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175 LORING AVE - BUILDING INSPECTION (3) The Commonwealth of Massachusetts R E C F I Vd D 2�OF Tz Board of Building Regulations and Standards ASP ECf ION Al_ E 2`9ALEM Massachusetts State Building Code,780 CMR Revised Mar2011 Building Permit Application To Construct,Repair, Renovate dO&0414 P 2: 5 1 One-or Two-Family Dwelling -This Section For Official Use Only Building Permit Number: Da Applied: Building Official(Print Name) - Signature Date SECTION 1:SITE INFORMATION 1.1 Proper[ lddress: 1.2 Assessors Map&Parcel Numbers l 7 S l�rri-4 Ll a Is this an accepted s t?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: Name(Print) A City,State,ZIP No.and Street J Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units_ Other ❑ specify: l( Ld6ysts' Brief Description of Proposed Worm': p (.ulmw SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials - 1.Building $ UGU0 1. Building Permit Fee:$ - Indicate how fee is determined: . - 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplies x - 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: - 5.Mechanical (Fire Suppression) $ Total All Fees:$ Check No.Ltlld Check Amount: Cash Amount: 6.Total Project Cost: 3/016 CV - 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) "177 y/Z &, License Number Expiration Date Name of CSL Holder �� `� Eric W.Palm - List CSL Type(see below)_� No.and Sheet 3 Hilton Street Type _Description Salem MA 01970 U Unrestricted(Buildings up to 35,000 cu.ft.) CitylCown,State,ZIP R Restricted 1&2 Family Dwelling M Masonr RC Roofing Covering WS Window and Siding (T O 7 11 ,O /1- SF Solid Fuel Burning Appliances "("! I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Atlantic Weather''iion,LLC l Re 2 U q E HIC Comp HIC Registration Number Expiration Date D4yAla &RO Name No.and StVOreelr�t1t�CC JJern Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance a building permit Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR�APPLIES FOR //�7BUILDING PERMIT I,as Owner of the subject property,hereby authorize_ (/Vi G 1 4/k;--w to act on my behalf,in all matters relative to work authorized by this building permit application. Pn'nt(�iwner's Name"(50ttronic Signatwa) Date SECTION 7b:.OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of pepury that all of the information contai gdmwthis aacau a and accurate to the best of my knowledge and understanding. g123 Print Owner's or Authorized Agent sName(Electronic Signature) _ Date NOTES: I. An 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 not 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 4'! Information on the Construction Supervisor License can be found at 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.IQ 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 Footage"may be substituted for"Total Project Cost" anr��OvemEst Saga le ®tflda� - (���ro��b� +a/mmmmisnfWesmtesanmeTi�+ocemem Ma��oSUGsCoosmerCndde�roaome7lm pv� �y(� g�1py pP�mn mgh� 'I42A).hotdoesn¢4a:dude =rd O&ceoF _ C��No®eHA'L¢t'IH$'ll R nlaHm'sCona®er7afonnr�oaBo"ok IC It61 u ce.mOmS'o6tt®a¢eewpya bYceDmg We f'ma�olt fe...1. 57 m 1-888-283-3757 arm anrwabvle T`°"\� J CQtIe<6+Wt�IuFnamatian Semcc Addressdo eotmeaPaa 01fztt8le mc Atlantic pry ' eatllCF1Ldlyi)li LLi, Ciry? - ConhratdSalespy �- - - S Zp Code . Ott AVenuf. SLf� �i(�s-b �j(� HnmeaAddn�(mat' Daytime Pfiode'^' ,:.:y: /m/�E fama • ^I Se Tap Code Mailing Advress(QdiHeRat/rutpaymx) 77 9-- M `7('y— B�%oae i Peaeal EmplgerIDarS.S Nmtba � anmaCv®en4H 3vte The Curu nor- sa�nu-�aoer�` 1y�0 9 3 /(Desaibe in �graes to do Wef°Aowingwatk iorthea—_ Z deLv7tlhe wad;tocomNead.sPmfi'mg{th�e41--lo 4ord`al f/ee+�+ak tuba / �+T74,// /7 "n� d ermits-7htfallowin7Shewal emued bythe tied canhur ommwnersat 6e,ysedstomlndcousige:na Sdted¢Ie-ILefnllowmgscbedule cn7l (J-✓ 7Fto 52eta8a[bait 'mi4s evsll ha CIIcab�'¢ndtheco¢¢actote excludedrom the Guaran conhol tare chapter p�bisioas or LO . . ZA.) Date whm aaoaaao;wglbeginconaaaedwork.- aPantaodte wyeo contmctrd watk tn7l6esdafan6agYn®plated. eon¢aaar P mmta ` ag—rope"t dxwmlttomish M"nou dU aodlaborspxi6edabuvcforthe ..d s®of Payments witi beral according to dtefnll owingsUredolr. S tenon si goiogconaaa(notroexaaed l/3 afWem�tcmt2aprice or the ettstof S 5 by/ / - apraal mdtrlt®;wlile6everis@ mapon completion of cul 0 by/ 1 a Pon compyetien of ¢Poo camPledonofthewnhact (Lawfoddds endued beaedm �e9Upmmtmmt heypriU S d®andmgfollpaCluclutuad mrtrma7 teotmaisevmplUcd to 6oihpara3''ssags&raion) m marl tbecompLyf nyadye.b"'Am mortz rob. far NG3 G5:(')Iedua7ng ab Sas¢e a S m d �aSns(=ey yTmrgtbes of thoz�y.depmr a:dou which b;o`lcc f(2)na_^Ihini rhemed aan�tpriwm x-Myceu rgdmd by the wmrmul heftre wodt b4ou `Pa'aal oNezed ie Advent¢(omeedtornmpl©®sah).tWe tent ofmysp�aWUPmmt eratsmmmademesy ctl Emrss 6✓�rrm _Lan :cv n 6' Submnttxctom- "den teemntm P Qx Yn atl PaztY/subconh-,.amThe etnpaaorogaesto basa7UYnspoagblefo:compledon ofthewmk �'�ermom mmstbe tenth I. _.puma m tedals atd labortmde d��e��aoT' Thetmntratterfmtbtra �ceb�reSam7�afdreaeti Contract Acc t 3ea to bemldY*espcum3lefmag °DS efmYthird Prance-Upoo signing,this doom[becomes a bmeim PaYtnmts to all mhcautractors for mnhact shag¢otimply ram aqy gen oraahtrsemaj Unlessadr 4contraaondalaw: envjxnotedwithin careflIDY befom signing thiscmtctt tYinabtasth3s Placed on themadmza; Reviewthe drisdoeommt,the fagag®lions mdnoticas c Donthep.,sF,�d�sigrrmgthe ran o bcan6aGomtobe�r�has cAdatote fake amem�a�21orRy!mdaatmdit As)cgoespaasifstmatbiogisunclezr. ra@shsedzractor�m lH Conaacmri�e6w tmPmvameoitmaaaomand xgsaahon by writing to theD' Daeeterofff m hP, era Te4nvasmostunedd < egissuch �wopyofalprohavrm�a9d�®rrhnGarRoom5l77Dll Boa MgZ Y by�g6craY73-E787 8wnir,.clur amPYcFa'pmotof- the Yee8-293-3757 'riIditsmdtesponsibilitia Itradgtelm sro gmtYo¢raacan6rm coveryrq oras"to Guide to theaome Pottant bd nctriou to dtc rave Shic of �°"®entCmmaaraLaw thisiorm cold get a COPY ofthe Cansmttr Ytu m7amce1 Ntisagzea¢mtifitlus ham sipyed a[a cmtraalorin writingmhi strmUn o�ceorbra¢dto&ceh mdmmymmv7 a`'d0t'snozm81 plawofaosin . third business d.� theme fallowia gmngaftidsamae p°S� bYtelegzam-rater by C'iVYPmvidedymaoSfytbe LD�RTO SIGN Ifffs ®PT3E �� edncficeofmaellaawforaTDrao � n¢tlmutL®mdag5tofthe r., mecctmc�cua�.e=atb 1i .R / £� mTlanmion ofddsright Qatw,ti,�t ekamyys*�atdmmtb a�.liP)I£SF��Sper mmae Htmms:xe's (Book= IzL Conhaarl Saguatme 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 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,We watrariojiftlstbyr14`the dispute to a private arbitration firm which has been approved by o the Secretary of the Ezechtr'&01fice of o a Affairs and Business Regulation and the consumer shall be required to submit to such arbitfatip#1;atipTo'fu� sachursetts General Laws,cha er 142A. �q {rfa Ho eowne2s Signa�pimre" Contractor's Slgnatue 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 agreement However,homeowners may be excluded from certain rights ifthe contractor they choose is not properly registered as proscribed 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 maybe 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 othermatters on which the homeowner and contractor lawfully agree maybe added to the tears of the contract as long as they do not restrict a homeowner's 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 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 paymentschedi le in cases where the homeowner deanis him/henself to be financially insecure. However,in instances whem a contractor deems him/herself to be financially insecure,the contractor may require that the balance of fiords not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work Withdrawal of fords from said account would require the signatures of both 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 fire 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 htto:/Ay%y%y.mass.2oyJocabr/ If you want to verify the registration of a contractor or ifyou 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 httm://% inv.mass.eov/ocabr/ . Go online to view the status of a Home Improvement Contractor's Registration http://dbstate.ma.us/homeimmovement/lioenseelistaso For assistance with informal mediation of disputes or to register formal complaints against a business,call: onsuiner plaint Section ' '-�)ffie mey General 617-727-8400 AND/OR Better Business Bureau 508-652 4800.508-755-2548 or 413-734-31 I4 version 21-t1122r?010 !.UY Ni E Uualdied 1 PURC 1IId64tr5 ann�gnPnry m ItgAr. VINYL DOUBLE HUNG IMPERIAL LS rdrpn�a tin Double GlaPing.Argon FilLlow E.Grids — SLL-c-24M152-DOOD2 ENERGY PERFORMANCE RATXNGS U-Factor (U.S./I-P) Solar Heat Gain Coe1-itcient © n 25 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance Condensation Resistance 0.45 I lasoactu a Sgp'btes d at these raitsngs cenrorm to aPPlkable HFRC P,atedwec fo. Aetr.myvs;•rle pnximt Patomance. rlFRC rzD+m�s are date:mb'etl F..r a n.�s?r�f I e•......:: no -„ nt th ant a soy of PY Pcd df IanY tan IVk mcnmme!-t anu ee !:u aces fu I tlierant the suitato or anY ryctoct.-r arp•:Cm2 ir__.Cen;vlt manura:twer s 'fterdnne f_v other Protluct Peiwmance lnrarmatmn. vn:nnNrt.P 1318555.060 The Commottwealti, ofMassac/zztsetts Department ofdndastrialAcc"[deeps d Congress Street,5arte 100 Ros"t, 'tLd 021d4--20-17 Workers'Compensation Insurance Affildav TO BE :Bui tiers/Contractors/Electricians/Plumbers. Alicantlnformation FILED IvrfH THE PERIYIITfItNG AUTHORITY. Name(Business/0rc.mization/Indiigdual): rAJI&9fic j Please Print L "bIv Address: ( K Ielx�,an rte<M 49 Be City/State/Zip: Are you a employer?Check the a p Phone#: ? _ '�[l/� Ppro race ba:: Y (] LjlI. 1 am a employer%vith�•,S_employem(full and/or part-time).- Wintomatio. f project(required): �.01 am a sole proprietor or partnership and have no employees working forme in ew construction any capacity.[No workers'comp.insurance required.] emodeling 3.®i am a homeonmer doing all wod:myself(No workers'comp.insurance required.]t 4.❑I am a homcm ner and will be hiring contractors to conduct all work n m emolfiOn ensure that all contractors either have workers'compensation insurance or aresolem l Moll uilding addition Proprietors with no employees. Electrical repairs or additions�.®I am a general conhactor and I have hired the sub-comrectors listed on the 3nached sheet lumbing These sub-contractors have employees and have workers'comp, ed ontht': a rePatrs or additions 6.0 We arc a corporation and its officers have eve efsed their right ofea a ance. per MGL c O repairs 15�,§I(4),and we have no employeel her' fAo workers comp.insurance required.] 6 it._'Any applicant that checks bo �l hesection below showing their workers'compensation ion_ t Homemvners who submit this affidavit indicating they are doing all hark and then hue outside contractors must submit a new employes duet check this ctobov must attached an additional sheet shmving the name of the sub-contractors and stare uhetheror not those entities have employees. lFthe sub-contractors have employees,the rn p affidavit indicating such Y tut provide their workers'comp.polity number. 1 1711,all emptoyer that is providing utfornzatiox. workers'corrrpensation insr�:ancefor n;p Insurance Company Name: errrp/-pees. Below is ttte policy andjob site or _ �UV't _k, Policy#or Self-ins.Lic.#: Zo f d , s ^ Expiration Date: / 7 Job Site Address: . LD'j�l,� e Y/gl'�Vt� Attach a copy of the workers compeasahon Ircy declaration page(showinbg the pt I cy nu��xpirahon date). Failure to secure coverage as required under IvIOL c. 152 c 25Aand/or one-year imprisonment,as well as civil penalties in the form of a STOP Violations a Criminal Punishable ORDER landya fine of up to$250.00 a day against the violator.A copy ofthis statement may be forwarded to the Office oflnvestigations of the DIA for insurance coverage verification. Ida hereby cer7r r J f undertirem:g.-..,,a.,e,,,,n;oe„�„P;,,.arba [the inforrna6orr prordded above is true and correct Signature: _ Phone#: _ 7 --- Date: Official rise only. Do not write in tltis area,to be completed by city:or tolvrr offcinl. City or Town- - issuingAuth®rlty(circle one): Permit/License# I.Board of Iieaith 2 Building Department 3.CitylFowa Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - g P clot Contact Person: Phone#: CER71FICATE OF ..• - DATE(Id641DD/YYV}9 T YiFICATE IS ISSUED AS A MATTER OF INFORII4ATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFlCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR AL'a ER THE COVERAGE AFFORDED BY7HE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE k CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRES BELOW UE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the olf terms and conditions of the policy,certain policies may require and endorsement q statement on this oertiffcate does not confee rights to the P cy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the certificate hostler in lieu of such endorsemen s. PRODUCER CONTACT EASTERN INS GROUP LLC NAME' 233 W CENTRAL STREET PHONE FAX (A/C,No,Exq: (A/C,Na): NATICK,MA 01760 ENWL 22MLW ADDRESS.- INSURED INSURER(S7 AFFOgO1NG COVERAGE NAICS ATLANTIC VVEATHERIZo-1TION LLC INSURER A: AMERICANZURFCHIN511RANCE COMPANY INSURER B: INSURER C: 61 REAR JEFFERSON AVE 'INSURER D: SALEILI.MA 01970 `INSUgEq e COVERAGES CERTIINSURER F. H O CERT6Y THATTHE I I ICE3OFplBUgAFNCe I I 11 ICATE NUMBER: REVISION NUMBER:F1pW RAVE BEENISSUEDTO TXE BISUAED NAMED ABOVE FOA THE POLICYPEAIOD@lOICA7m.NO7INTNSfANppIG Y gEQU1AEMENi,7ERrA OR CONOITIpN OF EVIL AACr OAOTHER UUMMENT WITH RESPECT i01VHICHTHIS CB1TG{CATENSPOLISSUED ORMAY PEpr 4FFOROED By THE POLICIE9OESCRIBEDHEREW IS SUBJECT TOALLTHE TERMS,EXCLUSIONS AND TONORI0115 OF CERTIFICATE POLICIES LBE ISSNOIVN NAY NAVEBEEIVAE INSURBY PAD CLAIMS' AEL THE...DANCE EISR LTR TYPE OF INSURANCE ADD SUB POLICY 6-F DATE POLICY EXP DATE L R POLICY NUMBER (MMIpDiVVW) (M6t Iclp YY)GENERAL LIABILITY LIMITS COMMERCIAL GENERAL LIABILITY `ACH OCCURRENCE CLAIMSMADE ®OCCUR. a 1 DAMAGE TO RENTED g PREMISES(Ea occuffence) ED EXP(Anyonepamm) g GEI AGGREGATE LIMIT APPLIES PER: _ ERSONAL&ADV 14UURY POLICY MPROJECTMLOC S ENERAL AGGREGATE $ AUTOMOBILE LIABILITY PRODUCTS-COMPIOP AGG S ANYAUTO ALL OW COMBINED SINGLE S OWNED AUTOS LIMIT(Ea acdtlent) SCHEDULE AUTOS BODILYWJUI S HIRED AUTOS (Per Person) ,I {NON-OWNED AUTOS BODILY INJURY S Per accident) PROPERTYDAMAGE g (L Per accideN) h UMBRELLA LIAR OCCUR L EXCESS LIAR CLAIMS.MADE EACHOCCURRENCE S DEDUCTIBLE AGGREGATE a RETENTION S S A WORKER'S COMPENSA710M AND g EMPLOYER'S LIABILITY YM My PROPERITORIPARTNEIVEXECUTIVE UBa8270121-15 032=015 0312LY2016 X %VC STATUTYJHY FOTHER OFRC6RRA0119ER EXCLUDED? NN N/A -LIMITS 1Maadatory t,NH) E.L EACH ACCIDENT Il Yes.dea.E vMer ',$ 500,000 OE SCRIFTCNOFOPERATION9below 91 DISEASE'EA EMPLOYEE g 500,000 DESCRIPTION OF OPERA17ONS/LOCA110NWVEHICLES/RE5TRICi1 E.L.DIBEASE•POUCY LRAR S 500,OD0 T1RS REPLACES ANY PRIOR CERTIFICATE ISSUED ToTH pNS/gPECtAL 1TEM9 ECER7FRCATEHOLDER AFT-F_CT, WORKERS COMP COVERAGE CERTIFICATE HOLDER CCTV OF SALEMI CANCELLATION . 93 WASHINGCONST SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF,NOTICE WELL BE DELIVE IN ACCORDANCE WRH THE POLICY PROVISIONS. RED SALEM,MA 01970 IN REPR.EE;:(�[TA ,CORD 25(2070l0 - .. _.e3.ti: .----c-�'a: I 51 The ACORD name and logo are � " �•��=:< � ��- '� - �-- _!registered marks of ACORD 7983'2"D ACORO CORPORATION. Att rights re- ad. DATE(6tMID0lY" THIS CERTIFICATE IS ISSUED A3 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED gy THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDFR- 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 Corder rights to the certificate holder in lieu of such endorsement(s). PRODUCER COMACT Eastern Insurance Group LLC w+o E Construoti.on 233 West Central St C . (800)333-7234 FAX Ne. EMAR ADDRESS: Naticl: LYfie 01760 INsu s AFFDROINGCOVERAGE NAICa INSURED INSURERA-Arballa Protecti.OA IaS. Co. _1360 Atlantic Westherization INSURER e�Tauti.lus Insurance Co 61 Rear Jefferson Avenue INSURER C: INSURER D- Salem Mt 01970 INSURER E: COVERAGES CERTIFICATE NUMBERSTSR 2015suRERP: Pm THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABVISION OF p THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY O ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. E)CCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A LTR TYPE OFINSURANCE S ENERAL PO�CY EFF PaMD�CYL7:P G LIABILITY POLICY NUMBER LBBrs 7 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A CLAIMS-MADE .a� REMIGS C�Roaim nre S 50,000 OCCUR 8500042816 /20/2015 /20/2026 MEOEXP(nnyonelxmson) S 5,000 PERSONALS ADVINJURY S 1,000,000 GEN'LAGGREGATE U?,STAppUES PER: GENERALAGGREGATE S 2,000,000 POLICY n PRO- LOG PRODUCTS-COMPIOPAGG I S 2,000,000 AUTOMOBILE LIABILITY S ANY AUTO COMBW SINGLE LIMIT3 Ea=dd N S 1 000 000 ALL OWNED$ X SCHEDULED BODILY INJURY(Perpamm) $ AUTOS AUTOS 020015871 /20/2015 /20/2016 y HIRED AUTOS a' NON-OWNEp BODILY NuURY(Perac15de S AUTOS PROPERTY DAMAGE Paraoddent S UMBRELLA LIAR OCCUR PIP-Bask 6 L EXCESS UAB a CLAIMSMADE EACH OCCURRENCE S 1,000,000 DED RETENTIONS 600058654 AGGREGATE S 11000,000 WORKERS COMPENSATION /20/2015 /20/2016 AND EMPLOYERS'LABILITY $ ANY PROPRIErOR/PARrNER/EXECUTI Y/N WC STA OTH- OFFICERFJEMBER EXCLUDED? ❑ NIA (Mandatory in NH) EL EACH ACCIDENT S 0 S 'U ON OF OPERATIONS baw, EL DISEASE-EA EMPLO 5 POLLUTION LIASILITY EL DISEASE-POUCYLIMrr S 00378613 �0/1/2014 0/1/2015 GENERALAGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 iCRIP'nON OF OPERATIONS/LOCATIONS!VEIBCLES IADarb AGORDT01,Addifi-z]R=ado:Sohedulk- mom re a iare � Mired) ZTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOV:0RDC071- ........ IES BE CANCELLED BEFORE CITY OF SaT.raa THE EXPIRATION DATE IMLL BE DELIVERED IN ACCORDANCE WITH THE PO 93 WASHINGTON STREET SALEM, YA 01970 AUTHORQEDRWRESENTATNE John Koegel/P2y8 TQD 25(209 D/OB)26 .umc�nLc�ann LITL�N. AtL rights reserved. III Coesrrn: a'-.Sarert.,s¢ _ _ CS4)SM77 EWC W PALM 3MTONSr Salem MA OMe q 042312016 (�PiFPSf!CCEI�-� i�e��5C�t3Taj:Trtl�C� ` eat :sty 35-000 cubic fed(9091W)of- CiO�€3SP,ii SDSCe . AIIII WfumYo 9emmsa curmaeffion ofthelNawnhusetts Raw SmTd®g Cade i$cam for rmcaUta of this Y¢a1sp- rwDPSGoifiarma'uur+vmt rvemca8ms�v/OPS . ... _ � ®ffreeePConsamee36Faa'sPsBvsmes&egadati0n 00E If PE OVMMr,CONMC`IOR oa 142089 '-Y[ _carton.. 3M212016 LM liabEty Cone o'� A-rLsA,nc NEATHEPJZATtON LLC. ERIC PALIL4 _ -61RJEFRERSONAVE - SALM MA 01970 Usderseesetary - Liceaseoseeg3sErai=oavatidsor?sn�idcdaseov[,y - bef -artoa dale. tD= offfts'CaaSmae=AfrWS and BUSIB ssR09a)a6aa ?OParkPlea3-SuiteSf70 gosYaa,It4&02'_35 RocvaNd-arsdxoatsigaafm'e " tll