18 WALTER ST - BUILDING INSPECTION (2) V r �
The Commonwealth ofMassachl t6CTiQNaL Sti2`d1C S
Board of Building Regulations and Standards CITY OF
WMassachusetts State Building Code, 780 CM SALEM
` 2015 StP I l A la- 3 2Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One- or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date plied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address• 1.2 Assessors Map& Parcel Numbers
18 L��kc S}
l.l a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) 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? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
\Ce'A kthG q\e m,ANC O1G1c�
Name(Print) City,State,ZIP
l g 'wA\ r Sk f�f� Sys S19q
No.and Street Telephone Email Address
SECTION 3:DESCRIPT ON OF PROPOSED WORW(check that apply)
New Construction❑ Existing Building Owner-Occupied Repairs(s) erl Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work 2, 1w� GZri> 'CP� t*w- `lla`thR
t
arc�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1 N 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 (HVAC) '$ List:
5.Mechanical (Fire $ Total All Fees:$
Su ression
I Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
ANT TT3 CL Z3
SECTI@]v s: CONST'RIICTION 5ER\r10ES
5.1 Construction Supervisor License(CSL) (` .. CIS—,
({Ll�s (-j/� C�
License Nwnber Expiration Dai<
Name of CSL Holder -
Q' List CSL T�q)e(see Uelow)
No.are Street type Description -
��t U Lnrestricied(Buildings u io 35.Oo0 cu.fiJ
R Restricted 7S2 Family Dwellin
City/7own. State,ZIP �
M Masonr} I
RC -RO—Ofing Covering
WS Window and Sidin
SF Solid Fuel Buming Appliances
1 Insulation
Telephone Email address D Demolitimo
5.2 Registered Home Improvement Contractor(HIC) '(l b �
^ \ n 0 h ! / 0
��'jJJ e'C ��C�YYI-N � YYt C5 C e,iY1Cis �}•`C'O U
III Cm any Name or MC Registrant Tame ` A1C Registration Number Expiration Date
o
�Sc}� Sec :I( Qc", mac.
To.and Streei Email address
City/Town.State,ZIP Telephone
SEL I IO1N.b:Wt3RKERS'CQMPf PiS)lTiON�IYSUliANCE AFI3Da13T
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the 1<_suan of the building permit.
Signed Affidavit Attached? Yes .......... No............❑
SECSIQN!a-. NERAUTHORIZtlTJOIVTO.BECOMPl7 TED'W€3Eh .
OWNER'S AGENT OR CONTRACTQR A3�LIES�'FnOR'$i3 I DING,TERMIT
1,as Owner of the subject property,hereby authorize MC5�66
to act on my behalf,in all matters relative to work authorized by this building permit application.
�� /f
Print Owners Name(Electronic Signature) _ - Date
IO b:=OWNERt t)R A'll'1'1'i@RIZED�iCENT�EC:Lr1RA'3'�ON
By entering my nVn
I h eby attest under the pains and penalties of perjury that all of the information
contained in this is a and accurate to the best of my-knowledge and understandin�g.�
Y IRIS
Print Owner's or Author e e(Electronic Signature) - Date
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 H1.0 Program can be found at
www.ntass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.8.) (including garage,finished basementfattics,decks or porch)
Gross living area(sq.ft.) Habitable room count _
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks!porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cosy' �
Project 3 1-67011-- Signed Sales Agreement — https://nitro.powerhrg.com/project_doctunents/6186404?pages=l
Pm7 t31-6J011-Sign Gales Agreement 5ZJPEG(1.59MB,244Rs3264) De ice:iPatl5,4
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NATIONAL HEADQUARTERS Ken Ond PST WM
250,5 ap Om clr mm,M 19013,y. POWER AUgus131.2015 .
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CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
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1 of 1 9/16/2015 8:49 AM
NATIONAL HEADOUARTERS Ken and Pat King
2501 Seaport Drive,Chester, PA 19013, POWER` 31-67011 -
August 31,2015
888-REMODEL
MA HIC#168616
PRODUCT SPECIFICATIONS
Buyer(s)'Information and Description of the Property: Project Number: 31-67011 August 31,2015
Ken King DaleoiAgreem nl
Pat King (617)548-5199(Ken's Cell) kingcatken@comcast.net
18 Walter St (978)745-3137(Home) E-Mad address t
Salem,MA,01970 -
County:Essex
Township:
Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services listed on the accompanying specification
sheets, in accordance with the prices and terms described in the Custom Remodeling and Improvement and the Product Specifications
(collectively,this"Agreement").
Pre Installation Inspection Date:Your pre installation inspection is tentatively scheduled for Tue 9/15 between 11:30a and 12:30p.
Roofing-GAF Inclusions: Includes Timberline Ultra HD Lifetime shingles with 50 year non prorated labor warranty.Also includes removal
of existing shingles, installation of F-Style drip edge,Weather Watch ice and water shield, Deck Armor breathable roof deck protection, Pro
Start starter strip, Snow Country ridge vent exhaust,Timbertex premium ridge cap shingles, PowerVent intake ventilation,all flashing where
needed and 6 nails per full shingle.All steep slope installation applications used only where applicable, Low slope roofs,ones below a 2/12
pitch and flat roofs do not apply. Clean up and haul away all job related debris.
'Low slope roofing installations include a 15 year non prorated labor and material warranty, removal of all existing roofing materials, new
decking,TriBuilt base and cap sheet,drip edge and flashing where applicable.
To protect our clients,Power HRG includes at no additional cost,the removal and replacement of up to 300 square feet of soft or rotted roof
decking if needed. Low slope roofs below a 2/12 pitch and roofs with cedar shingle removal do not apply as they will include all new decking
as part of the installation.Any additional wood replacement needed, over and above the 300sq/ft we provide,will be done at a cost to the
homeowner of$3.57 per sq/ft.(Buyer initials )
For Example:After the shingles have been removed, if we find there is a need to replace 325 sq/ft of wood, Power HRG will pay for the first
300sq/ft. It is the responsibility of the homeowner to pay for the cost of 25sq/ft of replacement wood at$3.57 per sq/ft,which in this example
is$89.25
It is agreed and understood by and between the parties that the Product Specifications,along with the Custom Remodeling and
Improvement Agreement, constitutes the entire understanding between the parties,and replace any and all prior negotiations,
representations,or agreements,either written or oral. The Product Specifications may not be changed, modified,or varied in any way unless
such changes are in writing and signed by both Buyer(s)and Contractor. Buyer(s)hereby acknowledge that Buyer(s)has read the Product
Specifications.
I have read and received each page of this 2 page agreement.
Power Home Remodeling Group Buyer(s) Buyer(s)
/08/31/15 /08/31/15 /08/31/15
Signature of Remodeling Consultant Signature Signature
Daniel Martini Ken King Pat King
YOU,THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD.BUSINESS DAY
AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF
THIS RIGHT.
August 31, 2015 20:25 IIIIIIII II III IIIIII I IIIIIIIII IIIIIIIIIII
Page 1 of 2
• NATIONAL HEADQUARTERS : Ken and Pat King
2501 Seaport Drive,Chester, RA 19013 �,,. ,. _ OWER 31-67011
August 31,2015
888-REMODEL
use s ee eee
MA HIC#166616
Project Specifications
Roofing: Whole House 1 1900.0'x1.0'
ROOFING: Models GAF Styles Architectural Shingles Types None Configs None
OPTIONS: Color Slate I Removal Standard Shingle I Installation Details None
OAFMAYERCORPORATION
slate# 4� b •
G, O
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Aerial Measurement
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August 31, 2015 20:25
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII III
Page 2 of 2
MARK E MORS?S1E'S
SS NEWELS:DR= _
N ATTLEBORO NIA0911812015
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. ��'�[-o>u.sn✓nru f�� .,ccr�zuwl„� '
fiice of Consumer Affairs&Business Regni28on
OME IMPROVEMENT CONTRACTOR
Regisiraiione'.::iSEE9£,. Typ._
Expiraimi3. 115320917 Supplemeni -
POWER HOME RE%jOj)€IInTC CROUP LLC.
MARK MORDINI
2501 SEAPORT DRIVE STE B910 -46 ��.__
CHESTER,PA 19013 '
- Undersecretary
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6.Q Wf are a cozpomtion ana iL o8'icxts havE exerfised clan rig]GL of ex 1L.�fltbt7
i52 Fi(5),end we have no 7 _ amp Uired h9CxY_c'
�P g [No v+or3cas'camp.;++a,.R., F reguved.j .
*Any applicant Vial ebmlcs box t+l mnft also tip out the s fim below showing then wozkers'campensatmn policy-fbnnwt Elomeow -wbo snbmil this affidavit mdic�ng they ate doing all work and thcil wo
1Contractozs that check this box must attached ea additiomt shxt sh otttside comtnctoo`mn.z submit nnev✓affidavit indimtiug such.
enzployces. Itibe sub-conhactozs bove employees,they must prmldeowthees�wwkvn'come Sots and caste whetbea m ns>IthoSe amities have
➢ policy mmmber. -
i am an employer that is proyidutg workers eompemafion imuranee for my employees. MOW is the policy and job site
information.
InStlrance Company Name:_F§/ZL€{t `9It L$ Out C O r ILVrt/2 Aactr y
Policy#or Self-ins.Lie.#: ?V I q f)®. { 2fi `�
Expiration Date:_
Sob Site Address: 0 y/S{ e/Z \�y`' nnA
Attach a copy of the wor3cels' compenSation pokey derlaradDa page(showing the policy nnluber and/expiration date).
Failure to secure coverage as required under MGL c- I52, k25A is a criminal violation puuis3able by a fine up to S 1,5DD.OD
and/or on�year imprisonment,PS weIl as civil penalties in the form of a STOP WORK ORDER and a fine of up to S25D.00 a day against the violator.A copy of ibis statement may be forwarded to the Office of InvestigntionS of the DIA far insurance coverage v
I do hereby doe pains and penalties ofperjury dau the information provided above is true and correct
S
phone#: 5tf g ZBd-6►i�
Ojftcial use only. Do rwt"rife Far this arm ro be completed by txty or towm ofjieiaL -
City or Town: Permit/Lieense#
Yssuing Authority(circle one):
1.Roard of 13ealth 2.wilding Department 3,City(Ibwn Clerk 4.Fh,rtrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone€r::
I
Gmail- Department of Public Safety Authorized Payment Confirmation https://mail.google.com/mail/u/0/?ui=2&ik=f845f768ee&view�pt&s...
w
ti ' TM Mark Mordini <markmordini66@gmail.com>
trrGoa3le-
Department of Public Safety Authorized Payment Confirmation
1 message
ConveniencePa ClientSu ort h com <ConveniencePa ClientSu Tue, Sep 1, 2015 at
Y PP @ P• Y PPort@hp.com>
7:31 AM
Reply-To: ConveniencePayClientSupport@hp.com
To: markmordini66@gmail.com
This is an electronically generated acknowledgement of your payment to Department of Public Safety
Payment. Please print this message or save it on your computer for future reference.
Here is your payment information:
License Number: CS-057645
Payment Date/Time: 9/1/2015 7:15:12 AM (ET)
Payment Amount: $100.00
Convenience Fee Amount: $2.49
Method of Payment: Visa
Card Number: ****8788
Confirmation Number: 053976
I of 1 9/17/2015 6:44 AM