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498 LORING AVE - BUILDING INSPECTION (2) IiN The Commonwealth ofiviassacI17 RECEIVED QVJ Board of Buildin Re ulations and SiaA ATIONA CITY OF g g $ERVIC S SALEM Massachusetts State Building Code, 780(CMeRp_ Revised,ti/w 20u Building Permit Application To Construct, Repair, Rfftivub), ben�la isl�a' One-or Two-Family Dwelling 6-- This Section For.Ofiioia) UseOnlp.::.:` Building Permit Number: Date.Ap Iled ) . 1 �I . Building OtTicial(Pont Name) Sfeature SECTION l:SITE`INEOOIATION- Ll Proper Address: _ 1.2 Assessors Map&Parcel Numbers �l�� Lla Is this an accepted stt4 t7yes_ no_ Map Number Parcel Number 1.3 Toni nformation: a# 1.4 Pr C1 +sp ' ZoningDistrict Proposed Use - Lot Area(sq it) f Frontage(u .. - 1.5 Building Setbacks(R) . Front Yard Sida Yards Bear Yard Require) - ProvidedF1.7rFlood ired Provided. Regoned - Provided 1.6 Water Supply:(M.G.L c.40,§5Zone lnformationi L$Sewage Disposal System: Public❑ - Private O - Outside flood Zorre7 Chock if 0 Municipal O On site dispo sal system ❑ .. SECTION 2: PROPERTY,O%VNERSIi1Pt 2.1 gwperr of Reco r� .NrSme(Pont) . .; Cray.Stote,ZIP - - - lz/, No.and Street - Telephone Email Addn= SECTION(3:DESCRIPTION OF PROPOSED WORKi(check all that apply)New Construction 13 Existing Building O 0wneM1Occepied O Repairs(s) O 1 Alteration(s) O Addition ❑ Demolition O Accessory Bidg.O Nmnber of Units_ Other o Specify. Brief Description of Proposed Work': SECTION 4:ESTIMATED CONSTRUCTION COSTS- Item Estimated Costs: Official Use Only Labor and rMateriah) y 1. Building S 1. Building Permit Fee:$- Indicate how fee is determined: 2.Electrical S O Standard Cilyfrown Application Fee Total Project Coss'(Item 6)x multiplier x 3.Plumbing S 2�Qther Fees: S 4.Mechanical (HVi1C) S List: 5.Mechanical (Fire - Su ressiun) S Total All Fees:S 6.Total Project Cost: S/�!m' Check No.119UACheckAmount: Cash Amount: t a l ❑Paid in Full 0 Outstanding Balance Due. .A,.j-,&SECTION 5: CONSTRUCTION SERVICES 5.1 Conslruction.Su crVisor iEcnse(CSL) �-)G/ y Z5 !p iJ.i Ypri:i` r — Expiration Date License umber NameoCCSLtIo er .(• 1 V%� drua (d. + 4 C,1 ('} List CSL'fype(see below) 'S Eric W.Palm Deserip ion .. Type..- .. No.and Street 3 1 tOR beet U Unrestricted Buildin u -to 35,000 w. Il. Salem MA 01970 R Restricted 1&2 Famil Dwelitn City?own,State,ZIP M my Maso RC RnniiO Covcrin WS Window andSidin -•� -7 �,/ p SF Solid Fuel Burning Appliances fj /y11l" D l 1 Insulation Tcle hone Email address - D Demolition 5.2 Registered dome Improvement Contractor(HIC) Y7-o 8 q 3 /Z /t , HIC Registration Number Expiration Date I IIC Company N.vn 1C egi N Email address No.mid Street ------------ Ci /town State ZIP Tel! hone SECTION 6cWORKERS'.COhIPENSATION tNSURANCE AFFIDAVIT(M:G,C.c.15..§ 25C(6)p,. 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 a building permit. Signed Affidavit Attached? Yes.......... No..I.I........❑ SECTION lac OWNER AUTHOR12AT10N TO BE-COMPE.ETED W HEN:, OWNEI('S AGENT OR CONTttACTOI APPLIES FOk BUPILDING.PERRitT I,as Owner of the subject property,hereby authorize t9 act on my behalf,in all matters relative to work authorized by this building permit application. Date Print(wner's Name(Electronic Signature) - - SECTION 7b:OWNER'OR.lUTHORIBED AGENT DECLARATION By entering my name below,)hereby attest under the pains and penalties of perjury that all of the information contained in this application is ue and accurate to the best of my knowledge and understanding Ib Print Owner's or Authorized Agcnt s Name( ectro ie Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her o %wwork,or an owner who(tires an unregistered contractor ( e Home-Imp -not registered in throvement Contractor(HIC)Progmm);will nut have access to a arbitration - - ---otherprogiam or guaranty fund under M.G.L.c. IJ2A. tmportnnf information on the HICYm ra--m can be t°un � www mass cov'oca information on the Construction Supervisor License can be found at w%%w mass"ovldns . Wlten substantial work is planned,provide the i (nation.(including below: r.otal floor area(sq. R.) garage,finished basementiattics,decks or porch) "t Habitable room count Gross living area(sq. R.) Number of bedrooms Number of fireplaces Number of half/baths ,Number of bathrooms Number of decks/porches 'fype of heating system Enclosed Open Type of cooling system J. "Total Project Square Footage"may be substituted ror`"Total Project Cost" Massachusetts Home Improvement Sample Contract This form satisfies ell basic requirements of the staWs Home Improvement Contractor law(MGL chapter 142A).but does not include sbodaM language id protect homeowners Seek legal advice if necessary. Any person planning home improvements should fim obtain a copy of"A Massachusetts Consumer Guide to Home Impmvemmr before agreeing many work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulations Consumer Informmma Hodine at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor information Name CompsrName Q ,-C Street Addners(d000tusea Post Oftitt B xaddress) Cantmmm/Salecpicand Owner Name City/Tav rate Zip Code Business Address( mlinclude a strct address) re.rH/, " v/9 "7 o Daytime Phon�— ' rims Phon� City'A' 7 714q- mot 3 S Zip Cade cr Meiling Ad^/dress(tt difkrent from miouct Business Phone I Federal Employer 0 or S.S.Number Nomcl�.o.®rCop�n�m a4 amn� Jere I+s rry�m�eremrbme �r� aww�aaw ��2 0 8 9 3 /Z11 .vJIJ rRmnaa•a•mM The Contractor agrees to do the following work for the Homeowner. (Describe in detail the wort,to wmpktedd,,specifying the type,be end,and ggrrad� �e of materials to be canal, uddidifi m h 'f .) d, U l l !/" rtN T /O s Q . Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowners agent: be adhered to unless circumstances beyond the contractors control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work. MGL chapter 142A.) - Date whea contracted work will be substantially completed. Total Contract Price and payment'Schedule The Contractor agrees to perform the work,famish the material and labor specified above for the total sum of. Payments will be made according to the following schedule: $ upon signing contract(not to exceed 1/3 ofthe total contract price Qr the cost ofslecial order items,whichever is greater) $ by_/ / or upon completion of f ) $ by_�/_or upon complctim of 77�[%Lt/ 0 k7 S7Sf/f/_ upon completion ofthe ramtlap. (Law forbids demanding full payer t until contract is completed to both parry's satisfaction) The following mafuinyaquipment mull be special E to -d or ordered before the contracted work began nr order I o meet the complpfon schedule(••) E o be for NOTES:(•)Ineluding all firutnce charges(••)Imv requv¢ulue any depmit nrrown-payment regaind by the commenin bdore work begun may rim exceed the greyer of(a)onNhird ofthe mml contract price")the the actual error ofmry special equipment m matom made material which must be special ordered in advunce to meet the camplc ion schedule- E W �rs en ezmessw be' ......:a tr ❑N ❑Y tall fth #b lambed th 1 Subrontractors-The contractor agrees to be solely responsible for completion ofthe work described regardless ofthe across of any third partylsubcontramor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for matgrialsandlaborunderthis r t Con Acceptance-Upon signing,this auctioneer becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautious and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understated it. Ask questions if something is nuclear. • Make sure the conamarrhagn valid Ron— subcontractorsM cot C trap R ' fmti The law requires most home improvement contractors and to be registered wrtlr due Director of Home bnpmvanwt Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the mnirapor have insurance? Ask the Counselor forhis insurance company information so that you cm confirm coverage,or ask to see a copy ofa`proofofinsnrmce"document. • Know your rights and responsibilities. Read the Important Information an the reverse side ofthis form and gel a copy ofthe Consumer Guide to the Home Improvement Cofactor Law. You may caaml this agreement if it has been signed at a place other than the mammon's normal place of business,provided you notify the contractor in writing at his/her main once or branch office by ordinary mail posted,by talesman sent or by delivery,am later than midnight ofthe third business day following the signing of this agreement. Sce the attached notice of cancellation form form explanation ofthis right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM tennis®awl cops ardor watran mmrxenmplctd and sia,m.one wmauawJ aomme ram ,.7ae OaormArpa,aax . IV homeowner's Signature �e� Combustion's Signature Da a Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless - both patties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration fine which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provid In Massachusetts General Laws,cha ter 142A ? �- AVA ° Homeowner's Signature Contracto s Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way,even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not property registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fond provisions of the Home improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). , Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully exceuted copy of the contract,and the three day rescission period has expired. Accelerated Payments - A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself j to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: - _ Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at httn,/hvww.mas's eov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: - Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the IIIC website at httn'//www mass-eov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: http-//db.state.nia.us/honieiiiiprovement/liceiiseelist-aso For assistance with informal mediation of disputes m-to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 vosion 2.1-11=010 File C'Ol zt--ton;veac'tiz of rvassecl?z!se2as 1Depat7Yzent of xncli<s aalA_eearle zis 1 Congress Street,Su&e 1 o@ BOSIO€£,IWIA 02114-2 01 7 xrlvlvrrlass gov/a;Il rkers'Compensation insurance Affidavit.Builders/moo-tractors/1Iectricians/Pluathers. Aolicart TO BE FILED 6yITi-I THE PERIMITTING AUTHORITY. Information NaMe(Business/OrganizationQndi,,iduap: AdntiC Address: City/State/Zip: Phone#: q 7 g - -I fi t Lt Arc you a employer?Check the a — [ Lit? ppropriate box: 1. !am a employer with �,•� Type of ptro,{ect(required): employees(full and/or part time).= ❑1 am a sole proprietor or par[narship and have no employees working forme in �' ©New construction am•capacity"[I�ro,,rorkers'comp.insurance required.] - il. Remodeling 3.O1 am a homeowner doing all urork myself[No Workers'comp"insurance required.]t 9- ❑Demolition 4.L7 I em a homeo,,mer and,,ill L-e hiringlcontmctors to conduct ail reork on my pmpery•. 1 will 10 G Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 11.0 Electrical repairs or additions �.�I am a general Connector and I have hired thesub-contractors listed on ihe�attached sheet 12-Q Plumbing repairs Or additions These subcontmctots have employees and have workers'comp.mmm e,; Ii-QRo frepairs d.�(Me are a corporation and its oGtcer hl ve evereised their rieFit of per NIGL c- FJ I S�,tl u I�. Other �_ �6 r- a (J,and we have no employees,[No workers'comp,insurance required.] Any applicant that checks box 11 must also fill out these UZ below showing their worker,'compensation policy information. t Homeonners who submit this attidaait-ndicating they are doing all work and then hire outside contractors must submit a new affidavit indiatine such. Contractors that check this box must at cc en additional sheet showin_e the name of the sub-contactors and state whether or not those entities hmre employees. Ifthesub-contractors have employees,[hey must provide their warkem,comp,policy number. t am all isffOlt.e;npfoper that is providing tpl rkers'coinpe;uatfon lrtJOriita fnse;elzcefor nip enrpfat=ees Bef011 is thepolicp avid job site Insurance Company Name:_ (11t'L ck 1 Policy'—-Or Self-ins.Lic.;;: i 70 / 1 Expiration Date: Job Site Address:= / (� /I ' f c-(JYr�Ct J�.1 At`ach a copy of the .vorl,.ers compensatro olicy declaration page(shotvingt the y/Stpol�y nu��� eApiratio 0-7 /n d e)- Failure to secure covetage as required under VIOL C. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP��41ORK ORDER and a fine of up to$500.00 a day against the violator.A copy ofthis(statement may be forwarded to the Office of Investigations of the DIA for Insurance coverage verification. I d0 hereby card nder the is Itfes o .v`7.1,e'{�!rl+drat the 6-rfonnatfon prordded above is trtle and correct. Sisitature- ._ -I- - - - -- — Date• o�,/� - Phone ?jj- 7qL+-i? - Official Ilse ojzIj: Do not write in dtis area,to be cola leted b= p J city or torvt official. City or T6R?• Permit/ icense f IssuittgAuthOrityt(circle one): __. -Board of Health 2.Building Department 5.Ci �Or2CIer: .� IeLicalinsectorb.Other 5.Plumbing In Contact Person: Phone P= ls� 'y>jpo:.-[s •`Zs �U. 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THIS GERTIFICATEl OF INSURANCE DOES NOT CONSTITUTE A CONTRACT EtETULJEEN THE ISSUING INSURERS}, AUTHORIZED RL-PRESENTATIVE OR.PRODUCER,FlND THE CERTIFICATEct HOLDER. theop ter s an I.the cefdflcatel fiolder is an ADDITIONAL INSUF.ED, the pOlicy(ies) muse be endorsed. SUBROGk T(ON IS WAIVED,subject to cEie Terms and condMOTIS Of the Polley,ceYrain policies may require an endorsenent. A statement on Phis certificate does not AIVE rights to the C2rtiticate holder in lieu Of Such end orsenent(s}. PRODUCER CONTACT P',ESt rL� =s SL=aaCe GSOia� may,(-' NAME.- Const=at;lon 233 S+lest Cep' PHOD"m Et- tE00)333-723a FAX °-mil St ATC Nn- -"W.L ADDP,EES- va�icL =@ 01760 INSURERB AFFORDING COVERAGE MAIO ON INSURED INSURERA-h elle P=Otection gas. Co. Ia_1360 Atlantic T•Sea-ter e,--_zati r INSURER 8ITau..iius 3as-a_aace Co 61 Rear 6-e__e=sor- kveaee INSURER C: WsuRERn: Sale _� 01970 I.MMERE- ' COVERAGES NSURERF- �ERTiFIG9TE N-tiM3ER.�FASTl,R 2015 THIS IS TO CERTIFY TSTA THE POLICIES OF INSURANCE LISTED BELOLAI HAVE BEEN ISSUED TO THE INSURED REVISION NAM p gBp{/E EFORR THE POLICY PERIOD INDICATED. NOTUNTE ISSUED ANY REQU1RE'NIENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT B0V RESPECT TO WHICH THIS j CERTIFlCATE MAY RE ISSUED OF MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS WITHSUBJECT TO ALL THE TERIyiS. E::CLUSIOMS AND COS 1DITIONS OF MAY POLICIES.LIMITS SHOViM MAY HAVE BEEN R IiJSR EDUCED BY PAID CLAIMS. LTR TYPE OFUJSURAItlCEI 'A LISUBI� INSR WV PDUCY EFF FOUCYp(p GENERAL UAeIUTY POUCY NUMBER M61Np I ftV81nO/YYYY1 LRdIS IL CO0.9PLERCIALC-TERA,LUABILRY EACH OCCURRENCE IS 1,000,000 PREMISES c'ac- I CLAIMS LeOE OCCUP,,, 35000i2816 MAGI 0 im�c= 5 50,000 /20/2015 /20/2016 MEDEXP(Anycnaparson) Is 5,000 PERSONAL&ADV INJURY IS 1,000,COO GEN'L LILY FGTAT�E LP.41TAppDES PERT GENERAL AGGREGATE S 21000,000 I�POLICY I p_i ?R�- LOC PRODUCTS-,m.. PAGG I S ? 000 AUTOMOBILE LIAeOn S ANY AUTO COMBINM BINGLE LR A N ( IEaamdeal S 1 000 ODD AUTOS OWNED SCHEDULED ' ff AUTOS 020015671 BODILY INJURY(Perp�soa} s � HIRED AUTOS I — ''ION-OVWEp /20/ZOIS /20/2016 AUTOS BODILYWJURY(Peraecasrl) S I-- PROPFJiTY DAF.UIGE (Paraccdsni S s' UMBRELLA DAB I=I OCCUR I PIPAasie S ' EXCESS UA6 I�CLAIMS.^ E EACH OCCURRENCE I S 1,000,000 DE D I RET'e4T10Ns _60 0 0 58 65 8 AGGREGATE S 1,000,000 4VORI(ERB C865PENSA7IQN /20/2015 /20/20156 AND-R.IPLOYERE DAB1O: I 5 'NY FF.OPRITOP✓PARTNEfiIEXECIRRcAllI TV✓CYS`TATLL) OTH-I O`=ICEPJhIEJEEP.IXCLUOEOt MIAI I(ITandsmry in NH) _ I EL EACH ACOMENr I s II yes,d S under DESCRPT ON ION OF OPERATIONS haIc EL-DISEASE-EA.-wPL S POLZILI^rOIP -` �-F+rTF I t EL DISEASE-POLICY UMIr s cb200378613 µO/1/2014 O/i/2D15 I GENERALAGGREGATE 51,000,000 CRIP 11ON OF OpeRATIONS/LOCATIONS/VEMEA POLLUTION CONDMON $1,000,000 CLES(Attach ACORD'1D7,AtldrTloml Rema&s Schedule,ii mors spaceis rsauirsd) '.TIMCGTE 1-101 DER C,?NCEU 3FiON SHOULD A"NYpiRA OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CS=i' OL+ S?T.r, THE Fn'PIRATION DATE THEREOF, NOTICE ACCORDANCEI MULL BE DELhrEpM IN 93 'v�7ASSi25'lG2pn? 5�`REET NlTH THE POLICY PROVISIONS. Ct1=r V, m Q1970 AUTii01'D;Ep REPRESENTATVE I i COP.POR:AT[ON. A7,..iu1�4s reseva�. t Massachusetts -Department of Public Safety �• Board of Building Regulations and Standards %tan:nronaer 1(11 o�'Ct�tnunr/rae/h ' Cunstructiou Supervisor C$j;F0lMPR e onsumer Affairs&Business Regulation License; CS-067977 OVEMENT CONTRACTORtion 142089Type: ERIC W PALM iration: 3/'1212016 Ltd Liah0ly Corpo:; 3 M.TON ST s ` Salem MA 01970- "s' i - ATLANTIC WEATHERIZATION LLC. ERIC PALM - �„[�� Expiration 61R JEFFERSON AVE - Q�— Corrmissioner 04/2312016 '- - SALEM.MA 01970 Undersecretary -• - .<. _ - - �. --. __ _._ . ... Wit. _.__ , Unrestricted-Buil Bu ildings of any use group which contain less then 35,000 cubic feet(991m')of License or registration valid for individnl use only enclosed Space. before the expiration date. If found return to: i Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 G� Failure to possess a current edition of the Massachusetts } State Building Code is pose for revocation of this license. '- For DIPS Ucensing information visit www.M Not valid without signatureass.6ov/DPS 4 i