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247 LAFAYETTE ST - BUILDING INSPECTION pL1YNSj"T BE fiLfdk" APPROVED BY T'+IE JdSPJ:tIW PAIOR TDA.PEBMIT 9WWQ GRANTED CITY OF SALEM No. \ o&W is Propany Locsm to Location of �L lM FYwlorto DhUtct7 yak—No�, -----+ Is Pmpwty Loodwd In to Co amston Ma? Yat No BWLDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof Reroof, Install Siding, Construct Deck, Shed, Pool, dReplace, Other- PI EASE FILL OUT LEGIBLY i 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 Address & Phone 047 L��� Architects Name Address & Phone ( I Mechanics Name c—)w C-) Address & Phone What is do Wpm of WWWV? �© �' �05 C A momm of mom? - n a dwWq,for how tnanY tami"? WN 6 A*Q oodomi to law? AsbnM? rawanst l F Lit. i� Signature of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DWE MAIL PERMIT TO: No. APPLICATION FOR PERIMTO v rl f-Q 6 CIO LOCATION. PERMIT GRANTED 51a�/a 2.0 AP �ov�D c INSPECT OF BUILDINGS The CattUltaatlreQfth ofJAffWbtt5c9 Dapa�M ohahsMif Aaidatts .07 Ww imp Banton,MA W11 WIMnalpWAIn Workers'Compe=tion lmm=a AMd"&Bu&kMCOntradWW leehida ar.ben ADDHe wd hrmstkiL P7tlse h{ef 1<iadhh. Name Add ie :i .rt chy/sntd7.�pe� , LL Phase : I—A Are you n Mon ft" . boss, typo dpni•e!p�odk -..., . .: a�proprinN J. 1.0 I mug eoghsya wil! ou � Q I am a Deaeai eeatfaaor ad[ eanplsyees(1hg aod/or pntrtt®e}+� berm ldriot so wt�y� � ❑Neer aaooh� 2.❑ I am a nobs proprietor a yerma6 lw d on to attub d sheet 1 7. ❑RamodeNeg ship and have no employees These rob.00ntracloes have s. ❑Deamffib wokbadtraaaisear 9. ❑BMIft adiwos (No wotdes'coop howance s. ❑we am i p0A1t3i'wow . regnked.1-1 oflfia j lyye 10.0 Bkoolal repass or additions 3.❑ Ian a bomwirow doing aQ.wedr sigdtot 11. Pitmbing repahn ar addidona worhes'oosop n, I32,fl( asili+►ehayt►att 12. Rootrepaii °oIDR 0anaeo4 1 Omer 'tif���ele�Deailm�t�Loqu1S4[wAia�bdoviwleaAik. aoa4!�tls tasaww�. h"Nobo MIS812Awdowot.ae.l�o.slsmitl;�,,,,d�tMMMMMas.asdstofeuim� ..aaato.etAnseao>.ys•.waere►.t�.e,ue,.w ,.�,b,r senorbdwnmdmL /ats 4 f�Aw kPrr"bsr ww*M?eo►Iowdao bsnvwwib►*V PtajtNs dat•sr to Aw Md 4forsr.tbn la+ r lm rmw coagmyName e ?aft f or Sebl:i m Lin, N. N,0-yNP2rnL5r=,'-1 Job Sion Addtes `r _, r Attack a pop!of the women'eompaaatl•n declaration pap(�qag the paq aambw am espratton date} Fabn to sews cnc npe ss r10911d under Section VA ofhsGL e. 152 can lead b mn itnpoaidon otaio®al pessaWN ore Sao up b S1,soaoo and/or oae•Yew hoprboumM s wd ar civa paaldn is the tinm of a STOP wpt[ORDER and a tine otup to 5230.00 a dry apho the violum Be advised that a copy a[mi statement 8trwanded b the O DE of LsvatWWM of the DIA for hwarmas mverap vaiBpuioa /el•AarOy coo eeaefarA•pGY aa/ rbar rb•dsfarmakfilPvW*d•boar b tsar•ad a ye tt o,Oleld as•mot Di s♦or»�4ts Gs rbb•ney r.Ev e•wP(dt/bp eLD aibaw•oJr6i C1ty or Town lermWLlexase N (saving Audwtty(cirde oae)s 1.Board of Heakh L BuBeUng Department 3.CItYfrows Clerk 6.Other l Ebbcbiesd Impector i Plumbing Inspector L=G lerwn !hone fs Information and Instructions �„,ioawrth�r�+Ptoy� wrtl0ea.0 crag ar�tares aR mores•. ar odter Lid ad4ti aceragall 'f�a atom mdly W ' and who resides themi%or the ooaPad bOM MW of s dwct�ms�bgvbg weo ema1oY�v�0s b 8o'm®aa'°00�00mo`°aio'ar r wee s dwa baasa of aarb�ar, meM ad aotbcOM dsaeh=pbymeat or of die a�°rmcMlbW bm'ldmi�°ad dM vAd&W tW�,**a�. cbfprrr 152.4�f)SW pats dtss a ar lost Member tbs d� tar oq rsewal d a Mean or Pes�.t!°was at a eaashad ea�rrair tegai& wM has ad P�aeeeP oat apt diM PuNdei ab s1Wl da=W,MM dorM IA 6W7) ofpobMe at nedi=Mtabb 00900 of aoaWlaaw w�tha iosatsaroe esArr ieto zw a lavircemew dies P 1e eastrtxdata►�0°4l• of ads dwaff havabeea pce+� ` dtebosar ibaot appbt bYast nssattaa a�d Ph:se�� tha woaresa'ao°°pmrad°a sffidavh �� auAibr+G)a1�i wig tbeic Ada)°� n00esa4r,wPPb )=m3*16 addrar(c* P (y�,p)wim go empigy"odor theses dw Carte(1d•C)a LinriOed LiebM34r Limited I3abr7i4t imaranca, it a 11.E a L1P does haves marbers ores Potaae!as niR wed b cs� ppd a fig Dgwulle t d should vadom of �,�p �ap aaa date tie ad4daysO� OOf Le ret�cd to O city of saws dot�s aPP�mas=teepaink b�a awo tcw lnd..W AaadcM _��,' s the s.a W � selHmsared oomrpa�shoatd eater tbeis Moeass n°°oDar oa the � CM,or Towa Ofiidsda Deft to P wAded a space at dies bottoas lneae be amc the aBldavit is aoaplese and pint"1eflw uona Las to coniad you=Pm6ft the aPP� of the affidavit far yes b®i oat in dm eve f" La used ar a reterace comber. In addWOk as WPC pM1case be sue>D®ia P a ear,need a*submit one affidavit iodicadRi csrea dot m necwaY =-job is 61 pp& at should write"an bcxdoa s WW Gg po1bY» .f,W MdavitdWbabaaoMcWbtsnmpodaL> ' --A !0rtowsmaybe 4MdeQ 2C* � obo is as files for am permsts or 1leemea A sew aftdavit moltbe fiMad o� lcgm ON Permit wa year.Whm as boM Gw�or eiiisra is ! N� m4 to OOmplets god" (ia a dog Haaw at pamd b bon leaves eta)rand persost Thu Offioo otIavesd . q0°b lrlro oD f6aDk you is advanea for gout mpe radon and should you Lave any 4uad0nse Please do cotbedow a dive as a ca9. The DePartmat't address,tekpb�and fu m nbw. I11e Commonwealth of Maasachnsetts Daps =cat of Industrial AccWcdS Oda of Investdgadons 600 Washington Stied Bo"MA 02111 Td #617-727-4900 ext 406 of 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mm.gov/dia CITY OP SALKNp MASSACHYStTTS PUBLIC PROPtRTY CRPARTM[NT 120 W""'Ma"M ROUT, 300 ►Uwa ULsr. MASSMMUS M 01670 T[LMNpMp 970-745.9596 MM. 390 'AMi 979.74p9M0 Wells— Debris Dlsoea�Farm In aoaordaaee witb the provisions of MGL c40 3 S4, a condidou of your Building Perron is that the debris raWdag from this work shall be disposed of is a properly licensed solid wasteidisposal fadnty as ddWed by MC3L Chapter Illy 3 ISO A. The debris will be disposed of in: (AJ � E L�tacrv�e (LacadouofFi cility) Ln M4 Signature of Applicant 5-- lb -o � Date MAR-31-2006 0E:44 A&A FOWLER INSURANCE LLC 9786642209 P.01/01. ACORD� CERTIFICATE OF LIABILITY III4SURANCE °"TE'MM' 3J31/06/06 PRODuceA THBi CERTIFC ATE IS(SUED ASA MATTER OF INFORMATION A S K Fowler Insurance Agency ONLY AND CONFERS NO RIGHTS UPONT HE CERTFICATE 200 Park Street HOLDER THIS CERTIPICATEDOES NOT AMM EXTEND OR North Reading, MA 01864 ALTBRTHECOVEPAGEAFRIROEOBYTHEPDLICiB EE.OW, _ _. .. .. _ IN9UR9iS AFFORDING COVERAGE NAIC* NDUR® Roofs Corp. INSJRd:A Western World Insurance Co. INSURERS Lib➢ Co. i P.O. Box 150 ..�—. rtY D7utual_Insurance N. Billerica, MA 01862 j wsuRErta wsuREfl D: INSURdtE' COVERAGES THE POLICIES OS INSURANCE LISTED BELOW HAVE BEEN ISSUED TO'HE INSUR EO NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY RECUR EMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSUPLANOE AFFORDED BY THE POLI DIES DESCRIBED HEREIN IS SU BJECT TG ALL THE TERM$,WC LUSIONS AND CONDITION POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAID CLAIMS. 5 OF SUCH INS& IECTIIET�CY eIPIR N NERD T INEURAA' POLICY NUM9Efl DALE(MM TOIYY, 0, 11MNS OBNERIU.LIABILITY ----I ��' ,000.DDD I— EAOHGCOURRENOE f 1 Av CO" M'eRCIALOENERALLABWTY NPP890507-1 8/25/05� 8/25/06 oR1eMAlsEsif;°R:`T'wECaNe a 5-0,000 CLAIMS M/DE }: OCCUR EL EXP(APy"WIan) Y 51000 PEREONALAAOVMNRY 9 1 0001000 GEN'LAGGREGATE UMR APP'„IE$PER'. GENERAL AOGR'eGAIF_� 2•DOC,000 T PRO PRODUCTS&COMPIOP AGO s, 1,000,000 POLICY YE Ir n LOC I AUTOMOMLE LIABILITY I I 'COMBWEC j SINGLE LRAIi jANYAU7D I IEe=I") a 7AlL O'ANEO AUTOS SCHEDULEDAUTOB BOpILY INJURY IPFrpNsan) i$ HH.IREDAUTCS I " NOH.UYMEO AUTOS i (PN eecaen0 S i t !PROPSFTY DAMAGE I I (PeracyypL) I GARAGE LIABILITY I ANYAUTC 1AU1EA ACGASNc ;E EAACC b I AOUTO NLY�' L AOG I EIICESNUMBRELLALIMILITY IEACH OCCURRENCE I OCCUR AGGREGATE ; DEDUCTI9LE +— RE- TON -- I I woRNERSCOMFEN8A7[ON AND I VIC STATU. B IEMPLOYE"'IABILRY IWC2318318531045 12/SI/05 12/9/06 TORYIIMyzs ' _, Fl ANYPROPRIETORMARTNFROCCUTNE E.L EACH ACCIDENT S 1OD,000 OFFEEPR&MOER EXCLUDED? —ONEP41 Val SIAw �EL DISEASE-.EA EMPLOYEE' 100,000 E.L DBEASE.PoucvuNlT 500,000 DINER r DESCRIPTION OF OPERATIONS/LOCATIONS/VENC IES/EXCL MIMS ADDED BY ENO ORSEMIBNT/SPECIAL PROVISIONS Insurance verification CERTIFICATE HOLDER CANCELLATION III ANY OF THE ABOVE DESCRIBED POLICICSBL CAROELLED SEFORETNE EXPIRATION DATE THDREOF,THE eSUINO INSURER WILL ENOEIWDN TO MALL 10 DAY6WWTTFA Roofs Corp NOTICEI'O THECERTIRCAYE HOLDER NAME:➢TO I HF�LEFT,BUT FAILURETO DODO SHALL IN"O"I"'OHIL NION OR LIABILITY OF ANY N D UPON THE INSURER,IT EITSOR REPREBIUOTRNE . AUTHORS:!➢RE E T ACORD 2§(20011D8) 0 ACORD COMI OPATION 1888 TOTAL P.OI