3 LEMON STREET CT - BUILDING INSPECTION (5)r
14- M -hYdSTIBE f -E— APPROVED By T44E
lKSPEMB PFWR Tp A PERMT BEWG GRANTED
`\ CITY OF SALEM
No�L .�L Data /
it Ward
Zoning District
Is Property Located in Location of2
the Historic District? Yes_No_ Building J L eras orb
Is Property Located In
the Conservation Area? Yes No
Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, In iding, Construct Deck, Shed, Pool,
Repair/Repla , Other:
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 w f I f f aM lne at, G'/OS
'3 Address & Phone Lemor Srf- cf 7V 39iy- 0��8
( 1
Architect's Name
Address & Phone �1
Mechanics Name �t'» e
( �� - &G'� -7o07Address & Phone 3yS G-re o?woo �-
Gvorce�eo
What Isthepurposeof building? Gv rkQdt�Material of building? If a dwelling,for how many families?
Will building coo onn to law? Asbestos?
Estimated cost 1/r Q 0 6 city License M State License ff
lr \ Rom ImpioV4ant E'C3r/ =
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DES CRI ON OF WORK TO BE DONE
79 110i n o%oU Cfa let Cea-?-2o f
� �ucf� titan
MAIL PERMIT TO: &7
124( tie/l1arn '3�-
&//eor r'C4, ma o /.?1/92
No.
J
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
19
APPROVFD
INSPECTOR OF BUILDINGS
5
AtI' M/�► I
� COmmonwrta(f/t Of irlt3llaChWaa�d ,
b ?�.pa.�.,.aa'.J.�.l..buf.i�«a...l.•
600 W.AUJ..Sim
�aaera 1 Gnmas &d, M..A.rA 02/1/
eona.ewe.
Workers' Cam nsadixg Insurance Affidayk
1, /��-e • 6 � � .
. . wish.a principal place of business as
e' �Sf dice s �
do hereby•cers$y under the pains and penalties of per*y,, zhM
Q 1 am an employer providing workers' compensation covers je for my eenpleayees working an
tbis jab.
Aftil—i&w �a�f 2 /�SSr,[�t�'� 2�?ivC2g8r 992.4�5
Insurance Company policy Number
c
1 am a sole proprietor and have no one working for n e in any oPsAcy.
() 1 am a sole proprietor, general contractor or homeowner (drde own) sod have hired do
contractors listed below who-ha" the following workers' caimpensatiion po0dee
Contractor lnsuranie Company/Policy Number
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
0 1 am a homeowner performing all the work myself.
•a reeouawd am a Cava of 06 apamoe we at ferwarord ed dw Ofrict Sl kwak ewe of ea DIA l r cer a.e wolacadw aM an Iabart r eaesa
ce.rrarr a rre.rre rnerr Sacien 2SA e1ltiGl 1 S2 can kao ae a+c irrw—dee of crirniwr ereade cor+ewrt via Me el w eei I.SODAD sawer ewe
rear'iAwvo.rwm a%o a e/f.i euukia in Ou lone of a STOP WORK ORDER an.s fer of 5,00A0 a am asiwt ar.
SiErled this . ` day of Gt ( DO
.icenaeei ermi[[ce 6uildin>i Gepars en[
:Jccnsing Ecarc
Seiectmens Office
�e�lth Depsrmem
-- - -.__ . _ -_ecpr ece e05 -pe T-rc
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 9RD FLOOR
SALEM,MA O 1970
TEL (970)748-9995 Err.860
FAX (974) 740-9646
STANLEY J. USOvm::L JIL.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance With the pmvisiom of MGI,c 40,S34,I ackwwledge that as a condition
of Building Permit 0 .all debris resulting fiom the constIuction activity
governed by this Building Permit shall be disposed of in a pmpcly licmw solid-waab
disposal facility,as debaed by MGL c III.
The debris will be disposed of at /L�2��
Location of Facility
Signature ofPem*Appmaw Date
FULLY complete the following iafomuatiow
(PLEASE PRINT'CLEARLY)
po4-
Name of Pewit Applicant T
Fam Name,if any
wake s ke Mot
Address,City&State
The above statute requires that debris from the demolition, renovation,rehab or other
alteration of wilding or strucnue be disposed in a pmperly_licensed solid-waste disposal
facility as defined by MU cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
• maw wENNRRu
- - � Anaorelwo7m
ROWRR - - - USE wxly JI[M OSFED AN AMATOR OF RAYINAINRI aT MID fdDERS
MARSH USA INC- MD mYTa YPDM TYE EUeW EN NQOd OIYER THAN dOETFROwOm M THE
ATTN'BRENDA BOOKER MEW.US CENWE IE ROES NOT MINN.EXTEND OR ALAN M COYERME
3475 PIEDMONT ROAD,N E. AFFwD[D s TY[PQI¢aOEifMTEO MEREYI.
(404))9952594 OFFICE COMPANIES AFFORDING COVERIOE
(404176M57BB FAX
ATTILIJWWTA70W5 , Cclumaw
I O0492JAASTRItMA- RMA A STEADFAST INSURANCE COMPANY
INJURED C Aml - • .
THOAT44OMESERVICFS INC. B WA
DBA THE HOME DEPOT A�-HOME SERVICES
2455 PACES FERRY ROAD NW CWPAW
BUILDING C-8 C AMERICAN HOME ASSURANCE COMPANY
ATLANTA,CA 303.39
GOAPhFY
D
.1M5�S!O�RT6Y MAT PQIpE!6 INS1RAiCIF DESCRIBED HEREIN HAW REEK ISSUED TOM UNSNIIEO NAMED"MEN FOR TNF pQICY P[lm NHpGIEO
pOUW MSTANpNG MY REQAREM EW.TERM OR CONDITION CF ANY CONTRACT OR OTAFA DODA MY W T4 RFSPFCT TONNCH THE CERTIFICATE MW A ISSUEDOR MR`
WRTAN-TNE.NSOµCE AFFEROW RY THE P W OES OESMOED HEREIN IS SNB ECT TO At THE TERMS CONOTIONS ANO EXpD9CINS O SUCH MOE$AGGREGATE
UMTa910.1N Yd NALE REPI R®IICED RYPAD QhYa
W ttrt M NWARK" PO NUNWR PQICYEFFFCTIYf PMI EXPOATMIN UNITSLTR DATERINOOM) DATE UNKRUITI
GENERAL IMPURITY GE f 4,OOQ000NDNM AGpIEG1F
A X CO FROA F.EHERM II/Bl1TY IPR 37576011-00 02JO1104 notEOS a/OWCTs-COYpiOp A[X: f 4,0001000
QAYSMFOE O OCCUR LIMITS OF POLICYARE EXCESS PERSONA a ATYINJURY f 4.000.0OD
p»NFT'SSCONTRAROASttEOT DFSIR. SI,ODO,000PEROCC- EACH OCORRENOE f 4,000,010D
FaE OAAAGEI�YP�•M f 4,OOD•000
MEDEa GR .el f EXCLUDED
WIONOLEIWRItt COASMEO SNQEIRRT f
AY MRO
A.I.ONXED AUTOS gyEY1NLRY f
IEhFOULEDAUTOS PAPANH)
HRED AUTOS eODIrINJ1RY f
NON-OMED AUTOS F'IN NYPaAAI
PROPERn DMAGE f
F AAClWIl1TP AROOCIY.EAACOOFNT f
Ar TIRO OUIIEAMMAUTOOAM `%P•��"\ '
EACH ACOpEw f
AGFFRfrielE f
ElQJ1lWSlw EACH SQIRRENO? f
LIMANFLIAFpIM AGGREGATE f
OTHER THAN UMRRELLAF0RR f
dPIOYERCLW{R'r X I T(RY lIMT9 EA .ss l•�+.�-'+•�•+
EL EAOI AOOOEIFT S_ I,000,000
C THE FRom"O'll wQ RMMC2981992 AOS 02JOI104 02FO1105 jL—m ,aK UMR f f,000,000
PM1xHISEIFO11nF
D CFNa3L5ME pQ EL OSEAgEAOI EMUtOYEE f 1,000,000
C WORKERS COMPENSATION
DEJOIPTOI Q OGAlORK04T1011mMpEMlr[pM ANUS '
RE:LOCATION NO,RMA.
�ftlED AW OF THE lw.wUAwb HPW at ljm WHINE wE IFFRAAOIGO nF{E6.
THE wmem MmM1 OINE.UQ ml EHNAVq TD Wl--20 mv,YIu na.MIKE FO NE
Q\N.xAll 14RN MHlD HVWH EIA MRYIE 1P MH a HpNQ.'M w HP Pt.G.a G
YNaRYOI,.W yq LMH'HI..F\YNOIOK<WF.AOE,,If MJM{p IEtiFGMATIE i OF fM
,gq Ot MFQI NIEiw
YMRI YJA MC
T. Frank KnneR � /-
-__ "'— Ny%-.•r+-T '_` ,N"'".f...� --H--•-- ... =.L;is . VAUD AS OF'07/02/04
AT-HOME Installed
SERVICES Siding and Windows
To Whom It May Concern:
I hereby authorize Bum Chhouy to secure permit on my behalf under MC
Registration number 126893.
617-
- - Board of Handing Regelations and Standards
--- HOME MOWMVEMENr COMTRAll
Registration: 125M
Sincerely, Expiration: af312W4
Type; Supplement Card .
Home Depot At-Home Services
MICHAEL BEDARD
3200 COBS 1A PKWY#28
Michael Bedard ALTTAWTA,GA 30339
Adadnistrator
License or registration valid for individul use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston,Mo.02108
Not valid without signature
Proudly sold,furnished and installed by RMA Home Services,Inc.,a Home Depot authorized contractor.
345 Greenwood St.Unit 2•Worcester,MA 01607•508-756-6686•Fax 508-756-2859•Toll Free 800-657-5182