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185 LORING AVE - BUILDING INSPECTION - -- ---- The Commonwealth of Massachusetts i� Board of Building Regulations and Standards CI"I'Y OF MassachuscttS State Building Code, 780 CMR SALE\I �/f f 'L,�.• - U Building Permit ApplicatioRenovateTo Construct, Repair. Renovate Or De wli Rer6rJ.tfar '0/1 One-ar Trvu-Family Utrrllittp This Section For Official Use Only Building Permit Number. Date Applied: Htc4AAt. L,r,v�r�WS� r o thidding Ot)icial(Print Nmne) Siyt Date SECTION is SITE I FORMATION 1.1 Property r 1.2 Assessors Mlap& Parcel Numbers I.la Is this an accepted street?yesJ no Map Numher Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dislrici Proposed Bse Lot Area(sq RI FmnlagC tll) 1.5 Building Setbacks(ft) Front Yard Side Yards Rem.Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§SJ) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone' _ Outside Flood Zone?Check it es0 ❑ On site disposal s)s tem ❑ SECTION 2: PROPERTV OWNERSHIP' 2.1 O rI of ecard• Nmne(P�nt) J C my.Slme,Zipl� l l n4/�,J�— zj > -3 Nu.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORW(check all i t apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specity: Brief Description of Proposed \Vork2: - � SECTION a: ESTIDIATED CONSTRUCTION COSTS Item Estimated Costs: Ofllcial Use Only(Labor and Materials) y I. Building g o I. Building Permit Fee: S tlidicate how fee is determined: ' Electrical S ❑Standard CityiTusvn Application Fee ❑Total Project Cost"(Item 6)s multiplier — _ .e 1. Mun(hing 5 2. Other Fees: $ — - --- 4. \Ixlcmical 111\':\('1 5 List: i Mechanical (Fire Su„ression) 5 Tutai :\II Fees: 5 - - --- --- --- —.. . ('heck No. ('heck Annont: _ Cash An(ount: _h. Total Project Cost i ❑Paid in Full 13 Outstanding Balance Due: SECTION 5: CONS"I'RIICTION SERVICES r 5.1 Constructio upen'isor icense(C'SL) Li .__m_ cense Number Pcpi uli n Dal¢ Nne of C'Sl. (folder F List('St. I)PC(see befoul__ _ .I.yPC Description No. and Slreel I I Inrestrictcd I Iluildin gs LI .lo)S,dt)O eu. II.) R Restricted 1&,2 Tamil [)%%ellillil C II\'%fow V. P N hhuon RC Rmwlin Co%erin _ AS Wind( :md tiidin SF Solid Fuel (turning Appliances I Insulation 'I'ele hone Email address D Demolition 5.2 Registered Home Intproven ent Cptts for(ILIC) to _ I IIC Registration Numher Gsp mii t Dutc I IIC C'ortt ar la eqr I IIC Ile istran t a li No. an St et Email address City/Town,State,ZIP r,le hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. 152.1 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 wilding 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 IAY to act on my behalf,in all matters relative to work authorized by this building permit application. �® �cv Print Owner's Name(Electronic Signature) D° ft SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby aft er the pains and penalties of perjury that all of the information coat ' d in this application is true and a cunt t e t of my knowledge and understanding. Print Owner's ur:\uthorired Agent's Name(h.Icc unit Sill aturc) D' e NOTES: I. .\n Owner who obtains a building permit to do his.her own work,or an owner who hires an unregistered contractor (nut registered in the Hume Improvement Contractor IHIC) Program),will rm have access to the arbitration program or guaranty fund under M.G.L.c. IJ_'A.Other important information on the HIC Program can be found at W%\% 111.1", % 0k, I Information on the Construction Supervisor License can be found at ? \\'hen substantial work is planned, pros ide the information below: Total flour area(sy. ft.) _ I including garage, finished basement allies.decks or porch) Gross living area(sq. it.) _ Habitable room count Number of fireplaces..__.. _.— Number of bedrooms Numhcr ol'bathroums — — - - Number of half hmhs Number of decks, porches .- fypeofcoolingsystem 1, "foial Project Square Footage- may he substituted fist"Total Project Cost" Fm:MyFax-David Barbells To:THD/AHS Right Fax(1 000 9 8 83 61 0) 23:1 6 10128111 GMT-05 Pg 01-09 HOME IMPROVEMENT CONTRACT PLEASE READ THIS t Sold,Furnished and Installed by: Branch Name: Boston Date:/G—a-y— H THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 345A Greenwood Street.Unit 2,Worcester,MA 01607 Taff Free(800)657-5182;Fax(508)756-8823 Branch Number:31 Federal ID#75-26984W;ME Lic#C 02439,RI Coat Licit 16427 CT Lic#HIC.0565522;MA Home Improvement Contractor Reg.x 126993 Installation Address: f/ �INe .fV&7_ 5?1L Eke SIR City State Zip Pureheser(s): Work Phone: Home Phom: Cell Phase: Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing emails from The Home Depot Pmlect Informallon: Undersigned("Customer'),the owners of the property located at the above installation address,agrees to buy, and THD Al-Home Services,Inc.("The Hume Depot")agrees to furnish,deliver and arrange for the installation('Installation")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable Slate Supplement and Payment Summary attached hereto and any Change Orders(collectively, .Contract"): lob#: Spec Sheets #: Pro ect Amount Raofmg LISiding mdoee; ❑Iosalmion u 0-3 �, ❑Gutters 1 Covers Doors ❑ J/��/ � $ �1 210 1 4q 0v7 Roofng ❑Siding❑windows LJ Inseliadm $ ❑Gaaers/Covers ❑Entry Donn ❑ ❑Roofeng ❑Siding ❑Windows ❑lasdntion ❑Gutters/Coven ❑Entry,Donn fl Roofing OSiding Wrrdows 0 btsuinian $ ❑Csaners/Covers ❑Fiery loon ❑ WT 25%Deposit of Contract A®t due upon eraurmaf this®oral. Total Contract Amotm $ 6 3 /U Marne ls Purmay tot dqm&®re m thaoNh-ud of We CaaractbmvN. Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer miler this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminme this Contract or any individual Pmduct(s)included herein,ar its discretion,if The Home Depot or its attahnrized service provider determines that it canna perform its obligations due to a structural problem with the home,cavironmontal hazards such as mold,asbestos or lead paint,other safety,concerns,pricing errors or because work required to complete the job was not included in the Coniran. Pavtnent Salutatory: The Payment Sumntory# included w pan of this Contract.sets forth the total Cataract amount and payments required for the depo 's and fined payments by Product(as applicable). NOTICE TO CUSTOMER You are emfikd to a completely fMed4n copy of the Contract at the time you sign- Do not sign a Completion Certificate(note: there is orre Completion Certificate for each listed Product as defined by individual Spec Shays)before work on that Product is complete. to the event of termination of this Contraet,Customer agrees to pay The Home Depot the costs of tnateriak,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceotarce and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and Tbe Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements.either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. Accepted by; Y: Customar's Sigaamm Date s Signature g t,Date X Telephone No. &/ >— S\ Custurnei's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (as app0rat`7 AGREEMENT WITHOUT PENALTY OR OBLIGATION p��LrhhO� �l�S /JRou,fOL/L� BY DELIVERING WRITTEN NOTICE TO THE HOME O� DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE NOTICE:ADDITIONALTERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE Aid)ARE PART Of THIS CONTRACT tar-13/1 CSC WMIa—azench File Yelow—Customer I, '�Jt4I� c JK2 Sf EACi iRD.IWT45' �- ±�`. 'RI.iYSarJnis�CtS.• Dc(J.rrtttLCut llt.'Y41iIj�l4'�It'41� S:. . Lf liMAf)Y,r•:' �. •.DoaritfrrG'ktuild'ut;;R�_ultttimtc�reiSyl:Uidauil� ;,: �. gyp(SCrUGtCR SUg2P 15'3r Special,y LEccmze • a., ;Licenssc CS St:.0fiss :!•• ..:.vr'- .�:r IN Resldc:edia: .ws5 •:.... �;; .• ` . ::. Y7 eenCtt;RgAoA4�F, ds . �-�•..+%Jj2`'.• •�api[priArl::$f0/tOIT, , .`:.'.,' 6'uun.dnied'.:B' Tr`X:'99699• $i�. . / yJ CITY OFSALENI, Akss:kcFiCSETI'S 3L:MDLVG DEP.IATIENT I?0 U7.uHLVGTON ST1tE8T, !'a FLOOR TLL (978) 745-9S9S KENMERLIEY ORLSCOLL F.IX(978) 740.9846 MAYOR THO.tiW ST.PtF1ut>t DI1tECTOR Op Pl'aLIC PROPERTY/at:an LNG CO-NNISSIONEX Construction Debris Disposal Atltdavit (required for all demolition and renovation work) . { In accordance with the sixth edition of the State Building Code, 780 CMR section 1 11.s Debris, and the provisions of MGL a 40, S 34; Building Permit p is issued with the condition that the debris resulting from ibis work shall be disposed of in a properly licemed waste disposal facility as defincd by MGL c l 11, S 1 SOA. The debris will be transported by: (name of hoular) The debris will be disposed of in 4me of fuatty) 4rknj, i0r4c'mill Jppl+cont to 1 < The Commonwealth ofMassuchusetts ,�- Department Of Industrial Accidents rt fOffice of Investigations - r e 600 Washington Street ' wF Boston, MA 02111 y www.mass.gov/dia Norkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers licant Information Please Print Legibly le (Business/Organization/Individual): YhP o—r-I ress: /State/Zip: Phone #: &6-7 51$P gu an employer? Check the appropriate box: Type of project(required): [ am a employer with :20_ 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. 0 Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers' comp. insurance comp. insurance.`' required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers comp. right exemption per MGL 12.❑ Ro repair— s �s I�IXD c. 152, §1(4), and we have no . O insurance required.] t ti employees. [No workers' 13 ther comp. insurance required.] plicant that checks box#I must also fill out the section below showing their workers'compensation policy information. owners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have es. If the sub-contractors have employees,they must provide their workers'comp.policy number. -- n employer that is providing workers'compensation insurance for my employees. Below is the policy and job site ation. �. ice Company Name: f #or Self-ins. Lic.#: Expiration Date: e Address: 1�tj�[jyNA q � City/State/Zip: SL .F� i a copy of the workers' compensation policy d laration page(showing the policy number and expiration date). to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a t to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine o $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of .gatiors of the for insurance coverage verification. ?reby certify nde Athaind enalties ofperjury that the information provided abfo e is rue and correct. tire: �� r #: TT Mal use only. Do not write in this area, to be completed by city or town official y or Town: Permit/License# sing Authority(circle one): 3oard of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector )her ntact Person: _ Phone#: t1_s i t 'National FenesaagOn - -Rating COands, j ENEERrGY oERe ORiMANCMIENTOEE RATINGS U-Factor EnCo Solar eat Gain Coefficient Facmr-U Coelidente:Gananda de Energia solar tl .;gill { , '111 11 • Jz .:--turn-'7 paeMcwaa '- ADDITIONAL PERFOR . . CE RATINGS t. EVALUAI sURLEMENTARIA DE RENDIMIENTO - Visible Transmittance TremmiiiandeLuaV101e 44 T . . I MMNacaueretiPulates lAalNese ratings tanfadroapDTcatle NFRC procedures rorderormlNng w£pla pmductPedartnanca NFAC . ratings are detemdned ffi aased set of ear6Mmenhl conditions and aspuft pmducteiae.NRiC does not recammend am)pmdud and does rat wmrdntthe suit oftof arty po dudfarany spedtic me.cmm t nenuracffie(,Des"for other praduatperfornev s . � - Nfamiation.wvrxnhcarg - Esw raedcame WWI quo Mtn valmesamplencon las pracedlmientos apgczales do NFRCpare derorminarel renddMbeoW del pmducto.losvatmd usados porNFaCaM detenninadns perm mryMto-fdo de candWona amEiemalesY M hmam de pmducto' NpKfto.NFRC no recadaldanlriimr Mbcto T no guanoisque at praducto sea adecuado Paa w um espectiho.Cansuae can el - filets del flini a para elm sinoplado deesro Pmducro.wwanhcarg _ - _ C:r:,.^a qua ii£ies 2oC EN2it::Y f34'Ari r regioatel: Northern, North antral, Bgatb Cnnttal, - ru Lw enidwd rnliEdra rarer le fal RIM: 29 - !� may, ryr7iLn:ev).EAA 2:.T 511 %U.LU, hocto canrcal, Sur cants L, •l. LYu: Hain 00{v.l n..a"li u" IIroSolar/11-LC25 •�- Tooted Size: Mi" x EV, i LND: Ha2u©rro i.o/YiAria 3.13 llama-LC26 DU ..•y-YJ 5 —Jt� TasoaAo Probado: 121.9 cw Is203.2 cm opplicab la '1'aat Standa>;d i57 : � AlOil�I.S/21 agAOJ05 1 '• L•MI'w`IPILCsaio-1/i.•o.2119�G-oa, 7Ei0bs001Ut �lasa cl aurnatz 911H696 ..[npddslo6d!^.rx•,;ElcFd45°53p'�.d!LlO masgrom de moas w%to.gtstdcFnv riots Www.mNgRNcgea. sm) AN CERTIFICATE OF I-AABILITYIN61JRUE', ;ERTIFICATE IS ISSUED AS A MATTER OF INFC)PRAATION ONLY AND D CONFER ALT R THE 'COMERaGc AFFOP,OEOAB`! THE POLICIES FICATE DOES NOT AFF)RMATI`!EL`! OR NEGATIVELY AMEND, - If. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 3ET4VEEN THE ISSUING INSURER(5), AUTHORIZED :SENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. i tTANT: if the certificate holder is an AD01T)ONAL INSURED, the pClicy(les) must be sndorGad. If SU3ROGAdoes IS'vcA fer ri subject to 'ms and conditions is the policy, certain Policies may require an endorsement. A statement on this Ceriificata does not confer nghts to the .,is Bolder in lieu of such endorsement(s). 1-404-995-3011 uoNTACT T — FAN PH ME JSA, Inc. AIO Na �C..-__PHONE A/C E-MAIL i ADDRESS: pot.cercenter, 3560sh.com Suite 2400 NAICx Liance center, 3560 Lenox Road, INSUFFft(5)AFFORDING COVERAGE _____. _...-_....... ....... A, GA 30326 Steadfast Ins Co 26387 INSURER A: 16535 12) 948-0902 Zurich American Ins Co __-..._ INSURER B me DePOt,`' Inc. INSURER C: New Hampshire Ins Co 23841 spot U.S.A., Inc. Illinois Natl Ins Cc 23817 _ aces Ferry Road NW INSURER O: --� ng C-20 INSURER E: NATIONAL VV.ION FIRE INS CO _OF PITTS 1-- a, GA 30339 Illinois Union Ins Co 27960 INSURE0.F REVISION NUMBER: CAGES CERTIFICATE NUMBER: 19834682PEIOD NAMED ABOVE FOR THE POICY IS To NOTWITHSTANDING CT ANYI REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOLWHICH THIS IFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, USIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.XF LIMITS AOOLSUSR POLICY NUMBER MMIDDIYY MMIOOM(Y TYPE OF INSURANCE GL04887714-01 03/01/1 03/01/12 EACH OCCURRENCE S 9,000,000 NERALLUMILITY - DAMAO O NT G 1,000,000 PR MISES(Eaoccvrmnce S COMMERCIAL GENERAL LIABILITY MED EXP(Ant one P-M-0 E EXCLUDED CLNMS-MAGE [jX] OCCUR - PERSONAL SADV INJURY LIMITS OF POLICY XS 9..000,000 GENERAL AGGREGATE E ____.._.__.... -OF SIR: $1M PER OCC 9,000,000 PRODUCTS-COMPIOP AGO E _ -__.._ ENL AGGREGATE LIMIT APPLIES PER: S POLICY PRO- LOC .„ - HAP 2938063-08 1 0 1 0 0 2 GOMcci;o SINGLE LIMIT 1,000,000 mi nt __ - -- -- - __.. 1TOMOBILELIABILITY BOGILY INURY(Par person) ANY AUTO BODILY INJURY(Paraaldent) f - ALLOWN'cD _ SCHEDULED PROPERTY DAMAGEAUTOS f AUTOS ' NONOWNEO Per odnt HIRED AUTOS AUTOS $ SIR AUTO P Y EAC__M_OCCURRENCE S UMBRELLA LIAR OCCUR - AGGREGATE S EXCESS UAB CLAIMS-MADE It OED RETENTIONS WC STATU- OTH. IORNERS COMPENSATION WC061967352 (ADS) 03/01/1 03/01/12 X - SoEMPLOYERS'LIABILRY YIN WC061967354 (FL) 03/01/1 03/01/12 E.L.EACH ACCIDENT f 1,000,000 .NY PROPRIETOMPARTNENEXECLMVE NIA 03/01/12 E.LOISEASE-EA EMPLOYE S 1.000,000 - IFFICEWMEMSEREXCLUDED7 WC061967353 (CA) - --�03/Ol/1 Mandatory in NH) E.L.DISEASE-POLICY LIMIT S 1,000,000 yyea.aescrTe antler )ESn.RIPTION OF OPERATIONS below 'or;cara Compensation IWC061967355(KY,XO,NY.WI, )01 Ol/1 03/Ol/12 'X Employers XS Indemnity TNSC46244151 (TX) 03/01/1 03/01/12 Occurrence/SIR 30M/1M Iorkara Compensation WC119237E (Q$I) 03/O1/1 03/01/12 SIR 1M IIPTION OF OPERATIONS I LOCATIONS I VEHICLES (A Mb h ACORO 101.Additional Remarks Schedule,I/more space is npulrad) EVIDENCE OF COVERAGE CANCELLATION TIFlCATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL Be DELIVERED IN 'HOME DEPOT, INC. ACCORDANCE WITH THE POLICY PROVISIONS. : DEPOT U.S.A., INC. I PACES FERRY ROAD NW AUTHORIZEO REPRESENTATIVE RING C-20 =A, CA 30339 _ USA - . ®7958-2070 ACORD CORPORATION. All rights reserved. )RO 25(2010105) The ACORD name and logo are registered marks of ACOR.D ;y L ,6� ✓ L/09IVIlL�OU(MCG^.2 O�✓NGICdd(LfOIC[OISKc OT �\ Office'of Consumer Affairs&Busidess Regulation " OMEIMPOVEMENT CONTRACTOR ' RegistratloRn- t26893 TYPE. .?Expiration.-8/3MCI!, Supplement 1 Th`e Home Depoi'At:l=torh���etvices RICHARD: - _ 2690 CUNiBERLANQ 3 0339� :Undersecretary 9 ry