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92 ORCHARD ST - BUILDING INSPECTION (3) 1 I�i vTrr,•r BiiE 1' V AM ORNMED 'ITY OF 904M i is woprq LON"r �...�. of ftmftbarroer W�Ns,✓ i.uiss 9��©t Lr , �. 4- r wap.q�.ow r NiTtaflTl Pe APPL=T=PDR: Pww!Im Oft widdmi' r mpW bod SIR11pYl t Conrim.Doak shv4 P@4 KRA=P"=UMLF Y AODYPL�STILO•• Y TO A%q=DO.AVS N PIgON�N TO TM INSPECTOR OF BINLDH : Maby rppla tar•pwwM to b W roowft to d» 'q- Ow ses Nwne 0 �--,n�aL I Aditn A Pin 9;:) (-)Ccx-ua CA 6+ . tqm(?�) I-I OCA . Amhkooft Nwm Ad**=a Phom ( 1 M Nwm Addma A Phan. ( 1 wir r e.ra.pa..�rrrSr tWrl d 4ii'of driq,ter t or mmy I�f YY�htlq OOdwm to W" 7000 r upmvammt I . 6/�" Lie. / )3 I&qe,, X .a ..r saw oP Ut 11 TTSt PWOMLL DfiCir"M OF WiK TO®! P. 1 �' �� - off ����� � � , 3�� �.n �,�U r,�sPb�r�-rt— r .I' COfn/nOA{ffslah Of m6ackelid be1 , � . � ` A '2ep..iaa.w! ./�adr.bial.�setiu ab' Jamq 1 Camomll 02 111 e.rnmeaorw Workers' Competuation Insurance Affida* with-a prindpai place of business a>G c-Ag dojhereby'certify under the palm and penihks of perjury, chm (� I am an employer providing workers' compensation coverage for my employees working a this job. �.�v__a]ac5 Tn5 � LoUC�-5/�h�'I��y -Q3 • Insurance Compaery Policy Number 1 I am a sole proprietor and have no one working for me In any capacity. () I am a sole proprietor, general comae or or homeowner (drde one) and have hind the contractors listed below who-how the following workers' c6anpensat3on policim Contractor Insurance Com Parry/Po4gr Number Contractor insurance Com parry/policy Number Contractor insurance Com pasty/Policy Number (} I am a homeowner ptrforming all the work myself. I uneeneane o+ae i CO" ea"iumnwre we be fo wmd ei Or Of at 61 kn.eakau of Ow DU ler ce.ersre ".Mead—awe due eaaw"m mare eo-o•iar y rrwa,e•racer Seed-25A d r7Gl 152 can kid to ow:eoa-den of eri firm oewade ee"&n .1 a it el eel wi I.S00=&nW er aw rear':nereernwne a .ra n clri eeN4ier Ore loan of a STOP WORK RK ORDER sne a Sne elf S 100.00 a sal arawac awt. Signed this . I g 4Ik day of Qc+,akn c' aoc�y censeermllece fen --' o c g Geparcrwen cn_Inf Eoare Seieamens Office r,cslth Gepsrtmcnt PUBLIC PROPERTY DEPARTMENT ' 1 120 W^sHINaToN 9TRKW,3RD FLOOR smim,MA 01970 TEL(979)7494599 EXT.390 FAx (979) 74o-omo STANLEY J. U90VICZ, JR. MAYOR DISPOSAL OF DEB=AFFIDAVIT In accordance with the provisions of MOL c 40,S34,I aclmowledge that as a condition of Building Permit 0_ all debris resulting from the crosWWtion activity governed by this Building Pemrit sW be disposed of in a properly licensed solid-waft disposal faeift.as defrned by MCB,c ID.S150A. Zhe debris will be disposed of at 1 + P Location of Faci ft S n::z Lx,,4 Ik S1gnat ue otPennit Applicant Data FULLY complete the kftmadM- (PLEASE PRIMP cLEARll Ly Q-CT.or d,4-g a"l)* Name o0emut Applicant Cob,nc4r, , Onl;mi+ ,A Firm Nana,if S4 . O �O Address,City dt State The above statute requires that debris Sum the demolition.renovation,rehab or other alteration of building or structure be disposed in a properly-licensed solid-waste disposal facility as de dined by MCB,cIlL SI50A, and the building permits or licenses are to indicate the location of the facility. A.CORD CERTIFICATE OF LIABILITY INSURANCE vaooucl:a CIRCLE BUSINESS INS AGENCY DATE IMAV00M 31211200, 247 NENBURY STREET THIS CERTIFICATE IS ISSUED Ai A MATTER OF INFORMATION ON DANVERS, MA 01923-1001 AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TF (888) 661-3938 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER TI XW673 700 COVERAGE AFFORDED BY THE POLICIES BELOW. INSURED INSURERS AFFORDING COVERAGE CABINETRY UNLIMITED INSURER A: The Travelers Indemnity Company Of Connecticut ENTERPRISES, INC. INSURER B: N/8 122 REAR MAIN ST. PEABODY, MA 01960 INSURER C: N/a INSURER D: N/a COVERAGES INsuREaE: Nla THE POLICIES E INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE IN 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 LNG PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MAY NSN LTR TYPE OF INSURANCE POUCYNUMBER POLICYEFFE GENERAL LABILITY DATE IMAEDBV Y) DATEPO�EXPIRATION 680-566Y177q-p3 (MMOOIYY) O� A X COMMERCIAL GENERAL LIABILITY 10/21/2003 10/21/2004 EACHOCCURRENCE CLAIMS MADE ❑X OCCUR PrtEOMUC£ $ 1,000, 000 WYOeiel $ 300 000 $ 5 000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 000 Goo X POUCY PRO LOC RTooLersoMPCIPAGe S 2 OOO OOO AUTOMOBILE LIABILITY S 2 000 OCO ANY AUTO COMBINED SINGLE LIMIT ALL OWNED AUTOS (Es Xcidam) $ SCHEDULED AUTOS BODILY INJURY HIREDAUTOS (Pow ixnw) $ NON-OMEOAUTOS BOOILYINJURY (PM rudW) $ PROPERTY DAMAGE GARAGE LIABILITY (PM aceftro $ ANY AUTO AUf00NLYEA ACOOEM $ OTHER THAN EA ACC $ EXCESS LUISILITT AUTO ONLY: AGC $ OCCUR 11CLIMSMADE EACH OCCURRENCE AGGREGATE $ DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION AND $ EMPLOYERS'LUBIUTY HIC CTATD OM TCR1'LM78 EA EL EAOHACCIDENT EL.DISEASE-EA EMPLOYEE $ OTHER EL DISEASE.POLICY LIMIT $ - S . ySy DESCRIPTION OF OPERATNONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS J INSURED INSTALLING CABINETTS CERTIFICATE HOLDER ADDITIONAL INSURED•INSURER LETTER: CITY OF SALEM � CANCELLATION 7AtSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE WASHINGTON STREET EXPIRATION DATE THEREOF,THE ISSUING INSURER VVILL ENDEAVOR TO MAIL 10 DAYS SALEM, MA 01970 WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SMALL IMPOSE NO OBUGATION OR LIABILITY OF ANY AND UPON THE INSURER, RE AGENTS OR REPRESENTATIVESTHORQED REPRESENTATIVE ACORD 25S(7/97) 0 ACORD CORPORATION 1988 1 J Board of Building Regqulations One Ashburton Place, !gym 1301 Boston, Ma.02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 04/28/1965 Number: CS 087554 Expires:04/28/2007 Restricted To: 00 N t i PETER BAGARELLA 28 MARLBORO RD SALEM, MA 01970 Tr.no: 87554 Keep top for receipt and change of address notification. � ��e Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home ImprovemeitContractor Registration Registration: 131846 Type: Private Corporation Expiration: 9/26/2006 CARPENTRY UNLIMITED ENTERPR-ISEI PETER BAGARELLA = _ 122 REAR MAIN ST. PEABODY, MA 01960 �O„ 4 Update Address and return card.Mark reason for change. DPS-CA1 0 SOM-MG44101216 ❑ Address ❑ Renewal Employment 7 Lost Card