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36 OAKLAND ST - BUILDING INSPECTION cK q (oo(P' 2-4 The Commonwealth of Massachusetts x: Board of Building Regulations and Standards i CIT}'OF, Massachusetts State Building Code, 780 CMR : ��b SAL ') 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 Pin-nit Number: Date A lied: Building Official(Print Name) .. . Signature . - Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 36 OAKLAND ST SALEM,Ml1 01970 17 17-0044 1.1 a Is this an acceptedstreet?yes no Map Number Parcel Number_ 1.3 Zoning Information: 1.4 Property Dimensions: RI ONE FAM Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rem`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 0 Private❑ - - - Zone: _ Outside Flood Zone? -Check if yesO Municipal❑ On site disposal system 0 SECTION 2: PROPERTY OWNERMW 2.1 Ownertof Record: THOMAS PAINVILLE SALEM,MA 01970 Name(Print) - City,State,2IP- 36 OAKLAND STREET 978-828-1997` No.and Street - - Telephone. Email Address ;SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction 0 Existing Building Owner-Occupied 19f I Repairs(s) lif I Alteration(s) 0 I Addition O Demolition 0 Accessory Bldg.O 1 Number of Units Other af Specify:Replacement Brief Description of proposedWork2: REPLACE 8 WINDOWS - NO STRUCTURAL CHANGE SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: 1`Use Of11c1a (Labor and Materials Only 1.Building $ 11, 938 . 00 1. Building Permit Fee:$ Indicate how fee is determined: 13 Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costs(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 AinouM: 6. Total Project Coat: $ 11, 938 . 00 0 Paid in Full ❑Ou tstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 90125 10-0 6-16 Jamie Moirn - License Number Expiration Date Name of CSL Holder - - U 86 Gardiner St Lis[CSL Type(see below) No.and Street .type Description Lynn; MA 01905 - U Unrestricted(Buildings u to 35,000 cu.fL _ R Restricted 1&2 Family Dwelling CityfFown,State,ZIP - M Masonry - - - RC Roofing Covering - W S window and Siding - SF Solid Fuel Burning Appliances 508-351-2214 I Insulation Telephone - Email address - D -Demolition 5.2 Registered Rome Improvement Contractor(HIC) 170810 12-2 3-17 Renewal by Andersen HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 30 Forbes Rd No.and Street 508-351-2214 Email address Northborough, MA 01532 /Town State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I..c. 152.$ 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...........❑ SECTION 7a:OWNER AUTHORIZATION TO RE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Jamie Morin to act an my behalf,in all matters relative to work authorized by this building permit application. SEE CONTRACT Print Owner's Name(Electronic Signature) - Date - - SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I here st in the pains and penalties of perjury that all of the information contained in this application is a and a to the best of my knowledge and understanding, JAIME MORII, Print Owner's or Authorized A ame(Electronic Signature) - - Date NOTES: 1. 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(MC)Program),will not have access to the arbitration program or guaranty fiord under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.sov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dam 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Niunber 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" CITY OF SALENl* IN SSACHUSEM Bta1 mG DEPAATAENT 120 W$HINGTON STREET,310 IRWOR TEL(978)745-9595 FAX(978)740-9846 KISIBERLEY DRISCOLt MAYOR THOU"ST.PMUUI DmEcrOA of Pt;mx Pitom Y/st:UDMG COh NUMONER Construction Debris Disposal Affidavit (required for au demolition and renovation work) In accordance with the sixth edition of the State Building Cods, 780 CMR section 111.5 Debris,and the provisions of MGL o 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111,S 150A ihe debris will be transported by: Renewal by Andersen (name of hauler) The debris will be disposed of in : - Renewal by Andersen (name of facitib) 30 Forbes Rd,Northborough, MA 01532 (address of facility) si of mut a 1'pe uant PP data �ea�aa� Renewal eAnewal Agreement Document and Payment Terms IJN Ider$en' dba:Renewal by Andersen of Boston - Thomas and Cynthia Rainville Legal Name: Renewal by Andersen LLC 36 Oakland St 170810 -.- - Salem, MA 01970 WINDOW xr ucrWrDT 30 Forbes Road I Northborough,MA 01532 H:(978)828-1997 Phone:508-351-2200 1 Fax:(508)986-7072 1 RbABoslonOperations®AndersenCorp.com Customer(s)Name: Thomas Rainville and Cynthia Rainville Contract Date: 05/04/16 Customer(s) Street Address: 36 Oakland St, Salem, MA 01970 Primary Telephone Number: (978)828-1997 Secondary Telephone Number: - Primary Email:: tomrain0comcast.net- Secondary Email: Buyer(s) hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen LLC d/b/a Renewal by Andersen of Boston("Contractor"), in accordance with the terms and conditions described in this Agreement Document and Payment Terms,.Notice of Cancellation, Itemized Order Receipt,Warranty,Terms and Conditions of Sale,Lead-Safe Form,Waiver,Owner or Builder, and any other document attached to this Agreement Document, the terms of which are all agreed to by the parties and incorporated herein by reference (collectively, this "Agreement").Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total job Amount: $11,938 By signing this agreement,you acknowledge that the Balance Due,and the Amount .Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: - $p Balance Due: $11,938 -Estimated Start: Estimated Completion: Amount Financed: $0 6-8 weeks 1-2 days Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on Notes:MasterCard 6/19 the date in which we complete the technical measurements. The installation date that we are providing at this time is only an estimate.We will communicate an official date 1/3 deposit $3978 - and time at a later date. Rain and extreme weather are the most common causes for 1/3 start of job $3978 delay. 1/3 substantial completion $3982 Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understanding changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor. Buyer(s) hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement, including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. - - NOTICE TO OWNER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 05/09/2016 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, BDMWfEPM brD�Vg 1�4.ATER.SEEdFNE(ATTACHED NOTICE OF CANCELLATION FORM FOR AN F`THIS RIGHT. Signature of Sales Person - Signature Signature Steve Palermo Thomas Rainville Cynthia Rainville Print Name of Sales Person Print Name Print Name 05/04/16 Page / 14 IRIee�newal Itemized Order Receipt - "J" "'der$en' dba:Renewal by Andersen of Boston Thomas and Cynthia Rainville Legal Name:Renewal by Andersen LLC - 36 Oakland St 170810 - Salem,MA 01970 wixoow xe ueewexT 30 Forbes Road I Northborough, MA 01532 H:(978)828-1997 Phone:508-351-22001 Fax:(508)986-7072 1 RbABostonOperations®AndersenCorp.com s • ROOM: 201 Stairway - Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: Stone, Screen: Fiberglass, Full Screen, Grille Style: No Grilles, Misc: Non 202 Bathroom Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High -Performance SmartSun Glass, No Pattern, Hardware: Stone, Screen: Fiberglass, Full Screen, Grille Style: No Grilles, Misc: Non 203 Bedroom 1 _ - _ Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All High Performance SmartSun Glass, No Pattern, Hardware: Stone, Screen: Fiberglass, Full Screen, Grille Style: No Grilles, Misc: Non 204 Master _ _ Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All, High Performance SmartSun Glass, No Pattern, Hardware: Stone, Screen: Fiberglass, Full Screen, Grille Style: No Grilles, Misc: Non 205 Master - Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All High Performance SmartSun Glass, No Pattern, Hardware: Stone, Screen: Fiberglass, Full Screen, Grille Style: No Grilles, Misr. Non 05/04/16 Page 4 / 14 Renewal Itemized Order Receipt by —-`ersen' dba:Renewal by Andersen of Boston Thomas and Cynthia Rainville Legal Name:Renewal by Andersen LLC 36 Oakland St 170810 - - Salem,.MA 01970 WINDOW RDAuerse.T - 30 Forbes Road I Northborough, MA 01532 H:(978)828-1997 Phone:.508-351-2200 1 Fax:(508)986-7072 1 RbABostonOperationsOAndersenCorp.com e 206 Master Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: Stone, Screen: Fiberglass, Full Screen, Grille Style: No Grilles, Misc: Non 207 Bedroom 2 - Window: Double-Hung, Equal, Slope Sill Insert; Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All High Performance SmartSun Glass, No Pattern, Hardware: Stone, Screen: Fiberglass, Full Screen, Grille Style: No Grilles, Misc Non 208 Bedroom 2 - _ - Window: Double-Hung, Equal, Slope Sill Insert,Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: Stone, Screen: Fiberglass, Full Screen, Grille Style: No Grilles, Misc: Non WINDOWS:8 PATIO DOORS:0 SPECIALTY:0 MISC:0 TOTAL $11,938 UPDATED: 05/04/16 Renewal by Andersen is committed to our customers'safety by complying with the rules and lead-safe work practices specified by the EPA. 05/04/16 Page 5 / 14 1'Ane Coemmniftwb&of V&worAmvras Depertnaeut of ld d=tvial:lCd*xft 01fike 11111tnV14,0ettotas 600 Waseringma.fAreet Boston,A:A 02111 WWW.Mir gorNdle SNorkers' i`otntteusrltlon hours ee Aft1davit;BuDders/CantroewnXt lectriclans/Plaumbers .'i,npdegnt Infor-madon McA.so lariat lap-My I`rtunc�]iusiness�titrga %rstionMri-i Aw 1; RENEWAL BY ANDERSEN Address: 30 FORBES ROAD C.ity/Stit ,7.ip- NORTHBORQMA01532 _ p))pt it:-508-351-2200 Are 'on an eetployer'Creek fire appropriate hei ~� Type of Project inquired), 1.W I mn a employar with—_30 _ 4. Cl I am a gcaensl cwmactor and I employees(fun and;'or pa:t-time).` itave,hired the a+tl*coMractors 6. s©'�eWc�atttx 2.0 1 am a sole proprietor or pahmer- listedeet.an the attached sh : � -°• ffi Remodeling ship and have no*mployeas chest sub-cortrwaors have S. ©ilemohtirm working for ate m any cap dw- wotrer5'ramp-iasnsaner. e• 0 Building"dition iNo workers,comp.inittmncc ;. 0 We are a eorpeaa:iun and iL 10.E Eli trtrical repairs ra additiarps required.) officals have mac sed their ;.[ 17 am a hrmeotsner doing all wmk right orm--.pion per MGI. 11:0 Plumbing repairs at additions Myself:lNo worker,-'comp, c. 152,§1(41,and we have ear 12.0 Roofre pairs imurance requu )I employees,[tip*orkers' i cea'p.inanamrenx(wrr3.] 13.© 'Azv.ghpi:e wdat ahn&x lane:rrmu&:,w fdl wr the vr4am NAO,4a%-0 a dieu wvrt:-n'•ter a am zn D;p+ci:niurra . 'ikwwb%&=whir*:lmitdiie affl",,rt India&%dwymz dom#ail%ori and dsnidhena ier:wkrara;uc aurae whenasew sToliit. tuA.. fi'w bwzttns m ewd dps INra mtat a wloa m add•urend~Adwmg oar.natha cdthc va0-:;+nhamr.:and Um works[:-wWv,peaty onamatimt lawaitea byartbathprovtd7t worbera,eampenradonhisurnnceJorttiremployerr. balorr&4e �n puhkyoudjubsihe inturahce Cumpanv Name: OLD REPUBLIC INS. CO. Policy k or Sell-irhs Lic.#;_..MW(�3Q543TQ0._____.,._v,_ lixpirafwlt t7aie. 10-0118-------- Job Site Address; 36 OAKLAND STREET Ci ;:S�,L SALEM,M_A 01970 h• rap:—.—.� Attach a cM of the workers'coatpeosetion potey deciaratitm page(shmia the t; Ply nuetber and erytr>titba date). Failure to secure covetage as required under Seaton'-SA of IViGi,c. 15-1 can lead to the imposition of crimuai penahi•s of a fine up to S 1.5(10.00 athdior one-year imprisonment,as aril as civil penatties in the fo.Rrr r,f a STOP WORK!ZER wo a fine of up to S250.00 a day against the violator. Bo adviser:that a arpy of this statement may be fihrwardad to the Office of Investigations of the 1NA for insurance coverage verif?emiot. t du hereby ' mader ekepants wtdpesakks elperfaryadW the ittjor a dm pmi*kdabat,&tc bw and comet, p} .#: 508-351-2200 011Jkiaf etc Daly. tap ant wttte is this urea,/o br coaytkterf by ar Lawn — -- — oj/Pctei City or a own: Per wit/Licaase A b%ufng Authority(circle onr): 1.Board of Health 2.Building;)epart+aent I CityPr aan Cleric 4.Electrical Inspector,S.Plumbing Inspector h.Other S:ootaet Person: Phone ANDECOR-01 YADAVYO CERTIFICATE OF LIABILITY INSURANCE 1011/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED,the pollay(l s)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this Certificate does not confer rights to tha Certificate holder In lieu of such andorsemeld(s). PRODUCER NAME" Willis Certificate Center Wills of Minnesota Inc. PMOKE . 877 945-7878 c/o 26 CenturyBh/� Ate Now: 888 467-2378 P.O.Box 305191 .O L Cerffflcatas@Wllis.com Nashville,TN 87230�191 INSURIE1431 AFFORDING COVERAGE NAIC6 INSURERA:Old Republic Insurarme Company 24147 INSURED INSURER B: Renewal by Andersen LLC INBURERC: 30 Forbes Road INSURER D. Northborough,MA 01532 INaIIRIa1 e: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY RAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER UNITS A X COMMERCIALOMRALLIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE M OCCUR LITAMY 305440 10/01/2016 10/OV2016SPREMISESfflq�jecanenee a 500,000 are ps nm,) S 10,00( ADV INJURY s 1,000,000ENL AGGREGATE LIMIT APPLIES PER GOREGATE S 4,000,00(PROPOLICY❑JjECCT LOC -COMPIOPAGG a 4,000,00OTHER:AUTOMOBIELIABILITY I UNIF S5,000,0A X ANYAUTO MWfB 305M 10/01/2015 10/D112016KY(Perp�I) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(PK eoddeM S HIRED AUTOS PRUF�RTY DAMAGE AUTOS Per�IrbrA 3 E UMBRELLAUAB ROCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS� AGGREGATE S DIED I I RETENTNIN S WORKERS COMPENSATION B AND FRPLOYERS'LIABILITY YIN X STRATUIE ER A ANYPROPRIETORIPARTNER,EXECUTIVE MV1�3050700 10/0112015 10101/2016 ELfvLCMACTJOENr OFRCERIMEMMR EXCLUDED? NIA $ 1,000 (MaMA/aNIn NN) tlemm,r ") EL DISEASE-EA EMPLOYEES 1,000 If yM�-, DESCRIPTION OF OPERATIONS bebx E.LDISEABE-POUCYLIMIT a 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/vrHtcLEs(ACORD 101,AA,Dumml RanlMb 8ebeeuM,my W a N@gI H men apes b nqutrne) 1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED NL ACCORDANCE MTN THE POLICY PROVISIONS. AUTHOR�ErD REPRESENTATINM Evidence of Insurance %- btd'— 01986-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts-Departrnent of Public Safety . Board of Building Regulations and Standards COBrtILrltea SupervisorVIIIIIIIIIIIIIL I If , �1 I 4� LYMWA %9111 IlP�v n to.a Expiration j CawmUrlonee 70JOB1207Fi li .••. c�la��>ononvealdc o�r+.�loevo.�.rvells i. _ ee of Consumer Aiiairs&Business Regulation ME IMPROVEMENT CONTRACTOR Reglatration:: 510640 Type: ExplraNpel}_} {i X7 Supplement Card RENEWAL BY AND=rwO JAIME MORIN 30 FORBES RD ,'••�-.:..s�:•j=--- NORTHBORO0OH,MA 01532 Undersecretary 1 Renewal P byAndersenm WINDOW- REPLACEMENT nn.4:denen<:rtmPdnq WoodNinyi Composite IF Fa �tjC�rrc= Dual Argon Low E4 SmarlSun Double Hung 171 100-00473518-010 ENERGY PERFORMANCE RATINGS U-Fac tor(U-S)/I-P Solar Heat Gain Coefficient ® a2 9 W1 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance OJ2 <enbre mepPra%m4N NFAC pmxUuraabr GalermMM9wdeb Pr^Guct prb:nlawa NFPC nIMp MN OemMlMetl lerarneaml olenvimnwnlulwnEdbne wq eapenifc pretluw nrte. NfeCdoof.rxemmand wY pmtlupl med doom AM'nmrmnl INA SAM9W Ad MAY Pmtluw IOrmnY SPmZm uw. 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