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106 MARGIN ST - BUILDING INSPECTION (2) 23 . 03.2010 02 : 09 AM PAGE. 2/ 2 i - The Commonwealth of Massachusetts ^ Board of Building Regulations and Standards C1TY Massachusetts State Building Code,780 CMR,7n edition 0i'SAI.FM Revised January Building Permit Application To Construct,Repair,Renovate Or Demolish a 1, 2008 - .__..... One-ur Two-Family Dweiling is Section For Official Use Only -..._._........ _.__.._. Building Permit Nu cr: .,_,.., _..,._— Date Applied: ' Signature: Our ding Comm ssiom specuxnfBuildings Date — SECTION 1:SITE INFORMATION 1.1 Property Address: Q 1.2 Assessors Map&Parcel Numbers --I b6 Mp2y 4. 5 ., ___ _ I All Is this an accepted street'. es_ K p t y no Map Number --- Pmeel Nwnbur ----- 1.3 Zoning Information: 1,4 Property Dimensions: Zoning District Lot Aroa(sq fl) � Frontage(Il) 1.4 Building Setbacks(ft) Front Yard _�...,..w,_ Side Yards Rear Yard Required Provided Required Provided Required Pm'ded 1.6 Water Supply:(MALL c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone?............. Check if Ycs❑ Municipal❑ On site disposal system ❑ _ --......_.. . _ SECTION 2: PROPRRITOWNERSBIP' -- _ 2.1 Owner of Reco_rd: Address for Service: Signature Telephone SECTION 3- DESCRIPTION OF PROPOSED WORle(check all that apply) New Construction Existing Building❑ Owner-Occupied ❑ Repair:a(s)J@ Alteration(s) ❑3 Addition ❑ Demolition O Aeevresory Bldg.❑ 1 Number of Units„_ Other Cl Specify; Brief Description of Proposed (VoJC' --__ SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs i -— Item Labor and Materials) Official Use Only 1.Building $ 1 1. Dailding Permit Pee: cate how fee is dctormined: 2.Electrical $ e ❑ Standard City/Town Applicalion Fee _-_..— ..._..... _..... ..___ ❑Total Project Costs(Item 6)x multiplier-_.___ 3.Plumbing $ u 2. Other Fm: 4.Mechanical (11VAC) $ U List: 5.Mechanical (Fire ' - .---- "!'-- ----.----- Su ression 0oral All Fees:$ Check No. Check Amount: Cush Amount: 6.Total Project Cost: $ 3 L1 to. 5 1 ❑Paid in Full O Outstanding Balance Due: V1,_e CJc;ca 23. 03.2010 02 : 09 AM PAGE. 1/ 2 _SECTION S: CONSTRUCTION SERVICE 5.1 Licensed Construlw__onSuperMsor(CSL) CA9 $`1 / .3 U`i 2O1� License Number Expiration Date Name of CSL•Holder µ 5*10 (AjASNr.+ti-M1 i Q MQWtCu List CSL Type(sea below) ----.(�,--_---._ Address -- Typo �_.......Descri_tion .. ._ U Unrestricted(np to 55,000 G1t,Ft.) Tatul ...—R __ Restricted IV..Family Pwoltin8_._..._ . Yt .:.2f".Z a' 12-1 Z M Meson Only.... .... Telephone RC Rcaidwitiel Roofit Coverin WS Residential Window and Siding Sr Residential Solid Fuel Rumin A line installation D Ite-sidetaial Demolition 5.2 Registered Home improvement Contractor�(HIC)P l 1 ;—Add ompanyNamcurNICRuxi"trantName Registration Number a W 1�4�oa ._._ress L Z,a 1.1...._'�1 Irt,k 2 {o•i Z 1 L pEa rr.�lion DateaW Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.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 of the building ptutnit. Signed Affidavit Attached'! Yes ......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED W HEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _ 1, �i�t SG�►a 0.►427A W d _ as Owner of the subject property hereby auth N rt...t cU%t%. . O 7A —to,act nil lily behalf,in all matters rcl ve wo authorized by this building permit application, ` tl � L9:3_za?--) Si a -r of owner Dale ---- ----- - _ SECTION 7b: OWNER O . .___.. _..___.......... .... ---_--_. ' R AUTHORI7,EA AGENTNT DECLARATION I, J0QAi%rf (,MM CA ga V-v ,as Owner or Au �d A t hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Sigtmtare of Owtter or Authorized Agent 11at (Signed under the pains and penalties ofkar'ur NOTES: I. An Owner who obtains it 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 undtr M.G.L.e. I42A.Other important inrornuttian on the HI(:Program and ConSlntetiotl Supervisor Lipen§ing(CSI.)can be found in 780 CMR Regulations I IO.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information helow� Total floors area(Sq.Ft.).. ...........�—__—_(including garage,finished bascmenNattics,decks or porch) Gross living area(Sq.Ft.) _ Habitable room count .. .._- - Number of fireplaces_ _ Number of bedrooms _ Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" t The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR,7 s edition OF SALEM Revised January Building Permit Application To Construct,Repair,Renovate Or Demolish a 1,2008 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Signature: Building Commissioner/Inspector of Buildings Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers / b6 M4241 J $t, Lla Is this an accepted street?yes K no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq tt) Frontage(tt) 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: Id uePPc Qv4yr a4.o.7 % Name(Print) Address for Service: 9tifr/ 3`t�-ff�3�6 Signature Telephone SECTION 3:DESCRIPTION OF PROPOSED WOW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': t-&P%L 6J,.1D DRw�s4c -to SAJ� SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 3 Z�fe, 5 1 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ o ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ U List: 5.Mechanical (Fire Suppression) $ v Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ (3 1 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed!Construction Supervisor(CSL) �cli C6ck } 3( `I ZA 11& tJ QA41 U%rfgeN&3a4 License Number Expiration Date Name of CSL-Holder List CSL Type(see below) �S�D WA5�1r-+4 Tc,.l ,Si. P . MZ W t[.ti Address Type Description U Unrestricted(up to 35,000 Cu.Ft. R Restricted 1&2 Family Dwelling M Masonry Only b• 121 Z. RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Impprovement Contractor(HIC)^ 11 } 1 NSW C� cam F, I w,aJ PcSZJ2� HIC Company Name or HIC Registrant Name Registration Number Address l l 4 I Z D t 1 'Sr If l•$Z,ta•�'L1 2✓ Expiration Date 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 of the building permit. Signed Affidavit Attached? Yes .......... M, No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I> I%.t S p Po Cvig2,T ku 4 G as Owner of the subject property hereby authorize nr,%-J c t ti q.1 7 (i w 1 D a c5 ZazUs to act on my behalf,in all matters relative to work authorized by this building permit application. x Signature of Owner Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION 1, 2> wQA1fr . l)l c4&,E:. 7.5 as Owner or Aufiwbzed A e t hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf.� P ' I Nam :r//Ll4U _ / Signature of Owner or Authorized Agent Date (Signed under the pains and penalties ofperjury) NOTES: 1. 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage,finished basement/attics,decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths P ype of heating system Number of decks/porches ype of cooling system Enclosed Open "Total Project Square Footage"maybe substituted for"Total Project Cost" NEW ENGLAND BUILD & RESTORE INC. 590 Washington St.Pembroke,MA. 02359 Professional building damage evaluation&repair experts (781) 826-7212 Fax(781) 826-0240 Client: Guiseppe and Agata Quartarone Home: (978)745-8038 Property: 106 Margin Street Salem,MA 01970 Operator Info: Operator: BRANT Estimator: Brant Guthenberg Business: (781)826-7212 x 28 Business: 590 Washington Street Pembroke,MA 02359 Type of Estimate: Wind Damage Date Entered: 3/18/2010 Date Assigned: 3/15/2010 Date Est. Completed: 3/18/2010 Date Job Completed: Price List: MAB05B_MARl0 Restoration/Service/Remodel Estimate: 59661 File Number: FP249951 This estimate is based solely on the findings at the time of our inspection.NEBR Inc.reserves the right to amend this estimate should hidden or unforeseen damages and/or building code violations or unsuitable job site access be discovered during or prior to construction. NEBR Inc.has estimated this project based on completing the entire scope of work as written,performing all phases in a continuous workman like manner. All work to be performed within normal working hours. NEBR Inc. to have complete control ofjob site at all times which includes the following but not limited to: Job supervision and scheduling,Subcontractor selection and scheduling,job site access,and construction methods and materials. Job site access may be limited by NEBR Inc.for safety reasons at any time during construction.No work to be allowed by owner or any other parties without written approval from NEBR Inc. After the pre-construction meeting is completed,any and all requests for changes to the scope of work or changes to the project under construction,shall be addressed in writing to the contractor NEBR Inc. on the form provided to the owner by the contractor,called"change order request". Once the form has been submitted to NEBR Inc.,we will calculate the cost of the requested changes, if any,and submit them in writing to the owner for approval.Upon approval of both parties will sign the change order and the changes shall be completed.Payment for approved change orders are due at the signing of said change orders.Change orders can affect the construction schedule and projected completion date. NEW ENGLAND BUILD & RESTORE INC. 590 Washington St. Pembroke,MA. 02359 Professional building damage evaluation&repair experts (781) 826-7212 Fax(781)826-0240 59661 Demolition DESCRIPTION QNTY 1. Dumpster load-Approx. 30 yards, 5-7 tons of debris 1.00 EA Main Level Roofl DESCRIPTION QNTY 2. Roof window-Detach&reset 1.00 EA 3. Roof vent-turtle type-Detach&reset 6.00 EA 4. Remove Tear off composition shingles(no haul off) 19.57 SQ 5. Remove Additional layer of comp. shingles,remove(no haul off) 19.57 SQ 6. R&R Drip edge/gutter apron 80.00 LF 7. R&R Aluminum rake/gable edge trim-color finish 97.85 LF 8. Ice&water shield 533.54 SF 9. Roofing felt- 15 lb. 14.24 SQ 10. R&R Roof window step flashing kit 1.00 EA 11. R&R Flashing-pipe jack 1.00 EA 12. R&R Chimney flashing-small(24"x 24") 1.00 EA 13. Asphalt starter-peel and stick 80.00 LF 14. 3 tab-25 yr. -comp. shingle roofing-w/out felt 21.67 SQ 15. Ridge cap-synthetic composite shingles 40.00 LF Code Upgrade DESCRIPTION QNTY 16. Re-nailing of roof sheathing-complete re-nail 1,956.90 SF 17. Ice&water shield 240.00 SF Note: Ice and water up 6'at gutter line 18. Hurricane nail 1,956.90 SF 19. Roofer-per hour 1.00 HR Note: Labor to cut in ridge vent 20. Continuous ridge vent-shingle-over style 40.00 LF Grand Total 13,276.51 Brant Guthenberg 5966_1 3/22/2010 Page: 2 NEW ENGLAND BUILD & RESTORE INC. 590 Washington St.Pembroke,MA. 02359 Professional building damage evaluation&repair experts (781) 826-7212 Fax(781) 826-0240 Grand Total Areas: 0.00 SF Walls 0.00 SF Ceiling 0.00 SF Walls and Ceiling 0.00 SF Floor 0.00 SY Flooring 0.00 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 0.00 LF Ceil.Perimeter 0.00 Floor Area 0.00 Total Area 0.00 Interior Wall Area 527.29 Exterior Wall Area 0.00 Exterior Perimeter of Walls 1,956.90 Surface Area 19.57 Number of Squares 177.85 Total Perimeter Length 40.00 Total Ridge Length 0.00 Total Hip Length 5966_1 3/22/2010 Page: 3 NEW ENGLAND BUILD & RESTORE INC. 590 Washington St.Pembroke,MA. 02359 Professional building damage evaluation&repair experts (781)826-7212 Fax(781) 826-0240 ram' i .5 1 Front elevation 3/12/2010 Taken By: Brant Guthenberg Front elevation 2 Rear slope 3/12/2010 Taken By: Brant Guthenberg Rear slope 5966_1 3/22/2010 Page: 4 NEW ENGLAND BUILD & RESTORE INC. 590 Washington St. Pembroke,MA. 02359 Professional building damage evaluation&repair experts (781) 826-7212 Fax(781)826-0240 [` 4 3 Frontslope 3/12/2010 Taken By: Brant Guthenberg Front slope - -V 4 Front slope 3/12/2010 Taken By: Brant Guthenberg Front slope 5966_1 3/22/2010 Page: 5 Main Level a b Ft FACE SQ FT C SQS F1 978.45 9.78 b F2 978.45 9.78 F2 - EstiMa Total: 1 TS 990 107 G9 4 Main Level 5966_1 3/22/2010 Page: 6 �. CITY OF S.UENI, LksS.A.CHUSETTS Bl.• Lxr,DEPAATNiL iT \ 120 WA4Hn4GToN STREET,3"0 FLOOR TEL (978)745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR T Hoaus ST.Pmn E DIRECTOR OF PUBLIC PROPERTY/BUUD1NG co%L%assto.iER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: TLoSA,j WA,%-e (name of hauler) The debris will be disposed of in : (name of facility) 2oc,�c..2o v� INPt (address of facility) /Z`sign e o ermit applic date debrisafrdac CITY OF S<ULENl. NUNSSACHUSETTS BL'IIDlNG DF3ART.%MNT • R 120 WASmiNGTDN STREET,Sm FLOOR ` TEL (978)745.9595 FAX(978)7449846 K NMERLEY DRISCOLL THO MAYOR AIAS ST.PlERRfS DIRECTOR OF Pt:BLIC PROPERTY/BL'ILDLNG CO%L%USSIO.ER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lettlbly Name(BusinemOrganizationtlndividtW): Alas ,1 el"LA.. bJa� Ic..=StJ Address: SeiO w awls j Ltua .S-r. City/State/Zip: Ma, Phone#! Are you an employer?Cheek the appropriate box: Type orproject(required): lei am a employer with l O 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contactors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet 7• ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ )am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.®Roof repairs insurance required.)t employees.[No workers' MCI Other-_ comp.insurance required.] •Any opplicam that chucks box ri mug also nil out The section below showing thcirwotken'compensation policy information. t 1 inmeowteaa who submit this affidavit indicating they am doing all work and then hire outside cmitracom mint submit a new affidavit indicting such. =Cotonctota that check this box must attached an additional shoes showing the mutant the cub contncters and theft woken'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site informmlon. insurance Company Name, LJ Aryn, 1 $. Policy b or Self-ins.Lie.fl: rJ ai.IJ O O O jy o jK S Expiration Date: ` U I , L10_ Job Site Address: 10 (s M0.2ti i.t 54. City/State/Zip:_ C lA%Z-"+ &*41k 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 S1,500.00 and/or one-year imprisonment,as wall as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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. 1 do hereby certify under ill s and penalties of perjury that the faformarlat provided above is true and correct i m t ire Date: —3 L L, / D m 9: Official use only. Do not write In this area,lobe completed by city or town ofciaL City or Town: Permit/License# issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other Contact Person: _ Phone M CERTIFICATE OF LIABILITY INSURANCE OP ID RR DATE(MMDDNYrY) PRODUCER NBWBUr-2 03 22/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McSweeney & Ricci Ins Ag Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 2021 Ocean Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Marshfield MA 02050 Phone:781-837-7788 Pax:781-837-3399 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURE A: Guard Insurance Gron New England Build & Restore, INSURER B: Steadrart xnanxaxe Cmvpery Inc. INSURER C: Peerless.Insurance C an 24198 em Washroke gt02359reat INSURER D: Pembroke MMAA INSURER E .COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THEPOLICY 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 PERTAW.THE INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUSIECTTOAfL THETERMS.EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. LTR NSR1 TYPE OF INSURANCE POLICY NUMBER ICY EFFECTI DATE MWO GATE Mf WO LIMITS GENERAL LIABILITY EACHOCCURRENCE S1,000,000 B X % COMMERCIAL GENERAL LIABILITY GPL596562702 03/08/3.0 03/0S/11 PREMISES ca amu) $100,000 7B CLAIMS MAOE ❑OCCUR MED EXP(Anywepew.) $5,000 PERSONAL&ADV WJURY $1,000,000. R Pollution GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICY 7 PRO- f7 LOC JECT AUTOMOBILE LIABaITY COMBINED SINGLE LIMIT 5110001000 C S aNralJro SA8566858 12/19/09 12/19/SO (Eaacddenl) ALL OWNED AUTOS BODILY INJURY $ % SCHEDULED AUTOS (Per person) R HIREDAUTOS I BODILY INJURY % NON-OWNEDAUTOS (Peraccident) $ PROPERTY DAMAGE $ (Peracaidenl) GARAGE LIABILITY AUTO ONLY-FA ACCIDENT $ ANYAUTO EAACC $ OTHER THAN AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACHOCCURRENCE $1,000,000 B 2: OCCUR CLAIMS MADE SEO596563302 03/08/10 03/08/11 AGGREGATE $1,000,0000 DEDUCTIBLE $ X RETENTION $10000 S WORKERS COMPENSATION 11 AND EMPLOYERS LIABILITY YIN E TORY LIMfS 2. ER ,A ANY PROPRIETORIPARTNEPIEXECUTIyyOOl------,, RP.� W0008085 11/01/09 11/01/10 E.L.EACH ACCIDENT $500,000 OFFICERIMEMBER EXCLUDED? 1 T (Mandatary In KH) EL DISEASE-EA EMPLOYEE $500,000 Ifye.dwaibeunder - SPECIALPROVISIONSbelm EL DISEASE-POLICY UMR $500,000 OTHER DESCRIPTION OF OPERATIONS LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS NEW Rentals is named as additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABCVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATU) OATETHEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTiCETO THE CERTIFICATE HOIJIM NAMEDTO THE LEFT,BUT FAILURE TO DO SOSHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPONTHE INSURER,RSAGENTS OR REPRESENTATIVES. D REPRESENTATIVE ACORD 25(2009f01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public SafetN BtiarU bf Building Regulations and Standards Construction Supervisor License License: CS 89597 Restricted.to: 00 BRANT R GUTHENBERG , 32 YEW STREET DOUGLAS, MA 01516 lum" 6, Expiration: 3/24@012 ('ummiisioner Tr#: 20293 ) 1 ��ee�iomrmernu�vo.��a�✓�aaaac,/uuel.�a Board,of Building Regulations and Standards HOMEIMPROVEMENT CONTRACTOR Regrstratwrt 137817 Expvati 99/2011 pplement Card NEW ENGLAND�BUIL1D&>RESTOR , 5FFJT G.UTHENB RGf�� �. s 590 WASHINGTON ST; .,.� PEMBROKE,MA 02359 j I Administrator f