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37 WALTER ST - BUILDING INSPECTION (2) 'ePL41611 c� ItSIS The Commonwealth of Massachusetts CITY OF a Board of Building Regulations and Standards SALEM ` Massachusetts State Building Code,780 CMR g Revised Mar 2011 Building Permit Application To Construct,Repair, Renovate Or Demolish a 1 One-or Two-Family Dwelling lv _ This Section For Official Use Only - Building Permit Number: Date Appli& r Date Building Official(Print Name) Signature - SECTION 1:SITE INFORMATION ll� 1.1� Property Addres �1 1.2 Assessors Map&Parcel Numbers�'J 1.1 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 O er oflcord• (' Anne i-e�rr 5172�'f �cc%eyn /h'9 Name(Print) City,State,ZIP 3-7 yS--sg 9• oo 3 0 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check a►l that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ I Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Wore: , y // 9 P✓ — O q-z, .2 — LI SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) - - 1.Building $ tP7a 1. Building Permit Fee:-$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(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: $(P7� ❑Paid in Full ❑Outstanding Balance Due: IY1 A t LC5TD L I / a N Saasl_ SECTIONS: CONSTRUCTION SERVICES /5.1 Construction Supervisor License(CSL) O / G 77 License Number Expiration Date Name of CSL Holder Eric W.Palm List CSL Type(see below) 1-f P No.and Street I toll beet Type Description Salem MA 01970 U Unrestricted(Buildings up to 35,000 cu.It. City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofino Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Tale hone Email address D Demolition 2 ` 5. Registered Home Improvement Contractor(IIIC) L4 Z 0 Atlantic Weatheriza6un LLC IIIC ComppgydNapl rHlC Re hie H1C Registration Number Expiration Date No.and Stree4S�aleiIl ClJtlil A Email address Ci !town,State,ZIP Tele hone 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. Sifl,as ned Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT wner of the subject property,hereby authorize Et G �Cv/IZnon my behalf,in all matters relative to work authorized by this building permit application. rune er s N Electronic S�ture) 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 contain d in this ap licatt a and accurate to the best of my knowledge and understanding. nlz, Pnnt Owner s or Amhonzed Agent s Name(Electronic Signature) Date MOTES: 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 Information on the Construction Supervisor License can be found at___z.:ue�.=.._a_:!fn_ 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.fQ Habitable room count Number of fireplaces Number Of bedrooms Number of bathrooms Number ofhalf/baths Type of heating system Number ofdecks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" Massac—hunth tee Iw ®veffi1,a,IS e�m le Contract 1LtsfotmaGsSa all e boric m9evememsoffim," 'sHen. MacaaAaC�� °n�SefkkVd adoi®H �rosxmmtCmtmctorlaw(ty1Q, 1 O16ceafCoasomaAaodB Homelmprov®ml"before ?roYPetsopp�mgbnmen�aoamtenta shodnr9 oatmdodoatandow! °SmesRegulatimYConsumcy%wndc®yomresiden¢Yau maYobtvnafiee aeOP3'ofA HomeownulBformation Houinear677-m3s?g�nrl•gae-za3a757uanae�wms�'tegrne N�f-- Contracforpnformation Je n T[ l� �� n er ComparyName Skeet Addrea(do aot meaPat awe Atlantic W �(, � c� eattteflLd(Ivi: Ciry/fawn J7•-> sraei_ zipCvde.,s 5� Avenue �f�tQ - ovmveoAddr¢s(Hoar' Daytimelgape-•s.- o:-_.,' Q ,, �/ Phme Mailing Addnze a�/ v Q�`_ )�S�A p ZD Cade (udi6emn0ptp abmx) / 6 "!('/— O�(� S-i'—ph.. FedeatEmplvrcIDmS.S.Numhc G�aaxmm The contracroragtees qo d o t fog o 's°djc°'°�t'� /-• e"✓ O 9 3/r// �/(Omcdbe iv decti tlrc wmk0 eomphe� ash for III e Romeawner. / Z/�(p — !aaramt:was aed m<,aaia J . r a .,�(o-sue �cs Requited Permits-7befollowingbuddin S�' //t'/ and Will be by We mahaaoras wgpe tI� P+oPosed StmtnndC smmed ralohed ededfenmthe�(()waejs who swore m��nPcrmtfcerillbe be' '�wmdasa;rcn���dthea®aaa�otgSChethdewtu MGL cha aataa[y Fand Pmvw moll // U mnuol grim pter142A.) /Z -- _Date when contmaarwX begin aontma�work total Con /lI ZU treat Ptioeaod — ewh®conbaaed WmkwMbe the Contraaor PaymmtSthednle °p�Y complaed a8ea t°Pefmm thermrk,famish Wematrria7 andlabar PaYmmm will bemede sPw w8bmn>fmtherotalatm of. aeeordingrogtero0owingschedNe: (% 8 upon sigomg<enbact(no[ro exceed 1/3 afthe toW tbotractprice it the mg of S by / / or upon completion of _ ��Hardmrtem.S wbichevaris grmter) S by / / �O wupon compledon of S oponm leli 7te fob mP on oftheconuact (laWfmbidsdentmdmgfnn ardemd beIteread/e9uipmra<vmn 6espmvN S / wb7 coonactiscomP2etedmhotb pady'sse re the mmplymmtC%46amoNn Stu be dFm us5ation) w me NOTES(')mded� s w d ag all finenmchvges(«1 yp,+iVnhv den�exettd�'yC1J8t�(�tv edmaeewmea CO°�vtptiwmro aeNalemtoen}'�bY drew work hegin5 aveermtrtmc 8a ress Wvrrm _Va themmpletrwsehedde Hny°Peameetepmemeremmmaatlemalm'at Snhmnteactom-77m .ran -O ' m roewvka Pa,7Y/subeontracinr coO6n��to basolelyre�on5tblefar �YC9°a vrthva aerials mdla a1�dbY0temntraaar. The con completion ofl6earmkdaen mmYbe wet wthew tender 'sa t uacmrtmiheras}era mbe mlel 'aPoast3temg�ess oftheactioas ofeny third Contract Acceptnnae_Upop 51 � dmamem becomaabiodmgc®naaoodtr �PaYmmGto all mbconiremom for mcamfu➢Y pnfinesig�og5 �or�vvrib(nterathas tremplaaed®tbe UnlessmhawisenmW within this residence Reviewthefollowiagcmtions ands pc the c DonY be ptt�pedi�51 v hlalmsum th oti h awitI ih�e�rm�entC°°aaanrgy�trapmon ld��9ocd,e,ir—ethmgismrlear. < D�onbl'w'WhIn theDimgpra 10�P8karp HODtt rofno ®eot Commcror �wtegmra mosthomctmptavavept wnuaaorsand seeaeu conuaanrhave in5manm?Ask the "Room 5170.Bostuo,AfA 02116Zoa YoumAYingtmeaignmobnen. PY ofa'bmofofiosmaore�document� or fbrhitinsmn,,,c op Yinfmmati 1m 617-973-87g7ar88g-283-3757. Knowyomrighlsmdrespmstlydipa,Read the Ln GuidemtbeHomehopne a mtC portant Wommeon on the Yon�ennfnm meamgq mwk to °°68aoriaw. reamsesideofihis farm and get aeepyoflhe Consmta onnuanori�n a�®mtifftha111 , third6 Wnhng athi4hermam o8icem gnedmaphuxmhatba them➢avpess day�l'V®d'SIGI1Tg'�'ffi�a�mmG�nSaa7tached P`e!l4bytce mzns ���A laerthYonm not'gbe ht afthe 'dm�imamartm��ye��N718r4CANYBLApM �ffg7���, � aPlmatim ofth..gbt SPACES!!! Hamw eYs si to _ /t /,j Conttaaar's Sigoauac Dale _ Date I 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 Tight 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 concerningthis contract,the con" t .rya sub�Mlt*e dispute to a private arbitration firm which has been approved by vu�'S". yr..... the Secretary of the Executive O ce of c er Affairs and Business Regulation and the consumer shall be required to submit to such arbi"iph;a5i blit>��t'$kcal" General Laws,cha er 1,2A. "., Homeo er's Si Contractor's Signature NOTICE:The signatures of the parties ab6ve 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 Fond provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,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 carry 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 homeowner's basic consumer rights. If you have questions about your consumer/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 been attacked. Parties are also advised not to sign the document until all blank sections have been filled in or marked 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 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 dcems bim/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 wo& 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 Regulation - 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at httnJhvww.mass.eov/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 Law,contact Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at htm:/A%nvw.mass.eoA,/ocabr/ Go online to view the status of a Home Improvement Contractors Registration: htto'//db.state.m&us/homeimorovementn icenseelist.asi) For assistance with informal mediation of disputes or to register formal complaints against a business,call: onsutner plaint Section mey General 617-727-8400 AND/OR Better Business Bureau 508-652-4800.508-755-2548 or 413-734-3I14 v tm2.t-uny2mo A Ili v i I 1� 1 L } d f) g. O Qualifipd 11rH�� y rrnaC endows B[Inguta guallry ro ttghr. VINYL DOUBLE HUNG ' IMPERIAL LS Ncakrd Fetedlaim Raftggcvmal'p Double Glazing.Argon Fill.l-ow E.Grids SLL-4-29-0f)162-000D2 U-Factor (U.S./I-P) Solar Heat Gain Coefficient ADDITIONAL PERFORMANCE RATINGS � Visible Transmittance .Condensation ?esistanct OAS 57 HancfamN s%pu13tes that these at" —fixm! appUcable TIFRC pro[eduras ie. dcronnt+i�0 N—. honsa pd(mladn@. i1FRC si mR5 K Cetem t Ibr a 0<g n t - i�r.:...::s no z mart the a00 a inky or ny m ct s6-e. BM dcm.,mt r.>nmme_md anv e "1e not warrant the sperform p1 alp'praduU fir a,ry•Te[i6c ir_.e.Cen_It manufacturer<_ fite2hna f�v ath°<p[pduct performance i:rtymatan. ivnlvnfrt.a _ 1318555.060 ` The cor2TP_onweafth of Ple'assachzisetts Depti-r<treatt 0j-b9d-S-Walflccide as a Congress street,siiiie I®ft BOston,lM 02_7+4-2017 ivivlv.mass gov/dla rkers'Compensation insurance AMdavit:Beilders/Con7actors/Electricians/Plua nbers. TO BE FILED WITH THE FERtbRTTL'IG AUf-ffORY£Y. Anolicant infornation Please Print Legibly Name(Business/Organization/Individual): Ad"aptic Y11C'' ?'-:-.iEd7i.La "ddress: 6i n Tit .ar1e�LTQ no City/State/Zip: Phone#: 9 - 7 ev Arc voua employer?Cheek the appropriate 6oxc =ype of project(required)- -_ I am a emplover%ith `Q3 employees(full and/orpart-time).= 7. E]New construction 2.❑I am a sole proprietor or partnership and have no employees working for:be in any capacity-[No workers comp.insurance required.] S. Remodeling - 3.01 am a it doing all work myself'[No workers comp.insurance required.]t 9- ❑Demolition 4.�I am a fiomeonmer and will be hiring connectors to conduct all work an m ra e 1 Hill I0[�Build[ng addition )P Pm'. ensure that all contractors either have workers compensation insurance or are sole II.�f EI ctricat repairs oradditions proprietors with no employees. - 5.�I am a general contractor and i have hired the sub-contractors listed on the"attached sheet. 12"❑Plumbing repairs Or additions These sub-conb2emr have employees and have workers-comp.insuranc:i I3.❑Ro0,reerp-a�irs P p 14-e Other Jv�'tJ IC 6.C(We are a corporation and its ocers ex have esised their Befit of exemption per MGL c lea h 152,}10),and we have no employees.[No workers camp.insurance required.) '-Anv applicant that eheels box-I must also fill out the section below showing their vmrkers'compensation poftcy information. r Homeowmem who submit this affidavit indicating they are doing all work and dhen hire outside contractors must submit a new affidavit indicating such. Contractors that check this box most 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. lanranenpla}pert/stir p;ovidittghvorkers'conrpetuationinser�r<cejorntpemplopees $elorvlstlaepolicpondjobSite ivtforas:aiiotz. Insurance Company Name: Uti•L C�� Policy=or Self-ins.Lic.§':_ „3 �,1 7® /a t { Expiration Date: Job Site Address 3 City/State/Zip: Sc, k",7 J Ettach 1 copy.of the workers'compensation policy declaration page(showing the policy number and expiration date)- Failure to secure coverage as required under iiVIGL c. 152,§25A is a criminal violation punishable by a fire up to S1,5o0.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of theDIA for insurance coverage verification. I do Irerebv cirri" -tde�thus ar !ties or�eLia+P drat the infornmtiox provided above is true m:d correct. Si_ena[ure: Date, Phone= 7 ? 7,YLj.F?l'/ .' ©ff0 t'se mr1}. Jo tot sprite in tliis area,to be completed by ckj,or town off ial. City or T Ow ermitUcense f issuing Authority(circle one): —Board of Rlealth 2.BuildingDiepartment 3.City/$or>•n Clerk 4. lectricaI_inspector d,Plumbing inspector 8-Other nn ia'l. t:t Person: Phone#• A� CERTIFICATE OF LIABOLITY INSURANCE 3/3/2015 � FR CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS TIFICATE DOES NOT AFFIRMAYIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THEPOLICIESOW. THIS CERTIFICATE OF INSURANC€ DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERRESENTATIVE OP,PRODUCER„AND THE CERTIFICATE HOLDER. RTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies}must be endorsed !f SUBROGATION !S WAIVED,subject to rms am)conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the icate holder in lieu of such endorsements). PRODUCER CONTACT NAME COnStruo-Um );astern Insurance Croup IrT.0 PHONE o �, (B00)333-7234 AGNo: 233 -west Central St E44ML ADDRESS Natick � 01760 INSURERS AFFORDING COVERAGE NAIOG INSURED "'SURE 1la PPotectioa Ins. Co. _1360 INSURER B.Tant7l'UU3 In9i1L231C@ CO atlantic TrJeathie- zation S 61 Rear Jefferson Avenue NURERc- INSURER D Salem INSURERE- ! D1970 INSURERF: COVERAGES CERTIFICATENUMBERMSTRR 2015 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES I INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING tLVY Y PERR,ENIENT• 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.UMrrS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iINSR LT4 TYPE OFINSURANCE SL V POLICY NUMBER APOUDO EFF PM�OOY EXP LamGENERAL LIABILITY EACH OCCURRENCE S 1,000,000 L COMMERCIAL GENERAL UABILITY PREMLSES Eaoamrenee S 50,000 A CLAIMS-haDE OCCUR 500042816 /20/2015 /20/2016 MEDEXP(Anyonaosean) Is 5,000 PERSONALBAOV MJURY $ 1,000,000 GENEFALAGGREGATE S 2,000,000 GEN'L AGGREGATE UMRAPPUESPER: PRODUCTS-COMPlOPAGG S 2,000,000 POLICY X PRD_ LOC S P TOMOBILE LIABILITY C MBI ED SMGLE LIMIT ANY AUTO .9 enti S 1 000 D00 ALL O'NNED -� SCHEDULED SOORYiNJURY(Perpersan) S AUTOS - AUTOS 020015871 /20/2015 /20/2016 80DILYMURY(Peraoddent) S HIRED AUTOS ' NON-OWNED AUTOS PROPERTY DAdU1GE S s UMBRELLA UAB pip-Basic s I a OCCUR EACH OCCURRENCE s 1,000,0001 J EXCESSUAS CLAIMS.MADE AGGREGATE S 1,000,000 OED RETENENSA-1nONS 600056654 /20/2015 /20/2016 AND RIPLOYER ENSATI IT S ANY EMPLOYERS'LIABLIIY UIC ST1 O_TH- ('NYFROhm"' RIPARrUOED?.(ECUnIC Y/N Y I M..d.to;in NER IXCLUDEO? ❑ NIA EL EACH ACCIDEFIT S If Yes. desc in and DESCRIPTION E.L DISEASE-FA 5NPL S YESCRIPTION OF OPt3xATIONS aeta:+ n01L-tlrr'I _ r014 EL DISEASE-POUITY �PL200378613 /1/2 0/1/2015GEHERALAGGREGATE 5±,000,000 . EA POLLUTION CONDITION $1,000,000 SCRIPTION OF OPERATIONS/LOCAnDMI VEHICLES(Attach ACORD tDt,Add,'UorW P.¢marks5cbedale,BmorssPaceis squired) RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY or S2T-iri+f THE EXPIRATION DATE ACCORDANCE Wrrt)THE OG�ROVIN TICE WILL BE DELIVERED IN 93 icTi',SHIYG"_0DT STREET SALEM, 1•`- 01970 AUTHORIZED REPRESENTATNE John Roegel/-=z% /RD 25(2010lOB} 12R r�nrnrtsr nt —.o-m nr'tna�.,��.e nnA innn n�:pnfr-nrcA®esB CORD GOP.PORATION. Ail rights reserl.2tL ,�E`.n IERTIFICATE OF LIABILQTY 96l9S�9�ft9�� - DATE fIBA4/ODIYY{^/)T -A TE DO E IS ISSUED AS A IIAATTER OF INFORd9ATlON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFiRN1AT1bELY OR NEGATIVELY AMEND,EKTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S),AUTHORIZED REPRESENTATIVE OR PR OUCER ND THE CE FICA E HOLDER IMPORTANT:R the s of p holder!'an ADDITIONAL INSURED,the p00Cy(fes)must be endorsed If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain Policies may require and endorsBment. A statement on this certificate does not confer rights to the certificate holder in lieu Of such endorsemen s, PRODUCER CONTACT EASTERN INS GROUP LLC NAME. 233 W CENTRAL STREET PHONE FAX (AIC,No,Ext): NATICK,MA OI760 E-Mi 22MLW ADDRESS: - INSURED INSURER(S)AFFORDING COVERAGE Ni ATLANTIC WEATHERIZA.TION LLC INSURER A: aM57tiCANZURICRINSURAN05 CDn/pANY INSURER B: INSURER C: 61 REAR JEFFERSON AVE 'INSURER D: SALEM-MA 01970 INSURER E: COVERAGES ]NEW RER F: H' OCER7FY ATTHE POLICIESOFINIII M OR , IELLSTED BCERTIFICATENUMBER: REVISION NUMBER:ET-0N XAVEB ISSUEDTO THEOTOWHONTHiSCEOVFICATE E EISISSPERBID@tOICA7ID.NO WCE PAIDAFFORORD BYTFfE OELI�CIE9 OE�SCFIBEDNHFAEIN 6gUBJECTTDALL THETEitL15,[OtCLU510RN�SPANDCON�TfICWlSOF Poll ES.YL@BITS BNOAM NNIY XAYEHE@I REDUCED eY ANDING PAID CLAWS. A(N.THEUCED y OlSq Lyn TYPE OF VISURANCE ADD SUB POUCYEFFOATE POLICY EXP DATE L R POLICY HUMBER IU•.Aa)D;YVWJ XA5 EIVWY)GENERAL LIABILITY Ul CO WERGAL GENERAL LIABILITY 'ACH OCCURRENCE S CLAIMS MADE 0OCCUR. AMAGETOREVTED t PREMISES(Ea occurrence) S ED EXP(Anyone peal S GENL AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY g POLICY ®pROJELT©LOC GENERAL AGGREGATE $ AUTOMOBILE LIABILITY PRODUCTS-COMP/OP AGG S ALL OWNS COMBINED SINGLE AUTO ALL OWNED LNAIT(Ea accill S SCHEDULE AUTOS BODILYINJURY S (— HIRED AUTOS (Per Parson) NON-OWNED AUTOS Sol INJURY S (Per accident) PROF[ATY DAMAGE g (Per accdani) UMBRELLA LIAR OCCUR EXCESS LIAR CLAUS461ADE EACHOCCURRENCE S DEDUCTIBLE AGGREGATE S RETENTION S S A WORKERS COMPENSATION AND g EMPLOYERS LIABII,ITy WN 03rZ02075 a > WC STATUTORY BOTHER OFFICER EROORTARTNEIVEXECUTIVE UB382r0127-15 O.1EN207H OFFICER.4 i,I EXCLUDED? WA OMRB (Oeii,dtory[�NHI E.LEACHACCIDENT' S 500.000 D yes,desotite OF O E.L DISEASE-EA EMPLOYEE DESCRIPTION OF OPERATIONSbeIAN S 500,000 r7MSCRtPLACES RIPTION OF OPERATIONS(LOCATIONSNEHICLESIREBTRiCr1pNS/SpEC1AL17EMS E.L.DISEASE-POLICY LIMIT S 500,000 ANY PRIOR CBR'faTGTE 65UIDT0 THE CEiTIF[GTE HOLDER A FFE7TING WOFUMS:COMP COVERAGE CERTIFICATE HOLDER CITY OF SALEM CANCELLATION . 93 WASHINGPONST SHOULDANYOFTHEABOVE DESC Fill BE PORETHEEXP ND C ROVLP9O0LINC3_ES BE CANCELLED IN4CCORDANCEWriiiHPOLIypEONTCEWLLBEDELIVEA ED SALEM.MA I970 AUTHORIZED REPR ,CORD 25(2070/05) The RCORD name and logo are - v registered marks of ACORD " - -- e 19BB=2010ACORDCORPORATIC, Ail ri gMsreserYed- V/ICPlJ1lJHinrPClr�/If o����4.DllPlJrri[f�/3 OaBi'ca of IS3FiIffi1Ry;<e.;u!a_Or'S•i;, SLi??wS ffice ofCoosomerAffaim&Business Regulation C'rnstr%clian Sups,-;car ME IMPROVEMENT CONTRACTOR - Lice Ga CS 087977 E egistration 142089 Type: FMC W PALM '` • � -, xpiration: .3/92l2016 Ltd LiabTdy Corpo:', 3 MLTO1V ST Y 1 ' ATLANTIC WEATHERQATION LL.C. ' Salem KA01970= ?-P-': - - - _ L ERIC PALM 61 R JEFFERSON AVE _ - i - SALEM,MA 01970 Undrrsccreinry con:-�i,�;c �s 0423/2090 Unrestricted-Boil -=�dings of any use group which —` IpOntain less than 35,000 cubic feet(991m)of License or registration valid for individul use only enclo,sed space. before the expiration date. 1f found return to: - Office of Consumer Affairs and Business Regulation - 10 Park Plaza-Suite 5170 r Boston,MA 02116 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit www_Mass.Gov/DPS - Not valid without signature - ' t