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29 GREEN ST - BUILDING INSPECTION Commonwealth of Massachusells 1; Board of Building Regulations and Standards CITY OF Massachusetts State Building Code. 780 C'MR SALEM Building Permit Application To Construct, Repair, Renovate Or Demolish u One-or Ttvu-Famih Dm ellin,\r This Section For 011icial Use Only Building Permit Number: Date pp ' MW w2 --- �Building 011icial(Print None) Signatu Du e SECTION 1:SITE INF IATION 1.1 Property Z I 1.2 Assessors.Map& Parcel Numbers a I.la Is this an accepted street,yes no %lap Numher Parcel Numher 1.3 Zoning Information: 1.4 Properly Dimensions: Zoning District Proposed(J a Lot Area(sq It) Frontage(Il) I.S Building Setbacks(R) From Yard Side Yards Rear Yard Required I'roviJed Required Provided Required provided 1.6 Water Supply:(M.G.I.c.40,§Sq) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Munici al❑ On site disposal Check if es❑ P system ❑ SECTION2: PROPERTY OWNERSHIP' 2.1 Own r' Rec — - na o Nautc(Print) City.state.ZIP Nu.and Street —��� ' telephone Email Address SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repair—' Alterationls) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ I Number of Units_ ther ❑ Spwit'y: Brief Description of Proposed Work=: �- 44 SECTION a: ESTIMATED CONSTRUCTION COSTS itent Estimated Costs: ILabor and \laterials) Official Use Only I. Building S I. Building Permit Fee: f —IiNicate how fee is determined: 2. Electrical S, ❑Standard City/Town Application Fee ❑Total Project Cost't Item 6).x mPulti her 7, Plumbing S J — - _. Other Fees: S 4. \Icchanical nlll'.1('1 S List: 5. .\lechanical tFirc - -- ------ -._..-.--. . ..- Culttcssion) S TatalAllpees: 5 Check No. ('heck amount: _ Couh \mount: _ b. Total Project Cost: S ❑pAd in Full Cl Outstanding BuLmce Due: SECTION5: CONS'MticrloNSERVICES 5.1 Construction Sullen isor License(CSL) --- I �yn{y1n License Nunlher Pylira nn ;ue N;une ol'CSI. l loll cr �.(,� � IisICSl. f�peVeehelowl__.__ _- -.--r�!/ -J-L-------- --------- I)pe Description No-uld Suec U I hueuncl.J I IfuilJin os tio to]S,UIIO cu. It R Rcslrivwd 1&2 Fanlil Dwcllill Cigil'oe n,.Slate,LlP ---- M Masollry RC'. Roolin Cmerin W'S ' Window aild Sidin SF Solid Fuel Ruming Appliances Insulation 'I'cle hone Email address D Danolilion 5.2 Registered Iprov meat Col aclor( IIC) . IIIC llegistration Nrunl+cr 1, tawW141V III ' 'o I w I,fN or I IIC(te istra a Ire— No.; I trl.•1 Email address City/ own,State,ZIP Tcic hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c, 152.1 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 Issuan of the building permit. Signed Affidavit Attached? Yes ..........91, No...........0 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 c�a2r to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Nwne(Elcclmnic Signature) °e SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby at nder the pains and penalties of perjury that all of the information c ed in this application is true an accu to tot best of my knowledge and understanding. D Print 0%%ncr't or ALiLhorired Agent's IF c trunic. Ignature) ale NOTES: I. An Owner who obtains a building permit to do his.her own work,or an owner who hires an unregistered contractor ([lot registered in the Hume hnprovement Contractor(HIC) Program),will no have access to the arbitration program or guaranty fund under M.G.L.c. 1 2A.Other important information on the HIC Program can be found at mm m t,, of i Information on the Construction Supervisor License can be found at 1%\%,% l.l,:�;.w ,Ill, 2. When substantial Iwrk is planned, provide the information below: Totai Fluor area(sq. 11.1 _ (including garage, finished basement attics.decks or porch I Gross living;rea l sq. III I _ _ Habitable room count \unlbcroflircplaces._-- Numherol'bedrooms \unlhcrofhathnronls _ -. \'umberufhalfh:uhs I)pe o0wating s)stem Number of decks, pordles - I I\)W of e0U1111g i)stCIII _ FIlelosed . . -_I)yell _ i. "total Project Square Footage-ma) he substitiacd Ibr••fot;d Projact Cost- 2012-01-07 07:31 2676-EXPIDITOR/PHONE 978463717 >> Home Depot AHS P 1/7 HOME IMPROVEM p:NT'CONTRACT PLEASE READ THIS ' � Surd,furnished and Installed by: Branch Name: Boston Date: (--r-i~ 1 a THD AL-Hone:Services,Inc. d/h/a The Home Depot Al-Houle Services 345A Greenwood Street,Unit 2,Wor Baer,MA 01607 Toll Free(8M)657-5182;fax(508)756-8823 Broach Number:31 Federal ID 4 75-2697460;ME Lic B C 02439;R1 Cont.Licii 16427 `yCT 14 k 1111C^.0550522;MA Home Improvcn¢nl Connacann Reg.it 126993 d Installation Address: v vT f`-�-U'� U I .J�I r�YI� r r'14 0 ( !-7 0 City Slate -lap Purdueser(s)t Work Phone: Home Please Cdl phma_: Home Address: Sf"lY"`s .- (If different from Installation Address) City State 'Lip it-mad Address(to receive project Comrounirattinnv and Home Repot updates): ❑100 NOT wish to receive any marketing emits from The Home Depot Protect Information: Undersigned("Customer'),the nwncn of the property located at the above installation address,agrees In buy, and THD At-Hona:Services,Inc.(`The Home Dep n-)agntes to furnish,deliver and arrange lot the installation("Inxtdletion"1 of all materials described on the below and on the refcrenued Spec Sheet(s),all of which arc incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Som in ry altachul hcn:to and any Change Orders(collectively, "Contract"): 3ob4h "°1""a a'�°`o Poporrtla 8 .Sheet(s)Lh Pro'xtAmnant l� GO 4 6O fj ❑R'vlfrag❑Siding Windows Insvintirer O��j $ 3 3 V V ❑Cmnaa l Coves ❑Pnl7 fktNv ❑_. f k> � $�y E]Roofiog ❑Siding Windows insulation $ ❑(milrs/Covers ❑FnnYDuurs I-1 ❑Rrxrfmg[].Siding ❑Windows El haulahonn ❑Garters/Tutees ❑pastry Ilona❑ l LAwling❑siding ❑Wandown Insuladpn $ ❑Csnrexi oven; []Envy Doors; fl q sa AfBuimo.rm ZS%IlyraatreCamrzd Amount due wLnxvndiM rethir®tray Total C4alrael Aamoat $ 7�b� MmmPmdm aaoddgwn*° t1®®e4bmdudtheCamrad ArmmLL , Customer agrees that.immediately upon completion of the work for each Product.,Customer will execute a Completion Certificate (one for each Pmot=w defiruxl by an individual Spec Shect)and pay any balance due, As applicable,curb Customer under this Contract agrees to,bo:jointly and severally obligated and liable hereunder. L . The Home Depot reervcs the right to issue a Change Order or terndnata this Contract or any individual Product(s)included herein,in its discrclium,if The Home Depot or its audtorned.service provider detenoittes that it canna perform its obligations due to a structural problem with the hunw,cuvironmental hazards such as muld,advents or lead paint,other safety concerns,pricing errors ur because work squired to(wmpidc the juh was ma included in the Conuacc Payment Summary: The Payment Sumuwry n--6-7 19 included m part of this Contract, sets forth the total Contract amount and payments required for the deposirs and final paymenw by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filkd-in copy of the Contract at the time you sign. Do ant sign a Completion Certificate(note: there is one Completion Certificate far each listed Product as defined by individual Spec Sbeetsj before work on that Product is complete. In the event of termination of this Contract,Container agrees to lacy The Home Depot the eosin of materials,labor,etpenscs and services provided by The Home Depot car Authorized Service Provider through the date of termination,plus any tither amounts act 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 THR HOME DEPOT'S OTHER REMEDIES FOR RECOVERY ON SUCH AMOUNTS. Acceptance aid Authorization. Cusmmer agrees and understands that this Agreement is the entire agreement between Cusronner and Tlx:Horne depot with regard to the Fr dmis and Installation services a supersedes all prior din:assmm and agreements,either rail or written.reWing to said Pnnlw:ts and Installation.This Agrement noun l be assigned or amelukd except by a writing sagncd by Customer and The Home Depot-Custumer acknowledges awl agruci Brat CL mer ha understands,whomrily accepts the terms of and has received a copy of this Agtce t men A by: S had Custmer s Sigamire Dab: Salci Consultant's Signature Date cz—.-. Tetophe.No.�A Vf 3 `73�F� Ctuxlnmi s Sigoamne fade Sales Cmrculuelt License No. _ CANCELLATION: CUSTOMER MAY CANCEL. THIS I (as applicehle) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFPER SIGNING TIMS AGREEMENT. TfLE STATE SUPPLEMENT A,rfACIIm HERi'10 CONTAINS A NORM TO USE. IF ONE. IS SPOAMICALLY PRESCRIBED BY LAW IN CUSTOMER'S SPATE I WiTICE:ADDITIONAL TERMS AND CIlNBiIIONS ARK.SPATEDON THY RYYERSE SWE AND ARE PART OKTHIs CONTRACT ....... rcr Whoa-Mavf,Film Yeaow-0x mn CITY OF SALEM, 1tiLuS:ICHUSETTS BLLWLNG DEP.IR77gLNT 120 WASHNGTON.STREET, Y°FLOOt TM. (978) 74 -9s9s KMESERI EY ORLSCOLL FAX(978) 740-9846 .MAYOR TkosW SLFmRRtt DIRECTOR OP PLBLIC PROPetTY/81L:MDLgG CO.%CNISStON Et Construction Debris Disposal Atttdavit (required for all demolition and renovation work) In accordance and accordance with the sixth Debris, edition of the State Building Code, 780 CMR section I 11,s theprovisiona Of c 40, S 54; Building Permit M is issued with the condition that the dcbris resulting from this I work shall be disposed of in a properly licensed waste disposal racility as defincd by NIGL c III, S IsOA. The debris will be transported by: (n.une ot'hauler) The debris will�1be disposed of in : (name o(Wcdiry) r l a rVl (Jddress or raellay) Sig Jtu(e orpermrt ipplic4nt IJ e y1 " . l ir,c;ly " ;7['i r.i Yi;uc•n'. _, .ry „ I� gu.trd n? 43!t iltlin nt -t -.tir �J �h nd ri'1' �cn>+ruction Sups ,i,o k Lican Urense: CS SL 99364 !stricted to: WS 1ERTE TORRES i FELTOM STREET ARLBOROUGH, MA01752 E.cpiration: 1612012 it=: 99364 ( muw..n ni`'r' vvv Restricted to: WS ? IA- Masonryonly RF- Roof Covering f WS-Windows and Siding SF- Solid Fuel Burning Devices DM-Demolition only Failure to possess a current edition of the I Massachusetts State Building Code is cause for revocation of this license. Referto: WWW.Mass.Cov/DPS a J 11.drizi T.3 city/StItelzip: IhG Type of project(pqlairzd) Are yo n employer? Check the.npproPriata bo,,K* I am 1 ffmzal rontader and 1 4, c C� D limy car,,Xuution 11 1 am a C410YLT With have blur the sub-contractors employees(fidi andfor p lWad on the d:ached shezt 7, Remodeling 2.0 1 Mn a solo proprietor or P These sub-=tradora have S. Demolition s ship Ima have no M Doers, comp..lasurMM 9 D Building ad&fOn Working for mein any capacity. Wa We,am R�Orpora&nand it Electrical tkorso comp., ect�ral repair's or Ldditiow [No WO&M, COMP. otucars We=rcised their -60M r . A qUM� I light of exemption per MGL I.1.[]plumbing repairs M additions 3.0 1 am a homeowner doing LU Work a, 152,J 1(4),and we have no 120 f Mpah ouself.[No Worken, clomp. emp �ej[No workc& �-4 loyc camp.ins�co required.]' 6 e= cc gmqp ccann 6 policy b6nca�ol- OAXY art 5mra 6916,di box I I must Rim fill cut ft I`ctim maw= s�' mud schaa&=w&rn&yit ia&�I OCIL t Jic==Wc=WIM a.bMIt this e—iarlit ladimas they L't dclas&II WCA K:4 11=hies outtda -COMP.PC'icy V=,,`IOIL tCaatzacten as Ld&d=ll shot she tha==of the rb-ccahzt=aud their W06= that 6=k ffils box=tl"Ir"�d I emplqeir that is providing workers'cotVensatiOnLwwanceforrnyrnproYcey- Blow is the Poacy andjoh site htfOrMat!OM wo-47 Lism-enc:e Company NIme: 1\�LC�lei— •Expiration Date: poUcy P,or Self-ins.Lie.9:— job Sitzkddrc&3:— ,kftch IL Copy of the workers' compen,-Itiou policy declaration page(showing the policy number and expiration date). Failure to secIn coverage its required=detSecdou25AofMGL c.152 can lead to the imposition of criminal penalties of a fine up to$I�oo.00 andlor one-year imprisorroamt,as well as civil penalties in the form of&STOP WORK ORDER and&fine may be forwarded to the Office of "'e" employees Imn asc h. Jmd,Not 3 FE sclL.y==ao of up to S250.00&day against the Yjolatar. Be ad,�Ised that Ii copy of this statement Investigations of the DLA for insurance coycrage yerification. ins ,I CEO her cat*�O u Mere I perjury thafthe Wormadon provided above d carted e 71y 1w 'pMalder Of Date. Si tLre. M Si Liz 1(�77,4�1_e3 ;Phoa�9: to be cotqL-fed by dV or town obf-xid OffwId we only. Do rior write In thLr areal w City or Town: )r W Issuing Authority(circle oat):' g Ims cc �Iacalth 2.Build 3�din Department 3.CitylTovym C[crk 4.Blectrical Inspector 5,Flumbin p tor 1.Board of HCRIth 2.Building 6.other Office of Consumer Affairs&Business Regulation.. OME IMPROVEM ENT CONTRACTOR Reglstration .if26893. Typf Expiration 3F1D=2 1 Supplement The Home Depot Services _ � r RICHARD FALLO����' �1t '. - 2690 CUMBERLAND� W 'A°fI�A'NYA,GA 30339 Undersecretary '. a "tp .y� NFAC `Natlonal Faneslratldn y, :ii o.. '.1..: ,': •-"-,• . Haring Caunatl® ENERGY PERFORMANCE RATINGS - EVALUACICN OF.RENOIMmWC ENEHGETIC0 U-Factor Solar Heat Gain coefficient i Cdefideram(lananda de:netgia Solar Factow . .'NSP-al aaatdcNSa. ' ' ADAMONAL PERFORMANCE RATINGS EVALUAOION SUPLEMENTAHIA OF PEN001ENT0 . Visitfle7ransmittance Transftntiislon deW hihle . V . 44 - - t ahpls prcduclpedertnany pmduC ManufaMer stlpulalesAatNesa2of arri pmenaaPPndtWa Nnd 1304cyle edu Prod"I MrmaiiM recomonerol ratlngs are determined far a rmd salal emAmnmelottanyal spn cmc09.consult manufaceiredReanaa?uahtotherprodudPed°n^a"e and does not Warrant the sulbGllyof my pm 11110mp500.vnaw.npcara _________ J t nu Este hhdcwte estlpulzque etas valarrs eumplen can Jos procedlmlentas rode Wes rof[�oNFHC PWbI,nW y antarnana de produueto l' pmducto.usvabo"%usadas parJIM son detemdnadas Po un con` 90 WnauRO con el - espeddca.NFHC rro ttwmhndarMgun p�pdpp ragaranticaque ofProducts sea adecvada Pats unusd especmca - Mae,del Narlcanle paradum sprapladodoasta pmducw.whw3*e.org .y:rz�'qua li£lay ICrr g.a2i7;;'1 GTAa ragionlsls Nocrhorn. 14 to ; 4n!ral, S+otrth Cnnlral, 9 _trbn�n.'-I rF e�^GYau�.: .. T., smidad rwli£irA nary ]nlgl FtT.. 24 - + ra7:� rta'.:).EriZoT 51d: p:o:Lu. _ our. ceatca.r Sur. 'NVL'Lu'LdlCCdl. ' ` IND: Swan Willa ss 1J'u'• DroSolacl S-L025 1 Tdacud Siza: si'u' x $U" • s w• * L••s..: Ra u0c.o LOJJIGHd 3.13 seal N-L02$' )h Tsoatto pcobado: ]a1.S apt x 203.2 cat E)p • ADDli�au.a Taste a!arl:ac•d isl: A.NSTJAANAJNWSCuA'101JI.3-2-D7'kk • ]fAi fSl:LV CS1.:01/21`6.2/Ag40-Oi,A .• IIdd%3�NL'CSAi01i2.e.2JAi�U-Cil. . CERTRCATE OF UABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS YC RIGHTS UPON THE CERTIFICATE HOLDER. T i2 I 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 BETINEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pel.cy(ies) mus;he endorsed. If SUBROGATION IS INIANED, suhject :D the terms and conditions of the policy, certain policies may requira an endorsement. A statement on this certifica'ta does net confer rights to the certificate holder in lieu of such endorsoment(s). PRODUCER 1-404-995-3000 CONTACT Marsh USA, Inc. PHONE V All c.�Va_Oal _ ___ . ___._.._ _._ _�LC N1 _..___ ... . homedepot.certrequest(Nmarsh.com pp RIESS'._ TwO Alliance Center, 3560 Lenox Road, Suite 24VU INSURER(S)AFFORDING COVERAGE _ .__NAIC N Atlanta, GA 30326 . Fax (212) 948-0902 INSURER A_Steadfast Ins Cc 26387 INSURED INSURER B: Zurich American Ins Cc 16535.-„__,,, The Home Depot, Inc. INSURER C. New Hampshire Ins Co _23841 .- Home Depot U.S.A., Inc. Illinois Natl Ins Cc 23817 2455Pa<ea Ferry Road NW� INSURER D: Building C-20 INSURER E: NATIONAL UNION FIRE INS CO OF PITTS 19445 lit Atlanta, GA 30339 -- INSURER F: Illinois Union Ins CO 27960 COVERAGES CERTIFICATE NUMBER: 19834682 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER100 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. INEft ADDL SUER POLICY EFF POLICY E%P UNITE LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDMIW A GENERAL LIABILRY GL04887714-01 03/01/1 03/01/12 EACH OCCURRENCE $ 9,000,000 X DAMAG TOR NTED 1,000,000 COMMERCIAL GENERV AL,LIABILITY PREMISES Ea occurrence $ LAIMS-MADE u OCCU0. MEO E%P(Any one person) $ EXCLUDED ._. ITS OF POLICY XS PERSONAL S ADV INJURY $ 9,000,000 SIR: $IN PER OCC GENERAL AGGREGATE $ 9,000,000 REGATE LIMIT APPLIES PER: PRODUCTS-COMPICP AGG $ 9.000_000--_,_Y PRO- Lac $ ILE LIABILITY HAP 2938863-08 3 Ol 1 03 Ol Ea aacc tlentED SINGLE LIMIT 1,000,_000 UTO BODILY INJURY(Per person) $ WNED SCHEDULED BODILY INJURY(Per accident) $ S AUTOS NON-OWNED _ PROPERTY DANIAGE $ DAUTOS AUTOGPero cident AUTO P Y $ UM BRELLA LIAB OCCUR EACH OCCURRENCE E EXCESS LIAB CLAIMS-MADE AGGREGATE____ $ DED RETENTIONS $ C WORKERS COMPENSATION WC061967352 (A05) 03/Ol/1 03/01/12 X WC STATU- CR AND EMPLOYERS'LIABILITY ST O ANY PROPRIETORIPARTNERIEXECUTIVE YIN NIA WC0 619 6 73 54 (FL) 03/01/1 03/01/12 E.L EACH ACCIDENT E 1,000,000 OFFICERrt,inN REXCLUOEOT WC061967353 (CA) 03/01/1 03/01/12 E.L.DISEASE-EA EMPLOYE S 1,000,000 E (Mandatory in BE .__ If yes.deschba under OE BCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT E 1,Q00,000 C Workers Compensation WC061967355(XY,MO,NY,WI, p3/Ol/1 03/01/12 F TX Employers XS Indemnity TNSC46244151 (TX) 03/01/1 03/O1/12 Occurrence/SIR 30M/lM E Workers Compensation WC1192378 (091) 03/01/1 03/O1/12 SIR 1M DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION r.',. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HOME DEPOT, INC - THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HOME DEPOT U.S.A., 'INC. ACCORDANCE WITH THE POLICY PROVISIONS. I2455 PACES FERRY ROAD NW - AUTHORIZED REPRESENTATIVE BUILDING C-20 ATLANTA, GA 30339 l C--�-✓1 I USA ©1988.2010 ACORD CORPORATION. All rights reserved. ACIDRD 25(2010105) The ACORD name and logo are registered marks of�ACORO::( jfiero hd t /9834662 T1 A