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6 WARD ST - BUILDING INSPECTION (4) l "PL.l MIMST9E f4Lfi8~ APPROVED By 94E -INSPECTOR PRICIR TO A PERMIT$LEWG GRANTED CITY OF SALEM �� l No. `�� Date {3 III ward Zoning District Is Property Located In Location of the Historic District? Yes_No guilLding Q Is Property Located in the Conservation Area? Yes No t1 Permit to: BUILDING PERMIT APPLICATION FOR: (Circle whichever apply) Roof, Reroof, Install Siding, ponstrugt Deck, Shed, Pool Repair/Replace, Other: Fi Firs �F(c*a '�b a4✓ �,� 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 c� IZ Ti14J- Address & Phone Va `P5o,x 15-5 4�s LO f l 47-3 c-31y Architect's Name No N Address & Phone f Mechanics Name V`e_r-IixIN i2e'J Ha 3 Address & Phone TO GA 4 5s`f �n dpg N/A- (1T8) `I Z3 0 ct/Y What Is the purpose of building? I-G5 1iQ-C r/t 1 Material of building? n C.t<—, If a dwelling,for how many families? 3 Will building conform to law? �f-s Asbestos? iV Estimated cost ��CS q" City License N 6tj"C1'(0— State License k L C3 g Hare fsprovement Lie. Signet of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE I� t ( I CcsN�l� Cv►--i K-crc,c_c�l' S va cSL +�a C�p�✓r 1.1.+2�✓� MAIL PERMIT TO: Taps C I �� 1 V ' No.`� APPLICATION FOR PERMIT TO LOCATION per Bo,Z PERMIT GRANTED 19 APP VFD . �tv o INSPECTO OF BUILDINGS MA £Xlstir49 Access +o `&C+r,_-Me �IcaI4it-iqt LL51y5lirm C. 1' I c ?G Ir c- 004 M6t} Q•t"V- N A l-L WA Y � zXy i<D stays t(Z" nnl Wa ! VCITCHErJ H—3� K 0 �Itaf �t�•cCl� Q i prNI�C— MaIN ANT__FEE ; CIoSL�' r crrpt' �a i 1 i 1:�crs-fr�4 r/onl 6earlN Wal! Flo N rb0 Q hard Wttrc CIa4e� UNdt/ ( S 1jOd to 11Qf 510.1(S —1 a LI_n ITY aF7 EY_ _ I PLAN°..��•_ -. . - n,{,� ° TYPE AND LD;... BED R00M ! I ALL FIP.: ; h. FINAL TES AND ANC,:. .._.. G RE MaVE GI0-5.5 BOOR t W I*1RstA / 2 2xy ICO IbI'6c FPWhv ' ! K19 TNSaIa•Ilor. 515CDX `HeahiP,14` Low E '1'4Jj V41pjoW�I � - ( 1/7 Dry urlJ '(zr trt66 0 Qppr'6XI - �t k 5 cecaf S�,I�,lc r dl �� vvlva rr S2 I a 6On h 1� ILNoT T A �cr�bl6c k foofir� w� o S� LE aXy r�� S,>_ ( f �XIS IN 1kcr LCa3INq +C) ' Nd i ' d FIGOr Nu To T I �,s r F( )6'�, °Z Ir tiutiq cxtere� 1 Wadst Sct (f tm I MA � � Exis�t�y Access fn fICQ+t N 5'y54'rm �)f� h t4 pGsek CotMotj ajGp, NALt WAY 2x4 kD STubs , I t(,Zn nil W�,'' I KITCHENI 3� IL pi RCO I Maim ENT C(o5A I c rto'' via 1 Yi541 4 WCtJ 6eariHq wall 1 LIV,N rwt 9 ff Math S�rdCCS '-4 3—� g BED 'ROVP>t 182 © Rc m')r GI0-55 Dom t W wwa 2 2xty Ko I '�6L ��.hNINE' 3 X►9 Twsa Wtov SI5CDX SHeOT tW Low F Vy rl4•I V41pjow 112! Dry WIJ St rJG as 2 J EqrC55 5 cec�r AlygqL s'diu, W„Pclu,,S APP o ;l` �1a 0 NoT To 5C A LF( \ 15'�HX �"W Co1jcrClt Faofltiq W( 2X4 *P1' SiLL �x lsftu9 Acor LeaA ioci +o 2tid t FIWr NOT To TII .S T" FM PUBLIC PROPERTY DEPARTMENT • 120 WASH INaTON STREET, $RD FLOOR ' SALEM,MA 01970 TEL (976)745-9595 EXT.360 FAx (976) 740-9846 STANLEY J. USOVICZ, JR. MAYOR DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40,S34,I aelmowledge that as a condition Of Building Permit# 2W __.,all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed soli -waste disposal facift as defined by MGI,c III,S 150A. The debris will be disposed of at: 0( Ff i q ILk I Ay e- Sc�- t Location of Facility 113 Si o P li Date FULLY complete the following information: (PLEASE PRINT CLEARLY) aj Name dfPenmrtApplicant E 51ate_ rt,-i j L LG Fur Name, if a" 3aX 155 To ps-rl e ��. , M A 01983 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 cIII, S 150A, and the building permits or licenses are to indicate the location of the facility. ACORD. CERTIFICATE OF LIABILITY INSURANCE °07220/2o04 aODUCER 978-468-6500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION FRAVEL INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE WILLOW DALE OFFICE PARK HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 203 WILLOW STREET SOUTH HAMILTON, MA 09182 INSURERS AFFORDING COVERAGE NAIC# ISURED INSURERA: ZURICH INSURANCE COMPANY VERNON REAL ESTATE MANAGEMENT CO. LLC WsuRERB: ZURICH INSURANCE COMPANY PO BOX 155 INSURERC: TOPSFIELD,MA 01983 WSURERU: WSURER E: :OVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. BR D' OFINSURANCP POLICY NUMBER POLICY EFFECMD;TIVE POUCYEXPIRAMON LWRS GENERAL LIABILITY EACHOCCURRENCE $ 1 OOO,OOO A X COMMERCMLGENERALLIABILITY PAS0043005033 02/01/04 02/Ol/O5 PREMISES Eaoccuranm S 50,000 CLAIMS MADE FRI OCCUR MEDEXP(An one arson) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GENTAGGREGATE LIMITAPPUES PER: PRODUCTS COMPMPAGG S 2,000,000 POLICYF-1 PRO• El LOC AUTOMOBILE LULBILITY COMBINED SINGLE LIMB ANY AUTO (Ea accident $ ALLOWNEDAUTOS BODILYINJURY SCHEDULEDAUTOS (Per Person) $ HIRED AUTOS BODILYINJURY j NOWOVMEDAUTOS (Peraccbant 1S PROPERTY DAMAGE $ (Peracabent) GARAGE LIABILITY AUTOONLY•EAACCIDENT $ ANYAUTO OTHERTHAN EAACC S R AUTO ONLY: AGG S EXCESSAJMBREUA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION is WORKERS WC STATU•DRY LIMS OTIL B EMPLOYERS'LIABILITY SATIONAND WC 0043005108 02/01/04 O2/O1/O5 ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERRAEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYEE S 100000 Wwcdbe under LPROVISX)NSbalow EL.DISEASE•POLICY LIMIT S 500000 OTHER ESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS IE:6 WARD STREET,SALEM, MA. :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRDTEN CITY OF SALEM NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL TOWN HALL IMPOSE NO OBLIGATION OR M131T OF ANY KIND(IN THE INSURER,ITS AGENTS OR SALEM.,MA. REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ,CORD 25(2001/O8) ORD CORPORATION 1988 � CommOnu/rtitWl of /l/n�aLhws�d , • •1J.Pa.r�..al�.11rri.f�eclaaala• . 600 w. Liayf.31.d Jsrsra 1 ua+ms /1la.rs�+u.� 02 I I l cam"Mmur Workers' Compensation Insurance Aff1dr4t •1, �/e1�tJaN �Ca� �STc� t'�G � ILnto rfT tb•••••++ommv ✓ . . with-a principal place of business ss: II do bem*y•cersify under the pains and pemil" of perjury, dm I am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Poliq Number I am a sok proprietor and have no one working fdr me is any capsdry• () 1 am a sole preprktor, general contractor or homeowner (circle one) and have bared she contractors lined below who-have the following workers' compensssion policlain Contractor Insurancs Company/Poligr Number Contractor insurance Company/Policy Number Contractor Insurance Company/Polky Number () I am a homeowner performing all the work myself. •I vnanoew m.a cast d.•o wamm 00 bt forwword s drr OfRc.el Mwbdn... m of dw DIA for ccr s asr.oAacain sno tow I.W.r soon cowranr a rrawro on.0 Srcden ISA of MOL 152 can kad co ew:rweocbn of cr+rn+w o.nade cxJadm of s sm el w 041•S M00 abler am gran•imareow"m a vs a e.i vaskie in dw loan of a STOP WORK ORDER mw a bw of S 100-00 a an atUel.L Signed this • �3't� day of 71(R, :iccns Aci ouilding Deparxrwent �jcenainf Eoarf Seiectmens Office �e:lth Depsr-.rner; 905 405, -05• 77S 1 J„l4if A , w 8 AY . . Y - it I mill ;w�u Ay a#F� bf �IQtNz°d PZ�4tb�8 XSf#kS g f TE Hh *lb ICE ECE i3t t3F I ""xt �Y r sa.�s . � tN�3rY RAQ+� t#1�u+ Bt7�QC$ QP BE2RAMAs�E OIPUE , .F -t' Wk k 4ekr�aN LF�MPt CI$ ITfF tFiC4 ROVTSL€TN �Pla"x `ukRA ks i rs` UP Sf�{.f T44 I}1T.? h � i�� $a <� to ' d �3s �fi' y.• '4"e,. `Y„J�� 0 n .s `=..if r* d' c w : � 1 i£ �^. , tit, }3.