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28 VALLEY ST - BUILDING INSPECTION f 2 I O G>�. 2q(,© The Commonwealth of Massachus ?_ GIN L r 94`14: ;. Board of Building Regulations and Sta&7rds CITY OF Massachusetts State Building Code, 78 SALEM �d fb tT —5 A !D: 0 3Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling I n This Section For Official Use Only Building Permit Number: Date Applied: ., ., Building Official(Print Name) Signature _ Date SECTION 1:SITE INFORMATION 1 1.1 Property A_ddre$s: 1.2 Assessors Map&Parcel Numbers Lla Is this an accepted street?yes_ no Map Number Parcel Number 13 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'of Record: Name(Print) City,StateCity,State . � Vale,, `t-) 4S-cNIM Awwrer.S;Q �latma;C No.and Street Telephone Emaiil ddress SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Buildin Owner-Occupied Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials a I.Building $ �-7 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ -36,bje-7 ❑Paid in Full ❑ Outstanding Balance Due: (003 - sg3 - a dV)AtLp 10 112- 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) U No.and Street Type Description b3 6LI U Unrestricted(Buildings up to 35,000 cu. ft. R Restricted 1&2 Family Dwelling City/T tate, M Masonry RC Roofing Covering WS Window and Sidin I,, SF Solid Fuel Burning Appliances 5�3- SI t r1 V1H r [V(2ZC/St(Q Lb�VI I I Insulation Tele hone Email ad ss D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1-7"b(0 mn c Cc, �s a'�Wek cam, .� Ll C— Expiration ion Da HIC Co an HIC Registration Number Expiration Date p }'Name bf HiC Registrant Name (-�a� no rAC.r rSS��Aiy_Ie CCC�A,MfO-fin .Cp1yvl No.a d Street �il address --T zmpp; EC0373`l-`� � CitymA,S ,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 .........10�- No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACT''OII ».q R APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize T(ryC_g qe 4A— Pe&,) k""Y 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: 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 pplication is e d accurate to the best of my knowledge and understanding. Print O er's ojXuthoriZed Agent's Na?(e(Electronic Signature) Date 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 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/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 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 heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-106570 Construction Supervisor as KARL H ROGERS 5 GABLE DRIVE EPPING NH 03042 - CA--- Expiration: L Commissioner 0712012018 . ffiee of Consumer Affairs&Business Regulation i'" '-Z --jam,OME IMPROVEMENT CONTRACTOR .Registration:--..175906 Type: Expiration 6/19/2017 _ Supplement C. HOMESCAPES OF NEW ENGLAND,.LLC. KARL ROGERS 5 GABLE DR. EPPING,NH 03042 Undersecretary :��r. �nmureruosa�/�c/Gll,�.'tir�n�c/C; Office of Consumer Affairs&Business Regulation �� HOMEIMPROVEMENT CONTRACTOR I i;Registration: 175906 Type: -- : Expiration: 6/19/2017 Corporation HOMESCAPES OF NEW ENGLAND,LLC. LYNETTE ROGERS 5 GABLE DR. EPPING,NH 03042 -- Undersecretary CITY OF S.UENI. N'IASSACHLSETTS • BUILDING DEPIRntENT 120 WASHINGTON STREET.Yo FLOOR TEL- (978)745-9595 FAX(978)7409846 KINIBERLEY DRISCOLL MAYOR T Homm ST.PtERRE DIRECTOR OF PUBLIC PROPERTY/BUILDMIG CONMISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print ibl Name(Business OrganiniioNlndividual): t 9S�C �JeAA3 6t.l q LLC- Address: f5 G��1z City/State/Zip: (7 � f./1s�030' 1� Phone #: Co-6-3.— 73LI—LI -0— Are yo an employer?Check the appropriate box: Type of project(required): I. I am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7• ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp,insurance. 9. C]Building addition [No workers'comp. insurance S. ❑ We are a corporation and its 10❑Electrics!repairs or additions required.) officers have exercised thew 3.❑ 1 am a homeowner doing all work right of exemption per MGL t LO Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs n insurance required.)t employees.[No workers' 1Other�' r tet. comp. insurance required.) -nnY aPPlicam that checks bms#1 must also fill out the section below showing their worked'onmpenwtion polity infotmaion. *I fonKownas who submit this affidavit indicating they are doing all work and then hire amide contractors must=limit a new affidavit indicating such 1Cuntn cion that check this has must anached an additional ohm showing the same of the=b centm too and their worker'comp,policy infmmution. lam an employer that it providing workers'compensation insarancefor my employees. Below is the policy and fob site information. AA pp Insurance Company Name:. .�"M0Ar _C, Policy#or Self-ins.Lie.#: �/�/C_��)��U71o'(7 Expiration Date: 'I/-;,& //7 Job Site Address: J City/State/Zip:�s� /L[f 6 Li-2 Zj Attach a copy of the workers'compefdation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. He advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. l do hereby cerrh=friltepains td !ties of perfary that the information provided above is true and correct. Signt tr • /V t(/( Date- Phone Oficial use only. Do not write in this area,to be completed by city or town ofykjoi City or Town: PermillLicense# Issuing Authority(circle one): I. Board of Ifealth 2.Building Department J.Citylfown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: CITY OF SMX.Nl, �'L-1SS.kCHUSETTS • BUILDING DEP\RT1ffrT L 130 WASHINGTON STREET, 3m FLOOR TEL (978) 745-9595 FAX(978) 740-9846 KI,,iBERLF-Y DRISCOLL MAYOR THo.%w ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING CON06USSIONF-R Construction Debris Disposal 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 c 40, S 54; Building Permit # is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by:(name of haul The debris will be disposed of in Z _l_0 S ' (name of facility) n (address of facility} sign turer fApermitcant lois /ILS date dcbri>vILJce Homescapes of New England, LcC 6 %" HardiePlank lap siding with HardieTrim Scope of Work to be performed: 1. Tear-off of all existing 11 layer of siding, trim and soffit on house (Except garage wall front & Half round shingles) 2. Inspect walls after tear off to ensure there is no unseen damage, if sheathing is damaged it will be replaced in order to properly install the siding. (additional charge) 3. HardieWrap weather barrier will then be installed on the house. It will be taped and flashed around windows, doors and other openings. 4. Installation of Siding, Trim and soffit Installation 61/4" HardiePlank Select Cedarmill siding- C+ option of Artisan Lap Installation 5/4 x 4" HardieTrim around Windows- C+ Installation 5/4 x 5" Outside Corners HardieTrim —C+ Installation 5/4 x 4" PVC trim around doors—White Installation 4/4 8" Fascia board with 4" rake board HardieTrim —C+ Installation 12" vented and Nonvented HardieSoffit- C+ Installation of z flashing, counter flashing and caulking according to Manufacturers Best Practices 5. Seal up two gable vents where siding is being replaced 6. Remove Gutters & Shutters (Estimated time of completion 2 weeks) TOTAL: 30,067 HardiePlank Telephone 603-734-4282 ♦ www.homescapesofne.com Hbrnescapes of New England, LLC OPTIONS & ACCESSORIES INVESTMENT 1,76-3 SG d, TOTAL -38.1 O SPECIAL ORDER TERMS: 100%OF PRODUCT COST DUE UPON ACCEPTANCE PRODUCT COST: BALANCE DUE AT SUBSTANTIAL COMPLETION BALANCE DUE: STANDARD ORDER TERMS: . 1/3 DEPOSIT DUE UPON ACCEPTANCE 1/3 DEPOSIT: 1/3 DUE UPON JOB START 1/3 JOB START: ( O�;Q .33 BALANCE DUE AT SUBSTANTIAL COMPLETION BALANCE DUE: YOU,THE OWNER MAY CANCEL THIS TRANSACTION'AT ANY TIME PRIOR TO MIDNIGHT'OFTHE.THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEETHE NOTICE OF CANCELLATION CLAUSE BELOW FOR AN EXPLANATION OF THIS RIGHT. ACCEPTED AND AGREED: The prices,specifications and conditions contained herein this Agreement are satisfactory and hereby accepted. You are authorized to perform the work as specked. (MUST BE SIGNED BY AL OWNERS) OWNER: DATE: �� — Z:—, C- OWNER: DATE: AGREEMENT IS WT FULLY EXE UTED UNTIL WED BY A SALESPERSON THAT IS CURRENTLY EMPLOYED BY Homescopes of New England. DATE: Lynette gers Homescapes of New Enalane We at HNE would like to thank you in advance for this opportunity to review and prepare this proposal for your home. We are totally committed to providing"100%Customer Satisfaction"before,during and after your siding project. We have taken pains to make sure this proposal is suited to meet your needs for now and in the future. Please call meat your convenience if you have any questions at all. We look forward to working with you. Yours truly, Lynette Rogers Telephone 603-734-4282 ♦ www.homescapesofne.com Hiomescapes of New England, LLC 30-year warranty on HardiePlank, Hardie5hingle, Hardie5offit, 15 year finish warranty on products with ColorPlus®Technology * 1-Year Warranty on Labor Workmen's Compensation and General Liability Insurance carried - Certificate of Insurance Provided Total Price: $ 30; Nle 71 YOU,THE OWNER MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE NOTICE OF CANCELLATION CLAUSE ATTACHED FOR AN EXPLANATION OF THIS RIGHT. This proposal is based upon current material and labor cost. This proposal may be withdrawn if not accepted within ten (10)days. ACCEPTED AND AGREED: The prices, specifications and conditions contained in this Agreement are satisfactory and hereby accepted. You are authorized to perform the work specified. (MUST BE SIGNED BY ALL OWNERS) OWNER: + DATE: x- 7-6- t J OWNER: �" DATE: AGREEMENT IS NOT FULLY EXECUTED UNTIL APPROVED AND SIGNED BYA REGISTERED OFFICER OF Homescapes of New England. Lynette-Roger,Ownlar Date We at HNE would like to thank you in advance for this opportunity to review and prepare this proposal for your home. We are totally committed to providing 100%customer satisfaction before,during and after your project. We have taken much time to make sure this proposal is suited to meet your needs now and in the future. Please call me at your convenience if you have any questions at all. We look forward to working with you. Sincerely, Lynette Rogers, Project Consultant Telephone 603-734-4282 ♦ www.homescapesofne.com