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11 HAYES RD - BUILDING INSPECTION g15L( The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF q ,r Massachusetts State Building Code, 780 CMR SALEM I Revised Mar 2011 n Building Permit Application To Construct, Repair, Renovate Or Demolish a - One-or Tivo-Family Dwelling _ 1 This Section For Official Use Only r►s cN Building Permit Number: _ Date Applied: �_ c lJ— Building Official(Print Name) Signature Daig'L SECTION 1:SITE INFORMATION iJ+p 1.1 Property AJJtess• ^ 1.2 Assessors Map& Parcel Numbers ¢, I.I a Is lhi'llp—ted str eP?yes_ no Map Nuntbcr Parcel Number -ham—t�T,-1 1.3 Zoning Information: IA Property Dimensions: Toning District Propose)Use Lot Area(sq It) Frnnlogc(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Rcyuired Provided Require) Provided Required Provided 1.6 Water Supply:(iM.G.l,c.do,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owned a• 2ecord: _ - � - N;unc(Print) 1 ^L (�"(� Cny1....SStt�atte.1{.ZIP No.anJ�--1 —Ll�- -[�-�1.__�� - - 'fclaphonc EnraiI Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check a at apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Rcpairs(s) Altemtion(s) ❑ r\Jdi[ion ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Speedy:__ _ Brief Description of Proposed Work'':__ - SECTION 4 STINIATF.D CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials) Official Use Only IF131tu Bilding $ nnDt. Building Permi[Fce: $ ndicate how tee is determined: rical $ ❑Standard Cityt I own App it cation Fee ❑Total Project Cost(Item 6)x multiplier x hingOther Fees: $ anical-(IIVAC) $ List:anical (Firesion) Total All Fees:Check No. Check Amount: Cash e\mount: l Project Cos[: $ El Paid in Pull ❑Outstanding Balance Due: S z �b �lLa v• R t 1 I A SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �„ �,�� License Number Expo• ion Date Name of CSL Holder List CSL"type(see below) No..an Type Description - U I Unrestricted(Buildings up to 35,000 cu. R.) City/Town Slate,ZIP M Ma R Restricted M2 FamilyDwelling- , son RC Roo ring Coverin WS Window and Siding Solid Fuel Burning Appliances I Insulation 'fete hone Email address U Demolition 5.2 Registered home Improve t Contra for(FIIC) 'wft t� FIIC Rc islra r i umber Expi ati 1 ate it IC CoWe FII ' leant-h4u No.an A Gnail address City/Town,State,ZIP I 'fete hone SECTION 6:WORKERS'CONIPENSATION INSURANCE AFFIDAVIT(M.G.L.C. 152. § 25C(6)) Workers Compensation Insurance affidavit must be co eted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuanc f the building permit. Signed Affidavit Attached? Yes ..........121, No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject properly, hereby authorize >K 1 2 I' to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Dale '4 SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my nan elow hereby attest under the pains and penalties of perjury that all of the information co is, plic ' is t to an accurate to the best of my knowledge and understanding. f Pon wner's o u orizeJ A ent's Nome{Faeelronic Signature) Date NOTES: I. An Owner who brains 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dps 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. Ii.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms _ _ Number of halt/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' }Yf , r CITY OF ��y 7:11.EiYt, ;tiL-1SS:ICHUSE'ITS w,-✓1r'`°,j/' ©t:ILDLNG DEPAR-i.ZNT > , 130 WASHLNGTON STRF_ET, 3'0 FLOOR 978 Tom.S ( ) 745-9 595 F4S Kl1tBEltLcY DRISCOLL .kx(973) 7-10-98 ,b LAY0a T Roatu ST.PIExRs DIRECTOR OF PGBUC PROPERTY/8L:MnLNG CONNISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 Ci4IR section It 1.5 Dcbris, wid the Provisions of t'vIGL c 40, S 54; Building Permit k is issued with the condition that the debris resulting Cram this work shall be disposed of in a properly licensed waste disposal facility as defined by VIGL c l 11, S 150A. The debris will be transported by: y y (name ut'heul(:r) The debris will be disposed orin --_ (name of facility) — (address of raClhty) *"rylitappli=Cj�11t Yignatur u 5 �l J.0 i � r ti 9/21 ellwl>narallf O '-,lla.uacfaeetG Office of Consumer Affairs&BVmness-Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 160616 Type: Office of Consumer Affairs and.Business Regulation Expiration: . 8/8/2014 Ltd Liability Corporati 10 Park.Plaza-Suite 5170 Boston,MA 02116 BETTER BUILT ENTERPRISES:LLC EVANGELOS LIAPIS_ - - 27 WATER STREET WAKEFIELD,MA 01880 .. Undersecretary t valid ut signature Massachusetts -Department n'Public Safety Board Of Building Regulationsand Standards - - C'U❑tCriltti�N1 SRi:e!'cjYltr -License: CS-084795 EVANGELOS LIAPIS 12 STONE STREET DANVERS N1A 01923 k• 'a JX"" 'f�*l" } .expiration - Commissioner 05/13/2015 i The ID¢�aw�eagOfIll &SVkk�s��dcc�th D �K/. a 3 c®mr ess RTveg➢swi2e Igo Bostoat9 MA 021114 2917 "— ttar,�wz�sR gevwlt -- `9y®aLge>Ps'�®a��B�s�fi�®>m][mgeaa����Af�"a���u8a1��119�errsltC®t�3��¢ r�!>vHes¢a���msI1P6>m>+iul��rg A flfltem�t II ff®tre�ss�+e II°fl��se flDadl�a4 IId 'bfl Nmne (Businessl@rgeeixation/lndividuai): _ Address: Clty'lg'ta Y : - e#: �rE an¢®plt9$¢P�Check tb appropriate bon* Type©f project(realolaeel): 4. ®I am a�eaetai cantor and I 1 I am a employer with �' 6. ®RTea conaaction employees(fall and/or part-time)° have hired the sub-contra."tars 2. 1 am a sole proprietor or partner- listed on the attached sheet. 9. ®Laemo"fin ship and have no employees These sub-contractors have g. ®Demolition working for me in any capacity. employees and have workers' Q ®Building addition t o workers' co insurance co iosmance.t required.] 5.®Weapre a corporation and'a4s 10.®Electrical repass or.dtiitions 3.0 I®m a homeowner doing all work officers have exercised their 1 fl. P 4ng repairs or additions right off eRemption per NiGL myself.[AIo workers' comp. 12. hoof repairs insurance requited.]t c. 152"§1(4),and we have no I3.®Other oortp.irtsu4aace r�aired.] ' *114, licmtthatchsc6ha#1mmalsofillwi3eeseedenbelawshowingthe¢�'campmrrlicapoGcYmfomdun. _ tHomeoemetowhosabmitthisaffidatitirdoetingtheyrsedomgallao*=dtbenhimo'stsidrmUnctmnmvf4esbmitonewafflk tindirn..4ogsucb. tContractare that checkthisbvx must smghsdm eddittonJ rhea ohowing theitame of thEsa6csatt�a+a oadatatewbediero,notthose eadEeshave employees. If the wb-coandm hove employees,they mne pmvide their wodtets'emnp.policymmtber. Jam an employer that iv providing Bed is gba policy®tad job site Insurance Company blame: Policy#or Self-ins.lAc.#: Expiration Date: Job uiP€Address: Citylstattdzim attach m copy.of tbewmrkers'compensation pmllerdeclatratl®nrunge Qebaavvlsag the ISsHlcy>maas ubee and sxplrrefd®m date). Failure to secure.coverage as required under Section 25A of MGL c.152 can lead to the imposition of MiYE&A penalties of a fine up to$1,500.00 and/or one-year imprigotement,as well as civil penalties in the form of a STOP WORK ORDER and a.fine ofup to$250.00 a day against the violator. Be advised that a copy of this stiWirimt rainy be forwarded to the Office of- investigations of 4he DIA for instrance coverage verification. I do hereby c y e o pe�ities®ffperjetgthat Me Stefocwaata®saprmvided above as tn card correct 3ieaua D e Phone#: oyjWad ace m Do naat pinta bra globs area,.99 be sm»ap@�3 by ®P Begat®fflei s1 City or TE wn: Hawing Atatboafty.$tdrt Ie®®e): Il.Board®Ya�ealeb 2.IfSaa®t gBHepartRartt 3.c�ltylTmAtt(�terh 4:Ps9�t�lcaQ llaapectmr S.IPIQa�Ingl IIms(e�tor G.Other Contact lteerao®: Phone#: r . d'',ff_i&e i t` S J' 'iF.1 1-7'daL��a.?J : a ,.'�:: - YJS M—a s?chulSptt.,S 0 116 Horne Improvemonf Contractor Registration Type: Sapp -n,eni Card THD AT HOME SERVICES, IN MO C13MBM 5 PARIONAY SUIT2 306 - ATi_ANTA;GA 3033 - — Update Addry..s mnd retaarn^.lard.Pm tot rema for cwge. Addrasla _i'S.^rterai J$nanla Twit r j Lai?Cvd a. ��? l fl1rL/6P7/'f:'!/f1!GJPn.��l.'i Y/:/rRa•.��. . �lae of Caae nvmr Aasajy!'&Sa iEa.Aguladoa Lieu=er r,.&"91013 valid for insliv oul net only 4-:" N(sIsF3it Am CISwPmcmaa Wore the sg katun Aefe,-0 bond=aa to ilea ai600*3ev A,1019.3 R at 31-Mine:3 Pegrin:ien :f 'kEc [ 4af5c; ;25{t�s ' ➢e: to'J ca3cijz` k-��fE4' - ..t. ptinn : 6 5uppleman4Csrd Bostisn •2br 'Tla)AT Hour-$Ewc A Iiq "7' 'Ph3E-Hl7flr1iai?EFcJ XTFi-O"MWsEwcES iCHAitq F/lLONE ?6966UMBERLA 6PARKiVAYS ..A'y'1�v�.faA96339 . 9:ndeneercteay- - - .. otva• w aigaa -. ° .. . ..._.. .. . .. OAT'c(MIAmDIY;ryy) THIS CERTIFICATE IS ISSUED AS A MATTE11118014 R OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TCERTIFICATE OF LIABILITY INSURANC HE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIYELY OR NEGATIVELY AMEND, EXTEND OR ALTER.THE COVERAGE AFFORDED 15 THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEp REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate hclder is an ADDITIONAL INSURED, the polICY(ies)must be Endo ad if SUBROGATION IS WAIVED, subject[o the terms and conditions of the Polendor,certain poliLies may require an endorsement. A statement on this certifiicate does not confer rights to the certificate holder in lieu Of such endorsement(sj. PRODUCER MARSH USA,INC. CON CT TWOALLIANCECENTER - NAME 3560 LENOX ROAD,SUITE 2400 PHONE .fAIC Na EM FAX ATLANTA,GA 30326 E-MAIL IAIC No: ADDRESS, 10C492-Home[)-GAW-14.15 INSURER(S)AFFORDING COVERAGE INSURER A:Slead(2st insuranm Company NAIC 4 INSURED THD AT-HOME SERVICES,INC. INsuRINSURE,?e:ZuriDh 263B7 Arttelican Insurance Ca DBA THE HOME DEPOT AT-HOMESERVICES 7w3`S 2690 CUMBERLAND PARKWAY,SUITE S00 INSuhbR c:New Hampshire Ins Co 23841 ATLANTA,GA 30339 INSURER 0:Millis National Insurance Company 23817 ' INSURER F: COVERAGES CERTIFICATE NUMBER: RtsuRERF: . THIS IS TO CERTIFY THAT THE POLICIES OF.INSURgNCE LISTED BELOW HAVE B ENS SUED TO THE INSURED MAIMED ANUMBEOR THE POLICY PERIOD INDICATED'-'NOTWITHSTANDING ANY REQUIREMENT,PERM OR CQNDITION-OF ANY CONTRACT OR OTHER DOCUMENT WIOVE TH 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 SHQ4VN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL BR LTR TYPE OF INSURANCE POLICY EFF POLICY EXP A GENERAL LABILITY S D POLICY NUMBER I h1MIDOTYVYY MMIDDIYYYy LIMrrS GL048B771404 03/012014 031012015 'X Comm GENERAL LWBILRY EACH OCCURRENCE $ 9,000,000 CLAIMS-MADE X OCCUR LIMJTS OF PODCYXS PREM SENT ES Ea occurrence S i.000,000 OFSIR:$1MPER000 MED EXP Anyoneperson) S EXCLUDED PERSONAL&ADV INJURY S 9,000,000 GEHL.AGGREGATE LIMrr APPLIES PER: GENERALAGGREGATE $ 9,000,000 X POLICY JECo-T 1_01 PRODUCTS-COMP/OPAGG S A 9,0�,OOD B AUTOMOBILE LIABILITY BAP 29366all S X 03/012014 03/0112015 COMBINED SINGLEUMIT - - ALL E - Beacclda 1,0W,000 A TOS SCHEDULED SELF INSURED AUTO PHY OMG BODILY INJURY(Perpersbn) S AUTOS MIRED AUTOS NON-OWNED BODILY INJURY(Pef accident) S AUTOS PROPERTY DAMAGE Per acciderd - S UMBRELLALIAB S OCCUR EXCESS LEAS CLAIM&MADE EACHOCCURRENCE $ DIED RETENTIONS AGGREGATE S C WORKERS COMPENSATION. WC049t01882 AOS $ C AND EMPLOYERS'LIABILITY - ( ) 031 12014 ONW015 X WC STATU- pT&ANY PROPRIETOR/PARTNER/EXECUTNE YIN WC0 4 9101 8 6 4(AK) TOY I ITS R D OFFICE to In ER IXCLUDED? .N❑ NIA 031012014 0310120i5 EL EACHACGDENT § 1,mmnm Ifyeam escrimunder WC049101BB3(FL) 031012U14 031012015 DESMIPTION OF OPERATIONS belmx E.L.DISEASE_EA EMPLO S 1,OOD,000 C WORKERS COMPENSATION WC049101885(KY,NQMi,VL) 031012014 03f012015 E.L.DISEASE-POLICY LIMB S 1,000,000 C (EL)LIMIT 1,000,000 WC049101866(NJ) 031012074 0311 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(AtIMO ACORD 101,Addlilenal Remarks Schedule, mom space Is requlretlj EVIDENCE OF INSURANCE h I CERTIFICATE HOLDER i CANCELLATION THD AT-HOME SERVICES,INC. DBA THE HOME DEPOT AT-HOME SERVICES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATLANTA,GA 30339 - ACCORDANCE WITH THE POLICY PROVISIONS. ! AUTHORIZED REPRESENTATIVE i of Marsh USA Inc. _ Msnashi Mukheriee _TVLM�La ;-�A-, - f HOME IMPROVEMENT CONTRACT Sold.Furnished and tnstalled by: PLEASE READ THIS CONTRACT THD At-Home Services,Inc. d/b/a The Nome Depot At-Home Services 908 Boston Turnpike Unit I,Shrewsbury,MA 01545 Branch Name: Boston North Date:1/19/2015 Toll Free 8779033768;Fax 8009863610ME Lie#C 02439 RI Cont.Lie# 16427 CT Lie# Branch No: 33 HIC.0565522 MA Home lmpmvcment Contmctor Reg.#126893 Federal ID#75-2698460 Installation Address: I I Hayes Rd SALEM MA 01970 City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: Mr.Geor a Quadros (978)594-1738 978 944-7769 I Home Address: I I Hayes SALEM MA 01970 (If different from Installation Address) City State Zip E-mail Address (to receive project communications and Home Depot updates):c quadros it,vahoo.com Marketing emails will not be sent from The Home Depot. Project Information: Undersigned("Customer'),the owners of the property located at the above installation address,agrees to buy,and THD At-Home Services,.Inc.("The Home,Depot")agrees to furnish,deliver and arrange for the installation("Installati on")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Sunmtary,(where applicable)attached hereto and any i( - Change Orders(collectively,"Contract"): 11,R tl Job#:(Internal Reference) Products: Spec Sheet(s): Project Amount 8022295 (Roofing 8022295 $9,999.00 Minimum 25% Deposit of Contract Amount Total Contract Amount $9,999.00 due upon execution of this contract Customer agrees that,immediately upon completion of the work for each Product,Customerwill 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 Home 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 Contract. Payment.Summary: The:Payment Summary# 8022295 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). 00nLI4-5A. Page I of 7 r HOME IMPROVEMENT CONTRACT PLEASE READ THIS CONTRACT NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time of 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 costs 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 RECOVER OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and:understands that this Contract is the entire agreement between Customer and The Home 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 Contract 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 of and has received. a copy of this Agreement. You are entitled to a paper copy of this Agreement if you choose. If you consent to an emailed copy,your consent applies. only to this Agreement. By contacting sales office (R77)gol_rFR,you may update your email address,withdraw your consent,or obtain a paper copy of the Agreement at no charge. By signing below,you confirm the following: • You consent to receive only an emailed copy of this Agreement • You have access to a computer that can receive and open emads and PDF(Adobe Reader Version 10.1.4 or later)formatted documents. • Your email address is correctly listed on the HomeImprovement Contract Submitted by: Accepted by: Sales Consultant Jeremy Fraley Customer ��✓ License Name. Signatures (877)903-3768 Customer Mr.George Quadros (Jan 19,2015,6:37 PM) Telephone No. Signature: Sales Consultant. License No. (as applicable) CANCELLATION:CUSTOMER MAY CANCEL THIS 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 ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS.SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE twnrnasa Page 7 at 7