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12 OLIVER ST - BUILDING INSPECTION The Commonwealth of Massachusetts FOR Board of Building Regulations and Standards ML1NIl'IP:\Li'll" t Massachusetts State Building Code. 780 CMR. 7"edition USE To Construct. Repair. Renovate Or Demolish a Rrri rd Jan0(4 r Permit Application P , Building _(p)y One- or Tiro-Famil), Dwelling \ This Section For Official Use Only Building Permit No r: Date Applied: r Signature: Buil ' g Commissioner/inspector of Buildings Date SECTION 1: SITE INFORMATION 1.1 Property Address: L2 Assessors Map & Parcel Numbers I .� 4` l _C_C S Ma Number Parcel Numt+er 1.la Is this an accepted street?yes_ no. P 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq tU Frontage i ft) 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: Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Public❑ Private❑ Check if yesCl SECTION 2: PROPERTY OWNERSHIP' / 2.1 -Owner'of Record: /� I a IeIrfSC% Re,\ \ der Name(Print) Address for Service: Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction Cl Existing Building Owner-Occupied X Repairs(s) Ni Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify: Brief Description of Proposed Work Q Cl e Vh Alt w 1 h SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item (Labor and Materials) 1. Building $ I. Building Permit Fee: $ Indicate haw 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 $ Total All Fees: $ Suppression) Check No. Check Amount: Cash Amount. 6. Total Project Cost: $ 0 Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 (Licensed yConstr C W�.uction Supervisor(CSL) a03W �O �'i�G h?.f l \h IZ \�V. \ LicenOse Number Ex Ira11U 1 Da1C Name of�L Hul�yr n List CSL Type(see helow) u Address 1� / Type Description Tf\�JV . ,f ,\ U I Unrestricted(up to 3.5.000 Cu. Ft.( - Ka R Restricted 1&2 FamilyDwellin Sign re M Mason Only RC I Residential Routin Cuvenn Te cph t �/ L \VS Residential Window and Sidra Residential Solid Fuel Burnm A pliamc In,tAlition D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) t �v" -O LW� h :2 HIC umpany ame or HIC Re istrant Name Registration Number o a Addr r 8/1/1-2 O i �S�.siyz Expiration Dal SXhariA 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 .......... ❑ No........... ❑ 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: OWNERI OR AUTHORIZED AGENT DECLARATION 1. ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of perjury) - 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(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 and Construction Supervisor Licensing (CSL)can be found in 780 CMR Regulations 110,116 and 110.R5, respectively. 2. When substantial work is planned, provide the information below: Total floors 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" 7w \<G y rIhe Commanweafth of a4cssachtuetks Department of IndustriarAccidents L Off=of lnvestigatwns 600 Washington Street, Boston, WA 02111 ---- - ----Workers'-Compensation lnsurancc-Afndavit--- - - ----- - --- ----. - - APPLICANT INFORMATION Please PRINT L,mbl, Name:_ jeelk Location: Z?O 90X > / - r� � r-7 City: 're h/ 4l � (� X ��Telephone n: i/ e 91 .�� /l �L I am a homeownerperforming all work myself.ED balm sole proprietor and have no one working in my capacity 1 Y I am an employer pro/viiding,{w�orkkeers, compensation for my employees working on this job Company Name: �_y'. / ../ /l°/�j/./��] Address: _I r C/l/, ,}g / City: yt' t'` Vr 7t- Telephoner• //7/drry�—^^b �p� -Sr7 insurance ComPnS / / Policy,".: Lz���e v�� /01,C.Q�F I am(circle one) sole pronrieror,general contractor or homeowner and have hired the contractors listed below who have the following workers' compensation policies Company Name: - .Address: City: Insrtradce Company: Policy#: Company Name: Address: City: Telephone#: Insurance Comp - Policy#: Attach additional sheet if necessary Fail.iie Fd secure coverage as reouired under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine Up to S 1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.00 a day against me. I understand that a cony of this statement may be forwarded to the Office of Investigations of the DLA for coverage verincation. I do hereby cerr:ry der pcins and pen ties ojperjury that the information above is tr4correcSignature; / Date: PrintName: , rtyj -/ � � Phone Official Use ONLY•Do not write in this area o Building Deparimenf City or Town: Permit/License#: ❑Licensing Board o Selectmen's Office D Health Department 0 Check if Immediate response is required 0 Other All Paradigm windows feature multiple Choose between no grills,traditional flat chamber profiles for superior Insulation profile or contour shape colonial grills and rigidity between the glass. Thermopane units utilize Cardinal Law E' '. with Argon gas and TruSeal Swiggle spacer for the best Insulating value and clarity of view,including a lifetime glass ..� seal warranty. 3 1l2"Flat Casing •� 908 Bod mould Casing fil{j ,� , a- Paradigm windows are available in either white or toasted almond. ERR I ;-- / �/ CARDINAL' IG TRU_4 i1' At Paradigm,we do it all for U!U is defined as the heat flow through the glazing system.When you specify our Starerite—glazing system featuring Cardinal IG glass the best Low E'energy saving glass in the industry and TruSeal Swiggle warm edge technology spacer system you get a window that's been tested and is NFRC compliant and exceeds all Energy Star°qualifications for the industry. Compare Paradigm's Uvalues and see why we're your best choice in windows! PERFORMANCE TESTING OF •• Window Glass S.H.G.C. V.L.T. Air Walter Structural Structural er Overall Six Type U Glass U Unit Unit Unit ®25mpmph PSF Rating Class Rating (PSG IAAMA) 6060 Clear .49 .48 63 .69 .01 CFM 11.25 60 R40 F-R40 6060 Low E' .30 31 .35 .61 01 CFM 11.25 60 R40 F-R40 6060 Low Er/Argon .25 27 .35 .61 �.01 CFM 11.25 60 R40 F-R40 • .• : ••r r. • 'Low E'with argon is standard in most Mondrian styles. S.H.G.C.is Shading Coefficient. r r - V.L.T.is Visible Light Transmittance. r 1 r I r: pare i Energy Star°Program,U.S.Environmental Protection Agency www eneraystarcav NFPC,Nation Fenestration Feting Council vastynfrc oro -aw.smm­ro.Ana. rwuaimo•..ss1w 011002 A i aradi m - p MondrianM /Window Solutions For Life. Architectural Shapes Series It's been said that, windows are the 'eyes of a home'. They communicate your personality and style, your flair for design, your creative side. They allow many moods and intensities of light to enter the home while opening up vistas that allow you to experience the outdoors from within your home.The Paradigm Mondrian Series of architectural shapes offers a tremendous variety of standard and custom shapes and sizes to meet any design requirements. � - Whether used as solitary accent windows, or when joined to any of the other Paradigm window styles as mullions, the Mondrian j Series makes a definitive statement.Add a Half Round window ` over a Double Hung window and see what happens. Imagine a r` S large Extended Archtop window gracing your central entryway or _ looking out on your colorful flower gardens.A Circular or Oval window is another exciting way to accent any area of your home <<' that otherwise might be just another room. All of the Mondrian Series are physically compatible with all other Paradigm Windows, both new construction and for , $. renovation/replacement.They are designed and crafted with quality tf - and backed by the same outstanding Higher Standard Lifetime Warranty against manufacturing defects and all components in _ 3 A { F I the window. Let Paradigm Window Solutions help you make a statement with the Mondrian Series. - Features found in Paradigm Mondrian windows: f • Fusion-welded frames for a lifetime of worry-free performance and maintenance-free service. •The StarBriteT"glazing with Low El glass and an Argon gas filled 4 chamber for superior thermal performance in winter and summer is standard in most Mondrian styles. •All Mondrain windows can be mulled to other Paradigm windows with a specially engineered mullion system. • Many grill designs and materials to choose from as well as white and toasted almond colors. • Molded in J channel gives the exterior a finished appearance and is a perfect fit for vinyl or wood siding. •A full range of wooden jamb extensions and interior finish mould- ings are available for the Mondrian Series. Typical Mondrian Configurations: y� p� t u, t 1 r.__ v .Sl—i!LI �L it-1 Vl DATE(MWUUIYIYY) AC_ OBD CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER (978)851-6678 FAX (978)851-0106 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Byette Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 853 Main St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tewksbury, MA 01876 INSURERS AFFORDING COVERAGE NAIC# INSURED Lemco, Inc. >sllrer. Norfolk & Dedham Mutual Ins Co 23965 P.O. Box 367 1899 Main Street Tewksbury, MA 01876 csuees D .".9.IJIicF COVERAGES 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' T'PE OF I!lSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABIUTV R0637849A 06/04/2007 06/04/2008 1,000,00 X __ _"L a-=uee. LI:,Rll.mr c.w1A,E To T 50,000 r III= I x I J-cLIP DExF All T 5,000 A FFFso%t , Ir: r 1,000,00 GENERAL AccF=_e« t 2,000,00 r_-.-.I e.-n"r.FFULs Kee PRODUCTS- IP - T 2,000,00 FRO- P5LIG" JECT LCf AUTOMOBILE LIABILITY �A a2 r:�Ue .c rt;L L'a I t B I:DIL'!IPIJIIPY ':'HEG�.F_rLTCL fear P-r��) r:vEC.:�LOS BODILY INJUGi flr IP C 1fn1', t GARAGE LIABILITY LITD �. - C L"!I nTHER THAN nLTr ONLY. .t EXCESSIUMBRELLA LIABILITY TBD 06/04/2007 06/04/2008 2F:OH o:.- ,OF=e;!c= t 1,000,00 7X IF 1 CLAIMS MADESGP.C3F. E A t 1,000,00 Diu_ x RECH 10,00 , WORKERS COMPENSATION AND TO FOLLOW UNDER EMPLOYERS'LIABILITY I.I =. ^NPPrEc�_ITn,e SEPARATE COVER EC Ire::+-nro. _L;r=r•, A ==.n. 11U— F' C'-EAb'E F �'!LI•dIT f OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECNL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAIS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Tewksbury BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABILTY 999 Whipple Road OF ANV HIi:D UPON THE INSURER,ITB AGENiS OR REPRESENTATIVES. Tewksbury, MA 01876 AUTHORIZED REPRESENTATIVE Shama Lamarche SHAWNA ACO RD 25(2001108) ©ACORDCORPORATION 19BB ti Ls/2007 2:0o Fn eRom: A_snian 9ycttc lneuc3nce 'PO: -1 ()7D) 051-4114 cAGC: 005 Or 007 IMPORTANT i If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, 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 the certificate holder in lieu of such endorsement(s). j� DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contrail between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(200110B) v_ C4}.� ✓�P, 1�01/F)/f6Y/UK'!!�(I/ O/v/�f1JNIl//[lJf� 00 ;» BOARD OF BUILDING REGULATIONS s Q' - License: CONSTRUCTION SUPERVISOR Number: CS 028380 Birthdate: 05/15/1957 Expires: 0 511 5/2 0 0 8 Tr. no: 23394 Restricted: 00 -- ROBERTJ LEMELIN PO BOX 367 ,rI ,Pf TEWKSBURY MA 01876 Commissioner. i L\ Lori d of,8 uildm Icc�ulanm(s and Standards HOME IMPROVEMENT CONTRACTOR Registration: 107981 Expiration,-8/19/2008__.—_ "Type: Private Corporation - LEMCO Robe,1 Lemelin - - - - - - - - I i. P.O. BOX 367/1899 MAIN ST .Tewksbury, MA U1876 Dcpnt)Adciinistrator r 3/24/2008 2 : 10 : 12 PM 87440 12 02/02 I Kill, .._._ -- ISSUEDA1h 0312412008 SUOMI —" PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Byeffe Insurance Agency Inc CONFERS N0 RIGHTS UPON I`HE CERTIFICATE HOLDER THIS CERTIT FICATIE 53 Mattl Street DOES ND.4I.,...:J,EXTEND,OR ALTMt TIiL COVE.YA_—_AFFORDED BY TIIL- POLICIE..S BELOW. ewksbury,MA 01876 COMPANIES AFFORDING COVERAGE SURED UPI Inc P O Box 367 - COMPANY A A.LML MUtU31 lFaUMUGe CO LETTER Tewksbury,MA 01876 T US IS TO CERTIr''TIIAT THE POLIC'IFS OF fNS u7fANCE LISTED B—.LOWHAVEBEEiN ffS,UED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD,AIDICATEL?NOTWTTHSTANDENO A_N`Y REQLHREFE-_TERM OR CONDITION OF ANY CONTRACT OR OTHERDOCUMENT WITH PFSPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSN III POIACYIPON Seu POLICY EFFECTIVE POLICY EYPIRATIOti LIMITS- ' LIR DATE(MirVDG'YP� LA"f£(MMIOC%hj GENERAL AGGREGATE .GENERAL LIABILITY PRODUCIS-COMPJJPA G COMMERCIAL GIrvI,.L LNelin i ( PERSONAL&ADV INJURY S ��cJ.AIMSMmE�GccuR EACH OCCUMENCE $ O OWNERS&CONCRACIOR'S PROT .FIRE DAMAGE{Anawe tve) NED.EXPENSEDDY9 ,camq AUTOMOBILE LIABILITY COMBINED SINGLE LIMB �AIlYAUI'O BODILY INJURY iiLL GWJ�JEDSVIO: (Pc Pmmy' SCHEDIJLEPAV S I. RED AUKS NON-O'FNEP AUTvS BODILY INNRY uu M GAPhGEGAHILRY (Pc xad[a[) PROPERTYDAMAGE EXCESS LIABEI EALH OCCUPEENCE i�MnI.L�,LA FORM AGGREGATE 0I'NEN THAN UMHRELLA.'DRM wo LO,YC CUT II.IT low AND i XA=0RYT,1R1T{'S z.PROPRli{Opl l ELEAEH ACCIDAMC c St1I1 I A AFA'ERS'�E%ECUTNE - 'nCIER5A4E- 6012ZIX112008 02/2012008 OZ/20/ZU09 ELDL4F .S AE-P.LICYLUVN!F _)/ I{��au INCL �EACL P.L DISEASE-EACH 500,000 EMPLOYEE COMMENTS'DESCRIPTION OF OPERATIONS OR LOCATIONS: OULD ANY OF THE ABOVE DT'-crmmxn POI BE CANfRI TED BEFORE THE ERPIRATIONDATE TIWREOF,'_ISaU-Wi CO!_VANY WB.L EN 'AIK TOLL4H.10 VBB PER FEINOTf`E TOTS CERTETCATEI OLDER NAMED R LIA TO I.E L BUT HE CORHO TO MA SUCH NOTICE SHALL IMPOSE NO OBLIGATION eILCLYY OF ANY RHVD CPON THE fi�ANY",PCs AOEN'[5 OR.ENTAT[VES. P 1 VPHORIZED REPRESENTATIVE L 2..1�-Z