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8 VICTORY RD - BUILDING INSPECTION 13 55 C-1< 19 51 cP The Commonwealth of Massachusetts 5 '- Board of Building Regulations and Standards CITY OF Vq\ Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Q Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling 60 1 " This Section For Official Use Only Building Permit Number: Date Applie . Building Official(Print Name) - Signature _ - 4004__ I SECTION 1:SITE INFORMATION t(� 1.1 ro rty A dr s: 1.2 Assessors Map&Parcel Numbers ! — 1.1 a s an accepted street?yes_ no Map Number Parcel 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? Check if yes❑ Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownkz�of R ecoytj: n Name(Print) City,State,ZIPr; °, - c�- No.and Street Teleph ne Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check al that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) 21 Alterations) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number Units Ot er ❑ Specify: Brief Description of Proposed Work'': ® rKc 7 SECTION 4:ESTIMATED CONSTRUCTION COSTS' Item Estimated Costs: (Labor and Materials) Official Use Only 1. Building $ 1. Building Permit Fee:$ ,-r-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 (HVAC) $ List: 5.Mechanical (Fire $ Su ression Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due: Illyg rA Att_� - SECTION s: CONSTRUCTION SERVICES. 5,1 Llcensed_ConstrucHon Sunetgisor(C$L) ____ '"n I ` � Li�e�a umber Ex - on Date Name ofCSL 1_d r l �1 Lt fie 1 I ist CSL Twe(see below)__ UK __ T e - Description U Unrestricted(u to AUU11 Ca.Ft.) Sl_ afore - R nesuicred 1&2 Famyy Dwellin M Maso Onl _Telephone l RC Residential RooSng Coveting WS Residential Window and Sidin SF Residential Solid Fuel Bumfn A fiance Installation 5.2 Reglgtel'fl - On1e IInDPOY en¢ D Residential Demolition _____----_-..... --uuteactor(I�I� R_eetsttatlon/--- --- - - an / Siepan re - Emiratiotlipat Telephone E,r,a>>.aaaress SECTION 6:WORKERS+COMPENSATION INSURANCE AFFIDAVIT.(M.G,L.c.152.§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this applicatio this affidavit will result in the decrial of the Issuanceeafthe building permit. n. Failure to provide Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZe?TION TO BE COM£LETEID YgEN O6VPIElt'$.AGEIVI OR CONTRACTORAPPI S FOIt.BUII DIl+IG PERMIT - 1, " � 2t as Owner of the subject roe hereby authorize __ _ j property rty y relative to work authorized by this cunning g permit application. to act on my behalf;in all matters $imatuce of Owne[, Date. SECTION 7b,OWIlERt OR AU IHORIZED.AGENT DECLARATION _ -- --- - as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. PA Si®azure,_f Owner or.Authorized_Aegnt, (Signed under the pains and penalties orperjtuy Date L An Owner who obtains a buildingCOTES: 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1 I O.R6 and 110.R5,respectively. 2. When substantial work is planned provide the information below. Total floors area(Sq.Ft) (including garage,finished basementlattics,decks or porch) Gross living area(Sq.Ft.) Number of fireplaces Habitable room count Number of batbmoms Number of bedrooms Type of heating system Number of half/baths Type of cooling system Number of decks/porches Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" CITY OF S.UE.\I, NWSACHUSETTS BUILDLNG DEPARTMENT • 130 WASI—INGTON STREET, 3i0 FLOOR `bf TEL (978) 745-9595 FAx(978) 740-9846 KIxtBBRLEY DRISCOLL MAYOR Tmws ST.Pmm DIRECTOR OF PUBLIC PROPERTY/BU MDNG COXINUSSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work In accordance with th e sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # 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 MGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in name facility) (address of facility) signature of permit applicant l� date � nd,v�r.dx i) 5 R CSSL-099M ROBERTPOCZOBUT 172 WHALERS LANE SALEM MA 01970 02/08/2018 �yl r-f J 1/. a 3 it / ]In�•r JJ. � :tf"sf3 _-/Zia: you an employer? Check thz aporouria:P ogx; Tyke of prolact(rzquird): 1. a 13m a general contractor and I d, �Tew.constIicton I a n a employer wida have hired the sub-contractor /, ❑Remodeling employees (full and(orpwr-rime)• listed on the attached sweet. t I am a sale nroorietor or parcel- Tjese sub-contractor ha're 8. ] Demolition shim and have no zmplOyees worker' g, Building addition ork ' comp.insurance. working for me in any capacitf. t 0❑Electrical repairs ar additions S. ❑ Wa are a corporation and its (?To works rs' comp. insurance - a>: I Oiilcers ha`/e e:UC.is2d their 11.1 p nmDing zeGau.,a 3..-tauw as _ re?l rzd.l right of exemption per NIOL ": , J I am a homeowner doing all wor.: a o --pairs c. 152, §1(.), and we have no 1_❑Rao"- p nagselr. [ To worker' comp. - sTo wor-'rers' vireo temployees. � 3. Oriet nsurance req' Como.insurance rz4uirzd.] �aoolicant that=flecks Sot i must also till our:he section hhelow ahowilg their worked compensation smile/inierrnation. a3cto hat check hiit hi-s Soz must attacned3m addeionaI ihuy aretiiiggt showing he arse of ineo u!o onlractor and heir wnr'.<re comma policy ins o'tmation s ,,t ,:,t,'� w•:rays' om rss(io,a as ranee for my ampi y:zs. sfaw is!.ae po;i,y z^dsob ;[e --� r stance Corrpaay I-lamz: „��T� - 1 icy# or Seli ins. Lic-d: Cif Ih Exp radon Date: ? / Site Add ress: City/State/Zip: ach a copy of the workers' compensation p icy declaration page (showing the policy ner umber and expiration datz . of ad to sition of sTiminal penalties Ofa lure to secure 500 00 and/or one4year mpruired und isonment,la well as iv l penalties in the forme of aoSTOP WORK ORDc-)f a fine ; upto $ rp to $236.00 a day against f`se violator. Be advised hat acop;/o d'lis statement may be for/arded to the Office o — estigations of the DIA for insurance coverage verification. P p fP � o hereby cer i nd r fhb wins and enofties o er1a first the injorrnatfan provided above ts true and correct. I . Date nature: � 2 sne #: / s area, to be completed by city or town official. Offciaf use only. Do not write in. thi PzrmitlLicensz# City o'r To'wri: (suing Authority (circle one): 1. Board of Health 2.building Department 3. CitylTown Clerk 4.Electrical Inspzctor 5.Plumbing nspettor i. Other Phone tl: -or,tact Person: J SEA L l� Pats BN D�,lza - 'J-coc LON'c: �lr,'HXRD p'o kr- C't �Alll 3o3Tj Ikd iorftu,daaL ru Ucen3e Ic 4 If foqnd r-- and ?JCLL P ON,= Baitott HOM- FriE HOME 'lilt of 13ad With "ACHAA0 -A r DAM(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 032015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ND OR BELOW. TTHIS CERTIFICATE FOICATEFIRMATIVELYOF NSURANCOE DOES NIOTLCONSTTDTEXAECONTRACTTBETW EN ER THE COVERAGE THE ISSUING FNS RER(S)ORDED BY TAUTHORIZHE IED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the palicy(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 Ile,of such endorsement(s). CONTACT PRODUCER NAME: FAX MARSH(USA,INC. PHONE ! pIC No PNO ALLIANCE CENTER. EMAIL 3560 LENOX,ROAD,SUITE 2400 ADDRESS: ATLANIA,GA 30325 INSURE S AFFORDING COVERAGE NAICp Steadfast Insurance Company 6 387 100492-Home0.GA'N'-15-17 INSURER A: 11fi535535 INSURER B:Zurich AR1911Can Insurance Co INSURED 23641 THD AT-HOME SERVICES,INC. INSURER C.New Hampshire Ins CO OBA THE HOME DEPOT AT-HOME SERVICES .Illinois National Insurance Company 23817 2690 CUMBERIAND PARK`NA'f,SUITE 300 INSURER D. ATLANTA,GA 30339 INSURER e: INSURER F: CERTIFICATE NUMBER: ATL.003746646-14 REVISION NUMBER:3 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HA VE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PH THIS ER( OD CERTIFICATE MANOTWITHSTANDING BE SISSUED OR MAY PERTAIN, THETNSURANCE AFFORDED BY THE POERM OR CONDITION OF ANY LICIES D SCRIBED HEREEN S SUBJECT TO ALL CERTIFICATETHEICTERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCEDUCF Y PAID Po POLICY CLAIMS. OMITS INSR ADOL SUBR POLICY NUMBER MMIDDAYYY - MMIDDIYYYY LTR TYPE OF a 9,000,000 GLO4887714-06 0310112016 '0310112017 EACH OCCURRENCE A X COMMERCIAL GENERAL LVIBILITY I OAMAG TOR NTED S 1,OW,900 1 PREMI E ac nonce CLAIMS-MADE OCCUR EXCLUDED I LIMITS OF POLICY XS I MED EXP(Any sne peewm 1OF SIR:SIM PER CCC I PERSONAL SADV INJURY 9,000,000 3,000,000 I I GENERALAGGREGATE EN'L AGGREGATE 9000 WO G ,IMITAPPLIES PER: I PRODUCTS AGG i IX PRO POLICY❑ JECT LOC 'r—II i j OTHER: (BAP 2938663-13 I03,01,2016 0361,2017 E-1 "EO SINGLE LIMIT 1,000A00 B AUTOMOBILE LIABILITY )DI ant BOOIC(INJURY;Psr Person; 3 X 1 ANY AUTO I BODILY INJURY(Per acc,d.t)1 i —'1 ALL OWNED AUTOS E0 I I SELF INSURED AUTO PHY DMG I I PROPERTY DAMAGE _ 5 AUTOS -- --- '- AUTOS —J, NONOWtIE ! ' I i � 'P r sccident. "�_ i-'-" 'HIRED.AUTOS--I - - AUTOS S UMBRELLA LIA13 i EACH OCCURRENCE 3 ��OCCUR I AGGREGATE S EXCESS ILIA B CLAIMS-MADE DIED RETENTION i 0310112016 '0310112017 X PTRT ETRH C WORKERS COMPENSATION WC015519215(ADS) AND EMPLDYERS'uaeluTY yIN I 0310112016 I0310112017 1,WO,WO C ANY PROPRIYERS' ARTNERIEXECUTIVE ❑ WC015519217(AK,KY,NH,NJ,lT) E.L.EACH ACCIDENT S 1,000,W0 N NIA WC015519216(FL) 03101/2016 0310112017 E.L.DISEASE-EA EMPLOYE S D (M ndA ary In NH)BER EXCLUDED? 1,000.000 If yes,deschbe under IConitnued on Additional Page E.I..DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS eelow DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES IACORO 101,Additional Remsdis Schedule,may be attached If more space Is requlredl EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THDAT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DBA DBA PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. 2455 ATLANTA,GA 30339 - AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manasht Mukherjee ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/Ot�_ —_The ACORD name and logo are registered marks of ACORD L "Job Contacts � • V"iil\ Saturday,November 05,2016 Comments Lead: 9673468 .GO Advanced Search 10:45 AM i r—In f 0'/Up—date's—I Homeowner Information '- Job Information -- Commissions Homeowner M/M Thomas Cunningham Sale Amount $4,948.00 Balance Due: $3,711.00 Homeowner2 Product 6500/6100 Series Windows(8%) Costs Job Site Address 6 Victory Road Status Sale/Material Ordered Documents SALEM,MA 01970} Branch Boston North - - Measure# 79264091 Schad Measure County ESSEX - - Silos Homeowner Billing Address 6 Victory Rd,Salem, MA 01970 Commission Rate SALEM, MA 01970 Consultant Name Term Date Spllt Como Plan Job Issues JAMES M CORLISS 100.00%Straight_Commission Labor Update Primary Phone (978)857-7102 " Work Phone _ _ Ext. B-Back: No Cross Ref# 1-9090381792 Siebel Ord... 351196 Order Detail Cell Phone -Key Dates .7 . Order Entry Work Phone 2 _ Sale Date 10/29/2016 FUP Date Cell Phone 2 Credit Date 10/29/2016 FPD-Customer Payments Email tacspd48@gmail.com RTP Date 10/31/2016 Post Install Date Permits Cross Street Start Date 11/25/2016 FPD-Home Depot - Marketing, _ Inspection PO Referral Store 2686-SALEM,MA - 7 Job Indicators Result Combo Base Store 2686-SALEM,MA Lead Paint:Assumed-LSWP Requir Services Lead Source 0390 HD.com Services Web Page, Show Mao TouchPoints User. ....... .. DateStatus' A. Time ` :y *a rs ,! Corr. 'Appt.Date Appt.Time. Consultant 1 _ Update Job . Ashley S Asigbey 11/3/2016 5:02 PM Material Ordered No 10/29/2016 3:30 PM JAMES M CORLISS Work Orders MARTIN PARKER 11/2/2016 11:24 AM Order Received-PSG No 10/29/2016 3:30 PM JAMES M CORLISS MARTIN PARKER 11/2/2016 11:24 AM Measure Complete No 10/29/2016 3.30 PM JAMES M CORLISS Cythina Raglin 10/31/2016 11:12 AM Released to Production No 10/29/2016 3:30 PM JAMES M CORLISS Cythina Raglin 10/31/2016 11:09 AM Order Entry No 10/29/2016 3:30 PM JAMES M CORLISS JAMES M CORLIS 10/29/2016 3:50 PM Credit Pending No 10/29/2016 3.30 PM JAMES M CORLISS JAMES M CORLIS 10/29/2016 3:50 PM Sale Pending No 10/29/2016 3:30 PM JAMES M CORLISS Dayend Dayend 10/28/2016 9:09 PM Sent to the Field No 10/29/2016 3:30 PM JAMES M CORLISS CHESTER AARON 10/28/2016 6:40 PM Confirmed-Customer No 10/29/2016 3:30 PM JAMES M CORLISS Internet Lead 10/28/2016 2:09 PM Pre-Book No 10/29/2016 3:30 PM JAMES M CORLISS Internet Lead 10/28/2016 2:09 PM Lead Entered No I "Close. Print k...,. Home Depot Contractor License Numbers: MA Home Improvement Contractor Reg. # 126893 Salesperson Name and Registration Number: JAMES M CORLISS : Home Improvement Agreement THD AT- HOME SERVICES, INC ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: Thomas Cunningham Boston North 9673468 First Name Last Name Branch Name Lead# 6 Victory Road SALEM MA 01970 Customer Address Ciry State Zip (978) 857-7102 Home Phon Work Phone Cell Phone# ! tacspd54@gmail.com Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address Ciry State Zip or Email CustomerCancellationNorthEast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowle g 11 by: 10/29/2016 X Date Cuetbmer's Signature 1 Distribution: White- Home Depot Yellow- Customer Copy WINDOW SPECIFICATION SHEET - Spec.Sheet#: 9673468 Sheet: 1 of 1 Customer: Thomas Cunningham Job#: 9673468 Consultant: JAMES M CORLISS Dale: 10/29/2016 New Window Hinge Locations Existing Window Measurements Grids Product Options Labor Options Fromcutside, Left to Right Bays,Bowls Location Color Rough Opening #of bars #of bars Csmnts,l Rol, use L,R or S Glass Misc Items Hardware Code Screens For dome use _ •g _ Mull ^S"=stationary or tt o - c u cp S E g N c `� -V operating E Style Wraps y m �' °' (i0 _ o c I r w In ryS E Room Floor Code (YIN) Style Code Series Code _ w 3 i ran L' o- > J STD, GlassPa 6500- B.WRAP, 1 LIV tsl BY-H Y BY 6500 O WH 101.00 60.00 161 Energy Srar-Nii ROOF,-SR SPECIAL CONSIDERATIONS. rap Color WHITE MISC1:MIL oterior Casing Type Colonial Bay or Bow window'. eetboard material(vinyl only-Birch or Oak) Oak Bay Project Angle(30 or 45) 3000 Bay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) 80 f tied to soffit,color of soft matelot WHITE have reviewed and agree with all the job specifications above and the ' Special Terms and Conditions on the following page onsbuct Roof(Yes or NO) Yes Garden Window: eatboaN Material(vinyl only-White Pionite,Birch or Oak) Customer Signature Wall Thickness(inches) Additional Shelf(Yes or No) 'There Is no guarantee that new shingles will match existing color.