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145 LORING AVE - BUILDING INSPECTION The Commonwealth of Massachusetts W Department of Public Safety I �' a•�% \le..achu•ett>?tate BudJmg Cod le l•SUC\IR)V•%enth Edi It, j City of Salem I Building Permit Application for any Building other than a I-or 2-Family Dwelling 1 rho For Official U<r Unlvl Budding Permit Number: Dale Applied: 1Z 2ol( Budding Inspector � SECTION 1: LOCATION iPlease indicate Block s and Lot s for locations for which a street address is not available) I y5 /Of a�gr` Sr�at .iAnet, ..No .Ind Street Cil% /Toon Zip Code :Name of Budding(tt.tpphcoble) SECTION 2:PROPOSED WORK It New Construction check here 0 or cheek all that apply In the two rows below - -- ---- EFlsting-BuiWin) �--Rrpair-Atteratiun-O--AJdHienn-❑- -D`;mulitiam�-(P4ease-hll-out-,%nd,ubm4t-AfTeAdix Change of Use ❑ Change of occupancy ❑ Other ❑ Specify: Are budding plan+and/or cunstructiun documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: _�O ma i /IIG SC IYfJ�- ��n( SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) 0 Existing Use Group(s): - Proposed Use Croup(s): r Existing Hazard Index 780CMR.34: Proposed Hazard Index 780 CIAR 34: SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Flours/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(al.h.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2r ❑ A-2ne 0 A-3 0 A4 0 A-5❑ 1 B: Business 0 E: Educational ❑ F: Factory F-i ❑ F2❑ I H: High Hazard H-1 0 H-2❑ H-3 ❑ H-4 0 H-5❑ 1: institutional 1-I ❑ 1-2 ❑ 1.3❑ 1-4❑ M: Merrmtile Cl R: Residential R-10 R-7„ ' R-3❑ R-? 0 S: Storage 5-1 0 S-20 U: Utility❑ Special Use❑and please describe below: Special Use. SECTION 6:CONSTRUCTION TYPE(Check as applicable) I, A ❑ too IIA O 118 0 IIIA ❑ file 0 IV ❑ VA 0 VB ❑ Il- SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 far details on each item) i Water Sly: Flood Zone Information: Sewage Disposal: trench Permit: ' Debris Removal: Pubbuppc❑ Chcdr duublJv Ile,r.l Lnnr O Indicate mumcipal❑ .\ trench will nut he Ltccmed Unpu.,d}rte❑ •rluueJ❑or trench I'n%.tic❑ ,n unt%n bl% Zrrne:_ unm.,tr•%•Irm❑ prrmrt i.cnrlu.rd 0 _ - Itailioad right-of-way: Hazards to Air Navigation: \I-\ I InL•nr i ..,,,,,n,,,•.,,It„ •., I'. \rl \pp L.eblc❑ Lyres lure rr ithnt.nrp,rcl ep)n, odt.trr.i• 1.th'a w, ,,. ...... ­l ...... l,. liudd cn,L •cJ❑ I Lc•❑ r-r Gr❑ N r.❑ 0 SECTION 8:CONTENT OF CERTIFICA rE OF OCCUPANCY i I .Idnm. i l- „Ic .__ L-c ldo)•r.i fr i`e gtn.Inp Ural tltiupanlln.l.l /'rr ll ,.r ' ' I r•„�the Dwhbnq, ntl.lin en�)`n nAler�\.lent' _ �pr%i.tl�Upul,tlurn` ____ ...__.___----_ � SECTION 9: PROPERTY OWNER AUTHORIZA TION \'.un.`.wyl .\Jdrv...d Pnperty ll)+ner Viniv(Print) \'o.and Street ('its. Linn t—. L _.(: t)�lut�+ll�arai`1''t;1, `$aard 6i-vtdiding R4 Latton§and VIM k+I .t �C*rt�tgon Supervisor Llcens8;, § J}, Rgafricteiiy,to: 00,,.E SEANANDERSON ' E 810ERTRUDE STREET- X LYNN MA'01$OZ '_' a. 5 rt " Ezpv6tidn 101260111 t a 'r lee �aommoiu..ealU o�✓�aaaac%uoelts ,Roard of Building Regulations ond�9iaodif is HOME IMPROVEMENT CONTRA CTOA Reg�Iriltuf 162103 r /1114/2011 Tr# 273768 � J SEAN ANDERSO �n"r '- g�AN `�- 81 GERT0 EST �-�'-- i vnini rae mono 01/05/2011 09:03 7815985957 DIVIRGILIO GROUP PAGE 02/02 Al CERTIFICATE OF LIABILITY INSURANCE OATE(MMI00i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGXT5 UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERI AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT, If the ce1'tifrcate holder i3 an ADDITIONAL INSURED,the OI;C ies mUSt be endorsetl. reSU the terms and conditions of the policy,certain POlil mBy require an endorsement A statementOn this c LIBBRO ATION IS notWAIV confer rights sub ec the cerl11109e holder in lieu of such endorsemen s). PRODUCER NTACT Divirgili0 Insurance ,Agency PIrowE 270 Broadway AIL781 592-5220 FAX . (781) 598-5957 P.O. Box 8065 A : al@divircrilio'mnsur=c4a.com PRODUCER Lynn, MA 01904 USTOMaRIDe• 4688 _ IeSUMP01 AP QMORIO COVERAGE NAICp _ INSURERA-Pa.trou Mutt I Insurance SEAN ANDERSON suRER B:TRAVELERS BIG A'S HOME IMPROVEMENT inI_.RM 0; 81 GERTRTME ST INsuRERD; I. LYNN, MA 01902 INsuaERE: '- COVERAGESINsuRERP: CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEp' l i m HgVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVITHSTANDMG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER M'MUM NTr WITH RESPECT TO WHICH THIS CERTIFICATE My BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED WEREW IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LWIITS SHOWN MAY HAVE BEETI REDUCED BY PAID CLAIMS. LLT TYPEOFINSURANCE - ...—ADS SI�nR ODCY UMBER GENmALUABILM MA7DIY UMTS A EACH OCCURReNOE 8 51 000 COMMERCIAL OE NEPALLWRIUTY CTROO10445 S/23/10 5/23/11 DANIA TO REN CLAWMADE L-1 OCCUR EREMtSES1ER-o➢aIDADT S 50 000 MEDEMP(A ane 1 8 5 00-- PERSONAL&AOVIwURY S 500 000_ GENERAL AGGREGATE $ 1,000_000 GEWL AGGREGATE I.MITAPPUES PER POLICY PRO- LOC PRODUCTS-COMPIORAGO S 1000000 AUTOMOBILE UAOIUT' 8 COMBINED SINGLE L MR S ANYAUTO (EA accli ALL OWNED AUTOS BODILY INJURY(Per pemi S 8CHEDULEDAUrOS BODILY INJURY(Pv ee Ii 8 HIRDDAUTOS - PROPERTY DAMAG[ S (Pm aoaNenQ NONowNED nuios s UMBRELLA LIAB 8 OCCUR EXCESS LIAeEACHOCCURRENCE S CLAIMS ORE MADE AOcg7E, 8 OEDIICTIBLE RETENTION 8 8 TION AND EMPLOYERS 7PJUB-4406P26-A-10 10/19/1010/12/11 WD Si ons. ANY AND SMPLOVERs LIABILITY LDA OPFICER R�ECLUOED�[cUTNE Y� N/A E.L,EACH ACCIDENT $ 100,000 IMAmiabyln NHl E.L.CIS EASE-EA 9WPLOYE B 100 000 ttyyee demo under DESCRIPTION OF OPERATION8balaw E.L.OISEASE.POucnlMrc s 500 000 DESCRIPTION OFOPERATIONS/LOCATIONS/Viii CLES (A"a"ACORDIOI,Artaaonal Rohner Bda o,amereal..Inme1/npI CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salem THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED w Attn: Bldg DeptACCORDANCE WITH 7HE POLICY PROVISIONS. Salem, MA 01970 AUTHOREED REPRESENTATIVE .Toa hine Salamanca ACORD 252009/09 ©1988,2009 ACORD re CORPORATION. All rights served. 1 The ACORD name and logo are registered marks OfACORD nightrax UZ-1 11/3/2010 7:21 :15 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF LIABILITY INSURANCE 11/03/2010 Tlu!a ERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOIDER. THI$ CERTIFICATE DOES NOT AFFlRM,IMVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES. BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSURIG MURER(S),0.UTNOR2ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the ctutIR-le hold;u h an ADDITIONAL INSURED,Wa PARCYDea)must M Andseud. If SUBROGATION IS WAWED,c-hJaet to The terms and...YKIon.aT th.poing archin p.Bdas may rsquim and eRtlomam.nl. A statement on this cadiffmia dopa not Confer d9Ms to the c.ri9kel.hold.,In Ilu-of such eadommaef(s), ' PRODUCER CONTACT NAME: PHONE FAX DIVIRGILIO INS AGENCY (Arc,No,EMH: FAX PO BOX8065 EMAIL (AIC,No): ADDRESS: PRODUCER 77WRS MA 019114CUSTOMER IO 0: 77W$$ INSURERS)AFFORDING COVERAGE HAIC9 INSURED INSURER A: TRAVELERS DIRECTASSICNAfi3NT INSURER B: ANDERSON SEAN DBA E IG A HOME IMIPR0V6IrIENT INSURER C: HSURER D: R I GERTRUDE S'T INSURER E: LYNN,MA 01902 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CEIGHYTHATTHE MUMS OF WSURANLEl15TED BELOW HAVE BEENIRWED TO THEINRUREDNAMEO ABOVE FORTHE POLICY PERIOD WNCATED. NOTLYMISTANWNG ANYREOUIUR ENT,TERM OR CONDITION OF a"D=pACT OR GTHBI OOCUNENT VATH RESPECT TO ttMCNTNMLT'RRPIOATE MAYES MALEC OR MAY PERrAN.THEBBURANCE AFFORDED BY THEPOLIGES DESCRIBE➢HERON 18 SUBJECT TO ALL THE TERMS,EXCLUBIONS MID CONOIRON9 O,SUCH POLICIES. LBADR Bust"AMY HAVE BEEN REDU:ED BY PAID CUM. NSR ADUSURR POLMYEFFOATE FDLICYEIIPDATE LM TGENERAL LIABILITYILITY BILITY NSURANLE NSR LYVD POLI Iftest ER (Le.N)0'.YYYY) iLghOIlM DWYM 1TD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS MADE OCCUR, DAMAGE TO RENTED $ PREMISES(Ea orsunance) MED EXP(Any ons parson) $ GEN'L AGGREGATE LIIAAT APP AES PER PERSONAL AS AOV INJURY S POLICY PROJECT LOC GENERAL AGGREGATE $ PRODUCTS-COMPIOP AGO $ ANYA AUTOMOBILEAUTO ANY AUTO COMBINED SINGLE $ ALLOWNEDAUTOS LIMIT(E3 amidant) SCHEDULE AUTOS SDDILYINJURY $ HIRED AUTOS (PerpoMoa) BODILY INJURY S I NON-OWNED AUTOS (For acddenp j PROPERTYDAMAGE S IParacoidan) UMBRELLA LIAS OCCUR EXCESS LEACH OCCURRENCE S VIB CL11MS-MADE DEDUCTIBLE AGGREGATE g RETENTION S $ S VJCRRER'S COMPENSATION AND WCSTANTORYUMRS OTHER EMPLOYER'S LIABILITY YM U&4406P26A-I0 10113@010 1011312DII E.L EACH ACCIDENT $ 1 ANY PROPERITORIPARTNE"Xk TIVE Y 00,000 OFIRCERMEMSER EXCLUDED? ElDISEASE-EA EMPLOYEE $ 100,000 (Lummsry mup CPSCOP"ONO OF E.L.DISEASE-POLICY LIMB $ 5001000 OEBCm?DON OF OPEAARONS h:l.r DESCRIPTION OF OPERATIONSR.OC'ATIONSNEHICLF.WRESTRICTIONSISPECIAL ITEMS TINS REPLACUS ANY PRIOR CERTID LATE ISSUED TO THE CERTMICATE IIOLDER Ar ECTI.NG WORMS C0a1P COVL'RAGC THE WORMS.COMPCiSAM?:POLL[}'ODES NOT PROVIDE MVERAGE FOR ANDERSON SEAN. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRBRD POUCIES BE CANCELLED BEFORE �\ IyJ5 L M` THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. �aL1 C� AUTHORIZED REPRESENTATIVE t Charles ACORD 25(2009109) J Clark 1988-2009 ACORD CORPORATION. All rights reserved. i