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9 MOONIE AVE - BUILDING INSPECTION ,PI � s � G lx -,*- -I The Commonwealth of MassachusettsINr PECTIO ;L SCI'�$''I®ES SALEM WE 0 �� Board of Building Regulations and Standards \� Massachusetts State Building Code, 780 CMR pp�� nnFFr(� Ke e 011 �' Building Permit Application To Construct, Repair, Renovate Or D�hS�ItSh 2 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date pplied: l lei Building Official(Print Name) Signature Date SECTION l:SITE INFORMATION (� LI Pro erty Address: 1.2 Assessors Map&Parcel Numbers �+ 1 � IIMTrt�P l� Ma Number Parcel Number I L 1 a Is this an accepted street. yes no P _^ 1.3 Zoning Information: 1.4 Property Dimensions: uZoning 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 of Record: RcearJ 0,4A(150A1 .,<.M/f 097D Name(Print) Ci ,St e,ZIP 9 A00file e (1))7f -R477 No.and Street Telephone Email Address SECTION 3: DESCRIPT ON OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building Owner-Occupied Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ 1 Number of Units Other ❑ Specify: Brief Description of Proposed Work Z: -19rinMA1z J6 &(7flf 990 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor andMaterials) 1.Building $ D/G 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ 3 ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Q Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 190 ❑Paid in Full ❑Outstanding Balance Due: (Y)r-"t_,&�- 12-t 1 `l 5 t�C SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License{CSI.) r CC i" i License Number Expiration Dale Name of CSt.Holder r Li,_t CS-L Type We below) No.and Sireet Type Description l 1 U Unrestricted(Buildings u to:f 5,000 cu.fi. 1 I' R Restricted 1&2 Family Dwellin City/Toein.State,ZIP M Masonry - RC Rocfirig Covering P'S Window and Siding (y,., Solid Fuel Burning Appliances a bL)—c) Sly! 7 Insulation Telephone Email address D Demolition 5.2 Registered Borne Improvement Contractor(H (I C/(tiI ed `N(S'Mf �E CYI�F�t �1 S�S� )1� HIC Registration Number ExpirationDate TC Company Name or HIC Registrant Name sox Seo,AorN O_,C .and Street Email address F9,es*v-<, PA \C\0\3 0 Ci /Town.State.ZIP Telephone SECTION 6:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.'152.§ 25C(6)) Werker<_Compensation Insurance affidavit must be completed and submitted with ibis application. Failure to provide this aflidavii will result in the denial of the Issuance of the building permit. SignedAffidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,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(Ele ign ) Date SECTI N 7b: WNER' OR AUTHORIZED AGENT DECLARATION By entering my name elo ,I h eb attest under the pains and penalties of perjury that all of the information contained in this applicat is e d accurate to the best of my knowledge and understanding. LZ �lD Print Owner's or Authorize t N e(Electr(nie Signature) Date - NOTO 1. An Owner who obtains 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.gov/o Information on the Construction Supervisor License can be,found at www.mass.Pov/dos 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 halflbaths 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" The Commonwealth ofMassaehusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgovldia Wivorkers'Compensation Insurance Affidavit:Builders/ContractorsMectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information P int Name(Business/Organization Individual): Address: '25b 1 ,)( /j�1 D/Znj �tZ IVC City/State/Zip:_tfe-rj e/t t`1 jg015 Phone#: 5d- Z80- 0151 Are yon an employer?Check,the appropriate box: Type of project(required): 1.�1 em a employer wilt 1 J employees(fell and/or part-time).* 7. ❑New construction 2.Q Into a sole proprietor orpatmership and have no employees working forme in S, E]Remodeling my capacity.[No workers'comp.immance requved.) 3.❑I am a homeowner doing all work myself[No workers'comp.insurance requ'nedl t 9. ❑Demolition 4.❑I am a horceowner and will be hiring contractors to conduct all work on my property. I win 10❑Building addition enstre that all contractors either have workers'compensation m m arce or are sola 11.0 Electricalrepairs or additions proprich"M with no employees. 5.❑I am a general contractor and Ihave hired the sub-contractors Roof 000ffrepairs listed on the attached shoa 12.❑Plumbingpa repairs or additions . its These sub-contractors pave employees and have workers'comp,insurance.: .. 6.Q We are a corporation and its officers have exercised their right of exemption per MGL a. 14. Other $ [h j� ' IGU`'1z4NN 152.§I(4),and we have no employees.[No workers'comp.insurance required.] -Any applicant that ehxla box#1 must also fill oat the section below showingtheir workers'compensation policy information. t Hmnnowners who submt this affidavit indicating they are doing all work and am hire outside contractors must submit a new affidavh indicating such. tConracmm that check this box must attached an additional sheet showier the name of the sab- tmcmrs and state whetter or net those entities have employees. If the sub-contactors have employees,they must provide thein workers'comp.policy number. I am an employer that is providing workers'compensation insurancefor my employees Below is the palicy and job site information. Insurance Company Name: i}lL 4 S V/t t Iz U0/2C Ej TCrL_ �I ftl g A.,t nE Policy#or Self-ins.Lic.y#:_ O f Sf� / Elcpimtion Date: Job Site Address: q l� 'ysola l i /-t V o. City/State/Zip: u;1,71 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ver] t I do hereby the pains and penalties ofperjury that the information provided above is true and correct Si e' A Date: 17, Phone#: $'08--Zgb-6156 Of trial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector b.Other Contact Person: Phone#: POWER-1 OP ID: EL ,d►coRO` CERTIFICATE OF LIABILITY INSURANCE D 091191111/2015/2016 0 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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 lieu of such endorsement(s). PRODUCER CONTACT NAME: Lacher&Associates Ins Agency PHONEFAX Lacher Insurance Group C J No :215-723-4378 A/C,No,. 215-723-8604 632 E Broad St P O Box 64398 E-MAIL ADDRESS: Souderton,PA 18964 Chad Lacher INSURERS)AFFORDING COVERAGE NAIC0 INSURERA:Harleysville Preferred Ins. Co 35696 INSURED Power Home Remodeling Group, INSURER B:Harleysville Worcester Ins Co 26182 LLC INSURER c:Nationwide Mutual Ins Company 23787 2501 Seaport Drive Ste B110 Chester, PA 19013 INSURERD:Pennsylvania Manufacturers 12262 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AODL WU POLICYNUMBER MMDDYIYYVY MMDCDIYYY LIMITS LTRINSD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 MPA00000089793N 10/01/2015 10/01/2016 DAMAGE TO RENTED 1,000,00 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 15,00 PERSONAL B ADV INJURY S 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,00 POLICY FX] PE' LOC PRODUCTS-COMP/OPAGG S 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 Ea accident B X ANY AUTO BA 00000089796N 10/01/2015 10/01/2016 BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILYINJURY(Peraccitlenp S AUTOS AUTOS NED PROPERTY DAMAGE S HIRED AUTOS AUTOSUTOS Per acutlenl S UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 C X EXCESS LIAB CLAIMS-MADE CMB00000089794N 10/01/2015 10/01/2016 AGGREGATE $ 5,00o,000 DED I I RETENTIONS $ WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D ANY PROPRIETORIPARTNER/ XECUTIVE YIN 201500-66-20-96-7 10/01/2015 19/01/2016 E.L.EACHACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 Ups,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 1,000,00 B Mass Auto BA00000018227P 10/01/2015 10/01/2016 Auto Liab 1,000,00 B NY Auto BA 0000007484SR 10101/2015 10/01/2016 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SALEM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Salem — 3rd Floor AUTHORIZED REPRESENTATIVE 12Washington St e� e ,Salem,MA 01970 '�'�'C ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD r i &2,wanummuawa l a nce of Consumer Affairs&Business Regulation License or registration valid for individul use only SOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:, 1 Office of Consumer Affairs and Business Regulation 68616 Type; .: Ex u9hon lop Plaza-Suite 5170 - P 3/1812017'. Suppiemenil,ard Zt 16 POWER HOME REMODELING GROUP LLC. MARK MORDINI 2501 SEAPORT DRIVE STEBT10 j CHESTER,PA 19013 - . - Undersecretary lid without signature Massachusetts Department of Public Safety I Qj Board.of Building Regulations and Standards License: CS-057645 - Construction Supervisor MARK E MORDINI`s�'~ 18 NEWELL DR : r, N ATTLEBORO OP 7 tom j vim-- Expiration: Commissioner 09/18/2017 - �$� ius ^�Ba BA�11�c11ARAnFR f� y'�� 801 Alb, :bei �t ' a 18 NEWELL DR � !. _ ------90R0UGH MA 02760.3525 _}`a,< r roo osxamurs< of ismor liiH.e_, 1 .T ar about:blank J t NATIONAL HEADOUARTERS Richard and Michelle Beauscliel zsolSeaport Drive.cIWPA 19013 'POWER' s1-.2025 November 20,2015 -,888-REMODEL -ua MR HIG 169810 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buya(eY trrroenreeon WW Description of the Property: Project Number:31-77825 November 20,2015 Richard Besusofel O aft . Michelle Beausdlial (Ina)7444"7(NOnN) rrbeausolkl�pxnraslnet 9 M00960 Ave (M)7854021 fRxhern CSR) Eaw�ev®r Salem, E 01870 I b County::Essen Townahlp: Buyer(s)filed above hereby jointly and severalty agrees to purchase the goods and/or services of Power Home Remodeling Group and its vendors CContredor')In accordance with the prices and terms described in this 8 page document and the Product l Specifications.which We Incorporated as part of the Agreement(collectivery,this"Agreement). This Agreement represents a cash , sale of goods and servask . Buye(s)agrees to pay the cost of the goods and services purchased as described herein,regardless of r timing of approval of any financing Buyar(s)may seek for their.purchese. Purchase Price: $1I.878.63 Fre Installation Inspection Dates: JA&IISe r:3S Down Par atenb U-00 Estimated i Balance Due on S74�� Project Stere:3 to 0 weeks {. Substantlal Completion: Estimated Completion:l to 2 days ` Method of Payment Other eyvrts>caOvsmr.eamasmmr�ti nm 4a"em Nar remeeeaae..owry _ moR err eenee.see OtlryNAvmen Wroitiaa I Buyers)hereby adaawiadges receipt Of e Copy of the pamphlet,"The Lead-Safe Certified Guile to Renovate Right",Informing Suyer(s)of the Potential risk of lead hazard alposurs from renovation activity to be performed In or at Buyer(s)'Property,at the address written above.Buyer(s)recetvad ifs pamphlet on the data of this Agreement,ballots commencement of wort ` —R-5 Buysr(s)'tnWeis. This Agreement constitutes the entie agreement and understanding between the parties,and this Agreement repisres any and all i prior negotfatlorls,repMesSIT[Rd ns,Or agreements,either written or oral. No amendnen,modification or waiver of this Agreement ehaf be valid or effective unless in writing and signed by both partes. Buyer(s)hereby adogwiedges that Buyer(s)1)has read the entre Agreement and hes received a completed,signed,and dated copy Of this Agreement,hlduding the two accompanying Notice i of Cancellation fore,on the date trot written above and 2)was orally Mitred of Mater right to cancel this transaction. '. Buysr(s)also agrees and understallas that t Buyers)trances the work with a third-party,the terms of gotfinandng will be i'. contained on separate documents 41Guding any finance charge. . {. Future promotions not applcable. X 1, DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. I hen road end receivetl sub prg Of�rto a pegs agreement. I Power Home Rerttodslirtg Group ((�� uYer( ) 11=5 711/20/15 �'""I7120J75 Signa of Remodeling Consultant Signature Signature Nidi SchwMsehleg Rlclu d Besusoliel Mlchsile Beeusofiel 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 PAW.. Nowtnber 20,201518:37 MPage 1 of 6 J 1 of 1 12/4/2015 3:20 PM • NATIONAL HEADO UAR 7E RS Richard and Michelle Beausoliel 2501 Seaport Drive,Chester, PA 19013 su, „ �.,:u„_ _ POWER 31-77825 November 20,2015 j 888-REMODEL .. ... MA HIC#168616 PRODUCT SPECIFICATIONS Buyer(s)'Information and Description of the Property: Project Number: 31-77825 November 20,2015 Richard BeausolielDafe o/Agieemen( Michelle Beausoliel (978)744-3467(Home) rrbeausoliel@comcast.net 9 Moonie Ave (978)766-4021 (Richard's Cell) E-M.d Aaanass i 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 TBD. Roofing-GAF Inclusions: For steep slope roofs,the application 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 Starter 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 applications used only where applicable. Clean up and haul away of all job related debris. 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 on steep slope applications. Any additional wood replacement needed,over and above the 300 square feet we provide will be done at a cost to the homeowner of$3.57 per square foot. (Buyer initials 1. For Example:After the shingles have been removed, if we find there is a need to replace 325 square feet of wood, Power HRG will pay for the first 300 square feet. It is the responsibility of the homeowner to pay for the cost of 25 square feet of replacement at$3.57 per square foot, which in this example is $89.25. For low slope roofs,which are roofs with a pitch below 2/12, the application includes 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. Roofs with cedar shingle removal will include all new decking as part of the installation. Clean up and haul away of all job related debris. 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) /11/20/15 111/20/15 /11/20/15 Signature of Remodeling Consultant Signature Signature Nick Schwertschlag Richard Beausoliel Michelle Beausoliel 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. November 20, 2015 19:37 IIIIiIII II III II IIIIII I IIIIII II Page 1 of 2 NATIONAL HEADQUARTERS - - Richard and Michelle Beausoliel 2501 Seaport Drive,Chester,PA 19013 ,., ;,, . POWER 31-77825 •'- ., November 20,2015 888-REMODEL .. .. .. MA HIC#168616 Project Specifications Roofing: Whole House 1 1600.0'x1.0' ROOFING: Models GAF Styles Architectural Shingles Types None Configs None OPTIONS: Color Pewter Gray i Removal Standard Shingle I Installation Details None OAF 61A7BiN13 OORPORATION Prb~Gray f r. Iwo I � a s°t + ' L f 1 #1 f rAll �4 Aerial Measurement November 20, 2015 19:37 III II VIII IIII IIIIIIIIII I I III IIIIIIII Page 2 of 2