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118 LEACH ST - BUILDING INSPECTION The Commonwealth of Massachusetts /H$ lec Board of Building Regulations and StandardsM Massachusetts State Building Code, 780 CR 101 [ �ised Mar 20 1C , S Building Permit Application To Construct, Repair, Renovate Or Demolish a 4 ""' '$ p One- or Two-Family Dwelling 0 This Section For Official Use Only Building Permit Number: Date pplied. Building Official(Print Name) Signature / Date SECTION 1: SITE INFORMATION 1.1 Property Addre • 1.2 Assessors Map& Parcel Numbers 1.1 a Is this an accepted street?yes—LZ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Districp 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 pply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Dis sal System: Public Private❑ Zone: Outside Flood Zone? Municipal On site disposal system ❑ Check if yes[] SECTION 2: PROPERTY OWNERSHIP' 2.1 k Owtn ter'of R/e/cord:2Q.bonfe, S'clew, , Inc, Name(Print)J City, State,ZIP //s- LeGck 9- Y o2.3f=8/ 114 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction ❑ Existing Building Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify: Brief Description of Proposed Work : eemoold to Ccw lac✓ aar CaGi% o �/��r•-.E J77P-Erl� .LvvncG't_ .�i .4t.+'eroe•o6 asL� _ I SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials l Building $ l6 flip 1. Building Permit Fee: $ Indicate how fee is determined: �. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost' (Item 6)x multiplier x 3. Plumbing $02�60 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $oR,poo ❑Paid in Full ❑Outstanding Balance Due: A0'J,'� 47 L M DAt- e�D M L L 5 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 11//� C //�� //// S-o6o/37 6 jl7bo h y/ 61✓1G yc.AeSy License Number Ex iraf n Da[e Name of CS17 Holder 17 S re/ r5 c, �n. List CSL Type(see below) [/ No.hand Street // Type Description /IZ P�.Gtt 44 t /'r Lc t7( 8'�N U Unrestricted2 Family (Buildings u to 3S 000 cu. ft. t R Restricted 1&2 Famil IIwellin City/Town,State,Z M Masonry RC Roofing Covering WS Window and Siding �1 SF Solid Fuel Burning Appliances �9B'�6Y-f�3Y°/ �Gnovts < l'Nc Coyyteesf.n I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 'I eovtSt 00. fO??� /S 6 W C Company Name or HIC Registrant Name HIC Registration Number E ira ioa pate �7 G'xctf, OR /16 p p .TALC�Cot+tcaa{./lc� No.and Sir et Email address In ��15 97s6�Y $3yy City/Town, State 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 .......... ❑ 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 tto, act on my behalf,in all matters relative to work authorized by this building permit application. Nor t Ownerji Name(Electronic e) 6 ate 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. A-d&o y. 6rc.,v4.((rs� lG 6 Print Owne s or Authorized Agent's Name(Electronic Signature) I Mate 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.gov/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"may be substituted for"Total Project Cost' revised 1/23/14 \ Plte Commonwealth of3da.ssachusem �',,Prim Form.'; _ DepartutentofLtditstrinlAccidetits Office of Itnrestigations •y- 1 Congress Street,Suite 100 Boston,MA 02114-2017 �9. twv,r.mass.gov/rh'n Work-en' Compensation Insm•ance Affidavit:Builders/Contractors/ i"triciam/Plumbers Applicant Information , � /� n Please Print Legibly' Name(&u�mpess/Qp®uooaYo�imraq: /f(? 6, A- el•.Y/C- Address/ � 9419 CitylSmtelzip: Pa l w 0.0 t"q Phone&: 9l0—6b (1 —9'3 V"I A"you tm employer?Check the apprb riate box: 1.©'I am a employer with_� 4. I a a general cornactor and I Ty'W of Protect(rMntred): m employees(faB andtor part-time) have hued the sub-contractors 6. ❑N����' ol+ 20 I am a sole proprietor ar partner- listed m the athcbed sheet 7. EAZ modelxm ship and has%m employees These sub<mhactors have g. ❑Demahbou wmk mg for me m any rapacity_ employees and have wtnkers'[No workers,com 9. ❑Braiding aadditionp. coup.msuranre 1 rearmed) 5. ❑ We are a corporation and in 10.0 Electrical repairs or additions - 3.❑ I am a homeowner doing all work officers have exercised their I1.❑Ph®bmg repairs or addmans myself No workers'comp right of ezmption per Ml fit 12.❑Roof repairs msurame re,p>;red]t c.152,41(4),and we have m emplcyees[No workers' 13.❑Other comp.msmame rearmedl '.ta]apfliclW thin[bI[Ill bw eI fod,t l{IO rill OLLt(�KK40a belOV th00V19t dvm Y'A�RI MplelyaC®fOaLf mlaimvCon t Ho,oweean abe eobw[dti,afrffi,it otdicuioa,bey we doigs At end sad dvm hve emits caneennn cow,coheir a rigs affidauv iedicewy,wh. 1Caamcma,ba chock star bm.a scribed m ddieamal,hmt,hrvma tM name R dw,abcmmcmxe ud,m aranhv m cot phew laud^,hsre a¢pblv,. If du,nb..,have amplo]w,.mey cmt pevida dwu vehm'comp.Pau,mmbm. I am an rnrp(gw dmt it prai�tty,vohars'mttpaovanrm insurance jar sry eanptayret Befow is the policy aerdjob sin urformaaott / / / i..�,,•-•,.r°Company Name: t .elT (/'C,uCa�( -urn rtaei Policy k or self-im.Lie 4 ala-5 3 9'PO a7— 013 Expi atim Date: /S' /S Iob site Address: //8- .Gear-(/ s, CitylStatw7ip: .('G.�eNI A" Artach a copy of the workers'compensation policy dedaaradm page(showing the policy number and etpiration date). Faikne to sense coverage as reg,nred under Sectim 25A ofMGL c. 152 can lead to the inpositim of atamll penalties of a fine up on 51,500.00 andlor one,year as well as mil penalties in the form of a STOP WORK ORDER and a fee of up to$250.00 a day agaimt the violator. Be arhised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for+um•rance coverage ver;Fcal;.m I do ken arm uredw ehr ins m en o deaf dm" armanm provided above it true and correct Sipaature: �j Date 1t7 /tl Phone ii F9rY' 6 9 6J Vy Official urn only. Do not wrim in this area,to be complr¢.d by city or roan official City or Towm PerraivLieenw k Issuing Authority(circle one): 1.Board of Health I Building Department 3.CityJowm Clerk 4,Electrical Inspector S.Phrmbing Inspector 6.Other Contact Person Phone ih Pave 7 of 8 r j� WORKERS COMPENSATION AND EMPLOYERS LIABILITY Liberty Mutual. INSURANCE POLICY INSURANCE f AR INFORMATION PAGE / 176 Berkeley Street Boston,MA 02116 Issued by LM INSURANCE CORPORATION 27243 Policy Number WC5-31S-389087-024 Issuing Office 016C RENEWAL OF: WC5-31S-389087-013 Issue Date 01-14-14 Account Number 1-389087 Sub Account 0000 1. Insured and Mailing Address A G CONSTRUCTION CO INC RISK ID 000180165 17 SHASTA DRIVE NORTH READING,MA 01864 Status 03 — CORPORATION Other workplaces not shown above: SEE ITEM 4. PREMIUM- EXTENSION OF INFORMATION PAGE 2. Policy Period:The policy period is from 01-26-2014 to 01-26-2015 12:01 A.M. standard time at the Insured's mailing address. 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100, 000 each accident Bodily Injury by Disease $ 500, 000 policy limit Bodily Injury by Disease $ 100, 000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE END WC 20 03 06B D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE 4. Premium: The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate per $100 Estimated Annual Classifications Number Estimated Annual Remuneration of Remuneration Premium See Extension of Information Page Minimum Premium $ 500 (MA) Total Estimated Annual Premium $ 2, 148 Premium will be billed ANNUAL Producer 0004-099853 PRESCOTT & SON INSURANCE AGENCY INC 963 EASTERN AVENUE MALDEN MA 02148 WC 00 00 01 A ©1987 National Council on Compensation Insurance,lnc. WC 00 00 01 B (NJ) Ed. 07/01/2011 All Rights Reserved Page 1 of 1 Insured Copy ��ze IPonanwow�ea�z o�Vr� � Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Type: W glstration: 107700plration: 8/5/2016 Private Corporatic AG CONST.CO INC 'i:` Anthony Gravallese - 17 Shasta Drive ' g-�--->® I N. Reading,MA 01864 - Undersecretary CITY OF BOSTON Lic. o B18942 MAYOR LS BOARD OF EXAMINERS sp 7 THOMAS M.MENINO '1'[ t THIS Ep "Y-.. A MY,. A IS YLI E IN ,EMDER -OFT HE D R ND - BOARD OF EXAMINERS t� ALERANDER H.MACLEOD,ALA T F SCOTT DARLING III PATRICK TRACY a P CITY OF SALEK MASSACHUSEM dr j� BUILDING DEPARTMENT 120 WASHINGTON STREET,31D FLOOR TEL. (978)745-9595 KIMBERLEY DRISCOLL FAX(978) 740-9846 MAYOR THomm STTPIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING CONaUSSIONER 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 c40, 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 deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: Zg' /-,Gq-4 - '�70' ev r- (name of hauler) The debris will be disposed of in: �S�G✓ ���4 e�^� �1'dae� (name of facility) (address of facility) Signature Of ar) licant D e -lOP OE --..-- --------- 113 Q Q — I MvB--E P12T3 w2yZ9j� DOOR KI'� aDW F9L NICRo w�-T � NnN6�NG xR VO�D SPAGk Iq 04 W a�20- 2,1 O y8 P oMal G r5 i_ — — © 3b" REF TIL(�93 o ii BFR.L 0334 6Y� Dw ® 90 PA�ELI d L 31 CEILING \97 %z - - - — —I HAND AT 3�, FRnM FINISHED FLoog- yid Bscz9 � Gr � Cc I i &ID15 oePW I � _ I 30 RANGE \`2 3(0 `IOOC 2 OD` P .— �oti'L 25�a i I s\ o I . d0nfe Jec.c.� S+ J FLOA-ck W& 5HEL\[E-S Q:'/ pi-:1 / /✓t4 , �6. LL DIMENSIONS AND IZE DESIGNATIONS DESIGN PLANS ARE PROVIDED FOR THE FAIR DESIGNED FOR IZ IVEN ARE SUBJECT TO USE BY THE CLIENT OR HIS AGENT IN LAP�OPJTc k_::'1C I' ERIFICATION 01 JOB COMPLETING THE PROJECT AS LISTED WITHIN --- THIS CONTRACT. DESIGN PLANS REMAIN THE TE AND ADJUSTMENT TO N PROPERTY OF THIS FIRM AND CAN NOT BE Fl`-W'0 EGr S& FL_ T JOB CONDITIONS. National Kitchen & Bath Association USED OR REUSED WITHOUT PERMISSION. �Sk �joo� V � i poompammom N 4. t t i tit lo'a�" Kip►" p �>j RM 1 f p t f a Kl( I G 1 } lJ Sale r^, lac.. r NYrrn•.n+r�•un. . �yAn.N-•ISM-..i1.wrNr , 1 1 x , up furl �aSiN^c"A ka-7kj �,bor\4c //8' jecrk S4 - . ti TOP DE --- -------- 113 �5%11-- -- 3��4�� � cEIL W2fi39 W2y291/, I DOOR oowF 9L N1Uzo 0%1-� nN 61NG KIT x0. VOID O SPA Lk 1 ly WDG 20- 2y I �$ I PFUM31 N6_ — © 3b" REF TILf-iy3 O = q I �e6 W3039 � \� 1S BFp3Jt �4n 3 D W L/ 0 PANELI a L cE1�1N� r1r= ° tlz„ — HANG C1t61NE'TR.y ^T �?," 3(0 � FRn rn FIN ISHEC FI-00� el'- yiJ 65C-L9 I C,f � Cc � 1 �— GID15 '— oBPW 1 65�z I I 13 I —'_ II 30 RMJCoE o7 / I ; 6192\ Si , �2 3(a NOOG 2001 P 25�a I I i5 7 5 No l/� ,✓,ecc� 5+ J FLOATIN(, SHE��E.`✓ 2y o� ,;t_F.-;; �G,(e r�l /✓la , LL DIMENSIONS AND =Kitchen DESIGN PLANS ARE PROVIDED FOR THE FAIR DESIGNED FOR IZE DESIGNATIONS ® — IVEN ARE SUBJ EC 70USE BY THE CLIENT OR HIS AGENT IN LAP JT ERIFICATION ON JOBCOMPLETING THE PROJECT AS LISTED WITHIN THIS CONTRACT. DESIGN PLANS REMAIN THE 3;:�'D TE AND ADJUSTMENT TOPROPERTY OF THIS FIRM AND CAN NOT BE FI`:a\SN T JOB CONDITIONS. h Association USED OR REUSED WITHOUT PERMISSION. �, o 759.6002 1-!k�_C VJA k'_ f '•, I PIJ R� . � 1 i►� ►+� � v'�t / 1 I cur. f � / VIA w lo-�r O I plwj R� .1 e c ! � ti I �•� a , e v , ,. 1 i I 9- 5 rig �-P�•�� ;E, Jalc" I �w�raf� c l I �a up �.:�� Yy { �i'y � I • I 'I � III ti � ;i ✓. •. /i8' Jeu.rk s{ - Sal t rA l^✓� V