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15 SAUNDERS ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts Department of Public Safety Massachusetts Stare Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) uilding Permit Number. Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) yj i 5 SA)p bEru SA La ztf /,'?R 01970 No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2.PROPOSED WORK Edition of MA State Code used_ If New Construction check here or check all that apply in the two rows below ai Existing Budding❑ Rep ❑ Alteration El fill Addition❑ Demolition ❑ (Pleasell out and submit Appendix 1) - }! Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: 1 Z X 7 O Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No O Brief Description of Proposed Work: ('Z X.�O 1c L7 i t-b i oh- & �� SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) Total Area(sq.It)and Total Height(ft) SECTION 5.USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A 1❑ A-5❑ 1 B: Business ❑ E. Educational ❑ F: Fact F-1❑ F2❑ H: Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1❑ I-2❑ I-3❑ 1-4❑ M. Mercantile❑ R. Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ III ❑ IIA ❑ ITB ❑ MA 1HB ❑ 1 IV ❑ I VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Trench Permit. Debris Removal: Water Supply: Flood Zone Information: I Sewage Disposal• Licensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be P Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor. Does the building contain an Sprinkler System?: Special Stipulations: Landscape Design Lot Clearing&Tree Removal Stone.Block&Timber Walls Water Gardens&Ponds Brick Walkways&Patios Drainage Design&Installation Dry Seeding&Hydro-Seeding Maintenance&Clean-ups &Sodding Shrub Planting equipment Services SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner '37EF.F /S, Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Cz W mq o mr l'b -L4 - 00 791 72Y S700 t\V.x\%4 ' I� Cunnccs�r hv` Title Telephone No.(business) Telephone No. (cell) —'b�lrn5h address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) f building is less Phan 35,000 cu.ft.of enclosed space and/or not under Construction Control then check h d skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 102 General Contractor _fortc76w0' S-T2VC_7'02EcS Company Name Igrib)g� ='w kuR-rz Za Z Name of Person Responsible for Construction License No. and Type if Applicable 27 -SouTH RID o/o8S Street Address City/Town State Zip V13a2. -)1 7f, _ Tele hone No. business Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT G.L.c.152§25C 6 A Workers Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of thejsSuance of the building permit. j Is a signedAffidavit Adavit submitted with this application? Yes�No ❑ SECTION 12•CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 7 V V Building Permit Fee=Total Construction Cost x (Insert here 2 Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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 ledge and understanding. Please prin sign name Ti a ephone No. Date K /S S>9yu1��2', ' Gt Street Address City/Town State Municipal Inspector to fill out this section upon application approval: 0 7 Name Date The Commompett sf ltirsetLs D arttnent o r ` ` r f i rialAccidertts e $adiva 60dGftagton, pear �. ��l►r,4 Barr-.� . T .�. thMlaSS90"a . . . Workers' Compensation Insurance.Affidavit:$uilde Applicant Information rs/Coatiractors7Efe¢tricisns/Pluil4fiers . { Please Print bl Name(Business/Organizetioa/Individual):l 1 O1 T0uj!%; !- tronture s Address: Go o2 ] �o r�harnvi+oil R _ Ci /state/zi st t. M+ .DIM .;Ph6ne9: H13 2 717P Are you an employer?Check the appropriate box: I1 I am a employer with $ 4. I am a g¢aeral contractor and I 77. [] t project(wired): emplo,YCes(fiili and/or part-time).• -have hired the sub-contraet03$ New•construction 2. I am a sole proprietor or partner 415ted on the attached sheet, • Remodeling ship and have no employees These subcontractors have Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.t 9. 0 Building addition tegtihw.j 5. 0 We area corporation,and.its MO Electrical repairs or additions . 3.El I am a homeowner doing all work officers have exercised their 11:0 Pllmbing repairs or additions myself. [No workers'comp. rigltCof'exemptxop:per MGL t. . insurance requited.]t c. 152,§1(4),and we have no 12•0 Roof repass employees.two workers' 13.0 Other comp• insuiaach ] .Any applicantthat-checks box#1 Must also fill dot the section below showll�*-a' *dikes•congtansation policy infotmatioa. t Homeowners who submit this attidsvit.iridii1ding they am domg.all work andthan him oolsi 1Con de contractors moat avtimit a new affidavit indicating such. wetors that check this box t� apachcd.an.additional sheet showing Am mme of the sub-contrectom and4iiate whether.or not those entities have employees. If the sub-conbactos have employees,they must provide then workm ,comp,policy numlwr: /am an env la er'that is nwrhers eo —�P Y Pror+drnS. mpensation insurance for my an/tye Below is the policy mad job site information. Insurance Company Nate: Ze�/A /Jl/t/Jii 1,15'IG�LJ t IAAp Policy#or Self ins:Lic.#: Expiration Date: $ 27 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration PW(showing the policy number and expiration date). Failure-to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,asmell as civil penalties infihe form:of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator`.: Be advised that a copy of this.stateh"'may be forwarded to the Office of Investigations of the DIA forinsuratu`e coverage verification. /do hereby certify under thepairs andpenaUtes ofprYjgry that the inforaradonprovided above.strue and correct Signature: l 1miio,.r xr) —Date; Phone#: 4"13 56? 3171 Official use only. Do not write in this area,tote complete by alyor town offuiai City or Town: Perntlif/License# Issuing Authority(circa one): 1.Board of Health .2.Building Department 3..City/rown Clerk,4.Electrical Inspector 5:Plumbing Inspector 6.Other Contact Person: Photie# Massachusetts- Department of public SafcF) . 1 Board of Buildin!-, Rc!_ulations and Standards Construction Supervisor License , License: CS 98186 ANDREW 1KURTZ 295 BROMLEY RD. HUNTINGTON, MA 01050 lA �y Expiration: 8/3/2013 . - (-.nnnisioncr Tr#: 20132 - - Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 159772 _ Type: Ltd Liability Corporation Expiration: 5/27/2012 Tr& 296849 HOMETOWN STRUCTURES ANDREW KURTZ 627 SOUTHAMPTON RD — - --- --- WESTFIELD,. MA 01085 - - -- _ -.------_ __.---- _ Update Address and return card.Mark reason for change. ❑ Address Renewal Employment ; Lost Card DPS-CA1 0 50*041104-010121e s Yryax Ai � gg �a a- ';a a f rff r- i ❑ k� :� y , � r p ury d�I oe e + �....' _ _ ;" .'r 4" S'1'I:1:�. 1�1�1�()�1'I�l;1�I) 1���(�I t)1 S Up To 3,500 pounds of holding power. W q APPLICATIONS OUR CUSTOMERS HAVE USED THE STEELARROWHEADS FOR SECURING: Sheds - Enclosures - Shelters - Portable Shelters - Towers -Antennas - Canopies Vineyards - Carports - Sports Goals - Fencing - Playground and Yard Equipment Fencing - and MUCH MORE! These arrowhead anchors are designed after our highly successful Mil-Spec anchors which have been proven and tested out in the field for over 40 years. The anchors are made of high quality 11 gauge galvanized steel with a matched galvanized aircraft cable and thimble loop or cable clamps. American Earth Anchor's 3-inch&4-inch steel anchors combine superior pullout resistance, ease of installation and dependability at a very affordable price. The distinctive design of the 3&4 inch American Earth Anchor provides up to 3,500 pounds of holding power,more than enough to secure a shed to a tower. Pullout Resistance In Pounds Loose Loose Fine Anchor Size Minimum Vertical Hard Pan Dense Sand& Medium Sandy Medium To Uncompacted In Inches Depth-Feet Soil Gravel Gravel Fine Sand Sand 111 : 11 11 rll 11 11 ' ll ' ll s , 3"With"Thimble End 3"With Plain End&Cable Clamps Phone:508520-8511 Toll Free:866-5208511 Fax:508-520-1252 E-mail:info®americanea.com Web:w .americanea.com GENERAL INSTALLATION INSTRUCTIONS step t Step 2 Step 3 Using a drive rod and Once driven to proper depth, Using drive rod for leverage,pull up on cable hammer,drive anchor into the ground retrieve drive rod end to set anchor horizontally in ground at the same angle you're tying off to • Y f� 'tMy • "-x•a Y�I J. . Ap E Great for Theft Deterrence, Weather Security and All Around Stability` I TYPICAL SHED ANCHOR INSTALLATION Step 2 Once driven to proper depth, Stop t retrieve drive rod Step 3 Using A Drive Rod and Small Sledge Using drive rod for leverage,pull up on cable end to set Hammer or Demolition Hammer Drive Anchor Into ••When Setting Anchor(Step 3)The anchor horizontally in ground The Ground Vertical To The Shed Thimble Will Pull Up 2"To 4"So Plan Final Thimble Location Accordingly F . w '�Y Step 4 Step 4 For Thimble End Use Boll,Nut& For Plain End and Cable Clamps Washer or Lag Bolt&Washer Wrap cable Around Supporting Member And Attache(3)Cable Clamps r I � *Our Thanks To Chapin's Wood Products In Whitman,MA For Their Help With The Installation&Shed Pictures DRIVE RODS 3"Steel Arrowhead Anchor Uses A 1/2" Round x 36" Long Steel Rod 4"Steel Arrowhead Anchor Uses A 3/4" Round x 36" Long Steel Rod Do Not Use Rebar The Ribs Will Stick In The Anchor �i,.,�-�w �� _ - �< ��_�-� r 4' y 9 . t a �♦4 Jwfh'ry r -. oik •-'jd Ti4..- } •F 1lw 1 . 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Yr�ca r +w. . � �,,,•e�E4,.,7�. ffi' .r r tv'g wt l t '4. ,y'�q,r 5�,t.�rr -t r r c / f r f 7 •C wy r.w t�;'.}� �`�w;F. 7+. 7�T�:e }K p. .�Sl �.L`r`y":",..V- a};�ar.'�'i^.?r°! x wy:y{f,kY':'^ ..rit.9..} '1 Ja �• -R A. .H -k it a ONE The Commonwealth of Massachusetts �•. w, s� Department of Public Safety S mJ Massachusetts State Building Code (780 CMR) LJds� o�D Building Permit Application to Construct,Repair, Renovate or Demolish any Building other than a One-or Two-Family Dwelling Code and Other Requirements for Building Permits The Department of Public Safety has issued these building permit application forms so that municipalities across the state can move toward use of a single permit form and consistent permit application process. The MA State Building Code specifies the requirements of building permits and the applicant is advised to review and be familiar with these requirements in order to avoid some of the common permit application problems. Likewise the applicant should be aware that some municipalities require that the owner confirm, even prior to acceptance of the building permit application,that no outstanding property taxes,water fees, etc. exist. Filing Instructions 1.Please contact the city or town where the work will be done to ensure that the city or town will accept this application form and if any additional information is required, and obtain the correct mailing address. After doing so, print the application, fill in completely and then submit to the local city or town where the work will be done. 2.All applications shall be considered complete and will be reviewed if construction documents, specifications, fee, and other materials that may be required as indicated in the Building Permit Application are included with the application. 3.Please include a check for the Building Permit fee. The fee may be calculated using the information to be supplied in section 12 of the Building Permit Application. The check is to be made payable to the local city or town where the work will be done. Appendix 2 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may requirerepeaters) 6 HVAC 7 1 Electrical 8 Plumbing include local connections 9 Gas Natural,Propane,Medical or other 10 Surveyed Site Plan(Utilities,Wetland,etc. 11 Specifications 12 Structural Peer Review 13 Structural Tests&inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Irrvestigation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other S 21 Other S 22 Other S *Areas of Design or Construction for which plan are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State 1p Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address Ci /Town State Zi Discipline Expiration Date Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block # and Lot# for locations for which a street address is not available) No. and Street City/Town Zip Name of Building(if applicable) For the above described property the following action was taken: P P t3' g Water Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) �.r ,r.y 1 Fully Assembled - Hometown Sheds BUILDINGS ARE DELIVERED FULLY ASSEMBLED Delivery includes positioning of building on your prepared level site,which must be accessible with their pick-up truck and trailer. 4x4 foundation beams set on blocks or stone base to level building. HOW WE DO IT! h f � �' S .J S � Loaded Driver Side Loaded Passenger Side Unloading Site Preparation: No tree branches lower than 15ft overhead in the path of the delivery truck-(they can damage the roof of your shed) No bushes or shrubbery impeding the delivery truck 3ft Working area around site is needed The customer is responsible for removal of fences,trimming of low branches, removal of debris,animal waste,or any other items in the way of delivery. IF FENCE POSTS ARE REMOVED FOR ACCESS, HOLES MUST BE COVERED OVER AND NOT LEFT EXPOSED. Vehicles should be moved out of the way of delivery and kept from the edge of the driveway prior to arrival of your shed. The area should be no more than 12"unlevel. To check the grade difference,find a straight 2x4 of sufficient length. With a 4'level on top find the highest ground,while in level position measure from the bottom of the 2x4 to the gound on the lowest side as follows: This determines how level your site is Astoria base is recommended for any 10x16 or larger sheds or if the site needs to be leveled.The base should be made tft larger than the size of the shed(ex: 10x16 shed needs a 12'x18'base)using 3/4"crushed stone approximately 34"thick. The stone base must be Flat and level, not placed to the slope of the land. Building permits,where applicable,is the responsibility of purchaser. Permit must be displayed on job site prior to start of work. Most towns and cities require a permit. In all cases,customers should check with their local building departments for requirements. Purchaser is responsible for the location of the building and there shall be no liability on the part of Hometown Sheds for incorrect location thereof,whether on the purchaser's property or on the property of a third party. All buildings come with a five year warranty against defects in material and workmanship and twenty year structural warranty (excluding doors). Roof shingles have a twenty-five year manufacturer's warranty; however they are not warranted in winds in excess of 55 MPH. Also,we do not warranty against natural disasters. Any referrals given are for your convenience, they are independent contractors not associated with Chapin's Wood Products/Hometown Sheds.We do not warranty their work and are not liable for their actions. CANCELLATION POLICY: We reserve the right to issue NO REFUNDS on custom orders. Once we resell the cancelled order,we then will refund the deposit or portions thereof. RESCHEDULING-In the event you are not prepared to accept your installation/delivery of your shed on the assigned day, please notify our main office in advance to avoid a redelivery charge,and to get the next available delivery date. Should our installers/delivery men arrive and not be able to install your building because of the above mentioned conditions not being met,the redelivery charge is$1.00 per sq.ft. (i.e. 10x12=$120.00) 1 HAVE READ AND UNDERSTOOD THIS CONTRACT CUSTOMER SIGNATURE J . l I DISTRIBUTED BY HOMETOWN SHEDS DISTRIBUTED BY.. CHAPIN'S WOOD PRODUCTS SALES CONTRACT CHAPIN'S WOOD PRODUCTS 556 Bedford Street ❑ 80 Washington Street Route 18 Mass. C.S.L. 98186 Route 1 Whitman, MA 02382 Mass. H.I.C. 159772 Plainville, MA 02762 781-447-4700 Fully Assembled Sheds- 508-699-8268 Date of Order Product Order# ADDrox. Delivery Date Wame Phone# Phone# PURCHASE PRICE 7Gc� C 7599 /%, �Z� -Zz�� �a� �"�®D yes 7 TAL CUSTOMER NAME , ///��-/�—/�•��— y� � � � j/��/� TAX S�-3. 38 ADDRESS OF JOB SITE ZIP CODE TOTAL /.s SITE ..�r ��/ �� �97� 88'7'?. 3? DEPOSIT MFG HOMETOWN OPTI NS 000 . oo n ^� �J ;1 RI may? .,.f') $ / 90 BALANCE DUE ' p SIZE T�7 G-/�, Z!7 LJtuoob ' mil {/ri1�DUAJX $ JOo ��ME Ho OFF PAYMENT ROO Y X I Z v V'S $ ! �S— ❑ CASH ❑DURATEMP VINYL $ ❑ CHECK BODY COLOR , CHARGE TRIM COLOR N ! YE DOOR COLOR, 'jam 11 � S Cr. CD SHUTTER COLOR Color of Roof Shingles: /J o �5' z DOOR&WINDOW PLACEMENT(Draw Picture) b 0 3�o XJ6 o LA) TD w7.), w roA �'v�nt� k LL__O,,,AA{D WITH DOORS FACING: I,.2T DRIVER SIDE Order taxed to PASSENGER SIDE affim: ❑ D UN 6 17 @ 60n1c,4,57 NET x Salesperson's Signature