24 WINTER ST - BUILDING INSPECTION (2) W --- Hie C'onunonweallh ol'MassachuseBs
DDDD y '� hoard of Building Regulations and Standards Cfl'1'OF
sI �MiWachusetts State Building Code, 7SO C'NIR SALEM
�.,,.• la•td.,ed 16,r'nlr
Building Permit Application TO Construct. Repair, Renovate Or Demolish a
One-or ruu•Parmh'Dtrel(in,\r
This Section For OI'riciul Use Only
Building Permit Number. Date Applied:
L ing U ,ial Print Si aturc _-
go Dalc
SECTION 1:SITE INFORNIATION
L IEE
resr. 1.2 Assessorsbla ds Parcel Numbers
NTST pI.l led street? yes no blap Nunther Parcel Nunther
I.] ation: I.J Property Dlmenslons:
oniI'ropnscJ lase Lot Ana(sy Itl Pnutluge(Il)
1.5 Building Setbacks(B)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Reyuircd Provided
1.6 Water Supply:(M.G.I.e.40.§») 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public ilil` Pdeute❑ zone: _ Outside Flood Zone? ✓
Check if �es❑ Municipal® On site disposals)stem ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
T6FFR6'Y L )9AFr SAI,rM ) AA 0190a
Mane(Print) City.State,ZIP
W1 it' "9 -3 7, 979-'74d; -7skf
No,and Street relephone Email Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Owner-Occupied Orl Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed %York-:._ 1AAtt3p N fZ y QF PAI R C
� GNfMA/�YS R Rlt r - ROOF 11yE P RFpoIA)TlN6.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Inm Estimated Costs:
ILabor and \laterials) Ofliclai Use Only
I. Building 5 y3 SOO. 1. Building Permit Fee: f Indicate how fee is determined:
'. lilectrical S ❑Standard CityiTosvn Application Fee
❑Total Project Cost'(Item 6)x multiplier __x
1. I'lumhing S ' -- -
_. Other Fens: 5
J. Vc-c nical ill\ \(') 5 List:
\u l tressionl S Total .\Il Fecs: S
('heck No. _('heck AntuunC l',toh \woum:
n Tutul Project Cnsl: 5 4��Jrt74 s ❑p;tiJ in Full ❑Outstanding Bal;tnec Due:
SECTIONS: CONSTM11crION SERVICE.-
S,1 Construction Supenisor License(CSL) a ^ 3
O19 a3 I icense Nwuhar I �pir;niau U;ne
N;unc of l'Sl. l lydder
RieHARp N �p ��,,rr — RESToleft7"roN Ii,lcsLr,pel:.eheln,u.__.__-_-- _
1:QJ'�s _--. /AAA r$Q _ h'P'' Description —
Nri. ,utJ greet
It I htrestriocd I Iluildin gs 11p to 151wo--two
D„ellin
Cilsi frren,.\late.Lll' .SI Mason
C
per, Q RC R,xrlin C'oserin
L AA47P,I C S .tA15 . 0402( S A NindowatI"i;....
a07 YQL O SF SoliJ Fuel Ilurning Appliances
632 ^aR0lo Jtr�p�f ecto(rea\Acotn a .gin, 1 insulation
fele hone IGnail aJJnss D Denxtliliun
S.2 Registered Home Improvement Contractor(HIC) I
�J 4 a, 02 1IIC Ilcgisuation Nunthcr I:\pintlion Duce
I IIC'l'ompan) Nance or I lit'Itcgistrunt Nance
RI0 HARD ZROUS -6ZE5?OR�If0/J MA5fiA7S Irohelres�ofre�nas6n�� nt!(,00 ,c na
No. utJ Slrcul Email address
r4251C,�a1AE1.6ur '-IMf 'P,05 c909--6 ::2WO
City/Town,State,ZIP l k rele hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,C. 152.y 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 BE COIIIPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
[, as Owner of the subject property,hereby authorize K(C HAP, D T RON-5
to act on my behalf,in all matters relative to work authorized by this building permit application.
TEFFR�Y �AAFt` s A3 1 Z`
Print D,mer's Nwne(Electronic Signaturo) ate
SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby 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,
RIe NNRp H Z Ro nls l 'Jc 1��Jtst mn� S Z3 A a..-,
Prim Dss ncr's or:\uduuircd,\gcul's N;unc Il.lcctrunw\Ignaauul Dale
NOTES:
I. •\n 0wner who obtains a building permit to do his.her own work,or an owner who hires an unregistered contractor
(nut registered in the Home Improvement Contractor IHIC) Program).will nrr have access to the arbitration
program or guaranty fund under M.G.L.c. 11_'A. Other important inrurmaiion on the HIC Program can be found at
rrors iP.n. '��, x.i Information on the Construction Supervisor License can be found at,r,,,r N.In+ �:�, .Ill,
\\'hen substantial pork is planned,provide the information below:
rota) Door area(sy. Il.) - _--_.._I including garage, finished basement attics,decks or porch)
Gross lining area I Sy. Il.l Habitable room count _-. _... .
\amber ol'fircplaccs .. Number of bedrooms
Number ot'hathroonu — \'untbcrofh;l(halhs
1)pe ol'hatling S)Slcnl N'umbcr of decks• porches
- (!pert
� I 1 pC Ot GJV hllg i1 Aelll I!Itc Irked
1. "lotal Project Square Foolagc•'ma) he suhstituted lilr"fatal Project Cost"
e
i
7,�� r
120 WASHINGTON STREET SAI Ev! MASSACHUSC�S 01970
(9M 619-5685 FAX (978) 740-0404
CERTIFICATE OF NON-APPLICABILITY
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
Reconstruction ❑ Alteration
❑ Demolition ❑ Painting
❑ Signage ❑ Other Work
as described below does not involve an exterior architectural feature or involves a feature covered by the
exemptions or limitations set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic
Districts Ordinance.
District: WashingjQn Square
Address of Property: 94 Winter Street
Name of Record Owner: Jeffrey and Ann i aaff
Description of Work Proposed:
Remove, reset and repoint brick on South and East main facades. Rebuild chimneys to replicating existing,
repointing as needed and including new copper flashing. Mortar to match existing in color, thickness and
texture. Re-slate South facing roof above flat roof to replicate existing. Replacement of flat roof and
gutter/downspouts to replicate existing.
No changes in color, material, design, location or outward appearance. Non-applicable due to being in kind
maintenance/replacement.
Dated: May 4, 2012 SALEM HISTO MISSION
By:
The homeowner has the option not to commence the work(unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of
Buildings (or any other necessary permits or approvals) prior to commencing work.
A Document Al 05TM - 2007
Standard Form of Agreement Between Owner and Contractor for a Residential or
Small Commercial Project
AGREEMENT made as of the day of
in the year
(7)1 words, indicate day, month and year) -"
-- ';� --- This document has important legal
BETWEEN the Owner: consequences.Consultation with
(Nance, legal status,address and other information) - an attorney is encouraged with
respect to its completion or
modification.
�y State or bcal law may impose
requirements on contracts for
home improvements.If this
�r document will be used for Work
G r 97� �/�-_O,pQ9 on the should residence,the
rT / 7 -� (J / r Owner should consult local
9 �lL1* _-_" authorities or an attorney to verify
and the Contractor- 1/ requirements applicable to this
(Name, legal status, address and other information) Agreement
for the following Project:
(Name, location and detailed description)
The Architect:
(Name, legal status, address and other information)
The Owner and Contractor agree as follows.
AIA Document A105——2007(fomrerly A105-—1993 and A205"—1993).Copyright 01993 and 2007 by The American Institute of Architects A0
Init. rights reserved.'F,'P.,RW,1:'.3:This .I!?'fccumenf f--pro?sc[ati by U.S.Cn:.y;ig;i21_:w and Ictr:irafioncJ Tmtilas.Qnaslhxi_eo rsproduction cr 1
:ils:riY.:uv.icn of tl;i_R.t;i`)acu.neW.cr arc,portior.of it,mat,result if,s,vore 5iv1!--_nd crtrrinal oznslC=s,znd will ha prcaecutid;o the w '•^'10 •
i estont possible under the lz%v.purchasers are permitted 10 reproduce ten(10)copies of this document when completed.To report copyright violations of
.3 addenda prepared by the Architect as follows:
Number Date Pages
.4 written orders for changes in the Work issued after execution of this Agreement; and
.5 other documents, if any,identified as follows:
ARTICLE 2 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION
The number of calendar days available to the Contractor to substantially complete the Work is the Contract Time.The
date of commencement of the Work shall be the date of this Agreement unless otherwise indicated below.The
Contractor shall substantially complete the Work,no later than /%calendar days
from the date of commencement,subject to adjustment as provided in Article 10 and Article I
(Insert the date of commencement, if it differs from the date of this Agreement.)
ARTICLE 3 CONTRACT SUM
§3.1 Subject to additions and deductions in accordince with Article 10,the Contract Sum is:
§3.2 For purposes of payment,the Contract Sum includes the following values related to portions of the Work: /
(Itemize the Contract Sum among the major portions of the Work) ...
Portion of the Work Value N K
Cy�sg 9t'�
3- Llrj/GG , 3. G
�it1o�J/Zefi�UF' `/-- Q
§3.3 Unit prices,if any,are as follows:
(Identi and slate the trait price;state the quantity limitations, if am,, to which the trait price will be applicable.)
Item Units and Limitations Price per Unit($0.00)
§3.4 Allowances included in the Contract Sum,if any,are as follows:
(Identify allowance and state e-rcluslonr.'ifaay,from the allowance price.)
Item Price($0.00)
i/cr�f� n l 2 Y
norr rays r A5A- 0 ?b
1i CAN/ � Sr �D�'-Gr/ s�
3;• i�G, , �o� , �v - '` ass°°//
AIA Document Al05"—2007(formerly A105^ —1993 a d A205"—1993).Copyright 01993 and 2007 by The American Institute of Architects.All
snit rights reserved.NXARNJNG:This Al 3Dorumeri is nrofec!ed'oy U.S.CcP'P: h-- v: snd!s;ernsUcnel Traa:iss.U-.auttoriz=_d rxproduc Eoa or 3
=.fr•bu:;on of:h"s W^ecu^eni or a^'i pc.lion may resw.•n;ever_ .rvil 2r.d..:imirzt mmalt.es._'id ..L L"a ,_c f.:ur::
I 38u'irt possible crdar the law.purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of
§3.5 The Contract Sum is based upon the following alternates,if any,which are described in the Contract Documents
and hereby accepted by the Owner:
(State the numbers or other identification of accepted alternates. If the bidding or proposal documents permit the
Owner to accept other alternates subsequent to the execution of this Agreement, attach a schedule ofsuch other
alternates showing
/the amount for each and the date when that amount expires)
§3.6 The Contract Sum shall include all items and services necessary.for the proper execution and completion of the
Work.
ARTICLE 4 PAYMENT
§4.1 Based on Contractor's Applications for Payment certified by the Architect,the Owner shall pay the Contractor, in
accordance with Article 12,as follows:
(Insert below tinning for payments arnd provisions for withholding retainage, if any.)
§4.2 Payments due and unpaid under the Contract Documents shall bear interest from the date payment is due at the rate
below,or in the absence thereof,at the legal rate prevailing at the place of the Project.
ARTICLE 5 INSURANCE
§5.1 The Contractor shall provide Contractor's general liability and other insurance as follows:
(Insert specific insurance requirements and limits.)
Type of Insurance Limit of Liability($0.00)
t?/�Q�K 'di �LY✓!/�' �3G�Jr�
§5.2 Thb Owner shall provide property insurance to cover the value of the Owner's property, including any Work
provided under this Agreement.The Contractor is entitled to receive an increase in the Contract Sum equal to the
insurance pmceeds related to a loss for damage to the Work covered by the Owner's property insurance.
§5.3 The Contractor shall obtain an endorsement to its general liability insurance policy to cover the Contractor's
obligations under Section 5.12.
§5.4 Each party shall provide certificates of insurance showing their respective coverages prior to commencement of the
Work.
§5.5 Unless specifically precluded by the Owner's property insurance policy,the Owner and Contractor waive all rights
against(1)each other and any of their subcontractors,suppliers, agents and employees,each of the other,and(2)the
Architect.Architect's consultants and any of their agents and employees,for damages caused by fire or other causes of
loss to the extent covered by property insurance or other insurance applicable to the Work.
AIA Document A105" —2007(formerly A105"' 1993 and A205--1993).copyright®1993 and 2007 by The American Institute of Architects All
ti a. .�+r Tr .. e + +z: c z, rcd.¢t n
Init. rl9hts reserved flA'.f+ < + r I '7c n:n + oP c"d J 7 4
r
rir:r- . '' inc �i .i. t ., i '�:+al.�e x+ _ a .,_ pri
t. ..n+ant pass Me un 1-low.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report cop violations of
§6.2 THE WORK.
The term"World'means the construction and services required by the Contract Documents,and includes all other labor,
materials,equipment and services provided,or to be provided,by the Contractor to fulfill the Contractor's obligations.
§6.3INTENT
The intent of the Contract Documents is to include all items necessary for the proper execution and completion of the
Work by the Contractor.The Contract Documents are complementary,and what is required by one shall be as binding
as if required by all. _
§6.4 OWNERSHIP AND USE OF ARCHITECTS DRAWINGS,SPECIFICATIONS AND OTHER DOCUMENTS
Documents prepared by the Architect are instruments of the Architect's service for use solely with respecrto this ,
Project The Architect shall retain all common law,statutory and other reseryeI"ghts,including the copyright.The
Contractor,subcontractors,sub-subcontractors,and material or equipment supphersare authorized tguse and reproduce
the instruments of service solely and exclusively for execution of the Work Tho'instruments ofsery emay itottie used
for other Projects or for additions to this Project outside the mope of the Work witlibut the`sQecificwritten_corisem of
the Architect. - A
ARTICLE OWNER
§7.1 INFORMATION AND SERVICES REQUIRED OF THE OWNER
§7.1.1 If requested by the Contractor,the Owner shah furnish all necessary surveys anita legal description of the site.
§7.1.2 Except foot perruts-andfeesthat-are.tlie"iesponsrbilrtyofthe t�irihactofuniiet the Con6act Documems;the--
Owner shall obtain and pay ftother necessary approvals,easements,assessments and charges.
§72 OWNER'S RIGHT TO STOP THE WORK
ti
If the Contractor fails to correct Work which is not' accordance with the Contras Documents,the Owner may direct
the Contractor in writing to stop the Work until the correction is made. *,.,
§T.3 OWNER'S RIGHT TO CARRY OUT THE WORK f �.
If the Contractor defaults or neglects to carry out the Work in accordance with the Contract Documents and fails within
a seven day period after receipt of written nonce from the Owned[()commence and continue correction of such default
or neglect with diligence and promptness,the-_Owner`may,without'prejddice to other remedies,correct such
deficiencies.In such case,the Contract Sum sQI be adjusted to deduct the cost of correction from payments due the
Contractor.
§7A OWNER'S RIGHT TO PERFORM CONSTRUCTION AND TO:AWARD SEPARATE CONTRACTS
§7.4.1 The Owner reserves the right to perform construction or operations related to the Project with the Owner's own
forces,and to award separate contracts in-connection witfi'other portions of the Project
s
§7.42 The ContfiRo—eshall coordinate and coop5ra[e with the Owner s own forces and separate contractors employed
by the Owner.f _r
§7.4.3 Costscaused by days or byimpropEdy timed activities or defective construction shall be borne by the party
responsible therefor.✓'
ARTICLE,8 CONTRACTOR
§8A REVIEW OF CONTRACT DOCUMENTS AND FIELD CONDITIONS BY CONTRACTOR
§8.1.1 Execution of the Conn by the Contractor is a representation that the Contractor has visited the site,become
Familiar with local 60n"ditio-6s under which the Work is to be performed and correlated personal observations with
requirements of the Eotmact Documents.
§8.12 The Contractor shall carefully study and compare the Contract Documents with each other and with information
furnished by the Owner.Before commencing activities,the Contractor shall(1)take field measurements and verify field
conditions;(2)carefully compare this and other information known to the Contractor with the Contract Documents;and
(3)promptly report errors,inconsistencies or omissions discovered to the Architect.
Inn. AIA Doeumern A105w-2007(formerly A105--1993 and A206^-1984eopyrght019e3 and 2007 by The Amercan lestUe of Architects A9
rights reserved.WARNING:?F.1s.4fA''DacumaiE is protem.d by it.S.Copyrtcht'.aty and;n!ern:fional ImaVez.UroWhQrlred repr.duClion or 5
dLst"R titian of firs uleDosvnerl.cr an'v p"•-tion o!ii.may, 3caere it qad crlminal tr:'ni -s,erA'r.':II Se wearalaA to the masirrum
axton9 poasiole under the law.Purchasers are permitted to nprodme ten(to)copies of this documem when completed To report capydght Aoletloea of
AIA Contrw Domments,amag The American Insteute of Architects'legal sound,cop Vt@aia.org.
g 82CONTRACTORS CONSTRUCTION SCHEDULE--
._T11e-Contractor:promptly-after being awarded dra Contract shall,prepare•and.submit for the Owner's and Architect's
-informationa.Contractor's construction-schedule-for the-Work-
§8.3 SUPERVISION AND CONSTRUCTION PROCEDURES
§8.3.1 The Contractor shall supervise and direct the Work,using the Contractors best skill and attention.The
Contractor shall be solely responsible for and have control over construction means,methods,techniques,sequences
and procedures,and forcoordinating all portions of the Work
§8.32 The Contractor,as soon as practicable after award of the Contract,shall famish in writing to-th6—Ownerrthrough
the Architect the names of subcontractors or suppliers for each portion of the Work The Contractor shall not cottfiact
with any subcontractor or supplier to whom the Owner or Architect have made a timely antrrea�onabk objection.
§8.4 LABOR AND MATERIALS
§8.4.1 Unless otherwise provided in the Contract Documents,the Contractor shall pminde and'pay forlabor,materials,
equipment,tools,utilities,transportation,and other facilities and services necessary-for proper ex'&-utron and-'
completion of the Work. _
§8A.2 The Contractor shall enforce strict discipline and good order among"the Cotltra�tor s employers and other
persons carrying out the Contract Work The Contractor shall not permit employme`in,of unfit persons or persons not
skilled in tasks assigned to them.
§8.5 WARRANTY
The Contractor warrants to the Owner and Architect that:(1)materials and equipment furnished under the Contract will
be new and of good quality unless otherwise required or pemdtlefiby the Contract Documents;(2)the Work will be
free from defects not inherent in the quality required or peimitted�and'(3)the Work will,conform to the requirements of
the Contract Documents. - ``•� -'•,`
§8.6TAXES
The Contractor shall pay sales,consumer,use and similar taxesthat are legally required when the Contract is executed.
§8.7 PERMITS,FEES AND NOTICES
§8JA The Contractor shall obtain and.pay for the building permit and,other permits and governmental fees,licenses
and inspections necessary for proper execution and completion of the Work
§8.72 The Contractor shall comply with and-giye notices regtiind by agencies having jurisdiction over the Work If the
Contractor performs Work knowing it to be cont dry to applicable laws,statutes,ordinances,codes,rules and
regulations,or lawful orders ofpublic authorities,the Contractor shall assume full responsibility for such Work and
shall bear the attributable costs.The Contractor shall promptly notify the Architect in writing of any known
inconsistencies in the Contmct'Documents:with such.govemmental laws,rules and regulations.
..j
§8.8 SUBMITTALS- .
The Contiactdr shall promptly_mview,`approve in'wn'ting and submit to the Architect Strop-Drawir ws,Product Data,
Samples amd similar submittals required by-the Contract Documents.Shop-Drawings,Product Data,Samples and
similar sulymittals are not Contract Documents.
§8.9 USE OF S(rE r,-'-
The Contractor shall confine operations at the site to auras pertained by law,ordinances,permits,the Contract
Documents and the Owner
§8.1000TTINGIAND^PATCHINGThe Contractor shall he responsible for cutting,fitting or patching required to complete the Work or to make its parts fit
together properly.
§8.11 CLEANING UP
The Contractor shall keep the premises and surrounding area free from accumulation of debris and trash related to the
Work At the completion of the Work,the Contractor shall remove its tools,construction equipment,machinery and
surplus material;and shall properly dispose of waste materials.
Init. AIA Document A105'e-2007(torntarty At 05m-1993 and A205nr-1993).Copyright 01993 and 2007 by The Arnencm Institute of Architects.All
rlghta reserved.WARNING;ThlSA!A'nacrmea!!s pro!.cted by U.S.Ccpydgra L«,and 11Troalf^s.U;+aulhcde?d roymduclibr.cr 6
ulion of this AIAr pocranant,ar:,ny?or!!on dt 3�r,m.ce��tt In aTeera.:Ivil c.ed nindnal ^_ro�icc,cud w'!b,.,propngcviod
1 nlent pots,bie undartinraw.pumha>are are permitted to reproduce fear(Io)copierof nila document when completed To report copyright violations of
ALA Contract Document,>n ail The American Instiute of Architects'legal camsd,copynghWaiawg.
§8.12INDEMNIFICATION
To the fullest extent permitted by law,the Contractor shall indemnify and hold harmless the Owner,Architect
Architect's consultants and agents and employees of any of them from and against claims,damages,losses and
expenses,including but not limited to attorneys' fees,arising out of or resulting from performance of the Work
provided that such claim,damage,loss or expense is attributable to bodily injury,sickness,disease or death,or to injury
to or destruction of tangible property(other than the Work itself),but only to the extent caused by the negligent acts or
omissions of the Contractor,a subcontractor,anyone directly or indirectly employed by them or anyone for whose acts
they may be liable,regardless of whether or not such claim,damage,loss or expense is caused iaps by a party
indemnified hereunder. -
ARTICLES ARCHifEC7
19.1 The Architect will provide administration of the Contract as described in ibe.,Contract Documents;The*hitect
will have authority to act on behalf of the Owner only to the extent provideclin the Contract Documents.
§9.2 The Architect will visit the site at intervals appropriate to the stage of construction[o become'generallle-familiar
with the progress and quality of the Work.
§9.3 The Architect will not have control over or charge of,and will not beriesponsible for,construction means,
methods,techniques,sequences or procedures,or for safety precautions;andprograiiisjn connecfionwith the Work,
since these are solely the Contractor's responsibility.The Architect will not be responsible for the Contractor's failure
to carry out the Work in accordance with the Contract Documents. '
-...§-%+Basedon ofthe•Contractor'3'"ffpplicali`vttsforpayment,the-Architect-- -
.`.will-revie wand cerfify-the-armums-due-the-Contractor.—
§9.5 The Architect has authority to reject Work that does not conform to the ContrackDocuments.
§9.6 The Architect will promptly review and approve c r take appmpriate action-upon Contractors submittals,but only
for the fimited purpose of checking for confotTnarice_with information given and the design concept expensed in the
Contract Documents.
§9.7 The Architect will promptly interpret and decide matters concerning performance under,and requirements of,the
Contract Documents on written request from either the'Owner or Contractor.
§9.8 interpretations and decisions of the Architect will be.consistent with the intent of and reasonably inferable from the
Contract Documents and will be in writing zor in the form of drawings.When making such interpretations and decisions,
the Architect will endeavor to secure faithful performance by both Owner and Contractor,will not show partiality to
either and will not be liable for results of interpretations of decisions rendered in good faith
§9.9 The Architixt's ditties,responsibilities and limits of authority as described in the Contract Documents shall not be
changed without consent of the O%Lcer,Contractor and Architect Consent shall not be unreasonably withheld.
ARTICLE IT CHANGES.IN THE WORK
§10.1 The Owner,without,irivalidatin•g the Contract,may order changes in the Work within the general scope of the
Contract consisting of additions,deletions or other revisions,the Contract Sum and Contract Time being adjusted
accordingly in writing.If the Owner and Contractor can not agree to a change in the Contract Sum,the Owner shall pay
the Contractorits actual cost plus6reasonable overhead and profit.
§10.2 The Architecfwiil"have au&rity to order minor changes in the Work not involving changes in the Contract Sum
or the Contract Time and.notinconsistcnt with the intent of the Contract Documents.Such orders shall be in writing and
shall be binding on the Owner and Contractor.The Contractor shall carry out such orders promptly.
§10.3 If concealed or unknown physical conditions are encountered at the site that differ materially from those indicated
in the Contract Documents or from those conditions ordinarily found to exist the Contract Sum and Contract Time shall
be subject to equitable adjustment.
AIA Doeument A105--2007(femredy A105--1902 and A209M_1993).Copyright*t993 and 2007 by The American Institute of Architects.An
In it. rlghbreserved.'WARNING:Ths AIA�Daurn:en{;.nvuc:ad b7 ti.5.Co?Yriyht!alr and b:ierrativrolTro.1'les.Unauthmlzed reerodacacr:o: 7
ahxriextbn>I Shia.910."Gncununt.er�mi prntior.o! .coy n..:!:in¢:veer ctvn v.:d vlmi::al�hsutiae,end vri;b^L`�co-xuia3 to;h_ma•4ru:+r
ntant possible under the late.Purchasers are pennined to reproduce ten(10)copes of this document when completed.To report copynght violations of
AIA Contract Documents,wrnaii The American Institute of Architects!legal counsel,copyright®aia-019.
ARTICLE 11 TIME
§11.1 Time limits stated in the Contract Documents are of the essence of the Contract.
§11.2 If the Contractor is delayed at any time in progress of the Work by changes ordered in the Work,or by labor
disputes,fire,unusual delay in deliveries,unavoidable casualties or othercauses beyond the Contractor's control,the
Contract Time shall be subject to equitable adjustment.
ARTICLE 12 PAYMENTS AND COMPLETION
§12.1 CONTRACT SUM
The Contract Sum stated in the Agreement,including authorized adjustments,is the total amount payable by the Owner
to the Contractor for performance of the Work under the Contract Documents.
§12 2 APPLICATIONS FOR PAYMENT r
§122..1 At least ten days before the date established for each process payment,the Contractor shall submit to the
Archite'ctagitemized Application for Payment for-Work complaed in accordance,with-the values stated:intbe Agreement Such_Application shall be supported by data substantiating the Contractor's right to payment.as-the,Owtter
or Architect may reasonably require.Payments shall be made oni account of materials and.equipment delivered and ,
suitably stored at the site,for subsequent incorporation in the Work.If approvedin•advance'b"y tbeQwner,payment may
similarly be made for materials and equipment stored,and protected from damage,.off the site at.a location agreed upon
in writing. ..
§1222 The Contractor warrants that title to all Work covered by_atr`Apptfcation for Payment will pass to'&&.Owner no
later than the time of payment The Contractor fvrti.I --warrants[hat upon submittal of an Application for Paymen4 all
Work for which Certificates for Payment have been.preinously issued and payments received from the Owner shall,to b
the best of the Contractor's knowledge,information and belief,"tie flee and clear of lens claims,security interests or
other encumbrances adverse to the Owner's interests.
§12.3 CERTIFICATES FOR PAYMENT
The Architect will:-within seven days after receiptof the Contractof s Application for Payment,either issue to the
Owner a Certificate for Payment,with a copy to the Contractor,.for such amount as the Architect determines is property
due,-or notify the Contractor and Owner in writing`f the Architect's-reasons for withholding certification in wfiole,or in !
part.
§12.4 PROGRESS PAYMENTS
§12A.1 After the AmbiteeEhas.issued;afertiticate,for Payment,the Owner shall make payment in,the.mannerprovided -
inthe-Contetct•Documents
§12A2 The Contractor shall prnmpdv pay'each.subcontractor and supplier,upon receipt of payment from the Owner,
an amount determined in accordance witli did terns of the applicable subcontracts and purchase orders.
§12A.3 Neithei the dinner nor the Architect shall haveresponsibility for payments to a subcontractor or supplier.
i
---§-'L2:4-."R ertiii fctor-Paymettt;a pieVess payment.'or partW or entire use or occupancy-of the Project by the Owner.-,=
"..-_..shall narcoostimte acceptance of Wgrlc ttofmaccorslarPce-with ihe'requrrements of theContiact-Documerds:.°_•,._,_,.....
§12Z SUBSTANTIAL COMPLETIOn.
§12.5.1'Substantial.Completion is the stage in the progress of the Work when the Work or designated portion thereof is
sufficiendy complete in accordance with the Contract Documents so the Owner can occupy or utilize the Work for its
intended use.
§1252 When the Work.or designated portion thereof is substantially complete,the Architect will make an inspection to
determine whether the Work is substantially complete.When the Architect determines that the Work is substantially
complete the Architect shall prepare a Certificate of Substantial Completion that shall establish the date of Substantial
Completion,shall establish the responsibilities of the Owner and Contractor,and shall fix the time within which the
Contractor shall finish all items on the list accompanying the Certificate.Warranties required by the Contract
Documents shall commence on the date of Substantial Completion of the Work or designated portion thereof unless
otherwise provided in the Certificate of Substantial Completion
Init. AIA Document A105�—2007(formerry A105"—1993 and A2051e—1993).Copyright®I and 2007 try The Amedem Institute of Architect AD
rights reserved.wARNiN.a. :. ,: iW Document is P;01ec;_d by U.S.Copyright lair and!n!zrnadonat?reatks,unauthwi.ed repro iucnon cc e
:icL tS tbn of Ihia AIA°Dcavn¢nt,cr aay pardon of R.ma`l mash fn caaaro civil nr::S u;mFcal r n_kies.a,M milt be proszatetl I.;Fs mulmum
l attont possible undor the ILe.Purchasers are permitted to reprocuCe ten(10)copes of this document when completed To report copyright violations of
AIA Contract Docimeni s,e.,aa The American InsfiWte of ArchRects'legal counsel,copyrhgtruPalaorg.
§'12.6 FINAL COMPLETION AND FINAL PAYMENT - 2
§126.1 Upon receipt of a5na1 Application for Payment,the Amhitzct will inspect the Work When theArchifect finds
', the W oak acceptable and-the Contract fully performed,[he Architect will promptly issue a finalCeitifica[e for Payment.
§12.62 Fnal payment shall not become'ilueuntil the Contractor submitsto the Architect releases and waivers of liens, j
and dam establisldng payment or satisfaction of obGgations,_sticli as receipts,claims,security int or encumbrances
,rt i
§126.3 Acceptance of Snal payment by the Contractor,a subcontractor or material supplier shall-constitufe a waiver of
cI aims by dhat,pay@e except those previously made in writing and identified by that payee as unsettle'd at thetime of
fina(,App*ation for Payment. r '
ARTICLE 13 PROTECTION OF PERSONS AND PROPERTY ~
The Contractor shall be responsible for initiating,maintaining and supervismg.aD safety precautions and programs,
including all those required by law in connection with performance of the Contract.Tfie,Contracior shall tales ,.-
reasonable precautions to prevent damage,injury or loss to employees on the Work,'the Work and`material4 acid
equipment to be incorporated therein,and other property at the site or adjacent thereto.The Contractor shall promptly
remedy damage and loss to property caused in whole or in part by the Contrpctor,- rby anyone fo7.,whose acts the
Contractor may be liable.
ARTICLE 14 CORRECTION OF WORK
§14.1 The Contractor shall promptly correct Work rejected by the Architect as failing to conform to the requirements of
the Contract Documents.The Contractor shall bear the cost of correcting stich rejected Work;including the costs of
uncovering,replacement and additional testing.
§142 In addition to the Contractor's other obligations including warranties underthe Contract,the Contractor shall,for
a period of one year after Substantial Completion,correct work not conforming to dw rrequirements of the Contract
Documents.
§14.3 If the Contractor fails to correct norlconfonning Work within a reasonable time,the Owner may correct it in
accordance with Section 7.3.
ARTICLE IS MISCELLANEOUS PROVISIONS'-.
§15.1 ASSIGNMENT OF CONTRACT ,M
Neither party to the Contract shall assign the Contract as a whole without written consent of the other.
'i152 TESTS AND INSPECTIONS.' -
§15.2.1 Arthe-appropriate times the Contractor shag arrange and bear cost of tests,inspections and'approvals of
portions of the Work required by the,Contract Documentaor by laws,statutes,.ord trances,codes,rules and regulations,
_ .��_ :ate f
or lawful orders of public authorities ---_ . .-.--.' _ dx/..�r .,;-
§15.22If the Architect requires additionaT:testitig the Contractor shaltperform those tests. <
§15.2.3'The OwnerstiA bear cost of tests;inspections or approvals that do not become requiii niems-until al erthe
Contract is executed:`
§15.3 GOVERNING,LAW
The Contract shall be governed by the law of the place where the Project is located.
ARTICLE 16 TERMINATK)N OF THE CONTRACT ,F -
r §-4f>.TEWAINATIONBLTHECQNTRACTOR
-- if the Ar+�ihitee!fails to cettify payment as provided inSection 12-3'for a f,3`period o0 days through no fault of the
Contractor,or, to make-payment as in Section.12-4.I-for a period of30day&,the Contractor
may.-upon seven additional days' written notice to the Owner and Architect,terminate the Contract and recover from
the Owner payment for Work executed including reasonable overhead and profit,and costs incurred by reason of such
termination.
AIA Daermrenf A105--2007(fornw Ay A105-—1993 and A20Sn—1993).Copyright O 1993 and 2007 by The American Institute of Architects.AO
Intl. rights reserved.'rJFnNIYG:This AlA3 Dca,meni is F±e;acted by iJ S.Copyright T.m and lnvrna!ianai?rsat zs.i;�autlm:`.xod re�raE-'dc!ior.rr 9
<!;atdbvtian of N.A W'Dan;ment,or any parfion of 6,¢my ro.+.:a in sv'var+a olv;:>nd.v3minn1 to,m�clrun+
( exiant possible inlay the ls;v.Purchasers are permittedto reproduce terra(10)copes of this document when completed.To reporteopyrigttviolafions of
AN Contract Doormen$email The American Institute of Architects'tegal counsel,copyright@aiaolg.
§16.2 TERMINATION BY THE OWNER FOR CAUSE
§16.2A The Owner may terminate the Contract if the Contractor
.1 mpentedly refuses or fails to supply enough properly skilled workcrs or proper materials:
.2 fails to make payment to subcontractors for materials or labor in accordance with the respective
agreements between the Contractor and the subcontractors:
.3 persistently disregards laws,ordinances,or rules,regulations or orders of a public authority having
jurisdiction;or
.4 is otherwise guilty of substantial breach of a provision of the Contract Do merds.
§16.2.2 When any of the above reasons exist,the Owner,after consultation with the ArchitectJ=ro Y wittrout prejudice to
any other rights or remedies of the Owner and after giving the Contractor and the Contractor's surety,if any,,seven
days' written notice,terminate employment of the Contmctor and may
.1 take possession of the site and of all materials thereon owned by the Contractor,
.2 finish the Work by whatever reasonable method the Owner may-deemexpedient
§161.3 When the Owner terminates the Contract for one of the reasons stated in Section 162.1,the-Qti tjtractor shall not
be entitled to receive further payment until the Work is finished
%,16:2;4-If-the-unpaid.balance of the-Corttract-Sttmexceedscostmf-finishing-th,--Wor:?mchezeess shalf be paid to the
Contractor,If such costs"exceedkthe unpaid balance,ttie Contractor shag paythe differeneeto the Owner:This
-•obligation.for-paymentshall sarviveterminatioo-of the Contract.
—.t%.3-TERMINATION'BYTHE`OWNER FOR CONVENIENCE--
The.Ownenmax.atanytime,-terminate the Contract for'tlie Owner's convenience and-withoiitcause .The-Contractor
-,shalt be entide&to receive-paymem-forWorifexecuted:-and:costsiiKutredby.reason.oisuch tem»nation,-alongwith--=..
reasonable overhead and-profirofithe'Work not executed:=-• _ .
ARTICLE 17 OTHER TERMS AND CONDITIONS _
(Insert any other terms or conditions below.)
.5
i
1
AIA Doenent A105m—2007(fomlerty A105n—1993 and A20"—1993).Copyrlght®t9ea and 2007 by The American Ins5Me of Arehitucts.All
IInit. b
rights reserved.Y/AF.KING:?Fs FIA'^ccumen[is proascted Ly U.S.Cc-cyright 12'a and Intornt ooa!Treaties.Unourhanwd reproducrion or
d'rtribUkn m of this AWDacu:ramt,of an,p Jono(itmayn`vt'itin:^.aru<M;nnct.`m:nai tv nmRis:.,::d vAl.�_pra�me_;ad!o;he mivimu.n 10
i oMmnt poasibte unw)r tho lave,purchasers are permitted to reprod!ee ten(10)copies of this document when completed To report copyright vidations 01
ALA Contract Documents,e-mail The American Ineftle of Archilacts'legal counsel,copyright@aiamg.
This Agivemerit entered into as of the day and year first written above.
(if required by law, insert concellaiian period,disclosures or other warning statements above the signatures.)
OWNER CONTRACTOR
(Signature) (Signature)
(Printed name, title and address) (Printed name, title and address)
LICENSE NO
(Signat e) V"
An urn JURISDICTION�
(Printed name, title and address) Ile
A Wirdcf T+
.jem , MA ojq7o
CAU11ON:You should sign an Oz-ahlril AiA C011!raOf Do,,onep.t,on vifich this,,xi spraa s in PED.An original assaras t".-
"nanoes will 1-1 ba
Init. AIA Domenerd A105'e-2W7(fonnorty,Ale!in'-IM and A205re-1M).Copyright®I and 2007 by The American Inatitine of Amh4acts.All
rights mwrved.VlARNrIG:T,ils,IIA�Do�ment is PfOW',10 by U.S.Copyright LoI and
to Mf be olos%Uwd Z.Ills j111,MUM
d;%tribUM6 Of this AWDO�=
=yjant p-*sfb!o urdor f�iaw.Purchasers are Permitted to reproduce ten(to)Copies Of this doOUMGot when wroPlOted To report copyright Violations Of
ALA Contact"ments,&-mail The American Instritite of Architects!legal counsd,copyrighttgWaorg.
CITY UN S,UEN19 NWSACHUSEITS
s BUILDING DEPAWMENT
120 \' ASHLNGTON STREET, 30 FLOOR
TM 7 r -9595
(9 8) 7 5
Fla(973) 7 W846
.j N I0 EALEY D RISCO LL Z?tOSL4S ST.P1F n a n
AAYOR
DAECTUR OF PUBLIC PROPERTY/at:I1.DING CONLUISSIONER
Workers' Compensation Insurance AlVdavit: Builders/Contructorv/Electrici•rne Plumbers
%polleant information Please Print Lezibiv
V;unc Ina.rin..r,or�nuati,tnlmuvirh,.11l: R I C.' i�ARO T20N S ' R�S7�RHT1n1U MA 50 S
Address: 3cR5- '141 S VA E LA nIE
CityiSratc/Zip:LIMER(CkJ ME, 0404k Phone#: XO 7 -632 ' a 80(,
Are an employer?Check the Appropriate box: Type urprn)ect(required):
I. I am a employer with Z 4. 0 1 am a general camroctor and 1 6, (1 Now construction
employees(Nil and/or part-time).• have hired the sub•contractan
2.0 I am a sole proprietor or partner. Iisiodoil the Ali ched.rhaeL t �• lt� ttemodeling
,hip and have no employees These subcanlraetors have S. 0 Demolition
working Ibr me in any capacity, workers'comp,insurance. 9, 0 Building addition
(No workcn',comp, insurance S. 0 we area corporation and its
required.) officers have exercised their
10.0 Electrical rcpsirs or additions
3.0 i am a homeowner doing all work right oroxetnplion per MOL I I.Q Plumbing repairs or additions
myself.(No workers'cutup. C. 152, 91(J),and we have no 12.0 Raof repairs
insurance requited.(t employees(No workers' 12.0 Other M AM MR V
comp.insurance required.)
•.very appa.vn oW chaos box al mum Aw nil oW Chi,uciiue bulaw.hawing their vakm'compenudun pulley maumation,
'I I„muuwnns aha,Omit mill alydavit Indlutins they are doing all worn and then him uubide eantmrean mWl auhmll a new anldavil indicting iwig.
4nnmmWun thal chwk this box mug jttxhW an uWallun:.hst showing the nwna o!the mb.omnewn and their wasting'camp.policy inlortnaeon.
I tun on employer that providing ivorkers'eampenmdun huuranee for my employees Below is rise policy and fob rife
injurmuNnn.
Insurutce Company Name: I C . 141.8(N E L-IAP40YCR.S MUTOA1. INS. e O f �
1-0 6
Policy 4 or Self-ina. Lie. rl: Expiration Date: Q M(EP
Job Silts Address;Aq W/AfT Ell �. Cilyislatrizipt 5R4-'Nl t AA A . 0 )9 V70
AllAch a copy of the workers' compensation policy declarallon page(:hawing the policy number and expiration data).
Kiiluro to wcuro coverage ua required under.4eclion 15A of MGL e. 152 can lead to the imposition of criminal penalties of a
tire up to S1,300A0 and/or one-year imprismmincnt,as wall as civil penalties in this farm of a STOP WORK ORDER and a tine
Of up to 5?JO.00 a Jay against the violator. Ile advised that a copy tit this..talen:cnt may be furwurdcd to the Milos of
lavr,tigaliun.r,ti the DIA I�arinsunnce cnwrage vest ticaliun.
l da Irere6y certify under doe paint and penuldes u f perjury shut the irrfarnmdun pro viJad above i.t true turd correct.
tt re I):Iwl�A t. a . o1OI Z
Ot icial u,e only. Oa nor wite in lhr:r urea, ra be cmuplervd by city or torvn nyllgiaL
City or I'tnnl:
k„Ao-,\uthurily (circle anu): — - -_
1. Ilu.lyd ul llcallh 1. Iluildln.. Delvlrlotuul I. !'i(y,Tomi C'Icrk 4, (itcctrical ln,pcclar i, Plunthin4 Inspector
6. 4)t11cr --.---._.
CITY OF sm-Em, AUSACHUSETTS
JLLWNG OEP.IRT1tE.\T
I.0 W.")INGTON STREET, 1'O FLOC It
'�. f�L 191� 7t.>•9595
P,Vt(973) 744904d
.'Cll®t:At&Y D4!lSCOLL '
MAYOR fkoxw ST.FMXAA
DIMTOIt OP K 3LIC PRGP!><TY/at;MnLYC CO.N01133ION EA
Construction Debris Dfsposaf Affidavit
(required for W demolition and renovation work)
fn accordance with the sixth edition otthe State Building Cade, 730 CMR section 1 l I.J
Debris, and the provisions of MGL a 40, 9 34;
Building Permit M is issued with the condition that the debris resulting from
This work shall be dispo' of in a properly licroscd wrote di3possi facility as deRncd by NIGL c
111, S I JOA.
The debris will be transportcd by:
RPcKARp siPo,US ^ R��oRAT10NMAsONS
(name ot'hauler)
The debris will be disposed of in :
4IMFIR1c6C i KAIJSFIER STATIoN
(name of f�cdiiy)
DO�� RIDGERA, I.IMERIck) ME pKOgf
1,Jdreu or'fc+hry)
- + 1n�mreuf,ermit +pphcrnt
a3 Zo19 ,
VD, Office of Consumer Affairs and usiness Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 114122
Type: DBA
Expiration: 8/6/2013 Tr# 215072
RICHARD IRONS - MASON
RICHARD IRONS
12 BURNHAM ROAD
LIMERICK, ME 04048
Update Address and return card.Mark reason for change.
"" ❑DPS-GAl O SOM-04/O4-G101216 Address Renewal ❑ Employment ❑ Lost Card
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,MA 02116
i
1
I
�® Massachusetts -Department of Public Safety. Not valid without signature
•=� Board of Building Regulations and Standards
Construction Supenisur --
License: CS-019238
RICHARD H III&S -`\ -7, ,
325 LEISUI&&1, (k
LIMERICK;AIE 04 4
l
Commissioner Expiration .
11/02/2013
2079851295 Business Services Kennebunk Savings 09:59:51 a.m, 05-23-2012 1 /1
.a`oR� CERTIFICATE OF LIABILITY INSURANCE DATE 12
5/23/2012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES 1401' AFFIRMATIVELY OR NEGATVELY 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 pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED,sub)ect 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 NAME:O marina Salang-White
Kennebunk Savings Insurance PHONE
4 a (207)985-2941 FNo,I]0]19R5-3111
50 Portland Road ADDRESS marina.ealangwhite®kennebunksavings.cam
PO Box 770 PROou. 00001637
'Kennebunk ME 04043 INSURERS AFFORDING COVERAGE NAIC0
INSURED
INSURERA:NGN Insurance Company 14788
INSURER B.MIRMIC 11149
Richard Irons Restoration Masons
325 Leisure Lane INSURER C:
INSURER D:
INSURER E:
Limerick ME 04048
INSURER F
COVERAGES CERTIFICATE NUMBER:CL124180ID28 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 HIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERTMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
BIER
TYPE OF INSURANCE ADOL OGCY EFF FOLIC FXPP
POLICYNUMBER W1'Y WoClYYYY UNITS
GENERAL LIABILITY
!EACHCURRENCE $ 2,000,000
X COMMERCIgI GENERAL LIMILITYS Eaacanenca $ 500000A CLAIMS-MADE rX OCCUR X IL2B25 1/22/2011 1/22/2012 maanon $ 10000L$AOV INJUgy g 2,000,00 AGGREGATE $ 4,000,000
GENL AGGREGATE UMIT APPLIES PER: PRODUCT$-COMPNP AGG $ 4,000,000
X POLICY PRO. Lac
AUTOMOBILE LIABILITY COMBINED SINGLE LIMB
ANY AUTO (Ea acddent) $
ALL OWNED AUTOS BODILY INJURY(Perpenm) 7-
SCHEDULED AUTOS BODILY INJURY(P.,.M nil $
HIRED AUTOS PROPERTY DAMAGE $
(Per accident)
NON-OWNED AUTOS $
It
UMBRELLA LIAO OCCUR
EACH OCCURRENCE $
EXCESS LIAR CLAIMSMAOE
SDIS�SE.
$
DEDUCTIBLE $
RETENTION S
WORKERS COMPENSATION $
B AND EMPLOYERS'LIABILITY OTH-
MYPROPRIETORPARTNEREXECUTIVE YIN $ 1OO 000
OFFICERIMEMSER EXCLUDED? ❑ NIA E.L. T
(Mandatory In NH) 5101800318 - /B/2012 /B/2013
Rye&deemibeundu EMPLOYE $ 100 000
DESCRIPTION OF OPERATIONSbelow ICY UMIT S 500 000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Allaeh ACOND ICI.Addillonal Remerka Schedule,It more apace IN required)
Job: 24 Winter Street, Salem, NA, City of Salem NA in named as Additional Insured respects to General Liability
Coverage.
CERTIFICATE HOLDER CANCELLATION
(978)740-9846 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.
Building Inspector Office
120 Washington Street AUTHORIZED REPRESENTATIVE
Salem, MA 01970
M Salang-White/NSW
ACORD 00 (2009l09) O 1988-2009 ACORD CORPORATION. All rights reserved.
INS025(zaoso9) The ACORD name and logo are registered marks of ACORD