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B-20-525 - 0093 BRIDGE STREET - Building Permit • The Commonwealth of Massachusetts . Board of Building Regulations and Standards CITY lf Massachusetts State Building Code,780 CMR ' SALEM . Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling t This Section For Official Use Only `.� Building Permit Number ' :Date,Applied !lam Building Official.(Print Name) Signature Dat- SEGTION:1 FSITE'INFORMATION.. 1.1 ProvertV Addr ss: 1.2 Assessors Map&Parcel Numbers r ZD. ��� 1.1a Is this an accepte street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) 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 O ner'of Rec rd: tire. Q,•c-o CNN + Mfg C)mo Name(Print) City,State,ZIP 40V� -, 5k�-Q3ZN 'm r. Pa336 s 1` -,A A �1\O'�h11Gi, C. m No.and Street Telephone Email Address SECTION 3.DESCRIP.TIONAF PROPOSED WORK2(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 Work': � SECTION 4 ESTIMATED'CONSTRUCTION COSTS; Item Estimated Costs: Official Use On Labor and Materials 1.Building $ d0 1.<Building Permit Fee $ . r Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Protect Costa(Item 6)x multiplier x 3.Plumbing $ 2 . Other Fees: $ _ �/ . 4.Mechanical (I-IVAC) 5.Mechanical (Fire $ Suppression) Tot a-Ali 6.Total Project Cost: $ L 00 ;Check;No Check Amount -Cash Amount .- - �33. ❑Paid m Full_ ❑Outstanding Balance Due: t SECTION 5:CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) lA License Number Expiration Date Name of CSL Holder` t 1 "`l p0 S� (l e List CSL Type(see below) V No.and Street �L� Type Description 1 �� 1� U Unrestricted(Buildings u to 35,000 cu.ft. �— R Restricted 1&2 Family Dwellin City/Town,S ate,ZIP M Masonry RC Roofing Covering WS Window and Siding q 1 SF Solid Fuel Burning Appliances I j�(1v1�Q(��t e t�(`[?V`(11�G ST.(�P I Insulation ele hone Email address D Demolition 5.2 Registered Home Improvement Contractor(IIIC) _ b1A ' - , �"n HIC Registration Number Expiration Date HIC Company N e or C egistr N \ 3CL �(i� . V� YY1 C.Ck No.and Street Email address Ci /Town, tate,ZIP Telephone lz 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 lssuanc f the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:,O.WNER AiTTHORIZATION TO BE'COMPLETED WHEN OWNER'S:AGENT,ORCONTRACTOR APPLIES FOR BUILDING..PERMIT. I,as Owner of the subject property,hereby authorize L to act on my behalf,in all matters relative to work authorized by this building permit appikation. Print Owner's Name(Electronic Signature) Date SECTION,7b:-OWNERt OR.AUTIORIZEI)AGENT,DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information cont e • this applic tion i true and accurate to the best of my knowledge and understanding. 6 a Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOT ES: 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 Information on the Construction Supervisor License can be found at www.mass.gov/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 halfibaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" -�. T-h" C'oinnionwealth oj`lWassach isetts ' F Depailment Of IndustHalAccidents 1 Con9 ress Street, Suite 1:00 i Boston;.i AL9 0`?114-?017 c : www inass.gov/dia Workers' Compensation l'nsuranee Affidavit: Builders/Contractors/Electric anslPlumbers : TO BE FILED ITH:THE PER,N11TTING A[TH02tTV. A Iicant.Inforntation Please Print.Le ibl Valile (BusinessiOrganization/Individual l'r " '� /Address: t�! 3 d ( p C rty/State/Z>p: ": A• c>/ 7 .:hone.:#:IT? - S Are you an emplover'Check the approliriate box:'. Type of project(retjuired): l� T ❑:Maw construction i,Y'"[atn a employer with etployees('full and/or part-tunel* 4 Remodeling 2: [am a-sole proprietor or par'trtershtp and have.no employees-working for-mean . any capacity.(No workers'comp.insurance required:- 9• ❑ Demolition 1F71 ram a homcownci;doingall work myself.[No:workcrs`comp:.'insuroncerequired:]'' 10 Bltilding addition [am a homeownerand wilftie hiring contractors to eonductail work on tnv;.propert} I will: . ensure that all contractors either Kaye;workers':compensation.insurance or are sole I l.[]:Elacti -a[ repairs or additions proprietors with no employees. 12.❑Plumbing repairs of additions S.o I am a general contractor and t have!tired the sub contractors listed on the attached sheet: t 3.E j Roof repairs These sub=contractors have employees trd have worxi rti'comp.inatuance; )lJ 6;❑We are a:corporation and its officers have exercised their nght ofexeniptibn per.vIGG c. I5i,310),and we>have no employees.[No workers comp.insurance required.] ;?any applicant-that checks box it[ {nisi also fill outtfie"section below showing their workers'compensation policy information. t Homeowners ho submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicatirg such. Contractors Ural check this hoe must attachedan additional sheet showin he name of the sub-contractors and'sate w.hcther or not those entities:have employees. If the sub-contractots.have employees they must orovidc.(heir workers'comp.policy number. 1 am-an en►ployei''that is providing workers'compensation insurt7nce fur:my employees. Below is the policy,and job site. information. `� Insurance Company.Name r Q :(J � � /l ePiration Date; Policy#or Self-ins. Lie. A.: d J l ` t Job:Site Address:_ ,- \ City/State%Zip: Attach a copy of the workers' compensation p ,icy declaration<page(showing the policy number:and expiration date). pnishabe by ahie u 52 §ZA to aure tosecure.covraga as-require dunderVGLc $1,50�.00 and/orone-year imprisonment,as well as civil penalties in the form of a STOP WORK-O RDER and a fine of up to$2SO.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. !do hereby certi cinder th and pertptties of perjury that the ijifoi'ruation-provided:;abov,e is true afid co&ect. Si nature: - Date: Phone#:. Offrciat use only. Do riot write in this area, to be completeil by city Otowfr official;. City or To.wd' Permit/License:#. CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 98 WASHINGTON STREET,2ND FLOOR TEL: 978-745-9595 KIMBERLEY DRISCOLL MAYOR THOMAS STYIERRE DIRECTOR OF PUBLIC PROPERTIES/BUILDING CONMHSSIONER Construction Debris Disposal Affidavit (requiredfor all demolition &'renovation work In accordance with the sixth edition of the State Building Code, 780 CMR,Section 111.5 Debris, and the provisions of MGL c40,S54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licenses waste deposit facility as defined by MGL c 111,S150A. The debris will be transported by: (name of ha�ier) The debris will be disposed of in: \\,VNNE ' (name of facil y) (address of facility) Signature of applicant (today's date) ROOF� ROOF v Relle filow lutt 304 Boston Post Road,Wayland,MA 01778 Office:508-358-7663 • Fax:508-358-7662 Skylight SPecificationS/Work Order "WE TOY THEM ALL" CUSTOMER •• • Name: Karen Crosbie Phone#: (805)637-8330 Job Address: 93 Bridge Street Fn rn nvEmail: hayesmiddle@hotmail.com Dumpster Location: Driveway City: Salem State: MA Zip: 01970 SKYLIGHT SUNTUNNEL • •• HOUSE CONDITIONS Model Size Product Code Blind Code Room Quantity Shaft I Cathedral Pole Handle Height Existing 1 Cut-In FCM Custom 0004 1 Existing EXISTING ROOF CONDITIONS Flat Roof f7l Approximate Pitch Skylight Only Number of Stories Pitched Roof Combo Job Ll EPDM ✓ Approximate Color Hard Access Dumpster Shingles I Yes_0 No R Yes r No INSTALLATION • Does Customer have matching shingles? Yes ❑ No ❑ Remove and replace existing curb-mounted skylight reflash curb onto EPDM roof See estimate for further details C® r-Y Customer Signature: - M Date06/03/2020 I - 4 ` HOME IMPROVEMENT CONTRACT Sold,Furnished and Installed by: Date: 06/03/2020 LaBelle Roofing,Inc. 304 Boston Post Road,Wayland,MA 01778 Job#: 5069 Phone:508-358-7663-Fax:508-358-7662 Federal ID#20-8350649 MA Home Improvement Contractor Reg.#154084 Installation Address: 93 Bridge Street,Salem,MA 01970 City State Zip Purchaser(s) Work Phone: Home Phone: Karen Crosbie ((805)6*-8330 T805)0-8330 Project Information: I/We/You("Purchaser"),the owners of the property located at the above installation address,offer to contract with LaBelle Roofing,Inc.to furnish,deliver and arrange for the installation of all materials as described on estimate#: 5069 LaBelle Roofing,Inc.reserves the right to cancel this contract if,upon re-inspection of the job,LaBelle Roofing,Inc. determines that it cannot perform its obligations due to a structural problem with the home or because work required to complete the job was not included in the contract. Contract Amount $_4,833.00 • Deposit: Less Deposit $_1,611.00 Please mail check or call with credit card for deposit payment. • Final Payment: Balance Due Due upon job completion,payable by check. on Completion $ 3,222.00 Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will pay any balance due.Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement:This agreement and its attachments,including any financing agreement,contain the complete agreement between the parties and cannot be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it.You are entitled to a completely filled-in copy of the contract at the time you sign.Keep it to protect your rights.Do not sign any completion Certificate or agreement stating that you are satisfied with the entire project before this project is complete.Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. BY MY/OUR SIGNATURE BELOW,1/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE RECELPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. DO NOT SIGN THIS CONTRACT 1F THERE ARE ANY BLANK SPACES. SUBMITTED BY: Date 06/03/2020 ' Sa es Consultant ACCEPTED BY:. P-SlanP�dhy Karen Cro-,hip. Date 06/03/2020 Homeowner NOTICE:ADDITIONAL TERMS,CONDITIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT. HOME IMPROVEMENT CONTRACT The Purchaser understands that: 1. Purchaser is required to have any security/alarm systems disconnected prior to the commencement of work. Neither LaBelle Roofing,Inc.nor its independent contractor will disarm,arm,remove,install or reinstall a security or alarm system. 2. Purchaser is responsible for removing all breakable items form walls and shelves inside the home prior to installation. 3. Miscellaneous labor for work not included in the estimate will be billed at$75.00 per man-hour plus materials.Rotted or damaged fascia or rake board can be replaced at$9.00 per linear foot for primed pine and$18.00 per foot for PVC Board. 4. Any surplus materials remaining after completion of this job shall remain the property of LaBelle Roofing Inc.and no credit is due to Purchaser with respect to such excess materials. 5. Performance of this agreement on the part of LaBelle Roofing,Inc.,its successors and assigns,and any and all subcontractors engaged by it or on its behalf and hereby authorized to perform work listed herein,shall be subject to delay due to acts of God and other causes beyond the control of LaBelle Roofing,Inc.,including without limitations,strikes and other labor disturbances,fires,wars and civil insurrection,inability to obtain materials or labor, and orders by any governmental agency,and LaBelle Roofing,Inc.,shall not be liable.Purchaser represents that no other representation or promise has been made to be relied upon by purchaser regarding any of the aforementioned matters. 6. Purchaser indemnifies and holds harmless LaBelle Roofing,Inc.and its employees,authorized contractors and their subcontractors from any claims as to the identification;detection,abatement,encapsulation or removal of asbestos,lead based products,mold or other hazardous substances inside or outside of the structure being improved. LaBelle Roofing,Inc.is NOT responsible for: 1. Pre-existing violations of building,electric,plumbing,or other governmental codes with respect to the premises. Corrections of violations are the responsibility of Purchaser and Purchaser represents and warrants that no such violations exist. Purchaser understands that LaBelle Roofing,Inc.will rely on such representation and warranty. 2. Rotted or damaged wood that is hidden or not visible,unless otherwise noted on the Specification Sheet. If,after work commences,LaBelle Roofing,Inc. finds any rotted or damaged wood,LaBelle Roofing,Inc.will provide Purchaser with a price for replacing the rotted wood,which will be in addition to the contract amount. Mediation: In the event that you and LaBelle Roofing,Inc.are unable to resolve any dispute which arises out of this Agreement or the Installation,you agree that before filing a lawsuit you will participate in mediation in an effort to fully resolve the dispute. That mediation will be at least one-half(1/2)day in length, utilizing an experienced mediation service acceptable to you and LaBelle Roofing,Inc. Start and Completion: Subject to obtaining credit approval in the case of financed purchases,the work described in this contract is estimated to begin within approximately eight weeks of the date of this contract and to be substantially completed within twelve weeks of the date of this contract. Note: These estimates are subject to the following DELAYS IN INSTALLATION conditions: LaBelle Roofing,Inc.shall not be liable for delays due to reasons beyond its control,including without limitation fire,Acts of God,labor or material shortages,war,government regulations,delays caused by Purchaser or Purchaser's other contractors. Home Improvement Installation Contract For Massachusetts Residents Only 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.However,the same right is not afforded to a contractor.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. Homeowners Rights:A homeowners rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e. MGL chapter 93 A)may not be waived in any way,even by agreement.However,homeowners may be excluded from certain rights if the contractor they chose is not properly registered as prescribed by law.Homeowners who secure their own building permits are automatically excluded from any 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 so implied warranty of merchantability and fitness for a particular purpose.An enumeration of these 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 homeowners basic consumer rights. if you have questions about your consumer/homeowners 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. 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 financially insecure,the contractor may require the balance of funds not yet due be placed in a joint escrow accounts 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 question 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 consumers Guide to Home Improvement Contractor Law"contact the Consumer Information Hotline at: Executive Office of Consumer Affairs•One Ashburn Place,Room 1411•Boston MA 02108.617-727-7780 If you want to verify the registration of a contractor or if you have additional questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact the director of Home Improvement Registration at: - Director,Home Improvement Contractor Registration•One Ashburton Place,Room 1301•Boston,MA 02108.617-727-8598 For assistance with informal mediation of disputes,or to register formal complaints against a business,call: Consumer Complaint Division•Office of the Attorney General•617-727-8400 A c D Wealth Massachuse �lw Fri s � oF el- .0 � ' ri R � � � 'Co . r vy es 051 r: r B 4 4 � Of 17 44,�4, s. v e- 3 � xg #ion �1 WM PROvg.�°T CC3 TRACTOR gggotion Yp " ��M a +3 � O ..� 1/AYLA�# 0 �78:..r .. ndersecreUta LABEL-1 OP : PS CERTIFICATE OF LIABILITY INSURANCE DA061081202 Y) os/o8/2020 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 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 endorsements. PRODUCER 978-448-3900 CONTACT Maria Millikin Dennis F.Murphy-Groton NA E PHONE 978-448-3900 F 978-448-0519 201 Main Street A/c,No,Ext: A/c,No: Groton,MA 01450 E-MAIL Maria MillikinADDRESS* INSURERS AFFORDING COVERAGE NAIC# INSURER A:Atlantic Casualty Insurance Co 42846 La� IN U e�le D Roofing Inc INSURER B:Safety Insurance Co. 39454 Robert LaBelle INSURER C 3Q4 Bostoa Po01t R$ aylan ,nn 7 INSURER D: 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. ILTR NSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE a OCCUR L261003288 06/23/2019 06/23/2020 DAMAGE TO REoNTED 100,000 ccurrence) $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY JECOT- LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 accident) ANY AUTO 6246495 06/23/2019 06/23/2020 BODILY INJURY Per erson $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N TO BE ISSUED S E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N/A If ato in Nliii BY INSURANCE COMPANY E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below TO BE ISSUED BY E.L.DISEASE-POLICY LIMIT INSURANCE COMPANY DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Winthrop ACCORDANCE WITH THE POLICY PROVISIONS. 1 Metcalf Square Winthrop, MA 02152 AUTHORIZED �lY-C '1�t1- d . ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Ac R® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYY`n 06/08/2020 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(les)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 NAME; Peggy Sawyer D FRANCIS MURPHY INSURANCE AGENCY INC PHONE; , (508)787-5101 FAX No): ADDRESS: psawyer@dfmurphy.com 50 MAIN ST INSURERS AFFORDING COVERAGE NAIC# HUDSON MA 01749 / INSURER A: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B LABELLE ROOFING INC INSURERC: DBA WAYLAND SKYLIGHTS INSURERD: 304 BOSTON POST ROAD INSURER E WAYLAND MA 01778 INSURERF. COVERAGES CERTIFICATE NUMBER: 541517 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 I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMIOD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION /� STATUTE ERH AND EMPLOYERS'LIABILITY Y/N A OFFI ERIMEM EREXCLUDED?ECUTIVE NIA N/A NIA 6S60UB7H93534920 03/22/2020 03/22/2021 L.EACH ACCIDENT $ 500,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 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 employees 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 Town Of Winthrop ACCORDANCE WITH THE POLICY PROVISIONS. 1 Metcalf Square AUTHORIZED REPRESENTATIVE Winthrop MA 02152 C, Daniel M.Cro ul y,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 93-95 Bridge St Condominium Association 93-95 Bridge St Salem, MA 01970 June 11th 2020 To: City of Salem Inspectional Services (Building Department/Public Property) Re: Permit to replace skylight at above location As a Trustee for the Homeowner's Association (93-95 Bridge St Condominium Association), I confirm that the owner of Unit 4 has been granted permission to proceed with a project to replace an existing skylight on the building's roof. Written consent was provided by all other homeowners in the association. Copies of that correspondence will be provided upon request. Kind regards, Karen Crosbie Cell: 805 637 8330 Email: hayesmiddle@hotmail.com