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175 LORING AVE - BUILDING INSPECTION (2) ga The Commonwealth ofMassachusetts RECEIVED Board of Building Regulations and StaudardP45PECTIONqL 3, „ FOR Massachusetts State Building Code,780 CMR ITY Building Permit Application To Construct,Repair,Renovate?61b&Wlia& Rlw USE USE 2011 One-or Two Family Dwelling This Section For Official Use Only. Building Permit Number. Date App �T Building Official(Print Name) Signature � ~ Date SECTION 1:SITE INFORMATION 1.1 Pro Address ^ 12 Assessors Map&Parcel Numbers 1.lals this an /accepted wf.7yes_ no_ Map Number it 1 13 Zoning information: 1.4 Property DiurWbo:i� Zouing District Proposed Use Lot Arm(sg ft) - - - - - Fronts e • — 1.5 Building Setbacks(ft) Front Yard .Side Yards Rear Yard Requited Provided Requited Provided Requited Provided 1.6 Water Supply:(AEG—Le—40,§54) 1.7 Flood Zone information: 1.8 SFwa g a Disposal po System: , Public❑ Private❑ Checkifyes❑ Zone:_ _ - Outside Flood Zone? Mrmicipal❑ On site disposal system ❑. ' SECTION 2: PROPERTY OWNERSEM4 2.1 Own Hof Rewr� `e ^� ^ /ems Name(Print) /f {�-A- City,State,ZIP �7�Lor;H "1 / _ , No.and Sheet Telephone ` Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ Existing Building O Owner-Occupied 17 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number ofUnits Other pe©fy: BriefDescription of Proposed Worle: s _ 2 L6Ce n �-1� — SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Cow' Official Use Only (Labor and Materials 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 3�U ❑Standard City/rown Application Fee , 2.Electrical $ ❑Total Project Costs� (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire Sup ion) $ ,Total All Fees:$ Check No.WII y CheckAmount Cash Amount 6.Total Project Cost- $ 3ce� • ❑Paid in Full ❑Outstanding Balance Due: t SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) c 7 7 7 —7 � OZ 3 1 Ueense Number Expiration Date Name of CSL Holder O Lriic.W. Puim list CSL Type(see bemw) y t Type Description No. ` �'t` tt Stle', Salem MA 01970 U Unrestrided(Buildings to 35,000 co.R -- R Restricted M2Fami1 city/fown,State,ZIP M Masonry RC Rooling Covering WS wmdowand Si ' . SF Solid FMBmningAppliances' I - Insulation Telephone Emailaddresa D Demolition - 5.2 Registered Home Improvement Contractor(MC) Atlantic We icttl.LLC HICIteBshationNunber. Expiration Date McCompanyl rikVNN" No.and Street SalemMA01970 Email address Cityfrown.State,ZIP Tewhana SECTION 6:WORKERS'COMPENSATION.INSURANCE AFFIDAVIT(NLG.L.c.15Z.$25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with ibis application. Failure to provide this affidavit will result in the denial ofthe Issuance o1flic building permit. SiguedAffidavitAttached? Yes.......... No----------❑ SECTION 72:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner ofthe subject property,hereby authorize ( r'r G PG1/Y" to act on my behalt;in all=rea to work authorized by this building permit application. �� 9�2 Prim owners Name(EI ignalme) Date SECTION 7bi OWNERt OR AUTHORIZED AGENT DECLARATION By enter ingmy name below;I hereby attest under the pains and penalties ofperjury that all ofthe information contained in this application's true and accurate to the best ofmy knowledge and understanding Print Owner's orAuthor'rad Agent's Name(Electronic Sigoature) Date NOTES: 1. An Owner who obtains abutlding permitto do his/her own work,or an ownerwho hires an unregistered contractor (not registered in the Home Improvement Contractor(MC)Programs will nor have access to the arbitration program or guaranty fund under M G.L.c.142A.Other important information on the HIC Program can be found at www.mass.eov/ova.Information on the Cons tntction Supervisor License can be found at www.mass.eov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.8.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.fl.) Habitable room count Number of fireplaces Number ofbedrooms Number of bathrooms Number ofhalt7baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. -rotal Project Square Footage"may be substituted for'Total Project Cost"- 1rlassachuntis Home he rovement Sam le Contract manti sa8 basderernm eeoboftbestatesMal . Iwtat6omeall Seek ImP+°�mrntCmaactarlaw d2A),Imrdoes avrmrindesfn 1 C (luidemHa me�adriceiFne nel Anypa (M�-dmPterl Q&ceoFC®snmrrAtfaus and9asmesRegW Y'onme barooea v tO® Igw' nsbo6tam afice l A� H0HtCetveer78{07met1oB Aadmeat617.975�787or 1-688-2833757arm� %the Nmne /}./J 1�1./�` COHtiHdpr l8fOr8t8tr08 / ✓me TT/r�i� CmWaoS'Name Sheet Addraaa((do 6eaPttttoMm,Bmteddrea) Atlantic W''CatheflLatlVlit LLC.' 7 Can sctm Said S e Code '+ern Avenue te emternAp�(o�_ Daytime Pho¢o-: e': "- ".� . . Er�B%ode �7 /'— //Q -�r��8 C't9?owa § tY4Lgn AddmU 5 di Zp Code (h O'meot8em aboae) 8mmea Phooa Frd�ai Emp"W"I'Mall Nambtr twrnm�mtnmmnl ''m°mr®�ma.4-x�m ra�esa The(Dnuibe in Cnatra.dealOi a8tes m da the FoEowmgwmkfortheHotaeowner. /�Z//tom wmtcm me-plel apadfreS me Im°°d•-aBadeafantaiN�(s//m be�usOdlD�a�dd' Dl deee;p - ) ad Will be taib-78efollawla8bm7dmBPmmits Slartmd (Owners'Wr] ' man-b atorasthebomeoxaers be C°mplat°nSrhedya-75efaQ StheGua"Imm Purl wt'll be ��mmleas �heY®dthe o�8smedvkwID esaloded from the Gooranty Food �SO0�10I arise MGLChapter142A.) PzsYillof 9 ��j�� Dam wh®convacoorvn7l yega cenba.edwwk. Total Contra.Priremd -1/—z- —ntewban cvmatlpdwalk Wit,he m6_uantiallYoampleted. The Contractor Psym®t Srhadal¢ ' mptrfmat the w.Z fmaisb the allasai andlahor ll de dieda 'efotthemml srm of Payments wdl be ma erx°vlingto etefoll°µ'ioSmbedolr ISM (% S LUw ttoov signing omtta.(aotmCoueed U3 ofdtetomlmnkact mrtoF 8��) 5 Nice the �ecalotder- '�p�, by/ ! orupm wmpletim of - �;whtcbmais —_ S3oty��, uPm complttim oftberantraat (lawfaddds demmdm m�� °na"*I—Lbsl6esamat s mh7 coa is epmpleted to bath Part3'ssebs6ctim mmeet thec®tpiehw arbedale(u)e�mmaxdtn he "d ) 5 m NQTES:(°)ladudmga8 fileame rgear"llaw _ be d.p °am�m bnsyccalederedm�ad,mee�pamm Um atl Mal b� o®aaamhrfinexmh yam;�, taepledoasd¢yde °'nditmmtmaatam made matvid 9obmnttn.om-The 'o . Pm1y/submntrapnr mn��B�to6pmleiYRtponmble for � ❑ o Y� 1 nrtpc - ae' sands u6�dhY the emdractor ]becon work desmbed 0e°t ` ehed to tpe rtmd 0dsa complertun oFthe re8ardlmro oFdteartiom ofagy all n Contract Acceptmce-Derd°� yamPonnblefm all payments to aU••�--- contract sheE ao[imPlydpat rBning;thisdogmeot becpmesabm _ - for earePalY betoresilPtrog this w�otrbanmtoroffi.samitYm�hazPia®thee Uvtes°8tctwisaotedwrtiw this residence Reviewmefogtmin the an DoaY beprasnped torn si SrmGoasmdnofices a M�es� Baegthe mnhacL Take " . Utu Vaud jo amemreadmd�Youdmsmvdd: banalis lobe 01C�O"'s'emaatCm Ask4ueatimsifmmNhin ngrsttaam re8tsmtad wvh ih Drrectorof 7bebtw sisnnrAear.: bywnmgm WelNtaIbeenectnrat le Home O°®entCanteamer na9mtesmastbomeimptnvemeat eonnatmall e meaeopyofa msmmce7 Asirtha ��Boom 5170,Basjoa,MA 02,1�sualim.Yanmayinquleabow==acmr PYofa guoofofionvavee^dactme�CQp�torforhis-anneeewmpmyiof �8d17A73-MGr858-2833757. e G demtheHome dtaPmmbdides.Read the lm �Oera"Uyo manaonfameaml- Goraskto /mpmvammtteonkac[mlaa. podmt Wantatine m the revenesideofthisfmm mdgetampyofWc Covsmnm You may rmcel this BBteem®[ifithasbxa th�N buctsmess day follom gdtc si8�g ma,blanch�Ca� man mdmmYmml�aattm'snn®ai Rem,of bell... agreement See the mmdtedbyrdeglm 1'mramifythe ®1i7 1rg�gG q�S� 18ACTYF Pam���m anufam t� aotla errbmmtdnightof be Tao ta..x.... EARL exPlmmtimafWisrigh� Oa1O�° :CfS ANYELAWSPACESert b�9�roeveYsSSgnaIDre Dine Dme 9/L Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an t alternative to court action)if they have a dispute with a contractor. The same right is not 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 Ekc8mive Office'o nsmner Affairs and Business Regulation and the consumer shall be required tog submit to such ittdtini>Rlis'�if��%tde Massachusetts General Laws,e11 ter 142A. QAM �!. Homeowners SignatureN Contractors Signature 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 any way,even by agreemenL 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. Homcowners 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 wan-antics provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of othermauers on which the homeowner and contractor lawfully agree maybe added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. Ifyou have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract most be executed in duplicate 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 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 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 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 fiords from said account would require the signatures ofboth parties. Additional Information - If you have general questions orneed additional information about the Home Improvement Contractor Law or other consumer rights,or ifyou 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 htm://% w�v.mus .gov/ocabr/ 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 hyn://%"cv.mass.gov/ocabr/ Go online to view the status of Home Improvement Contractor's Registration: httn:/Idb.state.mama/homeimi)rovement/f icenseelisLasp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Conss omplaint Section *.tr 0 Attorney General 617-727-8400 AND/OR Bever Business Bureau 508-652-4800.508-755 2548 cr 413-734-3114 Version 2.1-1 LIZZM10 7'lze Co"'YlofzWealtlt 0fMassac1ztzsetts lleparrm--zt o.f-Ind astialAceldezzts 7 Cotzg =&Met S,,fte700 BOV041,1dL4 02,74-2O77 WWWU R'orkers,Compensation Insurance Affrdaviafs Builders/Contractors/Electricians/plumbers. lumbers. TO BE FH.EID KITH THE PERI•IITTING AUTHO]IIT�r_ A licant nfotatafion NflfRe(Businesyp tanization/Individual); AI�A3p€tCe�j' Pl�e Pit 'blv Address: [ City/State/Zip: , u4 _ gib Arc you a employee Check the appropriate b. Phone#: g79 _ 7 �1. lam a emPloyernith�`•j employees(full muUm-Part-time).= Tyne of proiect(required): ❑1 am a sole PmptietororPartnership and have no employees working forme in 7. Q New construction any capacity-'Mu vorkers'comA insumnm required] - g_ 3.®1 am a homeowner doing all workysem i£[No warkvs' [ emode comp,insurance required]i 9. ❑Demolition n 4.❑I am a homemmeraml Q be hinag contractors to conduct all work on my Property. r"'M ❑Building ensure that all conuacmrs either have am 1 g addition prolmVon;avith no employees, rkers a°mpertsa°on insurance or are sole 17.QElectrical repairs or additions 5.01 am a general contrnaorand 1 have hired the vexv kc actors listed on the attached sheaf, 12-n PI Th�atb-c°naacwts have empla}•ees and haven ufnbing repairs Or additions vrheirr, P.insmm,c:: li.QRoo.repairs 6.0 We are a corporationndA have its employ have exercised dteirdght afe. Lion I�.a i(?),and tin have no employees.(No norlirs'COMP.- ce+°P Per MGL u I�• they j _ 6 i P insurance required] *Any appearl errs that checks bos:l must aim fill out the section belocvshou7n ' ontrac mers who submit this affidavit inditating they are doing all work and dreinvorkers=cunt �Contracmrs that check this hoc most attached an addidomishee[shot ' Pensation policy infonnadon. then hire onside comrsemrsmustsubmit a netvaffidavit indtcmina such employees. lfthemb.contmmmshave°mployees,theymust the name ofthe sub•contracmrs and statew Provide their wodters'com .Policy n 'hetheror notthose en tides have I ant an enr to P P ry unber. p )ertlratis providing rvorkerr,compens¢tlon insn,•ancefor nzr enrto Tees Beloit,is the oti_t iafararation' P J Insurance Company Name: P cimrdjobsite .—_..�IJv'i Gk Policy#or Self-ins.Lic_= ,j {�j��a Job Site Address: . Expiration Date: — Attach a co �, py.of the workers co mpensatrgnJpmtcy dedarafion a Ci /StatL/Zip: Failure to secure coverage as Page criminal f>the policy number and expiration date). day a.and/or one-year imprisonmen as required as civil pernalties in the faun of a STOP rWOton punishable by a fine up to S1,500 ORDER and a fine of up to .00 coverage the violator.A copy ofthis statement may be frwarded to the Office ofin eestigations of the DIA for insurance a rage verification. 1410 hereby cerifffj,under the a.,;,,.. - _ ` f) l rmation Signature: /..'�,r, ? .kemo pre tidedaboveIstrae and correct . 9�z Phone#: _7 Date Official use n: D&not tvrite in this area,to be completed by�j,or to)Pn offrclal City or'I'otvn: Issuing Authority(circle one): Permit/License 3 i.Board Of Health 2.Btdddittgllepartmen+ Other 6.®then 3,CitylPown Clerk Q Eleddcal Inspector 5.Plumbfnglnspector Contact Person: Phone .AC®/�®® CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDD)YYYY) rAtlantia $ CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE HOLDERSTHIS TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED T TOE POLICIES OW. THIS VERTIFlCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED RESENTATIVE OR PRODUCER,AND THE CERTIFlCATE HOLDER. ORTANT: If the certlflwte holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION iS WAIVED, subject[o erms and conditions of the policy,certain policies may require an endorsement A statement On this certificate does not confer rights to the ficate holder in lieu of such endorsement(s). ER ern Insurance Group LLC RAM c acrConstruction PHONE (g00)333-7234 FAX West Central St MAIL N AD ck MA 01760 INSU S AFFORDING COVERAGE NAIC9 I SURER AArbella ProteCtlOn IAs- Co. 1360 tic Weatherization INSURERBNautiluar Jefferson AvenueINSURERc: INSURER D- MA 01970 INSURERS: COVERAGES CERTIFICATENUMBER:24rLSTBR 2015 INSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE I 1 1111 11 VNAMEOD A11 1 R 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 POLIC[ES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OFINSURANCE MP�UC E EXP PO�CDY GENERAL LIABILITY POLICY NUMBER UMIrs X COMMERCIAL GENERAL UABILDY EACH OCCURRENCE S 1,000,000 A CLAIMS-MADE a]OCCUR 500042816 PRE Ea S 50-000 /20/2015 12012AIa MC-0E%P(AnY ana Parson) S 5,000 PERSONAL B ADV INJURY S 1,000,000 GEM LAGGREGATELOAITAPPLIES PER GENERAL AGGREGATE S 2,000,000 POLICY X PRO' PRODUCTS-COMP/OP AGG S 2,000,000 AUTOMOBILE LIABILITY LOC S BI I LIMIT A ANY auto S 1 000 000 ALL OS SCHEDULED BODILYINJURY(Parpll I $ AUTOS X AUTOS 020015871 /20/2015 /20/2016 X HIRED AUTOS X AIOfTN-OWNED BODILY INJURY(Parac W M) S OS PRO Param TY DAMAGE S X UMBRELLA UAB X OCCUR PIP-Basic S A EXCESS UAB CLAIMS EACH OCCURRENCE+4aoE S 11000,000 DEO RETENTIONS 600058654 AGGREGATE S 1,000,000 WORKERS COMPENSATON /20/2015 /20/2016 AND EMPLOYERS UAMUTY S ANY PROPRIETORIPARTNERIEXECUrNE YIN WC STATU- OTH- OFMCERIMEMBEREXCLUDEM ❑ NIA (MyyanftWy in NH) E.L.EACH ACCIDENT 8 0 Be 'PITONOF OPbebw E.L. DISEASE-EA EMPLOY S 3 POT LOTION LIABILITY ELDISEASE-PODGY LIMIT S 1.200378613 0/1/2014 0/1/2015 GENERALAGGREGA.IE $1,000,000 iSCRIP710NOFOPERATONSILOCATONS,VE0 EAPOI.I.UTION CONDITION $1,000,000 CLES lAttaeh ACORD t07,AtltliUonel Remmks Sphetlule,Bmore space is required) °RTIFICATE 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 aSALEM, MA 01970 AUTHOROW REPRESENTATIVE DRD 25(2010106) John Xoegel/PMA y! � 026 nmmsl m TA>Ar.ARn name anA IAnn arm ronicM�n„1 m Ara:rrF2A ------ CORPORATION. All rights reBBlVed. Il - Act vat - CERTIFICATE OF LIABILITY INSURANCE w -CEIFIRTIFICATE DO E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTI12!-— HOLDER�THIDS Yn THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTIME A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE DU D E CE TI T LOER. - T. Iurns an H the conditions of the p bolder is an ADDIfiONAL INSURED,the POIICy(ies)must be endorsed. if SUBROGATION IS WAIVED,sub terms antl hldrI of the policy,certain Policies may require and endorsement A statement on this ce B ROG does not confer rights to the certificate holder in lieu of such an certain kct to the semen s. PRODUCER CONTACT EASTERN INS GROUP LLC NAME: 233 W CENTRAL STREET PHONE FAX - (Al Na,Eat): (Al No): NATICK,MA 01760 EMAIL 22MLW ADDRESS: INSURED INSURER(s)AFFORDING COVERAGE INSURER A: AMBRICANZURICHINSURANCB COMPANY NAIC# ATLANTIC WEATHERIZATlON LLC INSURER B: INSURER C. 61 REAR JEFFERSON AVE INSURER D: SALEM.MA 01970 INSURER E. COVERAGES INSURER F. CERTIFICATE NUMBER: YT TERM EPOLRAEBO O! RAN OSTE08ELOW HAVEB 159U 70 THE INSURED NAMED 4BOVE FOR RMSIONNUMBER: AFFORDS IREMEAT,TERM OR CONDITWN OF 4NVCONmACT OR OTHER OOWMENi PAID CLAIMS. POLICIESOESCRD7Ep HEADN B3UBJECT TO WON nEsp TO WHICH THIS ciar FICATE MAY BE V���OICATEQ NOTWITNBrANOING PAD CLAUA& ALL TNETERMS,EXCLUSWNS AND CONDrrCNS OF SUCH POLICIES. La1=OR MAY PERT THE INSURANCE MSfl HOWN MAY HAVEBEEN REDUCED BY LTR TYPE OF AVSURANCE - 4D0 SUB POLICY EPF DATE POLCV Ear DATE GENERAL LIABILITY R POLDVNUMBER IMWDDIWYY) t=EXP YY) LBmS COMMERCIAL GENERAL LIABILITY ACH OCCURRENCE CLAIASMADE ❑OCCUR, $ AMAGE TO RENTED REMISES(Ea oaa ence) $ GENL AGGREGATE LIMIT APPLIES PER: ED EXP(All paI S ERSONAL S AOV INJURY $ POLICY O PROJECT❑LOC ENERAL AGGREGATE $ AUTOMOBILE LIABILITY RODUCTS-COMP/DP AGO $ ANYAUTO ALL OWNED AUTOS COMBINED SINGLE $ UAIT(Ea acicdent) SCHEOULEAUTOS BODILY INJURY $ HIRED AUTOS (Pw Penton) NON-OWNED AUTOS J BODILY INJURY $ Pw accident) PROPERTYDAMAGE $ (Pw accident) UMBRELLA LIAR OCCUR EXCESS LU1B CLAIMS-AMDE EACH OCCURRENCE $ DEDUCTIBLE AGGREGATE B RETENTION $ $ A WORKERS COMPENSATION AND $ EMPLOYER'S UABILITY yM ANY PRpPERnpR?pRTNERIEXECUTIVE U"R270121-15 py2pr2015 63/Z6/2616 1L' um ffs ORY OTHER OFFlCEMAEMBEfl EXCWpEo? El WA OMITS (Mandatary in NH) E.L EACH ACCIDENT IIYea.dasolb.unjv $ 500,000 DESCRIPTION OF OPERATDNSbaI. E.L DISEASE-EA EMPLOYEE $ 500.000 DESCRIPTION OF OPERATIONS/LOCAIiONSryENICLES/RESTR E.L.DISEASE-POLICY LIMIT $ 50D,DDD THIS REPLACES ANY PRIOR CERTDTCATE ISSUED ICTITE HOLD ECIAL ITEMS TO7TT8 CF MR HOLDER AFFECm-IG WORKERS COMP COVBRAGIS CERTIFICATE HOLDER CITY OF SALEM CANCELLATION 93 WASHINGCON ST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SALEM,MA 01970 AUIN0R2ED REPR ACORD 25(2010/OS) The ACORD name and b D :. :. • •'`" � ::�.r are registered marks of ACORD 192010 ACORDCORPO .RATION. All rtghfs reserved. 7�]t Massachusetts-Department of Public Safety �f Board of Building Regulations and Standards E'emtnse: Supervisor License: CS-06T977 ERIC W PALM = " 3 ffiLTON ST '' = Salem MA 01970= �t W • Expiration commissioner 04/23/2016 commissioner Office of Consumer Affairs&Business Regulanou 19 _ ME IMPROVEMENT CONTRACTOR Type: Istration: 142089 " Ltd Liability Corpel ` piration: .;3t{2I2016 € ATLANTIC WEATHERIZATION ERIC PALM 61R JEFFERSON AVE �e-�-> - SALEM,MA 01970- - Undersecretary