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82 OCEAN AVE - BUILDING INSPECTION (3) I'he C'onunonweahh of�i;usachusclts _ . Board of Building Regulations and Slaii&iMs CI I'll' OF JI' �Lts.aarhwctfs State Building Cute, 7SU('MR S.1LI-%f Building Permit ,\pplicatiun To Construct, Repair, Renovate Or Demolish a (fie- ur Tron•f'unuh Du ellin.y This Section For Official Us-Dill71 UuilJiny Permit Number: Date A J PP eJ; _ lImIdmy Dllicial(print Munc) wture Dale SECTION 1: SITE FOR31A L I Property Address: 1. s Map dt Parcel Numbers I.la Is this an acce ted street? es no Alnp Nnnthur Purcd Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoniny District I'ropuced(Jw Lol Area(sy III Fmntuya(I!) 1.1 Building Setbacks(R) Krum Yard Side Yards Provided Required Required Pmvidcd Rear Yard RryuRequired1'nsviJeJ 1.6 Water Supply.,IM.G.1.c. JU. §!a) Ij Flood Zone Information: I.S Sewaye Disposal System: Public O Private O Zone: _ Outside Flood Zone Cheek if cs0 Mvnidpd O On sih Jisposul s)stem O 3.1 Ownert of Reeardt SECTION]: PROPERTY OWN ERSHIr- ,2gV67anal GF �Cad i� Sotf`enA1.4 DJa7D N,une(trimy L'iq•,Statu,l.IP 8a OCeTj fiV 97�- s4�-8aYa Nu.unJ Street frlrphone Email AJdress SECTION J. DESCRIPTION OF PROPOSED WORKr(check all that apply) New Construction ❑ E.sistiny Buildiny ❑ Osv1 er•Occup(ed p Repa(rs(s) O erosion O Addition O Demolition O :\ccessory Bldg. O Nwnberof Units_ Other Specify; Brief Description ofPro used \Vork-: ini!'n/Aow/ /L D C ��7y�i 1 t^In.,7 4S SECTION 4: ESTI;II. TED CONSTRUCTION COSTS Item Estimated Costs: Il.ahur;md.Materials) OMclal Use Only I Building S �9 I. Building Permit Fee: S Indicate how fee is determined: ' 1.1wrical S ❑Standard City+Tossn Application Fee I s I'hunhiitg S ❑ Total Project Cush(Item 6)1 multiplier .'. Other Fees: i J. \Iec h.mical ill\ \t'1 3 List: �u „rcssiunl S fnfal \II Foes: S — I'mal Project Cmt: S 66 I.hccA \'u. _( Itad .lnunmt: l'.nh \nunun: ag37J O P.lid in Full OI)ulstmJiny Hdl.mcr Oue; SEC 11ON t: ('ONtiI'Rli(`flpN SENVI('ES S.I C'unstruclion Supenisur License(C'SL1 - I icen,e Nuu,her Pspirali,m I)aw �}tic(n_ Go rr Ir --- Vau,e I IA cr I Is1 CSl. l'spe l•cu l+vluol._ - — - Dcsariplion No. .utJ weel �! I I 1 hlrcilricleJ IIhu4lia s li l0 1S,IIIIU al. IL1 /V ✓Q /L/ c30�0—�— --- Ii Mam-icmJ IR? I .lutil I)t,eltin _ — \I \h1:un Cipil'oau,.S ele.Lll' RC• Raulill Cos Grin q'S A-indoo,,.aid SiJio SF Solid 1vel Ihoning,\ppiiances Insulalion �D 0—8 Y_ XLgWgx.�`f41 - D Demolition 1'elc hmw 1:111, aJJress tc lauatiun Num+cr3813 ovement Contractor(IIIC /66�6 5,1 Registered IlumeIms I:%pirnbon Uul e ) /b ,y IIIC i g L /1+Q I�A11O� l�vwaf �o I IIC'C'onl u11) Nome or I IIC Iteawralit.Num l/ limuil address No. and S"'id J Ci frown state e ZIP role hone 2SC(li)) SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. I37.1 Workers Compensation Insurance affidavit most be completed and submi ed with this application. Failure to provide this atYldavit will result in the denial of the Issu of the building Permit- ermit- Signed Affidavit Attached? Yes •.......•• SECTION GENTORCONTRACT UZATION TO BE Coll OWNER'S A ORAPPLIE9 OR BUILDING PERMIT 1, as Owner of the subject property,hereby authorize at Col/6rP Pt!>Q�! to act on my behalf,in all matters relative to work authorized by this building permit application. — ka Date Print Ussn—N W°e(Electronic Sianalurc) SECTION 7b: OWNEW OR AUTFIORI2E0 AGENT DECLARATION By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. /O 15 1 All Data I'rinlQaner'sor,\oth rircJ.\gonl'sNauluI11"trunicSignaturv) No'res: Inut re}istared inbhelHwne hdpruvamenit tlCun r'cturIHICI Progr nsl.n ollna, `have acQcss tot the a(tbitrditiunii Iractur prog`amlur guantill)Infam,a un on the Construction Supers for l i close can be found atormtion on the Program c,n+bat found at U hen substantial Iwrk is planncJ, prosiJe the nation bclo1'� finished bascm n't epics. Jerks or porchl ig S rotal (lour area 14 11.1 . ----'- ilabil.tble ruunl count _ .. Urosi lining area l sq. ll.l . . ._.... \un,hcr kit'bedrooms \un,hcroltinl+laces ,. ... _ Numberot'hall hallls �unlhcrol'hal)Inwols - VunlherojJccki, porches I) pc ai hcoting s)'Will I'nc61.cJ 01wil I')I+�, t�P01111 tj N 11e111 1 1 ..IPL11 Proicct S,lllare I'dPldy'C III:1\ he HIh,t11111eJ tiV l'otal I'roj"t Coll" CITY OF S.U.E.%I, L-uSACHUSETTS 13uimL\G DEPARTMENT N 120 WASHIINGTOY STREET, 3' FLOOR TEL (978) 745-9595 FAx(978) 7.10-9846 KI\{BERIEY DRISCOLL INLAYOR THo.%As ST.PIERRs DIRECTOR of PUBLIC PROPERTY/BCtLDL\G CO\LMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 11 1.5 Debris, and the provisions of MGL c 40, S 54; Building Pen-nit At is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in : (name of facility) --(address of facility) �1 signature Vp ermit applicant date The Commonwealth ofMassachusem Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ( � Please Print Legibly Name(Baunaarorganiattanrtadwidoxil: POWErL NGr1'l C_ �CMCDE.Lik6 l.9/?cy/9 Address: 2r�/ SrAP//?r Y m Blre) L uEz?_ P11 19013 City/State/Zip: Phone #: Llc - EW— 5-1)00 Arc)' sn employer?Check the appropriate box. "type of project(required): 1. I am a employer with i S 4• ❑ 1 am a gmeml contractor and 1 6 ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t ❑Remodeling ship and have no employees These sub-con Vectors have 8. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9. ❑ Building addition (No workers'comp.insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.) officers have exercised thew 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.(No workers'comp. c. 15Z ¢l(4),and we have no 12.0-koof repoirs — insurance required.]t employees.[No workers' 11[3 Other W/A/-00006 -' comp. insurance required.] •Any sppeowrls wfitam that chchs boa a1 mutt also fill out the section below showing thdr workers'wmprnufkon Policy talMmuam. l ttamho submit this sNldav l Imflcaang they ere doing as work and then hire ouralde raavoraaID meet tabmlt a Dew algdavh lodleadoa orb. lConbacem dun check this boa must utxtud an tddidoml sheet showing the time of the atb-eoonaaon and their workai comp.policy information. /airs an employer that is providing workers'compensation htssrrance for my employvet. Below B the paltry and job site Ixformadon. Imausuce Company Name: Nor RI'-ff 5 V I LLE WVR-GE--5TEie- Sn/S Gp Po1iey0 U,.iV WG000adaff9�9s Exp'uationDate /o /3 Job Site Addres S4 ©Gcwt Al City/Staicaip Sham 141A I q I 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 c. 152 can lead to the imposition of criminal penalties of a fine up to f 1,500.00 and/or one- ear]mprisoconwt,as well as civil penalties in the form of a STOP WORK ORDER and a fine or up to E250.00 a e 'olator. Be advised that a copy of this statement may be forwarded to the Office of Investigations o e D for co coverage verification. I do hereby c ern er e p and penattier of perjury dial the Information provided above is true and correct Silma Phone a. ?? y "ZS'll- Z6S� Off eild use only. Do not write in this area,to be completed by city or town offlclat City or Town: Permit/License A-- Issuing Authority(circle one): 1.Board of Health 2.Building Department 3,Cityfrowu Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone N: POWER-1 OP ID: EL CERTIFICATE OF LIABILITY INSURANCE 1 °"'09119°1�Y""' l79/19/12 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 polley(les) 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 endorsomen s. PRODUCER CONTACT Lacher&Associates Ins Agency Ak1Ei PHONE Lacher Insurance Group att: n 632 E Broad St P O Box 64398 ADDRESS; Souderton,PA 18964 Chad Lacher INSURERS AFFORDING COVERAGE NAICY NSURERA:Harleysville Worcester Ins Co 126182 INSURED Power Home Remodeling INSURER a:Harleysville Preferred Ins.Co _ Group,LLC 135896 Power Home Remodeling Group, INSURERC:Nationwide Mutual Ins Company i23787 _ Inc. INBURERD: 2601 Seaport Drive Ste B110 -- Chester,PA 19013 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. ILTR B TYPE OF mSURANCE MMIO PO P LIMITS POLICY NUNBER (POU GENERAL LIABILITY EACH OC(AJRREHCF. F 1.000.00 B X COMMERCIAL GENERAL LIABILITY MPA00000089793N-1 0912VI2 1DI01/13 SE80-e _ $ 100,00 C AMS44ADE O OCCUR MED EXP a,o vamnl S 10,00 PERSONALS ADVINJURY S 1,000,00 GFNERALAGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO S 2,000,00 POLICY X P 0- LOC y AUTOMOBILE LIABILITY CQMBINED IT 1,000.00 A X ANY AUTO BA00000089796N 09/22/12 10/01/13 BODILY PIJURY(Par pawn) 1 ALL OWNED SCHEDULED AUTOS AUTOS BODILY IUURY(Por eoda ) S HIRED AUTOS MON-OWNED PROPERTY DAMAGE — $ S UMBRELLA DAB X OCCUR EACH OCCURRENCE S 10,000.000 C X EXCESS LIAB CLAIMS-07ADE �CMB(10000089794N 0912V12 10/01/13 AGGREGATE $ 10,000,000 D RETENTION S WORRERSOOMPENSATION X WC 9TATU- OTN- AND EMPLOYERS'LIABILITY A ANY PROPRIETORNARTNERfflXECUTIVE YIN COCOOD089795 0912V12 10101/13 E.L.EACH ACCIDENT s 1,000 000 OFFICERHJEMBFR EXCLUDECT © NIA ._. (Mondelwy In NH) EL DISEASE-EA EMPLOYE S 1,000,00C D under D IPnON OPERATIONSbokpY E.L DISEASE-POLICY LISVT S 1,000,000 A Mass Auto Policy BADOOOOD18227P 09/22/12 10/01/13 Liability 1,000,00 Limit DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {Afiech ACORD fal,Addidanel Remarks SCRedulo,M m m apace to regWrod) 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 120 Washington St AUTHORIWO REPRESENTATIVE 3rd Floor alem,MA 01970 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/06) The ACORD name and logo are registered marks of ACORD Office of Consumer Aff ' and Business Regulation 10 Park Plaza - Suite 5170 Boston, N; sachusetts 02116 Home Improve rar ontractor Registration ..r• -� — --� Replstration: 168616 Type: Supplement Card i-I 6tpiration: 3/18/2013 POWER HOME REMODELING (A 1 ALLAN COLPITTS � 2501 SEAPORT DRIVE STE 611�_`r, nl — CHESTER, PA 19013 « r n Update Address and return card.Mark reason for changes �--'L DPSCAt 6 SON-0U04G101216 Address Renewal I] Employment Lost Card ' C '�arnm�a„ueo/uf o�./�auvr/uncld _ 0111"of Consumer Affairs&Business Regulation License or registration valid for Individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Reglatrationi AS&16 �'�� lOPa 10 Pa of Consumer Suite Affairs and Business Regulation rkYlarate5170 go Expl Supplement Card Boston,MA 01116 POWER HOME - UP WC. 11 w, ALLAN COUP? - a 2501 SEAPORT CHESTER,PA 19013• := " Undersecretary Not valid with§O signature 1291 Massachusetts - Department of Public Safety �f Board of Building Regulations and Standards 0m,truction Superr isor Licenses CS-001979 ' 11. ALLAN K COLP►14S _. ties 3 CHRISTI.AN DI NASHUA NH 03663 Expiration Commissioner 05/07/2014 about:blank NATIDft'A:L BEAD 3UARTERS Raymond and Juanita Prescod 2Sol 9caport[Nh2,eneuvr,VA POWER 3M2992 August 15 2012 888-RENii71DEL MA)41!-1asels CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyers Ipfomutlon 00.52992 Prefect Number - August 15,2012 Raymond Prescod • Aemagryo.n,wjl Juanita Pressed (07s_5s4-82a2(Home) , dprasaad(R9lnsll.com. 8?eman Ave (978)76"7 01(Raye10nd3 Cer!) _ salem,ruA.a1970'- county:Easels "Tovmshlp: Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services of power Nome Remodeling.Group("Contractor'_in accordance with the prices and terms described on the front and the'Wkwuing four pages o/this agreement an any specification sheets,vAttch are.incorporated as part of the Agreement(collacdvaty,this 'Agrooment").This Agreemem.represents a cash sale:ofgoods and:,somices.Buyer(s)agreesio pay tho'cost of the goods and s"ces purchased as described'Ir min,regardless of timing or approval of any:financing Buyer(e).may seek for their ourchaso.Problernsandin W1 s' a In this A ree ent ould directed'Fa the G tractor at 1.898.738-G335. Pureness Price: y2,938.gS 1 Pre Installation.InspectionDate: • ourPni>run.w Thuarl whM n2:0er.m Me .Down.Payment: $0.00 Estimated Project Start: . 51p-Tvreeks Balance Due on. $2,938.05 Estimated project Completion: Substantial I to days . Completion: - UeMits wmPleibn da'e a rkn:dl the esmnal.Decays troyondConaaolors conkUrwT Method of Payment Other In lAed In calculating time names.Sae[ksWti tlnknawn Coniflions an hWQMe. "Buyer(s)hereby acknowledges receipt of a-copy*fine pamphlet,"The LeadSafe Certified Guide to Renovate Right"; informing Buyer(s)of the potentfafrisk of lead-has ard.e mosure from renovaitonaicdvity to be performed In Buyers home, at the address written.above.Buyer(s)received this pamphtatonthe dale of this Agreement,.before commencement of work. (Buyers initials). It is agreed and understood by and between the.parties that this Agreement consfillutee the entire understandin'g,between the pardea;•and there are no verbal understandings changing or modifying.•my of the farms of this.Agreamont:Buyers) hereby acknowledges that Buyer($)1),has read the entire Agreement and has received a completed,signed,and dated copy of this Agreement,Including the two accompanying Notice of Cancellation forms,on the date first written above and 2)was orally Informed of hls_her right to cancel(his transaction.DO NOT SIGN THIS AGREEMENT;IF THERE ARE ANY BLANK -SPACES.. f` Future promotions not applicable; Inave:read and resolved each page of this page agreement.. Power Home Remodeling Group uye (s Buyar{�}-,-,./, •^—� !OB/•1S/12" /08115112 w�.--"" 108/15/12 Signature �Saies.Repmsentahve Signature Signature ,.Taylor Ferguson' Raymond,Prescod Juanita Prescod YOU,THE BUYER($),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO N_IDNIGHT OF THE THIRD BUSINESS DAY ,,•,r�T}( :DATE QF.MIS TRANSACTION. SEETHE NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS,PiGHT Page:?of 5 77: August 15,201$22:26 ` �It Ulift 1 of 1 10/15/2012 7:26 AM NATIONAL HEADQUARTERS Raymond and Juanita Prescod 2501 Seaport Drive.Chester, PA 19013 -, POWER• 30-52992 ,...-- - _ August 15,2012 888-REMODEL .. .. .:. MA HIC#168616 Project Specifications Windows: Boys room 2 33.0"x59.5" _ - _- Windows:Boys room 2 33.0"x59.5" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None OPTIONS: Color White/White: Grid Pattern: None i Removal Wood I Additional Details None Windows: Master br 2 33.0"x59.5" it _- - -- Windows:Master br 2 33.0"x59.5" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None OPTIONS: Color White/White: Grid Pattern: None i Removal Wood I Additional Details None August 15, 2012 22:26 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Page 2 of 2 •F. a 3�:chi[Y:�n:iY:dL';-ate>.b• 3sd:€1!!!tn'J18.t :'CER7IPIC[�F 1 1 1 4!•E.'9st4SiV x:.(i•8.d.'t�?:Rh rDi�C1lss�fr,31A1�4A1f1".ICnt;;, ysloEaTnaSmlitaQ:a�x •XW4 Ge,�:crt�ai�cn[i�tstanc�:;; M 5 ;;'''.." � Yti�i 14 1.7� 1"'t! `j`�`;.�7iT�5 11 A•.f N.'AR7{::Gsr > >11+4}7^•�frt i.t 5 �'r+p y,_.. il., !t i{ -r 1 ♦ �f� w..�De�c:.'r��.�a+. �1•v .4^ra1 1 iv?4..�•• v 4 h a +4 /� . t�t5t wF w a TO �Zp 1 a f t �{. l� a � .tA�r��5� =`�T-�°A .��i�ii��F%!'•''..�f{.X1�t I++„'Y �.�Y>��(tX�aEitl,^.3 SJ�'Y'rt�,'�.ai'J G� _^9 .t.-. , l ...u,5°ra n.a +..a. .,.�.a�.'�a..� J•�3?�'k f'C+° 1Te. .� fq. :ft �4Y,y��C F-. 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