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38 SHORE AVE - BUILDING INSPECTION air ` -'7 a\ The Commonwealth of Massachusetts (In Board of Building Regulations and Standards EC&VWF Massachusetts State BuildingCode, 780 CMR INSPEC 10NILA.6E.iR.VICE Revised Mar 20l! Building Permit Application To Construct, Repair, Renovate Or Demol' y One-or Two-Family Dwelling '!"O M Y b A 111 rj This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION Ll Property Ad" ter dW 1.2 Assessors Map& Parcel Numbers L la Is this an accepted street?yes no_ Map Number Parecl Number 1.3 Zoning Information: 1.4 Property Dimensions: 2ontng L'istrict Proposed Ilse Lot Area(sq t't) -- Pront-,ge(M —� 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: L8 Sewnge Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check ifbes❑ Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSI1IPt 2.1 Owner'of Record-- - - Naino(Print) � L — �ry City,Slade,ZIP i 'No.and Street C� Email Addross SECTION 3: DESCRIPTION OF PROPOSED WORK (check a 1 that apply) New Construction Cl Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specity:__ Bri'e.SDescription of Proposed Work-: ------------ ------- —- NVV--- SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials Official Use Only I.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ __ 4.Mechanical (FIVAC) $ List:- 5.Mechanical (Fire Su ression $ Total All Fees:$ _ Check No. Check Amount: Cash Amount— [].Paid G. Total Proj e pc Cost: $ �t in Full ❑Outstanding Balance Due: I"bPcILev Tp 3$ sc: (H01` ll+s s�� SECTION 5: CONSTRUCTION SERVICES 5.1 _ , uct upervisor License(CSL) u ' � t ? .l 1 � _/ �. License Num er Expr tion ate Name of�CSL Hot �e�r F66i» �vrv(/ r 1S List CSL Type(see below) Type Description No.and Street n t y������ U Unrestricted2 Family (Buildings u el ing ca ft.) AM ✓� R Restricted I&2 Famil Dwelling City1T6wn, rate M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances n I Insulation fele hone rrr f Email address D Demolition 5.2 Registered Home Im rovement Contr for(HIC) rs HIC Registration Number Exp rat Da e HIC am r om N tegi.t is No • r St t x �� Email address M -City/Town" it /Town, State ZIP Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be c mpleted and submitted with this application. Failure to provide this affidavit will result in the denial of the IssuartWof the building permit. Signed Affidavit Attached? Yes ......... O 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. �3ee Co Print Owner's Name(Electronic Signature) , - Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereb test under the pains and penalties of perjury that all of the information .> Z ed in this application is true and a cu to t he be t of my knowledge and understanding. /C Pri t wner's or Authorized Agent's c cotron c,ignature) 5/to 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.gov/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. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halt7baths Type of heating system Number of decks/porches Type ofcooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CI i 0 JiV Nf, LY La"1s&kcR US L' 1 1J BUILI)Nc DEPAal-M&NT � 130 Cq-. Sh. HLYGTOV STREET, 3 FLOOR 1aL (973) 745--9595 KI\IBERLBY DRISCOLL FAX(973) 74119844 &LAYOR -n-tostAs ST.PtE2Aa DMECTOIt OFPUBLIC PROPERTYIaLMDLNG CO\WISSIONEQ Construction Debris DisPosai Affidavit (required for all demolition and renovation work) In accordance with tite sixth edition of the State Building Coda, 730 Ci441R section 111.5 Debris, and the provisions of IAIGL c 40, S 54; Building Pennit # 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 IWGL c l 11, S 150A. The debris will be transported by: 1 ommcofhaulJr) The debris will be disposed of irl Oddress of r cillly) sigrtarure ofpermit appticam &Ile j �I 6-00 Yid��agra�. 3 U � ! � � k mod— Patin ar� �a Workers, aompensatio �sta 1La,� P" Pl a5z pe rlat Le&t, Anwsizant Name(Business/ftarozatic"AldL __f�t� T1_ i yore#. 7 It City/state/Zip: " _ — r rn rlat bbx: T p¢ Ara as emp4 Dyer. Check p P 4 I am a general courator and I 1. P1ew construction am a employer with__ .__. have hued the sub-contractors employees(full and/or part-time).' 7. R mcdeling listed on the attached sheet_ 2.❑ I am a soleproprietor of Pine These sulrcoutractors have o, E]De lolhi oil Ship and have no employees loyees andhave workers' working for me in any capacity. y. ❑Building add eon comp.Risurmce.t 10.❑Electrical repels or additions [No workers'comp.insurance 5. I] We area corporation and its required.] officers have exercised their i 1.I.[]Plumbing re_�s o'add t ons ffi 3.❑ l am a homeowner doing all work right of exemption per MGL myself.[No workers' comp. P p 12.[]Roo a rs c. 152,§l(4),and we have Do War ' r insurance required.]t Pulp lo•ee& to workers' 13'� -5! '7 comp.insurance required] *Any applicant that checks bo:#1 me also fill out the section below showing theirwarkers'compensation policy mrMatlon. all work aml tsm hist Outside eoat=Pd�mast submit a co"T 3Conaacto ethat Check this boxaffidavit ust attached an ad tional doing shoving the neme of the sub-c nkactovs end state wh thz or lot thos enti�hava� employees. If the sub-conhactocs have employees,they mast provide their ivorkers'comp.policy number. . rs'sosnTensataoaa insurance for any essgtitoyees. Beflosv is the policy and job site T am an enepdoyeP that ds perovaddag worke infornsatdon. _ Insurance Company Name: lr��k�2 L ExpirationDate: / Policy#or Self-ins.Lic.#:_ � � � City/StatelZip: Job Site Address: tine ol"ac ®®mabea and explrati®�date). Attach a copy®f the w®rOsers'compemsati®n>q®ficy.decIlaaada®®page(showl®g la Y Failure.to secure coverage as required unde*Sec5on 25A of MGL c. 152 can lead io the imposition of criminal penalises of a fine up to$ cure o and/or one year imprisonment as wall as civil penalises n the iarm of a S fGP VJOkI (}PDEit and a fine of up to o$1, 00 a day against the violator. Se advised that a copy of this s ateeneni may be fb v erica to the Office of Investigations of die DlA for insurance coverage verification. p do hereh ee der thep ne, .sendpeeaol6n �f perje,r7,pP�- aof tie informiador pie®waded above ee i'vsee and correct. / -es c ,v Date: f� ;ianai Z y f �,r c Phone#: official use only. Do not write in this area,to be cosnple2d by cry or town ufficiaL Permit/License h City or Town: — Issuing Authority(circle ome): City/I®avr Clark 4.Electrical Inspector g.Pimm¢hina Inspector 1.Board offfiealth 2.Building 1Depya�emt 3. 6.®thee P➢tome k Contact Person: I , x � Aft Ic e� 1 O X. HUNTING r ✓ - * i �W! 0/2011 i X Next Step Living, inca CT HIC.0629266•MAOCABR#162111•RI Contractor Reg.#37185 HOME IMPROVEMENT Date of Contract: Monday,April 21,2014 Customers)Name(s): Judith Janvrin Customer(s)StreetAdress: 38 Shore Ave City: SALEM State: MA Zip: 01970 Customer(s)Home Phone#: (978)741-4951 Customers)Mobile Phone#: Permit(s)Required: Permit Number(s): City/County Issuing Permit(s): Scheduled Inspection Date: Customer(s)jointly and severally agrees to purchase the products and/or services of Next Step Living,Inc.("Contractor")in accordance with the terms and conditions described on the front and reverse of this Home Improvement Agreement("Agreement')and the attached specification sheet(s). Customer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. ESTIMATED STARTING DATE: Monday,May 05,2014 ESTIMATED COMPLETION DATE: Monday,May 19,2014 PAYMENT METHOD: (select one option) PURCHASE PRICE: $ 3,164 Cash BX Credit Card DOWN PAYMENT: $ 1,055 Check Financing BALANCE DUE ON SUBSTANTIAL COMLETION: $ 2,109 Customer(s)acknowledges receipt of"Renovate Right:Important Lead Hazard information for Families,Child Care Providers,and Schools". Customer(s)received this pamphlet on the date of this Agreement,before commencement of work. CCustomer's In t—W--' (Rhode Island Customers Only)Customer(s)acknowledges receipt of required Contractors'Registration and Licensing Board consumer education materials. (Customer's Initials_ (Rhode Island Customers Only)Notice to buyer:(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign it.(3)You may at any time pay off the full unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You may cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an explanation of buyer's rights. Customer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of this Agreement.Customers)acknowledges that Customer(s)(1)has read this Agreement, understands the terms of[his Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two accompanying Notices of Cancellation,on the date first written above and(2)was orally informed of Customer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPA NEXT STEP LIVING, INC. By: Omar ENieves-Hernandez 112014 Print Name Lic.# *g,,tu Date CUSTOMER(S) Judith Janvrin ��J} K� . ^�la' '—� '•• JV 12112014 Print Name U Signature Date Print Name Signature Date YOU,THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIk4E PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ACCOMPANYING NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ©BLLP2013.NSL.CTMARI "%L Yre.m�nr.,..r+.vi�/�r'•// t}u:.rrrfu,:r(I ](,iC0O9G or regISfYLtlOpl valid for III(j]vAdU) use Qlllty OtTcc of Consumer �[taira& Basidess tte utallon before the expiration date, Lf found return to: ME IMPROVEMENT CONTRACTOR Office of Consumer AMirs and Dusiuess ROguistion h' - egWraifon: 161323 Type lflP'arhPlaxa-Sutte527G �ilyd�acplratlon: 1011 4/20 9 4 D8A Boston,TV1A. OZ1lb CRAIG WINDOWS I r -` RONALD CRAIG 3 PARK RIDGE DR. HUNTINCTON,MA01050 Underseerefary Not wink si�natura