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SPRINGSIDE AVE - BUILDING INSPECTION „� a: � Cx�-� �'�� � �' �5 . .� ��� � The Commonwealth of Massachusetts � �, ; � � Boazd of Building Regulations and Standazds CITY� �� Massachusetts State Building Code, 780 CMR SALE� �r� ,��, _ Revised Mar 11 y,rn Building Permit Application To Construct,Repair,Renovate Or Demolish a � r3►„� One-or Two-Family Dwelling �0 P�”. s�:..,"t. '* '.. .�!=ij`�..ThisSectionForOfficialUseOnly :.' �_:. Fk :� ��>C -�. . '' "" 7+`s-. �� � �;:, �� <_ ._, = v:� � ..,: � Bwiding Permit Number. �� Date hed.=� '.� � -'-'t�' �.�;�'' ¢ � - ` ,t�"' _ � 7! - .� i . ^" ..� .. �.� . -' � ;: �t � � � � , �� ��� � i tg °I` y � ' —u.�,, �It � �,1�j�_ �' ;��a. (� �.•BuddingO�c�al(PrintName) .._ .:p ._. .s.�_ t�z'� 'Signature,��� ._ .'s .,.;�a a+q,. "y�Y;..;� � . 'Date d�. � `= "� " ' = TION 1:SITE�INFORMATION :.. ` m. �:, �' = ; -t�r: . ,..... - � 1. rope ddress: 1.2 Assessors Map&Parcel Numbers � �/�h� Si)L vE Qr^-/f,2b2'd 11a Is this an accepted street?yes_ no Map Number Parcel Number � 1.3 Zoning Information• � 1.4 Property Dimensious: � /oZ.�J'tsF .2'fQ, � I Zoning District Prop�se � Lot Area(sq ft) Fron[age(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Reaz Yud � . Required Provided Required Provided Required Provided is:r ��' �. �1:6 Water Supply:(M.G.L c.4Q§54) 19 Flood Zone Informahon: 1.8 Sewage Disposal System: . Public�� Private❑ . Zone: _ Outside Flood Zone? Municipal�On si[e disposal system ❑ � � Check iEyesC9�� � � . } .,��; �'', s,,� „" � SECTION 2. PROP�RTY OR'NPRSHIP'_.,;. .. � m�`u3,� �, 'i� 2.1 Owner�ofg,ecord: � ,✓� ��/ / . ���ZrJ C: cnrN�l� ' I3�-LNC�/�/yGG L��Mn/ �fl UIQJ 2 �Name(Pdn � � CiTy,State,ZIP � � � �3�-�c1 d6Qr�— 7a��:seisps� o.�treet � Telephone Email Address - � :"' p'' � �,: °,�SECT[ON 3:�DESCRIPTION OF�PROPOSED WORKZ(check aIl that apply) ;� � � t -� ' �. . � New Construction Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑- Alteration(s) ❑ Addition ❑ � I'� � � .� Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief D ription of Proposed W�lI�: '%T.ELtY G ^ 6 `t �}�+ r �00 / 2 (e 'l�l� • (r"B 4FS�S 2 'AG "� Oo !w i � w / 3 /2�18 C!� Lry Rt� Z .�'!ov � '� � � `i .,F��i �� _,ryt '�_'=�'''SECTION4: STIMATEDCONSTRUCTIONCOSTS�y..�'� ;��i,�+' ?a;;�. EstimatedCosts:� �b�� �Exr - � � �' Item t Official Use Only "'' ' Labor and Materials �i�.°:._.� t �a - 1.Building $ � �� 1. Building Permit Fee $ ��'Indica[e how fee is determined:' ❑Standard Ciry/Town AppLcation Fee 2.Eteotrical $ 6 p'U �' -- �- �F �n � + Fu,� '` � ❑Total Pco�ect Cost'�(Item 6)�tt�nlpplier x �"�' 3.Plumbing $ i . U c)� 2 �Other�Fees $ -�'�� � �+ ' � " . ' ' 4.Mechanical (HVAC) $ �� �' List: � - � � > _ � :� he, � �. 5.Mechanical (Fire ��� Su ression $ � Total All Fees $_"" ` ' '" � ;,�. " Check No. 'Check AmounT. �Cash Amoant: � 6.Total Project Cost: $ ��� ❑paid in Full "` �:_ 0 Outstanding Balance Due`. � '�� �4• � �O � ��,t�M a� � _ i� ., �-�� "'� ;��` ': � �" = . �.SECTIONS:"�CONSTRUCTIONSERVICES �. �" �' ' ' �'� �' f , a,.: �._:, � - 5.1 Construc[ion Supervisor License(CSL) nn� �p �`� 03� �/1' LS" � !/- 2r F� JAv�`� C. 1,v �/el�o� LicenseNumber EapirationDate . ,�, Name of CSL HolQ�r/// ))) ((�� n ! � /V� � LA �(�, List CSL Type(see below) K ri( Se �� P•1. J �, y: ..: � No arid Street 6 . TYPe s-��` ._�'„ .__f�,Descnp�on j;._-. a.. J � + I �� � 1 n B� � Unrestricted uildin s u to 35,000 w.ft. �� ' N ��1 �'� R Restricted 1&2Fami1 Dwellin ity/To ,State,ZIP . M Maso � � . RC Roofin Coverin � WS Window and Sidin �� n/n ty��q ��� y����f�� ,n� SF Solid Fuel Buming Appliances p� �"� �� �Q � r� I Insula[ion Tele hone � Email address D Demolition � � 5.2 Registered Hon �provem Contrac[or(HIC) ;1_,�_ �'l.« D 1/� �'7• �� C Registration Number Expiration Date � �C N `�or � g t �b� Lu�V/'�LiL/��CC"0�� N'Q� . �' � . �n � yL ' ,/„�,/ / . vp� Email address a� p /v� Ci /Town State ZIP Tele houe ...,_ � -; , .:.. _,.. �.: , �_., ._ ...:.� ... . ..... � ... a;�;� 'SECTION 6:WORK�RS'COMPENSATION INSURANCE AFFIDAVITt(M G L.c.�152.§ 25C(b)) �`,�",", . .� . . .. . _.._ . . . . . . .. ... ..... . .. .. . . . .. � � . Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide � this affidavit will result in[he denial of the Issuance of the building permi[. Signed Affidavit Attached? Yes ..........❑ No...........❑ - � � � �"' �' k""� ... -����.�SECTION 7a:OWNER'AUTHOffiZATION TO BE COMPLETED.WHEN ��;� � � � f ""'"� � � .' .::.:�:,.F.�� : ' '`�� _�OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDI G PERMIT "' �. �`� ' " � � .� I,as Owner�of the subjec[property,hereby authorize ��/�� � (%� � � �I/r � - - � � � � to ac[on my behalf,in all matter�lative to ork aut orize y this bu di g perm application. . , � - �J�1 � El2 3-2Y- ld . � . Pdnt Owner's Name(Electronic Signature , . . . Date - . ' . . . � , ,.: " �' . ' ' � �' f�. t,�(p. 1.���4�"=� �.SECTION 7 O ER`OR AUTHORIZED AGENT DECLARATION ��, �,. I�I� � By entering�my name below,I � y attest under the pains and penalties of perjury�that all of the information��. . � . contained in this application is true and accurate to the best of my knowledge and understanding. Prin[Owner's or Au[horized Agent's Name(Electronic Signa[ure) Date . .... � ., .. .... _ .._ . . ..: . _�.,'� = k:. ..�:ar`�` Nd'P$3': � - . -dt _�.`IF�'� '�� '�`4 " . L* M Owner who obtains a building�permit to do his/her own work,or an owner who hires an unregistered contractor � � (not registered in the Home Improvemen[Contractor(HIC)Program),will not have access to the arbitrntion program or guaranty fund under M.G.L.a 142A.Other important information on the HIC Program can be found at ��tiwv.mass.gov/oca Information on the Construction Supervisor License can be found a[www.mass, o� 2. When substantial work is planned,provide the information below: � Total floor azea(sq.ft.) 1�/�j$ � (including garage,finished basemenUa[J['es,decks or porch) �� Gross living area(sq.ft.) � Habitable room count (o Number of fireplaces B- Number of bedrooms Number of bathrooms _ � Number of half/baths � . Type of heating system ('y,g-S Number of decks/porches Z, � Type of cooling sys[em E(ECf'r/�-- Enc(osed Open �/'' � � 3. "Total Project Square Foo[age"may be subs[itu[ed for"Total Project CosY' . . .. _— __. _ . _ .i - �, I`� �� Registry ID: � ' �.!o, G , Ra[ingNumber: EH0684 �A!/Uy� SALE SpringsideAv XX • Certified Energy Rater: lan Rex V'�' Rating Date: 3@9@016 XX SpringsideAve Rating Ordered For: 5alem,MA01970 �����,J I_, _ EstimatedAnnual Energy Cost , �� . � ��� Projected Rafing 5 Stars Plus use MMBtu cos� Percent Projected Rating: Based on Plans, Field Confirmation Required Heating �ss.o $2��� si°io Uniform Energy Rating System Energy Efficient Cooling 2.0 $106 2°�/0 HotWater , . 17.4 $326 7/a i Star 1 Star Plus 2 Stars 2 Stars Plus 3 Stars 3 Stars Plus 4 Stars 4 Stars Plus 5 Stars 5 Stars Plus Lights/Appliances 23.4 $1128 25% I 500-401 I 400301 I 300-257 I 250-201 I 200-154 I 150-101 100-91 90-86 85-77 70orLe55 ph0i0V01falcs -0.0 $-0 -O�a HERS Index: s� Service Charges $190 . 4% GenerallMormation � Total 187.7 $4467 100% ConditionedArea: 2309sq.ft. HouseType: Single-familydetached Conditioned Volume: 18606 cubic ft. Foundation: .Conditioned basement . . - . Bedroams: 3 This home meets or exceeds the minimum Mechanicai Systems Features criteria for all of the following: � � Heating: Fue�-fired airdistribution,Natural gas,92.1 AFUE. Cooling: Air conditioner,Electric,13.0 SEER. . � � - Water Heating: Comentional,Natural gas,0.67 EP,40.0 GaL � - Duct Leakage to Oukide: 110.00 CPM25. . Ventilation System: Exhaust Only:53 cfm,6.0 watts. . Programmable Thermostat Heating:Yes Cooling:Yes , Building Shell Features , Ceiling Flat: R-45.6 Slab: R-10.0 Edge,R-10.0 Under SealedAttic: NA - Exposed Floor: R30.0 Vaulted Ceiling: NA 1Mndow Type: U-Value:0.320,SHGC:0.320 Above Grade Walls: R-21.0 Infiltretion Rate: Htg:4.00 CIg:4.00ACH50 Founda6on Walls: R-18.0 Method: 8�owerdoortest Lights and Applianee Peatures � lan Rex - Percent Interior Lighting: 100.00 RangelOven Fuel: Natural gas Energy Hound Percent Garege Lighting: 0.00 Clothes Dryer Fuel: Electric 11 Broadway,Suite 3 � � � Rehigerator(kWh/yr): 691.00 ClothesDryerEF: 3.01 Beverly,MA01915 Dishwasher Energy Factor: 0.00 Ceiling Fan(cfmNVatt): 0.00 978-233-1433 Olgiuily xlgned by lan Ra The Home Energy Rating Standard Discbsure for�hs home is available hom the rating providec 'or�:��=ia�x..,o=me lan RexeT`9Y"°"°'°° REMIRate-Residential Energy Anatysis and Rating SoHware.vt4.5.1 a�=�a^�Tn=E^ef�"��^ � This informatpn does nol constAute an warran ot ener cosl or savin s. d:mm;�=us . Y �Y 9Y 9 �/� 'oso�:zbis.w.3oiasaaa . O 1985-2014ArchHectural EnergyCorporation,Boulder,Cobredo. Certified Energy R�V°� - rS AIR LEAKAGE REPORT � Date: March 30,2076 Rating No.: EH0684 Buiiding Name: SALE SpringsideAv XX Rating Org.: The Energy Hound . � Owners Name: � Phone No.: 978-233-1433 . � Property: XX SpringsideAve Rater's Name: lan Rex Address: Salem,MA01970 Rater's No.: 1454792 Builder's Name: Custom Built Corp Weather Site: Salem,MA Rating Type: Projected Ra6ng File Name: SALE SpringsideAv XX.blg RaGng Date: 3/29/2016 � Blower door test Whde House IMiltratlon Heating Cooling NaWraIACH: 0.25 0.19 � ACH�50 Pascals: 4.00 4.00 � � CFM @ 25 Pascais: 790 790 CFM @ 50 Pascals: �240 1240 � EB.LeakageArea: [sq.in] 68.1 68.1 SpecificLeakageArea: 0.00020 0.00020 - ELA/100sfshell: [sq.in] 0.50 0.50 Duct Leakage Leakage to Outside Units Throughout CFM�25 Pascals: 110 CFM25/CFMfan: 0.0635 CFM25 l CFA: 0.0476 CFM per Std 152: N/A CFM per Std 152/CFA: N/A CFM @ 50 Pascals: 173 E8.LeakageArea: [sq.in] 9.48 ThertnalEfficiency: NIA Total Duct Leakage Units CFM25ICFA � Total Duct Leakage: 0.0866 ' Ventilation Mechanical: ExhaustOnly Sensible Recovery Eff.(%): 0.0 Tofal Recovery Eff.(°k): 0.0 Rate(cfm): 53 � Hours/Day:� � 24.0 Fan Watts: � 6.0 Cooling Ven6lation: � Natural Venti�a6on ASHRAE 62.2-2010 Verrtilation RequiremeMs . For this home to comply with ASHRAE Standard 622-2010 Ventilation and Accepfable IndoorAir Qualily in Low-Rise Residendal Buildings,a minimum of 53 cfm of inechanical venblaGon must be provided confinuousiy,24 hours per day. Altematively,an intermittenlly operating mechanical venlilation system may be used ff ihe ventilation rate is adjusted accordingly. For example,a 106 cfin mechanical ventilatlon system would need to operate 12 hours per day,as long as the system operetes to provide required average venfila6on once each hour. , REMIRa[e-Residerrtial Energy Anatysis and Rating Software v14.5.1 . � This informa6o�does not constilute any warranty of energy cost or savings. • O 1985-2�14fvchftecWrel Energy Corporation,Boulder,Cobredo. ' . �Bo���a�ade Single 16" AJS� 25 Joist\J01 Dry� 1 span � No caMilevers � 0/12 slope April 72,2016 12:30:08 BC CALCQ�Design Report 16 OCS� Repetitive� Glued &nailed construction Build 4516 File Name: BC CALC Project Job Name: Description: DesignsW07 Address: Springside Ave Specifier: Boise Cascade-Greenland, NH City, State, Zip:Salem, MA Designer: Customer: Company: Yankee Pine Corp Code reports: ESR-7144 � Misc: � . , � i , , , , � , ..I I I i � 1 ' i � , I i I � =� �� , I i zs oo-00 eo B� Total Horizontal Product Lenglh=26-00•00 Reaction Summary(Down/Uplitt) �ms� Bearin Live Deatl Snow Wind Roof Live B0,4-3/8" 693/0 173/0 Bt,43/8" 693/0 � 173/0 - Live Deatl Snow Wlnd Root Live OCS Load Summary Tag Deacription LoadType Ref Start End 100% 90% 115% 160k 125% 1 tst Floor Unf.Area(Ib/ft^2) l 00-00-00 26-00-00 40 10 16 Controls Summary Value %Allowable Duratlon Case Location Disclosure PoS. Moment 5,375 ft-Ibs 55.3% 100% 1 13-00-00 Completeness and accuracy of input must End Reaction 867 IbS 67.4% 700% 1 00-00-00 be verified by anyone who would rely on End Shear 842 Ibs 40.8% 100% 1 00-04-06 output as evidence of suitability tor Total Load Defl. U547 0.557" 43.8°/, n/a 1 13-00-00 Particular appllcatlon.output here basetl � ) on building code-acceptetl design Live Load Defl. L/684(0.445") 52.6°/, n/a 2 13-00-00 properties and analysis methods. Max Defl. 0.557" 55.7% n/a 1 13-00-00 �ns�allation of Boise Cascade engineered Span/Depth 19 n/a n/a 0 00-00-00 Wood products must be in accordance with current Installation Guide and applicable building codes.To ob�ain Installation Guide %Allow %FUiow � oraskquestions,pleasecall Bearinq SupportS Dim.(L x V� � Value Support Member MateNal �(800)232-0788 before installation. BO Wall/Plate 4-3/8"x 3-1/2" 8671bs n/a 67.4% Unspecified B1 WalUPlate 4-3/8"x 3-1/2" 8671bs n/a 67.4% Unspecified BC CALC�,BC FRAMER�,TMSTM . ALLJOIST�,BC RIM BOARD ,BC�, BOISE GLULAMT^+,SIMPLE FRAMING NOtBS SYSTEM�,VERSA-LAM�,VERSA-RIM Design meets Code minimum(U240)Total load deflection criteria. . PLUS�,vEaSn-Flnn�, DOsign meet5 COde minimum(U360)Llve IOad defleCtiOn Criteria. VERSA-STRAND�,VERSA-STUD�are Desi n meets arbitra 1" Mauimum total load deflection criteria. trademarks of eoise Cascade Wood g ry( ) ProdUcts LL.C. Calculations assume Member is Fully Braced. Composite EI value based on 23/32"thick OSB sheathing glued and nailed to member. Design based on Dry Service Condition. Deflections less than 1/8"were ignored in the results. Page 1 of 1 � � J i CITY OF S.-�LEltii, tI�IASS�ICHL'SETTS '• � BI;II.UL�iG DEP:�R1'�tE�iT ` �� 130 W�SHiNGTQN STREET,31D FLOOR T�Ei.. (97� 745-9595 F.�)t(978) 740-9846 ���FRt FY DRISCOI.1. i�fAYOA �Q�►�ST.F�.xnH QIREGTOR OF PC:HL[C PROPERTY�BI:II�ING CO�L�IISSIQ�iER Construction Debris Disposal Affidavit (required for all deinolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section t 11.5 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 14TGL c 111, S 150A. The dehris will be Uansported by: �� �� �� �—(name of haule The debris will be disposed of in : � �� � �1,�tiu� �o —�— (name of faci ity) � (addres of facilit V� signahue ofpermit app cant � � `� � f� date � dc6rivlT.da: . i �� .- — .. ._ _ ___. _ r �' � - � CITY OF S<�1I.E��i, \rI�1SS��CHL`SETTS , . • B�u.D�c DEr�x�n�.yT + 130 W�SHIlVG'roN S�.T,3�FLooR �� � "PEI_ (978}745-9595 FnX(978)7A0-9846 xia��Y n�iscou MAYOR THoeus Sr.PgnRB DIRECTOR OF Pt�BLIC PROPERTY/HI:II.DING CO�L\QSSIO.iER I __ . __.._..__ ! Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Piumbera I Analicant Information Please Print Leeiblv ' :Vame�s�siness�orsanaa�iom�wi idual): SV !//// f � � Address: ��� (. /� // �� �� Ciry/StatelZip:���V� � # `►��/� O I�ld 2Phone N: � �� ' 2,� 2- ��"�3 Arc you ae employe►?C6eck the appropdate bo:: ' 7'ype of project(required): 1.Q 1 am a cmployu witt� 4. [9'razn a general conhaetor and I 6. ew conytruction employeea(full and/or part-acno).• heve hired rhe sub-convactors 2.0 I nm a sole proprieror or partner- 1is�ed on�he anached sheec.2 �• ❑Remodeling xhip and have no employeen '[hese subcontractors have 8. �Demoli[ion . working for me in uny capacity. workere'comp.insurance. q, �guilding addition [No workeis'comp. insurance 5. Q We are a corporation and its � rcquired.] � officers have exemised thcir 10.❑Eloctrical repairs or additions 3.� i am a homeowncr doing all work . � right of exemption per MGL t L�Plumbing repairs or additions . myscif.(Ivo workets'comp: c. 152,§I(4),and we have no �2.0 Roof repairs � insurance required.j t � cmptoyees.[iQo warkero' ' � ' � comp.insurance required.] 13.0 Other � . . •Any appliauu tMat a�hecka boz BI muc�also fill�uut ihe sec�im below alwwing ihe'u wmken'compenn�iun poliry inturmuioa r . . . �t I lnmcaanas who su6mit thu oflidavit indica4ing Uu.y ue doing uil work and thrn hirc ouuidC contracron muat w6mR a new alildavil indi�sting wch.� .. . . =Cumnrxon�Mt check this 6w�muse anachod an aJditiurcal nhae�showicg.�M naine o[the subarontrecW,7 and thelr wohe�e'comp.poliry infmmntioq.`r . . � � J uw ae e�nployer that Is previdin :workers'compensaltan tnsurance jor my emp/uyeex Below!s fhe pollcy and fab s!!e d� info�malioa tnsurrnce Company Vame: �SOCI /�� �IN�Tk�v�itc�' Policy/f or Self-ins.Lic.ii:�(yIGG��OIG�.304(� `LQ�6 Facpirrtion Da4: .3 ^ 7 ^ f � ' ' !ob Site Ad�ss: N !/MS/D(�y_ City/Statel2ip:�� � '�- Attac6 a eopy of tha wo n',compeotatfoo po8cy declaratlan page(showing the pollcy number sad expiratloa data). Failure m u:cure cove�age as required under Sec�ion 25A of MGL c. 152 can lead to the imposition of triminal penalties of a fine up ro S 1,50Q.00 nnd/or one-year imprisonment,ns welt as civil penaltins in the form of u STOP WORK ORI)6R and e fiae of up m S?50.00 a d•ry against rhe violator. 13e advi.xd thut a wpy of this�arement may be forwurded to�he Office of � Investigu�ions�,uf�he DIA for iiuurance coverage veritication. � ir /da/�e�rby c tl/Jy under r pains a d ptaa o perJury tbat f6e informutfon providrJ ubove/s�rue and corrreR 'm i �r • � I)a . � � i #: ' Z U O�rial use only. Do not write in rl�is areq to be cunepleted by ciry oNown o�ciaL City or'Cuwn: _ Pcrmitli.icenee# ' Issutng Au�hnrity(circic one): �, I.Uuard of Health 2.Building Departmenl J.C.itylfowa Clerk 4.Electrical tnspector 5.Plumbing Inspeetur ��. 6.Other . ' Cunlrct Pe�soa: Phone#• I .. _ _..._.....,.....>...._.. _......._..._�..a:,..�..�......�.._... . _.._ . . ._.......,......_.. ___ .._____. , ._..._.__..____..__.,.. . ... . . . , � , '`��� CERTIFICATE OF LIABILITY INSURANCE �3�z9/zoieY� '" THIS CER7IFICATE IS ISSUED AS A MATiER 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 8Y THE POLICIES BELOW. THIS CERTIFICATE OF INSUR4NCE DOES NOT CONSiITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. � IMPOR7ANT: If the certfficate holder is an ADDI710NAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subJect to the terms antl conditions of the policy,�certain policies may require an endorsement. A statement on this certificate does not confer Nghts to the certificate holder In Iieu of such endorsement(s). � PRODIICER N°pmEP�T Stephen Duffy, SY � Dll£f]� IRSUY8�1C0 AggRCy PH�NE , (781)593-1200 AAC No:(�Bl)593-'l260 317 Broadway - - E-MA�� steve@du£f nns.com � ADDRESS: Y Wyoma Scjllax0 . INSIIRERS AFFOR�INGCOVERAGE NAICp Lynn MA 01904-2602 iNsuaean:Travelers Indemnit Com an INSUREO � INSURERBASS0018tB(I E[[I lo ers Insurance CI18t0111 Built Coip. INSUREftC: 262 Ch5th3�R Street INSUftERO: INSURERE: Lynn MA OISO2-2SO2 INSURERF: � COVERAGES CERTIFICATE NUMBER:CL1632900664 REVISION NUMBER: THIS IS TO CERTIFV THAT THE POLICIES OF INSUFiANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY REqUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICAiE MAY BE ISSUE� OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS, - EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �LTR TYPEOFINSURANCE � 5eR pOLICYNUM6ER MMIO�DYEfY P��pYYYY LIMITS X COMMERCIALGENERqLLIpBILiTY — EACHOCCURftENCE g 1�000�000 A CWMS-MAOE �OCCUR EMGES�eoccurcenca 5 300.000 I-680—'lH603960—ACJ-15 5/29/2015 5/29/2016 MEUEXP Myone erson $ 5�000 PERSONALBAOVINJURV $ 1�000�000 GEN'LAGGREGATE LIMR APPLIES PER: GENERAL AGGREGATE $ 2�000�000 X P����Y�JEC �w� � � PROOUCTS-COMP/OP AG� $ 2�000�000 OTHER: - � � � �� $ AUTOMOBILE LIABILITY � � C M& ED SMGLE LIMIT 5 Ea eccideM ANYqUTO � ' . BO�ILYINJURV(Petperson) $ PLL OVVNED SCHE�VLE� BO�ILY INJURV Per acGdenl S AUTOS AUTOS � ( ) HIREOAUTOS AUTOS�ED . � PROPERTV�AMAGE $ � � � Peracclde� $ �` UMBRELLA LIA6 OCCUR � EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE � AGGREGFTE $ OED RETENTIONS � � g WOftKERSCOMPENSATION � �� - � � PER OTH- ANOEMPLOYERS'LIqBWTY � Y�N � STATUTE ER ANY PROPRIEiOR/PARTNER�EXECUTNE � � , � E.L EACH ACCIDENT $ 500 000 B OFFICER/MEM9ER E%CWOED4 ❑ NIA (Ma�WetorylnNH) . . 1PCC5010�3001-2016 3/9/2016 3/4/2019 ELDISEASE-EAEMPLOYE $ 500 000 I!yesdesa2eurMar EL�ISEASE-POLICVLIMIT �$ 500 000 OESG�RIPTION OF OPERATIONS below OESCRIPPON OF OPERqTIONSI LOCATIONS I VEHICLES(ACOR�10t,Atltl111onel Remuks Schatlul0.may be etlacM1etl If more space Is requlreE� CERTIFICATE HOLDER CANCELLATION custombuiltcorp@aol.com . SHOULD ANV OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE Sa10m BUilding DepaTtment THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVERED IN Salem� MA ACCOftDANCEWITHTHEPOLICYPROVISIONS. AUTHORIZED REPRESENTATIVE Lynne Glynn/LYNNE ���=--��_=���'�--_. , a01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014I01) The ACORD name and logo are registered marks of ACORD INS025�2oiao�� — ._ _ _. ._ ___— . I � i � , . i , i� � � � �' �e�Pr>urironuraa��,o��aJaac%u��� . ! � Office otConsumer Afl�airs&Business Regulntion i � ME IMPROVEMENT CONTRACT�R TYPe ���i egisfration 105303 , privalg Corpora�:� ! �3 xpiration 7k16/20?6; . .g , t l . � � � CUSTOM BUILT CORP � i ,�;_ . s � a� : � ' � , David WYckoff �'� � �:; �,� g � � ' � � 262 Chatham St. � Lynn, MA 01907 ��" Undersecretary ,,' � � `� . '. - - - �� -� . ' Massachusetts Department of Public Safety 'I . . ',�} Board of Building Regulations and Standards � � ' � License: CS-017103 . � Construdion Supervisor � �� I � a..� r� n .. 7 . �`� r-� r� rt4..: � � � � � DAVIDCWYCKOFF . , I � . � � � 262 CHATNAM SS �� . � LYNN MA 01902 . I . ', �. . ` . I . rrv� _ - �1 �/I�^,� �� Expiration: � � - ' Commissioner 1712512017 � 5.+.� . . . .. - . .. - . � . . � , . . . � � . . ..�� � � . . . � CITY OF �ALENI ROUTING SLIP �o� $3-l9� ��B•7�C- 77D ��-,��qlG- }�-vs- _ �ew tonstruction � Certificate ol'Occupanc} LOC.aT10N UaTE' ASSESSOR U:�TE � I� 93 �Vashingi t �,�b � CITY CLERK��z�� DATE �" i ' y31�'ashington t. _?� � ', �`PUBLIC SERWCES��i���r�TG�6 �FJ ` 120� Washington St. � _ lun or Engine : Q� behalf of � [:� �i�,�TGR� DATE_ �F/� �/6 oavid H. Knowttqn; P E. City Eng��eer� � l20 1'�'ashidgton St. j CkOSS CnNNECT(UN4&e�c�����TE -� /6 �Es`.Z_Y� Iv2� IV`l�Cil,� te 1�l ' 5 Jefferson Ave 1� 7� E r � .� PLANNING DATE _ 120 tVashington St. z ( j COtiSER'V,�TION � DATE � 120 �i'ashmgton St. ELECTRICr�L � -Ds1TE � 4$Lafa�+ette t. � � � � � � � FfRE PRE� ENTIO'�'�G��DA'TE � C�'�� ���� 29 Fnrt-Avenue " !�' I � �.. t� HEA!_TH � D 1TE �"�I 5 11 b � 120 �1`ashington St. 13UIL�iNG (M1'S('EC7'qR �,�a � E r.Z /4� ' � 12U ��'ashing[on SL � � � - � . $ � a i N/F \NEW ENGLAND POWER CO. `� PARCEL ID: 09-0261-0 ,j r F- ;� Z � \ � �`� w �m I w I 2,� � \ d � 3 � PT. 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