Loading...
216 LORING AVE - BUILDING INSPECTION (2) (� The Commonwealth ofMassachusetts I Board ofBuilding Regulations and Standards FOR ^ Massachusetts State Building Code,780 CMR MIINICIPAIdTY l , � 1 Building Permit Application To Construct,Repair,kenrEo� ftia�dM 2011 One-or Two-Family Dwelling y t�(1 7bis Section For Offici_g Use Onl BuildingPeimitNumbir D Applied Building Official(PtmtName) Sigaadae " ri+� Date- SECTION 1:SITE INFORMATION PrJAjperty Address:, / _ 1.2 Assessors Map&Parcel Numbers eC 1(O .fit-t- j - l.la Is this an accepted str yes_'no Map Number Parcel Number 13 Zoning Information: 1A Propeky.Diuiensionsc Zoning District Proposed Use LotArea(sq ft) " Fmntage(ft) 1.5 Building Setbacks(S) Fmnt Yard Side Yards - Rear Yard Reg rovided Required Provided 1.6 Water Supply:(Ad.G.L c.40,§54) 1.7.Flood Zone Information; . I.S Sewage Disposal System: Public❑ Private Zone: Outside Flood Zone? Municipal On site disposal system ❑ .. . . :Checkifyes❑ �. SECTION2: PROPERTY OWNERSHIP' 2.1 Owne of Record:, f�O rr^ SUl�moS /n!f Name(Print) City State,Zip zi6 tor," Ale, 7yy y��fSS No.and Street "Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORe(check all that apply) New Construction❑ Existing Build ng❑ OwnenOccupied A Repairs(s) ❑ teration(s) ❑ I Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units- Other QrSpeffr. Brief Description of 717, WOW- s SECTION 4.ESTDUTED CONSTRUCTION COSTS litnated Item abd Materials Official Use Only 1.Building $`� 1, Building Permit Fee:$ indicate how fee is determined: 2.Electrical $ 05 taudard City?own Application Fee ❑Total Project Cost'(Item 6)x multiplier ' x' 3.Plumbing $ 2. Other Fees: $ �.-t 4.Mechanical (HVAC) $ List 7 A S.Mechanical (Fire $ Su ression Total All Fees:$ Check No.lld�/ Check Amount Cash Amount 6.Total Project Cost $ �� _a ❑Paid in Full • j ❑Outstanding Balance Due: SECTION 5- CONSTRUCTION SERVICES &I Construction Supervisor License(CSL) q 7 licenseNumbe.r Expiration Date Name ofCSLHolder �(see below) _ j - List CSL Eric W.Palm Li No.and Sheet - Description 3 Hihott 3t[eet Type Unrestricted it to 3 000 cu.tt. MA.O1970 ! R Restricted 1&2FamU Dwel in City/1'uwn,State,ZQ' i i L: i _ M MMOM - RC Rooting Covering - WS Window and Sitting ���'���� �yII, i, SF Solid FuelBandagApprmnces a tl I I hodation Telephone Email address D I Demolition 5.2 Registered Home Improvement Contractor QUC) l/A 2-O Af 3 l Z & Atlantic Weafficri4dtwic, L.,. —L :HTCRegistration ExphationDate HiCCompanyN®eorHl VtxluC umber No.and Sheet Wan MA 01979 - 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-ofthehsua w ebuildingpermit Signed Affidavit Attached? Yes.......... I No..........❑ SECTION 79:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner ofthe subject properly,hereby authorize ) L '�Cl/rn to act on mm�ybehalf,in an matters relative to work authorized by this building permit application. . Print Owners Name(Elecbome Sigaalure) Date SECTION 7M OWNEW OR AUTHORIZED AGENT DECLARATION 1 By enteringmy name below,I hereby attest under the pains and penalties of peduty that all ofthe information contained'in ' applica n rs to the best of my knowledge and understands g YtiotOwner's orAothorrced Agem's Name(Electrome Signature) - - Data NOTES: 1. An Ownerwhoobtainsabmldingpermitto'dohislierownwork,oranownerwhohimanunvegisteredcontractor (not registered in the Home Improvement Contractor(MC)Progmm),will not have access to the arbitration program or guemnty fund underALG.L.c.142A.Other important information on the HIC Program can be found at www.mass gov bea.Information on the Construction Supervisor License can be found atwww.massgov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.IL) (including garage,finished basement/attics,decks or porch) Gross living area(sq.R) Habitable room count Number offuepla= T Number of bedrooms Number-of-bativooms Number-of-haWbaths — Type of heating system Number ofdecks/porches Type of cooling system Enclosed Open 3. 'Total Project Square Footage maybe substituted for`H'otal Project Cost". 17dnratsnS�es6 a111�;¢ rn ptf �1EL�L g" �©-iC® -. ' mP,atxi- �PmsoftSPEgg olme -(e'sEame Q ¢selSCons»�rGogJdad+dr,`sse 1asanw (LY`l''LcS�ta'1°.1A)bcka- .�aYdessa°?' ¢astmerq - ny wdBad P�m�at�sRtg¢l�g F¢SfianY - s'ewld5uta6hSo�sLn3a.-d r �'ZFa ,P'3'aFiD3 ��`��'g6�°at617A73.87S7tr1 �'Ob2�uafracoP3'12YcJliog(Le ZRm., -C82tJ.,g3-31SJ arm aexeS�te- � .. Ca�4raetar��-,�2Ei©a Strnidd a � O�JO.S - ,eme d (d°n°ttaPxPwEDfrtc-_8aw 3 �3ll"'i' Ciry ons. � Contrmta3galsp�� ¢c11eUL,j.j,l. AvefiUe D�Jtimemy. I� (/�V{�/ 8ueesAdd,�(®m--hatea b /fi . htylias.Ad,3jftd _ 6 �th/iaxm :. S� / t2re�f6¢¢nb¢12) 7.rP Ctye DRS;nCI'hay ' FM�f Lz4.+ui�o� —='�*�aa� IDarSSNmnha (DsciER iR CG`�nw`=""'m,3¢'-iiC i2ilp-�yg C.+r$folPiY =o:.y.-tom /t.2Q�G� mdo-.Rxrd:roeRo,��t ! j 3 2/ sPm$m�-Rd.ao/tl]SedeaF s V' F f� /T�r !m.�0.stoMrscl a=ut�n may. (:� g be d'nYthow ft" 3�bm 's3en l� /7 cs�y_eei( ,_�-'a..e+�.C`- .53•(t�2a3s ae^t h° + t¢ �¢+rm-r J°'a ea5P3a[e-ILefall¢wp �{s- � �''rormg®�sEsyvnd g=�e3nlern�l . _"�"-�=.Jt`us:;�, �''iEz3Dilz�,�`ros� g m°m�`°°:•srncaaiaos t .c:r. W lktenum°¢naae3rnzln�n°Oaaaete3xmt� ShR Coatmc!o,a��rsmPe�amihc me d smaedtye - 1CDstoxvm m¢tracrod the Pa3'msats v,ffi uedenca_. mnt�alMdlPhtr - '�rotuefa8mnn sP�vcdPbaonftrihnta73smn eF `-_----_e+ ta'(¢0im=�.PPd i/3¢ftneta�l ant�'t�ice nt!uneosto_vs. S—�. °�'EO3Plellra of ,®,� ���'t�wSicGeurs�yty �tt ) S dapaa mmNetiaa of {.,��, ) t ST"--�5 leb¢n¢fthee¢nnasL aawalb,er_,�'I I Gd'JZ-- "l e�I/4 Y7L/7�r arched' eQning;.:mi° �gfp11P=P.nertrm to mxN eaan*7:m�srE�,y�-, � S'---�-"' ' ; n°°.racr,sc'°Lwlerodro 6¢tup�3's.- ti n4-pa) SCv:tr -. asi:ardn:'m'P-knot,^.eidy v: L_ta� thad E-nr•-.i-J^r•,�.n_r 6��st¢a•-u.•:1�mmNtimr.'erydy�''rJ a�tafap_v,�LQIItrecra:cefatra:-E{;jnsmry - , Se5,:cnE`^_mt¢-rQ canes` . ... 55 a-ci �P+no,mco;tamardeavL-ial Perry/snEwnSMr.K:r:-,�C¢rn�m6esoiPi ,acmt--csn L��;o_i`;' - CcaeT^:^A�? raaderl i�Q�"'u:t`=Tnne•,a�e�¢Dl�gn+pieti¢n°i:ue rnr?-daaiae3F:,R R�� Ee': :3zr:n m-� _ mes na-+n5+llY 5sfetP si-rSmztaye° 6�•same;ahi¢¢mroletp*eyFanabFeferr,Il �nmismajl � =n gtl3s Cana-mGr'>�etlrat' a¢tlslats: t c J6a'`h^P=3u:c-'otasi_iAn .6° 'Pi�"cd¢n iherzsidQ u..� 'tLefc➢mrrng � m°'�'me ED the _ Estnrrdt tes diewnh¢Uargme the taPz'SPI�y¢acr Pt Tnela' gisn¢nlrPn . am'dommeaL ys� x �QZi1�6ar� ��11mng61 w9UWV aw°pmca�,.#¢aaewr:n¢d atdd;to tgea¢an �TP�stediaes. r d Le Y+�omn'Eansndrat 283 3757, �imexmentCoahau°r.,z�PoaPnt7a.�y.�u°n a:t°en:vesna ���prarnsl-to lbisfzsm °¢nt2.'t¢.rtcrt atgxt�.3L-�'r-attatifft ^h 4 e� ldSeta°°Pp°fthmco � ` r.. ihir6 hnsi¢Pu dzy;ou¢nia.-e -Mz ea.�-'y°n'hdi cagira;ot§nopaz secr any a.�ere:�!' - � ..nc .mde,&�e ilahaa �i no!lsertha°antr,5¢t°fth L..1:�,' w �.TrPl�'6—oflh¢rignG �1� � 1,L•1va'>JlA 94i �g� bsc� Date �ry, e Contractor Arbitration The Home lmpmvement ContracmrLaw provides homeowners with the right to initiate an arbitration action( d n a alternative to comtacdon)ifthey have a dispute-With a contractor- The==right is pyt Automatically contracto,however. The contractorwouid have to rasalve any dispute he/she has with a homeowner in tour'.unless both parties agree to the optiami clause providedbelow. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contactor and the homeowner hembymataaily agree in advance that in the event the contractor has a dispute concernin this L the co nhA2064T.W submit the dispute to aprivate arbitrative ram which has been approved by the Secretary of Nicuti}?office-A F°rmtmer Affair,and Business Regulation and the consumer shall be required m sulrarit to such mb'rihah�¢taPYdvrr In Massachusetts General Laws,chapter 142A- Contractor's Signature Homeowners$rgumme NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contactor- The homeowner may initiate alternative dispute resolution even wbere this section is not separately signed by The partim. Homeowner's Rights- A homeovaces rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(ie MGL chapter93A)may not be waived in any way,even by agreement However,homeowners may be excluded from mdamrights iftlie contractor they choose is no[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 vmrk as described,in a timely and worL-atanhke manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty forivorlmanship or materials. 1a addition m guarantees orwarranties . provided by the emmactor,all goods sold in Massachusetts tarty an Implied warramy of merchantability and fitness for a particular purpose. An enumeration of othermatters on which the homeowner and contractor lawfully agree maybe added to the terms ofthe contract as long as they do not restrict a homeowners basic consumer rights. If you have questions about your commer/homeorner rights,contact the Consumer Information Hotline(listed belov). saecution of Contract - The contact must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties Am,also advised notto sip the document until all blank-sections hzve been filled in or marbcd as void,deleted,prnot applicable. One original signed copy of the contract with Attachments is to be given to the over and the other kept by the contractor- Any modification to the original contract must bein writing and a_>med to by both parties.Contracted workmay not begin until both parties have received a fully executed cony of the contract,and the three day rescission period bag expired: ceeier ated Payments A contractor may not demand paymen&in advance of the dates specified on the paymentsduedute in cases where the homeowner de ms him/hemelfto be financially insewm- However,in instancessvhere a contractor deems himlherself to be financially insecure,the contractor may require that the balance of fiordsnotyet due beplaced inajoimescrow account as a prerequisite to continuing the r onracted win& vrithrlmwml of funds£•ore said account would require the sianabues of bothparties. Additional Information - if you have general questions orneed additional information about the Horne improvement Contactor Law or other consminerrigbts,or ifyou wish to obtain a Dee copy of"A Ivlessachusems Consumer Guide to Rome Improvemem'.' contact- . Constaner li forthatioaHm'. Office of Consumer Affair and Business Regulation ;10 Perk Plea,Room 517%Boston,MA 02116 617-973-—1S7,888 383 3757 or visit the OCABRwebsite at hao•11ximm-mass-eo•/ocnbrl If you want to verL;y the registration ofa contactor or ifyon have questions or treed additional information specifically about the contactor registration cornpopent of the Home hmpravement ComtactorLaw,contact Dire ctoi of Home ffiprowement Connector Registration Office of ConsumerAfi'aus and Business Regulation 10 Park?lma,Room 5170.Boston,MA 02116 617-973-8787,888-283-3757 or visit the HIC website at htm:/Atmay.mass-^ovlorabr! Go online to view the status Of 0 Home Lmpmvemcat Coatradors Registration - htlpJ/dbstatema-us/homeimorovemenUlicenseelistaso For assistance with infomal mediation of disputes or to register fnmal complaints against abusiness,call: Consumer Complaint Section - Offtcn.of the Attorney t General 617 7r7 S400 . IND/OR Better Business Bureau 508-652-4800,508-7552548 or 413-734.3114 versiun_t-rrr ro The Commonwealt/i of Massachusetts Department oflndustrialAccfdents 1 Congress Street,Suite 160 Boston,M4 02114--2017 Workers'Compensation Insurance Affidavit.TO BE FI t.Builders/Contractors/E►ectricians/P►umbem Alicantlnformation LED WITH THE PEILI•IITTING AUTIIORITy. Name(Business/Organization/individual): Adan(lt f Please Print L 'bi wL LL(. Address: 6.1 R Jeffe QV;Ue City/State/Zip: v Phone#_ Q78 - 7c14 - g [ct3 r a employer?Cbeck the appropriate box: m a employer with emType of project(required): P1oYees(full and/or part-time).. m a sole proprietor or paMership and have no employees working forme in 7• ❑New construction capaciry_[No workers'comp.insurance required) - - 8. QRemodeling a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition a homemmerand,01 be hiring contractors to conduct all work on my property. (Hill 10❑Building addition ure that all contractors either have workers compensation insurance or are sole rietors with no employees. ;- 11.0 Electrical repairs or additions a generel comractorand I have hired the subcontractors tilled on the attached sheet 12.❑Plumbing repairs or additions e subcontractors trove employees and have workers'compiasurmrce: 13. RO repairsrc a corporationandits officers have e..otcised their right ofexemption per MGL c 14• ther§10),and we have no employees.[No smrkers'coin ,insurance �n�CV �rf6 G i P required.] 'Arty applicant that checks box dI must also fill out the section below shmving their workers'compensation policy informmion. t Homeowners who submit this affidavit indicating they are doing all wort:and than hire outside wntramors mutt submit a new affidavit indicating such. �Contrecmrs that check this box must attached an additional sheet showing the name of the s. If the sub sub-contractors and stole whether or not those entities have subcontractors have employees,they mutt provide their workers'comp,polity number. fan'an employer that is prordding rvorkers'compensation insuraacejor my employees Below is tl:e policy and job site information. Insurance Company Name:_ Zuy-t C k Policy#or Self-ins.Lic.#:_ ,S 0 2-70 d — / A Expiration Date: Job Site Address & Ll /y�•t je-i- _a Attach a co City/State/Zip:-4ey/ -py.of the workers compen on policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to S 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 7 do hereby certify under tlre parrsTutd penazAJes oEp 'Try that the information provided above is tree and correct Signature: Phone#: f9iDate: Of elial Ilse onlJ: Do not write in this area,to be completed by cite or town official. City or Town: Permit(License# Issuing Authority(cirde one): L Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: —' • �� a'6A JGt VGl CEI3�IFICATE OF LIABILITY INSURANCE T IFICATE rs ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRhfAT1VELY OR NEGATIVELY AMEND,EXTEND OR AL' DED BY THE POLICIES BELOW. U D ER THE COVERAGE AFFOR THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWNG INSURER(S),AUTHORIZED REPRESENTATIVE C ODE EEN THE ISSUI IMPORTANT:it the certificate holder is an ADDITIONAL INSURED,the pO11CyQes)must be endorsed. It SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain potkies may requ've and endorsement. A statement certificate holder in Ifeu of such endorsemen s, on this certificate does not confer rights to the PRODUCER CONTACT EASTERN INS GROUP LLC NAME` 233 W CENTRAL STREET. PHONE (A/C,No,E%t). - FAX NATICTC.MA 01.760 E-MAIL (A/C,No): - 22MLW ADDRESS. INSURED INSURER(S)AFFORD WG COVERAGE MIDUCAN ATLANTIC WEATHERIZ.ATION LLC INSURER A: A zGRttarwsuRANcB NAICa INSURER B: COMFANY INSURER C. 61 REAR JEFFERSON AVE INSURER D: SALEM.MA 01970 INSURER E: COVERAGES INSURER F. CERTIFICATENUMBER: O Y NAT THE PO 80F BIaUgANCE Sf® WN VEB EN REVISION NUMBER: ANYREQUIRy I.7em OR CONDmONOFANYCONTRACTOR OTHER DOCUMENT TOTHEOTOWHI ®ABOVE FOR POLICY AFFORDED BVTNE POLIpES DESCRIBED HEREIN BSUBJECT To THE WRH RESPECTTO VMICH TMS PERIOD 9101CATE0 NDTVATHSTANONO P4m CLAUAS. TERMS.IXCW910NS AND CONDmONSOF SUCERT6fCATE MAYBE ISSUED On MAY pERTAN THE NEUIII CH POLICIE&Lama SHOWN MAY HAVE BEEN REDUCED BY aiSR LTR TYPE OF INSURANCE - ADD SUB POUCYEFFDATE PQLICYEWDATE L R POLICYNUMBER (NfApO,YVYY) OU DD1Wyy1 GENERAL LIABILITY LPAR6 COMMERCIAL GENERAL LIABILITY ACH OCCURRENCE CLAIMS MADE ❑ $ OCCUR. AMgGE TO RENTED REMLSES(Ea occurrence) $ GENt AGGREGATE LIMIT APPLIES PER: ED EXP(Any one parson) If ERSONAL A ADV PL/URy $ POLICY aPROJECT❑LOC ENERAL AGGREGATE $ AUTOMOBILE LIABILITY RODUCTS-COMP/OPAGG $ ANYAUTO ALL OWNED AUTOS COMBINED SINGLE $ LIMIT(Ea acritlere) SCHEOULEAUTOS - BODILY MJURY $ HIRED AUTOS (Per person) NON-OWNED AUTOS BODILY QUURY $ (Par aecideta) PROPERTY DAMAGE $ UMBRELLA LIAR OCCUR (Per aeciderl) EXCESS LIAR CLAM S.MAOE EACH OCCURRENCE g DEDUCTIBLE AGGREGATE $ RETENTION S $ A WORKER'S COMPENSATION AND $ EMPLOYER'S LIABILITY YM ANYpROPERITORTARTNERT%FCUi1VE U638ET0121-15 03/202DIS 03202016 X WCSTATUfORY OTHER OFRCERRAEMBER EXCWOEOY aN/A LIMITS Ir yes,.fiftyros uiker (MI I,NHI E.L EACH ACCIDENT esa $ SOO,WO DESCRIPTION OF OPENATIONSEeIow E.L.DISEASE-EA EMPLOYEE $ 500.000 DESCRIPTION OF OPERATIONS/Lo CAlIONWVEHICLES/RE5TRICRONS)SpEC1ALITEMB El.DISEASE-POLICY LIMIT T $ HIS REPLACES ANY PRIOR CERTIHCgTB LG 500.000 SUED TO THE CFR'RRCATE HOLDER AFFBCnNG WORKRS COMP COVERAGE. CERTIFICATE HOLDER CITY OF SALEM CANCELLATION . 93 WASHINGrONST SHOULD ANY OF THE ABOVE DESCRIBED pOUGES BE CANCELLED IN BEFORE THE E%PIR0.T rH DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE YATH THE POLICY PROVIlApH� SALEM,MA 01970 AUTHORIZED flEPR - - ACORD 25(?A10/OS) The ACORD nameand logo are '.. ..... .'-:•- .: .yam_ �. ~�:�,registeretl marks of ACORD 1966:20110 ACORDCO = ...RPORATION. All r(ghfa reservaL .AC�9�®® CERTIFICATE OF LIABILITY INSURANCE A i2D�s T" THIS CERTIFICATE t3 ISSUED pS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THlS 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 1NSURED,the the terms and conditions of the policy,certain policies may require an endorsement dorsed. If SUBROGATION IS WANED,subject to certificate holder in lieu of such endomement(s). ent on this certificate does not confer rights to the PRODUCER Eastern Insurance Group LLC NAME- Construction (800)333-7234 FAX 233 West Central St PHONEN &AOAIL AD E Natick 1� D1760 INW S AFFORDING COVERAGE HAIG9 INSURED INSURER AALL'bella Protection Ins. Co. 1360 Atlantic Weatherization INsuREReNeutilus Insurance Co 61 Rear Jefferson Avenue INSURERC: INSURER D: Salem NA 01970 INSURERE, COVERAGES CERTIMCATENUMBERMASTER 2015suRERF: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEREVISIOD ABOER. p THE POLICY PERIOD INDICATED. NOTUNTHSTANDING 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.UM' SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILSR TYPEOFINSURANCE POLICYN SI R amLICY EFF m DCY GENERAL LIABILITY p LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 A CLAIMS4VIADE ®OCCUR 500092816 /20/2025 P EMI ES Ea $ 50,000 /20/2016 N7®EP(AnY mePentpn) S 5,000 PERSONAL&ADV INJURY s 1,000,000 GEN'L AGGREGATE LIMIT APPUES PER GENERAL AGGREGATE S 2,000,000 POLICY X PR0. LOC PRODUCTS-COMP/OP AGG S 2,000,000 AUTOMOBILE LIABILITY S A ANY AUTO MB. LIMBALL S 1 000 000 1 AUTOS OWNED X SCHEDULED BODILY MJURY(PerPer m AUTOS 020015871 /20/2015 S X HIRED AUTOS X p�OSVI� /20/2016 BODILY INJURY(Pereoid PReOPERTYDAMAGE S X UMBRELLA LIAB X OCCUR PIP-Saaic $ A EXCESS LIAB CLAIMS-MADE EACH OCCURRENCE S 11000,000 DED RETENTIONS 600058654 AGGREGATE S 1,000,000 WORKERS COMPENSATION /20/2015 /20/2016 AND EMPLOYERS'LIABILITY S ANY PROPMETORIPARTNERIEXECUTIYE YIN WG STATU- 0TH- OFFICER/MEMBERD(CLJJDED7 ❑ N/A (Myandatory in NH) EL FACH ACCIDENT $ DESCRIPTION OF OPERATIONS tub. EL DISEASE-EA EMPL S 3 POLLUTION LIABILITY ELDISEASE-POIJCY LWIr S 1.200378613 0/1/2014 0/1/2015 GENERALAGGREGATE $1,000,000 MCRIPTION OF OPERATIONS/LOCATIONS,VEHICLES (Attach ACORD TM,Additional EA POLLUTION CONDITION $1,000,000 RamadLa SchadUla.Rmol)apela is required) 9RTIFICATE HOLDER CANCELIJITION CITY OF 3ALEM - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 93 MSHINGTON STREET ACCORDANCE WITH THE POLICY PROVISIONS. SALEM, MA 01970 AUTHORQED REPRESENTATIVE DRD 26(2010/06) John ICoegel/PMA Tom— -- n25r>mnnslm ©1888-2010ACORD CORpORgTION. All rights res The er npni nano and IrN+n are g erV@d. ronic}ar'M marlre of 9r`rTRi7 C tit Massachusetts -Department of Public Safety Board of Building Regulations acid Standards" Canaruction Supenicnr License: CS-087977 . ERIC W PALM 3HILTONST = f_ Salem MA Omer 11r, ` 04J2312016 954— commissioner " Unrestricted-Buildings Of any use group which contain less than 35,000 cubic feet(991M )of enclosed space_ iI Failure to possess a current edition of the Massachusetts Stare Building Code is cause for revocation of this license. For DPS licensing into rmadonVisit w .Mass-Gov/DPS - � "� _ C-%fie�anuuaurnrm/!�o`✓jtrarrrwie// _i Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR - egistration: 142089 TSB' iratlon: 311 2 12 0 1 6 Ltd Liability Corpo`., ATLANTIC VVEATHERIZATION-LUC. ERIC PALM 61 R JEFFERSON AVE - SALEK MA 01970 Undersecrery License or registration valid for individul use only _ before the expiration date. if found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valid without signature