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36 PHILLIPS ST - BUILDING INSPECTION P w�ss APPRovEo eY PIER TO A.PlME!BANG ORANTkD CITY OF SALEM Vftd Zowq owe No h•1Mpdo OYIMel4h vwa 1a�tiw of IS Pf4PWV LQ01ftd In OarmNdM ANO . Ym4,_No NNAMIO PlR Ill APPLICATM P01% wont tm (Chle whiolwwr apply) ADA Amoof, ln@W Skft CW40W Dad&, &»d, Pool, A IMinPlna. OUnr t �t h aC'oa t-. k�i i 00 PLUM M L OUT L RMY A CDYN.lilLY TO AVOW DRAYS N PRoX@� To THE I!GPBgM OF BUILDING& The undarslpnad hwebq applies for a psm* to bWM a000f ftic to joto Yq owners Nowe / L i R Aditn a Phone 3 Pti -7 yy - 1 3 ArohbWs Name Ad*m a Phone I W ift c. Name Ache.•a Peon. c � why o rr p•va•w ems► �i a � 'I� 2.a� -v, WON d L J N•dwaiq,br how•• NMM9 wN mom omomm b bw Ndkg Md=d3A a a cr qr LiomM• • c� S a 5 slprwa. of Applicant 111111111M UN TIN PWNALTY, oP PWLRNW OFm+e'oRlc� N: D MAIL PEFW TD; 2 nro R W6 t> JP // vG YJM , 00 5' 5 i Na APPLICATION FOR PERW 70 coA,s7,oP-1c7— LOCMION 36 A//gyps PERFAT GRANTED . A�PP ovFD , OF I 1ilf I L I ; I YearJJaW I I I AITED S o6rrrjrI T 1 o L �,�� 5� ipL Y. i _ — -- - r1w ID"---- l bl' O jxliSTfAl - � ^w j .R_LL{EVATi o /V R E AI lT O Al v i b jl _RcAr A: 1)Al r 177 Sig c 0 D' Fy 'e a'R rR A NI eTi1 1I. C'TR 1/ ITE- 1CIJaLL , �I!/ N tiA Ti4,4 I i I I j /3 EN/1 I I i I - — S CL TO1 � I /o Air ' j Ak5A l I L) I I I I Blueprints Are Not Intended I i I � — — — ! ; 0 Depict;The Final'Construction f l EMO F1 11/liilllLl in Every Exact Detail. vx41^ 16.B„ a o y jgLu!✓. i- tcA115 K . i`ChE!-d lv?'1.x I � I I I I I IB1s1®. CERTIFICATE OF INSURANCE ISSUE DATE'MM/DD"Y' —1 'PRODUCER 4/20/05THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, Parente Insurance Insurance Agency EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 94 Lynn Street Peabody,Mass. 01960 COMPANIES AFFORDING COVERAGE COMPANY LETTER A CODE SUB-CODE LETTER State Ins. Co. - _ ., COMPANY B INSURED... ... . . — ..._ . _... _ - LETTER Frank W. Gasinowski DBA COMPANY C LETTER Bilt Rite Builders - -.- 2 Norwood Ave. COMPANY D LETTER Peabody,Mass. 01960 COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER. POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS LTR DATE(MM/DD/YY) DATE(MM/DD/YV) GENERAL LIABILITY - GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY - PRODUCTS-COMP/OPS AGGREGATE $ CLAIMS MADE OCCUR.; PERSONAL&ADVERTISING INJURY $ OWNER'S&CONTRACTOR'S PROT.. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) S MEDICAL EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED ANY AUTO LIM TLE $ r ALL OWNED AUTOS - _ BODILY SCHEDULED AUTOS INJURY $ (Per person) HIRED AUTOS BODILY NON-OWNED AUTOS INJURY $ (Per accitlent). GARAGE LIABILITY .__.. PROPERTY DAMAGE _. _ j. .... . .........._. .... _ ..._.:. _.. .. EXCESS LIABILITY EACH AGGREGATE ' OCCURRENCE $ S OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY AND WC0097251 4/12/05 4/12/06 $ 100 (EACH ACCIDENT) EMPLOYERS'LIABILITY $ 500 (DISEASE—POLICY LIMIT) 1 $ lob (DISEASE—EACH EMPLOYEE OTHER ) ;.OT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLLER . 'CANCELLATION f` a SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIR ION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE UT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILI NY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUT OO ED FUSE TATIVE ©ACORD CORPORATION 1,9881 i y: " r31 ow BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 068032 Sirthdate: 03/30Y1952 Expires: 03/30/2006 Tr.no: 21311 Restricted: 00 FRANK W GASINOWSKI 2 NORWOOD AVE ✓ ��p PEABODY, MA 01960 Actin/ `—"dmnasFjoner _may .Jjtt :OaYIYRd!!G.'42L(%L 61 .1flL'1rzCTf GJIX4: D Rnard of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 123127 - Expiration: 12/12/2006 Type: Individual Bill Rite Builders ' FRANK GASINOWSKI 2 NORWOOD AVE PEABODY,MA 01960 administrator BILTRI ACORN INSURANCE BINDER OS/0 DATE 4/O5 , THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. PRODUCER ac°we Eat: 978-532-5445 COMPANY BINDERS FacNe. 9785322217 National Grange Mutual I PACKTBD B.K. McCarthy Ins. Agcy. Inc. DATE �FEI TIME DATEE"U"RAnON TIME 10 Centennial Drive X AM 04/12/06 X ,xotaM Peabody MA 01960 04/12/OS 12 : 01 PM NOON THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY CODE: 2 0—171 SUB CODE: PER EXPIRING POLICY P. AGENCY 26627 DESCRIPTION OF OPERAnONs ICLFsmaOPERTY pnaeam3 L« dm) D• INSURED BiltRite Builders Loc#1 : 2 Norwood Avenue; , Peabody 2 Norwood Avenue MA 01960 Peabody MA 01960 COVERAGES LIMITS TYPE OF INSURANCE COVERAGENORMS DEDUCTIBLE COINSX AMOUNT PROPERTY CAUSES OF LOSS BASIC El BROAD ❑SPEC GENERAL LIABILITY - EACH OCCURRENCE $5 O D 000 I X COMMERCIALGENERALLIABILITY ( DAMAGE TO $50 1 000 CLAIMS MADE OOCCUR MED EXP(My one person) E5 000 _ PERSONAL$ADV INJURY E500 000 GENERAL AGGREGATE $1 000 000 RETRO DATE FOR CLAIMS MADE: PRODUCTS-COMPIOP AGG $1 0 0 0 0 0 0 AUTOMOBILE UABILRY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNEDAUTOS BODILY INJURY Perec t) $ SCHEDULED AUTO$ PROPERTY DAMAGE $ HIREDAUTOS MEDICAL PAYMENTS $ NON-OWNEDAUTOS PERSONAL INJURY PROT $ UNINSURED MOTORIST $ E AUTO PHYSICAL DAMAGE DEDUCTIBLE ALL VEHICLES SCHEDULED VEHICLES ACT UAL CASH VALUE COWSION: STATE AM D CUNT $ OTHER THAN COL: OTHER GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHANAUTOONLY: EACHACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF-INSURED RETENTION ?' $ e " - WC STAMORY LIMITS - _ WIDIUMCS COMPENSATION E.L.EACH ACCIDENT $ AND EMPLOYERS LIABILITY- - E.L.DISEASE•EA EMPLOYEE 9 - E.L.DISEASE-POLICY LIMIT SPECIAL FEES $ COON MONS1 _. _ _ _ _ _ _ _ _ _ . TAXES COVERAGES ESTIMATED TOTAL PREMIUM NAME 8 ADDRESS MORTGAGEE ADDITIONAL INSURED BiltRite Builders LOSS PAYEE 2 Norwood Avenue LOAN III Peabody, MA 01960 ALTgIO�ATNE ACORD 75(2001I01)1 of 2 #144 77 NOTE:IMPORTANT STATE INFORMATION ON REVERSE SIDE LEG O ACORD CORPORATION 1993 Ofa ofinvadlsadw 6"WasA me"Surd BOmwo MA 02111 wwmtaru g*W& worhkeW Compenmadm Inmuranm AM&vh: Bn9delirCoutracto wMedridamMumben Ann)kaet Infomatim Please F ttt Leslibhr Name 6e, 14 dpr �'C -[gu> Address: 2 /U d R W 100 D 14Y e City vN ( o C'(C d. Prime, 9 f 8 S 30 t 2 Are you an eapkW Cheek the apprmprlame ham TM ofproject dads): 1.❑ Isms a aep woh oz. 4. ❑ Ism s gmad aoelesaor mull 6 0 New cmmuedoa esuploymowundwParmhoW have b6ed So Sob-ocetraeaota 2.❑ 1 mm s mole proprietor a pmuw- vnm m tee mumebse Shea s z ❑ ltemodding Ship ad bmve no employee Tbee smb•oontrsans beve s. ❑ Demolidom w gu me in aw Cape*. 3. ❑ wadew w camp.teaumum 9. ��s adddiom [No wo*Am comps ioaQaeoe m ca, -,, and it lap Eleehicd or addidomm oft=bM araeired thdr > 3.❑ I an a bbome4Nasi doted all wort rW ofcxempdw pw MM 11.0 Pbmbiot:igsks or additions MYWK[No_ ad em'ON* a 15%11(41 and webmve so 12.0 Rooftepdtm imoQaooe ngoirod]+ cuployow Db weasw 13.0 Dice � fw�l ;AnywptmomatdmbbmmttoddwMoomnndMbdowlswigAwkwatot'm�—o pdkymbamdioa Hommwmmwaox&WdbsM' IIbdsIftsA•ydoltssmwmtanddmtinodddsmm.m,a moo subs*aamAS&*bdcaftneswk iConswi ss mr Awk thou not dsobed m sddMoad abed dm*ft u ofan m&vm6mlon me ank wodmt'ooaq.pdky kNorn WIM r sat mm exv ywAd is p►oWAv wev*ers'esmtpousdew buwm wfsr my onpleysa. ddmw h As p Vy m Wjob s&s Inmazaooe QompaoyNaorx , ' r Pbft r or Self-ios.Lie.f- WC oo R Z 1 Fapfiados Date: z lJlo Jab Site Addrat of C� (�'�• // f S C,[y Attach a copy dthe workers'eompesudou policy declaration paps(wowing the Polley member mad cWhudon date). Pslhue m So=aovagp U in. , f coda Section 25A of MGL c. 152 cm lead to die isgomidom ofafimiami penalties of a Han op to$1.5W.00 mmd/ar one-year fi pritaomeme,me wcD m dvil pain is in me gam of s STOP WORK ORDER and s Hue of up to$00.00 s day apsimt me vioim r. Be advised mat a copy of thk sWcm=my be fbfwstded b the Oillm of lovatiptiom of me DMA for ioausm coverapm veriflestim I mL AswsAy tAs puM adTpaahlSt mJ AW At Arfwna*m p ffi d WWm it s us daffmit Sku= c7� GO Dams Z ptmg, q-7 2q Y OAid We 006L Do and*T*In fAhWW4 to be cemgdewdb t&dr am salrld City or Two Persamewe t Issshq Authorky(eirds onc): 1. Board of Heath L Building Department 3.Ctyfrows Clerk 4.Ekcb lcal Iagmml r S.PlunM"Inspector 6.Odw Contact Forms: pboae P. Caenaal Iaws d►apta 1 sz require an eagbym n pmvid�a 001°0�O°�0°rar�� r—v-- . pmsttast b dds stata00. an rwP'm!"� to defied ar-...cvay prom m dw saviee of auntie under mY contract of here, etrpras or®V&k orst or wrim As ewp*w is defined sa"a mdiwidual.Pwamc ship aweiWoao oawnppmwas fir es o kid a mod or i°y two otr taota is a jobtetmps4 atl iscbtdin�tls lead a of a located enpbya►a the of &C a ttaslee in sJoist papa .n ociadw a other legd co try.cogiry i empby0 & lea tti owoa of a dwcMmtboase bavbtd more the Ares spartmals and who nsida t(weik a the s so& t dw,ellmt Doan of md►er who®plays pastas a do mmtmmoe.0oaibuCtioa ea repair war#oa soeh dweMmZ boose off as the gtotmds erbns7diai aPVaa>maat�ma shall sat bemn of mch empbymatbo d=md bs be a employer.' ItiM chapter 15%125aQ also sum tbat"eweq stale w lead Masdt efi W the"hlb awenM>a aq� reard of s Maw or poradt a opwam a brines err*eon oW b WWlap Is sppbeaot wbe bas 04 prdaad sumplo to wjde 10omp1eaee wil\the warms"seeress regokq&" AddidowaMY.KM lss.I Cn gem"Neidwr the commoawralA aer aY of ill polidd sabd isiom Shan is the pad>®om ofp*a wod<ttatit aotxptable evidaa of oattoplisaoe wis tie ieauaeoe nVk=mUof d&ehapw bmbm prcftmftd is tier m' " APPMaaw pkm fill out the wodoeea'composxdos tdlldavit.Wkuiy,by eheckbg the boos shad appiir to year dtoadoa mk if neoasm,s q*V )oa0 0(s,addraKas)and p>me uu*c*)alms wish their ea ddcd*)of im nma. Li wd Liabft C=4da OIQ of Lm"LJOW PatoasbW Uy)with m mVbym odic the the members or panes, ue not tegnjmd io can wodmW iamraoa If a LLC a LLP doe bave embyas,a policy is regabed. Be advised that this affidavit miry be swbmiod b the Departmeet of Isdoetrisl Amide"for eaoffnmadoa of iosaasoe covcrW AM be tn,re b dp ad date tie atlldsvlL, The at'f;dsvit ahowid be reoanW b the cdy or sows that the app&adoa fm the pandt at Bataan it bemt mq= 0ed,d the Daparomeat of Sbonld you bttve eery goegdm the b1w a ifye m regaked to obtdm a workers' rn lndtstriA AoddcsO at dt4 tmmba listed below Sd6mswrod eompaaia amm cola their policy.Owe can the Dep#m seltiosmsma ticeen sudw as 1ha 1109 trty w Tom Omdab it We and 1&b nw ma 1 a SPwO attthe botsom please be sae that the aidavit ooatp pried of the affidavit far YOU b f M om is the event the Offieo of 1westiptiont ba b contact You setadbg the apP*-Ia pkm be sore to fm m the pamWHcmae nnmba which w iU be used w a refaaa ember. In addides.tm aPDlicat that taut nbmA md*lc Wm*licmu spp&sum many Vve yaa,need osly submu one affidavit mdicatlmt I reaI pokey iofomtama(if wmwy)and mWu"Job Sine AddreW 60 20HCat should wri00"an beatbm is (city or tower}"A copy of the of davit that has bee odldalty stamped err tt m*W by the coy er tows=Y be lam to de WHOM as proof that s vaMd affidavit is on 1ne fbr lhpae pander or l cum A new a®davk mot be titled oat each year Where sbona owaet 9/eittae It a a Moan err permit not teDtted b say basiaea err cammaoial "COW (i a a dog limn or pe uit to ban laver efe.)said Pa" NOT regtmed U cmplela thb a®davit: The Offim of Wctdpdow would lure to thank you in advance for your cooperatios and should you bave any Wstioua pkm do wtbeutase 10 live m a tan. The DeM=cst's addtest'tekpbm and flts numb? the Commonweddt of Mmwhuselb Dgwuneot of Industrial Accidettb O®ot of Iavesdgxdm 600 wa*mgtafd Strut BosWa,MA 02111 TeL #617-727-4900 ext 406 of 1-877-MASSAFE Fax#617-727-7749 Revved 5-26-03 warw.mmgov/dia CITY OP SALKNo MASSACHUSCTTS PUKJC PINOPCMY DCPANrMLNT I to%WU N INaTON a,*an,ado hoots >� t9701 71MiM CV.300 /AR (9745 74044N sTANUM A U@ i JR vm Is DL4lOitAL Q!DBBRt=AFPmAVlr la aaeoadasoa riot+td psoviaior a[1iQ,a r4 33�I ae�ortad�a that r a oaaiitia� o[saildbld>liaait� .r dslda�sas IY aoar�suedo�aeHvig► pnamat by ft s.mft Famit la AipoMi Orin a pwall Soma odli R vuw disOoaat Adligti r dv6rl by Ircii.s/FL sI'S 'iba Aa6eta rID ba diaOra/d a! (O'er(1�i Q �,�► (,c/A S �,e l adm a(Faaidldr SWWM oSFarmit Applicant DaOa FMLY comPLO On hffimbj kh msd m U AM FRW CLUXLY) Naasa ofPamitAffNad i '- 01 /1 Pl FimNMI%ifow Adder City A star- The above eta W regalm that deal.&a dw ds fidoR rrovama rehab or odr altavlia oibmUM or suaftm be d;osad a a pmpriy6>ieaoaad soil wuw&VOS d bdliq r da6se/by A1�8.�S1SQl� and dla bniidioSpamib a Semar>A m indcaot tie Widos of ft how.