56 VALIANT WAY - BUILDING INSPECTION r
0
The Commonwealth of Massachusetts
Board of Building Regulations tandards CITY OF
Massachusetts State Buil A SALEM
�tt�P Revised Mar 2011
Building Permit Application To Ctifts ruct, Repair, Renovate Or Demolish a
One- or Two-Fa i D Ili 23
This Sect ffictal Use Only
Building Permit Number: Date p ed:
A
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: U eJ 1.2 Assessors Map& Parcel Numbers
I.la Is this an accepted street?yes o Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
;Ae � t
Zoning District Proposed t e Lot Area(sq ft) Frontage(li)
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: L8 Sewage Disposal System:
Public ❑ Private❑ Zone: _ Outside Flood Zone'?Check if ves❑ Municipal ❑ On site disposal syslcm ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ownerf,gf Record:
Ill1 Im F—ark I��, rng o(97a
Name( mt)T City,State.ZIP
UbVr- 6(7-ay7-s59 r
No.and Street Telephone I,mail Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work'':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials y
I. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S i' 2. Other Fees: $
4. Mechanical (HVAC) $ List: 1)
5. Mechanical (Fire
Suppression) $ Total All Fees: $
6. Total Project Cost: $
433J Check No. Check Amount: Cash Amount:
❑ Paid in Full ❑ Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 6 /7/ 9 O d7
�nrpl greeno License Number Expi anon ate
Name of L FIorKr
10 List CSL Type(see below)
No.and Street t type Description
,r1/t � (n0 02 r-{- U Unrestricted(Buildings u to 35.000 cu. ft.)
�� 1 t+�,g.��� OJ R Restricted 1&2 Family Dwelling
City/ho , ,tale, " P M Masonry
� RC Roofing Covering
WS Window and Sidin
SF Solid Fuel Burning Appliances
bl7-�y2 4�oy I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
�mwne-,Some 0,fr4 I IIC Registration Number 3xpiration Datc
1-IIC Company Name or HIC gistrant Name
1�b �r'umot�( �� ficl'1rat�•Gho-lonQLl 5{ore, (pw� ,Z ,,.t
No. and Street �—
C_ L�l t�tm� 01 7` 9`0q y6 Email address
Cis/TCoown,State,ZI b 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 .......... 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 ��'cIlat �c6lmL
to act on my behalf, in all matters relative to work authorized by this building permit application.J
Print Owner's Name(EI ctronic Signa(ure) Date
SECTION 7b:OWNERS 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 e aid accurate to he b st of my knowledge and understanding.
0
Print Owners or Authorized Agent. ame(Electronic Signature) Date
NOTES:
I. 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
.www.ntass.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/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(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"
The Commonwealth.of Massachusetts
Department of Industrial Aceiifents
Offrce of lit vestigations,
600 Washington Street
+ Boston, MA 02111
www.moss.gov/dia
Workers' Compensation Insurances Affidavit: Builders/C}ontractors/Electricians/Plumbers
Applicant Information I Please Print Legibly
Nance (Business/organization/Individual): n06.lj Crvea
Address: ►O Rj*4q '[}I-jVQ
City/State/Zip: 1 eii,441 (nit 6,2156 Phone #: 4r7- 59) -N3A9
Ar you an employer? Check the appropriate box: Type of project (required):
am "t a employer with q. ❑l I am a general contractor and I
employees (till and/or part-time).
+ i have hired the sub-contractors 6. ElNet% construction
1 El I am a sole proprietor or partner- listed on the attached shed- 7. ❑ Remodeling
ship and have o employees these sub-contractors have
n g- ❑ Demolition
working for me in any capacity. j employees and have workers 9. ❑ Building addition
[No workers' comp. insurance I comp. insurance.:
required.) 5. ❑'We are a corporation and its ME] electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs nr addition.
myself: [ P No workers' com right of exemption per MT_insurance required.] t �c. 152, §1(4), and we have no 12.❑ Roof repairs
employees. [No workers' 1>.❑ Other----
comp. insurance required]
`Am'applicant that checks box HI must also fill out the section below showing their workers'con Ixmsation policy information,
i Homeowners who submit this affidavit indicating they are doing all work and then hire outside c6inractors must submit a new altidavit indicating such.
'Counaetcn's that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not tbow entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policylnumber.
I ton an eaaplover that is providing workers'compensation insurance for nay employees. Below is fhe policy and job site
information. �,t
Insurance Company Name: A•t.' . Mv404,1 _'nSUf r)vf �.
policy !.' or Self ins. Lic. M: !� lJG-t(00' 702 arrJ Q'f^ .1013/� expiration Date:
3 - {(^ I j
Job Site Address: �JG V0.11bY>4 �tlC.y � CitylStatcl�ip:_ �ln� 'eM M!4 61970
i
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
line up to S1,500.00 and/oi one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a line
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 under' he pains and penalties o'f perjury that the hafonnalion provided above is true and correct.
Si nalltrc: C�i (jyl/ ( )ate:
Phone #:
Official use only. Do not write in this area, to be completed by city or towh official
i
City or Town: Permit/Liccns 14
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
G. Other
Contact Person: 1'hon #:
-�' ffitt of consumer Affair,&fluxiness R<gulatinn License ar!registralion valid for individul use onh
� ,•�r HfOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
�Registr-dtion: 148688 Office of Consumer Affairs and Business Regulation
Expiration: Type 10 Park Plaza-Suite 51 70
P 10/1812015 Supplement and Boston.NIA.02116
LOWE'S HOMES CENTERS INC
RICHARD CHALONE
TURNPIKE RD.SUITE 700
SO
SOUfHBHBOROUGH, Mn 01772
Underxcremn' Not valid w•ithart si�n:ttu re
p.
P
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t { Massachusetts - Depaitrnent of PooPC safety "
1 80oard of Building Regulations and Standards
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is a Umilk- '
License; CSFA-061719 ~ �—
ROPIALDAGRH,141
10 RITA DR], I
MEDFORDMA i2J]
1012712015
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-2014-10-07 11 :04 isoprt75 7815375464 >> 9787409846 P 212
Village atVion. 1ft Square Corkdorniftiurn Trust::-"
Norman Bogosian PO Box 4523
Property Manager Salem,MA 01970
Office(978) 745-2225
Fax(978)745-2251
E-Mail: NormBogosian@Comeast.net
October 6, 2014
Richard Chalone
Window Installation Specialist
Fax : (781) 537-5464
RE: Village at Vinnin Square
37 Valiant Way (3 windows)
56 Valiant Way (I window)
Salem, MA 01970
Dear Mr. Chalone,
Pursuant to my conversations with the unit owner of both 37 Valiant Way (Martin Margolis)
and 56 Valiant Way (Bill Papa) it is my understanding that the unit owner have selected your
company to install replacement windows in their unit.
As the property manager and on behalf of the Trustees of the Village at Vinnin Square
Condominium Trust your company has permission to install windows at units # 37 & # 56
providing.-
1. The exterior appearance of the existing windows are maintained with your
replacement units.
2. Your installation meets or exceeds the existing building codes in Salem, MA
3. Your company provides proof of insurance
4- Your Company works between the hours of 8 am and 5 pm, Mon through Friday
5. Your company cleans up all debris at the end of each day
If you should have any questions please call the office at (978) 745-2225 or email at
Norm BoaosionC Camcast.net
Very truly yours,
/1'OIWOf 4POW40r
Property Manager
cc: Trustees - Village at Vinnin Square Condominium Trust
Bogosian and Company LLC(Property Management Co.)
00104 d
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NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamphlet Renovate Right By signing this Contract,Customer
acknowledges having received a copy of this pamphlet before work began Informing Customer of the potential risk of the lead hazard exposure
from renovation activity to be performed in Customers dwelling unit.
NOTE: H ratted wood is discovered during Installation additional charges will apply.You will be given a quote and a change order
must be completed and sig9ned by the customer for any additional charges. Customer must Initial.
'Any work or me anal not specirmd is not Included in this mnhacl.Any changes or additions will be at an additional charge for the material and labor.
PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees the right to take photographs of all work performed at the Premises related to this
Contract,and irrevocably grants to Lowe's all right,lite and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.
Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such
photographs for any lawful purpose,including, but not limited to, marketing,advertising, publicity, illustration,training and Web content. By initialing
here,Customer agrees to the foregoing. lCustomer to initial to the left].
Work is to comry en upon reasonable availability of Contraclor.andfor any special Ord or cpatoIner made Goodls)which is anticipated to be
{a/ �••y [fill In date].Estimated.completion data is yr•.ri/ /, �[fill In date].
Said estrmated Sub's n' rat m�te is po)of the essence.A statement of any contingences that would materially change said estimated substantial
completion date is as followS: L&I"- `'�'
t
(ft applicable,insert a statement of such contingencies).
This Contract provides that all claims by Customer or Lowe's will be resolved by BINDING ARBITRATION.Customer and Lowe's GIVE UP THE RIGHT
TO GO TO COURT to enforce this Contract(EXCEPT for matters that may be taken to SMALL CLAIMS COURT).Lowe's and Customer's rights will be
determined by a NEUTRAL ARBITRATOR and NOT a judge or jury. Lowe's and Customer are entitled to a FAIR HEARING. But the arbitration
procedures are SIMPLER AND MORE LIMITED THAN RULES APPLICABLE IN COURT.Arbitrator decisions are as enforceable as any court order and
are subject to VERY LIMITED REVIEW BY A COURT.FOR MORE DETAILS:Review the.sectlon titled ARBITRATION AGREEMENT,WAIVER OF JURY
TREAL AND WAIVER OF CLASS ACTION ADJUDICATION found in the Terms and Conditions of this Contract - -
DO NOT SIGN THIS CONTRACT UNTIL COMPLETE AND YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON ALL
PAGES OF THIS CONTRACT.BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND
AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON ALL PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A
COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. -
WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS�nN' DAY OF sLG.LS—.
Lowe's Home Centers, Inc.
- � owner .
Specialist or Above CD-owner or Witness
Customer acknowledges receipt of a true Copy of this contract which was completely filled in prior to Customers execution hereof.You,the buyer,ma'
cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation
form for an explanation of this rigid.
^• Fit F COPY 0acw by Lowa'aa w..a's and me lPbl.&I,