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B-19-818 - 0049 BELLEVIEW AVENUE - Building Permit A &k y7 $� o The Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards SALEM 60 W Massachusetts State Building Code, 780 CMR Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a 60 One-or Two-Family Dwelling 1 This Section For Official Use Only Building Permit Number: ate Applied: i Building Official(Print Name Signature SECTION 1: SITE INFORMATION. +z 1.1 Property Address: OR 1.2 Assessors Map&Parcel Numbers 4__ E l.la Is this an accepted street?yes no Map Number Parcel NumberVj `? ;{ . 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) ip p 1.5 Building Setbacks(11) '0 Vu Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2:'PROPERTY OWNERSHIP', 2.1 Owneri of Record: ✓[ANA ►Gke- SQ 6 " lit cICI !]C� Name(Print) City,State,ZIP q1q eie ( miu-) "e- No.and Sheet Telephone Email Address SECTION 3:DESCRIPTION OF,PROPOSED,WORKZ.(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work2: °, S US s� 60E inch SECTION,4:ESTIMATED.CONSTRUCTION COSTS` Estimated Costs: v Item Labor and Materials Official Use Only 1.Building $ D 04 1. Building Permit Fee:$ Indicate how fee is determined:- 2.Electrical $ ❑Standard City/Town-Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbipg $ 2. Other Fees. $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ ` Suppression) Total All Fees: $ oo Check No. Check Amount: Cash Amount: 6.Total]Project Cost: $ ( 0 0 ❑.Paid'in°Full; Q Outstanding Balance Due: r 7 { SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ( 9 SG9 toldila �— ��� 2�L License Number Expiration Date Name of CSL Holder List CSL Type(see below) 9 C _ No.and Street S'C TYl?e,' Description; .�G �`��G U Unrestricted(Buildings u to 35,000 cu.ft. ! R Restricted 1&2 Family Dwelling City/Town,Stat ,ZIP Mason ry RC7 Roofing Covering WS Window and.Siding n l SF Solid Fuel Burning Appliances -71 q Y'►C:�e—en no Y�CS Ci►��C 6 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) i SCE 14St-9 c r to �e e-L HIC Registration Number Expirati n Date �HIC Company Name or C Registrant Name�f No.and Street Email address w 97� 97914a0 Ci /Town, 9tafe,ZIP Telephone SECTION 6:,WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L..c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... No ........... ❑ SECTION.7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'SAGENT OR.CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize E r �keAe to act on my behalf,in all matters relative to work authorized by this building permit application. 1�>ronio ;�7;0 ►e t -_ -�1361 g Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. 6&-A- ` /3 c) 1 Print Owner's or thorized Agent's Name(Electronic 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 not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass. og} v/oca Information on the Construction Supervisor License can be found at www.mass. og v/dps 2. When substantial work is planned,provide the information below: Total floor 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 bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "TotalI Project Square Footage"may be substituted for"Total Project Cost" s CITY OF S,UEM, iNLAsSACHUSETTS + • BUUMLNG DEPAM ENT ' Ut 120 WASHINGTON STREET,3"°FLooit •1I..(978)745-9595 FAX(978)740-9846 KIZmBERLEY DIuSCOLL i1$AY43t Tuo>`w ST.PIFm DIRECTOR OF PUBLIC PROPERTY/BUILDING COMIISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name(EtusinessiOrganizatiordlndividual): Fv-►C. �2�L Address: City/State/Zip: u W 91 A QM-0q Phone t�: �? 7 `� -7 O Are y,pu an employer?Check the appropriate box: Type of project(required): 1.&XI am a employer with_�_ 4. ❑ 1 am a general contractor and l 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship,and have no employees 'These sub-contractors have S. C]Demolition working for me in any capacity. workers'comp.insurance. 9. (]Building addition [No workers'comp. insurance S. ❑ We are a corporation and its 10.❑Electrical repairs of additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 t.❑Plumbing repairs or additions myseaf.[No workers'comp. c. 152,§1(4),and we have no 12.[�oof repairs insurance required.)t employees.[No workers' 13.❑Other comp.insurance required.] Any applirAM that checks box#1 must also fin out the section below Mowing their workers'compensation policy information. t 1 rotncownera,who submit this affidavit indicating they ass doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that cheek this box must attached an additional sheet showing the name of the sub-cons wwm and their workero'comp,policy information. i am an employer that Is providing workers'compensation insurance for my employees. Below is the polity and job site injormationi. . Insurance Company Name: �,Xolwxa I1Sl)Y Ct Policy#or Self--ins.Lic.ii:�IAJC_y 6G`�C� ��c�D 1 Expiration Date; ) Job Site Adylress:_ City/State/Zip: Sn 6t�A, L10 619 70 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a rine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Inves►igutiotIs or the DIA for insurance coverage verification. !do hereby certify mild r thr pains and penalties of perjury that the information provided above is true and correct. Signature: � � Date: Phone 0: G 7 S- V 7 9' 7 7 a a Official rase only. Do not write its this area,to be completed by city or town ofrtiuL City or Town: Permit/License# Issuing.�ulhorlty(circle one): I. Board of Ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• r CITY OF Smmm, iNL-kSSACHUSETTS BL'1LDING DEPARTMENT . � 130 WASHINGTON STREET,3'°FLOOR TEL (978) 745-9595 FA.Y(978)740-9846 KIMffiERi EY PRISCOLI. MAYOR THOMAs ST.PmRRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Buildling Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in : Errc d (name of facility) (ddress of facility) signature of permit applicant �36-�1 date debri,uft:doc Massachusetts Home Improvement Sample Contract [Ths form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard gua a to rotect homeowners. Seek le al advice if necessa An erson lannin home im rovements should first obtain a co of"A g P g rY Y P P g P PYssachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the ice of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. 2 Homeowner Info mation tractor Information X1� Fri Q 2C. ame Company Name Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name St- o e S t City own State Zip Code siness Address(must include a street address) _ r\ Daytime Phone Evening Phone City/Town I State Zip Code _ 9-3 a0 Mailing Address(It different from above) Business Phone I Federal Employer ID or S.S.Number Home Improre 1 Cmara,tor Reg,Nmnb,r E yiration del, lam segaires that most home improvement contractors have I JO` (S 'i '�/ vaadse1,'n, `1 number LI The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) RZ?\Crest ex►%.�Nn -0o� Sh�r�le Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowners agent: be adhered to unless circumstances beyond the contractors control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work. MGL chapter 142A.) f Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,fumish the material and labor specified above for the total sum of: Payments will be made according to the following schedule: $__0 upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $_,0 by _/_/ or upon completion of $_ 6 by / / or upon completion of $ WDO upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ © to be paid for ordered before the contracted work begins in order _ to meet the completion schedule.(**) $_1 to be paid for NOTES:(*)Including all finance charges(**)taw requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warranty being orovided by the contractor? ❑No - es(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third patty/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home lmorovement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identical copies of the contract must becompleted and signed. One copy should go to the homeowner.The other copy should be kept by the contractor. Ho eowner's Signa Contractor's Signature _ - 7b6hi Date Date Contractor Arbitration rr 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 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 contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapter 142A. Homes Sign e Contractor's 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. Hgmcowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty 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 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 Th(,;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 he 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 of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at http://www.mass.gov/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 httr)://www.mass.pov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: htti)://db.state.ma.us/homeitnr)rovement/licenseelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or413-734-3114 Version 2.1-11/22/2010 AC�® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/09/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY 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 policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject 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 CONTACT Janet Nichols CIRCLE BUSINESS INS AGENCY INC a/Co No Ezt: (978)777-5619 FAX No: E-MAIL ADDRESS: jnichols@circleinsurance.net 247 NEWBURY ST INSURERS AFFORDING COVERAGE NAIC# DANVERS MA 01923 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B ERIC A TEEL ROOFING LLC INSURERC: INSURER D 672 WETHERSFIELD STREET INSURERE: ROWLEY MA 01969 INSURER F: COVERAGES CERTIFICATE NUMBER: 422594 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBER MM/DD/YYYY MM/DDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ :P CLAIMS-MADE OCCUR PREMI E (RENTED PREMISESS Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- JECT ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILELIABILI'rY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED P P er accident $ROPERTY DAMAGE HIRED AUTOS AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ FIDED RETENTION$ $ WORKERS COMPENSATION STATUTE EERH X AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? N/A N/A NIA AWC40070318742018A 11/19/2018 11/19/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to(.;mployees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION 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. 93 Washington Street, AUTHORIZED REPRESENTATIVE Salem MA 01970 L Daniel M.Crq6jey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD A��® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07109/19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY 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 policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 1:i WAIVED,subject 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 WNIA NAME: Fran McEvoy Circle Business Ins.Agcy,Inc PHONE Ext; 978-777-5619 A/c No;FAX 978-777-4898 JAIC,No.247 Newbury Street Danvers,MA 01923 ADDRESS: fmcevoy@circleinsurance.net INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: James River INSURED INSURERB: Safety Indemnity Insurance Eric A.Teel Roofing INSURER C: PO BOX 46 INSURER D: Rowley,MA 01969 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I--%I OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A 00069440-3 12/20/18 12/20/19 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY� PRO ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JF_CT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ B OWNED x SCHEDULED 6219821 09/10/18 09/10/19 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'L14.BILITY Y/N STATUTE X ERANY OFFICER/MEMBERI /EXC UDE/D?ECUTIVE❑ N/A WC COI IN SEP PDF E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under - DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Job Location:282 Derby Street Salem MA 01970 CERTIFICATE HOLDER CANCELLATION 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. 93 Washington St. Salem MA 01970 AUTHORIZEP REPRESENT IVV ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD J�Z Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvemer*Co'ntractor Registration Type: Individual ERIC A TEEL Registration: 150452 ' Expiration: 04/02/2020 672 WETHERSFIELD ST a ROW LEY,MA 019W Update Address and Return Card. SCA 1 O 2OM-05m Office of Consumer Affairs&Business Regulation HOME IMOROvEMENT CONTRACTOR Registration valid for individual use only TYPE:.lndMduai before the expiration date. If found return to: Exoirmon Office of Consumer Affairs and Business Regulation Vg!g�;-04/0=20 One Ashburton Place-Suite 1301 ERIC A TEFL _- - - Boston,MA 02108 ERIC A.TEEL 672 WETHERSFIELD.ST,..:. ROW LEY,MA 01069 UndersecretaryNot valid without signature Commonwealth of Massachusetts a�f Division of Professional Licensure 11-F) Board of Building Regulations and Standards Construction-`Sf,�(%sgr Specialty CSSL-099509 Expires 06123/.2021 e. ERIC A TEEL:,;. ' 1 . 872 WETHERSFIELD STi�EET ROWLEY MA D7969 A`() Commissioner 'i ROOFING ESTIMATE E R I C A. T E E L CSL. 99509 HIC. 150452 ROOFING O O Fi N('; Commercial and Residential Fully Insured t 672 Wethersfield Street Rowley, MA 01969 978-479-7420 ericteel@hotmail.com ESTIMATE SUBMITTED TO: JOB NAME JOB kc ,IVA 0 j C 4 1 ADDRESS ✓/�'I I A,! JOB LOCATION IT 1 9 l A I( y L V( CITY/STATE71P i0or TDATEg-19_t PHONE#WE HEREBY AGREE TO SUPPLY THE MATERIALS AND LABOR AS SPECIFIED IN THE MARKED BOXES BELOW... NOTE: ONLY THE MARKED BOXES/PERTAIN TO YOUR ESTIMATE. WE AGREE TO: 1. COMPLETELY STRIP THE NTIRE 1' I c. ROOF(S) OF THE EXISTING LAYERS OF SHINGLES. ❑ 2. INSTALL A NEW LAYER OF SHINGLES OVER THE x EXISTING ONE LAYER OF SHINGLES ON ROOF(S. ❑ 3. INSTALL A NEW RUBBER ROOF(S), USING ALL NEW RUBBER ROOFING MATERIALS ON THE 4. INSTALL NEW ICE&WATER SHIELD ON ROOF(S), ROOFS EDGE, RAKES,VALLEYS, DORMERS,SKYLIGHTS,CHIMNEYS,&FLAT ROOF AREAS. 5. INSTALL NEW J7 LB.ASPHALT FELT ROOFING PAPER ON THE ENTIRE ROOF OF THE C% 6. INSTALL NEW 81NCH lrr kJ( ALUMINUM DRIP EDGE ON THE ENTIRE ROOF(S). ❑ 7. INSTALL NEW ALUMINUM STEP FLASHING ON ROOF(S). 8 ' INSTALL NEW(VENT PIPE BOOTS)'ON' I' ROOF(S). ❑ 9. INSTALL NEW(ROOF BOX VENTS)ON ROOF(S). 10. CUT&INSTALL NEW RIDGE VENT ON . ROOF(S). r 11. INSTALL NEW LEAD ON X.CHIMNEY ON c ROOF(S). ❑ 12. INSTALL NEW SKYLIGHTS ON ROOF(S). ❑ 13. INSTALL FT.OF(ROOF BOARDS)OR(PLYWOOD SHEATHING)ON THE ROOF OF THE COSTS$3.00 PER SO.FOOT,COVERS MATERIALS&LABOR. 14. INSTALL NEW _ YEAR 1�► T�)7" SHINGLES ON THE ROOF(S) ❑ 15. INSTALL/REPLACE/OR REPAIR ❑ 16. SPECIAL CONDITIONS NOTE: WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS.CUSTOMERS SHOULD COVER VALUABLES, GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE BY COVERING EXTERIOR WALLS,OBJECTS,AND FOLIAGE WITH TARPS TO HELP PREVENT ANY DAMAGE DURING THE STRIPPING OF THE ROOF.HOWEVER SOME DAMAGE AND MARRING COULD OCCUR BEYOND OUR=CONTROL:.. - r NOTE: (IF)MORE,:LAYERS OF ROOFING MATERIALS ARE FOUND THAN INDICATED ABOVE,AN EXTRA CHARGE WILL BE ADDED FOR THE LABOR St THE REMOVAL OF DEBRIS OVER AND ABOVE THE PRICE OF THE ESTIMATE. We propose hereby to furnish rpaterial ranad labor—complete in accordance with the above specifications for the sum of: $ � (7V / /Jl Dollars with payments to be made as follows: Any alteration or deviation from the above specifications involving extra costs Respectfully will be executed only upon written order,and will become an extra charge over submitted and above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control Note—this proposal may be withdrawn by us if not accepted within days 2cceptance of Pro za—1 The above prices,specifications and conditions are satisfactory and are hereby Signature The You are authorized to do the work as specified.Payments will be made as outlined above. Date of Acceptance __ - Signature