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B-19-1052 - 0019 BUCHANAN ROAD - Building Permit `�Z8 ck7Z3 7 The Commonwealth of Massachusetts G Board of Building Regulations and StandardsMassachusetts State Building Code, 780 CMR Ninth Edition iBuilding Permit Application To Construct, Repair, Renovate Or Demolish a 1 One-or Two-Family Dwelling Revised Mar 2018 This Section For Official Use Only l� Building Permit Number: Date Applied: 9;23 1 Building Official(Print Name) Signature ) -. Date _ SECTION 1:SITE INFORMATION r ' 1.1 Property AddreJs�s+•yy n 1.2 Assessors Map& Parcel Numbers M s - �'' c-� ram,: l.la Is this an accepted street?yes no Map Number ParceliNumber� 1.3 Zoning Information: 1.4 Property Dimensions: o' Zoning District Proposed Use Lot Areas ft ' ( q ) Frontage(ft) 1.5 Building Setbacks(ft) , Front Yard Side Yards ' r Rear Yard `' Required Provided Required Provided Re aired "' q Provided i 1.6 Water Supply:(M.C.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 Owner of ecord: l� / Name(Print) - /fig[ U 1 7 !g�a City,State,ZIP No,an Street Telephone V —a dress 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 Other Specify:/,J£ATy(s/l i Z,q j j D .11 Brief Description of Proposed Work2:___� S'rA LL A j R, J3AR(? T l b SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials) Official Use Only 1.Building $ VQ —� 1. Building Permit Fee:$ Indicate!how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier:1 x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Su ression) $ Total All Fees:$ i 6.Total Project Cost: $ 3 Check No. Check Amount: ;Cash Amount: �� 0 Paid in Full 13 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Caleb Aho(dba ESE,Inc. ) CS-072316 12/19/2019 Name of CSL Holder License Number Expiration Date 482 Jarman Hill Rd. List CSL Type(see below) U No.and Street Type Description Sharon,NH 03458 U Unrestricted Buildin s UP to 35.000 cu.ft.) City/Town,State,ZIP R Restricted 102 Family Dwelling M Mason RC Roofing Covering WS Window and Siding 603-532-6346 permits@esaverenabler.com SF Solid Fuel Burning Appliances Telephone I Insulation Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Caleb Aho(dba ESE,Inc.) W44ft64�2� HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date 52 Fitzgerald Dr No.and Street permits@esaverenabler.com Jaffrey,NH 03452 603-532-6346 Email address city/Town,State,ZIP Tele hone 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 Issuan a 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 I,as Owner of the subject property,hereby authorize Caleb Aho ,D g,A. T57T ,„J to act on my behalf,in allmatters relative to work authorized by this building permit application. ��q R I lGS 10`£j Zi(please see attached signed permit authorization form) r 9 Print Owners Name(Electronic Signature) — Date SECTION 7b:OWNER'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 orate to the best o my knowledge and understanding. Caleb Aho dba ESE,Inc 15 Print Owner's or Authorized Aaent's Nan onic Signature) ate NOTES: I.- An Owner who obtains a building permit to do his/her own work,or an owner who hires aniunregistered 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.-goy/oca Information on the Construction Supervisor License can be found at www.mass.g-ov/dvs 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" CONTRACT -BtEAResuJf: o Waehlrigton Street Customer Name:CHARLES 40LETZ Wesfbamugh,;MA;,01681 Email:xenalagr@aol.com Phone:00 669.16ce Premise Addressrl9"Buchanan.Rd;Salem,MA 01970; Mailing Address:=19•Buchanari Rd,Salem;MA 01970; Proiect IDi3676187 date:Aug..-9P.20,19; .Job:Description: Contractor-v!ill,pecform or cause to be performed the following work on these"Premises"in,a professional manner and in accordance. With the terms of thfs Contract,inciudir g the attached recohnmendationsMork order describing the work in detail(the`Work")which are' 6orp,orated herein`!: reference:. }, �? 4tr� PSSl1p ... `x: + ? �tw` attZln 4tua11ti13.r21._, ,�� atal9$t' v Liustolt�G> c� : Wafis ,Wood Sided=4"Dense,Pack Cellulose 1347 SF $3273:21 $818:30 1— Total: $3;273,:21 Program Incentive: -$ .,454.911 Customer Total, $818 30 Payment Customer agrees to pay`Contractor for the Work the Cu§tdMeir Share of the Contract`Price as follows:Payment;#1:$272 00 as,a Deposit payable to CLEAResult upon signing the Contract'(not to exceed 1%3 of the total retail costs).Mail cheolC&conUact to CLEAResult;50 Washir►gton Street,-,Westborough,MA,01581.Final Payment:$540,30 as the final paymentJor the;Work shalite payable to the Home Performance.Cantractor(HPC).or;lndependent installat on ContMdbr.(IIC)upon satisfactory completion of:the. Wo(k:Customer understandsthat he/she Will not-be requi W.to pay the Utility Incentive Share of the Contract price In the ainountof, $2,454.91.Changes•to"individual line:iiterns'andlor previous irtaentives mayIncrease or decrease the size'of the Wily Incentive Share. Dispute.Resolution. The,I1Cand Custamerhereby mutually agr'ee in advance?that-in the event that the 110has a dispute conamhfng this Conti-act,the 11C rnak.WiW suiW dlsputb:to a private arbitration seivlce which has been app'rdved by'thbi ONice'of Consumer Affairs and Buslness`Reguiaftn and Cudomer.shall be r qulredto'suE mil to sucl:arbitration as provided in lu1:G L c 142A; Y: up jriay cancel this agreenient if it has been signed by a,party at 4blace other than an address of the seller,provided you notity the; selier-fn writing by ordinary mail,posted by telegram senior by delivery,not later than:midnight of the third business day.foflowing'the, signing of this agreement.DQ NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES:. 'Page 1,of 4 x a t Customer.Signa re Date IrTdicate your select,ed IIC here;if applicable Initial here if you, want the Program to assign'a Participating Contractor Tyler�Niillec . 8l20/2019 TyIeE.Mffi- CLEAResuit Signature Date Name of.CLEAResult Representative Nge 2 oF4 f' Ras IhLAiWI*W-MA"A h - r r - _ ' - i r 2aaya - ,► +[f�iaki. Ylsflt -Et►rgk7 ?lo Y ¢ r Ps 'i _ dercribo: ' - �. RmrJewo►�f�r; , laver - .. et ( , IMAIR ror Office Use Only Bushes ladder Neighbor Proximity Pocket•Doors, insert Radiators Ferics(sy Exlstlnp Conditions X--'Access 0=Vents Note Inside Square R=Roof S Soffit ,_C+dpl$ s. RV=Ridge Vent CS Continuous Soffit CDE=Continuous Drip Edge T ?dangle instbA Q=.New Access_Note in Circle C=Ceiling W=Wall S=Sheathing Temp tlnlesSalloEetf OttlefvVise a Q Yents,Note in Triangle R 8"Roof. S=Soffit G Gable M=1Z"Mushroprvm. ROx Access. r The Commonwealth of Massachusetts Department of Industrial Accidents s d I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): ESE, Inc. / Caleb Aho dba Address: 52 Fitzgerald Dr City/State/Zip: Jaffrey, NH 03452 Phone #: 603-532-6346 Are you an employer?Check the appropriate box: Type of project(required): 1.1Z I am a employer with 7 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will l0 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole I l.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.17 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.*- 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other weatherization i 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors 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 an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: National Liability& Fire Ins Co Policy#or Self-ins. Lic.#: V9WC055788 (3a) MA& NH Expiration Date: 03/08/2020 Job Site Address: Iq 8416A ¢ q/ J P", City/State/Zip:�;A/C.. 01011) 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 verification. I do hereby certify under the pai and penalties of p rjury that the information provided above is true and correct. Signature: Date: Ilkl Phone#: 603-532-6346 Official 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 5.Plumbing Inspector 6.Other Contact Person: Phone#: Ago CERTIFICATE OF LIABILITY INSURANCE F7E(MMIDDNYYY) 7/29/2019 NIS 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 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 endorsement(s). PRODUCER CONTACT Karen Shaughnessy NAME: FIAI/Cross Insurance PHONE No (603)669-3218 FAX AIC No E#: (Al03)645-4331 IC, 1100 Elm Street aooliess: kshaughnessy@crossagency.com INSURER(S)AFFORDING COVERAGE NAIC# Manchester NH 03101 INSURERA: WestAmerican Ins Co 44393 INSURED INSURER B: � pan Ohio Casual Insurance Company 24074 y ESE,Inc. INSURER CNational Liability&Fire Ins Co 20052 52 Fitzgerald Drive INSURER D: INSURER E: Jaffrey NH 03452 INSURER F: COVERAGES CERTIFICATE NUMBER: 19-20All lines 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 AUUL bUtSK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE N OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 15,000 A BKW55684497 07/31/2019 07/31/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑PRO ❑ 2,000,000 PRO- JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ g OWNED SCHEDULED BA055684497 07/31/2019 07/31/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Uninsured motorist $ 1,000,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE US055684497 07/31/2019 07/31/2020 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY X STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A V9WC055788(3a.)MA&NH 03/08/2019 03/08/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 Caelb,Mary&Marty Aho excluded from workers compensation coverage 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 For Informational Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. Informational Purposes Only AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ., • � �iof% �Qf�'G�12C�/7GC�PC�iGG�O��/��Gr�r��Cfl�C�c�G/��,�- , Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Mass�chusetts 02118 Home Improvement-OQntractor Registration Type: Corporation ESE INC z w Registration: 193253 52 FITZGERALD DRIVE w Expiration: 09/30/2020 JAFFREY,NH 03452 o w Update Address and Roturn Q'slyd. SCA 1 4 200MM/-05//1177 �7I/.G Jr>Its)'ZCr//r!'ll(/�/`.ii?(l!/JIIC/lllJL�fli. . Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corporation before the expiration date. If found return to: Reaistr'ation Expiration Office of Consumer Affairs and Business Regulation 193253 09130/2020 1000 Washington Stroet-Suite 790 AESE INC Boston,MA 029 , ..4, CALEB D.AHO 52 FITZGERALD DRIVE:;-- JAFFREY,NH 03452 undersecretary Not valid Without signature t Commonwealth of Massachusetts f Division of ProfiRssiopal Licensure Board of Building Regulations and Standards Construction{Supervisor rT l CS-072316 Expires: 12/19/2019 u ' r j CALEB AHO ( 482 JARMANY411LL RM ' SHARON NH 6468 I � Commissioner