Loading...
8 RED JACKET LN - BUILDING INSPECTION (2) The Commonwealth of Massachusetts �i Board of Building Regulations and Standards CITY OF �J �( Massachusetts State Building Code,780 CMR SALEM Building Permit Application To Co Revised Mm 2011 nstruct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling Tt ' ' -: T1iis Secdwt F.or;Official Use t�nly u . '��#! •>�! ��"57..{.��:�;� t�iT r r r�l}ram �,..-- cPY�'7_ry rz ..� .;.���.+��-,�. .^Bui1dm60fticTal��tlNfnne) �}-:�. ,Y_ «xt�^^ S - - igniittQe�r�;^� rSECTION'1c STIE INI+O'RMi?T 1.1 ProJONi.perty Address: 1.2 Assessors Map&Pareel Numbers 8 Red Jacket Lane Salem MA 01970 Us Is this en accepted street?yeses_ no Map Number Peril Number 13 Zoning Information: 1.4 Property Dimensions: Zoning DbWct Proposed Use Lot Ares(sq fi) Frontage(8) 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 Die Public O Private o Zone: Outside Flood Zone? Disposal System: Check Cap Municipal❑ On she disposal system o Nancy Gallagher Salem MA 01970 Name(Pnnt) City,State,ZIP _8 Rad IarkaT I ana 7R1_9dd-919R n No.and Street - --- - - — Telephone an.�ll1!7rnm act n t ' a - Email Address L� ON 3 DESCRIPTION OF PROPOSED YVOR�I{.(c(kekaB tkat apply k,,i New Construction O Existing Building Owner-Otxupied III Repairs(s) Yd Aherati Demolition O A Bl on(s) O Addition ❑ csed Work : O Numbea of Units_ Other Specify;Replacement Brief Description of Proposed Work: Replacing 6 windows, no structural changes ESTIMATEDCONS'TRUCTIONJCOSTS Item Estimated Costs: 0 and Materialsi,` ` r tit >DCIq�Use Only _ t` r;a 1.Building $9 567 �1Bmldih;Permit'Fea�1$ htdicate}tow fce is determined tl 2.Electrical $ DityllowmApplicafio'nFee ti' ; ` n Total`, act C' .. w'A F7 teZ—_ >'i'oJ (Iteer 6)x m 3.Plumbing $ 2 d OtherFees $ `�Jt - �- «+rr Ir� ,o.•-�,„a _ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire $ > r Suppress on That All Four$ 72_ _ 6.Total Protect Cost: $ 9 567 Che&No r' Check Arno& Cash Ai oim't 't " _- ❑Pahl n Full ` t'_zD Outstanding Balaitce'Due:'!r „� ,. ray= •. r �`7-`; -Try �e�SECfdOPT?S ff +NBTRUCTION`31;R,,\'ICES '+, ` ."�.y,'�,`•, 5.1 Construction Supervisor License(CSL) 90125 Jamie M 10-06-18 L License Number Expiration Date Name of CSL Holder 86 Gardiner St List CSL Type(ace below) U No.and Street 1 °C'YPc, 0. -. . �Deacrtph '' Lynn, MA 01905 U Unrestricted undin to 35 ODO cu.lt. City/Town,State,ZIP 1t Restricted IA2 Farok Dwelling M Maso RC Roo Coven wS window and Siding SF 508-351-2214 Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Rome Improvement Contractor(HIC) 170810 12-2 3-17 Renewal by Andersen RIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date 30 Forbes Rd No.and Street Northborough, MA 01532 508-351-2214 Email address C' /To S ZIP Tel oar _ SECTION*W2$I JE S COMPENSATION D CE'AFFIDAVIT 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 per! ._ Signed Affidavit Attached? Yes.......... No...........O `SECTION'7a_OWNER AUTHO]tiZ'A. ION TO'BE CAMP D r' VVNER'SAGEIT�OR• NflRAC�1bRAPPLS:FOItBUII;DINGpIrRl4II�, u.r I,as Owner of the subject property,hereby authorize Jamie Morin to act on my behalf;in all matters relative to work authorized by this building permit application. SEE CONTRACT 10/97/901 R Print Owner's Name(Eledmnic Signature) Date , "� '__ SECTION„96 O,W1VElt�£OR AUTHORIZED AGENT DELI ARATION ;: jp s T 1 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. JAIME MORIN 10/97/7016 ` Print Owner's or Authorized Agent's Name(Electronic Signature) Date I. An Owner who obtains a building permit to do his/her own wary,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 gumudy fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mess.gov/oca Information on the Construction Supervisor License can be found at vNML ss eov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.fL) (including garage,finished basementlattics,decks or porch) Gross living area(sq.1) 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”maybe substituted for"Total Project Cost" CITY OF SALE14 MASSACHUSEM BUILD=DE1PAaTmeNT 120 W-WWGTON STRM,r KOO& TEL(978)745-9595 1CISf8cn*m+DBISCOLL PAX(978)740-98" MAYOR THOMAS ST.PM= 61xECro1 of PUBLIC PROPFAW/eCMI)ING COADRSSIONEI Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code,780 OM section 111.5 Debris,and the provisions of MGL c 40,S 54; Building permit N is issued with the condition that the debris resulting from this work shall be disposed of-Fin a properly licensed waste disposal facility as defined by MGL c 111,S 150A. The debris will be transported by; Renewal by Andersen (name of healer) The debris will be disposed of in Renewal by Andersen (name of facility) 30 Forbes Rd, Northborough, MA 01532 (address of facility) signaprre of permit applicant data debrirarEdoc The Commanwe M ofArassachuse& DgwMm atofLm&sbfatAceldvn& tfitce of impudgadona 600 Waddnrm s*m Bovlb%MA 02111 www.maw,gvWdIa Workers' Compensation Insurance Affidavit:HoBders/Conhwtora/EkeWetauMumben Auvhemt Information N a Loidbly Name ): RENEWAL BY ANDERSEN Address: 30 FORBES ROAD City/statelzip: NORTHBORO,MA 01532 phone 0 5DB-351 2214 Are you an am~Cheek the app oprlate bm- 1.K] I am a employer with 30 4. ❑I am a geawal conlracmr and I T�Pe of Project(requhv ): areployeas(fall mdlor p dmo).• have hired the sub contractom 6. ❑Now construction 2.❑ I am a solo proprietor orperirm- listed on the attached sheet 7. g]Remodeling ship and have no cmployaw These atb conhactae have & ❑Demolition working for me in any capacity. emPloymm and have workers' [No worker,camp.insurance comp.insurmoe t 9. ❑Building adftm required.] 5. ❑ We aro a corporation and its 10.❑Ek*ical mpeas or additions 3.[3 I an a homwwner doing ell work offmans have weercised them myself[lie wado ms'amp. right of memptimpm MOL 11.❑Plumbing;ropaire or athliticm insamote roquhed]t a 152,¢I(4),and we bow no 12.❑Roof rrpdm rmployees.[No workers' 13.❑Oder comp.insmmm ra pared.] •Aq eyparaatad Checks boot eI coma den ton aotamemtbm bdow dswbg adr wodmr' Infimmolm t Hameowosawtto submaab emd"k mduaBmgAw medit dlwmk@add=boa� UWmbmn aaar :Omtmdme addw*d&bm must anwhad w eddWond&M dwwbp aesemaafeer mt.mmromm and ddewlm w��hm empbyaea Sae u b mammu hm cmPbrtm,aeymadpravide tbeh v mkm'aoaP.pdb mmbw, law u aapdeyer Am blauwift work=,ooapama egea t for ap Avoyem Below h depeaq mtdfob S& nl mmadmL hourance Company Name: OLD REPUBLIC INSURANCE COMPANY Policy#or SW-ins.Lie.#: MWC30823100 10I01/2017 Expiation Date lob SiteAddrear 8 Red Jacket Lane aty�soatn2;p;�alem_ MA 01970 Attach a ropy of the twttoeea'compensation policy deehtrad=page(a wvft the pogey number and emgdra&n date Paihue to secure as required under Section 25A ofMOL a 152 can iced to don impo®tiom of orimiaai pities of a fmo up to$1 M00 and/or one-year imp to®mt,as well as civil penalties m the form of a STOP WORK ORDER and a fine crop to Z250.�a day against the 8000 co Be advised abet a copy of"statement may be B r%wded 10 tine Ofte of for inemanca covamage verification, 1 do pdaa sad pesam�olPa auu dke irymnmmionprerfdtdeiova 6 Orase and aN 10/27/2016 8-351-2214 t7,Bidal mar sm* Do not wwdtr in dims ava,to be soar led by OW or tans offimW City or Town: PanmiuLbmm# haft Anther/ty(Nrds me): L Board�of Health 2.Bspdiog Departateat 3.Cltyfrawn Clerk 4.Elertrierl Deter S.Plmrbiog hnpeetar Contact Pasco Phma#: ANDECOR-01 SALWAIIIN GATE NMO CERTIFICATE w nYY+T OF LIABILIT Y INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 9/30T201B 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),AUTHORRED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the ;wti holder Is an ADDITIONAL INSURED,BEa Polk Ami must be endorsed. N SUBROGATION IS WAIVED,subj— the terms and COndltle o of the policy,certain policies may require an endorsement. A statement on this cenfifil s doss not Roller rights a to the Certificate holder In lieu of such andorseme s PROD of NAME: Willis Toarere Watson Certlfleate Cellar WillisCONTACT 26 Cs;pWpMy Blvd 1 E 877 945.797E PA,11RNL 305191 N. 888 467.2378 Nashville.TN 37230-5191 'NIwm UbLoom are s ANvoRDlNoewaRAce Noce INSURED INSURELA:Old Re ublic Insurance Com an _ 24147 INSURER a: Renewal by Andersen msuRER C: 30 Forbes Road deuReR o: Northborough,MA 01832 NNIRERE: INSURER P: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS B TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICTED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CX7NTRACT OR OTHER DOCUMENT WITH RESPECT TO WFIICH THIS CXCLIRGTE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORD® BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, IX(D.USION.4 AND C ONDRIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTN MF OF INSURANCE POLICY NUMBER • l.aaTa A X carveRcw cExeeALLIABwrr cLaMs-wwE X❑cc" WZY 808234 110101T2016 10/01T2017 EACH�RRENCE s 1,000,00 S 500,00 are 1 a 10,00 PERSOMgL B AOV INJURY S 1,000,000 DENvaaoPI[DATe LIMIT APPLIES PER ' X POLICY❑JIBLoc GENERAL a 4,000,00 RTrHr9 I I TS.COMMOPADS S 4,000,00 AUTOMOMMLL& ULI S C�rtRNED sINOLEimr $ 5-000,00 A X ANYAU O ATM 309232 r' nOWNED 1N01/2078 1W01T2017 BODILY IWURY(Ptr ANNULI E TOS AUTOSSCHEDULED eoRLrlwuRr(P«eouUsn) a HIR®Al1TOB AUTOS LTMWZUALBB OCCUR a EXCESS UAB ClNM6-MN]E I I I fACM OIXXNRRENOE S DED RETENTIONS AGOREOATE $ YRIRXEn COYPEI mm S AND EMPLAYFRB LUIDIUTY I I X m TUIE ER A ANYPROPMMErOR,PARTMER1FJECurNE YNx OP C30829f00 10l0712016 10T012017 FCERa�RERP7.CLIJDEDT N NNA El EAMACQpgRr a 1,OOD,9 WyyoamAa,Mms In 00 MCI OFaE:IiIPT 'IOH OF ppFRATIW♦B beW I I EL DISEASE.EA ISMS 1,000,00D ELDREAEE.PDuCyuw S 11000100 I DESCRWTWNOPOPERATIONa IL.00ATMMIVEIaCIES PICORD 101.Adtlltlene R•nsNo 8chamb,my YMeRMEImae sprw4,egWNe) CERTIFICATE HOLDER CANCELLATION I THOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SEPM E EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY pROVImON& AmxoRJZEp REPREBEI-DTI-! roofotimEsu Ce $0,-,f. br� ACORD 25 2014Po7 01088.2014 ACORD CORPORATION. All rights reserved. ( ) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of BuNding Regulations and Standards License: CS.090125 Construction Supervisor , JAME L MORIN ti Be QAROwwR ST ' LYNNMA 01906 W t-" zw CA— Expiration: Cofrmmissioner18 Construction Supervisor Restricted to: Unrestricted-Buildings of any use ggroup which contain less than 35,000 cubic feet(901 cutxc metros)of enclosed space. s P i ` I Failure to possess a sweat editias of the ♦Massachusetts ate It""Code Is cause for ravocallon of this Iteoase. OPS Lloeaahrg WOM1490o visit:WWW.MA6LQO WS i f �ile�/d4 y�H�aaaad&me!!a i #Of Coasamer Affairs&Badness Regaiados ME IMPROVEfAENT CONTRACTOR Rogkhatl ,Tye. FxPi _ Supplement Card RENEWAL BY AND _ .- r-.L 1l JAIME MORIN 30 FORBES RD NORTHBOROUGH,MA 01532 Uaderxcrctery . M1 a '.Do oatl®d1e�190d ao�lOspei9m.Aae11A1.16t?�elela®.. erne � U.Feola8dar Fk�aaln mdAde�R - . 1.66 0: 0,49 Rgtal, Agreement Do[ument and Payment Terms_ .. a�atreaaa�iK tEOii 11at $fMwYdi hY hncktsettLF s gW jacket ldnP. IIQCi'1T0610: . � Sitea.lA4Oi4�0'- -ram u..i. 3U rlrleS CaaadlTkwahtroros9b;.M14t01532' IE.f78194 42126, Cf+[mm�3�#",t-220016at:`f�98!�b7t7?2 F'P�EaatonLaeiati6n¢Qentu�p.ettnf Cnsooartr(tj Nome Ifancy 6alUaghef Gintrie 'Dnoc 09I2W16 Q4tq�r(r).-Street A 8 ped:laektt W�Salem.h1A Q1970. -. BI'hlfal}!�'�2�5pflt Q'1111u�lt\/0���2��'. 4iepbpd7f���2plldttd,r!�Iltll�@F�.. nancgalfOaortxasGnet� Soon y.., r r fe .�. ,� t, t 16erebp iotndy amd aeYaaQy ages m puxshasc the p nadttets anid!or servtoes of Rtoewaf bg'Awdeiaeo Cl C dlbla�titcwal bp` Aaduseao€Haseon('C.eav�eor',),In.i000rdareae-withdotgmeandaon�l6om edIn�ls_eVpeeaaearOmcumeeia Ehgmaarp >Teems i�auQ of Cernoe➢ittoe;Imam Order R®ixrpr,Tcan and Catdttio�ofSale'Lead Safe f omn Otsoes os budder:Fiecttomc Caasrn6]m' and an'other doaioieor anathed m thts Aotmenr 17aqummt:t6c c eeetoe of atlhti6 are all and ro by tltr pamessod she -haeie br'e�t�(mll. �vd�,tB 7 Bn}et�s);1r<'ebl?g co ugu.a C3= i1bDU ote after 'ontaeftw-"- ,: iratk uadv tLu A�cmuart; -i ar`al doh yAt rFttar ;9�567t: BY. 'i l'agtcrmen poa.a ledge that til $�hnde Qhee.arnd dieAmatms ` l:Gianaed mtRE be trade bYvctsaml shalt.ban3i:tlie�csadli' ar cisli - fl7kpe�t Rmtivedi #p EStlaooe�ue's f9,5G7 &.Mff dSUM. �et7maedCompkrLon- Amottat 13n5natd:r 54,567 fr6 weeks 1-2 dots' ��of Y nt Raandng �TVc scbedtde�naslfstlons bind m the dau of tlra signed eoetrxs and ikccwLdn on, the date o rs�ddt to aomp�me the tetlicttbi meaiu�nn®ts�e'mgallatlon flute ticai ► an, iRatcpturidengaetLtsti�rs®Ijaeestimate �Vewtlicmumartw¢an;G&dd&t $1166,'6 99L 1i1ad foR S anJ time silk latee'&'RAis"d daM OM&, :6m fer eots. 113 f�1l,1/3 y ._. ii3189:113tr331B8 and untEoesottd9 than this Agoenutmt c+oaranace dtc muse urtdasta 6etweem¢Inc panics and dnr titcic are no vrtbsl .; ®ae atao a auy of the tws of&ii Aominni'L t� to nr°der;setma Fsom th'ti Agee *nt etu bi l ,. aarhonr�c sigtttd.eritt;n both the 6-4a Wiioj Catttractor S14dW herby dx'�tsyxstsl 1)htiv teed thts mretit taa:undcmds:l6e tams a thtr Agee r,®d ral rooa a complerod Sipe end d: VW of Ape �llgeciinatr.hula the ewe ateadted 14a6t is_af Caeodlitiot%,on rAe date firs wiitten a5otiae and 2!sort ayDp tgFor pf&qas d*m analAli" ' 7�?CY9VNf#t W trot thin onntrte tfhlanlu'IGott aHe enlPelcd m a d6¢y`4f dte Contra a the time ymtt dltn; Ifou,THE SFkYlslt i4�AY G11NCBl:THTS 1RAI1SA '1 iON�1[I ANY<TtME j�41111 I110 ER THAN.hflgLNLGHI OP G9I73J34'16 ORTH6 THYBD BUSIMrSS DAY AF!'ERTM DATE OF TES TRANShMON," �RfHGliB1rER DATE LS IA}e'T��*6/�`'RY�p�1S��BC�T�ll_�E�,y�KITACHBD 1�tOtR(��OF GNC�LLATION FORMi FORAN`, Sr, Bf�SaG#14rlGb � tYte- }K�I twt :k ICofariti Pellei(er< iamy. ser '.Brterl�eufSaler(ieteo ,Nnrie Irttiite= Pe7et t�fd�e' �.ogr2olrcH Z +.t�':: Itemized order Receipt. _ `�. ��a16►,IcdnwgaFBuo-. 'Mrn5Y6sdagti�, toga How Rtsceytiel hr Niderse rte; 8&d hEka lane, HCC1+TGas10,. _ 31�Iw�OlA70 „_.. 6t4781 44-2128. ".�,... um.. 30 farlia 3wd t N�rhhorou0h AW 915ft' � . . Horne: i+i1-22G01 iac f�l%rXr7072 t Nti�SinnGQmau¢RsQA�9essenCary.eoin�' 101 Omilig toxin Wfed6W Gliding Hauhle .Gliding 1 1:: W6ivpiFasstre Base, ZOO ame; W'MRjORI Ite'INTERIgR WFilttr 6 ;Sash All M.Igh Itir#nrinan�.5rnaes5irn,Glass Na Pattene;HacdwareWhite;" Staeeitr Fii�erg1a35~Fsetis�ecn'Gr+lla.;ty�'e NoGril1¢r AArsC': 'Noo 1� LAi11114f00i1► Vl rift*. Gliding �ou61e;Glid+ng,;I U,-IXctire'lPaisue'Base: Frama, E%TERIQiIW�[It,tp1TERI0R tMhltico 6(11�,'Sa`sh All Eli9h ,'F&urmanoeSrrrartSunGlass HoPatfecn_. Hardware.White' Stree[i� Fiberglass Fotl56to Grille SeXie Plo45gIIaj Misc , Ain: 1c103 hem, t1lPttedbw.Girding f>6uble{Gliding, 1 iineYcu+relPassnre Base, €�amor Ex��icRwhlte;�airgalaR tie. � n da;�ii�n <liei#yimanae'SnrarlSrinGla�; No Pattei>at Nard�®are White? Streerr Fiberglass FoliStaeeh Grlllestyle HoGilr"Iles Mist Nan'. 104 I m�11,3 YY Wa* Gliding @orb Glyding6.1 1i.Wtnre1.Paesve Base' Frame' EtcTERIaR WhItG IF7TER]OR,Vghlre 6Pti "5asn al( &llgn sRerfioimanoe SmarlSrtn Gnu,Hq Pa�[Qm Hard�rraee'Wh�; su+ecrr Fiberglass Full}Sueen �rilib.styde NrnGoles eAlsr'-. i Rl. OWroD g YIR'nd4tY Gliding 0ocilrle Ghdmg 11 rYcurefPasstge Base_: 'FrameE)c1 A101tWhhe BNTERIaR,WhIleAftu Sesh'All MIgN �Perlrxmanoe SmartSrco Glans,No Patten► Hardware^White, tom. '�� t TX '• '^ r r: h 'T�.." l S�f iber FtdiSueert GYiIleStyle FlaleSYMrsi` t Non' Sk t f t 0$fblrl6x I'a'Oe 4�.:�� �( 1 itemized Order ReceiptbA Mkmn . 11 �d«o °teas . [emi Name.Reiutiral by kwerrseF ilc S?A Ad et NXH70810.„ Sakia rgaa197Us 30rarY�s�adiwait b Mygk;VAOISM, 10161944:?l26� @Faun 50�351-t2001 far.1;40BE 94lbhit2, Hheg�tonOPvaBai�`Asl�enCd�p.eam-: M MfaFtktw' i YlfPridow Gliding Double Giding-lj-.i ActiialPaasnre, ®ase_ �kame, EX-rERIOA Wlad�,SNTERJOR.Whi6N.,61'�is:Sash all .;High Peddrmante.Smart5ori Gust: NoTattem. anpewd GI "< Flai_dw�ra ;wbiJte,sueae 'Fihcrglass, �uGl 5¢tecct, 6t911a Siyte-No ddltes,Milo Nan' wraoouds6 wtm000aa�:a s�leoauirl► Nilsc.a ror;+� UPi�ATEID.:09f2Q/16` ,s'' � Rereaual bj.trder�it rora�aeJtt�d h err eareuu�eerf raf�,8j I camprra"asab der.liter spud Jra ¢!rr.6 pwcteccr rprelf�rd e�rbe EJsi ,Q912MCy Qaae S l 13