15 LYNDE ST - BUILDING INSPECTION (3) Z,
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APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT
ALL STRUCTURES EXCEPT I AND 2 FAMILY DWELLINGS
INTPORTAN-I':Applicants mutt complete.u11 items on this jTa—ge -
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SITE INFORMATION I
Location Name 7r3 vv%ple Ov✓. Building
Property Address ' ij '—Yjtge� S— �e
Map 4
Located in: Conservation Area Y/N —AL—Historic district Y/N
Use Groups
(check one)
Residential(3 or more Units) RZ
Type of improventent Residential(howl/motel RI
(check one) Assembly(churches) Al
New Building^ Assembly(nightclubs etc) A2—
Addition Assembly(restaurants, recreation) A3
Alteration Business
Repair/Replacement Educational
Demolition— Factory(moderate hazard) F
Movelptelocate Factory(low hazard) F2
Foundation Only High Havard [,I
Accessory Building-- Institutional (residential care) 11—
Other(describe) institutional (incapacitated) 12
Institutional(restrained) 13
MercanxilQ M
Storage(moderate hazard) sl
—
Stcrage Moxv hazard) Sz
OWNERSBIP INFORMATION(Please type or Print Clearly)
OWNER Name j90 I� I r t--
Address
Telephone 9 7 21 OF-
DESCRIPTION OF WORK TO BE PERFORMfj)
ROO 1F
ESTINLItTED CONSTRUCTION COST 0
1 �9f
9�
Board of Building Regula ions and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 155890
Type: Individual
Expiration: 5/15/2009 Tr# 255443
MARK AUDETTE
MARK AUDETTE
18 HIGH RD.
NEWBURY, MA 01951
Update Address and return card.Mark reason for change.
)PS-CA1 0 50M-05106.PC8490 Address ❑ Renewal Employment Lost Card
Board of Building Regulations and Standards License or registration valid for Individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration:. 155890 Board of Building Regulations and Standards
UIF One Ashburton Place Rm 1301
Expiration: g/:15/2009 Tr# 255443 Boston,Ma.02108
Type: Individual
MARK AUDETTE
MARK AUDETTE
18 HIGH RD.
NEWBURY,MA 01951 Administrator Not valid without signature
oard of.BdOdtn it" Ypio'iU I 4.+ r
r k7l 008 `"� v,•. -
4
ib}ARK L AUbETT��
18 HIGH ROAD
NEW BURY, MA 0941,111,,{ "'1 mmt' 'r
CONTRACTOR INFORMATION
Name 6A V'K, .4 N Oog:'rte
Address h6x (y kQ NeU-,D rn;, ipdy`
Telephone 27r-Z?0 - '4?-3 y
Construction Supervisor's Lic# CS Z S
Home Improvement Contractor#
ARCHITECT/ENGINEER INFORMATION
Name &JA
Address
Telephone
Mass. Retristration #
PERMIT FEE CALCULATION 40
Residential est. cost x $7/$1,000+ $5.00= SS."
Commercial est. cost x $11/$1,000 +$5.00=
COMMENTS
The undersigned does hereby attest that all information stated above is true to the best
of nmy knowledge under the penalties of perjury
Signed
Date
OCT-08-2008 08:05 From: 19789881082 To:9784656607 P.1'1
RightFax N2-2 10/8/2008 9. 10.04 AM PACE 3/003 Fax Sarver
ACORD. CERTIFICATE OF INSURANCE DATE(MM1DDIYY) 10.08.08
AROOUC!`R. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTG UPON THE CERTIFICATE
LYNIAN INS AOCY INC HOLDER.THIS CERTIFICATE DOE$NOT AMEND.EXTEND OR
299 RAL.LAROVALL ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
1L'ILMINL7I0N,MA OI%S'/
COMPANY
72PER A 'I'AtAVULLxSU11L1iCr AS51G.IAM:Nr
INSURED COMPANY
B
JrrA INC
COMPANY
IPA BOX IA80 C
NL'VVIIL RYPORT, MA DIVYII COMPANY
D
COVERAGE
1111515 TO CERTIFY THAT THE roVf.IEH Dr PBUR1Nc!MATlO slLOW NIIVe seen MsueD 1'U'TNe IMOUReo NAMED ABOVE FOR 1KE POLICE PeNoD INDICATED,
NOTWITHWANDINC.ANY REOUMEMENF T E RM ON CONDITION OF ANY CONTRACT OR OTHER DOCUMENT YYI1H RCSPELT TO WMICHIHIS C ERYIFICATE MAYBE MOVED OR
MAYPIUMM. THE INSURANCE AFFORDED OVINE POLICIAS DESCRIBED HEREIRS SUBJECT TO AU_TME TERUO.OCLU91ONS AND CONDITIONS OF OUCH FOUCIEB,
UMITS BROWN WIT HAVE BEEN NLUUUAV NV YAIU CLAIMO.
CIO POLICY EFF POLCY EXP
LTR TYPEOFINSURANCE POLICY NUMBER DATE IWDDIYY) DATE LIMITS
OENERAL LIAOIUTV GENE RAIL AGGREGATE 3
COMMERCIAL GENERAL PRODUCTS COMP/OP AGG. S
CLnDAO MADE OCCUR PFRSOMII.AA AD,/ INJURY 3
OWNER'S AR CONTRACTORS PROT. EACHOCCURRENCE 3
FIRE DAMAGE IAAV uIU E.I 3
MCC 6%PENG6(Aly lnn Pnrmn) .3
AUTOMOBILE LIABILITY
ANY AUTO COMSMED SINGLE LIMIT 3
ALL OWNED AUTOS BODILY NJURY(PM Pmon) 3
SCHEDULE AUTOS OOOILY eAURY(PIR AsoUNUj 3
HIRED AUTOS PRGPARTY DAMAGE S
NON OWNED AUTC)d
GARAGE LIAR RITV
ANY ALIT05 AUTO CNLV EA ACCIDENT S
OTHE R I MAN AUTO ONLY.
EACH ACCIDENT S
AGREGATE 3
EXCESS LIANUTY
UMBRELLA FORM EACH OCCURRENCE $
GTHFR I HAN OMHHk LLA FORM AGGREGATE S
WORKEN'5 CWYENSAI'ION AND
A FMPOLVER'S LIABILITY UB-OSS48004.08 010108 01'01-00 OTATJTORY LIMITS X
THE PROPRIETOR/ EACNACCIDENT 3 500,000
PAATNCR5/CXCCVTIVE % INUL OIDEADC-POLICY LMIT 3 900000
OFFICERSARE: CXCL 1JGFADE EACHF,IAPLOYFE 3 500000
OIHk N
OCSCRIPTION OF OPERATIONSROCATIONSNEKCLES�RESTRICTIONS.SPECMLITCMi
' TUIX NFYLAf Y.V ANH'Y/VUR C3^n1D1 DATR IStLl'D TO LTII'CML'IIHCAIC INunR%AYYY('IINu 1vUNRY%d Ci N!vf`VV'H%nOH '.. - -
CERTIFICATE HOLDER CANCELLATION
SHWLU ANY tfi Ift ASWk UkUUNIUSV I'VLIMkU Uk CMVELLkUtlkYV2 IHk
TEMPLE COURT 170W)MIN IUM ERHRAVON DATC IIIERCOC,THIC rsounx(;c"rANYWLL CNMAUOR TO MAIL I(
DAYS Wltl'IIEN VUIILI:1 V I Hk CENI EIDAI t IIW.lN NAM11kU I V IHt ItFl.lRll
75LYNBESTREET` HALURE10 MAC OUCRNOTICE GMAIULIIAPC^ NOODUCATIONCRUAMLITYOF
AVY KINn UPON THE COMPANY,ITSAOENT5 OR REPRESEVTAIWES.
SALEM.MA 01970 AUTHORIZED REPRESENTATIVE
ACORD 25-5(3193) Charles)Clark