29 LEACH ST - BUILDING INSPECTION (2) � 35
The Commonwealth of NIassachusetts
Board oi'Building Regulations and Standards CITY OF
Ui Massachusetts State Building Code, 780 CMR SALEM
Nenised rldnr 20/1
'Building Permit Application To Construct,Repair, Renovate 0r Demolish a
One-or Tiro-Frimily Duelling
This Section For Official Use Only
(\ Building Permit Number: Date Appii _
Building Official(Print Name) Sigmdure Date
C SECTION ]:SITE INFORNIATION
1.1\\Property Address: L .,t r, 1.2 Assessors A'lap &Parcel Numbers
^ 1.1 a Is this an accepted street?yes 130_ hlap Number Parcel Numbcr
1.3 Zoning information: 1.4/Property Dimensions:
I-- Zoning District Proposed Use Lot Area(sq 11) Frontage(ti)
1.5 Building Setbacks(ft)
Front Yard Side Yards RcarYwd
Required Provided Required Provided ' Required Provided
1.6\1':tter Supply:(M.G.L e.40,§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood%one?Checkifyes0 Municipal O On site disposal system ❑
SECTION 2: PROPERTYOVVNERSHIP`
2.1 Ownert of Record: \\ [[ A- A —1
Name( t) City,State,'L
No.and Street Telephone Email Address
SECTION 3:DESCRI PT N OF PROPOSED\rORK'(check all that apply)
New Construction❑ Existing Building V I Owner-Occupied Repairs(s) ❑ I Alteration(s) ❑ LAddition ❑
Demolition ❑ Accessory Bldg.❑ NumberofUnhs I Other ❑ Specify:
Brief Description of Proposed\\rork2: \1
ct'�
S't-c� �r� loCwE`w. � ro s)`r•.tX —rr.\ t,�.k^�
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: '
(Labor and&Iaterials) Official Use Only
I.Building I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6).x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire !
Suppression) $ Total All Fees:$
\�r Check No. Check Amount Cash Amount:_
6.Total Project Cost: $ 7 ❑Paid in Full ❑Outstanding Balance Due:
I
cD C, C
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 057 (--
Koine CSL
MaL �0(l18; License Number J Expiration Date
older
IS NewilA k List CSl"Type(see below)
No.and Street I Type Description
O /) U Umcstricted(Buildingsu to 35,000 cu.R.).
V R Restricted l&2 Famil Dwelling
Citylrown,State,ZIP
M Masonry
RC Roofing Covering
WS Window and Siding
S U C� SF Solid Fuel Burning Appliances
J 1 Insulation
Telephone Email address D I Demolition (7l
5.2 Registered Home Or.)
Contractor(HIC)
I)a C16%('l 31fW/7
HIC!mNanicoili[Clieg trantNamedWCC I��10RegistrationtiU HIC Nurn Expiration Date
No.�gnd Street b - 1�1�,1, Dig Email address
31 /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„APPPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize IYI�.(�( (Vi lI)1
to act on my behalf,in all matters relative to work authorized by this building permit application.
G3-c � MIN,k\&--,Z
Print Owne Name(Electronic Signature)
SECTION 7b:OWNER_'OR ORIZED AGENT DECLARATION
By entering my name below,I hereby a t on er pa'is and penalties of perjury that all of the information
contained in this application is true and a cu a to a st of my knowledge and understanding.
Print Owncr's or Authorized Agcm's Name(EI i Signanuc 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 HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass."ov/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/altics,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"
about:blallk
National Headquarters Sue Maitland
2501 Seaport Drive,Chester,PA 19013 32-20211
e98-7366335 October 19,2016
•/ WWW.POWERHRG.COM
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT MA HIGH 166e16
euyege)'InrormaVon and Description of the Property: Project Number:32.20211 October 19,2016
Sue Maitland o°vdApfpp1K"`
29 Leach st (617)OW2753(Greg's Celt)
Salem,MA,01970
County:Essex j
Township:
Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services of Power Home Remodeling Group
and its vendors("Contractor")in accordance with the prices and terms described in this 5 page document and the Product
Specifications,which are incorporated as part of the Agreement(collectively,this'Agreement"). This Agreement represents a cash
sale of goods and services. Buyer(s)agrees to pay the cost of the goods and services purchased as described herein,regardless of
timingor approval of a financing Bu er s l PP M rig y ( )rosy seek for their purchase.
Purchase Price: $4,858.00 Pre Installation Inspection Dates:
Down Payment: $0.00 Wad hats Ootseen 10:3oa ero 11aoa 1
Balance Due on 84,858.00 Estimated Project Start:S to 7 weeks ,
Substantial Completion: Estimated Project Completion:)to 2 days
Method of Payment: Other ilarene)ecxmw,ea3e trmtemrmae ebsans waroleson ants we No7wtlw essence. De"becm e
Contractors control W M0406 M alwlaa,g time kmnna.see DelerfllnN,onn rawitlons.
Buyer(s)hereby acknowledges receipt of a copy of the pamphlet,"The Lead-Safe Certified Guide to Renovate Right",Informing
Buyer(s)of the potential risk of lead hazard exposure from renovation actk*to be performed In or at Buyer(s)'Property,at the
addrestj written above.Buyer(s)received this pamphlet on the date of this Agreement,before commencement of work. '
_Buyer(s)'Initials.
This Agreement constitutes the entire agreement and understanding between the pates,and this Agreement replaces any and all
prior negotiations,representations,or agreements,either written or oral. No amendmerd,modification or water of this Agreement
shall be valid or effective unless in writing and signed by both parties. Buyer(s)hereby atiolowledges that Buyer(s)1)has read the ]
entire Agreement and has received a completed,signed,and dated copy of this Agreement,including the two accompanying Notice
of Cancellation forms,on the date first written above and 2)was orally informed of histher right to cancel this transaction.
Buyers)also agrees and understands that 0 Buyer(s)finances the work with a third-party,the terms of that financing will be `
contained on separate documents,inducting any finance charge.
Future promotions not applicable. ,
t
t
DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. I
I have toad and received each page of this 5 page agreement,
Power ome Remodeling Group may]/Buyer(r(s)
18116 /u`�`it 10/19/16
Signature of Remodeling Consultant Signature j
Derek Merchant Sue Maitland f
I
YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY I
AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF 1
TXIS RIGHT.
October 19,201612:14 ( ��
Page 1 of 5
1 of 1 10/26/2016 6:20 PM
National Headquarters Sue Maitland
2501 Seaport Drive,Chester,PA 19013 32-20211
888-736.6335 October 19,2016
WWW.POWERHRG.COM
MA HICK 168616
PRODUCT SPECIFICATIONS
Buyer(s)'Information and Description of the Property: Project Number: 32-20211 October 19,2016
Sue Maitland Date o/Agreement
(617)686-2753(Greg's Cell)
29 Leach st
Salem,MA,01970
County:Essex
Township:
Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services listed on the accompanying specification
sheets, in accordance with the prices and terms described in the Custom Remodeling and Improvement and the Product Specifications
(collectively,this"Agreement").
Pre Installation Inspection Date:Your pre installation inspection is tentatively scheduled for Wed 10/26 between 10:30a and 11:30a.
Windows-SL 2700 Inclusions: Includes metal reinforced meeting rails and nighttime safety locks on double hung windows only,welded
corners,foam injected frames,Sashlite technology, Heatshield, Duraglass, exterior custom capping,installation,clean up and haul away of
all job related debris.
It is agreed and understood by and between the parties that the Product Specifications,along with the Custom Remodeling and
Improvement Agreement,constitutes the entire understanding between the parties, and replace any and all prior negotiations,
representations,or agreements,either written or oral. The Product Specifications may not be changed, modified,or varied in any way unless
such changes are in writing and signed by both Buyer(s)and Contractor. Buyers)hereby acknowledge that Buyers)has read the Product
Specifications.
I have read and received each page of this 2 page agreement.
Power Home Remodeling Group Buyer(s)
/10/19/16 /10/19/16
Signature of Remodeling Consultant Signature
Derek Marchant Sue Maitland
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 ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF
THIS RIGHT.
October 19, 2016 12:14 IIIIIII I II I II II I IIII II II I II I I III
Page 1 of 2
National Headquarters Sue Maitland
2501 Seaport Drive,Chester,PA 19013 32-20211
888-736.6335 October 19,2016
WWW.POWERHRG.COM
MA HIC#168616
Project Specifications
Windows: Bathroom 1 33.5"x44.0"
WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None D
OPTIONS: Color White/While: Grid Pattern: None I Removal Wood I Additional Details None
Windows: Kitchen 1 33.5"k60.0"
WINDOWS: Models SL 2700 Styles Double Hung Types None Confgs None 19
OPTIONS: Color White/White: Grid Pattern: None I Removal Wood I Additional Details None
Windows: Dining room 1 25.5"x(30.0"
WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None M,1
OPTIONS: Color White/White: Grid Pattern: None I Removal Wood I Additional Details None
I
Windows: Dining room 1 35.5"x60.0"
WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None d
OPTIONS: Color White/White: Grid Pattern: None I Removal Wood I Additional Details None
Windows: Dining room 1 25.5`40.0"
WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None 49
OPTIONS: Color White/White: Grid Pattern: None I Removal Wood I Additional Details None
Windows: Kitchen 1 33.5"x60.0"
WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None 15
OPTIONS: Color White/White: Grid Pattern: None I Removal Wood I Additional Details None
October 19, 2016 12:14 IIIIIII II IIIIIIIIIIIII IIIIIIIIII III III III
Page 2 of 2
7 7,
'Pe: cq 1,4 Q
U
_/tA
-Tia
Tc-r BE FILLY) V%"-i 14 TIlF'Lkht7--Tl-rG
A
Mdlress:29101- Seaport [Drive
Chester ter PA 1913 Phone 0:508-280-0156
Are sort on employer?Check the appropriate butt: Type of project(required):
15 employees trail=&or part-time) New construction
I 1 27 1-a,,a employer with
1 an,,sole rnorfxtol 05 PaTmership and btVC M tmplcyec Working for Me in 8. Q Remodeling
u,,,aace required,J
g.lei [No ,,,p-iTIEUTarge TkqdfiTE&3 Cl Deraoliticri
y-
all wckm 10[]Building addition
4,ED]a,, ll Pro
Perry I will ' 11,0 Electrical TCPRiTS CT lt&WOTIS
Ire SOK
um"ceorare
WCPr,(vor w1r.To empoyets 12.0 Piumbing TCPSiTS OT additions
&,,no Sleet I I-
87,a gencia,CCOUcio7 and I have b"O the 1.szec or,the ava �.[]R(yuf repairs
These sub-commucirs hb,e employees and have workers'comp.insurance' 14.E]Otber_
6ED v,a are a corporation and Its Officers haw a exercised their right Of exemption Per MG1 c
if-2,§1(4),and we have no employees.[No workers'comp.insurance requiroij
-Any a?pi.icautthat checks box 91 must also rill out the section below showing their workers'compensation Policy athronalion.
Homeowners who submit this affidavit indicating they are doing all work and then hire Outside con,,,,on must submit a new affidavit indicating such.
,h
hCottrantrairs that check this box must attached anaddidnotiad shoat showing the name of the orb-Contractors and state % ether or not those entities have
employ,,s. If the sub-contractor-have employees,they must provide their workers*comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. Harleysville Worcester insurance Company
Insurance Company Name:
1: Zo I L vo Expiratian Date:1D1112017
Policy#or Self-ins.Lit;. City .[Lip: � JAA
Job Site Address, -IL� fstate
Attach a copy of the workers'compensation policy declaration page(SUDWIng the policy number and expiration(late).
Failure to secure coverage as required under MGL D. 152,§25A is a criminal violation punishable by a fine up to$I,50D.00
and/or one-year i men well as civil penalties in the form of a STOP WORK ORDER end a fine of up to$250.00 a
day against th iolatDr A py o this statement may be forwarded to the Office of InVeStigations of the DIA for insurance,
coverage ve fication. information provided above Is true and correct.
Ido hereby c i U er nsamdpenaWlticaso perjury that the inform
Sin re: A W-- Date-
Phnned-508-290-01 56
official use only. Do not write in this area,to be completed by city or town official.
IjPerrniUlhense#
Citv,or Town:
Electrical
Jo
Issuing Authority(circle one): Inspector 5.P71umbuiglulpeltOr
I ii one):
Departm r
1.Board of Health 2�.. Building Department 3.Cityrrown Clerk 4.Electrical inspector 5.Plumbing inspector
5.
0 Oth1,
er
Phone 9:�
Contact Person:
I
g17
rs.& 6usinw Rrqulafiun. License or registration valid for individul use only
CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Re ulationType S10 Par Plaza-Suite 5170
Supplement JaN go oo,yl 116
POWER.HOME REMODELING GROUP L-C.
MARK MORDINI
2501 SEAPORT DRIVE STE B110
CHIi$TER,PA 19013 Unaen<cremry t valid without signature
s Massachusetts Department of Public Safety
� +I Board of Building Regulations and Standards
License: CS-057645
Construction Supervisor
MARK E MORDINC�
18 NEWELL OR
N ATTLEBORO MA 02y760„ 6
Expiration:
Commissioner 09118=17
I'FR"i4
SL2700 DOUBLE HUNG`NINDOVI
VINYL FRA?i DOUBLE GLAZED
;: '- FOAM FILL GRIDS LOW E/ARGON
p�t� _ S=+'^�R 100 07.2`I:S�'8 00465344/0,01
ENERGY PERFORMANCE RATINGS
F� ,
t:1 ,dytt-f�#+ a�., Vi3.45
7 r eFu
ADDITIONAL PERFORMANCE RATINGS
e
-
4
ltzy,�n rf aeilru v n, t ��•{,Y
��s f r9ftTk rzt,�ru naa»atd trtci Sltw�are� ]u.rbfrr 1lun�,. t ��
{{ IhR/ld't(
Ir .73:sr* +f-.ka ,'QNF`'� Cage '�rfi 1(•2� Fr ,k `tt�' 3
!�^�� x4 k§� $•Sx4'+SrSR ✓Am'rYA C nr � � q-{-�tJ.9}C 1 X.1 MR,
x tYeDvrsat axb�'�'ui�fivn. '+ �fiIA`f� f �` �
���"'"�s rislx'trli''?t*'WfabrhxRan� �'` � wrf,>;t St-pY4G,CU mLol t:
f :�`escst• .8::� t .t3" _ d5 f- 'v S-4. v �.--`!"-f.� t
4*.07t<.x ) bra('ril t5rl r �+rtiwk�-A"iL?JO¢ 4 (�j. i,7 1 <£�tt:OtNa rcrtf» a sw2- ryza P.n5<.iickrti Tt zufx ' �j i,:-.
5t-�'ReCrnNo;3htr &snarl[s` Jrl unl'il v r �S'Yi✓i+ F+YS?a s ±,�4 9L�{�ti^'t '
` '+�. Cnbt'gPst <+:uaA:-oJ i' eeirs' S♦<27C4 s'-neeD 7li