6 LORING HILLS AVE - BUILDING INSPECTION (9) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CMR, 7'edition OF SALEM
ReviseJJunuun-
Building Permit Application To Construct. Repair, Renovate Or Demolish a
One-or Two-family Dwelling
This Section For Official Use Only
Building Permit Numbe Date Applied:
Signature:
Buildi �C=missioncvyrnJpcctuWo uildings Date
SECTION 1:SITE INFORMATION
I.lapiroh"is'
t�.Addr ss: 1.2 Assessors Map& Parcel Number
( tea { �1I I4 �10
I. an accepted street? no Map Number Parcel Number
IJ Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use La Area(sq 11) Frontage(it)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40,§54) 1.1 Flood Zone Information: 1.8 Sewage Dhposol System:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if es❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owngt of Recor
\ d
Name(Print) Addrea for Service:
�o Cry- ter �l
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(cheek all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work-:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: 011lclol Use Only
Labor and Materials
I. Building S 1 I. Building Permit Fee:S Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
❑Total Project Cost(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (IIVAC) S List:
5. Mechanical (Fire S
Suppression) Total All Fees:S
Check No. Check Amount: Cash Amount:
6. Total Project Cost: S ❑Paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
S.I Llccnse4 Construction Supervisor(CSL) I.ic ense�(�/]�
V111 Y1��.����1 lg lVumbn I:vpi wn Yute
Name of CSI. 1Io1Jer List C'SL Type(see below)—�_
( Dewriotion
WJres U I IIrimstricted(up to 33.000 Cu. Ft.
R I Restricted IR2 Famil Owellin
Signature M f Masonry Only
3 3 RC Residential Ristifing Covering
NtepMme WS Residential Window and Siding
SF I Residential Solid Fuel Burning Appliance Installation
D I Residential Demolition
5.2 RegisteredKpir Im ve rect HIC) �� �gLq�r��_
I IIC C m an Name orIIC Re 1 Regislr.)ition Numl cr
o '
AJ res 1Q1 4T3 5'-2(33 Erpimli
re 'rclepMate
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. IS2.! 2SC(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...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 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
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
1 ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are We and accurate,to the best of my knowledge and
behalf.
ri�
Prim N4ne /
Signatu ot'< ����
ner or Authorized Agent Date
Siti2gj undef the eains and penalties of 'u
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who him an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will=have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 7110 CMR Regulations 110.116 and I WAS, respectively.
?. When substantial work is planned,provide the information below:
Total floors area ISq. 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
T)Ise of cooling system Enclosed Open
). "Total Project Square Footage"maybe substituted for-Total Project Cost"
08/09/2010 12;41 15087568823 THD AT HOME SERVICES PACs_ 01/07
HOME IMPROVEMENT CONTRACT
t - PLEASE.READ THIS
�w A
.7 Sold.Famished and Installed by:
Branch Name: Basing Date: / a THD At-Home Services,The.
d(Va The Home Depot At-Home Services
345A Greenwood Street,Unit 2,Worcester,MA 01607
Branch Number:31 Toll Free(8M)657-S 192; Fax(509)756-8823
Federal ID 4 75-2699460;ME Lie 0 C 02439;RI Cont.Licn 16427
r ,, r1 `r Lie N 565522:MA Home Improvement Contm;W Rego.0126893
Installation Address: � 1�K'1�'' � �`S + _s�.��P.r+� ►YI a 0' r d D
City State Zip
Rrrehwer(s)l Work Photon Hoare Phoau: Cog Phu
vty— taw A-6Ic IJ
Home Address:
(If drwerent from installation Address) City State Zip
E-mail Address(to receive project communications and Home Depot updates), 5 k 1Al ' V 1 CT o 1L G Jl01411- • (t7N.
❑I DO NOT wish to receive any marketing emails from The Home Depot
e rn o � Undersigned("Lustomer").the owners of the pioporty located at the above instalrition addrom,agrees to buy,
and•T$T� i- ome Services,Inc.( ABC Horne Depot")agrees m famish,deliver and arrange for the installation(`Installation")of
all materials described on the below and on the referenced Spec Shect(s). all of which are meerporsted into this Contract by this
reference,along with any applicable State Supplement and Payment Summary.attarhed hereto and any Change Orders(collectively,
"Contract"): .
Job ti: rtrov.rx"rtn+ea Sheet(s)8: Pro eet Amount
oofing []Siding nxlows ❑insulation �j r% $ -^7 ara
f 3 ❑Gumots/Co ❑Entry D—s ❑ 4_/ Z Lf
�-j-- LJRwGng 13Siding Windows ❑Inanlazion $
J ❑Ounen/Covers ❑Envy Doors ❑
Ranfing Siding Windows insulation $
❑Gutters/Covers ❑Entry Doors❑
❑Roofing Siding Windows ❑Insulation $
❑Gutters/Covers ❑Entry Douro ❑
(� Mltamnm 235'n Deposit dCmtmd Answer due upon execution alibis contract Total Contract Anunsnt $ r1 -7-7 �
V� Maine Purchases not deposit more than ospthird al �the CtmAnmt m d
Customer agrees that immediately upon completion of the work for each Product Customer will execute a CompletionCatiBcate
(r (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable, each Customer under this
vv Contract agrees to be jolndy and severally obligated and liable hereunder.
The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,a
its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural
problem with the home.environnwnul hazards such as mold,asbesms or lead paint,other safety concerns,pricing errors or because
wodt rtx)uired to complete the job was not included r contract
Pa it Sum cmary: The Payment Summary p 1 a k , included as part of this Contract. sets forth the total
Contract amount and payments requited for the deposits and final payments by Product(as applicable).
NOTICE TO CUSTOMER
You arc entitled to a completely filled-in ropy of the Contract at the time you sign. Do not sign a Completion Certificate(note:
mere is Me Completimt Certificate for each listed Product as defined by individual Spec Shays)before work on that Product
is complete.
In the event of termination of this Contract,Customer agrees to pay The Rome Depot the costs of materials,labor,expanses
and services provided by The Home Depot or Authorized Service Provider thrvrugh the date of termination,plus any other
amounts set forth in this Agreemeot or allowed under applicable law. THE HOME DEPOT MAY W ITHROLD AMOUNTS
OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADF, WITHOUT
LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS.
Aetxmtance and Authorization Customer agrees and understands that this Agreement is the entire agreement between Customer
and The Home Depot with regard to the Products and lnstallaion services and superscdes all prior discussions and agreements,either
oral or written,relating to said Products and installation.This Agreement cannot be d or xmcnded except by a writing signed
by Customer and The Home Depot.Customer acknowledges and agrees that Customer ha. read,unde ands.voluntarily accepts the
tame of and has eiv copy of tllis AgrecmenL
7- a $��p
Accepted by: Submitted by:
X Q/jwlo I-A6 k
Customer's Signalurc Date Sales Consultant's Signature on S � Date
X Telephone No. 0 8 �1 11 -« - 13 _-
Cusmmer's Signature Date
Sales Consultant License No.
CANCELLATION: CUSTOMER MAY CANCEL THIS (as oppnrnhlo)
AGREEMENT WITHOUT PENALTY OR OBLIGATION
BY DELIVERING WRITTEN NOTICE TO THE HOME
DEPOT BY MIDNIGHT ON TIM TTARD 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:ADDITIONAL TERMS Ards CONDITIONS ARM STATED ON THE REVERSE SLOE ANO ARK PART OF TIUS CONTRACT
5-7.10 CSC White-Bmnch File Yellow-GultoM0,
WINOOW SPECIEICATt1�ON SilEET - Spx.Sheet R: 298437 sheer of -
Consultnnc L!-fV � eT " Gate:
Cusmman
(,7 New Wmdow
0 tahoi Hingetaanans
Existing vfindow Mmsuiarn b Grids Prol:lttOpt»ns �4ar;s From awlde,
W Leh[o Pi ht
C7
a Bays,Bwrt
G- Luntion Cvlor Bough Opening adbars pof bars Cs.Ms.I PH,
GIa55 "I"'.Hardware Code Fordoorsw.
tCo,,
Mull W=operating
S s �•Ie Cade Series Code -
- 3 IG� W �,J &L s� t 3`114 9S-va W %J 3l �4S 7f6
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SPxNI meantl Cand'N os[fie Wd:dlhf sNlvn l[iraamegmry.
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:li; I in w l 1, - Dc p;it l own of public SafvIA
7 Board of Building Rceulmiun, am: Standards
Construction Supervisor License
License: CS 74722
Restricted to: 00
KOSTANTINOS S VAITIS
16 HANSON ROAD
SAUGUS, MA 01906
Expiration: 7/5/2011
f nun i:�i•iner Trk: 19412
' � �/rc �aomvnwnweaU/ o�..�i�acac�weelG .
Office of Consumer Affairs& Business Regulation
HOME IMPROVEMENT CONTRACTOR
Registratiorl 129206
t - Expiratid0 7f22/2Q11 Tr# 290357
Type DBE1'1 -
t AEGEAN CONSTRUCT1bNr
Kostanlinos
16 Hanson Road `_—
Saugus, MA 01906 Uncle,secretary
.422
!N"
: CITY OF SALEM
=� I PUBLIC PROPRERTY
DEI'AR"I•'�tENT
:.,I . •n I': \\.�,I IIv..,��1(:U.r r • 1�i l ti, Mia .., ; I . _I'� _
Construction Debris Disposal Allidavit
(r«lune d liir all denmlition and renovation work)
In accordance %%ith the sixth edition of the State Building Code, 780 CNIR section 1 1 1.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit it is issued with the condition that the debris resulting front
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
l 11. S 150A.
The debris will be transported by:
;nmVt _
name of hauler)
I'he debris will be disposed of in
(nume of laclllt
fi
laddrusn u(I'acilim
Ur of pennn applicant
I L
V.
... ..::: :. ... l.._.
4.. -
.Address: -'kr-'�'.j'~ i , ;^sue::•• i jy ' ' ' t --
City/Stata/ZiD: �731t t a
F-krey an employer'!Check the appropriate box: Ty b-�3pe of project tresln :
I am a employer with tn 4 I a a Demerol contractor and I 6. Ne
w cmi 1iucron
rployees(fish and/or part-time).* lisle bored rota sub-contractorsached sse
r; �leliri
listed on the attached
7 B„
2.❑ 1 am a sole proprietor or partner- Th se sultcomtractors have 3- ®Demolition
ship and have no employees
working for me in any capacity. employees and have workers'working
®Buhr`-- addition
inomerce �
[No workers'eon�r. 5- Eli We
e at-a corporation and its 10.[]Electrical repays or additions
required.] ®f5ccrs have exercised d ie 11.®Phumbing repairs or additions
3.® I myself
a homeowner s'co all work right of exemption per MGL 12.®Roof re(rahs
myself e r wored-] comp. . a 152.§1(4),and we have no 13_ ram]
insurance required-] amployee&[No workers'
cow.insurance regal-] .
;Any ayp0'tt�ut ilaatrMla bus 91 mar arm fill out the sccticu ia4ovshmsria5 t�rxvdcts- P° ®fore-stioas
t Hotrcowaas rho sobrtnt his
alLdarit indicting dwy are doing all wok and the hire at6itie cwaattms mat stilsndt a nem arSdar+ti=titic h WdL
vt:
TCWn tors that check this box iawl suadwd an addiduaA Shoe Auniag lhenam"of@e9&cuuaraams aldstate s��Wnot tFmse atitieslure
c:arytoyees. utbemb-cowtr tanht cmptaym.nxymnrtaav tl✓mr cvrzp->9OJicynunib=-
I am an employer that is providing workers'compensation inwrancefor my employees. Below is the policy and job site
informatio.,
Lisurance Company Name:
k -
policy#or Self-ins-Lic.# �— motion Dab--
Job SiteAddreces: City/statelZip: lafllb(� F'IL.,
e a copy o the Workers-compensa on poncy
Failure to secure coverage as required under Section 25A of MGL a 152 can lead to the imposition of tzimind penaties ofa
fine up to 51,500-00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP INFORK ORDER and a fine
of up to S250-00 a day against doe violator. Be advised that a copy of this stalownt may be%ruarded to die Mike of
Investigations of the DIA for inv.ranra coverage v®fication
I do hereby certify uad p "ns a penalties ofpcdury that the informadon provided above true d correct
Si afore lP14 Da� —
Phone# !9���r�-3�
rDaly. Do not write mthis area.to be completed by cirj+ortownojJuia!
n• Permit/License#oritp(circle one):ealth 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
son Phone#