12 SETTLERS WAY - BUILDING INSPECTION (4) i
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
y/I Massachusetts State Building Code, 780 CMR SALEM
Building Permit Application To Cons Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two- ami ell'
This Se on F ial Use Only
Building Permit Number: &fobate Applied:
�fCbf "�77- 5l (1 J -7 to l
Building Official(Print Name) V Signature - - Date
SECTION 1::SITE INFORMATION
1.1^PropCperrtt"yy (Ad1d[ess: 1.2 Assessors Map& Parcel Numbers
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information• �, �
Z 1.4 Property Dimensions:
oning District rope 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:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if yes❑ Municipal ❑ On site disposal system ❑
SECTION2: PROPERTY OWNERSHIP`
2.1 Owner,of Record
Name(Print) t City,State,ZIP
) P Se" 'C" LJ(( '4 q-40---� (4 — S�
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORKz(check all that apply)
New Construction ❑ Existing Buildin ner-Occupied epairs(s). Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other—Er'Specify: e
Brief Description of Proposed Work : k o t
A a S
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I.Building $ S,uJ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
O Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2."Other Fees: $
4.Mechanical (I-IVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check-Amount: Cash Amount:
6.Total Project Cost: $ 3SC( S.d o 0 Paid in Full 0 Outstanding.Balance Due:
f
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
e E as fy
�j��(� e �emu. License Number Expiration Date
Name of CS Hol er -
11 � V edit"
I t" n(.7 i us List CSL Type(see below)
No.and Street l a Type Descriptions-i -
-m U Unrestricted(Buildings up to 35,000�cu.ft.
R Restricted 1&2 FamilyDwelling
Ciry/Town, State,ZIPP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
55..2 Registered
)I Home Im(\prov ent Contractor(HIC)
PCP_ r-Lua l l 18 C✓5 ( � on Number
;ra.3 I te
� �✓^S HIC Registration Number Expiration Date
1 IC Corn ,Name pr IC Registrant Name
and Stk�et1 J Email address
hq
4-land
or— o� Fw�a O1S3� Saa-3s l-2drw
Ci /Town,State,ZIP Telephone s $
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 ........ No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING-PERMIT
I,as Owner of the subject property,hereby authorize Sc�,p h K e z 2
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 licathion is true and accurate to the best of my knowledge and understanding.
t_3
Print O er' r 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 hives 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
www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
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(s9 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" g 3 j c{ S_,o�
CITY OF SM EN21, MASSACHUSETTS
BLUMNGDEP RTMENT
130
W.ksHINGTON STREET,3� Ft ooit
TEL (978)745-9595
Pnu(978) 740-98"
1Q�ffiERLEY DRIS � = .- _ .
MAYOR COLL THoma ST.Pw-m
DIREC[OR OF PUBLIC PROPERTY/13UUMING 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:
(name of hauler)
The debris will be disposed of in :
�ey1GwG�� � �1��etr)en
(na of facility)
� b�A CA " SI - �D� a'w Vk4 6IS3Z
(address of facility)
i gnature of permit applicant
date
dcbriwff..doc
Renewal MA Home Improvement Contractor
I„I�Arf,,IL YY �� License#170810(Expires 12/23/2013)
"JAI Idersen' Renewal by Andersen Corporation a Federal Tax ID#41-1s18413
WINDOW REPLACEMENT -Mdr—Comminy
104 Otis St.,Northborough,MA 01532
(508)351-2200•Fax:(651)351-4810 '
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
Bayer),)Name - - Dateof Agreemem
b Erb
Buyer),)Street Ad Ciiy,State,and Zip Code
/-:2 5 erns Gv Q �i zf- � p/9 70-
EMm11 Address Home Telephone Number Work Telephone Number
-
Buyer(s) hereby jointly and severally agrees to purchase the products 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. '
Estimated Star'tin,g,LDate: +M+et�hod of Payment:
Total Job Amount Amount Financed _$.",L-5 4&ck OCash
Deposit Received(33%): �i�IQS�I /W "`/_ Ov`,a. C ❑Discover
Balance at Start of (33%):. /.L.(1 — 0 OFinonced OAMEX
... . Estimated Completion Dote: If credit card is selected,please
Balance on Subsidntiol / see Credit Card Payment Form.
Completion of Job
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 Buyer(s) 1) has read this Agreement, understands the terms of this 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 Erse.Corporation Buyer(s) Buyer(s)
'Signature ofa/ct/Ian r / t Signature
Tint Name of Product M nager Print Name Print Name `
YOU, THE BUYER(S),�MAY CANCEL THIS TRANSACTION AT ANY TIME PR16R TO MIDNIGHT OF THE THIRD
BUSINESS DAYAFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS
FOR AN EXPLANATION OF THIS RIGHT. . ,. _ . _ •Te
..:. at aI .. i r mo , 1 1 41 .�
NOTICE OF CANCELLATION "" a- K ''` NOTICE OF CANCELLATION -
Date of Transaction c5 n——/7. You may cancel Date of Transaction - — — You may cancel
this transaction,without any penalty or obligation,within this transaction,witho any penshy or obligation,within
three business days from the above date.ifyou cancel,any three business days from the above date.If you cancel,any
property traded in,any payments made by you under the property traded in,any payments made by you under the
Contract of Sale,and any negotiable instrument executed I Comrad of Sale,and any neslotiables instrument executed
by you will be returned within 10 days following receipt by you will be returned within 10 days following receipt
by the Contactor ("Seller") of your cancellation notice, by the Contractor ("Seller') of your cancellation notice,
and any security interest arising out of the transaction will and any security interest arising out of the transaction will
be canceled.If you cancel,you must make available to the be canceled.If you cancel,you must make available to the
Seller at your residence,in substantially as good condition Seller at your residence,in substantially as goad condition
as when received, any goods delivered to you under as when received,any goods delivered to you under this
this Contract or Sale; oil may, if you wish, comply Contract or Sale;or you may,if you wish,comply with the
with the instructions of the Seller regarding the return instructions of the Seller regarding the return shipment of
_ shipment of the goods at the Seller's expense and risk. I the goods at the Seller's expense and risk.R you do make
If you do make the goods available to the Seller and the the goods available to the Seller and the Seller does not
Seller does not pick them up within 20 days of the date pick them up within 20 days'of the dale of your-Notice
of your Notice of Cancellation,you may retain or dispose of Cancellation,you may retain or dispose of the goods
of the goods without any further obligation.If you fail ro without anyy further oblr-ganon. K you fail to make the
make the goods available: to the Seller, or if u agree ) goods available to the Seller,or if you agree to return the
to return the goods to the Seller and fail to do so, then s to the Seller and fail to do so,then you remain liable
you remain liable for performance of all obligations under for performance of all obligations under the Contract.
the Contrdtl. To cancel this transaction, mail or deliver a I To cancel this transaction, mail or deliver a signed and
signed and dated copy of this cancellation notice or any dated copy of this cancellation notice or any other written
other written notice, or send a telegram to Contractor: notice,or send a telegram to Contractor.. "
Renewal by Andersen Corporation, 104 Otis Renewal by Andersen Corporation, 104 Otis Stets,
Street, NorthboroMh_MA 01532, BY NOT LATER THAN Northbofaugh,MA 01532,BY NOT LATER THAN MIDNIGHT
MIDNIGHT OF� ��3 .(Dare) OF (pate)
1 HEREBY CANCEL THIS TRANSACTION. I HEREBY CANCEL THIS TRANSACTION.
Buyer's Slgnmure Prim Name Dina Buyer's Signature Print Name Date
RbA Copy- White Buyer Copy-Yellow Buyer Copy-Pink CeLIP2009.RBA.Ph u Nll
Renewal ' ;. �Gnewal by Andersen COrporatit MA Home Improvement Contractor
�„, „/� O 104 Otis St.,Northborough,MA 01532 License#1708 10(Expires 12/23/2013)
"Jill dersen' (508)351-2200•Fax:(651)351-4810 Federal Tax ID#41-1918413
WINDOW REPLACEMENT mMdenen Company
WINDOW SPECIFICATION SHEET
Buyer(s)Name Date of Agreement
02 N L�-�
The Buyers)list ch above hereby jointly and severally agree to purase the goods and/or services listed below,in accordance vnth the prices and terms
described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,
of which this Specification Sheet is a part.
WINDOW DFIAILS
1. Contractor will Install a total of windows in Owner's home,using the following individual quantities:
Double Hung(DB)_Equal sash_Cottage sash 0/3 top,2/3 bottom)_Oriel sash(2/3 tap.I/3 bottom)_Flat sill ewomcr is of
em of class min
Square Check Rail_Curve Check Rail -
Casement(CS)_Hinge right Hinge left(as viewed from exterior)
Double Casement(CD)
2 Lite Gliding Window(GW)
Casement/Picture/Casement(C7) 1:1:1 or_1:2:1
Glider/Picture/Glider(GFW)_1:1:1 or_1:2:1
Picture Window Bay or Bow
Awning Window _#Lights Soffit/Roof Shingle/Copper
Specialty Window Patio Doors b,,,separate char spec sheen Seat to be Primed/Oak/Pine
2. �2--Qty of Windows to be Custom Fit Replacement:
3. -�17 Qty of Windows to be Custom Fit Full frame(INCLUDES NEW INTERIOR&EXTERIOR CASINGS)
Exterior c s:_Pine_--51mitenance-free material_Factory applied 908 Fibrex brickmold
4.Glazing to be:_HP LOW-F.-4 us Tempered —Other If other,please specify:
5.Exterior color to be:.�ite—Said_Canvas—Terratone Cocoa Bean—Dark Bronze_Forest Green—Black
6.Interior color to be: White_kfanvas Pine_Maple_Oak_Same as Exterior Note:Woad interiors need to finished by Owner.
7.Hardware:_White Stonevaz Estate Hardware: Style:
8.Terstall Lifts with Double Hung Wmdo s
I
9. Screens:windows to _Half or dal]screens Screens to be. rglass—Aluminum_TmScene
GRILLE DETAILS
10. Windows have grilles:Grille Between Glass(GBG)_Removable Interior Wood(INTW) Full Divided Light q DL)
(�_)Owner approved(initials) Draw grille patterns below 'Use additional sheet if needed
Qty Qty: Qty Qty: Qty: Qty: Qty:
ADETMONAL WORK DFEARS
I i. Qty of Sills_Sill noses to be replaced by Contractor
12. Contractor will remove metal frames of windows.
13. PO Contractor Will install new_paint-ready or_stain-ready Interior_Exterior casings in—Pure_Maintenance-free material
14. AJ-0 Contractor,will install new_paint-ready or_stain-ready_Interior_Exterior stops in_Pine_Maintenance-free material
15.(cf� 1 Inds-Owner I.aware,contractor does not do any painting or removal/installation of alarm system/hardware. It is the
responsibility of the homeowner to have the alarm system/hardware removed prior to installation.
16. Contractor will wrap exterior casings with coil stock of color.
Note:Wrapping may be required with storm Window removal;removal of storm windows will leave screw holes in casing.
17.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,win-
doya,5tman windows and vacuum nightly included. Upon completion of thejob and payment in full,a]United warranty shall be issued.
18.®Yes�No Building Permit--Contractor will secure any and all necessary permits.The fee for the permit(s)is not
included in the Contract Price and a separate check is required at the time of sale for this fee. Ck# $
19.� es(]No All discounts have been applied to this Agreement price.
20.Additional job details:
23.b<es❑No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/fitmttce form(s).
It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING
AGREEMENT,constitutes the entire understanding between the partiess 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)end Contractor.Buyer(s)hereby acknowledge that Buyers)has read this Sp Ification Sheet.
Ren/ewal/�y/�/� Corpo Buyer � Buyers)
Signature of onager Signature Signature
Print Name of Product Manager Print Name Print Name
w
W€t
p
t
COLLINS COVE CONDOMINIUM ASSOCIATION
37 Settlers Way, Salem, MA 01970-5269
Ms. Megan White July 1, 2013
Renewal by Renewal by Andersen
Dear Ms. White,
The Collins Cove Board of Trustees have approved the
installation of two lite gliding windows in unit #12. As you know,
any exterior trim than needs to be removed must be replaced with
white nzec trim. Work cannot start before 8am.
Sincerely yours,
Jeffrey W. Conley
President
Collins Cove Condo Assoc.
Page 1 of 2
White, Megan
From: Jeff Conley [s-jconley@comcast.net]
Sent: Monday, July 01, 2013 5:04 PM
To: White, Megan
Subject: RE: George Danek 12 Settlers Way Salem, MAS 01970
Attachments: CCCA Danek approval letter.doc
See attached
From: White, Megan [mailto:Megan.White@andersencorp.com]
Sent: Monday, July 01, 2013 10:34 AM
To: Jeff Conley
Subject: RE: George Danek 12 Settlers Way Salem, MAS 01970
Great cane you please sign the attached form and get back to me so we can move forward with this project.
Thank you.
.Megan"White
Sales Administration
Renewal by Andersen
Ph:508-351-2200 ext 56437
Fax:508-986-7072
From: Jeff Conley rmailto:s-iconley@comcast.net]
Sent: Saturday,June 29, 2013 8:21 AM
To: White, Megan
Subject: RE: George Danek 12 Settlers Way Salem, MAS 01970
The installation has been approved by the Collins Cove Trustees
Jeff Conley, President, CCCA
From: White, Megan rmailto:Meoan.White@andersencoro.com]'
Sent: Tuesday, June 25, 2013 12:37 PM
To: s-iconley@comcast.net
Subject: FW: George Danek 12 Settlers Way Salem, MAS 01970
Hello,
I am checking on the status of approval. Can you please send me an update? Thank you
.Megan"White
Sales Administration
Renewal by Andersen
Ph:508-351-2200 ext 56437 -
Fax:508-986-7072
From: White, Megan
Sent: Wednesday, May 22, 2013 4:19 PM
To: 's-jconley@comcast.net'
Subject: George Danek 12 Settlers Way Salem, MAS 01970
Good Afternoon Jeff,
I am contacting you in regards to window replacement approval for George Danek at the
r I
I
7/1/2013
Page 2 of 2
address listed above. I have included with this letter our Certificate of Insurance,the window
specifications, and an approval request which upon approval must be signed and dated and faxed
back to me at the fax#listed below.
The window order for the above property is as follows:
(2) Lite Gliding windows - Canvas interior/White exterior without grilles
If you need any further information, please let me know. If you could also confirm receipt of this
information and let me know when a decision can be expected that would be great.
If you need any further information, please contact meat 508-351-2200 X 56437 or email me at
megan.white@andersencori).com.
I look forward to hearing from you. Thank you and have a great day!
Megan White
Sales Administration
Renewal by Andersen
Ph:508-351-2200 ext 56437
Fax:508-986-7072
7/1/2013
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a' CERTIFICATE OF LIABILITY INSURANCE
0,/25/2012
THIS CERTIFICATE IS NtSUED RI A MATTER OF WFORWy A ONLY AND C OR AL NO Rif E C IIPON THE CER7 FWATE HOLDER THE
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DOER NOT TE OF IISURA OR NEOATRIELY AMEND, EXTEND OR ALTER THE AFFORDED BY THE POLCCEI
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00 South sth Street • 63.2-333-3323 .c12-373-7270
Suite 700
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Rensval 8y Amdersen Corporation ML9elEnA: OLO ddPC�LIC ae CO 24147
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104 Otte Street
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COVERAGES F
CERTIFICATE NUMBEIY: 29229436 REVISWN NUMBf3L
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED ggOW HAVE BEEN ISSU®TO THE INSUR®NA41ED ABOVE FOR THE POLICV PERIOD
INDICATED. NO7WITHSTAND04G ANY REQUOffi0tENT,TERM OR CONDITION OF ANY
CERTFICAATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BV TNE�OL qEG � WITH RESPECT TO WHICH THIS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUqED BY PAIC f:LAdCS, HEREIN IS SUBJECT TO ALL THE TERMS,
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CERTIFICATE HOLDER CANCELLATION
vvidence Of Ioauranee SHOULD ANY OF THE ABOVE DESCRIBED Pis BE CANCELLED BEFORE
THE EIIPIgAI DATE THEREOF, NOTICE WILL BE DEIUVEgED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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ME IMPROVEMENT CONTRACTOR
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JOSEPH REZZA
104 OTIS STREET
NORTHBOROUGH,MA 01532 1
Undersecretary 1
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Massachusetts -Department of Public Safety '
Board of Building Regulations and Standards
Construction Supenisor
License: CS-065272
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Commissioner 04/25/2014
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To whom it may concern:
Enclosed is a permit application package for a project we have been contracted to do in your
town. Thank you in advance for receiving this package by mail. As we work in every town in
the state, it greatly helps us in our process.
We have also enclosed a self addressed and postage paid envelope and would request that
when the permit application has been processed, that you would mail it back to us.
Enclosed for you review in this package is:
o Permit Application
o Home Improvement Contractor License
o Construction Supervisor License
o Proof of hisurance
o Proof of Energy Efficiency Rating
o Signed Contract from Customer
o Permit Fee(if accepted at time of applying)
if you have any questions regarding this application please call me at: 508-351-2200 X55285
Regards
Kelley Donahue
Permit Coordinator
104 offs street
Neetbbmuuab,MA,01532
Fboa(509)351-2200
Website:
Fa(651)-351.49M
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