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288 HIGHLAND AVE - BUILDING INSPECTION C-4-, S \ The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF u Massachusetts State Building Code,780 CMR EIV ►NSPECtRI t�is���;ISi Building Permit Application To Construct, Repair,Renovate Or Demolish a One-or Two-Family Dwelling 111 This Section For Official Use Only Building Permit Number: Date App ' Building Official(Print Name) _ '" Signature.,-:" , ' SECTION 1 SITE INFORMATION 1.1 Property r dres : 1.2 Assessors Map&Parcel Numbers � �Q� d &L—e= L la Is this an accepted st4t?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ %-SECTION2: PROPERTY OWNERSHIP' 2.1 Ownerr of Record: Name(Pnnt) City,State,ZIP No.and Street JTelephone Email Address ` SECTION 3 DESCRIPTION OF PROPOSED WORK'(check all tout apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': C SECTION 4t ESTIMATED CONSTRUCTION COSTS " r " , Item Estimated Costs: Official Use Onl Labor and Materials Y i.Building $ I. Building Permit Fee. $' Indicate how fee is determined:' 2.Electrical $ ❑Standard City/fo wa Application Fee ❑Total Project Cost'(Item 6)"x multiplier "r X. 3.Plumbing $ 2.:Other Fees: $ 4.Mechanical (HVAC) $ List v 5.Mechanical (Fire $ Total All Fees $ " Su ression Check No. • " Check Amount: Cash Amount: - 6. Total Project Cost: $ 13 Paid in Full , 0 Outstanding Balance Due: ' SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Sue 'sor License(CSL) r no License Exp' do ate Name of CS older List CSL Type(see below) No.and Street Type Descnpuon -�'�,:= AiAnnt" � U Unrestricted2 Family (Buildings u el 35,000 cu.ft.A City/Town,State,ZIP �"� R Restricted l&2 Famil Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances ele hone Email address D Demolition 5.2 Registered Home Improv men Contractor(HIC) � IIIC Registration Number Ex rraT n ate HIC Co n I e .me No.and Stre t - _ Email address City/Town,State, IP telephone SECTION 6 W RKERS'COMPENSATI ..fi ON INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(�)- s Workers Compensation Insurance affidavit must be coirWItted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuan the building permit. Signed Affidavit Attached? Yes ......... No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN ._ OWNER'S AGENT OR CONTRACTOR APPLIES1 _FOR BUIIL{DIING PERMIT l I,as Owner of the subject property,hereby authorize7_�� to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNEW OR`AUTHORIZED AGENT DECLARATION,, .,',,, By entering my name below,I here y est under the pains and penalties of perjury that all of the information co ined in this application is tru an a to the est of my knowledge and understanding. PrintOwner's or A thorized s e(Electionic Signature) D to r -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 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 jnD .mass. o�Information on the Construction Supervisor License can be found at www.mass g_tov/dps/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.ft.) Habitable 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" Next Step Living, Inc. CT HIC.0629266•MA OCABR#162111•RI Contractor Reg.#37185 IMPROVEMENTHOME Date of Contract: Thursday,August 07,2014 Customer(s)Name(s): Marion Gallo-Muise Customers)Street Adress: 288 Highland Ave City: Salem State: MA zip: 01970-1841 Customer(s)Home Phone#: Home:(978)745-1801 Customer(s)Mobile Phone#: Permit(s)Required: Permit Number(s): City/County Issuing Permit(s): Scheduled Inspection Date: Customer(s)jointly and severally agrees to purchase the products and/or services of Next Step Living,Inc.("Contractor")in accordance with the terms and conditions described on the front and reverse of this Home Improvement Agreement("Agreement')and the attached specification sheet(s). Customer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. ESTIMATED STARTING DATE: Thursday,August 21,2014 ESTIMATED COMPLETION DATE: Thursday,September 04,2014 PAYMENT METHOD: (select one option) PURCHASE PRICE: $ 7,760 H Cash RX Credit Card DOWN PAYMENT: $ 776 Check Financing BALANCE DUE ON SUBSTANTIAL COMLETION: $ 6,984 Customer(s)acknowledges receipt of"Renovate Right:Important Lead Hazard Information for Families,Child Care Providers,and Schools". Customer(s)received this pamphlet on the date of this Agreement,before commencement of work. Customer's Irma a (Rhode Island Customers Only)Customer(s)acknowledges receipt of required Contractors'Registration and Licensing Board consumer education materials. Customer's Initials (Rhode Island Customers Only)Notice to buyer:(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank(2)You are entitled to a copy of this Agreement at the time you sign it.(3)You may at any time pay off the full unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You may cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an explanation of buyer's rights. Customer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of this Agreement.Customer(s)acknowledges that Customer(s)(1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two accompanying Notices of Cancellation,on the date first written above and(2)was orally informed of Customer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. NEXT STEP LIVING, INC. By: Omar Nieves-Hernandez F : 8/7/2014 Print Name Lic.# Si atur Date CUSTOMER(S) _ Marion Gallo-Muise - T I /7/2014 Print Name Signature Date Print Name Signature Date YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ACCOMPANYING NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ©BLLP2013.NSL.CTMARI � �. cy� fl a w v.nao ss go / a� ��r'oakpr3' Co pen5ntit? L lu��ts_t_Mdxv�t: OEM Bttl dea' 'l vrr}Yu^-su, �1 P] 3a�3P117 ] Puebla: Name (Bus nes Or3azdzat 11 enJlnd J > r f Address: ne#: r City/St�te/Zip: Typ°., of Project(, quirzd): Are an ennployer4 Check sap ToP 4. ❑ I am a general contractor and I 6 ❑New censteaction 1. 1 am a employer.W.11h (_ _ .$ have hired the sub-contractors employees(frill and/oi part-time), 7. R modzling listed on the attached sheet. ❑ 2.❑ I am a.sole proprietor or partner- Tbese sub=contractors have 8. (]Demolition ship and have no®ployees employees,andbave workers' 9. [].Building addiran working for me in any capacity. comp•,iri�rra. ; t pq:o workers' comp.insurance 5. ❑ Plc etch corporation and its 10.❑Electrical repairs or zdd t ens require officers bave exercised their 11.[]Plumbing repairs or addi5ons 3.❑ I am,a homeowner doing all work right of exemption per MGL 12.[]Roo repair, myself. [No workers' camp. a 152,§1(4),aadwehaveno f' ivsurance required.]t employees.[No.workers' 13.[ l7hEr . . toms.insurance required] icy *Any applicant that cbecks boxl!1 must alsa,fill oath a s ao�below showing o k and then 6i�'e oat jd;c°otrao ors mensation ust su6m new affida-rit iodicaGoB such.. . t Hoineovmers wbo m.bnut ibis affidavtr indicating ey t s _ of tbe employees�li.tba such-coohacOXIihrsbat8t1Hc toyces thel'm'lst perovide tbeirt- cikecse Camp.pol ynuumber. stria wfiethei or not those enhtiu have ve . la CAtitQt iS POpIdiM WOPI[CYS CONY O LM5ati091 insurance•for MYenV10yers. Below is the'Policy and job SiJ¢ I am.an.emp Y P g � 1ri,fOTM9aQ10Pd... t� .Insurance Company Name. • Expiration Date: Policy#or Self-ins.Lic.#: CitylstatelZip: Job Site Address:_ The olic number and ebpintion date)• ttach a co 'y®S tie vrorkers'c�oa gcoEncy declaration pa 52(hen lid to the imposition of criminal penalties of a A P. Failure to secure coverage as required under Section 25A of MGL c. fine up to$1,500.00 and/or ane-yeaz imprisorrorent,as well as civil penalties n 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 forwazdcd to the Office of— Investigations of the MIA for insurance coverage verification. / n eA the mist atdpetgoJtees of p�cvja y that the i;,prittationprovided abovo is b�eAe oild correct Id h ,etaAlrfy � ➢ t Date: • rT.�.;nm . � .. � . ;. • . e only. Do not write in this area,to be completed by city or town official gertmjtlicense# wn: uth0r7ty(circle aae): _... .... a se....a..:,.al dnnancrMir 9_�tMf77b'illlta�gTpCetGr WE THIS.CERTIFICATE IS ISSUED AS A MATTER OF I0OFi01ATION ONLY AND CONE€RSE�qjDHOR k UPON T€P THE COVERACERTIFICATE HOL°R, THIS OERTIFICAT€'OQFS N.OT APFIRMATRELY OR NEGATIVELY AMENO; P-„ .-1 AFFORDED By THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONBTITLIYE&LOIc`T09 nne1 €�11l66,: TH€IRSUIRd IHSURER(Sj,AUTHCRIfED tiEPRESENTATIVE OR PRODUCER ANDTNE CERTIFICATE HOLDER. IMPORTANT; It lh,clrtf;ate hGtdCr r cn AODITIONALiNsURED,IhepGllcv(is=j mustbe P.n6wEe& It SUERO!sATOS ISVr'EdVR3, sublmt to lhctltirma and oolldfionq of the RnllpY,ctialn PGllcleP rcx .reguirven v�1dus=r:,et A stcLmcat cWhls C.s^Uficite CIPes nolcoRiFttigHt6t0lii0cET¢HEcslullet:taPinliEUO£Evels6ndGsssnlent�=): -.- CCNtAGr FRODUCEi NAIAU, .PHC1Y! CARELLAS INS ADDY INO AA:Ha Edl• I FAA IUC Nm•: __ ?Or PARK.AVENUE ENN WEST 5PRINGFIELD,MA010B5 _INSURENt51APFORDUMCOVEPA06 NfiICa .NPURER A:IFIEAV:1.EAPSPRDPERTV CA 1.1 COUPAHY OF DISIREl) •haUREF.p: . CRAIG ROIOA+LO OSA CRAIG waERC: _ WINDOWS .nsuPERG. PO BOX 299 - -- HUVTINGTON,MA 01050 :nsJRSR E: HSIEER FFit D sop CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED THE POLICY PERIOD INDICATED. NOTWITHSTANDINQ ANY REQUIREMENT, TERM OR CONDITION OF ANY OR OTHER DOCUMENT NRTH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN,THE AFFORDED BY THE POLICIES DESCRIBED HEREIN.IS SUBJECT TO.ALL THETERMS,.EXCLUSIONS AND S OF SUCH POLICIES.LIMITS SHOW N MAY HAVE BEENRSYPAIOCLAITPOOFINSUPAVC2 kL !u! POLICY NIfHOEID uvXmmr" m IIEaTI@ EACHOCWRRENCO 6 UARELMRIERCW.OENERALLIA6ILOY DNIPD TO f16EyD: 6, M11.%uacE❑ Occun IJEO EXP v Pnv wlCvnl. 6 IERSONAL DAOV&UFR' 6 GENCRALAGOREWO. 6 0 NLADOREDATp LIN?APPL, 6PER: mmum S'.CCN Op A00 6 Rp Dc v POLICY "'PO 1 UNIT ! NOOILELWldEY ANY AUTO MDILYI WURY IPx PEI-1 Y ... ALL ONTIED _ASCU OCSULED- .. .. _ .. -....dOOILYJNJUNY.IPx.,.a.o E .9.. 'ALHOS ED NOH O1YNEO FR dMAO! 1 HAEDAUr00 AUTOS 6 UNBSELIA LIAR OCCUR - EACH OCCURRENCS Y 9SG6ffi UAD "'NI LI40E JGGnE0Ai8 E CEO .Rli=HEWN6 - E 1YO,AJUGCCIJPEHSATIDN X Y/GSTATU• ER 1HD EY1lDYE110•LIAmury y TOPY LAIIT! ER ANYPPGPRIET jR EXCLUDID?tEGur,vA�N F.L.EACH ACCIDENT $100,000 Xamdot1ENE6fl FIDLUOipY U NIA ]PULE 03.15.2014 03•iS•2015 ELOGEOI-EAEMPLOY09 $500.000 (IlAndtlallANlry 5BB77428 I'm wimbm.1 LL DMEASE.PGL.Cr LNDr $100,OOD OESCAIPTIONOFOPlRATICH �Irn OTHEWOR EASSpTION S'COMPENBATIONPOLIATIOW1 LOCATIONS[ CY A DOESNOTPROVIDECOVERAGEFORCRAIG,RONALD CANCELLATION SHOULD ANY OF TIIE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH TPI POLICY PROVISIONS. AUTNOREED HEPRESENTATTYE ) (J vb 11'99&`2DID ACORD CORPORATION.All riOidfi resumml ACOHD 25(2010105) The ACORD NnmR and!aqu Grs m11i61vrod marks M ACORD i i i I � .. I •...,.� ';ili lr,l:F�.a R�gu4ezi rrsi vlci �;nnc'-'rttttl,)17. .7t1'(JCrx`i4ar .l iF.p":'��•-i. . ? iL�LSx.�'daL�•'�a:t�ti:6'H\L`dx1 HER UN ..Ulrr•.gt✓rNlr��� r• f fu�.'n r.•%I<:�•�`.r: r ' {s Cnns3.mcr rtiCfn,rs @ Susi css Rc�v{atinn q�llE� 1SJIPROVElVIENT CDNTRACTDF. Type: 'F2egls4ration: 161323 DCA z%'uir' ^pi�Yian: 10/id261/• .s• CRAIG �,. RON ALD CRAIG. t PARKRiDGE DR: nl i I HU1gr-llm•.TOM, MfH0i050 �indcrsecrct^":-P k I I i CITY OF SM EINI. 2UNSSACHUSETTS BUILDING DEPARTNILNT 130 WASHINGTON STREET, 3"D FLOOR 1FL (978) 745-9595 FAX(978) 740-9846 KIN(BERLEY DRISCOLL MAYOR THo&w ST.Pwm DIRECTOR OF PUBLIC PROPERTY/BUILDING CONWSSIONER 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 with 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: �,q.1 (name of hailer) The debris will be disposed of in : (name of a•ility) o,W' (address of facility) s' nature of perm=it-appticant d e dcbriu lUm