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13 OCEAN TER - BUILDING INSPECTION 6Z5 GK g� IZ J 5 ©L The Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards SALEM q / q Massachusetts State Building Code, 780 CMR Revised,llorl0ll Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Fmnily Dwelling This Section ForOfff'il Use Only Building Permit Number: Da .Applied: � / Building Otlicial(Print Name). Signature Date ( SECTION 1:SITE INFORMATION' 1.1 Property Add es,�r� 1.2 Assessors Map&Parcel Numbers YDAY1 )eCj?dC..e �(I I.la Is this an accepted street?yes_ it Map Number Parcel Number I4'= 1.3 Zoning Information: IA Properly Dimensions: 1 Zoning District Proposed Use Lot Area(sq tl) Frontage(It) ttt 1.5 Building Setbacks(R) Front Yard Side Yank 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: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if es❑ p SECTION2: PROPERTY OWNERSHIP,' 2.1 Own t rd• 'P�nnt (� „�— City,State,ZI �� `U �Llhl� 2L7TH r No. and Street elep o e Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK=(check nll at apply) New Construction❑ FExisting Building❑ Owner-Occupied ❑ Repairs(s)01 Alteration(s) ❑ Addition ❑ Demolition ❑ Acczssory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': SECTION 4: ESTIMATED CONSTRUCTION,COSTS Estimated Costs: Offlc�Wse Only Item Labor and Materials 1, Building S I. Building permit Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical 3 ❑Total Project Cose(Item 6)x multiplier x 3. Plumbing S 2�(,ether Fees: S t. Mechanical (HVAC) S List: 5.Mechanical (Fire Total All Fees:S Suppression) Check No._Check Amount: Cash Amount:_ 6.Total Project Cost: 3 ❑Paid in Full ❑Outstanding Balance Due: S�?T I LI� �IS SECTION 5: CONSTRUCTION SERVICES 5.1 Coustructimt Su ) rvisor License(CSL) A�'vnn License Number E.vpir do ale Wmnc of CSL Holder-�� ,,,•i List CSL'rype(sue below) No.and Stre t G� •rype Description ' - U Unrestricted OuilJin s u -to 35,000 cu. It. R Restricted I&2 Familv Dwelling Cityrfo%v State,Z Ni Masonry RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances 1 Insulation Tele Dne . i Email address D Demolition 5.2 Registered H Ti r v tee ntract r HIC) HIC ffegistratiori Number F..rpi ti Date I i a faxt rlll •n Name No. 1 Email address Cit /Town late ZIP Tefe hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)), Workers Compensation Insurance affidavit must be co eted and submitted with this application. Failure to provide this affidavit will result in the denial of the Isivan f the building permit. Signed Affidavit Attached? Yes......... No........... O 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 C1114Z t9 act on my behalf,in all matters relative to work authorized by this building permh application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNERt ORAUTHORIZED AGENT DECLARATI By entering no a below, I her y attest under the pains and penalties of perjury that all of the information contained h his app icatio is t an .ccurate to the best of my knowledge and understanding. Print Owncr i or ettnforizcd Agent's Name(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 (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.rah �Information on the Construction Supervisor License can be found at www.mass.,,ov'dos . 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. it.) Habitable room court Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches 'type ofcooling system Enclose) Open_ 1 "Total Project Square Foolage"may be substituted tier"'rutai Project Cost" i HOME IMPROVEMENT CONTRACT Sold,Furnished and Installed by: PLEASE READ THIS CONTRACT THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 908 Boston Turnpike Unit LShrewsbury,MA 01545 Branch Name: Boston North Date:11/24/2014 Toll Free 8779033768;Fax 8009863610 ME Lie#C 02439 RI Cont.Lie# 16427 CT Lie# HIC.0565522 MA Home Improvement Contractor Branch No: 33 Reg.#126893 Federal lD#75-2698460 Installation Address: 13 Ocean Terrace SALEM MA 01970 City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: M/M Jeffrey Barrows (781)631-1312 (617)257-7247 Home Address: 13 Ocean Terace SALEM MA 01970 (If different from Installation Address) City State Zip E-mail Address (to receive project communications and Home Depot updates):jeffreybarrows(a)comcast.net Marketing entails will not be sent from The Home Depot. Proiect 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 furnish,deliver and arrange for the installation("Installad �J on")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary(where applicable)attached hereto and any /'� Change Orders(collectively,"Contract"): /�(Ga�l Job#:(internal Reference) Products: Spec Sheet(s): Project Amount 7948131 Windows 7948131 $1,032.20 771 Minimum 25% Deposit of Contract Amount Total Contract Amount $1,032.20 due upon execution of this contract 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 due. 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 terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,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# 7948131 included as part of this Contract,sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). 07109/14SA Page t of 8 HOME IMPROVEMENT CONTRACT PLEASE READ THIS CONTRACT NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time of 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 through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law.THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVER OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Contract 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 products and installation.This Contract cannot be assigned or amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. You are entitled to a paper copy of this Agreement if you choose. If you consent to an emailed copy,your consent applies only to this Agreement.By contacting sales office (g77)90'i-376R,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement at no charge. By signing below,you confirm the following: • You consent to receive only an entailed copy of this Agreement • You have access to a computer that can receive and open emails and PDF(Adobe Reader Version 10.1.4 or later)formatted documents. • Your email address is correctly listed on the Home Improvement Contract Submitted by: Accepted by: Sales Consultant Jason Beisiegel Customer License Name. Signature: (877)903-3768 Customer M/M JeffreyBarrows Nov 24, 2014, 4:57 PM Telephone No. Signature: Sales Consultant License No. (as applicable) CANCELLATION:CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING 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 CUSTOMER'S STATE 07109114SA Page 8 of 8 Nss�hus�# ,s z Merl op .54 ` t.. cts�• M CS-i 8q� S 3 THOMA 101 SABERS 1T- MXDF@ w4 c � a E If ill *�. E ti Commissioner pro 9 1 ,, .E N lI :Y N E Y� N _0 I f t I 1 . 4C The Commonwealth of MassdT- IDepartment of IndustrialAcQuae of Investigation1 Congress Street,Suite Boston;MA 02114-201If w%wmass.govd1a Workers'Compensation Insurance Affidavit:Buffders/ ns/Plumbers Aviftent Information Please Print Le bl Name (Business/organization/Individual): Address: CiI /S :1 e#: Are an employer?Check tkP appropriate box: Type of project(required): v 4. C] I am a general contractor and I 1 I am a employer with _ 6. New construction employees(full and/or part-time).• have hired the sub-contractors 2.0 i am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition and have workers'working for me in any capacity. employees9. ❑Building addition [No workers' comp.insurance comp.inaluance.t 10. Electrical repairs or additions required.] 5. We are a corporation end its 3. 1 qm Q a homeowner doing all work officers have exercised their I I Q Plumbin repairs or additions . Myself.[No workers' comp. right of exemption per MGL 12'Og R reps' insurance required.]t c. 152,§1(4),and we have no 13. er comp.insurance required.] •My applic uttthu ebecks box Z must also fill out the section below showing tirn worker'compaaadon policy information. t Homeowners who submit this affidavit indicating they see doing all works andthen hire aatdde canhactas mast submits new affidavit indicadagauch. ., tContractors that check this box must Machad m additional sheet showing the nuns of the sub-conhadors and state whether a not those entitles have .employees. If the sub-cattrectors have employees,they must provide their worker'emnp.policy manlier. I anan employer that isprovidhrg workers'compensation insurance for my trmp/oyeca Below Lis the poUcy and Job site information. ��' Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address:- City/SuWZip: 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 S1,500.00 and/or one-year impriamlment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 y gainst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations 9of the D A for.i ce coverage verification. I do hereby rd pa and penalties ofperjury that the informadon provided above it tr e and correct OBIcia/use only. Do not%WM in this area,.to be completed by city or town oJJ7cta1. City or Town: Pernnitlucense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDfY1^ry) 14 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 INSURE't(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 endorsement(s). PRODUCER MARSH USA,INC. CONTACT TWO ALLIANCE CENTER NAME` PHONE . � FAX 3560 LENOX ROAD,SUITE 2400 c ac No ATLANTA,CA 30325 E-MAIL ADDRESS: 100492-HOmeD-GAW-14-15 INSURER S)AFFORDING COVERAGE NAIL# INSURED ' - - INSURER A:SteatlfaSi Insurance Company 26387 THD AT-HOME SERVICES,INC. MSURER e:Zunch American Insurance Cc DBA THE HOME DEPOT AT-HOME SERVICES -- 16535 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER c:New Hampshire Ins Cc 238411 ATLAMA GA 30339 INSURER o:lllinois National Insurance Company 2381717 INSURER E: COVERAGES - INSURER F: CERTIFICATE NUMBER: - pTL-003242s8507 THIS IS TO CERTIFY THAT THE POLICIES OF,INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAIMED ABOVENUM FOR OR THE POLICY PERIOD INDICATED: NOTWITHSTANDING ANY REQUIREMENT,'TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT IMTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, 7fiE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE D S -" S POLICY NUMBER MMFDID MhWDY/YYYY A GENERAL LIABILITY GL0488771404 LIMITS X D3/012014 03/0120f$ EACH OCCURRENCE - 9.000.000 CdNMERCIAL GENERAL LIABILITY E AG ORE E CLAIMSMADE OCCUR LIMITS OF POLICY XS PREMISES Ea occurrence E 1,0W,000 OF SIR:$iM PER OCC MED ECP(Anyona person) $ EXCLUDED PERSONAL$ADV INJURY $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 9,000,000 X POLICY Pi LOC PRODUCTS-COMP/OP AGG $ 9,OOD.000 B AUTOMOBILE LIABILRY BAP 293886311 $ X 03/01/2014 03/012015 COMBINED SINGLE LIMIT ANYAUTO Ea accldem $ 1,000.000 ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS SELF INSURED AUTO PITY DMG - - HIREDAUTOS NON-OWNED BODILY INJURY(Per accident) $ AUTOS' PROPERTY DAMAGE Per accident Is UMBRELLA LIAB $ OCCUR EXCESS LIAB CLAIM&MADE - EACH OCCURRENCE $ DED RETENTION AGGREGATE $ -.-�- C AND EMPLOYERS' 4sgnoN _ WC049101882(AOS) 0311 0 3/01 2 01 5 we STgiu- $ C AND ROPRIEERS'LURTNEY YIN OTH- ANYCERA1EETOILPARTUDED? curNE WC049101884(AK) 031012014 03/012015 I TS D OFFICER/MEMBER EXCLUDED? ❑N NIA E.L.EACH ACCIDENT It1,OOD,000 (Mandatory In NH) WC049101883 FL if ) 031012014 Dyes,It scribe under ( 03/012015 1000000 ES 19ION OF OPERA TONS below E.L.DISEASE-EA EMPLOYE $ C WORKERS COMPENSATION EL.DISEASE-IF——LIMIT $ 1,000,ODO WC04910285(KY,NC,NH,VI:) 031012014 03/01/2015 (EL)LIMIT C 1,000,000 WC049101886(NJ) 03/012014 03)012015 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addlllonal Remarks Schedule.R more space Is required) EVIDENCE OF INSURANCE I I , CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. DBA THE HOME DEPOT AT-HOME SERVICES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD - THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATLANTA,Cyr 30339 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Of Marsh USA Inc. Me' Mukherjee �/✓�'T.r^.: ^ J�.->r� -i';•Jr 741, 1�3 "-P'ty a`9 _-- i y '" mk—Pia Suite -17 Boston, Massachusetts UL i i 6 Hare Improvement. eontraetor Registration - Pagis�at�-^c :�6E83 Type: Supplem Lnl Card E alloni r,1 MI6 THD AT HOME SE�RVtCES, J rl RICHA t AE£0 1 _:. --- — ----- feg9 CUMBOIILA 7 FARKNAY SUITE 33� - — --- ATLANTA GA 30339 _... Update Addr=znd retarn card. M2rk reemn for change. . . . ' Addr+.ss j �xn a: J Empfa;m-a Lns?Cr.;d 'CA.? .r s^faaa11i y„ :7,sr•Tira Affa.s�r-rmrn�(1 r2r-z r.;;nrl/r,.w; z- fnce a!Caner u ir is 9u' aw-.RegfilaEia2 Ll L1m Or T%* raficu VOW for mdividal nst Orly Gtt 5�' More the wkmAbnd--L-- Mounda=anto! { Cta drP� 6P1PR�5°J P�Eh�# C4Jd7�3°�i P C�SnntrsECvnstsax vAmma?esn,autR.cnie�e s tira,�rt� F!e is4 ailolu, °2E Tyne: 10 Vur2�FP7 sz5 ie 517P '� s' - uPGraf�on _fy /�01fi Supplement-Cud Bostun,' - CIDA:fHPRMS$RVICES.Nr,_ 7HEHOMLDEFTATI10M SERVICES RICHARC7 �6 0 CUAh6@RW6'FARKWAY 5 4 �=o CaA30339 - L'ntlerxcrtlavy- .. " 0I VE w eh s,gua i CITY OF SALE4 MASSACHUSEM • 1 i v BUa.DiNG DEPARTMENT 120 WASHINGTONS7RBET,3mFLOOR nL.(978)745-9595 KRMERLEYDRISWLL FAX(978)740-9846 MAYOR THOMAS ST.PIERRE DIRECTOR OF PUB1JCPROFERTY/BLu DM CDMffSSIOMR 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 111.5 Debris, and the provisions of MGL c40, 5 54, Building Permit# t is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit 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) ature f applicant r to