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8 RED JACKET LN - BUILDING INSPECTIONr T3 - t-t - IID2 `ffoo2t s� 55"° The Commonwealth of Massachusetts 0 ° Board of Building Regulations and Standards"t'tM A P CITY OF Massachusetts State Building Code, 'ffl%JR 1Uta� .ir a r -' SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or D m�1is a.!. One-or Two-Family Dwelling 1114 OC1 2-' Awl' J , This Section For Official Use Only Building Permit Number: Date Appli Ion Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers �,,..f �n c_k of La ✓1,e I2 006 3- i?sS L I a Is this an accepted street?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.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private ❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: dhvi,.t Qr llacher S, Iem ,�Vl Gme Name(PrinW J 1J City,State,ZIP Y Red --&zckef Road '79V—r�l/OJ6 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building W Owner-Occupied IN I Repairs(s) 1$ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ® Specify: eji f Brief Description of Proposed Work': l� eg1,r:5, a roar- - tiy sA Ica ura l GU, H y- SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only Labor and Materials 1.Building $ y, 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑ Total Project Cost' (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $.7 Md o a ❑ Paid in Full ❑ Outstanding Balance Due: �E4JT 'to PNDi=.'R:�ot�1 i0�24� SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) of G t 2 S (G -4 T.ZO I y �G I rr R- 11' t CI t l V1 License Number Expiration Date Name of CSL Holder -f �ii List CSL Type(see below) U �(e Q6LrU 111 e 1- ST No.and Str Type Description I CIO J� U Unrestricted(Buildings u to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/TJwn, State',ZIP M Masonry RC Roofing Covering WS Window and Siding (� SF Solid Fuel Burning Appliances .�b 2SL2X 1 1Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) i (� I 170g 10 tZ'Z3-/S e ,e,q ewg I 6 V ('� hld /'SPr1 HIC Registration Number Expiration Date HIC Com y Name or I Registrant Name 30 Ti r un es 1 No. Street nn Email address nr � ho�o , MJ DiS 3Z D'ok 35/-aaOQ City/Town, 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 of the building permit. Signed Affidavit Attached? Yes .......... I@' 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 �a I M 2 1(�r�O r t Pl to act on �(my behalf, in all matters relative to work authorized by this building permit application. Ap'Ic4 `ia oagi -er Print Ow er's Namel(Elebilronic Si lure) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby att deFthep; ains and penalties of perjury that all of the information contained in this apppliication is true.7accuratest of my knowledge and understanding. IY17e \t �Urt 7- 3/ - Print Owner's or Authorized A nt's e(Electronic Signature) Date NOTES: 1. An Owner who obta' 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 www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos 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" i CITY OF SALEM, 2NvL-kSSACHUSETTS Btii.DLNG DEPARTMENT 130 WASHINGTON STREET,3�ELOOR TEL (978) 745-9595 FAX(978) 740-9846 KnmBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING CONMIISSIONER 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 111.5 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 150A. The debris will be transported p by: / 1\C/le")- l ��l NlIcIer5eo (n=6 of hauler) The debris will bef disposed of in : e17euJa ( Dy n/lC'G/'sa 11 (name of facility) �,f � drbeS I�oIep. Lr I� 6o,'0,A9 G( 53Z (address of facility) lure of permit applicant date dvbriyirdm Renewal MA Home Improvement Contractor License#170810(Expires 1 2/2 3120 1 5) bY/�fldr?fSefl- N,<rea �m Renewal by Andersen Corporation Federal Tax ID#41-1918413 ae. ..a.-a...., 104 Otis SL Nodhborouah.MA 01532 (508)351-2200 FDA(5081-986-7072 CUSTOMER WINDOW AND DOOR REMODET GAGREEMENI' Bu er s Name Date: NANCY GALLAGHER JULY 9,2014 Buyer(s)Street Address city State Zi Code 8 RED JACKET LANE SALEM MA 01970 Email Address Home Telephone Number Work/Cell Telephone Number 781-244-2126 Buyer(s)hereby jointly and severally agrees to purchase the goads and/or services of Renewal by Anderson Corporation("Contractor'),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheetjs)(collectively,this"Agreement"). Buyerls)hereby agrees to sign a completion certificate after Contractor has Completed all work under this Agreement. Total Job Amount $ 7,140.00 scroom Flnametl$ 7.140.00 Est Start Date Method of Payment Deposit Received(W%)$ 0.00 10 weeks C Check/Cash Balance Stan of Job(M%)$ 0.00 Caesar M dianM$ 3,570.00 Choo`a Balance on Substantial Al subelamlel Est Install Time 0 Credit Card Completion of Job(33%)$ 0.00 completion$ 3,570.00 1-2 days u credit card ls®bdaq Please sae CretlH Cool P era lore Buyerls)agrees and understands that this Agreement constitutes the entire understanding between the partles,and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed,wriNon consent of both Buyer(s)and Contractor. Buyerls)hereby acknowledges that Suyeds)1)has read Mis Agreement,understands Me terms Of this Agreement,and has received a completed,signed and dated copy of this Agreeme it Including Me two attached Notices of Cancellation,on the date first written above and 2)was orally Informed of Buyer's night to cancel ME Agreemerd. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Andersen nCCorporation /�//y/�t Buyer(s) Buyer(s) By: \riu(-iWl L-Lr4�U.LC/ Qa Y�1/ Signature of Project Manager Blgnature J Signature ROLAND PELLETIER NANCY GALLAGHER PrimeU Name M i'mjact Manager Primed Name Primed Name YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION ATANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAYAFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTCE OF CANCELLATION FORMS FOR AN E%PLAHATON OF THE BMW.. NOTICEOFCANCELATION NOTIC E OF CA2Cn1.ltVON Ootevfluesso m )/9/11 Vnu Wry camel Mi, Dot—fTewoemn 7/9/I4 You Wry eoneel We oetinv,withnvt ovy pecod,. eNgvtiw widths Wree bucici do"6om Her gwithout mypeealty tie v64gatioq wiWiv the,hugivne doys 6vmthe above dote.If you ot-1,avy property rroaea Iv,say po co—ts made by you cede show dote.If you cancel,any Property traded in,ovy pvymmto mode by you code, Ue Coswct of sole,mtl or,mgotishle inemumest eoeeuted by you sill be Me Cmreoet ar Eale,vsd my vegorioble metrument ezecutetl by 2ou sill be eetuenea aitbiv lD ae Me n fn Bowivg rew:pe bycrii vat of etrostei Tam I reheneaw:,b:nr.a aid rmnwmgrencert the cenwt of ecretonfyam con-led. sea�eer.eca.iN Interest oeloivg rat nr Me trm nv a916e cAan ties ey aern.ihiat ar:.:vg out er Me trov..ce.ov wall be anceled. I(yav cenrol,you mvetrookeawaabkbtheedlleeMseedbe idenegin ulesta—eledeRy yoscoomel,yoaemn mk reached,say SdsdettrereroToo order .nbemdvlly..tines mndis®mwTeen rece:wa.mygaaa.aeliwreamyoa arise l oasConcely..gala mryid® ..xLenrewlwa,my gesso,inweeai,se o mar Scotreacto,terretersm.Sir col goods or thr Se.W.repoaiomortbe thisCoatracloe SalMee:ese.shicor.ofou Beer,ff a.Foods or eS.tbeimtmninmor the isk Iny—do rMivg Weremes,"bl,t Me egooseM Icetartd,,petpandrisk. In .docrooie, ertwnalobb, rof Negoodsmreell—'eezp.Ipi see en, Ifynu do rooks,Meedoou of"or to Me sense ovd Go M.6,you does-Weir dtemse Ifynu do do"of good,moOat mice S.of C. Had Se ae res,cotpiok ehemap of Me ccessw0 days atbesa ay Author.Nada o(CmIt.Are to may Fred.We dispose ofHi,Vdaysof to tloor of yficaer Notice of CIf".DO to numoye oce or ds available ofthe ant,at ifTtscre.toestate dhe a. Insole ye se StemvYe ord fee to o doo,Mr. or Me gootle—ff To svy ru teecare Me g. le-der,start, sed We gaodoa,decte tn the connote,a,a'you agree to estate Me gandamtee Sege, eCooa me. so,ganc mdtectors, obl,ymegreemreee of so ogge ... oke theC Orade sgdtm you remsbeeksi, e,peRonsanm i,Jl cred dou onded WrCwtmct.To can- you rtmaocurs, ,—doUreveeifed obggadnvo cedes the eme-Tr.Ta cmere orior s yothe wri lnede4r s—damdmdto to Co copy occorn emesWdm nndve this mye6cdm,munodm, w,asigmdmddnedanpyof this cmeeOWov mtiee say other weittenmugh, s 01$32,BYNOT Contranon RenewY by Mdenen,I avy9 St. cerise-ogh,ALL 153,eBYNO LATER HI MIDNIGHT Avdeexq 1a9 Oue SL NoMb-cough,MA a1592,HV NOT IATER THAN MIDNICFIT OF (01 Oua EL Nveehhmnvgh,MA p1592,BY NOT LATER'1'1(AN M(DMCHT OF 1/I2/1t .(peal INEUDITTNICELTNISTRUNSACTION. )/12/14 .(anal rHPAEBY CANCELTNISTRAN6AC120N. 4,pe15grWure Rm W"e Wb .".s. lrt W RAeMn� Renewal by Andersen Corporation MA Home Improvement Contractor byN Iderjen 104 Otis St. Northborough,MA 01532 License#170810 (Expires 12/23/2015) vo.... ..lacer... ....a.w.,,mc.m,...1 (508)351-2200 Fax:(508)-988-7072 Federal ID#41-1918413 Window Specification Sheet Buyer(s)Name Date of A clement NANCY GALLAGHER WED.JUL 9, 2014 The buyer(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,of which the Specification Sheet is part. WINDOW DETAILS Approx. EtleMr ftr CgIDr Him.'. Hmdwua lsae" GNIe Gnlr Glass Room 4 U.I. WindmMoor le Detail Ceelne Ext-ad Color ecmans. Sm.wun Grill® Seantls aeae2 Llms O lone Livina 2 art PS Est.MF 908 NHM4 White stated FFG sormsta Nw. ---- ---- ----- No Total 2 BAY&BOW DETAILS *See Ba /Bow Metatare Sheet Syls Debil/ Alp., Approx NumaB Frsme Window EM Coln LowE/ Rood/ Hemwere From Coum le Flanxers U.I. Coln a A le Ito Inledor EMmCobr Grillo soho anho Screens Snam.un spelt Color SPECW TY WINDOW DETAILS Full/ Appmx. .awFI sp.clally BAY/BOW ADDITIONAL WORN NOTES From Daum We Intent U.I. Smarttan Get. Grile gain Eq/IM Cobr Cavon¢r is awareero with ba/Mw m.&—under 12 inch. there Wl best ifiram lea icon ADDITIONAL WORK DETAILS: 1 No Contractor will map exterior casings with toll stock color of Ownerls.wars Nat Contractor does not do any pairbog/stelning or removal/Installation of alarm system or window treatments/hardware.It/s the responsibility o/the homeowner to have Me alarm system and window tresbo entstimph a s removedpdor to installation. We make rra guarantee as to a ` whatheralmins or window treatments/harlwam will fit after replacement. Customer is also aware In some cases there will be glass loss. If there is,the amount will be dependent on the type of existing whitlows,type of installation and window style.We make no guarantee as to the amount ofglass has. Customerls aware and understands any and all unseen cot Is not included/n this contract.Should any rat be found there will be an additional charge for time and materiels unless so stated in this contract. :3 yes Contractor will Insulate,caulk and seal windows with 3-poird system to prevent water and air Infiltration.Removal and disposal of all Job related debris, windows.doors,stone windows and vacuum nightly Included. Upon completion of the lob and payment In full,a limited warranty shall be Issued. 4 Yes Building Permit--Contractor will secure any and all necessary Pamirs. The fee for the permR(s)Is not Included In the Contract Price and a separate check is required at the time of sale for this fee. Check a IM4 $ 49 s Yes All discounts have been applied to this agreement. 9 u yes a No (Tuner agrees to be present on the Mal day of Installation for final Inspection and to deliver final payment/finance form(s). It is agreed and understood by and mimmerr the panics that this Specification Sheet along with the CUSTOM NINDOW AND DOOR REMODELING AGREEMENT,continuous,the enlire understanding betwern the panics,and there arc no verbal understandings changing or modifying any of the Innis.This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in wilting and signed by both the Buyer(,)and Contractor. Buyer(.)hereby acknowledge that euyecs)has read this Specification Sheet. RevewaT by Ande.sen Corporation Buyer(.) Buyer(.) kV4zP11&11 9 Signature of Project Manager Ignature Signature ROLAND PELLETIER NANCY GALLAG R Print Name of Project Manager Print Name Print Name ►57.m wa WINPOW REPLACEMENT snAF;J nCormpeny ------------- townrt iW r#�4 fish* i tiwltGw.C+ N. 'a ptong zyms Asal lAw sbavv Wobrw " ems+. snows i , }fir+,++t W.& one oaf, 1+t w a kkbw Tt++n� �laea • **a*.IsaJ 1 v +aa}i�xx,nqj3ttb;dtgyry ✓,pp e Q CA 101 Out We( Fit 00 ,OS5102 V4�s�aRe:rocavwaea�tnalin�rstet': t:ca�in The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): RENEWAL BY ANDERSEN Address: 30 FORBES ROAD City/State/Zip: NORTHBORO, MA 01532 Phone #: 508-351-2200 Are you an employer? Check the appropriate box. Type of project(required): 1.0 I am a employer with 30 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp. insurance.: 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LEJ Plumbing repairs or additions myself. o workers' com right of exemption per MGL Y � p� 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] 'Any applicant that checks box 41 must also fill out the section bow showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:OLD REPUBLIC INS. CO. Policy# or Self-ins. Lic. #: MWC 30293800 Expiration Date: 10/01/15 Job Site Address:_ 9 ee,d. SC c.,c c L n City/State/Zip:s,� ,,,. IMo. 0 k 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of thi DIA for in urance coverage verification. I do herebr tify r the pains and penalties ofperjury that the information provided above is true and correct Si Date: Phone#: 8-351-22� Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: ./� ANDECOR-01 YADAVYO A�Ro CERTIFICATE OF LIABILITY INSURANCE DATE 1 10/112/1/2014 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(ies)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 endorsement(s). PRODUCER CNAME,ONTACT certificates@willis.com Willis of Minnesota,Inc. PHONE 877 945-7378 A/C No Ent:( ) Pa/c we: 888 467-2378 WO 28 Century 1 ( ) P.O.Box,TN 37 ADDRESS, Nashville,TN 37230-5191 AODREss: INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Old Republic Insurance Company 24147 INSURED ---- INSURER B Renewal by Andersen Corporation INSURER C: 30 Forbes Road INSURER D: Northborough,MA 01532 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, ILTR TYPE OF INSURANCE L 9TE POLICY NUMBER MMNDY/YYFYY M_15MIG YD/YEYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE OCCUR MWZY302940 10/01/2014 10/01/2015 PREMSES Ea occunence $ 500,00 MED EXP(Any one Person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. GENERALAGGREGATE $ 4,000,00 X POLICY JECOT D LOC PRODUCTS-COMPIOP AGO $ 4,000,00 OTHER. S AUTOMOBILE LIABILITY EeacciEDI GL SINELIMIT $ S,OOg,00 A X ANY AUTO MWTB302575 10/01/2014 10/01/2016 BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS ( ) HIRED AUTOS NON-OVMED PROPERTVDAMAGE $ Per arslderd E UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- IE AND EMPLAYERS'LIABILITY X STATUTE ER ._ A ANY PROPRIETORIPARTNERXECUTIVE YIN MWC30293800 10/01/2014 10/01/2015 E.L.EACH ACCIDENT $ 1,000,00 OFFICER#$EMBER EXCLUDED? N❑ N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE E 1,000,00 DySCRIPcnbe under E.L.DISEASE-POUCVUMiT E 1,000,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Ackift al Remarks Schedule,may W attached N more apace Is required) 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. AUTHOORI D REPRESENTATIVE Evidence of Insurance �Ns ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-090125 JAIM L MORIN� 86 GARDENER ST LYNN MA 01905 Expiration Commissioner 10/06/2016 ii -. � - C�/ee�posnmwnure¢/�o�P�aaaac/uWelta � 1 free of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR , Registration 170810 Type: Ezpiratton 2/23/2015: Supplement 'RENEWAL BY ANDER50N CORPORATION 0. 4,, JAINIE MORIN 104OTIS STREET NORTHBOROUGH, MA 01532 " Undersecretary I : TQ� ■�a ®aQQQ QQAA�{ Q Q IMP �` l �Q� R7 1'�17 AA PU;I IQ IQ 1�� 1 3:9,,ti 1 1 tl 1 I ::,if k£ I •I' It 1 r !7:4 0 1 . a�K ' � i't a T � � ,��!' � 3 �3•�' � � �t#f Y �; 4 1' �;�i.y " 1 ..:� 'r i` (, ;: - , W. g �a9. 9 � 9 � 959999 �g999 � 999999999� a3':9a9 � 9 � 933993s � 399 � 5� 'Z: pk� � 999 � � 9 � � � 99 � 9 � '�� 9 � 9999959 � 99999999a999a5999399993 � � �� 99 �aa � da9 � � 5a � 9999 �a9 � 99553 � 9:� 9999:999999.a9939999 � 9 i.l 1. y LU T. 1{`. 1. 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