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13 LUSSIER ST - BUILDING INSPECTION t The Commonwealth of Massachusetts Board ul'Building Regulations and Standards CITY Massachusetts (yF SALtM Slate Building Code. 780 MR, T"edition C' RvvisrJJmraery Building Permit Application To Const , Repair. Renovate Or Demolish a One-or Two-F mi v Dwelling This Secti4 ForlOfficioll Use On Building Permit Numbe : ate Ajlpfi J Signature: _ ''�'``�� Huilding Cummissionc nspectur of Buildin Dale SECTION 1:HTE INFORMATION 1.1 P%party Add 1.2 Assessors Map dl: Parcel Numbers L la Is this an accepted street?yes no Map Number Parcel Number IJ Zoning Information: 1.4 Property Dimensions: Zuning District Proposed Use Lot Area(sq 11) Frontage(11) 1.5 Building Setbacks(R) From Yard Side Yards Rev Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zoo*Information: 1.8 Sewage Disposal System: Public❑ Private❑ zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if es❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ow art of Record S1— Name(Print) Address for Service: r77 k- /l_S Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction O 1 Existing Building Owner-Occupied ❑ Repairs(s) Cl 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. O 1 Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work': i NSM-1 .Dll -feolT i ice- /�� NrXjti �✓l 2�'' 1�/a o� SECTION 4: ESTIMATED CONSTRUCTION COSTS Item' Estimated Costs: 011lelal Use Only Labor and Materials I. Building S 2116, I. Building Permit Fee: S Indicate how fee is determined: O Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost(Item 6)x multiplier x J. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees:S Check No. _Check Amount: Cash Amount: 6. Total Project Cost: S �, yb 0 Paid in Full ❑Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES IF 5.1 Licensed Construction Supervisor(CSL) j 7 7/�/7 y�/)FirliY ��lJ r �n nse Number Fxpiraliun D-ju: Name of CSI.• I Ialdcr CSL Type(nee below( (J h S�Oiry c �/ SA'�rn ' Ixaeri ion (InresricteJ w)S,000Cu.Ft.Restricted IA2 Famil DwellinSidra use M onl Residential Roulin CoverinI'depMme I Residential Window and Siding SF I Residential Solid Fuel Burning Appliance Installation D I Residential Demolition 3.2 ReghterSA Home Imyrpvemenf Contrsclo►(HIC) J r�ry CC�r� �So/< �,Tr s I IIC Company Name ur HIC 7istrani Name Registration Number /7F-kA S''-,as/b Expiration Date Si 'releplusm SENM/10111 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. ISL/ 2SC(6)) Worken 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. Silowureofowner Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION ,;", &� z ,,-, �Uy���i6rPas Owner or Authorized Agent hereby declare that the statements and ififiarmation on the foregoing application are we and accurate,to the best of my knowledge and behalf. Print N a c Signature of(honer or Authorized Agent Date iSimned under the pains and penalties of 'u NOTES: Lof Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor t registered in the Home Improvement Contractor(HIC)Program),will ad have access to the arbitration gram or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and nstruction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS, respectively. en substantial work is planned,provide the information below: oors area ISq. Ft.) (including garage, finished basement/attics.decks or porch) iving area(Sq. FL) Habitable room count of fireplaces Number of bedrooms of bathrooms Number of half/baths healing system Number of decks/porches cooling system Enclosed Open tal Project Square Footage"may be substituted for"Total Project Cost" HomeCare-Solutions 6 Scenic place �� Salem,Ma 01970 Office:L (97s)4 1337 3 Fax:License 336A044 ,,,1 HIC License#133783 CS License#77147 Put Your Home In Our Handal ]'WINDOWS AND STORM PRODUCT SPECIFICATION CHEST Buyer(s)Name Date of Contract S hea ) e I!L I14tn 1 9 Z.S by Buyer(s)Street Address,City,State and Zip Code Daytime Telephone Number Evening Telephone Number Mobile Tele hone Number E-Mail Address The Suyer(s)listed above hereby lolntly and severally agree to purchase the goods and/or services listed below,in accordancs with the prices and terms described!on this Specifcation sheet no the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification Sheet Is a pan. /— WINDOW REPLACEMENT ,fir Remove and di ose o.# t� YT` �' ntnl erg existing windows. siail #_ g new ------ 0 /- windows: Vinyt ❑Wood (ManeManu act Options: Style C. Grid pattern I/ Color Interior j /R Color Exterior (/./jj - Glass Type LC;Lu L %>/ rap exterior trim with aluminum: Style �17.�s Color (xJ 4, windows will be installed according to the installation procedures in the portfolio, sulk all interior and exterior edges. sylats where possible around new units,nsulate window weight pockets it exist,and around new window units where possible, nc uped in this proposal are set up,clean up,Hepa vacuum and cleaning windows inside and out. wlding permit included. BAY/BOWS/CASEMENT UNITS/ANY FULL CONSTRUCTION WINDOWS /9&'1AA ,-'C` ❑ Create new window opening by cutting through existing home and framing in opening. Jt ❑ Remove and dispose of existing unites)in its entirety. Note:Electric and plumbing may exist in wall and will require additional costs to customer if need to be dealt with. ❑ Install window(s)into opening(s): Note: If Bay or Bow installation to include cable support system,new roof system(matching color as close as possible) or tie into existing soffit system. ❑ Bay ❑Bow ❑Casement the,window(s)to include new interior style trim and new exterior style him and head flashing as needed. f,(n,� LJ r)�. 7,9r A / ,q� kj❑ Note: Painting and staining not included. TC.. // , V`� -L-fl —� !/'C-I(� STORM PRODUCTS ❑ Remove and dispose of# existing storm window(s). ❑ Install new storm windows# Manufacturer Style Color Option ❑ Remove and dispose of# existing storm door(s). ❑ Install new storm doors# Manufacturer Style Color Type: ❑Aluminum ❑Solid Core SPECIAL INSTRUCTIONS: t Tv C 4 V6 '°' T z Fcnv, nil On Gyo X is agreed and understood by and between the parties that this Spacificatton Street,alone with CUSTOM REMODELING AND IMPROVEMENTAOREEME ZtM1e entim untlerstnnding twrwean the pertlee,entlthere ere no verbal undemtandirrga Man In Or moll In an tcan4Xutea evr modified or veiled in any way Oslsae auM changes are In writing and signed by both the B a g Yet The N Thla eomraH may n hengad or re has read this Specification Sheet g /{ Wer(a)and the Comraetof. ar(a)h by Z edge t t B y (e Conmac nt I Date: / Z. //� _ ` ( D Buyer's Initials ate:_t( .L(J,�'�.J v