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43 RAVENNA AVE - BUILDING INSPECTION (2) CK The Commonwealth of Massachusetts RECEIN EUs�R� S $ Board of Building Regulations and Standards JN T SPEC li DR �ITY oo, Massachusetts State Building Code,780 CMR,7m edition ._:. . • W+ i Building Permit Application To Construct,Repair,Renovate Or,"o a? ;A"i edJanuwy One-or Two-Family Dwelling 1,2008 This Section For Official Use Only Building Permit Number: Date Applied;'. / _- Signature F 47� �1 y Building Cammt§sioued Inspector of Bmldiugs Date SECTION 1:SITE INFORMATION - 1.1 Pro a� /�,1,dress: "e— 1.2 Assessors Ma &4lhr"IM m&Ti;i1,o ' �� a v e n n t� J�r p.....�a rytely(I�t Lin Is this an accepted street?yes_ no _ Map Number P cel Number 11 1.3 Zoning Informationo-- 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.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: T Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yeso 'SECTION 2: PROPERTY OWNERSHIP', 2.1 O}}vvooer'of Reco,rrd: / �`I� Ghn-sf-mDh-cv CctyCQ �?i gayenn� C, P-1- 1 Name(Print) ��j� &) Address for Service: �' lu,n l/f��LP I Signabue �— - Telephone - ' SECTION 3-DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ eration(ss))1❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other Specify: 'L✓vSw�R yIL. Brief Descri ti n of Proposed Work : n ,, ., .. Cep G SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only - Labor and Materials , 1.Building $ i 1. Building Permit Fee $ Indicate how fee is determined: 2.Electrical q. $ ❑Standard Cityfrown Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ "• �_ `\ r• 4.Mechanical (HVAC) $ List S.Mechanical (Fire $ Su cession Total All Fees:$ i Check No. Check Amount: Cash Amotinti 6.Total Project Cost: $ �` I W ❑Paid in Full ❑Outstanding Balance Due i)i raxn«« SECTION 5:` CONSTRUCTION SERVICES 5.1 Licensed Construetton�SuH�(CSL) '� D�"� cf 3 �� License Number _ Expiration Date - Name.ofCSLHolde µ',;, tu"tit5,.: (A - 3��S1i0Cf, List CS Type(see below) Address S8]CBI (t]�Q T - � :_'.' Description .`. U Unrestricted(up to 35,000 Cu.Ft R Restricted 1&2 Family Dwelling Signature M -Masonry Only RC Residential RoofingCoverin Telephone _ _ WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation y— D Residential Demolition 51 Registered Home Improvement Contractor(HIC) /y Atianluc WeadwAzatifm_ HE ti s ion Number HIC Company Name g ff�lama6W 'R egi Ad s j w ott1�o Expiration Date - Signati re 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 Me building permit. Signed Affidavit Attached? Yes.......... No...........13 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN. OWNER'S AGENT/OR CONTRACTOR APPLIES FOR BUII DING PERMIT' I, C�YY$ l N CANC-0 as Owner of the subject property hereby authorize / Cr, C ('�, --vi to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b:OWNERr OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Er< < n� ( Pn,i,N Signatureo Owneror Authored genh - Date - - (Signed under the pains and allies of 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.a 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I0.R6 and I IO.RS,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage,finished basementlattics,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"maybe substituted for"Total Project Cost" I Massachusetts Home ICmrovement Sanante Contract This formsa iffiesallhaAo requiremmts ofthestmes Home bnpunement Co micurLaw(MGLebapter 142A),but dosmtincludesmndard language to protemhomeo"em Seek legal adtdce ifnecscary�-ArQ•persan Pbuudng home impme=mm should first obtain a ropy of'..k hlassadluseus Consumer Guide m Home hnprovemmt'before agreeing to myv%wk on yourresideam You may obtain a fvempyby calling the . OEce a{Co smater Affairs and Business Regulation's Consumerinformation Hotline at 617.911-11787 ar 1-229IM3757 or.owwebsim. Homeowner Information Contractor Information Fame Campsm Vxme . C c sues Addrass(d not Pan OffiaBn<• 1 Cmts3tof5 n ,vet,PI atte 61 R Jeffefson�19/AV�ro U Ch,:T�y, Seua ZiP �a BucnesAddnss(vita �U ern 1 Lwl o I`-76 0itY Daymme Phone Ercnng Phone Ciq?awn State Tip Cade dlailine Addre0(11 diffemt from abate) Business Phm< FderalEmpl ctIDa55-\umbe tan wnp,LatLwc-new, aCit t��a4..\'e9e �L=e ., l-PrP�et Ca,atan Y,s - a,aCd tCwatl®cchr The Cantractoragses to do the fallowing work for the Hommnner. ,Dactibe in dem!the uvrt m eamPtned,spxifsine the type,brtttd and grade,£mucirb to be rind,mead MMIsheenffnere -) Required Permits-The ioOawing bmldmg permits are required Proposed Startand Completion Schedule-The follmsingschedule will and will be seemed by themntraaoras the homeowners agent be adhered to unless cimmorpaxs beyond the contractors commI arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of lD 3G Datenhmcontracmrwillhellocontactedswrk YTGL chapter NIL) Daze nban cootamed wad:mill be substantially completed. Tomi Contract Price and Paymeor Schedule - ,s/!" The Connacmms rae to pc*m thennrkfumish the material andlaborspecifiedabmxfor the mv)sum of (2 Vl/ Pa)mmm will be made according to the folloning schedule: 5 —yn)V upon sieving comma(not to ecceed.Ir of the total contact price In the cost ofspeiial order items,whichecaia greater) s by__I_I_or upon completion of s lg6v- by&.'30iAlwuponmmPleumol' / �'✓ W/'+�//�P�j tJ\_ l 5 opoo completion ofdreconmtt (late{'finds demanding full pavraffly no contra'is completed to both party's sakftman) Thefauouiore tha orameuipmmnmust in Order S to paid . ardardouae atemuagedwork bogie in Order to arm the completion sdmdulg") s o� far .NOTES:(•)including ail finance cbMm 1'-)Lasrsequim abm any deposit wdoua-M,;Uat required by de ctnuamer bl,i wank lr el. mar at exttd the ocmrof(.)...third of the tonal Val mzu prim Or the acteai eon ofam•special equipateal-otatom nudesreterial which grim be special arderd in dtancetoa m 0ecompledon uLdule' Es swat h-Is an M.Irgrorym b'mr amided by the cvmad.r? f x ❑T Lill rthe nnom.njrmusth bd a the1 Subcontractors-The comractm agrees to be solely responsible forconpiedon of the wvrk described restardless of the actions of my third pat,y/subcontractor utilized br the commeroc The wnnaaorfiurhaagrees to be solely responsible farall palments to all subcomormors for materials and laborundcr this m _ . Contras attepmuce-Upon signing this document becomes a binding contract ender lase Unless otherwise noted within this document,The camectsha0 not imply that any lien orothersecurity interenbasbeen plamdm thereside ce. Revietvibefollowingmutionsandvotioes carefully before siewtnu this contmtt s Don't be pressured into signing the cmtrdtt Tale time to read and fully understood it Ask questions ifsomethingis mclear. Make sure the conuacmLoas valid H elm roBnmt Con Re ' -o .Thelm requires most home impmtrmmt contrecrors and subcontta'oe TMIeginaed uith the Dbectural'Home improttmm[Conn=Regimadon. You may inquimabom contactor regismtion by%Witing to the Director Or 10 Part:Plan.Room 5170,Bosma,MA 02116 orb),calling 617-9734ig7 or$88-283-3757. P Dos the ceotm'orlVe msuance? Ask-the Contractor forhisilummum company infonnadouso 003vu can confirm cotemme orask to see a copy of a"Proof of insurance`document = Mow you rights and responsibilities. Read the important Information on themerse side of this faro and gel a copy of the Consumer Guide to the Home impratement ContractarLaw. Yau may cmc-1 driesagrzancut ifuhas b�"Un atopaceolhIt an thecontractors nomal place of busiaess,pmlided you ratify the conaz'or in"airing az hivha main,lice orbtmch office by a[dinan"mml ported,by telegram sent or by delitm•,not later than midnight of the dsird business day follotsing the si_ming,Flinn agrxment See the mmcLed nodce oFemcellxdop Form for an eeplamtian pfdtis right DO 1rOT S!GN THIS CONTR9CT IF THERE 9RE APIY $L;NK SPACES!!! Two:ndplejnn,t2-cann_temh_ ' _la eel':ew:TccPsam"✓'-^datetiema_-c. Homeowners Sign Cant-cmes Siloam. Date Daze 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 hoe 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 contractor maysubmit'flie dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Cgnsurger Affairs an Business d Busi Revelation and the consumer shalt be required to submit to such arbitration as ro'viilehVMassachusetts General Laws,chapter 142A. Homeowner's Siggature 1 (/ Contract s lure 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 not 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 manner. Homeowner 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 cane 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 terns of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumerlhomeowner rights.contact the Consumer information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be sighted unfit a copy of all exhibits and referenced- documents have been attached. Parties are also advised not to sign the documem until all blank sections have been filled in or marisd 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 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 him/herself to be financially insecure.the contractor may,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 funds 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 Consumer Information Hotline Office of Consumer Affairs and Business Reputation 10 ParkPlaza.Room 5170.Boson.MA 02116 617-973-8787.888-283-3757 or visit the OCABR vicebsite at :s:'°.:e.v: 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 617-973.9787.888-2833757or visit the HICwvebsiteat::ar,::::v: oear,- Go online to view the status of a Home Improvement Contractor's Registration: - -;;db.;tatasra.uc:iti:T��;r:nravar-a lic 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 APIDIOR Better Business Bureau 508-6524800,508-755-548 or413-734-3114 CITY OF SMY-1 NWSACHUSETTS Al BUILD .NG DEPARTMENT • 130 WASHINGTON STREET,3"FLOOR T EL (9.78)745-9595 FlAx(978)r740 98A6 1QJBFRr EY DRISCOLL T .P�tO&W—STMM LIAYOR PE DIRECTOR OF PUBLIC PRORTY/HtaI;D1NG CO\LNtLSS[ONER WgkeW Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbet s Annlicant information Please Print Leeibiv Name(Dusitxss Organizationlfndiviioot): Atlantic Weatf crization,LLC VCBUC Address: Salem MA 019M City/State/Zlp Phone#: Arc yo n employer?.Check the appropriate bosh Type of project(required): 1. -I am a employer with a.5 4. ❑ I am a general contractor and;l 6. ❑New construction emp toy ees(full and/or part-litre).4 have hired the sub-contractors,' 2. 1 sin asoteproprietor or pattneY listed on the attached sheet : [ Remodeling ship'aadhavent crnployeea..;:." These subcontractorahave a. C1Demolition - working for mo many capacity. workers'.comp insurance:" q, Building addition (No workers comp msutance' S. We are a corporation and its 1 .required officers have exercised thou, 10.0 Electrical repairs or additions .3 ❑ I am ahomeownordoing all work right of exemption per MGL. 11.❑Plumbing repairs or additions myself.(No workers.comp. c 152 §1(4} and we have do 12,� repairs insurance rcqutmd j t employees tNa workers' 13. Other 14 comp.His ra ace requutA.j -'lAny applir m that chocks boibl l moat aiau fill uurtlic=ioo below.showing their workers'comm peatf on policy mfom attom r l hvneaurm"'who iubmil this affidavit indicating,they ate doing all work slid then hiro yauida contractors mot pultmita new alQdavit indicating catch. �Comrwioratlot cheskihif box moat a)Ixhed an adlliipcwttltaet showing lha name Qfthaneg aa sontrao andthek worken`wmp.paltry lnfomiaticn. !am vn unplayer that is provldlag workers'rompsnsadan htrurance jar My tonployeex Below is the policy and Job site hijormartar4 - - tmurunce Company Name: IAII Policy.kor Spif ins.Lic.H: Expiration Dste: 3 1Q Job Site Addrtssi City/State/Zip:S�l �d� Attach a copy of the.workers'compensation:polley declaration page(showing the policy number and expiration date). Failure to s sure coverage as required under Section 25A of MGL c.,152 can lead to the imposition of criminal penalties of a fine up to SI,Sd0.00 and/or one-year,imprisonmenr as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to:$250.00'a Jay against the violator. Be advised that a copy of this statement may be forwarded to the Office of Invatigatiunsufthc DlA roriiisurancecoveragcveritieation. l do hereby rrrpm^/0 lj-tder thapitilt 1aAVA /,�rp'{d rah/es ojprrJary that the hrjonnatlorn provided aB ve IS t e oad correce $11.n Wore'- 9 ^'') 111. Date:- Ja' OJjriat aseonly. :Do not sprite in this area,to be Onrpieled by airy or town official City or Town: PermitfUcense# Issuing Authority(circle one): 1.Bourd of Health 2.Building Department 3.caytrown Clerk 4.Electrical Inspector S.Plumbing Inspector ' &.Other _-- Contact Person: Phone#: '4 CERTIFICATE OF LIABILITY INSURANCE °3110110/'201414 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(ios) 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 andorsement(s). PRODUCER Construction NAAME:ME, Eastern Insurance Group LLC PHONE , (508)651-7700 —F(AIAX Nok 233 West Central Street E-o IL SSI INSURERS AFFORDING COVERAGE NAIC d Natick MA 01760 INSURER AArbella Protection Ina. Co. 1360 INSURED INSURER BArbella IndemnityIna CO. 0017 Atlantic JeffersWeatheron Avenue INSURER C14autiluS Insurance CO 61 Rear Jefferson AVen110 INSURER D: INSURER E: Salem MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER3taste: 2014 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. NSRODE SUGH Im TYPEOFINSURANCE POLICY EFF POLICY EXP POLICY NUMBER M MR) LIMBS GENERALUABIDTY EACH OCCURRENCE 5 1,000,006 X COMMERCIAL GENERAL UABIUTY RMISESEa or ertoa S 50,000 A CLAIMS-MADE X❑OCCUR 500042816 /20/2014 /20/2015 MED EXP(An one person) S 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE 5 2,000,000 - GEN'L AGGREGATE LIMIT APPUESPER; PRODUCTS-COMP/OP AGO S 2,000,000 POUCY FZ PRO. LOC S P OMOBILE LIABILITY CEO aBINEDSING LIMIT 3 1,000,000 Yen BANY AUTO BODILY INJURY(Per Person) S ALL OWNED X SCHEDULED 020025871 /20/2014 /20/2015 ( ) AUTOS AUTOS BODILY INJURY PeraWdent S MIRED AUTOS X NONoWNED —PROPERTY—DAMAGE AUTOS Per 'dent 5 PIP-Basic S B 000 X UMBRELLA UPS X OCCUR EACH OCCURRENCE S 11000,0001 A EXCESS LWB CLAIMS-MADE AGGREGATE 5 1,000,000 ED RETENTIONS 4600OS8654 /20/2014 /20/2015 5 WORKERS COMPENSATION - WO STATIY OTH- AND EMPLOYERS'UABILTY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE - E.L.EACH ACCIDENT S OFFICER/MEMSER EXCLUDED? NIA (Mandatory in NH) E.L DISEASE-EA EMPLOYE 5 "PISS DC WOhNa O PERATIONS trom EL DISEASE-POLICY OMIT S C POLLUTION LIABILITY PL200378602 0/1/2013 O/1/2014 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS i LOCATIONSI VEHICLES(ANaeh ACORD IOt,AWrdonal Remarks Schedule,If more space Ls mquhed) i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SALEM ACCORDANCE WITH THE POLICY PROVISIONS. 93 WASHINGTON STREET SALEM, MA 01970 AUTHORIZED REPRESENTATIVE Ronald Cleaves/SME 1 �r ACORD 25(2010105) 01988-2010 ACORD CORPORATION. All rights reserved. INS025 iminrvM The aCORn name and Inn^aw roniafered mark.of arnpn TuEju uan 1TJ-1 J/1L/LUlY "/ :ZL/ :0'1 AM YAUr J9/Udti PB.X b6Y'VBZ' A �® CERTIFICATE OF LIABILITY INSURANCE [�O�Al.=4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT FFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIi 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(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the party,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endoreemem(s). I PRODUCER CONTACT NAME: EASTERN INS GROUP LLC PHONE FAx 233 WEST CENTRAL ST NA EMI: AIC.No): , NATICK,MA O1760 EMAIL _ INSUREyS)AFFORDING COVERAGE NAICA INSURER A:AMERICAN ZURICH INSURANCE COMPANY INSURED INSURER B: ATLANTIC WEATHERIZATION LLC INSURER C: 61 REAR JEFFERSON AVE SALEM,MA 01970 INSURER o: INSURER E: INSUflER F: CERTIFICATE 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 EEE 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 AOD SUS POLICY EFF POLICY EXP LTA INBR WYD POUCYNUMBER MINDOM/YY MMiO LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S CIAIMb-MAOF a OCCUR MED EXP UA wepnwnl S PERSONALSAOVINJtlRY 5 GENERALAGGREGATE S GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPA]P AGO S POLICY PRO. OL S JEOT AUTOMOBILEUASILITY MBINEO SINGLE LIMIT S ANY AUTO a aaadent All OWNED SCHEDULED BODILY INIUAY(Per pawn) S AUTOS AUTOS BODILY IWURY(Per awdent) S HIRED AUTOS NONOWNED OPE Y AMAGE AUTOS S S UMBRELLA LIAR OCCUR EACHOCCURRENCE $ EXCESS UAS CLAIMS-MADE AGGREGATE S CEO) RETENTIONS S WORKERS COMPENSATION ' X WO STATU- ANO EMPLOYERS'LIABILITY YIN TORYL TN. X O ER ANY PROPRIEtORTARTNER/EXECUTIV�OFFICERNEMBER EXCLUDED? Ir,O NIA E.L.EACH ACC IOENT 6ZZLIS 03-20-2014 03-20-201$ $5()0'000 (MaMelmyln NH) BB270121 EL.DISEASE-EA EMPLOYEE $500,000 IIymdeavib under DESCRIPTION OF OPERATIONS lxp E.L.DISEASE-POLICY LIMIT $SOO,000 DESCRIPTION OF OPERATIONSI LOCATIONS/VEHICLES(Ah¢h ACORD 191,Addabnal Remarks SAHeduM,H mono spaW Is required) CANCELLATION CITY OF SALEM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 93 WASHINGTON ST CANCELLED BEFORE THE EXPIRATION DATE THEREOF, SALEM,MAO1970 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1986.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i 1 ! Massachusetts-Department of Public Safety W Board of Building Regulations and Standards Construction Supenisor _ License: CS-087977 , ERIC W PALM `' r 3 Salemlem MA MA 01 019707 Fxpiration UIV c Commisssiionner� 0412312016 • c✓J/re�mnruauroerr�!/a�PJl�rrsanrwtelh Of<ce of consumer Affairs&Business Regulation ex, ME IMPROVEMENT CONTRACTORType: istration 142089piration 3112/2016 Ltd Liability Corpo: ATLANTIC WEATHERIZATION LL.C. s ERIC PALM 61R JEFFERSON AVE' - g�6�-- -- SALEM,MA 01970- Undersecretary i