Loading...
10 QUADRANT RD - BUILDING INSPECTION (2) q - /(OS F, C.K 9(OZ027 $S I The Commonwealth of Massachusetts ° Board of Building Regulations and Standards OF SAT LEM Massachusetts State Building Code, 780 CMR Revised 11 Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling g H This Section For Official Use Only Building Permit Number: Da Applied: y rn Building Official(Print Name) - Signature rn SECTION 1: SITE INFORMATION 1.1 Prop Address: 1.2 Assessors Map&Parcel Numbers 1.1 a Is this is accepted street?yes�- no Map Number . Parcel Number . 1.3 Zon-i�g Information: 1.4 Property Dimensions: Zoning District Proposed Use . _. Lot Area(sq ft) Frontage(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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 O ner of RecordWu, D 00 Item Name(P City,State,ZIP nn[ /0 � uda/z a� 9'7?_ 74ss 6677. No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ IRepairs(s) ❑ 1 Alteration s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other pecify: Brief Description of Proposed Work': M Lt! SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only Labor and Materials 1.Building $ 6 qW,rJ p 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costs{Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Su ression Total All Fees:$ / Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 9� /, 0e) ❑ Paid in Full 13 Outstanding Balance Due: SjzT3T IOI'm SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �TA/144,-- /;4gem- License Number Expiration Date Name of CSL Holder u " tion Description : �ja List CSL Type(see below) J!- ' No. d Street Type ' �� D�d� Unrestricted(Buildings u to 35,000 cu.ft. �' y.. . i R Restricted I&2 Family Dwelling ;City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding t SF Solid Fuel Burning Appliances /7, I 1 Insulation Telephone Email address D Demolition 5.2Q�Re i q�rov/edd/Home)InaJp'�rove ut Cofy`nnt�tractor(HIC) W �\ /����i�+eN HIC Registration Number Expiration Date HIC Company NWe or H /".De3 6,IC Registr Name No. SVeet1,/ Ae C, S7 Email address City/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 ..........Db No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED'WHEN ' k OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize---�Afl/t Q /L4ft—A— to act on my behalf,in all matters relative to work authorized by this building permit application. •Stars �I'¢e Print Owner's Name ectronic 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 a and a urate to the best of my.knowledge and understanding. - y I /vW /p Print Owner's or Authorized Agent's am lectronic Signature) Date NOTES:' l 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 m2n .mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/d s 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" CITY OF S.UMNI, UNSSACHUSEM Bt:UMLNG DEPARTMENT 1 120 WASHINGTON STREET,3'a FL oo& TEL (978) 745-9595 FAX(978) 740-9846 KI�fBFR.L.EY DRISCOLL MAYOR THomAs ST.Pwmz DmRECI'OR OF PuBLic PROPERTY/Bt:BAtNG 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 of 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: A�ec�2,( Xe,Zz ,alfQe4s e,✓ (name of hauleif The debris will be disposed of in : bALt a/2-S (name of facility) 30 -news x�b Alor#j6vro, &(e" 2— (address of facility) signs 'e of permit applicant date dcbrimlT.do The Commonwealth of Massachusetts Department oflnduslrialAccidents Office of Investigations d I Congress Street, Suite 100 s` Boston, MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): RENEWAL BY ANDERSEN Address:30 FORBES ROAD City/State/Zip: NORTHBORO, MA 01532 Phone #:508-351-2200 Are you an employer? Check the appropriate box: Type of project(required): 1.01 1 am a employer with 30 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. © Remodeling ship and have no employees These sub-contractors have 8, ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance: 9. ❑ Building addition [No workers' comp, insurance P� required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I l.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof re ' s insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. ther Q 6Eea_ comp. insurance required.] Any applicant that checks box#1 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 him 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-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 my employees Below is the policy and job site information. Insurance Company Name:OLD REPUBLIC INS. CO. Policy#or Self-ins. Lic. #:MMWI�C 30293800 Expiration Date: 10/01/15 Job Site Address:_lo L} u-&-oireA A*- /tpQ^ City/State/Zip:cJR/4hc, 14-e4_ Ol g'7D 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 $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$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 cert'y unde the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: ,O7 Phone#: 50 - 51-220 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 Contact Person: Phone#: I J Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Super.isnr '. License: CS-090125 f JAIME L MORIN 86 GARDEUM ST $ %V LYNN MA 019K 1.1�t{ g r - `,, p Expiration Commissioner IOM612016 fJrr"e �ponrmrmrr`rra�.F/c o�t�aAsat,�raeC2 �: ffice of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Registration 17081b type Expiration 1323/2015 ' , Supplement r RENEWAL BY ANDERSONtORPORATION JAIME -MORIN `" 104 OTIS STREET ' NORTHBOROUGH,MA 01532 n U dcrsecretary _ ,t 3r Fla 44 RmBng —s ';i.:✓ ' •�,• � endom nt I�norydtlgya Lil I Jj6� � •�� n �J � _M �2{ � .' � � Icy ; r� I ( MA Home Improvement Contractor License#170810(Expires 1 212 3/2 01 51 t by ..RnCt5ell. - Renewal by Andersen Corporation Federal Tax ID#41-1 91 841 3 maw .r.ranewan, .,,,��M..��a.,m 104 Otis St. Northborouah.MA 01532 1508)351-2200 Fax(508)-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name Date: FRANCIS MURPHY - AUGUST 8, 2014 Buyer(s)Street Address city State Zip Code 10 QUADRANT RD. SALEM MA 1 01970 Email Address Home Telephone Number Work/Cell Telephone Number FM URP HY 1 36LDAOL.CO M 978-745-6677 iBuyer(s)hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation("Contractor'),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. t Total Job Amount $ 6,921.00 mount Financed$ 0.00 Est.Start Date Method of Payment Deposit Received(33%)$ 2,307.00 ,,✓, Check/Cash 10-12 weeks Balance Stan of Job 33% $ 2.307.00 oe Checks ( ) posh at signing$ 0.00 Balance on Substantial Est Install Time Al connotation €J Credit Card Completion of Job(33%)$ 2,307.00 connotation$ 0.00 T.B.D. If credit card is Selected,please am Credit Card Pe nt Pone Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing or modifying any of the terms of this Agreement No alteration to or deviation from this Agreement will be valid without the signed,written consent of both Buyers)and Contractor. Buyer(s)hereby acknowledges that Bunions)1)has read this Agreement,understands the terms of th is 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. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Andersen Corporation / r(s) Buyer(s) By: -AI CA CY Signature of Project Manager Signature Signature JOHN BEAVER FRANCIS MURPHY Printed Name of Project Manager Printed Name Pnnte i Name YOU,THE BUYER(S).MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF WIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EIIPLANAnON OF THIS FROM. ------------------------------------ ________ ____________I NOTICE OF GANCELIATION NOTICE OF CANCEWAnols I I Date of Trimaeelm 8/6/14 You ma may cancel penalty ycnessays I DatrdTment mypoiim 0/8n14 seusirm.dys this .b.data,If y6out my,on,property,tation,witny duninsam Bead.by you Sevenake die, I trasonedte.IT oucamypendtyor obligations,a threents maydays bum the do,Co...I or We, yeana rtyo-aded{n,my pay manor ye.teat ev order above date.IT yovcmcel,arypmpemytrWedtu,soy payments madebyyou under the Cmo-am of Sala and my negotiable t by&a Co eaemted by you wen your I the Contract is Sale,and my negotiable i by Co n ec or(, by youof be returned within m days feflmy ac mg receipt by the Connector a ("Seller") d yam I returned n 10 drys foruowi mury interest a es thr Cmtremur a(,-San_-)of ymm mcegation entice,and my secmeityintereet ariaivg out d We transamiov will be I commutation entice,and my xemity ivteren viv:ng out of the tranaaedon wDl be canceled. stanti If ymu cancel,you mans when madwd,m the Seger m your re you under to ancded. D ymv caved,ymn morn make method m the odds hem your reatdmce,e avbemvtiagy as goad cmdtdm as when recrired,my goods delivered to you order I evbmmtiaey m goad covdtim u when received,my goods delivmd m you order this Coutran ur Sheet or you may,if you wish,comply with the tmetracttova d the this Cmtram er Sde; oryau mar if you w ,eomplyw M the matructions of the Seger rega.divg the return ahipmane of We goods at the 6eger a upeme and rick. I Scrum eegerdtog the return sbipmant of the goods at the Sellur'e npense and r:sk. If yen do make the goods available to else Sauer and the Seger time ant pia them up If you do make the goods awgaMe to the Sauer and the Seger does mot pick them up within 20 dot's of the data of your Notice d Concentric-,yen may retain or dtepose I within 20 days a the date of your Notice of Cancegation,you may retain or dispose of she gonde w:tbout any Culler obtigatioo. If you fag eo make the,mods aveaalte I of the goods without my number obligation. If you fdl on make the goods available mthe Bud—,or if you agree so reevrn the gouda to the Seller and fan to do ao,they I to the Senor,or If yno.agree m return the goods to the Seger and fail to do ao,then you remain Battle for performance of eU obligations under the Contrace.To cored I you remain Dable for pertermuce of an obfigatims order the Contract.To cancel this trvmam-,mN or deliver a signed and dated copy d&is mmedlation notice I this tramardon,mail or deRom a signed and dated copy a this cancellation votire or my ater written entice,m send a telegram to Contraction Removal by Andervm,l myotherwrittmnotire,orsevdatdegeaneto Contractor: Renewdby Anders, 104 Oda St. Nombbomugh,MA 01532,BY NOT LITER TTIA4 MIDNIGHT OF I IN Otis St.Northbomagh,MA 01532,BY NOT IFTER TITAN MIDNIGHT OF .(Dme) IHEREBYCANCM=g TRANSACTION. I .(Date) IIreREBV CANf:EI.TMS TRANSACTION. I son'.ft.. P,M No— rim i au".5greW,e RIRNrme Gale I I Renewal Renewal by Andersen Corporation MA Home Improvement Contractor PYA ,del$en- 104 Otis St Northborough,MA 01532 License#170810 (Expires 12/23/2015) WINDOW areaxoEstExr m,AN­Clma..., (508)351-2200 Fax:(508)-986-7072 Federal lD#41-1918413 Window Specification Sheet Buyer(s)Name Date of Agreement FRANCIS MURPHY FRIr AUG Ss 2014 I The buyer(s)listed above herebyjointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on the Specification Sheet and the Gont and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING I AGREEMENT,of which the Specification Sheet is part. WINDOW DETAIIS Approx. ExtedorAtedor Color Hardware Hardware ta— Grille Gnlie Glass Room a U.I. Wintlow/DoorStyle Oelal Gash s Exl Color BCreena Bandar, Grilles Brain In Stan Lifts Options Living 2 115 New GW insert late NO 1WHIM114 White Standard I 6norrej Nom ----- ----- ----- No Bed 1 3 99 New GW insert raid No Hiw White Standard FTS laronsh.4 Nom ----- ----- ----- No Totsl 5 BAY&BOW DETAIIS *See Ba /Bow Measure Sheet Styledatell/ Approx. Appmx. No bar Frame Window Entl Center LOWEI Roof/ Hardware Roam Court a Flankers W. eaain a An le Laos Interior EWnt Color Geller sashes sashes Screena Smansim Strait Color SPECIALTY WINDOW DETAILS Fuel/ Apo=. UNIF/ Spaclalty BAY/BOW ADDITIONAL WORK NOTES Roam Court style Insert U.I. Smarlem Grilles Grille Is Extent Color Cuswaer is aware that with bay/hew windows under 72 inches there will be si ificant gLos lose. ADDITIONAL WORK DETAILS: I No Contractor will wrap exterior casings with coil stock color of i Owner is aware that Contractor does not do any painting/staining or removal/installation of alarm system or window treatments hardware.it Is the responslbilily of the homeowner to have the aferm system and window bea enentsiham/ware removed prior to installation. We make no guarantee as fo 2 whethera/ands or window treatments/hardwars will fit after replacement. Customer Is also aware in some cases Hera Willis glass loss. If Mere is,the amount Wilts dependent on the type of existing wintlows,type of installation and window style.We make no guarantee as to the amount ofglass loss. Customerts aware and understands any and all unseen rot is not included to this contract.Should any not be found there will be an additional charge for time andmatedals unless so statedin tM's contract. s Yes Contractor will insulate,caulk and seal windows With 3-point system to prevent water and air infiltration.Removal and disposal of all Job related debris, windows,doors,storm windows and vacuum nightly Included. Upon completion of the job and payment in full,a limited warranty shall be Issued. < Yes Building Permit--Contractor will secure any and all necessary permits. The fee for the plaintiffs)Is not Included in the Contract Price and a separate check Is required at the time of sale for this fee. Check It $ 5 Yes All discounts have been applied to this agreement. 6 E� Ycs C No Owner agrees to be preset on the final day of installation for final Inspection and to decant final payment/finance form(a). It is agreed and understood by and between the parties that this Specifi,mi,n Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,constitutes the entire understanding between the panics,and there are no verbal understandings changing or modifying any of the terms. This Specification Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s)and Central Imor(s)hereby acknowledge that bowels)has read this Specification Sheet. Renewal by Andersen Corporation Bu r(sJ Buyer(,) L B. Signature of Project Manager Signature Signature JOHN BEAVER FRANCIS MURPHY Print Name of Project Manager Print Name Print Name