10 SYMONDS ST - BUILDING INSPECTION fL1MN�*NSfi-9EfH.{��D APPROVED BY T IE
UaISPFC7iiii ,pIFmiR TP.A.PERNT $SING GRANTED
CITY OF SALEM
\!i Date 3 / U`
No.
it
a -
Is Property Located In Location of /0 SYM0NOS
the Historic District? Yes_No x
gnilaing S4CE4 A 9- O Z
Is Propedy Located in
the Conservation Area? Yab_N6
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) R Reroof, Install onstruct Deck, Shed, Pool,
Repair eplace, Other: 4r
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:
Owners Name
Cu o i c v a t 4,241
Address & Phone L 6 ACON 171 S<}61CM r 1
Architect's Name
Address & Phone
Meehanies Name E✓ N6 � L sw /� 3"
Address & Phone A00 9 S � tY�B j 53S" 3�
What Is the purpose of building?
Material of building? cC If a dwening,for how many families?
will building conform to law? ��J Asbestos?
Estimated cost - 2S0 _City License• N A state to
e a C t7
Ems improvement
Lie. 1 i x
'!9 natu of Applicantw
P,xp 2/loloe SIG UNDER THE PENALTY
O ERJURY
DESCRIPTION OF WORK TO BE DONE
jeEPcgCE SRO/N6 <}nV /MP/gd�� ST96>c r y
DG 711C Sv/G D/ A)
MAIL PERMIT TO:
No.
APPLICATION FOR
PERMIT/TO
LOCATION
PERMIT GRANTED
aPLL Z-z" 2C> o6
APP OVfD
#lP TOR OF UILDINGS
CITY OF SALEM, MASSACHUSETTS
• PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3RD FLOOR
SALEM. MASSACHUSETTS 01970
STANLEY J. UEOYICE, JR. TELEPHONE: 978-747-9395 EXT. 380
MAroR FAX: 979-740-9046
Salem Building Depgdy ten•
Debris Dls 1 ro m
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
�E96 ?0Y d yMp (Location of Facility)
Si a of plicant
Date
?Ire Commonwealth ofM4ssae6usdb
Department of lndusi iel Accidents
Orci 41k,irstlgadons
600 Wasidnston Sbed
Boston,MA 02111
wwwasmgo>MM
Workers'Compensation Insurance Affidavit Blinders/Contractors/Eledridans/Plambere
AvpHcmd Information Please Print Leznft
Name : ayj y, RRDPE2TY seeNlee-r LLe
Address: 300 49NI "Ce 570e 5y/7C 31/
c�tyistata PF���r N1A . �/9 Phone# 9 -s3S-3�o3�
Are you err eri Cluck ft Hutchens'
?7, aP Type of project("Rdred):
1. I am a employer with er I am a general conksc or and I 6. ❑New constnWidan
employed(bin and/or past thn4* havelifiedfinm6eiguackus
2.❑ I am a sole proprietor or parma listed on she snacked sheet= y o Remodetioj
skip and have no employed These sub-eontracoosa have S. ❑ Demolition
world far me in any capacity. a'adq,comp.inauraoc� 9. q�s aaamon
[No ���, 5. ❑ We die a corporadon'M
]a[]Electrical mpai s or additions
ofHoat kayo eai�reod Ikea
3.p I am a homeownerdoing allwrlt v right of piton per MGL 11.0 Plumbing repairs cur additions
myself[No wodwW.com0 a 1s2,41(A an raeLsve'bo 12.0 Roofrepab
reanramere:iuuod.it cop 13.p Other
•alit epplieeot am ehteb Ueoe,Yt mM.Lo 56 optt4t+e bebr etwwtoa tbteirlwrt�p'aortgm.uoa war n
txomeo.ioaawl�ont�r�.®avismdkaiet�lradd.t•il•atmaPo.el��oti{e. .atirraimie.nw.fBavaramea�.och
rcono.obn Hsu d�eotc rob t�iron w�ehea e.ddidoou rbees�howvK ffi.ms Yrrmr.ol►moticloar.oeeai Mwlcas•
r sw�ensploysreGss 6 provfdbrd se�srlrers'eosrpsesspos brawwsa fa sry•e�prpt 3dow b t1k psAkj Job slat
InsuranxCumpaayNama GY�9n/lTE S%9Ts /N�y�An�E COMP9�vy
Policy N or Sels-ins.Lis# Gl/A2T/j Exphation Daft: Z 3 d 7 _
rob site Ad& _/0 )YMDn/DI sM Cny/stateab:,L&C M MA D/97 U
Attach a copy of the workers'eompenumon policy declaration page(showing the poltey number and e:plratloa date).
Fasilme to secure coverage as required ander Section 25A of MGL a 152 can lead to Poe imposition of crro®al penaltid of a
fine up to S1,So0.00 md/or one-year imprhanuc%as well a9 civil penalties in tie form of a STOP WORK ORDER and a rise
of up to$250.00 a day against Me'violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for inamanee ooversge vai&adoa.
I A Aemby"rdp Wsy tAs sal penalties ofpsrJaq A rbe lefdnn dI-provllcl aAM b ave and esrrecs
D .3 Zi ZDD�'
Fkoue
O,flleld err.dur/p Ds sd w►AtsGs uU6 sns,m br css�plettlby e!lyaarwa oaleld
City or Town PwmlNi.ldnse M
Issuing Authority(drde one)s
I.Board of Health 2.Building Department 3.Cityfrowu Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#-
Information and Instructions
n fm their emp
Magsachusettt General Laws du pter 152 requires all cnVWers to P av*m the sery contract ofbae,
putsumt to this salUM an ea�°y°t is defined as"...every person ice Qf aunties under any
Upress or implied,oral or written."
associatiON oaPaatim or other legal entity,or any two or mOrs '
An g plo w is defined as"m individual.PartaaahtP. .Or dw
of the foregoing enpvd in a joint eaterPsise,and including a of a g emplo emP eve�
receiver trmtI of an bdivfdt A Pam or other legal entity,empkrymg emp of
owner of a dwelling louse having not man than three and who resides tIIaain.or the occupant homes
owns fog hO we li another who empktys Persons 10 do maintenance,conmadon or repair wa*on such dwelling
thaU shall not because of such employment be deemed 10 be an amgbYec."
as on the grounds orbua'Mmg •
MGL Chapter 152,42SC(�also sates that"every state of local Nees sing ageney shag wkhYold Owego
tsifor or
renewal of a license or purer to operate a badness or to cmdmet bit WbW to the commonvraNh for any
Applicant who has iwt producedte�sbk eviftm of eompumce wo the Iassrs M coverage required"
Additionally,h cW@ut 15Z 125C(7)sates"Neither the commonwealth mr any of its Polidpl sham
Sot the paformanca of public wodt not acceptable evidence of compliance w�the icstuance
eater into any contract a me contracting=*a�i .
Me piremema of this djapa+bavebaapraatted
Applicants
please fill,out the workers' nation affidavit eompletdy,by tiering;�that apply b Y�Siumd0st�if
necessary,SUP Foo s)name(sX addresses)so Phone mmnba( with their catificAc(g)of
neces� Limited Lability Companies(iM or Limited Liability Permashtpr(I.Lp)with no auployeee other dim d w
merman or pmaa L am,not ra uW to tarn'workee,can�ation iosuraace. If m LLC or LLP does have
members
o a policy is m,nut d Be advised that this affidav4 may be mbantocd to the Dep=Umg of Industrial
Accidents for ration of i0m ance coverage. Also be sore to alga said date the afsdsvlt. The atBdave sbould
or town that the application permit or license is being requested.sot the Deporkers t
of
be rehunad to the city the
have any quett'O=ngardmg the law or if you we required to obain a workers'
ladustnal Acctdtess+ SDpa1d you al the mmbR be1�' Self-insured cgmpaau+liquid enter their
caU the Depsrtneot
zoom�pensatioapoiicy;plwe- line ..
self-iasurmoeliame.im=On die
City or Town Oflldals
ptesse be sine that the affidavit's
Compkic and printed legibly. The DWarmtent has Provided a space at the bottom
a in fill out in the evens the Office of Investigations has to contact Y�regarding�aPPii
cauL
of the affidavit for you nu mber which will be used as a refacow number. In addition,an aPP
Hcsd
please be sure 10 fill in the permit/bceau licatians in any given year,need only submit one affidavit indicating current
that nstst submit 01*1e pamwhcem aPP
>aSoMmanoa(if accessary),and,under"Job Site Address"the applicant sbould write"all locatbm m 1D ne
A coPY afildav�ties has bees offiasi et os.-��bXT otY or lawn tiny be pfilled
applicant a1{proof dial a valid affidavit ie on fib for fpare Poaaa of HceOsea Anew affitlavh z�tbe filled out each _
year.Where a home owns or citizen is obtaining a license or permit not related to any business or commercial venture
(!&a dog license or Permit to burn leaves etc.)said person is NOT required to cmOPlie this affidavit
ns would Me to thank you in advance for your cooperation ad sbould you bave any questions,
The Office of Iavatigatio
-please do not besitM 10 give us s cal
The Deparmenf s address,telephone and fat mmher:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investfgadons
600 Washington Street
Boston,MA 021 It
Tel. #617-7274900 eft 406 of 1-877-MASSAFE
Fax#617-727-7749
RevW 1-26-01 www.mm.gov/dia
OARD��OF�I�tLl51�fG `........_.,•�,... .�
ie A— ✓�fONS
License: CONSTRUCTION SUPERVISOR '�
Number: CS 084795
Birthdate: 06/13/1967 - -
Expires: 0 5/1 312 0 0 7 Tr.no: 84795
Restricted: 00 !,
EVANGELOS LIAPI$
36 CENTRAL RD#3
SOMERVILLE, MA 02143 Administrator
I
P� ✓/re eiamomooero l!/i o�,/�aaaaclauaetra
�\ Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 149833
TV Expiration: 2/10/2008
Type: Ltd Liability Corporation
NEWTON PROPERTY SERVICES LLC
EVANGELOS LIAPIS
300 ANDOVER STREET SUITE 39
PEABODY,MA 01960 Administrator
02/13/2006 16:26 FAX 19785322217 B R MCCARTRY Z 001
Clie .25507 1 NEWTO
AGORDP, CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDNYYn
- 02113/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
S K McCarthy IDS Agency ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE
10 Centennial Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND.EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Peabody,MA 01960
978 532.5445 INSURERS AFFORDING COVERAGE NAIC S
'''BORED eaeuRERA PreBuilders Speciality Insurance Co. 36137
Newton Property Services,LLC wsuREN& Granite State Insurance Company
300 Andover Street,Suite 391- INDuRERc:Travelers Commercial Insurance Compa
Peabody,MA INSURER D:
WAIR(RE
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSVRaO NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER 000UMENT 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,DMUISIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NBRPOLICY EFFECTIVE POLICY EXPIRATION 11MRS
LTR NSR TFPEOFINEURANGE POLICY NUMBER OD M uD
A oENER&LABILRY 5006459 09130105 09130106 EADU OCCURRENCE S1,000,000
RENT
X COMMERCNLGTNQOLLDP(NN OAMAGETOY ED,� a50000
X CWM3MA0E QOCCUR MED DfP( one 165,000
PERSONAL L ACV INNRY SS 000 O00
OEWERALAGGRWATE $2000000
GENT.AGGREGATELDNTAPPLIFSPER PRODUCTS.COMPIDP AGO 51000000
POUCY PRP-ECTLOD
C AUTOMOBILE LIALISJTY BA4046AO3705SEL 10/15100 10115106 COMBINED SINGLE LIMB s
ANYAOTO (Ea.TwideN
ALLOWNEDAUTOE BODILYlwIRY $100,000
Ix
SCHEDULED AUTO3 (Pe P, In)HIREO AUTOS BODILY INJURY
NONDwNEO AUTOS
TPv.udanq 2300.000
PROPERTY DAMAGE S2SO,000
(FeraP40 n)
CAAAar LueanY AUTO ONLY-EA AGCIoE r s
ANY AUTO OTHERTHAN EA ACC 1
AUTO ONLY; AGG S
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE t
OCCUR CWMS MADE AGGREGATE L
S
DEOVUMPLE S
RETENTION 5 3
B WORKERSCOMPENCATNINAND WARTED 02107/06 02107/07 WOSr"Tt}I I_ER-
EMPLOY2RS,UOMUTT
ANY PROPRIETOPIPARTNERIEXECAJIA/E EL EACH ACCIDENT SSOO OLIO
OFrTCEwMFUABER E)U:LUDEOTI ELDISEASE-EAEMPLOYEE $500000
6 CKLPROMI eulAw FlDISEASE-POLICYLIMIT $500,000
OTHER
DESCRIPTION OF OPERATNINSI LOCATIONS I YEWCLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL.PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF WE ABOVE DESCRIBED POLIOIES BE CANCELLED BEFORE THE EXPIRATION
For Record Purposes DATE THEREOF,THE IBSMG INSURERYALL ENDEAVOR TO MAIL ._2D_ DAYEWA.VWW
NOTICE TO THE CNRTIFICATE HOLDER NAMED TO THE LEFT,SLIT FAILURE TO DO SD SKALL
IMPOSE NO OBLIGATION OR LIABLRY OF/WTI WNO UPON THE WBURER,TITS AOENTS OR
REPRESENTATIVES.
A HORIZEO REPRESENTATIVE
A .k
ACORD 25(2001108)1 Of 2 #50079 DMN O ACORD CORPORATION 1988