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B-19-871 - 0008 ALBION STREET - Building Permiti -7 p cK ! 3a 3y The Commonwealth of Massachusetts is. k n Board of Building Regulations and Standards "CITY'OF Massachusetts State Building Code,780 CMR ^; 3 � �UG 13 Avidll ar 2011 Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only V Building Permit Number: Date pp ied: V I �f�y 1 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Proper 9 A dress: 1.2 Assessors Map&Parcel Numbers L,glbu a, (� 1.1a Is this an accepted street?yes no Map Number Parcel Number �!1 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dishict 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? Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 flilnerl of R ord: ° Feuza fALrFM M w 01g1b Name(Print) . NTp3 City,State,ZIP —Al�le�ll Si- 9 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Building Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: Brief Description of Pry os W rkz: 5�m 1„I 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: [IStandard City/Town Application Fee $ 2.Electrical ❑ Total Project Cosr(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ �� r 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ��q 0 Paid in Full 0 Outstanding Balance Due: i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) D r 6 y r ,!8 ' , License Number Expiration Date Name of CSL older � List CSL Type(see below) V No.an Street 17' W Type Description 0i � RiW U Unrestricted(Buildings LIP to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Mason ry RC Roofing Covering WS Window and Siding SF I SA -AD- D ( Solid Fuel Burning Appliances Insulation Telephone Email address D Demolition 5.2 Registered Ho a Improvement Contractor (HIC) 3 •Dia�►�t Ylr�►�, nnr��,it�l� H ��or HIC gistrant Name HIC Registration Number Expiration Date C(-'omp Name N °d Street rt � 110 Email address Cit !Town,State,ZIP )) 1,! 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 IssuTX of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize � � MVILDIA-1 I to act on my behalf,in all matters relative to work authorized by this building permit application. `{x' Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby a s and the pains and penalties of perjury that all of the information contained in thus application is true an a ura t the best of my knowledge and understanding.Print Owner's or Authorized Agent's Name(Electroni cVSignature) 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 w.111ass.soV ioca Information on the Construction Supervisor License can be found at wivAv.niwqsj.1ovidpq 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" f ' CITY OF SALEK M�SSAMLJSEM BunDrNG DEPARnaNT 120 WASHI NGTON STREET,37D Flom ni-(978)745-9595 FAX KDMERLEY DRISODLL (978)740 9846 MAYOR THOMAS STMERRE DIRECTOR OF PUBLIC PROPERTY/BUIIDING COMOSSIOMR Construction Debris Disposal Affidavit (required for all demolition & 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,S54;Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licenses waste deposit facility as defined by MGL c 111,S150A. The debris will be transported by: C-L (name of hauler) The debris will be disposed of in: ..L 4I ' J Oar S (name 4 facility) (address of facility) qA .OA Signature of applicant (today's date) i p n The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations i I Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print.Leaibl Name(Business/Organization/individual):Power Home Remodeling Address:2501 Seaport Drive City/State/Zip:Chester PA 19013 Phone#:508-280-0156 Are you an employer?Check the appropriate box: men Type of project(required): 1.0 I am a employer with ❑30 4. I am a general contractor and I employees(bill and/or part-time).* have hired(lie sub-contractors 6. New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no employees These sub-contractors]lave R. Demolition working for me in any capacity. employees and have workers' con insurance.$ 9• ❑Building addition [No workers'comp.insurance P• required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL l ❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box ffl must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing it.work and then hire rnrtside contractors must submit a new affidavit nidicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am tin employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Harleysville Worcester Insurance Company Policy#or Self-ins.Lie.i4:2018006620967 Expiration Date:10/1/2019 Job Site Address: City%State/Zip: ► LC-M m Attach a copy of the workers'compensation 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$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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi nd r t e ains and alties o •er u that the information provided above is true and correct. Signature: 4 Date:' Phoni:#:508-280-0156 Ojficial 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): LL6_ ther (Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5..Plumbing Inspector O ontact Person: Phone#: r ;aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) �./ 3/20/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE [,)DES 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 have ADDITIONAL INSURED provisions or 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 endorsements. PRODUCER CONTACT NAME: Lacher&Associates Insurance Agency PHONE 215-723-4378 Alc No:215-723-5757 Lacher Insurance Group E-MAIL 632 East Broad Street ADDRESS: lacher lacherinsurance.com Souderton PA 18964 INSURERS AFFORDING COVERAGE NAIC# INSURERA:Pennsylvania Manufacturers 12262 INSURED POWERCL-01 INSURER B Power Home Remodeling Group, LLC 2501 Seaport Drive,4th Floor INSURER C: Chester PA 19013 INSURERO: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:375895116 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBER MMIDD MM/DD YY A X COMMERCIAL GENERAL LIABILITY 6620967301975 4/l/2019 4/1/2020 EACH OCCURRENCE $2,000,000 DAMAGE TO_7CLAIMS-MADE F OCCUR PREM SES EaENTE occurrence) $1,000,000 MED EXP(Any one person $10,000 PERSONAL 8 ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 X POLICY C.I PE� LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ A AUTOMOBILE LIABILITY 151800-66-20-96-7 10/1/2018 10/1/2019 COMBINED SINGLE LIMIT $1,000,000 (Ea, a accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONI-Y AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONI.Y AUTOS ONLY Per accident I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION 201875-66-20-96-7 10/l/2018 10/1/2019 X PER OTH- ANDEMPLOYER,�LIABILITY Y/N STATUTE ER ANYPROPRIETOF�t/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBE R EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Salem ACCORDANCE WITH THE POLICY PROVISIONS. 3rd Floor 120 Washington St Salem MA 01970 AUTHORIZED REPRESENTATIVE USA �� " ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts %fr %r..ririrrr rf/r�.alas rrr�. � Division of Professional Licensure Board Of Building Regulations and Standards Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Constr.U..!•t1'66:lSi p4,-rvisor TYPE:Sgoolement Card Registration Expiration CS-057645 Expires 09/18/2019 168616; 03/17/2021 POWER HOMEREMOD,ELING GROUP LLC. 7.V� MARK E MORDINI. 18 NEWELL DR, Nl3RTH ATTLEBO_RO.MA 02760: MARK MORDINI 2501 SEAPORT DRIVE CHESTER,PA 19013 - Undersecretary Commissioner Construction Supervisor Unrestricted-Buildings of any use.group which contain less than 35,000 cubic feet(991 cubic.meters)of enclosed Registration valid for individual use only space. before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 1000 Was ' ton Street-Suite 710 Bosto A 118 Failure to possess a current edition of the Massachusetts of vali Without Signature State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.rriass.gov/dpl . y f National Headquarters Eliza Santos and Henry Aguilar 2501 Seaport Drive,Chester,PA 19013 34-08328 888-736-6335 August 12,2019 WWW.POWERHRG.COM -- CUSTOM REMODELING AND IMPROVEMENT AGREEMENT MA HIC#168616 Buyer(s)'Information and Description of the Property: Project Number:34-08328 August 12,2019 Eliza Santos Date or Agreement Henry Aguilar (857)991-8207(Eliza's Cell) esantos84.es@gmail.com 8 Albion Street (617)918-3916(Henry's Cell) E-Mail Address 1 Salem,MA,01970 hdaguilarl416@gmail.com County:Essex - E-Mail Address Township: Buyer(s) listed above hereby jointly and severally agrees to purchase the goods and/or services of Power Home Remodeling Group and its vendors("Contractor") in accordance with the prices and terms described in this 6 page document and the Product Specifications,which are incorporated as part of the Agreement(collectively,this"Agreement"). This Agreement represents a cash sale of goods and services. Buyer(s)agrees to pay the cost of the goods and services purchased as described herein, regardless of timing or approval of any financing Buyer(s) may seek for their purchase. Purchase Price: $10,509.91 Pre Installation Inspection Dates: Down Payment: $0.00 Estimated Project Start: 3 to 4 weeks Balance Due on $10,509.91 Estimated Project Completion: 1 to 2 days Substantial Completion: Buyer(s)acknowledge that a definite start and completion dates are NOT of the essence. Delays beyond Method of Payment: Other Contractor's control not included in calculating time frames. See Delay/Unknown Conditions. Buyer(s) hereby acknowledges receipt of a copy of the pamphlet,"The Lead-Safe Certified Guide to Renovate Right", informing Buyer(s)of the potential risk of lead hazard exposure from renovation activity to be performed in or at Buyer(s)'Property, at the address written above. Buyer(s) received this pamphlet on the date of this Agreement, before commencement of work. (:�Z Buyer(s)' Initials. This Agreement constitutes the entire agreement and understanding between the parties, and this Agreement replaces any and all prior negotiations, representations,or agreements, either written or oral. No amendment, modification or waiver of this Agreement shall be valid or effective unless in writing and signed by both parties. Buyer(s) hereby acknowledges that Buyer(s) 1) has read the entire Agreement and has received a completed,signed, and dated copy of this Agreement, including the two accompanying Notice of Cancellation forms,on the date first written above and 2)was orally informed of his/her right to cancel this transaction. Buyer(s)also agrees and understands that if Buyer(s)finances the work with a third-party,the terms of that financing will be contained on separate documents, including any finance charge. Future promotions not applicable. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. I have read and received each page of this 6 page agreement. Pow Sr Home Remodeling Group t Buyer(s) Buyer(s) /08/12if19 /08/12/19 /08/12/19 Signatur `. f Remodeling Consultant Signature Signature Amy Carroll Eliza Santos Henry Aguilar YOU,THE BU'YER(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. August 12, 2019 22:12 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Page 1 of 6 I National Headquarters Eliza Santos and Henry Aguilar 2501 Seaport Drive,Chester,PA 19013 34-08328 888-736-6335 August 12,2019 WWW.POWERHRG.COM MA HIC#168616 -- PRODUCT SPECIFICATIONS Buyer(s)'Information and Description of the Property: Project Number:34-08328 August 12,2019 Eliza Santos Dateo/Agreement Henry Aguilar (857)991-8207(Eliza's Cell) esantos84.es@gmail.com 8 Albion Street (617)918-3916(Henry's Cell) E-Mail Address t Salem,MA,01970 hdaguilar1416@gmail.com County:Essex E-Mail Address 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 Fortitude 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 and chimney crickets 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 320 square feet of soft or rotted roof decking if needed on steep slope applications. Any additional wood replacement needed,over and above the 320 square feet we provide will be done at a cost to the homeowner of$3.57 per square foot. For Example:After the shingles have been removed, if we find there is a need to replace 345 square feet of wood, Power HRG will pay for the first 320 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,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) 4 /08/12/19 /08/12/19 /08/12/19 SignatureMf Remodeling Consultant Signature Signature Amy Carroll Eliza Santos Henry Aguilar 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. August 12, 2019 22:12 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Page 1 of 2 National Headquarters Eliza Santos and Henry Aguilar 2501 Seaport Drive,Chester,PA 19013 34-08328 888-736-6335 August 12,2019 WWW.POWERHRG.COM MA HIC#168616 Project Specifications Roofing: Whole House 1 1300.0'x1.0' ROOFING: Moclels GAF Styles Fortitude Types None Configs None OPTIONS: Color Graphite/Removal Standard Shingle/Installation Details None Graphite „ y v " �„ r 0 di y'x �Y 1' i August 12, 2919 22:12 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Page 2 of 2