3 MASON ST - BUILDING INSPECTION (3) - r s
41.1tN64"T-BEf%+94 0 APPROVED By T+IE
Jd:r E=118 PP" TD A.PEFJIlAIT fkMO GRANTED
CITY OF SALEM
No. Date
\ I
Is Property Located In Location of
the Historic District? Yes No_ Building
Is Property Located in
Qe Conservabon Ares? Yes No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications: /
Owner's Name 2 S y T T ;/q- C
Address & Phone Al s7- 1 Yr(— 376E
Architect's Name
Address & Phone AT Afr—C"A&-P b (7A/1Z�`d�C3vzl
Mechanics Name 'A w � l
Address & Phone ( 1
Whet Is the pwrpose of building?
Warta!of burp? n a dwel tg,for how many fami ss?
WE buk tg cordorm to law? Asbestos?
Eftnated
z)(SO ' city War=r n1 A License K
Bone Lproveaent
/ L,AJ0 f Lic. t
S' ature of Applicant
NED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
L 5-
MAIL PERMIT TO:0//Z G K A J S prI ST T 4
(�S s
T`
APPLICATION FOR
PERWr TO
LOCATION;t
c
PERMIT GiRANTED
APPRO46
S ECTOR OF BUILDINGS
a
Clie `,iW59 NEMN10.
"A D;. CERTIFICATE OF LIABILITY INSURANCE o sro
rPRODUCER THR'CEIR I FICATE IS ISSUED AS A MATTER OFiNFORMATIOM
B.K.McCarthy Ins.Agry.Inc. - ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR...
10 Centennial Drive -- ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Peabody .MA 01960
978 532=Sµ5 INSURERS AFFORDING COVERAGE NAIL a
BNMBIEe-: _. NORMA,.CreReasolINUQB1se
New England Home Improvement,InD. WBuuReaa Oberty Mutual Insurance Company
280 Main Street` INSURERc
Stoneham,MA 02180 RRAtERR`,
. INSURERS ... .
COVERAGES - . _ .. ..
THE POLICIES OF INSURANCE UBTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FN)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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE.LeETSLSHOWN MAY HAVE BEEN REDUCED BY PAID CIAMS._. . _ -
TYPE OFNMAIRANCE POLWVWA/ POHCYEFFECTVE POLICY IJWTa
A GENERALUAINUTY NFOPB19102 01/24/04 01/24105 EACH OCCURRENCE 31000000
COMLPRCIALGEMERALLUBMY - TGRENTED $100000'..
_ ���CpLAI�MS MADE �GDCUR MED E%P ar... f '9 0 .
y4 SPiLJRCZd:J& PERSONAL BADV[KAM {1001)000 e
. GENERAL AGGREGATE $ ODo..
GETiI AGGREGATE 7
APPLIES PER PRODUCTS-COIAP>rm AGO $1 O0O 000
AUTOMOBILE UAERTY.. COMBINED WGIE.umrf f.
ANY AUTO - ..
ALL OWNED AUTOS BODEYWAIRYSCHEDULEDAUTOS
"f
IGREDAUTOS - BODILY IWURY.. . 'f
(Pu ac* n0
NON9NRlEO AUMS N
DANPAGB, f H!J ,�
ar+. AUTO OILY-EA ACCIDENT t
ANY AUTO
OTHER THAN EXAM 5
AUTO ONLY. f.
LU186n► -. : ON0.T t
AGGREGATE .t
OCCUR �(]AIMSIMDE -
i.
t
DEDUCTIBLE -
RETENTION
B WORKERS COMPEN$ATIONAND WC131S340616014 01128t04 01128105 WCSTATIF EMPLOYERS LIABILITY E.L.EACHACdDEriP'-` f509000.
ANY PROPRIETORNARTNEREXECURVE OFFICERNELSER EXCLUDED? E.L.DISEASE•EA EMROYE i500 O00
Syu. PROVISI(MLR
OTHER
EL DISEASE.POLICY UMW t500000
PPHER
DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLE$I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS.
CERTIFICATE HOLDER - CANCELLATI ON
{MOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Worcester Building Department DATsrHERNOF,TwINElors SONanwaLENOEAvoRro MAL —10- DAY$mwruN
25 Meade Street NOMETOTHE CERTIFICATE HOLDER Kum TO THE BUT FAILURE TO DO ED SHALL
Worcester,MA01610 IMPOSE NO OBLIGATION ORUAKMOF MIN WIND TEAM OR
A
AUTNp®REFFE BWAVA-
ACORD 25(2001108)1 Of 2` ` 0"636 LEG a ACORD CORPORATION 1988
ail
Ate �ar►vrr+�o�uue�rC� a�� ��a�aac�uulet�a
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement'Contractor Registration
Registration: 137531
Type: Private Corporation
y, Expiration: 11/22/2004
NEW ENGLAND HOME IMPROVEMENT#4,r. --
THOMAS ROSSI
331 CHELSEA ST.
EASTBOSTON, MA 02928
-' - - -- Update Address and return card.Mark reason for change.
�T Address , i renewal Emprovmeot Lost Card
✓i{e �Oavnnuao+uieall� a��/ nma`/+uoelA - . -
_ _ Board of Building Regulations and Standards License or registration valid for individul use only
HONE IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Re01stra0on: 137531 Board of Building Regulations and Standards
U04 One Ashburton Place hurt kL
Expiration:: 1371
Boston,Ms.02108
Type; Private Corporagon
NEW ENGLAND HOME IMPROVEMENT INC.
THOMAS ROSSI �JJ
331 CHELSEA ST. �i --- C� ��'^"'SL------
EASTBOSTON, MA 02126 gdmrniantnr - of� � withodt sil+,natun
via,