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10 LORING AVE - BUILDING INSPECTION CK I©0 q 3 �2S The Commonwealth of Massachusetts Board of Building Regulations and Standards RECEIVE CITY OF Massachusetts State Building Code,780 CMitNSPECTIONAL ERVISHEM Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate ] enifilis One-or Two-Family Dwelling "� 3 5 ' i This Section For Official Use Only Building Permit Number: Da Applied: Building Official(Print Name) Signature Dat SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers /o LOY-) r:.or L l a Is this an accepted eet?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq a) Frontage(R) 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? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 O err pf Record � ra r �u I� � N rrA n Name(Print) City,State,ZIP to L Orn..1 At- 7q1 • N 9G G/ No.and Street J Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply) , New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Al eration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of UnitsI Other Er specify: wla uL Brief Description of Proposed Work': ,,,A-4.i Ce 6 s-p— ,tJct S SECTION 4:'ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 'j — 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: ' 5.Mechanical (Fire $ Su ression Total All Fees:$ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 30b ,, ❑Paid in Full ❑Outstanding Balance Due: s SECTIONS: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 1�7?2-7 23 /(o License Number Expiration Date Name of CSL Holder 'CIG ti. t'aii;l 3 Hilton Street List CSL Type(see below) (/1 No.and Street Salern MA 01970 Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering INS Window and Siding 7/ t I A p I� / SF Solid Fuel Burning Appliances "!VI O "I I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) lqZoBy 31z /(,p HIC Registration Number Expiration Date HIC Comp No.and Street 61'lA�` A1FCIIe SaI M MA 01970 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 o uilding 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 Er IC Pa l WL to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information containe_d in this ap licatiio a and accurate to the best of my knowledge and understanding. 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/d s 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"maybe substituted for"Total Project Cost" XV assachusetft Faaaae)Cm Ihisfmm a°Dveaaa eat$aantwill IeCoatract Imgvege rob `�°°PJ° °f 9mds xame MassadtusetlsCo eoaeets•Seeklegdedvimtfaece rgeem Coaaacrortmv(MGL chit wl i OfiiceofCo-GWdaroAome '�YPetsoa �tdaestrotID oammcggs(rs and BnshtessRtSuhoioos `.=to*wmtm rese-�Pt°`'®mteskoWd6rst obmiaacop�+adard $emeoa'ner(nf0 C"aO'"�I"fO`rsvtia°xoWn°,t bl dance.Yoe may°btausftee mPy byy�Stno rntatl0n - �• $781or t-8gB-+�9-37s orad aor vebill de ContraetorInformetion S Adwee(dotmtmipost Offrteldacz uil Lor . `'4"S I 61`R Ted�ir�ue LPcwa ��t�f tf�Q Beso�Addnsr(met e101970 o)moaPboln•G Et q2Z ? ramg P bove - Cur,7otct " .1166g Addma(bdfrmetaom Worry ��•'/ Sore zip Cad. Bmiaeul6we •. rA 6� Rdetd IDwSb.ASoeha �almummemr ��/�1�t�1j�aR�a-p� t� The Conttactorttgtaesmdo tlrotonottbugwyrgmrNeH 3�izl/ (� roesenLe in deaultheweek totmmpt�y����bmttd.aedgrehef R otaeowner. . (l/�M/1/✓ emviaktobemd eL .me""' l_ t Required Pe s-eu If' wd%"jbe corns•Themllotliogbm7dieglteedgere sratred bydremmucir sNehomeenaars be PmMS ComldelSdted (Owners ohosecuretheir With. fdlmria.RsabNPlawin escludedfromtheGuatau Fuudp tsnillbe rc aib vwmemo�ttersmouotatise MCLchap ter ld2A) LYFandplovis(onsof 3 I � —��Date aitm coapagarjNl6egin roneaaedtmtk TOW Comm Pdmaad -�—Dazen�hen mmrdttM wort;wM be The Contract PayotmtShedWe m��nYcmepletetL a4rees re parmm thesmrk Sttnisfi Nenmtajel mdlabot Palments win 6e madeeacotda qedfiedabotefarthetatalmmof. —3CJ(f(j . gmlhefoamvingsrhedWc �(°) S rP mnoacl(nmto eccad It3 oFNelaml mnaaetp,im g dmmgoPspedal otdo-' S�by //wuP ricampletion of •�,,.�� 5uhichetais wl S3W°V �•��,�J waPm mmpletimt of npmeemplefionofth'eer` -(tom„ Cc;rh Thefatlmtiagmmedd/eyWPmeo[mua bespeeiW fot6tds tUnza -8Rt11pavm I®Id mer,"e etpl roboth •__ ordered bUarethe S Paayssadsfaction) tomwthemmPl eAn !�°�roin older m Widf s 'NOTES:f°Ibch iesml iman.a.b Mpy w iftmCicemi n5f mmt pespaiy� 0°.°d"`d Olthe oral maorae`t imdonvygrmmt to mted r tt K•t medtueeromeatheeamWyedt"on�W`c aoal.mtorenrspa.af matt@pffigt„0-sieli mew! Subcontractors-Tbeaw Pam••/atbmnpacrw old a�mttrattpmr Te�abta fwmmpfepm efOuart-d�htl ° t mntrdct shall oat unPlYthaz n agamg•��docummtbecomecawa6teesro 6emldyrespomt'bletwp�o�to subtn�h�aorsfor evefWl}'beforestgnmg Nm contrattworhaseamq'mtetaTltashceo taxd ttnadclan-Unka othenvisemaed wi P wthertsidentx.Re°iewNe �n Nis doanmeot,the ° Oao16a - f°nonmgrantimts avd nodtaa pttasmed btto sitPtieg Ne ° mf6contraamembe val•` raleammoreadeod"ytmdeyaod it AsF aesti re - �stmedwdNNeDi - 9 ans if sommldngisoodev..° Oamseatioo 6pmidngro NeDhectmmlOPmkp m0elmwatmmr Conaaaorgoe�ve�4W+ilemomberes. ror.�yt ° ICaon�v ofuaprooroe nuance"dotsmssurilill Ask theCh,mmL mlmsutaae�m�cotrtpanv MA 116 orbypl"s MIlA 3S ea onuwm tmsand is and a ufdghm end tWbanahw so Natyao ran cal coo GWde to the Homelm `menitc`sn2cwLReadthehe 'erage,or al ProeementCmkaaertaw. pef�lnfO�alionmthemxmside ofrbisfmm mnaaa11, wetl11-dog at4"matifitbas Gem sigtalmaplaaoNmNao mdl3ela mpYofNe Consumer Nird 6usinesstiayfollouing Nesigaiag f�° ��ceNo a a�Ioa tde�nseot ar 6�` � Svnaotifythe DO NOTSIGNT�� taocdlaomfanom Nanmidnightofthe ttiaiaadet�orwe IiISCONTItACTIF oPlmtadohoFNisrighc - �rs;mad°T;am.t1=teFi-,t�ysem�����a�AC�FSi'! =asaw Hemeo Daze t I � I � �oanaaats �/ t{ eryiA r . Contractur Ar6itiation homeowvdes with the rigbtto initiate an arbiratioa action hats an The Home lmProvemeot C°°tractor P�°" .t a eoMmctor. 'Ihe same risht is tit autometicaily afOmled to a alternative to coral action)ifthey have a dispute ate he/she has�vtth a hmnemvnet in couR unless contractor,however. The conraemnvould have to revolve any lisp _ boW parties agree totheoptional clanseptavidedhelow.This clausewould gtvetheconuaetorthesamerislltto arbitration as is aflmdedto dtehomentiwtet'by the HomeimprovamemConuactorLarv. The conhactorand the homeormerhereby mutue0y a m advance theta the event the contactor has a dispute r yuy®trhe dispute m aprivare arbitration firm which has been approved by concemmgihisconhac4thecaotractp.play oaandtbecunsmaershallberequaed theSa== ortheEx=adveOfficegf�^massy A�andBalLION Ra€ulan t snbmitto Snch arbirattoaa piowiggdln Massachusetls General Iawes,rile lei 142A. � ,y v nnt> J Homeowner's Contractors Signature Signare \0nC&The signatures of the parries above apply only to the agreement of the ponies t altemetive dispute resolution initiamilby the contiactoc The homeownermay initiate alternative dispute resolution even where this section is notseparatalY signed by the parties. Homeowneesiughts tCanractor Lawn(MGL chapter 142A)and other consumer A homeowner s rights under Home ant Hotivever,homeowners protection laws Cie.MGL chapter93A)may not be waived in any way,even by registered as prescribed by taw. may be excluded from certain rights ifthe contractor ibey choose is not Proper. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Iarlimvement Contractor lawv. the contactor isbe responsible t otther specific tegl rights if thecontractorr in x dosely and workmanlike menner. Homeowners may guarantees or provides an express warranty forworlamnship or mntedals. III addition to guarantees or warranties. orowided by the contractor;all goods sold in Massachusetts terry an impliedwarranty ofinerchantabt'liity and fitness for a oarticutar purpose. An entmteradm of other mantis;on which the hom ownerand contractor lot Wy agree maybe added to the terns ofdie commit as long as t If you have hey do not restrict a homeowner's basic consumerrigbts. contact the ConsumerTnfommtionHotline(listed below). questions about your consumedhomeownerrtghts Execution of Contract The contract must beesecutedin duplicate andshouldnotbesignedrmu7acopyOfallexhibitsandrefteoced documents have been anached. Parties are"advised nuttn sigathe document until all blank sermons have been filled in or marked as void,deleted or not applicable. One original si®ed copy ofthe contract with attacbmens is to be given to the owner and the otherlreptby the comractr Any modification tothcorigical contractinustbe ei writing and agreedio by both parties.Contracted work-MAY not begin until both partishave received atally excoutof the contract and the three day rescission period has expired Accelerated Payments AcontractortraynotdemandpaymentsinadvanceofthedatesspecifiedonthepaymentschedIA -where the homeowner deemsbim/lierself to be financially insecure. Howeser.in the balance of funds es when a et due contractor nplaced in am himl¢rse f in be financially insecure,the contractor may require account as a prerequisite to continuing the coamaated wort;.WiUtdrawat of finds from said account would require the simumses of both parries. Additional Information Comm=Law or other If you have general questions or need additional infomtation about the Home Improvement consumer rights,or if you wish to obtain a free copy or"A Massachusetts Consumer Guide toRome Improvement" contact .. Consumer Information Hotline lotion Office of Consumer ASairs and Business Regulation 10 ParkPlara,Room 5170,Boston,MA 02116 617-973-8787,888-283 3757 orvisitthe 0CABR website at in.11.'"1 VAL In-s-sm-;cc=1r= Ifyou want to verify the regisridon of a contractor orifyrou have questions or need additional information specifically about the contrectOr ragisuatiou component of the Home itnprovement Contractor Law,contact Director of Home Improvement CornractorRegistrafitm Office of Consumer Affdrs and Business Regulation to p&kPtmRoom 5170,Bostoq MA W16 617AT$787,888-2833757errvisittheHICwebsitaatii-1r •w"°}t'n aQV;ocab: Go online to view the status of a Kom Improvement Conraaor s Registration: 1'd' g,�.,na.LLc'hOnt`irt�mwtrl•"t�liC.:trxl'a'..a�� Forassistance with informal medhuion of disputes orto reg;sstertmmel complaints agehsst a business,call: Coasimter Complaint Section 05icepfthe Aromey General 617-7_7-8400 APIWOR Bem aBusiness Bureau 508_M-480o,508-755-23.18or413-Tr13114 v�at_tt ro om� APB rt' _ - -�_'-, s 3"fte4 FaLEde IfiSY9 AMC7'�u rs9 a3 �*9et3auq o SJ -i�r (R"davft:Rome c acfro»a/ Hs� aa�/ fl� € 3 Kai (i3usta"s.ior .6.0onl+ltdlviduap: Aidaiitic W 'I Add_ eatheruAtiviy LLC Address: 61 R Jeff Avenue Cfty/srat-elziD; 6tt'A gam,- - i 'a a imy¢t p wee ttb o solroprc ate I3 phone�: 979- 7qq-8/ employeruhh� `�0 Ioyees(M and/or g UMe ; A ® t am a general con;motor and r 71�parsssecE 2• :am a sole proprietor or ) have hired these ctats ship and have no pig` listed an the anacbeed aba 6 P1evt construction employees sheer 7. ©FPeatodelin C o wOor ae in say capacinJ• Thesoe sub-contractors have 8- g coma institan� emPi Yees and have F ' ❑DemoIition :.[ regni_red•] comp.Fasu,�nce# � F am a homsavrter do' i 5. C] a`�a 9- wilding addition y�eI �la 0v tmer d mg aF wo P ration and its 10.j�Electrical repairs or additions m , i tk afiicer.have C° right exercised their rnts nsutattce�Nui ed.J' emption per Y(Gr 11.[�P-h1mbiag ai reprs to 1S2 S e- additions ,,F(.),and we have no 12.,0, -�oofreptd. °na a etaployees.[Rlov�orkers, F3.�er T 3' PPlicaatrhatchecfshoxa c0TP- Esulatice. NSln./ t HCT-vlmer,wne -i must ahm fill out We s�Hon below showing ed.J Ct 1 OJ�1 scantraGorshSatchech,���da"Ift- ca[iggdte- gth*v.vr�= employees. ifdre dtis 6os roust ansched�ad y are doing all Walk aud then hire as CO��afionpoli i suh.Conaactotshaeea ditioaaisheet side Con policy nFemratioa 2Frd aiz a ran y� zs mPtoyes,they mustptovid �ryd the su �e t o���M ad state w eust suh ttheron davit iodigt;n&such. z=ej"atIi9ta, �� g £ 'eai Policythes 'YSet3S'df r'3 FFBS£dP"n"CeAk,Pt=' . PAW- insurance wm J>�'�°�e�: pony iYsme; S �c rrc% i''atiCY`or Sett ins.i,ic,it i8a70/a I Jab Site Addiess: Expiration Date; �e`ecCtt a�333'Of the Failure to s i9Q""`"§'SP3a"�•3cxasgt >• ty/State% yj: S' /Lt n ecurecoverageas �o-e3=�G F]Fgizor;; wIepi, 1Tae up to S1,500.00 �4u�under Seciioa Elmi'e(eL'07& Polk oPap to 0250-00 a da againsi one-year�°prison>ncnt,as well C. 152 con lead to the itttpo r and $ Lv�dga ons of. Dsh for insttra eolaot a advised that a copy f flis staFe�ient ll Penalties in the apt ooa STOP FVo tg jZand oties f a da Ft2Pe�>y eeP� 'eFage YcafionY a forwarded to the fine u deP� asa Office of 31Lr,7OIL ] 7 DSP= a ��-���tiiYL•74'£i,i,'_' 7��' 6� --•----.,Bate.'' l t s F se Bo ner � uanm; e>Po2ca: > v�; a ^off; t1�ci y cP_oar oJr �ac,4t".F 9x�.iLyE2LF!'3,{'sse`Cte EaEe�• °.. '3rE. 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THIS the talTns and conditions of Bolder is an ADpIT'ONgL INSU THE ISSUING INSURER Y THE POLICIES ce v6cate holder in lieu In andolsePolicy manIn P RED, the (S)• AUTHORIZED PRODUCER Policies may re Pollcg(iesj must be endorsed, if SUBROGgIION IS 9 9uire an endorsement'A statement on TNA ^szsterII _nstlrat this cerORgte dOeS not NE0,subject to 233 Fe St CentralGroTlp ZzC N°11 FACT CO�StrD confer rights tO the Street PNONE ctioa c 7 I Nal . (508)651-7700 01760 ADDRII A!C N0; IRBUR'eD LM-`- , 0 C1eIIt oII MSURER s7 AFFORDING IRS A COVERAGE 61 Repre it=a�}y�lZat.j, URER f'Sbe.11a jarotectj.oa I NAICs Te�ers wsuRERe_a=2jella -Tod rIIS. ke an Avelue wsuReRCNau�jlyu Tlran �s Co. 141360 Salem NSURERD: ee CO 0077 COVEPAGES 01970 ` I THIS IS TO CERTIFY :CER;J FIGATENUM6 INSURER E: I INDICATEDTHAT THE POLICIES INSURERF• I . NO OF INSU ER3sasrer 2019 CERTIFICATE MAy BE ISSUED OR NY REQUIREM CE LISTED BELOW ELOW HAVE BEEN ISSUED— REVISION ND CONDITIONS OF UCH PERTAIN TERM OR CONDITION OF I O THE INSURED NUMBER: LmRI THE INSURANCE AFFORDED 8Y THE PCTn'EOFwSURANCE AO`1CIES.LIMITS SHOWN By CONTRACT OR OTHER DOCUMENT WITI, FOR THE POLICY PERIOD GENERAL UASIUtt I r I PdAY HAVE BEEN REDUCED BY PAIDSCRIBED HEREIN IS SUgJRESP_ECT TO ysg{!C TH,S POUCY NUraeER POLICY Ell CL UMS. HTHIS a I C0=1uelfl GEN_ irOLIClYEll 9 U I O ALL THE TERrdS. I =RAG LIABILITY- I C'.AimS-xL:DE LOEnS OCCUR IEACH OCCURRENCE S00042826 'A OR_ S 1,000,000 GEN°AGGREGA�- I /20/2019 Lo/2015 Nse 8`P[An cet Is 50,0°0 P.cn? _Uf.,l-AppUE$Pfl P_RSONi.L;ADVINI IS 5,000 OUCY � P�0. 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All rights reserved. 91D Massachusetts -Dapartment-af Public Safety Board of Building Regulations and Standards Construction Supervisor , License: CS-067977 �`ZI, MC W PALM _ 3HILTONSI Salem MA 019707 ) pi e;. ExPiration Commissioner 0412SF2016 Parunronrneo/// C�l�nuar�n�n(/J mce of Consumer Affairs&Baslum ReVI005 . ME IMPROVEMENT CONTRACTOR LstrAcn: 142089 Type: iration: ,311212016 Ltd I abUy Corpo' _ ATLANTIC WEATHERIZATION LLC. ERIC PAW! - 61RJEFFERSONAVE - _ SALEM,MA 01970. Uadersecrelary