Loading...
3 RAYMOND AVE - BUILDING INSPECTION t'2-11 c2S0-1' cX ll '-735 The Commonwealth of Massachusetts 61guilding OF Board of Building Regulations and Standards CITY OFMMassachusetts State Building Code, 780 CMR SALEMRevised,l/ur 201!Building Permit Application To Construct, Repair, Renovate Or DemolishOne-or Two-Family DwellingThis Section FcrOMcia)UseOnf tPennitNumber. Date.AD� aZ !Official(Print Name) - - Signature : ,. ate _ SECTION 1:SITE INFORiVIATION' i 1.1 Pro rty A dress: 1.2 Assessors Alsp&Parcel Numbers U ) 1.1 a Is this an acre ed street? es no Map Number Parcel Number i"a, ( 1.3 Zoning information: 1.4 Pro ert hue�,sloos g%� "Luning District Proposed Use LofArea(sq it) Frontage(R) 1.3 Building Setbacks(R) Front Yard Side Yarm Rear Yard Required - Provided -Required. '-- Provided-- . Required Provided 1.6 Water Supply:(M.O.L a 46,§54) 1.7 Flood Zone Information: 1.3 Selvage Disposal System: Zone: Outside Flood Zone? PublicFrivolo O.- Municipal O On site disposal system O- C.hedw 0_. SECT(ONZ. PROPERTv:OWNERS,10 * 2.1 0 vnerr of Rece Q,_ / _ P7 1.1' ta'f a nand' -e- /'t '7 aTtme(P' t) City,Slpte,ZIP - - - - 3 �aur?e�-d� No.and Street f Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK=(check ail that apply)` New Construction 0 Existing Building O I OwneoOccupied O 1 Repairs(s) ❑ 1 Alteration(s) O 1 Addition 13 Demolition O Accessory Bldg.O Number of Units Other O Specify: Brief Descriptionpf roposed Work': — !7 fnA4v r� .r ;�' 4 Gam- W .a Iky,`Z SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials L Building Is - — 111. Building Permit Fee:S Indicate how fee is determined: 2. Electrical s O Standard City(fowm Application Fee- 2. Project Costs(item 6)x multiplier x 3. Plumbing IS P Qther Fees: S d.Mechanical (FIVAC) Is List., 5.iMtchanical (Fire S Suppression) Total All Fees:S Check No.1173,fCheck Amount: Cash Amount: 6.Total Project Cost: S 3"j . 0 Paid in Full ❑Outstanding Balance Due: (rlAt �� 1z.I Z_1 i lv SASC SECTION 5: CONSTRUCTION SERVICES 5.i Construction Supervisor License(CSL) �7 _ f., 2,3 140 License umber Expiration Date Name of CSL Holder list CSL Type(see below) Eric W. Palm . Type '.. - .: 11. Description . No.and Street 1(OA geC( U Unrestricted Ouiidtn u to 35,Oo0 cu. Il. Salem NTA 01970 R Restricted M2 Family Dwelling Cityfrown,State,ZIP .t M Masonry RC Rool2 Covcrin /,� - WS Window ondSiilin q1 7tf"t - 9M 3 IF Solid- Insulations Burning Appliances. Tcic hone Email address D I Demolition 5.2 Registered dome Improvement Contractor(H IC) f qt o is q 3 /Z A, HIC Registration Number Expiration Date HIC Company Nam 1C egi N No.and Street Email address Ci /Town State ZIP Telephone SECTION6:WORKERS'.COMPENSATION:IINSY"EAFFIDAVITinG. :.e.152, 2$C(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 a building permit Signed Affidavit Attached? Yes .......... No...........O SECTION 70:OWNER AUTHO[t12ATION TO BE.COMPLETED,WHEN.'- OWNEWS AGENT OR CONTRACTOILAPPLIE9 FOR BUILDING'PERh[IT` 1,as Owner of the subject property,hereby authorizeLf G ( ('t /f'r^ tg act on my behalf,in all matters relative to work authorized by this building permit application. /� 1�i Print Osvnar' ame(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION i By entering my name below,I hereby attest under the pains and penalties of pedury that all of the information contained in this application is a and accurate to the best of my knowledge and understanding. (Zlic� Print Owner's or Authorized Agent's Name( edromc Signature) Date NOTES: 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 rot have access to the arbitration program or guamnty fund under M.G.L.c. IJ2A.OtCrerimportanC mfoimafion on the HTCYrogram can ba"found ar - — www.m:us.eov.'oca Information on the Construction Supervisor License can be found at wtaw.mass. ov:Jtss . 2. When substantial work is planned,provide the information below: Total door area(sq.R.) 's (including garage,finished basement/attics,decks or porch) Gross living area(sq.R.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of hall7baths T 11 ype of heating system Number of decks/porches Type of cooling system Enclosed Open j. "Total Project Square Footage"may be substitutcd tor-Total Project Cost' lydassachuRtts H, le ro�fe�ent Sam le Contrset This Phoasft meonntss�ofrbestateYF7®elmpmvemmtCw MLC®snmsrA(5us�aa g� �®td"bufinesroaPt� �® eatsoWd Et400Ulama��aadaN O>ficeoF ®°ecsReg°Jig- oaswacfof Ytwrkao Y°mttvd®re Yon mayaldemafiee COPY°f"A HOn1eOfPner]nrorm8btm °!1pffiOp Nalliaeat677.9735787°r 1.88&283-3757 ar®oma�m�beg the Name -/I� Contraarorinfortnagon amet Street d (do tusea Pnst OtfieeR.. Com AtWtic W d .) eet}lerilallo,t LLi. amd ayr t , tates; �@Cde>++n �}AVeIIUe 6.I - SnvmmAd6es(vnat Daytimelzhone` EtxamgPhwe -2�l2- 7,leG % CH7fawn Sete 2PCde Mailing Ad (ydie'ereotfivm abmx) /7a ' �7 Baa'vtes Ph®e /��— 'R/ � Fdeo'Emptere-Mo, S.Member a>p®r�Vvtevs /°6���f mwaoini y� The Coatrnaorn91bildo the FWowiu °*aarsauamno> � •/)q^/^2" " 9 (Delin devil th-,,.tto oospleted,zpraryag�forthe Aomettwner. ele ,/J/ �adeof!®hcSWs to ba F�'Eojn rL erm-Ls-3befolfow;agbuddmlen, / sectaed bythewnbadm.as thetr°meouaelsa�g b° aedm tmlesWon SshedWe- gachw[ao secure their own Fermaitg wip be eue®slmmmbe d ThefffiowmFrom theta Yrm themnbaapr'nwnbolpfer142A.) n�Fand patxvisions of // Date Vdrm c°nhaorwtLbegincontrnded workvPrice Oatewhw onehaaed work wM bennaorngream dpafmm rbeSmedde 5V °t y°omptNod Payments winbmederdnthWeO •fmO1shrich Smofo8owiogeedmamedal wdfahnrspecified ahoveforthemml stnn of. �M upon sigaingwnlraG(ootm g nxaeed 773 ofWe tocol tmntractprice or the costoF by// artrpw rampletiw of sPenalmderrmms wvvWdevvtsgreNc m upon wmpfedw of °Poa eampledan oftyeeoihaet. @arvfnrhidsd I'hefod be&g=h d' � ;�Paymeotwb7 c°ahadfseompletedmbeth egtepmemnnet h.Weaiel S b/rte/g6/t Party's Sebsfaction) t°oM`nm eh°comPsvns eC")3+elinon r In dter S NOTES:(°)leduding aU gnmiwcharga ., Ia d which be-`F°cal md(e�in�adva•�alow inimarx-�m� �diwotreaarberoie bzgoq @)taeectind zverh Ez res We „a eaeasehdde �'zPQulequipmeotNmW°m taedematen-al -r Sobconhuctots-Tye ° ed aha mntm r7 ❑No❑ Petry/sbbconttaumr nnntragorog,eey to be solUYresponstblefor Yn atl rernz°fauq ateri san °�dbY the contractor. She c°°h'aaor fuab e°mPlelion ofdre °1 a mthorn trn la rundv tbisa vagrees fo besolNkdgtn2edregmdfesa oFtheaaiwsafsay third Cwtmct Accepmace-U Y resPonmbleforUlpaymwls m all wnhact sydl notimPlymaz�mhBunG this dotannem becomes a bindm sahmnhaetotsfm careFuBybefore si orathvsemuiryimetpy(�y�P1a wthe��dmee ��e�''eO0�9'I�m�s dawme the going fhiscon 4 Review the Following mttions and aoficer ° Doa't be PtxsSwed uao signingthe ° M as°rethe wna�tw asavalfd�oa Thnam�tread and fullytmderstaod it: Ask gtractorallistged wyym mtCa trzmorg 9uestioas ifsomethin isupdem. '-eParabw by untmre We raft r 7ome� r—Ofr' lbC Lew req h,.tnthmne " Dmilbecon Impr°y mtcn Regwa b Yo°mayin E00 aarswd o Kou COPYof'a'ptunfn rumymMd¢ee^dCe,gSku�e C�Pa3Gorifil s3l7mseat8moceom���orbY4lfing6l7A73-g7877mSSS 7. Yoorrift ends ciprmmbdides mmetiw so tht¢yotr nm eoafnvt w G°idemtheHmefm Read Ste lmptmaut vemgq arask to Pt°Vemeotca°haa'Lli f"f01m�onmtbemvds 'deofthisft .dgUac°pyoflhc Con er You m=Y cancel tyfsagicemwtffithas been siymed ata cwtractorm writing a[his/hvmain ot"MM � Pfnceotherthaa the third business day followin wnbaaat's°°>mat pfareofbnsivrs,pmtdded you no8fyote g It'd See the by Wegron sent or NOT GN �ceeadwf lrydeyvery.nmlatvthmm=tofthe r"a rae,uwv 7•H&S C®IyT�ACT IF�' yam, om for anaphma.wa: fari �nt+na,d o:ilmwmma°vtxARE t�NY BLANKSPACES!(r a xomeoss Signabox - {z , cnnuaao s8;goahve oaz 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 right to arbitration as is afforded to the bomcowner 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 contract�oj.f{tay,MWk he dispute to a private arbitration firm which has been approved by the Secretary of the Exechti've OY)rrce of og�(mer Affairs and Business Regulation and the consumer shall be required to submit to such arlllfttip�.a—'St �'� 9f48Ssachusetts General Laws,chi er 142A Grp 6 eta �� � i11.`wl x a�e Homeownet9 Signature Contra oct is Signature NOTICE:The signatures 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 taws(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 proscribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund 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 terns of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consu ner/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 allached- 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 fidly 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 connected work 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 foe copy of "A Massachusetts Consumer Guide to Home hnprovcmenf' 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 htto://vw v.mass.aov/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 617-973-8737,888-283-3757 or visit the HIC website at htm:/Ax�vw.mass.nov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration:- http://db.state.ma.us/homeimnrovement/licenseelist.aso For assistance with informal mediation of disputes or to register formal complaints against a business,call: .3, onsuvter plaint Section 'tr,yy ` ffi _ otney General s4:. 617-727-8400 AND/OR Better Business Bureau 508-652-4800.508-755-2548 or 413-734-3114 V.3.v-t ravzoto Tile CorrzMosaweaitie of lMI-assachasetts " Depar-7•Yzent 0f!f2dvstKa1Acc1deizts 1 Congress,5't.eel,SEIiee.100 305'1`0et,HII 021114-20.17 MAW-wossgov/dior rkers'Compensation insurance Af ildavit:-Builders/Co,.tractors/o!eericians/Plu,•nbers. TO BE FILED VVI T H THE PE%-t-TT s LNG A UTHORI tTY. Aaolicantinforna`ion Please$rint �,^aibly Name(Business(Or�-anization/Individual): ({-itw) tSC Ji. ( n`T R Joffid ggt'D ACk�llrP, Address: City/State/Zip: Phone#: C1 ?a - ? Arc you ap employer?Checic the appropriate hoz: Type of project(required): L®I am a employer with ..3,� employees((till and/or part-time).= 7- ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working forme in any capaciry"(No narkes comp.insurance required-] — a- ©Remodeling 3.EJ 1 am a homeowner dome all work myself[No workers'comp"insurance required.)t 4- tI❑�� DOmoliflOR 4.L I am a homeowner and will be hiring contractors to conduct all work on m•properly- f pill 10 L!Building addition } propensurithatancon emploactors,either have workers'compensadon insurance orare sole II.[]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractor listed on thi Wreched sheet. These sub-contractors have employees and have workers comp.insurances r 1 d.QRoO.repairs 6."We area corporation and its officer have exercised their right of exemption per MGL c. 153,$1(4),and we have no employees.[No workers comp,insurance required.] °Ary applicane that checlr hox-I must also ill out the section below shining tnm eirworkers' mpensarion policy information" 'Hom eonners ccho submit this affidavit indicating they are doing all nmrk and glen hire outside contractors must submit a new affidavit indicating such. 'Contractors drat check this bra must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Ifthe sub-contractorshave employees,they must provide their workers comp"policy number- ?anz as eiaployer that is providing workers'cottzperzsatloa iaszL-aticefor ntP enzplopees. Beloly is the police and job site information. Insurance Company Name:_ �✓(}Ci'j,C,�1 Policy--"or Self-ins. Lic.r: "up f a •� Q Expiration Date: gLad Job Site Address: J I 9Q 4 Ar, City/State/Zip- s jxf_.O r Attach a copy Of Tire workers'coAlpensatior policy declaration page(showing the policy number and expiration date)- Failure to secure coverage as required under YMGL a 152,§25A is a criminal violation punishable by a fine up to SI,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby Certify ander thegalas and patralties o1�persrzp that&C,itlonnatiatz provided above is tare and correct Signature: Date: /l(. Phone r: 5 7„_ TqQ ------------ f C{ iffzdel rose otzlp. 1)o got write in.Iris a,ea,to be corzpleted by citJr or town of tciat `y or Town: ?ermit/License n - ... issaia Authority(circle one): 5.I.Board of Health 2.Building Depa.-tment 3.CiVFuTvn Clerk a.ZieC-Tical Pnspector 5.p umbing aaspeetac Contact Person: Phone : � �-.: <e�a P LYAO U a �r#jpq yJ NCE IC;7c DGHS iilO;^eF7R(e7r>> kR,.rF 3D1F0 (�:. eaz�tt!a(�rne »-�I RAI -­ORtL�::tNG CO\rt- (� �3/lyyan L•-PI Fi;_ei ( , '3yEL'�OR RE�I7IVELL'CAifEN 'EP.S i9@Rt�H YS t-tPP(,c?!@E CE1�4I l;ATr r j CI'•;PFQQUCcR. •k GFu SURaPIGc DJ>;'�lDY QONB±'U7g C6 E END JR'•tL?glx?tJF CQV - � He6DEt?. 'ht5 --- NQ s�.E G'EP,i1F7CCt. l a - C'3E17i�--• ER6;CaE t.FFORDEIJ 6Y EBLiCIES'BELGitr. �i liv,PQR^-if1S:iE='e � lOLDE^- Gu1 Tri�iSSUL\IG LtlSURERfSj 9lr'i iii s d fl n_ce.?iiir•6 nDlri>;is an:"r ,• .7P�c,j fir srns and condiiicns of thepolic7 c Jed 3"`CA,aL'n5J>:'. 1 ED,:Iis PDlicg(iPs L�% c-�.ipicate hDldE;in tieu � �`z1Dl 11, ED, j.:,us.he endorsed li 3LgROGtl7IOfV iS 1', r Di such eRdD-- '£9u�='z.;d eRdo;sereirc ;2 /I!-faiEr�,suhJ I PRODUCER `cE"�`nY�)• statanlERi Dal ihl5 C2T itlOEF2 does not CBli'0' 2Ci i0 ifrE ! - �+3h`�io the ,V'`i$_r• iICOP.R•,iC7 , '„ i:i rT7,�_r S-lp Dt�a E 1 1 r TICli, 01A Otrr; G_i- �il�Or iV9): '_2t�LWADDRCS4 f IidSUREO JgL z' tNSURER(S)AFPOROI�G LA,�,T!C LlE- COVERAGE p zcR7cRRVslmarucEcor ___ ;y (ilAlc� j INSUR'eR 6: •IPAPtY ---Ifs- -mi Si `e,AR iEr��SDiYA-v ,hNSJR�pC ' S.A!,EP:Li:•f.-t 0197 '! y U � COVERACca i•1NSURER F: jl 741315 TO Y TivEn, CCES +IFICA7Emuifi6cR: OF LYSURAR _ 'I j ' .::FOTO>3., .c i•iD OESCJIpADi SYYCO, OR Yl%N.dr Ee:iviSUED YOB t 1^-PCLICio nESCn19FrJ Y.- �DOCUl.'oir till':-1 Re3PcCi=QtFFJS P, : RE!7510Y filU((98_R. 'pie Ciiilih3. eAEIY u-SUUECTT +8++90VE FOR'+FfE POLICY lA1Ca,:J9 Cc'3i rF:CdSE E"-_^-Y3E rS5U6n OR'-?.dIII iD,M. AN _ 1•-.e,�tUalOYS At,D CON-DnIOP!S OF Eli P.POLICIESLCTes �•NOiS'?R{7yi,rr y.:G r HONn v,i:Y H_Vice-- H-'1-US plC_ I T'r PE DF assuaaHcE. a9nasvucaD_- G�_NERALL L R rPcucY�naT= _� IiRCiAL POGCYi1U.•:�aci i (i�Wpi`!Y•/y OL'Vlom ) j I COr.9,l;ERC,AC GSVERAL L h J Ir-+-'�IU9IY.YYJ j 1=-- ras1LITY j —— � i Lrsr ,� 11 -CiAlii,5;.ADE OCCUR. 1 !:EACH OCCURRISgi 1 4 if AIV/AC-E 70 RENTED c GEDfLA i• i EM, ma cc- cel GGRECATELitwin App,l I ! (16150 EnP ) S j ESP_-n-: i (Anyone psr�r_,n I POLICY M = i PF,OJECT- iLOC ! 1 f IPERSO\AL d ADV IXUURY- � �0`iOSILE LlkSl!ITY f ' i !! faEMERAL AGCREGAT-= 1S 'i� APIY AUTO I r ; , 1 f�P,000CTS-CO:YtP/OP AGC 1�! -ALL GYVprED AUTOS Si, t ' iX0T1SIIVED Slri j ! UIDS i r Lh9lt (�a[cd_N) �S t N_ HIRED AUT05 - t 80DlCY!ADURY tl � VON-CV'OIEJ ALr05 ltP�pann) I" I _r ! Uivi I! RELA LIRE f ' `per ac`rROPERiY 6.riu±AC-E b liic_ssc1 c ! i OCCUR I i i f ctl9N) S (i _ !rab L�jeurrsiADE i I II ::OEOUCTIIBLE t '-EACH CCCURRt'llrgp ?_r TENi rt j 'AGBRECAT �S ;1 iWORY,EP.� ' cL 1p, COitipE;,"WON AIVO ' 5 ' r D:,ER'SLm. Is miler 15.40.ERR 9[L,TI I ' ' 0=.?FarTfE?21EC rail US_E_ 1 _ 5 j jO=RC:F.^:i'cdL15=c Ui1rE _� rOt?l-TS 0_129r<Qi_ _ (C'_UOc '+ 012076 - O.TY e0ir-!5R� r t::;.:rdacn,h itHJ O. UA_i t j ° OJp r" ;`•'lCSrATUT 1 �� :LI31na' i aE-L EACH ACC,DFj i -lc.:• i {E.L DISEAS=-_, IS EGOAGD I iSCRIPROir,OF OoERATi06>--,LOC47t �� —t = - t-+EJ?LOl•EE'S EDO.GOD , iS RcrvLzt=g OlSprc'RICLc'SIRESTRICIO—�� I R.OP.'..,-�.-,rirlC;' r 'la^PEC/ALtarli5 'E�OISEASE-POLICY UigR" ig t t SSuaD TO las CER - 500000 .OLDER q)-C.%C-`)DRBX S iCOVERAGE, 7 um=pI =L__ ors=�-•�(t; { _ i�a�tCELLiiel6id -- ' +A3iiL�rGTOi`ISi 3 r - r i 5.i0ULO ANYOFTiE ABOVEOESGRIR c ? EFORE Ir!E SGIRk„ON m•0DC(ES 615 CANCELLEC • r cr.:1 r• ? I(i=:CCOROAitlOE+i 4T-r OA+ETriEREOF,i➢OT10E:?1LL Be DELIVERED tl --..-,h•-r 01970 n-HE:aOLIC`lpg 'A-I'D rZED R.erac -L�, -- DVIe1Di.5- c3rme,=a.,.e:I•s r'::LOFD _ - .:. ..... .SE'b-201C ar�gD COF�Or.?TfORJ. .gil;icn£s,�a;.e;y,-,-y E OF L9A DES Iff` DV�O �I� G`JI�P QATE(Eifi(DDMYSNf THIS CEP I(FICA (S ISSUED AS A i!(La,7 i ER OF INFORit7Fl T 10N C-L inf.CATC DOES NOT AFFIP,R7kiI1lcLY OR iVEGA77tlEL?` II,ONLY AIVD COP7FERS NO RIGHeiu UPON 714F-CERi7 lJ-KOt_2 =$ BELOlq{, T7•I1S CEP,T!-rICA7Z OF I7VSURAN Fll 7END, twe-En1D OR ALTER THE COVERAGE AFFORDED DE., THIS R-PRESENTATIVE OR PP.GDUC=P CIE DOES NOT CONSTfTUi_ A CONTPACT 3ET@!E , EL. &?°T;-IE POLICIES ,AND THE CER?IFICa:I�HC?1JE4 EN E ISSUING INSURER{S), ^,UTIOR7�ED I@IP s T ANT: ie P cel of te;pour Icl is an iailDIT10NAL IidSUREa, 7,y2 pcticy{ias)Susi be endored. f--SUBROGAYION IS WAIVED,s[7bjeci 20 Che Tei IRs and COP.L7FJDOS G:the Policy,Ce) -lain 7701ICIE5;nay reGUIi2 an endorsemient. A statement On TI715 CBiiiRCdte('TOPS il0<_'£Dnie7}jgt7�i0 the ceriiicate 6olderin lieu oislc endore,•nanf(s). p?,o➢ucER Easte=za '"-•L--'aDoe C-_oto T.TC INAR.- Coast.,-Genoa 233 :Jest CEaL;._ 7 PHONE E-7. CE00)333-7_3_ A $t (CIC.Ne 7 A F IIa1L (AIC.M AD➢P,-ee. lV6SL_C-L -.UL 03760 TSURERIS)AFFORDING CO CE 1.15UR_D _ INSURERA -T._TJ2l= a_ _ NAIC,`, a�-antic i;Tez-hc-==zzcion 53 aeG- UC?=a=5oa 1� c�-or_ sa s. Co.Ls 3amX23mSsuRRE-Ra-X ' �vwr-e INUR£- 60 I I S3 INSURER D- GI :,ra INSUR 03970 I-------- I i:Q!fE`4CE5 I INSURER EP,71FtC,epF:litlNt320_5 I THIS IS TO CERTIFY THAT THE POLICIES OF IDISURANCE LISTED BELOLM HP.VE BEEN ISSUED TO THE INSURED NAivED ABO FOR THE POLICY PEP,100 CERTIFICATE AIOTIMTHSTA7dOIN6 ANY REOUIREi NT, , REV7SIONNUt1lISER: CV P.TIF7CATE MA BE ISSUED OR IVAY PERTAIF{ �'ri OR CONOIiiON OF ANY COid I '-..CLUSIOMS AMD WNDi T IONS OF8UCH POLICIES,LIMITS SHPOVOI fviAY HAVE BEEN PTHE POLCEDICIES gIE RACT OR OTHER CR DOCUMEM VVTH RESPECT TO !rir,-7ICH Tr11S INSR ICE AFFORDED N THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERiviS, -LTRI TYPE CFINSUFUiCOE ADDL SUER I GENERALz IIN5R I4m10I FOUCYEFF -IABIUY � POLICY ryUfA3- FDUCY-• -R IIPAhtIDD/WYYII d1Pd/p0lri�y}� COr-IMF_RCIAL C-ElERF,L LIABILITY LlinLa EACH OCCURRENCE I S 11000,000 CCAI695?i�D'c OCCUR. AtyAGES RPsgEO Li 350002 7 PREA.115E5 c-a c¢Ulrmcel S 50.000 8_6 .3/20/2015 /-'0/2016 i z+ilEO-1P fAnycII moa) IS 5,000 (�- PERS0.4ALBADVINJURY 15 2,000,000 I CEN'L AGGREGATE LI.?i7rppP DES PEP..- I I 2,000,000 I I POLICY r-I a�D- II C-ENERgLACGRECATc AUTGJOpjLEUAEIW� LOC PROOUCTS-COPAPJOPAGG Is 21000,000 I ANYAUTO I—� "LONNEO c0eaod�NSI ICLEIJI L_AUTOS S0'"I�ULED' < HIRED OSGiWED' I 0200:58 i3 /20j_0=5 ' ' BODILY INJURY 7 - - 010.000 (Pereurvn I S ( - AUTOS ' /_0/_026 BODPerILYINJURY ( eceda.t) 5 PROPEP.TYDAi:UtC-E J UEiBRELLQ Dq6 (Perar''dent I S • I'I OCCUR I PIP-Bask I S ' IEHCuSUA'o j i OED I I I CLAIMS±AA➢E E5CH OCCURRENCc RET'cNnOi•IS I 19 000,00( 4VORI(ERSCOfifPEINLATiOg (160 0 05 8 65 8 '/20/2015 AGDRECATE S 1,001,000 ANO EDP LR1--TCF✓PA=OYERS'UAaILIT' I /20/2016 .<Ny FfiOPIN Jc.eCfmP c�l I - GJC STAIN- I S -CE:1:iEdE?.r;CLUDeD> IT RY III I I��I li::andatcry in NH3 tI(A I �, li•;=5,tle::rt=vnd=: EL EACH ACCIDENT 15 DESCRI?Tloia GF GPeZe pTIODiS b_'e.:• I cLO1SEASE-EAaGPLOY�S E'e_*�200378613 7. ELDISEASE-pOUCYUlNT 5 �a/-/20'- 1>•0/I/2015 I GENERALAGGREGATE :R7PTION I �` I S1,DDD,000) OFDPeRan➢ias/LOCailON"I" I1CLES A E5 POLLLMOR CONDMON, f 1t-=cb ACORD 9Dt,AtldiUc S'I,000,000 ml Rema;.ts Setedule,mors ypasiSrsquirse) _ 1{•II_�t'e HO LDy O,?VCEi3 z.;ICN SHOULD ANY OF THE.ABOVE DESCRLg�=- -2 C' O $=10_ THE c^:PIRAT70N D. E Rvg�rr ACCOP,Dp(VCE Iyd ATE THER-cOF, N5.:_.u�_ IH THc'POLtC;'PRO PS'92ME-rv7, ivy VISI 03970 AU T:IORL?-O REPRESEN'An 19:19ran .-1 �J O4 � may_ I 1888-2010 A-co O COpPOP.A.-IDR, . Az _-a a E!rd C�.-'3L; A-OfriteofConsummAffaim&BugnessRePlatiOn CS-Offlo ME IMPROVEMENT CONTRACTOR gistration. 142089 Type* FMCWPALM piration- 311212016 Lid Liabirdy COTPO. 3HMTONST - am ell Salem KA 01970-- ATLANTICATLArC WEATHERIZATION LLC. ERIC PALM 6IRJEFFERSON AVE 04123120116 SALEM,MA 01970 Undersecretn'Y Unrestricted-Buildings of any use group which pntain less than 35,000 cubic feet(991m")of License or registration valid for individul use only before the expiration date. If found return to: enclosed space. 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 www_Mass.Gov/DPS - Not valid Without signature Massachusetts -Department of Public Safety _ ar_tl`Pf.Building Regulations and Starydards Consttuctio_n Sup -thor .Liter" se rrS-08g561�- r.na 42 STARK AVE, WAKEFIELD P4A 01 - r Commisssiionne Expiration 08/022018 —_ Orice of Consumer A(faun&BO ines9 Reg laery n M"APRovEm�.ewrZorlrRAcroR- ---. egistra0on (ft97 _ xairationi4tt :' HOME C _ Coryoration I RAFTERS INC E rL t51-NORTH V ' r ri AVE. IAKEFIELO MA Oy } .. --_: ..._...._._. rete �