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29 HORTON ST - BUILDING INSPECTION t The Commonwcallh of Massachuscits wnof Board of Building Regulations and Standards To nt� Massachusetts State Building Code, 780 CMR. T"edition Building Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a 1 One- or Tiro-Fmntly Dwelling \ This Section For Official Use Only �7l Building Permit Number: Date Applied: Signature: YN�� 9,/ /s/o:;? Building Commissioner/to to of Buildings Date SECTION 1:SITE INFORMATION 1.1 Property 17ss;` �_ 1.2 Assessors Map& Parcel Numbers c 1.1 a Is this an accepted street?yea no Map Number Parcel Number IJ Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use La Area(sq fl) Frontage(R) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal O On site disposal system O Public O Private O Cheek if es0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of 1}etord may, �� Cac��1 1 L1 i ?J 1 �ibLl �JG Name(Print)) Aildressi for Si e: ��S lac-If--1 Signature Telephone SECTION): DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction O Existing Building O Owner-Occupied O 1 Repairs(s) Alteration(s) ❑ Addition ❑ Demolition O Accessory Bldg. O Number of Units_ Other O Specify: Brief Description of Proposed work-: SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: 011ltld Use Only Uem Labor and Matenab I. Building S 1. Building Permit Fee: f Indicate how fee is determined: O Standard City/Town Application Fee 2 Electrical S O Total Project Cost(Item 6)x multiplier x ). Plumbing $ 2. Other Fees: S 4. Mechanical IHVAC) S List: s Mechanical (Fire S Total All Fen: f Su ression Check No. _Check Amount: Cash Amount:_ 6 Total Project Cost: f 0 Paid in Full 13 Outstanding Balance Due: t SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL► License Number Espuati n Da N,poe C L- H IJer List CSL T YVe bee be low) T Dewri non Address U Unrestricted(up to 35,000 Cu. Ft. R Restricted 1&1 Famil Dwell.n Signatur M .,%fasonry Only RC Residemtal Roofin Covering Telephone w5 Residential Window and Siding SF I Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home 1 rov ent for( IC) HIC o p ame or H Re t N Registration Num er _L A rel� z�/ 3 Expiration Da e n Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 2SC(6)) Workers Compensation Insurance affidavit must be cop2pleted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuan of the building permit. Signed Affidavit Attached? Yes.......... No........... O SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES 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. Signature of Owner Date SECTION 7b: OWN ERt OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statemenu d information on the 6reja4rig application are true and accurate, to the best of my knowledge and behalf Min i Signature of ner or Mithoiffed Agent Dat (Signed under the pains and penalties of perjury) 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 W have access to the arbitration program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS, respectively. 2. When substantial work is planned,provide the information below: Total floors 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 halfbaths Type of heating .system Number of decks/porches Tspe of cooling system Enclosed Open 3 "Total Project Square Footage" may he substituted for 'Total Project Cost" Sep 04 09 05:53p PA HOME IMPROVEMENT CONTRACT r PLEASE READ THIS qqqq Sold,Furnished and Installed by: Branch Name: Boston Date: 4I�I Z66 THD At-Home Services,Inc. dtl,4 The Home Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Branch Number.31 Tor Free(800)657-5182; Fax(508)756-8823 federal lD Y 75 2698460;ME Lie#C 02439;RI Cont.Lice 16427 - - CT Lic#565522;MA Homee improvement Contractor Reg..#11266843 lnsWlation Address: Z�_, ,©�t /--�.. city t _ /N S/�_ e zip Parchaeer(s): Work Phone: Home Phone: Call Phone: ly 8zs-m44- [ Tbzozsin 4j t� Home Address: (Ifdifferom from Installation Address) City State Zip E-mall Address(to receive project communications and Home Depot updates): ❑1 DO NOT wish to receive any marketing minds from The Home Depot Project Information. Undersigned("Customer"),the owners of the property kIcated 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("InstaOatiou'l of all materials described on the below and on the referenced Spec Sheet(s),aU of which me moorlwrated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached herein and any Change Orders(collectively, "Contract"): lob#: ataaa.,ur ductc: S sheet(s)d: Proect Amount i 10 ❑Roofing Siding mdaws Insulation f O S 3 Gut[ns/Covers Entry Doors [I � Roofing ElSidirig MWiridows0 Insulation ❑Gulnas/Covers ❑Enoy Doors ❑ $ ❑Roofing Siding Windows insulation ❑Gutters/Cowers ❑Entry Doors❑ Roofing LISiding Windows DInsulation ❑Gutters/Covers ❑EmyDoors ❑ $ Nr.,'b n25%Deposit ofConazct Amoumdue upon mecodou of this mntreet Total Contract Amount S 33ZQ Mates Purchasers may not deposit Role than one-third of the CommitAmouot Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (mic for each Product as defined by an individual Spec Sheet)Rod 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. , included as pan of this Contract, sets forth rite total Payment Summary: The Payment Summary# I Ift Contract amount and payments required fin 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 tetminatop 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 HE OWED TO THE HOME DEPOT FROM T DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT I-IMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorigrn: Customer agrees and understands that this Agreement 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 Agrcemmt 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. S I tamZ p )q CustomeaSigrmture Dare onsullanl's ignemhc Date �9 p X Telephone No. ��3 ' 4 L\ Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (aa apptimbte) 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. NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDC A.No AM PART of THIS CONTRACT 7.15.09 CSC While—Branch File Yellow—Customer Pink—Salm Consultant e CITY OF SALEM � i PUBLIC PROPRERTY � AN DEPARTMENT S1 120W.\illl\G'iONSrItLET • S.Vr\1,NiMiltLIIli1.1'iiJI`i I rj: 178-74 9i95 ♦ 1°ns:97S-740.9846 Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of die State Building Code, 780 CN1R section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # _ is issued with the condition that the debris resulting front 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: 6 .P f��� (name of hauler) _ The debris will be disposed of in (name of fac fly) o fv) (address of facility) signtu a of pea it applicant 1 date debt r.>11 due 1 ' I fBuil Building 4 a`d°fib �{ g✓`d of Budding Regulahofis ea/Gd Standards ' Construction Supervisor License . License:,CS 87400 Birthdate. 1 0124/1 9 64 ExPira dn: 1012412009 Tr# 3861 r s ` Restricilon: -00 . I j JOHN L NUNES 54 SACHEM ST 7_commissioner ' BILLERICA.MA 01821 J Fa'a .val!/e qe✓��rdu'c/urdelta � iwmonu Board of Building Regulations and Standards k.. :? . HOME IMPROVEMENT CONTRACTOR ` 7 Re91Stfidton: 148206 a Tr# 132133 ,�.,. Expiration: 911312009 T'ype: .DBA 1 J.N.CONSTRUCTION i - ?:". - JOHN NUNES ;;1.. _ s a 54 SACHEM ST. - Admns iitrator x 1 BILLERICA,MA 01821 < { q' C. - eN1�l.L1, N DE 9 �iF,SLPrU SNi,Kwr`I" U Faaoc solar Heat Gain Coefficient ' _�yr,13 CwAdoaGutm,da de fnzNia:aPnr . . !0 . 32 1 . @ 0 ' 29 a� Ar)C)MONAL FERFORhiANCE RATINGS EYA LU,,C1CNp7PUDAEXTAA6koepo+aara04TO VisibleTansmittance n¢�awlo„aat,avl,m4 . 0 . 52 Na¢atErai eq,/m.?ad Rtio.esarii mdam 9 a;pka[h Mf1C Recadrti h-dr®rMd,p.hb pedal RarNmrca lint _ . - - nmrp n]as�*ab�kr a ra.d ut 1 ar#ovnrihl a�Ohrs xd�D e12 Sri m.M?L dros na nmrocecd ary Rate _ ad tr adhak d+n R, arr V.,Ic ui arr Ann' j3 rmmn 16 !a aQffi xo&.e m1ta'arm .. . . .... 6n hutiso.�DJa a.a�i vafaa•am o o.or¢a9r+airo o da Mac vn d,*rk Y itra,ah,WfD 17W dd p6dmt tv nb a iad20 Pa N RC an orhrtrha4a Lorin cal+'*M da o br arD1r'.ul�y hrtcru de pnam gecdm Mpc ro rv=Mw da Arv-Rad+�'/M w-=Y d Rua r ea alp Raa T uo aga<lam Qisum or. .. .. (mom del N'j=ft 7aa/m K+ryhd da arla Room rwwmca0 .. '.'Un LL quo LLfLtl foc eNCRCY !!Ui �¢q Lon(i) : 1lo cLn¢cn, No cCn - _ ' C•n[.¢L, .9o..Ln rjnt•a L, lo.Gn a.n- ' - caitgn(u l eNC6or 3rxft: Hotta, Noc[t Ctn Cetl, -3-C Can teal, INO. 6tLn. 00/CLi22 Jf31-/H-ft431. ? i¢j[ad. 9Laa JC ' INO: (ta f-¢c:o 00/YLdc Lo 2.31 xnlH-.R43 DP . 145 { - 4S P<ObAdo: 9L.1 .'Ica cr 40771 . H3 Hoffea 23311I1 .. LipAifob.lhrp¢ab4aQIQG(SUA'n6afa.TalamnmonMwvw.mary�ta9at.. • '. r*00 pme genhiC namDoElat EHEt6Y SUC tan mnxarmm aaim dA ato,V611a'aw+ranaryrstocpac _ - . 1 i, `,.�.- _;..�re �aomrmarrurealdz a�./C�.rwac%uaelta i Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Regcstratlor_ 126893 ' -Expiration: 8/3/2010 __.Ty pe: Supplement Card The Home Depot At-Home Service , RICHARD FALLONE ; - ,; 2690 CUMBERLAND PARKWAY S ��•,,�,,,,,` . A'fT�A.'RffrA GA 30339 a. frga:M` WID CONTRACTING 401 349 M04 08/24/2M9 09:34 #719 P.M4/MB Aug, 20. 2009 3:29PM No. 7809 P. 4 AtZORD CERTRCATE OF LIABILITY INSURANCE w:70/w�mTT aaer�eat -404-993.3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION "4„n usA. inC, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATP HOLDER. THIS CERTIFICATE DOES WT AMCNU, M"O OI{ c:atdaroc.eerc:a:]uratanD}ah.Cam - ALTER THE COVERAGE AFFORDED fly THE POLICIES BELOW. ;34?6 9isd00nt Rd MR, $vita Liao ;?0..tN, m 30305 :-eq. 012) 948-0002 INSURERS AFFORDING COVERAGE NAICS I itNW`O nmP[ah0toadd!aat Its CD 26347 aD At-110ba !...Keay, IRe. w9VAiR8S. 141% AC.r1C.. Ina Co 16533 12650DCumberland P411LA.ay zzz— CMATIONAL NXION P30.7 TNS CO OP PITTS 19448 i Atlanta . CA 10339 0MUNIMANer Rammethus i0s Ce 23841 i wppWABlulfteis area lot ab 2391? COVE GES THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTIff WSURED NAMEOPBOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTAkCkQ i _ ANY REpUIREMENT.TERN OR CONDITION OR ANY CONTRWr OR OTHER DOCUMENT WITH RESPECT TO WHICH"CMTWGITB MAY BE WSUED OR MAY PERTAW,THE IN URANCE AFFORDED BY THE POLICES DESCRMED HMIN 63t®JECTTOALL Tiff TFAM6�EXCLUSIONS AND CONDITN)NB ON BUD" POUC MS.AGMEOATE LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CL4w& /OLKYpwMeA LWR4 A W,MMLUAYUh APR 1787 600-07 03/01/09 01/61/18 fACNOtbIRRgCE 14,004.000 I X CMhMJlUoMOSpp ID 2.LUABY LI CT MITS OF POL3 AIR e $1.040.400 CtA2RNA0o QOOLLR 'OP =11, 01,006.000 MXX. LIl06v ,,,, aNmO [T2CLOO OMAIR! $4,080.904 aEeDAtAem¢w/E ee.000.000 I °� 16Ur7AMN'avOA Pa00VOB•COPPIwADO s4,o00,eee X y011Er LOG B AReMWkeUasn/(Y W 7l30061-08 03/61/09 03/01/20 X AtnAtNO la%= L06m.T 11,000,000 ::=AV= 1 . spimu LEDAVt01 P AY [ 1BRwwM0s eonrPLUAr NW&ANWAUlOe : BXLT INBOBBD xyW w28zdU OANaOB aAAwGO 6 / vuuaa,re�urr eW0OKLT-lAA0Cww 3 uMAuro VIA= 4 A00 / A EINa4OLM ARtIA UABUtY IVI 3757 604.03 03/02/09 03/01/3.0 6 OCOUMS 1.000,000 AVM owum CLAWATS _ 3,606.B00 0®LC'tet2 e i M [' 1 C .vaeutcD,mrNAAnOn AaD 13[[016 cow WOW* D3102120 X ° ANOL°1 VA*a!(1' 35e6111(A02) It,000,000 AM-Pe0tltemRPANng Wes 01/01/O9 03/01/10 ALGCNAOGIOSIIt 1 2 OIRICMMWNa1t[aCLyp®} 154B517 (ZLI 01/01/09 01/01/16 EL -FA O'/2E 92,000,00 —imMaNamm 31 07NN E . GeY-IOUC'llNNf 000.096 - D Nerka CaeryaONAti00 3364711 (2Y. NO. N2. NIX. ) 03/01/01 07/01/30 P B2pl0yara stage" TOBC45SP4422 (TX) 03/01/0! 07f01/10 rteCs/BI.R 73N/7K Cwarke. C°nPDmatlem 42011211MAl1 07/01/O! D)/oi/iO , I- tvpp0P of nu01l®CATMNMIVN00L00/8'6GNMWA00100T01gpIt0Np1fe06pµ PaowpOtM � Bi hi0>OtC[ D► BLB0IWICB :ERTIPICATEH DER CANCELLATION tN0UM0ANY0R ML A2WI W[CMyDOWCeI e[�-"^°' •^0000As 71NBNMATMN ND A2-NOt4 BERVICBS, INC. OA7[tNDt2M,TM NWNB aMVaeI aYAL FeOeAVM,90IWt 10 OAre Ynlnp - MWMe 1DTM 0eA7UCAR NOLDMtw1N00 n/TMA t4A7,M RAe.WI t0 W 104NaLL 190 CVI®BRLANO PAINMY _ PVM NO Ok"flON ON t t OF MOM NNM WON M Meet,Oa ANea74 OR 71T2 300 R!0 MHO. tLkom CA 3033P ANTNW00PaAA6NNraBvO a01A CORD25(2MXm)Ores.+.. hd 13.171100 ®ACORD CORPORATION iBp - F The Corarron��ealt.h of.�'lassacnusetts I?e,anrtmenr cf Industrial Accidents 1 r I � Name (Business/Organization/Individual)_ Address: lei rn1 �/ City/State/Zip:__ T��y,. Phone.# - -�117f7 4061 ` 192— Are yo an employer? Check the appropriate box: Type of project(required):_ - I. I am a employer with__V� 4- ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g_ Demolition workingfor me in an capacity. employees and have workers' y p ry. 9. ❑Building addition [No.workers' comp.insurance comp- insurance.$ required.] 5, ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3,0 1 am a homeowner doing all work officers have exercised their 1 LE] Plumbing repairs or additions right of exemption per MGL myself [No workers' comp. 12.❑ Roof pairs insurance required.] t _ c. 152, §1(4), and we have no . - employees. [No workers' 13. ther comp. insurance required.] .-Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowncrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit new affidavit indicating such. [Contractors thatch cck this box must attached wad ditional sheets howing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp-policy numbci. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �-- - Insurance Company Name: Policy#or Self-ins- Lic. #: �+/��� +C Expiratio%Date: Job Site Address: � � City/State /7 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failureto secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$:1,5.00.00 and/or one-year imprisonment,-as-w€11a 1-��--t"" '^ `u" `^"" ^P" e-t--gg-�prg{'�y ORDPR2nd a fin 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 certi un r e p s-an penalties ofperjury that the information provided above is true and correct. Si ahire: Date: — Phone# t.1 Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: PermitLLicense # Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other P....n- Phone #: