36 OCEAN AVE - BUILDING INSPECTION "pumllA1 ToEfNfa4l1D APPROVED BY 744E
MgpJI =PWOR TDA.PERWt AMG GRANTED
CITY OF_SALEM
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof Install SdrQ, Construct Deck, Shed, P001,
RepawReplace. Other:
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS N PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The wWwaigred hereby applies for a permit to build according to the following
specifications-
Owners Name
Address& Phone 06 O C e4l'U �U j I
Anititeces Name
Address 3 Phorw
Mechanics New ���-✓ ��'� I �tC.� y
r,.. e
Address 3 Phone Zv (i�i�) 5 9)f
No is"PAPM ur tw~
md"a OWidYip? IJooD N a WAW4.for taw awry taw"?
err tsriarq to law? A,,s A.b.nos�_1J-
EaYmatadcost Clgr Llouw I N A ♦ Al
$H�. secs 01-r%awt �(
Lic. I i 3L / TZB
SWaturs, f Apfiktmt
SXMW UNDER THE PENALTY
DESCRIPTION OF WORK TO BE DONE OF PERJURY
MAILPERMITTO: �36 DC��'V ffU2
No.
APPLICATION FOR
PERVT TO
57R�P �/1�Roof
LOCATION
PERMIT GRANTED
APPppVFm
OR OF BUILDINGS
. f
ud of Buiidiug Regulations and Standards
"1F HOME IMPROVEMENT CONTRACTOR i -
ReBisiratton:-138632: -
Expiratiohr 811/2007
Type DBA
t! RYAN.B SON
i - PETER RYAN , , -
a 13 SUNSE I DR ,,�Y% ,- �G-_•"�iyr-^^
; _ WAKEFIELD,MA01880- Administrator
CITY OR SALS149 MAlsACNYsaws
PUBUG PROPUK" 0ePAATI1RMT
12e WMANIN<TOM "Naar, Sae Puee
s�aM. �wa�ewusaTn e�s7e
TaLapm"& 970.749-USo 9W, 300
►as 876-746""
In samcdanee wit"the prnvidoas Of MM c40 3 A a candid=of your
Hnildia=1'lermit is that the deb&m"S &M this work shill be dbposed
Of is a paopedy licensed SON W&M diiposd faculty as deflaed by M(X
Chapter lilt 3 ISO A.
MW debris will be disposed of ia: /
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Information and Instructi011s
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JUI-01-2006(THU) 09:41 Curley Insurance (FAX)781 246 14qc1 P. on1/002
AGDRDR, CERTIFICATE OF LIABILITY INSURq''CE _ osjs %z o
PRCDUrCR (781)245-0033 FAX - . 1)246-1490 THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION
Joseph A. Curley Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3S Albion Street HOLDER.THIS CERTIFICATE DOES NOT AMEND.EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
rvak�field, MA 01880-0890 INSURERS AFFORDINGCOVLRAGIi NAiG#
INSURE.) Bart C. Costa ba Ryan & Sons GeneraT Contract INSURERA: Western World HT8013
13 Sunset Drive INSURER B: —
Wakefield, MA 01880 INSURERC:
INSURER D:
INSURER E:
COVL-RAGES ---
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING I
AN) REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAC PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCI I
POLICIES.AOOREOATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR=131 TYPE OF INSURANCE POLICY NUMBER POLICY CFFCCTMC POLICY EXPIRATION LIMITS
OUNFRAL41AOILITY NPP1010964 12/30/2005 12/30/2006 FACHOCCURkENCE S 1,000,(100
X COMMFRCIW.CENFHALLIAN11.1'IY DAMAGCTOPFNIEU $
rREMIT,E,r.I�:y 50 0 00
CLAIMS WOE OCCUR MED EXP(Any one parson) $ 5,(l00
A PERSONAL G AOV INJURY S 1,600'(100
GENERAL AGGREGATE G 2,000,000
CLNL AGGREGATE LIMITAPPLIES PER. PRODUCTS•COMPIOP AGO 2,000,(IDO
'OLDY PRCT O- LOC
JE
h AUTOMOBILE LIARILRY
C9MRINEO 6INCLE LIMIT
ANY AUTO iFn accingnp
ALL OWNED AUTOS BODILY INJURY —!
_ 5:)HIR)HI. )AU'I'05 (Far parson) —
HIRED Ali'IOS BODILY INJURY $ I
NON-OWNED AUTOS (Per auci0enl)
PROPERTY DAMAGE $ --
(PcrAccidnnU
OARAGE LIABILITY AUTO ONLY-EAACCIDCNT S
ANYAU'I'O OTHER THAN LA ACC $
AUTO ONLY: AGO $
12XCE9SJUMhkpLLA LIABILITY CACTI OCCURRENCE
OCCUR CLAIMS MADE AGGREGATE
S
DEDUCTIBLE $ T—
RETENTION $ $
l^JC -A1I,ti 'H-
WORKERS COMPENSATION AND LTi U1
E MPLOYERS�LIABILITY
9 LY I'H01'kIE'TOHIPARTNERIF)(ECl7(IVE
E.L.EACH ACCIDENT
c rICERIMEMBCRIXCLUDID7 C.L OISOASF;-FA FIAPLOYEE
I"yRs,rlg aarlba Undue —
�_ : 'ECIAL PROVISIONS beluw F L.DISEASE-P.000Y LIMIT
THCR
_T
OESCR ;TIDN JF•OPERATIONS)LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS —�
L
CANCELLATIONCERTIFICATE HOLDER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES OC CANCELLED BEFORE THE
EXPIRA71ON DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL
20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Walter & Mary Mielcarz BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIADIUTY
36'Ocean Avenue OF ANY KIND UPON THE INSURER,JTSJI0ENT5 ORREPRESENTATIVES.
Salem, MA 01970 AUTHORIZED IIAWESENTATIVE
ACORD 26(2001108) FAX: C978)740-9846 OACORD CORPORATION 1988
JU1-01-2006(THU) 09:42 Curley Insurance (FAX)781 246 1490 F'. 00222!002
NAY-31-2006(R'ED) 15 :ZZ Curley Insurance (FAX)TV 246 i490 P. OUI
Transaction Report
Send
TansacriTnn
No TX Date/Time Destination Duration. PA Result Mode
I 42i MAY-31 15: 21 978''409846 O' DD' 49' DDi OK N EC'm
Lam—
Curley Insurance Agency, Inc.
35 Albion Street, P.O. Box 490 Wakefield, MA 01880-0890
FAX COVER SHEET
Date: May 31, 2006
To: Walter& Mag Mielcarz From: Poll A. Berigren
Com ant Phone: 781 245-0033 _
Fax#: 978-740-9846 Fax: 781 246-1490
RB: Bart C.Costa dba Ryan & sons General Contractor
No. of Pages Incl. Cover 13
Certificate of Insurance
Should you have any questions, please do not hesitate to call, Thank you.
i,�v�