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207 LORING AVE - BUILDING INSPECTION (3) The Commonwealth of Massachusetts L Board of Building Regulations and Standards CITY Massachusetts Slate Building Code, 780 C'MR, 7i11 e OF SALEM ReviseJJunnrrry Building Permit Application To Construct. Repair, Renovate Or Demolish a /. :(MAY One-or Two-Family Dwelling di tion This Section For Official Use Only C—' Building Permit Number: I Date Applied: Signature: Building Cummissionerl Inspector of Buildings Date SECTION 1:SITE INFORMATION 1.1 Property A re �— 1.2 Assessors Map 42 Psrcel Numbers I.I a Is this an acce led street?y no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(11) 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 Rood Zone Information: 1.3 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesCI SECTION 2: PROPERTY OWNERSHIP' 2.1 Own r' f Record, VDI� -pin Name(Print) Address for Service: Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK"(check&#that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ 1 Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Ofllr fal Use Only Labor and Materials 1. building IS I. Building Permit Fee:S Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical s ❑Total Project Cosl'(Item 6)x multiplier x 3. Plumbing s 2. Other Fees: S 4. Mechanical (IIVAC) s List: 5. Mechanical (Fire Su ression) S Total All Fees:S Check No. _Check Amount: Cash Amount: 6. Total Project Cost: Soe?-351 13 Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor ICSL) (��GJ� License NumberJ=L lixpiruti n I to Name u "1.• I Iu1J �- List CSL Type(see below) f Description :%ddm U (InmtricteJ u to 35.000 Co.A. R ly Dwelling Sign. ore M Masonry Only r /J� RC Residential RoutingCovering fdepMme WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residentid Demolition 5.2 RegBtered Hom mpror meottt ctor( 66 � VIP MCC C ame ur III 'Re i e RegiWation Nu ber AZdre ( Expiration to Z at re Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.1 2SC(6)) Workers Compensation Insurance affidavit must be c3m6pleted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuanc of the building permit. Signed Affidavit Attached? Yes .......... No...........O SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date ECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION [th�at as Owner or Authorized Agent hereby declare he statements and i rmation on the foregoing application arc true and accurate,to the best of my knowledge and f.N eureof()wner Aulhori Agent Date rl."" under the a s and ealties of 'u NOTES: 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 W have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 790 CMR Regulations I I O.R6 and 110.RS, respectively. When substantial work is planned,provide the information below: otal floors area ISq. Ft.) (including garage, finished basement/altics,decks or porch) Gross living area(Sq.Ff.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/parches T)pe of cooling system Enclosed Open ). "Total Project Square Footage"may be substituted for"Total Project Cost" 10-JON-30 12:24PM FROM-Home Depot 2688 +97674D1402 T-002 1`.001/006 F-801 AV1\38 r.rarAv\YJ\1Y.1\!-YY.\l1YfY• PLEASE READ THIS Sold,Famished and Installed by: Bradt Name: Boston Date: 61 / TWO At-Hmne Services,Inc. dlbla The Home Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 r Branch Number.37 Toll Free(800)657-5182: Fax(508)75fa8823 . Federal M#75-2698460;ME Lie RC v2439;IRI Cont.LIC#16427 L VVV ^ �I Cr Lie#565522;MA Homem bnproveemn Contractor Reg.0 126893 o[ Installation Address: 0-7L—o ig-(Y J4`t4 g ot-lewt+ 14 o(J Z G City . State 7jp Purchnser(9)c Workphonc now Phone: CeR Phane: Hare Address: s/tv�.e_ L f (If different from Installadoo Address) City State Zip E.m a Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing smalls from The Home Depot PrnicM Infnruaiiow Undersigned("CnatotileY7;the owners of the property located or the above installation address,agrees to buy. and THD At-Home Services,Inc.L-Ime Home Deport agrees to futmsh,deliver and arrange for the installation("Imsfaffatim")of all materials described on the below and on the referenced Spec Sheet(%), all of.which are incorporated into ibis Contract by 4his reference,along with any.applicable State Supplueeat end Payment Summary attached bereto and any Change Ordms(collectively. "ContraU"): _ Job#: m� p S s S+ An oat 5 o R y 6 6 ots 0 nA13mry o lasolada r a?� °91 $ 0 oo6ag 03iding ❑windows hun lation $ OGutrers/Coves ❑Petry Doors n _ LjRoofing Siding U Windows Insulation $ . Matters/Covers 0Peny Doors fl QRoofnrg LJSiding U Windows hemdetion $ . p(iutters/Cov ❑Enemy[bass p Marimom25%DepWietCanumdAmamafteupmexommfonormhemmnd. Tag Coutratt Amount Is a 3 S 1 a-a Maine Pmurttasasarmy notdopordtmommanoneehbd o[��reConnadArmunt. Customer agrees drat,imunctliately upon,compledmv-of dte-wok for each Product Cumlecr win lutCOutee-ComPlation.Certificate (one for each Product as definenl by an individual Spec Shred and pay any balance due. A#applicable,each Customer under this .Contract agrees to be jointly and severally obligated and liable hemnunder. . . The Home Depot reserves the right to issue a Change Order or temdnan this Contract.cr any individual Product(%)included herein,at its discumon,ifhe Home Depot or its eudtodzed seryice provider detemmhtes:that it cannot perform its obligations due w a sometoral problem with the home,environmental hazards such as mold.asbestos or lead paint.other safety concerns,pricing c xers or because work required to complete thOob was not included in the Contract. Pavmrmant Summary: The Payment Summary # 3 1-1 S 1 "�" included as part of this Comma, sets forth the total Convect amount and payments required for the deposits and final payments by Product(as applicable).' NOTICE TO CUSTOMER You are entitled to a completely f5Dedmm copy of the Contract at the time you sign Do net sign A Completion Certificate(pate: there is me Compledon Cer•tiDCate for each fisted preduct as defined by individual Spec Shama)before watr an that product is complete. In the event of termination of this Contract,Crammer agrees to pay The Home Depot the costs of'natured%,labor,expanses and services provided by The Home Depot or AnthomvPd Service Provider theough the slate of termination,plus any other amounts sU forth in this Agreement or allowed under appOrrWe law. THE HOME DEPOT MAY WIT$HOLD AMOUNTS OWED TO THE ROME DEPOT FROM THE DEPOSTT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LDAI ING THE HOME DEPOTS OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNT& Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agrcerec+rt between Customer and The Home Depot with regard re,the products and Installation services and supersedes all prior discussions and agreements,either ash or written,relating to said Products and Installation.This Agreement carrot be - ed or amended except by a writing signed by Customer and The Home Depm.Customer acknowledges and agues that Cusomer d,understa voluntarily accepts the terms of and has received a copy of this Agreement. Accepted by: a Sabmfited by: VIM 1-44541w-. Custo sr's SisfievoDate Sales Consultant's Signature bate .940 I( Telephoce No. * 2 4 3 7 3 LI A Customer's Signature Date Safes Consular License No. CANCELI.ATTON: CUSTOMER MAY CANCEL THIS 0 appU=ble) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE TH M BUSINESS DAY ALTER 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:ADWTIONAL TERMS AND CONDITIONS ARE STATED ON Ten ARVINa.9E SmE AND ARE PAINT OF WES CONTEACr 17A0.09 C-6c wnes—aranenpile vaaw—casmnmer 'Pink—Sah.0 rmaaent CITY OF SALEM j PUBLIC PROPRERTY DEPARTMENT T 4 S.V 1 %1. Mt Ii.\l :11 11 I 97g_174 9546 Construction Debris Disposal Affidavit (raluired lirr all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CNIR section 1 1 1.5 Dcbris, and the provisions of MGL c 40, S 54; Building Permit 9 is issued with the condition that the debris resultin.- from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c I 11. S 150A. The debris will be transported by: (namc of harder) 'I he debris will be disposed of in (nameut facility) (address of facility) sign lure >f ptnni applicant zy i dchn,aa'due Phone t:irylStata/Zip_ l �r-4— — r- er'Check the ap te propria _Are y an empios has: T'Ipe of P'ajet:t{,rtl --d) d I am a several contractor and 1 6. New enWuu+-.tioa 1_ I am a employer uith have hiz-cd the sub-coatactoes employees(full and/or part-tiree).x y;��cn the artacl ed sheet 7_ R--modcEr6o .0 I am a sole proprietor or partrt.'r- Tic sub-contractors have 3_ ®Demolition shop and have no empleYees and have worl`ers' employees 9. ❑Buildins additit3n worldn.- for no in any capacity- camp_instuance-1 ;or addidotss [No workers'comp-insurance its 10.�Electrical repay 5_❑ We era a corporation rparatian s I I' Phunbi a repairs or adeitioais required.] their ❑ o� �' ) officers have exercised 3-[] I am a homeowner loins all work rij�t of a,remption per MGL 12.® reps as myself.[No workers'comp- c_152.§10),and we have no S insurance required-)t employees.[No avrkers' 13 J Utner cmvp.insumnee regnire&I .. a .Oirsoit dsatth¢ks box 51 muu also sa out the sccaiM below showing rbrir'Mlcu' +pohey iuforamtieu- '•Ar tuaaxtes mast subsrmtaac+e alCidavirimli®duy mrb. PF wmde y bnet this affidavit mdtobog dreg arc duiugaa nmtY and atct hoc t Honre jm dwha sv thenameordwsub __-_—==and state whcibQ Drool dcosc rnClies bass rConarxeturs drat check"box musl auarJmd an additvmal sireetstnmiag employees. trdresabs�totsbaveemploycrs.axy mart p.ovtde drar:vc�rss'w�-a ru I am an employer that is providing workers'compensoSon insarancejor my employem Below is the policy andloh she information. \ 1� j1�'P�^ Insurance Company Name: _—tee Policy tl or Self-ins.Lie.P. Expiration Date: L_ job Site Address: GtyState2tp: 'Affachacopy— Failure to secure coverage as required under Section 25A of MOL a 152 can lead to the imposition orcriminal 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 kkORK ORDER aid a fine of up to M0.00 a day against ft violator. Be advised that a ropy of this statement May be forwarded m the Once of Investinations of the DIA for inmma coveraee v®ficatiomi I do hereby certlfp and [ pa{ns a penalties ofpejury that the in ormahon prevrded abode is true and correct - - -- Sienatore Da� Phone N - --'� � Official use only. Do not write In this area.to be completed by cup or town of W&L City or Town: Permit/License ff Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone n: nj,r(MMIDMYYYr) CERTIFICATE Or LIABILITY INSURANCE D2/19/1D PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Marsh USA, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.eertrequest� arsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fax_(Z12) Sae-D9az___—.__ ------------ INSURERS AFFORDING COVERAGE NAIC ti Two Alliance Center, 3560 Lenox Road, suite 2400 ACLant a, GA 30325 l-- — _ — .- --- INSURE] In15'JRERA:seadF38 Ins Co _.._. .__ 1253B�-_,__ The Home De?et, Inc. - iINSURER—A, icy i..an I Co Ilec 5_ _. —.. Some Depot U.S.A., Inc. 12J841__ Z 455 Paces Ferry Road LPF- INSURERC NewHa.'nes5 re Lis Co _ __ -- ___ e I Building C-20 IINSVRERJ rA:-ION L UV ION-FIRE. I.Is CO 0 PITTS 19 4p__ ___ -." - .... - a - Atlanta, GA 30339 INSURER EL I1l inois Vnion In CO 127950 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEANY REQUIRIOD INDICATED.NOTWITHSTANDI0 OR NG NT TH RESPECT TO THIS CERTI MAY BE ISSUE ICH MAY PERTAIRN,THE INSURANCE AFFORDED BY THE POLICIES CIES DESCRIBED HEREIN IS I TERM OR CONDITIOI�OF ANY SUBJECT TO ALL THE TERFMS,EXCLUSIONS ANDTCONOIT ONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _---------------------- POLICYEFFECTIVE POLICY EXPIRATION LIMITS INSR DO'L POLICY NUMBER AT M NYYY OAT YY 03/01/10 O7/Ol/11 EACH OCCURRENCE E 4,000,000_ A GENERAL LIABILITY GL04887714-00 DAMAGE R L E 1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES1Ea 94cur a cej_ MED EXP IA Y p n Pe ori)_ $EXCLUDAD CLAIMS MADE a% OCCUR PERSONAL3ADVN4URY_ $4 000,000 _ -- - GENERAL AGGREGATE S_4.000,000.-_,______ -- - PRODUCTS-COMPIOP AGO $4._000,000 _ GEML AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOD B AUTOMOBILE LIABILITY HAP 2938863-07 03/01/10 03/0l/11 COMBINED SINGLE LIMIT E 1,000,000 (Es caft-0 X ANY AUTO - BODILY INJURY S ALL OWNED AUTOS - (Perperson) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accfeen) NON-OWNED AUTOS X SELF INSURED AUTO PROPERTY DAMAGE E _ _ (Per acciEenq PHYSICAL DAMAGE AUTO O_N_LY_C-A ACCIDENT- _5_..__—........ _. GARAGE LIABILITY OTHER THAN _EAACC .E-___-___- ANY AUTO - AUTO ONLY. AGG E 03/01/11 EACH OCCURRENCE S 5,000.000 . A - EXCESS I UMBRELLA LIABILITY . GL04087714-00 03/01/10 AGGREGATE 59,0a 0,000_ _ X OCCUR CLAIMS MADE S DEDUCTIBLE S RETENTION $ WC STATU- OTH- wORKE0.5COMPENSATION WCO20342355 (ADS) 03/01/10 03/01/11' X WT - C AND EMPLOYERS'LIABILITY YIN 1,D00,000 — D ANY PROPRIETORIPARTNEREXECUTIVE� WCO20342356 (CA) 03/O1/10 03/OS/11 E.L.EACH ACCIDENT_ S_ OFFICERIMEMBER EXCLUDED?'. WCO20742357 (FL) 03/Dl/10 03/01/11 E.L.OISEASE_EA EMPLOYE EI_000_000_____ E (Mantl4eacnb NH) - E.L.DISEASE-POLICY LIMIT E 1,000,000 Ir Yes,AL PR VISIONS - SPECIAL PROVISIONS Below OTHER - 03/01/16 03/01/11, Occurrence/SIR 70M/2M 8 TX �Employers Excess TNSC46242773 (TX) D Workers Compensation WCO910566 (OSI) 03/O1/10 Ol/O1/11 C Workers Compensation WCO20342358(XY,M0,NY,WI, ) 03/ 03/O1/11 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY END00.5EMENTI SPECIAALL PROVISIONS RE: EVIDENCE OF COVERAGE - CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN THE HOME DEPOT, INC. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT',BUT FAILURE TO DO SO SHALT. HOME DEPOT U.S.A., INC. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KING UPON THE INSURI'R.ITS AGENTS OR 2455 PACES FERRY ROAD NW REPRESENTATIVES. BUIL➢ING C-20 - - I AUTHORIZED REPRESENTATIVE ATLANTA, GA 30339 USA I ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/01)Jthornton_hd 14481889 The ACORD name and logo are registered marks of ACORD Z"l ENERGY RAI �0 . 32 1 . 8 ADOMONAL PERFORMANCE RATINGS V4ALL1A=N SUPU.MWARA De.P9NCMW`(TO VsibleTransmittarica 0 . 52 ad dua r%A*S(r"ft agnigi cm kx putrigrta W&3 &NRC;an dftmkw it m%*rJffft bU dd Eft lbeurdo W%Lb QA OW Walls put m l.W yam .W.p, pff L.11=*Aft W do.=vkbw arbAl"y m Urnam do 90*XZ fv=n*Wa nhvn I M qw d pmd&a Sea e. xubx Wa Uri up mom cumm aini d .'�W�mm�, *V=pnww, •Unit q..al.lflag for XWERGY STIR -haeft, wogtK .10,;tk Cant.31�, so.tha.A. , VWCR as ST)L.A:. 140-ti. centca 94C.. two: F talek Go/cLail 1132'/K-FtAS . _r13 2 AD sl b JeT r Sr IND, Raf.arso Q(l/VLdcLo 2.311 su%/K-RAS. =A* cobado: 91.4 VS.x 19Q. CW. +4 5 4 5 40773 KI Koff"(% z_r"z-, o 8 San Boa Uilcu, iiagulat 0*,o d Standards. HOME IMPS ENT t CTOR. Registritimi, 126893 Expiration-:;A/3120i �-----------1 i,-' Type:--SUp-plmMtl t Card Supplement The Home Depot'.W Home Seivlce FtICHARD FALLONE�a�u��-�y 2690 CUMBERLANb,PARKWAY S GA 30339 Administrator