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10-2 LOVETT ST - BUILDING INSPECTION &� EITN BF ,ALEI - - , 7 PUBLIC PROPERTY DEPARTMENT KISIRMLEY DRISCOLL MAYOR 120 WASHINGTON STREET•SA 1:K MA\UCHLSLXrS 01970 1Ei 978-745-9595 0 FAX 97&740-98" APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION. DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: /0 - ,4jvP S— Building: Property Address: Property is located in a; Conservation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land SU �/ Name: Address: Telephone: 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (so Renovated construction or renovation of existing building New Brief Description of Proposed Work: Mail Permit to: What is the current use of the Building? //6 'a Material of Building? If dwelling, how many units? Will the Building Conform to Law?_ 5 Asbestos? d Architect's Name Address and Phone Mechanic's Name Address and Phone Construction Supervisors License# HIC Registration# Estimated Cost r 'ect 00az Permit Fee Calculation Permit Fee$ ° Estimated Cost X$7/$1000 Residential Estimated Cost X$111$1000 Commercial An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to uild to the above s d specifications. Signed under penalty of perjury X Date 4: a 06 o � � � a �N CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDNY9y) PRODUCER OS/05/2006 (978)587-4900 FAX (978)887-2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Selnott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. 0. Box 4ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ' Topsfield, MA 02983 INSURERS AFFORDING COVERAGE NAIC N INSURED Aqua Terra Property en W6agemt, Inc. INSURER A: One Beacon on Co. 21970 ne DBA Warm Traditions Stove Shoppe INSURERS American Ho Assurance Co P 0 Box 2091 INSURER D: — — Danvers, MA 01923 INsuRERD: — — _ INSURER E: —' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDINe ANY REOUIREMENT,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,EXCWSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR pS TYPE OF INSURANCE POLICY NUMBER OLICYDATE EF DATE N --- LIMITS GENERAL LIABILITY1U11863 04/14/2006 04/14/2007 EACH OCCURRENCE E 1 000 X COMMERCIAL GENERAL LIABILITY D S E c1r S S00, CLAIMS MADE OCCUR MED EXP(My one Person) S _ S 000 A PERSONALS ADV INIURY S 1,000,00( _ GENERAL AGGREGATE E 2,000 GENL AGGREGATE LIMIT APPLIES PER: r RODUCTS-COMP/OPAGG S PoLICY ECT LOD Z QOD AUTOMOBILE LIABILITY IE64294 04/14/2006 04/14/2007OMBINED SINGLE LIMIT S —V ANY AUTO (En=Iftnli ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY E A (Per Penonl S00, X HIRED AUTOS X BODILY NON-OWNED AUTOS d $ (Pe,xcaenmtI q 500,00 PROPERTY DAMAGE S I Per ercinenll Soo GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S _ - AUTO ONLY: - AGG $ EXCESSAIMBRELLA UABIUTY EACH OCCURRENCE --I}$ OCCUR C,CLAIMS MADE AGGREGATE _ $ S DEDUCTIBLE. $ -- RETENTION $ S 'WORKERS S'LMUM SATgN AND WC895^42-65 0$/14/2006 O4/14/2007 TORYLIMITS ER EN ANY PRORS'UABXJYY E.L.EACH ACCIDENT S B wo OFFICERRMEIM ER XCLUDED ECUTIVE SOD, E.L.DISEASE EA EMPLOYE S u Soo,ON M yyee,lb601bB YMBI ---- --- SPE CAL PROWWNSoelow E.L.DI SEASE-POLICYLIMIT f S(X]F OTHER DESCRIPTOR OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANV OF rn waev¢o¢B<Rrele eeuc,ee ne ewwe¢,.Lae narmc two EXPNUTWN DAiE TMEFIEOF.THE IBBYINO IN¢YRER 1MLL 6N0¢wM0�O Nw, yew. �_DAVE VANTTEN NOTICE TO THE CERTIF"TE HOLlmi NwN BUT FAILURE TO RAN.DyOH NOTICE SHALL IMPOSE NO OBLIOAIp- OF ANY LURE UPON THE INSURER.rt8 NT.OF REEJPRESENTATIVES. Susan Lepnard AUTHORI�OREPRESE� 10-2 Love t St Peter Seonott LA sr SaleM, ©ACORD CORPORATION 1988