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42 LARCHMONT RD - BUILDING INSPECTION (2) The Commonwealth of Massachusetts r � R ' 9 Board of Building Regulations and Standards Y F Massachusetts State Building Code, 780 CIVIR JU 9 RevlseJ.tilur 1011 Building Permit Application To Construct, Repair, Renovate Or Demolish`' .5 One-or Two-Family Dwelling . This action KwOfliciul use Only Building Permit Number. Date: _pplied: r• �3 > OUZoning ng Official(Print Name). Signatures Dale SECTION 1:SITEINFORMATIOPI.� ply Address p 1.2 Assessors��Inp Sr Parcel Numbers t r-c�l7 1�e1 is an accepted stree0yes no MapNwnber Uj Information. lA Propertyj.0lmensigsYstrict -' Proposed Use - Lotilrea(sy ft) t- F ntag 1.5 guildingSetbacks(R) Front Yard - Side Yards Rear Yard ' - Requfred - Provided Required Provided. . .Requireri Provided - 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information, 1.8 Sewage Disposal Systeru: Public O Private O. Zone: _ Outside Flood Zone? Municipal O On site disposalsystern 13 C.hecklf esO.. - SECTION2r PROPERTYO�VNERSFIIIvi 2.1 /VI� nerafIteegrd: tlrr `t ;IfGvt )me(Print) / � � city,State,ZIP - rG FDemo t Telephone Email Adhj s SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) ction❑ Existing Building O Owner Occupied O Repairs(s) 13 Iteration(s) O Addition ❑ 13 Accessory Bids.❑ Number of Units Othetion of Proposed Work': u SECTION a:ESTIMATED CONSTRUCTION COSTS- Item Estimated Costs: Official Use Only Labor and Materials y 1. Building S 1. Building Permit Fee.S Indicate how fee is determined: _.Electrical ❑Standard Cilyffown Application Fee, S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 10 Qlher Fees: S 4.Mcchanic,I (tf VAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees:S Check Nod /G(_Check Amount: Cash Amount: 6.Total Project Cost: S 3 0 Paid in Full ❑Outstanding Bel;ruse Due: SECTION 5: CONSTRUCTION SERVICES / rvisor License(CSL) $ 7.y 7 y lZ 3{/g" 5.1 Con!�TF to),S!iPe License Number Expiration Date Name of CSL fluWer• f 'Eric W.Palm I.ist CSL-rype(see below) 3 HIM S"-a'r't Tye ' . Description . No.and Street S21t:m MA 019T0 U Unrestricted Buildin u to 35 000 cu. 11. R Restricted M2 ra"HI Dwellin Cityffown,State,ZIP M Maso RC Roolin Covcrin LVS Window and Sidin 2 SF Solid Fuel Burning Appliances q,-7 --7 fit(1. 90 l : 1 Insulation Tcl� hone Email address D- - Demolition ntmcto_rSHIC /2 /� 4.2 Registered-1[ome Improvement Co , ,( ) ,3/ - ic e9lheTt72IUW1.LLI. HIC Registration Number Expiration Date HIC Company Name oe Email address Nu.and Street - Ci frown State ZIP Tel hone .. SECTION 6 WORKERS'.COM1IPENSATION INSURANCE AFFIDAVTF(M.G.G:cc 152.§25.C(b)y.. Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide ' this affidavit will result in the denial of the isiuence o wilding permit. Signed Affidavit Attached? Yes.......... No...........13 TIOMT 15MCOMBLE FED.WHEN':.," SECTION 7a:OWNER AUTRORI2A_ OWNER'S AGENT ORCONTEtACTORA PIP GIESFORBUILDING.PERf111T ' 1,as Owner of the subject property,hereby authorize tg act on my behalf,in all matters relative to work authorized by this building permit application: Date PrintOwner's Name(Electronic Sigmt _ SECTION 7b:OWt ER'OR AUTHORIZED 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. !',�.�_ e lectronic Signature) Date Print Owner s or r uthorized rI� � � NOTESr I. A n 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 nut have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other tmportan-L informs rf on on Uuie HCC Program can be ou, .vww mass eov.'ocit information on the Construction Supervisor License can be-found at w%vw.ntass.:•ovldns . 2. When substantial work is planned,provide the information below: Total floor area(sq.it.) (including garage,finished basementlattics,decks or porch) Habitable room count Grass living area(sq. IL) Number of fireplaces. Number of bedrooms Number of bathrooms Number of half/baths Type of healing system Number of decks/porches Type of cooling system Enclosed Open J. "Total project Square Footage"may be substituted for"rot:d Project Cost" I Massaehnsetts Home Im rovement Sam le Contract ie `w 7ltis fmm saffberieregtutemeoglan9mvAeftprufcntb oftbestatds)3atm asdm °on tufrom1�in III dvimi�� eat CmtreaarLaw(tdG[,C1144-142A),burdens not mdnde 0T-0CenwmerAMir;m dBu�essvenleer "Mcir�toaay.ypumm'kanyoWmilkg e�®y A-edd inea btamacopyof-,kd RegdacmkCaaseaaerbd'mmzd®Aotliaeet617A7�I 2833757m-- g HOmeOwOer 11170tIDatlDO Name//M/ 0 Contractorlafprenat100 Street Addres(dovot useal°Oat If yBa ndd es Cooux mlaillil I: 'I It City L ct rch 6 Jetfer Av SeenLe zipC°de 9as®Addeess(tmat' me Daydmephage ...,.. „ i 970 . G 4.e• /-EvIlft ph ope 7/ T�/•<w City?wna p J Stale SP Cade Meiling Addn s MdiBeteet jp abve) Bemt®phase Float Etoployo-ID o<S.x Mmtbo- . - �°.wemnaema® � ummaQ,na,br ado The CantraaaragR$te do the fa (Devedbe in decal the yskm °y'3pE work(ar th¢Aom¢awnar. �Pletn{apr sfyigg:etypq htanQmdlPade of _ /� / aaads:Evamd . ) e 110/r//�� �y4,,1cl /1S Lam Reguared Perffim-Thefaa "' /S Y- - "' C,/,t L- -( ®d wiE baSecwM bW1°86m7dmBPamis amregeued !-Pried Sftmml bYNeth it , al aimuesegcet 6e adb mtmless �e-7Lefatlowi'ngs3eabelewl➢ (Owners who secure b yma are centmcmta excluded from the GBusauty Foap dml� be MGLchapter74EA.) Pyavisioasof 7 Dalead,eamnbmmrwd3hegnaaptrac(sdwp� Totel Contreapsimmd L7 �04b®'bated wak Will be std�ntidjy..WdaL The Cmtnu agters to uar PPerin..fatm the v mek,6 FnYmmtSkfi _ un3sb roeVm'cd l eod)abor Payments will be made accmdmg tothefo0 edabovefartherotal sum awwgSCbrriale: ". g-r1L1LY �' uoon sigoiog a®has(aotm sawed 113 aftba,a®trot . Sby crug®camPleim of Price or thec�tofapcual aab.3taag.yy3ry�� a) -br���/ oa / .-r__ _ crupaompleemof— / 0-j7 e01rc��P'77 S V/IeA1 �—upon compleam aftheeonaacG (fanvfabids ".'bU egui3aamtmust WaDmd S d� '�Paym®tmn eonaadis pleealtobompmts'sseisfagion). :meet the We('Ommealo- tp eampimat S ---�� 11'OTC$;(°)1aGudingdlfmame - far am IXteed We °berHe(O°I Liwregtmetbetany drymit or whirhiaasbe al°v+d av)d coro 1Oee�t m°�Ia3rsor �:a aeaW aft�'tbemanact°r hefinewma hegi.may krmesW 'be tmmachdde ew sP�7 IalPmem eraatemmaoc .Und vtv-p o.oa� Snhcoahncm 7l. t. ed lm th f.++a°M Il t7 Pant/subconuactar per hasatdyPomblefr n nhhzed 6ydt contracmr The camplea aftbewmkdesm'6ed be trn a r der eaatrraorfaWapgreesroix:mldy re�paw.yr te�dl�oftbeaaeoyyofmyIII Contract Aecepmntr-Upm signing;this doammt aBPaymeotsmall mbaanhaatyafor contract shill mtimPlYthar eayam orother beeamesabiodin carefully 6etore sig®gads contn�rry �t6asheeaplaoettm theme UNessodtenviseamed w115ro thisdpaomeuz:the eoce Revfewtbefollmviog®t3msandao5cas a DmY bepressmad into sigmngalew _When,Take e Mnite�m—ermlid�L`. ®%ua_^'^rRYmdaalmdiL Ask 9aestionsifsometLmBis:deer ., Re. lbelaw tegtdrabce by wnmg9to��ro DmeorofHnox lmpmv®eot Co 1e9 most home3mlmvsmeM a Doesthe eotdmamrhave onellun¢r8" Plea,Roam 5170.BoI MA 021, QM Ym may iatptheabout mntracror 'sand ° KnowyaSucace�ivriatr df gocum®C®uactorforhishtanmcemmyaoy ifo�tr calling �B� SSmB o*ask to Glide tothelgh's Ln Read the lmpm/aet pravematcomaeariau; 1of0ner the revetses3de oflbisfmm and Yoam gdacopy ofttraCopamna ay inm itusa0isiba ifitlnM ner signed ataplur,'I thirdabasmm!!ay(oaomia the 8`c-u cho&byatdhz ymat7p by�ae®Iplaceafburia eery. yjdedymn ID0NOTSIGN NM4CTW �nh ceofaa o�form6orS, °Otlaterthao gytaftlm TIH%S CO aJ+lmafim ofW3sri rne- nano��ue1�tm:amm o,,,��MEAREANYBjAjf KSPACESrrr h. Hammwaer'953goaaae 7 Ih t oaaaaaYs S gna a s Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not auromatically afforded to a contractor,however- The contractor would have to resolve my 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 contact,the co m t' le dispute to a private arbitration firm which has been approved by the Secretary op E o er Aff firs and Business Regulation and the consumer shall be required to submit to sucfi itratio JAI&Machusetts General Laws,chapter 142A: /� }33 0� Homeowner's Signature a/ Con s tare a 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 homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in my 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 contactor,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 contactor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about yourconsumer/homeowner rights,contact the Consumer Information Hotline(listed below). Eaecution of Contract The contract must be executed in dualicate 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 blank sections have been filled in or marked 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 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/berself to be financially insecure. However,in instances where a contractor deems him/berself to be financially insecure,the contracmrmay 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 fiords 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 Contactor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer htforroafion 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 htto://~vmass.gov/ombr/ If you want to verify the registration of a contractor ar 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 ContrictorPtegisttaton Office of Consumer Affairs and Business Regulation - 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 m visit the WC website at htto:/hvwty mass aov/ocabr/ Go online to view the status of a Home Improvement Contractors Registration: http://db.state.ma.us/homeimi)ro%,cmenttliunseelist.asil For assistance with informal mediation of disputes or to register formal complaints against a business,call: *?�q_. Cons omplaint Section d ' O Attorney General 617-727-8400 AND/OR Better Business Bureau 508-6524800.508-755-2548 or 413-734-3114 Vmiav 2.1-112ffiala The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aaulicant Information Please Print Legibly Name (Business/Organization/Individual): Atlantic Wca[hcti6atwll, LLC Jeftersov Avenue Address: Salem M n 91970 City/State/Zip: Phone #: of 7 9'' 711W- Fl q 3 Are yo n employer? Check the appropriate box:' Type of project(required): 1. am a employer with Z__J'� 4. ❑ m a general contractor and I I a employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 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' [No workers' comp. insurance comp. insurance. t 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself o workers' com right of exemption per MGL Y [N P• 12.❑ Roof pairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 11 ther �/Si.c/a comp. insurance required.] "Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and slate whether or not those entities have employees. If the sub-contractors have employees,they most provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. JJ Insurance Company Name: Policy #or Self-ins. Lic.#: ::M // 27 O /2 I Expiration Date:( ,3/ZO/I -7 Job Site Address: yg (ar a �(�t �,d • City/State/Zip: 9 �-eha /;14 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$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 do hereby cerfift under the pains and penalties ofperjury that the information provided above is true and orrect. Signature: Date 7 Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: - - --- . _.. .••• �.-,.r.: o. Uvo rax server i . : CE� ICATIe OF LIABILITY IIVSUeaMIVCE DATE(MM/DD/YYYY) CERTIFICATE DO E!S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS THIS CERTIFICATE DOES NOT INSURANCE 00 LYI OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT OR ROOUCER CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE Y E C ICATE O E . IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the PI must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the Policy,certain POHCIes may require and endorsement A statement on this certificate does not confer rights to the Certrficate holder in lieu of such endorsamen a, PRODUCER CONTACT EASTERN INS GROUP LLC NAME: 233 W CENTRAL STREET PHONE FAX (NC,No,Ext): (A/C,No): NATICK,MA 01760 j E-MAIL 22MLW ` ADDRESS: INSURERS)AFFORDING COVERAGE NA/Ca INSURED INSURERA: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERMATION LLC INSURER B: INSURER C: 61 REAR JEFFERSON AVE INSURERD: SALEM,MA 01970 INSURER E: COVERAGES CERTIFICATE NUMBER: INSURER F. ON NUMBER: CERTIF/TH4 T E MMONF SUIT USTEO GELD NAVES EN ISSUEDT THE PISURm NAMED ABOVE FORTHEPOLICVVVSIEp10DINDX:ATED. NOTYAMSTANpe,IC. ANYflEOUIREMEE TERM OR CONDmON OFANYCOt}iRACr OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BEISSUED OR MAY PITED. N THEa1SURAHCE PAID Em By THE POLICES DESCRIBED HEREelB5119JECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLIGTEs, ISSUED OR MAY PERTAAVE IN.T EDUCED BY PAID CLAIMS- � ' INSR 40D SUB LTR TYPE OF RISORANCE POLICY Er DATE POI GENERAL LIABILITY EXP OATS IL R POLICYNUMBER (YLAWIVWY) tNMN, WVY) LIMITS COMMERCIAL GENERAL LIABILITY CH OCCURRENCE $ CLAIMS MADEED OCCUR. DAMAGE TO RENTED $ PREMISES(EB ptcueance) ED EXP(Any one Peron) $ GEN'L AGGREGATE LIMIT APPLIES PER- PERSONAL&ADV INJURY S POLICY ®PROJECT®LOC ENERAL AGGREGATE g PRODUCTS-COMP/OPAGG $ AUTOMOBILE LIABILITY i ANY AUTO COMBINEDSINGLE $ ALL OWNED AUTOS I LIMIT(Ea amident) SCHEDULEAUTOS I BODILY INJURY $ HIRED AUTOS i (Per Person) NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTYDAMAGE g (Per awidant) UMBRELLA LIAR OCCUR EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE $ DEDUCTIBLE j AGGREGATE $ RETENTION S i S A WORKER'SCOMPENSATION AND I $ EMPLOYER'S LIABILITY YIN I UB-58270121-16 03202016 x WCSTATUTORY OTHER ANY PROPERITOFVPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N/A I 03/21V2017 LIMITS Q (Manoatwyin NB) ! E.L EACH ACCIDENT $ Sao. 0 If yes.desoft a under E.L.DISEASE-FA EMPLOYEE E 500,000 DESCRIPTION OF OPERATIONS tol" j DESCRIPTION OF OPERATIONS/LOCAMONSNEHICLES/REBTRIC710NS/gpECIAL ITEMS E.L DISEASE-POLICY LIMB $ 500.000 THIS REPLACES ANY PRIOR CERTIFICATE ISSUED Tp TTTE CyR.pINCAM HOLDER AFFECTING WORKERS COMPCOVERAGg 1 CERTIFICATE HOLDER CANCELLATION 93 WASHINGTO CITY OF i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED NGTON ST $ BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED I IN ACCORDANCE WITH THE POLICY PROVISIONS. SALEM,MA 01970 I AUTHORIZED REPR ...ACORD 26(2010/OS) The ACORD name and to o are 2 0 8 registered marks of ACORD 79BB=2010 ACORD CORPORATION. All rights resewad_ I A � CER1lFICATF OF LIABILITY INSURANCE DATE,, D°""Y"' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. IS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 HOW of such endorsement(s). PRODUCER CONTACT ME: Construction Eastern Insurance Group I.LG PRONE (800)333333-7234 FAx 233 West Central St E-MAIL AIC Ho- I ADD Nat' ' INSURER S AFFORDING COVERAGE 1 CIC Nacf MA 017160 msuRERAArbella Protection Ins. Co_ 41360 INSURED Atlantic Welatherization ' wsuRERBNautilus Insurance Co 61 Rear Jefferson Avenue INSURER C: INSURER D- Salem INSURER E: IR1 01970 INSURER F: COVERAGES CERTIFICATE NUMBER34astar 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 PO�. NSR ICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPEOFINSURANCE - POUCYNUMBER MMOUC EFF POOLID UNITS POLICY GENERAL LIABILITY I X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S 1,000,000 DAMA NTED A CLAIMS-MADE ®OCCUR E ISE a nee S 50,00 1 500042616 /20/2016 /20/2017 MED EXP( aneperson) S 5,000 X CONTRACTUAL LTPBILITY " X CG0001 10/01 PORN " PERSONALS ADV INJURY S 1,000,00 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X PRO. LOC i PRODUCTS-COMPIOP AGG S 2,000,000 AUTOMOBILE LIABILITY S A ANY AUTO i COMB INcu SINGLE LIMIT S 1 000 000 ALL OWNED X SCHEDULED 020015871 BODILY INJURY(Perpenzed S ED /20/2016 /20/2017 BODILYINJURY(Peraccu.G S X AUTOS AUTOS HIRED AUTOS X NON-OWNED PeTOS Oem�MDAMAG S X UMBRELLA LWB X OCCUR +� PIP-Basle S A EXCESS UAS CLAIMS-MADE EACH OCCURRENCE S 1,000,000 AGGREGATE S 1,000,000 OED RETENTI NS 10,00 4 600056654 /20/2015 /20/2017 AND EMPS CGMPELI A LIABILITY S AND EMPLOYERS'LIABILITY VVC STATU- OTH- ANYPROPRIETOR/PARTNERIpM-AR YIN OFandat.MEMBER in NH)EXCWOEDt ❑ NIA EL EACH ACCIDENT S (Mantlatory In NH) If yyesdeacdheunder EL DISEASE-EA EMPLOYES DESG42IPNON OF OPERATIONS btlow B POLLDTION E.L DISEASE-POLICY LIMIT S L200378614 0/1/2015 0/1/2016 EA POLLUTION CONDITION $1,000,000 GENERAL AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLE S( uch ACORD'101.AddlOonal Rema,Ts Schedule,if more space is required) CERTIFICATE HOLDER ( CANCELLATION f SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SATCM i ACCORDANCE WITH THE POLICY PROVISIONS. 93 WASHINGTON STREET SALEM, MA 01970 AUTHORIZED REPRESENTATME j John Hoegel/S0ffi ACORD 25(2010106) INs025nn,nna,m sn �arnnn..�..,e�„a lnnn�.e wniv-Mm.f ©1988 2Ar� ORD CORPORATION. All rights reserved. I Massachusetts Department of Public Safety Construction Supervisor ' Board of Building Regulations and Standards Restricted to: License: CS-087977 less than 35,000 cubic feet 9of 91scubbic m meters)of kfich �rn Construction Supervisor enclosed space. ERIC IN PALM 3 HILTON ST SALEM MA 019711 = - Failure to possess a Current e"03%ofthu"assar]mr etffi r—IZCK- CA— Expiration: State Buiidmg Code is cause for revadhonoBlSnsGcense- Commissioner 04/23/2018 pps Licensing information visit Vn i:MASSGOVIDPS T. License or registration valid for individai we 0619 '- Office of Consumer Affairs&Business Repletion _ - before theexpirathmdate. Iffoundreturnto:- - - - - i r—M ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regninhon CflOP142089 Type. eegstration: arkFiaza-Suite5170 p ration: 3r1212018- Ltd Liability Corpor Boston,TVIA 02116 ATLANTIC WEATHERIZR7101V1LI-C. f�/) ERIC PALM f '�. 61RJEFFERSONAVE SALEM,NIA01970 - - Not valid evitho�sigoatme [lnderseeretary i .. I i