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29 GREEN ST - BUILDING INSPECTION (2) \ The Commonwealth of Nassachusetts CITY OF Board of Building Regulations and Standards SALEM Massachusetts State Building Code, 730 CMR Revised.Mir 201! Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Frrnily Dwelling This Section For Official Use Only Building Permit Number, Date Ap ied7 R�a� BuildingOfficial(Print Name). Signature .SECTION 1:SITE INFORtIMATION'1.1 Property Address: //� CC1.2 Assessors hlap&PareJ 7 I.I a Is this an accepted street?yes noNlap Number 1.3 Zoning Information: 1.4 Property DimensionsOZoning District Proposed UseLot Area(sy tt)1.5 Building Setbacks(R)Front Yard Side Yams Rear Yana V' Reyui cd 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 yes13 SECT[ PROPERTY OWNERSHIP, 2.1 Ownert of ccord: S 0. I to A` .N7 me(Print) City,State,ZIP ��' (�rcz.ti Sr` No.mid Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORIO(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ I Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work-': n 'r ro r l ' d S 0 rYU t 11 do -7X ia t, A � SECTION a: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials 1. Building S p� (, it 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard CitylTown Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)s multiplier s 3. Plumbing S P Qther fees: S 4.�\lechanical (HVAC) S List: 5.Mechanical (Fire S Total All Fees:S Suppression) Check No._Check Amount: Cash Amount: G. Total Project Cust: .'S Qr G' !' 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Const<r jeetion SupervisoQr License(CSL) 0 � �7 -1 > 1�J b! l- f Oc,?O bU)+ License Number Expiration Date Name of CSL[folder I- List CSL Type(see below) Type - - Description No. ;md Street ( U Unrestricted(Buildings tip-to 35,000 cu. 11. Sa lr? vvl AA e` R Restricted M Family Dwelling Citylrown,Stale,ZIP M Masonry RC Ranting Covering WS Window and Siding SF Solid Fuel Burning Appliances yU (�5 - ,�4 I I Insulation Telephone Email address D Demolition 5.2 Registered Home improvement Contractor(HIC) � -3_/6 /D ( g 93 L ! )v yy\e 1 4 HIC Registration Number Expiration Date 1IIC CggtB:in Na pie or HI RegistAr t Name • -II UU W eup n y4v( Nu.and Street Snr2WJb oe AA q D t^ p 9 9 _ a Yr Email address r City/Town,State ZIP 7 Telephone SECTION 6:WORKERS'CONIPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§2SC(6)) Workers Compensation Insurance affidavit must be c pleted and submitted with this application. Failure to provide this affidavit will result in the denial of the lstuan5eof the building permit. Signed Affidavit Attached? Yes .......... No...........O SECTION 7a,OWNER AUTHORIZATION:TO BE.COMPLETED W HEN• OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize 140 p IJ 4YOC)f t9 act on my behalf,in all matters relative to work authorized by this building permit application. fe Je ✓' CJAA; Ay do ^A Cv� I„tiry Print Owner's Nmne(Electronic Signature) I 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. AA aJ`1< A)t L/ +� c- 2 Y Print Owner's or Authorized i gc 's Name(ElectronicSignature) L 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 ran have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at %cww.mass.eov:'oca Information on the Construction Supervisor License can be found at www.�s . 2. When substantial work is planned,provide the information below: 'rota) floor area(sq. R.) `a (including garage,finished basement/attics,decks or porch) Gross living area(sq. R.) 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 I'or"rued Project Cost' q CJ / Li llc.rj /� � t- _,'.v$�;:•� � j��j�. (�nt)'it✓ii:�'�r't:,l �i'•1-U 'L�1%LL�ii fl7rr l-�/(%1Llrv:,�-.:,I'��`�a'"G u✓�;�v'��.J' office of Consumer Affairs-and Business Regalflatgoll 10 Park Plaza Suite 5170 Wir•'i5:r: Boston, Mpssachusetts 02116 Home In iproveiT-Ap it;.tContractor Registration Reglstratlon: 126893 %'.rr:F..:' :'•i:i j.s:'' .'7 Type: Supplement Card `'i'�:t�+';'.;lri ,�'• .�,:::.,r.,.�..,..:'. . Expiration: 8/3/2016 THD AT HOME SERVICES, !NC MAR2690 IAD . -_......... _. .__.. — — - 2690 CUMBERLAND PARKWAY S111.Th '3.0.0;'::';';: . :. ATLANTA, GA 30339 " Update Address and return card.tYfark reason for change. sCAI tS 20M•0511 ] Address rJ Renewil rutployment ! 1 ost CmA r:�/rY('rururoarnrn/l/r�('.11rr.urrr•/rnarr/Lr W \ O(ficc of Consumer Affairs 81 0ustness pesutution License or registration valid for individul use only "1 before the expiration date. 1f found return to; t SOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation ror. RegistratioA:-1268�3•� Type: 10 Park Plaza-Suite 5170 p g Supplement Card Roston,Rai A 02116 ra Eu Iratlo ;;:; I3),2p1.6. THD AT HOME SEf1VtCE5;,IIVC: '1 ' .. THE HOME DEPOT,ATk,IP„M,E',SERVICES MARK NIADNA `. . " 2690 CUMBERIAND PARKVVAY S d—�-- d— Ot�1� _ L _ Xff5k�,GA 30339 �— Uadcrusretnry Iyotvntid withoutsignnturo I r , 1 . tom! Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Spedultv License:CSSL 1119M9 = _ ROBBRT POCZOIIUT sat an A 019 1tr Salem MA 01970 l ,yj i ro ' Expiration 0?/092018 Commissioner . . The QPWMWMV8fffth 0j- ffasachrsaft _ = 600 f/'�asCz&-top-S. Barion,AM )1-1 eRjgg r�' Ca eaasa#jaa llns� eeAffidavat BaLldess/Caemt metesslE@ easams/Phmners Name(I3usinesdOrmnizavonrindividuu): ddress: g®S 6®5-iVAj 1p/� City/Slate/zip: �'/et,r9�j ,��e D/SyS- Phone: Are you an employer?Check the appropriate box: Type of project(requhvr.'): I. I am a employer with 4. `(�I am a general contractor and I 6. Q New construction employees(full ancYor part-5me)= have hired the sub-contractors 7- R�o�l�tr 2.❑ I am a sole proprietor or parmer- listed on the attached sheer= 3 ship and have no employees These sub-contractors have U. Q Demolition working for me in any capacity. workers'comp-msmarim 9. Building addition [nio workers' comp_insurance 5. We are a corporation and its 10.0 Electrical repairs oraeidilions required.] officers have zxereised their 3.❑ lam a homeowner doing all p ork ri`ht of exemption per MGL l LD Plumbing repairs or additions myself.[No workers'comp. c 152_§1(}).and we have no 12-Q Roof repairs insurance required.]t employees.[NO workers' 13p� camp-insurance required] �orher I k,K t ::ernxppliantItochecshoc0tmustalsofillamthescetronbelowshowingtneirwadMi colellmsolioa Oft"io6r®ation. r ttomcuumcm a rho submit this affidavit mdieadngibey=dab%all nark andibem hheoutddeewauaetors nowsubmita new at5dm4t mdharing=ch. - =Contractors tlna cheek sus box mmtmtaehed anaddidaml sheet showme The co ne ofnros^b-conuncioF and theiena ime comp.policy tafonmtion. as-.err e.-_n/ores iiz�is/rrnt+fe'mg roar¢e:s'eorzoer�satiorz€nsnrmzce}bt�ry esrplapees. Setow is liZe porzey and jab sire info;ur¢�atz �� jj'' /(� _ Insurance Company Name d.v`Zr.J /r"�/�ry �y`�r��r+ g-�"s (� g Policy2orSelt=ins-Lie:.q-q C, � I / 3 d -3 E\TiradonDae: 3 Job Site Addrass: ` V�� e ti S C"ry/StatelZip: Attach a copy of the workers'cmapeanettion policy declarafon page(showing the policy number and expiraiaou rdPte). Failure to secure coverage as required trader Section 25A of MGL c.153 can lead to the imposition of criminal pemalties off a fine up to S 1500.00 and/or one-year it p onmcmt as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to - O.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 covera-ge verification_ J do£e?esy rn uj� irza�fie�t+ms aarlpeaaifies ofperjcry fig fieo,yreiiorrPravitied above is ipae t int'carrel Sianature- t Vlam- 1f /r'/VLm.,— I Date: - Phone#: ( f.;- �'J rciel use or,F:c Do nm nrr&e hz ift area,to be comyleted Sy Iffy o;frown ofys_ci¢? CityarFown:' - a''errnwucense# Issuing Authority(efrele one): i.Board of HeRIM 2.Banding Department 3,atyruwn Oers n_EL ctricai%uspector 5 PImabing Inspector s.Other Contact Parson: P honein -� ®. - _ - _ µ _ _ - DATE(MNa""YYYI') CERTIFICATE OF LIABILITY INSURANCE 02242015 THIS 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 polfcy(fes)must be endorsed. If SUBROGATION IS WANED, 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 MARSH USA:INC: . . .. _ - _ NAME_.. TWOALLIANCE CENTER PHONE FAX 3560 LENOX ROAD,SURE 2400 E4WL xo ATLANTA.GA 30326 ADDRESS INSURERS AFFORDING COVE RAGE NAICP 100992-Home6GAW45-_16 INSURER A:Steadfast Inedranoe Go Tp-uny 26387 - INSURED INSURER B:ZI" P111B10I11fISaR11C¢(b 16535 THD AT-HOME SERVICES,INC. DBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hampshire Ins Co 23841 2690 CUMBERLAND PARKWAY,SUITE 300 ixsUREli e:Illinois National Insurance Company 23817 ATLANTA,GA 3D339 - - - INEURER E: NSURER F: COVERAGES CERTIFICATE NUMBER: - ATL-=42sasos REVISION NUMBER:7 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 ORCONDITION OF ANY CONTRACTOft OTHER DOCUMENT 1MTH RESPECT TO WHICH THIS CFRMEIPAM MAY RE ISSUED OR MAY E-INSURAN POLICIES-IBESCRIBED-HEREIN EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INER POLICY EFF POLICY E%P LTR TYPE OF INSURANCE POLICY NUMBER MMIDD UMRS A GIBIERALLIABILITY GLO48B7714-05 03ID11201L EACH OCCURRENCE $ 9•�•�COMMERCIALGENERALLIABILITY PREMISES occurrenm 81.000.000 CLAIMS-MADE OCCUR LIMITS OF POLICY XS MEDEXP{AlryonePerson) $ EXCLUDED OF SIR:$IM PER OGG PERSONALaADVINIURY $ 9.000.000 GENERAL AGGREGATE g 9DOD000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 9,ODO.000 X PoLICV JECT LOC8 B AUTOMOBILE LIABILITY BAP 2938B6312 03N1201C BINEDSINGLEUMIT R Ea amlderd $ Low,= - ANYAUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG AUTOS AUTOS BODILY INJURY(Per emlden0 $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per 2c errt S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LWB - CLAIMS-MADE AGGREGATE 8 DEL) RETENTIONST E -C WORKERSCOMPEHSATION ----._---WC017731493-(AOS)--- 03)0120T5FOEWD16 I6 WC STAN- OTI4 —_- AND EMPLOYERS•LIABILITY TO S 10�.000 G ANY PROPRIETORMARTNERIFXE-CUTNE YIN W0017731495(AK,KY,NH,NJ,VT) awr201516 EL EACH ACCIDENT E D OFFICER,MEMBER EXCLUDED? � NIA (Mandatory In NH) W0017731494(FL) 0=2015 EL DISEASE-FA ITIPLO E 1•W0.ODD nyas,aescam under Continuation Additional Page DESCRIPTION OF OPERATIONS hslon 9 E.L DISEASE- 1•�•�POUCYLIMIT $ DESCRIPnONOF OPERATONS I WCATDNS I VEHICLES(Attach ACORD 107,AddNlmal Remarks SeMMuN,R more space h rW aired) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATVE of Marsh USA Inc. - ManashiMukherjee' .3+rlauaanu �4,.AICAaAi,�et. ©1908-2010 ACORD CORPORATION. All rights reserved. ACORD 25(20101051 The ACORD name and logo are registered marks of ACORD sL. 33, Simonton Windows S 6500 VantagePointe u}x_C Double-Hung Vinyl 1/8"Glass Argon Low-E No Laminated Glass No Grids Ventana de doble guillotina.:_Vinilo.:3.18mm Vldrio.Arg6n Lowi Sin- -Rvypcaim(p� __�,-____�,_�._T--vidflo laminado_,Sln fejillas__� CPD:SBP-A-44-21042-00001 4 •07-75 DH F ENERGY PERFORMANCE RATINGS ° EVALUACION DE RENDIMIENTO ENERGETICO U-Factor Solar Heat Gain Coefficient Faclpr-0 ZoeOcronla Garmcce de Enapis Solar _ 0.29.. _ 1 .65 _0.27 N.S.g P) IMalriso/Sq ADDITIONAL PERFORMANCE RATINGS EVALUACION SUPLEMENTARIA DE RENDIMIENTO F -Visible Transmittance---. i 0.50 Manufacturer Stollen!hat these ratings conform to apprcmbla NFRC precedure[for doll i ing whole product pedormarl NFRC ratings are determined`ar a e ad set ofendronmental conditions and a specific product size.NFRC does net atom mend any pmdu9 and tloes nolwarrent the sullehlliry,of any prodml faranyspecdq use.Con°uli manufacturer's literature for other product pedormame'mformalien.wrww.rim are Esle lahncanla aslipula que Words eumplen eon in procedimientes splcalas de'Ji pare determiner ebandimtento lolal del prodnl Los valcraS vanes per NFRC soli delorminadYa par on cOnjunto fii de nadiciones adobjeont In y un larnano de pmdllcl capacities.chl no reaomisuda _ } ningen pzdL1..1 y n0 garanied que al product sea adecuado prom L nwe G9pecIiC O.Ccresure call el follete del fedua 2 pare el use apoplado de ) sidle produ'l wrvw.of,Ong / }t Unit qualifies for ENERGY. i r STAR®region(s): Northern, c ' North Central,South Central, Southern. NO _F DP:+25/-25 IND:Rein 00/Glass ProSolar/H-LC25 Tested Size:48"x 80" Florida Product Approval: FL5167 n e 4 I t I e Applicable Test Standard(s): ANSI/AAMA/NWWDA 101/I.S.2-97,AAMANVDMA/CSA 101A.S.2/A440-05,AAMA/WDMA/CSA 101A.S.2/A440-08, `- A440S1-09 Canadian Suppl 9 E 8971158/03 g0465 HS Gerlach 6860223 $ i Keep!Iris label for possible ENERGY STARE)rebates.To learn more viral ens,energpstar.gov. Guards esta etiquela posi les reemboLos ENERGY STARLE.Par conocer mac acema de eslo,virile www.energyslar gov. I Federal ID#75-2698460;ME Lic#-C 02439;RI Cam,Licit 16427- - - - - - - - - Cr Lic#HIC.0565522;MA Hume Improvement Contractor Reg.#126893 Installation Address: ( �(�Q� �"}' �Accyyn � n I q 6 City State Zip � Purchtiser(s): Work Phone: Home Phone: Cell Phone: CAAA Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑ I DO NOT wish to receive any marketing entails from The Home Depot Proieet Information: Undersigned("Customer'),the owners of the property located at the above installation address,agrees to buy, and THD Al-Home Services, Inc. (-The Haute Depot")agrees to furni all materials described sh,deliver and arrange for the installation("Installation'")on the below and on the referenced Spec Sheet(s), all of which are incorporated into this Contract by this t reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job#: namsaiRefire o Products: Spec Sheet(s)#: Pro ect.Amount Roofing Sid in ,Jews Insulation ^/ ❑Gutters/Covers ❑Entry Doors ❑ �[[[JJJ['�^J $ L.JRoofin Siding Wimiows Insulation ❑Gutters/Covers ❑Entry Doors ❑ $ Roofing LJSiding LJ Windows Insulation []Gotten/Covers ❑Entry Doors❑ $ Roofing UNMIng LJ Windows U Insulation ❑Gutters/Covers [I Entry Doors ❑ $ Minimum2S%Deposit or Contract Amount due upon execution dthiscwmact Total Contract Amount Maim:Purchasers may not deposit more Nan orrNhird dtheCantract Amount $ Customer agrees that, immediately upon completion of the work for each Product, Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable, 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 Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Monte Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns, pricing errors or because work required to complete the job was not.included in the Conte CO. Payment Summary: The Payment Summary# , included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy or the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the casts of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination, plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Hume Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms ofand has received a copy of is Agreement. ccepted y S 't et r3� �� .wmc Signature Date S p Sullant' ign t Dntc Telephone No. �q— uslDDler s Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS r r t( � t w (as applicable) { AGREEMENT WITHOUT PENALTY OR OBLIGATION W W BY DEPOT BY DELIVERING WRITTEN NOTICE TO THE HOME �� b40• ,k\,� �� DEPOT BY MIDNIGHT ON THE THIRD BUSINESS '�xj DAY AFTER SIGNING THIS AGREEMENT. THE ; STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN �L CUSTOM FR'S STATE T' NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE.AND ARE PART OF THIS CONTRACT 00-07-19 White-Branch File Vnllnw-f1i^.iom�r