23 CLIFTON AVE - BUILDING INSPECTION (2) r �
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
MUNICIPALITY
Massachusetts State Building Code, 780 CMR
USE
Building Permit Application To Construct,Repair, Renovate Or Dem is a Revised Mar 2011
'Cly I One-or Two-Family Dwelling
This Section Fo icialyse Only
Building Permit Number: Date pplied:
1
t7 IBuilding Official(Print Name) Signature ate
SECTION 1:SITE INFORMATION
1.1 Pro e y Address: 1.2 Assessors Map& Parcel Numbers
^�1 �sFI,�rY1 �lra C�lAlY1
`w L la Is this an accepted street?yes no - Map Number Parcel Number !'
1.3 Zoning Information: 1.4 Property Dimensions:
\I Zoning District Proposed Use - Lot Area(sq f) Frontage(11)
^P� 1.5 Building Setbacks(ft)
\ Front Yard Side Yards Rear Yard
JRequired 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:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private❑ Check if yes❑ P p y
I SECTION 2: PROPERTY OWNERSHIP'
Name(Print) _ ` City,State,ZIP
A,- OJU -on ale (78,1�ii�din
No.and S et Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK''(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': L a
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:
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 $ Total All Fees: $
Suppression)
Check No. Check Amount: Cash Amount:
6. Total Project Cost:. $ ❑Paid in Full ❑Outstanding Balance Due:
C' 8= �s
y
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)Name(o f CSL H.older � n e m
em\cy) er Expiration Date
List CSL Type(see below)
No.and Street Type Description _
U Unrestricted(Buildings up to 35,000 cu.ft.
R -Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
i+ Roofin Covering WS Window and Sid in
SF - Solid Fuel Burning Appliances
I Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) / / J
�(�➢ 1 fi HIC Registration Number xpi lion Date
HI?C CQm�I Cage or it Name
No.and Street F'C Email address
/eWlr b.ry ,Mfg 01976 (gl�Rl P,-87c�9
City/Town,State, IP 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 ........:. ❑ No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject properly,hereby authorize
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: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 accurate to the best of my knowledge and understanding.
Print Owner's or Xutlhorized Agent's Name(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.sov/oca Information on the Construction Supervisor License can be found at www mass.Qov/dos
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'
,� .�
next step living �/�1' .
home Nflciency,made easy
pAffnclpATING
This agreement is made by and among
Cbrlstina Porter Next Step hiving,Inc("NSL")
23 Clifton Ave 21 Drydock Avenue 2-floor
Boston,MA 02210 _
Salem,MA 01970-5447
Customer ED:C00000052095 Contract ED:20120518 WORK
Site ED:S00002042080
1. DESCRIPTION OF WORK TO BE PERFORMED
NSL will perform or cause to be performed the following work on the cussthmees address above,in a professional manner and in accordance with the tertre of
this Contract,Including the attached moomnendationsrwak order describing the work in detail(the'Worle)which are Incorporated herein by reference:'
Deecrlptlon - - Quantity Location
Insulate Clapboard Sided Well With 4°Dense Pack Cellulose___ _981 L V SDece_
Insulate Clapboard Sided Well With 4°Dense Pack Cellulose__ 1 102_ _Lh4n9 Space _,. $2_115.84
Attic Floor Enclosed Cellulose Dense Pack 8' . 670 __Laing S�r_a_ce- _- _ $1,400.30
Insulate Rim Joist with 6.25'Fiberglass Betting_ 97___Wmg8pece_
Insulate Gable Wall With4°Blown Cellulose - _ _ 43 Living Space —
Attic Floor Enclosed Cellulose Dense Peck 6'_.____... 39 _wing SPA._ _ -..._ _ -$74.49
DO ing ..__ .._7
.. _- N/A $12.39
12°MushroomVent _ Oc
_____ $123.83
Install8 Roof Vent 2 Attic _. $178.46
Door:Palylsocyanu ate 2'_fAttic__ . _.. -._ - ... 7.. LIA apace $49.45
Sub Total: $6,112.26
Energy Efficiency Incentive $2,000.00
Not Sales Tax After Incentive $0.00
Total $4,112.26
Printed:5111111120112 Page 1 of 1
2. PAYMENT:CUSTOMER agrees to pay NSL for the work as follows: -
Payment#1:$
Lredh Cant or Echack deposit is due at the time the Work is scheduled.Required payment information will be collected over the phone by a asiomer service
representative at the time of scheduling.,Deposit is not to exceed 1/3 of the hotel retail=is.This contract is not in effect until this deposit Is paid by the
Customer. (Note:Mastercard,Visa,and Discoveraccepkd).
Additional Payments and final Invoice:$ 44►12 ,21�. Vi0- S5 S)Mq: }\fat Um" _
-Additional payments for the Work shall be due upon completion of the Work.
u er T e!G '40ay_22, 2012
- Clstome�rSl naNre � Data
NSL Signature Date Named NSL Represe e -
The Terms of this Agreement are contained on both sides of this page
Next Step Laing 21 Drydock Avenue-2n0 floor°Boston,MA 02210°(866)8678729-inquiry@nexlsteplMnginccom-www.nextsteplivirginc.com
Document Integrity Verified EahoSiur,Trahsectfon a„moer:m8W7AP3D7D6A53
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uarar
next step living ''" a° 4
home e/finexy,made easy -
CO PMnCWATOM OO
This agreement is made by and among
Christina Porter Next step Living,Inc.('NSL')
23 Clifton Ave 21 Drydodc Avenue 2-Floor
Boston,MA 02210 -
Salem,MA 01970-5447 -
Customer ED:C00000052095' Contract ED:20120315_ASEAL,
Site ED:S00002042080
1. DESCRIPTION OF WORK TO BE PERFORMED
NSL will pedorm or cause to be performed the folloxlhhg w rk on the customers address above,in a professional manner and in accordance with the terms of
this Contract including the attached rewmmendationstwork order describing the work in detail(the'WoW)which are incorporated herein by reference:
Description Quantity Location
Perform Air Seating all-Estimated-62.5 CFM50 Per Hour _. 2_. .,_LMng Specs. $150.50
Sub Total: $150.50
Energy Efficiency Incentive $150.50
Net Sales Tax After Incentive $0.00
Total $0.00
Printed:511811012 Page 1 of 1
2. PAYMENT:CUSTOMER agrees to pay NSL forthe work as follows:
11 Payment#1:$ OAt
-Credi Cab or Eeheck deposit's due at the time the Work is scheduled.Required payment information will be collected over the phone by a customer service
representative at the time of scheduling. Deposit is not to exceed 173 of the total rdati wets. This contract is act In effect until this deposit Is paid by the
Customer.(Note:Mastercard,Visa,and Discover accepted)
Additional Payments and Final Invoice:It d .0 6
Additional paymenis for the Work shall be due upon completion of the Work.
A�/a '- ,17-
4, ,z/ �4 May 22. 2012
omw Tumwn I aY a.2oi2)
Ciistowlersi nature Date
NSL Signature Date Name of NSL Representativ
The Terms of this Agreement are contained on both sides of this page
Next Step Living 21 Drydock Avenue-2n°floor-Boston,MA 02210,(866)867-8729-inquiry@rheensteplivirginc.wm^www.nextstepiivhginc.wm
Document Integrity Verified E�hnslyn Tranaacrnn Number MBvWAP3D]D6A5S SONOWNssswesel
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®ffice of�onsllmlr Afaar anti Business12egulation
10 Park Plaza- Suite 5170
Boston,1 saclausetts 02116
Homel�nprovelbihIt 4yontractor Registration
Reaistration: 162111
TVPe: Supplement Card
Y ^'
=" Expiration: -t11412013
NEXT STEP LIVING INC.
BRIAN HESSION
25 DRYDOCK AVE. 5TH FL
'
BOSTON, MA 02210
Update Address and return;card.mark.reason for change.
Address Q Renew:- O BmPleymenl Lost Card
��I.E 19oT41RMNUr.6 '
Ou of Consumer Affairs Wau�essfiegalatioo hefo er the expinLicanneor vt on date. if found,r ty return to:u
.tME IMPROVEMENT CONTRACTOR _ _ _.Office of Coosomer Affairs and Business Regulation
sgistratiaal±[62.'171 '. � TYPe: . lOYark1'laia-Suite 5170. .
• � j Supplement Card aoston,MA02316
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Department of indushfal%dolents
OAbe offnvesfigaUons
660 Washington Street
Boston,MA02111
www mesa eav/di�
Workers'Compensation Insurance Affidavit:Builders F easacrorelEaeclbriclansl plumbers Gas
622gicantuldwd BID 7
NAME(Businessforgani�onit�id6al)
ADDRESS:
CITYISTATE2IP: Type of project(required)
Are you an employer? Circle the appropriate number:
6.New oanstruclion
��(3 4. I am a general can't
and I have hired the Remodeling
1.1 am an employerwM�hi ls�- subcontractors listed on the a0aahed sheet.These a. Demolition
employaes(full andlor pa dime) subcontractors have workers'camp insurance. g, Building addition
i b.Electrical repairs or addition
2.1 am a sate proprietor or partnership 11.plumbing repairs.. �^
and have no employees working for 6 we are a corporation and As Officers have 18,Roof re
me in'any capacity(No workers'camp exerclsed their right of exemption per MGL tg,Other
Insurance required). c,162,section 1(4).and we have no.
&1 am a hoineawner doing all the employees (no workers'comp insurance
reputred).
work myaelf(no workers'comp
insurancarequired)
Any applicant that checks box 011 ust also fill out the section betowahowtng their workers'comp actors m policy information.
Conga oHomsayffigrs who s bmltttl's°amlevit uat a'
ac a6'addifl nal sot ag at win he subco 811 work fil'then hire fracrdre 8lheirlworkers ram mito ne nr ifidavit.
I is
l am an employerNar is Providing w°►leers'eompensa0en insurr°ee for myempf°yaes•Below is the policy and%ob slte
Insurance Company Name: 1 1
r77'L ' Expiration Date:
Pclicy#ortlelf-insiic#: 1 JJ City/Slatel2ip - _
Job SIboAddress:
owing/fraP itanderplragondissi-
Attach a copy of'he warfrers'eom SECTION PensaQon policydeclamUon page
R IMPRISONBSEPIT,AS WELL AS CIVIL PENALTIES
CRIh11NAl.PENALTIESFAI OF A NE P TO S,GS COVERAGE AS100.a ANDIf7R ONE•YEASA OF 1BOLe.162 CANLEAO TO THE IMPOSITIONSE OF
HATA COPY OF THj FORM OF A STOP
HIS STATEM NT M EE FOFINE OF
FEO To THE OFFICE OFUp TO lifilifilit.09 A DAY ANVESTiOA EONIS OFTTNE OIA FOR
IN U"NOE COVERAGE VERIFICATION.
[HERESY CERTIFYUNDER THE PENA OF PERJURY THAT THE INFORMATION PROVIDED ABOVE IS
LTIES
TRUEANDCORRECT. DATE
SIGNATURE: ,$ss`
TELEPHONE#: �� arMwnofficial.
office use Doty. Do notwrfta in th(s area,robe compe an it I d LIB se*
city or Tawn:
Issuing Aulhodly(circle one):
1. Board of Health 1 Building
Oepartmanl 3.Citylrown Clerk 4.Electrical Inspector 5.�Plumbing 8 Gas Inspector
6. Other phone#:
Contact Person: