7 RED JACKET LN - BUILDING INSPECTION (2) q1� cr- -z�f�
The Commonwealth of Massachusetts
Q Board of Building Regulations and Standards {CIAA�TY OF
WMassachusetts State Building Code, 780 CMR i�1b Revlsed Eff-
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 A lied:
Building Official(Print Name) Signature Date
pe SECTION 1:SITE INFORMATION
1 PA LANE SALEM,MA019 7 0 1.2 Assessors Map&Parcel
7 RED
DJCKET NTIq '�0 3-8 6 2
1.1 a Is thisan accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: CONDO 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) 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 Rood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if yesEl Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
SABRINA FEDERICO SALEM,MA 01970
Name(Print) City,State,ZIP
7 RED JACKET LANE 978-979-3227
No.and Street Telephone Email Address
,SECTION 3:DESCRIPTION OF PROPOSED WORK'(ebeck all that apply)
New Construction❑ Existing Building 16 Owner-Occupied Rf Repairs(s) If I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other Specify:Replacement
Brief Description of Proposed Worle- REPLACE 5 WINDOWS & 2 DOORS
NO STRUCTURAL CHANGE
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:and Materials Official Use Only
1.Building $ 13, 084 . 00 1, Building Permit Fee:$ Indicate how fee is dotenumed:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier a
3.Plumbing $ 2. Other Fees; $
4.Mechanical (HVAC) $ LisC
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 13 , 084 . 00 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 90125 10-0 6-16
Jamie Moirn License Number Expiration Date
Name of CSL Holder U
86 Gardiner St List CSL Type(see below)
No.and Street `Iype Description
Lynn, MA 01905 U Unrestricted(Buildings u to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP. M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2214 1 Insulation
Telephone Email address D Demolition
5.2 Registered Rome Improvement Contractor(HIC) 170810 12-2 3-17
Renewal by Andersen HIC Registration Number Expiration Date
HIC Company Nme or HIC Registrant Name
30 Forbes Rd
No.and Sheet 508-351-2214 Email address
Northborough, MA 01532
City/Town,State,ZIP Telephone
SECTION 6:WOREERS'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 of the building permit.
Signed Affidavit Attached? Yes.......... No...........❑
SECTION 7a:OWNER AUTHORIZATION TO RE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Jamie Morin
to act on my behalf,in all matters relative to work authorized by this building permit application.
SEE CONTRACT
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby un the pains and penalties of perjury that all of the information
contained in this application is true d accrue[ to the best of my knowledge and understanding.
JAIME MORIN of
Print Owner's or Authorized A s_qaa1QEIec sic 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
mmLmass.eoy/oca Information on the Construction Supervisor License can be found at www.m-qu-g v/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch)
Gross living area(sq.it.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of haWbaths
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"
,i CITY OF SALEM, MASSACHUSEM
Bt:1LD=DEPAmtENT
130 W kMINGTOPI STREET,3'a FLooA
TEL (978)745-9595
FAR(979)740-98"
KLMSERLEY DRISCOLL
MAYOR TROittes ST.PmttRB
DIRECTOR OF Pl;BUC PROPEM/13UUMtNG CONMILMONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code,780 CMR section It 1,5
Debris,and the provisions of MGL c 40,S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111,S l 50A.
The debris will be transported by:
Renewal by Andersen
(name of hauler)
The debris will be disposed of in :
Renewal by Andersen
(name of facility)
30 Forbes Rd, Northborough, MA 01532
(address of facility)
Of permit applicant
date
dcbrimff.drc
RaFers e�nkriamal illy Aunknen at Dwain
wl Agreement Document and Payment Terms
kefirinn Fndiakil
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Riieuty 17 L d:SJI'112470YdhOo.toln SE+tLnnrlarx fttYail-
Dwy+elan hereby prd wly:anti'sewrrally,agrces ro pumhoc.Ahr lrlc:titlnro andhor sctwicea of',Rcocneal by tiladrumn,tl.cila IRenewd by
,aIB11Ir1 ALTI adI'RrrxllllYl"l.ai,YeAx{L r',II al a0V0l LIILILi.Y'WhK Elie Arlmv and Luttlitlona dlrltrihr=d Ili AIIIN 7`pe4t ctil Dwellt lefil arld ltayntrnt
°li tri Nii of i`aaiirlLimili n Chit .14911m A, Icrnui�.nd t;nnAl.lAillnn nF Lilt, 'ratl+'et:
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irroargnantca 1lcnelYt IYy rch,tence�{cnllectivcly.Alrls"aLrt,teiltetl7"i. 99tlk+eclxl hct¢Ix,!~ap�tmerlo xiN,11 a cn,ullileciolr crrtilicaAc attee{lnnttae[tla IYat
coMoeced ill mirk L1ndCF this Arru mnent.
TaL2E J6 r.AnVllLIYL: S13,084 Fw ftt■iorg shic agrrwmuuA,yt,uat:l:nun+: llge Char tlyc R IaA1xe. Ar;.amtf:e11e,4aooArltt
Filuaneol ApIrA55 In 111ar1e 4"r arpi�trukn ila ik chi txc liw cud,Yarcash-
lk�oirsie 9tt-t:+t:lvdsd: SO
1ysl.mrr93nc1 $13,084 IAuinYaltrol iTar1; 1'`.tuinwtttlGkIII&IklPl
A4anonni Flan Yectli S13,084 ii weeks 2.3 days
i$l"hod of ll:lyanvilia: Finanting We sclt UIC i nuallations b mcd un the hate of Elie Aped contraac and secondarily on
the due in which we onrrl leca the seernied The enstalladon date time
Nnans--Flnanee plan 6060 wr amrpr*YWing at this time is onla•aa.cnirri%lie will communicatean official dace
113 deposit 54361 Arid state al a lacer daw. Nda and raeteute weadver are A w initnt contemn aiii But
I I3 start.of Joel S4361 c3elyv. - -
113 substar}Siu1 complAation
S4362
Puyetis)al;Ices and undernlands dint this Aµwnaclll constiLlltes she etallm dLtadelvta Wh4--,,s b0iWen the ptandesand duct Ilacre are rar+ethal
Yutdcv5larrdiolr{ClLalt tit 6 01 n■rldn'k hlg Altyr of tht'ACtlliA nl'iLtliii Ai;wcnkei;a. Ndr alreta:Llana l i ur dcvkmiutla fcunr this r`g cmunt will lie i-alld
mirltclut thit,06wA,wri,twri vwpSenT(if limit The Binrcgiw and Contra¢tor. 15uscrii IYcrek,ack:nvaledgen tPLat I user{Ft I)has rend this
AgAeelment,understands the tttE.s ci this Agteme;c.aad has received a conipletetf xru•:A, and dated colt+c i51;s K99"ent,including
the Ei attached Notices aFiC'�uneel laiinn,on the d: rc ifiant wrirtan ali and m)veils Orally BnFnrr i of Boat ds r0t rn cancel this
AVeclrrcnt. -
NILI tl ICUK'1'r,'y 4'1NWNIy.R: l tan sly Yl LIAS eontrzem If 61uwk-Ynu aw entitled,AdrA CUP)'-4115C OnilliPlsl:at Ilan.limit yswl sij5u,
YOI7,TIII;B[WR, MAY C;AIWii TM IS°I RANSAC1'1C7N AT ANY"TI M I'. NOT LATER T14AN M[DINIC;HT
OF OSd 1.012016 ORTHE THIRD BUSINESS DAY AFTER TH.E DATE OF THIS TRANSACTION.
XTER.SEIy4kW ATTACHED NOTICE OF CANCELIA'TION FORM FOR AN
MS RIGHT.
SgtYsrwn ttf:Salcsl IAtirt SiAlwore SII[IYaLLIfi
Stove Palarmo Sabrina Federico
aute4)fSdcs Nri nil Kim NAnrr Milt N;u at
Ll=,aar 16 Pace 2 1 16
R jew l Itemized order Receipt
AUerSen 4"Rt iiwal lrr Amdtmen uF H�too. Sstrlme F41d4d;o-
tapir etame Rerimal llt'Araigrwi tv: tent jacket lace
1.70810 5alrrn.w 41970
�amaw au ,.r.... 30 Fset;e:-'Food 1 I'vili Grod4h,aiq.r�i532 " P47&}9?9-,3227
Frei :5Q -3:,7-22009Fa,i:la09h Ycc.7r772irW Eo51q±IGk^B'atl.n<�9 s9�r5enf.RrP R111 .
101 Dining 'Wlndiswt Gliding -Doubles, Glyding, 1:1, Pa5srvk,A Atiruv. BaNL
Franiv, I:RTIRIQR Whge, INIeRrpR Whlvi ,.Crlafa:$ao-, All: FI 9h
Perfarmane SmartSun Glass, NGPattern, Hardware[White,
Screen: TruScene vrith E'Fterirar Color Match, Full Screen,
Grille Style; No Gr:ilhe , Misc; Non
102 I.ivInq Window: Gliding -Dou7alr`, Gliding, 1:1, Pas,,tav F Acirvo, D,iw
Irani-, l`x10110,KWhat. INT(AID1i 14tftile, Glass.: Sash AII: High
Performance SmartSun Glass, AND Pattern. Hardwares.White,
Screen: FifaergAass,. HY3 5• reen, Grille Style.0o Grilles, Misc;
Orin
103 KitclU-1 Window: Glidlnel -b4UblQ1, Gbrinlr, 1.1. P,bssist laYtiwo, r;no
Iminr, I ktf;ItlpR Whge, IN1l Hl(]R Whijo, R6.ss $rsfli All: FIIiJNS
Performance SmartSun Glass, MD Pattern, Hardware; White,
Screen: TruScene ytiyh Exterior Color Match, €fall Screen,
Grille Styles No Grilles,Mi5cs Non
104 Bedroom 1 Window: Gliding - Double, Gliding, 1:1, Pasuve 4'Aciruc, Biaso
(faro[, l"X1f.ItitSlt WhIt., INn Htt0li White, Glass: Sash All, Plig s
ferl'ormance SmartSun Glass; No Panergn, Hardware: White.
5creen: TruScene vnih EXlerior Color Match..Halt Screen,
Grille Style; No GriiPes,Miser NDn
105 Ba1hroofrl 'Window, Gliding - Double, Gliding, 1:1, Pa5st%v i Active, Base
drartre, EXTERIOR White, INTERIOR Whilo, Glass' StOi All: Hlglr
Pnei�+m, hce Srn,irtSun rjlass, Nu P,:nturm, retrilxtml C,lrris,
Hardwaro; Whitt', Screen: lruktne with:€ttedbor Coto+
Match. Half Screen, Grille Style; No Grdli s, Misc. Non
05105a16 Paae 4 1 lea
ewa1 Itemized Order Receipt
liv
_e er J6aa RaorwaiiIjp r ridme b of flowtsn #d`brinP HndirdKa
tewr@@ame RE-TwAralIIYFn+efselLtd: 7Rt*jla4kethim
17061D °. a n.Mu 6) "m
.:mrr. u ��crarer 3J'`•9+tu5�x�IP10�iIlEIN9U911,h'Ir�,fuGy32 F i97&�79-�227
More:535mH21-2200 IFac 1398P 5'e&7072 I RbkEO5i9nGyat±at�cn<�ai�s32�enCDtp.4Rftm
1O6 From door Ullse. 'Add Him, Emir door.wo iwa:h d Orev
107 Fran! Misrct 'Acid HLAv, Sturm door, zee attached shEE
VAN DOWS_S PATIO DOORS,0 SPECIALTY,m MISC: 2 ToTA $113,084
UPOA,TED. 0510506
kewmvr1 by A4d4-rnru Or roommimod fir ape 4rMiwwrri'lr00 �p
�rl7l .. .,f�witi��ri'n��Aih rdw vulri.furl,fr,r�•A.�i uwih yorNitOrt tfrc,�ke.f d;F T1Fr 1�1'AI.
G.Byf�3571 Si Palle 5 j 16
Condmih,dun? Ti-ust
May 27; 2016,
K% 1l6an LaBaire
lk nwwtil fly,Andef$on.
30 Tarbes Raid
Northborotmgln, M.A 0 1532
RE. 7 iced Jacket Lane, Salern, MA
Dear Mira 1:,tBnim
On Ochtilfofthc Htfmlct Trtostees.Plefasc ttueelit thi i let'eer girt notice orftPproved"
uoricnrning thm window and door artstfil146011 rCalueSt for 7 Red Jackot Ltftte(Sabrina
Federico)
Approval is subject to tho rcplacc-nent of the windows and doors with identical
(amthctically) %vi.ndows and dons that c.urrerat y exist at 7 Red.Jacket Lane and
throughout 1•larntet Condominium
The cwnar 00 Red J cket ha3 tnutlturitruiorn `ffint the PODIA frf Trusteos Co mek PUtil,itm
to carry out tltta Proposed h utl tation,
Should you have any questions,please contact this ofiec at 978-532-4m—
S c NY
PlnlEnl� traauart
CROP TINSRIELD MANAGEMENT CORP,, As ;w",Sing Agent for
Hamlet Condoattinium Trust.
Afm is qj rf v? urrn,1ri rif Lira .. ta>'Erw inomlS z Pr'.SP,rr i l: T a&Nly,'141 rf_7P7[i
TO PtP 07--0 532-4-'?4C - f: t, i97'dits, • vrlsr,'X4-aTVnfnxl ergrc m
The Comatoatarellh of hlossaehtneras
- Depe:Mmitt of 11 dMtttw ACddenmas
Qh%e adrlmes4gatlow
600 y itsi►fngrott greet
Boston,x4 02111
wommoss.gm+,�dla
9vorkers' compensnlitn Insurance 1 ffWavit;DuRdetWCantmetors/ElectiWansfpWatbeas
AttWdyayt Inform atEon i'teaa"t'rct Z V
7`9[ne�liusineasliVgecirationMdi.idue i; RENEWAL BY ANDERSEN
Addre&S: 30 FORBES ROAD
C.ity1StsW7-ir' NORTHBORO•MA 01532 _ ]hptle i?;-508-351-2200
Are-,ou an empbyerl Coeck etc appropriate box: 7}p,e of pr*,rt(requiredy.
I.tJ I am a atupleyer with 30_ 4. 0 1 am a general.vrmactor and I 6. 0\ew caishvNion
employees(fw7 andJor pat-time)!' have himl the 'subcontractors
3.0 1 am a soleproprietor orpatner- listal tm the attached:dwrt VRemodeling
ship and have no employees These sul-ixmhaclars have 8. Q Demolition
working for me in aro tWttcjty_ Wodws,comp-insuranx. c.
[No workers'comp.insutaace ;, We are a corporatjon and iL 0 Building addition
required-) officers have exert sai their IRLc Electrical repairs or;tddilkyls
;.[ j 1 am a homeowner doing all Bark right of em-kiption per M G1. 11:0 Plumbing repairs or additions
m}self-INo worWrs'comp. C. 152,f 1(4),and we have rat 12.:,3 Roof repairs
instaance ragait�l t employees.[No Workers'
,mmp.inonance mquired.l i 13,[J Other--.—_.-__.--_--
'ARV 044 enw that ar&,.tan e i a.tat aua:fill cot the vzfirm hch.a shotrew tixtr wvrk:++'rarvxaaum poirey:arurm&t:.
Ikxaeim&?n,who+:�thkaKdavaiadiva zbn,r.;:doW all%"find don itaenurii:wuraummeuauhmnaa MTUUvhahlusnap,sW.t.
^Cw bwfta me.'Wd th%hex.mat peened w addit«aal suv0,4 i wmr lea nm ie of tric wb+antrsmr:.and Om vwmw 'comp pwicy tithw7 ,tkat
I am an employer that is proms workers'cotttpensudon b►sa aurae j`or aa9•employees. Nelor h the poNcy akAjob she
hearzoddem
lnsttrance Ctmnpanp Nane: OLD REPUBLIC INS. CO.
Policy t?or Sel%inx. Lic. ;_.. 1?xpirat;w Hato: 10-01-16
Job Site Address: 7 RED JACKET LANE C,jt,;5targ,:Lip.SALEM,MA 01970
Attach a cap of the workers'compensation parr decigmtit a page(she WIM1g the poIk) munbe.read esplrsttion deer).
Failure to secure coveiage as required andrr Seaton 25A of h1GL c: 152 can load to the cnposition of:rirninai pertxhi.N of a
fine up to$1 500.00 aidior untsyear imprisonment,as well as r:jvil penalties in the fo.rn of a STOP WURK OMER and a fm
of up to S250.00 a day against the violator. Ho advises:that a copy of this sratmetetu may be forwardad at the Office of
Irvestigations of the 1NA for insurance covvrage vent?cation.
I
I do hereby eat&nadrr the pacts amlpenalhIrs ofperjagt dW the bujk0MWAW ptvtlded ebene k Mw and comet
phi 508-351-2200r_ - -- _
O#kW are only. Do not write in tbit ores,to be romphted by r!(p or town oAeded
City or Town: PernWi.icease to
Isouiag Authority(airck one):
1.Surd of Health 2.Building Departuent 3.i h).7'owo Clerk 4.EkeU*W Inspector.S.Plamblog Iuspector
6.Other
US:ontact Person;
I
ANDECOR-01 YADAVYO
® ONTE(NINDpryYYY)
CERTIFICATE OF LIABILITY INSURANCE 10/1/2015
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 INSURERS),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WANED,eubjeet to
the terms and conditions of the policy,certain policies may require an endorsement A statement on this caracate does not confer rights to the
certificate holder In lieu of such endorsement(S).
PRODUCER CO RAMEA� Willis Certificate Center
Willis of Minnesota Inc PHONE c/o 26 Century BQ Aq� 8T/ 94S-7S78
N : SSS 467-2378
P.O.Box 305191 catasdWIlls.com
Nashville,TN 37230-b181 INSUREIWJ AFFORDING COVERAGE
Iwc3
MWRERA:Old R ublic Insurance Company 24147
INSURED INSURER B:
Renw.val by Andersen LLC INSURER C;
30 Forbes Road INSURER D;
Norfhborough,MA 01632
INsuRlx 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 NAMEDABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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.
INISIR SUM
LTR TYPE OF IISURIWCE Poh NUMBER IMMIUCYYYYYMIpD EXP LIMITS
A X COMMERCIAL OES?RAL LIABILITY RSIGM
RENCE S 1,000,00
CLAIMS-MADE OCCUR 305440 10101/201S 10M12016adca,,,eride 3 500,0
dne pB,Idd 3 10.
ADVINJURY $ 1,000,00
GENL AGGREGATE WAR APPLIES PER GREGATE $ 4.000,0011
X POLICY j�T Lac COMPIOP AGO S 4.000.
OTHER: 3
AUTOMOBILE LIA9LIT! EPINEI GM LMR S 5.000,0
A X ANY AUTO MWTB 305438 10/0112015 10/0112016 BODILY INJURY(Pepwsan) $
ALLONINED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per ) 4
HIRED AUTOS �O-SWNEU Pdr Goddentl 3
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UMBRELLA LAB HOCCUR EACH OCCURRENCE S
fJICG89 LAa CLAWS-MADE AGGREGATE $
DED RETENTIONS 3
TNDRKERS COMPENSATION
AND ENPLOYERS LIABILITY YIN X STATUTE ER
A ANYCERNAEETOR/PARTNDED? UTIVE MWC30S43700 10/01/2015 10/01/2016 EL EACH ACCIDENT
OPFICERMEANBER f:XCLUDED'! N❑ NIA $ 1,000,
(MNMdhgIn
NHI
da>xlDa uMer and EL DISEASE-IA EMPL 3 1,000
rc yam,
DESCRIPTION OF OPERATIONS babes E.L.DISEASE-POLICY LMR S 1,000.00
Dfi3C1UPTON OFOPERATI0N8/LIXU1710N8/VEIICLES(ACORD 1U1,Add"bdud RBddr Bebdduh,my Ma IHHJ I mdn W -h mquhdd) ;
i
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORED REPRESENTATIVE
EWdenee of Insurance
C 1958.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ,
{ Ma;seohusetts-Department of Pubes Safety
Board of Building Regulations and Standards
Construchon SUpenizor +}
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ME IMPROVEMENT CONTRACTOR
Registration;:4-AM10 - Type:
Explradq�€.'J: Supplement Card
RENEWALBYANDL4il3fkid C'
JAIME MORIN
30 FORBES RD �-� •>
NORTHBOROUGH,MA 01532 Undenteretary
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