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39 GREENWAY RD - BUILDING INSPECTION (2) 1 i ( I'he Commonwealth ot'Massachusetts I\Wf-1 t Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, Vh edition OF SALEM t Hct•i.red Juneutrt• Building Permit Application 'ro Construct, Repair, Re ovate Or Demolish a 1. 'oux One-or Two-Furnih�Dwellir is S •tion For Otl'jci4PfJse Only Building Permit Number: at pplied: : c Signature: r VZ•"co Building Commis. ner/Inspector of Il it ngs Date SECT N 1:SITE INFORMATION 1.1 Property Am 33, (ti�U ,(�n 1.2 Assessors Map& Parcel Numbers rel)gvin1.la Is this an accepted street?yes_ no / Map Number - Parcel Number 1.3 Zoning Information: IA Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(R) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required 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 SECTION 2: PROPERTY OWNERSHIP' / 2.1 0 nnErr Rec \\ 6 le P 1/ Name(Prin AdIlress lor Service: `7�-}9 �9� Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check a at apply) New Construction❑ Existing Building❑ 1 Owner-Occupied ❑ Repairs(s) CfJ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': 1 SECTION J: ESTIMATED CONSTRuCliori COSTS Item Estimated Costs: Official Use Only (Labor and Materials I. Building $ ! 1. Building Permi[ Fee:$ "indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (IIVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees: S Check No. Check Amount: Cash Amount: 6.Total Project Cost: S 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) 1-J�1 ( � 7 91u�k d Orl WK/ License Ntnnber I?spi tiun O c �' Name u' 'l.- Iulder ` I List C'SL-Type(see below) r% Description Il IInrestrictcd a to 35,000 Cu.Ft. 12 Restricted l&2 FamilyDwelling S a oreg At Mason Only I (( til�I< //}} RC Residential Routing Covering lbkphone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Ho roe en C ctor( Midavoit r IfIC egut t Registration Number Gspimtion le Telephone WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6)) ion Insurance affidavit must be •ompleted and submitted with this application. Failure to provide ult in the denial of the ISSamt 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 1, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION 1, , as Owner or Authorized Agent hereby declare that the statements and it ormation on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print g , u - r or Aulhon zed Agent Date ne u er the pains and penalties ofperjury) 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 trot have access to the arbitration program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.115, respectively. 2. When substantial work is planned, provide the information below: Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch) Gross living area(Sq. Ft.) Ilabitable 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" 2010-11-08 09:09 2676-EXPIDITOR/PHONE 978463717 >> Home Depot AHS P 1/5 HOME IMPROVEMENT CONTRACT (�p PLEASE READ THIS • 9 Sold,Furnished and Installed by. Name: Branch Na : Beaton Date: /.2f/ 1 o THD At-Home Services,Ioc d/h/a The Home Depot At-Home Services 345A Greenwood Street Unit 2,Worcester,MA 01607 Branch Number.31 'Poll Fox(890)657-5182; Fes(508)756-8823 Federal 11)tt 75-269MW;MC I.iv N C 02439;RI Curl.Lieft 16427 �GF U.' 0565522;MA Homee Improvement Contractor Neg.0 126993 7astallatlm Address: `�� ��-M08..L�lT�( `Sn-NS _"7 a lq--Cl7 City State Zip rPunhaxt(a): Work Phone: Hame P1,05541 sellCan Phone: C [ ] I J [ ] New Address: _ _ E-mitAdifferent re m to receive Address) City Suite Zip i —7 El I D Address(w receive a my communications and The tome update.-r): /v �i' ❑t TO NOT wish to receive any marketing email.from The Home Depot Pitied Information: Undersigned("CustonYr-) the ow.max of the property located at the above installation address,agocs to buy, and"I'HD At-Home Services,inc.("The Hecate Depot")agrees to furnish.deliver and arrange for the installation("InsaBatiun'l of all materials dcscTitsd on the below and on the referenced Spcc Shoxl(x),all of which rem incorporated into this Contract by this reference,slung with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job M: eY'^"'r�"'el .�//_ Products: Spoe Sheel(s)t: Project Amours �JROOfmg LJSiding El windows ❑Insulation ❑Gutters/(coverer ❑nntry laham ❑_. ( O d e4Y $ r Q / .. .._ EIRoofing ❑Siding ❑Windows ❑hwolwim ❑Gutters/(:ovms ❑Cnhy nooru ❑ Roofing ❑Sidma ❑Windows Iocudarinn - - . .._ ❑butters/[:aver; ❑Fntry Duu+s❑ $ []Roofing OSidiftg ❑Windows ❑I".,,lston $ ©(lancers 1 Covers ❑1!wry M." El AT®mrm25%DepowtdCmhaaAnmmtdreopssmandanafWsmmnat Total Contract Amount '� GS / Q Maine Pund.aas may not dsrpnil mote than uhethird nfshe CoM mm raviAuL / U Customer agrees that immediately upon completion of the work for each PnxhM,Customer will execute a Completion Certificate (one for each Product as defined by an isidlMdual Spec: Sheet)and pay any balance due. As applicable,each Customer under this - Cuntract agrees it,bujuintly awl severally obligated and liable heromder. The Hama:Depot reerv-es the right to issue a Change Order or terminate this Cnnhact or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determine..that it cannel perform its obligations true to a strtutrmtl problcTn with the home,environmental hazards such as mold,ashcshes or Lead paint other satiety concerns,pricing errors or because work required to complete the job was riot included in the Contract Payment Summary: The Payment Summary 0 '�IkLL2_, included as part of this Contract, sets forth the total Contract amount and payments reillhod for the deposits and final payments by Product(as applicable). NOTICE 1`0 CIJSTOMHR You arc entitled to a completely Hied-in co of the(ontruct 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 pa•The Home Depof the eotsts of materials,labor,expenses De and services provided by The Home, pot 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 DEPO'I' E'ROM THE: DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT JAMITTNG THE HOME DEPOT'S OTHER REMEDIES FOR RE(YIVERY OF SUCH AMOUNTS. Agxntantse and Authorimtion: (customer agrees and undast ands that this Agreement is the entire agreement between Customer and The Items Lxpol with regard to the Products and installation Noav;ccs anti all prior discussions and agreements,either oral or written,nelating to said Products and Installation.This Aymxmemt can t asaigned amended except by a writing signed 2_"M�V stohxlgas and ag !N that:byt to ha understands,voluntarily accepts the (t—d7pt1 U 2 Smbmi [(1 L � x � 0 x Customer's Si urc Date Sales Consultant's Signature Date v X Telephone No. �V e�2 y Customer's Signalure Date Sales Consultant laera:u:No. 'CANCELLATION: CUSTOMER MAY CANCEL TERS (as applicable) AGREEMENT WITHOUT PFNALTY OR OBLIGATION BY DRIVEIONG WRITTEN NOTICE'")THR HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFIIER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM 'TO USE IF ONE IN SPECMCALLY PRE.SCRHiEU BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 7-7-10 CSC White-Branch Fila Yalkm-Customer CITY OF S.U.ENI, L-kSS.kcHUSETI'S • BUILDIING DEPAR-M NT • 120 W x.SHLNGTON STREET, 3*0 FLOOR s� TEL (978) 745-9595 PAX(978) 740-98" Kl3(BEIU FY DIUSCOLL MAYORTHO.+tas ST.PIERRB DIRECTOR OF PUBLIC PROPERTY/BUILDIIVG COMMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris,and the provisions of MGL c 40, S 54; Building Permit# is issued-witi the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of ha ler) The debris will be disposed of in : r(name facility Ke.1ef�- (address of facility) sign re of permit applicant ,late dcbnvlLJs :Nl ss chusett. llcli a tIIICilt nl PilI)Iic Sa fety Board of Uuddnr, R ul ttions and St tuthink )u♦,.ervi > i License: CS SL 101192 Restricted to: RF,WS ZOUHAIR FERRIMY 2 ROLLING MEADOW DRIVE ;_ MILLIS, MA 02054 Expiration: 1/30/2012 f , nrriirti.r Tr=: 101192 0Jfi'of Investigations 600 Washington Street Boston,MA 02111 r Tvww.m-ass gov/dia Workers' Compensation Iusurancx Affidavit: Bm"lders/Contractors/E1Petricians/Pln 'hers ApLcant Information -�—� _ Please Print Legibly Name 03nsIness/0cgmmzaH0nFinaWId=D - Address: Civ/Stee/Lip: � �6` Phone#: > Are yo an employer!Cheek the-aPPropliate bon Type of project(regalre�; I L. I am a employer with ' >_ 4. �] ;am a general contractor and I 6. n New construction employes(Lrn anNorvait-time)• havclirtod�e sub ooaatractozs ,7._� -_:: __. listed°a3i$�-af7a't5iedslicxeh=�" _ -. _ . 0 Demolition: ship and Lave no employees These sub Cont=wrshave working-for ma in any capacity- . < workras'comp.insurance 9. Q BmLding addifion (No hem,gyp,insurance - 5: El We are a corporation and its 10.0 Electrical repairs or additions regaued l officers Lave exercised Theis arts or additions 3-❑ I am a homeoamer doing all WorkrigLtorexemptionper.MGi- _' 11.0 P Vw nrysel£[No Workers- COUP. C 152,§1(-[No T wehaveno 12 Q RooFrepans insurance requaed_l t employes [No workus' 13.0 Other, comp.bsurance iogmred l 'Any tmnt4Ackzb=#I ffiasos *ctft cimbciow Aowiog6,ww ikm V6bg7 - rHomw.roFsswTasobmitPoisWeviti mar,ue aomg..n.w&mamrnlmeoutademorsmmambmtraaew effww&io�mch tCmysebas eaaw* isbmxs afraeked m S&Vdand sleet BU*W'Vg tties�eofthe Wb.00a4ec6o.smd"fheirwodotd rump-P 9 I Mn an carptoy a that isP r wvr*zm'cvmPursauoa msOrlowefor my aaPloyees .Below is thepabW andjob-V to inforntadon_ �— Insurance cbmpanyName l01 n) • n �I(� �Y�S �17 Policy#or Self-ins.Ur-C. 1�1ci� ..� Expiration Date: Job Site Address: Attach acopy of the workers'compensation policy dalaia4on Page(slowing the policy number and a piraf�on date} ooveragcasro4oaeduderSedionZ5AofMGLai52can-lead-tothc.iomposilum to alp esofa . FaLmetoseCa?'c.. . v. 3 - .K - f�'SYOP�VEHL&O td-a-fine {meuptoSf �B % ieoai great t.'arwoiat _, .._ the-vioLmor Beadvrsadthataoopyofthisstatementnraybefnrvvardod>otbeOffCe of ofup to$250.00 a day against - ce oovdagoNCrWCX ioai . I LrvcstigaimnsoflheDIA I do hettby�under olPed"U&&the LrfarrrraliorsP^ovlded above is*we and Corm l ► J phone#: Official am only Do nat writs in Ibis aura,to be avmpldedbY CRY OrMM of wdrL (Sty or Town Perms :Irene# Issuing Anthority(circleone): r 4 5_Plmnbingl»P or 1.Board of HeaN�h. _Bonding Department 3_(SiytCown Qeilc .Electrical Tnspecto 6.Other Phone#: D' ® A IEE IMMIDDIVYYY) A�Rb CERTIFICATE OF LIABILITY INSURANCE 02,19,10 PRODUCER 1-404-995-30CC THIS CERTIFICATE IS ISSUED-AS A. MATTER OF INFORMATION Marsh USA, Inc. OPILY AND CONFERS NO RIGHTS LPCV .Fit Ccol oh r FCL THIS C RT'FIC DOES Ivr V 10 EXTENI, 3 :.node c c rr a ,�s-L^.na;sh.Con Ai_>_ar-_a Car.a _E50 Len CX Road, �..ra 2400 T.uo o . -_anti G% 317 -i N^I,ic o rr''L 7DI`'i CC _ CIS_f.`D I Dept, 1_'.c. Co := I -CooDyout C.S.A. V *ma__caa ha _ 7_7_ 2455 Paces Ferri Road NW 1d1R..�1'.New Hamosvre In. C. ic__ ,,.__- Building C-2U INSURER D:NATIONAL UNION FIRE INS CO OF PITTS 13445 Atlanta, GA 30333 __ __—_. ..-.__ ___._..___. INSURER E: Illinois Union Ins Co 127960 COVERAGES - 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 ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _. _____--_.. WBR OO'L POLICY EFFECTIVE POLICY EXPIRATION LIMITS T POLICY NUMBER q I ry T MMI NV V GENERAL LIABILITY GL04887714-00 03/02/10 03/Ol/].1, EACH OCCURRENCE S4,000,000 UAMA�G TO RENTED TAUTOMOSILELIABILITY ERCIAL GENERAL LIABILITY PREMI ES Ea accurrenceL 81,000,000 ____ LAIMS MADE ❑% OCCUR MED EXP(Any one parson) $ EXCLUDED____ PERSONAL B ADV INJURY 54.000, GENERAL AGGREGATE S 4,000,000_ REGATE LIMIT APPLIES PER: - PRODUCTS-COMPIOP AGO S4,000,000 _ Y PRO- LOC _ B BAP 2938863-07 03/01/10 03401/11 COMBINED SINGLE LIMIT - (Ea accident) S 1,000,000 % ANY AUTO '--'--- ALL OWNED AUTOS . BODILY INJURY $ (Per person) SCHEDULED AUTOS --- -- HIRED AUTOS BODILY INJURY E (Per accident) NON-OWNED AUTOS ------ X SELF INSURED AUTO PROPERTY DAMAGE E (Per accident) PHYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S _ ANY ALTO - - OTHER THAN EA ACC E AUTO ONLY: AGO $ 11 NESS I UMBRELLA LIABILITY GL04887714-00 03/01/10 03/01/11 EACH OCCURRENCE S 51000,000 _ OCCUR F_ICILMMo MADE AGGREGATE Y 310001000_ E DEDUCTIBLE RETENTION E - S C WORKERS COMPENSATION WCO20342355 (ADS) 03/01/10 ;03/01/11 /11 X 'WC STATII OTH- —__-- —-_ AND EMPLOYERS'LIABILITY YIN 1,000,000 D ANY PROPRIETORIPARTNERIEXECUTNE� WCO20342356 (CA) 03/01/10 /11 E.L.EACH ACCIDENT S _00 _ OFFICEWMEMBER EXCLUDEOT - E (Mandatory in NH) WCO20342357 (FL) 03/01/10 E.L.DISEASE-EA EMPLOYE S1,000,000Ilyes.describe ender - - EL DISEASE.POLICY LIMIT S1,000,000 SPECIAL PROVISIONS belowOTHER E TX Employers Excess - TNSC46242373 (TX) 03/01/10 /11 Occurrence/SIR 30M/2MD Workers Compensation WC0910566 (QSI) 0.3/01/10 /11 C Workers Compensation WCO20342358(XY,MO,NY,WI, ) 03/01/10 /11 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN THE HOME DEPOT, INC. HONE DEPOT U.S.A., INC. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR 2455 PACES PERRY ROAD NW "'"" BUILDING C-20 - REPRE'SENTATIVcS. AUTHORIZED REPRESENTATIVE ATLANTA, GA 30339 USA ACORD 25(2009/01).Tthornton_hd ©1988-2009 ACORD CORPORATION. All rights reserved. 14481889 The ACORD name and logo are registered marks of ACORD . .. e OTe.�onvrnaruae¢ i o�./l�aaa¢c%uaelta Office of Consumer Affairs&Business Regulation OME IMPROVFMENT CONTRACTOR , - i Registration }26893 TYPO Expel a5on 8 31R62 Supplement,i The Home pepot}ArHame selvizes - RICHARD FALLONE= 2690 CUMBERLAND FsAE2MAY S Aft'GA 30339. = Undersecretary