17 PATTON RD - BUILDING INSPECTION -F3 -ILL- lt z-
The Commonwealth of Massachusetts
W
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
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:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
/7 PWt L iol
L la Is this an accepted sheet?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 Banding Setbacks(it)
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 OWNERSIIIP' co
2.1 Owner}of Record: r cmn
/¢nlr'Lion.. CQ.-Heva O/�70 -t. .
Name(Print) City,State,ZIP _ C:
No.and Street Telephone Email Address .
SECTION 3:DESCRIPTION OF PROPOSED WORIe(check all that apply)
New Construction❑ Existing Building El Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ A4;1tion S
Demolition dt Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work : C s/ i v cI— o /°/ x/4
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/rown Application Fee
2.Electrical $
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Su ssion) Total All Fees: $
Check No. Check Amount: Cash Amount:
A
6.Total Project Cost: $ / 0 S'oZS' ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Da u.-d (/P (J R 9 License Number Expiration Date
Name of CSL Holder
10 i.Q ^ List CSL Type(see below) V
No.and Street Type Description
,��� U Unrestricted(Buildingsu to 35000 cu.ft.
J R Restricted 1&2 Family Dwelling
Cityfrown,State,ZIP - M Mason
ry
RC Roofing Covering
WS Window and Sidin
n/ SF Solid Fuel Burning Appliances
8 6, 7— ,S'(a�'dZ oe711 l/rjt 2oq,4 I 1 Insulation
ele hone Elraff address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name R d I B y' Q Q ��4ir7M ooaj - I/'2 O
No.an S Email address
27 NlP e �076 f7 v(f�
City/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 /Jcz v,d & (] 4,7/7 e
to act on my behalf,in all matters relative to work authorized by this building permit application.
Q //- /y
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained
ig hue accurate to the best of my knowledge and understanding-
-
ntrized Agent's 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 MG.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.sov/oca Information on the Construction Supervisor License can be found at jnnymass.gov/des
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basementlattics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of balf/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'
)gj( Masszchusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor A _
License: CS-075353 F
�a r.
i
DAVID M DEGA(skE
1049B MAMMOTH RD`
Pelham NH O.i07b '
lrrn`d Expiration
c 08/23/2015
J•� 'dam
Commissioner -
i
(92. Janvnemr.&x _ .. ..__
Office of Consumer Affairs&Business Regulation License or registrationvalid for iodividul use Only
ME IMPROVEMENT CONTRACTOR -before the expiration date. If found return to:
egistrabon 176866 Type: Office of Consumer Affairs and Business Regulation
piration 52a201b Individual 10 Park Plaza Suite5170
Boston,MAy02o ztni,
DAVID DEGAGNE
s F
DAVID DE 01-HR _ •� 9-1
1049 MAMMOTH D UNIT B _
PELHAM,NH 0376 r -' T'—
Undersecretary Not valid without signatdFe
r:'
CITY OF S.u.&%I, XLksSACHLSEM
BUMDL\G DEPART%ffiNT
120 WASHf.�IGTON STREET,r FLOOR
TV1- (978)745-9595
FAX(978) 740-9846
KI\IBERLEY DRISCOLL
MAYOR THOMAS ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BUMDIING CO\LUISSIONER
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 c 40,S 54;
Building Permit# 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
lc{debris
lwill be transported by:
Vage Aerfc A/ S&o Sa 1
(name of hauler)
The debris will be disposed of in :
LL ¢- 5 //7r ,
(name of facility)
saw /e,-;7 &#
(address of facility)
signature of permit applicant
date
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Massachusetts Home Improvement Sample Contract
This form satisfies ell basic requirements of the states Home Improvement Contractor Law(MGL chapter 142A),but does not include ohm `rd
language to protect homeowners, Seek legal advice irecorssary. Any person planning home improvements should first obtain a cnpy a A
Massachusetts Consumer Guide to dome Improvement"before agreeing to any work on your residence You may obtain a free cnpy by calling the
Cce of Consumer Affairs and Business Regulation's Consumer Informglian Hodirre at 617-973-R 787 or 7-R8A-283-3757 or on our website.
Homeowner Information Contractor Information
NLam�c �) t/)) Company Name
S3' T/l'12 -- ._ z
Rteet Addmcsfdavy, aPml(Mce Bozaddmsa)-- Crmenclarl"Wecpersm✓�hvner Name —"
(tity/Town shoe Zip CMe — Brsinms Adds mot include astreeteddress) ----
Dayhmc phrme F.vetdng phone Qtylfoogl Stnec Zip Cnlc
//art C 3G �Co L
Moiling Address(It different fmm above) Nosiness Phone F eml EmploynrlDrn5.5.
ogre lmpmem[pl CmOntlgReR mmbe PghXlm hle '
Lwmre�e[m into p[q[
..�.ma.,,m.X•m.r<
- The Contractor agrees In do the following work for the Homeowner.
(Describe in detail the work to omddcd,.pcufying re,lyp/e'reand,,aard undo of materials to be use,vic,
additional dualsif ,)
=ffillowingits-The fol lowing building permits are required Proposed Start and Completion Schedule-The following schedule wit Iured by the contractor as the hommwmees agent. he adhered to uless circumstances beyond the contractor's control arise
o secure their own permits wll he /m the Guaranty Fund provisions of � as I,Date when contractor will begin contracted work.
er 142A.) $/i /,-
v7 n�f f —�_tDate when contracted work will he substantially completed.
Total Contract Prir a and Payrnent Schedule
The Contractor agrees to perform the work,formal,the material and labor specified above for the total sum of, �(/ J �' __(•)
Payments will be made according to the following schedule:
S Jy Jr�t� upon,igningeontr..a(net to csccad 1/3 of the total contract price or the cast of special order trans,whichever is greater)
S J %J` :>o by_/_/_or upon completion of to e c A 1j-q�Ze_
$_/c7=� by.__!_�__or upon completion of_b{LGn 7 ez �ar� -�"�L�G 'T/4/t7 �oi'� �c'-f'•.�
S - aS upon completion of the contract. (Law forbids demanding full payment until contract is completed to both p:uty's satisfaction)
The following mateioVegaipment mut be special $____to repaid for
ore erect before the corms,ad workbeirm,in order
to meet the completion achedWn(*^1 E_—_tohe Pat d far
_—
NOTES'.(^)tndnding all finerve charges(^^)Law squires thin any deposit or duaniq yment required by the aommctrbefore wark ixgiu may
not exceed the greater of(a)one-third of the total cemhact prics ar(b)the achml cast of any special agNpment or ataom mode material
which must ba sped al colorist in advance to meet the completion ochMuk.
x W -t rdv - —' 6 11--- + Q N Q f he fh. bib ravers Il
Subcontractors-The contractor agrees to be solely resPonstble for completion of the work described regardless of the actions of:my third
party/subcommetor utilized by the contractor. The contrcinrfurther agrees to besoledyresptmsible,lorall payments to allsubcantactorsfor
materialamil labor under this MEmment
Contract Acceptance-Upon signing,this dec o ma becomes a birding contract under law. Unless otherwise noted within this document,the
contract chal I not imply that any hen or other security interest has been placed on the residence. Review the following cautions and notices
carefully before signing this contract.
• Don't be pressured into signing the contact.Take time to read and fully understand iL Ask questions if something is unclear.
• Make site the contactor has 1'd Home Imaroverniant Contra`tQr Ruditioduroa. The law requurs most home tuprovement contractors and
subcontractors to be registered with the Director of Home Improvement CoMmator Registration. You may inquire about contractor
registration by writing to the Director at 10 Park Phis,Room 5170,Boston,MA 02115 or by calling 617-973-9797 or 88R-283-3757
• Does the contactor have insurance? Ask the Contactor for his insurance company information an that you can confirm coverage,or ask to
see s copy nfa"proof of insumncc'docrtment.
• Knowyour rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer
Guide to the Home imprwemem Conlmcror taw.
You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the.
contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram seat or by delivery,not Iater than midnight of he
third business day following the sigringof this agreement See the attached notice of,onedledo form for an explanation of this righe.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM
Twnidmticfll creek.nftM1e canamt means compltledand.iptW.Ora copy.dmrrid Ro bare hmrcmrmr.lhemhe Idbekw byaee cmbray.
Iiameowner's Signature C.
,ontractor's Si<gn--,a/anim ----
Dnm --- -----"-- 7z`" —
Dean
Contractor Arbitration
The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an
alternative to court aetion)if they have a dispute with a contractor. The same right is not automatically afforded to a
contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless
both parties agree to the optional clause provided below. This clause would give the contractor the same right to
arbitration as is afforded to the homeowner by the Home Improvement Contractor Law.
The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute
concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by
the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required
to submit to such arbitration as provided In Massachusetts General Laws, ter 142A.
--- � -
Homeowner's Signature Contractors Srgnature
NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute
resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even whore this
section is not separately signed by the parties.
Homeowner's Rights
A homeowner's tights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer
protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners-
may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law.
Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of
the Home Improvement Contactor Law. The contractor is responsible for completing the work as described.in a
timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor
guarantees or provides an express warranty for workmanship or materials. In addifion to guarantees or warranties
provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for
a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be
added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have
questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below).
Execution of Contract
The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced
documents have been attached. Parties are also advised not to sign the document until all blank sections have been
filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to
be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing
and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of
the contract,and the three day rescission period has expired.
Accelerated Payments
A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the
homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself
to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a,joint escrow
account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the
signatures of both parties.
Additional Information
If you have general questions or need additional information about the Home Improvement Contractor Law or other
consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement"
contact:
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza,Room 5170,Boston,MA 02116
617-973-8787,888-283-3757 or visit the OCABR website at h!Q irrww.mass.t;ov/ncabr!
If you want to verity the registration of a contractor or if you have questions or need additional information specifically
about the contractor registration component of the Home Improvement Contractor Law,contact:
Director of Home Improvement Contractor Registration
Office of Consumer Affairs and Business Regulation
10 Pak Plaza,Room 5170,Boston.MA 02116
617-973-8787.888-283-3757 or visit the HIC website at htlp; p1rt}'mass a-m 4+cab,
Go online to view the status of a Home Improvement Contractor's Registration:
It1:gdb statc.nxtualhomci111111 mcnt Iiconuolisf aso.
For assistance with informal mediation of disputes or to register formal complaints against a business,call:
Consumer Complaint Section
Office of the Attorney General
617-727-8400
AND/OR
Better Business Bureau
508-652-480Q,508-755-2548 or 413-734-3114
Verson 2.1-11/2212010
/-p 11ae'2 CI .:,ir ft 17
Remove and dispose of existing deck on rear of house.
Construct a 14'x 16'deck off the rear of home with 3'6"x 3'6"platform leading to a straight staircase
down to ground level.
Materials to be used:
-azek"brownstone" 5/4 vinyl decking with blind fastening_
-Veranda white vinyl "regency"railings.
-Pvc trimwork to be applied around rim of deck,outside stair stringers and stair risers.
* This Contract is subject to the city's approval of deck design and deck materials to be used.