22R BECKET ST - BPA-2006-847 RENO FOR RENTALr
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pLitNB*%*T,6Ef**04A0 A?PROVED BY T44E
AmPz=DB PA" TO A.PERLUT BEIN0 GRANTED
CITY OF SALEM
Date
No.
is Property Located in Location of
Ow Historic District? Yes No Bol la ,+o
is Property Located in
ow Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Insta Sidin Construct Shed, Pool,
Repair/Replace, Other. m; insu/a , z o%ms
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 3c'YSTrnn
Address & Phone ,D ti Qq I � 130� -3SSS
Architect's Name
Address & Phone N14 f 1
Mechanics Name 1,114
Address & Phone NSA p f
who is an p apose d bulldlrtp?�imir�c� �t sin4/E �m�1✓emu=���9_-
AA WAI of Wkkq? M a dw"N, for how many families?
WN hid conform to law? X Asbestos? All A
Esunwed coat city Ucense s N A Mae 93y3$
Hona LProvuent X
Lie. i1 11/34/ I\ Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
�'W'I lfl��
C�OO/r S
MAIL PERMIT TO: A4eA I
APPLICATION FOR
>PERWr TO
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(Ow /P�e �Pryno �c�Xolit
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LOCATION.
D-d �P�r C7Ff FB/
PERMIT GRANTED
20
AP OV�D
INSPEC OR OF BUILDINGS ��
AC-OB-QM CERTIFICATE OF LIABILITY INSURANCE 04/12/zoos
PRODUCER (978)840-8700 FAX (978)840-0440 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
WOOdZome Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
80 Erdman `r ay, suite 100 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Leominster, MA 01453
CIC, Cheryl Brogna INSURERS AFFORDING COVERAGE NAIC#
INSURED Nu Line Construction & Remo a Tng Inc INSORERA: National Grange Mutual Ins Co. 14789
40 Horse Pond Road INSURER B:
Shirley, MA 01464 INSURER C:
INSURER 0:
INSURER E:
COVERAGE
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 MAYBE 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.
IL7RNSR DO' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE IMmonryn DATE neompL= LIMITS
GENERAL LIABILITY MPB63229 07/19/Z005 07/19/2006 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GFNERAI, JARILITY DAMAGE'10 RENTED S 50,000
OI,AIMS MADE OOCCUR NED EXF(Any we peman) S 51000
A PERSONAL&ADVIWURY S 1.000 000
GENERAL AGGREGATE S 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP ADD S
POLICY PRO. 2,000,00
PRO,
LCC
ACT
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO (Ed Accidnnl)
ALL OWNED AUTOS BODILY INJURY
SCHEDIILEf)AUfOS (Per peleon) S
HIRED AU TUS
BODILY INJURY S -
NON-OWNED AUTOS (Per HNaenll
PROPERTYDAMAGE $
(Per sL dMH
GARAGE LIABILITY AUTO ONLY•EA AGCICFNT S
ANv gUTO
OTHER THAN EA ACC E
AUTO ONLY: AGO E
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR ❑CLAIMS MAOF AGGREGATE E
S
CEDUCTIRI F- 4
RETENTION E S
WORKERS COMPENSATION AND CERTIFICATE ORDERED I WC STA TU- OTH-
EMPLOYERV LIABILITY
ANY PROPRISTORMARTNPRIEXECUTWE E.L.EACH ACCIDENT S
OFFICERIMFMRFR EXCLUDED? E.L.DISEASE•EA EMPLOYEE S 'I
II Yes,describe uAdnr
SPECIAL PROVISIONS be[.. E4,DISEASE-POLICY LIMIT E
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
ICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF SALEM MASSACHUSETT5 EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
ATTN: TOM ST. PIERRE 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
120 WASHINGTON STREET BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
3 RD FLOOR OF ANY KIND UPON THE INSURE CENTS OR REPRESENTATIVES.
SALEM, MA 01970 AUT RIZED REPRES NTA7.1
ACORD 25(2001/08) �,_ y a�- (f f�Q CACORD CORPORATION 1988