Loading...
82 OCEAN AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusetts t /) g Board of Building Regulations and Standards CITY OF v t Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 �1 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only ` Building Permit Number: Date Applied: 1�29 1� Building Official(Print Name) Signature I U Date SECTION 1:SITE INFORMATION 1.1 Property A ress• 1.2 Assessors Map&Parcel Numbers 82 c� 4 of Lla Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distriet 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? Municipal ❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner' Record: �cetp /r /� (Zati, i��rrn� Name City,State,ZIP R� bcoib, v6- _ G»B-m/-6zV2 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building V I Owner-Occupied Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': /.Uf7/}LL 3 /ZWLnoFM& r IJJ� Ookjf rc N SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 1?r y7 Z — 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costs(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ c� f/ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 91 ❑Paid in Full ❑Outstanding Balance Due: (M AI LGY.O �,I 5 Y If SECTION 5: CONSTRUCTION SERVICES 5.1 Construction S rvis upor License(CSL) OS76y� -l9 8-rr ay bfy& License Number Expiration Date Name of CSL Holder�6(�/rzu Del. � ) � List CSL Type(see below) l/ No.and Street Type Description U Unrestricted(Buildings2 Fm u el ing cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 5,&Z-Be-yr 4 I Insulation Telephone Email address D Demolition 5.2 R istered Ho'rqa Improve ent Contractor(HIC) MC Comp Name or HIC Registrant Name HIC Registration Number Expiration Date '9S3onrc�fT S, NMStreet y� Aftizg � IT. (�• (7{-Z s�J p- p �t� Email address Ci /Town,State,ZIP 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 I,as 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 JB m name below,l hereby attest under[he pains and penalties of perjury that all of the information in isapplication is true and accurate to the best of my knowledge and understanding. r r uth""d Al Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered 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.mass.gov/dys 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" a , The Commonwealth of Massachusetts , Department of Industrial Accidents- Office of Investigations 1 600 Washington Street Boston,MA 02111 www.mass.Qov.dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _ . Anolicant Information Please Print Legibly Name(Business/Organization/Individual):- it- IYV1 CL �C Address: TV, 13110 City/State/Zip: Ci1ZH t�R 13 Phone#: SO S' - Are you an employer?Check the appropriate box: •- - - - - - Type of project(required):•- -- ---- I. Wfam employer-with IS" 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. ❑ 1'am a sole proprietor or partner- listed on the attached sheet.1 7. ❑Remodeling ship and have no employees These sub-contractors have 8• ❑Demolition working for me in any capacity. Workers'comp.insurance. 9. ❑Building addition - _ (No worker's comp.,insurance - 5. ❑ We are a corporation and its 10. ❑Electrical repairs or additions 11. ❑Plumbing repairs or additions required.) officers have exercised their 12. ❑ of repair - 3. ❑ I am homeowner doing all work right of exemption per MGL -13. @ Other lej W00110 - __ Myself.(No workers'comp. c:152,§1(4),and we have no - -Insurance required.)t employees.[No worker's ._- _t sect Comp.insurance required.] " !-My applicant that checks box_#1 must also-fill out the section below showing their workers'compensation policy information: tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit anew affidavit indicating such. lContractors that check this box must attach an additional sheet showing the name of the sub-contractors and their workers comp,policy information Pain an employer that'1s providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: P}U.YysVj/C.1/'e ��mcffTCt'rt. '1Vff Policy#orSelf-ins.-Lic.#: Lod4 bIc 00 - Z00 Expiration Dateit?' � � ZO! S' Job Site Address: S Z: ant, V g. City/State/Zip:cJf{��Lr1 l d l iii;,n YAttach.a,sopy,of the;workers'compensation policy.declaration page(showing the policy number and expiration date). - - Failure to secufe coverage as required under Section 25Aof MGL c. 152 can lead to the imposition of criminal penalties of a fine up to.$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to ;;,i_ $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 insurancii, v rification. I.do here �� er thendpenaties ofperjury thatthe information providedabove is true andcorrect-.-.- Si nature: Date: ,ZO•,/S Phone# Zgb" O1r6 ji,"c rOffrcial use only.Do not write in this area,to be completed by official .. Pr,• .-r°'t ctt i P rmit/License# Issuing Authority(circle one): �. +94;,-' .1: Boardrof.Health 2.-Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other r Contact Person: - Phone#: ' u . /', POWER-1 OP ID:EL CERTIFICATE OF LIABILITY INSURANCE DA0 E( 911 112 0 1 411/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject 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 endorsements. PRODUCER CONTACT Lacher&Associates Ins Agency PHONE FAX Lacher Insurance Group AIC No Ea[:215-723-4378INC,No: 215-723-8604 632 E Broad St P O Box 64398 E-MAIL Souderton,PA 18964 ADDRESS: Chad Lacher INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Harleysville Preferred Ins.Co 35696 INSURED Power Home Remodeling Group, INSURERS:Harleysville Worcester Ins Cc 26182 LLC 2501 Seaport Drive,Suite 8110 INSURER C:Nationwide Mutual Ins Company23787 Chester,PA19013 INSURER o:Pennsylvania Manufacturers 12262 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION 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. INSR S B POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POUCYNUMBER IMMIDDiYYYY1 (MIUDD/YYYYJLIMITS A X COMMERCIAL GENERALLIABILRY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE FX1 OCCUR MPA00000089793N 1010112014 1010112015 PREMISES Ea occurrence) $ 1,000,00 MED EXP IAny one person) $ 15,00 PERSONAL B ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY T PRO-JET LOC PRODUCTS-COMPIOP AGG $ 2,000,00 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea amount $ 1,000,00 B X ANY AUTO BA OODOOOSS796N 10/0112014 1010112015 BODILY INJURY(Per person) $ ALL OWNED F7 SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) E HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS PeractJdent $ UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 10,000,00 C X EXCESS LIAB CLAIMS-MADE CMBOOOOOOSS794N 10/0112014 1010112015 AGGREGATE $ 10,000,00 DED I I RETENTIONS 1$ WORKERS COMPENSATION X PER OTH. AND EMPLOYERS'LIABILITY STATUTE ER D ANY PROPRIETORIPARTNERIEXECUTIVE YIN 2014006620967 1010112014 10/0112015 E.L.EACH ACCIDENT $ 1,000,00 OFFICERMIEMBER EXCLUDED? Y MIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 B Mass Auto BA 00000018227P 10/0112014 1010112016 Auto Liab 1,000,00 B NY Auto BA 00000074949R 10/01/2014 10/01/2016 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO d01,Additional Remarks Schedule,may be aeached if more space is required) CERTIFICATE HOLDER CANCELLATION SALEM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Salem 3rd Floor AUTHO/RZZED REPRESENTATIVE 120 Washington St Salem,MA 01970 ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD e - _ WIh oWs fS eNFRC DOUBLE HUNG WINDOW VINYL VINYL FRAME - DOUBLE GLAZED FOAM FILL - GRIDS LOW E/ARGON National Fenestration NFRC CPDR: NBP•K-14-00008-00002 RatingCouncila �- ® CR100107.21.01 ELL 8M 44/001 NLLVH01 VI1/!0 - R' ENERGY PERFORMANCE RATINGS 0M27 0 , 26 ADDITIONAL PERFORMANCE RATINGS s _ 0 .47 61 ' - Rlsiq[agm e:MipUbtes mal inese ra➢ngs CprigiC lU aPPIedWl xFFC prp[mwls(or Ce[ermL:ng MA�e ' p,Muu PlY.U'+1de[P JPRC rdiegldrceplPrnmpURr alwHse:UI eOwOnn.ey'y tonefigesama - sper(arpLnl53e N=RC Caes Om re[UrtS:RN aery ryOtluv aN UOes N:oanMl Ne su.'AM'Eyd a'ryry PrNJet.Ur a"y sp!<I'•(We CUMUII,NrNfd[IV(1f5 Al2(yWf r[Y Oi11fr PICCU[I peeO,lUdU[p eLpTil C�1 ' - awx n+rc oy a 70 M =FR�N. C.. eSDIdsB r !S0 Xb�t X Code'. I. P =RadnCZ llti D r•,P Pi€€t tr I%D ode B a a as fl at C c � � - ° LiE2700 - - a3F�_r'•• on Fenas�tl��'Retlri o nc Cod NBP i + +)0 s f 7 m ad cw(dat0 R;-Ft0atng ,q a one n Coun°... .e - ' � C�ILG Y�MIUpLd/L(/M.C(.G(/L O�(%I�CQd�LGdCCt 1 . nice of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Registration 16861b= - Type -Expiration 31/ 8I2U15J;: - Supplement - - '- - POWER HOME REMODELING`-GROUP L-C. -- - MARK MORDINI . 2601 SEAPORT DRIVE'STE�8.1�10 ���e-o® CHESTER,PA 19013 Undersecretary Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen isor Y License CS-057645 o, rr ay MARK E MORDIM 18NEWELLDR; �{ NATTLEBORO I,►A - - r s f 3 -:.r "" J.IL..��.6fq�..��'H��• Expiration - ' Commissioner 09/1=015 j -, about:b1ank Fit 1, 11 NATI ON At HEADOLIAR L Il 'd I ISO)Report DAM Ohe5h:1 RA TER 1 5 1 R.1/mOnd Proceed an Writer Lynch ­ila�inwhii � 1p-Freeload r 11 '' 888-REMODEL EL t, ,- 31.33503 ',IL ecomber 03,2014 pp lily 1 HI WAC0163610 CUSTOM REMODELING AND IMPROVEMENT AG EEMENT I" It le� I I, , L fill and DericritatIon of the Property ' Ill I , , I Project Number:31-335031' 1 i � V ;trecernbar 03 2014 pit y1' f Raymond Presciad I. Ill. .I �i I I I�Tl �.1 j -1 r , I I I i firinfiiiII-7;3ill "'nd' Prescod 11! Juanita Lynch Gi_a C-01, t elpirescod@gmail.carn -;)W (H I It iL I'll- 1- 4111 82 Colari AV, �97 4242- illfra) x", r E1,IWIleli, 11 Ix il�, tl 3 11 1 1 1 , — 4,if 14 9 salon MA.01970 q A4 -rFi di t ctually:er. Township % %:,., Ift 4 Ili fill", .' - , :1 , 11 R wi Buyer(s)listed above hereby jointly and Severally agrees to purchase the goods andlor services of Power Home Remodeling Group j I V and its vendors('Contractor")in accordance with the prices and terms described in INS 6 page document and the Product, r W I" Specifications,which are Incorporated as part of the Agreement(col;ectively,this'Agreementf.'This Agreement represents a cash I i Sale Of QDOdS and services. Buyer(s)agrees to pay the cost of the goods and Services purchased as described herein,regardless oft. timing or approval of any financing Buyets)may seek for their purchase.It'i ;4f f rj;!,J, , I" 1"If, rAil ii'l r I Purchase P -1"1$247217 "1 Pre Installation Inspection Dates. I ':III, rpurc " !� $0�00 S "a ymn Down dtaZ111'Bearer Balance Due on Lf t$2.472.17 ..iil;l Estimated Prc It• I Complention, I 1J;FI Estill Pro act 6 'a �If Oth�;ilf!l ZenalFitirment W "I :8iinpietionI'to 2 IS calnevarltivalaw. Caneftre. 'e I J' Buyers)hereby acknowledges receipt of a copy of the pamphlet, The Lead E�uryerjsofthe potential risk -Safe Certified Guide to Renovate Righl"Jirforming f1g of lead hazard exposure from renovation activity to be performed In or at Sui Property,at the JIL Rilil �ri sp r 'ad t ritten above.Buyer(s)received INS pamphlet on the date of this Agreemari before commencement of work, 14 Buyer(s)'IntnIs.I:­ 1�'I? it'll ialwmflo It" hi Aglemtl constitutes the entire agreement and understanding between the parties,and this Agreement replaces,any and all iti P" r neegotiati 11li di ons-representations of agreements,either written or oni No amendment,modification or waiver of INS Agreement I Shall be valid or effective unless in writing and signed by both partili Buyers)hereby acknowledges;that Buiveris)1)has read the entire Agreement and has received a'completed,signed,;and dated copy of INS Agreement,including the tvn accompanying Notice brdi pal of Cancellation forms,on the date first written above and 2)was amity informed of his/her rightto cancel this transaction I 1 11 11,- If, 1.1—Il - -T-11P Iflux It -It Buyer(s)also agates and understands that if Buyer(s)finances the vvi with a third-partyrhe terms of that financing will k yl , ,Aft contained on separate documents,including any finance charge. I i I Future promotions not applicable'Ji J,)t r 1- lie q DO NOT SIGN THIS AGREEMENT IF THERE AS ANY BLANKSPACES. � , ; 1, Itil IIFrIt 6 have read and recall L Pill FOUP r 1 6 Jill ell It a j 1 � T� tyPtt ix} ,E . � ),�kFN Ile I V.i %) � �Y1 �� Power Ho V7 9 if- IF' ic In uy, it r(,l t'.r I 1; 4 1/12103114, 11 AL 2103 14 /12103/14 PI iSignature eling Consultant., �1 SIg nature ,J11i411JJ11 tillf ,, , fit Our Hat lil"o, "&I Donald McCarthyyd Raymond YOU THE BUYER($),MAY CANCEL THIS TRANSACTION AT ANYTIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY 1111i ;AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION ,,THIS RIGHT i. I U,14'V, III F it bSe'm­ber0'3',20142_045 PI- 1-1? page pill 4i III, it 1 of 1 1/28/2015 7:06 AM 6 f NATIONAL HEADQUARTERS Raymond Prescod and Juanita Lynch 1501 Seaport Drive ...,,,•,-�,,#:.'w^.°�.w PrescodPR 31-33503 888-REMODEL December 03,2014 .. .. ... MA HIC#168616 PRODUCT SPECIFICATIONS Buyer(s)'Information and Description of the Property: Project Number: 31-33503 December 03,2014 Raymond Prescod Dale ofAgrse enl (978)764-7032(Raymond's Cell) Juanita Lynch Prescod rjprescod@gmail.com 82 Ocean Ave (978)594-8242(Home) e-MOAdd.0 1 Salem,MA,01970 County:Essex Township: Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described in the Custom Remodeling and Improvement and the Product Specifications (collectively,this"Agreement"). Pre Installation Inspection Date:Your pre installation inspection is tentatively scheduled for Wed 12/17 between 1:55p and 2:55p. Windows-SL 2700 Inclusions: Includes metal reinforced meeting rails and nighttime safety locks on double hung windows only, welded corners, foam injected frames, Sashlite technology, Heatshield, Duraglass, exterior custom capping, installation, clean up and haul away of all job related debris. It is agreed and understood by and between the parties that the Product Specifications,along with the Custom Remodeling and Improvement Agreement,constitutes the entire understanding between the parties,and replace any and all prior negotiations, representations,or agreements,either written or oral. The Product Specifications may not be changed, modified,or varied in any way unless such changes are in writing and signed by both Buyer(s)and Contractor. Buyer(s)hereby acknowledge that Buyer(s)has read the Product Specifications. I have read and received each page of this 2 page agreement. Power Home Remodeling Group Buyer(s) Buyer(s) /12/03/14 /12/03/14 /12/03/14 Signature of Remodeling Consultant Signature Signature Donald McCarthy Raymond Prescod Juanita Lynch Prescod YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. December 03, 2014 20:45 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Page 1 of 2 F NATIONAL HEADOUARTERS Raymond Prescod and Juanita Lynch 2501 Seaport Drive,Chester,PA 19013 _ �OWER`iy Prescod ' ... ag ,J 31-33503 888-REMODEL December 03,2014 .. . k too •o" MA HIC#168616 Project Specifications Windows: kitchen 1 33.0"x40.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None Er OPTIONS: Color White/White: Grid Pattern: None I Removal Aluminum/Vinyl I Additional Details None Windows: kitchen 1 33.5k60.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None !1 OPTIONS: Color White/White: Grid Pattern: None I Removal Aluminum/Vinyl I Additional Details None Windows: kitchen 1 33.5 x60.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None OPTIONS: Color-White/White: Grid Pattern: None I Removal Aluminum/Vinyl I Additional Details None December 03, 2014 20:45 IIII III IIIIIIIIIIIIIIIIIIIII III IIIIIIIIIIIIII Page 2 of 2