Loading...
B-19-844 - 0014 BUFFUM STREET - Building Permit i i r y3 0 r- cr, )'-f The Commonwealth of Massachusetts _ fa *r•.� OF Board of Building Regulations and Standards = CITY® SALEM Massachusetts State Building Code,780 CMR .�, ZI N JG _'� A �. ORevised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official,Use'Only Building Permit Number: Date Applied t Blind g Official(Print Name) Signature Date SECTION1:SITE]INFOINIATION s v 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 14 BUFFUM STREET L I a Is this an accepted 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: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP,- 2.1. Owner'of Record: GEORGE PAPADOPOULOS Salem,MA 01970 Name(Print) City,State,ZIP 14 BUFFUM STREET 98-818-4340 george65pap@aol.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED.WOW(check all that apply) New Construction❑ Existing Building&- Owner-Occupied Repairs(s Iteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other\] Specify:Roofing Brief'Description of Proposed Workz:strip and replace roof with architectural shingles,take down 2 chimneys to roof line and board in,change out old skylight to Velux C06 Manual Venting with solar blind SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item :Official.Use Only Labor and Materials 1.Building $10850 1. Building Permit Fee.$ Indicate how fee is determined: ❑Standard{City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item O x multiplier x 3.Plumbing $ 2 Other Fees:,$ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire $ Su ression Total All Fees.--$ " Check No. ' " -Check Amount. Cash Amount. a 6.Total Project Cost: $108550 ❑Paid in Full ❑Outstanding Balance Due: o -z-n G c . SECTION 5:,CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 094763 5/14/20 Tom Dobbins License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 23 R Winter Street, No.and Street ": Type Description .:. Peabody,MA 01960 U Unrestricted Buildin s up to 35,000 cu.ft. City/Toivn,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 978-531-8234 office@lengibely.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 100811 6/22l20 Len Gihely Contracting HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 23 R Winter Street, office@lengibely.com No.and Street Email address Peabody,MA 01960 978-531-8234 City/Town,State,ZIP Telephone SECTION 6.WORKERS'COMPENSATION INSURANCE AFFIDAVITR(M.G L.c:1.52.§ 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'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT.' : I,as Owner of the subject property,hereby authorize Len Gibey Contracting to act on my behalf,in all matters relative to work authorized by this building permit application. GEORGE PAPADOPOULOS Print(Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'ORAUTHORIZED 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. Tom Dobbins Print Owner's or Authorized Agent's Name(Electronic Signature) Date 6 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.p-ov/oc Information on the Construction Supervisor License can be found at www.massgov/dps/dam 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. "Total Project Square Footage"maybe substituted for"Total Project Cost" Commonwealth of;Massachusetts Division of Professional Licensure Board of Building Regulations and'Standards OS-094649 Expires:.03108/2020 BRIAN J BOBBINS - N Commissioner ��irP U�.CF7J!)N/!/t/It(Q�/II.(�f(l.l�rlJ,iL!(frtlrP�;� - office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Comoraation before the expiration date.if found return to: Registration Expiration Office of Consumer Affairs and Business Regulation f00811. 06/22/2020 One Ashburton Place-Suite 1301 LEN GIBELY courFiAcTiNG COMPANY,INC. Boston,MA 02108 BRIAN J.DOBBINS. t - 23R WINTER STREET � C ^ PEABODY,NIA 01960 Undersecretary Not valid lkhout signature i i Commonwealth of Massachusetts Division of Professional l_icensure Board of Building Regulations and.Standards GS-094753 Expires: 05/14/2020 THOMAS R DOBBINSn i Commissioner " I r1�ie`�nsunzcFsrrnert✓N_/��'Icun�u:e!!' I I Office of Conuumer./iifairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration'valid for individual use only TYPE:Suoalement Card before the expiration date. If found return to: I R stratlon. iration 9iP Office of Consumer Affairs and Business R_ 100811 06/22/2020 eguiafion One Ashburton Place-Suite 1301 LEN GIBELY CONTRACTING COMPANY,INC. Boston,MA 02108 f i I R I S BOBBINS 23 23R WINTER STREET PEABODY,MA 01960 Undersecretary -Not valid without signature: i The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 5*J' www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name:LEN GIBELY CONTRACTING Address:23 R WINTER STREET City/State/Zip:PEABODY, MA 01960 Phone#:978-531-8234 Are you an employer?Check the appropriate box: Business Type(required): 1.❑✓ I ani a employer with 10 employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. [--1 Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] g• ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),and we have 10.0 Manufacturing no employees. [No workers'comp.insurance required]* 11.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12.❑� Other CONRACTING *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:AIM MUTUAL INSURANCE COMPANY Insurer's Address: 14 BUFFUM STREET City/State/Zip: SALEM, MA 01970 Policy#or Self-ins.Lic.#VWC1 006010979201 8AI2019A Expiration Date:8/3/19-8/3/20 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$2.50.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify,under the pains and penalties of perjury that the information provided above is true and correct Signature: _ 3 Date: Phone#:978-531-8234 Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Conta6-t Person: Phone#: www.mass.gov/dia i Cox OF SALEK M4sS. ajL SEM BUILDING DEPnRMa 120 WASHNGTONSTREET,3 FlooR TEL(9T8)745.9595 KIlv1BEfiLEYDI�SOOlL FAX(978)740-9845 WYOR THOMAS S ,per DLRECfOROFPtM CPROPERTY/BLATD IISSIOMR Construction Debris Dis ova! Aff day required for all demolition & renoVt?tion w rk) In accordance with the sixth edition of the State Building Code, 786 CMti,Section 111.i Debris, and the provisions of JI c40,S54;Building permit# is issued with condition that the debris resulting from this work shall be disposed of in a properly l c h ses waste deposit facility as defined by MGL c 111,5150A. The debris will be transported by: (name of hauler) The debris will be disposed of in; k�lL Was (name of facility oo (address of facility) . 2�i✓ Ilk Signature of applicant (today's date) , 4 ,aco CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD"YYY) 07/19/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOTES 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 ty)e 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 NAME: Fran McEvoy CROSS INSURANCE-WAKEFIELD INC LAHHCNNp M: (207)947-7345 FAx A/C No): E-MAIL @ ADDRESS: fran@sennoftinsurance.com 401 EDGEWATER PLACE STE 220 INSURERS AFFORDING COVERAGE NAIC# WAKEFIELD MA 01880 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: LEN GIBELY CONTRACTING COMPANY INC INSURERC: INSURER D: 23 WINTER STREET REAR INSURERE: PEABODY MA 019605941 INSURER F: COVERAGES CERTIFICATE NUMBER: 293400 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 ADDL SUBR POLICY EFF POLICY EXP L7R TYPEl)FINSURANCE WVD POLICY NUMBER MM/DDfYYM (MWDDNYYYI LIMITS COMMERCIAL GENERAL LABILITY 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 $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILELIAHILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOSAUTOS Per accident $ $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ORH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? NIA NIA NIA VWC10060109792018A 08/03/2018 08/03/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I 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 Len Gibely ACCORDANCE WITH THE POLICY PROVISIONS. 23R Winter Street AUTHORIZED REPRESENTATIVE ` Cp Peabody MA 01960 J__Q Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I CERTIFICATE OF LIABILITY INSURANCE DATE(MIODIYYYY) 07118/2019 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 REPRESENTATIPIE 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 CONrA T .NAME, Marianne Hoysradt CROSS INSURANCE-WAKEFIELD INC �1ONE 781 914-1000 FAX No, EaoaRE , mhoysradt@tgacross.com 401 EDGEWATER PLACE STE 220 INSURER s AFFORDING COVERAGE NAIC# WAKEFIELD MA 01880 INsuRERA. AIM MUTUAL INS CO 33758 INSURED INSURERS: LEN GIBELY CONTRACTING COMPANY INC INSURERC: INSURER D: _ 23 WINTER STREET REAR INsuRtire: PEABODY MA 019605941 INSURERF: COVERAGES CERTIFICATE NUMBER: 426517 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. ILR. TYPE:OF INSURANCE ADDLSU POLICY NUMBER PPOOLICCYEFF POLICYEXP .... LIMITS COMMERCIAL GENERALLIABILnY - EACH OCCURRENCE:. -$ j .CLAIMS-MADE OCCUR DGOPREMISES Ea occurrence) $ �MED EXP(Any one person) ;$- NIA. PERSONAL:AADVINJURY $. 1 GENL AGGREGATE LIMIT APPLIES PIER: I GENERAL AGGREGATE $ POLICY C].Ea LOC PRODUCTS--COMPIIOPAGG $. OTHER: $.: AUTOMOBILE1.1i.kBI ITY - COMBINED SINGLE LIMR $ - a accident ..... ANYAUTO BODILY INJURY(Per person) $- ALL OWNED SCHEDULED -- AUTOS AUTOS NIA BODILY INJURY(Per accident) $ NON-OWNED HIRED AUTOS PROPERTYdnt) MACE AUTO Per accident UMBRELLltLIM OCCUR EACH OCCURRENCE. -$ EXCESS LJAe CLAIMS-MADE NIA AGGREGATE $. DED 1W M ON$ _ $ WORKERS COMPENSAWON Xj STATUTE- ER AND EMPLOYERS'LIABILITY Y I N ANYPROPMETOILPARTNER ID ECUTIVE E.L.:EACH ACCIDENT $. 500,000 A OFFICERIMEMBERB(CLUDED? -A NIA NIA VWC10060109792019A 08/03/2019 .08/0312020 (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ .500,000 If yyes,describe under - - DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500.000 N/A DESCRI"ON OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 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 atlrAM mass.govllwd/workers-compensationfinvestigations/, CERTIFICATE-HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE. DELIVERED IN ACCORDANCE WITH THE POUCY'PROVISIONS. AUTHORIZED REPRESENTATIVE r Cr �t.._t'`Lli Daniel M.Cro y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(201,14101) The ACORO name and logo are:registered marks of ACORD r � DATE(IIIM/DD/YYYt� ACC>RV' CERTIFICATE OF LIABILITY INSURANCE 01izu2019 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.ADDI ZONAL INSURED provisions orbe.endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER CONTACT Stephen Gill NAME: Cross Insurance-Wakefield PHONE (781)-9141000 FAX $1).2245TTf A/C No Ext: No 401 Edgewater Place Suite 220 al rom .ADDRESS:. s g. @sennottinsurance, INSURER(S)AFFORDING COVERAGE NAIC S Wakefield MA 01880 INSURER a United National Insurance Co. 13064 INSURED IMSURERB: Safetylndemnity 33618 Len Gibely Contracting Co.,Inc. INSURER C: 23R Winter Street INSURER o INSURER E:: Peabody MA 01960 INSURER F: COVERAGES CERTIFICATE NUMBER: 19-20 Master REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEENAEDUCED BY PAID CLAIMS. s LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER M/D .LIMITS X COMMERCIAL GENERAL LIABLRY EACH OCCURRENCE .. .-$.1,000,000 CLAIMS-MADE 5 DAMAGE TO RMTED l OCCUR PREMISES Ea oomrrence -$ 50'000 MED.EXP(Anyonepeisai) $ 5,000 A L7221167-A 01/29-/2019 01/29/2020 1,000.000 - PERSONAL&ADV]NJ URY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POUCY�]IPM El LOC PRODUCTS-COMP/OP.AGG $ 20)0,000 OTHER_ AUTOMOBILE LIABILITY - - .." COMBINED SINGLE LIMIT :$ 1;000,000 (Ed spWent) ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 62211i93. 01129/2019 01/2912W0 BODILY INJURY PereIoddent i$AUTOS ONLY M AUTOS ( ) Ix HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY per acrSdent $ UMBRELLALIA6 OCCUR EACH OCCURRENCE :$. EXCESS7JA6 HCLAIMS-MADE AGGREGATE. $ DED I I RETENTION.$ ,$. WORKERS C041PENSATION - . . PER OTW AND EMPLOYERS'LIMILr1Y YIN .STATUTE ER ANY PROPRIETORIPARTNERTXECUTIVE ❑ MIA E.L EACH ACCIDENT �$ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA.EMPLOYEE $ If yes,desaile under DESCRIPTION OF OPERATIONS below .. . .. . E.L.DISEASE-POLICY LIMIT -$. DESCRIPTION OF OPERATIONS I:LOCATIONS/VEHICLES:(ACORO 101,Additional Remarks Schedule.may be,atfached It more space ls.required) . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL.BE DELIVERED IN. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED-REPRESENTATIVE ©19W2015 ACORD CORPORATION. All fights reserved. ACORD 25(20-16103) The ACORD name and logo are registered marks of ACORD i . i:EN CaIBELY CO.mTRtitrTft+tG CO , INC.,: t'sge tva of Pages 23F2VYlnterStreet PF4BODY, MASSAChUSETTS,01960 A7!home Improverma wnteactors and aubrtmtractors (M)531 8234 Fax,(978}631 304 engaged to fidirre improvemenf.contracfing unlesa . wwr1N lengibelycoilfracting turn specifically exempt,from,registration by t�iovlsions:of Chapte'r:142A oi.tha ganerai tapw9',mtt9t DB'regtste�et! ;� Subinttfsd n � with the Commanweaitb:bf Massechu9ett& inquiries To "� f '-� � Q f1 t?/OS about regi&tratloh and status 0h*uld be made to the Dfrect+3r ttartle.tmprouerncnt C4nfrac! ge'gfstrat3ori; '' .One Asifburtop Place Ftoott't 1�4T;�a4tofr:MA 02t08 (617)-.727 gS9e Owners who secu6e:3helr otNii Q.ra consirtacdon rslt�ted Perin is or deal with pr"gtsterod a - contractors writ!tee ezctuded from the Guaranty Fund e A .��' � qp :dry Prottus7onof AAGt:•c 142A'', s �. ...p and aec jq tnoaii i ' 7 I w herc4Y s+bta+t spcarwrwrtd dstur�t for wwh ro Uv pertomied qpr a�s:t:t be used ty 1 4. LIS r , P > ' . e6Qrr 4. � .. CotEEia - rot- r ats befor9: USt&Ltlsy , rs9��� tnas apechcd t�erem wrffin Cenctw wd3 vAw '4 about : (a arncausea try cuiTstances b®Ion6 ConrraCtar's coni K mrif be eemv ^(aateJ T awn6 h6Cy :zWmr+'o esaeuf agrc2s tral Ne schedWmy YY��tesare zl»rcixnTtate ehif dt+u.tvpl iiahYS ltat a.e rwt a7ev"dah�bl' 'carrunata;sha9 n.A bo as Wdsmns d���s Ayeemu'nt. { 76dt1enrpt or enndEane trot 3£eri'at irr10We5Tir;a+z'fltBtiatt9 targeted tabe�tepctxed 6t rttdei�w. +.t�i�tl4�aecarfp�led ai5_:,:.„.,,.,,,.•,.,__va�!;tmw(nSAf+r+ouFl. _.` WAPRA m Tire Contractor+rwmr"ihat tt-s quirk turnd•ed nazau+wer sKak be free tmae 4atecty in Mot"stet wsiesiayshgs tQra p+vsad - . Ufa-rrAi+irtxneiita of tJ[)g<.greefrw+il,in dr awnr any QetettLro wtxknsanstup.W tx(t&i3L oraamaga caused by+ha Controctor 9usg r aelors. or agen :ier dtcr:o+s:rwithin ane yaw afar ,eompIODor:of awry job,ineluari+g de'w �true ConlrxKar sfiat6 atfiw Won aupE vse fatths�at ra mdy;_iepsr m act,+aybce as rauav to be rernadeck repaired or rept8ceu wCli rb.'drrage Or,sv�t.t#tacl rrs srkiWxWts arwa+rr.+ar;5tpp'Rietoir rlarranae9 shah duiev atanV!^'�R��onyerfidt?itgdmconnvctrw+wnh 9fis e9ree4-' On wwk el Propose hereby.la urnish'titats ia!and iabar:-complete in acco iianae with above spec+tiCatic3n5 for t�h-e�suQm of:' �; Paymern to be matte fEo as tows: titt guaramadsar+art products front marudaowtei � � ' - t�ear+Jab$kq,Tintl Rernave Ap Job'r+'8sh °6 r .. l upon sigrnng Cria!!Sck,G : ADP AF.RgtIfiG057.�,rtEEDEl7 WE P1/t t.V AM►T.•_ t t+fa,-tgreer bcn.f W. �rrgirovemor'cn»ira-tmg work,sWi reqLae'a ° - .. § Pa'Jrr -'.(edvanca 1 of Mace than arse-t(utq Df dw'.tce31�rRcact uwri crz*> erwrt cd---.,�:. or t rat amcifht ..pa'iits ar 0WIMentg Vlf l 13:e CWW W MOM .. iri. '{icu,: -'or ds'or.tftt+P `isQ:rFalairi crelive!y Cfspe4taf Grder . Una#:4ainadoioromitf erycn gym. er Ls' �qw StL.37.K,ikD13. .ittk>r . ... tomtNeiloe ot'y:iv',t�ugQert{vs zoraract- .. .. .: t'vtaTYiB(?+at ariri.'YEin10�M&a14nUyLSNkdACCEptedai6rsi !. itidut e. .. }7 ACCgjatBilCe Qt f?lO CS31 1 fia+�react both sides of this rant and a pt t specif(cattoiis 8rxt ctxtiSiiioris sla?(is l undeistand ttaat.upon signirfg,his prcppsaI becom@5 a tiiMing;c4f7tracR:.Y40U i7im Aultrorized tti:, to as ecif?ed.l�ayrnenr wiu tie moue u oufli-#d above: ti t Your the Suyer,rttay.ci�ncfei trite trarisactlon at 8ny':tiint*pt to nigh.of.,tile th#tc#busirsess eiay:&ftcr the . i Ae of this:transaction Cpft!i1 aboi must`tie done t1 writ g ; DQ 7ir�e/O�TS414THIS C4id AAC'T 3F THEA /i F Amv BI AMK SPACP-S a irs6i�`iiif�rr,i e, t/iAt!ON atv aaC„