Loading...
11 PRESTON RD - BUILDING INSPECTION � � � - B y CK • 3 to3 CL CITY OF The Commonwealth of Nfassachusetts SAL Board of Building Regulations and Standards M Massachusetts State Building Code, 780 CMR Revised Mar 2011 ALEN[ Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Tivo-Family Divelling This Section:For`Official Use Only 1 zit Building Permit Numbs:: D A Iced Vz> /3 Building Ofrcial(Print Name) gna[ure - Date SECTION l:SITE INFORrINIATION - 1.1 Property Address: 1.2 Assessors Map & Parcel Numbers lI Pres�� � 1� D 1.I a Is this an accepted street?yes no Mao Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(it) 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: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public ❑ Private ❑ Check if yes❑ P p y SECTION 2:: PROPERTY OWNERSHIPL 2.1 Owner of Record: ellseo f2w0\1-q:ieZ- Sot )2iyt �q nlg7o Name(Print) City,State,ZIP I I Pie r�r, Sfi 9-7 fr- 335- Yro l 7 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK"(check that apply) New Construction ❑ Existing Building❑ 1 Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other Cl Specify: Brief Description of Proposed Work': .$ir'p av�cl !P'foof (/IorvP wt�'l'1 C�EhF AicGt/ C(\l�a( -fhr'nc�[e.S' — f7 SCE SECTION 4: ESTINLATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only' . Labor and Materials) L Building 95*� 1. Building Permit Fee S Indic3ce how fee is determined: ❑ Standard CityaoLwnApplication Fee. 2. Electrical $ ' ❑"Coral Pioject Costa_(Item b)s multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (HVAQ 'S List: 5. Mechanical (Fire S Sit ression) _ CotelAll Fees: ,S Check No. Check Anwunt: Cash Amount fi fatal Project Cost S 1 `?9 -- lance Duct------❑ Paid lin Lull ----_❑ Outstanding —Ba ---.-- D�C7 K ✓� 3`f i/0 SECTION5: CONS'rRUcrIONSERVICES 5.1 Construction Supervisor License (CSI.) )3-19_ _ 51111tf- A001A CID1P1* _ License Number Expiration Date Name of— CSL Ifuld f-- V . 1 List CSL Type(see below) `3 C.,lj 'janOr Type Description No. and Street 11,, U Unrestricted BuiWin s u to 35,000 cu. ('t. /�/owfwa tV rl 0343 R Restricted 13e2 Family Dwellin Ciry/"rown,State, ZIP M Masonry RC RooWindow Covering WS Window and Siding -- V SF Solid Fuel Burning Appliances (010--97(f-60oyX3y3C1 _ [ Insulation I'cle hone Email address D Demolition 5.2 Registered Home Improvement Contractor(11IC) ) (09 04 3 1$ I$ too VJ elf—"'06e- I "Y10GIRer/ �.v✓ HIC Registration Number Expiration Date I IIC Company Name or flfC Registrant Nam No.an Str— q, eet Email address `oesW)PA o ol3 Gf0 -S( )N- 6000 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 Affldavit Attached? Yes .......... 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 Alimn 6o 1et4 r fW'r:7 to act on my behalf, in all matters relative to work authorized by this building permit application. E11SNo 2cld,,1 vCZ See C'OnRctch $113').3 Print Uwner's Name( lee onic Signature) Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my mmne 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 knowledge and understanding. _ A f l ovN t 6 )3 1 -1� Print Owncr's or A thurized Agent's Name(Electronic Signature) Date NOT S: 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. 112A. Other important information on the HIC Program can be found at www.m:us. uv:oca Information on the Construction Supervisor License can be found at yvww.nrus.uo�'d'dL 2. When substantial work is planned,provide the information below: Total door area(sq. ft.) _ __. _(including garage, finished basement/attics, decks or porch) Oros, living area(sq. It) Habitable room count Number of fireplaces_--_ Number of bedrooms — ----_-_--- Number ot'bathroons Number ofhal6baths - -- _ I\'pc of heating system - -- ..-_ - -_._-- Number of decks/ porches 1)peo(cooIingsy;ten_-- Enclosed_—_ --- - --Open _-- S `I'ot.d ho)"Ct lquure Fnnta e" may be sub;titntad rol I'M.tl Ihojad Co;t'. /her CITY OF S�1LE1,I2 jNLkSS:ICHUSETTS t� y 2 ,• =. j BCtIDLNG DEP-%1M NT 120 7kSHLNGTON STREET, 3' FLo0R TEL (978) 745-9595 t<I\IDERL.EY DRISCOLL R+x(978) 7-W-9346 i�iL1YOR THOmu;ST.PtERRB DIRECTOR OF PUBLIC PROPERTY/aLMDLN(;COMNISSIOYER Construction Debris Disposal Affidavit (required for all demolition and renovation work) r In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of tbfGL c 40, S 54; Building Permit All 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 1'YIGL c I 11, S 150A. The debris will be transported by: Lagar,re — I-Faavert ,-(I } (nomc of hauler) The debris will be disposed of in : -- (name of taeility) (�ddross of facility) 513I1ature of PC V,applicant 8�a7�13 dice t The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance davit: Buildens/Contractor&%Iectricians/Plumbers Applicant Information ' r Please Print 1ALibly m Nae(Buzmecdorga�n-iationnndividuaq: kw Er, (loalc/n E/I'1COcLw( Address: ZT0 1cI](�l•'r-f id// . -Yeliv BIlO Lcy7fr< City/State/Zip: Phone #: L I C E N—57'00 Are an employer?Check the appropriate box: Type of project(required): 1. l am a employer with 15' 4. ❑ 1 am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner• listed on the attached sheet. ❑ Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. workers' comp.insurance. 9. Q Building addition [No workers'comp.insurance 5. ElWe are a corporation and its required.] officers have exercised their 10.Q Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152. 11(4),and we have no 12. oof repairs insurance required.]r employees. [No workers' - - 13.0 Other comp. insurance required.] •Any eppliant that checks Ira al atop also fill oat the section below showing their workers'mmpmmYon policy Innxmasim. t Humea mars who submit this alrulavit imlirating they see dams an work and then hits Outside cmaacton muse submit a new of elavit lat iutiag se&. ICaatoctors thu check this box man anadted an addtdoml sheet showing the name of the subeemitseots and their workers'comp.policy mtonmtion. lam an employer that Lr providing workinn'compensadon Insurancefor my employees. Below Is the policy and job sue informadon. Insurance Company Name: HARLEyStr]L�E LI�r�2GE�TE+� -.T:-fV5 C—d Peliey a ar spry-u.a.t_ie.u �� O�O�1Q��� Expiration Date Job Site Addres ]i Pies IV/t y r City/State/Zip OI.1 eM mA D[g7o 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 floe IW to S 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$250.110 a y iolator. Be advised that a copy of this statement may be forwarded to the Office of Investigation o e D for coverage verification. I do hereby c un er he p and penalties of perjury that the Information provided above is true and coned Date- a'a 1� Phone Official use only. Do not write in this area,to be completed by city or town afciaL City or Town: Perm iffLicense a Issuing Authority(circle one): �_—_--- 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector '6.Other Contact Person: Phone#: POWER-1 OP ID: EL CERTIFICATE OF LIABILITY INSURANCE °"'09 ""' 09/1911/19/12 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 certRcate 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 certlflcate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CONTACTA Lacher&Assoclates Ins Agency P ONE Lacher Insurance Group ( arc No 632 E Bread St P O Box 64398 ADDRESS. Souderton,PA 18964 Chad Lacher INSURE SAFFORDINGCOVERAGE 0AIC9 INSURERA!Harleysville Worcester Ins Co 26182 INSURED Power Home Remodeling LNsumRa:Harleysville Preferred Ins.CO 35696 Group,LLC Power Home Remodeling Group, msuRERc:Nationwide Mutual Ins M annY 23787 Inc. INSURER 0: 2501 Seaport Drive Ste 8110 Chester, PA 19013 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISIONNUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 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, IRIS TYPE OF INSURANCE p POLICY NUMBER E PO C MMlDDIYWY M D DMITS GENERAL LABILITY EACH OCCURRENCE S 1,000,000 B X COMMERCIAL GENERAL LIABILITY MPA00000089793N-1 09/22/12 10/01113, ryg ,`men 4 100,00 CWMS-tMOE (OCCUR MED EJIPM aw a/Con S 10,00 PERSONAL S ADV INJURY S 1000,000 GENERALAGGREGA19 q, 2,'00 00,000 GEN'LAGGREGATE DMRAPPLIES PER: PRODUCTS-COMP/OP AGG 00,000 n X PFCTRO- LOG LIABNTY M.NaIN SISIN LE LIMB00,00O BA00000089796N 09/22/12 10/01/13 BODILY INJURY(Pv pemon)ED SCHEDULED AUrOS BODILY INJURY(Peracvden0 TOS AUTOSWNEDPROPER DANPe S LA UAB X OCCUR FAGOREGATE ENCE S 10,000,000 LIAR CAIMSNADE CMBOOO00089794N 09/22/12 10/01/13 $ 10,000,001 DED RETENTIONS S AND ERSEMPLOYERS' COMPENSATION - OTH- ANO EMPLOYERS'LWa WTY A OF IFCErRWENSM actuoem ECViIVE Y© NIA WC00000069796 09122/12 10/01/13 OENY S 1,000,00yyeeeneeEA EMPLOY - S 1000000 OESdRIPT�IDNOFOPERATIONSEelal POLICY LIMIT S 1,000,000 A Aass Auto Policy BAOOOOOO18227P 09/22/12 10/01/13 Liability 1,000,00 Limit DESCRIPMOtl FOPERAT1011S/LOCATIONS/VEHICLES (Adace ACORD 131,Addloonal Ranarks Schedule,Nm ra spnrnla rcqulred) 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 AUTHfOOIUZZ6D REPRESENTATIVE 3rd Floor alem, MA 01970 ®1938-2010 ACORD CORPORATION. All rights reserved. ACIDRD 26(2010106) The ACORD name and logo are registered marks of ACORD Office 0 Consumer Affairs sand Business Regulation 10 Park Plaza - Suite 5 170 Boston, Massachusetts 021 16 Lome Improvement Contractor Registration Registration: 168616 POWER HOME REMODELING GROUP LLC atioTypm Supplement Card ALLAN COLPITTS Expiration: 3/18/2015 2501 SEAPORT DRIVE STE B110 CHESTER, PA 19013 SCA {lpdote Address and return card. Mark reason for change. ! f. ron+.asn; Address _ Renewal Emplo yment Lost Card _ !lice ofConsumer:�(fairsR flusiness Rrenlatfnu Licenseor registration "' r' ME IMPROVEMENT CONTRACTOR before the expiration dates If found d for treturn to vidul only _diogistra6on: 168616 Type; office of Consumer Affairs and Business Regulation'--�' Expiration: y18/201g 10 Park Plaza-Suite,S I70' POWER HOME REMODELING GROUP LLC Supplement i.and Boston, NIA 02116 ALLAN COLPITTS 2501 SEAPORTDRIVE STEB110 3:...a...�f CHESTE R,PA 19013 ----�_ I InJn'f<rreta ry valid w' at Signature Massachusets Departmerr, of Public Salety Board of Budding Reguiahons and Standards ( nn+irnr q:qi iup¢rV.ur l_tCense CS-001979 ALLAN K COLPITTS 3 CHRISTI.AN DR NASHUA NH 03063 anon 05/07/2014 Fr NA116WAL HEADDUAR TENS ez rt Eltsso and Esthete Rodrigu .R3o1 seals D,W Crvaid%PA _ h'...y�xyjjQ� _.y� y/,�:... a( c..-•-� ar- 4� Au u al 13.2ai3 l•azag^�iLilrl/��L, i ���^. rr'w�'"i.T x 0�" 2,1M _ 41r, 'pAmcrr Issss " - CUSTOM REMODELING AND IMPROVEMENT AGREEMENT euirer'vrnfu mdl.n Project Number.,30.82788' August l$9a13 Efis oRodriguez 08)ada-0a1T+,t1,saos Cs10 ' "aurcnmwm.ri 1 Esthala Rodriguez - EARaddauevalignail,wm 'it Preston - EYMrAm�lvmsr stem,wu county:Essml:.. Townehlp: } auyerts)listed above hereby]ointlir'and severalty agrees be purchase the goods and/or services at Power Nome., t Remodeling Group("Contractor")In accordance with the prices and terms described on file front and the following four pages of thlsagmement and any specification sheets,which are incorporated as part of the Agreement(collectively,this r "Agreemenrl,This Agreement represents a cash sale of goods and services.Buyers)agrees to pay the cost ofthe goads al dservices purehasedas dancrtbedhereiitl regardless of timing or approval of any financing Buyer(s)may seek for their' ,- pprchose,Problems and lmquttie§regardingthis Ag'Taament should be directed to the Contractor at 1-8118-738-035, ; ` Purchase Pricey $'I4;S$a.Td p w. 1 Pre Installation Inspection Data: Oov+n Payme SD,o-Ji $wr:pM'.vAmFrt an Tea&�"'u oeta wvt?)a 3-tap eglenca Due oo- gt4.953.70 Estimated Oral ct Start 3'to dRerat weeks .t aubstmnlel CompmBan: Estimated Project Completion:1 to 2 days' Method of Payment: Wer, ogs`0;gN*(0 a44 isw4e£urcres;eryta.neto}'u map d iml-ded0( ( - ca'rutanq urrvam see darrvrunwiona coiecans an revclse.. .. Buyeris)hereby acknowledges receipt of a copy of theparramet,"The Lead-Sate Certified Guide to Renovate Righf', Y informing Buyer(s)oPlhe potential risk of lead hazard exposure hum rehwailon activlty to be performed in Buyer's home, t atthe addr written above Buyers)received this pamphlet on the date of this Agreatdent,betake commencement of n work (Buyer's initials). i!! Itls agreeda et understoodpy and between the pardestNatthls Agreement constitutes the entire-uridarstanding between the parties,,AtWthere are no verbal unitetstandldp§thanglog or modifying arty otthe terms aftltls Agreement Blows) 7 ' hereby acknowledges that etiyar(s)ll has meddle entire Agreement and has received a completed;signed,and dated copy ofthis AgreameM Including the two accompanying Notice of Cancellation forms,on the date firstwntten above and 2)was 1 orally Informed of histher right to cancel this transaction.DO NOT SICN THIS AGREEMENTIF THERE ARE.ANY BLANK SPACES. ' Future promotions not applicable. a r' t I - 1 have mad and raceiyod.oach page of this a page agreement •f I Power Nome Remodeling Group 4 Buy ?*] Buyer(s) I `• d ...' 4 OtAt18 oe 8r13t13 708113r13 ;tna Consultant +" I Signature Signature - Matthew Bergamo EliseoRodri ' Esthete Rodriguez I YOU,THE EUYER(SI,MAY CANCEL THIS TRANSACTION.AT'•ANY TIME PRIOR TO a DNIONT OF THE THIRD SUS!NESs 1UiY AFTER TH6 DATE OF THIS TRANSACTION, SEE THE 14071CS OF CANCELLATION FORM FOR AN EkPLANATION OF THIS RIGHT, August 13,2013 2010 IIII I)I II IIII I II II IIIQ I I'U II . Page 1 of 6 NATIONAL HEADOLIARTERS 2501 Seaport Drive.Chester,PA 19011 Project Specifications Rooliny. Mein Roof 1 1650.0'x1,0' ROOFING: Models GAF Styles Architectural Shingles Types None Configs Norte OPTIONS. Color Pewter Gray I Removal Standard Shingle I Installation Details None CORP�ORON Roofing: Ridge Vent 1 44.0'x1.0' ROOFING: Models GAF GrayStylesI Cobra Ridge Vans types None Configs None OPTIONS: Color Pewter Grey Installation Details None ` fGAFMArEF4CORPORATION Rooting. Replacement Wood 1 300.0'x1.0' 8 ROOFING. Models GAF Styles Replace Wood Types Plywood Contgs None Options Norio Installation Details None QJERIALS CORPORATION August 13, 2013 20:17 I II II III III I I I IIII III I III Page 2 of 2