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10 CEDAR VIEW STREET - BPA-11-532 The Commonwealth of Massachusetts Board State Building Code, 180 CMR, 7rd of Building Regulations and Standards CITY Massachusem clition OFSALFM 1r Revised Junuary Building Permit Application To Construct,Repair, Reng gW0.r'Demolish,a /. 2/NAY One-or Two-Family Dwelling. , This Section r O ficial Use-Only :, .... .,.: Building Permit Number lcAppli d: Signature: / Building Ca issioner/Ins or of uildin Date SE a!O L-SITE INFORMATION L I Property Address: 11 / s/d1.2 Assessors Map& Parcel Numbers Fort•. 't iC�rk�l U�c I.la Is this el:aC e t Feet?yes no Map Number Parcel Number IJ Zonin !' foSattatloM. 1.4 Property Dimensions: Zoning,District' Proposed Use Lot Area(sq 11) Frontage(R) 1.3 Building Setbacks(B) Front Yard Side Yards Rem Yard Required Provided 'Required Provided Required Provided - 1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone? Public 13Private 0 Check if a❑ Municipal❑.Onsite-0isposal system ❑ SECTION 2: PROPERTY OWNERSHIP' ' 2.1 Owner y9�J Reeord: KO�`cr+ l7rko�1 %U Cc IJ.c�' Name(Prin Address for Service:.- ( 9-)2) - 7 y y 57�e6) Signature Ttlephone ' SECTION 3: DESCRIPTION OF PROPOSED WORKS(ctieck,all that apply) New Construction❑ .Existing Building O Owner-Occupied_❑, Repairs(s) ❑ Alteration(s) 0 Addition O Demolition ❑ Accessory Bldgeify: BrierDescriptionoll' sed Work': LJch+ { SSS 7/S�r/ . .cc(IGlesz �1(S 2 %3 ?r ; c 1 - /Poch dwtl- / 2 C>u.l+k ���rf5 - U- SECTION 4 ESTIMATED COtYSTRUCTION COSTS Item Estimaled'Costs: Omclal Use=Only Labor and Materials �"� - I. Building Is I. BuildingPermit FeefS. `Indicate;how tee is determined: �.Electrical S O Standard :City?own Application•Fee- ❑Total ProjafCos t'(Item 6)x multiplier x 3. Plumbing I 5 2. Other Fees: S 4. Mechanical(HVAC) I S. .List:. . 5. Mechanical (Fire S Su ression) Total All Fees:$ Check No. Check Amount: Cash Amount:_ 6. Total Project Cost: s Vl oo.. '9 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5:I Licensed Construction Supervisor(CSL) y 77 y 3If L License Number Fxpiralion Date Name of CSI.•Itolder Efic W.-Palm LutCSL'ryype(scebelow) t? 3 MOA Rum--- f� Dexri ion Address 1881,1�1A-'fl1g/0 U Utimstricled u to 35,000 Cu.Ft. R Restricted Ik2 Family Dwellinit Signature /�� y"q� M M Onl RC ResiJemial Routin Coverin fdephoneWS Residential Window and Siding SF ` / C . ti- -15 /Y j Residential Solid Fuel Appliance liance Installation q -2 fs -2 . D Residential Demolition ESECTION Improvement Contractor(HIC) fig ( �z fllC Rr�istrant s�. rlbb*3/11!12 Espira 143 Telephone: ORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.1 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...........O SECTION Tat OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT �� XQ as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by thisbuildingpermit application. r sivaiturcofowner - Date SECTION 7bE<OWNERr OR AUTHORIZED AGENT DECLARATION I C=.( as Owner or Authorized Agent hereby declare that the:statements and information on the foregoing application are true and accurate,:to the best of my knowledge and behalf. PrintNom�iG��/ Signature ner or.Authorized Agent^ Date Si edanderthepains andpnaltiesof ur NOTES: I. 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 fId have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other importanl information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 790 CMR Regulations 11016 and 110.114,respectively. �. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage,finished basement/attics,.decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of.tiathmoms- Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" I i The Commonwealth of Massachusetts " Department of IndustrialAccidents ! Offee of Investigations lvw�k; 600 Washington Street Boston,MA 02111 w;vw.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): Aflanfic We4erkA ion,LLC 61 R e erson Avenue Address: Salem MA 01,970 City/State/Zip: Phone#: g 7 y y- 03 3 Are yoy4tn employer?Check the appropriate boa: Type of project(required): 1. I am a employer"with DL S� 4. ❑ I am a general contractor and I • have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me inan. ca aci employees andkave workers' y P insurance.t 9. ❑Building addition [No workers comp.incorasurance p• required.] 5. E] We are a corporation and its 10.❑ Electrical repairs or additions 3.[3 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entitles have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that Is providing workers'compensation insurance for my employees. Below is the policy and job site information. r Insurance Company Name: Policy#or Self-ins.Lic.#: 911 132 0 3o 9 _'Expiration Date: /i Job Site Address: W Ce - e J AA-0— City/State/Zip: 4>J,0;7- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under-Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER-and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the AIA for insurance coverage verification. I do herel y certify under the pains and penalties of perjury that the information provided above is true and correct n Sinature• l/ - Date: /�7/ , /,&2 Phone q�� �V`! - � IY 3, Of ficial use only. Do not write in this area,to be completed by city or town official Ct. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person Phone#: ���'---rte. � n "i'i'1..4S:J ,,. ,.."L� , ♦.. ( ;.c n_l n,,. '�_. �',,..d,P,r �i t �r+ + ACTION, INC r 47 Washington Street Gloucester, MA 01930 dd1111II1 Agency; NSCAP NGRID;ApRlrcationt#; PROGRAM:` AARAWAI' fi rkjyrOrtleOrDate 12/13%1'0 f p J do?. Na ) hDO 0,' ESC: erform r N9 z Atla'. 4,PrTmary'tro0646tor{ (atic Weatlienzatipn ' ' "` q `OtheirContracfo r Manchester'Electnc, L'l C #BU'IbSinstalled S0tie0`9� t"• ' a, '''l' ^y ,>, • /,aCoat?of,, Ib5, S•I} iRvd ' •; r Cllent' Robert Dixon nspC$�125�0 Max $bt ooi Sttedt� 1t0 Cedar V,rew:'AVenue Ofher Ih Kind 5ro q0 City{State,Zips Salem,yMar' 019,70 " Electnoal'WorK. ($01,06-f �Telepl�o-0rie 9781-Z44�fi700'_: ' s 7�mountt Kdi ySp pan -$0 6,q '`J dI Adplit Vati'©nel' GY 'dI '�' 001. .`Blowerpoor Tient' , Y,es ;„ t7 1Se Iltili'l Ifiapect1Krtotil&TufZe, No DateJob CpmpletedY f Estllnatedjjte�aff owl $190%00+: yActual'Repat'rlfotals $bQOrI Weathemzation., Act Coati ,i. s Fa'"E§t C6s"tt:', 'a_'Act Cost. •.:: Door Kith _ ?+, ;.. `' 3 _; u hj`, ;$43sD0 .' 's;$129J40 �1 . ;, + 1{5:00, :$45.06 Mal r��I. AUtomatl6b6 r`S�Nw _. 7 ri': .: +x ,_,?:�w. ' -:�'I! '-'$2 L t'. 'sM a ar 1 M-0 . #Air 5ealih4,;Z "aititdaK er-hour �,-�2��:.9. t 176,00, AttiZrAidSealln'r2 art.f0am: eehour a p�.4' :"' !SC nr $75 1_.• ;$A,50AQ'r ; ^;',Y.�:Lt'tu7�} JNeatherstri ,VHindowr $5:00 CC17• Seal_Ducta-MestCc'!I W �€, ..f ", 1" =�, ti$62*00 G a o, �(o o ,r W/S 8"In"su.'.AtttGM 3tc�i.R307F6,. �„"` 1:_. � ` .F:$32.0 . .':$32':00` •" ? AJ r' `` z N f>:+`-- -t. is -:✓d_ir cam. �. 1, ( -•;-e L. F s ,,,,t°�.0,i.`"a' ,..",. xi.`:Mi�.+:a �.�._r41_•#a n f ax L.2y.$Qi:QQ i. '.�(.�'',�pi D�D7.. ! .a2:i,..':i�",Ay5��3�'0'....�Y• I QiQQ J 1..1 r ,.:l:.Li�1L1. ' .�" ..'l•tv1U7� •i.:-.� r. .�.i vlf Y ,�.. 'ter �•i ,rhA.,,�.,.' �ti 1 $0100 r ii"l' r '/j.•d..' .�s��'TS�F..n..tii�.k�J.P,. x-.u•^ ti..,Z.:> .Is+..� ,i �" f '.. '' 0.00 -0a a; •.ar ,7 - M �DI a 1,r1 Weatherizaticn'Zwtals'_ s G_ _ $506 d0?. ! �;,."'$0 00+': ,; Ihsulatfona a ,,:v;r EsU r"a r A¢t _.. Cost, ' .(, :Esti Coafw " Act,Cost; 'Attic',Fiat:R38d&"enr.. . ,k . - ,487, t ' ;$1 40'.'. ;! 7$68ti.80_W Attic:F,lat,R3�o errs .4 :� a D c t.."�.', ogjla .... Attic,F„let/Slo e5aR30'restncted,•>.. r ;C . - �^ 1;:.4:1.,4 _I;: a q _ :'i� y',yotto�o, - 171-1- X2.-x r' n •� ( ”` `•,;,;ti N r4 f:. r r ,$,1�.:J5i Y h N..�0 a Di.. .t.. ,C!L�,IJfrY_. %Atfic^FlatlSlo esst�20`rest'mcfed. _�.,.,.. t.. ; �., �;`s AtUcK'neewal;R'1'3r,FG_ - ^'` $11:25+' f� D c,, K r.°, j�[ai f4ttfc:KWall'R13rCelliw/Membrane »i. t 1:.65 "� ;r; n1 a InsGlatesAltic Stairs'&1$llalfs,";` k iSidewall§',106 d:Shin Ie R1;3iDP';a A 1'5b `' v i1'µ , . 11.70'::, i $266.,750L 1"' r a•o (a_t �(ntenon WaIIbR13,>P,.la§ter;R,'I'r3rDPI.;.'_;.�,'d.,t,.�,��r�,.` ' •• biP>_`�" 1s'$1 ��D c ':�, ,f t,, t u o iilest;l)nlf,+Sidew"alls;,4•Stdes,�.,,+E,r��'.. :: . -v.'.i:,:?z�ti 1 . :"::_ • •. ;ti'1�.$fi0':00: 3: Y_�"{"off o o ,,;' r�r '�o a a� ;7T 7- �a 01 �H"dFohic�l.'f"e'�lsultto+l'l7RSr�`; . v',"u ��: .,t �t�a.�_$3225'�_ •�.�''fJ{a0�=_ .._in. _•.'��a o a 'Steam Pi"' InsuRtoY2"+R5ti -. ' n -,P ,� 62; a ,M+ :a $6V05t n• t '_; 375M I;Oi:•' f...t...: 1. h DHV?lrFi"erlhsaaffomrRS w a, 6 i` . ` is ' $2s50g f_ ;$1i5i00;" _ 4 c1 . 4nsulaietDoor�''" ';,.�•r..?a.�F. ,-•f�.,1, �,t'r . '�"�:r at$44.ieW f:, 44,W% [SIII°2' aitfoam w%iFG�BatUR19z r_ .90>' {:,I ` '`• f:,_ ..$2:QOr+ i $180:OOf _„ " :,_: o,l�1z Ihsul`atibnrTbtais:,',,.7� $0?OOi_.` a,,`-ui—t --rn. ^^�." y._r - .h" _ , r_r_ ,, ..• — C r•e' ,� Rolle D onL ry. , ag� _ ._�u._�.A'c it• Other' 'easures -" Est p Act Costs Est'Cost Ack'Cost Roof.•Ventt-smalll.; _ .':_. .1 , 1 . , '$76:00, ". .$761MO. LCL•; W, Do Gable.Vent�"Aectan ular ' 76.0$88100„ $A0 S-G'NO Nln IrRe`"lacemenf.1N11ridow 23,ury t `• ,',$39d'!0o, Wala_o _, I vr%16Re lacemenf!Wltitlow 83ti`ut:r�� �.� i$40Q:b0 �'c��Z` ,� o'�)'' z Vtn"ILR'e''tacenientiVllfndow,9,3.ui-. ^ + •r k_ ,�. l' , 34MO . arle; o a �. f ��,o a a ,�In tsRe�"lac`emen`t�INfndow:1;M w '''',"�:;.. r ;- ,. ._ n? `.$425:.00,� � :_'d,O,tl D'.• i - ' 'd���l. n faf;e L'esmllrHb ec•INfodcw�,,.. ,f._� •: k�,. $25'_00' l .�QC.?c' , ; ,�o o- iSteel4Pie S011dM01'8,1J'OOGW/llikdw9re: ; 1350,M)" _ ' , a'FT Cw Faiicet:e�tor.'I,r:1'�''f „',:�'�,?� r +:;; i ,� �x$915.00•; i r�'{��' _ I•.tl.i�T'a.•, Lowflb iiShowerhead. 2'5'00 AMU I t 4011 Blower+D'oor Test-"„ a V. i 1$45400 45100'' c1'"fa7o ' .f M nooy . u(u' Wfhdor:Grids er�sash., s'; jBuiliitng"4RerrriitFees " `��` F :rf 1F ',_.'�', i' t 100: ' J �ia�ouy,NGt`r096o - ` � f y „r ;r� 9mxEiem t;h 042385`280 L ,, j) N }} M:. TO �1dJMB �-a0 I NGRDl1 p licatiom#., 0 , v04,ondki,.0 , rfoti:1�,�mR Enm*cy ynha� r,+t�"Uanpc thenzandn er•l7mt 5,45004i". °, rr al�tel'��n�TBC(Of�;,MaRbl�C9tLTu�l�elgei/�L� ,r " M' i ' _.%.p , r »r�. •, � •'�1 C4ent. 6ertI)ucoa K+tfjlvIL lloP z 3ire�t•IA d'ed§r View Avenge. ; ' IC8T ;0 t w ctsratelr�t :salmi t� : Dq�o', , :; TklepBva 1 78 744,-570Q _: w Sfand,Alone O i ,)31RCLD00f1Te8t:;lees y. l Ins'ect1lCnob&lube?, .1`l'0 ,IIlens,CbntnanroE d , vl Ile u�tticl5sulatConi, w �W %n_'. 1 E'srCOSC ActCok 9 x. ;.� 2 4141. . �,., Y 1' lI- AtucEle�R490 ea _ :. : $153 ilbI,�,i' ♦I w.♦ AtnclFlat.R9�8 o aq_.. �. �;�` � :T�':�r r:<.':. ,.: _•.. - ;�g =. � _�.'{`• , 'M,4'Q'-', Attici lFUW0o __$130 AmmF1eCR20�o Vin' 'i i14• Iry _`.' $1t23 i� .r dTP _ 1 :T (v)g, Attic FltiflSlb e,R30,resk7cte"d 'lot gtti-.Flat/Slc; , .Q,restnbted F ki'`r.' .V Attic EI1,tlSl "e.R1l04cstnCted% ',{,� � i': . Amc✓ `klo6c3,rans"t2tom'DBc�IA''ft.._.'. ., '_'. . ._� r ,: '' �'' ..:�i .. 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S 1 •..i.\.f�) � r .. .. _. .. + 'RoliekDixBa,;, ;' :Pa e 2 I ..NanonelS6ndl20➢d,`, ! " "r J f" 1 r, y 1 �:✓'.: r T li°' "'f 'Y �.- 1"qa J `u 1 • fACt, s:. .. ....'�St' 'OS,. 1 ,, 'CMC 3[ x - `Yalliia�41�`atl"om , 6m a NaJ7bd ASbees[6st/A 'tial Dl? C;" _' r $2 I- , I ; .1 r DodKleilaled'GSs6esfos1�41i®mim,DP'. $2.20 °;r y, i s_ �iit�rio�V�TaO Blow,,=YlesteIIDE'' r �; r�., ' I�h'"lioardb�)Woo 4Shin-e7/r Vein 1DE. .+ ':-,529, �' ! .. ., ilc: t .' $170'-,'ri. ,' _i .,',.$89930-,. ,: F �•^5 .,�iq, •- � - . 1(e9hDiilP4aldea'F. 1 u :,1: c,''. $60:00".. S,1u or '� �tj�•�0+ i IAiF'SealiII Li'm4f- - r od, i e,�:... �r. - Sin le'6'em0 ..iv%Blo'w'eaDoorta'S40ti• ,'",;_.a yi;,' '' '1" 1 .• .s °.`_: tUI111t11115...$200' f. F 0$43[00,i oar'Sive �✓� ff e ^r,. � 500 `I !. }' +' [. '�� a I. ''/�9[OmatlGD00��L,$1We 4 _ _ :Flf' �� F- �:•. 00irs, L?�Ilp.: $C6I'lIl ,!�Iacur9ypjaX}_�.r�r :w• a ;i 'i$7SiQo r Kia .f C:4J, 1�, .r i, 1, f. ".�x,:. Rr " " -,_ � . '... � _ .- � ': $9.2k t i�w, 8"l J 14r4a '_i-'. . �"'- F�F�10 '• :'' �1Y9'&Re 1' 'aca�nt,,�:_ ;k- - •`' r`..:,_::�$42.b0� 1., �•�-:�D1lDP1. ,�( _ ,t�{1¢1m� -': "�;,,; �otal`A[i;$ealln Qost „_.I i b _ _ T[ afln°1s•%errL. ' _ atlO1L��$Call �r.'"9`lt' 1 f.�W J i :� ....• a . .- -� " -°- ��i�.'YH� �'41J. _ ... �` } drOIIl[E'&1 6r]IIBI1�ShUII,�O 1' . '•.''�^ , _ _ °'. _ .. ' _ : ",`$a,z5�'i ...91X,t'7N. ._ _ u, - ! dro[ugP4 eals,ilehoaal 2si. R51 _ C:.. . +31y1 a?�f41t1 . _'� i1. _•_ . $350=.... _. .,. .. ''- S[ea]l[)�1-falatlOA'i[O�e1�,25��RS•s_,^_ .1 i -', ( _ -.-" _ $183 7p5_ .' "�➢ll9! __ .�,_ tealll!l?.1 •1lIBUIetlOII"1'.S.C,r,7i;�"R ".1» u i Ir ::.... 1... :_r W05e 1[;_. vn{,a7'YJ 1 .$!(,1W - H 4a'Qi' Pam Re aid:;.. . .tl. ,,.�. le... r , ' .3`0!OOa L,.• 1 °Ix lli rr. '�*Awcin epproval,oeeded'Malc!iSSOO. 0 *'[""Actual T4.talidoes hat,liielude•E1425 00pK 8 T;chg; $1,083':05 „.•Es4Total , L _ 'I j SO 00} 4 .Ajf otal I A DITOR raGdon Domngton' J, '4 EIG Fax Server 4/8/2010 3 : 15: 24 PM PAGE 2/003 Fax Server ACORQ CERTIFICATE OF LIABILITY INSURANCE 04/06/2010 PRODUCER (508)651-7700 FAX (508)655-8853 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 West Central Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, MA 01760 INSURERS AFFORDING COVERAGE NAIC 0 INSURED Atlantic Weaterization LLC INSURERA Arbella Protection Ins. Co. 41360 61 Rear Jefferson Avenue INSURERS: Arbella Indemnity Ins Co. 10017 Salem, MA 01970 INSURER C: INSURER 0: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR NDD-L TYPE OF NSURANCE POLICY NUMBER POUCYEFFECTIVE PDUCYEXPIRATION LIMITS GENERAL UABILrrY 8500042816 03/20/2010 03/20/2011 EACH OCCURRENCE 11 11000,00 X OOMMERCIALGENERALLIABILITY DAMAGETORENTEO PREMISrA IF, y 50,000 CLAIMSMAOE FX OCCUR MED EXP(Any one person) $ 5.00 A - PERSONAL&ADV INJURY S 1,000,00 GENERAL.AGGREGATE $ 2,000,00 GENII.AGGREGATE LIMIT APPLIES PER: PRODUCTS-CCMP/OP AGO $ 2,000,00 POLICYFX-1jET LOC AUTOMOBILE LIABILITY 93827400003 03/20/2010 03/20/2011 COMBINED SIN I GLELIMIT ANY AUTO (Ea acddent) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Par Ferson) $ B X HIRED AUTOS BODILY INJURY X NON•OWNED AUTOS (Per a"Ident) $ PROPERTY DAMAGE $ (Per ecclderrt) 0GARAGELIABILITY AUTO ONLY.EAACCIDENT $ ANY AUTO OTHER THAN EA ACO E AUTO ONLY: AGG E EXCE9BU RELLA LIABILITY EACH OCCURRENCE $ OCCUR 0CLAMSMADE AGGREGATE E S DEDUCTIBLE S RETENTION $ S WORKERS COMPENSATION AND 9111820309 03/20/2010 03/20/2011 X WcsT& oTH- EMPLOYERS'UABILTTY - E.L.EACHACCIDENT $ 500,00 A ANY PROPRIETOR/PARTNERIEXECVnVE OFFICERAAEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE 5 500,00 R yes,Caserbe Wft E.L.DISEASE•POLICY LIMIT S 500.000 SPECIAL PROVISIONS balm OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS C SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, CITY OF SALEM BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 120 WASHINGTON STREET OF ANY NIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. SALEM, MA AUTHORIZED REPRESENTATIVE 4L��,w —1- ', �• Rosemar Fulham/PMA � ©ACORD CORPORATION 1988 ACORD 25(2001108) Atlantic Weatherization, LLC 6 1 R Jefferson Avenue Salem MA 01970 To Whom It May Concern, I, Eric Palm, owner of Atlantic Weatherization, LLC authorize my employee, to pull permits for my Company. Sincerely, Eric Palm Atlantic Weatherization, LLC Subscribed and sworn to before me This day of.2&-- 2010. Notary Public My Cominission Expires:Zv) 201 o I `i Ucense or roestration wild.for individul use only '. before the"pirutWadate. If foundr refttrn to: _ office ofGonsutrtes,AfWrs:satd Business Regulation to ft}!"-'SuiteSl70 Wissachuaetts - Department of Public Safety Boma,M+AW-1416 Board of Building Regulations and Standard, Construction Supervisor License License: CS 879Ti Restricted to: 000 ERIC W PALM iN'okratid' liuttti ! 3 HILTON ST 1 ------ --------- ; SALEM, MA 01970 Expiration: 4/23/2012 r ( nnmisniq rer - Tr#: 22214 Restricted to: 00 00- Unrestricted e000i+� o�./G�aaeac�iweCla 1G '1 2 Family Homes Qf}JceeuGoaaamer kftLira&Rusin"Heguiatior itONi&fMPR !&WtET44 CMTRACTO R Rogistrallo� y089 Failure to possess a current edition of the Expirat { _ 2 TO 892124 Massachusetts State Building Code 7Yti»i — ; tpOor is cause for revocation of this license. ATLANTIC 1Nf�2( T'1�:C. T: s RRtC Referto: WWW-Mass-Gov/DPS 81t3BFi£f8&41! - a MA("970 T3odeyrsrrretsry