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26 HATHORNE ST - BUILDING INSPECTION (2) ZA The Commonwealth of Massachusetts I ; Board of Building Regulations and Standards CITY Massachusetts Slate Building Code, 780 C'MR, 7i°edition OF SALEM 'w Revised Jantuorp I Building Permit Application To Construct, Repair, Renovate Or Demolish a 1. 2(41 One-or Two-Fiji4y Dwelling s S on Fo Official Use OPW Building Permit Number: ljbjue Appli : Signature: Building Commissioner/Ins of Buil ' rhic SECTIO 1 ITE INFORMATION 1.1 Property A rea ' I �1 c 1.2 Assessors Map& Parcel Numbers ��o Y7QtJ1�DfYt.Q 7 I.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use La Area(sq 11) Frontage(11) 1.5 Building Setbacks(it) From 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: 1.3 Sewage Disposal System: Zone: Outside Flood Zone?Public❑ Private❑ — Check if es❑ Municipal❑ On site disposal system ❑ SECTION2: PROPERTY OWNERSHIP' 2.1 Owne of Recrd, / ma1g f If]IIe� LJi4t�Tfh�/hP,��` �r� Name(Print) Address for Service: Signature Telephone� �L+�� SECTION 3: DESCRIPTION OF PROPOSED WORK'(check!OJ that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Orl Alleration(s) O 1 Addition ❑ Demolition O Accessory Bldg.❑ Number of Unit_ Other ❑ Specify: Brief Description of Proposed Work': SECTION 4: ESTIMATED CONSTRITCY16d COSTS Item Estimated Costs: OlDclal Use Only Labor and Materials . Duilding S 1. Building Permit Fee:S Indicate how fee is determined: 1 1. Electrical $ ❑Standard Cityfrown Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) S List: 5. Mechanical (Fire S Su ression Total All Fees:S Check No. _Check Amount: Cash Amount: 6. Total Project Cost: S _ 0 Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES .5.1 Licensed Construction Supervisor(CSL) am � I hl�. li.vp' li ITuIe Name ul'CS -I lulder e below) Dncri ion Add icted'--I',000 Cu.Ft. ed Id2 Famil 11—ilin Si t10�-y , (Ail 4( /1 SO3 3 RC Residential Rwl,,x Covering frlepMnte WS I Residential Window and Siding SF I Residential Solid Fuel Burning Appliarwc Installation D Reiidenttai Demolition 5.2 Registered Home Im vemepl contrac r(HI � IIIC a I eu HIC 5 istrart P e ! Regislmtim Nuem�(L«,/-! + Ad ?� Erpimtion bake 1e Ph um SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 25C(6)) Workers Compensation Insurance affidavit must be ompleted and submitted with this application. Failure to provide this affidavit will result in the denial of the lssu!i±of the building permit. - O - Signed Affidavit Attached? Yea .......... 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. Siumure of Owner Data nbehalf. ECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare information on the foregoing application are we and accurate,to the best of my knowledge and I u Signature of Ownyr or Authorized Agent Date 70wner pains and penalties of 'u NOTES: r who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor ered in the Home Improvement Contractor(HIC)Program),will=have access to the arbitration r guaranty fund under M.G.L.c. 1J2A.Other important information on the HIC Program and on Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.RS,respectively. 2. stantial work is planned,provide the int'orrnation below: otaoorsarea(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 healing system Number of decks/porches T)peof cooling system Enclosed Open ). "Total Project Square Footage'-may be substituted for"Total Project Cost" 10-JUL-25 03:06PN FROWHme Depot 2666 1.9T87401402 T-936 P-001/007 F-182 ' HOML"lMPrtu V L�'a'LL"1\a l.lri�a aaraa.a PLEASE READ THIS 1 "�r�" Said,Famished and installed by: ! Branch Name: Bosun .. Date:I/,AV f D - THD At-Home ServicM Inc. d/Wa The Home Depot At-Hame Services 345A Greenwood Sncet,.Unir 2.Worcester,MA 01607 Branch Nnmber.,3Y Toll Free(800)657-5182'. Fox(506)756-8823 Federal.ID#75.2699460;ME Hie#C 02439;RI Coat.Lice 16427 CT lie#5655274 MA Home Improvemem Contractor Rao;.#126893 Installation Address: 2.(a' 44--Hrof rie S4'r ee;f� Sa et1-t 1-/h ex`i city State zip Purehamr(s): Work Phone: Home Phone: Cell phopa [770 5M wfi iz [q ]a�is �zb6 [ ] [ ] [ ] Home Address: State Zip (If differem mll from Insatioa Address) - City E-mail Address(w receive project communications and Home Depot updates): ❑1 DO NOT wish to receive any marketing emails from The Home Depot Project Informstion: Undersigned("Custimper'),the owners of the property located at the shove installation address,agrees to buy, and THD At-Home Services.Inc.('"rhe Home Depot")agrees to furnish,deliver and arrange for the installation("Installation')of is aLL materiels described the below and on rhe referenced Spec Sheet(s), attached hereto d of which are incorporated Chao o Orders(this co ac ve1Y• reference,alongwith an applicable State Supplement and Payment Summary 6e Job#: Prioduc4F: a #: - Protect Ampo®t 2oo9ng Sidutg nedows Tnsulmioo �(i) SK-3.5 � L`1'1 1 SI a 3 3 8 ❑antmrs/Covers ❑F'tryDunrs ❑ d flag ❑Siding Windows Inmindm $ 0CMters/Coven ❑ arry Coats rl fing ❑Siding'T� Windows mmladan OGuaen/Covers C]E.rtay,Dean M ItaofinS Siding VPmdows Tnrvladon ❑rumen/Corm []Entry Doors EL_ M®�t7S%D�asB of CaotraaA eAdmupmem+eutimattfibean act- Total CottttactAmnnnt $ ( � ,q Mahmpurtlmsas may Owdeposa more tha¢aredoad of the CantrarlA^IO„a Customer sgrees that,immediately upon completion of the work for each Produer,•CustOnter will execute a Completion Cerdficete (one for each Product as defined by an individual Spec Sheet)+and pay any balance due. As applicable,each Customer andar this Contract agrees to be jointly sad severally obligated and,liable hmtunder. . The Home Depot resmves the right to issue a Change Order Or termiame this Contract or my individual Products)included herein,at its discretion.if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a swctarai problem with rho home,envirormirmal hazards such as mold,asbestos or lead paint,other safety concerns,pricing emote or because work required in complete the job was no;included in the Contratx. Q J . included as pert of this Contract. sets Emit the total Paant Summer • The Payment Summary #_ �"8 Contract amount and payments required for the deposits and final payments by Product(as applicable): NOTICE TO CUSTOMER You are entitled to a cMeFp eW BBed-Hn'copy of the Contract at the time yea sign, Do trot sign a Completion Certificate(note: there is one Completion CeriifIt=for each Hated Product as dented 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 costs of materials,labor,expenses .and services provided by The Home Depot or Authorized Service Provider through the date of termination,pins 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 Tin DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and AuthorHation: C Vnamer agrees and understands that this Agreement is the entire agreement between Customtx The ffame Depot with regard to the Products and lnsmilation services and supersedes all prior dissuasions and agreements,either oral or written,relating to said Products and Installation.This AgrBement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer aclmowledges and agrees tbm C bus read.understands,voluntarily accepts the terms of and has raccivoil a copy of this Agrc�emem. Accepted by: - Submitted x 033��� t.W1�l� re ?-dY-tO /du Cus[omer's Sigtttdmre Data Sales Consultant's Signature 7 3 73 T 6 x Date Telephone No. �J!'rt7i)� Y Qtsromer's Signature Dire Sales Count=[Incense No. CANCELLATION: CUSTOMER MAY CANCEL THIS ter`appi.wet) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE.HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS. DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTAC® HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW .IN CUSTOMER'S STATE NOTICE:ADOTTION'AL TERMS AND CONDITIONS AR&5Tw1'ED ON 1 H-R6VERSk SIDE AND ARE PART OP TILLS CONTRACT 5.7-10 C-SC Whao—araneh File Veam—Caaromer CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT ,1 . •I: C: \\-.\,ni%,,., N it!n:rr i l �i. \I,\,;N, .. i Construction Debris Disposal Affidavit (required lirr all demolition and renovation work) In accordance ith the sixth edition of the State Building Code, 780 CMR section 1 1 1.5 Debris, and the provisions of MGL c 40, S 54; Building Permit !k is issued with the condition that the debris resulting front this work shall he disposed of in a properly licensed waste disposal lacility as defined by MGL c 111. S 150A. The debris will be transported by: Inamc ut hat rr) The debris will be disposed of in : e name of I'acili y) I❑ddress of I'acI lily) 1411 all ere of p"rmit applicant Tate/ :l]n,,;IC II I'cf 1, - D Cit.u Inu'nI of Pith 1IC ti: Icts 34 Ro:u'd of Ruildin Ret-,uhtiuns :ut,: J[;t nlaldx Construction Supervisor License License: CS 74722 Restricted to: 00 KOSTANTINOS.S VAffIS s 16 HANSON ROAD SAUGUS, MA 01906 t Expiration: 7/5/2011 f numi—i.uu. Toe: 19412 • � ✓RC 10dYILIffM(WC(LGA2 6�.�'(2(J�'2G'/ Office of Consumer Affairs& Business Regutalion r HOME IM%RO .E CONTRACTOR y Reglstrauo03 a 29206206 Expiration 7122/2Q11 Tr# 290357 lug . I , . Type WAi4 - t AEGEAN CONSTRUCT1dN Kostantinos VatttS -.,-_g . y _" 16 Hanson Road zjw a o_ Saugus,MA 01906 ' ,,-- .Undersecretary 4 , -97 n Ta��,a ?iTaG'>rI f�T �iit2.{s�rrr >r:r ,tr f 3�r r max^ L° a a .tom i—lT,Z ----s--j--'„r_— ""L � J'3��-1�7" �]7'4z7L'?�r. �"1 •tI17���i� CIty6aiteMp- 1/ Are y an employer?Check the appropriate box: 33 pe of projen Irzquu d)- r 4. El I am a general contractor and l 6• ®New•consuttction r. I am a emplover With have hi3 hired the sub-conttactors employees(full an&orpart-tirce)-x Rdelittg 2.❑ I am a sole proprietor or parta'r- ➢isles on the attached sav 7_ 0 � and have no employees These subcontractorsL bave S- ®De�latian ship employees and have workers' S• ®Building addition working for me in any capacity t cam.iuoutantx- (No workers'comp-instaance I a. Electrical repairs or additions required-] 5•❑ We ate a corporation and its officers have exercised their 1I_®Plumbing repairs of additions 3.0 I am a homeowner doing right work right of exemption per MGL 12•®Roof repairs myself[No workers'comp_ c.152.§1(4),and we have no insurance required.]t etrtployces[No w�orkeerss7 13-t v r" • n�Yr v?S comp.insurance require[.] -Ay applicant fttihWIM box 91 nafat also rill out the Meam bdovrsfawing axirwm&ers'm4r�'3Ci9ry PRAY®farcmtio+s tHomcownes who wbrtit this affidavitmdxsting any arc doin all wmkand aau hire mmidc=racros nummmbnut ancv aQfvdavitulf- ling sorb. tt:mt tors Ghat check this box met atudid ao additi®al tieee dwviag d= xin,of the subemmxbrsand%[ale wbclhQ oroot dxo cotilits have ucryloyees. Ifthesubcora=eoshiveemployees.dnYnutt WA&axxr wetivas comp-pafY I • I am an employer that it providirrg workers'compensation insitrancefor my employees Beh uv is the polity and job site information. Insurance Company Name Policy#or Self-ins.Lic.# Gaon Dam Job Site Address- C'ty'S 7r'P L- F c .s copy at e Workers-compensation Policy Failure to secure coverage as required under Section 25.4.of MGL c. 152 can lead to the imposition ofcriminal penalties of a fine up to 51,500-00 and/or one-year imprisonrt"mL as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be fornarded to the Office of Investigations of the DIA for insurance coverage verification. - — I do hereby certify and t pains a penalties ofpedury that the information provided above is true sad correct Signature: Danz: 1 0 — Phone# �� � Official use only. Do not write in this area,to be completed by city or town ojJiciat City or Town- Permit/License# Issuing Authority(circle one): - 1.Board of Health 2.Building Department 3.City/Town Clerk 4•Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person- Phone n: uaore�' Go I73 i r . 7V., 2. L'-r'a'cr SclarHen Cain 0�e,Gent r0 . 32 1 . S 0 . 29 ' ' ADOMONAL PERFORMANCE RATINGS � . [wlw�aoNsuv(sraEKrerwoeaENonaexro Vsible7ransmittance .. ttu!urLlon de(3¢VL04 . 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GiP#4h6JfaP011hWaW :Te6 moniMvt+w:iwgpgtM. ' Gumd.ims*( uPmm'jadik mffNhuINI16TSW hmmroivmm wpm 4j*:feeruaupftpt , Ofi OrAee OGt "sR erFJ�IN stTiurs BIISe88 Re E3N(tx tN RF3W &(1T CONTRACT6j ; 8 � `s`SuppjeRfenr The"Home Dep a ° P.ZICFM, D FFLt Ai*Llk Fak 3©379"1 � Undersecretary CERTIFICATE OF LIABILITY INSURANCE I °0 ;19,/10 YYY' IRoouceR 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh- USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTENiD OR homedepot.certrequestr.narsh.ccm _ALTER. THE COVERAGE AFFORDED 9Y THE POLICIES Bc.06V. 'Isro Alliance Center, 3350 Lenox Road, Suite 2400 Atlanta, GA 30325 - INSURERS,AFFOROING COVERAGE NAIC 0 IrIgURIC - I1IC1jRCRA. SZS.d_'.St Ins The Home Dept-, Inc. INSI!RE0.B:Zuriccz Ametic3n Ins,Co _... 1 _7.`5....... ......... Nome Depot U.S.N. , Inc. 2455 Paces Fa_ry Road N'd "S"REa,'N w Haaio,Cire ins Cc 2334 _ 9tilding C 20 INSURER D.NATIONAL UN ON FIR INS CO OF PITTS 11944 Atlanta, GA 30339 _ ..- -.. INSURERc 111inois Union Ins Ca 27960 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 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 GREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _..._. _. ___.__ .._._.__-_—.___..__. POLICY Ef FECTIVE POLY EXPIRATION . Ii TF iiR POLICY NUMB ER qT M / Y Y T MM IYY LIMIIB - A GENERAL LIABILITY GL04887714-00 03/01/10 03/Ol/11 EACH OCCURRENCE___ 59y000,000 ' nM��(-S-RI HTEG X COMMERCIAL GENERAL LIABILITY PREMI$�SlEagccurrence)_--.f_3_000;000 CLAIMS MADE 5_1 OCCUR ME❑E%P(An parsanl E EXCL(H)ED - PERSOrvAL agDV INJURY 59,000,000 n GENERAL AGGREGATE f 4,000 000_ GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMFIOP AGG 54,000,000 X POLICY PRO- LOG B AUTOMOBILE LIABILITY - BAP 2938863-07 .110 110 03/01/11 COMBINED SINGLE OMIT Es acciEent) S 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY S - (Per person) ' SCHEDULED AUTOS HIRCOAUTOS BODILY INJURY f - - IPer ectlamq NON-OWNED AUTOS X SELF INSURED AUTO -PROPERTY DAMAGE S IPer accbrn0 - PHYSICAL DAMAGE AUTO ONLY-EA ACCIDENT 5 GARAGE LIABILITY n ACC S_ _ --0.-- .0- ANY AUTO OTHER THAN 03/O /11 AUTO qGGS EACHOBCURRENCE__—__ 0_ A EXCESS I UMBRELLA LIABILITY GL04687714-00 03/01/10 _- _,-_--__.......... X OCCUR F1 CLAIMS MADE AGGREGATE 5 5:000,000 DEDUCTIBLE S RETENTION S WORKERS COMPENSATION 03/91/11 X WLSTATU DTH- C ANC EMPLOYERS'LIABILITY WCO20742 J$5 (ADS) O]/01/10 - BY_CCIIS D ANY PROPRIETORIPARTNEMEXECUTNE� WCO20342356 (CA) 03/01/10 03/01/11 E.L.EACH nCc10ENT f l_000,000 --__ OFFICER/MEMBER E%CLVDEO4 WCO2034235J (FL) 03/O1/10 03/01/11 E.L.DISEASE-EA_9 PLOYE 51,000,000 E (Mandatory in NH)Oe Under E.L.DISEASE-POLICY LIMIT' f 1,000,000 SPECIAL PROVISIONS SPECVISIONS below - OTHER 03/ 11/10 03/01/11 Occurrence/SIR 30M/2M' E TX Employers Excess - TNSC962423(Q (TX) 03/01/10 03/O1/11 D Workers Compensation WC0910566 (OSI) C Workers Compensation WCO20342358(XY,MO,NY,WI, ) 03/01/10 03/01/11 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AO OVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN THE ROME DEPOT, INC. - NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT GgILURF.TO Df1 SO SHALL HOME DEPOT U.S.A., INC. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 2455 PACES FERRY ROAD NW - REPRESENTATIVES. 'BUILDING C-20 AUTHORIZED REPRESENTATIVE ATLANTA, CA 30339 USA 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009101)Schoen eon_hd O 14481889 The ACORD name and logo are registered marks of ACORD