38 HANSON ST - BUILDING INSPECTION ;
/ The Commonwealth of Massachusetts
Board of Bwtding Regulutlans and Stantlards )()R
n MUNIt 1PA1 111
Mtissachusetts State Buttdmg Code 78U CMR 7 edingn Ub>:
Butldtng Permlt Apphcuhon To Construct, Repalr,Renpvute Or l�pr»altsh u Ruvzcr(Jrnurur�.
pne •ar.7tto FrttililY;, we. to QL; 'txt3
h $eitton,For';pfticiu!Use Only
:= Building Pe'rtnit Number - Dal Applied: ' 'x
Signature � �`
ntdingCtrmmisslane nspc or Bui1J Date ,
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TE;�.INFORMA,TION
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1 1 Prop Arid ess i.2 Assessairs'Map&Parcel Numbers
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l..lp Is th(S uti:quepted street t yes no Map Number ' Punw1 tt-
13 Zonlag Infortaatioa ! ` 1.4.Properly;Dimensinns
Zoning Distriet.,:-- ,• Ptoposed Use Luk'Areu(sq ft) ': Fronlage:�(R)
T$ gullding;Setbaoils(ft)
Fiont Ymd Srde Yards - Rgar Yard
r. r ,,,Regplred ,.. ProVtded .... Rer(uired „, :.i, Pmvrded� +'.Required I'riwided
16 Water S pply (M O L"c 40 §54) 17 Flood Zone Ioforttadon 1 S Sewage Disposal Systetn
Zone putstde-;FlaalZoye7
PublicPnvate Q Chcek if yesfd� Municipal fd'On site dtsposnl system ❑
i SECTION PROPERTYOW.,NERSHIPt
2I, toCRecord -�` e��';�jgycrAAt/ CS'� :119tF+
t ` Name(Print) Address for Seryrc'e ,
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Telephonetit -
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` '" ` '� SECTIONS,DESCRIPT[ON;OF,PROPOSEDWORK=(check;alltkatapply�
Neu;Constrycdon❑ {Fat snng Hwitfing Q. Owoer Occupied RePatrs(s) Q,, ,Atterntiori(s)J8'P, Addki Q
Dertiolibon L Q Acc'essnry BI'dg_Q, Niiarberof Ugits Outer QtSpcc(fy -
Bnef Desertpu(in of Proposed urkij
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:4 SECTION 4 ESTIMATED,CONSTRCJCTION COSTS
Ile rn Esnmatcd Costs Otlicia�`Use On)
(Labor and Materials)`: Y
1 Building $ Gj} t Budding Permit Fep $ fndreaie haw fee is determined
2"i3lectdcal r$ ,. �y ❑Standard Clty/i'ownAppitcation Fee
Ci Total Pi»ject Cos4s,,(Itam 6)x mWU tier a
3 PlumWng $ cpt ether Fees $
4.,htechapica!,tH1�AC) $ Ust '`
5 tNechanlcal (Fos' _ $ at
All Fees
S resston)
Check No. Che4k Amuunc Cash Amount
6 Total Pro ect Cost $ •• `
3 Q Paid in Fult .;h❑Outstanding Bulunce Due
1
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SECT
SERVICES 111179N 5 �P_R IN. 0,
Construckionpuperviser(UIL)
p;Number Expiration
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CSLT' ' h 160)"U!ft (sw he tow)I"F YIN
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HIC "tr Mail' Numbce
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6i"RS'.COMM Cil,-A, DAVIT(M.G.L.c;152 2 5 C(6)),
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Work
Co. with A Is APPI Endure_,O in peaso etw4ffid A mittia i6utjdW,Fui reoto provide
J. r this luffiduytt will restdttn thedeaiai of the Issuance of us-PArmit
AffiO
"SECTION *OW AUTHORIZATION TO$B COMPLETED WHEN
MDNG"
VTO TDIUB W ONTRA
as Owner of the subJect property hereby ,
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ate,
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j,SjgL ION,7fij�OWNER'OR UT1161II&D AGENT,DkCL;A DECLARATION
jig 0%�fi�rtirAuihciri7�idrAgeiii�hii"ydgi�iate
that thestrttements and information on e,flottgoing-app tot on are.true an accurate,to. best ofmy,"6wfw
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ge and
'Inn M ury
NOTUS:
1 An Wii6i,,Avh&bb ns'a-:b'utidin'g!'P-'C'Mlt'tb'do hisAe�:dwh%vbik��'6iah6iV6etivh6 hors'anUnrCSi-St-e'redr4.'-Unt&CI3�,�
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(,''dt-- "af6 PfUgm SIM iid4M_"ljiatm;;Improvement -On C ......
C
be'fit, tton
r program or guaranty n rM MOM Outer ti 'tProgramn
780 A
nd
Consfnrcdon 66ftl�,iiim C Regulations
;f(Ai6d, n vil
7_4
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far 9 'tij 0%,", .Fatalttoorsurea(St
bet in nian Onr
eflAu stantut
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u ulg,� r
garage. mishW basi�ffi nt atti s.�, c,s7qrqpjWU
C e
H
atinab e mom count
N'mber'of bid-
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of
hutfibath
ooms
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f decks/porches '
-7 n to d Open
1 0 eel ware Foam a ma be sutistttuted for 'fotaE Pro ct Cast
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to ncrtin y behalf
} ) Workers' Compensation and tmoioygr's Liadility'PI of icy
.�0^-1 L✓ NorGUARD Insurance Company -A Stock Company
,6U ANC;- Aoiicy Number BAWC616O68
-- _,r'"- of NEW -
�; _ � 1 -' NCCINo.[zs8aa]
Policy information Page Endorsement
f i i Named Insured and Mailing Address Agency
BACON BROTHEPS CONSTRUCTION LLC ROBERTS INSURANCE AGENCY
27 WALNUT STREET 1G 1060 Osgood St.
PEABOD'(, MA. 01960 North Andover, MA 0184E
Agency Code: 1IAROBEI0
Federal Employer's ID 20-5418701 insured is Limited Liability Corp (LLCj
Risk ID Number 000282810
f2] Policy Period
From A''rnl 30, 2009 to April 30, 2010, 12:01 AM, standard time at the 1 net red's mailing address. —
Endorsement
Endorsement#3, effective on the date shown below, 12:01 AM, standard time, changes
the listed items. All other terms and conditions of the policy remain unchanged.
WC890614-Forms- Eff. 04/30/2009
WC00030H - Partners, Officers and Others Exclusion Endorsemen - Eff. 04/30/2009
[31 Coverage
A. yorkers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation
Law of the following states: Massachusetts
B. Employer's Liability Insurance- Part Two of this policy applies to work in each of the states listed
in item f3]A. The limits of our liability under Part Two are:
Bodily Injury by Accident- each accident $500,000
Bodily injury by Disease - each employee 5500,000
Bodily Injury by Disease - policy limit $500,000
C. Ocher States Insurance - Part Three of this policy applies to all states, except any state listed in
item [31A. and the states of North Dakota, Ohio, Washington, West Virginia, and Wyoming.
D. This policy includes these endorsements and schedules:
See 'cctensicn of Information Page - Schedule of Forms
(4] Premium -
The Premium Basis and, therefore, the premium will be determined by our Manual of Ruies,
Classifications, Rates, and Rating Plans. All required information is subject to verification and change
by audit. (Continued on another page)
Total Estimated Policy Premium $ 6,780 `
Total Surcharges/Assessments $ 405
Total Estimated Cost 5 7,185 7
nviERNnl u< .14 Page - 1 - Endorsement
MG. BAWCOl506e WC890600
Dace -07/O9/2009
16 South River Street.P.O. Box A-H •Wilkes-Barre, PA 18703-0020 •www.guard-com
I Ina.d orIhdlding Rcgulatinns and SlavIarAI r
HOME IMPROVEMENT CON TRACTOR ,
Registration: 153458
Expiration: 12/5/2010 Tr# 277806
Type: Ltd Liability Corpor
BACON BROTHERS CONSTRUCTION LI_C.
JUDD BACON
27 WALNUT ST.SUITE 1 G
PEABODY,MA 01960 Administrator
102329
00
JAMES BACON ,q
25 MOUNTAIN HOME RE)
LONDONDERRY, NH 03053'
4/412013
��----_ 102329