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27 TURNER ST - BUILDING INSPECTION (2) IMIk VSIMSTeE flUED-ANG APPROVED BY T*IE =PECT.DA ,PFWJ3 TO A PERMIT BEING GRANTED CITY OF SALEM No \\\ �V" 1 ��t�' ..� �'�\ Date !r9 f d Ward Zoning District is Property Located in Location of r— the Historic District? Yes_No_ Building a�l /&. /V"t_ �/• 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: 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 �r�i;c /�C q Address & Phone �� i ((yo�) 2 / 4/.1 N�• Architect's Name Address & Phone ( ) Mechanics Name Address & Phone ��£� (, `'�4 ©/th��<. c ��`11� � What is the purpose of building? Material of building? If a dwelling, for how many families? will building contoQO to law? Asbestos? Estimated cost J� City License rt State License ak Home Improvement Lic. i / ,4/`9O Sig ture of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE •'�i'�i�-f —ail/�� -/Ls-� /k�-e MAIL PERMIT TO: /14 00y Ts- .1. 1\ No. V APPLICATION FOR PERMIT TO LOCATION PERMIT GRANTED Ah66V�D e� INSPECTO OF BUILDINGS Jun-03-04 03:29PM From-Al G 973-316-6003 T-505 P-002/002 F-812 k'l .06/03104., 'R '1CWrE::0FjNS V ERMF U PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION A ONLY AND CONFERS NO RIG14TS UPON THE CERTIFICATE 1) C Appleby&Wyman 7HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR T T COVERAGE 858 Washington St Suite 104 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Dedham,MA 02026 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Scott Girard 7 Eden Glen Avenue Danvers,MA 0 1923-0000 COVERAQES,,E4 "P;7711, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR I THE POLICY PERIOD INDICATED,NOT WITHSTANDING 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 THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDCLAMS. -00 LTR TYPE OF INSURANCE POUCYNUMBER POLICY EFFECM DATE POLICY EXPIRATION DATE RKERS COMPENSATION D EMPLOYERS'LIASILITY LIMITS r PROPRIETOR! ARTNERSEXECUTIVE 11 FICERS ARE: J! CL n OCCL 0 8167442 8/03/2003 8/03/2004 STATUTORY um" TH ER rIIge Appilei;to MA Opuiilllcm OrAy- ACCIDENT s 100,000 IS EASE POLICY LIMIT $ 500.000 1, -EACH EMPLOYEE SE S 100,00C FSCRIPTION OF OprzRATIONSIVEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION N EIL ASSOCIATES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCrILLW BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 2 JORDAN ROAD DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT REVERE, MA 02151 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR I%EPFtGSFNTATTVFS. AUTHORIZED REPRESENTATIVE L - r'/ee �oammaruoealU o�✓lluaaac%uaella Board of Building Regalatim s and Standards License or registration valid for mdrvtdul use only HOME IMPROVEMENT CONTRACTOR .. before the expiration date If found return to i1 *, I Board of Building Regulations and Standards Registrtitbn 136190 One Ashburton Place Rm 1301 lug Eap*.I—M_'Q20I2006 - Boston,Ms.02108 �TYypr i - GIRARD CONSTRUCTIONS SCOTT GIRARD' P, 7 EDEN GLEN DANVERS,AAA 01923�`— Administrator Not valid without signature � COIrifi1011Wai.i� Of ii1�93ChWe� . � 1Jep..lat.a! ar.7.f.ilri.l..�nis,l,• 600 W.4.11 .31red �afttes 1 uatoo.e &d.., M. ." 02111 Cayane,onr Workers' Compit Iawrance davit . . wi*.a principal place of business ac do hemby'certify under the pains and peniMes of perj xye dou 1 am an employer providing workers' compensation coverage for my einptoyees working M thb job. imurance Compw Polity Number 1 am a sole proprietor and have no one working fdr me in any capacity. () 1 am a sole proprietor, general contractor or homeowner (drde one) and have hired she contractors listed below who-have the following workers' compensation poSICIM Contractor Insurance Companry/Poliq Number Contractor insurance Compan ylpolicy Number Contractor Insurance Company/Policy Number () I am a homeowner performing all the work myself. I wnanune am a copy of the autmwet we be fen wo.. to d" Ogee el It m*n,wo of ttw DIA for co.ernte.Ntetaaea Me out Itrtpt r"COM co, sit ar ttoterro.new Soc*m 25A of MGL 15 2 can kad to ON wwotoen of t'rir* ooeadn eor.awp of a hat of to w4I.SOD:OD&Wor one nai inwoomwoK a v.new Dwaida k the form eta STOP WORK ORDER an0 a bw of S I00.00 a an aPLut me. Signe this , —at� day of G� :iccrscciFcrmiltee iiuilding Depart ent 'Ljcensinf Eeare Seiectmens Office wealth Geparmer� iL PUBLIC PROPERTY DEPARTMENT 120 WASH:NGTON STREET, 3RD FLOOR SALEM, MA 01970 TEL (978)745-9595 EXT. 380 FAX (978) 740-9846 STANLEY J. USOVICZ, JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40,S34,I acknowledge that as a condition of Building Permit# . all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid-waste disposal facility,as defused by MGL c III,S 150A r_ ' The debris will be disposed of at Location of Facility J-e3) 1A Signature of Permit Applicant Date FULLY complete the following information: (PLEASE PRINT CLEARLY) Name ofyPerrmiit Applicant Firm Name,if any At`t Address City&state The above statute requires that debris from the demolition, renovation,rehab or other alteration of building or structure be disposed in a properly-licensed solid-waste disposal facility as defined by MGL cl1I, S 150A, and the building permits or licenses are to indicate the location of the facility. i