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39 LINDEN ST - BUILDING INSPECTION (2)f pY . The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF — 1 {Jt Massachusetts State Building Code,780 CMR SALEM Ql) Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Offtcial Use Only Building Permit Number: Da Applied: Building Official(Print Name) Si Iate I SECTION 1:SITE INFORMATION 1.1 P operty Address: 1.2 Assessors Map Parcel Numbers �T �SH16�it l (�/470 1.1 a k this an accepted street?yes__ no Map Number Parcel Number 1.3 Zoning Information: 1.4'Property Dimensions: Zoning District 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 Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: - Public❑ Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system ❑ - SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownert of R cord: �� Nl jllc2� i� Q/ Name(Print) City,State,ZIP 13q Li'"X;n/ SST No.and Street Telephone Email Address - SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ AI[eration(s) ❑ Addition ❑ . Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Prgposed Work: SECTION 4:ESTIMATED CONSTRUCTION COSTS 'tem Estimated Costs: i - Labor and Materials Official Use Only 1. Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier xx 3. Plumbing S 12. Other Fees: $: 4. Mechanical (HVAC) $ List: , 5. Mechanical (Fire Suppression) $ Total All Fees:$ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ �l ❑Paid in Full ❑Outstanding Balance Due: � I SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 91377 `6 114—`5slblyG License Number Expiration Date Name of CSL Holder n /7 e1 „ /J� / / List CSL Type(see below) No.and Street ��f�. Type Description p�7 U Unrestricted(Buildings up to 35,000 cu.ft.) U1Ci< R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) / pt a Z/1 HIC Registration Number Expirati Date CryName 2/ or HIC R�td aj t Nl�e and-Nreet Email address City/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 .......... No...........❑ SECTION lac OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize /`<f to act on,,my''beeAhaaRlf,, in//all matters relative to work authorized by this building permit application. Print Owner's Name(ElectroniccSSignature)1 I �— Date - SECTION 7b:OWNER[OR AUTHORIZED AGENT DECLARATION By entering my name below,1 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. f-, A4>�K5 /O/ Print Owner's or Authorized Agent's Name(Electronic Signature) 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. ov/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" I � rf''"`�..,,✓ � G ational rill Tho power of action` Conservation Services Group This service is brought to you through support from your local utility This Agreement is made by and among — and i MassSAVE MIRE GRIFFIN Conservation Services Group (CSG) 39 LINDEN ST 40 Washington Street; Suite 3000 SALEM MA 01970 4520. Westborough,MA 01681 Customer ID:S10004019375 Contract ID: 1922011C s I. DESCRIPTION OF WORK TO BE PERFORMED � G CSG will perform or cause to be performed the following work on the"Premises"known as / .eft ,in a i professional manner and in accordance with the terms of this Contract,including the attached recommendationsiwork order i describing the work in detail(the"Work")which are incorporated herein by reference: i Description quantity Location - Densepack Cellulose-6" _ _ 703 AFL $1,342,73 Wall Ins.inlerlor6"C_allulose 36 HALLWAY $78.48 Wall Ins.Interior 4"Cellulose 70 HALLWAY �$140.00� Door Polylsocyanurate 2" _ 1 HALLWAY T $49.45 Sheathing access - 2 SHEATHNG $65.04 Damming 10 $17.70 w. ---- — _.-.-.-... — — ----— — — -- S 12"Mushroom Vent - 2 OVERALL $247.26 8"Roof Vent _ 1 OVERALL $09.23 Vent bath fen to roof flapper 1 OVERALL $116.10 Sub Total: $2,146.99 e Energy Efficiency Incentive 41,609.49 c Net Sales Tax After Incentive $040 Total $536.60 e. It. PAYMENT CUSTOMER agrees to�o>>pay CSG9 for the Work as follows: Printed 07/11/2011 Page 1 of 2 Payment#1: $�i�L_ -Deposit upon signing the Contract(Not to exceed 1/3 of the total retail costs or actual costs of special orders,whichever is greater) • Additional Payments and Final Invoice:$ 3S7iG -Additional payments for the Work shall be due 3U days from the date shown on the Invoice. FSnal payment for the Work shall be due 30 days from tire date shown on the Mind Invoice. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or a branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. DO NO S N THI ONT THERE ARE ANY BLANK SPACES. Cos mer Si aWr Date ate � � CSC,,5' s Date me of CSG Repr . tative r The Terms of this Agreement are contained on both sides of this page Conservation Services Group•40 Washington Street^ Westborough,MA 01581"800-480-7472 ov,o 11/16/00, TITU 17:04 Fta 617 393 2415 "-.ef f�00B Y l The Cofsareromweallh of Massachasexls c;;;<i;:- :: :'' Depav�ageeet!ojliarPaastriaP..gee6tfeeeas _ '�S "� 1�',�'' ®ice ojJaavesfigadiooas• t ; 600 Washin #om.Sfreef Boslon,18A 02J11 � yy .. eoevw.ewas�gov/Ala Workers' Compensadoll 1<imsuauaance Affidavit: $aailde¢s/Coeatmc¢oes/Electvaeimns/Plu mbeas ApWicaant Information I^1 1 { h Mease Print bly Name(Business/Organimtion/lndivid Z ual): J y 4c- 1 1 y ;roc t e Address: c).� ore ko,,—k -1� City/State/Zip: oZz, i o Phone#: ��you an employee?CBeeek She apII ruQe box: Type of project(re0 ): I,�] D am a em 1 er with J� 4. ❑ 1 inn a metal mntracror and I D oY g 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 7. ❑Remodeling 2.® I am a sole proprietor or partnes- listed on the attached sheet ship and bave no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ®Building addition [No workers' oomp.insurance 5_ ❑ We are a corporation and its mmuired•) officers have exercised their 10.®Electrical repairs ar a�itiotts 3•❑ 1 am a homeowner doing all work right of exemption per MGL 11-Q Plumbing repairs or additions ®yselt[No.workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs I insurance requited)t employees.[No workers' 13.M Ocher Zy,,- )u . i tromp. insurance required.) °Any apphitsnt 161 checks box NI must also fell out We section below snowing their workers'oompensation policy information. 7 Wmwwscs who submit this affidavit indicating they are doing eel work and then him outside camma rs must submit a sew affidavit ImIkatiog such. $Comradors that durk.this boa must attacked an additional shot aluwmg the name ofthe submmmciors and their workers'comp.policy infomu im ,Faea art mfloyer t ar is providing workeas'sorpemafdoat i mmnee for amy erWloyem AWow ss frteyoGry madjob s&C Insurance C:ompatry Nanae: F e ra Policy#or Self-ins. l,ic. #: Expiration Date: /// 4/ ze1Z lob Site Address: Ci¢y/Statemp: Attach a copy of the®writers'eomspensaitlon policy declaration page(sbowing the policy number gild eapiradon date)- Pailum to secure coverage as required tinder Section 25A of MOL c- 152 can lead to the bnpoddon of criminal penalties of a fine up to S1,500,00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to 5250.00 a day against the violator. Be advised that a copy of this stateman may be forwarded to the O1Tice of Iavestizations of the DIA for it a; r tx v o erifiation. P do hereby eenyy eradd°r rlae ,'%`od ofpgmj y fbof Me laformradoa presided above is acute and correct C/ Phone#. Ohklol use only. Do nol write in lhdr area,Bin be cowyilered by cl&or lower of'lclaL City or Town: Peo�lt/laccnse# Iss�ug Audboddy(oinrde one): . .;1—illoard off llde9ltb �aekwi®epas�anent i Ch¢y/P®wn Clerk 4.cloctnical Inspector 5.Plumbing Inspector GD.®AIICe Contact Pearson phe ' �lassachusctts- Dcp:u'tmcnt u( Publif �:d'ct� Board of Buildin_ Rculul:ttiuns and $hmdards Construction Supervisor License License: CS 91377 BRIAN F HESSICN 2 PATRICK RD , TEWKSBURY, MA 01876 Expiration: 10/9/2012 ('onuni.eiwrci. Tr#: 4623 f 07-77 Office of Consumer Affair and Business Regulation 10 Park Plaza - Suite 5170 Boston, Ma.5sachusetts 02116 Home Improve ent.-Contractor Registration Registration: 162111 Type: Supplement Card NEXT STEP LIVING INC. Expiration: 1n4/2o13 BRIAN HESSION =' 25 DRYDOCK AVE. 5TH FL 'a BOSTON, MA 02210 _ Update Address and return card.Mark reason for change. n-oaioa-cmtzis ❑ Address ❑ Renewal ❑ Employment Lost Card ✓fee Virnrvrreo�rucealCfz a�,/�roaacfCuael!a dfice of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration 162111 Type: 10 Park Plaza-Suite 5170 Expiration 1114/2013.. Supplement Card Boston,MA 02116 P LIVING INC ESSION,. JCK AVE',!`STH.FL MA 02210 ''° _ Undersecretary Not valid without signature e r I uppri F: OU46 IYCA iJ ICr CERTIFICATE OF LIABILITY INSURANCE DATE(M201� •RODUCER - '�. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION William Gallagher Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE nsurance Brokers,Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. $70 Atlantic Avenue 3oston, MA 02210 INSURERS AFFORDING COVERAGE NAIC# NSURED INSURER A: One Beacon Insurance Company 21970 Next Step Living,Inc. INSURER B: A.I.M.Mutual Insurance Co. 33758 25 Drydock Avenue INSURER c: Riverport Insurance Company 36684 5th Floor NsuRER D: Hartford Fire Insurance Co. 19682 Boston, MA 02210.2600 INSURER E: ;OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ISR DD' POLICYEFFECTIVE POLICY EXPIRATION TR SRI TYPEOFINSURANCE POLICY NUMBER D DD DATE MM/DONYYYEPERONA LIMITS A GENERAL LIABILITY - 792000560 11/1112011 11111/2012 RENCE $1000000 ENTEDX COMMERCIAL GENERALLIABILtTV rr $1 OD0000CLAIMS MADE O OCCUR one person) $1O 000 ADV INJURY $1 000000 GENERAL AGGREGATE $2 00O 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1 00O 000 POLICY P ECT RO- LOC A AUTOMOBILE LIABILITY 390001209 11/11/2011 11/11/2012 COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC IS AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY 792000561 11/11/2011 1111112012 EACH OCCURRENCE $3 OOO OOO 7X:1 OCCUR CLAIMS MADE AGGREGATE s3.000.000 $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND 71733288 1111112011 11/11/2012 X WCSTATUUMIT- 1 2 EMPLOYERS'LIABILITY C ANY PROPRIETORIPARTNERIEXECUTIVE TBD106787 11111/2011 1111112012 E.L.EACH ACCIDENT js500,000 (MFs.tlE�R/OM��ER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER D Property OBUUMHX5485 11/1112011 11/11/2012 $212,594 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Evidence of Insurance DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL An DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - ACORD 25(2009101)1 of 2 #S239491/M239489 © 9 8 -200 CORD CORPORATION. All rights reserved.