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31 WILLIAMS ST - BUILDING INSPECTION (2) z4S© $ZS The Commonwealth of Massachusetts RECEI' ED Board of Building Regulations and Standards �NSPECRECEI SE Massachusetts State Building Code, 780 CMR Revised Mar 2011 ( Application To Construct Repair, Renovate Or o �J Building Permitp >��� �C'�ia 1 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date pplied: 4v J ,41 V Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address• 1.2 Assessors Map&Parcel Numbers L la 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 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? Municipal❑ On site disposal system ❑ Check if yes[] SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner' f�tecord• .� � /Cosmos �i1z1 AA& 019-7a Nye(Print) City,State,ZIP 3/ C J�2_ -71J7 ' No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units 2 1 Other ❑ Specify: Brief Description of Proposed Work': PTA,/,g A&d Ae�_UO� / UJZ &Vr✓ '70 T� / LOA— D&I'y 'Cr�cfr7lr c., Co 6f-f d� /L'G C- c✓/Irr n.- Lsl�nfL1 / SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ S� 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ s ❑Total Project Cos[ (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ �/ �� 4.Mechanical (HVAC) $ List: C; 5.Mechanical (Fire $ Su ression Total All Fees: $ / Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 3L/SJ I ❑Paid in Full ❑ Outstanding Balance Due: f11Tk }L.crTJ �d' � � ?,7 W SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CST,Type(see below) i No.and Street Type Description U Unrestricted(B 'din s up to 35,000 cu.ft.) R Restricted 1& Family Dwelling City/Town,State,Z M Mason RC Roofing(Acting WS Windo and Siding SF Solid net Burning Appliances I lnsu) tion Telephone Email address D Deinolition 5.2 Registered Home Impr vement Contractor(HIC) H Registration Number Expiration Dale HIC Company Name or HIC Registr. t Name No.and Street Email address City/Town, State,ZIP Telephone SECTION 6:WORKERS'CO ENSATION INSURANgi AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit ust be completed an submitted with this application. Failure to provide this affidavit will result in the denial of the Is ance of the buildi g permit. Signed Affidavit Attached? Yes .......... ❑ No.... ......❑ SECTION 7a: OWNER AU ORIZA ION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTPACTQR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work auth r ed by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER")I,-.AUTHORI D AGENT DECLARATION By entering my name below,I hereby attest u er the pains and penal 'es of perjury that all of the information contained in this application is true and accur to to the best of my know dge and understanding. Print Owner's or Authorized Agent's Name( ectronic Signature) Date NOTES: 1. An Owner who obtains a buildin ermit to do his/her own work,or an ow er who hires an unregistered contractor (not registered in the Home Impr vement Contractor(HIC)Program),will t have access to the arbitration program or guaranty fund unde .G.L.c. 142A.Other important informatio on the HIC Program can be found at ww Tnfotmati on the Construction Supervisor License can a w.mass.¢ov/oca found at www.mass.eov/dos 2. When substantial work is pla ned,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" SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) r g d/(,(l fi ��)�/ny)( S' License Number Expiration Date Name of CSL Holder `!!� p)��k� List CSL Type(see below) [� No.and Street V T - Description Unrestricted(Buildings up to 35,000 cu.ft.) U J Restricted 1&2 Family Dwelling City/Town,State, M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ..t-r��l11 /�V h��� HIC Registration Number_ Ex uatio Date I-)fCpComp y N e or HIC Regis ant Name cr:j�CJ/I/Lu No. d Street 1144- of q�7 f! p k,0 Email address Ci /Town,State,ZIP ° Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.g 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 7n:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,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. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and pe res of pequry that all of the information contained in this application is true and accurate to the best of my wl of and understanding. int Owner's or A t orized Agent's Name(Electronic Signature) Date N ESc 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/d s 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,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" National Management Team Inc. This form smisfies all basic requirements of the some's Home Improvement Contractor Lew(h1GL chapter 142A),but does not include standard Ianguage to protect homeowners. Seek legal advice if necessary. Any person planning home hnproxements should fast obtain.cop of°A Mossachmato Construct Guide to Home Improvement•before agreeing many work on your resideuce.You ntav,obtain a free copy by calling the OBim of Consu rm Affairs and Business Regulaton's Co marver Information Hodine at 617-973-8787 or 1-888-283-3757 or on am website. Homeowner Information Contractor Information Name 1�An C Name Sneer. (do uo aPon OtLtt Bosaderessr) mntmctoN SNespersoN suer Navne, / `IY I�6 Oi Cuy.Toav - store Zip Code Business (umst ice We n snw.6ma ess) MA og tH _ Daynaw hove 3✓!/Evom Yh� Ciw.Tmsv Slate Idp Code s- �/. �^ Mailing (R differeutfmmabow) Btaiuess Phrue FeAemlEmploverWorS.S.Number ry p l\ p 7 W�L'LO f/✓ /"F/ a�.r��ommcemlenra<t r+omea ervhnmumw LCV mnslRl Yhlmul he0f tFl t(1 � /�' Im:nrtmmlefuvfePon hfR / y/�/� a nel sho.iweamhff /O(O / W an O tb The Contractor agrees to do the following work for the Homeowner. O 00 Mesedbe in delat the wad m cmupleted,specityin4 doe type.bmad.mW deof materials to be ) 00 / ga used,we additional sM1msi[n Z o e a V A11 Av V X4/'t60/— /1�0u PV_ 0Ott/f1 7D 77A.P /Wy— QaG.0 g � f0 I ji2� O� ��� CC!/d/2/� Jr�1111-� d��G��Gi! /z•Z�B✓lun- Ar✓O W 0.1 w ec�Tir/r��Zz`Y) /lAcfarGrGCyuuz�STi✓ S Fi � Q O Required Perrdfs-'Ilse following building permits are required proposed Start and Completion Schedule-The following schedule will Fa py00 and will be secured by the contractor n the homeowners agent: be adhered to unless circumstances beyond the contmctoes record arise 19 (Ommers who secure their own permits will be EEgg// im r excluded from the Guaranty Fund provisions of J�q/f} Date when crontmcror will begin m¢trncted work. ' l 00 MGL chapter 142A.) �•7 C Dace when contracted work will he substantially compleced. Z C Total Contract Price and Payment Schedule {�.♦ �/ Q •d The Contractor agrees to perform the work,famish die material and labor specified above for the total sum of • C Payments will be made according m the following schedule: d7 z N P. $ upon signing contract(not to escced 1/3 ofthe mad contract price 21 the con ofspecial order items,whichever is greater) S by_/_/ coupon completion of $ by_/_/ "upon completion of S_2�510 upon completion ofthe contract (Law forbids demanding fug payment until contact is compin di w both partyjs satisfaction) The fotowlug materahequ:pmmt rem be special 8 mbe paid for ordered before the co meted work begins in order to meet the complttioo srhedide.n 8 to be paid for NOTES:M Enduring all future doings(°)law requires test my deposit or down-payment required by the contactor before work begins way not wmmd tut greater of(a)rue ldrd Of the mlal coumet price or(b)the scowl cost ofany,special equipwrof or crown made uaMie( which must be special ordered in advance to meet the completion schedule. - Exneeas Worramv-Is an torwross,MDgmv,bl provided by the 1 m[2llltN Y !Rt fW most he m thera Subcontractors-The conmeror agrees ro be solely responsible for compl EFOf 0 work described regardless ofthe action ofany third party/subcontractor utilized by the contractor. The contractor further agrees to be sole responsible for all materials and labor under this acreanent h'�P payments ro'ali subcontractors for Contend Acceptance-Upon signing,this document becomes a binding contract order,law. Unless otherwise noted within this domment the contract shall not imply that any lien or other security interest her been placed on the residenm. Review the following caution and notices carefully,before signing this contract. e Don't be pressured into signing the contract.Take time m read and fully understand it. Ask questions if somethi¢a is nuclear. e Make sure the contractor her a valid Home I t Commerce Region ti . The law requires most home improvement contractors and subcontractors robe registered with the Dimas,of Home Improvemeat Contractor Registration. You may inquire about moo,cror registration by writing to the Director at 10 Parr Plaza,Room 5170,Boston.MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the conmctor have insurance? Ask the Contnctor for his insurance company information so that you can confirot coverage,or ask m see a copy ofa"proof ofiasum¢ee'document. a Know your rights and responsibilities. Read the haportont intomtation on the reverse side of taus form and get a copy ofthe Consumer (hide to the Home improvement Contractor Law. You may m¢ttI Otis agrcemeut ifit has been signed at a place other than the contractors normal place ofbusiness,provided you notify the contractor inwriting athis/her main office or brunch office by ordinary mail posted,by relevant seat or by delivery,not later tan midnight ofthe tthd business day following the signing of this agreement See the attached notice ofeencella ma far an expla on o his right. DO NOT SIGN THIS CONTRACT IF THERE A LAN AC U admiral r�opi/�e/s�o®faarccai/m/atm/uu/b/e��w%�o/glel�<d/m�dligned Oar egry shard panne odzrmpv die tepl by as anmrroc Homeowners$ngnm rR Con traC s we Date F Dale Contractor Arbitration The Home hnprovement Contractor Law provides homeowners with the right to initiate on arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contr s a dispute concerning this contract,the contractor may submit the dispute to a private e 'ration Z v ch has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Re on and t consume shall be required to submit to such arbitration as provided pr7 In Massachusetts General Laws a er 142A Homeow'n s Signature C tractor's S atur NOTICE:The signatures of the parties above apply only to the ee at of the part alternative dispute resolution initiated by the contractor. The homeowner may initia alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as presetibed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree my be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Conti-act The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of fiords from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation - 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at httT)://www.nims.,Rtw/ocabr/ - If you want to verify the registration of a contractor or if you have questions or need additional iufornmation specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888.283-3757 or visit the H[C website at http://% wiv.mass eov/ocalir/ Go online to view the status of a Home Improvement Contractor's Registration: ]ittp://db state me mAmomeinmrovetumt/licenseelist oso For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652.4800,508.755-2548 or 413-734-3114 Venim 2.1-t 1/2212ata 4 t Massachusetts_pe Boautogggf� ParpaeMdfPut'o"safety f[ �'8BulaN6as aac(Staridazds Cons;mctioa;SupetY�sur / E :LfoeUse:CS•OBM4gg 51'1T'CA112�� �' • i CgK&0038 ' y . • t1 commissbaer ratba tEB/20t0 „ �s Busm ss Office o on e r sum Oe aAl tion 10 Park Plaza - Suite 5170 Boston, sachusetts 02116 Home Improve ontractor Rdgistration Regforation: 178186 Type: •Supplement Card " Expiration: 3/24/2016 NATIONAL MANAGEMENT TEAM GEORGE VASILIADES d 2 AUSTIN SQUARE LYNN, MA 01905 r 04 oq ya" Update Address and return card.Mark reason for change. Address Renewal FlEmployment LostCard.' SGA 1 0 90M-0e/11 f0ce of Co Affairs&Business Regulation License or registration valid for f ndividul use only • ME IMPROV NT CONT.RACTOR before the expiration date. If found return to: Office of Consumer Affairs and$usiness Regulation egrstrati Type: 10 Park Plaza-Suite 5170 Expi Supplement Card Boston,MA 02116 NATIONAL MANA n C: GEORGE VASIU P.O.BOX 366 g � TOPSFIELD,MA 01983 Undersecretary Not Valid without signature . . The Commonwealth ofMassachusetts Department oflndustritdAccidents Office of Invewdgations 600 Washington Street Boston,MA 021.1.1 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electrium A licaut Information cians/Pl bers �t �� • Please Print Le bl Name(Business/Orgaai7atioa/ladividuat): /I�iTr/o dw /�/�l,�i/Irn�i �l i / �r/rYM Ltll� Address- fh)fTn/ rQyrle City/State/Zip: l/ Phone# Are you an employer?Checkthe appropriate box: 70 1.Of lam a employer with-- — 4. 0 I am a general contractor and I Type of projectr(required): employees(full and/or part-time). have hired the sub-contractors 6• E]New constraction 2.[] I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling Ship and have no employees These subcontractors have ------ wor g or me mean c city - — ,.... .._8. Demolition Y emPluyrxs�ndave word—ers_ -- ............ .. .. . . [No workers'comp.insurance required.] 5. El We are aeorporation and its 10.[]Electrical repairs or additions 3. I am a'homeowner doing all work officers have axeroised their myself. 1 Q]Plumbing repairs or additions Y [No workers.comp, right of exemption per MGL insurance required.]t c. 152,g1(4),and we have no 12•Wkoofrepairs employees.[No workers' 13.0 other comp.insurance required.] `Any sPPlicant that cheeks boa#1 must ah fdl out the section below showing their wodkers•com aeration Policy iat'onueti t Homeowners who submit this affidavit indicating they are doing alt work and then hire outside con P cy mr. toDahnchns that check this box must attached an atdditional sheet eh trsctors mustsubmit anew affidavit indicatingmcb. employees. Ifthe subcontractors have employees,they must pmvideeW�gtheir�wodmts ofau subcontractors mid auto whetherornotthose entities have comp.polity number. I inffoormation.nit employer that Ls providbtg workers'compensation uts'wranee for my employees. Below Is the policy and job sue / // T lnsumuce.Company Nam: fin/) /ntn,� tJ��T1 r fir Policy#or Self-ins.Lic.#: 2 /7 x CO - /s�rr� / S� BgpirationDate• t Job Site Address:_ r?/ xr� City/State/Tap:_ (r//1. - Attach a copy of the workers' M/� O/�j7� compensation policy'declaration page(showing the Polley number and expiration date). Paihtre to secure coverage as required'under Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil T'cnalties in the foam of a STOP WORK ORDER and a fine of up to$250.00 a day against the viola . Be advised that a co of this Inyes g—ahons oe D _.oy ms rian --. .pY. .... -. .statement may be forwarded to the Office of _ overageyer_ ifcah -. I do hereby certo under the palms d p allies ofperfary that the information provided above is true and correct ' afore• Date: /Z one • 7D Official use only. Do not write in A&area,to completed by city or town oriciaL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.CitylPown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#•