32 HANSON ST - BUILDING INSPECTION (2) 1/I The Commonwealth of Massachusetts FOR
} Board of Building Regulations and Standards MUNICIPALITY
I I Massachusetts State Building Code,780 CMR USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised May 2011
One-or 71vo-Family Dwelling
.:.This SechouFui OffipjatIise Oril',. ,
Building:PerrtritNumber. ;Bate ed
Bmldiog Ofiirctsl(PriatName)
Date
.�..,. . .%Mnm
SfiCTION 1 :S1TE INFO N -i
1Property Address - 1.2 Assessors Map&Parcel Numbers
1.1 a Is this an accepted street?yes_ no
MepNumber Parcel Number
Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq N) Frontage(it)
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 Zane Information: 1.8 Sewage Disposal.System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public Private❑ Checkifyes❑
SECTION2 PR:pPERTYQWNERSI{IP'
L Owner' eco d: �P1m
��5e� Y
Name(Print City,State,W
32 �G.51�r�� '1 qjj. Z - 13
No.and Street Telephone Email Address
z .. r
SECxION :DESCRIE1IONOFEICOP�SE1f:WORK (c>ieckailthaEaPPIY)
New Construction❑ I Existing Building❑ owner-Occupied. ❑ Repairs(s) ❑ 1 Alteretion(s) ❑ 1 Addition ❑
Demolition 01 AccessoryBidg.❑ INumberofUnits_ Other ❑ Specify:
Brief Description of Proposed Work:
ltt t
SECTIfIN;4 ESTIIY&TED CONSTRUCTIO.MCOSTS
Item Estimated Costs Official Use Only
Labor and Materials
1.Building $ 1 BurldmgFermit Fee Ind;cafe how fee is deteimmed
❑.Standard. City/Town Application Fee. -
2.Electrical $ ❑.Total Protect Cost'(Item 6)x multiplier x
3.Plumbing $ 21 Other Fees::
4.Mechanical (HVAC) $
5.Mechanical (Fire $ Total All;Fees $ -
Suppression
Check No Check Amount Cash it itrWnt
6.Total Project Cost: $2 QZ p PaidmEull, O:Outstandmg BalariceLlpe
0
SECTION 5 CONSTRUCTION SERVICES
5.1--�Construction Supervisor License(CSL) 0/1 27�
License Number Expiration Date
Name of)C`f Holder List CSL Type(see below)
tio
No.and Street q U Unrestricted(Buildin u to"'U"cu.ft)
Ya�)\(., V R Restricted 1&2 Famil Dwelling
City(fo State M Masonry
\{�)�\� RC Roofing Coverin
_ ✓'�\/ 1 1 /"� WS Window and Siding
SF Solid Fuel Burning Appliances
�75A�� }zcl I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(RIC)
(::kn S v)0 HIC Registration Number Expiration Date
EC C an Name or HIC 'stravt Name
o.and treet a A
Email address
j ivl
Ci /Town,State T-el eltone „
SECJION'6 lv9klclEitS'GONTYEISATCQN INSLTIIANCE 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
SEGTIOIS:Ta�NNERAI#TH0 UM!. IOIV T013E COMPLETED:WHEN
OWN 1 °SiiICrENT OR.CQNTR kCT�OR:AIfPLIE3roR'BUILIIIIHG pt",
I,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. _
rn, C � kr\�I Dat e d
print Owner's Name(Electronic Signature) -
,,_,;: SEfJTTQN'Ib;:OWMERx.ORAUTHORIZEDAGENTDECLARATION
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. r
ad
Date �
Print Ovmer's or Authorized Agent's Name(Electronic
l. 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/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
ths
Number of bathrooms Number of decks/half/b porches
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"
91n�sstchusetts- Department of PuUlec Safct%
89:er11 of Building RcLuistiuns and Standard!
Construction Supervisor License
License: CS 91377
s
BRIAN F HESSIOyI
2 PATRICK RD
TEWKSBURY,MA 09876
Expiration: 1002012
- Cummexxiuncr Tm' 4629
Office of Consumer Affairs' and business Regulation
10 Park Plaza e Suite 5170
Boston, Massachusetts 02116
Biome Improvex ��ontractor Registration
Registration: 162111
......:....;t f r Type: Supplement Card
NEXT-STEP LIVING INC. Expiration: 1/1 412 0 1 3
BRIAN HESSION
25 DRYDOCK AVE. 5TH FL
BOSTON, MA 02210
Update Address and return card.Mark reason for change. _
)4104.G101216 Ej Address Renewal ]Employment Lost Card
,fee�oommorsu�ealtdc o�,/yoeeoc�aruefYa
rice of Consumer Affairs&Business Regulation (License or registration valid for individul use only
- 'ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration:;ff62111 , Type: Office of Consumer Affairs and Business Regulation
Erzpirati9�:--.. lOParkPlaia-Suite5170 -
C13. Supplement Card
UViNl{ C": Boston,MA02116
SSIO
K P VE_5TW Ft �4�ti.y®P� I
AA 02
Undersecretary Not valid without si ature
-�Smm�uwnrn
��. � .: �ORTIFICATE ®F LIABILITY IfNbUKANUr- 11,29�D71
I THIS CERTIFICATE IS ISSUED AS A MATTER Of INfbRMAT10N
Ga a9her Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC.gTEE
HOLDER.THIS CERTIFICATE DOES NOT AMEND;EItTEND OR
CIS Brokers,Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Intic Avenue NgIC#
MA 02210 INSURERS AFFORDING COVERAGE
INSURER A: ORO Bnaon InaYnna Company 21870
Next Shp Living,Inc. INSURER B: A.I.M.mutual Insurance Co. 33758
6
25 Drydock Avenue INsuRERc: RIw InsuranesCompeny _ 3E54
5th Floor INSURER D: HgA7ord Firo Insurance Co. 19682
Boston,MA 02210.2600 INSURER E:
AGES NAMED ABOVE BELOW HAVE
EOUIREMENT TERM OR N I
CONDITIO OF ANY CONE TRACT OR OT ER DOCUMENT WITH RESPECT To WHICH THIS CERTIFICATE MAYBE ISSUED TOR DING
=RTAIN.THE INSURANCE AFFORDED BY THE POLICIESO ESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS �F SUCH
ES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. P iloN LIMITS
TYPEoFB1SUNANCE POLICY NUMBER OEM
792000560 1111112011 11/1112012 E914000URREMIE $1 p0 000
GENERAL UABHRY T RENtiED $1 D 000
X COMMERCIAL GENERAL LIABILITY MEDEXP(NVM Moen 51016D
CLAIMS MADE Fx-1 OCCUR PERSONAL SADV INJURY 51 005 000
GENERALAGGIRMTE $2 ODD 000
PRCOUCTS.COMPIOPAGG $1 ODOORO
GENL AGGREGATE LIMIT APPLIES PER:
POLICY M
PRTO- LOG
AUTONIOBILELIABILITY 390001209 11/1112011 1111112012 CCFOMBINOrDEINGLELIMIT $1,000,000
ANY AUTO - - -
BODILY INJURY S
ALL OWNED AUTOS (Per perwo)
X SCHEDULEDAUTOS BOOILY INJURY $
tPara
X HIRED ADIOS IPOraedeeN)
X NON.OWNED AUTOS
PROPERTY DAMAGE S
(PereKlHel)
AUTO ONLY.EA ACCIDENT S
EDEDUCnIBIlE
Y OTHER THAN 'EA ACC S
AUTO ONLY: 'AGG $
LA LIABILM 792000561 1111112011 1111112012 EACH OCCURRENCE 53 QDQ Q0O
AGGREGATE $3 DBO OOO
CLAIMS MADE - S
S
S WCSTATU- DTN•
OR KERB COMPa15AT1ON AND T1733286 11111I2011 1111112012 X -
MPLOVERS'UA$BJTT 1111112011 11H712012 E.L.FACXPCCIDENT $500000
ggjf,,LBE�R EXCUDED?EGUTNE TBDIOB7B7 E.L.DISEASE-FA EMPLOYEE $500 ODO
ery eRNI ELDISEASE-POLICYLIMIT' $600.D00
yes,dRTeADB uMer
PECIKL PROV ISNINS below
?HER .:
Iroperty OBUUMHX5485 1111112011 1111112012 $212,594
IPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
pFICATE HOLDER CANCELLATION
SHOULD ANY OF THEABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION
DATE THE THE ISSUING INSURER WILL ENDEAVOR TO MAI --S0_ DAYS WRITTEN
Evidence of Insurance
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO OO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESEMATIVES.
pVINOR1iEO REPRESENTAT Yy _ _
- The Commonwealth of Massachusetts
Department of Industrial Accidents
Office ofInvestigations
500 Washington Sheet
Boston,MA 02111
wMaress.gowbia
Workers'Compensation Insurance Affidavit: Builders/Contradtom/Electdcians/Plumbers and Gas
Applicant Information Please Print Legibly
NAME(Business/Organization/Individual) 4- L
ADDRESS: 5 S C7olr
CITY/STATElZIP: 1y V \ d 10
Are you an employer? Circle the appropriate number: Type of project(required)
1.1 am an employer with 4. 1 am a general contractor and i have hired the 6.New construction
employees(full and/or part-lime)• subcontractors listed on the attached sheet.These 7. Remodeling
subcontractors have workers'comp insurance. 5. Demolition
2.1 am a sole proprietor or partnership 9. Building addition
and have no employees working for 10.Electrical repairs or addition
me in any capacity(No workers'comp 5. We are a corporation and its officers have 11.Plumbing repairs" "
Insurance required). exercised their right of exemption per MGL 12.Roof re
c.152,section 1(4),and we have no 13.Other (JL1�Y�Y
3.1 am a homeowner doing all the employees (no workers'comp insurance
work myself(no workers'comp required).
insurance required).
Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. '
Homeoymers who submit this affidavit indicating they are doing all work&then hire outside contractors must submit a new affidavit.
Contractors that check this box must attach an additional sheet showing the subcontractors&their workers camp policy Info
lama n employer that is providing workers'compensation insurance for my employees.Below is the policy andjob site
inrom moon.
Insurance Company Name:_^'�—Y K in c1L-, < </`"1{ c/--+cc).
Policy#or Self-ins Lic#: ( 1 �33�LK-64"`7 Expiration Date:_� �
Job Site Address: City/StatelZip
Attach a copy of the workers'compensaffon policy declaration page(showing the policy#and expiration date).
FAILURE TO SECURE COVERAGE AS REQUIRED UNDER SECTION 25A OF MGLc.152 CAN LEAD TO THE IMPOSITION OF
CRIMINAL PENALTIES OF A FINE UP TO$1,500.00 ANDIOR ONE-YEAR IMPRISONMENT,AS WELL AS CIVIL PENALTIES
IN THE FORM OF ASTOP 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 HEREBY CERTIFY UNDER THE P PENALTIES OF PERJURY THAT THE INFORMATION PROVIDED ABOVE/S
TRUE AND CORRECT.
SIGNATURE: P 1\ DATE CAL
L
TELEPHONE#;( GO3) 2It72' BSSG
e
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License M
Issuing Authority(circle one):
1. Board of Health 2,Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing&Gas Inspector
6. Other
Contact Person: Phone#:
next step living ►
lore enkranq,made cry
5
This agreement is made and among
Eric Easley Next step tdving,inch _
- 32 Henan St#1 25 OrMck Avenue 5"'floor
"ton,MA0220
$atcm,MA 01970-13as _
Customer ID;C$$gggroxos Contract ED:20111209-1 WORK
Site ED:S00002027091
I
i. DESCRIPTION OF WORKTO BE PERFORMED
NSL Wil perform or class,to be Padommd the 11OHOwlrrgwO*OR the customer's address above,In a professional manner and In accordance with the tun Of
this Contract,Including the attached mcommendetloreheork order describing the work in detail(the Vorll)which are incorporated herein by refemnda
Desorlp0on Quantity Location
PteWate Multl•L rSldgreWall With 4"Dom park,Cellulose_...__.__880 1^a8p $$r11200_.
Blower DsorTestONgrp. aaostic Testlr!9.P1_...__.-._. _. _.._..1Wa ....._................._........."P-00_ .
Sub Total: _ $2,172.00
Enwo Efficiency lncenuvo $1,629.00
Nd Sal"Tu ARerincenthe, $0.06
Total $543.00
1.CUSTOMER eMrme that they have received no IncontNss during the past 12 months.Was here
2.The Incentive Is dependent upon the padege purchased endfor pdarinmrd we utteriftwo. to NdhAtlual line Items enddor
Previous Immndves may Increase ordeeroat"Ilre size of On Incentive.
3.CUSTOMER aMl that thehralund on provlderls national Odd tes.Initial here
v ILL—
Printed:112iMil Pagel oft
2. PAYMENT:CUSTOMER agrees to pay NSL for the work as fdlove:
Payment#1:>�pp
RmditCmd or Edwok deposit Is due able time the Work Is scheduled.Re#mdpaymenthdomatoncogbecogectedmrtha Phonebyaaswmreemiw
representable at the time olscfmdullng: Deposk te not be exceed U3 dive anal retell costs.Tits contract Is not In e6ed umB this depesh te pent by Bra
Customer. (Note:MeslermN,Mae,and Carom somplpted)
Additional Payments and Find Invoice$�_�o
-Additional payments for the Work shall be due upon complalbn tithe Work
9 Dec 15, 2011
rSlgn � Data
NSL Signs Date Name of NSL Repms rnalve
The Temte of this Agreement are contained on both aides of this page '
Ned Step Living 25 Orydodr Avenue•5sficor•Boston,MA 02210•(868)867-8729•Itpulry@rextstsplMngbrccom•mm.nexbteplMnaftcom .
le Document Integrity Verified EU Sign Tmnsa0im NumG r.KKN53P2N5Se5Xe