1 NEW LIBERTY ST - MUSEUM PLACE MALL� _ Ward
N LO�� �-.J�`� City of Salem
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p���IC�►TION
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PER111fIT TO BUtLD ADDiTION, MAKEALTERATIONS OR NEW CONSTRUCTION
IMROR7Al1lT•APPI�nt to cvmPlete aU-ltems in seetions:l, Ib n� N, ard IX.
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(� AT(LOGIIOW. � . Te�n
LOC.ATJOM A!D ppgssmgfl
� . eE7w�N .: _ . ..�sa�n � . .,�. ..
BUILDING �-�T—�� -. �
�
q, TYPE AND COST OF BUILDiN6'�N'aPd��:�������
�. rrvE oF iMw+ovanoir a ewovoseo use•FOR ro�nounoN-usE�+osr A�r usE
. � �, �.' � . . � � � Moanna..rr
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,z o �.�„ ,s.a�.�.�.
, O „�OItlo�M�aidd�..mer,.,,r�ee.a,.. .
Iqwnp uYm_a00e0.Y anY.�.0�a 1� ���❑'Two a mde tr�i�Y•Enls nu�tl�+ �f"l y�r. ,:.
d uib ... .__ i:7
. �3 a AMerao�ISb 2�Oa�/ � .. . 2/ Q���99�Y�
. Q R�.�� 11 Q ��aE01111�1►' '� ❑rSMYi.s.�lii0M1m0��W�i� � .
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. S ❑ W�e0��9L,,,,ue'f,,,,i1„s,d�Gwnnler . _.� 2+ 1�1.olb.e.uk,o�
d wrs n d�a.q in P�rt 0.f7) 13 ❑ GraP 4+..
b � �9NMpopdy 16 ❑ CaeOort 7S � PWYeMWf�
�;Q,.RrL0e4 fErrY•oYw�OuC�lionl
7 Q Foumo�aW 17 ❑ OOr'SP,cYY . 27 ��Slona�� -
� ,m� 3MR lows
� &OWNERSWP .
e Q �..aw�ad.�«o«.�n.m� z� � °e--so�car
� irisle6ai�aG . � .
9 a PW�c�FeESK Sr+ss a laal yo�!^M . . . . ..
. p�,,,�� rio;,sma,w c oeaoce�oeo+.�!eoo.w�m.a a.iamo�.•a woa o�asw.
C.COS7 „�y,:e a�oo.mu�an eu+a�n m�e�e�eran'�"oa ae�aerr rtno�eoroti
evoolo��s o��kr de"aaiasr aow.��a�uro ei�q.ai�e eWtlYw
Rro
p e s � y�y.�1�1.�uxa.em�n9le�EinV'��een9e�s�gtl.M�O'°F°rOL�t .
ia ca+a:ro�+ n �/
roa�iguraaincr:�e,e.ti / . �4�tr/Jr06 � " p/��•5� T-�
no+�w:+� " C,i � n ? .
z B�era f /� �i �—
' � i-t /"lat -� i"����_—
n f�.na.�v
.{�fUrirq.�r��9 ._ . .
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�11.�9'fII�COBiOFIMPNOVHAEM � P811$.E-1..�
•
111. SELECTED CHARAC7ERISTICS Q�BUu.D1t�iG -Fnr new buildings and addi�ons.
canPlete on a�Rs J 8 IG,aAothers skip to N
E P�T'��� F �TRPE OF�ATWG FilEl c. Trve oF stwac.�o�saosw � Trve oF wECN�wcu
�� � m.Q.p,aeora�scess�r w.��•r
3p :-►yso�n:t+��� � ..
31 �'V/md�a�r 38 O7 11 Q"R"'r°b°0��� y. Q.y �S a No
' 37 �JeEfi1Y
92'a"��bs li TYPE OF WATEA SUPPLY .vArws M+�w�f-
�,II�.;+�,�,,, ��� �.��a....�. .�.� �, -�. � �
3..D ow'-sa.� 'a-Q d""s°w" i ,a:�] rn�w.a+�
J.DIMENSpN$ �
°� "°"1OH°"� M:. DEA40UTION OF STAUCTURES:
+s. roai w�m bn a mw area
�nooz wxo a,a�a ; }.�a's;APP�wal from Nistorical Commfssion been received
-��"""" ' fcx.arry structu2 over fif�'(501 Y�s? Yes_ Np_
sa T«r m�ae.,n a ,;';"'�g�(e Number
K 1AIMBER OF OFFSTpEl7 pppNlN(',Spq�6
s�. �„ Pesr�omra:
sz °"mo'. - ''7�lVE TFIE FOLLOWING UTILfTIE$BEEN DISCONNECTED?
li: �
��e+nK auinwcs oKr Yes No
xi E,�..e • " :� : •. . : ,: :
, ,.,, ._..,.
, . ,._. _.__,�. .
Fr . �
s�ii�nee�a Sewer;
� wr �liv1ENTATION FOR THE ABOVE MUST BE ATfACFIEp
- BEFORE A PERMR CJW BE ISSUEp.
_ .
N. COMPLETEfiF{EFOLLOWWG;
H"�or�c-Dis�ict? Yes_ No (B Yes,Please encloss,
... ---- _. __
Aoam�tioo hsm-Nist.C�; ,,..
_ .._. _. ._ .
Conservation Ar�? Yes_ N6_ (B Yes.Wease enc�e�rder of Cond'iipip) - - . .
Has Fire�Pre�engon epprored and stamPed Plans a ePd�catia�s? Yee` i�_
Is propeAy bcate�in Bre SR3t diShid7 Ye�_ Wq_� .
�dr wip�2orti,g?_ �/eg_ Wo_ (ff no.er�close�6oerdd�A9veal de�ion)
Is bt grendfalher�d?:;yeg� �,�p_ (ff YeS.submit docurtierifatipn/i(�0.s�mit Bo�d of Appeal de�isip��
H'�+"�6rucbon.i�s tl�e_prvper Rafing SIiP been encbse�7 ,ye„ �_
,:M.
Is ArohitecturahAc�Board'approval required7 Yes` �� (H Yes.subnet dpquneMatip�)
Massach�State Caitractor Licer�se S Selem licenee�
�0��P�e�nt ContaCbr�t
. . , . .... . �eo�vr�rs;Exe�t torm(it aPPfi�ble) Yes_ Np,_
.. �• . � :� ��CRn ... + . .. e:. ..., �. . . ..
CONSTAUC170N.T0 BE..COMMENCED WITHIN SIX Is)�OHTHS OF ISSUANCE OF BUILOWG PERMIT
CONSTRUCTION IS TO BE COMPLETED BY: 'N e^eMer�si�is^eoessarg Pl�se subnN
� in writing 4o ihe in�Spectat�QY g`�
K 1DENTtFlCAT10M- To be cotnpleted by all aQplicana
� "�e aussr•N.neer,mm.
1. . �//.ntlWY � 2IDCab klNa
Owra � � .. ...
1i�s
Car°ctr . , . � �- c �. '
. .- - _ ' �r ,: . . . . .. . . � -
1 � ' . Lion�Ila
..�4aw — � S .
FrP�r
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� ��Y a.'MY tlffi�he M9rlc�s2t�ar¢eg tiY Mle owner Of recotd 2ntl C1�6h2ve tieen -
as his eunariZee- � we awee to conbrm ..aN t een aWqoraed by the oWner to make IAis�ePP�ca9ai
��+2 0} �D �13w9 of Nis iunsdic6'On.
i .�es4 � �� I
C . �S -CJ �
va�2�7
VI. VALIDATION
'Budding
Permit number
Budding
Permit issued
fludtlng
Pemtit Fee $
Certificate of Occupancy
Drain Tie
Plan Review Fee
a
a
a
NOTES AND Doig • (For department um)
PERMIT TO BE MAILED T0:
DATE MAILED:
DO NOT WRITE BELOW THIS LINE
18_
- FORDEPAR'TMEW USE Oran
Use Grow
Fie Graft
Uva Loaft
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD
REAR YARD
NOTES
77 r I
his certificate is executed by Liberry Mutual la urance Group as respects such insurance as is afforded by those BM0068
Certificate of Insurance
This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This terminate is act an insurance policy and does not amend, extend, or alter the coverage
afforded by the policies listed below.
r 111. 1... ".-.r.. r ....
P.J. SPILLANE CO., INC.
97 TILESTON ST
EVERETT, MA 02149-1928
is. altered b an re uiremevt
Ex vadon T e
Continuous'
Extended
X
-Policy Term
Workers Compensation
General Liability
HClaims Made
X Occurrence
Retro Date
Automobile Liability
X
:Ownedn-Owneded
Umbrella Excess
Inland Marine -Install.
o..1..... ..
03/01/2005 11 YY2-111-256970-014
03/01/2005 1 AS2-111-256970-024
03/01/2005 1 YM2-111-256970-044
/S l
to all their roans, exclusions and conditions and
Coverage afforded under WC law of Employers Liability
the following states: Bodily Injury By Accident
Each Accident
Bodily Injury By Disease
Policy Limit
Bodily Injury By Disease
Each Person
General Aggregate -Other than Prod/Completed Operations
Products/Completed Operations Aggregate
Bodily Injury and Property Damage Liability I Per
Personal and Advertising Injury I Per Person /
Other Liability
Other Liability
Each Accident - Single Limit - B. I. and P. D. Combined
Each Person
Each Accident or Occurrence
Each Accident or Occurrence
$15,000,000 Single Limit For BI & PD Over Underlying Limits
Per Schedule
C Project: Museum Place Parking Garage
O EK Project # 040039086
M Garage Repairs
M Wavier of subrogation applies to the Additional Insured: City of Salem (Owner) and including their respective members, officers, directors, stockholders, beneficiaries, agents,
E servants and employees, its successors and assign as their interest may appear.
N
T
u me cemncate expim en date is continuous or extended term, you will be notified ff wveage is terminated or reduced before the cerfifia[e ezpialion date. However, you will not be not ed annually of
the continuation of coverage.
Special Notice - Ohio: Any person who, with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or
deceptive statement is guilty of insurance fiaud
Important influ ation to Florida policyholders and certificate holders: in the event you have any questions or need information about this certificate for any reason, please contact your local sales pmduceq
whose name and telephone number appears in the lower left comer ofthis certificate. The appropriate local sales office mailing address may also be obtained by calling this number.
Notice of cancellation: (not applicable unless a number ofdays is entered below) . Before the stated expiation date [he company will not cancel or reduce the insurance affonled wder the above
policies until at least 30 days notice of such cancellation has been mailed to
Office: DANVERS, MA Phone: 978-774-0300
Certificate Holder:
City of Salem
Purchasing Dept.
120 Washington Street
Third Floor
Salem, MA 01970
MARIA ABRANTES
Date Issued: 05/26/2004 Prepared By: IS