Loading...
0040 REAR HIGHLAND AVENUE - BPA-8-1073 CY[Y OF SALEN4 PUBLJC PRO PE."R'I'Y D EP A RUNIE NT 1 20\N.%Ii JIM;I I INS I R, ; I + lA' N.v%.6%, III 1 0 117s 7'1. F—APPLICATION FOR PLAN FXAMINATION AND B PEUILDING RMVr ALL STRUCTURES EXCEPT I AND 2 FAMIL Y DWELL INGS INIPORTANF:Applicanis must complete all items on this page SITE INFORMAJION Location Name_fv-4 k`f457/?rUY Building fl*e /I— �Wep�eAV&D property Address j*vlap Located in: Conservation Area Y)N Historic district Y/N Use Groups (�k one) Residential (3 or more Units) R-27 Type of improvement Residential(hotel/motel RI (check one) Assembly(churches) AI New Building Assembly(nightclubs etc) A2_ Addition Assembly(restaurants, recreation) A3_ Alteration Business B Repair/Replacement Educational E Demolition— Factory(moderate hazard) F11 —Move,/Relocate Factory(low hazard) F2—Foundation Only High Hazard If—Accessory Building V Institutional (residential care) 11 — Other 11 Institutional (incapacitated) r— 1�7a)6eqFx Institutional (restrained) 13 —ro JA l/ Mercantile Yl—Storage(moderate hazard) Sl —Storage(lo" hazard) S2— OWNERSHIP INFORMATION(Please type or Print Clearly) OWNER Name Address !Y D 6'6rtP--=r W 12 7F 42 — 4 "01 Telephone 061 - /C DESCRIP HON OF WORK 10 BE PERFORMED e4F Azlo�Lir;Koazi& -66,Alin LS*1'1.,NIA'l ED CONSTRUCTION COST t r t CONTRACTOR INFORMATION Name �1 Address G 5;7- Telephone Construction Supervisor's Lip # 6 7t,/ 7 Home Improvement Contractor# — i ARCHITECT/ENGINEER INFORMATION Name Address Telephone Mass. Registration # PERMIT FEE CALCULATION Residential est. cost x $7/$1,000 + $5.00 = Commercial est. cost x $11/$1,000 + $5.00= COMMENTS �j ' /� t�, ,7 ^ &Y _ L/G� GF{✓��vs � �C�i�72 'LJ The undersigned does hereby attest that all information stated above is trite to the best of nay knowledge under the penalties of perjury p� Signe Date Z Z 4W7 2210fj �0 �� CITY OF SALEM PUBLIC PROPRERTY , t DEPARTMENT - I I 1 'y:•: `I I'! t '1'8.-11; ;;,I; ♦ 1 N orkers' C'umpcnsalinn Insurance :\1'lidr�it: iiuilders/Contracti)rs%Electricians/Plumbers \ r )Itcant Information Please Print Le t�'bly \.1I Ili alien utc•• ( II .m va t I,m In.ln tJual l: .\Lid rIJS: C'ily State.Zip: Phone 4' tire you an employer'! Check the appropriate bus: Type of project (required): i I.❑ I :un a employer with 4. ❑ 1 :un a general contractor and I 6 ❑ New construction cuytloytes(full and'ur part-111110.' have hired the sub-contractors 2 ❑ Remodeling - '.❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees I hest sub-contractors [take S. ❑ Demulitiuo workers' comp. insurance. y, ❑ Building addition working tilt me in any capacity. workers' ❑ We are a corporation and its [No workers'' comp. insurance officers have exercised their 10.❑ Electrical repairs or additions required.[ 1 I. Plumbing repairs or additions }.❑ 1 am a homeowner cluing all work right of exemption per MGL ❑ g p' C. 152, $1(4),and we have no 1'_.❑ Roof repairs myself. [No workers' sump. , insurance required.[ } employees. [No worker 13 ❑ Other comp. insurance required.( ".1y,:ppicant that checks box NI must also it, ou the section below+hooking their workers'compensation policy information. ' I lomeuwners who submit this afidav Indicating they are doing all work and then hire outside contractors most submit a new affidavit inJicut:ng such. t (lnvrac u+rs that check this box must otec had an additional sheet showing the name of the sub-contractors and their workers'comp.policy inforration. l urn an employer that is providing workers'compensation insuranceJbr troy employees. Below is die policy and job site inforntafion. Insurance Company Name: Policy z or Self-ins. Lic. k: Expiration Date: Job Site Address: City State/Zip: .1mach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). 1:allore to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to S 1,51111.00 amL'or one--year imprisonment, as well as civil penalties in the firm of a STOP WORK ORDER and a fine of tip to)250.00.1 day ❑eattlst [tic %iolator. Be ad\-Ised that a Copy of this sta 1C I71CI77 may be for\\Ceded to the Office of It�r.n'_atiatts of the 1)I:\ tar insurance corcrage %cnficauoo. l do hereby tertill-lm ter the pains and penalties of perjury that the infirrtration prrvided above is true and correct. Date: �ryn,nurc. ore onlr. Do nat write in this area, to he completed by city or town ajjhiaL Issuing \Whorih' (circle one): I. Board of Health 2. Building Deparhncut 1. C'it%, Town C'Icrk J. F:Iccirical Inspcchr S. Plumbing Inspector 6. Other --- -- -- --- - Phone __-- Information and Instructions \I.i—a,l!useus (icneraI I a\%s ch:Ipter 1 �' requl res all einplo%cIs Io pro\de oorkcrs'•compensation for I lie ir emplol ces. 1'111.u.I111 to this ,t.uutc. .III rorplowe is JclhrcJ as .. cl cr% person In the scn cc of.mother under .uI% contract of hue. c\1,I..; or on I,!Icd, oral or \\nrtcn,.. \u cnrplo rer is Jc I ined as ".In utdn:Jua I. p.oti:c r,lo p, .In;oCta I ion. curporauon or other legal cumv. or .uI% r\%o or more ,a the IU11gOolc engaged in a loon cntcrprise. and Including the legal rcprcsentan%es of a deceased clnplo.Ner. or the ;cccr%cr or trustee of.ut mill\IJual, parmernhip. association or inter legal cnuty. employ tng cnlployces. .Ilo%\e%cr the „•.%Tier of :I JI%cllmg house baking fit)( :pore than three ipartnrcnts and I%ho resides therein. or the occupant oflhe J\%eiang house otanother \\ho etuplo.\s persons to do mauncnance, construction or repair %\irk on such J%%elling house •, ,,I the growlJs or building alipurtenant dlcreto shall not hecause ot.uch cngtlo%ntcnt he deemed Iu he an employer..' \161. chapter I S', j lic(o) also .tale., that '"cry state or local licensing agency %hall n ithhold the issuance or renew it of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant Ishii has not produced acceptable e%idence of compliance pith the insurance coverage required." \JduIona sly, %1(;L chapter 152, j]5('(-1 states '"Neither the annnwn%vcal th nor any of its pal It suhdi%is ions shall enter into any contract for the per torilance of pubhe Murk unit acceptable e\tdctice of Co I I,pliance with the insurance re,p urnlents of this chapter ha\'e been presented tothe contracting authority." \pplicants Ill case till out the workers' compensation ❑Ilida%it completely, by checking the boxes that apply to your situation and, if necessary. supply sub-contractors) flannels), addresses) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP dues have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their ,elf-insurance license number on the appropriate line. City or Town Officials please he sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to till out in (he event file Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit,license number which will be used as a reference number. In addition, an applicant that must submit multiple permiulicense applications in;my given year, need only submit one affidavit indicating current policy infixmation (if necessary) and under "Job Site Address"the applicant should write "all locations in (city or to%%n)." A copy of the affidavit that has been ot'ficially stamped or marked by the city or town may be provided to the applicant as pruuf that a valid affidavit is on file for future permits or licenses. A new atfidavit must be filled out each }car. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. it Jog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. the ()lfice of Imestigatiuns would like m thank you in adv:mce to your cooperation and should you ha%e any questions, plca,c do not llcettare to give its a Call. I he Dcp.utment s address, telephone .Ind tax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 www.mass.gov/dia Information and Instructions \Ln•.r.4u.cus li:ner.il I .rn, ch.ymer 1 Iequme, .111 cinployet:s to pray lie <\orkcrs' iampcii,ation ti,r their employees. • l'ml,llan( Ill tins 't.0111C. .11, e 10horee I, deln:ed as ' c\er\ pci,on in the ,cn tee of.venter under .im :onoact of lure. or :ngdlcd, oral or t\nuen... rmldmer I, detincd .is .ill n.11y:dual- 1•.un:er,hip. .I„ocl.uton. corporation or other legal cnuty. or .in) two or more ,d the Iite Ullle cm_eQcd in a joint entetprne. .tad Including the Ir_al rcprr,entati\C, of a decca,cd employer. or the .yyci\cr or uu,ice of it, uuli%ldual, p.utner,hip. .I„ociatiun ,-r other level Cant), cntplo)uIg cmpluyces. flo\yewr the t,"Ater oa .I\velllllg house hay ine not :pore than three .Ip.irtnlcnts and oho re,Ide, therein. or the occupant it the ,lo ei:wp lathe of another %%ho employ, per,on, to do maintenance. eon,tructlon or repair work on ouch dwelling house .r .,n the _t,twd, or building uppurten.uu thereto .hall not hee.ui,e ot.uch employ mein be deemed I,, be an employer'• \I(.1, chapter I)_1. @ 1S(1(,) also .tare, that 'every %late or local licensing agency ,hall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwcallh for any applicant who his not produced acceptable ev idence of compliance with the insurance coverage required." \ddltionilly. .Wit. chapter 152, �25i'1-) ,hues`\either the conunon%walth nor any of us political >ubdiy owns ,hall enter in any contract for the per to rnlanCC Ot public work unit iceeptable C\IdCilee of Compliance with the insurance requirements Of this chapter have been presented to the contracting authority." Applicants I'lease till out the workers' compensation alfidayit completely, by checking the burrs that apply to your situation and, if necessary, supply sub-contractor(s) nanlc(s), address(es) and phone nutnber(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships 1 LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,apolicy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also he sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' Compensation policy, please call the Department at the number listed below. Self-insured companies should enter their ,elf-insurance license number on the appropriate line. City or Town Officials Please he sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the perrnit,license number which will be used as a reference number. In addition,an applicant that must submit multiple permiblicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under"Job Site Address"the applicant should write "all locations in (city or too it).** A copy of the affidavit that has been officially ,tamped or marked by the city or town may be provided to the Applicant as proof that a valid affidavit is on the for future permits or licenses. A new affidavit must be filled out each I. year. W here a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i e. a dog license or permit to burn leases crc.)said person is NOT required to complete this affidavit. I he (Mice of hncstigations could like to thank you in .Idvance tier your cooperation and should you 11a\e any questions, plca,e do not he,ILue In gl%e uS a call. I he 1)epaumcnt', address. Iclephune and fax number: The Commonwealth of Massachusetts Department of industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax p 617-727-7749 Itdy i�cd �-�n.ui www.mass.gov/dia l � r � C CITY OF SALEM9 MASSACHUSETTS BOARD OF APPEAL 120 WASHINGTON STREET. 3RD FLOOR 0 SALEM. MA 01970 TEL. (976) 745-9595 FAX (978) 740.9848 2005 GAS PERMIT FEES RESIDENTIAL: (One & Two Family Dwelling Only) New Construction - $50.00 PLUS $5.00 FOR EACH FIXTURE Remodeling/Repairs $25.00 Ranges $20.00 Dryers $20.00 Gas Log $20.00 Gas Dryer $20.00 Hot Water Tanks $30.00 Boilers $30.00 One 9D: $10.00 with boiler & water connection(Total 40.00) Piping Only $20.00 Furnace $30.00 Tests , $20.00 FINE VIOLATION: $200.00 *COMMERCIAL I INDUSTRIAL I MULTI-FAMILY DWELLINGS* Initial Permit $60.00(initial permit) plus $25.00 per each fixture Piping Only $25.00 Reinspection for unaccepted work $60.00 for each reinspection Fine violation $200.00 *STRUCTURES CONTAINING THREE OR MORE FAMILY DWELLINGS INCLUDING RESIDENTIAL HOMES AND CONDOMINIUMS NOTE: No fee paid in connection with an application for a building, plumbing or gas permit shall be returned if a permit is granted whether or not the work is done. NOTE: Work commenced without obtaining a permit within 48 hours shall be subject to twice the scheduled fees. { * . CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT A N,J lUa{.,IN srsmf T • SA rv, \r,t;iu w III ', :1" I T I: ')78-74n�);4j ♦ 1':Is: 778.74-9841, Construction Debris Disposal Affidavit (rc(Iuired lur all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CN1R section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit It is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c t 11, S 150A. The debris will be transported by: �yO � a 0f Inane of hauler) I he debris will be disposed of in (name of facility) (address of r'acility) --. sienului pe it a ) can ZZ --- date ---- co qq CITY OF SALEM� MASSACHUSETTS +t2\L BOARD OF APPEAL a 120 WASHINGTON STREET, 3RD FLOOR ' 9 Q SALEM, MASSACHUSETTS 01970 TELEPHONE: 978-745-9595 FAX: 978-740-9846 Z609 MAY - 49 KIMBERLEY DRISCOLL � P �� MAYOR FILE May 1, 2008 CITY CLEF;1, SAI EM, t1ASS. Decision City of Salem Zoning Board of Appeals Petition of Clifford Ageloff requesting a variance from the maximum height of accessory structures to allow for a 173' tall temporary wind monitoring tower on the property of the Fairweather Apartments located at 40R Highland Avenue LR3 . A public hearing on the above Petition was opened on April 16, 2008 pursuant to Mass General Law Ch. 40A, §§ 11. The public hearing was closed on April 16, 2008 with the following Zoning Board members present: Robin Stein (Chair), Rebecca Curran, Elizabeth Debski, Richard Dionne, and Bonnie Belair (Alternate). Petitioner seeks a variance pursuant to the following sections of the Salem Zoning Ordinance: Sec. 7-8 Accessory Buildings and Structures. Statements of fact: 1. Cliff Ageloff, Construction Clerk for the Preservation of Affordable Housing (POAH) introduced Manager of Communications, Karen Blomquist. 2. Materials accompanying the petition include NRG TallTower Specifications, a photograph of the Fairweather Apartments with the proposed tower superimposed, an aerial photograph showing the proposed location, and photographs of meteorological towers that have been erected elsewhere in Massachusetts. 3. POAH is seeking a variance to erect a temporary meteorological tower in the wooded area behind the Fairwea her Apartments t for o a period of thirteen months. 4. The purpose of the tower is to collect data to determine if wind power is a possible option for generating electricity for the Salem Fairweather and Salem Heights apartment complexes, affordable housing which POAH owns and s r r s operates. These two properties are financed to remain affordable to elderly and disabled residents for the next several decades. POAH has made a number of efforts to improve the energy efficiency of these properties in order to manage rising energy costs. I 2 5. POAH received grant funding from the Massachusetts Technology Collaborative and MassHousing to explore the possibility of using wind power to produce electricity for the two properties. 6. Karen Blomquist submitted a petition in support of the request which was signed by twenty-five (25) residents of Salem Heights, as well as Twenty-one (21) individual petitions signed by residents of the Fairweather Apartments at 40R Highland Avenue. 7. Letters of support were submitted by Cindy Keegan, Chair of the City's Renewable Energy Taskforce, as well as Mayor Kimberly Driscoll. 8. The Department of Planning and Community Development received calls from Bertha Morin, Deborah Sabri, Joseph LaBella, Olga Sokolowski, and the McGovems requesting that their names be mentioned at the hearing as being in support of the request. 9. The Department of Planning and Community Development received calls from Ms. Marcey and Leanne Duncan requesting that their names be mentioned at the hearing as being in opposition to the request. Leanne Duncan also submitted a letter voicing opposition. 10. There was no opposition to the t request at the public hearing. The Board of Appeal, after careful consideration of the evidence presented at the public hearing, and after thorough review of the plans and petition submitted, makes the following findings: 1. The petitioner's request for a variance does not constitute substantial detriment to the public good as the applicant seeks to evaluate the feasibility of an alternative clean energy resource; specifically wind power for the generation of electricity. The applicant provides affordable housing for many elderly Salem residents and managing rising energy costs is an essential component to affordability. 2. The request to erect a temporary tower does not nullify or substantially derogate from the intent or purpose of the Zoning Ordinance. 3. A literal enforcement of the Zoning Ordinance would create a substantial hardship to the petitioner, which hardship is due to the maximum zoning height of 18 feet for accessory structures. There are no wind turbines in commercial production that could comply with the 18 foot requirement and it is therefore necessary to study wind resources at higher heights. Though many communities in Massachusetts have adopted ordinance provisions to regulate wind energy facilities by special permit, Salem has no ordinance provision to regulate this emerging technology. 3 On the basis of the above findings of fact and all evidence presented at the public hearing including, but not limited to, the Plans, Documents and testimony, the Zoning Board of Appeals concludes: 1. To allow for a 173 8 meteorological tower for a period of thirteen (13) months, the petitioner may vary, the terms of the Salem Zoning Ordinance, specifically the maximum height allowed for accessory structures. In consideration of the above, the Salem Board of Appeals voted, five (5) in favor (Dionne, Stein, Curran, Debski, and Belair) and none (0) opposed, to grant petitioner's request subject to the following terms, conditions, and safeguards: 1. Petitioner shall comply with all City and State statues, ordinances, codes, and regulations. 2. All construction shall be done as per the plans and dimensions submitted to and approved by the Building Commissioner. 3. Petitioner is to obtain approval from any City Board or Commission having jurisdiction including, but not limited to, the Planning Board. 'Robin Stein, Chair Salem Zoning Board of Appeals A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK Appeal from this decision, if any, shall be made pursuant to Section 17 of the Massachusetts General Laws Chapter 40A, and shall be filed within 20 days of filing of this decision in the office of the City Clerk. Pursuant to the Massachusetts General Laws Chapter 40A, Section 11,the Variance or Special Permit granted herein shall not take effect until a copy of the decision bearing the certificate of the City Clerk has been filed with the Essex South Registry of Deeds. Date MAY 2 2 2000 I hereby certify that 20 days have 1191 from the date this instrument was neoelved, and that NO APPEAL has been filed in this office. A True Copy aWJ- ATTEST.Cl LERK,Salem, Mass. FROM :LIGHTHOUSE ELECTRICAL FAX NO. :7812938492 May. 27 2000 04:28PM P1 -%, -'V^' CONTRACTIN -v. FACSIMILE TRANSMISSION SHEET To: Date: - Co: From � Fax: ?'7 j?- 7y0 , / y�, No.of Pa (Including cover sheet) Subject: Message; 34 Fairway Lane-Pembroke, MA 023S9 M Phone: 781-293-7948 n Fax.• 781-293-8492 FROM :LIGHTHOUSE ELECTRICAL FAX NO. :7e1293e492 May. 27 2008 04:28PM P2 CITY OF SALEM \, ,�_ n PUBLIC PROPRERTY b DEPARTMENT .;i Lt�•gt i I_': �\ ,.r,:+,,.:,,� 51li�llci,l: ve. \t\•+N �., , . :1 +". 1%urkers .('ore nsrtion Insurance affidavit- I;uiiders/Conirawtursikilectr[dans/Plufnbers r l A licant In r a on Molise Erint L.e )b1 �t11tlC,llu,rne•.�i1 R�rnv, nnl flL7ll ldtl.d r: .0.— 'T�T Y� ©lt.5 e� O�C�(`' "c�r� ��C3�„�^��/1r�� c'tly titate.Zipi: ��`r`'` � � � Phone .Ire tome an cmployer'l C ack�tlhe app "priate but: 1),o ytx of project(required): I.�l Jill a elllplyyer u it �SJ 4, ❑ fain a general controctur and I Jlnplayccs 1{}uli and' r purr•Uatai.• have hind the sub-runaa"tors El dew construction 0 1 .nu a sole pn+prieto or parener- listed on the attached sheet. ; ❑ Remodeling shlp and havk nu em luyees These sub•eontraoldr&Ila" ❑ Demuliliun Larking fiai,ine in u y capacity, mvurkail'eonlp. insurance, 6ulWing addition I No workers`comp. lnurance 5. We ere o umpwatiori and its required.) officers have exercised Ill [:lea:tncul repairs oY addllions 3.0 I am a hordeowner d ing all work right of cxellipllon pit N1GL 11.0 plumbing repairs or additions myself,(No workers ewrtlp, c- 152, 11(4),And we have nu 12.0 Roof repairs - inaurance required.j employees. [No workers' sump, insurance required.) !3.❑brier 'Ally dpplievnt riot eheu�tm box N 1 ust also fill oqt she section below..howmg their wyrkPe`vumpanaltiwr policy information. ' I lumuuwnnn W hu,."Il this nt7i iawn,mikuune they arc Jumg all work and then hire uuntdq ciAlwhrtl muse submit a new affidavit imdkaling much. -r'iegnl4lnrm rim vh�k 1 in htM m +nurhaJ an utWllrgltal inset showing the name Alfhe gaba:annannfq and drei!wufkgn'cwnp,PAlk:y iRtntmslfen. /ate an carpfoyer tfjm is p idir'k x arkrrr'eatnperrsativa Insuwere,/bi•my rnlplayers: Below is the p Ay and fob site lnjarrnwfw+. 1 htsurunea Conipony Namc:_ R Iz-�:'� Policy n or Sclt'•ills. lie.a. Expiration Date: — 1 C� fob Site,kddnws: Lt L U city,State/tip'. ' \�=Vvl , Q� ,lttach s copy of fhk works 'compere Lion policy,declaration page(showing the policy number sad expiration date). Failure lu wetire aoienige as 7equirud under Section ISA E&WIL c. 152 can lead m the imposition oreriminal penalties of a lino up to SI.001600 hinVor o e-year imprisonment. as well as ci.it Pcnahfes in the (grin or STOP WORK ORDER and a tine of up to S230.01i a day again% the xiolahlr. De]dvimW that a ropy of rhiN iruivincot ntay he toru'arded to the Office of Itn o.mpuonv o0lie DIA for nvurance oncrage Intel::won. /.lu/rrrtrh)'pparrli/1'Irdde►the tarns and rer+.ehiI. I tier ary Ilear the rnfitrinarian praridtvl(aba�e rc true lend earrecit I'Iwne _ 7 ZZ O%Jl.ddl ld%e wdy. •Da oar i rite in this arra.m be evinplerref by miry ur foxy offleial ('itv it INaina \urhurifl'.1,'irefe , e): 1. Iloorfl It Ilealth 2. Hui Jing Department 3.(-it)l'fawn Clerk 4. Electrical tnvpecdpr s. Plumbiog Inspeeeor 6. Other .. .._ .---.--'---- (;ontact Period: _ Phnnl e:�..,.__ FROM :LIGHTHOUSE ELECTRICAL FAX NO. :7812938492 May. 27 2008 04:28PM P3 03/17/2008 15.44 9789757596 SEGREVE HAL PAGE 02/03 A ORD CERTIFICATE OF LIABILITY INSURANCE �,=$�jP_2 OATTp""°°"e P M' oil/17 TNB CERTIPICATE 18 405ULO A8 A NATTER OF INFORMATION 80greve & Ra11 znG=.Ass c Iac ONLY ANO CONFER8 NO RIGHTAI UPON THE CERTIFICATE 181p HOLDER.TN8 COR7EOCATP OONA NOT AMEND,EXTEND OR Aadpvez NA 018 305 north AA at. ALItknm con tAcEAFFORDeoMY THE POLIammM.OW. Phemes978-975-1300 Pazs972-976W7596 MOURER8AFFORDINeCOYERAIIE NAIL# ISIURER A: AmN1L 3ighthan a gloctryCa1 wZRM 9: CoRgIlOVO4 1naur8Lce CO. 347901 �r&A%MBygL�oN MUMR D: P ro a A� OZ759 ualulrcR o: .., CQVBRAOEa THB POUOIBOF w9URIWCC 03rED ME HAVE 9HEN ISOU90 TO THE INSURED NAMIO ABOVE FOR THE!POLICY PERIOD INDICATED.NPTWITHITANDING ANYPJRUIR"NT,TERMOROONDRIONOPANYCONrMCTOROTHIRDOOUMENr WITHRESPECTMWHICHT141p CRRTUIpAT9MAT f88VEDOR INAY PERTAIN,THI NaSURANCE aFPORDID W TNi POLIOA%DSBDRIBEDHlRClu IBSUBJICT TO ALLTHq 7GRMg,PJfd.USIONs ANO CtlNOR1ONs of SUCH POLICIES.AG"MOGAT!LIM99 SHOWN MAY HAVE BEEN REOUCEo CY PAID OLAIA.n. LT ... .BUMNL'I POLICYNUMBER . lBARE 061 c""tlm BACHOCCDRRFN([ S 1000000 A b COML£RCIALORNMR LLIABam 8900037455 01/29/08 01/20/00 P'REMDEB Egaawronle i 100000 CLAIMS MADE'�,M IOCCUR MRO VP(APrP Pe M) 110000 — 8 CC2010 bcp PENONAL A ACV INJURY 81000000 7S CO202s &MRALAGGRE[TnTE -A 20o0p00 ceNL"°ORIOATs`IRR"ppu..'""RL18q PER; PRPDUCTB-ODM7/OPAOD 52000000 PouCY X PICT LOO -......- AUTOMGIILI LIABILRY b ANY AUTO 88NYCAT6 01/29/08 01/28/09 (ftfleaanq wdlmQNED SINGLE LAST 41000000 SRS _ ALL OWNED AUTOS Mg. ftk c pm,, logo pp01LY INJURY ... H b euie°ulJc°nuro9 (pw Pgg) a�p X HRROAUTOB z NOHowaeDAurDs I00;= s ..PROPERTYQ GE •• 8 ._._ (PNAIENllO CARA¢E WBILRT AUTC ONLV•EA ACCIOENi ! ANY Aura .........__....___ ---------4 OTNER TWAN EA ACC S AUTO ONLY: AGG i R 119,9NARIRMLA�UABILRY PAOH OCOURRENCE _ 15000000 I _ A b OCCUR J CLAIMSMADI F4600030656 01/28/08 02/28/09 i AGBREGATE i 3000000 09=71818 x RETENTION i S TYPRRT:Ra CIumvvu j Tq LOYMW A y D R D 90989E 03/15/00 03/15/09 F,OACNACCIDMT 51000000 OFPICETiIMEMBER IXCLU09oT. Iyylol dxmppggunn�dRf E.L.tl19iAiE^RA9MPLOY0 A 1000000 RdW.PRtlVIgICNS oeNvr 6•L.OCABE-POLIGY LIMIT 51000000 DTHIR DESCRIPTION OF OP LESIUCLU9IDN9Amimily INDORSEI1ENT/ L NA CERTIFICATE HOLDER CANCELLATION ZXZ=bb BHOULD ANY OF THE ABOVE IOMRWEV PO6IWE98C OAROCLLOO BEFORE THE EXPIRATION CATITIIa8110P,TN66lIPNa IIBIMRHtWRL BNPEAVORTO MAL _DAYBWRRTEII NOTI°R TO"1 OIRTDRCATB HOLM WAD TO THE LEFT,Bur FAI,CRE TO DO 90 SMALL OPOSE NO OBIJOATION OR LM81U►T OP ANY mm UPON THE 1"wRIR,ITN AOSNTI OR REPR ATA/8& wT1VE ACORD 29(2001108) ®AICORD CORPORATION 1960