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184 LAFAYETTE ST - BUILDING INSPECTION (4) gpw"IItlim fads4h D APPROVED BY Da JIWSPA=P4W TDA,P.L`9W A04 ORANTED CITY OF SALEM of it"A ow a wk.Naz ftuAsm Sty aw amals# s? Yft, No V/ BU LDM PERWT APPNCATION FOR:- per"w: (Circle WhWhewr appiV) Roof. R=A Instal Sidino, Conwrud Dods. Slwd. Pool, RiparlRipisoe. Ourer: �.cr� so-�--e PLUM RLL OW LaMLY A COURAWLY TO AVOID DELAVG W PROCESS" TO THE l dSPECT0R OF&JIL ue&- The husbv apples,for a permit to build acooxWV to tlw to*Kvmg Address& Phone 4JI--reiV, Archkeds Now Address a Phan j 1 mechanics Nana / o 0 Address a Phone a 60 ��1e� rA 1 � sittl M rr p�aaa d ewerOt__ Nast d t��`' ? c e v a OmM ft for hm wear twrwi s rown e E aeeas �a.t a � a manX Ur. , to D UNDER THE PENALTY DucA1 nam OF WORK TO BE DONE of PeRruRY r� L.c:?�►av l g�{ a.�-�,4-�-,--ram NAIL PERW m • SOS HO1�d 41 77 7 aatmm 1w#j3d T NOILV=1 S �� , 9 -ON Departanestt ajbrlwsadilAa4datts Ofat 60 Strad Bestoa`Md M11 wwtaa m psAAW Worker'Compemdou Insurance AiBdavth BadersIContradora/EledddanSlPlamben AppOca d MnstlesPldsta hfmt LealAla� Name Addles: o� 9-e ll.se�,ti � i. I n a employer wiA �1 am s Renal ao.rsetor and I 0 New�aaas�e6 aeployeee(sB aodlar rims}• bavelde d dim aaIVedstsraors 2 0 1 sus s solepaoptk i a psrma6 Need as dw am"dw&t 7. of Remoddieg I*sand bays m employees Tbm mbcosemra bave >L ❑Demolidaa wndciw gfrmsia aspreapeciw a°ebmp comp i�rm.eea 9. ❑Bolas addwm (No wO&W comp.iaantseCe S. ❑we see s caDOr Aae4 i0t, ofiteiai{ �dt 1&0 Mae"repaies or additioer 3.01aaa }omeoasardoing4we* Tweaf }j(etMdL 1143P1me6tesrq*noraddidons myself ;off, a 1��P a �leDarem 12QRootmpaW mssnos •. ,..� . . 130 Omer �Aq.potic�es 3�t.ea:p a...ro�w�s4e�bdo�r iovms p�k..�I aamp..tlo.volio�i�m�tlo� 1 Norma•M aAuItAY.�d.vll�A.rw�i wtrs.arij'asaie�•o�asadrr�be�aa rar.manss..or tcu+a+r.er4"die.iUweModw .dddlo..ta.wOooirar.serrreor...r...sa,.r am*psihIn„riaa 1 o Ar taaplgerrAar�P+�f Mwdos'eew/eneaafisr Arrrrr�irJJrgd ddwrb sAa/adfr�nadJoi cedar 6.firwefNrt. tnnaaooe CompanyNsme?oft it or SdFipa.Lice,,s I,JG �� Expkadoa Data Job Site Addrese� 't Altae!a Dopy of the werkerr'eompaaatloa poBq deebtratloa pep(riowirg tie policy numbs and esphwdes date} Fsa ue 10 sews Cover*as required mrda Secdoa 2JA of MCL a 132 en lead am die imposidoa oferimisd penaldes ors Bas cep to$1,5OQ00 aiwar osayear haipboumaA se wd ar dva pesshb In an form of a STOB wORL ORDER and a fine otup io f2J0A0 s dry against do victwL Be advbed dat s Copy of*b f0co at maybe AwwwM ao die Office of tmradgsdou a<tie DlA fw io umm eovmp vaifiadoa /do Awry SalaAepao Cal pssadrlo AN&AfOrmadowarovfdrl above/s&w aced carrel Dam Op"mu Cab► Do mof»vd'a/n Air array to by cowpUd by old or ow ajkW City or Town: ?Wai ea"N lasalag Audorky(circle ose)s 1.Board of Heakk L Building Dfpartment 3.Cltyfrows Clerk 1,Eitctrieal impedor i Plumbing inspector !i.Ober Contact Penans Pion ah Information and Instructions .. . ix dk*employ"& C1cmxd Los elm 152 ragosa an aoptoptgip ooaea�ofbh% dassaehosdls �� . 'emoi to ab swam. am�"dcdned as -.eva�I lied 299M a implied,arat ett.rri�es asaodatio�cotpaatios tir Orbs IWI mitt of ray two or mote rpil%ad meted g l 1ep1 4f a HOWMIeeoeatel m4 0e wod�va a ttsstea d s iadivid44 per►>aodados a odor]ep1 esaity.emp>ay>�C°4bf'0a� owner of a dMrelNogbonn mt more dm throe apssbnnit asi who raids suck a the oeee _ dwenieg blease otaaoddar WM eeaploy$pawns to do msisteaaeeer a te4 to De a emPsub sbYot" or as dw gteasds arbobft �s sW satbeaose of saeh esapbaystrst UM obi 1311.125aQ abto sma,_dat'rm7 stars or 109111em&g 26ft%LT aba•wkhlwM the b e""4w restwd of a tice"or psrma to operde a bsdsem a to eombuct baWasp Is tb as sosw'"M for as w wM ace o[eampa�w1a tba bwnsn eoamege regabtei Mmaead wM bar sd Vr�seOdoft'Neiaac do aoam mweaidt mr mW d�poiidat wb shall Addldosa ,MM eb p�pffftnlmw ofpebtie worto aaephblo Cimeaae ot00op�00°wrb dre imamwe ��e of dtir�w bavebem prowled to d w pmo etior.aR>t�o ' ` Saboam dot appidr SYM ebled a 24 if Pkaw fa affidavit eampieb►.b1►ebeekieg od the worlcaa' wia their Nwdcaoa(a)of utelow. Pb )nsme(sl;addtaa(ea > sma'ba(�) wiffi no eo4ioYees Omar thn doe bursoos titoiled i iabs'li4r a Limioed LiabT7iQt mmibas a patteas,are na req�irod b e� imaraooa V an I1.0 or I1.p door bavo a poley is requited. Be advised drat dds affidavh-Vbe mhmiaod b da Deparumed Of ladmIM ACCWCW tz CON&M f of b d d oe covaap� x to bd ir�aa fiascos is belt rtganted."the Department of be�totbeeiW may daiawaifyaoamsego, Amobabawarltaw Pdyad aambeF W beim. Selbinsmed'amps"abosld asses their cur or Taws Offidda please be sae that to affidavit is amVlm and printed bcblY. The Department bar provided s apace at Ibe ba0 m of the affidavit for yea 0 do out in the even,the office of UNclopticm bas 0 contact Yon regardin the apP L please be sma b®is the pan&*= a smuda wbid w91 be need as a refacm mmba. Is addiiios,m appblad drat aab�t msldPk P appgcadm is any eves year,tad one=be*one affidavit isdi"ft semen policy (if necasaY)and mWee"Jab Site Addtds"des appNead sboald write btndoas --In dw Or tcwn�"A copy ofdW affidavit ad bm ben oMdit atssuped aL> by_. a ,pi r m proof that a vaW affidavh is as doh fur dmre petmds a Neeases. A new sffidavk mnabe riled out ewk year.Where a boors owner to bras Iesvessaid petsos it NOT ngsirad b oomp�icle thin avtt vmaao (Le.a dog&ems p The office of lavat�m wonid bite to tbmb yas is advance far your mcgentim and should you bat any gsadom, please do m hesitate b d�us s cae. The Department's a mma t tol y wm and fa tamtbar The Commonwealth dMassachusetts Department of Industrial Accidmb ofilm d favesdpdau 600 Washington stied Boston MA 02111 TeL #617-727-4900 ext 406 of 1-877-MASSAFE Fax#617-727-7749 Revised 5.26-O5 www.mm.gov/&a t 4 CITY OR SALXM9 MASSACHUSMmi PUSUC PROPUMM 09PA"M[NT 120 VIMSMiMefOM STlli{T, io0 fume lKt11, MIWAdw�<Ttrl 0/070 Tft&PW MO 970-746•gp gT. ire PAM 978•74afa4e Qebrls D6eead liars is aocmdancs with the p+ovidow of Mt$,coo S A a cmdidm of year Hnildln=IPlarmit is that the debts S Am this wroth"be ftp w5d at mplyJOHcwmW tolld wom dlgmd hwafg r a dallaed by MOB. A. The debris will be dlspoied of he U.AsTe 00Noo of Facil*L,21�ITZc r�cvl 3iSnatace of A lkaat DAN Pp T VJomn+�r+�� ,/�aaaac�eune(!a BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR i Number:XS. 019668 BiqAate 03118Y1952 ExplrflsrrQ31t812008 Tr. no: 13534 Resiri�ed j00 � .-- STEP EN 144 SPINNAKER PORTS MOUTH, N'n 03801 Commissioner lie t�Jmiinzaoer�iea�� o �aaoac�uiov,!!a Board of Building Regulationg and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 104414 Board of Building Regulations and Standards Expiration: 7/14/2008 One Ashburton Place Ron1301 IFType: Private Corporation Boston,Mo.02108 ED & COMPANY INC. ^ Stephenphen Edwards One Nelson Terrace Melrose, MA 02176 Deputy Administrator of v81id without signflture ACORDM CERTIFICATE OF LIABILITY INSURANCE DAT IMM,°° 06/05/2006 PRODUCER (781)438-5000 FAX (781)438-SO28 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION New England Heritage Insurance Agency Group, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 335 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Stoneham, MA 02180 INSURERS AFFORDING COVERAGE NAIC# INSURED Edwards & Company, Inc. INSURERA: Central Mutual 1 Nelson Terrace INSURERS: Commerce Insurance Melrose, MA 02176 INSURER INSURER 0'. INSURER E'. COVERAGES 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. XPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY I POLICY EFFECTIVEPDATE OLICY MMIDDMI LIMITS GENERAL LIABILITY CLP 7939343 07/24/2005 07/24/2006 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurence S 100,000 CLAIMS MADE FX7 OCCUR MED EXP(Any one person) $ 5,000. A PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY PRO- ECT r7 LOC AUTOMOBILE LIABILITY W22385 07/24/2005 07/24/2006 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 ALL OWNED AUTOS BODILY INJURY $ B X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY CXS 7939344 07/24/2005 07/24/2006 EACH OCCURRENCE $ 1,000,000 X OCCUR ❑ CLAIMS MADE AGGREGATE S 1,000,000 A $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC 7939345 05 07/24/2005 07/24/2006 X 70RV LIMITS ER EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 500,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Interior carpentry/renovation work. Subject to terms, conditions, endorsements and exclusions on the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL North Shore ARC 1_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Larry LeGault BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 64 Holten Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Danvers, MA 01923 AUTHORIZED REPRESENTATIVE / William Kell /MAM ACORD 25(2001/08) ©ACORD CORPORATION 1988