Loading...
11 BELLEVIEW AVE - BUILDING INSPECTION (2) IThe C'onunomvealth of Massachuscus Board of 1uilding Regulations and Standards CITY OF Massachusetts Slate Building Code, 780 C NIR SA 'M L,,.. Reri. J.Ifir'llll Building Permit Application To Construct, Repair, Renovate Or Dent sh a One-or Two-FamilY Dlrellin,tr This Section For Ol33cial Use Onl Building Permit Number: Date Appl' d: Building 0irmal(Print Mune) Signature Ll 4-4 SECTION I:SITE INFORMATION L I Property Ad ress: 1.2 Assessors Nlap& Parcel Numbers I.la Is this an accepted street?yes no Map Nunthcr Parcel NunncLr 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use ` Eel Area($y It) Frontage(11) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Required Irovided Required Provided Required Provided 1.6 Water Supply:(M.G.I.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: -Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal s un ❑ Check if .es❑ P po' ),t SECTION 2: PROPERTY OWNERSHIP' 2,1 Owner o R ord: N;une(Print) City,Slate.ZIP Nu.and Strcct v �29 Telephone Entail Address SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Alterations) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ 1 Number of Units . 1,01her ❑ .Spccity: Brief Description of Proposed Work=: SECTION 4: ESTIMATED CONSTRUCTION COSTS llem Estimated Costs: (Labor and.Materials) Official Use Only i. Building S ` I. Building Permit Fee: f Indicate how fee is determined: 2. IFlccirical S ❑Standard City/Town Application Fee ❑Total Project C-ostr(Item 6)x multiplier _._ x 1. Plumbing S 2. Other Fees: S a. \ledianical I III' \C) S List:_ 3. \lecltanival tFire Suppression) S Total All Fees: S Total Project Cost: S Check No. heck Anwunt•. _ l',uh \nwunt: ❑Paid in Full ❑Outstanding 13:d:mce Due: r SECTION5: CONS"I'RUCTIONSERVICES 5.1 Construction Sullen isor License(('Sl.) License Number Py+ir lion );uc' N;uneof'C'.SI Ilnller -"�---_ I ist C'SI. 1)pa lNee bloat,_" _ .I.)pe Description No. and 9tr•et Lilt U l Inreslricmd I Iluddi❑�s li it) 15,000 cu. It.l _ • 4—___---.._ . ItRe,tric uomled 1&2 Family Dacllin Cil)ir"'m,.\ ote./IP MI ML RC Rlwlin C'owrin ?n-L� VA Window wld Siding SF ISolid Pad 11timing Appliances nsulwiun I elc hone Fillail address D Demolition 5.2 Registered Home Im )rovemetit Con rector(HIC) R 'o�DW III Rcgistrltwn Numher Ifs raw i Uute IIIC' 'o l poq. ore•or I '1 aktra I uu No.an St • 1 Email address Ci /Town,State,ZIP �telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152.4 25C(6)) Workers Compensation Insurance affidavit must be con)pl ted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of a building permit. Signed Affidavit Attached? Yes.......... No........... O SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .11f� I,as Owner of the subject property,hereby authorize �T_catiilkB to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's None(Electronic Signature) D te�-- SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under t e pains and penalties of perjury that all of the information contain ' this application is true and accurate to 11 be of knowledge and understanding. Print Oaner's or:\uduviieJ Agent's Name(Electronic 5 gnalure) rate 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 Hume Improvement Contractor(HIC)Program),will no have access to the arbitration program or guaranty fund under M.G.L.c. I42.4.Othcr important information on the HIC Program can be found at ++ae w.i,, Information on the Construction Supervisor License can be round at mWn: dP+ 2. \\'lien substantial work is planned,provide the inl'ormatiun below: rota) floor area(Ny. ft.) _ (including garnge, finished basemenCattics,decks or porch) Cross lis ing area I sq. 11.l _.--"- _._- _ Habitable room count Numbcr of lircplaces._-.. ..- —. ..._ \umber of bedrooms iNumherofbadtn,onts \unlberofhalfhaths f pc of heating s)slcm Number of decks, porches I I\pC PI iPUllllg N\51e111 _ FIICIUXd 1, "fatal Prolect Square Footage"ma) be substituted Ibr"total Project Cost" CITY OF S.V-E•NI, AkSSACHUSETTS 9CILD6VG DFP.IATtE,VT 120 WAS)INGTON S7 XW, S"FtOaA rM (978) 745-9599 KJAMERLEY DIMOLL FAX(978) 740-9846 MAYOR Nciuu ST.Pm uts DIRECrato or PLBUC PR0PFATY/8t::M,0NG CO. 1311SSIOVER Construction Debris Disposal Atttdavit. (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section I 1 I.5 Debris, and the provisions of MGL a 40, S 54; Building Permit p is issued with the condition that the debris resulting from 111 work shall be disposed of in a properly licensed waste disposal facility as defined by b1GL c I l 1, S I50A. The debris will be transported by: (nQOfer) t The debris will be disposed of in : (name of facility ��— la)firlCL (+Jgras Or•r�cilny) °1Mn�nu Ofper� itipplicant h 4•w. `]",r Y,v'IifYi t n v1`la/1 %lS' ., �eD�,r/rra�rsi ajlr,�l��strif�iticc?a.1z;�✓ 10jjac ,oj InvesiirlriDrls t _ � BDslon, MA 02111 �'•, ➢< )v W3 iYlllss.gov1dhl t._ Workers' Con?pensation Insurnns -e Affida-vit. Biiliders/Contractors aleetri4" ans/P]ulrlbers Aippiieant Information Please Print Legibly Naive (Business/Organization/Individuai): _ Address: ► IV City/State/Zip: Phone #: �51 Are an employer? Check the appropriate box: Type of project(required): 1. I am a employer with�!)— 4. ❑ I am a general contractor and I 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 g, ❑ Demolition ' working for me in any capacity. employees and have workers , 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its ME] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions per MGL ti p f right ig o exemption myself..[No workers' comp. r 12.❑ Rp6f 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#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: — Policy # or Self-ins. Lic. #: pExpiration Dater Job Site Address: d ie A A-lie City/State/Zip: sc�VYt l ' 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 certify and t e pains andpenalues of perjury that the information provided above is true and correct. Si nature: Date: Phone#: 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 y :Fib CERTiFICATE OF LIAB1UTY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORNIATION ONLY AND CONFERS NO RIGHTS UPON THE CL3TI'I TE HOLCE3 14 II 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 BETIEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HCLD'cR. IMPORTANT: If the certificate holder is an ADDITIONAL IPI5URE0,the pOlicu(iesj must he endorsed. If SUBROGATION IS WANED, s is t.t t0 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). cONracr PRODUCER 1-404-995-300C NAME: -"' Marsh USA, Inc. PHONE v DRE AIL homedepot.certreqiiest@marsh.com ' ADDRESS: Two Alliance Center, 3560 Lenox Road, Suite 2400 INSURERS)AFFOROING COVERAGE Atlanta, GA 30326 Steadfast Ins Cc 26387 - Fax (212) 945-0902 INSURER A: —Zurich American Ins Co 16535 INSURED INSURER B: _--"-"- The Home Depot, Inc. INSURER C: Mew Hampshire Ins Cc 23A41 Home Depot V.S.A., Inc. Z Co 23817_-„_ 2455 Paces Ferry,Road NW -INSURERD: Illinois Na IO FIRE INS CO OF PITT 19445 Building C-20 INSURERE: NATIONAL ON FIRE „ Atlanta, GA 30339 - - INSURER F Illinois Union Ins Co 27960 : COVERAGES CERTIFICATE NUMBER: 199141/2 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERICD 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. ____------- EXCLUSIONS AOLICIDLS POLICY EFF POUCYEXP LIMITS LTR ' TYPE OF INSURANCE POLICY NUMBER MMIDDNY'Y MWOOII'-(Y A GENERAL LIABILITY GL04 B87714-01 03/OS/1 03/01/12 EACH OCCURRENCE 39,000,000 DAMAG TOR NT 0 1,000,000 X PREMISE (E occurrence E COMMERCIAL GENERAL LIABILITY EXCLUDED CLAIMS-MADE aOCCUR MERE%P(Any oneperson) E PERSONAL B ADV INJURY $9.000,000 X LIMITS OF POLICY XS --- -' GENERAL AGGREGATE S9__000,000 - X OF—SIR.. $1M PER OCC ---- - PRODUCTS-COMPIOP AGO S 9,000_000__ GEN'L AGGREGATE LIMIT APPLIES PER: $ - - X POLICY PRO- LOC 0 0 0 O1 2 COMBINED SINGLE LIMIT 1,000,000 H AUTOMOBILE LIABILITY HAP 2938863-08 aac ______.__.._... .._.. BODILYY INJURY(Par person) E ANY AUTO - BODILY INJURY(Per amdan0 S ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED P ra (dent __—.------ - HIRED AUTOS AUTOS E X SIR AUTO P Y EACH OCCURRENCE UMBRELLA LUIB OCCUR ---------- AGGREGATE _ E __.__._.__......._. EXCESS UAB CLAIMS-MADE -- DED RETENTIONS 03/Ol/12 % WC STATU- OTH- C WORKERS COMPENSATION WC061967352 (ADS) 03/01/1 ANDEMPLOYERTLIABILITY YIN 03/O1/12 E.L.EACH ACCIDENT f 1,000,000 D ANY PROPRIETORIPARTNEWEXECUTIVE WC061967759 (Pt.) O7/Ol/1 OFFICERIMEMBER EXCLVOE07 N NIA 03/Ol/12 E.L.DISEASE-EA EMPLOYE 51,000,000 WC061967353 (CA) E (Mandatory In NH) It yea,dasvlEe antler E.L:DISEASE-POLICY LIMIT E1,000,000 DESCRIPTION OF OPERATIONS telow C Workers Compensation WC061967355(XY,MO,NY,WI, vp3/Ol/1 03/Ol 12 Indemnity TNSC46244151 (TX) 03/01/1 03/01/12 Occurrence/SIR p TX Employers 30M/1M XS In E Workers Compensation wC1192378 (QSI) 03/O1/1 03/O1/12 SIR 1M DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES t useh ACORD 10%Additional Remarks schedule.it more space Is required) RE: EVIDENCE OF COVERAGE \ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN =TERRYROAD T, INC. ACCORDANCE WITH THE POLICY PROVISIONS. S.A., INC. RRY ROAD NW AUTHORIZED REPRESENTATIVE 30339 USA ©1988.201U ACORD.CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD jfiero_hd '1 r, y - 1 -'Natlanal Fenest[atlan ... •��=��•- ENERGY PER} flRM1ANCE RAT1NCS EVALUACION DE RENOIMEMO ENERGETICO Factor SGIar HeatGain CGefficient U• F FactU Coeride sleGananda de.ner9ia Solar l} -:0 lusa•w d<rnrusn ' ADDITIONAL PERFORMANCE RATINGS EVALUACION SUPLEMEMAAIA DE RENDIMIEMO VisibleTransmiMnce TransmIsian de LuzVisible - 0 . 44 ' e i manufacturer stlpulates Mat Ixesaetof wnfantPapPrpec xwasFRC oceduresfardehnNMywholenet recrassormany product ratlngs are determined foradsed set enNmnmenUltPndlccmc usEaonsunt pmdact ch cf,je. RlCdee foroherpreendanypmduct and doesmtMnWt Me sutatHn of anypmdudtat any specillc use.tPnsua manufacNier'i Ole2Nre for aNerpraduRpedarmance NIPmldtlPa.WYMA1RArg Este hbMante esUPNa qw estasvalares cumplen can ms p mcadWent"apacablea de NRtC Para date rminarat renOimientototal del - pmducto.Loswlarse usados perNFAC sees detem,Mados Par 0cwjunto Pjo de candicienn amtienWes Yun Wnarode Preducto" . use espeon1cmConsul especiAeo.NFRC rro recomiendanNgun producto Y no garantlea qua el pfoducto eazadecwdo pars 0a on el - mete del fabdcanb pare d wo ap�oD�oda erta Pradudo.T,wxntrc.or9 _ qua Liiiae 'foc tiN2ii;I STAR " �• cegionfsl: Nucthecn, North .09 9ntraL, south Csntrat, ?oar,.hncn.'f T.r. uni�arl rw l.if rA Caca 1gr41 fire. 29 . reul Nucae-caaccal, suc canacai, S•.:C. ZVuc Eain C0/Class 1/5" CcN5olac/8-LC2$ •� TaAted aa:a: /1's" x 8U" Ra�uoz:o JG/Vaclt 3.13 Acid R-1.C25� np �..}%h��•�(.� - TaooaArs pcobado m: 121.9 c x 203.2 CAI •' li APplicalo la Test standard isl: d.VSI/AA2LV NGllu A101/L9.i-97,Ad . ' 2sA,'WG:(A/L'SA:oI/i.a.zlasso-os,s . - L'1dl wNA/C`u'Ai71Ls.2%j4�0-0d, . Office of Consumer Affairs&Business Regntation` l OMEIMPROVEMENT CON TRACTOR C ; Registration '126893Ili— - Type Expire 1an 8(3f20'42 Supplement The Home Depot+•AR djne.SerVices - t. RICHARD FALLOI E 2690 CUMBERLANQ PAhKWAY'S -->6+��—c t A'f�At� s GA 30339 r� Undersecretary �i:bvKhU�Cit. - UC�):Ill in<n. ... ruin.• •, ,...: Suar,l ni' (3tliLlim� Hc'.!ulatiun" .tad ,tltnd:trli�, Construction Superiisor Specialty License License: CS SL 99364 estricted to: WS AERTE TORRES 6 FELTOM STREET AARLBOROUGH, MA 01752 ram- �y Expiration: 3/612012 / -- rr4: 99364 Restricted to: WS i Um Masonry only RF Roof Covering WS-Windows and Siding ' SF- Solid Fuel Burning Devices DM-Demolition only Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS Dec041110:48p Kowalczik 9789352838 PA HOME IMPROVEMENT CO CT PLEASE READ THIS+ ��/�//� Sold,Furnished and Installed by: Branch Name: Boston Date: THD At-Home Services,Inc. d/b/a The Home Depot At HomeServices 3451 Greenwood Street,Unit 2,Worcester,MA 01W7 Toll Free(800)657-5182;Fax(508)756-8873 Brunch Number:31 Federal If B 75-2698460;ME Lie#C(L439:RI COM Lic#I M27 CT Lic#HIC.056 522;MA Home Impmverrrent Contractor R�ega.#126893 Installation Address: m� ��% 7U City State Zip Purchasce(s): Work Phone: Home Phone: Cvll Phone: [ l [ 7 [ 7 Home Address: (if different from Installation Address) City S/CgA[���1 Zip E-!pafl Address(to receive project communications and Home Depot updates): 1 DO NOT Wish to receive any marketing email.,from The Home Depot Project Information: Undersigned("Customer),the owners of the property 1 -ated at the above installation address.agrees to buy, and THD At-Home Services,Inc.('The Home Depot`)agrees to furnish,deli r and arrange for the installation("Installation")of all materials described on the below and on the referenced Spec Sheu(s), all 'f which arc mcorpoented into this Contract by this reference,along with any applicable Slate Supplement and Payment Summary Cached hereto and any Change Orders(collectively, "Contract"): Job#: o.,, al,rm tProducts: Spec Sheets)#: Prakat Amount ❑Roa{ng ❑SiinC Windows ❑Inwlatiun $ ((}B 5�w/Q 01t7�� ❑Goners/Coven ❑Furry Doors [I tog ❑Roofing Siding ❑Windows ❑Insulation $ ❑Guuers/Covers []Entry Doors rl ❑Routing ❑Siding ❑Wimluu. insularion $ ❑Guuers/Covers ❑Entry 1). _ ❑Roofing ❑Siding ❑Windows Inmlatio l $ ❑Gaacn/Covers ❑Entry Dunn ❑ Minirmun2510epr�tmttbrtrat2Anwnntdueulumezecutirmofthemntrat T at Contract Amount $ t Mahre purchsax®y nut depuel more than oneahird afthe Crwrmt Arrant. Customer agrca y that,immediately upon completion of the work for each Pr cl,Customer Will execute n Completion Cerrif - (one for each Product as defined by an individual Spec Sheet)and pay any]it ancc due. As applicahle,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 Osier or terminate this Cc itract or any individual Producl(s)included herein,at its discrelion,if The Home Depot ar its aulhorvrd service provider determines il at it cannot peribnn its obligatiotts due to a structural problem with the home,environmenud haruds such as mold,asbestos or lead aim,other safety concerns,pricing errors or because work required to complete lhejob is not included in th•Contract. Payment Summary: The Payment Summary # i icluded as pan of this Contract. sets forth the total Contract amount and payments acyulred for the deposits and final payments by F oduct(as applicable). NOTICE TO CUSTOMS You are entitled to a completely filled-in copy of the Contract at the time ya I sign. Do not Sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by in lividual Spec Sheets)before work on Hint Product is complete it,the event of termination of this Contract,Customer agrees to pay The I ome Depot the costs or materials,labor.expenses and services provided by The Home Dept or Authorized Service Provid through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THI HOMP.DEPOT MAY WITHHOLD AMOUNTS' OWED TO THE HOME DEPOT FROM 'THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE W IIII0UT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RFCOVET 'OF SUCH AMOUNTS. Acceptance and Autbnr6a5on: Customer agrees and understands that this i greement is the entire agreement between Customer ancc T'he Home Depot with regard to the Products and Installation services mid, persedes all prior discussions and agreements,either oral or written.relating to said Products and Installation.This Agreentem carob t he assigned or amended except by a writing signed by Customer and The Houle Depot.Customer acknowledges and agrees that C stonier has read,understands.voluntarily accepts the terns of and has received a copy of this Agreemn:nl. Acce reel by: Sub i d In j� yr, /j j /ZhI/ Custorpar's)Sienamrc Date Sales Consul -at's/,F�(n(�atue/ /� / GDuG[c X� '1 V C�l ,mil �a 3't! Telephone N ( !%b =C J.3 ,E6 0 , Customer's signatufc Date Sales Consuli nt License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (a%uppncabtc) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT- BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE NOTICE:ADDITIONALTERMSAND CONDITIONS ARF.STATED ON THERE 'RSE SIDE.AND ARE PARTOF THIS CONTRACT 12-27-10 CSC White-Branch File Veltow-Cust?mer