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12 LINDEN ST - BUILDING INSPECTION (2) --- I'hc Cbmnlumrc;dlh of Nlassarhusclts 1: l� Board of Building Regulations and Standards CI'I'1'OF tl ;, �.Iassachuselts State Building Cude,'7SO CNIR SALEMI 'L:., /le ri.,ci/.I/u•_'ill/ Building Permit Application To Construct. Repair. Renovate Or Demolish a (bls•-ur Trvn•Plunils' Un d/lin,M This Section Fur Official Usc Only Building Permit Number. Date Applied: _ lhulding OBlcial(Print Marc) Signalurc Date SECTION I:SITE INFORMATION 1.1 Property Address 1.2 Assessors.lap dt Parcel Ambers 12 LiZen St. I.la Is this an acce led street?yes no Mall Numher Parcel Nunther 1.3 Zoning Information: 1.4 Property Dimensions: Luniny District I'ropoxJ llsu Lai Area(sy 11) Frontage(11) 1.5 Building Setbacks(it) Front Yard Side Yams Rear Yard Rquired Provided Required Provided Reyuirad Provided 1.6 Water Supply:(M.G.I.e.40.§34) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: INrblle O Privale❑ Zone: _ Outside Flood Zona?Check if)cs❑ Municipal On site disposals)stem ❑ SECTION2: PROPERTY OWNERSHIP' I.1 Owners of Recyrd- t` ... 14T( her r��m ,MA 01976 N;une 1 Print) City.State.Z P l2 Lrr,den & (91 771-b p3 Nu.and Slreel retephone Finail Address SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ E.risting Building❑ Osvner-Occupied O Repairs(s) Alterotlon(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specily: Brief Description of Proposed Work': C SECTION 4: ESTIMATED CONSTRUCTION C05TS ltein Estintaled Costs: (Labor and.Materials) Ofilclul Use Only I. Building S 1 63 I. Building Permit Fee: S Indicate how tee is determined: '. Occirical S ❑Standard CityrTussn Application Fee ❑Tuml Project Cost'(hem 6).v multiplier 1. I'lunihing S '. Other Fees: S- J. \l"Ilallic.d ill\ \(•I S Lisl:-_ 5 \lMmo atl it ne eu+,ressionl 6 rota .\II Fccs: S — o Dotal Project Cost: S �/ G22 i ('he" No. _ C11"I.A nounl: _ C.teh \m,nml: i/✓ ❑ P.tid in F-ull ❑Oulslanding llakulcc Due: „ SEX"PION S: ('ONS I'RUCTION SF'RVI('F..0 5.1 C•onstrucIion Su pen isor License(('St.) z / ff I iee11 Numhcr Pspirelia I Da e \'ant¢o t'.\I. 11,flAr I ist('St. I')IV I"ec hclm�l 11pe Description No. and Street (I t hveslricleJ I Iloddin s oli it) 15•000 cu. It.I r� f�it 21 �_____,. . . R Reslrivied ldl•2 Fdmil Mlellin CIS, .11n.Staletale.Lt11 \I Shlsou RC Roidin 01 Grin µ'S Window and Sidin SF Solid Fuel Iluming AppRam- 10 Insulation 1'cic hone F Entail address D Demolition 5.2 Registered Home Improvement Contractor 0110 j LOW e, F� �rvi n/o v 2»?in� I I I C Itegutratiun Numher FNpirulton Will I IIC Compan) Ni lie 1IIC Il.p'strut t�q ( b TJN04 N? Ica Nov _ 17'3Sy-0 46 'm•'lud ass 01 CitylTown.State P T.le hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. I52.§ 2SC(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...........0 SECTION Tat OWNS AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property.hereby authorize R(c,%N*-rA hos\o h C. to act on my behalf,in all matters reipt�to work authorized by this building permit application. jPo,r � p1104.ar �'Cud7 �� oa� �7 Print U,wtcr's Nmne(Elecwn(c Signature) 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 a acc to (t best of my knowledge and understanding. �iclnarc�C.�.a�ent 1 � crt 5 D ,: Print owncr'i or.%uthorircd Agenl'i NuIIw IHd ii0itinalure) D to NOTES: 70%�iicrr who obtains a building permit to do his.her own work,ur an owner who hires an unregistered cuntractur tered in the Hume Improvement CuntracturIHIC) Program).will nu have access to the arbitration ur guaranty fund underM G.L.c. la_'A.Other impunant information on the HIC Program can be Ilsund at . n ",A Information on the Construction Superisor License can be found at,towstantial twrk is planned,preside the inlurmatiun below: a 1 sy. ILI . _--_.._I including garage. finished basement attics.decks or perdu Groii lining area I sy. it.I _ Habitable roust count \unlhcrol'lird+laces .. —.— \umher kit'hedrovou \other of halhnwuni \umber of hail'hathi I\pc of hc.umg iy slcut \umhcr ol'dccks porches j I' pe l'amlinyiyacln I!nclaicd Open 1. "II,d 1'rtljeU 1tIII;ItY Fool,igc,❑1;11 I+c stiles uwd liar"fowl 'nojcd Cost” CONDOIVIINIUIVi PERMISSION FORM OYt'�UII,DING PERMIT We> 11�n�ff. �ultk'' l 5N`Qmt+�Nwrn w51 of, 4r5004 ©i4Lv ` Name of condo anociation or tnanagement company address " being the duly authorized'representatives of. � (�LAai l c)uO6fAIMtv;n �u s 1 Name of condo association have reviewed the plans and specifications for improvements to., 12 LiNnE � swi, a ©HIO Address and number of condo unit owned by �tav� ,i�ntc6itfi Name of condo owners The condo association or management company agree that the w above oners have perrnissionto seek permits and;to carry:out the proposed work. Signature of c9fiAb association repfesentative and title. N �� e use Print Name (In lieu of this,form, a letter, statmg,the same purpose as above; on'the condominium or . managementcompany stationary,may be submitted) The Commonwealth of Massaehusetty Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrici'ans/Plumbers Applicant Information Please Print Legibly Name (Business/organisation/In(liviclusl): Lze /t(eenf �v��{-G 114�•I OrI `o ��(, �ioh A�d (jf 'erye Address: 16 5 Bow 5+"R+ City/State/Zip: Ev'ere +t l MA 02149 Phone#: b17- 592—t(3o9 ��Are///you an employer?Check the appropriate box: Type of project(required): Imo, I am an employer with _ _ 4. 1 am a general contractor and 1 6. 1 New construction /_employees(full and/or part time).* have hired the sub-contractors 2. 1 1 am a sole proprietor or partner- listed on the attached sheet. 7 1 Remodeling ship and have no employees These sub-contractors have 8. 1 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. * 9. 1 Building addition required] 5. ! We are a corporation and its 10. 1 Electrical repairs or additions 3. 1 1 am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL 11. 1 Plumbing repairs or additions insurance required] i c. 152, § ](4),and we have no 12. 1 Roof repairs employees. [no workers' 13 Other comp. .insurance required.] -- i `Any applicant that checks box#t must also till out the section below showing their workers'compensation policy information. }Homeowners who submit this affidavit indicating[hew are doing all work and then hire outside contractors must submit a new affidavit indicating such. $('o factors that check this box nmst attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have emplovees. Ir the sub-contractors have emplowees,they trust provide their workers'comp policy mber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andiob site information. Insurance Company Name: A �. , 1MV VIv'__ n511fQCfG� °LO___ Policy #or Self-ins. Lic. #:_ 70 2 5 5 9y 01;L 011 _ Expiration Date:/3 Job Site Address:_____ 12- Li Y 7P F City/State/Zip: __ Sn Ia. 1 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 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 STOP WORK ORDER and a tine of $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Si,mruiu 1�/.✓.i�o,y Dale Print Name: &y),k Q Gry^e eh f Phone#: 6 1 $92 `l3o 1 Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license#: Issuing Authority(circle one): l.Board of Heath 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact person: Phone#: T/ee Foo„meonuw,a!!! o�,��¢oo«c%ueede . Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Registration:AA8666 Type Expiratfori:-AW.812013 Supplement LOWE S HOMES.tCg E s 1NG RICHARD CHALONE•: 136 TURNPIKE RO.SUITE 100 SOUTH BOROUGH,MA-01272 Undersecretary e �lassacbusctt<- Dcp:utntcnt of Public valet% Board fit'Building Rcgut:ttionx and Standard% Construction Supervisor License License: CS 61719 RONALD A GREENE 10 RITA DRIVE MEDFORD, MA 02155 o— 1 Expiration: 10/Z7/2013 ( nunh�F..n''rr Tr-": 5199 Massachusetts - Dc r imeat o 'ublia :-Jvt+ 13onrd of Buildin , Rel"'Uhlim s and standards Constru on Supervisor License License: C 61719 Restricted t . 1 G D A GREENE a RITAD MEDFORD, MA 1$5 zpiratcow. 10/27/201 f xnbu;ptiimt i Tr=: 6717 ;J�o"�iynrnri» ymrl� a/:',. 1�Luac��utCellc Office of Consumer At ays&�gu ness Kegulahon HOME IMPROVEMENT CONTRACTOR f 6h Registration: 102957 Type: Expiration: 7/3/2012 Private Corporatior GREENEINSTALLATION CO INC. i a Ronald Greene 165 Bow Street �. �—. Everett, MA 02149 � Undersecretary 7" ,y ,e dersecretary From: 03/05/2012 11 :57 #275 P.001/001 CERTIFICATE OF LIABILITY INSURANCE DATFfN4?wDD/YYY) 03/05/2012 THIS CERTIFICATE IS ISSUE➢ AS A NATTER OF INFOPMATIOR ONLY WD CONFERS NO RIGHTS UPON TN8 CBRTIPICATE NOLDEA. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EETEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5)I AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. tothTANT: I£ the certlf lcate ho Lder is an ADDITIONAL INSURED, the to the terms and Policy(ies) must he endorsed. I£ SURAOGATION I3 WAIVED, contlitiona of the golicy, certain goliciea may require as endorsement. A statement oa this certificate doeaunotct cosa£er I'lghta to the certificate h__ldes is lieu of such endora®ent(aJ . pnwDCLR — New England Heritage Insurance Agency Group IncTI- eA�e. A., 335 Main Street wpRs;P�-Fye-- -- Stoneham, MA 02180 cDvxs«p"®11e8F ------ eR vnE. • ;rl:el:pF.(• __ _ CReapl➢PI .VTaxDIXG CmtRAC6 I"sueeR A: A.I.M. Mutual Insurance Co xuc S : Green Installation Co Inc 33758 165 Bow Street '"{aweR e' IxxUpaR L: — _ I Everett, MA 02149 —._ - - _xsu=A C: nlrew. r __..._____._____ COVERAGES CERTIFICATE.N_ llMBER: REVISION NUMBER: TNiS I.R TO CfRT2FY THAT THE PoLICIFS OP INSURANCE LISTED HEL=NAVE BEEN aSSUFD TO S,F ]NR11FID NOTHITH3TANDING ANY pEOUTAEI®TP, TERM OR CONDITION OF AH, CONTRA,[ OR OTHER DOCUMoT WITH tV@¢D ABOVE FOR T11E POL:CT IS PERIOD INDICATM PER]'q]N. TNF INSURANCE y PAIDED GY THE POLICIES DESCRIbD HEREIN IS SUR.SECT TO All. THE TERMS, E/,CLUSIONS g�DHCONp IT30N5 OF SUCYI BE. POLICIES. OR T LIMITS SHOWS MAT HAVE BEEN PFDUCFI! HT PAID CIAIMS. -- - _ TYPE OF INSURANCE POLICY NtpIDER POLICY EFF PO�LI LIMITS ❑' ISYI IV 1]IYF IlgYl1.1 i eRGN OLCVP}HCL j —� ❑❑ ] 1 ..� ❑.:.:Il(. PPo1i¢SIe IEx�oepaaanwl 5 ❑ C.nv m„r nR•Pn�n.m t ElvEasoxw•wv I s _. aRE..arE un:.All're: AU9Lw:e a •P ,rlr_>:. r ❑F;LI•f ❑11'I CT❑L'.' YRW VCT9 -CtlR/OP AS f _ 1 AII]'OMODILE LI ILITY 0 011 /CPU ..... ➢O IL ) Ipee nel { ❑:% 1 !i!:.' aODfLY IWVRYIPo��eeaCnna) 5 ❑Mi iF[. R.'i ❑ A- ❑P ❑i A—--Ae ❑I.Fr,.�TIRIL. AC4140ATE ❑ri'I'I:Ilf1111 { ____ .- iJOPAIRS CWAPFSiSATION ® — EHPLOYF,F,S LIARILiTY 7I1E (FLFFIE:OFi FpC.TUEV 1! __ ,.__ A L.F-I!ITl'!E •]FFICEFS AP.E I,L. C..R[CIOIM { 500,000 ® Iln'l ❑ c,.cl 7025599012012 I.L. PssuzE -voma Llmr s 500,000 03/04/2012 03/04/2013 1 DI84{[ - u AHlu EE S 500,000 cormmA ➢asrnspxvnx or wxxArxoxs oa Soc.Anoxe: _ WORKERS COMPENSATION COVERAGE APPLIES TO MA EMPLOYEES ONLY I I CERTIFICATE HOLDER _ LINORTH PANIES INC —�-- — CANCELLATION CE SWUM ANY OF THE AHOVE OZSCAIBED POLICIES BE CANCELLED BEFORE THE 1I MIMTION DATF. THEREOF, NOTICT, WILL BE DFI.rVFRF:;I iN ACCORUMN ,. WITH THE POLICY PROVISIONS. ESBORO, NC 28656 AVTXDRISFD"pUSEnATIVE - - J t CONTRACT 4 0 0/ MASSACHUSETTS EXTERIOR SOLUTIONS INSTALLED SALES CONTRACT INSTALLED SALES SPECIALIST NVMSER C'U�9JlOMER STORE NO STREET ADDRESS STREET A00RE5S CIN STATE ZIP Cltt V STATE 1,+,d ZIP vf5 .z�x . otaa( TELEPHONE ,'� ' TELEPHONE i r C o0 (01—1 �7I ' Q1r`c9� DATE LOWESHOME CENTERS,INC:S MA NIC N0.:118600 CABx l L6L • J — '] I FEIN:a88]d8380 ,VJ ThISkontyaRupteforthe Merchandise and anythis P'leEbekm' This bewmesanegream Iuxonpayment Upon vareart the ergina'asernent,inducia Vie spasnallymnosta papesMN¢: document Nendro antl ConE Pone lndutletl wi0 thissadenAntend any other adds..and etledi rehemro.sM1ellberebm,i lalrereln es N'scaMro2' PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGEAND FOLLOWING PAGES BEFORE SIGNING. INSTALLATIONSTREETADDRESS CITY STATE ZIP l 17C'f'•:��, ,t'i h ?/.r ,InS Cfl�e'-. 1' lf[il l if <t.I M, .. Contract Total Are permits required for this installation?:[-]Yes [ ]No 'applicable tax included 1, to) 3 NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees the right to take photographs of all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity. Customer authorizes Lowe's to copyright, use-and publish the photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, including;but not limited to,marketing, advertising, publicity, illustration, training and Web content. By initialing here,Customer agrees to the foregoing. �'if [Customer to initial to the left]. Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be + [fille in date].Estimated completion date is 7- 3"/Z [fill in date]. Said estimated substantial completion date is not of the essence. A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable,inserts stalment of such contingencies) IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. CO/MPLETC THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00, yl Customer to Pay in Full; OR ( I Customer to use the following payment schedule: (1)Deposit S to be paid upon siging contract Deposit should be 1/3 the total contract price;and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation,I/We authonze Lowe s to do one of the following(check appropriate box below): [ I Charge mylour credit card for the amount of the payment Indicated above anytime after the date this Contract is signed; or I I Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT IMS COVERED BY M.G.L.042A LOW E'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOW E'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFF OF CONSUMER AFFAIRS AND BUISNESS GULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION BY PoIO6� Date Lewis s Home'Centeis.Inc. l l/_�00 ByL Date: 3 ' S owner Signature THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G L.c.142A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRnACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS 3 DAY OF -1.•'(, 1 / Lowe's Home enterS, nc. �tl-,L 7�'`" 'L�� fin,,•(: �c - lSpecialist or Above Owner Co-owner or Witness Customer acknowledges receipt of a ue copy of this contract which was completely filled in prior to Customer's execution hereof.You,the buyer,may cancel this transaction at any time for 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. tF90981(Rev.12110) FILE COPY It are'regist reo ®derneeriaof LF theorpoationI,