143 NORTH ST - BUILDING INSPECTION 76- i i 2q Z
ILI The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
U4 Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Ap ted:
Building Official(Print Name) Signature Date /
SECTION 1: SITE INFORMATION
1.1 Property Ad it ; 1.2 Assessors Map& Parcel Numbers
I.to Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(m
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 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2. Owner]ofRec rd as p I 0 i ,` 6j� �n
e C P l / m/ A/" ) f/Yt /y�N l)
Name(Print) City,State,ZIP
Loa k0A tsf- . 0. v
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units Other Specify: f it)1,661JI,
Brief Description of Proposed Work':
W i Gv17r/)�
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 00 —;to Py—
LMAI.L.w T) License Number Expi anon Date
Name of CSL Holder
List CSL Type(see below)
Q •
No.and Street Type Description
I/VI ,n /�U iy r„� U Unrestricted(Buildings u to 35,000 cu.ft.)
d � LV�T "I R Restricted 1&2 Family Dwelling
�ei /Town,State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
q SF Solid Fuel Burning Appliances
k)I (wi-)VhSUJ 1 Insulation
Telephone Email address D Demolition
5.2 Registered H me Improvement Contractor(HIC) st t7
l /3
0 ' +Ur�� HIC Regist
ration Expiration Date
HIC Comp'a1ny�N a, a or H C Rcstrant� N �
�. o u �P y N 1 O!
o.and Street Email address
o
Ci Town, State,ZIP Telephone _
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 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 the building permit.
Signed Affidavit Attached? Yes .......... N, 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 t� (`n(�,{���(�IC
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) ate
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application i�e and accurate to the best of my knowledge and understanding.
a
Print Owner's or Authorized Agent's am (Electronic Signature) ate
NOTES:
I. 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 not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/d/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.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
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
08/05/2014 10:22AM 7615929746 E B WINDOW PAGE 02/02
John E. Lyon Condominiums Trust
143 North Street
Salem,MA 01970
July 25, 2014
EB Window and Siding Company
756 Western Avenue
Lynn,MA 01905
Atm. Kathy Byrne
Dear ES Window and Siding Company:
Please be advised that 143 North Street,Unit I is permitted by the John E. Lyon
Condominium Trust to replace the windows in their unit.
Sincerely,
Rebecca Maloney,Trustee
John E.Lyon Condominium Trust
CITY OF'S.U.EM, iNLksSACHUSETTS
BUUMLNG DEPART MNT
120 WASHNGTON STREET, r FLoat
TEL (978) 745-9595
FAX(978)740-9846
KI\tBERLEY DRISCOLL
MAYOR THo&w ST.PIERRH
DIRECTOR OF MBLIC PROPERTY/BUUMLNG CONMUSSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions o£MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:,
(name of hauler)
The debris will be disposed of in :
.(name of facility)
(address:of acility)
'o /
signature of pc nta pL
da)
dcbrwitrdoc:
T
co� 0 n I'n SU 72 n 42 T)u,=-,a b
-
A On.i_ 32 pt Imiorrantiou leas-, Prim Lea:b1v
4
A dcLl�s: AIR
Gvv =:at-/zip:Z��J&n Mal Phone --':(D v ) ,59,2 1 2 c/ 7_
.A,re v o z:an emplover? Cbeck the avpropritae bo:c:
1 Tvr--of projeci(required):
4. ❑ 1 arn 2 RCI—,-Tal CO.BZ-ICMT and [
tzao- a employe;%�rifa (a - 1 6� Newcoasauctom,
--loyees, (fuLD and/or pan-tmme).* have hired the sLb-coD-aac-.o
T listed on the a=cbed sheet 7- Rc—modeling I an a Sole Proprietor or pwmcr�
sh-, and have no e=loyees 7bese sub-conmacions have 9, Demolition
-a:'rkimg for me IIl Smy capacity workcrs' contp. irsuramcc.
9. Building addiocn
"�O�kets' corm. insurance We area corporation and its
Their
eXCTCi
10.F—I El ectricai r-pars or additions
_outdo] omce7l haves-ed.
'I T am a homec,,Nm—doing all work T per Ej=61 Of eXC=TiOD 1. MOL 11.❑ Plumb-Ig rcnaL-s or additions
cornp- C, 1527 S 1;1.), and vve�Lav-no
tlf �I lo worker I I El hoof repair
irazzance requi:ed.l cmployaes. _N'Lr o worker,'
comp. insurance mquired.1 13.1�j Other
.:,-Iy a=! zhw--h—CUbox fl mug also ffli out The s mon bclo.t howrng their in&=n0a
SUM z C m'hire cu=de corrm=7z=.,_n zuIxni!a nrawEida,it i=d catinv_who suixnntnis affida,-,'ir4i alm,the"are doing rJI'Nork=d th
LC== mr,that check this bps rwzz ar=hcd sm add;timal sheet snowing the name of the sub=tre_tors and their women.,'zarr.T.Policy i�t -Drm_60m.
,ram.art e.nolo-verthar is providing wor)terecompensarion insurance for my employees. Below i3firepolicy and job sire
Insurar-C.-Corapany N'ame:
C ScLrins, Lic. # eZbw�4—*)o 76)�2 A ? Fxpir adouDa(te:
Job S'a - ddr- S: & LQ t Sdtm civ, SL eizip: �dpj7
n , Mlfi 'V
Artach a -opyof the", rkers' compensationnpolicy decinration page(shoNving-the policy number and evpiratioa date).
Failure tosecuTecoverage as requiredu.n der SectioL,-"-Aof.,VGLc- 152 can lead to the imposition ofcrirrenalpemakdes of a
a 0 oeuDm�l._�Q 00 andioT one-year i zip.riscrunent as well as civil*penalties in he Form of a STOP WORK ORDER and a time
of up to S-1 50.00 a day against the-violator. Be ad%�.scd that a cony'of 0'�-smternemr ra2v be for;vard"-4 to the OfFic-- of
of*he DIA for ins=ance coverage venni canon.
I do hereby cemjy under the pains and per:aliles of Jury er d=Me informarion provided b ve is rrue and Correct
A
aX L 0: Date
Phone L/
only. Do not i-rfre in this area, to be coin-plered by ci:y or rown of3cia-I lI
issuing AL-boriry icircle one):
i c f Heall f h 2. B u i I di_n ol D ep amt ci �7wClark e�z ri ca r Zsn ecl Or S ?1 um-b i T as ei= rrm -
Crtt'
stnM p t
i
i
i x Y
i • , # r s
is,
C1MEIMPROVE, f�1 �t�t�C�i�1C1®�2
�gistratio-n: 128fZ4
�ti�dtim ► 2t45 DSA
#i)SY"R,NE Vi11NC9f��lJ Gt�
@itUi�NA SYRNEr j
7% Tom[AVE i
} C19tClre
� .riF ri
r
%ii
Test Method:
AAMA/WDMiJC SA 101/I.S.2/A440-08
and CSA A44081.09
Max Test Size"SX96 "-- "----
Window Size-.?7.ix52.25
PG30 - I 214-900767
� ���IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII III
FiI-SIDE
NFRC WINOOU COMPANY
MODEL L201 - DOUBLE HUNG
Na Raun Feneslratln CPO' RI-S-R-I1-05582-00002
Rating councltE
I SOLID UINYL - UELOED - DOUBLE GLZO
� 3/4 IG, SS LO-E. RRGON, GRIDS < 1"
VP ERFORMANCE RATINGS
U F3ctrr Solar Heat Gain Coefficient
0. 30 ; 1 . 7® I0 . 28
-
_ A_DDB_TIC►NA ific�s�I
..... �.M: .__....,,_,..1,„.,_._.,.
Visible 7ransmit�- PERFORMANCE RATINGS
)
tance - ---
0 . d*0
�Nanututurer stipulates that 1'ese rating,ccnform to applirabte NFRC pd W aras for datmining whols
protluct performance.NFRC r tinge are de:ermioed tx a fired;e;of eroironalental conditions and a
specific producl5ize.NFRf,dr s net reconnnend arty produ l arid does nol warrant the suitability of any
product for any specific usa t.nsu'f manotaclurer s to other product performance intormalioa.
. e..�• �:nhc.orrg
E.B. Window and Siding Co. Invoice
756 Western Ave. (Rt 107)
Lynn MA 01905 Date. Invoice#
7/1/2014 50016
Bill To
Micheal Maloney
143 North St.
Salem,MA 01970
P.O. No. Terms Project
Description Qty Rate Amount
Famish and install 9 Fusion White Replacement Windows with 1 3.500.00 3,500.00
Low E/Argon gas and a.30 U Value.
Remove old windows and storm windows.. Insulate weight pockets 0.00
with fiberglass insulation.Add unfinished pine insides 4"jambs.
Caulk inside and out with"Fite-Bond Lifetime Sealant.. Remove all .
job related debris.
Lifetime manufacturers warranties.
Angles Discount 1 -350.00 -350.00
Any building permit required to complete project to be added at cost 1 0.00 0.00
to the final payment
i
E.B. Windo eprese t
Thank you for your business. Subtotal
$3,150.00
Sales Tax (6.25%) $0.00
Total $3,150.00
Payments/Credits 41.050.00
Balance Due $2,100.00
Phone# Fax# F-mail Web Site
781-592-9747 781-592-9746 ebwindow@msn.com www.ebwindow.com
K—P zz
-Nu
; N---J'RA-NCEE- POLICY
NFOR.-MA"'ON PA3-
A.I.M. Mutual Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
(8001, 876-27650 NOO i NC 28�,562
POLICY Nv.
7=1- av;.ns W.Indow--C7.-E.ny
a: n G1v.S s s: 756 vVestarn Ave
g Y'- -2.5
L ag a E n tt i T y'p 5: S,,ie
sno"'m' a Sq-: L'oa+inn
t ont, 4 2:r
DI L r
A ;r-!i a"i� wonk=�o�l w-:C- oV'S Compan sal— aw
Da: Psn Tw:
Sm S.A
are: Bo
ace jetscst Enc-zfse"'Cn'Vic Ca 0-At
'fa
4 T t,G ore -o?tr;LS VJ 1 i ri tbe e j el-a m,i I d oy C t 1, 4-j,-Tsjs o� It -zt:aj' -�a n$.'a
t-n rso'�'l�rad ZS—' 'S
N C4,c.
a 7 s rat
N T R;k 5 C4:
Me'n!"num PISMO- T P
GOV Gav,
CLASS
MA. 5+51
ne"Gbi
S'DO S
Sar'llos C-;'S'
sn.';-� ce Agency
54w 7n.rd Aver Ue
MA OtQK3 D
VC 001 CC a, A (7,1
C!the N'Stional
Um ft v '6,pe,m' sSicn.