260 LAFAYETTE ST - BUILDING INSPECTION t
fL*p61AI16TiEfILfB�MID #AWROVED BY THE
JL,LS JCM PIM TD A P.EBMIT REM GRANTED
• CITY OF_SALEM
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BUILDING PERMIT APPLICATION FOR:
Permit Uo:
(Girds whwhwm apply) Root Coralruct Dods. Stwd. Pool,
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PLEASE ALL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUUMUOS:
Tho undsrap applies for a permit to build actor Wq to dw following
nod turaby
Name e s of
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DESCRIPTION OF WORK TO BE DONE OP UR
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MAIL PERMIT TO:
No.
APPLICATION FOR
PERWr TO
d'C���G//C•C ��Gr/l`Je�.-c�S — l�5 � � 5.o1�i�� .
LOCATION
PERMIT GRANTED
ro�l3��� to
INSPECTOR WBUILDINGS
4
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration. 140432
Expiration:;10l15l2007
lug r-
i a Type:.DBA
RB REMODELING
ROBERT BENSON,'��
4 HARRIS ST.
MARBLEHEAD,MA-01946 Administrator
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PAS 679-740""
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Is WCOMaMce with the peWASIOss Of MM CO S A a coadidoo of your
HniWias Pend is that the debdo h S ftm this work shall be disposed
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Chapter UL 3150 A.
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TeL #617-727F�� of.7749 '-MASSAFE
Rcvised 3-2" www mass.gov/dia —
08/08/2006 13:03 FAX 508 653 8089 EASTERN INSURANCE SELECT IR 002/005
ACORQ CERTIFICATE OF LIABILITY INSURANCE o6/08/2o6
PRODUCER (801)g333-7234 FAX (S08)653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Eastern insurance Group LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
233 West Central Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Natick, MA 01760
Commercial Lines ext 3389 INSURERS AFFORDING COVERAGE NAIC#
INSURED RB Remodel ing Company, Inc. N3uRERA Continental Casualty Company 20443C
S Bessom Street INSURER B:
Marblehead, MA 0194S INSURERC:
INSURER D:
INSURER E
OVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN
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.
INSR kDVI TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICYENP114MIRATION LIMITS
GENERAL LVABILrrY EACH OCCURRENCE S
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED y
CLAIMS MACE 7 OCCUR MED EXP(My we PIX -) $
PERSONAL d AOV INJURY $
GENEPALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG S
POLICY IRO- LOC
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea aeddol) $
ALL OWNED AUTOS
BODILY INJURY S
SCHEDULED AUTOS (Pere )
HIREDAUTOS
BODILY S
NONAWNED AUTOS (PIX PCGdent)EenI)
PROPERTY DAMAGE S
(PIX eCddenO
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHFRIHANI EA ACC S
AUTO ONLY: 0.GG $
EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR DCLAIMS MADE AGGREGATE S
$
DEDUCTIBLE $
RETENTION $ S
WORKERS COMPENSATION AND CERTIFICATE TO BE 08/28/200S OB/28/2006 7( WCST4TU•EMPLOYERS'LIARILITY ISSUED FROM
A ANY PROPRIETORMARTNERIEXECUTNE EL EACH ACCIDENT S
OFFICEWMEMBEREXCLUDEDT CONTINENTAL CASUALTY E.L.DI$EASE•EA EMPLOYEE
$
SPECALFFROVSION5 IwIDW COVERAGE IS IN EFFECT E.L.DISEASE•POLICY LIMIT $
OTHER
OESCRIPnON OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
IX IRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
City of Salem 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Building Inspector BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
120 Washington Street OF ANY KIND UPON THE INSU $ EWSORRFPREBL:NrOVM
Salem, MA 01970 AUTHORIZEDAEPRESENTA
Corinne Ro ers
ACORD 25(2001/08) VACO ORPORATION 1988