18 NORTHEND AVE - BUILDING INSPECTION e
Ki�L T-
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The Commonwealth of Massachusetts
I*v—I Board of Building Regulations and Standards RECEIVE CITY OF
Massachusetts State Building Code, 780 CM44SPECTIORAL S7 RVICf,EM
y Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate ilylt�pli�slsja Is 20
N One- or Two-Family Dwelling 19Rti
This Section For Official Use Only
N Building Permit Number: Date Applied:
330
Building Official(Print Name) Signature Date,,,, `?
SECTION 1: SITE INFORMATION
1.1 Property(Wres I/ 1.2 Assessors Map& Parcel Numbers
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private ❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal ❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP' r
2.1 Owner'of Reford
f►' ;NL/"e1em/ 1Yl19 01�70
Name(Pfint) City,state,ZIP
1� LA -ifl7-S6S3
No. and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION tOSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
1. Building $ -7• q s 1. Building Permit Fee: $ Indicate how fee is determined::
2. Electrical $
❑Standard City/Town Application Fee '
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (FIVAC) $ / List:
5. Mechanical (Fire
Suppression) $ Total All Fees: $
q Check No. Check Amount: Cash Amount
6. Total Project Cost: $ 157. 1 5 ❑ Paid in Full ❑Outstanding Balance Due:
rY1 ra I L- I-C)
rvtir�t,,�ro 3L3111s
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supe"isor/LLice se(CSL)
yY 1{Lt'14.Q( ��IISI� License 1~� F;x6pir tio3n 'te
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description -j
�g(err, Vnil d 1 y 70 a Unrestricted(Buildings up to 35.000 cu. ft.)
Cit•/Toy e Z R Restricted 1&2 Family Dwelling
} ' M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
170 —7y.S— r3`y 1 Insulation
Tele phone Email address D Demolition
5. Registered' IH-o,-m�e_Improvement Contractor(HIC) Ig y% IO '�
�i Mom �-"-�5— HIC Registration Number Expiration Date
HIC C mpany Name.9 r HIC ar�strant Name
19 T rh,Ity Nds rio .rd • C6dom Q MorQ. )owe). (pM
No. nd Sjjyrrggpet��� /
� (.7 yy)o+ 0(77 6/)-3Sg_p 9ef 6 Email dre
Cit /Town,State,ZI
Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 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 of the building permit.
Signed Affidavit Attached? Yes .......... No........... ❑
SECTION 7a: OWNER(AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property, hereby authorize (C fffL L,-�
to act on my behalf, in all matters relative to work authorized y this building permit application.
tc\na Ii n:z- 3 ar /S
Print Owner's Name(E ectroni Signature) Date
SECTION 71b: OWNER' OR AUTHORIZED AGENT DECLARATION {n; '
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
con ned i this application s true and accurate to the best of my knowledge and understanding.
Pnn Own�r uthonz nt'sN me(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(nonregistered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.niass.eov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
i
I I
'•�,. Inc a:ontmonweaun o Inus'sa�r:nasetts -
�� Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite ir00
S Boston, MA 02114-20117
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
,applicant Information Please Print Legibly
I
Name (Business/Organization/h Michael
!. tic hael
Address:
City/State/Zip: ig70 Phone 630-717�
Are you an employer? Check the appropriate box: Type of project (required):
1.❑ 1 am a employer with 4.`,❑ 1 am a general contractorI and I
�( employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
2.[ 1 am a sole proprietor or partner- V , listed on the attached sheet. 7. ❑ Remodeling
( shipand have no ern to ees These sub-contractors h e
p y ai 8. ❑ Demolition
working for me in any capacity, t II employees and have wor ers' 9 ❑ Building addition
[No workers' comp, insurance f comp. insurance.
required.] 51F❑ We are a corporation an its 10.❑ Electrical repairs or additions
=.El ain a homeowner doing all work j officers have exercised t�ieir i 1.❑ Plumbing repairs or additions
myself. [No workers' comp, right of exemption per MGL
1 12.0 Roof repairs
insurance required.] j c. 152, §1(4),and we ha no
j employees. [No workers!) 13.❑ Other
comp. insurance required.] �T
'Any applicant that checks box 91 must also sill out the section below showing their workers'ccmpensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
^Contractors that check this box must attached an additional sheet showing the name of the sub- ntractors and state whether or not those entities have
employees. I I the sub-contractors have employees,they must provide their workers'comp.polity number.
I am an employer that is providing workers'compensation insurance fur in employees. Below is the poliev and jab site
information.
insurance Company Name:
Policy#or Self-ins. Lic. k I Expiration Date:
Job Site Address: d AuQ. City/State/Zip: _5tlevn,M4 OI Q70
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage;as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of
fine up to $1,500.00 andloir one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and.a fine
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 of the DIA for insurance coverage verification.
t do hereb Z certi under The ins and enattil!es o er'u that the in orn:ption provided above is true and correct.
Signature: q p 1 Date .
Phone #: ! 70— S3� -1/7y
Official use only. Do not write in this area)to Abe completed by city or town official
l
Citv or Town:
Permit/Lice'nse#
Issuing Authority (circle one): j
I
i. Board of Health 2.!Building Department 3. City/Town Clerk 4.Electrical inspector 5. Plumbing Inspector
6. Other
Contort Persnn: Phnlnn#•
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®COUI.Oncl A ff.ww Business Reg Ulu ,_�registration valid for aa, us,( }
. —HOME IMPROVEMENT CONTRACTOR beforeaexpiration date. ,found m_ In:
_, __ �. _�«c__wars: Regulation
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J` _m m�e Supplement�_ 10 o /16 - )
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�1 a CERTIFICATE OF LIABILITY INSURANCE
(D BATE(HHMYWt
081251/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAM END.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES'
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOTCONSTTTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:It file cortlitcato holder Is an ADDITIONAL INSURED,the Pollcy(los)must be endorsed.If SUBROGATION IS WAIVED,subject to the
I onns and conditions Of the Poticy,cortaln Policies may require an ondoraemonl.A statement on this corfiRcato does not confer rights to the
certificate h0109r In flou of such en orso nt s.
PRODUCER
EA Kelley
CONTACT Brenda Coxxolino
>c Nr"�,—��qoT 497•g993 � � r
(gU))p3f-8890 450 Veterans tAemaial Parkwpy oR ss brendocfDcakelioy.crxn
Buildings PRpuuc v<Ja_t63601 _--
Cast Providence RI 02914
MO Construction wSURERA: AllenUc CBsunh Ins Co
L•JAUpER P'
5 Bristol Rd
wsuREn c:
Snlom MA 01970
wsunER E:
R+SUkER P:
COVERAGES CERTIFICATE NUMBER: NUMBER:
THIS IS TO CERTIFY THAT THE.POLICIES OF WSVRANCE LISTED BELOW HAVE BEEN ISSUED TO THE V45UREDNAMEO ABOVE FOR THE POLICY PERIOD
INDICATED.NOVAOTHSTAZIDINGANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFOROEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS,
wsR ,,4.jONSANf 'ON I7lON RyyOE OICI . . T§.SHOWNMAYHAVF REEN,.e 0
TYPE OF INSURANCE ll R POt JCY NUMPER P I EF OL ExP
GENERAL LIAOUTY LIMNS _
X Ciu+.nlERCa�.GENEJ;,.u.i;ABn.ITY a<sH OCCUnu£r+rE__ F 300.000
�tu,w. .e.pti xt �C�^_r:�e tncu 9x'yfM; �.n 1 5.000
A Y L116000742.2 00,1912014 (J0gD)2015 PEP�,N ri Tt.�wnl.:.P•m,n+.ur+T s 100,000
.:EI.ERPL A::e prcnrc _ T 600,000
=NiAcceEcrra.UMIi r4:aLrc cTe. .. .--�
X PCLICt J• Ltin.. vRonitt'rs.ccrar^oP ni.e .. t „. 300,000
AUTONOeh.a LNFJILITY
COM1fOPJGO$y+lrlk'Lib!IT
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DESCRIPTION OF OPERATIONS!LOCATIONS t yK14CLES(Aeach ACORD 101,Addeona RrmaMa ecludol..S more Aaau 4 nrP+indl
h is understood and agmccd that IOWC S Com Pamce Inc.and it's subsidiaries are Iiskil a s an Additional Insured.
Carpentry Contractor.
CERTIfICATE OLDER CANCELLATIO -
Lowe's Companies SHOULDANY OF THE ABOVE DESCRIBED POLICIEB BE CANCELLED BEFORE
Alin!Is Insurance THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
PO Box 1111 ACCORDANCE WITH THE.POLICY PROVISIONO.
North Wilkesboro NC 20656 RUTIJORIZEp REPRESEItrATVE '"-� '�'
Kal-heririe M. Kelley, AAI, GIG
ACORD 25(2009109) The ACOFD name and logo am registered mark 1988-2009 ORD ACORD CORPORATION.All rights rosor"d.TO-it X•fA 1.3Pr13Ctl'l 4H ot, :6T P?Ti120160
STORE COPY
INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR
LOWE'S OF DANVERS, MA., STORE# 1094 STORE PHONE: (978)646-9099
15 NDOVER STREET SALESPERSON: BERNARD STUBBS
DANVERS, MA 01923-1450 SALESPERSON ID: 1503347
Document Print Date :03/21/2015
— -----Thisis-only-a-Quote-for-the-merchandl anal seivtr;esprir5teer-below. This becomes an agreementupon pd issuance of a owes receipt, upon which the entire agree-
ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any
other addenda or attachments hereto, shall be referred to herein as this "Contract."
PLEASE READ THIS ENTIRE DOCUMENT INCLUDING THE"TERMS AND CONDITIONS BEFORE SIGNING
Lowe's Registration or Contractor License Number/Lowe's Contractor Name
Customer Name Home Phone
MICHAEL SPATAFORE 978-818-5683
O Customer Address Other Phone
18 N END AVE
L City State/Province Zip/Postal Code
D SALEM MA 01970
Installation Address
T 18 N END AVE
O Installation City Installation State/Province Installation Zip/Postal Code
SALEM MA
01970
MERCHANDISE AND INSTALLATION SUMMARY
MERCHANDISE SUMMARY
F70O1
544 : STK : 1-4-4 RED OAK BOARD : 1-4-4 RED OAK BOARD : BABCOCK LUMBER - QTY 1
SCP.96 : STK : 2X4X96" TOP CHOICE STUD : 2X4X96" TOP CHOICE STUD : CANFOR WOOD PRODUCTS MARKETING - QTY 1
98543 : L 210 8FJPMD : STK : PFJ SHNG L210 1-5/8"X5/8"X8' : PFJ SHNG L210 1-5/8"X5/8"X8' : EMPIRE COMPANY, INC. (THE) -QTY 1
130159 : DMFGTC0186Z30RB : STK : 36" BMTT FG TRACRT 3/4 OVL MAH RH : 36" BMTT FG TRACRT 3/4 OVL MAH RH : TRU LOGISTICS INCORPOR-
ATED - QTY 1
131155 : 131155 : STK : 1X10X8 TOP CHOICE EWP PREM S4S : 1X10X8 TOP CHOICE EWP PREM S4S : IRVING FOREST PRODUCTS (MAINE) - QTY 1
131207 : 131207 : STK : 1X8X16 PRIMED FNGR JNT (+333358) : 1X8X16 PRIMED FNGR JNT(+333358) : IRVING FOREST PRODUCTS(MAINE) - QTY 2
Materials Price $ 650.95
Store 1094 Project No. 435741262 for MICHAEL SPATAFORE Page 1 of 8
STORE COPY
INSTALLATION DESCRIPTION
Stock or SOS : Stock Door Type : Exterior
Select Location : Front Door _ Select New Door : Single Pre-hung
Number of Doors to Install : 1 J Side Lights or Transoms : No
Hardwood (Mahogany or Oak) Door: No Hidden Damage Description : None
Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No
Install Storm Door: No Lead Safe Practices : No
Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door : Yes
us omer Understands Scope of the Froject : Yes Permit Required : No
Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None
Local Disposal Fee : Yes Describe Other Work Needed : B/O jamb. Biuld down top to fit 80" door.
Other Work Charge : Yes Comments : Remove existing storm door. dQ0 replace.
Labor Charges $ 542.0
Detail Deduction -$ 35.001
Additional Specifications:
Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system.equipment. Customer is responsible to advise if prop-
erty is governed by Historic District Regulations.
Additional Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right: Important Lead Hazard Information for Families,
Child Care Providers and Schools. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing
Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit.
PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where In-
stallation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title, interest in
and to the photographs for use in all markets and media, worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in
print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpos. , 'ncluding, but not limited to, marketing, advertising, publi-
city, illustration, training and Web content. By initialing here, Customer agrees to the foregoing. [Customer to initial to the left].
NOTICE TO CUSTOMER-PRICE CALCULATIONS: In order to properly perform the installation of certain Goods, the Contract Price may include more Goods
than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump-sum Price stated in this
Contract is calculated upon both the value of the estimated Goods required to fulfill the Contract (including waste), which may exceed the actual square footage
of the Project Area, and the labor which may be estimated based on the amount of Goods required to fulfill the contract (including waste). By signing this Con-
Store 1094 Project No. 435741262 for MICHAEL SPATAFORE Page 2 of 8
STORE COPY
tract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the
Installation Services are performed..
C-HARG-ES-Of-AL-L-MERCHANDISE-AND-SERVICES .where applicable
SUB-TOTAL $ 1157.9
'TAX $ 0.0
DELIVERY $ 0.0
BALANCE DUE
Work is to commence upon reaso able vailablity of Contractor which is anticipated to be [fill in date).
Estimated completion date is L S [fill in date].
NOTICE TO CUSTOMER
All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing
on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation
necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom-
er.
IF THE CONTRACT TOTAL IS $1 000 00 OR LESS Customer must lay in full
O PLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS $1,000.00:
Customer to Pay in Full; OR
[_j Customer to use the following payment schedule:
(1) Deposit of$ to be paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3)
of the contract price; and
(2) Payment of $ to be collected upon or after the commencement of work. IMe authorize Lowe's to do one of the following (check ap-
propriate box below):
[_] Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or
Store 1094 Project No. 435741262 for MICHAEL SPATAFORE Page 3 of 8
STORE COPY
(_) Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work; and
(3) Final payment of$100.00, to be paid upon completion of the installation to both parties' satisfaction.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON-
TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU
HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY _
OF TFf15 C NTRACT AT THE TIME OF SIGNATURE.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M L c 142A
LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON-
TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET-
ANY
R AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB-
MIT T UCH14 ITR I AS PROVIDED IN M.G.L. c.142A. c'
BY Date: ? 2/ I lv
By:_ n /�// �% \ \ Date:
Ow er ✓`` `— /
BY: Date:
Co-owner or Witness
THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION
INITIATED BY LOWE'S PURSUANT TOM M.G.L. c 142A THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION
EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY §IGNED BY THV PARTIES.
WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS-2/
Lowe's Home Centers, LLC
By: (Seal)
Print Name: �!.�
IL ., (Seal)
A�Jd�ss
o�nErF
Store 1094 Project No. 435741262 for MICHAEL SPATAFORE Page 4 of 8