8 POPE ST - BUILDING INSPECTION (2) op Z,
The Commonwealth of Massachusetts
A OF
Board'of Building Regulations and Standards CITY m
REG'IVE�. ALEM t
Massachusetts State Building Code,780 CMR ftiSECT4�N L r
R�M�011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
t
,�(� One-or Two-Family Dwelling
00 "This Section For Official Vse Only'
Building Perrin Ahuiiber:" x Date plied:
r�
$witting Official(Print Name) , ry4 "Signature '" Dat
7 SECTTO'N.1.SITE INFORMATION. a
1.1 Pro e_r dress: 1.2 Assessors Map&Parcel Numbers
fter-
L l a Is this an accepted street?yes_ Map Number Parcel Number n t
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq fl) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Regdud 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'
2.1 caner'of Record: --
Name(Print) Ct \tate,ZIP
$ Po
No.and Street - T lephone Email Address _
SECTION 3:DESCRIPTION OF PROPOSED WORD`(check.all that apply)
New Construction❑ Existing Building❑ [Owner-Occupied ❑ Repairs(s)IQ Alteration(s) ❑ Addition ❑
Demolition 0 Accessory Bldg.❑ 1 Number of Units Other ❑ Specify:
Brief Description of Proposed Work : e
SECTION 4:ESTIMATED CONSTRUCTION COSTS .
Estimated Costs:
Item OfMial Use Only
bor and Materials
1.Building $ CXX) r 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town'Apolication Fee
❑Total Project Cost'(It&6)x multiplier x
3.Plumbing $ _ 2. Other Fees: $ _
4.Mechanical (HVAC) $ _ List:
7.
5.Mechanical (Fire Suppression)
$ Total All Fees:$
Check No. ` Cheek Amount: Cash Amount:
6.Total Project Cost: $ a pop ❑Paid in Full ❑Outstandirig Balance Due:'
r
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 310£,��� 1�•�-
1A A.A;C� _' 1; ' i ('S License Number Expiration Date
ame of CSL Holder
List CSL Type(see below)
No.and Street '� .T e Descripfion
U Unrestricted(Buildingsu to cu.R
� � Restricted 1&2 Family Dwelling
in
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
n SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5. a rstered Home Improvement Contractor(HIC)
bl UJ&J0.C31d..1 HIC Registration Numbbr Expiration Date
HI Com any Name or HIC Registrant Name
Ur gL Ls,
No.and tree[ Email address
City/Town, State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NLG.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
R APPLIES FOR BUILDING PERMIT
1`'`C_1,as Owner of the subject property,hereby authorize L A A
to act on my behalf,in all matters relative to work authorized by this building permit application. `
Print Owner's Name(Electronic Signature) Date
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 is true and accurate to the best of my knowledge and understanding.
a
Prmt Owner's or Authorized Agent's Name(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(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
wtivw.mass.sot v,!oca Information on the Construction Supervisor License can be found at www.mass.eov(dns
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"
07 Y OF SALEA MASSAaR SE M
DuaDmGDBeAFinaw
120 WASfIDJ6"TMSUW,33Dp%OOtt
IkL(978)745.9595.
SI PAN(978)740.9846
MBF.RIEYDRISQ7LL
AUYCR 7)KPIAsSTYLO EE
DutEcrcit cFpLa cpxoFn7Y/BLIII mcamw Sga9=
Construction Debris Disposa/Afdavit
(required for all demolition and,renovation work)
In accordance with the sbtth edition of the State Building Code, 780 CMR, Section 111.5 Debris,
and the provisions of MGL coo,S 54; Building Permit 8 is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by.
(name of h uler)
The debris will be disposed of in:
(name of facility)
(address of facility)
Signature of applicant
� -�,
Date
�
The Cominonwealth of Massachusetts MOWN
'�' N
Department of Industrial.Accidents
Office of Investigations
I Congress Street, Suite 100
Boston, M4 02114-2017
ewwv.tnassgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluuabers
Applicant Information Please Print Leeillly
Name(Business/Organization/Individual): AE11A 1.=4U04IU1e -e- fj.xyy2 LLB'
Address: 4J RrA
City/State/Zip: YZ t t ) Phone#:
Are you an employer?Check the appropriate box:
1.MI am a employer with �.- 4. ❑ I am a general contractor and 1 Type of project(required):
employees(full and/or part-time).
have hued the sub-contractors 6. ❑ New construction
2.❑ I am a sole proprietor or partner- fisted on the attached sheet. 7. [�J[temodeling
ship and have no employees These sub-contractors have S, ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.
t 9. ❑Building addition
required.] 5. corporation We are a co oration and its 10.❑ Electrical repairs or additions
❑
3.❑ 1 am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions
myself [No workers'comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
[
employees. No workers' 13.❑ Other
.
comp.insurance required.]
'Awry applicant that checks box#t must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
[Contractors that check this box must attached an additional sheet showing the name of the stdt-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for ney employees. Below is the policy and job site
information.
Insurance Company Name: N `F etrt Q C�S�/ p a2 s jai 5 6
Policy#or Self-ins.Lie.#: 406O—P 0 f c Y Expiration Date: 77 -J" J}o
Job Site Address: City/State/Zip:
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
tine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a flue
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby,certify under the Eains and enalties of erjury that the information provided above is true and correct.
Signahue: -- —_-- - - -- Date: -
Phone#: ® 7fj ' Zhj-�r� -- ---
-1
O eci f al use only. Do not write in this area to be completed town
t� a feted 8 city or o vn n rciaL
Y p y ty ff
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2. Buildium Denartment .;.Citv/'Ifuw n Clork 4 91petr1pnt n-e._:k,.. _ -:a-,..,e�
m�9k r`
Y4 �
' : . • sl YIAl Otn � JSi�! ! �x%
ben4P CS-089853 � r
WILLIAMRf1ICHOLS
�7 PEARTREE Rf3' -
I-IAVERHILLMA 01830 k
i
1XpIra!'ic?"h t
=,n Gmm��essi=l7e'r 1 0/2 612 01 6
s ,
'
License or registration valid for individul use only
11 ce of Consumer Affairs&Business Regulation before the expiration date. If found return to:
E IMPROVEMENT CONTRACTOR - Office of Consumer Affairs and Business Regulation
Type: 10 Park Plaza-suite 5170
egistration. 183279
17' Supplement C-�,rtd Boston,MA 02116
Expiration: 9/24I20
NEW ENGLAND WINDOW-&DOOR',LLC. -
PELLA WINDOWS&DOORS:
William Nichols
�.,.4: x .;..
45 FONDI ROAD ��— Not valid without signature
HAVERHILL,RNA 01832 Undersecretary
Contract - Detailed
Pella Window and Door Showroom of Haverhill III Sales Rep Name: Kelly, Thomas
® 45 Fondi Rd I Sales Rep Phone: 978-373-2500
Haverhill, MA 01832 I Sales Rep Fax:
Phone: (978) 373-2500 Fax: (978) 373-7274 Sales Rep E-Mail: kellytl@pellaboston.com
Customer formation Project/Delivery Address Order Information
Craig Barcelo Barcelo,Craig,1711311 Quote Name: Barcelo,Craig,1711311
8 Pope St 8 Pape St
Order Number: 741
SALEM,MA 01970-2113 Lot# Quote Number: 7767192
Primary Phone:(339)3681869 Salem,MA 01970-2113 Order Type: Installed Sales
Mobile Phone: County: Payment Terms:
Fax Number: Tax Code: MA TAX 6.25
E•Mail: dgpainter@vedzon.net Quoted Date: 4/19/2016
Great Plains#:
Customer Number: 1007874331
Customer Account: 1003732053
Line# Location: Attributes
10 None Assigned Delivery/Setup- Delivery/Setup Qty
1
For more information regarding the finishing,maintenance, service and warranty of all Pella@ products, visit the Pella@ website at www.pelia.com
Printed on 4/20/2016 Contract-Detailed Page 1 of 5
Customer: Craig Baroelo Project Name: Barcelo,Craig,1711311 Order Number: 741 Quote Number: 7767192
Line# Location: Attributes
20 None Assigned Pella Brand, Entry Door Inswing,33.5 X 81.75,White, 4 9116" Qty
1
�N{ ''-s 1:3280 Entry Door
4.+ -1 PK# Frame Size: 33 1/2 X 81 314
�'—'�,,: 784 Unit Type: Left Inswing Standard Sill,No Fire Rating,No Fire Rating
Dimension Options: No Cut Down
iY General Information: 5 7/8",1 5/16",4 9/16"
�_.;" 11- Panel Style: Full Light
M5 - Glass: Tempered Blinds-Between-The-Glass Air Filled
Viewed From Exterior Panel Selection: Smooth,Painted,White,Painted,White
Frame Size:33.5"X 81.75" Frame Selection: Clad,Pine,Oak Threshold,No Panel Reinforcement,Standard Enduraclad,White,Wood,Primed
Hardware Options: Multi Point Bore(includes mechanism),2 3/8",2 1/8",Eclipse,Eclipse,Satin Nickel,Aluminum Adjustable,Satin Nickel,Nickel Finish
Sill
Unit Accessories: No Bang Panel
Wrapping Information: Nail Fin,Factory Applied,No Extenor Trim,No Interior Trim,4 9116",5 718",Factory Applied,Pella Recommended Clearance,
Perimeter Length=231".
PVC Upgrade>48-PVC Upgrade greater than 48 inches Qty 1
ES-Single-Install Single Entry Door Qty 1
Entry Trim Finish-Finish Paint/Stain Entry Interior Trim Only Qty 1
Thank You For Purchasing Pella@ Products
PELLA WARRANTY:
Pella products are covered by Pella's limited warranties in effect at the time of sale.All applicable product warranties are incorporated into and become a part of this contract.
Please see the warranties for complete details,taking special note of the two important notice sections regarding installation of Pella products and proper management of moisture
within the wall system.Neither Pella Corporation nor Pella Windows&Doors will be bound by any other warranty unless specifically set out in this contract. However,Pella
Corporation will not be liable for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties.
Clear opening(egress)information does not take into consideration the addition of a Rolscreen[or any other accessory] to the product.You should consult your local building code
to ensure your Pella products meet local egress requirements.
Per the manufacturer's limited warranty,unfinished mahogany exterior windows and doors must be finished upon receipt prior to installing and refinished annually,thereafter.
Variations in wood grain,color,texture or natural characteristics are not covered under the limited warranty.
INSYNCTIVE PRODUCTS:In addition,Pella Insynctive Products are covered by the Pella Insynctive Products Software License Agreement and Pella Insynctive Products
Privacy Policy in effect at the time of sale,which can be found at Insynctive.pella.com. By installing or using Your Insynctive Products you are acknowledging the Insynctive
Software Agreement and Privacy Policy are part of the terms of sale.
Product Performance Information:
U-Factor, Solar Heat Gain Coefficient(SHGC),and Visible Light Transmittance(VLT)are certified by the National Fenestration Rating Council(NFRC).Manufacturer stipulates
that these ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are determined for a fixed set of environmental conditions
and a specific product size.NFRC does not recommend any products and does not warrant the suitability of any product for any specific use.
Design Pressure(DP),Performance Class,and Performance Grade(PG)are certified by a third party organization, in many cases the Window and Door Manufacturers Association
(AT)MA).The certification requires the performance of at least one product of the product line to be tested in accordance with the applicable performance standards and verified
For more information regarding the finishing,maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pelia.com
Printed on 4/20/2016 Contract-Detailed Page 2 of 5
Customer: Craig Barcelo Project Name: Barcelo,Craig,1711311 Order Number: 741 Quote Number: 7767192
by an independent parry.The certification indicates that the product(s)of the product line passed the applicable tests.The certification does not apply to mulled and/or product
combinations unless noted.Actual product results will vary and change over the products life.
For more performance information along with information on Florida Product Approval System(FPAS)Number and Texas Dept.of Insurance(TDI)number go to www.pella.com
/performance.
Project Checklist Review (Installed Orders Only)
Before the Installation the Homeowner agrees to do the following:
Obtain Condo Association Approval
Obtain Historic Approval
Remove existing shutters and awnings
Remove air conditioners
Remove existing shades, drapes, window treatments, wall hangings, and personal belongings
Move furniture at least 3 feet away from work area
Tie or cut back trees, bushes and shrubs in the work area
Arrange to have alarm system and doorbells disconnected
Arrange to have any plumbing and electrical repairs or changes made by appropriate licensed contractor
Provide a door handle and lockset for entry door if Pella handle and lockset is not purchased.
Before the Installation Pella agrees to do the following:
Obtain Building Permit(When required)
Prefinish products when purchased in contract
During the Installation the Homeowner agrees to do the following:
Keep pets safely away from work area
Keep children safely away from work area
Allow Pella Installer room to work safely within your home
During the Installation Pella agrees to do the following:
Deliver and unload products purchased per contract
Place and remove drop cloths in work area then vacuum, and remove all debris at end of day
Remove existing product, including storm windows, and dispose of it unless otherwise specified
Install all products using method specified in contract per Pella Installation Instructions
Replace interior and/or exterior trim only if purchased
If Purchased, install exterior primed pine wood trim or Composite. Composite will be unfinished.
If Purchased, install interior trim matching wood window finish or White trim for Impervia and Encompass
Install non-Pella entry door lockset provided by you. Pella is not responsible for it's quality or performance
After the Installation the Homeowner agrees to do the following:
Be available for completion and sign off to verify all products purchased are in working order
Reinstall existing shutters and awnings
For more information regarding the finishing, maintenance, service and warranty of all Pella®products, visit the Pella®website at www.pelia.com
Printed'on 4120/2016 Contract-Detailed Page 3 of 5
Customer: Craig Barcelo Project Name: Barcelo,Craig,1711311 Order Number: 741 Quote Number: 7767192
Re-install existing shades, drapes, window treatments, wall hangings, and reposition furniture
Arrange to have alarm system and doorbells reinstalled
Reinstall air conditioners
Remove stickers from product and save for energy rebate and tax purposes
Wash all interior&exterior glass surfaces
Fill nail holes and joints on interior trim if windows are to be stained (after staining)
Clean up exterior casing issues due to storm window removal if full wrap or new exterior trim is not purchased
csb Project Checklist has been reviewed
Customer initial
Product Only Addendum has been reviewed
Customer initial
Credit Card Account#: Last 4 Digits
Expiration Date: /
Charge final payment to same account
(Upon substantial Completion) Customer initial
For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pelia.com
Printed'on 4/20/2016 Contract-Detailed Page 4 of 5
Customer: Craig Barcelo Project Name: Barcelo,Craig,1711311 Order Number: 741 Quote Number: 7767192
Project Checklist has been reviewed
Craig s barcelo Thomas Kelly
Customer Name (Please print) Pella Sales Rep Name (Please print) Order Totals
walg J ba do P Taxable Subtotal $2,710.10
Customer Signature Pella Sales Rep Signatur4l Sales Tax @ 6.25% $169.38
4/20/16 4/20/16 Non-taxable Subtotal $1,440.00
Date Date Total $4,319.48
Deposit Received $0.00
Credit Card Approval Signature jAmount Due $4,319.48
For more information regarding the finishing, maintenance, service and warranty of all Pella@ products, visit the Pella@ website at www.pelia.com
Prinledon 4/20/2016 Contract-Detailed Page 5 of 5
a u Pubirs Safe'i
,o s d r4s,
-!�ql lit tion MIN
a re��a CS-089853 refi"�
4 W ILLL,M R NICHOLS � n' �'�I -.-
17 PEA'RTREERIb"
HAVERHILL MA Q18304�, y,
girt rs. -
�tr,,
-Gmrmss;or,er IM612016
�J//� r�,,,,,,,,,,,d��,/if���,Il /,,,�<��
- License or registration valid for individul use only
flee of Consumer Affairs&Business Regulation before the expiration date. If found return to:
r11E IMPROVEMENT CONTRACTOR f office of Consumer Affairs and Business Regulation
Type: 10 Park Plaza
egistrabon 183279 -Suite 5170
Supplement C:.ird Boston,MA02116
Expiration: 9/24/2017 .
NEW ENGLAND WINDOW t DOOR;LLC. -
PELLA WINDOWS&DOORS-
William Nichols / --
45 FONDI ROAD _ Not valid.withOut signature
HAVERHILL,MA 01832 Undersecretary