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9 HORTON ST - BUILDING INSPECTION (3) y -r IN --- I'he C'onutlotmeahh of Massachuscus Board of fuilding Regulations and Slandards CI'I'1' OF Massachusetts State Building Code,7SU C NIR ti,\LI:,\i' \OA' Building Permit Application To Construct, Repair. Renovate Or Demolish a One-or Dn.dNn.\+ This Section Fur 011icial Use Oni Building Permit Number: __. Date App icd; r /6-71 y - Oo Building Otlicial(Print Mum) Siy,salurc Dale SECTION I:SITE INFORDIATION 1.1 Property Address: 1,2 Assessors Map& Parcel Number e? No'-to n v ree f I.la ls this an acce ted street? es no Map Number Parcel Nwnbxr 1.3 Zoning Information: 1.4 Property Dimensions: Loniny District Proposed Use Lot Arco(sq III Frontage(11) 1.5 Building Setbacks(R) Front Yard Side Yams Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.1.c.40.§54) 1.7 Flood Zone Inrormallons 1.8 Sewage Disposal System: Nibllc o Pdva(e o Zone: _ Outside Flood Zone?Check if yesO Municipal o On site disposal*)slum SECTION2: PROPERTY OWNERSHIP' 2.1 Ownerl or Record• W11114m TrPiYF�lasl SalemMd (5t97c' N;une(Print) City.State,ZIP g110rol, 971?-ZYf - No.and Suces relephone Email Address SECTION J: DESCRIPTION OF PROPOSED$VORKs(check all that apply) New Construction❑ Existing Building Osvner-Occupied ❑ Repairs(s) ❑ Alteration(s) o I Addition o Denwlition o Accessory Bldg.❑ 1 Number of Units_ Other O spccily: Brief Description of Proposed Work% i1/P2 11 8Polacemenf r�doly8 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only 1 Lahur and..\Iateriab► I. Building I S 8„j I. Building Permit Fee: S Indicate hoot tee is determined: i '. l:'latrical S o Standard City+Tusvn Application Fee O Total Project Cost'(Item 6)x mulliplier x 1 1'lumhiag S r. Other Fees: S_ -- J. \Iccl.mic.d ill\ \('1 S List: _ 5 INJ.:nir,d iF,ry - -- - --- - - - - - \IINeiiltlnl S f„GII .\Il Fcef: S_ —._ ('hc6h No. ( hcek :\nunml: C.iih tnomic a 1'uwl 1'mject Cnvt S ga yQ/ ❑ Riid in Full (3 Oulstanding llal mcc Due: 6 r10.r`I 40 f{oh,e owl P ple4 S-e—, SE("PION S: ( O NNI-RUCTION SFRVICFS e 5.1 ('onstructialtSupcn'isorLicense(('SI.) lq-71— . Sf — I icenx Nunihcr Pynralm t Date - N:uneul'l'SLIIn1,1cr - _--- lutl'.til. l)peVenhduwl.__,_ _3Gj1rIs'hor� BCcr _-- --.--- I,PC Ucscriptiun No. and wcct (I I hnrestricicJ I Ilui Win s ri 10)t,I)Otl ar. ll.l Ate,Lrk,etdll/� -3��i3 ItIlnlrioeJ L'l•?Pmnil D+tcllin Cit n ifoan,state.LIP %1 \htsun RC R,Mmin C'oscrin SF SoliJ Fuel Ilurning Applianccs GIn9 `�?y'SOUo7!di5'r7�f (d �"�4• Gv 1 Insulation 1'ele hew P:maII;iJJress ��— U Demolition .1.2 RegisteredllomeImprovementContractor(HIC) 1686!(! 4413 13 !7� Ly(.v o✓ 'W r IIIC Itcglb mr iun NuniKr Fynrutiun UJIe I IIC C'ompan) N;mw or I IIC'Registrant nw a501 S hd 'e'0 No. wiJ Street /r all address PSyL/ P� 19D13 Fa/D /�'?r{'SCaox'o"fs0 City/Town. State ZIP relcithone SECTION 61 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e. 152. 1 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 ..........9 No...........13 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 �{I &1© to act on my behalf, in all matters relative to work authorized by this building Jermit application. Date Print Uwncr's Nwtic(Hectrunic nuture) SECTION 7b:OWN ERn 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 its true and accurate to the best of my knowledge and understanding. Print owner'i ur:\utlwri/vd,vgcnt'i Nome IPlcctrrnic\ignaturul atu NOFES: 70%�ncrr %Ou obtains a building permit to do his.her osvn work,oran owner who hires an unregistered contractor tered in the Hune Improvement Contrncturi HIC) Program).will M) have access to the arbitration ur guar my fund under I.G.L. c. 1J?.A.Uther important information on the HIC Program can be found at •+ t Information0n the Construction Supervisor License can be found at +,+ w.n+ �:stamial twrk is planned, providethe infurntatiun below: a 1 sy. Il.l _ __—_.._(including garage. finished basement attics.Decks ur porch) Grris It%ing area 154. 11.1 Habitable room count - \umher of hedruunu \umherol'hathroums . . . . . \'untberothalfhalhs _ I pc of heating s)stcm \unthcr ot'decki, porches I\pe ol,c.wllmg i):Icnl 1'11clo+ed .. Open ). "I.d.d 1'r„jcct \rinnre footage nnw he suh,ututcd 11m"1',oai Projccl 00s1" Office of Consumer Affai and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvem�ontractor Registration -n '; ^---*----,-:,_- Registration: 188818 Type: Supplement Cab IT. =' Expiration: 3/182013 POWER HOME REMODELING MARK MORDINt 2501 SEAPORT DRIVE STE 1511 , - - CHESTER, PA 19013 Update Address and return card.Mark reason for change. ovsu! A sor♦amaarmzle t.-'- Address I] Renewal 0 Employment Lost Card �a'�oasrorovu�icalAe o�./Craae(ia�iwe/b O®ee of Gossamer Afhin k Bminm Regulalioa License or registration valid for individul use only OME IMPROVFMENT CONTRACTOR before the expiration date. If found return to: 0111ce of Consumer Affairs and Business Regulation Repiatratlont¢386616 Type: 10 Park.Pla to-Suite 5170 g ExPIR /3 Supplement Card Boston,MA 02116 POWER HOME ,.,i. ItOUP INC. rA r. MARK MO IN t"r. •:�p�<< j � 2501 SEAPORT CHESTER,PA 1901� Undersecretary l Not all �i hair signature s M issachusEtt.- Department of Public Safety Board of Building ReLulations and Standards Construction Supervisor License ,.-License: CS 1979 . . Resttictecl,So 00,,;,,,„, 3 CHRISTIAN.`DR r! ,NASHUA NH,03083" Expiration: 5/7/2012 ` Gnnmicsinnri" Tril: 25028 - ' vovvert-iKu niTps:tinitro.powernrgconitproject-oocumeriEsi.)aDD-ii Pages i Project A 422(A NA:10NAL III,AUOUAI?fERy WX,. +w J ...... 750 D'r. ctvqe' ?A 19013 888-REMODEL M"' 1'et zO 2 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT ilary.es intermatIon w4zz64 William Tremblay Ptyavf Number March 23."12 Josephine Tremblay 4978174141821(Hosev) 9 H.w1a.Sr Sus"MA,01971) County;15ww Township: Suyen(s)listed above hereby jointly and saverally,agreaw.to purchase the goods andfor services of Power Home Remodeling Group('vontratilor')In accordance with the prices and forms described on the front and the following four pages of this egtwmeM and any specifiCatlon Shoals,(oollactiveiV.this"Agreement").This Agreement repmeninis a cash vale of goods and services.Buy"(2)agrees to pay the Cost of the goods and services purchased as described herein, rogairdless of timing or approval of any financing Butron(s)may seek for their purchase. Purchase price. $4.995.42 1 Pro Installation Inspection Date: Down Payment: $0.00 Estimated Project Start: 60?wa . Balance Due or, $4.999.42 Substantial Estimated Project Completion: Completion: er 7 d'. Deftroa�Plu�naw rx 4 t a Ina"mo,o Dewya wy�cwllla,[w*rantic" Method of Payment Other a"Wed 1.C ' Wax,Mnv f.Coe Buyer(s)hereby acknowledges receipt of a copy of the pamphlet,-The Lead-sals,Certified Gu We to Renovate Right", Informing Guyer(s)of the potential risk at Is"heated exposure from renovation activity to be performed In Buyer's home.at the st!3�mas written above.Buyer(a)received this pamphlet an the date of this Agreement,before commencement of work. 51 (Buyer's Inflials). It Is agreed and understood by and between the Parties that in]$Agreement constitute$the entire understanding between the parties,and there are no verbal understandings changing or modifying any of the kerms,of this Agreement,Buyer(s) hereby acknowledges that Buyer(sl 1)has mad the entire Agreement and has received a completed,signed,and dated copy of this Agmernent.Including the two accompanying Nafte of Cancellation forms,on the date ant written above and 2)was orally Informed of hils/hor right to cancel this transaction.DO NOT SIGN THIS AGREEMENT IFTHERE ARE ANY BLANK SPACES, Future promotions not applicable. I have"ad and received each page of this 5 page agreement. Power Home Remodeling Group Buyere), Buyer � *­ I '(Z�L �a"111�161 )li�.. VnA�-- I Sion On -.1�i- pllwr;�iwe- azure 11��' I Signature Or Jemmyyog*l William Tremblay Josephine Tremblay YOU.THE BUYEP4 S).MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR 10 MIDNIGHT OF THE THIRD BUWN FSS DAY AFTER THE DATE OF THIS TRANSACTION SEC tHE NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. March 2J, 20 J I Page I o(S —---------- wmm F.ieemn I of 2 4/6/2012 H I PM NATIONAL HEADOUARTERS William and Josephine Tremblay 2A off Drive Chester PA)9013 i Seaport SOWER 30-42264 888-REMODEL. c March 23,2012 MA HICe 168616 Project Specifications Windows: Kitchen 1 48.0"x38.0'• ---- Windows:Kitchen 1 48.0"48.0" WINDOWS:Models SL 2700 Styles Double Hung Types None Conti None - OPTIONS:Color White/While: Grid Pattern; None I Removal Steel I Additional Details None Windows: Kitchen 1 48.0"x38.0" - -=— Windows:Kitchen 1 48.0"x38.0" WINDOWS:Models SL 2700 Styles Double Hung Types None Confgs None OPTIONS:Color White/White: Grid Pattern: None I Removal Steel I Additional Details None Windows: Living Room i 18.0"40.25" Windows:Living Room 1 18.0'x50.25" WINDOWS:Models SL 27DO Styles Double Hung Types None Configs None OPTIONS:Color White/White: Grid Pattern: None 1 Removal Wood I Additional Details None Windows: Dining Room 1 18.0'x50.25' Windows:Dining Room 1 18.0"x50.25" WINDOWS:Models SL 2700 Styles Double Hung Types None Configs None OPTIONS:Color White/while: Grid Pattern: None I Removal Wood I Additional Details None ajry _ l Windows: Dining Room 1 76.0"x50.25' Windows:Dining Room 1 76.0"x50.25" WINDOWS:Models SL 2700 Styles Picture Types None Confgs None OPTIONS:Color White/White: Grid Pattern: None I Removal Wood I Additional Dolads None March 23, 2012 16:13 IIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIII I�IIIIIIII Page 2 of 2 i:0; Batch ID: Order NfLine it .CERTIFIED 11 1 1 Go. . . • ' go • - • - o U-Factor(U.S.1 t-P) Solar Heat Gain Coe(licient Visible Transmittance Condensation Resistance 1 � • _Y �I •r r� 7��+ .r r Itt 1: � ryd l, _11 11 ll .. '�� e 7 >r l�li. 1 I I ;• I � O y 1 I • p I i .......k �I i3 '�_:'�y+' { K}ry L a� -: f�Yl '1 �. y,l.x.�,,,,.1 t,{' r•al..., I I � a .`_71fY I '} 1i'Y IY»fPl �N`, �I � '�iitr i� � .♦ I . .. ., a ••. 8.+-w>.. p tI fG I ,,..i.11P E t" (!I S 0jI I ,,� 3� t, t+•I r p l � � �t l � rr'k jl r._ It-11�� t 4 .y!1 rV frtr S•_-.�.�I { ( ` I•owerl I KU nitps:irmtro.powernrg.comproj ect_ooc turnntsr6u2>uu'/pages-t �01XlER I Pond-cr I Ionic Rcmodcling ( 11,0111 ). I Li` .\un uthrn'ut 'Allicudi :r'lll" ), it, IL, C["� I( 1\I RI\IOI H,l\(, ANl) I\IPR( )t IAlIA] .\( ,P Ilt .illd In 1' %t I'II P'nll'r I Inlllt' In, . 'G'II:v.It II•!'- • •Ilid WAtic'm +�Gx'�lh\n :IIIII 11. \I 1 ` It(", It% .1,1,'I' lil .:'IIt'I:d mid lllod)h lilt' A\411 I-tilt'III .I> II IIiI .i t',1 !'•r it,ll. ( l! wr Ill. III lnit• ;ill Illy it'rlll` alll! I I•I hlil w-- ill III'' \L:ft I IA;-Ili %IIG N'llmill 111 II;II III;. t' .111d ,Ill I !. I lii> .\I!a :1,1I:1 ,fl111t Oldil!t lllh III lhl' .i' II','lll�'lli. IIlt n�I�'M I!1; di!t III!I,II`. ahr:;ll'r'11`. rI '!rII'!I�1(h II: "d Iq'•ttl!II f� .Old 't' POt Gn6 Lov;,r\,�. 2cclrn ( 44p Z 5pe Tn ' d Iol , )CCD1 �:C"t- taper•'. carpp �vS: Lnc-). 14 7%Hx. 11 5 %z , Nv &;CNs , 1, Nh C-Ji V. r .\+ ;1 ITsOlt Ill I!It•5c (-IMI'Llli". Ilb' lollimil'.g, It•1•III• Ili tilt' .\'.;t't'!llt'1`1 ,;11' ,11�••I I:Ll,lli_III�'11 Illt'rt' 1, il" 1'Il,tlht Ill' I!I;I!'kI'tI ,I` ..`/.\ Iln Ii, ;Ili I i!( 111,11 Ile t'Ila ll',1' ;f 111)1t4 New Purchase Price tiJ Ly New Es Stoning Date' t^.erhed a. Payment:I/Check 0 Cien rn Name on C.1 Ccrd. / n New Down Poymenl 1C - W /U ! rt B New Est. Completion Date: Credit Cord (< /\ ,//R New alunce Due on r/ q ' `� Soh,tinnhnl Comnir�rinn (1 �'� t t rr ICI:C nrC rn Dnre /I r' /.1 of 3 4/6/2012 1:10 PM The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I n Please Print Leibly m Nae(Budoesrtorganiaaria✓tadividudy PowEe HomE i 6moDf:cli, 6;Z5012 Address: zso/ St1PA07-1, &17r 81/0 Cif st � 19013 City/State/Zip: Phone #: &,I t-6 7V- 06)0 Arn an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 15 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction❑ 2.❑ I am a sole proprietor or partner- listed on the attached sheet r 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workets'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.]t employees.(No workers' 13.1E/Other tn//Ad,9915 tromp.insurance required.) 'Any applicant that checks box al mar also fill oat the sepias below showing their workers'compensation policy blarmatim. t Hnmeown ns who submit this affidavit indicating they an doing as work and than hie outsldo woanrzors anon suit a new affidavit idicatmg such. 1Cwmcmn that check this box mast attached an additiotnl sheet showing the oamc of the mrbeooaaums and theirworkers'comp.policy information. 1 am an employer that Is providing workers'eompensadon insurance for my employees. Below is the policy andlob site Information. Insurance Company Name: Fi5 iS' L , Pr1i tt r-rl rvn_e 2 Dnlicy Nor Self_inc.Lie_ft• 20/10o—f,-GD-f1E.'_6Lda—_ Expimtion Date, ZZ. /Z Job Site Address: 9 ,44o on Sf City/Statc/Zip: 7a Attach a copy of the workers'compensation policy declaration 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 fine 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 I do hereby cardfy under the pains and penalties ofpookuy that the Information provided above Is true and correct. Sing Date- a /a Phone ft to� So as Q,aielbt use only. Do not write in this area,to be completed by city or town olJkiaL City or Town: PermitfLicense# Issuing Authority(circle one): ' 1. Board of Health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: POWER-1 OP ID: EL CERTIFICATE OF LIABILITY INSURANCE I °";D, 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 THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SA AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER IMPORTANT: If the codtFkate holder Is erl ADDITIONAL INSURED, the policy(lea)must be ondoesed. If SUBROGATION la WAIVED,oub)act to the turns and conditions of the policy,certain policies may require on Mdoreement A statement on it"aerailcalo does not corder rights to the cerTMeata holder In Eau*(such ondarweme • PRDOUCER 21S:7 378 Chad Lacher Lacher S.A.00datos Ite Agency 215-723.8604 ,yae .ee•k Lacher Inou inco Group 632 E Broad St P O Boa W98 Souderton,PA IBM rmu"G • AFFanowa COVOL ISChad Lacher wSURERA:Penntrylvenla Manufacturers 41424 sounm Power Home Rem odoling &"wa1 Pennsylvania Manufacturers 12262 aa07 O roupS,elapono.rt Olive Ste Ell to tauxeR c!lronshoreS ecia in Co. S Chester,PA 19013 1N°""EROi iWlpRe: wawa• : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS Is TO CERTIFY THAT 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 WHEN THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AffORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. E=WSXWS/GAD CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. TV Or weURANCS eWlM.r aIYBCR Y LaYYa °acRAL LRetJIT' Fl{FI OGCLaREMCE _ 1 1.000. A X COMMERCPL f-ENERAL LIAa0.RY 0 21 100-06-20-BB-7 OW22M1 DN22112 _ ��. QNM&MKC OCCUR MEOE%P M a.•Pertunl I _ 10. PER90NN b AW NJIRV { 1,000, r .OEREPN.N.GREWTE { 2 GENL AOGREGATC LINO ArTL1E50ER t :PROWCTS CoM Pa G I 2.000. X P01.KY LOG I COMew N 1.DD0, AYraYOBILa WaaITY 151100.BB-20413-7A 09J22H1 OWMI2 000ar w,uRr IPK Pw�•1 i A jmr�o .. __......., ... AUTOSVINEO -� �i9ULE0 6000.Y wJJRYI Pw w:oaW{ i NON-oY EO P n° { NRFD AU106 AUi06 "- - i Massie WIZ X V OCNRRE M { 6,000. X X 2=100 LY6 CLAM OSNR S-MADE M159200 OW22111 0=2r12 AGGREWTE { B.DOD, 10D0DISTATU OFF,CEAAE.�ER © Ty�lo.wWOODENRCOYPMIATCII �y ce MTL OrR- 1.000,A GPRMOkPERCJDYE 1004840W7A OW22MI 09=12 { FA M01 _ 12011074B.206M.78MASS) 00�2Z'11 �12�12 EL dSEAE[.FAdPLOrEE'i 1.00D. u aKw.e•.rcYw tL INfitA6E-POLKY LwR { 1,000, BCRPTION OF OFERATION6 b•la, A Ass Auro 0710748a040-7'e oersv+l 09122J12 LaBlLrnr I.Owim OaerAVexJwlli OPEMTKINlLGCAIgNe YYENcIae IAaKa Acaa Tel,ANlewwl Rwnrn•sa,•ee•,rcmen eaaanar+Al HOLD Et CANCELLATION SALEM SHOULD ANY OF THE ABOVE DSSCROM POLICIES BE CANCELLED SSFORS THE OPIRATTIIN (LATE THEREOF. NOTICE VALL BE DELIVERED IN Salem ACCORDANCE WITH THE POLICY►ROVISKMS, 120 Washington St Wd Floor AUTMFUND WPRraaNrAMnI Sarem,MA 01970 /J/ e 101999.2010ACOROCORPORATION. Allrlghtsrasorve6 ACORD 25(2010103) The ACORD nwra and logo we reglatcred marks of ACORD