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97 MARGIN ST - BUILDING INSPECTION What is the current use of the Building? Material of Building? lceO&E If dwelling, how many units? Will the Building Conform to Law? s Asbestos? Architect's Name1J'11lE�'�G Address and Phone 2 Mechanles Name 414 447/ 7 � Address and Phone Construction Supervisors License# HIC Registration# , Estimated Cost of Project 3Z0,00 Permit Fee Calculation Permit Fee$--L OO Estimated Cost X$7/$1000 Residential Estimated Cost X$11/$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 build to the above stated specifications. Signed under penalty of perjury Date S Zoo a � °o rn o ►. � a �9 F Z U C C7 d y ACORD CERTIFICATE OF INSURANCE ISSUE DATE 04/09/2007 PRODUCER This certificate is issued as a matter of information only and confers no rights MCGRIFF,SEIBELS&WILLIAMS,INC. upon the Certificate Holder. This Certificate does not amend,extend or alter the P.O.Box 10265 coverage afforded by the policies below. Birmingham,AL 35202 205-22�522--9871 COMPANIES AFFORDING COVERAGE �J ,4 Company Self-Insured INSURED U/ Company National Union Fire Ins.Cc of PA(AIG) National Grid USA and National Grid USA Service Company,Inc. B i 1pluding Massachusetts Electric Company "Research Drive Company Westborough,MA 01582 C Company • D Company E This is to certify that the policies of insurance described herein have been issued to the Insured named herein for the policy period indicated. Notwithstanding any requirement,term or condition of 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,conditions and exclusions of such policies. Limits shown may have been reduced by paid claims. CO TYPE OF INSURANCE POLICY NUMBER EFFECTIVE LIMITS OF LIABILITY LT EXPIRATION A GENERAL LIABILITY Self-Insured 04/01/2007 EACH OCCURRENCE $ 3,000,000 ®Commercial General Liabillty 04/01/2008 FIRE DAMAGE $ ❑Claims made ®Occurrence MEDICAL EXPENSE $ ❑Owners and Contractors'Protection ❑ PERS.AND ADVERTISING INJURY $ ❑ GENERAL AGGREGATE $ General Aggregate Limit applies per: PRODUCTS AND COMP.OPER.AGG. $ ❑Policy ❑Project ❑Location AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ❑Any Automobile BODILY INJURY Perperson) $ ❑At Owned Automobiles ❑scheduled Automosilos BODILY INJURY Per accident $ ❑Hired Automobiles PROPERTY DAMAGE Per accident $ ❑Non-owned Automobiles COMPREHENSIVE ❑ COLLISION WORKERS'COMPENSATION WC Statutory Limit Other FF- AND EMPLOYERS'LIABILITY EL EACH ACCIDENT $ EL DISEASE Each employee) $ EL DISEASE(Policy Limit $ B EXCESS LIABILITY 9834751 04/01/2007 EACH OCCURRENCE $ 5,000,000 MOaurrence ❑Claims Made 04/01/2008 AGGREGATE Is 5,000,000 $ Re: Building permit for work activities at Massachusetts Electric Company's Railyard Substation,Salem,MA;construction work to be performed by National Grid USA Service Company,Inc. Excess Liability(Company B above)includes the following retentions:General Liability,Automobile Liability,Pollution Liability:$3,000,000 Self-Insured Retention, Combined Single Limit. CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Authorized Representative City of Salem Building Department 93 Washington Streeter-'Salem,, MA MA 01970 Page i of i Cerufrate lop 1VYJ215M fI/o/ZDDJ T�Z �o�- Uzi 7�sa Report fi e Work Category Est.Cost Proposed Use Details (Phone#) Work Description Fees Paid Check# REPAIR/REPLACE $38,000.00 Commercial Other COMMUNICATIONS CELL TONER INSTALLATIONS&EQUIPMENT $418.00 3760 LC REPAIR/REPLACE $150,000.00 Residential Two or more units - rvices RENNOVATION AND 3RD. FLOOR ADDITION PER BOA APPROVAL $170.00 128, REPAIR/REPLACE $10,000.00 Residential Two or more units Lerch(978)774-4679 REMODEL?ND FLOOR BATH $105.00 5035 REPAIR/REPLACE $1,750.00 Residential Single Family Home PELLET STOVE $25.00 cash I Other .r CrrY OF SALsm ' PUBLIC PROPEM i DBPAnUENr �• �s.m.eoranras.s�.xr,oa�,eaee� �+�nr+ae�•a.su��.+w Coa &ucdoa u&rb no-V @I l AAldsvit book"�ax&mum ad naMraden as% is aoewdi wA dw"sOn at&$ba sdtlft Coat 70 CMI am"ttt.! pdM%Imddrpovletenad UOL444254 WA&A be d ip="stinapaop�r Mewvw dW�dui dodils a br% ltan tu.�tsar► roddwb win be*=Woodbx �i DEarzis ��s��59G To (ereatbrla� /h S�`�oT�,p r�O2 ��6iT�%The dabda wilt be discoed atin: (aJdfau a/htil(ry) ytwtwofpan �p�i a ZD� / ire EI`I'Y�OF�LEC -- PUBLIC PROPERTY DEPr1RTVIEI�IT KIMBERLEY DIUS[:ULL MAYOR i2)WASHING"bruEr SAL&'.,mAAAcHLsLrm01970 TEL 973-745-9S9S 0 FAX 979-740.9846 APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION. DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY Y EXISTING STRUCTURE OR BUILDING 1 A SITE INFORMATION Location Name: 0yiz .y72n �r/L�STA ie� Building: Property Address: 9 lf-l9 ce;VAV s 7 5.4�� /lam 0�970 Property is located in a; Conservation Area YIN Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: Address: 2-- Teiephone: -4 04 — L %— 7 y' 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: 57A/6 s li�S7�T/�.a/ Div o -�— - -- Mail Permit to: --