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3 GOODELL ST - BUILDING INSPECTION (2) -1> 2 S GlG 1 22-o The Commonweaith Own VICE Board of Building Rrig n tan ards CITY OF Massachusetts State Building Code, 78 SALEM ��pp���� q K 41 RevisedShir2011 Building Permit Application To Consneer,�a}, Renovate Or Demolish a One-or Two-Family Dwelling This Section ForOfficial Use Only Building Permit Number: pate.A Ited•'i;! Building OtTiciai(PrintName) .-_ :Sig_natur@ - Date SECTION 1:SITE INFOILNATION.' 1 L1 Proper Add s° 1.2 Assessors btap&Parcel Numbers I.la Is this an accepted street?yes_ no_ Map Number Parcel Number Coning7nformntion: 1.4 ProoertADlrttet�t�Clons-4 1 Zuning District Proposed Use - Lot-Ama(sg a) 1.5 Building Setbaeks(R) - Front Yard - Side Yards Rear Yard - - Requin:J Provided -Required P.rovided. ,Required Provided 1.61Vater Supply:(M.G. c.40,§54) 1.7 Flood Zone Information; 1.9 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check if es❑_ . Municipd t] On site disposal system ❑ . SECTIONZ: PROPERTY,OWNERSHIPt 2.1 O ert of Record: me(Print) State.ZIP Ef 97Fr 33S fly3. No.and Street Telephone Email AdJr�ss SECTION 3:DESCRIPTION OF PROPOSED WORKA(check all tint apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Iteration(s).0 Addition O Demolition ❑ Accessory 81dg.❑ Number of units_ Other Specify: Brief Description of Proposed Work=: c _ SECTION 4:E IMATED CONSTRUCTION COSTS. : . Item Estimated Costs: Offie(rl Use only Labor and Materials) I. Building S _ I. Building Permit Fee•.$ Indicate_ hose fee is determined: 2.Electrical s ❑Standard CityM%vn Application Fee. ❑Total Project Cost-'(Item 6)x multiplier s 3.Plumbing S ? Qther Fees: S 4.Me:hi nk.1 (1 i VAC) S List: 5.:\lechanieal (Fire Su ressiun) S Total All Fees:S 6. Total Project Cost: .S Check No.Q401ecicAmount. Cash Amount: �y��r ❑Paid in Full 0Outstanding Balance Due: SECTIONV5:-tCONSfRUCfION SERVICES 5.1 Construction Supervisor Licctise(CSL) r.,�ur i is License Nutriber Expiration Date- NiimC of CSL Holder _ r h '' `i FIT (.ist CSL'rype(see below) Eric W.Palm Type Description , No.and Street 1 tOD )feet U Unrestricted Duildin a to 35,000 eu.11. Salem MA 01970 R Restricted 1&2 Famil Dwenin Cityfform,State,ZIP M Mmo RC Roolin Coverin WS Window and Sidin ,/ SF Solid Fuel Burning Appliances Cf 1$ �7/t41 - SPN I fo lid Fun Tcic hone Email address D Demolition Registered Home Improvement Cautraeta. (HIC) ' U 8 -5 �.z Re �1 Z �]' g H[C Registration Number Expiration Date IIIC Company Nam IC gi N Email address No.mid Street Ci /rown Stat ZIP Tele hone SECTION 6r1VORKER$'.C.OhIPENSATIONINSURANCE AFFIDAVI'F(NLG.: c:152 92$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 ls4uance a building perm Signed Affidavit Attaehed? Yes.......... No...........❑SECTION 7agOWNERAUTIiO1UZATION TO BE-COMPLETED WNEN., ONVNEK'S AGENT OR CONTRACTOR APPLIES FOR BUILDING.PERMIT t,as Owner of the subject property,hereby authorize t9 act on my behalf,in all-m-a—crssrelative to work authorized by this building permit application. i 1 ��� y I Ar Date Print Owners Name(EleNronic Signature) - - SECTION 7b:ONWVNERt 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 rue and accurate to the best of my knowledge and understanding. W /s' Print Owaer's ar Authonud Agent s Nano(L eciromc 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 reeistered in the Home[inContractor(HIC)Program);will our have access to the arbitration proSiam or guaranty fund under NLG.L.c. Ia2A.Other mportant information on the M-Program can be ou t�a[- ivww mass aov'octl information on the Construction Supervisor License can be found at www.mas sovhlns . 2. When substantial work is Planned,provide the information.(Including lgarage.finished basement/attics,decks or porch) Total floor area(sq..R.) Habitable room count Gross living area(sq.R.) Number of bedrooms Number of fireplaces Number of half/batlis Number of bathrooms Number of decks/porches type of heating system Enclosed Open "type of cooling system j. "Total Project Syu:ue Foomge"may be substantal I'or"total Project Cost' g8➢E,�Us �g n smm8�s6aalll�n'a9we@¢�ofma ®I'l Z ��¢t5�ffi 6�tt®mm$ �°Q �IO+el�mproleaabnae,s. suh'synme G ce Cn�a�GtoH ene o Mifaeeess? ep�tCwnaaoriav(b.IQ, 14 dnasooa• standard ImPmvemeo[° Pasonplkm mlan°Gmmiszbad E�cobtama dHmmrasReBnlatanSc wera pp�m�Ynark onyom•rm'd®e¢Yoa Y hb>mafns �`� 3IDrOt7aaQipil nimsConBotGneet617A733787 coo or188&&283-3757 m•�n�w Sthe Name F'Yerl � �h camp:ml. a �'oseOrlaforma6ota StrcetAddrea(donoinseal+od GlfixRns 1 At 3 � � vl!antic Weutherizatioa C;ty/Pmv� / e eyy -(Y`lC jscne;; rmceae._,._ Avenue ➢aYampeFhoueGG i Hmarnlidmess fron t' 70 ' �'�7Sr E�aigFh®e City/fmva .✓:. r Mailing Ada�(bdiffamt ✓ Sht a bone 1'��F+vpi%erID eras�,nbtr • �..• i^^�vmvummrem a$t �aa.nmta Tire n[raCCGt' (DesCacibe indemaa" adot6efoll °�CwarlcfortbeHem //(O J/°pmPleiedap¢i{Ying megp,lmoa•and�m' CCI�Gc.)�61-e_ YQ�i d , ao wners �35b coa ft,WRcanes eh be�O munld C3 ao Sa -lbefo0rnm ((2wstetsm6o _ 1 ese&adetB from fi6e G tR sb WW he ''A bR'wdtha embedalewra ?fu^I,ofiapterIAB.r�,j® YF°odPauvesioasor .. mnaaa°r3Centralan,, --'-=-�nalesN,®aonhacm,.,vi77 watraded nndc Total Caneinet Prieanad �_7)ataaxd 7bc Contrapor PL9meat5cbedye wntracudsvorkan7l bemibsimb gy"Veted Pa ° mPmfmm th6—k fnimsb Poe . tmteats iv7)bem� I amu maieoal avdlabarspxified aboveforihemmlamn of �y� I;Ih °fin%schedde --c upon siping c fq S ®hact(notmt�eed l/3 efthe ' yypine=r theo�of Xdd=—�—/ oropoa eompteBon oPO� Miieberers ) SLYO-l-- °capon eompiedon of / Upon wmpledoa of ewn - Thefopecaagmap�jey hart a ` fad(i&damandmg ap m�ae2atC eamke �'; tI macW S tU 4e Gmntl7 Capn•�t isc=plmComh pad3J3 SChNW+ )'a In °� �a+'fdCfian) NCTr;„q:(')inm deb eC�gns(j%tawmyamy S to whim murtba�gat,(a)me•ihhd of a��'dWs:a:daua sreaat a*daGdmvdvmeam����rcm(b)iyen➢mentnsimmd EY d,Gemimemr SuhconW (. retamrymptmmSehtlWeaz�emi Glanyypy�l az� new H -MILem Party/suhwnatrm�viar�e QOIInTa2eestd basaiel 'dm em ,n erial an aThe..,Yrttpoaa ContrictA_ '�n die 6J'WewaPreece- mbagae pl oaI L Oi allydaytn 'bedoP c.r b eo x wattact slinOgarm a t, yth nsigaing ads'deameen[ fl4'aesm bewielyaaapmmble� P�'IDmutoall msoFmytld aarelidly before si aRi•llw orthl semnitybueestbas ea %a0pnnderlaw-Unlessotb enb�himan or going ibis wahact ern'iseaoted xltbm this conmt heprac�iaed unasigam%We bewplacedw iberasid®ce Revietvthefopoaip docament the o _ %amttionsdnotr su "cootrzeiarhas adHraSetrmemd�d he°aoaztnn;to be °01eY cefdsliaaon FryexitingimoW vaW dn:' ar wt--��amornem'R �d d'b'�`9amg.ifsom Does the watmgarhaya' �•Toe alhm m a-roaw '"wmraF 1OparlcPlaz%noIpo�mt Cmnhxnear)Ze olvsthomeimM'av®eoteanaoeas 0 XnatvyotmYou riagaeafofmmn�w.,men W? theC:`-Ormrbismsmanw hfA02116orhy M 61yiogaabotcemmcier and Guide to theH e7mpmvementC� Read the . °0m-a�•�®ahonso Out 73��ar8g8293-3757. can conff--I connmoYc:olor in��y"'''®®Votet ft h�9 rLa 'podt�84on not tb Rvasesdeoftbisfmm dga...pYoftlicCansom�er'to athi thirdnbusioe dayfaIIowinB the Sign,- Or ch chofam by nrdmayp wah^-tlot'sno®ni Plaxof F��)37HB� 33 a mwt Son the aaaahedadp�hWLbytdeBamsemorby Pmeawyonnohfydm rwv tt�cimr wc.Qv`�Ifl4dB��®J�TY7�[j °tmnwllmioofonnf an eYF oone, igbtoftbo j I�d� Oampy � (off thisrI i o wee Homweay+s Sigoalmn ' Co< Done 4���X COdGeYsSign L4 & Contractor Arbitration - The Home Improvement Contractor Law provides homeowners with the right to initiate an arbi ration action(as an alternative to court action)if they have a dispute with a contractor.The same right is list automriatically afforded to a contractor,however_ The eomtmctorwould have to resolve my dispute he/she has with a homeowner in cortumlass both parties agree to the optional clause providedbelow. This clause would give the conttcc i the same right to arbitration as is afforded to the homeowner by the Home improvement Contractor Law. The contractor and the homeowner hereby annually.agree in advance that in the event the contractor bas a dispute concerning this contract,the connacto .uta};.sp6rliitettme dispute to a private arbitration firm which has been approved by the Secretary of the Exechti"ve Once of o Affairs and Business Regulation and the caosumer shall be required to submit to such arlliYcatipP. e � sachttsetis General Laws,ch 142A e 6"Ae.n ri Homeowner's signature Conractor's Signature I NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties Homeowner's Rights A homeowne s rights under the Home hnprovement Contractor Law(MGL chapter 142A)an other consumer protection laws(i-e!MGL chapter 93A)may not be waived in any way,even by agreement However,homeovriers maybe 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 Guarhnty Fund provisions of the Home Improvement Contractor Lawv. The contractor is responsible for completing the wo2k as described,in a timely and workmanlike manner- Homeowners may be entitled to other specific legal rights i`1the 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 othermatters on which the homeowner and contractdr lawfully agree maybe added to the terms ofthe contract as long as they do not restrict a homeowners basic comsumdr rights. If you have questions about your consurner/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in dtmGcate and should not be signed until a copy of all exhibi a and referenced documents have been attached. Parties are also advised not to sign the document until all him -sections have been filled in ormarked 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 contactor. 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 bim/herself to be financially insecure. However in instances where a cam motor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the commuted work withdrawal of fimds from said abcountwould require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home haprovement Contractor Law or other consumer rights,or ifyou wish to obtain a free copy of "A Massachusetts Consumer Guide tp Home Improvement" contact: - Consumer Information Hotline Office of Consumer Affair.and Business Regulation 10 Park Plena,Room 5170,Boston,MA 02116 617-973-8787,888 283 3757 or visit the OCABR wvebsite at httD]//wn9y.mas goy/OCabr/ If you want to verify the registration of a contactor 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 111C website at hUD://g9w•w.maaS. v/ocabr/ . Go online to view the status of a Home Improvement Contractor's Registration f h0n'//db state me.us/homeimnrovement/licenseelistasm For assistance with informal mediation of disputes or to register formal complaints against a business,calk I onsuiner plaint Section M - rney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2549 or 413-734-3I14 V¢sion2l-I IP-7lIDt0 The Commonwealth ofMassachusetts Department oflndustrial Accidents Office oflnvestigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -( Please Print Legibly Name(Business/Organization/individual): A t}i. Weduicrie&uui4 LLC ' 61 e a:�K� venue Address: ,slem \4A 1l1970 City/State/Zip: Phone#: f7k- 7q-/�J- P/L/3 Are yo employer?Check the appropriate box: 4. I am a general contractor and I Type of project(required): 1. am a employer with�� ❑ g 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 g, n Demolition working for me in any capacity. employees and have workers' �-II [No workers' comp. insurance comp. insurance.t 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.d 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.❑Roofr pairs insurance required.]t c. 152, §1 4 ,and we have no employees. [No workers' 13. I ther comp. insurance�required j *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy inforlltration. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submi:a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the time of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: u 1 r G Policy#or Self-ins. Lic.#: Sg 27 0 /Z /�// Expiration Datei ZO 1 7 Job Site Address: 3 �t�� J7 City/State/Zip._ Attach a copy of the workers' compensation policy declaration page(showing the policy oni nher 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$250.00 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 I do hereby cetfifrvunder the pains and penalties ofperjury that the information provided above is true and correct. Signature• CA&&e 4 Date y� Phone gjy3 [[Contact cial use only. Do not write in this area,to be completed by city or town official or Town: Permit/License# ng Authority(circle one): ard of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector I.Plumbing Inspector her Person: Phone#: nignciax UJ-Z L/'L4/'LU16 9:Z8 :45 AM PAGE 3/003 Fax Server DATE(M11/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE T424,eRTIFICATE 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 ACONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE ZR PRODUCER, CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the poiicy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rig Me to he Certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: EASTERN INS GROUP LLC PHONE FAX 233 W CENTRAL STREET (A/C,No,Exq: (A/C,No): EAIL NATICK,MA 01760 AD ADDDRERE SS: 22MLW INSURER(S)AFFORDING COVERAGE NAIC9 INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURER B: INSURERC: INSURER D: 61 REAR JEFFERSON AVE INSURER E: SALEM,MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUM BER: THIS IS TO IFYTHAT THE POLICIES OF INSURANM LISTED BELOW HAYS BEEN ISSUED TO THE INSURED NAMED ABOVE FORWE POLICY PERIOD INDICATED. NOTWITNSTANDNG 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 WCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. WISH ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICYNUMBER tNAoMYYYY) (MMDD\WYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. REMISES(Ea occurrence) ED EXP(Anyone person) $ ERSONAL S ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY PROJECT aLOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS Per accident) PROPERTYDAMAGE $ (Per accident) UMBRELLA LIAR r7 OCCUR EACH OCCURRENCE $ EXCESS UAB 11 CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X 'WCSTATUTORY OTHER EMPLOYER'S LIABILITY YIN U"B270121-16 03202016 03/20/2017 LB11TS ANYPROPERITOWPARTNEWEXECUTIVE a WA E.L.EACH ACCIDENT $ 500.000 OFFICE WMEMBER EXCLUDED? (MwdMnyin NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes,desalbe.Mer DESCRIPTION OF OPERATIONSWM E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIDNSNEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CBRTIFICATB ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION CTTYOFSALEM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 93 WASHINGTON ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR A YE SALEM,MA 01970 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1980-2010 ACORD CORPORATION. All rights reserved. '°'� CERTIFICATE OF LIABILITY INSURANCE 3/9/2 D/m9 mD/YYYY) /2016 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((es)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 CONTAC GOnetSI1Ct10n ME: Eastern Insurance Group LLC PHONE Este (800)333-7234 FAX 233 West Central St I-MAIL Natick INSURER(S)AFFORDING COVERAGE NAIC# MA 01760 INSURERAArbella Protection Ins. Co. 41360 INSURED INSURERBNautilus Insurance Cc Atlantic Weatherization e1SURERC: 61 Rear Jefferson Avenue INSURER D: INSURER E: Salem MA 01970 1 INSURER F: COVERAGES CERTIFICATENUMBER34aster 2016 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. -UN SR LTR TYPE OFINSURANCE POLICY NUMBER 61MIUCY EFF MPOMIpCV IXP LIMITS GENERAL LIABILITY _ EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITYA A CLAIMS-MADE OCCUR 500042816 /20/2016 /20/2017 PREMISES $ 55,000 MED EXP(Any one person) S 5,000 X CONTRACTUAL LIABILITY PERSONAL S ADV INJURY $ 1,000,000 X CGOOOI 10/01 FORK GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS AGG $ 2,000,000 POLICY X PROr F- L� S AUTOMOBILE LIABILITY COMBBIINEDesed)SIN LE Lim, 1,000,000 AP ANY AUTO BODILY INJURY(Perpareon) S ALL OWNED X SCHEDULED 020015871 /20/2016 /20/2017 ( ) AUTOS AUTOS BODILY INJURY Peramaem S HIRED AUTOS X AUTOS PR PERTYDAMAGE $ Peracashm X UMBRELLA QAB X PIP-Basic $ OCCUR EACH OCCURRENCE $ 1,666,000 A EXCESS LIAR CINMS-MADE AGGREGATE $ 1,000,000 DEC RETENTION$ 10,00 600058654 /20/2016 /20/2017 $ WORKERS COMPENSATION WC STATLL OTH- AND EMPLOYERS'LIABILITY �./N ANY PROPRIETORIPARTNERIEXECUTIVE TS OFRCERIMEMBER EXCLUDED? ❑ NIA EL EACH ACCIDENT $ (f Yes.d ory in NH) EL DISEASE-EA EMPLOYE S U yes,Describe OF O DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMB $ B POLLDTION PL200378614 0/1/2015 0/1/2016 EAPOLLUTIONCONDITION $1,000,00C GENERAL AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AHaeh ACORD 101,AEUitlonal Remarks Schedule,it more space Is n qubed) 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 EAI.EM, MA 01970 AUTHORIZED REPRESENTATIVE JOhn Aoegel/S dE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. T INS0251?mnrtsl m h. Arr1Rrl nomn and Innn aro roniaforod madre of armor Massachusetts Department of Public Safety i Board of Building Regulations and Standards Construction Supervisor Restricted to: License:CS-087977 Unrestricted-Buildings of any use group which cortiain Construction Supervisor s, less than 35,000 cubic feet(991 cubic metiers)Of . n � enclosed space. ERIC W PALM 3HILTONST SALEM MA 019.70 MM CA, Expiration: Failure to possess acurrenteditionofthefilassachusetis Commissioner 04/23/2018 State Building Code is cause for revocation of this license. OPS Licensing information visit W W W.MASS.GOV/DPS ^11.lifr&7"1,Mit rcr/!/el: Ife'!Wan,;, License or registration valid for individul use only _Office of Consumer Affairs&Bnsium Regulation before the expiration date. if found return to: . i - ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation �1 egrstration: 142089 Types lO park plaza-Suite 5170 xpiration:- .3112j2618, Ltd Lrablfiq Corpor _ Boston,111A 02116 IFA ATLANTIC WEATHERIZATIQN L.L.C. - ERIC PALM 61RJEFFERSONAVE SALEM,MA 01970 Undersecretnry Not valid without signature I I `