotal Contm,p,,i —"'-- --D�ewbm emeadad,york tcv77 bemhstzapallY-Weted
The ContranWe ymttnt5ffiWe1e
to Pefmm thcrvmlr,Mnis3 t)+eniat®81�d)abar
Paymenh WAbe m +cording Ntb adea sgxmedabovcfartheta�7J samoE - CJ 7C119. —(a)
i etol)mnivgscbcde . _ -
.mon signing ombaet(Out to exceed Ia ofthe tail S omtrzat
dal order by��ornvm compled no or av of tSewsToF rtemS whlchavmisgrsater)
- Y 1 / orepon compietrm of
npoommp(ctimoftbeent"n't (i 'beddsd�dm /
Tic rah _ gmimtg
mord�vdhabmtb... yetirsmmder S wbe dfar h is eomplemd[o both petwesffiiirafTion)
the ranpl�un srltedde(•.j
g d
NC wG;(=1)aclW�ng digneax
nm d�85 C'%tatvr-the ilmt�ydepyitordmaa
""'ehhueenbat° ,Je emdw hiM oflhetaci.,... ^t ryjcm -��mt�itdmi bylhcwou'..ttarberoicxmk hgjre
?Pacid mdaad ivedsvecm weeathecomplr5mse6dde, ofaoyaP-mid quipmmt areauam m,&may
Gsnrra Wvrraa -L n _ '
Sobronesa�;nm-fiecvntracmr tandv mvidcd E-tbamal.- r_+ Q Imo, �
Party/s,lh^_OntP..CtafCtifi�d a2r�tabe-0IdyreyPoaSluleFnr eJYcw°il temzar]be .-
byihecoo wmplelion ofdre vnrb- mmsyecrraeh�m,h°mntry ateriais mdlabar,mderthiea emn o?emt IbewntraGorfmYber oae+b-dreg-.ages ofdteartian;nfaaytWird
Contrcct Ar"e �(D�''�dYseapore9,Icfma4paymmmtoagsoGo,
Fmnm-Uoon signtrrg,this do^rmeat 6ecomsa ors for
watract shaG noLimPlyIhat anY Gen oroWers bradtascmtr-utnnda rarefullY 6efare ageing[his oonn-,,at, h` •�t)ms btmplatW mtL<res Uales adsersw�aated rv)ihin this dacommt.the
deuce,Reviewtltefogatringr�rdontmd mdces
° �°�smrrh�d�srgamg the 0°anad.7aSe '
weir baz valid nine amemraad mdfut)Ymdeamndit e�bconhactomtohereg Mitered
)bwrathlm.m iD tC�aostmea[Coninamm.r?behAmh '. gsmdem.wgstratrmbynritgto m -
i
rwuires nmsthomcimpmcemeeiwnaaarets and° Does the Goidn rhave
7 17 _ th12�116iYCojA 9�Seca copy Ofa-PmoF � "kh�t�arforhis lbg67387e.SSB. 3o57r,+.Knoroy d �t m7anapyinfmmdm so thatyan m=f..mvz�Sriglitssd i '-?QtJtotbegFro ce Centuew -ImpodmtIefnr reationi sde 3,r to
w.
ofWisfom
WYivru muasyi oenssce>,l]am tr.''fd eWrCmfficaefnmr s 6egnx.:ao,lm a5+pernla readrerihm the wna-umtsnmmalplace
avd getarmpyoftheCenuen,
wntrec:o; rvL is ® witbmbeeasgd
raaah
mgaen
mng dn
Sw tbe��P.a°-tat.by tde�am smtdlnooidedpm aalitythe
F+�RT®t SYf'I!! al4rhednhdwef® aay.notlmathmmidnightafdm �
rna;e=e_�,r°s�„���+ '§t'-'dDPdT6g��r,+L.;.���.� °Ci�mfomm foraQ e;Pbmatim ofibiceight
• �hwm�a°aPy",_„yq c,t__����II.ART&{SPA�!!t
'�dac.76ps emoreroz
Homeo,:ye.+s Sigwnnr
1 S - CmtraaYa s gnatme 1-�
Date (
+tale
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 cumractr5u uiayjsubulit�the dispute to a private arbitration firm which has been approved by
the Secretary of the Executive Once OfC�o er Affairs and Business Regulation and the consumer shall be required
to submit to such arbitraUpt+as4P 48in�sachusetts General Laws,cha er 142A.
• (-A
Homeowner's Signature Contractor's Signature
NOTICE:The signatures of the parties above apply only to the agreement of the parties to altemative,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(i.e.MGL chapter 93A)may not be waived in any way,even by agreement However,bomeowners
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 Food provisions of
the Home Improvement Contractor Law. The contractor is responsible for completing the work as desmbed,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 warranties
provided by the contractor,all goods sold in Massachusetts curry 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 long as they do not restrict a homeowners basic consumer rights. Ifyou have
questions about yourconsumer/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 heea attached. Parties are also advised not to sign the document until all blank sections have been
filled in ormarked 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 writmi NK
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 him/herself to be financially insecure. However,in instances where a contractor deems himtherself
to be financially insecure,the comractormay 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 finds from said account would require the
signatures ofboth 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 Plana Room 5170,Boston,MA 02116
617-973-8787,888-283-3757 or visit the OCABR website at hnn:/1w%vw.mass.aov/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 Lava,contact
Director of Home Improvement Contractor Regishatma
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
617-973-8787,888-283-3757 or visit the IIIC website at htm:/ionvw.mass.2m,/ocabr/
Go online to view the status of a Home Improvement Contractors Registration:
hau-.1/dbstate.maus/homeimnrovementnicenseelistaso
For assistance with informal mediation of disputes or to register formal complaints against a business,call:
onsuiner plaint Section
°:_,•z �x,;atffr omay General
617-727-8400
AND/OR
Better Business Bureau
508-652-4800.508-755-2548 or 413-734-3I14
Version 11-11112polo
- k
The Commonwealth ofMassachusetas
Department Of lndustrialAccidents
1 Congress.Street,,Suite 100 i
Boston,M4 02114-2017
Tworkers'Compensationinsura
www.massgov/dia I
nce Affidavit:-Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PEMMITTING AUTHORIT V. '
A20kant Information Please Prrat L biv
NaMe(Busmess/Organ¢ation/Individual): AdafltiC We�hftWAMAsggl Ll,(
Address: bf R Je¢fr,-Aw Aeouge
_ I
City/State/Zip: Phone#:_ T
FI—
V2nY
employer?Check the appropriate box:
em to er tvith cE
project(required):
P y employees(full and/or part-time). ew construction'
sole proprietor or partnership and have no employees working forme inacity_[No workers comp.insurance required.) _ - S. modeling
homeowner doing all work myself[No workers'comp,insurance required]t emolitionomeotner and tall 6e hiring contraMors to comluct all work on my property. I mill ilding addition
that ail contractors either have workers compensation insurance or are sole
Proprietors with no employees. ectrical repairs or additions
501 am a general contractor and 1 have hired the sub-contactors listed on the attached sheet. mbing repairs Or additions
o
These sub-contmdors have employees and have warkcrs'comp.insuranc.: repairs /6.E]We are acorporation and its officers have esemised their right ofexemption per MGL c. erJ�'V IC �16 4 2
152,§I(4),and the have no employees.[No workers'comp.insurance required)
"Any applicant that checks box 91 must alto fail out the section below shoving theirwurkers'compensation policy information.
}Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
�Contmcmrs that check this box must attached an additional sheet showing the time Of the subcontractors and state ttihetheror not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp,policy number.
I
I am an employer I110t is providing ivorkers'campeastition instrrancejor illy employees Below is the policy and job site
information.
Insurance Company Name: ZUU^i G
Policy#or Self-ins.Lic.#:_ S Cj 2-70 a
Expiration Date: 3
Job Site Address: . / Q Gtt S / ✓/..
� 1 �,1 'w City/State/Zip: Gt, fit..-t
Attach a copy.of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine 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.
i
41
I do lrerebp certify under the pputs cord erral ies o er'r t/rat the information provided above is true and correct'
P.:;..t
Signature. _
y ��(�/ '���f� Date
Phone#: 0 74U—g1 U $
Official use only. Do not write in this area,to be completed by city or tovn octal.
City or Town• Permit(License# _
Issuing Authority(circle one
1.Board of Health 2.Building Department 3.City/1'own Clerk 4.Electrical Inspector 5.Plumbing inspector
6.Other
Contact Person:
Phone#•
CER-nFICATE OF LOA&I&Q INSURANCE DATE ffl& DD/YYYY)
IS ISSUED AS A M ATTER OF INFORI19ATtON DNLY dND CDNFERS CERTIFICAT NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
EDGES NOT AFFIRMATIVELY OR NEGATIVELY A(WEND,EMEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW.
FNIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE d CONTRACT BETWtEEN THE ISSUING 1NSURER(S),AUTHORIZED REPRESEMATIVE
OR PRODUCER AND THE CE TtF(CATE HOLDER.
IMPORTANT:11 Me Certificate holder is an ADDITIONAL INSURED,the policy(fes)must be endorsed it SUBROGATION IS WAIVED,subject to the
terns and conditions of the policy,Certain policies may require and endorsemelrt A statement on this Certificate does not Call rights to the
}
eWdficate hoiden in lieu of such endem orsen s.
PRODUCER
ffIlAl
EASTERN INS GROUP LLC 239 W CEIVTPAL STREET FJiX
(Arc,No):
NATICK.NIA 01760 E-MAIL
221v1LW ADDRESS:
INSURERS)AFFORDING COVERAGE NAIC9
INSURED INSURER A: AMERlCANZ[iffiCRINSORANCS COAfPANY ATLANT?C WEATHERIZATION LLC
INSURER B:
IH5URER C.
61 REAR JEFFERSON AVE I INSURER p:
SALENL MA 01970 'iRLRURER E:
I COVERAGES INSURER F:
CERTFICATENUMBER:
rMYR Yo RER1ry rHRUORCOMMON weeRANw REVISION NUMBER:
BELOP/HAVE BEENISBU TO THE LV6UAED NA6fEO ABOVE PoATHE POOCYpERKiO INDICATED.wo"wNSTANDLVG
NIYAEQUIRERIENT,iEfldlS ESCRmON OF ANYCOMRAC{OBO AFFORDED BY THE POLICIFa DESCRIBED HEREIN iS 6UBJECTT �H'INETIXlEXWnHAES AND OF SUCH POU E NAYBEISSUED OR MAYPERI'ABL THE RMHANCE
I PAW CLAIMS. OALLTHETEAM6,EXCLUSIONS AND COMMONS OF SUCH POLICIES LINIMISHOWNUAVILWEBEENREDUCEOBV
I LT RI
ADD SUB
,I LTRi TIRE OF MSURANCE POUCYEFFOATE POLICY EitP DRTE �L A POLICY HUMEER (IPJIIIID�YYVY)3 IMM�1GE )
—NEgAL LIABILITY a IODIVYYY LOtnS
R t�rr--C--OM� MEflCiAL GENERAL LIABILITY i LACH OCCURRENCc S
UI�CLAIMS MADE ®OCCUR. {{{)))
j rOREN TO RENTED 5
i�..mj f(ir ?REMISES(Ea occonence)
{[�t MED EXP(Anyonepereml) S
I GEN'L AGGREGATE LIMIT APPLIES PEP.: ERSONAL&ADV INJURY 5
Ii i POLICY ®PROJECT�LOC GENERAL AGGREGATE S
�AUTOMOB{LE LIABILITY RODUCTS-COMPIOPAGG S
'(_f9 aNY alTp COMBINEDSINGLE S
(-5 ALL OWNED AUTOS LIMIT(Ea accideN)
SCHEDULE AUTOS BODILY INJURY IS
I HIRED AUTOS (Per Person)
NON-OWNED AUTOS RODILY INJURY S
I accident)
1 PROPERTY DAMAGE S
Per acadenq
EXCESS LL IAR OCCUR
I L CLAWS-MADE L(AB �I—�i EACH OCCURRENCE
S
A DEDUCTIBLE AGGREGATE S
RETENTION S S
A WORILERS COMPENSATION AND ! S
EMPLOYER'S UA131LTiY vim !
U8y8270121-15 03/20/2p15 DE32 is !LVC STATUTORY OTHER
ANYCERIAE ITORfEAATJERlEXECUTIVE N2016 ,LVARS I OFRCERTAEM6Efl E%CLUOEO? Wk 1
9 I PAondarory In NH) E.LEACH ACCIDENT S Sao,0p0
14 1 j yes.
D dI ON urger EL DISEASE-Eq QVipLOyEE ESCR IPTICN OF OPERAT1pN5tzlnvv 5 SDO,DOD
DESCRIPiTONOFOPERATiON51LOCAT10H5NEHICLESMESTRICMONa(SPECIALITEMS El.DISEASE-POLICY LIMir 5 5Dg000
MS REPL,:CES RNYPRIOR CERTIFICATE ISSUED TO rHE CERTIFICATE HOLDER AFFECMG WORKERS COMP COVERAGE
CERFiFICAFE HOLDER
CITY OF SALEN] CANCELLATION
93 WASH N GTON ST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORETHE EXPIRATION DATE 71iEREOF,NDTiCE VRLL 13EDELFLIERED
IN ACCORDANCE Vines THE POLICY PROVISIONS.
SALEIK NIA 01970 AUT HORRED REPRO t A VE ,h )
:COP,D 25(2030lOS) The ACORD name and logo are, "- �4 � ' � ` "3 ����"egistered marls of Al 19Wa 201 O ACORO CORPORATION. AU rights raserved-
F i -
4-71
G Qualified
1 ggpp �'p
�1lJH�a y
nrnac endows
Ildn"g 11W mIIgAt.
VINYL DOUBLE HUNG
rr�we rfn a a on IMPERIAL Lr
Raftgr!vm-14D Double Glazing.Argon F111.1-ow E.Grids
SLL-A-2g-M152-00002
ENERGY PERFORMANCE RATINgS
U-Factor (U.S./I-P) Solar Heat Gain Coef,ident
o e2rl 8 0Hp
ADDMONAL PERFORMANCE RATINGS a
Visible Transmittance Condensation Resistance
m
i
Flanc:fac[um'stioutates that rhea ratings conform n app0table NFRC pmceduac for
deir•mN.,q r'knie rmfi rt pafotmance. TIFRC Mtft1g5 are deternuned fM a haed`?i^t
r _• iantm6 and a wedfic prod-t sim IIFEc de n not r^amn,E7 any znmd:^
am not ra"ot the sUtftl ty o,any piadua Fx any Ttnrr_arse.Ccrvt manufa.ticer
1 fteranne ru othe,product performance all= tion.
ynmr.nfrco
1318555.060
i
sit Massachusetts-Department of Public Safety C921
Board of Building Regulations and Standards ffrceofConsumerAffairs&BusinessRegolatiOn
Constructinu Su8icn7is7or aME IMPROVEMENT
-
CONTRACTOR
License: CS07 -t'tjon- 142089
Type:
p:hat0n: 3/1212016 Lid Liability CO W
ERIC W PALM - 11
ATLANTIC WEATHERIZATION LLC.
3 IMTON
ST f Salem MA OL70-
r ERIC PALM
61R JEFFERSON AVE
Expiration SALEM,MA 01970 UnderstembarY
Commissioner 04/2312016
Unrestricted-Buildings of any use group which
(991M)of License or registration valid for individul use only
lcontain less than 35,000 cubic fed before the expiration date. If found return to:
enclosed space. Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,NA 02116
Failure to possess a current edition of the Massachusetts
State Building Code is muse for revocation of this license.
Not valid without signature : _i
For DPS 1.1cerising infomiation visit: v .Miiss.Gov/DPS
X