6 ORIENT WAY - BUILDING INSPECTION A
K
The Commonwealth of Massachusetts CITY
Board of Building Regulations and Standards OF SALEM
Massachusetts State Building Code, 780 CMR,7 h edition Revised January
�\ Building Permit Application To Construct, Repair, Renovate Or Demolish a 1, 2008
One or Two Family Dwelling SAL6q
�` 1 y TlusSecttonFo ffimalUseonly &
SuddmgPermitum K D to pbed '
A
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ECTIONI , I E
1.1 Property Address- 1.2 Assessors Map&Parcel Numbers
(o C�r,ent Wa,,.l SQ.ICrr� Ia 9 gNG r
l.la 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(ft)
1.5 Building Setbacks(ft)
x
Front Yard - Side Yards Rear Yazd
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[]
Ii',.�X
2.1 Owner of Record: �Y l er-1 wG y SU.,Iern. M�
Dav id I-I�Id�
Name(P Address for Service:
`7$ I- (oU8 - 1550
Signature Telephone
x` SEC )ON 3 DESCRIPTION.QF PROPQSEIIIVORK#lieck1all that aPP�Y)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) IA, Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of ProposedWorkz: InStall Cl replgCerrtenf Wind0W%
Ind PtiISl-tn4f � Pn.n S
lie
SEC PION 4 E$TIlYL4 PED SONS 1BVCPION COSTS
Estimated Costs: t
Item '��� � *�;Of�iciallse Qnly z i .,
Labor and Materials
1 Blta�dmg Per nit Fee $ "` th`ch�ato h0 ifCe,ISLdetEl�rmad
1.Building
ClStatidard City/TovnApphoattonFea
2.Electrical $ "'a''h` * - `` s,t
'oFaT3Prolect,Costa)(ltem 6)x mulpphei��r r x�� \
5 r tx
�+hy v' 'Bk Sa a' ��$ ��q � •l f} 3�'�r
3.Plumbing $ 2 bt3teeFees $ � _ � 2sr a� S
4.Mechanical,(HVAC)
5.Mechanical (Fire
Total �I1Fees'$
Suppression)
Oheck IQo � _ "a' Check Amount �, = Cash Amount
—7 3 I S
6.Total Project Cost: $ ' ❑�pai'a °Full [ Outstanding Balance D}e ' _ .
SECTION 5 'CONSTR7JCTION:SERYICES
ry
5.1 Licensed Construction Supervisor(CSL) 9 d 9 ( I I G -Z OI
License Numberp Expiration Date
somas Name of CSL-HoldsC e . W Qh`t n List CSL Type(see below) V
o Wescri°tton -
Addre�� 'GkIL p U Unrestricte to 35,000 Cu.Ft.
Restricted
R Restncted 1&2 Family Dwellin
Signature M Maso Out
•-1 g l Q 3�. $3(X� RC Residential Roofm Covering
Telephone WS - Residential Window and Sidin
SF Residential Solid Fuel imming Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC) !u loSS�
r Regisuation Number
HIC Company Name or HIC egistrant Name
13 Wncel �� Inlnh��Yr� 5 5 Zoll
Address --I� I g 3 d fr 300 Expiration Date
Signature Telephone
,* �� SEGTI01�6 WORKERS'GOMPE�ISe1TION INSURANCE AFFIDAVIT(M G L c i52 § 25C(6)}� `�`
ailure to provide
Workers CompensationInsurance affidavit must be completed and submitted with this application F
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes No ❑
e ,
SECTION 7a OWNF R AUTHORIZATION I O BE CONIPI E 1 EI1 WIIENs '` u� 4 x x t y
tjWl`TR',S"AGE1�T OR(QlV1ZieICTOR.IPPLIS 1 Qlt UILT>I1tiG PAR f .
I QV l d I Il l d e as Owner of the subject property hereby
authorize IJ e t•;. 2( to act on my behalf,in all matters
relative to work authorized by this building permit application.
Si afore of Ovmer Date >)
„� s ;� �'`� SZCTIQN 7b.' OWNER;}OR AUTTIORIT,ED.AGENT IfECLARAT�(?l�_ �,� 8„ ,., ,. .-
I 5 P d UVl ,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. n P U X CXl
bY)�G5
Print Name_ry�
' 4 i Date
Signature of Owner or Authorized Agent
Si ed under the arcs and enalties of er _ c r r p,rc
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.R6 and I IOA5,respectively.
2. When substantial work is planned,provide the information below:
including garage,finished basement/attics,decks or porch)
Total floors area( Ft.) (including Habitable room count
Gross living area Number of bedrooms
Number of fireplacceses Ft.) Number of halfibaths
Number of bathrooms Number of decks/porches
Type of heating system
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
MA Reg#146589 rromomxomwyma... v
Federal ID#20-2625129
CT Reg#0605216' HEMNIMPAW RI Reg#26463 Windows,Siding and More 60065
,4 Corporate Headquarters,26 Cedar St,Woburn,MA,(P)800-342-2211 (F)781-933-9626,www.newpro.com
THIS CONTRACT MADE THE E day of `� 20�a between
(Home O oars) Home Phone
)( (Bus/Cell Phone)
Of /Wr I � J
(A dress) (City) (State) p)
the"Owner"and NEWPRO Operating, LLC, "NEWPRO" The job address is a condominium.
NEWPRO hereby agrees that it will for the consideration hereinafter mentioned,fu sh all labor and material necessary to install the following
describe ark at t e premises located at � � f ,
1� r V
Job Address (E-Mail for proprietary use only
TOTAL Additional Model TOTAL
Windows Purchased EWPR ZYVork Number Q CASH
Window Color In Out: tiding Glass Door PRICE d
Capping Color /�. Steel Securit Door �-�
(r Door Co/or In: Out: DEPOSIT
Model Name Mo I Number ) Sidelites WITH D�'
Double Hung New Construction Unit f ORDER ��vlll
Picture Window ^• Storm Door BALANCE
Casement Obscure Glass DUE AT
2 Lite/3 Lite Slider Screens A INSTALL
Bay/Bow Frame Please Initial:
Roof.' ❑ Soffit: ❑ Customer understands that NE P OO does not CASH
Garden Window do any painting or staining. fie:when removing Balan aid to instal at installation
Awning or replacing interior stops or trim)
Hopper NEWPRO®is not responsible for conditions or
Shaped circumstances beyond its control including con- FINANCE
Other densation resulting from or due to pre-existing Bank completion form signed at installation
GRIDS o ma 0 condi ions.
D RIBE WORK: Q
J � 9
v
Est. Start Date: ! 0 Customer understands this is an"estimated date" Est.Comp. Date:
i is
17
Initials Customer understands all steel security doors will have a 3/4"aluminum threshold installed over existing threshold.
It shall be the obligation of NEWPRO to obtain any and all permits necessary under this agreement,as the Owner's Agent. The Owners who secure their
own construction-related permits,or deal with unregistered Contractors will be excluded from the guaranty fund provisions of MGLC, 142A. All Home
Improvement Contractors and Subcontractors shall be registered by the Director and any inquiries about a Contractor or Subcontractor relating to a registration
should be directed to: Director,Home Improvement Contractor Registration,One Ashburton PI,Room 1301,Boston,MA 02108,(617)727-8598, If the
Owner is obtaining financing by way of a Retail Installment Sales Agreement,such Agreement shall include a time schedule of payments to be made under
said contract and the amount of each payment stated in dollars,including all finance charges. The Retail Installment Sales Agreement shall be incorporated
herein by reference. If the Owner is obtaining a revolving credit line to pay,in whole or in part,for the contract amount herein,the terms of the revolving
line of credit including interest rate and payment terms,shall be clearly set out on the credit application. The portion of the credit application referencing
a time schedule of payment,to be made under this contract,and the amount of each payment stated in dollars,including all finance charges,shall be
incorporated herein by reference.
NEWPRO represents that it carries Workmen's Compensation and Public Liability Insurance in the amount of$100,000-$300,000.
If the Owner refuses to permit NEWPRO to proceed with the work herein,or in the event of any breach of the Owner of this agreement,for any reason
whatsoever shall cause the owner to pay NEWPRO a sum of money equal to thirty-three and one-third percent of the price agreed to be paid,as fixed,
liquidated and ascertained damages,and not as a penalty,without further proof of loss or damage.
NEWPRO shall not be held liable indamages for delays in the performance of this contract due to causes beyond its reasonable control.
Owner warrants that he is the owner of the property on which the work is to be performed or that he is otherwise authorized on behalf of the owners to enter
into this agreement.
This contract represents the entire agreement between Owner and NEWPRO and cannot be changed except in writing signed by both the Owner and
NEWPRO.
You are entitled to a copy of the Contract at the time you sign. Keep it to protect your legal rights. We,the
aforesaid owners, certify that immediately after the signing of the aforesaid agreement, a copy was furnished to us.
You may cancel this.agreement if it has been signed by a party thereto at a place other than an address of the
seller,which may be his main office, or branch thereof, provided you notify seller in writing at his main office or
branch by ordinary mail posted, by.telegram sent or by delivery, not later than midnight of the third business day
following the signing of this agreement. (Saturday is a legal business day). See the attached notice of cancellation
form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
The owner has seen"sample"warranties that will be provided by NEWPRO upon fpytaRation. Sample warranties provided t� r.
IN WITNESS WHEREOF,the parties have hereunto signed their names this �(„/ 1-/-'O�f!• da o 16(�3
G � EIN# Signed
TM ,k,t4,,g Representative Printed Name Owner
Accepte ' EWPRO Operating,LLC
By Signed
Owner
CORPORATE OFFICE -
WARWICK BRANCH OFFICE
26 Cedar St
Wobum,MA 01801 24 Minnesota Ave
(P)800-242-9974(From NE) Warwick RI 02888
(F)781-933-0717 (P)800-356-3312(From NE)
(F)407-732-1371
WHITE: Branch Copy YELLOW: Customer's Copy PINK: File Copy GOLD: Finance Copy
us-is
R0508
i
11/25/2009 13:26 FAX 17819330717 NEWPRO SALES Service 2001
# Nlado .IMP
Iidmg.andMao Page Of
CUSTOMER
EMAIL ADDR/ESS HOME PHONE
DATE 1 0 WORWCELLPHONE
(Coda one)
ADDRESS
BEST DAY TO INSTALL: M T W� 71a F
CITY,STATE V (Please drale one)
PRODUCT SPECIALIST CH: �. EST1MATEO START DATE
TOTAL 0 OF. #OF DOORS WINDOW COLOR
WINDOWS #OF BOWIMAYIGARDEN Siam,steal,Pave molde+0utddo CAP COLOR
OPENING SIZE STOPS `
NO. STYLE W x H . U•1. LOCATION RID SCRI IN OUT ADDITIONS OPENING CUT
p Ds— VO 6/� Rto
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5/7/2009 3:59 PM PROM: Mackintl[a Insu[ance MacKinGt[e Lnau[ance Agen TO: 0,17819320860 'ME: 002 OF OD3
ACORQ CERTIFICATE OF LIABILITY INSURANCE os/07/200
P--CER (508)366-6161 - FAX. (505)365-5201 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Mackintire.Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THECERTIFICATE
11 West Main Street ALTER THTHIS
COVERAGE NFFORDETE DOESDeY THE POLICIES BELOW. c
Westborough, MA 01591-1931
INSURERS AFFORDING COVERAGE NAICM
wwREo Neupro Operating LLC IN9AedA'. Peerless Insurance Co. 24198
26 Cedar St. IMSIAERB: . j
Woburn. MA 01801 WWIERQ
INANERO:
INSURER E: li
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT.TERM OR CONOmDN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO MICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONOmONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
N9RD P OLICYEFFEC„VE PDLICYEYPIMTON
I ' UWIL MSVMN<F PO,IC/MVMBER
MTE
u ExERuAea LIMITS
Om C P 8588370 - MA POLICY 12/31/2008 12/31/2009 E- ETORF z 1,000,00C
/7 0�
X eoNenmcot GM LWLL"C P 8589577 - RI POLICY - ETOR z 300,00 ✓ i9
vEn E%o IAnY�P.R•A) z 15,00 Board of Building RegulaGoos and Standards
uuuW LYVE X�OCCUR
A FERBDNaaADVINMRr F 1 000 0o HOME IMPROVEMENT CONTRACTOR
GENLPo I•GLICY DP .GRGEAMB7E 2,000,00(OHEW7E ➢PLESPQ PRODUM-CrPOE x•DDD DD Re91Strddlon 146589
PRO-
LOC
lug
AUTO.,.LIRBARY 8A 8534174 12/31/2008 12/31/2009 EXPlratlpn 5/512011 I
CGM911&D SINGIELIMIT
1,000 00 PP---,Type:. _Supplement Card
.I.O.EUAUTOS - BODILYnuav
X su,ED AUTos Iveyusm•1
A x wraDAuros eoDILVINAm NEWPROOPERA`µTi�
(P.1%dMMLI
X NouowHm/Uros THOMAS FOXON , •, j
PSOPERtt orBasE i - 26 CEDAR ST.
RPx x4<MI • _�
Nnoawv-EAF.ccIOEMT i WOBURN.MA 01801 - � ~' 1
j1U..E3IWMBR0.1.A
Administrator zLusnm CU 8582578 12/31/2008 12/31/2009 EACHocuRRE,+cE s 5 D00 00
Occuo cLwuS ME z 5 000 00ARETENTION 9 10,00 F
vxsn7u oTw<oMPExeJmoxnxD
UABenY WC864S974 OS/01/2009 OS/01/2030 El.BACMAWILENT F Soo 00 ,
A aRV PROPRIETORRemIewFOSOmvE EL.o�E-EAEMFLOY z Sao 00
I mes
IIAft I MEMBFA E%C,10ED1
Nmm lmaa El,oISELSE-Pa LI
MIT i 500,00 ;Massachusetts- Deportment of Public Safety
sPEcuL PRovISIa seaa.
OTHER Board of Building Regulations and Standards
Construction Supervisor License
DESCRRnONOF OPEfGnON81 LO47,GNSIVFHICLEBI EYCLUFIONF GDOEDBYENG0R9E10:MISPECIM.PRON410N8 License: CS 29090
Restrictedto:. 00
THOMAS P,FOXON .
230 WALNUT STCERTIFICATE HOL12LE
- '
SxouLD UN OF TxE AeovF DEBtn®EDPauclEseE CM,MELLED BEFORE WE - READING, MA 01867� `a `
Ell MMN MTE THEREOF.THE RW WG MBURER ML EMOEAYOR TO MAIL
1Q_MY8 WRmEN No1RE TO THE CERTIFICATE HOLDER NAMED TO WE LEFT.
Tom of Saugus eUr FAAURETOMNL WCH NoTeS BNe••..a Mo O.TOM MLueILm i �-i.. �y Expiration: 1 1/1 912 01 1
298 central.Street AaExrs ORREPassExrArnEa
Saugus, MA : (ommis9iuner TrN: 8950
Timothy 3. Mo a h - .____ _.,,- —_' ___.
ACORD 25(2001/08) _.. -
0ACORD CORPORATION 1988
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in Highlighted Regions
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NEWPRO MANUFACTURING
Grreac /JEWPRO 2000 DOUBLE HUNG
Cellular PVC frame,Triple glazed,
. Np FenedNaVDn Low.E coating_(e=0.034, S2&6),
patln_ gciundl® Krypton/Argonfair filled
DEV•K-27A001 fi•00001 .
ENERGY PERFORMANCE RATINGS
U-Factor Solar Heat Gain/�Coefficient
. OM ■ MQA 0.27
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance Air Leakage(U.SJI-P)
0,40 0A
Condensation Resistance
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WWW
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The Commonwealth of tnassacnusc"
Department of Industrial Accidents
Office of Investigations
— -- -------600-Washington-Street. ---- -- ----- - -- - -
' Boston, MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Elect Print Le ibly
Applicant Information
Name Business/Organization Individual): /V E W P A
Address: 2b CEbAp- ST
City/State.-Zip: WOl3u2n/ MA
01801 Phoney: 781 . 93�- 83a0 ExT ,z51
Type of project (required):
Are you an employer? Check the appropriate❑b I am a general contractor and I
6. New construction
1.[ I am a employer with 50 have hired the sub-contractors
employees (full and/or part-time)-* 7. Remodeling
listed nit the attached sheet
2.❑ I a, , a SGiE prvpi+ v:o;partner- These sub-contractors have 8. Demolition
ship and have no employees workers• con insurance.
working for me in any capacity. p 9. ❑ Building addition
[No workers' comp. insurance 5. � We are a corporation and its IO.❑ Electricalrepairs or additions
required.] officers have exercised their
3.❑ I am a homeowner doing all work
right of exemption per MGL 11.❑ Plumbing repairs Or additions
myself [No workers' comp. C. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.] f _ employees. [No workers' 13.❑ Other
comp. insurance required.]
' ,nv applicant that checks box a must also fill out the section below showing their workers'compensation Polic}•information:
t Homeo�mets who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Contractors that check this box must attached an additional sheet showing the name of the sub
-contrectors and their workers'camp.policy infor-manon.
I am an employer that is providing workers'compensation irsurance for my employees. Below is the polity and job site
information
InsuranceCotnpanyName: "Cickin+ire d-nscm2riCe- A r -
Policy'- or Self-ins. Lic. =:
W G 9 to u 5 9` L Expiration Date: 5 Z O U
Job Site Address:
Or Ql WCLq City/State/Zip: SCdeel•
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1.500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a da} against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DI A for insurance coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct
SrEnature
FOR N " WPRODate 7 e
Phone#: If 1-g53- IL4tp
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Phone#:
Contact Person: