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6 NAPLES RD - BUILDING INSPECTION .!, �,, The Cammonwea of ussaehusetts, �'. ' * Baurd q( Bwldtng R ons and Sttndurds {t)R ' �� Ndtssachusgtts State Huiltlmg Code,7$fl CjvtR 7s'edition ' MttNtE 1P,�i 1 Ct USE - ,Butidtng Pernut Apphcagon To Construct, Rcputr,'Renaautn fir Oemottsh u � Riusz d kuunu t i � Otte arT'ii kilt/Lhvellu;g _ 1 ^iXJB ButIdrng'i'tmi, lV bet. to Applied Signutur e AQ B ifdi Cumtm_issianerf 1 torn SECT,ION.Tz,' TWINFORMATIM > ! , I:Iope ,yyAyr 12 Assesses N[np 8t i*arcei Ntirnbsrs istots;tbisanur tad;street} es Wit Nutg6tx, PunclNumtiv Ztt 77 77 77 13 Z eety Dimensions zo ing t7tstrtct Peoposed Use :, [>at An:u{sq Ri Fran i Se ftU, , 1 3, Puitding Setlsecks:ftt) . ';Front Yard .� ��Stde"Yanis -'Rear Ywd;� +" - ; Requited:"'. Pr'ov,ded ,Required Provided . ' Reyuircrl+i ,,.'Pruvrskd 16 t'Vuter ply {M Ci:6 a d0 §54) 17 Eloud Zone Infos meHon : 1 flSewuge Dlapasal System ' Zane t7uLti[de F7oad Zooe4 ": . Putdte I Pnnnta O '. `._Cheek tF esCl^:;`„. MunfctpnE of sue disposal system-� sECTION'a• PBUPERTY`OWNERSHIP�', 1.I Ois pert o[Recar Ntime( - Address fnrS, mice �.. .: SECTI„lJN3s,DESCRIPTIOIVOF,PROPO¢ED3VORK=(eheck rthataPP(Y) , r = New Construction❑ ,f ztsnng Btiildtng CJ, ,OwnerrOa upied C3 RtatrsCs)t+ „ Aiternton(s) ,O _Adduron':.C7 DemoltUan , :{ ❑ Ageessary8tdg Q„ wNumberbFtln(ts� _.; ,Odter;(] 9pectfy 4 Brief 'estiiption of Proposed Work ea� SECTION 4 ES'fIMATEIYCOiVSTRUGTIONOOSTS tram EsHmnted Costs of [lNiciel Use Only ' : (LuharnttJMnierialsy 1 _Bwldtng P $ " [ ' _ t Hutiding Parmir$ee St_ __ Indtcpibltaw tea is determined ' ❑Stondprd C:tylCown ApphcuHorrFee 2:Etectncal $ " ❑Totatt Project Cost'(Item�x mutttpiief a 3,Piurnbing $ �' 0{hcr<Fees $ " ' 4,aMechuntcul, (iIVAC) $` Ust 5.Mcehantcui`(Fire 5u "ress;an) e s-$ +:: Tutus Atl Fees ti �* -. Ches.kNo Ghet.k*Amount `Crsh Amount 6 Total Project:Cost ;k3 `... + i7'Putd`ntFutt „OOutstandtngBglurne+bue tq s s , Is r SECTIONS *C4PiSTItUCTIONS> RYICHS �- 9 I Licensed C3nstrnttion Supervisar'(#C&L) ` pp//e��n3e um t� Ex mu n � Nr pfC`8L Hokiec` � Pp' 1 � a �st�SL1'yFe ta?e be(owI + ° ' � , �� "" > tJ :� UnrtstHEledtu to35ptSbCu Pia ' �yy,, {.Resfniitcd t '' F&mil Dw*llfi 'r S1gn LnreA7SgO { r i + h Y41" II5On Dnl { RC.; ' R�mdehlttl!RoriBn .t'oucnn r Tittphane WS-, RLsriivntWl �Ymthiwiand Stdtn' { .� ' R�»idadlluL-So13a1:Fuel 8nmm A` h,tnu laelitll3uiHt ? 5 2 Re istered o Improvement Ctmttvetar{HICy " t° R f Cua�p y rune er HtG R gtxtruntr tune ; Regtstrat on Numb r ,,' Stgnatum glephatre S TI 6:WO RISI'VOMP>Id SATIOIV IN'SURATiCE AFF1pA V[T(1tA G L c ySZ § 2SCis#! VYorkers Gompensahon insurance ae idavtt must be totiip7efed atW submitted wail this appilcunun Fntlurc[u pn»tde this uft)du"vtt,wiii�rasuiE m the dontai ofthe ' unnca of the bothitptpjmp rit, r ,. Stgned Piffidavit Attached? < y,Yes " 'i L i No ❑ SECTION Tat OWNER AUTHORIZATION TO RE_COMPLETED WHEN ,,;:QWNER'S.AGEIV'i`QR"COL'+1'CRA'C'i'OIt=APFI:IES�Fdlts@UILI)ING'PERMIT . '': :- r t, as Owner of t@e subject property hbrefiy authtsttze ' to act on my beh'alf>to aid matrers relad to Wark uthorited by ttd3:bu tdtpg rent a`pphgatioin ` � { Y JL v S # s, ji A ^ i tic "of e „Date.' SECTSQN?b OWNERt dR AU1HOR3ZQ AGENT DECLARi>TION I Xfz nl�1�'� � r 1'r'1 cis Qttmer Authorized Agent hereby des lace tha to stare eta and mfonnat on pn the for rag appitea on«re true and accurate to the bes[ottmy knawledga and belts � t Print N Stgna rt' f rA Agent , m { .x i 4 ' Date St ed unde sins and. adtir�Eot u )< r..".�iz. . w NOT[Sa _ b I An dilnar who ptifums a bu�idtrtg pettttiE';tp da htsJherown work pr m awncr who Lucas nn uprcgtstered cunttauor (noiregtatered m the Flome Tinprovemeoi t'nntrnctn (fIICy Prtigram) wtl kitot hove acLess tp the urbdi atton u-« pmgram or guitratity fupd under M O L c t42A Other tmportanz fnfiormatten an the HIC Frp�ra ri apd Conativcfton SupervtsprLacstistng(CSL} cap he found in 7$OCMR Regultiupnsr11MR6 and l R iQ S reapr lively 2 When'isubstnnnalvarlt is piagned provrde the intortnatiop below - Total doors urea tSq-Ft)' auMcudtngISM ge tiriihed basementlt hes deal tx petrchi Hubnablu roam count _ Number of fireplaces w " _ Number of bedreoma Nttrrtbe�of�rathiooms - t Number of hti[fPoaths; . - f ,Pypeofheaungsystem Num�erofdksYpprch6 Pype pt ibaltag sp'stein Etttlosec Open -3 "tota►`Pipject Square Footage,may be subsututad fur "Form P,ro�ect Cost ' *' 3 4 {} � � 3 ACORD CERTIFICATE OF LIABILITY INSURANCE i2 0) PRODUCER (978) 745-6464 THIS CERTIFICATE IS ISSUED AS A MATTER OF INF RMATION ONLY AND CONFERS NO RIGHTS UPON THE CE° iF{CATE Rose Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 66 Loring Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 958 Salem MA 01970- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A.ESSEX INSURANCE COMPANY Noysa Construction and Remodeling Inc INSURER B.AIG 68 Loring Avenue INSURER C: INSURER D: Salem MA 01970- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 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 POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADVL POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDIYY) DATE(MMIDD/YY! GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 GE OOO PREMISES X COMMERCIAL GENERAL LIABILITY PREMISES S( RENTED 50 Ea occurrence 6 CLAIMS MADE ❑OCCUR 3CV6117 11/14/2007 11/14/2008 MED EXP(An ore person) 6 5,000 PERSONAL&ADV INJURY 6 1,000,000 GENERAL AGGREGATE 6 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 6 2,000,000 PRO- POLICY JECT LOC AUTOMOBILE LABILITY COMBINED SINGLE LIMIT (Ea accident) 6 ANY AUTO ALL OWNED AUTOS BODILYINJIIRY (Per person) 6 SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) 6 NON-OWNED AUTOS PROPERTY DAMAGE (Peram ert[) s GAR AGE LABILITY AUTO ONLY-EA ACCIDENT 6 ANYAUTO OTHER THAN EA ACC 6 AUTO ONLY. AGO 6 EXCESS/UMBRELLA LABILITY EACH OCCURRENCE 6 OCCUR CLAIMS MADE AGGREGATE 6 6 DEDUCTIBLE RETENTION $ HL 08/10/2007 OB/10/2008 X WC STATUS OE B WORKERS COMPENSATION AND 6878516 TORYUMITS ER EMPLOYERS'LABILITY 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEj 6 1001000 If yes,describe under 500,000 SPECIAL PROVISIONS bebw E.L.DISEASE-POLICY LIMIT 6 OTHER DESCRIPTION OF OPERATIONG/LOCATIONS HICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECALPROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Town of Marblehead FAILURE TO DO W SHALL IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. — AUTH ESENTATIVE ACORD 26(2001109) O(/✓l /LK-1 ©ACORD CORPORATION 1988 ry-INS025(DIM)D5 ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 e 2