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39 GREENWAY RD - BUILDING INSPECTION
53S Thecommonwealth ofMassachusetts RECEWED CITY OF q / Board of Building Regulations and SarXisTt� f,i SERVI ES SALEM Massachusetts State Building Code, 7 0` R RI vLreJ.Nor 101 Building Permit Application To Construct; Repair, Ren D�&IIA a2- One-or Avo-Family Dwelling This Section Foro icial Use Only Building Permit Number: Date. . piled: b10 /7 m� Building ORcial(Print Name) Siguature•:'- ,: Dote - SECTION it SITE INFORMATION` I.i Property Add ress:3 a /t rte^ y 12 Assessors Map.&Parcel Numbers I.1a Is this an accepted street9 yes%2, no Map Number Parcel Number IJ Zoning Information: 1.4 Property Dimensions: Zoning District . ... .Proposed Use - LotArea(sq fl) - Frontage(g) 1.3 Building Setbacks(R) Front Yard. ... $idd Yards'.' .. . Rear Yard ' Itcj4h d Provide! Required Provided Rerjuirrcd Provided 1.6 Water Supply:(M.G.6 c.40,§54) 1.7'Flood Zone Iaformatlon: 1.8 Sewage Disposal'system: Zone: _ Outside Flood Zone? Mantel O On site di stem`O Public D - Private O.� .• .. C6edcif aO . - P?t +sPosal system SECTIONI: PROPL41TYOWIVER$HYP! 2.1 Owner'VlR ord: C I0. VIA Alr\ ne(Print) - C11-,state,ZIP - `� q r.ea!, wJa./ tZ 978- 9K • 3yy7 No.sod Street - Telephone Email Address SECTION 3r DESCRIPTION OF PROPOSED WORKA(check all that apply)` New Construction O I E. sting Building O Owner•Oecupied O 1 ttepairs(s) tj Alterations) O4AddifionDemolition O AccessoryBldg.4 Number.ofUnits Other O Speciroposed Work=: 1 1a / ✓L 7SECTION 4t ESTIDIATED CONSTRU TON COSTS hem Estimated Costs: - Official Use OnlyLabor and Materials I. BuildingS 3 /, I. Building Permit Fee:T InJieati how fee is determined: 2.Electrical S OStandard CityagwoApplicationFee O Total Project Cos?(Item 6)x multiplier x 3. Plumbing S 2?QtherFees: S 4.Mechanical (HVAC) S List: 5.Alechanical (Fire S Su resswn) Total All Fees:S Check No. Check Amount: Cash Amount: f S 5 6.Total 1 r ryect Cast: I JjY 0 Paid in Full 13 Outstanding Balance Due: mcg �v� Tb YJ I EIP- c�� l Z4 11 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) U q9 6 9q PDG L 0 b o) _ License Number Expiration Date Name of CSL\[[older List CSL Type(see below) I- L) ,IG Id rl S '1 Type .. _'. . Bested P too . Re.and Street - S q f U U=RedlBuirdingsu0 to 35,000 cu.It. a. R Restricted I&2 Family Dwellitut Cityfrown,State,ZIP M masonu RC Roaring Covering WS Window Sklinst SF Solid Fuel Burning Appliances 02 4 ?q I Insulation Telephone Email address D I Demolition 5.2 Registered Home Improvemeq Contractor(HIC) / ";t 6 V 3 E3 NOV�- u) - HIC Registration Number Expiration Date HICame 75p.pt�• ugNam; r` P�`ctC Wsrr�(vfn � - No.and Street v N01-499 - VY Email address Ci frown Siete ZIP Telephone SECTION 6:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L cc 152.4 21lC(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 Istuance of the building permit. Signed Affidavit Attached? Yes.......... No...........O SECTION 7s.OWNER AUTHORIZATION TOBE.COMPLETED.WHEN' ,; OWNER'S AGENT OR CONTRACTOR APPLIES FOR'BUILDING.PERM IT' 1,as Owner of the subject property,hereby authorim ty act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) - Date SECTION 71s:OWNEW ORAUTHORIZED AGENT DECLARATION By entering my name below,)hereby attest under the pains and penalties of perjury that all of the information contained' this application is true and./accurate toTet of my knowiedg{eAnd understanding. V Gfr / Iq �,v AC, ,V,�<C11, 1 2 _ ! D - /J Print Owner's or Authorized Agent's Name(Electronic Signature) Dote NOTES: I. 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 Hame Improvement Contractor(HIC)Program);will fir(have access to the arbitration program or guaranty fund under M.G.L.c. IJ2A.Other Important n rmu-tion on the HIC Program can Ge ot`flir d at www.mass.eov'oca Information on the Construction Supervisor License can be found at www.macs.aov/ons 2. When substantial work is planned,provide the information below: "rotas floor area(sq. ft.) 'i' (including garage, finished basement/attics,decks or porch) (boss living area(sq. R.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of hall)baths 'type of heating system Number of decks/porches 'type of cooling system Enclosed Open I . "Total Project Square Footage"may be substituted I'or"roGd Project Cost" d.C% �Gi�J1?i�r"d'�e''d C.lf��trt% b O' Office of Consumer Affairs and Business Regulation I 10 Park plaza - Suite 5170 Boston, Mopsachusetts 02116 Home Improverru,�nt,(PoYl$1'act01' Registration Registration: 126893 Type: Supplement card THD AT HOME SERVICES INC.. W';i...''i.il Expiration: 81312016 MARK NIADNA -------- --- -----,._..__._,. 2690 CUMBERLAND PARKWAY SUI7lT'' .00'';?;r - --- --•_.`.___.____._.._..__...... ATLANTA, GA 30339 :'.;;;;,•.' -__ ......__....._.._�. - .... - _..:_....... Update Address and return card.Marls reason for change. SCA r 0 2UM•05/11 0 Address f_j Renewal ❑ Employment j Lost Card 17�74rY�;:bnur.,)mr•rr0/r� /(.nsrrr/rac/Jr �, Oftice of Consumer ARubs Ni Business Regulation License or registration valid for fudividul use only IOME IMPROV•FrMENT CONTRACTOR before the expiration date. if found return to: Office of Consumer Affairs and Business Regulation Reglstratigp:!.;j2¢¢93 Type: l0 Park Plaza-Suite 5170 Explratidp;;•Hl3%20,76. Supplement Card Boston,MA 02116 THD AT HOME THE HOMEDEPO'CAT,fi1 p ''.SERVICES MARK NIADNA 2690 CUMBERLAND PARKWAY S � � -- —] n��/-•`��ow 14 %,QA 30339 ' Undersceretory rtlpt valid Without signatu A'ti9+�` � I r • r' I r ( , I 1 1�! Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialty License:CSSL,�OY7�699 ROBERTPOCZO$UT --- 't 172 WHALERSs Salem MA 0197 ,Uv 0 . )I le Expiration' 02108=16commissioner THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER'IiI�CATE HO1DHt THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ABNElIM MEND OR ALTER THE COVERAGE AFFORDED SY THE TER,TES ` BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUIIBG VMRER(S). AUTHOR® REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER_ IMPORTANT: If thendi ions tate Route11 r Ls an ADDTR001AL U SURED the poOcy(r�)mus4 be."endorsed- >g SUBtO1aATTON IS WAyVVEE1E subjtxt[p Ina!elms ano CondTipns of Ute POIny,Cariain POIl(1Tdjr rill an endorsement A"56t@RentoD this cer6Ecafe does not conFerrights to the certificate holder rieN 01—ch endomement(5). PRODUCER CONYACI MARSH USA,INC TWOALUANCEGQ,fTER P ONE WW LENOX ROAD,SUITE 240D 6N1NL I CNn ATLANTA GA 30326 ADORIeo 1004924NAED-GAW-iS1E UISUREERAFFORDIUGCOURAGE ?t/UCS INSURED INSURHtA.Sr®drdgrlB]Pd0@ 2MU THD AT-HOMESENICES[NC" INSURERB:21RImRIMMUSOU]MUaMco 1ms DB.4 THE HOME DE+OTAT-HO)dE SERVICES INSURER C.NeDHan11310WRISCO - 239DCUMBERLAND PARKtVAY SUI7E300 23841 ATLANTA.CA 36339 INSUREZO.0mdsN�mmttrlswal¢eCmnFalp 23917 INSURER E. . COVERAGES IRswml I - TI THIS IS TO CERTIFY TIiATTHE POLICt�OFA NASURA(4CE LISTED BELOW HAVE H ISSUED 7D THE R, :1, NUDBBEIRI INDICATED_ NOTWITHSTANDING ANY REQUIREiV�M,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOC11m0rr vlRTu nsaPe¢ct III I) 1 11 110101E FOR THE vnvAsncc��an CERTIFICATE NIpY BE 15sOEO oIx laAY i'HRrnw,TriE RasVSgryDE AFFORDED BY THE POLICIES DESCROM E)CCLUSIONS AND CONDITIONS OF SUCHPOLICIES_UMRS SHDWNMAYHAIlE gF1-711[�()CEpgytaprp CLAWS. HEREIN 15 SU6IECT TO ALL THE TERMS INSR LTR TYPEOFIRSURARCE I D ISUS POLICYIS=F PODCYE]� A I GENERALLWBILITY t wo PODCYNRB®ER p L�5 GL09007M9-05 03N1lL015 03NUZD16 EACHOCCUttRENCE S 9DOgUUD y I C01.U.ISRC1ALGENERALLNS1Ul i CIAUJSJADE OCCUR UMTTSOFPOUCYXS S 1.OADBD PiEDEXP(AmI, eptwn) S FXCUIG® OFSIRSIM PEROCC PEmDNALanwDRIIRRv s QO(ODD) GEI _ RaiE i s 9ptIbODD G�1Jt aGC-REGATc UAniAP?UES Pr]t Y, ?OLICY n PRI I 1 LOC PRODUCTS-Comp1OPAGa s QO1b U0D 6 AUTOPlASILELIAffil ISINGIE1015 S BNP 2438863-12 03101203N12016 cw.faR� Narr 1.DOQOOD X Al HAP ALLCWNEO R0O°-YU�U<n'1�P®R) s AUTOS SAV, SUS SELF09SUREDAU(OPHYDMG RODaYIN.RR[Y - I NON-0mm I (PereDtl�I S HIRc-DAUTpS ( !aV{'03 PRO _ DAMAGE s —I era UR1aRELLAt1AB I OCCUR 5 S4CE3S LIAS I EICREGAl t8VCE S CdIUHSdUtOE AGGREGATE I S DED i I RE(EmIONS I s C ANORI'r4PLO RV+r Lt ATIDN WWVM49 [[ROM ®IOIf1015 031612Bi6 XMUM. WCSTTOi4 O11i- AHDEI4PLOYERSPARD RA rR t� C ANYPROPRIETOSEXCUIDED �U1R1E YIN V1CDt7M495pd%jY.NH.N3.Vr) W@1(m15 03N1Q016 1.DB0.0UD D OFGCERRRb45ER EwCWOr'D> m NIA In EACRAGCIPWr S [rnanaalary in NH) WCD177314 IR) 038112015 031072016 Il Yes,desenTe un9er EL06El,¢-Er S 1.000000 DESCRIPTION OFOTr'"WSTIDNSbEtoci CDNIIpBOOIAE�(�Ol Pd92 5 1,DOD,000 VIDENPTIOF OSURANCTIDilSI FACATIpI15lVEfItOES[AOdWACOlRp10f,AAdUmpi Remar�SebalDiq DnnRey®xlsAyUlie+O EVIDENCE OF INSURANCE " CERTIFICATE HOLIER CANCELLATION THD AT-HOMTHEHOESERUI TAT4jC. SEOULDANYOFTlIEABOVEDESCR(6®ppl(�SgEra1NCERL®Bt�O1Re DBA THE FEDEPOTAT-HOEtE5ER1rICES THE EXPIRATION GATE MEREOP Mmme mmt BE DELFUER O IN 2489PACESFER339 - ACCORDANCEVMMTHEPOLICVPROI=onS ATLANTA,GA 30339 AU(HOR®TU3rRESHRTATNE ofill USA Inc. I wimasm Iftmepee ACORD25{289QN5} ThRACORDDameand I r»m��h ©ftcfACORD DCORP®RAT['ON�Aii ^OaigRRs o90a1e maF&sofAL'ORD ✓ � HOME IMPROVEMENT CONTRACT 1 PLF,ASE READ THIS / (( Sold,Furnished and Installed by; Branch Name:Boston North&South Da1eaJV'' 16 THD AI-Home Services,Inc. �f� dAVa The Hotne Depot At-Home Services Breach Number:31 and 33 908 Boston Turnpike.Unit J.Shrewsbury.MA (I MS 'roll Free 577-903-3769 Fedend ID:175.2698460;ML'ric 9 CO2439;RI Cont.Liot 16x27 �jq (�,, ���,n CT LiLie,N HHIC.0565522;MA Hum.Improvertwnt Gmuncun Reg_p 126893 Installation Address: J t GJZ t:b s' �—*q k�/ yl-i M1y 01 0n 6 City Stine Zip Purel ser(s$ Work Phone: Home Phone: Cell Phone: C I [ ] 11 1 11 1 I ` aAC� T Home Address: (If different from Installation Address) City State Trp E-mail Address(lo receive project communications and Home Depot updates); ❑1 DO NOT wish to receive any marketing entails from The Home Depot Mcoiee I IInformation; Undersigned("Customer'),the owners of the properly located at the above installation address.agrees to.buy. THD At-Home Services.Inc.("The Home Depot")agrees to famish,deliver and arrange for the installation(7nstRlhatiOri)of all materials described on the below and on the referenced Spec Sheet(s).all of which are incorporated into this Contract by this reference,along with any applicable Stale Supplement and Payment Summary attached hereto and any Change Orders(collectively. "Contract"): Job a: 'tM^°°°`a'm^t Prat Sper Sheeda k: Protect Amount Roofing Sidin Widows insulation 0Gutters/Covers ❑Entry Doors $ /103 3 Roofing OSiding 0 Windows LJ Insulation 013uners/Covers []Enwy Doors ❑ $ aKng OSiding LI Windows Insulation ElGuuers/Covers Entry Doors❑ $ Roofing OSiding 0 Windows 0 Insulation OGmlers/Covert ❑Envy Doors ❑ $ Minimum 25%Deposit ofCmiract Amount due uponeuuttion of this conbucL Total Contract Amount $ <'`y <9A alalne Purchaevs may not depadtmaethan onisthird ofthe Contract Amount. V 1 *e Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any Valance due. As applicable.each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein.at ;<� its discretion,if The Home Depot or its authorized service provider determines that it canna perform its obligations due to a swctural >' P roblent with the home,environmental hazards such as mold,asbestos or lead paint.other safety concerns.pricing errors or because work required to complete uhejob was not included in the ConvacL Payment Summary: The Payment Summary X included as pen of this Contract, sets forth the total Contract amountand payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each Rated Product as defined by individual Spec Sheets)beforework on that Product ;III} is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT IAMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Am mnce and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer unJ The Home 'pm with regard to Inc Products and Installation services and supersetks.all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned Or amended except by a writing signed by Customer and The Ho a Depot.Customer acknowledges and agrees that Customer has read.undersmnds,voluntarily accepts the f and In. - ived a opy of this Agreement. Atteple byIt tin H ed by: x It er's Sign Date S' es L .u tam' .'i noun DU te� —� X Telephone No �_\MIS Customer's Signature Date � Sales Qmwlao License No. y. CANCELLATION: CUSTOMER MAY CANCELTHIS tot,uppliamo _ AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON TFIE THIRD BUSINGti.S DAY AFTER SIGNING THIS AGREEMENT. THE _ STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN 7 CUSTOMF,R'SSTATE. .� NOTICE:ADDITIONAL TERSIS AND CONDITIONS ARE STATED ON THE REVERSE SIDE.AND ARE PART OFTHIS CON"IVACT o3.141a Whose-Branch Fib Yeeow-Cuabmer , � _ s*�+Ac'LS'7gps�i . •vwc� Uf- . - - I c�cd i3:aaS 5 ,i...r rid t n 4n`5� 'E• I12=6 /..:�.a:a i.2 Cru:.. _ c �( � _ c ll!` .. cor.rept;as d ?%:S8?-4 112-0061£-urnU= 3-3_ DH y ENERGY PERFORMANCE RATINGS 1_ EVALUACION DE RENDIGDENTO ENERGETICO `iea:Gatv.cc afficied r �0 1 .70 0.25 :. ADDITIONAL PERrORPAANCE RATINGS EVALUACION SUPLE?9ENTA UA DE RENDIM191ENT0 �T � 0.47•._' - _e 1 i _ f NF} 1 lel L r j U ?'Ms'-' unit qualifies for ENERGY ,�. ,/,9 .. ,(�+�-!, STAR®region�sy Northern. rj•r �+ .r , cbrih Cenval.South Centrat, ' Southern. z�ja z�. STC:N/A a3Nd� `3 1 ,e ri 9 J'� t �:y6.,� 6a;;Rein DO/Glass ProSolar/H-R20 DP.•'f'20!-20 Tested Size:48"x80.. ti is pr. M Aop4ca.`;e Tas!Standard(sl: AAMAM/DP4A/CSA 101/LS.2/A440-05,AAMAlJVDMA/CSA 10111.S.2,A440-08 ' 866:451:!0'. 60347 HS Perry 6592698A ... wt - S..i. TAM d Pcc• u I P 511 11 a a .