12C RUSSELL DR - BUILDING INSPECTION SALEM
13L'13 _Ic 1)im1)1:IZ'1MUNI
'1"
�^u AC:�a u�'cn�.:n;i 7.� • �v.r.�i.AL�<.�„n zi ri;nlo- i
APPLICATION FOR PLAN EXAMINATION AND
BUILDING PERMIT
ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS
IMPORTANT: Applicants must complete all items on this page
SITE INFORMATION
Location Name /Z C Qd5.4511 kg Building
Property Address
am—
Located in: Conservation Area Y/N Historic district
APPLICATION DATE (� • �7• o •b
Use Groups
(check one)
Group Homes R3_R4_
Residential (3 or more Units) R2_✓
Type of improvement Residential (hotel/motel) RI _
(check one) Assembly (Theaters) Al _ wf1
New Building_ Assembly (restaurants & clubs) A2r_A2nc_ V
Addition Assembly (churches) Al
Alteration Business B_
Repair/ Replacement Educational E_
Demolition_ Factory (moderate hazard) F1 _
Move/Relocale Factory(low hazard) F2_
Foundation Only High Hazard 11_
Accessory Building Institutional (residential care) 11 _
Institutional (incapacitated) 12_
Institutional (restrained) I3_
Mercantile M _
Storage S1 _Moderate I-lazard
Storage S2 Low I-Lazard
OWNERSHIP INFORMATION(Please type or Print Clearly)
OWNER Name ?A I d 1
Address /Z a jeamu l PR.
Telephone 97ft- SZV- 6/6,V
Signature
UI•:SCOltlll'I'ION OF )PORK T'O BE PERFORMED
yiy S�ie.� q�o�e wrtrcleeue �tv� �x�SiZ'ny4
PJD6N.L)v4s /1ljx led 17 /o(�v/�
ES'ITNIATED CONSTRUCTION COST
CONTRACTOR INFORNIA HON ��+
Name !r/r'w�RD 7HngzR, s f/TDxd�J
Address &16 ej5V,*.2-S7—
Telephone
Construction Supervisor's Lic # OA 6190 t]
Home Improvement Contractor# 1V 'K5
ARCHrl'1?CT/ENGINEER INFORMATION
Name
Address
Telephone
Mass. Registration #
,r _PE'RNlrr FEE CALCULATION
Estimated Cost x $11/$1,000 + $5.00=
CONINIEN'rs
The undersigned applicat:t does hereby attest that all information staled above is true to the best of my knowledge
iuider the penalties of perjury
Signed /f r"� ✓LG, (0"n") (argent)
APPROVED BY :
DATE APPROVED:
CITY OF SALEM
PUBLIC PROPRERTY
DEPAR"I'V1ENT
III 'I'\.'J i. fir I \\ 'i�.V L"
r construction Debris Disposal Affidavit
(re\luircd litr all demolition and renu\'utiun work)
In accordance \% ith the sixth edition of the State Building Code, 750 C NIR section I 11 5
Debris, and the provisions of N1GL c 40, S 54:
Building Permit A is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal lacility as defined by vIGL c
I11, S 150X
The debris will be transported by:
1 name of hauler)
he debris will be disposed of in
tl Jmr u(fJcd y)
IadJriv, H lJclhtvl
�iL�S MAiJ�G�
,IL'IIJIl11 l' tf pcnnit Jppllc Jnt
,larn
MA Reg#146589 IM rmmeurflowto oun... Federal ID#20-2625129
orrm
CT Reg#0605216
RI Reg#26463 windows,siding and More
Corporate Headquarters,26 Cedar St,Woburn,MA,(P)800-342-2211 (F)781-933-9626,www.newpro.com
THIS C'ONTTRACT MADE THE 0/ day of C C`� .2 �
^0 (between
CJ(.�E� r.
(Home Owners) ` (Home Phone) (Bu Cell hone)
Of 12- Cr a, 01170
(Address) (City) (State) (Zip)
the"Owner"and NEWPRO Operating, LLC, "NEWPRO". The job address is a condominium.
NEWPRO hereby agrees that it will for the consideration hereinafter mentioned,furnish al I )r and material necessary to install the following
described work at the premises located at at
Job Address) ` E-Mail) for proprietary use only
TOTAL ) Additional Model TOTAL
Windows Purchased NEWPRO (� Work AtImber City CASH /y
Window Color In: Out: Sliding Glass Door - PRICE Zvc .j
Capping Color Steel Security Door
Door Color In: Out: DEPOSIT
Model Name Model Numbers Sidelites WITH
Double Hung New Construction Unit ORDER,/
Picture Window Storm Door BALANCE
Casement Obscure Glass BOTTOM DUE AT
2 Lite/3 Lite Slider Screens FULL INSTALL
Bay/Bow Frame Please Initial:
Roof: ❑ Soffit: ❑ Customer understands t ®does not CASH
Garden Window do any painting or staining. lie:when removing Balance paid er 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 !i
Other densation resulting from or due to pre-existing Bank completion form signed at installation
GRIDS Colonial I SDL Euro conditions.
DESCRIBE WO : e r�( 5
S rti u `7 f 24-)P4-J IL-1tfJ 461A �4?�, PeL4j6 i
Est.Start Date: ff�/0 L Customer understands this is an"estimated date" Est.Comp.Date:
ni is siTTt'i'a��s"
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 in damages 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 b ordinary mail posted, b telegram sent or by delivery, not later than midnight of the third business day
Y rY P Y
following the 'gning of this agreement. (Saturday is a legal business day). See the attached notice of cancellation
=eowner
xplanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
as seen"sample"warranties that will be provided by NEWPRO upon installation. Sample Wirral provided tojOwner.
WITNESS WHEREOF,the (s„av hereunto signed their names this�_d y of 20 O1D,
/�J 5 EIN# Signed
arketing R resentative Printed Name
,",�) Owner
Accepted: EW Operatin�Cf�
By + Signed
Owner
CORPORVE OFFICE SHREWSBURY BRANCH OFFICE WARWICK BRANCH OFFICE
26 Cedar St 151-153 Memorial Drive Business Pk 24 Minnesota Ave
Woburn,MA 01801 Suite B-C Warwick,RI 02888
(P)800-242-9974(From NE) Shrewsbury;MA 01545 - (P)800-356-3312(From NE)
(F)781-933-0717 (P)800-456-0555(From NE) (F)401-732-1371
(F)508-842-9248
WHITE: Branch Copy YELLOW: Customers Copy PINK: File Copy GOLD: Finance Copy
US-15 R0508
�i
\`��
\�'"I/� �
��-
I,
� Ind ows/Doors In
`'—) NL07
JOB# /OT� THE REPLACEMENT WINDOW PEOPLE
��,,nn L1,, W) Pa e_of
CUSTOMER ,-1 Cti.C., Q,- 40-t �
E-MAIL ADDRESS ( HOME PHONE
DATE I C) I y T E \ WOR /CELL PHONE
ADDRESS tc7 C ttD 5-,,n-C (1 T (Circle one)
CITY,STATE EST DAY TO INSTALL: M T W TH F
l 6 (Please circle one) ter[^
PRODUCT SPECIALIST�� �� BRANCH: VLSI ESTIMATED START DATE ,vA
TOTAL#OF - #OFDO WINDOW COLOR -
WINDOWS #OF BOW/BAY/GARDEN :�mnn,Steel, atia inside/Outside CAP COLOR
OPENING SIZE STOPS
O. STYLE W x H U.I. LOCATION.GRIDE SCR IN OUT ADDITIONS OPENING CUT
Lv( k-f— f x x
LJ ( 07S 3 9 )04 74 L-A x x
2 a-KC ,3C ),q (A- r x x
J03 S ( 3% } ct �LL x x
C cp S 3s Y N(Q tUr x x
��I! c7l x x
a() C91�f ✓b-)L , x x
3yo�1/ (Z / 3fxNb x x
dV�j d7!.S6 3��L.l l,p g ,� x x
x x
x x
x x
x x
x x
x x
Measureman:
vnooucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Aw.egican First Ins Agency Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
12,e"'Quinc]I Shore Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
No.E'Ch Quincy MA 02171
Phones 617-770-9000 INSURERS AFFORDING COVERAGE NAICM
INSURED INSURER A: Arbeiia Protection Ins. CO
INSURER 8:
Newpro 0$orating LLC INSURERC:
Woburn OX 21901801 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMEM,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.
LTR NSR TYPE OF INSURANCE POLICY NUMBER OATS MMIOON DATE MMIDO/Y LIMITS
GENERAL LIABILITY EACH OCCURRENCE SSa OOOa OOO
A X COMMERCIAL GENERAL LABILITY 850000010649 01/O1/09 01/01/09 PREMISES Eaocourehce) S 50a000
CLAIMS MADE ®OCCUR MEO EXP(Any one person) E$'000
PERSONAL 6 ADV INJURY E1,000,090
GENERAL AGGREGATE S 2,000,000
GENL AGGREGATE LIMIT APPLIES PER: PROOUCTS•COMP/OP AGG s2,000,000
y> 77 POLICY 7 PEGO7 LOC
AUTOMOBILE umUTY COMBINED SINGLE LIMIT 51 000,000
'A ANY AUTO 81037400001 12/31/07 12/31/08 (Ea acddenq
ALLOWNEOAUTOS BODILY INJURY E
(Per Person)
X SCHEDULED AUTOS
X HIRED AUTOS BODILYINJURV S
IParaccident)
X NON-OWNED AUTOS
PROPERTY DAMAGE E
(Per accident
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 'S
ANY AUTO OTHERTHAN EAACC E
AUTO ONLY: AGO S
EIICESS/UMBRELLALIABILITY EACHOCCURRENCE S 5.000.000
A X. OCCUR �CLAIMSMADE 4600010709 01/01/08 01/01/09 AGGREGATE $ 5,000,000
s
S
DEDUCTIBLE
S
1 , RETENTION S
( *WORKERS COMPENSATION AND X TORV LIMBS ER
EMPLOYERS'LIABILITY ' 90967005 05/01/08 05/01/09 E.L.EACH ACCIDENT
E500a 000
A+� ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFyFICERIMEMBER-EXCLUDED? E.L DISEASE-EAEMPLOYE $ 500,000
' DOCIAL PROV rider DeIOW E.L.DISEASE•POLCY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS RLOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
OPERATIONS OF INSURED
CERTIFICATE HOLDER CANCELLATION
SPECIME SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAT:
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEI
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO:SHAI
,4 SPECIMEN IMPOSE NO OBLIGATION OR IUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
+(_ SENTA ES.
ti pUTHORIiEDR RESEN ATI
r n
®ACORD CORPORATION 19
ACORD 25.(2001l08)
O tce o nvestigations
600 Washington Street
n Boston, MA 02111
z www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information PIease Print Legibly
Name(Businessiorganization/Individual): NEWPRO
Address: 26 CEDAR STREET
City/State/Zip: WOBURN,MA 01801 Phone#: 781-932-8300 Ext.251
Are you an employer? Check the appropriate box: Type of project(required):
1.X I am a employer with 50+. 4. ❑ I am a general contractor and I 6. ❑ New construction
employees (full and/or part-time).* have hired the sub-contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. $ 7• X Remodeling
ship and have no employees - - These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
required.] officers have exercised their
3. ❑ I am a homeowner doing all work right of exemption per MGL l 1.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, § 1(4),and we have no 12.❑ Roof repairs
insurance required.]+ employees. [No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
+Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
/am an employer that is providing workers'compensation insurance for my employees.Below is the policy andjob site information..
Insurance Company Name:. AR13ELLA PROTECTION INSURANCE
Policy#or Self-ins.Lic.#- 90967005 Expiration Date: 05/01/2008
Job Site Address: City/State/Zip: ,$ M D!$76
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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify underlhepains and penalties ofperjury that the information provided above is true and correct.
Signature �—� � FORNEWPRO Date: e,, e jf —
Phone#: 781-953-8146
Official use only.Do not write in this area, to be completed by city or town official.
City or Town: Permit/License# _
Issuing Authority(circle one):
artme
1.Board of Health .Buildin Be n 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
p
Board o!tiding Regulations and'$taridands' i
t •�J� Construt,i�oxn Supervisor License
Litgtse� CS 29090-
f
z �g TO -� 1,Q/2009 Tr# 8131
1 tdN�d _
THOMAS'P FOXC'���: {�'
230 WALNUT ST
READING,.MA 01867 {�'r1 Commitaioner
o,
Board of Building Regulations andStandards ;I
HOME MPROVEMENTCONTRACTOR.-
Regi!54*1 tT`'�g6589
E?lRi!eGort {5/3009
F 41YR -PR lement Card "
f a rs
NEWPRO OPERA'FIPiG'LL`C_�!„
THOMAS FOXON � " 1
.
26 CEDAR ST
WOBURN,MA 01801
i
V-
for sa.4?,,,-j
krnerican Properties Team, Inc.
TO: Jacqueline Hall, 12 Russell Drive
FROM: Jen Pappas, Property Manager
RE: Window Replacement
DATE: October 6, 2005
Please be advised, that the Board of Trustees for Pickrnan Park does not object to.the
replacement of your windows providing they match the existing windows, and can fit in
the existing opening. They must be the same in appearance front the exterior. The Board
will not allow windows with grids, crank outs, etc.
We also require that permits be pulled in advance, and then a copy of the final approved
permit once completed must be sent to APT for the unit file as well.
You will need to bring a copy of this letter to the Salem Building Department in order to
receive your permit.
Should you have any questions or require additional information, please feel Tree to call
me directiv at i751)932-9229 x675
cnn AA/FCT (9IMMIN(:S PARK • SUITF 6050 • WOBURN • MA • 01801 < 781-932-9229 • FAX 781-935-4289
ENERGY STAR"' Qualified
in Highlighted
maw
®=Qualified In all zone.
1 NEWPRO MANUFACTURING
I �R�
Ka 3000 PICTURE WINDOW
1 Cellular PVC frame,Triple glazed,
NatlurWfenestlatlon
I petlrpCouncil®, Low E coating (e=9.094, 52 8 5),
i Argon/air ffiled
OEV-K-22-00006
ENERGY PERFORMANCE RATINGS
U-Factor(U.S.A-P) Solar Heat Gain Coefficient.
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance Condensation Resistance
Mvmfaokrer"Indanathatthaepretlnps cordorm k eppticeMe NFaCprocedures krdetmminNgwhole
product pedormence.NFgCretlng9eredekrmined kre faetl.alai envlronmenkl cendltlansantle
epecllkpreduGalm.NFPCtlsea notresemmendw preductenddoeinatwerrentthesuX R5ofany
product eranyspecouse.fknsuttmermladunr's 114ere1ureforotherpmduot pedormanae lMomraOon.
wweesyl .or
v