Loading...
288 HIGHLAND AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusetts Boar of Building Regulations and Standards CITY OF � SALEM, Mass ichusetts State Building Code,780 CMR Revised Mar2011 11 Building Pei it Ap lication To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling REC VED This Section For Official Use Only AL SERVICE Building Permit Number:) Date Applied; 3 Building Official(Print Naime) - Signature - Date SECTION 1:SITE INFORMATION 1.1 Prope�Add rqss. A / 1.2 Assessors Map&Parcel Numbers r i L l a is this an accept sheet?yes no Map Number Parcel Number _ -- -1-.3-Z6-ning information 1.4 Property Dimensions: Zoning District Proposed Ust Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard I Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.1,c.40,§ 4) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ I Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 OwnertofRecoJIA Q/bCtn ti, u u i S C, Name(Print) City,State,ZIP p ' 029 1 � Ct a Mr I O Q 1 No.and Street Telephone Email Address SECTION 3:D ESCRIPTION OF PROPOSED WORIO(check all that apply) New Construction❑ 1 Elkisting B ilding❑ Owner-Occupied ❑ 1 Repairs(s) ❑ eration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other Specify: Brief Description of Proposed Wo k2- l/LvV✓ L SECTION 4:ESTIMATED CONSTRUCTION COSTS Item I Est mated Costs:Labo 7 and Materials Official Use Only 1.Building $ 3 OVV . 1."Building Permit Fee:$ Indicate how fee is determined: 2.Electrical I $ ❑Standard City/Town Application Fee ' ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC)I $ List: 5.Mechanical (Fire I $Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 300- ❑Paid in Full ❑Outstanding Balance Due: Cf� Cx t�-eSD LO( s� SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Name of CSL Holder ' Eric W.Palm Expiration Date H1lton Street List CSL Type(see below) LA. No.and Street SilleMMA01970 Type Description U Unrestricted uildin s u to 35,000 cu.ft. City/Town,State,ZIP — R Restricted l&2 Fami!X Dwelling M Maso RC Roofm Coverin WS Window and Sidin )� • T��,�il SF Solid Fuel Burning Appliances I t I Insulation Tele hone Email address D Demolition 5.2 Registered Homei Improv,4 ment Contractor(HIC) J�L�O�cl 1 !(v _HIC_Company Nameor-lue e i 4 e HICRegistration Number Expiraion Date �f � xsbtl Avenue No.and.Street I ft MA O1970 (?Y Email address Ct /Town,State,ZIP Tele hone SECTION 6aV1)PRIG '.COMPENSATION.INSURANCE AFFIDAVIT(M.G.L.c.152.§35C(6)) Workers Compensation Insurame affidavit must be completed and submitted with this application. Failure to provide this affidavit will resA in the de nial of the Issuan of the building pennit. Signed Affidavit Atta0ed? Yes ..........EfNo...........❑ SECTION 7 :OWNER AUTHORIZATION TO BE COMPLETED WREN OWN R'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subj Ict proper ,hereby authorize ( r t G PGI,I✓t to act onmyy/ behalf,in all matter relative to work authorized by this building permit application. Print Owner's Name(Elearonic Sigi tature) 5 e Date SECTION b:OWNER'ORAUTHORIZEDAGENTDECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application 7 te and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent' Name(Electronic Signature /J Date NOTES: 1. An Owner who obtains a bui ding permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home I nprovement Contractor(JHQ Program),will not have access to the arbitration program or guaranty fund on,ter M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.eov/oca�nfiirmat on on the Construction Supervisor License can be found at www ma_ ss eov/dns 2. When substantial work is plained,provide the information below: Total floor area(sq.fL) (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 Footag "may be substituted for"Total Project Cost" Massachusetts Home Iinprovement Sample Contract ThisCorm satisfies all basic requirements of the stales 7!r ent Contractor Lmv GLcIangungem protect homeowners.Sreklegal advire, haptm 142A).but does not indude standard'Momchuseas Consumer Guide to AOme Lnpmvemmperson planning home improwementsshoWd first obtain a copyof"A 'to mY workmyourresidmce-You nary abudnafree copy by calling the Office ofCanmma ARairs and Business Regulatibn'smtion Hoilinc m 619A73-8787 or 1$88-283-3757 or an our website-Flomeowaerinformatioa � ContraMorInfofmationName ��, V a•I I f/ pmy Name .. - H _ .. . , .SnMAddr�(do net use Pastce Boz ) no-aam/Salespnson/ ND6�E5/ r' ' fe 'er�on AVepue - Citylfm�n me Zip Code _ ins Address(must toe Six OI 9-7 0 Daytime Phone gypypg Marc _ Fay pun Score Zip Code 7L15 80/ Malting Addnss(11 di@rem(mm above) Business Phone Federal fin lover m or S.S.Numb, . bn,q•uvwsmm ame rreeeaga•,mgt Comrsumq,a ®y r�nye' - rmpwn�r..u,me,.m.r . The Conhaemragroes to do the following wait for Me Homeowner. rDe2ein detail rhea S.",0. pkted,apxifying the type,bmnd.and grade of materials to be used, tat sheets fna�"--) Required Permits-The following building permits required Proposed Start and Ca mplatimi and will be seemed by the Contractor as the homemvnees agent. be adhered to an, circumslmlces�edoie The following schedule will (Owners who license their owa.perinits will be beyond the commt•es cannot aran excluded from the Guaranty Fund provisit, of blGL chapter 142A.) lU l Z Date when cmtractmwill begin mntrmted wnri: - " Data when contracted work will be substantially completed. Total Contract Price aad Payment Schedule The Contractor agrees to perform We wank,fmnisb the material and labor specified above for the total min of. Payments will be made according to the following scIIhedule: ' ices s' ,u 5 V V Q• upon signing contract(not to exceed 1/3 of the total contract price or the cent ofs ecial older it- P ems,whichever is greener) , S q by_/_/ or upon completion of - /=r tic upon completion of i S upon completion of the motram (Law,forbids demanding full paymen until contrmt'a completed to both Party _ P ssmisfacdon)- ThefWioxingma[anal/egaipmmt most be spwal S robe elf oWaed trepan the mNmcled work begin.to Inter' most the cmopkam schedule.(•) g. . paid NOTES:(•)bsciuding all fmarme ebarges(.•)tawrequires that Cory depnir ordoan•paymmt required by den conlmctm broom work begin may- nor'hoedtbe Wciaof(a)dinadNww the=primarch)meacnpl caaaCsay spceial equipsemtmcmam made material .wNchmm 6espeeial wdam in advmceromem rhecompletim smredule E W 6 warranry h' 'tied h M1 ten ❑ ❑ wtunfloft MUAM1 S boa freer -7keeAMwhW to the Mutmol contract"agrees to be solely responsible forcompledon of the work described regardless of the action of my third party/submntmctor utilized by the connector. The matmewrfunheragm,lobendely responsible hrall payments to all subcommeaors for m t '1 ell nor der Lh' enr Contract Acceptance Upon signing,this dommtam comaea a binding contract mda law. Unless otherwise noted within this document.the contract shall act imply that my lien or other semrityiamfest has been placed on the resideact. Reviewflicfoilowing®utionssndnotims carefully before signing this contract. t~ s • Don't be pressured into signing the commas.Take time to read and fully understand iL Ask questions ifsamcthing is unclear. • Make sure the mrsra_m•r has a valhi Hamel rovement ntraco Res snmion.The law requires most home impmvemen co tmrauors and spbcmtemursto Be registered waW the Duectoro7Home Improvement Contra=Registrmion You may inquire about contractor regisirafion by writiog to the Director al IO Park Plain,Room 5170,Boston,MA 02116 ur by calling 6l7-973.8787 or888-283-3757. . • Dom the mntrammhave insurance? Ask the Coomamor fahis immu,commpmy information se than you cm confirm coverage,mask an `sees copy ofa-proof ofiu mace"docmrem.1 - - - • Knowyomrightsandresponr3ilikes.Read the imponmtlnfmmanim out thereverseside of this forth Budget acopy of the Consumer to the Home improvement Contractor Law. t You may cuncd thmageemmt if ithw ben signed ma place otherthan the contractors nonnel lace of business, contractor in Writing M his/heir main office or breach office posted,by gel P G55•Pmvilkd younotifytke 6y ordinary mail oti eglam sent m for an 2ery,m later then right. ht of the third business day following the signing of this agreement. Sce rite attached notice of cancellation fora for m explmatim of this right. DO NOT SIGN THIS CONTRACT IF THERE.ARE ANy BLANK SPACES!!!Twn idmaral copiesoflWmaaatmuuhe osspteud and sib owe ov,r._..so to homm•M1w� I IM by red rowan•.. a Homcoxma's Signamre - , Contractor s Signature Lei 9 Dale Date s Contractor Arbitration The Home improvement Contractor Law provides homeowners with the right to initiate as arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is W automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. - The contractor and the homeowner hereby,mutually agree in advance that in the event the contractor has a dispute concerning this contract the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the.Execotive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitra�pgn.a/lsnpF_ovidgil In Massachusetts General Laws,chapter 142A. Homeowners Signature Cos ngnature 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 homeowners rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection taws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement However,homeowners may be 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 Guaranty Fund provisions of the Home improvement Contractor Law. The contractor is responsible for completing the work as described.in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as lone as they do not restrict a homeowners basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract - The contract must be executed in duplicate and should not be signed until a copy of all exhbits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both patties.Contracted wark 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 him/herself to be financia0y insecure. However,in instances where a contractor 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 contracted work Withdrawal of funds from said account would require the signatures of both parties. Additional Information - - - If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Massachusetts Consumer Guide to Home Improvement".- contact: ' - Consumer Information Hotline Office of Consumer Affairs and Business Regulation - 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787.888-283-3757 or visit the OCABR website at it=in:'wa;;;;.mass.eaw FxaL_ If you want to verify the registration of a contractor 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 HIC website at htmJ;wwtt.w:mass:-uv:o_:,br9 r Go online to view the status of a Home Improvement Contractors Registration: '•itoi?d!-sta�e maul%iremeimprovenr•7?I�.en-•eli--^-ri - - For assistance with infrrmal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-9400 AND/OR Better Business Bureau 508-652-4800_.508-755-2548 or 413-734-3114 vasfoa±.t.t rn_"±ono The Commonwealth ofrllassacltusetis Department oflndustrialAccidents Offceoflnvestigations 1 Congress Street,Suite 100 Boston,NIA 02114-2017 www.mass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Amlicant Information Please Print]Ge ably Name (Business/OrganizatioMndividual): f�h f yL w eri 7n 7t i Address: Cal 2. J e.-e, City/State/Zi A" Qt q�7 p Phone#: g? • 7yy. kjy 3 Are Yo employer?Check the appropriate boa: ]. I am a employer with 4. Q I am a general contractor and I Type of project(required): 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 working for me in any capacity. employees and have workers' S' ElDemolition [No workers' comp.insurance comp. insurance t 9. ❑Building addition 3.❑ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions I am a homeowner doing all work officers have exercised their myself 11.0 plumbing repairs or additions Y [No workers comp, right of exemption per MGL insurance required.]t c. 152,§1(4),and we have no 12•D� Roof repairs employees. [No workers' 13•LYUther tvy rn.f a comp.insurance required.] r °Any applicant that checks box must also 811 out the section below showing their workers'compensation policy infotnratim. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contracWrs must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-mntramn,and state whether or not those entities have employees. If the sub•conuactors have employees,they must provide their workers'comp,policy number. l am an employer that Is providing workers'compensation insurance for my employees Below is tJte pofiey and job site information Insurance Company Name: �tt rr c�r Policy#or Self-ins.Lic.#: �7 p/I II Expiration Date:_3/a /15 Job Site Address: $k l q 4/&J Al-f City/State/Zip- 0/970 �t�r Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). h Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the nposition 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. t ao irereb cent y der the tns a e allies of era that the inf ormation provided above Is tru and correct Si afore: _.�._ ..__ _�_ Phone#: f 7 F 74/L/. 8'14-/3 Official use only. Do not write in this area,to be completed by.city or town offclal City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:- Phone#: a i "' "' s.vJ.s U •�'r r zul YHVG DO/VWD rax Server � I CERTIFICATE OF LBABOUT`� 8 SURANC� 0GA3.T1E2-2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE i 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, subjectto the terms and conditions of the policy,certain pa Mies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in Oep of such andor same rd(6). PRODUCER CONrAGT EASTERN INS GROUP LLC oailEi 233 WEST CENTRAL ST 'HONE Fax AC Na NA71CK,MA 01760 INSURER(5)AFFORDDIG COVERAGE NAIC0 INSURER A:AMERICAN ZUMCH,.SDRANCi M.IPANY DISURED ATLANTIC WEATHERIZATION LLC I INSUAERB: 61 REAR JEFFERSON AVE INSURER C: SALEM,IAA 01970 + INSURER D: INSURER E: INSURER F: _COVERAGES CERTIFICATE NI M99a, 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 0.00 SUB LTR TYPEOFINSURANCE I POLICY EFF POLUNEXP GENERAL LIABILITY INSR W 13 VD POUCYNUMBER (MMD.'YM) DIYY DMRS COSA!ERCULL GENERAL LIARILITY EACH OCCURRENCE S CLAIMShfADE❑ OCCUR OAAAIAG TO RENTED e I S MED EXP rAay aagpaaa,l) S PERSONALAADVIMURY S GEWLAGGFEGATELWIIIFUESPER: GENERALAGGREGATE B POLICY PRO- PRODUCTS-COMP,OP AGG S JECT LOC VIUMOBILELIABILRY S ANY AUTO M&EO SINGLE UMrr S ALL C-MiEO SCHEDULED BODILY IMURY IP®parson) S AUTOS NO N -WOMED a VILY IMURY wer auSw) S HIRED AUTOS AUTOS d!OPE AMAGE S UMBRELLA LUS OCCUR S EXCESS LIAB CIAIMS-!.!ROE EACHOCCURRENCE S LIED( RETENTIONS AGGREGATE E \YORKERS COMPENSATION S AND EMPLOYERS'LIASILRY x WC STATU- OTH- A.�P/PROPRIETORrPAATNERteXECUTN�YM TORYLP.!ITS ER OPFICERAIELOER EXCLUDED? LN NIA ' fiZZUB EL.EACH ACCIDENT $500,000!mamarmym NmI, 03-20-2014 03.20-2015 IIY=4 aespte uuaxj 68270121 E.L.DISEASE-EA EMPLOYEE $500,000 DESCRIPRO F OPERATIONS EL DISEASE-POLICY LIMIT $SOO,000 DESCRIPTION OF OPERATIONS/LOCATIONS,VEHICLES(Anael!ACORD iDl,Ad1lflbnal Raman¢Sdwau)a,I more apace m ragWreO) CESTIFfC4 AL R CANCELLATION CITY OF SALEM SHOULD ANY OF THE ABOVE DESCRIBE=POLICIEESEBE 93 WASHINGTONST CANCELLED BEFORE THE EXPIRATION SALEM,MAO197O NOTICE WILL BE DELIVERED IN ACCORD POLICY PROVISIONS. AUMORMED REPRESM.....E L I ACORD 25(2010/05) The ACORD name and logo are register019marks of ACORDCORPORATION.All rights reserved, Afi 98®®® �-- CERTIFICATE ®F LIABILITY 9�S�RA6��E THIS CERTIFICATE IS ISSUED Iqg q MATTER OF INFORMATION ONLY AND CONFER3 NO RIGHTS UPON THE CERTIFICATE HOLDER.yig CERTIFlCATE DOES NOT gFFlF INSURANCE E NEGATIVELY AMEND, FJcr) ND OR ALTER THE COVERAGE AFFORDED T HOLDE . THIS BELOW. THIS CERTIFTOATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ORDEDINSURER(S),THE AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: conditions the ce of th holder(s rt ADDITIONAL INSURED, the lic es)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and mflan, 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 entloreement(s).PRODUCER Eastern insurance Group IyC NA C14Tonstruction Construction 233 West Central Street PHONE . (508)651-7700 FAx E-MAIL Eft.NA1: AD R S• Natick MA 01760 INSURERS AFFORDING COVERAGE INSURED INSURER A:Arbella PrOteCt,,, Zns. Co. NAIC4 Atlantic Weatherization INSURER BArbella Indemni 1360 61 Rear Jefferson Avenue INSURE RcNautilus Insurance Co Co 0017 IxsURER O: Salem MA' 01970 INSURER E- COVERAGES INSURER F: THIS IS TO cERnFY THAT rHE POLICIES OF INSURANCMEBUSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME"'I ...VE FOR THE POLICY PERIOD INDICATED. NOTW4Tt{STgNDING ANY REQUIREMENT• TERM OR CONDITION OF ANY CONTRACT OR OTHER OOE REVISION N'AIUIMBR RESPECT TO WHICH THIS ER- CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROED 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. NSR TYPEOFINSURANCE GENERAL Slurry POLICY NUMB PfONUCY EFF MOLICY EI LIMITS X COMMERCIAL GENERAL LIABILITY( EACH OCCURRENCE S 1,000,000 dM A CLAIMSDE Ez OCCUR I 500042816 /20/2014 /20/2015 F I 50,000 MI An "'Penton) 5 5,000 PERSONALSADVINJURY S 1,000,000 GENL AGGREGATE LIMIT APPLIES PER:: GENERAL AGGREGATE $ 2,000,000 POLICY X PRO- LOC PRODUCTS-COMPIOP AGO S 2, AUTOMOBILE UAaRRY 000,000 S B ANY AUTO ? C aSSIIN SI IGLEUMIT ALLAlA SS X SCHEDULED! BODILY INJURY per _ S 1 000 000 X AUTOS 4 020015873. /20/2014 ( inn) S HIRED AUTOS X NNIOBNOS'MJED7 /20/2015 BODILY INJURY(Per acdden0 S X era DAMA E S UMBRELLA UAB X OCCUR j A IXCESS LULB PIP-Basic S CLAIMS MADE B OOO EACH OCCURRENCE S 11000,000 WORKERS COMPENSATION 600058654 /20/2014 AGGREGATE S 11000,000 ANo EMPLOYEq�UABI /20/2015 ANY PROPRIETOR/P BAATNEw? CUTIVE YIN S wC STATl1- OTH- OFFICERIM In NN)IXCI.UDED7 NIA(Mantlmory in NX) EL EACH ACCIDENT Ityee,describe antler S DESCRIPTION OF OPERATIONS w,., I E.L OIBEASE-EA EMPLOYE S C POLLUTION LIABILITY EL DISEASE-POUCYUMIT S PL200378602 0/1/2013 0/1/2014 j GENERAL AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VE!IICLES(Anedh ACORD Ill.AddIUI RemaNw Sehed4le,if more POLLUTION CONDITION $1,000,OD0 ' sPaace Lt repulsed) i i I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SALEM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 93 WASHINGTON STREET� SALEMr MA 01970 AUTHOROED REPRESENTATIVE i i -ACORD 25(201 Ronald Cleaves/sm 0/05) INS025 nmmLsl m j Th¢Af:rtRn ©1988.2010 ACORD CORPORATION. All rights reserved. nem¢anA Innn¢ro roni¢f¢rod maHr¢of Arnfon r 9( Massachusetts-Denartment:*f Public Safety f Board of Building Regulations and S.andards Construction Superrisor License:C&O87Wn ERIC W PALM L t Salem MA 01970- Expiration Co mmissioner mmmisssionerr e ' 04/23/2016 - C cIr 1�onu.,nn,oealU�c!!n tarlurin #ME CsamAO'airs&Business Reguiadoa IRAPROVEMENTCONTRACTORistraa0on142089Type=ir.Mon: 311212016: - Ltd Liability Cargo: ATLANTIC WEATHERIZATION LL.C. "ERIC PALM' - 61RJEFFERSON AVE - SALEM,MA01970. Undersecretary