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146 NORTH ST - BUILDING INSPECTION �L�tNSiNIl6T�EffLf� APPROVED By T44E ,MMPECTDB PFWR TP.A PEW BEING GRANTED CITY OF SALEM No. ..4 1 Date 2: / 65 vv✓✓ ;�`.3 yeti,. /r am Is Property Located in Location of the Historic District? Yes_NoZ &d1ding /�4IVO&f5T/ Z — Is Property Located in �oNDe 2 the Conservation Area? Yes No z BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool, Repair/Replace, Other: 1�iTUfi�✓-PrIL 2�lay�L �rrc1�Z 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 C:/f/1�5�PiiFE� /1 K Address & Phone a*A1ZgA1 f 9>9)13�-6 - /Z S� /bn9�3v.2Yi,�lR oi9�3 Architect's Name Address & Phone ) Mechanics Name Address & Phone �c� Anx 692 `/_y""-r/11 'oy ( �Pi) 3lrSScsC7 What is the purpose of building? ��� l�cGssJ77f3 C Materiel of bulkling? If a dwelling,for how many families? Will building conform to law? `� Asbestos? p Estimated cost -�i� PO d City License n N A State License N�S ( �> �!3 Norte Iaprovetaent Lic. 113720 Signature of Applic SIGNED UND#R1H1f PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE MAIL PERMIT TO: eNR151-zvffh-;e o3 r — ]N No. APPUCATION FOR PERMIT TO LOCATION PERMIT GRANTED AP VFD a ,moo INSPECTOR F BUILDINGS v CITY OF 5ALEM9 MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT • 4 120 WASHINGTON STREET, 3RD FLOOR 1p SALEM, MA 01 970 TEL. (978)745-9595 EXT. 380 FAX (978) 740-9846 STANLEY J. USOVICZ, JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40, S34,I acknowledge that as a condition - - —- - of-Building Permit# -- -- -all-debris-resulting-from-the-construction-activity-- - - ---- --- — governed by this Building Permit shall be disposed of in a properly licensed solid-waste disposal facility, as defined by MGL c III, S 150A.A The debris will be disposed of at: lO of� 5' � e �f>ze 7< vGP Location of Facility �/7 Signature of Permit Ap Date FULLY complete the following information: (PLEASE PRINT CLEARLY) Name of Permit Applicant Firm Name,if any Address, City& State The above statute requires that debris from the demolition, renovation, rehab or other alteration of building or structure be disposed in a properly-licensed solid-waste disposal facility as defined by MGL cIII, S 150A, and the building permits or licenses are to indicate the location of the facility. l ACORDTN CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DDAYYV 3/3/O5 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Divirgilio Insurance Agency ONLY AND CONFERS NO RIGHTS UPON T HEC ERTIFICATE 252 Maple Street HOLDER THIS CERTIFICATEDOES NOT AMEND,EXTEND OR P.O. Box 8065 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lynn, MA 01904 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Patrons Mutual Insurance TOP NOTCH FRAMING & GENERAL CO INSURERS: LIBERTY MUTUAL 121 BELLEVUE ROAD INSURER C LYNN, MA 01904 INSURER D: 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 D' POUCY EF FECTI\£ fOUCY EXPIRATION LIMITS POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ 1,00D 000 A COMMERCIAL GENERAL LIABILITY CTR0004870 3/31/05 3/31/06 PREMISES Eacccurence $ CLAMS MADE OCCUR MEDEXP(Anycneper.crn $ 5.000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY 7 PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILY RV $ SCHEDULED AUTOS (Perr person) HIRED AUTOS BOD ILY INJU RV $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO EAACC $ OTHER THAN AUTO ONLY. AGG $ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERSCOMPENSATION AND WC STATU- OTH- T VI B EMPLOYERS' WC5-315-351649-014 4/8/04 4/8/05 ANY E.L.EACH ACCIDENT $ 10D 000 ANY PROROFR IETDR/PPR TNER/E(ECUTISE OFFICERIMEMBER EXCLU DED7 E.L.DISEASE-EA EMPLOYEE $ 100,000 If tes,dwcn be under SPECI AL PROVIS ON S below E.L.DISEASE-POLICY LIM IT $ 500,000 OTHER D ESCRIPTIO N OF 0 AERATIONS/LOCATIONS/VEH IDLES EXCL USIONS ADDED BY END CRSEM ENT/SPECIAL PROVISIO NS CARPENTRY & GENERAL CONTRACTING CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESC RI BED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _DAYSWRITTEN SALEM BUILDING DEPARTMENT NOTIC ETO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TOD OSO SHALL SALEM, MA 01970 IMPOSENO 08LIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORRED REP TA E ACORD 25(2001/08) ©ACORD CORPORATION 19 88