3 SALT WALL LN - BUILDING INSPECTION r '
What is the current use of the Building?
l rnn r7� If dwelling.how many un'ds?___--
Material ofgui{ding? V Asbestos?
Will the Building Conform to Law?
Architeds Name ( )
Address and Phone ar
Medtanie'e Name
Address and Phone 30 0
Conslyuction Supervisors License O HIC Registration 0
Estimated Cost__ GG Permit F w Cak;usatlon
Permit Fee: Estmatsd Cost X$1/$1000 Residential
EstIm.W Cost X$111$1000 Cammerelal
- An Additional$6.00 Is added as an
Administrable charge.
Make wro that all fields are properly and legibly wntten to avoid delays in processing.
The undersigned dam hereby apply for a Building permit to build to the above stated
specificatkxa. Signed under penalty of perlurY X 0} •"
Date 5 t� d
S1 0�
J N
0
� y V
' BOARD OF BUILDING REGULATIONSi
Lkeneec.CONSTRUGTIONSUPERVISOR
x
Number GiSr.'`092158 4�'
Q, Birmdate 09/08/1955
3 Ez i s 09N8YQW— Tr.no 92158
� s ?I
I IM CHAEL;i 0.SBORNFr
30 DOLLOfF AVE `ra1' :a
BEVERLY, MA 01915fl }
r 5. . 3" ''- CommWlo�er
B,aar/ldeof Building Regulations and Standards
HOMEIMPROVEMENTCONTRACTOR
ReQ�I0r!'L ,16312 TAi 128358
Ei—PIW lo- S09008
yf: � I Id`idual
MICHAELOSBORIE1
MICHAEL OSBORt
,,',COVE AVE —� AdmillistFator
BEVERLY,MA 01915- .- - _,.... ,9»-.•rxr+^"-'
DAM IMA&D
DNY)
.. A 1LLl 01 05 U.% 18 07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
E A STEVENS CO INC HOLDER. THIS CERTIFICATE' DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
389 MAIN ST BOX 188 COMPANIES AFFORDING COVERAGE
MALDEN MA 02148-5076 COMPANY
A CENTRAL INSURANCE
INSURED COMPANY
MICHAEL OSBORNE 9
COMPANY
30 DOLOFF AVE C
BEVERLY MA 01915 COMPANY
D
COYERAGES.
0
.........
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
LTR DATE(MWDD(YY) DATE(MWDDfYY) LIMITS
GENERAL UABILITY BOP7986677 10/-0--5706 —1-0-705/07 GENERAL AGGREGATE $2, 000 , 000
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG s2, 000 , 000
CLAIMS MADE FX—]OCCUR PERSONAL&ADV INJURY $1, 000 , 000
OWNERS&CONTRACTOR'S PROT EACH OCCURRENCE $1, 000 , 000
FIRE DAMAGE(Any one fire) $ 100 , 000
MED EXP(Any one person) $ 5, 000
AUTOMOBILE UASIUTY
ANY AUTO COMBINED SINGLE LIMIT $
ALL OWNED AUTOS BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
I AGGREGATE $
EXCESS UABIUTY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
U
EMPLOYERS'UABJUTY I H"
WORKERS COMPENSATION AND TWW LIMITS
ER I'
EL EACH ACCIDENT $
THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $
PARTNERS/EXECUTIVE
OFFICERS ARE EXCL FL DISEASE-EA EMPLOYEE $
OTHER
DESCRIPTION OF OPERATIONSILOCATONS(VEHICLE&SPECIAL ITEMS
CANO
E
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
MICHAEL OSBOURNE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
LEFT,
30 DOLOFF AVE
BUT BILITY
BEVERLY, MA. 01915 0 N N TIVES.
AUTHORIZED
F.
vP , GC C
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
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ww wo'Compwadoo Iaaarana AM&v* HopdwrWCo
Antudgmt
Phan sys.r r
Natste l •Nl f C�-��� �'cC���r-t„
City/ Phone 4-46 7 _
An yes as owpayrt Cbeek the ayproprbb bast
1.0 Issasampbywwidi 4. ❑ 1amapawlomtradwandI
mpbym(1411 aad/er Pa "=).a Ism hired the d` Q N@w C00wastdoie
2.)41 an a sok proprietor or pesates. lived an the washed Shwa t 7. Q Bamodelity
Ship and have an amployw These sawoo0taelw haw A Q Deasdldan
world" the me to any capacity. waskem'comp,'m manse 9, Q Buildingaddklan(No wadoW comp manaeoe J. Q We an a oaepesadon and it
3.❑ 1 ho ownw ofiketa haw exam, that IO.Q meow mew or addhtom
dopy all work righa of asamptloa pw 11 m 11.13 Phnabbg repairs of rddidom
MY"(b wteltaea•comp. a 132.1i(41 aed vie haw an 12.Q Itoaf mpaha
imatranoa eequked)t empioyaoa.04 wnckrsa' 13.Q Other
Cam iormaoee )
;M Mph/ad dub Its el�eln as w ar crates Mew As%*��
RasaaaaaerYaraY�ftllYSol�YireWyartwditratrts�deslbwtlberwd� Ma
tCoersaae Asf tank*b arc nm imAw n add deed Styes dtaotp as acme of r �ast►
MOMMMEMEN� eiteasaaos n1 tkeY aada'e°r� 1�tc!tee
w der b prevfdfst worbns•nwpawden GcrrnueaJor wl ew/�yeea Nefsw Is/bPe ft wad jeb sdb
I:tauranq Company Names
Policy 0 Or Self-ices.Lies N
Fspindoe Data:
Job Site Address CUy/Shq/Lip
AttaeY a copy at the workers'wmpenSatioa policy deslantloa pap(Showing the Policy aandw and expiration dw).
Failure to secant covanp as reraieed under Senior uA of MOL L 152 Can head 10 the imp oche of aimioei P=aWM of a
fuse up to S 1,300.00 anwor=*.Yew imprisonment,as wall u civil penaldn in the fmm Of Al STOP WORK ORDER and a Aso
of up to$250.00 a day spiot the vioiatae. Be advised that a copy of this sasommat may be forwarded to the Ot7lee of
Invesdgadoas of the DIA far insursoc covtrap vaWadon.
/do here)eerd/y wrda rbrpoGSs and pe dgw ofpf,y.,y Am as Ja/oiwsdoe Prov!/ef above L Ow awf rorveca
O/Jlrid use os/p Do sot wri4 in 1*18 area,to be esNOW by MY or town 04kid
City or Town: Perosivueasa
Issuing Authority(clrcb oast):
I.
Board of Halth 2. Bulldleg Department 2.pryfrowa perk rI. Electrical Inspector S.Plumbing Inspector
d. Other
Contact Person OL.__w
`.� CITY OF SALEM
PUBLIC PROPRERTY
• '� DEPARTMENT
\l.uc�n 120Vt�.\iIiIV<�iJNSTREET SALr\1,MASSACHI.SLI--ISu19/C
Trt:978-745-9i95 #F.vc:978-74G)846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # _ ._ ._ is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111,S 1.50A.
The debris will be transported by:
d"l1cl�cl�1 C'9
(name of hauler)
The debris will be disposed of in
(namr of facility)
la�l�l �t�ility) .
. '. ,�crn,icappi{cant \-
' �� ,:ate -----
'S' PUBLIC PROPERTY
DEPt1R'I1bIFr�1T
KMAWN"ORMOAL
wroe
t3O WASUNGTn -%MAT 0 SuEK Wsua LSk1-S 01970
'h7:M. 7d5.9595 0 PAZ 97L740.9W
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OC irANCy. FOR ANY EXISTING
STRUCTURE OR BUILDIN
1.0 SITE INFORMATION .
Location Name: Building;
Property Addreax_3 --
Property Is bested in a;Conservation Ares Hbtorlc 01wict
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land ------
Name: r\6
Address: 3 Gt,XtVAIV LY)
Telephone: qar�,,L U
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Oemolition Existing
Approximate year of Area per floor(sQ Renovated
Construction or renovation
of existing building New
Brie[Own'ption of Proposed Work �E'yv�/01 &'C
c� �'IBrM Blear,
--------- ------—
Mail Permit to: C4 w0L j y�