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128 HIGHLAND AVE - BUILDING INSPECTION (2) Z6 The Commonwealth of•Massachusetts Board of Building Regulations and Standards CITY tag Massachusetts State Building Code, 780 CMR, 7' cdiiion OF Rrrisax/Jm dJuny " unvv Building Permit Application To Construct, Repair, Renovate Or Demolish a I. :tNky One-or Two-Family Dwelling i This Section For O.Rcial Use Only Building Permit Number: A _ Date Applied: Signature: 14 /Y �y Building Commissioned Inspector WBuildings Date SECTION 1:SITE INFORMATION 1.1 Property rmss: 1.2 Assessors Map A Parcel Numbers ii� ""1f55 1.la Is this an accepted stre49 yes v no Map Number Parcel Number IJ Zoning Information: 1.4 Property Dlmensloas: Zoning District Proposed Use Lot Area(sq 11) Frontage(11) 1.3 Building Setbacks(n) 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: Public O Private O Zone: _ Outside Flood Zone? Municipal O On site disposal system O Check if es0 SECTION 2: PROPERTY OWNERSHIP'2.1 Own n to ° Name(Print) _. Address W Sc °.�c, � �r l Signature � Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check at apply) New Construction O Existing Building O Owner-Occupied O Repairs(s) C11 Alteration(s) O 1 Addition O Demolition O Accessory Bldg.O Number of Unit_ O er O Speciry: Brief Description of Proposed Work': n 40 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: 011lclal Use Only Labor and Materials I. Building S I. Building Permit Fee: $ Indicate how fee is determined: O Standard City/Town Application Fee 2. Electrical S O Total Project Cost'(Item 6)x multiplier x 1. Plumbing S q2. Other Fen: S 4. Mechanical (NVAC) S ist:5. Mechanical (FireSu ression S otal All Fen:Sheck No. _Check Amount: Cash Amount: 6. Total Protect Cost: S Paid in Full ❑Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) iDRcsitkntial � � 7 � ' ber FtNpimtioI leN a 1'L'.'I. I kidder e(sere belowl�Descri ion Addm restricted W 14 nm Cu. Ft.stricted IA2 Famil UwellinSipulu (kid(p idential Raclin Coverinidential Window and Sidinidential Solid Fuel Bumin A liidential Demolition 5.2 Registered Home Ins ens u Co t (HIC I IIC C HIC Ile • istrant Regisurattm� be Addre Espintion Si Telephone SE ION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.I..e. IS2. f 2SC(6)) Workers Compensation Insurance affidavit must mpleted and submitted with this application. Failure to provide this affidavit will result in the denial of the Its ce of the building permit. Signed Affidavit Attached? Yes .......... No...........O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR AJePLIES 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. o� -Signature of Owner Dste SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION 1 ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application arc we and accurate,to the best of my knowledge and . behalf. tJ Print N C Signature 1'Ow or Atlthorfzed Agent Date (Signed under t4 pains and penalties ofperjury) NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who him an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will W have access to the arbitration program or guaranty fund under M.G.L.c. 112A.Other important information on the HIC Program and Construction Supervisor Licensing(CSLI can be fowd in 7R0 CMR Regulations 1 IO.R6 and 110.115.respectively. Ln substantial work is planned,provide the information below: rs area(Sq. Ft.) (including garage,finished basement/artics,decks or porch) ing area(Sq.Ft.) llabitable room count f fireplaces Number of bedrooms f bathrooms Number of half/baths eating system Number of decks/porches olingsystem Enclosed ()pen l Project Square Footage"may be substituted for"Total Project Cost" 08/09/2010 12:50 15087568823 THD AT HOME SERVICES PAGE 61/07 FIOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name: Boston Hate--/26/ L O THD At-Horne Services,Inc. d/b/a The Home Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Branch Number:31 - Toll Free(800)057-5182; Fan(508)756-M23 Federal ID#75-2698460,ME Lie tl C 02439;RT Cont.Lic#16427 - 1 ' I CT Lie#565522;MA Home Tmprovcmcnt Conuactnr Reg.#126893 Installation Address: J z$ SA-�e.t.- P% 0 l 9 0-7 City State Zip Purchnser(s): Work Phone: Home Phone: Cell Phone: At-tF6IAIJ [ej-70 -7Y5. as3; [7i;IIZ r I jrMa Home Address: S A--1,-e' (lf different from Tnstallntion Address) City State zip E-mail Address(to receive project communications anti Home Depot updates): ❑T DO NOT wish to receive any marketing emails from The Home Depot Project Information: Undersigned("Customer"),the owners of the property lOcamct 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 ("Installation")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 Shute Supplement and Payment Summary attached hereto and any Change Orders (collectively, "Contract"): - Job#: o��cmni a,xen.�a Pra s: S e Shre1 s #: Prti cet Amount ❑Roofing ❑Siding indows' Insulation $ �� cd SW el 0 ( ❑Gutters/Covers ❑Entry Doors ❑ 3 3 a� I o Roofing .Siding Ej Windows L Inculas.ion $ ❑Gurers/Covers ❑Entry Dean; ❑ ❑Roofing ❑Siding ❑Windows ❑Insulation $ ❑Cutters/Covers ❑Entry Doom Ronf?ng LjSidmg Windows Dlnsnlation $ ❑Gurmrs/Covers ❑Entry Doors ❑ Mloimum J54 AaPcait ofContradAmount doe upon execution of this contract Total Contract Amotmt Maine Purchaers may not deposit more than ime-third of the ContaaGAmaonl ' Customer agrees that, immediately upon completion of the work COY each Product,Cuxtnmer will execute a Completion Certificate (ono for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable, each Customer under this Contract agrees to bcjointly 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 authorised 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 crors or because work required to complete the job was not included in the Contract. Payment Spmmarv: The Payment Summary # 3 ( ;�- V3 y 'r- 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). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract 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 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 PAST4FNT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPIDT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorisation: Customer agrccN and understands that this An eemenr is the entire agreement between Customer and The Home Depot with regard to the Products and TnSmllnion Services and supersedes all prior discussions and agreements.either oral or written,relating to said Products and Installation.This Agreement cannot he as.', ed or amended except by a wnfing signed by Customer and The Home Depot Customer acknowledges and agrees that Customer haZT oluntnri ly accepts the terms of and has received a copy of this Agreement. y Acc v - Submitted by:. -`-- X °` j��I�a X Io L,(44(e Cusmmer's Signature Dale Sales Con.sultanCA�Siigtnature Date 7 X Telephone No. 5 2� 3. -_ 3`4(' Customer's Signature Date Sales Consultant License No, CANCELLATION: CUSTOMER MAY CANCEL TINS (os nplsn,;able) AGREEMENT WTTHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTTCE TO THE HOME DEPOT BY MIDNIGHT ON.THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACFIED HERETO CONTAINS A FORM TO USE IF ONE. IS SPECIFICALLY PRESCRIBED 13Y LAW IN CUSTOMER'S STATE. . ,NOTICE:ADDITTONAL TERMS AND CONDITIONS ARE ST'ATF.D ON THE REVERSE SIDE AND ARE PART OV'rHIS CONTRA[T 5-7-10 OSC Whit—., mh cxe vam-_r...r,...- CITY OF SALEM PUBLIC PROPRERTY DEPAIZ"I•LIENT Construction Debris Disposal AlVdavit (reiluited for all demolition and renovation wurk) In accordance n ill, the sixth edition of the State Building Code, 780 CNIR section I 1 1.5 Debt is, and the provisions WAIGL c 40, S 54; Building Permit N is issued with the condition that the debris resullin.- from this work shall he disposed of in it properly licensed waste disposal I•acility as defined by MGL c l 11. S I50A. The debris will be transported by: (name of hauler) I he debris will be disposed of in : VIE tnu,ne w lacthty (address ,I 1'ueilitv) s i¢uutu n of pin ut upplicunt JIY e � !c, .... ..... titassnchuscits - Depmtiuent r t Public S.Ifctc - Board of BuildinIg Re uhnonc ur, Standards . ��--> Construction Supervisor License License: CS 74722 Restricted to: 00 KOSTANTINOS.S VAITIS 16 HANSON ROAD /a - SAUGUS, MA 01906 Expiration: 7/512011 (' uuui•=i.nmr - Tr#: 19412 . Office of Consumer Affairs& Business Regulation HOME IMPROVEMENT CONTRACTOR - Registratioll.1129206 r - Expiration;_;:I-ZRQi1 Tr# 290357 1 . Type ,V3 AEGEAN CONSTRkIGrr'�LC7fy� Kostanfinos VaitiS?�=_;-;-•,is--- - ' 16 Hanson Road Saugus,MA 01906 --,?-;-=5' Und<iseucrctary G The Commonwealth of3fassachuseltr Department of Industrial Accidents Office of In vestigat* ns 600 Washington Street Boston, 3M 02111 y www.ntass.gov/tlia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _i Please Print Lelibly Name (Business/Or_ganizat ion.'I ndividual): Address: Ran C.--N�� l�i r�l— tL L `i City/State/Zip:__ Phone #: [E] re an employer?Check the appropriate box: Type of project (required): 1amaemployerwith j r)t7 4. ❑ 1 am a general contractor and 1 6. ❑New'construction employees(full and/or part-time).• have hired the sub-contractors 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp, insurance. 9_ ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised.their .10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] ' employees. [No workers' comp. insurance required.] 13. ther •Any applicarrt that checks box ill must also fill out the section below showing their workers'oompensation policy information. t Homeox%ners who submit this affidavit indicating they are doing all wmtr and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional shoot showing the name of the subcontractors and their workers'camp.policy information. lam an employer that is providu/g workers'compensation Insurance for my employees Below is the polky and job site information. Insurance Company Name:_ Policy #or Self-ins. Lic. #: ) yt�r Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation polic ecNration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a floe up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP 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. 1 do hereby cerri a der t/ s and penalties ofperluty that the information provided above is true and correct. Signature: Date: Phone#: OYIcial use only. Do not write in this area,to be completed by clty or town official 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 a te' CEF TiF1CAT�=L flfF LIABILITY INSUR1-NCB _�q 35J 3C0- c - �,I T a Cr. zmuCEa n I Thw'fC AtiT� (,OVr IRS mo PGH S i. I .-1= C P C•r I o _ a l i T L: = P=L _ farsh USA, r.JLu -. '`_rlsVr_>> __Q.u['I Ey _ ._ 1.nRt?d-np.t.c9C CT�C'r-'+rJ `,S E ROaC. .. - �� - 2334- Jceepot T:.S 4 _:c. I . RrY Fa... __ - _.__.. 05 P3CE3 Pz'^ry RJ33 b,4 I -�, U�TZL T IQ INS CC Imo'' Aclanta, GA 30339 Ip;SURER E.I SlicG_a Union Ins Co v-c SD COVERAGES THE POLICIES OF INS-1,10 ORICOND CONDSTANDING ITION ANY CONTRACT OR OTHER DOCUM NTEWITHORESPECT TO NOJHIC:HP HIS CERTIF LATE MAY eIEI ISSUED SUCH ANY REQUIREMENT, MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH —"------ - - LIMIIE IMS POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID ao ICY EFFECTIVE POLICY EXPIRATIGN (MMID m Y IITSR DD'L POLICY NUMBER A M I YY AT ! T 03/01/10 03/01/11 EACH OCCURRENCE 44,000_000 _-_„ A GENERAL LIABILITY GL04887714-00 DAMAGE O `EELATED IS 11000,000 PREMISES Ea accurreneeL_ _ X COMMERCIAL GENERAL LIABILITY MED EXPIMY amparsan) CLAIMS MADE a OCCUR PERSONAL a ADV INJURY S 4,000,000_ I GENERAL AGGREGATE S 4,000,000 PROWCTS-COMPIOP AGG_ GENL AGGREGATE UNIT APPLIES PER: PRO­ X POLICY T LOG 03/O1/11 2938863-07 _ 03/Ol/10 COMBINED SINGLE LIMB E 11000,000 BAP B AUTOMOBILE LIABILITY - (Ea accidenp_ X ANY AUTO - BODILY INJURY g ALL OWNED AUTOS (Per Oersen) _ SCHEDULED AUTOS- S BODILY INJURY - HIREDAUTOS (Per acdden0 _ NON-OW NEO AUTOS PROPERTY DAMAGE E % SELP INSIIRED AUTO (Per acudmq PHYSICAL DAMAGE AUTO ONLY-EISACCIDENT GARAGE LIABILITY "' OTHER THAN�4- EA ACC S ANY AUTO AUTO ONLY: AGG S A EXCESS UMBRELLA LIABILITY GL04887714-00 03/Ol/10 03/01/11 EACH OCCURRENCE S 5_000,f)00 AGGREGATE S 5,000,00.0 X OCCUR CLAIMS MADE DEDUCTIBLE RETEMION ...E-_ _ WC STATU- WCO20342355 (ADS) OJ/Ol/10 03/Ol/11 X_ RY LIMLIS_ _ G WORKERS COMPENSATION1,000,000 AND En1PLOYER5 LIABILITY 03/Ol/11 ELEACH ACCIDENT S O ANY PROPRIETORIPARTNERIEXECUTIVE� WCO20342356 (CA) 03/01/10 03/01/11 EL.DISEASE-EA EMPLOYE S_7.000,000 ._, OFFICERMEMBER E%CWDE01 WCO20342357 (FL) E (Mandaro.y in NH) E.L.DISEASE-POLICY LIMIT S 1,000,000 It yes,describe under SPECIAL PROVISIONS below 3 0M/2M OTHER TNSC46242373 -'(TX)-- 03/01/10 03/01/11 Occurrence/SIR E TX EmplOYare Excaea WC0910566 IQEII 03/01/10 03/01/11 D Workers COmpensation C Workers Compensation WCO20342358(XY,MO,NY,WI, ) 03/01/30 03/01/11 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: EVIDENCE OF COVERAGE CANCELLATION CERTIFICATE HOLDER SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS Y ITTFN THE HOME DEPOT, INC. NOTICE TO THECERTIFICATE HOLDER NAMED TO THE LEFT,BUTFAILURETODOSO SHALT. 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 REPRESENTATrvE ATLANTA, GA 30339 USA __ ^^ n T F^' F -- ©1988-2009 ACORD CORPORATION. A!I rights reservrd. a .7'3 43-43 7N V1a'1 I .V1a11J Y?BC S=JQ ?rc•Su__ .,_._a 3::�q I V,:L::na da ScbLa q11L' otlaa Nador,lFrattrttlon 3;32, CLaaa I 2.33 xu VLdrl o lkoftC-mde No Lax!na_ad C_aaa I 9=n ..1i-10 iax.nalo No Gs11a I S1n cajillaa ENERGY PERFORMANCE RATINGS EW �N DE RENOWENT0 DOWIETC10 . U-Factor SolarHeat Gain Coefficient HcmrU eo ftlemGwa ds da Eneryia Solo /0 . 32 1 . 8 0 ..'2 ADDITIONAL PERFORMANCE RATINGS .t,. � ^^N9tDttDrENTAR)ADeRENDOAElYfO Vlsi ble Transmittance tr,nanuwn d,(,tvhmN - - . . 0 . 52 rta.e ta„r>n eaeat.ra�a ro�ae�, aAco�pm&d o" :. a,tliata.attmaa„d OraAoE wtr.awambntu oondaar ad,sDaEa padutaLt��rol,etvnrow.y aauxt addoea not wurart7t adttM d)M�tY ary Vcftua Wtrtneerhttmt hMaa�AaLxvnr+Rea0 .'6t Amalssda mutt N altos.-lob cuff.W iWnb; I 1 1 b*Kpmditminvdmdl Wa*bWdr podumld wataea us,dos pa[EilC an dstan0udo,pattn mAmbila dstetdtYaw arLMislrYun taroro6pnxEma-� en fkaatdbmnr . - - d raltatdo ulo etperalodf ro taoActo .� I�aRLroiwnWad, Y. pua�Pas D't� ,. . ., foGm dd Wdcadrpnruo atrorm UALt q.aLlrlas To. �ENERCY STAR aagLon(a): Northern, Nocth CanCaal, forth Ctnt.al, 9ortha.n. EfdER6f TTAR La uni6ad oallrina,pa.a Lifd'.- . cegLOn(aa) 1swaROY STAR: Norte, _ Norte Cantral, 9uc Cantralc 9�c. •` IND: Rein OC/Claaf 3/324/9-R03 7 Ttated 91:e: 36'. r 63` IND: "ruaca0 OC/VLdcla 2.38 im/R-R43 - DP.• 145! —45 Saeado.pcobado: Bl_4 ea r 16C CA E69�U95rG1. aaTn . B9 Borman 25311M KarpMNEnIforpombh ENERGY SWmW&TotoommanVMWWN-W yfacpar. Gwfi um tl6 M pact p,abla mmba6a ENERGY SW"Pon mwu mat d(aca h hb,Vh04 fan.on11119mRdc` ONE - °T/� Po>nd/,d o�✓r�aoaac/.ueeQz Office of Consumer Affairs&Business Regulation MEMO OME IMPROVEMENT CONTRACTOR - I ' Registration ,426693 T . Expi�ra6tm �g t�� Supplementent The Home Depdt,�At ameSetvi'c�es RICHARD FALLQ�NE�;� .�. ,aI 2690-CUMBERLANb PARKWAY S ���--78^•�� AI , GA 30339 Undersecretary