18 SUMNER RD - BUILDING INSPECTION f The Commonwealth of Massachusetts ilECEIVED
Board of Building Regulations and Standards .1 $PEMRAL S1 RVI'CE5
Massachusetts State Building Code,790 CMR ALEM
xevrseaMar mr � 59
Building Permit Application To Construct Repair,Renovate Or Demolish a 1014 MAY
One-or Two-Family Dwelling
_++ This Section For Official Use Only a.
Building Perm-it Number: Date Applied: _
�.Building Of t1&1(Ihint Name)
M SECTION 1:SITE INFORMATION,
1.1 Property Address: 11 Assessors Map&Parcel Numbers {
18 Sumner rd 23 0207 0
Lla Is this an accepted street_?yes_ no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
From 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 0 Private 0 Zone: _ Outside Flood Zone? M
Check if es0 unkipal 0 On site disposal system 0
SECCiON2: PROPERTY OWNERSHIP"
2.1 Owner'ofRecord: salem ma01970
Anthony Salvo m�N �
ame 1 t8)Sumner rd City S N7744-5659
No.and Street _ — -' Telephone Email Address
QEC jIbN 3i DESCRB?TION OF PROPOSED WORK'(checksll that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 1 Aheration(s) M Addition 0
Demolition 0 Accessory Bldg.0 Number of Unit_ I Other ❑ Specify:
Brief Description of Proposed Work": replacing 5 windows no structural changes
. . g
SEC'TiON 4:ESTIMATED CONSTRUCnON:COSTS, .
Costs-
item Estimated Costs:
and Materiels ?4; 0ffiIclati Uae Only i�.-1 � fir"
1.Building $ 10894.00 11¢ Buddutg Permit Fees$ &dicate how fee is determined;;
2.Electrical $
O Standard Gtty/TtSwn Application Fec [;
_ 6) e x multiplier �a a �z, k
�Total act Costs tear x
3.Plumbing $ `List.O&er Fees $*ors,..-.
4.Mechanical (HVAC) $,
5.Mechanical (Fire
$ Ttllleeet$S ion ' ' s l4:
6.Total Project Cost: $ 10894.00 4 Check No. ' Check Amomt .'Cash Amounti f l `t
-, -
I 0 Pard'in Full '� �. ❑Outstanding Balance Due 'Ja-.'a.
M,A,Lwo v-d Cc)N, - 51-7
_ tf+rSa+ a SEG'IION S::CONSTRUCTION SERVICES a
5;11,Canshvctnn.Sapervisor License(CSL) CS-090125 10/06/2014
Jaime Morin License Number Expiration Date
P ;p Na3ne otf CSL Holder u
y Ken P,J9 List CSL Type(see below)
86 Gardiner st
No.and Street Iy� Demotion '
Lynn ma 01905 U Unrestricted(Buildings up to 35,000 ca.It
R Restricted 1&2 Family Dwelling
City/rown,Ststc,ZIP t M Masonry
RC Rooling Covering
WS window and Siding
617-966-0412 SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 170810 12/23/2015
Renewal by Andersen/Jaime Morin HIC Registration Number Expiration Date
BIC CompTOCtls o HIC Registrant Name
No.
Northhhrroughma01539 508-351-2200 Email address
City/Town,State,Zffi Tcl one
n_...= .f._. , �.._w�- _. �,,.„�x�,-._ -..-.....ter . .. :..._. � -.• y-
SECTION 6t WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.1,Io.152.t 2SC(6))_
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide ,
this affidavit will remit in the denial of the Issuance of the building permit
Signed Affidavit Attached? Yes..........CY No...........O
SE(1'ION'7e:QWNER'AUTHORIZATION:TU'BE COMPLETED WHENN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize RbA/Jaime Morin
to act on my behalf,in all matters relative to work authorized by this building permit application.
see agreement 05/01/2014
Print Owner's Name(Electronic Signature) Date
w.
SECTION'71b:OWNEW 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 ate to the best of my knowledge and understanding.,,.
05/01/2014
Print owner's ti rued Agent's Nam(Electronic Signature) Date
�c _ — IRk.. NOTES.
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an vunregistered contractor
(not registered in the Home Improvement Contractor 911C)programs),will not have access to the arbitration
program or guaranty find under M.G.L.a 142A.Other important information on the HIC Program can be found at
yanLa ss.eov/oca Information on the Construction Supervisor Liter can be found at ximmess.sov/dos
2. When sttbstential work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basemenf(athes,decks or porch)
Gross living area(sq.$.) Habitable mom count
Number of fireplaces Number of bedrooms — —
Nu®ber of bathrooms Number of half/baths
Type of heating system Number of decks/parches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"maybe substituted for'total Project Cosr
CITY OF SALEMi, N ASSACHUSEM
1Ava n=DEPAMAIE T
120 W.WMoTON Siva sr,r PI.OoI!
'1IL(979)745-9595
PAX(978)740-9M
KIMBERLEY DRWOLL
MAYOR THOM s S't'•PMUR
DIRECTOR OP Pt;KX PROPEM/HUIMIG COMML% M
`"Construction Debris Disposal .Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code,780 CMR,section 111.5
Debris,and the provisions of MGL c 40,S 54;
Building Permit# is issued with the condition that the debris resulting$rnn
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111,S 150&
The debris will be transported by:
Renewal by Andersen
(namo of hauler)
The debris will be disposed of in s
Renewal by Andersen
(name of facility)
104 Otis st Northborough me 01532
(address of facility)
signature of pamdt awlicaut
05/01/2014
data
Jcbrisotrdoc
Massachusetts Depaftme'nt'of Public Safdt -II
'Board of Building Regulations and Sta aids
Construction Supxrvisor
License CS-09O125
JAIME L MORiN
�,i,GARDINB1t S'F
r nviv Htn oi9os I
C
Expiration '
>.Commissioner 9O/O5/Zll}4
SCA 1 Q 2OM-05111
ffire of Consumer p�f�tai�n B�
oatoese Regaldoa
OME IMPROVEIYIFNT CONTRgCTOR
ReBistratton t7061Q_.
ExPlraton`Al2j2Oj$' Type'
RENEWAL BY ANpERSON pORATION Supplement c
JAIME MORIN _
104 OTIS STREET x.
NORTHBOROUGH. g
MA 07532
Underae��ry
The Commonwealth ofmassachusetts
Departmentoflndustri dAccidents
Office of investigations
600 Washington street
Boston,MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information fJ Please Print Leeibly
Name (Business/orpwzaton&ciividual): I�en ew c k
Address: 1 b y `. 14
City/State/Zip: 1A0( QYO( LS3,)Phone#:_
Are you an employer?Check theappropriate box: Typ
1,0 1 am a employer with d t) 4. ❑ I am a general contractor and I e of project(required):
employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction
2.❑ I am a sole'proprietor or partner- listed on the attached sheet. 7. Q-Xw—nodeling
ship and have no employees These sub-conhactors have
8. ❑Demolition
working forme in any capacity, employees atld have workers'
[No workers' comp. insurance comp.insurance, 9. ❑Building addition
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I.am a boineownei doing all work officers have exercised their 11.❑PhmrBmg repairs or additions
myself. [No workers'comp, right of exemption per MGL
insurance required.]t c. 152, §1(4),and we have no 12.❑Roof repairs
employees, [No workers' 13.❑Other
comp.insurance regdired:] -11
*Any applicant that checks box#1 MIM io fin out the section bbluw showing they workers'kbmpe' on policy infoi 6n.
t Homeowners who submit this affidavit indicating they am doing all work and then hire outside eommotars must submit,
mum affidavit'indicating such.
tContractors that check this box must attached an additional shed showing tho-mme of the subconeraetms and state whether nor ow
those entities have
employees. If the subcontractors have employees,they must provide their workers'comp.,policy,;mmkar.
I asn an employer that Lr providing workers'compensation insurance for my anployeem Below Is o '
injormaidom tits li l 'Aid Job site
Insurance Company Name-DU Rt AA l<�
Policy#or Self-ins.Lic.#.-_WW , 0 6 Expiration Date: I ()— ) — ( q .
Job Site Address:�l C k {(1 f 1 ( C City/State/Zip j_ cLn a O ��
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:crin"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 epabts and penaUla ofperjary that the information provided above tote and correct
S• store:
Phone#: O
EEeD only. Do not write in this area,to be congskied by airy or town opkiaL
n• Permit/License#
hority(circle one):Health 2.Building Department 3.City/Town Clerk 4•Electrical Inspector 5.Plumbing Inspector
son Phone#:
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ENERGY PERFORAANOE RATINGS
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0.29 1 .65 '0.28:
.AnOnioNAL PENFcRmmGE RATINGS
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Renewal----------
MA Home Improvement Contractor
byAndersen. Renewal by Andersen Corporation License#170810(Expires 12/23/2015)
Federal Tax ID#41-1918413
104 Otis St. Northborough,MA 01532
(508)351-2200 Fax(508)-986-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
Buyer(s)Name Date:
ANTHONY SALVO - MARCH.24, 2014
Buyer(s)Street Address City State Zip Code
18 SUMNER RD. SALEM MA 1 01970
'Email Address Home Telephone Number Work/Cell Telephone Number
V ICTOR21 1 @YAHOO.COM 9787445659
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.
Est.Start Date Method of Payment
Total Job Amount $ 20,000.00 oum Financed$ - 0.00
Deposit Received(33%)$ 6,666.67 Check/Cash
8-10 weeks
Balance Start of Job(330/6)$ 6,666.67 WposO at signing$ 0.00 Check#
Balance on Substantial At substantial Est Install Time ;� Credit Card
Completion of Job(33%)$ 6,666.67 Completion$ 0.00
2-3 days If credit card is selected,please
see Credit Card Payment form
I
�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 Buyer(s)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 by Andersen Corporation Buy s) p _ 0 Buyer(s)
BY:
To-;Ije"el- °, a CLWD-
Signature of Protect Manager Signature Signature
JOHN BEAVER ANTHONY SALVO
Printed Name of Project Manager Printed Name Printed Name
YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTaIN. III
SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT.
----- -- _- -_NOTICE OF CCELLAT AN ION - NOTICE OF CANCELLATION AN
I
Date of Transaction 3124/14 You may emcel this Date of Transaction 3124/14 You may conrrl this
lmIntersection,withovtany penalty or obligation,w re idln the business days fi en the I transaction,wthmr any penalty or obligation,withio there busivex days From the
abour date.N you cancel,any property traded in,any payments made by you under I above dote.If you cancel,my property traded in,very payments made by you under
the Contract of Sale,and any negotiable instrument exemted by yov wID be I the Conwa of Safe,mdanoeg ablebu mtexecatrd by yoeewinbe
irumrned wlthiu 10 days following owing receipt by de Commerce,I"Sallee") of your I returned within 10 days follows.,receipt by de Camr„ciar("Seller") of your
viceDatien notice,and any,aceoricy interest arising out of de transaction wan be I contribution entice,and any security interest arising oat a the transaction w➢1 be
canceled. If you cancel,you meet make available to the Seer ar your residence,in I canceled. Ili yov cevicel,you raver make available m the Sallee atyour revdmeq bl
substantially as good com idm as when mceiwd,any geode delivered to you undo enbatantle➢y u goad couditina m whenmceived,anygoo&d liveredwyouveder
this Contract or Sale;ne you oeryyUYou wish,comply untb the instructions of the this Coutrort or Sab;or You mry,if You wish,complywith the Instructions of the
Store regarding the return shipment of the grads at the Seller's expense and risk. Seller regarding the return shipment of the goods at the Seller's expense and risk.
11f you do make the goods available to the Seer and d,Seller does at p'a th®up H you do make the goods aeaDable to de Seller and de Seller does not pick deem up
within 20 days of the date of your Notice of Cancellation,you may made or dtapooe with.20 drys a the date of year Notice of Centered.,yen may retain or dispose
of de goods widovt any fvrder obligatlov. If you fa➢m make de goods avaeLble of the goad„widum any future obligation. If you Far to make de goods srarable
iu de Serer,or if yen agree to rearm the nods to de Seller end fall to de ea,due 1 to the Seller,or X you of to reman de goods to the Seller,and fell to do m,den
"a remain➢able far prefurmence of all ebligmic—under the Contrace To cancel yo«remain Sable for pereffin—re of all obligations order the Centract.T,cancel
this tr„nsactio,maO or deSvur a aimed end dated copy of this contributes notice I this transaction,mag or deliver a eioreed and dated copy of this cancellation notice
or any odor writen notice,or seed a telegram to Contractor,Renewal by Andersev,t avyadmwrittenvedcgorsendatdegramto Contractor: Rmewalby Anpenen,
M ous Se. Northborough,MA 01532,BYNOT LATER TITIAN MIDNIGHT OF 1 104 Otis St.Northborevgb,MA 01532, BY NOT LITER TIL1N MHIMGIIT OF
I 3/27/14 .(Date) I BRUORY CANCEL,THIS TRANSACTION. 3/27/14 .(Datr) 1IffiREEY CANC]➢.TRISTIUWSACTION.
iI
auyeA e¢alun NAName Date .'e.sear . P,IN Name
eA MneWa� Renewal by Andersen Corporation MA Home Improvement Contractor
% CM
byN Idersen. 104 Olis St. Northborough,MA 01532 License#170810 (Expires 1 212 3/2 01 5)
3.1 sae. Breueenes. .„n,s:n.,„,r..„,.,.., (508)351-2200 Fax:(508)-986-7072 Federal lD#41-1918413
Window Specification Sheet
Buyer(s)Name Date of Agreement
ANTHONY SALVO MON, MAR 24, 2014
The buyers)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 front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING
AGREEMENT,of which the Specification Sheet is part.
WINDOW DETAILS
Approx. Extenoolotenor Color Hardware Hadware LOWE4/ Grille Grua Glass
Room p U.I. WindowllS le Detail Casing, Ext-Int Color Screens Smartsun Chiles Sash tfd aeons Una options
Kitchen 1 69 CD full frame Ext.MF 908 WH/PN Stone Standard FAL Low-Ea Gas 213 2/3 No
Kitchen 1 96 CT 1:1:1 full frame Ext.MF 908 W WPN Stone Standard FAL Low-E4 Gas 2/3 2/3 No
Hall 1 69 CS:R full frame Ext.MF 908 WH/PN Stone Standard FAL Low-E4 GBG 2/3 2/3 No
Bath 1 1 69 CS:R full frame Ext.MF 908 W WPN Stone Standard FAL Low-E4 Gm 2/3 2/3 No
Bed 1 1 69 CT 1:1:1 full frame Ext.MF 908 W WPN Stone Standard FAL Low-E4 Gas - 2/3 2/3 ----- No
Bed 1 1 82 CD full forme Ext.MF 908 WWPN Stone Standard FAL Low-E4 Gas 2/3 2/3 No
Bed 2 1 2 82 CD full frame Ext.MF 908 W WPN Stone Standard FAL Low-Ea Gee 2/3 2/3 No
Total 8 BAY&BOWDETAIIS *See Ba /Bow Measure Sheet
Style Detail/ Approx. Approx. Number Forme window End Center L.E/ Roof/ Hamwam
Room Count S e Flenkers U.I. Culn s Angle Line Interior E ct Color Grilles sashes sazhes Screare Smateon Soffit Color
SPECIALTY WINDOW DETAILS
Fun/ Approx. Lows/ speolalty BAY/BOW ADDITIONAL WORK NOTES
Room Count S e Insert U.I. SmartSun Grilles GrilleStyle ExUnt Color Cntomern--Aar wiA ba/bow wi,Mo sunder rR inrAcs
Them will ben ificanc lao lmc
ADDITIONAL WORK DETAILS:
I No Contractor will wrap exterior casings with coil stock color of j
Owner is aware that Contractor does not do any painting/staining or removal/installation of alamr system or window treatments/hardware.It is the
responsibility of the homeowner to have the alarm system and window treatments/hardware removed prior to installation. We make no guarantee as to
2 `y: whether alarms or window treatments/hardware will fit after replacement. Customer is also aware in some cases there will be glass loss. If there is,the
amount will be dependent on the type of existing windows,type of installation and window style.We make no guarantee as to the amount of glass loss.
Customer is aware and understands any and all unseen rot is not included in this contract.Should any mt be found them will be an additional charge for
time and materials unless so stated in this contract.
I 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,stone windows and vacuum nightly included. Upon completion of the job and payment in full,a limited warranty shall be issued.
4 Yes Building Pennit--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 time of sale for this fee. Check If $
5 Yes All discounts have been applied to this agreement.
6 ::% Yes 11 No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/finance form(s).
It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING AGREEtv(ENT,constitutes the
entire understanding between the parries,and there art no verbal understandings changing or modifying any of the terms This Specification Shea may not he changed or its terms
modified or varied in any way unless such changes are in writing and signed by both the Buyer(s)and Contractor. Buyers)hereby acknowledge that BuyeQs)has read this Specification
Sheet ���rtyu� �,,(/�p'
Renewal by Anders,,e[n/,C�orpportdon 1p BuyctQsJl//??y o /I A Buyer(s)
Signature of Project Manager Signature Signature
JOHN BEAVER ANTHONY SALVO
Print Name of Project Manager Print Name Print Name
RenewalRenewal by Andersen Corporation
n ��� � 104 Otis Street•Northborough,Massachusetts 01532 MA home Improvement Contractor
byAndersen. Phone(508)351-2200•Fax(508)986-7072 Mn License#17o81o$i2o1s)
wiwoow aevraeem¢xr i�nA.J.�rnG�mr^�y Federal Tax 1D# 41-1918413
CONTRACT AMENDMENT
This Amendment("Amendment') is to the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT("Agreement')by and
between Renewal by Andersen Corporation and Anthony Salvo("buyers"), Contractor and Buyer(s)hereby agree to amend and modify the
Agreement as indicated below. Other than as specifically indicated below,all the terms and conditions of the Agreement will remain in full
force and effect. This Amendment is subject to the terms and conditions of the Agreement. The following additions,alterations,or deletions
to the products and services Buyer(s)ordered are being made:
Reducing order by 3 units and we are now ordering white interior full frames instead of pine interior.
As a result of these changes, the following terms of the Agreement are also changing (if there is no change, an item will be left blank or
marked as"N/A",indicating that no change applies:
NEW'total Job Amount: $10,894.00 Payment Method:
New Deposit Received:$6,666.67 Check
New Balance at Start of job:
New Balance on Check/Credit Card
Substantial Completion of Job:$4227.33
'Please Note— Your job will be delayed until amendment is
signed and received.
It is agreed and understood by and between the parties that this Amendment and the original Agreement constitute the entire understanding be-
tween the parties,and there are no verbal understandings changing or modifying any of the terms of this Amendment Buyer(s) hereby acknowl-
edges that Buyer(s)has read this Amendment and has received a completed,signed,and dated copy of this Amendment on.the date written below.
Renewal by An r Corporation Buyer(s)
q _ zj_ 11
By: Li�zYeox iLv��
SignVte of Pro c ger Signature Date
ohn av 4/2/2014
Print Name of Product Manager Signature Date
v Renews!
byAndersen.
WINDOW REPLACEMENT an Andersen Company
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:
❑ Permit Application
❑ Home Improvement Contractor License
❑ Construction Supervisor License
❑ Proof of Insurance
❑ Proof of Energy Efficiency Rating
❑ Signed Contract from Customer
❑ Permit Fee (if Accepted at time of applying)
If you have any questions regarding this application please call me at: 508-351-2200 X 55285
Regards,
Kelley Donahue
Permit Coordinator
104 Otis Street
Northborough,MA,01532
Phone(508)351-2200 X 55285
Fax (774)-987-3013
Website:www.renewalbyandersen.com
l I