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284 WASHINGTON ST - BUILDING INSPECTION (4) D8CL tQ-114 The Commonwealth of Massachusetts Board of Building Regulations and Standards RECEIVED CITY OF Massachusetts State Building Code,780iq SE WCTIONA1 M' ICE%ALEM f Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolisli.4 One-or Two-Family Dwelling SEP 2 LA V' ,This Section 17br'Offici?]Use Only., IB4 ldig')?6mifi Leda 9; � Bui Q SECFTI6NJ"-8 INFORMATION 1.1 Property Address* 1.2 Assessors Map&Parcel Numbers 1.1als this an accepted street?yes V. �no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq?)- Frontage(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required .Provided Required Provided 1.6 Water Supply: (M.G.Lc.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone?Check if ycsO Municipal L3 On site disposal system 0 'rSECTJON 2.1 Owner'of Record:Ko,4V\-Prika StrttS SA te- 0.", )0 Narne(Print) City,State,ZIP Q aq V/gSk A+V.A 3 _ b 17- 6° b- No.and Street Telephone Email Address SECTION 3 F t,'jjjffiCoN�0PROPOSED QW(c]beck�a New Construction 0 Existing Building 0 Owner-Occupi:ed:❑��Rep:airs(s) Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.El Number of Units Other Q Specify: Brief Description of Proposed World: 4 c� j COSTS Estimated Costs: -i4-Official se Item V Only v'y (Labor and Materials) - . I gTenrit ce. w fie isAet&rmiredL]Standart 1.Building $ -d 2.Electrical $ E3-Total:Pr*ct Cos (Item 3.Plumbing $ ,2'.!OthbrF66/:I - 4.Mechanical (HVAQ $ 5.Mechanical (Fire Suppression) $ Total All Fees- Check No, 6.Total Project Cost: lq-paid ifiRill ❑Pu_ SECTION 5: CONSTRUCTION SEpRYICES 5.1 eunst�O�Q,(Supervisor 'ILicense za�t7�) License I� �qq � yl`O nse Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street "4 Type Description aQ \R S p)f��0 U Unrestricted(Buildingsu to 35000 cu.ft. � - "l R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Lfut" e�q - a�s9 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ra b 0�7 G Z- S-1 c HVM-e 'Ok Yn of HIC Registration Number Expiration Date `FIJ,COCgripany m Name or HIC Registrant ae 1 "B ccS 4y\ -J r n uO 're No.and ",r JSIDy� {9 0ISyS �'bcl `p ,� Email address City/Tow, State,ZIP Tel, hone SECTION 6.WORKERS, COMPENSATION INSURANCE AFF ADA T(}1I G L.c.'152.§ 25C(6)) ` 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 .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN " yG OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDIN PERMIT I,as Owner of the subject property,hereby authorize Ho m e- i,-\ -r t to act on my behalf,in all matters relative to work authorized by this building permit application. S-e.e &bg4-,rv,c t- 9 a s is Print Owner's Name(Electronic Signature) Date SECTION 76:OWNER'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 accurratte/to the best of my knowledge and understanding. N )O-,rIC 0 1 /"-- vvgw4 AVIA �t �j 2 z -�� Print Owner's or Authorized Agent's Name(Electro c Signature) U Date 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 a1+nv.ntass.eovIota Information on the Construction Supervisor License can be found at www.niass.gov/dps 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 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 Cost" I i � ztN.`„, /.4d `u(!tJJs2J1';J '2lUE'C; Z'u� dV�V l�f elf L d. dlY3dinaer �°r-ffairS and DL1S1C1t 5S Regulation 10 Park Plaza - Suite 5170 r Boston, Kassachusetts 02116 Hoine Improver-p i,, ontractor Registration Registration: 126893 Type: Supplement Gma Expiration: 8&2016 THD AT HOME SERVICES, !NC,, ,,,;;,,,;,,, , ;J,.,_: :;•, MARK NIADNA -----..____.___..__.__-_...__ _._ ._ . .. .... 2690 CUMBERLAND PARKWAY SUITL 36 ..:.. .. ...... ..... ATLANTA, GA 30339 " .'.'' ' ' .. Update Address and return card.Mark reason for change. i scn i e1 auM.asm Address ❑ Renewal (-] Employment Lost Card r-;�/rr 1}''rnrrrrorrrnrvr�/�r�%'.��rr.:;rrr�rar./Ll w Office of Consumer Affairs tlr Business Regulation License or registration valid for indlvidul use only ;i]Il before the expiration date. If found return to: •rcOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registratlgp::-126893 Type: IOPnYIc Plaza-Suite5170 P 8 h` Eu iratfon;;:; 1912t);1.6..; Supplement Card Boston,INdA02116 THD AT HOME :INC .. THE HOME DEPOT.AT,r',OM .SERVICES MARK NIAONA ' 2690 CUMBERLAND PARKWAYS A"ht5+1M,GA 30339 Underacrctnry _ — of Valid withou signature i - ai , Massachusetts-Department of public Safety Board of Building Regulations and Standards Construction Supervisor Specialh• License:CSSL� ,A IN 9 lot ROBERT POCZO" A1019 1 Sal ' Salemm MA 81970 Expiration ; - comnissiona Oy08/2018 ILI\ T The Commonwealth of Massachusetts Department of lndusftW Acciden& x Office ofinvestigadens t 6001Waskhrgton Street Boston,MA 02111 www-mass gov/dia Workers' Compensation Insurance Atli UAt: Bu11deritControctors/Electnclan0 lumbers_ Applicant Information Please Print Legibly Nat11e(Business/organization/Individual): Nome, be_,A.f' �'� TI&M e— �t'i/yl[.P�S Address; q09 605_4_�J City/State/Zip: Az6oAk VLt, v/SySr Phone #: SOS- Are you an employer?Check the appropriate box: Type or project(required): l 1. 1 am a employer with 4. Y I am a general contractor and I a employees(full and/or part-time).' have hired the sub-contractors 6 New construction 9. - - - Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition 4 working for me.re any capacity. workers'comp.insurance. 9. Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised then i 3.(] I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions k myself.[No workers'comp, c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees.[No workers' 13 Other comp.insurance required.] *An epWicant drat checks box#1 must dso fill out We sectimr below shnwiog taeir workers'wmpa,setinn poliryinformetion. i t homeowners who submit this affidavit indicating they arc doing all work and then hire oubide contractors must suMnn a new affidsvh indicating such, j tconbsctors that check this box must atlsched an additional sbod showing the omm of the sub canal tuts and their workers'comp polity ivibnaatioa. lam an employer that ds providing workers'compensaton insurance for my employees. Bedew Is the potley and job site Information- /� S Insurance Company Name: r/Q�1N J�/7 tr e. $ (io r� 2 2 1 Policy#or Self-ins.Lic.#: C i�/ / d J Expiration Date; 4 Job Site Address: y �i^4v,, S Y City/Statelzip: Sy,k-J13 M of Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date} Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a E fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the 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 statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. t - i /do hereby certify under tie pains and poraldra�ofperlmy that the inforne don provided above is one and comct i autre w C Date: Phone#: [ OfflcW use only. Do not write in 9kh area,to be eoarkied by city or town gBlciaL e City or Town: Permit/License# Issuing Authority(circle one): } 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:_ Phone#: 1 � ® — DATE IMMIDDRYW) 6 A��v CERTIFICATE}OF LIABILITY INSURANCE OAM42015 a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. . THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER....: IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(7es) 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 lieu of such endorsement(s). PRODUCER - CONTACT ---^ t ..�—,,...._..�__ ._�....... _ _MARSH-USA,INC..,' PHONE FAx f TWO ALLIANCE CENTER 3560 LENOX ROAD,SUITE 2400 - w10 No ATLANTA,GA 39326 - - ADDRESS: INSURERS EAF�FOROINGCOWMGE NAIL{100492-HomeD-GAW-15-16 INSURER A:Steadfast Insurance _ 26387INSURED INSURERB:ZurchAmelmnins 16535 THD AT-HOME SERVICES,INCDBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hampshre ins 23841269D CUMBERLAND PARKWAY,SUITE 30D Illinois National Insur 23817 .. ATLANTA,GA 30339 .. - ... -... _ _ .. INSURER E:- v INSURER F: COVERAGES CERTIFICATE NUMBER: - ATL�=42685-09 REVISION NUMBER:7. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD.. INDICATED:—NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT IMTH RESPECT TO WHICH THISTHS INSURANCE AFFORDED BY THE POLICIES DESCRIBE. MMNIS �u,jt�j IC-7TE IML CERTIFICATE MAY BE ISSUED OR MAY PERTAIN ` EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER (IMMI I 901101whyfnLIMITS A GENERALLABILITY ' - GLO48B7714-05 =120LM0301016EACH OCCURRENCE $X COMMERCIAL GENERAL LIABILITY PREMISES EaoreED $ 1,OOD,000 CLAIMS-MADE Fxl OCCUR LIMITS OF POLICY XS MEO UP(Anyonc'person) $ EXCLUDED OF SIR:SIM PER OCC PERSONAL b ADV INJURY $ 9,610g000GENERAL AGGREGATE $ 9,OOD,000GEN-L AGGREGATE LIMITAPPUES PER: PRODUCTS-COMP/OP AGG S S,DW.000X POLICY JPEC'TTLCC B AUTOMOBILE LIABILITY BAP 2938863-12 03/01201COMBINNEDtSINGLE LIMIT E a $ 1000000 I X ANYAUTO BODILY INJURY(Per person) $ I ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG AUTOS AUTOS BODILY INJURY(Per amiden0 $ HIRED AUTOS NON-0WNED PROPERTY DAMAGE # AUTOS Peraccfdenl $ $ F UMBRELLA LIAR OCCUR EACH OCCURRENCE $ i EXCESS LAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ - $ -- — -WORKERSCOMPENSATON —WC017731493-(AOSj 031012015 03I01r1016 11 1 WC STATU- OTH- AND EMPLOYERS'LABILITY I IT 1 000 C ANY PROPRIETOR/PARTNER/EXECUTNE YIN WC017731495(AK,KY,NH,NJ,VT) 03I012015 03N12016 EL EACH ACCIDENT $ D OFFICERAAEMBER EXCLUDED? r NIA WCA17731494 FL (Mandatory In NH) ( ) 03/012015 03 roui6 E.L.DISEASE-EA EMPLOYE $ 1.000,000 Ifyes,describe under Conflnued on Add4ional Pa e - i DESCRIPTION OF OPERATIONS below 9 E.L.DISEASE POLICY LIMIT $ 1,000,000 () S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ANach ACORD 101,Additional Remarks Scrseule,0 more space le Mulrsd) EVIDENCE OF INSURANCE ttt 9 d l ( CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE MALL BE DELIVERED IN 2455 PACER FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. t ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE W Marsh USA Inc. I Manashi Mukherjee �S.sLUJron: 3+�•aA- -nel.d-e,L i ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Ijo ooC n:move until final_code ins7e4CUli. 5s/e labial for iuttira rafefence. ' i lified or area Indicated. Canada � xnargyxtelfnrcw '� I a c.ea Y ri S�f'.0��.� �Ud�•. U.S.I CU. onelgystar.a.v _n .>; puetifieA/Admissible ............................................................... ae ;:•• A wlxoowx.oeaxa r�en rexeze e .i da?F:xsl si•� .n 4 AND-N-74 .Itslird2tzxx:rs 'Nood/Vinyl Composite IF Dual Argon Low-E4SmartSun P aductType: Double Hung ENERGY PERFORMANCE RATINGS U-Factor Solar Heat Gain Coefficient 0.29 1 .65 0 . 21 U.S.A-P Metrlc/SI ADDITIONAL PERFORMANCE RATINGS Visible Transmittance wPs - 0 .48 --- btanNacMrendpuld,e,Met M!,,rat.gj Con%nn W z 10wCan'.WRC prdttdun.5 ter d!t!rmnio-q Mpl!pmroa[[� - pertWmdnCl.IIFnC rdr�n^5 df!tl!1!rmin!tl rPl d I ,d$!,Men ,Mn,ntp S1ndtlon,and'a 1P!CxK W W'Jft In! mm . ,. dIFRL 00e5 no,recC !dMy MdVCt aM dies not 4dnan,Me Sult!tWlry el vy pledMt W My*PTCMC Me Coni4ll mJn'RJCNr!YS IRwJIW!to,9Mer pMMR,ell neance mlormaton, w NR.dry el ersen o fire on: Series oo e a ou a un. dnu r,war s cu.as a_1 wmalua n ,a :^rung s an s z Standard Rating - rldss R-Fi25.. . 0Al4\:D6,A'CSA 101a<ygaao-09 S.a Wstatl:ac.`•,7 qn: \ DP'-SFStiBPst A:N.%%%DrxaCSA IOTA.:2:+Ad4"5 LPH-R^_S Pst ' r r 10o-Do5�gb4 2-o2r' Fle!IiMCI!Ctl}FIE!�..:E':.$I ECC.iv In'70-DnreCluln:menli V+0F44 MdPi3in•'RNrleil9M1PlC9fJn'_ " 2015-08-24 05:36 EXPDTR 9787390618 >> Home Depot AHS P 2/8 - - - HOME IMPROVEMENT CONTRACT ,f PLEASE READ' HIS r Sold,Furnished and Installed by: Branch Name "W: IL North&Small Date: l THD At-Hvmc Services,Inc. Whiz, The Hunle Depot Al-Home Stuvices Branch Nmnber:31 and 33 9(IS&*ton Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free 877-903-3708 p al ID#75-26994(,0;Mh l.icoC WA39:RI Gmt.Ludt 16427 Cl'Lic#I IC 1 1 665 5 2 22:MA Home lmpruminuit Comnapnr Reg.#1269991 Installation Addreav: W P N i N k� �l'TL-�'•�` r V � [9-1 v C:i y Suite Lip Purchaser(s): _ Wurk Phun : Home Phone: Cjell Phmle� [ �C S/20 j S [�l�l cow S76 1 [ —i H,ane Atltlrecs•. C�A5 1&ire" 4 '�TAe-C n 1 Q? a (I F dillencnt from Installation Address) Ci y State Zip Email Address(to receive project communications and Home Dept up es): ❑1 DO NOT wish toreceive:my marketing snails from The Home rk PrcAect Information: Undersigne t("Cuatnmer').the owners of the Two xurLy located at the above installation address.agrees to buy, and THD Al.-Home Services,Inc. (`'The Home Depot")agrees to fumi'i,deliver and arrange for the i istallnhon("Installation")of Al materials described on (he below and on the referenced Spec Sheet('i, all of which are incorporated into this Contract by this reference,along with any applicable State Supp)cmcmt and Payment Sun maryallachod herein and soy Change Orders(collectively, "Contract"): Job#: Products: Spec Sbea n4$, Prrhject Amount j ❑ Siding nw.c Insulation ^� � J,❑Guanuttem/Corers ❑8n¢Y Duonv ❑ 2emlin sidin b ❑; g Windows Insulation I i $ FiGmmm/Covers ❑EnmyDwex ❑ Roofing Milding, ❑p/innnws Invuialiun $/Cnverx QFs¢y Lk URcam- nws❑ � I Rtxg L.I.Siding ❑Winnows Insulation I QGnmeni/Covers ❑11mry Oaxx ❑- Midnum115%lleyttilor lamhad Anount duenlHmcomdm rd M*nminwL Total Coati Amount Maim Putclmscls may out deposit mare thaueno-pdrd.Attu CrxmadAmunn U f ! CJ Cusum u,T agrees that, immediately upon completion of the work lie eat h Product,Customer will execute a Completion Certificate (title for each Rodnct as dclincil by an individual Spec Shur)and pay ny bnhrnm duc. As applicable,each Customer wider this Contract agrees,to be juror y and w,crally oblijemed and liable hereunder. The Home IAyxa rust-rvcK the right to isstee a Change Order•or terminate his Contract orally individual P..ducts)included he, ;it its discretion,ifThc Hoot Depot or itu;ik,rh,mizzd.%aviceproviderdetm uncm than it Cannot perform m%ubligutums due to a stmcmrral problem with the home,environmental harardi such m mold,asbestos cBeau(paint,other safety conurns,)Hieing a'rors or becauu work required to complen,the job was act included in the e77Contract. Payment Summary:- The Payment Summary # �� 9.0,71 _, included as pact of this C'emuact, sets forth the brad Contract amount anti p yrni required for the ticros a and final payme .>by Product(as apphnblc). NOTICE TO CUS MER Yo arc endtled w a completely filled-in copy of the Contract at the m si yrgn u Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defint,I by individual Spice Sheets)before work on dud product is complete.. fitthe event of termination of this Contract,Cmi mer agrees to pal The lloaue Depot the teat,of materials,labor,expense, and services provided by The Homc Depot or Authorized Service i rnvider Borough the dale of torinj nation,pit*pay other amounts set forth in this Agreement or allowed Wider applicable Ir . THE HOME DF.POI MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPU I FROM THE DEPOSIT' PAY 4ENT OR OTHER PAYMENTS MADE, WITHOUT LI]MITINGTHE HOME DEPOT'S DITHER REMEDIES FOR REC. VERY OF SUCH AMOUNTS. Acccnhmee and Authnrizadon: QhSIOLaCr age ,and undersm,&Hu.this Agreement Fs the entire agreement bilmecn Customer' and The Hume Uepew with regrurt to the Prtxluclus and histallatiom serene and supersedm all prior discussions and agreements,either twat or written,relating ur said Products and Insiallaliwr'1'his Agerme u-mnta tat assigned w amcvhdevl eaerpt by a writing sikmtal by Customer and The Home lhput.Customer acknowledges and agrees that CuxWmcr has read,undexstundv,voluntarily accepts the r`(((um5/ittff anA has nce've a Copy tit this AUrtvnheni. pCe�lCll Cbm d ;CnStnitler)$Ibmlialc Dale 5ulnall's(wirnm7 later Date^�� X __ ITcle:p me Ns,.�.i`-D ��._q'1•y.' .— Customer Sigparme Date j Sales sulmnt License No. CANCELLATION: CUSTOMER MAY CANCEL THIS („HpplinlNe) AGRERMEN'i WITHOUT PENALTY OR OBLIGATION BY DELIVEAIN(: WRITTEN NOTICE:"1'0 THE HOME: DEPOT BY MIDNIGHT ON THE THIRD NOISINESS DAY AFTER SIGNING THIS AGREEMENT. THE � STATE SUPPLEMENT ATTACHED 11ERFTO CONTAINS A FORM Ttl USE IF ONE. IS j SPECIFICALLY PRESCRIBED BY LAW IN CUSTOM LR'S STATT. NOTK*X:Am)]17ONAL TERMS AND CONDITIONS AR a SI'A EA)ON HE REVEKSESIDE AND ARP.PART OP TIBS CONTRAC I' 0e44.15 White Branch File Vnll Customer