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2 PAUL AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 20)) Building Permit Application To Construct, Repair, Renovate Or Demolish a I One-or Two-Family Dwelling This Section For Official Use O Building Permit Number: D Ap ad /zi /3 Building Official(Print Name) Si Date SECTION 1: SITE INFO ION 1.1 Pro erty Address: 1.2 As essors Map&Parcel Numbers 2 f u l 191IP Lla Is this an accepted street?yes no Map Number Parcei 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? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2 iWard Record: Ward Sckw i , ma eiga) Name(Print) City,State,ZIP 2 Rbui wue q� Tray c��G No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other VSpecify:Ina)iat-I on Brief Description of Proposed Workz: 6 I V-XQ ( ny-0 Irvoiate per Mcia'1 Ve•. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ z6 3 6 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: ' )i li/1 5.Mechanical (Fire $ Su ression Total All Fees:$ 2 � '^ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ ' ❑Paid in Full ❑Outstanding Balance Due: Y SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �. 1 {� �p C� -O`�j'�5� �AJ De I In I'll. License Number Expvation ate Name of CSL Holder Ca List CSL Type(see below) �O �. no Cam ( Ed.No.and Street Type Description ,(� 1 Ip '/fin�J r' U Unrestricted(Buildings u to 35,000 cu.ft. Al.pr000r, 01 O N R415 R Restricted 1&2 Family Dwelling City/Town, M Masonry RC Roofing Covering WS Window and Siding !Q7 /' SF Solid Fuel Burning Appliances U"TZh 3 I I Insulation Telephone Email address D I Demolition 5.2 Registered{H,ome Improvement Contractor(HIC) _ +G I 'u H eH CoM t,�Oon Tnc- HIC Registration Number Expirati n Date HIC Company Name or HIC Registrant Name R0 caropwi I ( rd. p, 41 and' )ree S ([r��u "q J Email address !� LJ S 1 YJ 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 .......... V 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 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: 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 in this application is true and accurate to the best of my kno�dge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) 1^� 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.goyMps 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" j `.1y�.'��/y. soma taorav serbi 5� q® PARTICIPATING ry� a e ass save CONTRACTOR savings through errorgy cllkicncy � PERMIT AUTHORIZATION FORM I, Richard Vaccaro owner of the property located at: (Owner's Name,printed( 2 Paul Ave Salem (Properly Street Address) (city) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X Owners Signature 04/23/13 Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Rev. 12132011 PRODUCTS �`�®y/N TRACT FOR p/y� ® nationalgrid Conner atlon s " ODUCTS SERVICE WORK HEREWITH YOU.HERE FOR YOU. Services Group This service is brought to you through support from your local utility qq F This Agreement is made by and among W 1 ( and f Conservation Services Group(CSG) Attn:RCS Richard Vacrnio ;;a 50 Washington Street,Suite3000 2 Pau(Ave Westborough,MA 01581 y - Salcm,MA 01970 1959 Reg No. 173484 s Project ID:P00000138715 Contract LD:20130423 WORK retleral ID No.222457170 Site ID:500002134376 Ofid completes contract to address above) ` I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will peni'onn or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract,including tire attached reconrmendatimrs/work in describing the work to detail(the"Work")which me incorporated herein by reference Description Quantity Location AWc Floor Open Blow Cellulose 6' 1,056 _ Living Spa a ^_ _ _ $1,415.04_ Install Aluminum Soffit Vent(4"xi6') 6_ Attic _ _ _ _ $171.00 _ Propment Toro' _ _. 6_Attic T _ _ _. _S21.00 , Damming_ _$107.30 _ Sub Total: \ $1,714.34 Energy Efficiency Incentive 3$1,285.76 Not Sales Tax After Incentive _ $0.00 !«Total S428.58 Printed:4/2312013 Page 2 of 2 It. PAYMENT y+...r•-"- r(� - • / Cumo ier agrees to pay Contractor for[lie Work,the Customer Share of the Contract Price as follows:Payment ril:_$ ' -as a Deposit payable to CSG upon signing the Contract(not to exceed 1/3 of the total retail costs or actual cd>y8o P{Iea ,whichever is greater).mail check&contract to CSG, Atin:RCS,50 Washington St.,Ste.3000,Westborough,61A 01581.Final Payment:$ -l r /d_� as the Mai payment for the Work shall be due and payable to the Independent Instatalion Contractor("IIC'J upon satisfactor•completion of Me Work.Customer mWeastands that he/she will not be required to pay the Utilih,Incentive Share of the Contract price in the a molutt o[.5_/�,� j The Utility Incentive Share is dependent upon the package purchased stator prior incentive utilization.Chaarges to Individual line itens mnpor precious incentives may increase or decrease the size of the Utility Incentive Share. Ili. DISPUTE RESOLUTION The RC and Ctalrnher hembynwmaally agree In adr.mm gent i n the event that the RC has a dispute m ac' nnaysdarit such dispute to a pfiale arbitration sehcice cvldcln lots been >prrned by the OOice_o Cahsawrer AOairs mrd Rosiness Reghdatan and Qstom shall he rt ui to nut to such arbitration as provided in hLG.L c 142A CusW ter•--CJ"`"'"'` d', '` a-GGu'U J Contractor. You may cancel this agreement if it has been signed by a party there�t�lac other than an address of the seller, which may be his main office or a branch there of, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of t is agreement. p0 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Customer ' ore p hhdicate your selected lIC here,if:Tplicable -" Initial here if you w,vt. C Tl 3 ,•^ /�%/�� the Program to assi n n un llatc Nam of CSGepres es mtative(Printed)/i.LvC/y ii t Participating Contractor for CSC Si n t TERMS AND CONDMONS APPEAR.ON THE REVERSE. 1/13 PRODUCTS CONTRA CT F,�®dap/�p ®gam nationalgrid Con ser atlon y RODU TS / SERVICE Y67®P9U'A HERE WITH YOU.HERE FOR YOU. Services Group This service is brought to you through support from your local utility This Agreement is made by and among t - and Conservation Services Group(CSG) Attn:RCS g Richard Vaccaro 50 Washington Street,Suite 3000 � 2 Paul Ave Westborough,MA 01581 ; Salem,MA 01970-1959 _ Reg. No. 173484 Project ID:P00000138715 Contract ID:20130423_ASEAL er Fedal ID No. 222457170 (Ill ail completeid contract,to address above) ' Site ID:S00002134376 «. -, ' ; ' - , I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance pith the tents of this Contract,including We attached recommiendations/work order describing the work in detail(the 91'ork")which are incorporated herein by reference Description Quantity Location Perform Air Sealing al Estimaled 62_6 CFM50 Per Hour __0 _ Living Space_ _ w J$616.00 _ Attic Stair Cover Thermal Barden with carper"-- ___1__ Living Space_ TM_ - $237.65 Door Sweep __._- 1_ WA - _ �_.__ _ _ $21.17 _. Exterior Door Weather Shipping_ _ 1 NIA �$25.20_ Sub Total: $900.02 Energy Efficiency Inconlivo, S900.02 Not Sales Tax After Incentive $0.00 Total $0.00 Printed:412312013 Page 1 of 2 11. PAYMENT ..,._...,,.r... /"r't ._. Coslonwr agrees to pay Contractor for(lie\fork,the Customer Sham of the Contract Price as foil ov'-:Payment Hl:$ C9 as a Deposit payable to CSG upon signing the Contract 0mt to exceed 113 of the total retail costs or actual costs of ci rders,whichever is greater).Mail check&contract to CSG, Attn:RCS,50 Washington St.,St,.300Q Westborough,NIA 01681.N}n;d Pa_vmnenC$___ ens the Onal p:nwnenl for the Work shall be due end payable to the Independent installation Contractor("IIC')upon s 'sfnctuI •,Cpmpletlon of the Work.Customer understands thatlte/she sill not be required to pay the Utility Incentive Slime of the Contract price in the muount of$�"er,00�the Utility Incentive Slime is dependent upon the package purchased and/or prior incentive utilimfion.Changes to bndiuidu:d line items and/o'preiious incentives mqv increase ordecre.'rse,the size of the Utility Incentive Share III. DISPUTE RESOLUTION The IIC end Customer hereby nndhW(v agree in advance that in(lie event that the 11C furs a dispute / roncrnwn this tgll IIt'1I1.11':14 mt sue sevice dell has;been approved by tin qf ce of CossonerAirtirs mid Fiminess Regulation will Qutomersha bilmb t<iloisnp mule p mrovaidperidv aiute A mI.Gb.iLun eti7o4u2 A. Cushmc : lh�M ve - 7 Contractor. You may cancel this agreement if it has been signed by a party there to at gpja oth I�than an-addieess of the seller, which may be his main office or a branch there of, provided you notify the seller in writing at his-mitdin office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signin of i agreement DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPA S. ma qq �_ s' r /3 � Customer Sig Vat Indicate your se/lte�cted IIC here,if applicable ( RI hdtial here if you wan r ,� f1 ;T/P" 1� IC?(",r-1 ✓1I the Program to assign CSG Signatu a — ate Name of CSG Representative(Printed) Participating Contractor TERMS AND CONDITIONS APPEAR ON THE REVERSE. 1/13 The Conzinonwealtlt of Massachusetts Department of Industrial Accidents Office of Investigations U1 600 Washington street Boston, NIA 02111 wwwanass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busi l!,WQrgani77ation/Individual): - '�'-t lf� '�'� �M ISO-VU�` IZA$ i f City/State/Zip: �ll. ibjL')L�- { 6g wk c) phone.#: ?Q4=:=- Are ypr(i an employer?Check the appropriate box: L LJ�I am a employer with Z. 4. Q I am a general contractor and I Type of project(required):. employees(full and/or part-time).*. have hired the sub-contractors - 6- ❑New construction 2-0 I am a We proprietor or partner- listed on the-attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g- El Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance t 9. Building addition required.] 5. Q We are a corporation and its 10-Q Electrical repairs or additions 3-❑ I am a homeowner doing all work officers have exercised their 11-D plumbing repairs or additions myself [No workers'comp- right of exemption per MGL insurance required.]t c. 152,§1(4),and we have no 12-0/oof repairs employees. [No workers' 13.1- Other AAS� p comp.insurance requued.] i 'AnY aPPlicant that checks box Rl must also fill out the section below showing their workers'eo - t homeowners who submit this affidavit indicating _k and d=hire outside contractors most posts information. _ tConoacturs dutcheck this box must attached an additional doing the name of the sub-contractors and state whether or affidavit entities have employees. If the mb­cantrzetors have employees,they must pravidbtheir workers'comP-Po-cY h- number. 'am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site information. Insurance Company Name- - Policy#or Self-ins-Lie. Expiration Date: Job Site Address: 2 �t� fle City/State/Tap;_JjtMt M(q Op do .. Attach a copy of the workers-compensation policy declaration page'(showing the polity 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$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$250.00 a day against the violator. Be advised that a co Investi ations of the DIA for ins" covers a verificafion copy of this statement maybe forwarded to the Office of I do hereby cent under th painsa al ties of /roperjury that theittjormation provided above is true and correct Signature, 13 `--� Date Phone#: :i�[ OJJicia[are only. Do not write in this area,to be completed by city or town o tcral City or Town: Permit/License# Issuing Authority(circle one): .I-Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: VCR i irRrH i C Vr L.ijuion-i 1 T imoun rift oC 11/08/2012 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 endorsement(s). - PRODUCER CONTNAME:Michael Emond Emond 8.Associates PNONE No 157 Turnpike Street E-MAa - AooREss:mike,_ )Une 133 INSU S AFFORDING COVERAGE NAIL If Vodh Andover MA 01845 INSURER A:Farm Family Casualty Insurance Company INSURED INSURER B: HRH Construction 80 Campbell Road INSURER C• rosuRERo• North Andover MA 01845 IxsuRERE- 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. NSR DUL SUBR POLICY EFF POLICYEXP LIR TYPEOFINSURANCE mo POUCYNUMSER IMMIDDITYrn UNMAHUTYMLIMITS GENERALLJASILRY EACH OCCURRENCE $ 1 000 0 0 X COMMERCIAL GENERAL LV181LIIY �.� PREMISES esmarenrJ3 $ CLAIMS-MADE Q OCCUR MED EXP(Am/ale person) $5 OOO A 2001XO726 11/20/2011 11/20/2012 PERSONAL S ADV INJURY $Included 11/20/201 11/20/201 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT"PLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PR4 LOC 1 1 $ AUTOMOBILE LIABILITY �: Ea NUm�t SINGLEL n $- ANY AUTO BODILY INJURY(Per person) S I All-OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per w6denp $ A IX X NON-OWNED 2001 C4287-4A 03/16/2012 03/16I2013 PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per armdenl X UMBRELLA Line X OCCUR r r EACH OCCURRENCE $1 ODO 000 A EXCESS LIA9 CLAMS-MADE 2001EII69 12/14/2011 12114/2012 -AGGREGATE $1,000,000 DED I X I RETENTIONS 12/14/2012 12/14/2013 S WORKERS COMPENSATION VYC STATU- OTH- AND EMPLOYERS'LIABIL TY A ANYCE/MEMaFR EXCLUDED? Y�. r 2005W6827 12/07/2011 121071201z ER OPFICE/PRISE RIPARTDEDT NIA EL EACH ACCIDENT $ (Mandatory In NH) 12/07/2012 12/07/2013 E.L DISEASE-EA EMPLOYEE 00 If yea,dasabe umter EL DISEASE-PODGY LIMB $500,000 r� BESCPop710 OF OP TIDNS/L TONS/VEHICLES(ANaoh ACORDtet,Add[UomlReaanm SehedWe,Ifmomspame mgnhed) pera tons�y name Insurer CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR6la1T4 / ©1988-2010ACORD CORPORATION. All rights reserved. 1 Massachusetts-Department a �uoi:c 3aiar; Board Of Building Regulations and Sc. Con+tnrcth anoarhs n 5upcni.or License:C 457754 tir 'r� �a.L1An�nao�s 80 CAUBizfaL pD NANDOVX#MA 01845 = Commissioner • =rc o:rae�;- 03/04/2014 of rice ofConsnmerAfalm Bc Rosin ... .. - .. ... .. ._ • ME IMPROVEMENT Regalation License or registration valid for individul use only OVEMENTCONTRp istila bon= -:161730 CONTRACTOR before the expiration date. If found return to: � ' Private Mee Of Consumer Affairs and Business Regulation p, P-, r .._6/29%21k9� rp ratio. 10 Park Pbtza-Suite 5170 HRH CONSTRUCTION.INC_ ' l(:' - Boston,MA02116 William Hope 80 CAMPBELL RD _ .. NORTHANDO 4 VFa2,MA 01845 Undersecretary ersecretary SVotvalidwithtiutsi ature