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12 BARSTOW ST - BPA-16-1282 INSULATION • � T? O c=K � zg3�� —,ern The Commonwealth of MassachusettSTIGI'nC l ' Board of Building Regulations and Standards CIY OF l t itft W Massachusetts State Building Code, 780 C SALEM NOV -3 p f yrf1Shw 2011 QO Building Permit Application To Construct,Repair, Renovate Or Demolish a One-orAvo-FamilyDivelling ,. ,; ,tiq, This Section For OfTciol use 0"19 -*o 1 Building Permit Number. Data:Applieds Building Otticial(Print Name) ;Signature,'.:,:- - Dale SECTION 1-:51TKINFORNIATION3. 1.1 Property ddress: 11 Assessors blap&Parcel Numbers �a fL,-si .. S�. I.Igls this an accepted street?yes no hlap Nw" lt_(.:1jt)a 1.3 Zoning Information: 1.4 Propertyr,Dfrhemsi.ctw rrllyl k (g Zoning District Proposed Use - - - LorAres(sgit) - '��"F iif a(it) - 1.5 Building Setbacks(R) - Front Yard -- Side Yorib - Rear Yard Requintil : Provided Required P.mviJed. Required -Provided- 1.16%ViierSupoli:(M.G.Lc.40,§54) 1 1.7 Flood Zone Information:e? I.8 Sewage DtspaemISyslem: Zone: Outside Flood Zon ' Public Private — Chedtl[ asO. Municipal 13On site disposalsystem 0 .. - SECTION I::PROPERTY.OIVNERSH/hN�' � ' 2.1 OwnggrofRecord l� :C14//fVzz-.*L ��lCGvr r✓L/ d "a(Print City;State,ZIP No.aml Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(cheek all that apply)` New Construction 0 Existing Building O Owner•Occupied O -Repairs(s) O Itemtion(s) O I Addition 0 Demolition O Accessory Bldg.Q Number of Units Other Specify: BriefDescrip 'a of Proposed Work vVt�i - S. - 1 SECTION 4:ESTIMATED CONSTRUCTION COSTS Itcm Estimated Costs: OfQelal Use Only Labor and Materials) ' 1.Building S (/ ow I. Building Permit Fees 9 Indicate how fee is determined 2.Electrical S - 0 Standard ChyMawn.Application Fee. 0 Total Project Costs(Item 6)x multiplier x 3. Plumbing S ??Qther Fees: S 4.Mechanical (HVAC) S List: 5.Mechanical (Fire S Su reseion) Total ill Fees:S Check NoJd834 Check Amount: Cash Amount: G.Tntul 11roject Cost; S J�1 , / 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5A Construction Supervisor License(CSL) $ ? y y lZ 3`/$ 7 F _ Vogl 411 1 � Lic6�ense Number Expiration Date Name of CSL Holder Elie W.Palm Lisa CSL Type(see below) i Hilton P!Xed Type. Description .. No.and Street Salem MA 01970 U Unrest Leted Buildin a to 35,000 cu. 11. R Restricted 1&2 Family Dwelling: Cityfrawn,State,ZIP M Masomy RC RoothatCovens WS Window and Sidin � SF Solid Fuel Burning Appliances q'-7�-• /•l 9—/ 4 5 ; I I Insulation Telephone Email address D I Demolition 5.2 Registered,t(ome Improvement Contractor HIC) 1.0 HIC Registration Number Expiration Date f11C Company Name _. ;,u �� No.and Street 01970 Email address Ci flown State ZIP Tcicphone SECTION 6:%VORKEIM COMPENSATION INSURANCE AFFIDAVIT i G-L ce 151§3$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 Isbuance oJAWIntulding permit. Signed Affidavit Attached? Yes.......... No...........0 SECTION 7a:OWNERAUTHO)IIZATIONTOBE.COMPLETED.WHEN' OWNER'S AGENT OR CONTRACTOR APPLIEE FOR BUI/LDING.PERh11T 1,as Owner of the subject property,hereby authorize �✓t G Pa ` rn t9 act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's c(Electronic Signature) Dote _ SECTION 7b:OWNEW ORAUTHORIZED AGENT DECLARATION By entering my name below,)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. � � Print Owner s or r utha—zed 1 c leclronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home.Improvement Contractor(HIC)Program);will Of have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other lmportanimmformafion on the HIC Yrogrvn can beto0rid www.mass cov'oca Information on the Construction Supervisor License can be.found at wtrlv.mass ov,'Jus 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) N (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 r Enclosed Open j. "Total Project Square Footage"may be substituted for"'rural Project Cost" "_. oaradd(v,rjm au's i�V�j�4B� amyta t>aictega;,zmm�� II°�"JG1bQ1entt�J'"e��' hnmeonaas alaeesHoae Gddelog ' ladvit�� HOvAn�CmaaaarLary 47A�6atdaseot' AaYPdma 1 tsafeaasvmerO�E berm a„aeemgioMyTivvikkgy -d am�aWdfos[o6fmma�cwpp�o�d ot?tata3 �lia6eacat617?73 g7g7ar1�➢8 so a appby the g Neese it .8?-37s7m•alonrn,3ly� L//S �UBE2ECFgTdpt'Ot{?7£2FOLs Srcef Add,,, CamRayAr�e (des of a?tb-tDlfiM �� C C�xa oatrtetatlSal. �p Sete CHush=11"IMI ede a�n(Itdi�erent5aazbmFa Sp}e ZaPCade H�mYhme _ ' rara'u>4.�r� L'`L.'��IDarSBAr�Ic 'ate ConRactara . =�ima`,srros�t i.aetr �; tDZ;t:e in dctn➢ da=Lafo9 2.G� / //''A,r mmcvmpt stB fo`eLzEoawt , maw ldl�llay`t Alf � � /-f EeSttirUa�e.YtiG.n- �' �- -. and va will xesecaa-y bvtha ;e w�nygyasrbahna+raEaremgaued ><anassdSlur aadC (v�sv�•,s: O SBL'EYi; a", xeadaexdto amidahm cmw.,r..-lhefa➢ ^o7lG2r)�^, a�g� F��=sus vr3d w_ '� a�sshet3de ..�i�- �E9PHHCsm ass os c'Bg`aadWecaatmdms a ----__Dzleuban caadracturV711', maaacted To.."i:or`"'rceand Z` .,_Dzlezzb® nntly inv Conanc:orzs'.zsmPm'orm t5cILemfid,� aaaaaciedxm?Ivdl xa aas4,-aGz➢y�Ptetcd Pa}m.^at;tai116em:dezC,qu➢akrtbcfo➢tnriagyt �dlaxarya�abwc�wetrJennt aE � 5---•�_ucoa sigryaoc�., {aattc e;aead iG by S —'Im-napa caaple5aa of Pda @ rheteritaFflx+ul �--�_cy �—__ cfievas°g2ar¢) S�Q,//�/V _i o-aPo1 emiPieliaa aF -�1. / / apart ruaWcBoa oFtueeonerz2 (EasrForirid—'--L r=! �/1� Trcinlla.,dngsm�r�a-�� ard_•mdicFarour_ rrmvtxvatcini o➢p<ymeo[�h7aaaQay?iso m arp/tim� �:er.,ep m�ie-ag �._a ! olafcdte5a75Pa'n''str-ti,�Gioa) rhzdme(y) F riet r 0 d:.i, ayid ' niia an:.i•;;ws OF(e)On-+Ln''rdm Le t3 aea=Yd,;,,,fta:dmu c tom:e;t5 m lairs;@}t�"cSrJ�ataF a`e.=e:Fcxa r-h�asm,. uu�� •r-�nls,:nnn e:�;,-�s^.�enntvF• '^7redao25a1e1e ¢}•�IceiPaL-rtar ryyaa�dec¢tm;l o.oe.�abr-Tryncaaua -'O °m:ldnd.,_recm-t-: rt L;:v Pnch,•/Euaon�otar., �^v"r�xob: nuteri�s an Inca-j�dt:'�eaaatjr��7DY,�a�opypjc m'4 =8r-r,t__„�_ar, c Connac.a vnd":tx::a �aWa�-�ctar a)etioa a:rutrurt-. T+n:^+svmey �P5c2-r z�rn; fafx¢-a ae..'^•rusd=eg,'-a2�roEtSe. "'nv�;sarnv caols<c[s6all mta ( -fPaa si. ' ., 3r''a[a eesate[yrepay�-de��n�m�to„ ons man Ir'•1 cercivll PYfiatw-e}• �tldsdo:�aa[haga¢a a7t...w� yrnad }xe,'arsi�SexiswntaeG ��e�t}'fator�YLs�a�Samhn,7nodg.l,,rr 7fy¢y far Caa`t ia_r,.rtluaczdtm tnereaden °�anfleCaotedt.`rlSia 0lisdo 'riairs,��"wed i`ta'd�Bexaq _ '�Rcviavt6efa➢arrIDSraGmsandaaC�S the ilf aldFdYTMd=t :�bcen I p y st4 s ith a {� Gmtacmretoaz - d nel«r 4=¢aoasirsoaetp'Iag�®rJcar r Dir taraE& 'a, Sto tueDu-w Im}ngr®�tCo aaJ'm Paz ca;.��ctark�yi ,��?p to l' p{;a.�aamJ77f), a`��Ro. mD�eLaaeimPraveaeotcaotra 1,ci's ;, cFiosuaacel s'c7ae Coax.., rbr.. , Bw-iagivL102il6vrb}•ta(�gu a"aad LaaspaLrabtsa dacuaen! Gar- 617-97.s7g7 as Guide fo dtcfio-:e,yr ➢id¢. duafaom'xmtr��,amacamaanystra �:otatyoamtcoa�'S 3��57. i`a,,.y Coutrdclarr -�mexaa °�S6 orxskto You:,_-. •.=td as tnc2vGse�daoflBt'af calm'a?aael riii5a"e a�a`]fjt x mm aadgetucogpoFeheCan_�ec Ixir 6 ro,in l.:�xa"ridlncra•,�a ogce� 11 . �t`a"�Trc➢oxmsabogo °ramac4aaiaWe•t> �acyrt*�arsafma.� gcifti; aa�.-y rpP P) t2�aluie�Fmvidedyma m[Sx fFr odactiaafr~atelen-�oor" =a7:aot ° Ebtfob 1s¢tyna the gmrnn c:AL�a.7oa oEIItisr taf 3amm;:natc Siw_ �aW�u2l � Dme ! 7/ Coa?.rtoPs$i€+Lxlwr Contmetor Arbitration The Home Improvement Contractor Lawprovides homeowners with the right to initiate an arbitration.action(as an alternative to court action)ifthey have a dispute with a contractor. The same r�is not automatically afforded i� contractor,hmvaver. The contractorwould bave to resolve my dispu both parties agree to the optional clause provided below. This clausewould give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvamant Contractor Law_ The contractor and the homeowner hereby muttmUy agree in advance that in the event the contractor has a dispute concerning this contract,the ecm2nm t, Q t dispute to a private arbitration firm which has been approved by the Secretary oftl odarmam Affair and Business Regulation and the consumer shall be required s " usetts General Laws,chapter 142A. to submit to such matioasE1dS�ch �. ttlglq'fs.nnt.. Homeowner's SiFlOtUrtr Con�c�^ rgmaure NOTICE:The signaoues ofthe 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 when this section is notseparatclY signed by tlteparties. Homeowner's Rights A homeowners rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(Le.MGL chapter93A)may act be waived in anyway,even by agreement However,homeowners maybe excluded @om certain lights if the contractor Omy choose is notproperly 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 woria mlltlm manner. Homeowners maybe entitled to otnerspccffic legal rights if the contractor guarantees orpmvides an exprws naaanty forwodanaoship ormaterials. To addition to gamantees ar warranties provided by the contractor,all goods sold in Massachusetts way an implied warranty of rumbantabiTrty and fitness for apartimdm'purpose. An enumeration of othermattels mi which the homeowner and contractor lawfidly agree maybe added to the temts of the contract as long as they do not restrict a homeowner's basic consumer rights. Ifyou have questions about your consmwedhonneownerrights,contact the Consumer Information Hotline(listed below). Execution of centract The contract must be executed in dtmGwte 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 hlanksections have bean filled in ormarked as void,deleted,or not applicable. One original signed copy ofthe contract with attachments is to be given to the owner and the otherkept by the contractor. Any modification to the original contract mustbe in wridna and agreed to by both parties.Contracted workmay not begin until both navies have received a filly executed copy of the conoaot 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 wbere the homeowner deems hinJherself to be financially insecure. However,in instances where a contractor deems hinchlemelf to be financially insecure,the contactor may require that the balance offumds not yet due be placed in a joint escrow account as a prerequisite m continuing the contracted wvodc Flithdrawal of_finds from said aecountvA uld require the sigoamres of both parties. _ Additional Information If you have mineral questions orneed additional information aboutthe Home Improvement Contractoriaw or other consumer rights,or ifyon 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 PadcPlazo,Room5170,Boston,MA 02116 617-973-8787-888283 3757 or visit the OCABRwebsite at httndhvnm,.mnss aov/ocabr/ If you wantto verify the registration of contractor or ifyou have questions or need additional Warnation specifically about the contractortegistration component of the Home Improvement ContratnorLaw,contact Director of Hume dement Cons actorRegisn90n .Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888 283-3757 orAsitthe HIC webs ire at 11ADW11MUnasssov/o cab rI Go online to view the status of a Home Imp tnecont Contmetor's Regishmtiom htro•//db statemaus/homeimorovementllicenseelistasu For assistance with informal mediation of disputes or to register formal complaint,against a business,calk " Consu aint Section :-. �teCampl Of$ce ofttie Attorney General 617-727-9400 4ND/OR Setter Business Bureau 508-652-"00..508-755 2548 or 413-734-31 I4 Vedm21-I10010 The Commonwealth of Massachusetts Department of Industrial Accidents rr ir�- OEM Office of Investigations s a7 `I 600 Wash&gton Street g Roston, I1 02111 _N mvimnassbovldia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aorrlicant information Please Print Legibly Name (BusinesslOrganization/Individual): N. Address: „ae 'x; , lig7r, "ity/State/Zip: Phone Are yo 6 employer?Check the appropriate box: Type of project(required): 1.(2`[ am a employer with 5/ 0 I am a general contractor and I employees(Full and/or part-time)." have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No worker' comp. insurance comp. insurance t required.] 5. We are a corporation and its 10.[] Electrical repairs or additions 3 ❑ I am a homeowner doing all work officers have exercised their 11.[] Plumbing repairs or additions myself. [No workers' comp_ right of exemption per MGL 12.0 Roof r pairs insurance required.]; c. 152, §1(4),and we have no employees. [No workers` Li. -therr /�fvSi c/G It av comp. insurance required.] `Any applicant that checks box;il must also fill out the section below shoving their workTm'compensation policy information. Mmneowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name or the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,thev must provide their workers comp.policy number. •am an employer that is providing workers'compensation insurance for nzy eniplovees. Below is the policy and job site nfornratiorz. insurance Company Name: EiUc �r G .i I olicy z or Self-ins.Lie. ': ,,rr�� '7 6 27 0 1 z t Expiration Date: [� .//3!2011Z// �, ob Site Address: la ►✓ tr-S�/ Sf• City/State/Zip: �Yal eo-t fi - -tach a Copy of the woricers' Compensation policy declaration page(shoving the policy number and expiration date). allure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 fine f up to$250.00 a day against die violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby certify wider the pains and penalties of perjtsn1 that tl¢e illyortnatiote provided above is true and correct isnature: Jt%,vn ::;,v ji;; Date: Il/1i hone Official use ottly. Do not surite in this area,to be completed by city or town official City or Town: Permit/License# 55 7ina Atithority(circle one): F. 30ard Of Health 2. Building Departm ent 3. City/Town Cleric 4.Electrical Inspector S.Plumbing inspector 6. Other Contact Person: Phone#• lvJ;b!!`TURCA U E OF UABOLI 0 1f ONC�J�/II�IAUI"1CIS DATEIMEUDDIWYYJ THIS CERTIFICATE 1S ISSUED AS k IVIATiER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS cEP,T1FlCATE GOES NOT AFFIRMATIVELY OP, NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS GEP.TiF(CATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREP,(S], AUTHORIZED REPRESENTATIVE OP,PRODUCER,AND THE CERTIFICATE HOLDER,. IMPORTANT: If the ceI`uficate holder is:an ADDITIONAL INSURED,ffie pOlicy(ies) must he endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this eeruficate does not confer rights to the cer`Jficate holder in lieu of such endorsemerd(s]. PRODUCER Eastern 2nsi=ance Grotm Tmc: Noth Const=uction 233 West Cen:L raj. St PxoNB (800)333-723a_ FAX C n E-hiAtl c.No DDRESS Nat-i ck 1`A O17GO INSURERS AFFOROMG COVERAGE NAt[z INSURED INSURERAAr)'Jeua Protection 'nc_ CO_ 41360 AtlElntiC 1'lTea.ttlerlZatiOII INSURERe�Tantt.171S Tn eL+ra-Lce co 61 RL-a Jefferson Avenile INSURERC: N2 RERD: Salem ML? 01970 INSURER E: CCVEP.AGES INSURER F: CERTIFICATt NUMBER�ste-. 2016 INDI IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEp BELOW HAVE BEEN ISSUED TO THE INSURED NMSAIED ABOON VE&FOR THE POLICY PERIOD INDICATED_ NDTlnJfBE Is U ING ANY REAUIR INUYT 7ER I OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT BOV RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS WITHSUBJECT TO ALL THE TERMS. EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES.LIMITS SHOWN NIAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OFINSURANCE ASDLS POLICY EFF POLICY ESP GENERAL LIABILITY POLICY NUMBER hi DIYYNI MMR)D LIMITS X COW-IEP.CIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 PREMISES aatta aam S 50,000 CLAC 4ADE O OCCUR, 8500042616 /20/2026 /20/2017 X CONyOarTOPS LIF3lyy ny hiED EXP(Any anepersnn) 5 5,000 CG0001 10/Ol 90R14 PERSONAL&ADV INJURY IS 1,000,000 GENLAC-GRsGATELIAOTAFPLIESPER: GENERALAGGRECATE S 2,000,000 POLICY :=_ Pnp- PRODUCTS-COhIP/OPAGG S 2,000,000 LOC AUTOhiOBiL.E LIABOJN S ANY AUTO COMBINEn SINGLE LI ALL O`PJ�_D Eaamdemt IS 1 000,000 AUTOS X SCHEOtR.ED 0200IS871 BODILY NJURr(P¢lPpnara) IS AUTOS I HIRED AUTO ii AON-0UtTlEO L3/20/2016 /20/2017 BODILY INJURY -- S AUTOS !P aaNeN) S PROP OA1dACE S UMBRELLA UAB Tf I PIP.Base S -" OCCUR A EXCESS LIAR CLAIMSNADE EACH OCCURRENCE S i,000,000 I - I CIE F.ETENTIONs I0,00( 600058654 AGGREGATE S 1,000,000 WOP,RERS COMPENSAT7011 /20/2016 /20/2017 ANDENIPLOYeRs'UABILiiy I S ANY PROFRIE�NIN)P NC STATU- IOiH- OFFlC_RAIE5 ARTNeE/ CUIP>c❑ `! II c (Mandate 10�-`y' DEO? RIA ry m and EL EACH ACCIDENT If yas,descibeuntler S DECRIP7iONOFOPERATIONSmim, E.L.DISEASE- EA IILPLOYE 5 !3 ?OLLDT20Lb' I EL DISEASE-POLICY UMIr I S 7,200378614 0/1/2015 01112026 E9 POLLUTON CONOmON $1,000,000 DESCRIP"oil OF OPERATIONS I LOCATIONS I UaOCLE$(ABamA IGENERALAGGREGATE $1,000,000 CORD 101,ACdNmal R emarlm Schedule,Umam j Spam Is required) :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE C.Tl. , OF Sajzm THE EXPIRATION DATE THEREOF, NOTICE INILL BE DELIVERED IN D3 µt3�I�S� ACCORDANCE WITH THE POLICY PROVISIONS.IGT0 -q STREET SAL•EM, � 01970 ' AUTHOROM REPRESENTATIVE :ORD 25(2010106) .TChn Raegel/S.[re — �, s02snn,n:r.n, _ ©19882010 ACORD CORPORATION. All rights reserved. -,c..pCr'D2rl aPr.:P vnc:nnn a-.a en.+m.a:nri rmH,rc nL d(:(TRt) r Rx z'erver IPICATE IS ISSUED AS A MATTER OF INFORMAyION ONLY i i CONFERS NO RIGHYS UPON THE CERTIFICATE MOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ADAEND, TfiiS CERTIFICATE OF INSURANCE DOES NOT E%CTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. I OR PROOUC CONSTITUTE A CON'4-RACY BETI.URem THE ISSUING 1NSURER(S),AUTHORIZED REPRESENTATIVE ND'yE CERTi ICATE HOLDER. thIMPORTANT:R the itlon Certificate t holder is an/IDD1T10tVAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and rnnditlons of the policy,certain Policies may require and endorsement A statement the certificate holder I-lieu of such endorsements_ on this certificate does not confer r(ghts to PRODUCER CONTACT EASTERN LUS OROUP LLC ((NAME: 233 tV CENTRAL STREET PHONE VA'C,No,Ezt): FAX NATICIC,MA 01760 (A/C,Noy: 22MLW E-MAIL ADDRESS: INSURED INSURER(Sy AFFORDINGCOVERAGE ATLANTIC`APEATHE INSURERA: AbfERNZURICHRtSORANCB COMPANY NAIC9 R[ZATION LLC ICA 'INSURER B: 61 REAR JE INSURER C: r PFERSON AVE — i INSURER D: SALEPd,MA 01970 INSURER E: COVERAGES CERTIFICATE PLUMBER: INSURER F: TITLS-IS"fDC IFYTHATTHE POLII.TES OF ERMFI AHY REOUIREMEM,TERN OR CORo 11 CE1 11 1eELDWN VE BEEN REVISION NUMBER: AFFOflDEDBYTHEPOLIGES DESCRIVONHFANY� A�OR DTMERp ED TO THE NSURED NAlAEp ABOVE FDATHE Pd10 CLAOAS. ERELV 65UBJECr TGALL O �TCLUS RESPECTTO YAllC"MoS CEATGICATEASAYPDLISSUED 0DINOICATEp.190....... DaJG THe TERNS,EXCLUSIONSAND CANORIONS OFSUCH Pp11C1ES. BeeE IBSUEDOR MAYPESITADL THE015UAANCE IN SR I ums SHGIYN ragY HAVE REM REDUCEp BY LTfl� IVPE OFaISURANCE �4D0 S 1 L R POLIC7UIRABER POUCY�DATE POLICYFhRDATE GENERAL LIABILTrY I A1DDIVYYY) (lawD,nm t_I COMMERCIAL GENERAL LIABILITY ' Lcns L� CLAIMS MADE ® CH OCCURRENCE OCCUR $ DAMAGE TO RENTED S REMISES(Fa OCCUDence) GEN'L AGGREGATE LWrr APPLIES PER: A'LED EXP(Anyone Parson) S i POLICY PROJECT®LOG PERSONAL&AOV INJURY S AUTOMOBILE LIABILITY GENERAL AGGREGATE S III1 ANYAUTO PRODUCTS-COMPIOP AGG S (L ALL OWNED AUTOS COMBINED SINGLE !� SCHEOULEAUTOS UNIT,(Ee acddeN) S HIRED AUTOS BODILYMUURy S .`(NON-OWNEO AUTOS i t (PwpWson) f BODRYINJURy S IPer accident) PROPERTY DAMAGE S UMBRELLA Lb1B i (Per accidenq OCCUR EXCESS!1A6 CLAIMS-MADE DEDUCTIBLE EACHOCCUgRENCE S J RETENTIONS AGGREGATE ' � S A IV IORKER'SCOMPENSATON APR) 1 S E-19PLO.ER-S UABILITY S ANY PROPERRORIPARTNER/EXECUnve YIN UBSB270121-16 03202016 Vr i VC STATUTORY (g OFFICEPoIAENBER EXCLUDEOT N I D31202m7 LOAITSdescib I OTHER I lmanaarwy-v,wxl N!A 11 I I1 rSeunder I E.LEACH ACCIDENT DESCRlPTlCIPnON OF OPERATIONS Wjwi ' EJ_OLSEASE-�EMPLOYEES S 600.000 ESCRIP770N OF OPERATIONS'LOCATIONSNEHICLES)RE I 0,000 E.L DISEASE-POLICY LIMIT S 500000 HIS REPLACES ANYPRIOR C6!1TIFICATE ISSUED TD THE C'ER ICTIONS/SPECIAL ITEMS BOLDER AFFECTING WORKERS COMP COVERAGE. SRTPFICATE HOLDER CITY OF SALEM 1CANCELLATION 93 LVASHINGTON$T 33 .,..._._--OVEDESCRIBED POLICIES BE CANCELLED t .i BEFORETHE EXPIRATION DATE 71HEREOF,NORCE VALL BE DELNERED JJ IN ACCORDANCE WITH THE POLICY PROVISIONS. SAj-EM,MA 0f 970 AUTHORIZED REPRFLSPy' T ' f >I'D 25(201D/05) 8o are registered marks of ACORRD 1988._:1 «•:`: ' " .:- .�- I 20i0 ACORD CORPORATION, AB righLa reservetl. Massachusetts Department of Public Safety Construction Supervisor Board of Building Regulations and Standards Restricted to: License: CS-087977 + - Unrestricted -Buconicfort any u cubicmete�s of which�n Construction Supervisor less than 35,000 enclosed space. a 9 ERIC W PALM 3 HILTON ST } "€. SALEM MA 01970 fl$ /' , C-ailure to possess a Current ed§ion oltheMassachusetts v�-- Expiration: State Building Code is cause for revocation oflMs Gcensa Commissioner 04/23/2018 - - OPS Licensing Information vrstt W W W.M16SS.GOVIDPS t � e �J�r.cmxroxnmfrL n`�'flua:xaxr£! License or registration valid for urdividnl use only Office of Consumer Affairs&Business Regulation _ before the eEpiration date. If f9und rabar" :_ i ME IMPROVEMENT CONTRACTOR Office of Consumer ASeirs and Business Regulation j1 �eg'�sriafion; 142089 Type: 10ParkPlan-SuM5190 ration: 3112/21118 Ltd Liability Carpor - - Boston,MA 02116 ATLANTIC WEATHERI7ATION L.tC: ERIC PALM 81RJEFFERSONAVE SALEM,MA 01970 Undersecretary Not validwithontstghatnre �I "