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16 GLOVER ST - BUILDING INSPECTION Z � o--o The Commonwealth of tblassachusetts RECTI "pCITY OF y,� Board of Building Regulations and Standards INSPECTID,`ir;{ � SALENL Massachusetts State Building Code, 780 CMR Et` Revised,Ltli��10!! Building Permit Application To Construct, Repair, Renovate Orjl, "tilh Its P 2 3$ Cao IV ®o. Q I One-or Avo-Family Dwelling m This Section ForOfficial Use Only I Building Permit Number Date Applied: Ln lot i -Building )mcinl(Print Name). ate SECTION 1.SITE INFORMATION 1.1 Pro arty Address. ±1.4 sessors Flap&Parcel Numbers CL la Is this an aae ted street9 yes noumber Parcel Number iJ 'Coning information. ropertyDimension;Ja(sy N) - 01$-F 1$FZa bg nri .. . . Zoning District -' Proposed Use _ - 1.5 Building Setbacks(R) . Front Yard Sidi Yards Rear Yard. Required Provided Required ProviJed Required Provided 1.6 Nater Supply:(M.G.L c.40,§Sd) 1.7 Flood Zone Inforroationi 1.8 Sewage Disposal System: Public O Private O. Zone: _ Outside Flood Zone? Municipal O On site disposal system O C k if esO SECTION 2: PROPERTY.OWNERSHIPI 2.1 Ownerl of ford: It Ami A �e✓h OY'L- � ✓1 tTfine(Print) Cily,State,ZIP No.and Street Telephone Email Address SECTION I DESCRIPTION OF PROPOSED WORK;(check all that apply)` New Construction O I Existing Building O Owner-Occupied O -Repairs(s) D 1 A tions) O Addition O Demolition 1 O 1 Accessory Bldg.O . Number of Units_ Other pecity: Brief Description of Proposed yVgrk": SECTION d:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Ofllcial Use Only Item Labor and Materials I. Building i. Building Permit Fee:S Indicate how fee is determined: I]Standard City/Town Application Fee 2. Electrical S 0 Total Project Cost'(item 6)x multiplier x - 3.Plumbing 5 2P Qther Fees: S d.Mechanical (FIVAC) S List: 5.Mechanical (Fire S 'total All Fees:S Su ression) Check No. Check Amount: Cash Amount: 6. "rota) Project Cost: S a14n - 0 Paid in Full 13 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 7 5.1 Construction Supervisor License(CSL) 97c/-7-7 2 License Number Expiration Uate Name of CSL Holder EPIC W. Palin List CSL'rype(see below) - 3 Hilton Steil Type'. . : . Descr(plion . No.and Street - Sakln lA 01970 U Unrestricted(Buildings u i to 35,000 cu. It. R Restricted l&2 Family Dwelling_ Cityfrown,State,ZIP - M Masonry RC Roolina Covering WS Window and Siding SF Solid Fuel Burning Appliances 1 Insulation Telephone Email address D Demolition 5.2 Registd Na m rovementC tractor(HIC) Atlrantic Wea alza(tut1,T O HIC Registration Number Expiration Date IIIC Company No.and Streets2km MAn14� Email address Ci !Town State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AF F!DAyIt(M.G.L c.I152.4 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 Is§wartce,pMe building permit. Signed Affidavit Attached? Yes.......... No...........0 SECTION Tae OWNER AUTHORIZATIONTO BE.COMPLETED.WHEN: OWNER'S AGENT OR CONTRACTOR APPLIES FORR'BUILDING PERMIT' 1,as Owner of the subject property,hereby authorize F C r"r A-*, t9 act on my behalf,in all matters relative to work authorized by this building permit application. ,zl, l Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNERt ORAUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contat to this n li at' i t e and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Elcctron(e Signature) Date 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 Lad have access to the arbitration - - .tm— program or guaranty fund under M.G.L.M.G.L.c. 142A.-Other portortantnformufto`n on theFfICYrogram can be ou d-,�t- ----- www m:us gov;'oca Information on the Construction Supervisor License can be found at wtvw.mas.,. »;dos 2. When substantial work is planned,provide the information below: 'rota)floor area(sq. ft.) 'r (including garage,finished basementlattics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths 'type of heating system Number of decks/porches Type ofcoolingsystem Enclosed Open J. "Total Project Square Footage"may be substituted for"Tutal Project Cost" -Eviassachasetts H, e r I roveffient Sana to Contract imguageta homeonIaUbmftaetsvfthesta(e�HomelmPtuvemeatContractetLaw Office of CaammterGuide tDHame tladvleetfnece$ory.AnyPmaonldawmgh®ems-chapmr141A),bntdos notmdudeslmdard Mamechasm i C00s°meASFauxwdB.*l R w�Canswpe siOwY�'mkw}vmtesdBre Ya¢�ahmddfast1 -copy0f°A Homeownerinrormation mmahon Hmlineat617A73�787w1 afic cqy gale Norte COph9WOr Informad 012i C®Paay sore Street ddr®(dons!urea Oaken.. CmsIAtlantic IVeafheruelwuLL� City Dun • 0 j i sore.:: Mme,,;° � CISOn Avenue .7 Gr^� n 0®neaAddes(mD ' CPO(O E mng Y'hwweQ 7 g �''rym°`VO Stam MUlivg Addrem(adig'meDtfmm abouej 97 PCade BasDenPhmm O/ Fedvat EraWv➢mID arSS N®Iw °ep..va�arrssg��cc�ts rxxr°w°,mm�mvm14amac am The CuolraUorageestodothefWawiDgWortrforWeAomemynet- ��� /Z/�(p (Descibe in devil t1¢//�vJjmta m�l�_ ^+IImam m be tura,P.sz add.. Requjmd1s,midPt:�W gbut7dmgp�titsarere9tdred peoPpsedStetaad . and will be snnaedUarothebomeownelsagmt beadhtedltatml (rlwaeis who sown CamPlegon SHtedWe-13efo0tnmgscbedule wi0 es eluded from Per WHS wenbe �'a�st®asbeywd Necwttaamsaoohal adse MGL chapter 1Ey Fand provisions of 2 a•Dme ad, m ennnemorwill begin conbscted vmd, Tatal Cantmap'ic12-/ZZ,iet°hmemhmded tSffiedole wwkvn7ibemtbsbnda0y�PItedhewml;,fmnnh IhematedU avdlaj r Paymmts will hemedeaceatding to Chef-11-109scitedole: spmi6ed aboecforiheiora)s>w of ,-.� (a) S k 000n si goingr tinct(nottoexceed//3ofthetotU mntractprice or thecostoF $ b3 � � orapm mmpl�w of v�01���whichevmisgrtatc) S�-I-��/69�L�bl' (2/ZZ/�orupon mmpleooa of ,L,?-Ltt.tL' � t '� �oPnn aompletiw ofthewntmet (fawfadridsd Thefnamcvt ®8°�g; natit md:,ed 8u '� mim bes»ciy s awaacttseompleicd to hothPmty's,iiv6eano) m mee[the mmpi�°nachWaie.(+yb�Ot°ber be �tuAtm NOd•L+S:(°)lnclwti S �`'`-'O A b'vli rmanm clmges.. wftichm b--`Feeaml mid( in�vd a-lth`t�°cde°°°aet�tmmdO1ep Le9m®'mq.,ed by ac.aDtmcmrhetm° s rocs wn aAvs:ecmmeetthe°aatNmaysehdWeemtnmy emt of'evy^P�Ivlapmevtmemtmv vtede nuverial -6 tri�ae $nheDDhnemrn-7qm ° the vtry YI ❑NO LIY PartY)submntr2ctorohbeyye��a° to he salUymsponvble foreompletian oftbe work i aTmew aterials dla itxlar. 3lteconhmiorfmrthm es1be into the to Centrad Acce order[hiss e . agree to bamlel dsmihedteyrsrdlesa ofthe acdo>s of Purace-Upw signing,ads dotr®mt 3'' mWef�aapaymmm toall.-b.•�eoy thDd coatrac[sbsO notimplymm becomsabmdin for carePolty before si aaYhh_en orothvsemdryitnetsthas bemPiaeedw merem'dmceUessamerwiseno[ed vdWmthis doc®m gmng this wa - Reviewthefo➢Dtvlogtmtsonsavdnoffas the ° Make bnuedinto sigorogthetxmbael.7aketimeto _ svbmntrantomtobe h °vaiid sore vemmtcoa and Yuvdasmnd it Askgmni sifyamethm is tegismrtd vdW the n. 7belawregtdrs mos[home'g' 1mUear. = Does 0temhl'wtitivgmmeDirac[are"opnpnrkor�O1pe'm�avemm[CoattaztDrOn. 1mPravementaanllnmarsand seenm ntrac[orhav°mmamca7Askthe IW.Raom517-BWnn,AM021116.by Yaamayiagtmcaboutcanhnamr ° Gwdemthei•�m�fresP�QeS Read the Lmgimmtr ia�a��PmY infmma6oWtha3"can cunGrnt aoOr &vxmgG Or to Km9wyaarri is Pme'ammtcwaapmLew. Information m the mvmseside ofthis farm and You m7cmcel this getaCOPY nfmc Conmma cmbactor to Im.b.t aeramnmtifiihas hem siymed 11 11 third business idin lhermai 0 Mar Ch mby mmCI 11, lofsnttmty P'. .,t day fallowing thesigoiagofddsagre®ew sae iho y� ��O�smtar b�1Frovrdedywntmfythe DON®7'$rQ,lt(�ffiSCO aacLednbdxofwnce0ahonfourfor aYno Zy'hmmidoightofthe tna idmuuimnm°raom,trm,mv b: N � for ktmtiw of0tisriglD. ARE ANY BLfeNdCSPE, rre �Jm-.a ee emomar Homrnwne s rgn�n,.,. (pQl v Dwe Comractors Sigoahoe Dm l Z 11/ 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 bas with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to 'y 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 concerning this contract,the conttr�¢ccy �i}iagstlx,Ii(4/the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of o��ssyymmer Affairs and Business Regulation and the consumer shall be required to submit to such aril)latip{r;a�p1`oX 4w5145.4sachusetts General Laws,eba er 742A. Won r ` rjtO, t 1' cr Homeowners si Contractor's Signature NOTICE:The s gnatures of the parties above 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 homeowners 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 Fwd 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 ar warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and lioness 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 attached. 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 must 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 deems him/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 work. Withdrawal of funds from said account would require the signatures ofboth 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 See 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 httn://%"viv.mass.izov/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://ranvraamass.aov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: httT):I/db.state.ma.us/homeimT)rovementAicenseelist.asl) For assistance with informal mediation of disputes or to register format complaints against a business,call: onsuiner plaint Section n , orney General 617-727-8400 AND/OR Better Business Bureau 50"52-4800.508-755-2548 or 413-734-3114 version 21-rM 2010 Tize Commonwealth of312-assacitatsetts P-Departinent of Ziz¢asir a1Accidenis 3 Congress Street,Saite 100 Boston,T69-- 0211e_27077 •'` www inassgov/dfa n'orkers'Compensation insurance Affidavit:Builders/Contractors/Rlectricians/Plumbers. TO BE FILEDWITH THE PEP"NUTTLNG AUTHORt i 9'. jaolicant information Please Print 'r,eQibEv Nafne(Business/Orpanization/Individuap: Atlantic y'Ji%"nT __iaer .L Address: 'i n iett�=�^ Atriz�i�re City/State/Zip: Phone#:_ CQ 7 _ `?gq, - g 1�,t T, Arc you ap employer?Chech the appropriate box: =ype of project(required): L�i am a employer aatith .`.�,� employees(full and/or part-time).= 7. [#New construction 2.❑1 am a sole proprietor or partnership and have no emoloyeas w,orkine forme in o am•capacity.[No aamrkers'comp.insurance required.) - u- 0 Remodeling 3.�t am a homeowner doing all work myself(No workers'comp-insurance required.]f 9. E Demolition J.n lam a homeowvner and roll be hiring contractors to conduct all work on m•property- I hill 10 0 Building addition 3 PrP 9- ensurethat all contractors either have w-orkers'compensatoo insurance o-M sole I1.OElectrical repairs or additions proprietor with no employees. 5-�1 am a general contractorand 1 have hired the sub-contractors listed on the attached sheet. 12.f-1 Plumbing repairs or additions These sub-contractors have employees and have workers'camp.insurance. 13.QRoo repairs 6.L[We are a corporation and its officers have exercised their right of exemption per MGL c. 14-t Othei-rJC'fJ��(!fi 151,§1(4),and who have no employees.[NO workers camp.insurance required.) -Any applicant that checir box 'I must also 611 out the section below shouine their workers'compensation polis-v information. T Homeonner who submit this affidavit indicating they are doing all work and then 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. Ifthe sub-contractors have employees.[hey most provide their workers'comp.policy number- I ern an eazpioper that is providing tvorlters'catape,zrat7on 7tzsrtrazzc information. efor ntp etnplopees Below is t/te policy and jag site Insurance Company Name:_ ---;ut-i C,IN Policy=ar Self-ins.Lia T: :�Le 70 [al ] E.xpiration Date: Job Site Address: . �� G/� t--e r c) T City/State/Zip: YGt le Attach a copy of tthe workers'compensation policy declaration page(shoLving the policy number and expiration date). Failure to secure coverage as required under YIGL a 152,§25A is a criminal violation punishable by a fine up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$350.00 a day against tile violator.A copy of this statement may be forwarded to the Office of Investigations of theDiA for insurance coverage verification. /do/rere6Dr cert h n.-zder the pzi zs and pe;ral{ies oy ie. r�113,that the izrfonnatiozz prodded above is trueand correct. <' t Simtature- - '1�'`-� Dae Z/6/ Phone 4: �7 n- 76'L'�-R/ <' F-V e on1J: Jo trot rprite in t111s area,to he completed by city or,oot:ojcial. Li` • Permit/License thority(circle one):Iyeni h 2.Building Department 3.C 4TFown Cler Ic 4.Eled-Tical T nspector 5.Plumbing inspector rson, Phone 2- THIS GEP,TfFJC.^,7E IS ISSUEL7 FIS A IUJ,n 1� DATE(Ei,�IDDMNYJ CERTlPfCATL- DOES D10T AFF1P,(L9ATNELY OR �cC401RMATJOU DULY AUD GOUFERS UO RIGpys TIPOU THE 1 3/3f2015 y; BELONJ. sI-11S GEP.T!'r1CATE•OF li1SUP,. U EL 1?I+IEUp, -Ri7FICA7EHOLDER. ]7-i15 Cz DOES NOT CpUs- SEPJD pR ALTEER THE COVERAGE AFFORDED By-1 He POLICIES ::EPP,ESEPfTATIVE GP,PRGDUC=R,AMD THE _ ,--, ItTG11= Fi CONTRACT 3�j{nrEEU -HE ;gSliiUG 3NSURER(S), 1;?;7lOP,I�ED CI TJACAt-rIpLIER. I@JPOP,TA UT: c pithe cer's Ofte'holder is an i?DD!T10NAL lUSU%ED,the VuIIDYVdS)MUSE 3e endored. If a'UBROGATJOU IS 141A1VFD, subjeC to Che ferns and Cord�.ions of`.he policy,ceresin poiicles�Ey;acuJ;a ar,eadorsenenP. A sCaie,Tl-do-e this S BRO t_TION not sig ceriffca. holder fnlfeuoisuchEndorenant(s). PROD ICED o o hs to' O the ------------------------------------- iS2S ce_= _n CONTACT suzaace Garoppp T-(+ IMAI Con54--11atnII 233 iesi CII r 7 PHONE 3 Z 3i. r_arc W-E.0- {B00) -S-723A FAX c,.7All IAPC.NOP AODP.EeS: _VcC3CJ5 A 7 I INsuRy 0-750 INSURI ISI AFFORDING MAIC., INSURERA a a_oCea-:ior -41s. Co. 11112.360 i•,'Ie��fiE__yCuga 1NEUReR8J112LL�j 7LT5 3,smx-aa- ce Co I u= INSURER D; Sa1�-1 21 1, 0`±970 INSURER- I COVER GES �Ri'!F[CeTg ViiM3'Ra• _ INSURER . THIS IS TO CERTIFY T HqT THE POLICIES OF ID!SURANCE LIST BE O N HAVE BEEN 75auED Tp THE INSURED NAiuED ABOVE FOR T:IE POLICY PEP,1pD IIVDICATED. NOT7.AnTHST.ANDINe ANY R REVISION Nii;1116ER: C-,CLUSCATE ND I BE ISSUED OR AV-AY PERTA/"v7ETH i ERiLi OR CODJDITION OF ANY COI` E:CLUSIOMS PND C0i•1DITIONS OF SUCH POLICIES.LIMITS SHOViTI iv7AY HAVE BEEN REDUCED BYIPq POR AID TMI DOCUR3Ef�UUiTF'RESPECT TO If 741CH THIS ILL THE IIJSUP,AAICE AFFORDED BY THE POLICIES DESCRIBED HEREIN is SUBJECT TO ALL THE TERMS. INSR Lr, I TY==CFINSURANCE AnnL susel S. GENERAL LIAEIUN 1 IINSR S, MAY POLICY I NuIaEER FOGOYEFF POLICY�.;p IIPdM/OOAyypl P.9PdfOD11'YY1'II LPwl,a WhvfGERCWL C-@IEPAL UABILfY' EACH OCCURRENCES i5 1,000,000 CL?IliS-0:2?Oc OCCUR. I DAMAGE TO RENiEO jell 350002816 � PREMISES ea csmrm¢7 S 50,000 :3/_012015 /20/2016 I +'AiiO E:,P(Any onaPron) 7IS 5,000 �- PERE e-ADVINJU.4Y I S 1,OGQ,000 I -S IL AGGRECAic Lfti(iAPPLIES PEP.: POLICY r'_i � PPD-J-�- 17 LOC GENERALACGRECATE Is 2,000.000 I PRODUCTS- AL4Ci;i0aILEUARW,: COMP/OP AEGIS 21000,000 IS 1 I �ANYAUTO - COMBINED SINELE LLSIR I J7 ALL GSW. EO (Ea aceen, _ O L_I AUTOS SCHEDULED 51 01000, AUTOS 0200'SR71 BODILY INJURY Mueeravn IwP.EO AUTOS I NON-Gln.•NED� /2D/2015 '/20/2016 ) I5 I AUTOS p OILY INJURY(Pxr tle-10 S PROP- UEfERELLA UAB, I I /Peramaer;llCE 15 I=J OCCUR PIP-ass;e is EXCESS LlA6 I I CL.,n S M I I I OvD I EACH OCCUP.RENCE Is _,000,Doo I RESAT II1I I I o'OOOSB6sa AGGREGA'r '.d0R1(ERG COfi52ENSAT,0:7 �3/20/20S 3/20/2036 5 7.,000 000 ANO EDrLOYERS OAa1L1�' I IS `NY PRCPRI_�OP✓PARPN 1-/=;� I I I- I WC�A '='-ICEFJ;.iE:J'cEP.E(CLUOEpt ' 1 � T Y L:1TU- I I��I Ii::andeton�in iJH3 �--..J fi'IA P li y^s,tlesaiCe urtd?.^ . IOE'aCRI?TIOid OF CPERATloM1i56.`c.:• 1 cL EACH ACCIDErr IS eO1;T.,iJ^£Oi`i _ I I nL I DISEASE-EA @GPLOYE t S EL OISEASE_POUCYUfA(r GEZ200379613 �O/i/SOL_ 0/1/20 S L3 I GENERALAGGREGA7E r- 51,000,GGG :R1.-TION GP DPcRA71Qi1S1 LOCATIONS/VESICLES EA POLLUTION CONDITION iAracn ACORD S=r 000,000 dDt,AdtliSon<I Remsv¢Scnedule,cmor spam is r;quirse] J4=P�=;Tfe HOLDER �Y^[11 SHOULD IaNY OF THE AE:OVE DESCRIBED POLICIES BE CANCELLED BEFORE C? OL' 8=_i 1.= THE EEXPIRAT1oN DATE THEREOF, �Er_: I fiCCOP,DA(dCE IMTH THE POLIC;'PROM510?cE 'INCL E;E DELRIEREp fp! OA... 0_970 AUi iON25p P?RESENTATIVE I J 23(20-10/051 iadrr I." a'z* -Fe at�.nxx; -o�o.�en<-» ©"!BBS-20^:O AGOPJ Ct3RPOPv+f-x1061. A--.I -- -anicL^ci:- +mss: S Ir€cam€s rss>��D As e n a��a t G�BC�1 IOU �U ��� 11-'� � a ✓1 ��rFe4C�1� Da,EmuvDDiYrw) `� �jCGR"il=let,`?c DOES NO3!SFFlf:CCE OF 3plFORyLa3pN ONL"fiND CDUFERS i10 RIGH eS 0P6P13[FE CE(?i}FICA E HOLDER. e'(•3I5 "S Ct:P i(PIC.^-.1 7yELY OA NEGaTM acUIEND,c.{END Ot?aL- r ;t 4� -E OF INSURANCE DOES 110T C .6R_IHE_.OVERAGE AFFORDED 6Y7HE POLICIES 8 LCIV. I�uP PF:QDLCcR_„NO a;rE Cr �� ,. ON$;�;UZE::COe;In7EEPIf:sE ig51)Il1GINSllRSR(Sj,Alfi730RI�m73 REPRES£NF�I7IVE.I TzPiC.f 1 E,IOLDER- t(ulhOf?;Al,17:lifhecer•iiicet `-aFnS and conditions of the I7cD,c{s- n•�®1l6DNAL2NSURED,the olicv ies „ P 9 zair, R3ay fegUhe and endo:serenrL A statainent on This ce.Bineate does not catlfe,lights o{he e CCiiIilCata hO1dET In lie D OI SIICII0%Endws cental Wilo ES ff PRODUCER i ! 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Or N,1g 7 CANCELLi1;70id 93 iVASNIA'GY'ON ST a SHOULD ANY OF TKE ABGVS DESCRIBEDe I IN ACC RDA CEiRATION DATE 7-0 EREOOFrNOi10E'OLICII6Lt BEDEWERED 1 c.p 3 IN VWai 71dE POLICYF I "-• 1•i�!� 01970 yr ROVIS10I _ :.aUS;IORIZED `Ru cS(ZU?D/Os7 Tne:?CORD aama aid loot a.e, = 'F-t.-:- -' :ns-..�"Xt. '`Rina:ad Ttih�i ACOAD AC-ok? .Se'o=2CA0 AOORO COAPOF.3?T10N_ .gil:lgg;,,_e.:'aNad_ MMassachusetts -Department of Public Safe:y Board of Building Regulations and Standards 0110'Awac —115 Construction Supervisor `"� Office of Consumer Affairs&Business Regulation - License: CS-087977 kaeigist=? EVEMENT CONTRACTOR : 142089 TyPe: ERIC W PALM �' piration: 3/12/2016 Ltd Liability Carpo', 3 EMTOPI ST Salem MA 01970 `r ATLANTIC WEATHERIZATION L.L.C: '• i : - ERIC PALM �P1f . " "` Expoi ati9n 61R JEFFERSON AVE - a Commissioner 04/23/2016 SALEM,MA 01970 Undersecretary i Unrestricted-Buildings of any use group which _ contain less than 35,000 cubic feet(991M3)Of License or registration valid for mdividul use only enclosed space. i before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 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: w -Mass.Gov/DPSNo— t valid without signature _5 . i