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23 RAYMOND AVE - BUILDING INSPECTION �7 Pe 1 Apr S�, � r/► � Esc 6�����, b� 2- F The Commonwealth of Massachusetts CITY OF ' 35 Board of Building Regulations and Standards SALEM Massachusetts State Building Code,780 CMR Revised.thar 1011 Building Permit Application To Construe% Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building"Permit Number Date p hed Building ORicial(Print Name). SiLTature Date SECTION l:SITE INFOMMATION ' 1.1 Property address: 2 AssesSorg Map&Parcel Numbers I�V-dl ° a3 ��, m� 1. 1.1 a Is this an accepted street9 yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District °'Proposed Use Lot A=(sq tt) ,. Frontage(R) 1.5 Building Setbacks(R) Front Yard Side Yards - Rear Yard Requiatl - Provided Require!Outside Provided . Required Provided " 1.6 Water Supply:(M.G.L c.40,§54) L7 Flood Zmation: 1.8 Sewage Disposal System: Public O Private O Zone: _ Flood Zone? Municipal O On site disposal system ❑f es0 SECTION 2: PROPERTYOWNERSHIPI z.1 owner'orR 2fef ,z/t� 10./ ItiiA p (q >D me(Print) City,State,ZIP No.and Street _ Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)' New Construction O Existing Building❑ Owner-Occupied ❑ 1 Repairs(s)&L7 Alteration($) ❑ Addition O Demolition ❑ Accessory Bldg.13 Number of Units_ Other 17 Specify: Brief Descript' n of Proposed Work-- n s r +)� r SECTION 4: ESTIMATED CONSTRUCTION COSTS hem Estimated Costs: Oftieial Use Only Labor and Materials I. Building $ �7(y I, Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ - p Total Pioject Cost.'(item 6)'x multiplier x 3.Plumbing $ 2?s Qther Fees: $ 4.Mechanical (HVAC) List:Lisi: a 5.\lechanical (Fire 5 'rotaI`All Fees:S' ' p Suppression) - - Check No._Check Amount: Cash Amount: 6.Total Project Cost: 3 t�� 7U (3 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) QV Y 71 5— 3 ✓ao7s�� D\1 � j G'- �P �� License Number Expiration Date Name of CSL 1101961 ' n _ T List CSL type(see Below) No.;rad Strect ` .Type. • Description, p` U Unrestricted(Buil in no to 35.000 cu.-It. R Restricted 1&2 Family Dwelling Cityfrown,State,ZIP N Masomy RC Roofing Covering WS Window and Sidina SF Solid Fuel Burning Appliances / 1 Insulation Telephone Email address D Demolition `' "" 5.2 Registered 1 orae Improvement Contractor(HIC) a d7 3 <�-3"Y ✓n HIC Registration Number Espimtion Date H I Cum an arae o I I IC Re ' Ira t Nawne b 4�p �f to0(!k No.and Sued,,,, W S b d�s ,Ib(-��q`ay?a Email address' City/Town,StateZIP- %Tel e hone SECTION 6:"WORKERS'.COMPENSATIONINSURANCEAFFIDAVIT(M.G.I:c 152.§2$C(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...........❑ SECTION 76:OWNER AUTHORIZATIONTO BE.COMPLETED.W HEN OWNEIE'SAGENTORCONTRACTOILAPPLIE 'FORBUICDING.PE"I1T 1,as Owner of the subject property,hereby authorize t9 act on my behalf,in all matters relative to work authorized by this building permit app ication. F X /J Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW 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 accurate to the best of my kgowledge and understanding. ' [MGH< Vm x :te e c44, Print Owner's or Authorized Agent's Name(Elecu6nic 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 Trot have access to the arbitration program or guaranty fund under 1I.G.1,.c.'142A.Other important information on the HIC Program can be found at ww wmass eov'oca Informatiotron the Construction Supervisor License can be found at w,ew.nta,sov!Jns' 2:` When substantial work is planned,provide the information below: Total fluor area(sq. R.) N .(including garage,I'mished basementlattics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces ' Number of bedrooms Number of bathrooms Natuber of h:d f/ballis 'rypeorhentingsystem - _r_ Number ofdecks/porches 'rypeofcoolingsystel EnclosedOpen 3. `rural Project Square Fooiage"may be substitutcd lar"Total Project Cost" z , QTY OF SALEK MASSACHLNEM Bug Dnlc DEPARTAzNT 120 WAS}MCTONS7REET,3"RLOOR nL(978)745-9595. FAX(978)740.9846 i.LIIvJBERLEYDRISOt�LL MAYOR THWAS STREM DntECroR op ptzucrRorER7Y/BtnDn1G mmmissiomR Construction Debris Disposa/Affidavit (required for all demolition and,renovation work) in accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL c40, S 54; Building Permitil is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in: i7k-,O Jvx-rs� (name of facility) S h'''- z bvrZ A,4 (address of facility) C 44 c-.,1 c, Sign ure of applicant ) 1 ` Date CdepaFftlen o,fgdaWidAee€deet& ecce Qf IfiWa-Ellof€dP)w 630 Wes?zazearfam street Boszosar PILL 02122 :.•,—� :°JrP7F"J._332�a^Se�-F37�rti2ff COMPel?asai?€e10-1185aramee Affidavittae �/�l?1��11ae�t3a�8 esnabasl��l��c§ ���scase ©e2ds� — plelase Mat 1I�-'o[ryl 1\Tarne(13usincssl0m-anizatiaailndividuai):-9014Pi beano-k /— Al✓33'k,e— !t ddress: q®g 6 e 54c;,As fi 6A—P, Chy/State%ip:��Teu9s/�vrr�, c v eJS`r.5- Phoneft: F.re you an emglovcr?C'secft the approgriate hos: Type of Project reg_ -ned): I. 1 am a employer nidi 4_ Eff I am a general contractor and I employees(full and:=or part-time)' have hired the sub-contractors 6- New construction 2. I am a sole proprietor or patmer- listed on the attached sheet t 7_ Remodeling ship and have no employees These sub-contractors have :._ Demolition viorkina for me in any capacity. workers'comp_insurimm 9_ Q Building addition [Mo Workers'comp_insurance 5- ❑ We are a corporation and its required_] officers have exercised their I O.C]Electrical repairs or additions 3.Q I am a homeowner doing all work ri`ht of exemption per NGL II.[]Plumbing repairs or additions myself[No workers`comp_ c. 152.§1(4),and we have no a[]Roof repairs insurance required.]1 employees_[No workers' 13XOther comp_insurance require&] `•;\ny applicant th.checks hoc d l must also fill as thcs tion beloarsitaw a their%%wkcrs'compensation policy mformtion_ 110mumncis who whmit this affidavit indiraffi=_they aiedomgall Hurl:and then hhcoutvdeeaoanetoa rmstsubmitanerratridmltmdiMungsuck ' -CnntMIOM that check this bac mastanadied anadditiotnl sbeet sbotvmg the name of thesuh-camraclois and theinvmkeis`comix policy ioronrmiwL rr rtz ei-,rt�7aPer flret is pfnr eng rvarfte:�'compens¢riarz Fnsr!ra:zcejor may.e-.rplaVees_ Below is fire pormy az,1 job site irjoe:rc¢iZRit_ n ,� j - �. instuanceCompanyName- J-V`�� Gry�f`Jhie -5 . _ O _ g Policy y or Self-ins-tic_ _ka G -3 Expiration Dare: 3 Job Site Address: Rayer j Ale _ CiylState/Zip: SCc,1'rM �Sd Attach a copy of the woritms'compensation policy deeiaraJon page(showing the policy aumbe.ane expiration date-- Failure ate-- I ailure to secure coverage as requited trader Section 25A of MGL c_ 153 can lead to the imposition oFcriminal penalties of a fine up to S 1,500.00 andior one-year imprisonment as well as civil penalties in the forret of a STOP WORIC ORDER and a fine or up to 5350.00 a day against the violator_ Be advised that a copy of this statement may be rorwarded to the Of of Investigations ofthe D1A for insurance coverage venfication- f do hereby cer�iiT gide,rpe pahts 9dPen¢dries of Pei7t^>tit the info,Madon provided above is&ae me comets SirJiature: rIIA �lLDate: Plroneel: &-2)0 . ,Ql,weeal ase aiioL Do rat wi-LL,iR&iS area 10 be£Jjaplered by&0,or,sown o iCILr e..flty or Town: ?er:T.rwucense# Issuing Autlio,:c r(circle one): r.Board of ki-c2IM r.Btiitd'tng i')epat tment 3,C,ityffawa cle_rfr a Irie saI 7nspetbor 9.Plurnb sasttec5as u.Otber Coatact.person: nonep v— mmms THIS CERTIFICATE IS ISSUED AS A MATTER OF WFUfMTION ONLYAND CONFERS NO RiG}HTS UPON THE CERTI47CATE HOLDER.THIS CERTIFICATE DOES NOT AFFlRMATNELy OR NEGA-nVELY A{IVEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES \ BELOW. THIS CERTIFICATE OF WSURANCE DOES NOT CONSTITUTE A CONTRACT BEIVVEBV 'DHE ISSUING WSURER(S).AUTHORED . REPRESENTATVEORPRODUCER,ANDTHE CERTFCATEHOLUM IMPORTANT_ If the ce cafe holder is an ADDITIONAL BLLSURED.the vo6evC1':11)a 'Ust he endo sed. H SUBR011ATIOAI IS VIDWsobjea to me leek and conditions orthe poncy,oeriam pOncUasmay re lieween endorsement A'statement on iris .rra..91e does not Center rights to the certificate holder in Jim Of such endomement(s). PRODUCER CONTACT MARSH US0.V4C. TWOALUANCECBM Rat FAX 3550LE40XROAD suREvell [All–Nor ATLANTA.OA III ADDRESS: ORII AR2RDWGCOVERACE NA1CL 1 HDmeD-GAN-15.16 wSUREI SI�DIas[I�DeC®Dpuy 2./ INSURED Z=AoWftnlDadaDD@Op n+Dar-HDraEsalvlcEs Mc. wsuAera: tis OBA THE HOME DEPOTAT-HOtdE SERVICES INSURENC:NwHargumm eCD 23891 ATLANTA. NTA.CUMBERLAND PARKWAY.SIA�3D0 NlsuRet D:DmdsNetaDal lDaDalaeCm�y ATLNTA,Cq 30339 23917 IINSURWI MSUNRR P: COVERAGES CERTIFICATE NIII ATL43M242695D9 REIHSION NUM661:T I THIS Is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUm TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO IRWTHSTANDING ANY REQUIRENMr.TOM OR CONDITION OF ANY CONTRACTOR OTHER OOP AED CERTiFiCATE NAY as r,mI OR tippy PeFrn,,L T'1E03M WATIA[T6aPECT m V&MOtr1'StTO EXCLUSIONS AND CONDITIONS OFSUCH POLICIES-LWDTS SHOVNJMAYj{p AFFORDED BY PAID(9.AOOg. �N�s TO ALL THE TERMS, NSR LTR TYPE OFIRSIIRARCE am wwo PDUCYRD96ll32 OLMYEFF EW T oENaRwLLlnenlrr GL0968)Tfn.�rs munmym NIwrAl5 ORMI 116 ERCH OCCURRENCE s BMUM X COMMERCUh.GENERALUARIUTY PREER$ arammQ 5 1,OOLLOW I cuhaslaADE aoccuR UtAi'SOFPOUCYXS NEO E7W(Atgma pDyoO s EXCLUDED OFSIIt SIN PER OCC PERSONALaADVOOURY $ eetaBewt Asr-d1EGwTE s 9AOD.OW G�IJLAGOREOATE URtITAPPUES PBY. PRODUCTS-COMPIOPAGG S 20D0.00D X POLICY n JE I ILOC 5 B au7oMO61LE uARtLRY I RAP 7938963-12 010=15 MID12D16 CONfin® LR21r 1�� _ X ANYAUTO ;-1EDULED SODh.YWA1RY -- AUTOSN"D I IA 3 SHFW6UREDAUTOPHYDMG somynawtPeraoddem 5 HIREDAUTOi � T wUTO9�E 5 s H UAIE LI I OCCUR I EACHOCCURRENCE S EXCESSS6LIAS N5 Ij-IS CIARISIMOE pmoNS AGGREGATE S OED (COMPENSATION C AND EM L YER&ISATON - W(,MM1493 03MM15 6 WCSrATLL OfN- S D AND EAPLOYEORPA rNO ANY PRDPRIETOR?ARR UTNE YIN WC01T1374%(AK,KY;NH,NJ,VI) 03NiQD15 031018076 HLERQIACCMBU s 1,RW,D00 D OFRCERIMEMSER H)F..CWDED'/ NIA Iayyae¢ndag In NH) tnXiUT31484(Ra 03I012ot5 03DIQ016 PVD _Er s 1.DD0.DOD DESCRISPTIOR OFOPMMOrSbNaN CamTDadmlA page 1,WD.oDD - ELDb,rA.4e-POIICYLDAR 5 DESCRIPTION OFOPERATONEI LoCATIONSIVERUCLES(AAednACORDII".AdMand RemMh.SdmdA➢RRamespmhHequllel) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD ESERV DBA THEHOMEOEPDTAT-HOMESEAVICES - SHOULDANIrOFTI@ABOVE DESCRBWPOLMMSECANCELLED BEFORE THE EXPIRAI DATE THENBO , NOTICE WELL BE DEWBt® DV 2455 PACES FERRY ROAD - ACCORDANCEIVIM THE POLICY PROVIMOME, ATLANTA.DA RD339 AUTHORIZED RWRESENTATVE DIRlalsh USA IDG I Mamahi Mo8hedee _]A1L.Au bz o9B86-2D1D AcoRD CORpomnow AB rights Ems. ACORD 26(2010105) The ACORD name and logo ate legisteered maths orAOORD Office of Caflasilnaer Affairs and Business regulation =, C 10 Park Plaza - Suite 5170 Boston, M4ssachusetts 02116 Home 1flnprovempi6:,q®YltY'aCl®fl Regbsttati®n iiir•ti•�..`.`F�•• °•!:i;;;,:`S'' Registration: 126893 ✓ "' •' "` Type: Supplement Card THD AT HOME SERVICES INC. :';;'t;i:::'i ""'' expiration; 6/312016 MARK NIADNA ;- ----...------ 2690 CUMBERLAND PARKWAY SUITE" .QO.'''r;:' — ATLANTA, GA 30339 ;;;:; Update Address and return card.Mark reason for change. SCA 1 t; 20M•05/11 LL] Address I 1 Renewal O Employment [:I Lost Card 4:%/r Y ninnraurnrvr//�r%r�%(rr.�rrr/rar.Nr ^wr1 Ofliee of Consumer Atarhs 1&flusinces[tesumdonI ki License or registration valid for individul use only before the expiration date, if found return to; OMEIMPROVFrMENTC6NTRACTOR P f�•�j Office of Consumer Affairs and Business Regulation Registration:;.126893• Type: Y0ParkPInza-Suite SY70 ems' Expiratippyi6r9%20,1.11. Supplement Card Roston,MA 02116 THD AT HOME SERV.CE$;,INC' , THE HOME DEP6P AT.6 . ,P'AERVICES ` MARK NIADNA ';`.YL;!P 2690 CUMBERLAND PARKWAY S 411_1e_. Orn,l� r^ A l`AI'�rA,OA 30339 • Uuderseeretnry Apt valid without sigesture j I i I � I t Sold,Furnished and instilled by: Branch Name:Boston North&South Dater/_q 2(J t THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services Branch Number:31 and 33 908 Boston Tumpike,Unit 1, Shrewsbury,MA 01545 Toll Free 877-903-3768 Federal ID#75-2699460:ME Lic#C 02439;RI Cont.Lie#16427 CT Lic#HIC.0565522;MA Home Improvement Contractor Reg.# 126893 Installation Address: e. `�^�IF) &1 ,0 A `�A tA—_r-A I IVA" AI t47 j City Zip Purchaser(s): _ Work Phone: Home Phone: Cell Phone: --r Home Address: (If different from Installation Address) City State Zip Fkmjtit"Addres,s(to receive project communications and Home Depot updates): 71�RGA116) ,1 sf I Ly�L I.A1Q,f(X) O NOT wish to receive any marketing emails from The Home Depot ^n n n D�- r/- " I �- � Project Information: Undersigned("Customer"),the owners of the property located at the above i st anon address, grecs to buy, and T14D At-Home Services, Inc. ("the Home Depot") agrees to furnish, deliver and arrange for the installation("Installation") of all materials described on the below and on the referenced Spec Shect(s), all of which are incorporated into this Contract by this .reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders (collectively, "Contract"): Job#: a.w.:d tts rear Products:' Sec Sheets #: PWle Amount ,�s-., ❑Roofing 11iding LJ Windows LJ Insulation ❑Gutters/Covers ❑Entry Doors ❑ ❑Roofing ❑Siding El Windows Insulation ❑Gutters/Covers ❑EntryDorns EJ_ $ - Roofing OSiding ❑ Windows ❑ Insulation ❑Guam l Covers ❑Entry Docs❑ $ ❑Roofing ❑Siding LJ Windows ❑ Insulation ❑Gutters!Covers ❑Entry Doors ❑ $ Minimum 25%flepositofContract Amomrtdue upon executionofthis contract. Total Contract Amount $ Maim:Purchasers may not drposit mom than one-third of the ContractAmount I 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 balance 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, i f The Home Depot or its authorized service provider determines that it cannot perform its obligations due lou structural problem with the home, environmental hazards such as mold, asbestos or lead paint, other safety concerns, pricing errors or because work required to complete the job was not included in the Contract. r Payment. Summarv: The Payment Summary #__ j l' 44`r� a included as part of this Contract, sets forth the total Contract amount tmd 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 listed Product as defined.by individual Spec Sheets)before work on that Product 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 or termination, phis 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 LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and Installation services and supersedes all print discussions and agreements, either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or arnended except by a.writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read, understands, voluntarily accepts the terms of and has received a copy of this Agreement. Accepted by; Suby: bmit a X 7r7�.. I AA,!f ;9��- r /1 y lig' X _� t4, toCustor6er'sAmaltire U Date /— Sales Consultant's Sig tare p Dale X Telephone No.. � ZM 5 ( 4 ik Offirc of Qmsumcrt firs Business Regulation ,-HOME IMP EM TCONTRACTOR Regis ton: 0516 Type: -`' Expiratio 016 Ltd Liability Cntpo: BETTER BUILT ERPRISES LLC EVANGEL S LIAPIS 100 CUMMINGS CENTER SUITE Z KVIERLY,MA 01915 Ondetseeretarc f�f Massachusetts -Department of 7ubiiG Safety Boarof Ruii;tirr 0 Hnguicions ,and 3=:,t>.C1u M. License: GS-084795+ EVANGELOS LIAPIS 12 STONE STREET = r..- DANVERS MA 61923ez ` N � I ,l`N Expiration Cn nm� ssicner 05113/2017