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4 LILLIAN RD - BUILDING INSPECTION (2) cK s � ZA Ta- I _[ ED The Commonwealth of Massachusy(�PECT0A Board of Building Regulations and Stah'dards CITY OF I Massachusetts State Buildin Code, 780 CNI 4uSALEM dr g 111�4 JUL 22 A RevLked.Nnr?OI L Building Permit Application To Construct, Repair, Reno ate Or Demolish a Otte-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date.AppVed: Building Official(Print Name). - Signulure• _ Date SECTION 1:SITE INFORMATION 1.1 Property Add_ryss: 1 i 1.2 Assessors blip& Parcel Numbers UU{{ l ��f j�t~1 �� I.1 a Is this an accepted street?yes_ no hlap Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sy R) Frontage(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Witter Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public El Private❑ Check if es❑ Municipal CI On site Disposal system ❑ SECTION2: PROPERTY OWNERSHIP' 2.1 Ownc t of cco /1 &h shale(Print) 4T n{/fit City,state,21 Na.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work'-: SECTION a: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official se Only Labor and Materials) I. Building $ ea 1,2_ 1. Building Permit Fee:S / Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical .S ❑Total Project Cost'(Item 6)x multiplier x J. Plumbing S 7. Other Fees: S 4. Mechanical (FIVAC) S List: 5. Mechanical (Fire S Su cession) "Coal All Fees:S Check No. Check Amount: Cash Amount:_ G. Total Project Cost: S ❑ Paid in Full ❑Outstanding Balance Due: Sa-IT- M GPpvCa. CA3tiJ100WS '1 ''Z1 •SECTION 5: CONSTRUCTION SERVICES 5.1 Construct' Supervisor License(CSL), .0y)� ,�� License Number Espir•• ion e Name of((,,' 11uIJ /a ( /�� List CSL'fype(see below) Type , . Description No. anJ Street g.�- 1�r'' �y�-�,-•� U Unrestricted(Buildings u to 35,000 cu. If.) rit IVI��_,.., tlx ��//�C./ R Restricted l&2 Family Dwelling CilylCown,State,L ibl Masonry RC Roo ring Covering WS Window and Siding � Solid Fuel Burning Appliances I J Insulation reliphone ` Email address D Demolition 5.2 Registered Home proveme t Coritractor(HIC) HIC Rcg sfhatiJ Gspir ion Uule HIC tp e o F C R< ' Name - No.and. t, el Email address Cit /Town, State,ZIP Telephone T 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 at'tidavit will result in the denial of the IsSua of the building permit. Signed Affidavit Attached? Yes .......... d 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 t4 act on my behalf, in all matters relative to work authorized by this building permapplication. Print Owner's Nvue(Electronic Signature) ate SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION- By ell cri o y name elow,l hereby attest under the pains and penalties of perjury that all of the information contain it hi n heat o is true and accurate to the best of my knowledge and understanding. Print( vn ts or Authorized Agent's Name(Electronic Signature) - Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires ,fit unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program),will not have access to the arbitration program or guaranty Fund under NLG.L.c. 1 d2A.Other important information on the HIC Program can be found at www.mass.eI'l oca Information on the Construction Supervisor License can be found at www.nrass.rzov'dns 2. When substantial work is planned,provide the information below: 'rota) floor area(sq. R.) (including garage, finished basement/attics,decks or porch) Gross living area(sq. 11.) Habitable room count Number of tireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of healing system Number of decks/porches Type of cooling system Enclosed Open 3. ,rota) Project Square Footage"may be substituted for"'total Project Cost" 1 11 t n�a� �fZsi4�te�ts�t3 uii'2_ - .�as3an,1�4 ©y�11 �S"D3]fPT3' cGID CIlu i'l;tn j➢� IU'pt ce_ffid Y3 : BAl�d 1'3i'I Tlir:d^.tuY°�1 i iisit� iIli��ei I f c 3�E TitiYPvi�i' ianaa]3'P8i3��3L�Di3n33-17G]3 e.s...s_ � '" - - !~ladle(}Susmess/Organaationlladvidial): Address: City/State/tip ne#: 7 Are it employer?Checkt ap ropriate boa: Type ofpro]ce (raq➢sirxd): 4. ❑ I am a general cbnti actor and I 5 Nw✓conqtraction 1. I am a employer with_ have hired the sub-contactors employees(full and/or part-ftme).# - Remodeling 7. listed on the attached sheet ❑ 2.❑ I am a.sole.proprietoi or partner- These sub contactors have g. ❑Demolition ship and have no.employees employees tindhave workers' 0..❑Building addition working for me in any capacity. comp.hsmimce=. [No workers'comp.insurance 5 ❑ We are a corporation and its 1�•❑Electrical repairs or add t ons required.] offices have eiercised then 11.❑Plumbing repairs o-additions 3.❑ I am a homeowner doing'all work right of exemption Per MGL myself [No workers' comp. P>h P P 12.❑Roo airs c. 152,§1(4)�,and we have no 13.[ Ober_C��. insurance required.]t employees. [No workers' - - comp.insurance required.] *Any applicant that checks box#1 must alsom oath a section� ell wmk and then hive ovisido showing their workers' coa mct rs must st suhm�now ai5dn rit indicating such.. . t Homeowners who submit this affidatat indicating ey g, he_. . tConfrattat3 that GLecL this box must attached an additionalosb eovide tabektivaikerse comp,pof the olicy trey asmitier�d state whelliei or not those enfifiec have employees. if the sub-contractors Lave employees,they P I am an eJ®➢pdoyer that is providing workers'conpensatloa insurance far my emprloyees: �elo➢v is the policy and job si8e lafOPllfatiOJG- • •./ Insurance Company Name: _ Expiration Date.: Policy#or Self-his.Lic.#: �q n J i ➢ I _. K City/State/Zip: Job Site Address: the ollc rim®bar and egpiratao®dais). Attach a copy Of tl➢e worlrers'coaapeossatioa policy declaration page(can leading p Y Failure to secure coverage as required under Section 25A of MGL c. l52 can lead to the imposition of criminal penalties a a fine up to secure$1,50 co and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to R250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification.. n er the mist rzrodpeeq�lEie6'e!lperju ythot the inforeeedfiors,pvovided abom is t�Pr a ea corec,t I do here6 :eerW"n p Si :a e. Date: — --- � , Phone#: * . 7issmingAuthornity Do not write in this area,to be coWkied by city or town d0ciaL Per➢nitflicerisey(circle one):th 2.Budding Department 3.City/Torm Clerk d.Electrical Inspector 5.1 immi➢oaag Irispectnr � CITY OF S U EM. UNSSACHUSETTS d BI:IL NG DEPARTNaNT 120 WASHIINGTON STREET, 3" FLOOR T EL (978) 745-9595 Fmx.(978) 740-9846 KI\tBERLEY DRISCOLL AWOR T 14o.%us ST.PtERRB DIRECTOR OF PUBLIC PROPERTY/BUILDNG CONNISSIONER. 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 MOL c 40, 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 disposal facility as defined by MGL c I It, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in : (name of facility) (ad ress of facility) JA 4AM 's na re o'permit applicant date Jcbrc:alf Jew Next Step Living, Inc. CT HIC.0629266•MAOCABR#162111•RI Contractor Reg.437185 HOME IMPROVEMENT Date of Contract: Wednesday,May 07,2014 Customer(s)Name(s):'Donald Tondreault Customer(s)Street Adress: 4 Lillian Rd City: SALEM State: MA Zip: 01970 Customer(s)Home Phone N: (978)744-9390 Customer(s)Mobile Phone#: Penal Required: Permft Number(s): City/County Issuing Permit(s): Scheduled Inspection Date: Customer(s)jointly and severally agrees to purchase the products and/or services of Next Step Living,Inc.("Contractor")in accordance with the terms and conditions described on the front and reverse of this Home Improvement Agreement("Agreement')and the attached specification sheet(s). Customer(s)hereby agrees to sign a completion certificate utter Contractor has completed all work under this Agreement. ESTIMATED STARTING DATE: Wednesday,May 21,2014 ESTIMATED COMPLETION DATE: Wednesday,June 04, 2014 PAYMENT METHOD: (select one option) PURCHASE PRICE: $ 2,818 HCash RX Credit Card DOWN PAYMENT: $ 319 Check Financing BALANCE DUE ON SUBSTANTIAL COMLETION: $ 2,55�50000/ Customer(s)acknowledges receipt of"Renovate Right:Important Lead Hazard information for Families,Child Care Providers and Schools". 4, Customer(s)received this pamphlet on the date of this Agreement,before commencement of work. ',(Customer's Initial)', bbL (Rhode Leland Customers Only)Customer(s)acknowledges receipt of required Contractors'Registration and Licensing Board consumer education materials. Customer s Initials') , (Rhode Island Customers Only)Notice to buyer:(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign it.(3)You may at any time pay off the full unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goads purchased under this Agreement.(5)You may cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an explanation of buyer's rights. Customer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of this Agreement.Customer(s)acknowledges that Customer(s)(1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two accompanying Notices of Cancellation,on the date first written above and(2)was orally informed of Customer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPAC S. NEXT STEP LIVING, INC. By: Irving Lizardo r —7 5/7/2014 Print Name Lic.It Signature Date CUSTOMER(S) J� Donald Tondreault r7 _ '� bp14 Print Name Signature C" DateF Print Name Signature Date 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 ACCOMPANYING NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ©BLLP2013.NSL.CTMARI �f Pub I ir, *Roarc, , Busimno Regulilinni; ('on%tructjon SupvrN iw r Avlaft., 4frnnse. CS-092929 RONALD G CRAI*6 PO BOX 292 HUNTINGTC 0712=015 Y Office of Comumer Affairs& Basitt"s Regulation ME IMPROVEM ENT CONTRACTOR Type: ' .ikegjstratlon: 161323 *Xpiration: 101142014 CSA CRAIdWINDOWS RONALD CRAJIG S PARK RIDGE DR. HUNTINCTON, MA 01050 Undersecretary