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157 NORTH ST - BUILDING INSPECTION (2) The Commonwealth of Nfassachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code,730 CNIR �7t r 1� Building Permit Application To Construct, Repair, Renovate Or Demoli]aN One-or Two-Family avelling This SectioriForOfficiat Uso0 Building Permit Number:-. Date A ie z Building Official(PriatName) ,`.: $ignat re, Date SECTION 1:SITEINFORr1'(AT 1.1 Property Address- n)i % 1.2 Assessors dt & Parcel Numbers 1.1a Is this an acceppted street?yes ��no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq it) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesO SECTIONZ; PROPERTISOWNERSH7Pt 2.1 Ownerr It o Name(Print) City,State,ZIP �2 No.and Street - e ep"C 1 hone - Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK°'(check a at apply) New Construction ❑ Existing Building❑ Owner-Occupied Cl Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work': 5 SECTION4: EST INL&ED CONSTRUCTION COSTS Estimated Costs: Rem Official Use Only... Labor and Materials I. Building S S71 Inn 1. Building Permit Fee:S Gidicate how fee is determined: Cl Standard.CityPPown•Application Fe&. _. Electrical $ ❑'CotalPiojectCosP(Item.b)xmultiplier x 3. Plumbing 5 2. Other Fees:•S t. ,M-chanical (IIVAC) 3 List: hanical (Fire $ Sn ) re„ion) _ _ 'l'otal All Fccs:.S_ n, Filial I'rnjcct Cluck No. Check Amount: Cash AnwunC t'utL $ , . -- [�-T❑ I and m Fnll Cl Outstanding Balance I)ua: , SECTION 5: CONS'l-RUCTION SERVICES 5.1 Construction Su visor License L) 1 — © License Number 8.epi - io Dai Name ot•CSL I lok List CSL'Type(see below)_ t S —_ 1a�I-V1C ( a �� _ Type Description No. and Street U Unrtricte red(Buildings s u to Dwelling cu. tt. ©� ARC Restricted 13e?Family Dwellin City/rown,State,ZIP \-lason Lootin Window and 5idinSolid Fuel Bunting Appliances 'cle hwtcEmail addressDemolition 5.2 Registered Hom21mrovemeyt for(IIIC) ��FIIC Registration NumberE. it ion ateHICC pyrN n No.and t e �5 Email address City/Town,/Town,State ZIP Tale hone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance pffhe building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ns Owner of the subject property,hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION 7—to e below, I hereby att der the pains and penalties of perjury that all of the information containli Lion is true and ceur e o the st of my knowledge and understanding. rnuri�cd:\;entb N.unc(G ctronic Signanue) Date VOTES: I. An Owner who obtnins a building permit to do his/her own work,or an owner who hires an unregistered contractor (nut registered in the Home Improvement Contractor(HIC) Program),will ,rot have access to the arbitration program or guaranty rind under M.G.L.c. I42A. Other important information on the HIC Program can be found at w ww m;us.eovhxa Information on the Construction Supervisor License can be found at www.mass. u�rdyd 3 When substantial work is planned,provide the information below: Total floor area(sy. R.) _(including garage, tinisited hnsementlattics,decks or porch) tiro;; living;trey(sq. tt.l -_ If abitable room count _ MimberoCtircpleccs_.--__----- Number of bedrooms _------------.-_—._-- Numbcr of bathrooms ------ Number of halL'batIts I'ype of heating ;yalcnt _ . Number of decks;porches __--.. _---- ---__-- Enclosed I\peo(conling ;vaunt _ - pen i. "I' iLil I'nq.a Syuaro Foor.r,a"ut.ty, hc ; III;t ill it 6m"I'"r.tl hlgcet C'rit" tat Massachusetts -Department of Public Safety Board of Building Regulations and Standards . <a "-41 i License CSSL-0996i ^sv,` ROBERT POCT.OBUT 172 WHALENS LANE''�r e, Salem MA OJ970 4 n+' �t Expiration COnaTSSioner - 02/08/2014 �\ Of6ceaf Coapq lzr Afffii;.•]MIIsIA 9Y IZCnlllatiop VSIIIt il/1'lI1diY aIUt 11339:e1Y - 01ViElt,7PROVEMENT:C Oil TR GTOR 6eorethcgxprratsondata:'iffauudreiurntc:. 10EaSCP +xunesa'affat,BxittEBuslne sPeFuly Iin � Reglstra�gn Q93 Type IOfat'kptA?R ^SwtaSlTd � Expiraf>3 ( Supplwrent aIs v t3Asion,NdAbki The Home De,,o RICHAPID FA I 1690 CUM©E.RLA''!�� ��`-$ .,. ��6... .. . i,r T'r ".Pi rAt� l�GA3Q334atet ':" Ubds"}secretary .� '' • `ataelid '.jthM s4osYure CERTIFICATE OF LIABILITY INSURANCE °62127-- 3 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON.THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE. OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be end t on t s SUBROGATION IS WANED,rights to to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such en77:MZufth PR MARSEHRUSA,INC. xa: TWO ALLIANCE CENTER 35W LENOX ROAD,SUITE 2400 ATlANTA,GA 30326 INSURERIS1 AFFORDING COVERAGE NAICfast Insurnce Company26387IONW-HomeO-GAW-13-14 16535 INSURED• INSURERB: h Amed(2G Id5U(3ACe Co 23841 THE HOME DEPOT,INC. .- New Hampshire Ins CG HOME DEPOT U.S.A.,INC.- IxsuRERc: 23817 2455 PACES FERRY ROAD,NW INSURER D:Illinois National Ins CD BUILDING C-20 INSURER E AT LANTA,GA 30339 _ INSURERF: COVERAGES CERTIFICATE NUMBER: ATL4703159545-04 REy1SED NUMBER:] THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS PO ICY E POLICY OVC Y EXP ' _ 1 SR TYPE OF INSURANCE POLICY NUMBER MMIDD 9000000 - L GLO48877144)3 103r01P1013 ON112014 EACH OCCURRENCE S A GENERAL LIABILITY 1,00D,000 PA MI S E� R O a S X COMMERCIALGENERALUABILITY EXCLUDED Cl-A1MS.MADE ]000UR LIMITS OF POLICY XS I MED EXP An ane arson) S OF SIR:$iM PER OCC L . . PERSONAL a ADVINJURY S __ Q�O� - -- ------ - ---'— GENERALAGGREGATE S. 09 —3 I PRODUCTS-COMPIOPAGG S. 9,000000 GENL AGGREGATE LIMIT APPLIES -X'- PJUCY. PRO. LCCn . T--"TBA --- 30112013 - I00112M4 COMGINED SINGL U MI 1$ 1,0000 A A!AOMOB!LE UABILITY P 2E963-10 aatltl nt 00 1 I BODILY INJURY(Per person} '5 1 AUTO SCGLY INJURY(Pmaccident) $_ —(rr1 �A.LUNEO SCHEDULED SELF INSURED AUTO PHY DMG ! AMOS - AUTOS PROPERTY DAMAGE 5 1I NON-0WNEO Per acddenl_ HIREOAUTOS AUTOSS & UMBRELLA UAB OCCUR EACH OCCURRENCE AGGREGATE S EXCESS UAB CLAIMS-MADE - - I " S CEO I I RETENTIONS I Y.ICSTATU- OTH- C WORKERS COMPENSATION - WC033575314(A S) 0310112013 '. I031OV2014 X 1,003.000 C I AND EMPLOYERS'LIABILITY YIN 4YC033575315(AK,AZ) 0310112013 0310112014 E.L.EACH ACCIDENT S ANY PROPRIETORIPARTNER/EXECUtIVE 1,00D,000 D I OFFICERIMEMSER EXCLUDED? E NIA WC033575316(FL) - 0310MO13 0310112014 E.L.DISEASE-EA EMPLOYE S (M D EYyandatory In NH) 1,11M.000 SCRIPTION undOF OPERATIONS Oe!ew E.L DISEASE-POLICY LIMIT S 1,000,000 C WORKERS COMPENSATION WC03357531T(XY,NO.NH,VT) 030112013 0310112014 (EL)LIMIT C WC033575316(NJ) 030112013 031,0112014 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,[(more space Is required) EVIDENCE OF COVERAGE - CERTIFICATE HOLDER CANCELLATION THE HOME ME DEPOT POTUSA INC. SHOTHE�EXPIRATIION DATED ANY OF THE VTHEREOF, NOTICE DESCRIBED ES WIBLL CANCELLED Be DELIVERED IN HOME ACES FERRY ROAD, 2455 PACES FERRY ROAD,NW ACCORDANCE WITH THE POLICY PROVISIONS. 'BUILDING C20 ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE ofMamh USA lno. - Manashi Mukhegee X+ %A.040N' 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Offlee of Investigations 600 Washington Street Boston,MA 02111 www.mass gov din lumbers Workers' Compensation Insurance Affidavit: Builders/Contractors/Elepclease Print Le ibl Applicant Information Name(BusunessfOrgam yanonllndividuai) Address: a City/State/Zip: Phone.#: Are you on employer?G7reck the appropriate b : Type of project(required): 4. I am a general contractor and I 6. New construction 1.El am a employer with have hired the sub-contractors employees(fide andtor par!-rims).' listed on the-attached sheet 7. ❑Remodeling 2.El I am sole proprietor or Partoet- These sub-contractors have g. []Demolition ship and have no employees and have workers' aci employees9. ❑Budding addition working for me in any capacity. comp.insurance.t• I [No workers'comp.insurance. . 5• n we see-&-corporation and its 10.0 Elextrcal repairs or additions tie-quired.) 4— ogroara have exercised there 1 L[Plumbing repairs to additions '3_❑'3 note,homeowner doing all work right 6f exemption per MOL 12.❑R repairs myseiE[No workers'comp. c. 152,§1(4),and we have no i 13. emptoyeew.[I'I worker insurance required-1 t - o s j , comp insurancerequued.j °�1tuY aFPRasnt flat cheeks boz ill tarsal also ffl out the see6on below showing then wodtca cornpeosatsas poVeY ssefornnti®. .. an doing ellwmt cad torn lase outside canlxactora itgistsutmdtanew affidavit indicating suds,.: t Husm-oweas who submit thin etlldavitfidlsxdng astir 8 .the,tunw of the subecnadtaon a�,stae whether ormtthose entities have ?Contractors that check this box must adached an additional het ds R � workaa'comp.poHry numbtQ - empsoyeea if the subs nmwtm bavd mvloycm dwY .o I oac Selaw l9 fire Aoltcy and Job s(18 i ram an employer that is prm/ding.;workers eompensanon rreswrurs r r i. information. ��, Insurance Company Name Exp'urationDate: � Policy#or Self-ins.Lic.#:_ City/State/Zip: Job Site Address: expiration date Attach a copy of the workers'compensation policy declaration page(showing the pow numbef and E1P Penalties of a Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the'imposition of criminal p -year imprisonment'as well as civil peaalties in the form of a STOP WORK ORDER and a fin Fme tip to$1,500.00 and/or one e of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations for' ce covers a verification yr e p d p aId ofperjury that the information providedshot .is trae and correct Date: not write 1n rrs arertownoffrclal. TPermit/License Arcle one):d .Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector r j Contact Person• Phone M 3 CtrrofS'UZN[, "VLASSACHUSETTS A'! i,4 ) E3LMDLgC;DEPARTU NT \ � l tp ;.���•� 1V.IsFICtGTONST1tE&1' 3 Ft,00R T EL (973) 745.9595 KIM13F.IiSy DRISCOLL FVX(973) 7-W-9346 i,L�YOIt T}IOSGIB ST.P1FRri8 DIAECTOrt OF PuLic PROPEATy/g(;MDDiG CONWISSIO,V ER Construction Debris Disposal Att7davit (required for all demolition :md renovation work) In accordance with the sixth edition orthe State Building Code, 730 C�bfR section l l LS Dcbris, uld the provisions of MOL c 40, S id; ©wilding Permit f< is this wo shall be issued with the condition that the dcbrfs resulting from l 11. S I JOA. disposed of in a properly licensed waste disposal racility as defined by jvfGL e The debris will be trinsportcd by: � (uamu ut haulur) -- The debris will be disposed of in -- (name u*tjy) - si toy uru f perntit d I': t - - VP t� ---- I e6/01/2013 21:29 17818940331 TODD RIDEMAN PAGE 01 HOME IMPROVEMENT CONTRACT S '�'s? 3• ., „ 'r , - v PLEASE READ THIS .. .. -•t * :, f:, :` S . ' r ` Said,Furnished and Installed by- f Branch Na : Boston Date: 611 '3 THD At-Horne Servitxs,Inc,Nam: ' d/b/a The Home Depot At-Home Services ' 908 Boston Turnpike,Unit I,Shrewsbury,MA 01545 t , } •' Toll Free(800)657-5182:Fax(508)845-6017 Branch Number:31 Federal ID#75-2699460;ME Lic#C 02419;RI Cont.Lie#16427 _ �-7 n.r/ .._ (_ _�_. - _... CT Lic#)JHIC.0565522:MA Home ImpmvementCOnlraetor Reg.#126893 -- In.Stallatioo Address: �� / dQarN Jr _<44,n /11A 019'70. . r' City State Zip . Purchaft-113): - Work Phone: ~Home Krone: C¢11 Phone:- . fari1A�1t1�J [ J G [ J ffisrl�ik 0�6 Hama Address:. > . 01'different from Installation Address) City Snafu Zip , E-mail Address(to receive prulect communications and Ham,Depot updates] ❑ I DO NOT wish to receive any marketing emailc from The Home Depot Project Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, and THD At-Home Services,Inc.("The Home Depot")agrees to famish,deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced Spec Sheet(s), all of which am incorporated into this Contract by this reference, along with any applicable State Supplement and payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job#: 'I°'^"m"`"'°°^' Products: S Sheet(s)#: ProiectAmount Roofing 0siding W windows LJ Insulation /, J (7 q 759 ❑Gums/Cove,- ❑Entry Donn ❑ J $ ._/ 9„ 00 Q_� CI Rarfing ;ding ❑Windows Insulation ^� ❑C+utrcrs/Coven ❑Entry Doors ❑ elm O $ ❑Roofing OSiding El Windows L1 Insulation ❑Gutters/Coven ❑Envy Dews❑ _ $ ❑Roofing OSiding ❑Windows U Inwladon ❑Gunn/Covers ❑Entry Doran ❑ $ ?))q yn� Mird ZS%Deposit afCom wm a rrat Am due upon mention oftldsemmut. Total Contract Ammnt $ 936/. oV Maine Pta'dtaerrss soy notI more than wrrihird at the CwtDtat Ampmt Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance date. As applicable, each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or tennirste Ibis Contract or any individual Produa t(s)included herein,at its discretion,if The Hartle Depot or its authorized service provider determines that it cannot perform is obligations due to a structural problem with the home,environmental hazards such as mid.asbestos or lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary# / /b 5;�3 , included as pan of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy or the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product IS:complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider throug8h the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE,HOMF,DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME. DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT 1dMITING THE HOME ITEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance act Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Produce and Installation-This Agreement cannot be assigned or amended except by a writing signed by Customer and The Horne Depot.Customer acknowledges and agrees that Customer read.ondentands.voluntarily accepts the terms of and has received a copy of this Agreement. �,��,,�{� SubmiHed by Cusl mer's Signztur "�'-��-veDate Sales Cumultant's Signature Date X Telephone No- Customer's Signature Date Sales Consultant License No. CANCEI,I,ATIDN: CUSTOMER MAY CANCEL THIS tas:,pptisahkl AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DEI,IVF,RING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMF,RIS STATF. NOTLti;ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE RRVF,RSF,Si ry,AND ARE PART OF THIS CONTRACT 10-11-12 Wlate-Branch File Yelbw-Cuatuner HP Officejet J3600 series J3680 .. ,.Personal Printer/Fax/Copier/Scanner Fax Log for Richard Fallone . _ 4014531367 Jun 09 2013 5: 090 Last Transaction Date Time Type Station ID Duration Pages Result- Jun 09 05: 08p Fax Sent 14012462868 0: 35 0 Error 387* * H communication error occurred during the transaction. Try again. If you 're sending , try again and/or call to make sure- the recipient 's" fax machine is ready to receive faxes. If , uou 're ,receiving, contact . the initiator and ask them to send the document_ again. It t [