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10 PETER RD - BUILDING INSPECTION �I< 7 3 c l / OClb S The Commonwealth of Massachusetts RECEIVED CITY OF °t Board of Building Regulations and177�� y���71` idAL $ERtirl E$ SALEM Massachusetts State Building Code,7800C1VTRjlC r Building Permit Application To Construct,Repair,R Revised Mar 20]1 gaf PfokN One-or-Two-Family Dwellin C 3 This Section For Official Use Only Building Permit Number: Date plied: Building Official(Print Name) Signature Dale ^ SECTION 1: SITE INFORMATION I•L� .) 1.1 Proro perty,��r Address: a1.2 Assessors Map&Parcel Numbers f� lI Aa 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"Lone? Municipal❑ On site disposal system ❑ Check if yes[] SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Lf WA I�enadla �' I,MA Name(Print) City,State,ZIP �0 I) 3D7- and S e[ Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building Owner-Occupied Repairs(s) ❑ 1 Alteration(s) Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units Other ❑ Specify: Brief Description of Proposed Work': SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ CP—01 ❑ Standard City/Town Application Fee ❑Total Project Cost'(item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: a 5. Mechanical (Fire $ Suppression) Total All Fees: $ I Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ Isl ® 0 Paid in Full 13 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License{CSL) r t'!� ' ,\& Akn''k-"n� License Number Expiration Date Name of CSL-Holder List CSL Type(see belowl \Al No.and Street 1`) Type Description Ni r, 1 ` ��`� ` h A }, Q-A--1 i A,_.t (p0 R Unrestricted ,2 Family (Buildings u el ing cu.ft.) V eT \ '`rW'i R Restricted l&2 Family Dwellin City/Fown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances c-2\St1j - 1 Insulation Telephone Email address D Demolition Xt� f _\G' 5"..2 Registered Home Improvement Contractor(HIC C d ` mf �e`(1'l�f�1 V� ME Registration Number Exptnbaon Dtate C Company Name or ME Registrant Name So\ Senl�or't oc. No.and Street Email address \-,eS+e< , PA laoti3 X08 a�tv'(�1SSo Ci /Town,State.ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.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 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(Electronic Signature) Date SE N bd OWNER' OR AUTHORIZED AGENT DECLARATION By entering mQnammcto ,I h reby attest under the pains and penalties of perjury that all of the information contained in thtio is a and accurate to the best of my knowledge and understanding. SS — Print Owner's or Auth ge 's ame(Electronic Signature) 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 TUC Program can be found at www.mass. ov/oca Information on the Construction Supervisor License can be found at www.mass.eov/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 half/baths Type of beating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage'may be substituted for"Total Project Cost" The Commonweadfh of Waswhasetds Department oflndustritalAccidents 1 Congress Street, Snite 100 Boston,AL4 02114 20.77 WJ4W wass gov/dim Workers'Compensation Insurance Affidavit:Builders/Contractorsi Iectricians/Plumbers. TO BE 1'7I D RITE TME 1PElRWurnNG AUMOltf ry. A licantInformation Please rin t Le 'b Name(Businessiorganizabon//hdividual): A Address:_ e5bi Jcub/z-fir City/State/ZiP: 1 ` -" /t �� � 5 Phone#: �Q8� Z� — O J S6 Areyoa an employer?Check the appropriate boa: y c Type of project(required): i. I an a employer with 1 J emplayees(full mdlurpay tna).= 7. (]New construction . 2.❑lamastilepropiieJm orpmmwakipandhavememployeeswo,icing ford. 8. �REIDOdCling any opacity.[No workers'comp.insmance re9�.) 3.[]I am a homeowner doing all work myself [No workers'com,,insurance required.]1 9. ❑Demolition 4.❑]am a Iromsow>�and well be hiring comracrors to conduct all workw my property. I well 10�Buildi g addition Crime that a71 contractors eider have workers'compensation insauaoce or are sok 17.[f Electrical 7epairs or additions proNietors wins m employees. - 5.O Iamen ageralcoMracior aadIhavehira7lhe sob-coz>tecrora listed on the attachod sheet12.®Plumbing repairs or additions , . 7hesc snbcormactors have employees and have workers,comp.msmmmel 13.0 Roof repairs 6.❑We are a corporation and its-M—but.exercised thea right ofexeopurn per MGL c. 14.❑Other 152,§I(4),end we have no employees.[No wrdwn,comp.insurance required.) 'Any applicant that checks box#1 most also fill ons the section below showing theirworkffe compeasationpolicy infomiubm I Homeowners who submit id-affidavit mdreaung they are doing all work and then hire outside contractors mast submit anew affidavit indicating such tConhactors that check this box must Attached an additional sheet showing then,me of the andoft whom,,Arnot those amities have eorployees. if the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compearsation insurance for my employees. Below is the policy and job site information. �f Insurance Company Name:_Ll-ft�Ctaf ViLL[e UK C JfrL- In A ttriz Gj Policy#or Self-ins.Lic.#:_ ZC tf"pD'(,( —t.D s Expiration Date:_ 10-1 -2016 Job Site Address:A) r rd City/Statc(zip:_ ' 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 Ofee of Investigations of the DIA for insurance coverage v ' I do hereby the pains and penalties ofperjary that the information provided above is true and correct Sign 4 p Date: Phone# SDB�ZOd—DJS� [6. rkial use only. Do not write in this area,to be completed by city or town OffMW ity or Town: Permit/License# suing Authority(circle one): Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector S.Plumbing Inspector Otherontact Person: Phone#: �",' nice of La nsumer Arfa�rs S Ausiuess Regulation License or registration valid for individui use only e OFAE IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 16861E Office of Consumer Affairs and Business Regulation Typ'` 30 Par Plaza-Suite 5370 _ Expiration: 3118)2017 Supplemerl :anj POWER HOME REMODELING:GROUP LLC. Bo 0D'' 1fl6 kt 1 MARK MORDINI !r 2.501 SEAPORT DRIVE STE-Elio CHESTER,PA 19013 — k Undersecretary of valid without signature _ Massachusetts Department of Public Safety -` Board of Building Regulations and Standards License:CS-057645 Construction SupQrvisc,r a ¢j rtv Ydf .r. � MARK E MORDINI., { _ 18 NEWELL DR N ATTLEBORO 1��_/l"'"�- '✓�- Expiration: Commissioner 091188-017 w , F 'NA'r11.EBUfFtDUGN IW16Zfib0- b � r about:blank 't y�drt-. a S'^g''�' aawt'.:. ak-Ua' r Yi9 NATIONAL HEADODARTERS Dominic and Lauren Donadio , 2801 Seaport DrNC Ctresk6r.tN 19013 , POWER 37-72712 Novemf)Or 04,2015 �yt X888-REMODEL Ile s1,11itgb IPen '^Y AIA HICl 169816 � 1 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyeltl,wormseon and Dowdi lotr of"M Property: Project Number:31-75752 November Oe,tots 15, Dominic Doneelo °s1idApr�'"'" Ati Lauren Donedio (Tet)307.2990(Leunnt 0e9) du xftu!6 eJr o P; 10 Peter Se (976)3049170(Dommc9 Ce0) Salem.:E 01970 (617)310,7600 minic T600(Oo5 NbAd County:Essen �y hwmehlp: .r,N Buyers)listed abM hereby jointly and severally agrees to purchase the goods and/or services of Paver Home Remodeling Group and Its vendors('Contractorl in accordance with the prices and terms described In this 6 page document and the Product i SPecifiCetions,which ere Incorporated as part of fire Agreement(coilecgvely.this'Agreement°). This Agreement represents a cash ,I sale of goods and services. Buyer(s)agrees to pay the cost of the goods and services purchased as described herein,regardless of t timing or approval of any financing Buyer(s)may seek for their purchase. Purchase Price: $78,709.06 Pre Installation Inspection Dates: Dam Payment: $11,08 tie,1tn2 ed.m.Mp ane amp Balance,Due on $15,100.06 Estimated Project Siert:3 to 4 weeks sdbslerrom Completion; EaBmsled Project Completion:I to 2 days e Method of Payment: ONer amrtUr w9,maa.aae xM UM pompkuon adeen NOr olOnevmn.Odaye Contrxmr9 tuned noterL,tletl YrtsloJm'v,0 tune hmaa Sas DelayN�n Caneltlmu. r1 Buyer(s)hereby admOw dgea receipt of a COPY of are pamphlet,"The Lead-Safe Certified Guide to Rerwvete RIghC,informing Wi0 of tire potantlal risk of lead hazard elglosum from renovation ac"to be performed In or at Buyer(s)'Property,at the :< above.Buyer(a)received this pamphlet on the date of this Agreement,before commencement of wodc Buyw(s)'Inalals. :S This Agreement constitutes the entire agreement and understanding between the parties,and this Agreement replaces any and all . r Prior negotiations,rePres00e0ons,Of agreements,either written or oral. No ameMment,modification or walvar of this Agreement ahafi be valid or effephre unless In wrung and signed by both parties. Buyer(s)hereby acknowledges that Buyer(e)1)has mad the ° enttre Agreement and has received a conlPimed,signed,and dated cop/of this Agreement,Including the two accomparrying Notice of Cancellation forms,en the time firs written ab�o a and 2)was orally Informed of his/her right fo cancel this transaction. Buyer(s)also agrees and umlerseMs that If Buyer(6)finances the work with a third-PartY,the terms of that financing will be f contained on separate documents,Including any finance charge. Future promotion not appik". ' I NOT&GN TIM AGREEMENT IF THERE ARE ANY BLANK SPACES, A � 5" f Grou rMd LM Mak-edmteh page olMpBpop apraemerd. 1/04/15 1!04115 WO'v` M11AWJS ;RertkodeYfq Consultant Signature Signature x .„ � -' Neta DomiNc Donadlo Lauren Donadlo f 14Ly THE MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF ®1 NE page 1 Of B 1 of 1 11/13/2015 12:50 PM .r NATIONAL HEADQUARTERS Dominic and Lauren Donadio 2501 Seaport Drive,Chester, PA 19013 ,� , 'POWER 31-75752 - .y - November 04,2015 888-REMODEL .. .. ... MA HIC#168616 PRODUCT SPECIFICATIONS Buyer(s)'Information and Description of the Property: Project Number: 31-75752 November 04,2015 Dominic DonadioDate or Agreement Lauren Donadio (781)307-2930(Lauren's Cell) @y domdnd ahoo.com 10 Peter Rd (978)3043170(Dominic's Cell) E-Mail Address a Salem,MA,01970 (617)389-7600(Dominic's Work) 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 Thu 11/12 between 2:00p and 3:00p. 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 ). 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 rap 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) 111/04/15 /11/04/15 /11/04/15 Signature of Remodeling Consultant Signature Signature Daniel Abate Dominic Donadio Lauren Donadio 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 04, 2015 21:10 VIII (IIIIIIII II I IIIIII IIIIIIII II IIIIIIII Page 1 of 2 NATIONAL HEADOUARTERS Dominic and Lauren Donadlo • 2501 Seaport Drive,Chester,PA 19013 'POWER 31-75752 November 04,2015 888-REMODEL .. .. ... MA HIC#168616 Project Specifications Roofing: Whole House 1 1625.0Sc1.0' ROOFING: Models GAF Styles Architectural Shingles Types None Configs None OPTIONS: Color Biscayne Blue I Removal Standard Shingle I Installation Details None coaPoannoN Biscayne Blue r t� e4 r * #1 Oil �r x ®1►�-� �/ Aerial Measurement November 04, 2015 21:10 IIIIIIII 1111111 IIIIIIIIIII IIIIIIII (IIIIIIII Page 2 of 2 ---- 1 POWER-1 OP ID:EL ,d►coRO` CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODfYYYY) 09111/2015 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(les) 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 PHONE FAX Lacher Insurance Group AIC No Eat:215.723-4378 AIc Ne: 215-723-8604 632 E Broad St P O Box 64398 E-MAIL Souderton,PA 18964 ADDRESS: Chad Lacher INSURERS)AFFORDING COVERAGE NAIC9 INSURER A: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 INSURER D: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. /NSR TYPE OF INSURANCE ADSL SUER POLICY EFF POLICYNUMBER MMIDD/YYYY MM LICY EXP TR IDDIYYVV LIMITS A n0MMERCUU-GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE 1K OCCUR MPA00000089793N 10/01/2015 10/0112016 PREMISES Ea RENTED $ 1,000,00 MED EXP(Any one person) $ 15,000 PERSONAL B ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY�JECDT F LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 Ea ac 1dent B X ANY AUTO BA 00000089796N 10/01/2015 10/01/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOSAUTOS 1,0 OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Peramtlent 8 UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 5,000,00 C X EXCESS Lw6 CLAIMSMADE CMB00000089794N 10/01/2015 10/01/2016 AGGREGATE $ 5,000,00 DED RETENTIONS $ WORKERS COMPENSATION X PER R AND EMPLOYERS'LIABILITY STATUTE ER D ANY PROPRIETORIPARTNERIEXECUTIVE YIN 201500-66-20.96-7 10/01/2015 10/0112016 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 Ues,ReaCme under SO IPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 11,000,010 B Mass Auto BA 00000018227P 10/01/2015 10101/2016 Auto Liab 1,000,00 B NY Auto BA 000000748498 10/01/2015 10/0112016 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD tot,Additional Remarks Schedule,maybe 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 AUTHORRED REPRESENTATIVE 120 Washington St /��p , '.Z�ep�g/�. Salem,MA 01970 `— C" ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD