386 HIGHLAND AVE - BUILDING INSPECTION (2) -rp--?- I Lf-1 (P (P (o -,pI 19 #-553
The Commonwealth of Massachusetts
! Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR E{Y�Q SALEM
ROMMar 2011
Building Permit Application To Construct,Repair, Renovate' is a
One-or Two-Family Dwelling
This Section For Official Use Only HN
Building Permit Number: Da AO0ppllied:
Building Official(Print Name) Signature Date/
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
- /�i�hll 15V f
Lla Is this an accepted street?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❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Own r of Record:
Fr'L' F✓9SC bi Y'i.$('.✓n
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) erl Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work': ZP Mode L r t Cl.t-V rl"k 13 h Zr rual+t,
CovmnitJe C-0tl
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 9 tom: 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ UV ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ CTCr S r ❑Paid in Full ❑Outstanding Balance Due:
Tb H• CD .
SE:.1�1T L'i��23
SECTION 5: CONSTRUCTION SERVICES 11
r/ 5.1 Construction Supervisor License(CSL) 556 a oC
S'}e�C (Gh ✓ I7 License Number Expiration Date
Name of CSL Holder
�, ) 0 i c List CSL Type(see below)
9 Lfl�'1c L'.e'' J�
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
7 Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
33 3 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
,Vkvv Dt��'w-� G. c H HI d e S 7 /�
IC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
ors c t ; )i,�. s#
No.and Street
,��_ � A), I,{ '20-3 Y T 3.3 1� Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE 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..........0-- No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize 5*ku P- /%,c-+.
to act on my behalf,in all mTop
tive to work authorized by this building permit application.
r dean! - i0 15 Iq
Print Owner's Name(Electronic Signature) 'e Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
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. )
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. 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 MC Program can be found at
www.mass. os v/oca Information on the Construction Supervisor License can be found at www.mass.gov/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"maybe substituted for"Total Project Cost"
CERTIFICATE OF LIABILITY INSURANCE
9/18/2014
'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY y,,2�POLICIES
.i BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
;I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: I the certificate holder Is an ADDITIONAL INSURED,the poliey(les)must be endorsed If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endaraemerlt A statement on this Certificate does not confer rights to the
certmcato holder In lieu of such endorsement(s).
PRODUCER co
NT CTLinda Bogdenowicz
INSURANCE SOLUTIONS CORPORATION PHONE N. (603)382-4600 F^= (603)382-2034
60 Westville Rd -una Appgm.lindab@isc-insurance.com
INSUREFW AFFORDING COVERAGE NAICs
Plaistow NH 03865 msURERA:Peerless Indemnity Insurance
INSURED
ISI{11EN B,ILlm Mutual
Steven P. DiChiara Contractor ISURERC:
PO Box 356 OSURFA N:
BSUREfl E
Newton Junction SIR 03859-0356 1 INSURERF:
COVERAGES I CERTIFICATE NUMBER.CL1412715129 REVISIONNUMBER:
THIS IS TO CERTIFY THAT 1114E 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
MR I TVPEOFINSURANCE ADD R POLCY NNMBEII POLR.'Y EFF POUCY E7cP LOmS
GENEAALLWBflJTY EACH OCCURRENCE E 1,000,000
$ CawArRcb GENERAL UAaLrry DAMAGE TO RENTED
s own c E 100,000
A CLAIMSbUOE ®OCCUR 8743045 2/30/2013 2/30/2019 AGED EXP(Arym PNsm) E 15,000
PETSONAL&ADV INJURY s 1,000,00
GENERAL AGGREGATE $ 2,000,000
GSA AGGREGATE ULOT APPLIES PEP
PRODUCTS_COMPIOP AM E 2,000,000
E POLICY PRO- LOC E
AUTOMOBILE LUmILnV C MIBINEO N UMDT
a '
ANYAUTO BODILY DLRU(Y(Per Persar) $
DULED
AUTOS AUTOS BODILY OLURY(Perawde S
WRED AUTOS ANIOR N-OVYNED _ _ PROPERTY DAMAGE E _
$
UMBRELLAUl1B H OCCIA( EACH OCCURRENCE s
EXCESS LMB CLAIMSAMDE
AGGREGATE E
DED RETENTIONS E
B VNORKERS CONPENSATON Y FA7L4 OTN-
AMEMPLOYERS'LUUMM WN _ 1
ANY PROPRETORMARTNERIEXECUTNE E.L.EACH ACCIDENT E 100.00
OFMCERAAEN(FR EXCLUDED? ® NIA
(Mmrderary In NH) -SOO-5012476-2013A /26/2014 /26/2019 EL DISEASE-EA HAPL E 100,00
If desm'ba urdr
OES AN N OF OPERATIONS bd. E.L DISEASE-POUCY LIMIT E 500,00
DESCRPUGN OFOPERATRINS/LOCATIONS/VEMC FS(Amch ACORD(Ot,AddnmwT Ramarta Sdmdul%R mare space b regabad)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS
AUTHORED REPRESENTATIVE
Keith Naglia/LJB �-�J— -
ACORD 25(201 DAM 01988-2010 ACORD CORPORATION- All rights reserved.
INRVIx..rmltnrtaT nt_ Th.arnnn..nm.nn,t 1, ..ero renida,m.t nwArc.J AMnn
t
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Co tractor Registration
Registration: 116688
Type: Individual
�z. Expiration: 7/6/2016 Tr# 252862
STEVEN PAUL DICHIARA h�
STEVEN DICHIARA
68 WHITTIER ST W
NEWTON, NH 03858 9-
0Update Address and return card.Mark reason for change.
Address ❑ Renewal Employment ❑ Lost Card
SCA 1 G 20M-05/11
V13O IQ09YVIILOOLWC�G/L�VUL(CdXI�N.�d
Vegistration:
N Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
116688 Type: Office of Consumer Affairs and Business Regulation
piration: 7/672016;-- Individual - 10 Park Plaza-Suite 5170
Boston,MA 02116
STEVEN PAUL DICHIARA�
STEVEN DICHIARA
68 WHITTIER ST
NEWTON, NH 03858 �� �
Undersecretary Not valid without signature
Massachusetts -DepartmentR l ns and Standards
Board of Building
Construction supervisor 1 &2 Family
License: CSFA-0.5562?STEVEN P.D1
'
68 Whittier St
Newton NH 03859