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30 VALIANT WAY - BUILDING INSPECTION
SZ3- 1 q 'The Commonwealth of Massachusetts !� Board of Building Regulations and Standards CITY OF d((,� Massachusetts State Building Code, 780 CNIR SALEIVI Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised,Vlur 2011 One-or Two-Family Dwelling i' This Section For Official Use Only Building Permit Number: Date.Applied: Building OlTicial(Pont N;une). ~' �• ) Si at - Date Proper SECTION 1:SITE INFORMATION 1.1 ty Addre$s: d �ICrtl- L6!r 1.2 Assessors Map&Parcel Numbers I.In Is this an accepted street? es no_ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Tuning District ProposedProposed Use— Lot Area(sy R) .Frontage(R) LS Building Setbacks(ft) I uired Re Front Yard Side Yams Rear Yard y Provided Required Provided Required Provided 1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: Public O Private❑ Zone: _ Outside Flood Zone? 1 8 Sewage Disposal System: Check if es❑ Municipal ❑ On site disposal system ❑ SECT(ON2: PROPERTY OWNERSHIP 2.1 Owners of Reco-r�+ N�1me(P-,s r,m)tc�/'�GGk¢nzt e .-34M �'1G Gl47rl LILY,State,ZIP V41tcM11— wf�,/ 7 S; C71W_ Nu.;md Stncl I Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)Email Address New Construction❑ Existing Building Owner•Occupied 6 Repairs(s) ❑ 1 Altemtion(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units ( I Other ❑ Specit'y: Brief Description of ProposedWurk': --lrpeh � I'Edow.S SECTION d: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials OFricial Use Only I. Building ,g I. Building Permit Fee:S Indicate how fee is determined: 2. Electrical S ❑Standard City/Town Application Fee 3. Plumbing $ ❑Total Project Cost'(Item 6)x multiplier x 2. Other Fees: S 4. mccharlical (l-IVAC) S List: 5. Mechanical (Fire Su ression) 'S Total All Fees:S 6. Total Project Cost: .$ 3a7 Check No._Check Amount: Cash Amount_ ❑Paid in Full ❑Outstanding Balance Due: i �� h ck SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 'j I _ L _ cth License Number Expiration Date i ame orCSL Mulder y List CSL'rype(see below) �! �T $ 1 Type Description p J No,and Street U Unrestricted Buildin s u to 35,000 cu.Il.) ff-- ,ram It Restricted M2 Famil Dwellin Mason CitylTown,State,"LIP RC Rootin Coverin WS Window and Siding SF Solid Fuel Burning Appliances _ we/h I Insulatio n 7 13-r Gk 3eb� US�hdSl't D Demolition N 1'ele Kona Email address ress 5.2 Registered tlome Improvement Contractor(HIC) ( _ HIC Registmtmn Number Exptrulion Date istr N.une cc I II Cui`pangName o�(IC f ag lUP I 1 . yh'1 Ire ..��-- 1X Emad res No.and treet '77U cJ�( 2IJ� for p S!h 1 Yo13 --�--- Tele hone Ci /Town,mate-ZIP - SECTION 6:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G L.C. 152. l re to pro 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 .........: ZI No ......... ❑ TED SECTION7a:OWNERAUTHORI7ATIONTOBECOMPLDINGPE MI OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize t9 act on my behalf,in all matters relative to work authorized by this building permit application. Date Print Owner's Nmne(Electronic Signature) SECTION 7b, OWNEW 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 knowledge and understanding. //!. UJ b n ''St L�� ate Print Owner's or Authonzed r\gents Name(Electronic Signature) NOTES: � it na�Owner who red inbl et Home improvement tCon mtetor(H(C) Ps/her own �ogmm)n iillni rtcr vhavetaccess toires an ttthe arbitration registered tractar program or guaranty fund under hM G.L.c. I�l2A.Other important information on the tllC Program can be found at www.ma_ s_�tw'�ct'Information on the Construction Supervisor License can be found at www' m It s 2, When substantial work is planned,provide the info In ction below: e, finished basetnent/attics,decks or porch) Total Boor area(sq. ft.) Habitable room count Gross living area(sq. R.) _,____-- ,lumber of bedrooms Number of fireplaces Number of half/baths Number of bathrooms Number of decks/porches�— rype of heating system — Enclosed —Open Type of cooling system 3 •`Total Project Square Footage"may be substituted for"'[Dial Project Cost" CITY OF Siu E�I, ti�.1SSACHUSETI S . + fIUIMNG DEPARTMENT 120 WASHLYGTON STREET,3" FLOOR THL (978) 745-9595 KI1tBERLEY DRISCOLL F.LX(978) 740-9846 NL.xyox Trfo.sw ST.PmRRja DIRECTOR OF PUBLIC PROPERTY/BUll_DD4G COS6nSSIONER Construction debris Disposal Arfidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section it 1.5 Debris, and the provisions of MG,L c 40, S 54; Building Permit k is issued with the condition that the debris resulting from this work shall be l 11, S I SOA. disposed of in a properly licensed waste disposal facility as defined by tMGL c The debris will be transported by: y �� envt�avke„k. r (name of hauler) The debris will be disposed of in --- - (name of facility) _---_---(address of facility) . I stgnatur of permit pplicant (late abomblank NATIO 25015enNAL HeADOUARTLRS . 9013. �w.n 1888 REMODEL p .R Senora Macke. 30-91447 NO.emller O7.2013 Buyer$Wonraft, CUSTOM REMODELING AND IMPROVEMENT AGREEMENT " HM 16m'6 Sandra Mackenzie Pmject Number.30.91447 30 Vaiart Way Rwembw 07,2013 Salem,MA,01970 (978)594ai45(Hyde) 0rre,ge�w Count':Essex Twrmhb� Buyer(s)fisted above hereby jointly and severally agrees to purchase the goods aMior services of Power Nome Remodeling Group(-Contractor-)In axordance with the Prices and terms described on the f:Pages of this agreement and any specification sheets which are Inc rated es rout and the following Pour "Agreement"):This Agreement represents$cash sale of goods and miees:Buyer(sorthe Agreement(collectively,this { and services purchasetl as described herein,regartless of timing or approval of myfinmldn Bes to uyer(s) the costee of thegdobe purchase..Pr_isms and Inglilfas regarding this Agreenent.shouid be directed to tBontracto at14 B.73��mar Purchase Pdre;- - 53,077A9 1 Pre Installation Inspection - Doan P art,. $1,53s.72 arvr ra a ffllle 11119 9p aw tPop�aaa Balance Due on $1,538.71 Estimated Project Start:6 to Tweaks I Substanital Canple0on: - Estimated Project Completion:t to 2 days MothodolPaycnent Check Odlrlt mpftwaae is nd otmeetsene. caktWta enerams.aced aeialwew�[Iai4MtlMYrl�4eab IamtrwnCwwbeann:aae. Poems)hereby aekrlovfedBas receipt of.a copy of the pamphlet,^The LeadSefe Certified Guide Renovate Right", 9 8uyer(s)of me Potential risk of leadharard exposure flan renovation activity to be Performed in Buyers home, at the a writen above..Buyer(e)receivedthls PampMet on the hate of this Agreement,before commencement of �wortt•. Buyer's inhitle). R is agreed$ d understood by and between the parties matthis Agreerent constitutes the entire understanding between the parties,and there are no verbal understandings changing or modifying any ofthe terms this Agreement Suyer(s) hereby acknowledges that Bayer(s)1)has read the entire Agreement and has received a completed,:signed,and dated copy •of this Agreement,including file two accompanying Nodes of Cancellation forts,on the dam first written above and.2)was orally informed of Warner right to cancel this transaction.DO NOT SIGN T ISAGREEMENTIF THERE ARE ANY BLANK SPACES. Future promotions nor applicable. . . t " I haw reed and received each page of t1is;5 page agreement. I war o e no Group; -K Buyer(/s) /11/07/13M.Q ' .tc: 7113" m efng Consultant. 'ignature Crystal Hodges Sandra Mackenzie YOU,THE SUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THEDATE OF THIS TRANSACTION.SEE THE NOTICE OF CANCELLATION FORM FOR AN E%PLANATION OF THIS RIGHT. November 07,@013 t 1:47 II(I RIII I IIII((��plll'�pl��IIII II11I uu II Pagel oi5 s The Commonwealth of Massachusetts Departure»t of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Instirance Affidavit: Builders/Contractors/Electricians/Plumbers _Annlicant Information n Please Print U tibly Name(Business/otganiridonandividuai): Pyw{{-- E Hour-: 1`E/1')CI)EC,I/+1,z�� l��'�-ty/ Address: 2SDi ICftPMi-1, Jl'ITE Elio {zHFSiE/Z �rl 19013 City/stateMP7 Phone#: C,lC -e?q—S-4,o ' Are rodsn employer?Check the appropriate box: Type of project(required): l. I am a employer with_�, 4. O 1 am a general contractor and 1 6. 0 New construction employees(frill andlor part-tune).' have hired the sub-contractors 2.0 1 am a sole proprietor or partner. listed on the attached sheeL t 7. Q Remodeling ship and have no employees These s i contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑ Building addition (No workers'comp.insurance 5. ❑ We we a corporation and its required.] officrn have exercised their 10.0 Electrical repairs or additives 3.0 1 am a homeowner doing all work right of exemption per MOL I I.©Plumbing repa'as or additions myself.[No wofkcrs'comp. e.152,§1(4),and we have no I2.[2 Roof repairs insurance required.)t employees.(No workers' UO Outer comp.insurance required.). - - 'Any applicant that checks bar 61 must also fill nor the section below showing theirvotkers compraadon policy laformaStw. _ t Hemeowoas who mbmh this affidavit indicating they are doing all wak and din hie outside co atacton mug submit a new dBdsvb indiudag mcb. . rCmtmemta that cluck this box omst saecivd an additional shoot showing the name of the subcvotraaas and their wodmW comp.policy mformatim. - I am an employer that is providing worfccrs'eonWitsatten brsuronee for sty employee.& Below it the poUcy and fob site � ins a" Ha R� s� I wE wo ec� SNS co/ r insurance Company Name• __... ooHey a or sett_i„s?Qric,'.e!. WC Q®�®�[3 89?R5 Expiration otmc, 101 .J /may ]oh Site Add. JCJ (/Crll G'a" VJLNI city/State/zip. Attach a copy of the workers'compensation paliey declaration page(showing the policy,number and expiration bate). Failure to secure coverage as required under Section 25A of MOL a 152 can lead to the imposition of criminal penalties of a fine up to S 1,5M.o0 and/or one ear imprisoomc tt,as well as civil penalties in the form of a STOP WORK ORDER and it fine of up to 5250.00 a Be advised that a copy of this statement may be forwarded to the Office of investigati ras o D far covmage verification. I do hereby c u' p and penaJtles of perjury that the tnformadom providedtc: /ab cis a and correct. SiJZDRhue. • • Phone kilo!use only. Donor write in this arra,to be completed by city or town off fclal City or Town: PermitfLicense tt _ - Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing inspector 6.Other Contact Person: Phone tt: c�C7►'1X/E12 WJndows&Sic/fng` �� VINYL DOUBLE HUNG WINDOW VINYL FRAME � DOUBLE GLAZED FOAM FILL - GRIDS LOW E/ARGON ddtlOndlfpnQStYdt10n NFRC CPO#, 000&00002 Ratingtouncila '" � • C R 100107.21.01 004883441001 KELLYMI 'III III ENERGY PERFORMANCE RATINGS f ADDITIONAL PERFORMANCE RATINGS 4 .47 61 Ali( .[i iC 1 C31FC5 JI GG P C -FG('9I ry 9Kd1 t ilC P C .(p CIG 9 SPG•(! r5 0li 1n CO �1 to TI N11V 11 Ufl NlC l VP+atni ) r tU Iraruh[4ef5t } e., In'r 'N1iY P'C0r Fr 1 to nr urfu I}:en ax�nh<Crg g at Y �'fir3pR uahr{4neennco'khe -�^ •' " . e,• d �. is'tandisd ltl n,; Serves :S1.2 00 6o"` t�;,,QQe�dnianee Meta '1' Natlonal.Fenecfn7(on RatlJtp Couh'Ql.' Type�V5DHnns s Wk'( ` a AR/c€uurga, `r CodeNB�,,K'y O.tt ,�`` 7nls'p u thas`Y, dJMta2ed nd gene ir$V21ti0 <rs cema R A(taflgOce wRh ` o5XXo to 51 er . + r eftona R J RRatlnp�'o3`'c T i '« Jsprodubas0e9Odphd �ar. Senes' aS'{ 00 *._ i #` ..,,aa�. 9 c6rbfed aNbt e dh k � ag 1 1v8t�7onaJFeR tre nJRd n1,CouR r x p(�yWn , x �J x sErio e .. :.Y a«NAaJ7onet, nes On �y+r} j d .021( it « IEi.•+p« •1i« ..� o .«� Yt.`lhlaptod iytytes e` d Seri6s"tV '•r 3 cc�l!H' Jn a wdh v.. ,` 2 "q `Case K '* tadonp+JFoieatra RegdOCnitltyl TY➢¢«P.FX +, e moa: x: i'+ « Y T!I}6[➢(OdfJa�haEbee'' led sra Se sl 1�5« T'BuA y �' r 'ts iertrdedd} ` § ce �. t �� ,J7atJoRprfenestrc. anop . x�sY e +P NI,� �'•. - 'rTiti;��' ? ;�(. kd� l,•r€.�'. �Co�e��NBp"` K� ,..'� � �; lug Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston Massachusetts 02116 Home Improvem pQQontractor Registration 7 Registration: 168616 n Type: Supplement Card - 1<I v W Expiration: 3/18/2015 POWER HOME REMODELING GROUPP3LLC W JUSTIN SMITH " 2501 SEAPORT DRIVE STE 13110` CHESTER, PA 19013 wj1 b ;. ;;Se Update Address and return card.Mark reason for change. SCA 1 0 2OM-05111 � Address ❑ Renewal [-] Employment E] Lost Card �e rpamvmoaxureceCC�a`'P/�aaeacluiaelta .. fRegistration: ee of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR. before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation ;`188616= Type: - 10 Park Plaza-Suite 5170 Expiration=.:37,18/S;I Supplement Card ,J Boston,MA 02116 ` POWER HOME REMODELING GROUP LLC. F'p :J JUSTIN SMITH 2501 SEAPORT DRIVE?SSE B1,10 --- CHESTER,PA 19013 Undersecretary Not valid without signature i Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supcn'isur License: CS-093980 6F I JUSTIN W SMF H {� ,r•� 58 WALLEN>WAYl ; NORTHBR[DGE MAi;0153 eys. - J�"' � tt•ts� Expiration Commissioner 01/05/2014