22 SUMMIT AVE - BUILDING INSPECTION fL MillST-BE fILffT�Nfl APPROVED BY T*IE
.=PEXTD-13 PWR T-0.A PEFINT BFMG GRANTED
CITY OF SALEM
No. V "� ��\ Date
"WHINE .
Is Property Located in Location of a /
the Historic District? Yes_No '`Sfi«,
Is Property Located in
the Conservation Area? Yes No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: (w, i 74
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 17 v e,✓v\,Lx (6 Hl
Address & Phone (97f-) 9-10- o 3',57
Architect's Name
Address & Phone ( )
Mechanics Name —3')FarJ1U r ix -
Address & Phone q6 StWAI" -!54r r," MA (96(-) 6S9- 0677
What is the purpose of building? L- Cam` 9 RI- 51�-9 - OG'7 f
Material of building? If a dwelling, for how many families? 3
Will building conform to law? Asbestos?
Estimated coif '..I tJ( teas • <:� City License a N P' State License n O"? 7/ 9
Home Improvement
�CSs.(� Lie. f 9" ,/►`
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
1��E �ern0bel )]F A F��Sr FLOL� 2 F-i)GL
L71 (2c Nri.A: M .SR/M - /UCa CV-'TU" 'J!'
1 N--0 " CD �emRr" .Q rr> SA�e.
ko
MAIL PERMIT TO: '1/6 <t4eQyAr4
No.
APPLICATION FOR
PERMIT TO Q
LOCATION
S Al
PERMIT GRANTED
°1�a1 M"
APPMOVFD
v
INSPECTOR BUILDINGS
. I
f Clientq:l4795
CORP01
4105
A OW. CERTIFICATE OF LIABILITY INSURANCE 03111 a'PRoou Imo. ! THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
B.K.h c(Carthy Ins.Agcy.Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE:
10 Certajnnial Drive R E DOES NOT AMEND,EXTENDi
HOLDER.THIS CERTIFICATE 6R
I )P ALTER THE COVERAGE AFFORDED BY THE POLICIES BEi.OW.
e ab fi� MA 01960
q �� I
978 532-6445 INSURERS AFFORDING COVERAGE NAIC#
INSURED ! INSURER A: National Grange Mutual Insurance Co.
Corporal Construction Inc. INSURER S, American Zurich Insurance Co.
46 Shepard Street
Marblehead,MA 01945 IN$uRERO:
DiSURER D: :.
INSURER E: I!;
COVE 'A9^ES
THE O.ECIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY .S:IUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY 'E TrAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POL R IEi.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Rut I L1RR I. TYPE OF INSURANCE POLICY NUMI6R DATE POLICY
PoGDY EJ(POTATON OWi9
q GENERAL AatLm MPI93500 03/01/05 MOMS EACH OCCURRENCE $500600
K COMMERCW-GENERAL UABIUIY I DAMAGE TO RENTED 500,000
CLAIMS MADE nxOCCUR i ASDEIIP(AnyoneP ) $10060
1 { PERSONAL S ADV INJURY $SOD OOO
I
f j GENERAL AGGREGATE $1 000'000
^ENLAGGREGATE UMRAPPLIES PER: PRODUCTS-COMPIOP AGG $1000000
! S POLICY gr LDG
1 _A UTOMOBILE LIABILITY
£ COMBINED SINGLE LIMIT $
{ ANY AUTO (Ea erdE )
ALL OWNED AUTOS BODILY INJURY
I SCHEDULED AUTOS $
L HIRED AUTOS
BODILY INJURY
f NONED AUTOS (Pa acdel") $ONTI
k PROPERTY�)AMAce $
I:
UxBaUTYAUTO MAY-EA ACCIDENT $ 1
ANYAUTO
OTHER THAN EA ACC $
j , I AUTO ONLY: AGG S
j 17ICESSMNBRELIA lNB1IJEY EACH OCCURRENCE S
]OCCUR CLAMS MADE AGGREGATE b
$
} [ DEDUCTIBLE $
RETENTION S $
B wq u; Rs COMPENSATION AND 6ZZUBOMS75605 03(03105 03/03/06
EMI'U.,YERV DABILNTY FR
ANF�T:'Fi0PRIETORIPANTNEWEXEcuTivE El EACHACGDENT $100dOO
°tt Fyy�ii�RIIRMEMBER EXCLUDED? I EL.aseasE-EAEMPLOY $100 00
Imo'-'C L °PR°HSlw+bmow E.LDISEASE-PMJLwUMR $500600
I I
DESCRIP IOf,:i OF OPERATIONS I LOCATIONS I veac Es IEXCLusious ADDED BY ENDORSEL¢NT/SPECIAL PROVISIONS
I f �
CERTIO,E pTE HOLDER CANCELLATION
�t SHOULD ANY OF THE ABOVE DES POLICIES BE CANCELLED BEFORE THIE EXPIRATION
t:ityofSalem I DATETM3IEOF,TMMWJ I M UP WRLEIBIEAVORTOMAIL I_ DArSWRITTEN
Attn,Building Inspector NOTICETOTNECERTIFICATENOIDER NAIIIEPTOTHE LEFT,BUT FAILURE TO 00 SO SHALL
One Salem Green ; IMPOSE NO OBLIGATION OR LMBILIY D PoN THE INSURER,RS AGENTS OR
Salem,MA 01970 REPRF,SENTATIVES. I -
{ AUTHOR®REPRESENTATIVE
f!
ACOR O Zil(2001M)1 Of 2 #M47332 EG 0 ACORD CORPO(tAT(ON 1988
I`
i
LVPWMM b uealsaaasacaaees
O,Qlod ylxmsosd&w
600 wad*jdaeb&ON
dodo%MA 0011
IrIr1l�.rdes
Workers'Cmpo dm Inwreaa AfMvlt:EnOde Xon ben
AenMei�t Tebesmltert Phan P r M L.ealtbb
rjgme Ad . 4, �Le�?,LA�c- f ( (32Pa•LR� COrJ c - roc- '
CSty/Smerl3p�(1 �i ,t�l � rw� �/9YsK Pboee ft 9t't- 6 3 Y - Q 677
Aee yN m eaijlq- CbI*fk go eeprtegbm O t s a pact as for d t �M di Oepbvdk
1.lIar.a ,• _� R ONeerooeeedoa
e�bym(1d=d1or yaa+bosl• two lied As
Z.0 1 as s cola palpeieeor a paleeh Had as Aa atuA d dot t to Rmombg
dip adeoee eo a zwkwapo ' WOO eolco OU"leive L 0 DemoMom
s bra nw aIad s W~amp.b L A p Banmbs,dwm
��• i� s. l]WLasaaa�onitoaaflir 100'81eeMiealnpisoeaddMkar
rava�l a: Odbnb"V'"M b dAdr
3.0 1 s a rtdtotesing tepaldn 1I r!P"I iieBlepais err addkbm
eq'Clow o.Ij;11(4%ad°vvImvw 12.0 i1 eosin
iewtaaea Inv l t �raibsa' 13.0 Odor'
aau�iewweoe�)
'AxympVmW*A4bmdwiw/ls _MtdW000`"dim
Malrtiit�sY�foP�41�
�Hoso�a�a rba s�b�iela aailni�i/erly aryw doia i�waalnbbiaalil�ae`rd�sl nbai awr iliw!�aaoL
rCasfaed err eM¢AYbw aa+��Itld w tldhid�ieais Ar a arar a.►as�ura d44 wb1 eea+yois biwerntluL
I�w�dlat b/�eridq�vdnr'oreyrasadee baaneard f iir q dw/1r�ra 3wlrm b/Ar/�awfJa►atM
n
hwormuoa CmiplgNaare
ftftIforSdFIWLip,0 6Zzv3C�ys—�C S'7Sl�,n� t3apioao.Daax��D
Job Sift
AMaeb a ap0 of tM werian'aapeeatlee paBq deelaratlee pqe(daeh{tin Oaky eeaiar N a*stlaa date}
Paine b tawle aowap■ragairad under Sac"7JA o[)d(S,a 13'l ea ted 11 on lepidoe o[arb.nbd pedtts ote
&@ up Ia it,woo and/or cawymar ■emB err dd paaltee in for fm=oh g"WORK ORDER Bed a flee
otep eo V54kOO a day>PhW ft viOWw- Be advised Art a OW of dh$bt=M mq be binvwM b ft ofte of
Iavaedpd=alAa MA br ioueaeoe aovaw vaw doL
AP
="Wy,
asPAW sim'Iow"•1M*1 do as y*rwadMpgpwEMvb Raw wdmmes
Ploead I)K1— 639— o e-27
O,QkY1w� Dr ner+rrdlr b tAb srw,a M aatpiwrt4 dda►trM a,0lrrd
Cur ar Toes TaraMRJaar 0
laew AaMW*(dbrdt neap
1.Board of NuMb L Belldlep Dgwtaent L CMg/rowe Clark t Ekdrkal Iaepador L nunbin IeapO"
tc Odmr
Canted Pereael Pbo.e p1
Mataeh MM Gownd Laws ebapw 152 mq*a ill mot M b Provide WOMM.a p. wvm'
puteaat b t4 ,�� �1 dedsad ".••9401Y lI a dN tatvioe da,erba<aadaR MW mos'et ofbh%
�r>�Oal Or wrolea�
it G&W'WE aft or aalr aero ea mna
Ai a�/Mdur is dedeed ar"aa iodivid,al Dartomdit► °�►0°e�� d,loosed atpioycs�or am
bajoitaespiM,tsdi�httlaSr� a
diiethrNoi4 apoeisio�aroAtrb4ataabl,ae>P1a�t�pby'� fip�arovard•
bom ut dre.spars"set wha raids dtsei►oa sc of eel ddtti
dwd lita boaae otaeoder whe ONP%ps pmm b do M&NNN%eoseteedw or i'wa*r
aroedr rbaild� sashvat•otbecom"otmeaaepbymaot
bodommod
M(g.abpter 15%il2�6)alit SO"d g oeeery data r heal fi,aerat�q a>r wItY,Y the taaaaaee�
res,w,l d•■,aaa er Pm�b a baeYas r Wand" b thus�weib 1r aq
app wM hea nd padated aldtaeo daa jlwee wMa tie Irr,oa iwra�r,t �
/lddidoe,>b►.11ti. Isk i2m son"Neisrr dr eoeeaeoaarellt ttr aapr dir poi11ia1 aabdivielo/eaaid
aft:iae mw cons"1st dts pr�asosa[peblk watt aatit+ o��0ed°°e°�llro°eorlt�!e ivaeawee
dtfr deP/�>"bespxaadbdroostteelir�tead4rlb
APpdb�
Piano®eat do�' dadwit 00 by o dtaboma dal appbr b yar ait"fo�tsd,it
»m( add�aefo�asdpina (/) ab*=dial*)of
f00 C�ospegdw([3d�rLiddi I.it�l4► 1 mgal ,°e O&w thus dr
mt mbata r peruse,,m aateagitd 4 easy wothad0e Its l i.0 r 1iif doe
a Do1uy Y 1ppM Ha advlreitl dnt tbi amasvitmier bo>tghshled b du Dgwuw td Ld Wrhl
Aeeidaee fr oaadret dos 4tieem om eovemp AM car saro>.elm ad d,te W sledtdtr Vaa,eNstiit shosbl
be rebmad b AO eigr or lucre tMt the apptleadoa 1w Se paemitr ltotaw i betas aegmled.eat die Depetmast of
ladaaaid Aaidaetr. Shoot btveatgr 4 `s dr Ler r ityea aa► d 4 obui,waelraea'
yegteAplen,ealtb.DeeueterdMtsmbe<urb+edoor selFiwmedaoaylideanerbe+r
eMieweboeltoade,�rc.se >isa:- _
Q4'K Tows OIOdJa.
place be nn des til+ is e0Pbe ad�� I lye ptavided a rpaoe at *bulb&
of aw amdsvh far you b®oat b de evert der omw ofhwadpdom be'b eoemet you re�diq iL,pplkat
Pkae be ease b dl b thus psmitAieeeaa amdn�wm be aced e,xhraoe a,tabetr. h add",w appli"
that m suboeie mehipb pamWgcgm WVcmdm In any tdvem yew,used o,br submit oee atlldavh kdicsttas eenaat
PoUcy WMmWm(Noomnry)ad ada-kb Sib M &W Am appli"tboaid web*&a bo doaa is__JtdW at
towed.'A eoly otdr afedsvit tlrt baa been ofilc �!seopd r mated by thus eidr or tows may be pevided b thus
app m ptoddnt a valid afglttvt i m ft fir hum perm&r li¢are. A sew a®dwk mttsbe®ad oat aott
lt"
yet W hea„Cosa~qg dfiin it obttiit a llreala r pewit tot redead b eq btudeaa r aoemet W valsn
(ter a doe titxaM rpush b bus leave Out.)IM DoMM is NOT reoW b ooe4ble dda aMwk
would like b thasb^ is advsooe 1tr yaw eooperalioa ad aboaY you bm my owdom
of ye.
1ae Ocoee
lavadasioee
pkea do not heidb a dvu a a calif
Vat:Dga m el addeae,teitpboet used dta a®!a
7U Cammouweald OlMASSIct~uadb
Depe bud dltdduakW Acadmb
Ombf dbmd*d d a
6W WubkgW Sheet
Bodhaf.MA 02111
TeL 0 617-7274900 at 406 of 1-877-MASSAFE
Fai 0 617-727-7749
Remised 3-2&M wwm.mmpv/dia
'Rol IV yr .rw`MM" / t a
PUKA Pmopmw DLPA11 viT
120 Ma1/M11nven Dfl1w !M puma
SMAM MA 01 ar3o
TaL(W%71040N CO.NO
FAB JOM 740416"
DOPOM Of DillM AiltlUM
1a aeaWAa adlb&@ peovWWW dM&s 44 U4 i (frt r a oe.rWfo�
at m ft jpmm �l r�_�� —�ai e+da>+andd�So.s.oo..eeda..--
/wamat 1!Y a�as»'+s aba�1a dtl east Grin a P wl* nlliwaft
dlowd r6aA�albRr1/lis>4dlOA
'iti datda�ba dt�peaa�Grant �Laa�S dlraitigr a.n��c �w�n�s`�o� "G
Gr!�AOD Dab
YMY aompbo fa bllowigp lob1m11oat
MMU P>RW CU M V)
Nara off=*App&W
�s�2AaRA�, CC l&�
FfisNm`it�r
b
Addm%CIV A SIM
no abaw MW mf*u U dabda Qom Muado%tyeovadoaa,(�a adlar
aWWw dbul ft a amm bt dgwW it a pmpirtY.&Now aoNd.MM&pow
Ac ft adadad V UM dX $is"ad&I bm7dtypwmW a Scmw me b
W& M dr loadaa dit AdW
M