12 VISTA AVE - BUILDING INSPECTION (2) iP- 14 —Ig7Z # l� � S ZS
The Commonwealth of Massachusetts
INSPECTIONAL SE�
Board of Building Regulations and Standards
VICES
Massachusetts State Building Code, 780 CMR SAL
� y $IMP — R se�,� z 0/1
Building Permit Application To Construct, Repair, Renovate Or bp
a
One-or Tivo-Family Dwelling
=NUmber:
his Section For Officia se Only
BuiDate pplied:
B Signature Date
SECTION I:SITE INFORMATION
1.1 Propertyt drsss`t / 1.2 Assessors Map& Parcel Numbers
!l�1ll//
I.I a Is this an accepted street?yes no Map Number Parccl Number
1.3 Zoning Information: IA Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G. .c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 "wrccoM/gNan t State.ZIPly� __ �/o2g3
No.and Street felephm e Gnmil Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs Altemtion(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Speeily:
Brief D .c 'ptio of Propos d \Vo k':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials y
I. Building S 3 e) a I. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard Cityfrown Application Fee
❑Total Project Cost(Item 6)x multiplier x ,
3. Plumbing S 2. Other Fees: S
4. Mechanical (IIVAC) $ List:__ C•h%����
5. Mechanical (Fire
Suppression) S Total All Fees:
3�7 Clieck No. _ Check Amount: Cash r\mount:
(. Total Project Cost: S .5 ��b ❑ Paid in Full--- 0 Outstanding Balance Due: ---
SECTION 5: CONSTRUCTION SERVICES
5. Construction Supervisor License(CSL)
, t
I MOZI, /�U V, License Number Ex iration Date
NaineofCS1,11older, r ,Ilr - / /
List CSL.'fype(see below) �/
No.a SS -t r�J G( 'FYN Description
�� 0J��� U Unrestricted(Build
ings5A00 cu. RJ
((( R Restricted IRe2 Family
Citylfown,State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
i ��� SF Solid Fuel Burning
I Insulation
Telephone Email address D Demolition
a 2 Re istered Iyor a Improvement Contractor(IIIC) � Q r
h tJ
9�J HI Registration Number Expiration Date
f np y a r IC =istr �rme
.a 'tr et Email address
� nil ss s-r
City/Town,State,ZIP 'fete hone
SECTION 6:WORKERS'CONIPENSATION 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 �Jl/C41
to act on m behalf,in all matters relative to work authorized by this building permit application/
ye Coh-zl.-GC,� ) p
Print Owner's Name(Electronic Signature) Dale
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the b 'my knowledge and understanding.
y✓11c1061 / add
Prim Owner's or Authorize)A 's Name(Electronic Signature) Vp;,e
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 Flome Improvement Contractor(FIIC) Program), will not have access to the arbitration
program or guaranty fund under M.G.L. c. 1 d2A.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.ntass.eov/das
2. When substantial work is planned, provide the information below:
Total Floor area(sq. R.) (including garage, Finished basement/attics,decks or porch)
Gross living area(sq. 11.) Habitable room count
Number of fireplaces_ Number of bedrooms _
Number of bathrooms Numberofhalf/baths _
Type of heating system Number of decks/porches _
TYpeofcoolingsystem Enclosed Open__ _
3. `'Total Project Square Footage"may be substituted for"Total Project Cost'
_ 0 (j9/VIIEdK[I1CLL�
Massaohusettt t of Public Safety R z
Board of BuiIQInE ns and Standards If�e ol`Coosumer AtTaip&Busmex}Regulaligal
Constructio'''"'nCCCCCCSuporvtsoi ME.IMPROVF�NT CONTRACTOR
Ty
y
License: csta.' " * a ' F, Registratigni guppleme '��
r
Expira�i. r
MICHAELE:DUD,EE � F4� UNITEDHOMEE�E
E6 TBI STREET ? = E '
AsWend MA 617E1 t
NtiMj,PHAEL DUDLEY
4 0 2U0 BUTTERFIELD.
Expiration I`- (�SHLAND,MA01721 Uoderu-q-
' Commissioner
c
CITY OF SALEM, MASSAa7fUSEM
BUILDING DEPARTMENT
120 WASHINGTON STREET 31D FLOOR
TEL. (978)745-9595
KIMBERLEY DRISCOLL FAX(978)740-9846
MAYOR THo"ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
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 c40, 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 deposit facility as defined by MGL c 111, 5 150A.
The debris will be transported by:
hl eis 11obtc ,c/-/J
(name of hauler)
The debris will be disposed of in:
(name of facility)
Ile 6i/�
(address of facility)
Signature of ap licant
Date
The Commonwealth of Massachusetts
tt nO-'Departinentoflndustria!Accidents =4.
Office of Investigations
s' 1 Congress Street,"Suite 100
Boston,'MA'02114-2017
www massgov/dia
Workers'Compensation.InsuranceAffdavit: Builders/Contractors/Electricians/Plumbers
Apyficafitlnformatjon - -
Please Print Le ibl
Name (Business/Orgam7ation/Indivtdual):; ' f �A �7 1 s .. .r;.
Address:. ���•,i G 01)( �y
City/State/,Zt :_ a/t;Phon VU Fs
Ar y an employer?Check the appropriate boa` t' Il {
Type of protect(required)
v n _ +4': { I am:a eneral contractor and'I i,it
1. I am a employer with ❑ g
employees(full'and/or part-time)!* have hired tbe`sub contractors 6 ❑New construcnon r ,
2 ❑ 1 am a"sole propnetor'or partner-, listed,on the attached sheet. 7. / emodelmg; n
ship and have no employees The`"se'sub-contractors have" 8. ❑ Demolition '
working for me in any=capa'crty.' "" ' employees:.and have workers' "9:- Buifdm addition
t
[No workers' comp. insurance comp. insurance ❑ g
,inquired]° , , f",
5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work t officers have exercised their' 1'1;❑ Plum mg repairs or additions
right of exem tion MGL "'"'
myself. [No+workers, comp„ P P� 12.❑Roof repairs
insurance required]t c 152,§1(4)`and we have no
;n . =13.❑Other ;:, r .,
employees. [No workers
• co"mp:"insurance required.]'
<..
'My applicant that checksbox NI must also fill out the secuon below`showmg they woftcers compensauon policy informai<on.
t Homeowners'who submit this affidavrl iniiicating they'are doing all work and then dire outside'contractors must submit a new affidavit indicating such
?Contractors that check this box must attached an additional skeet showing the name of tke'su64:ontractors and state whether or not thdse erititieshave''^ '
employees.,If the subxontmctors hayeemployees;.they must provide,the r Workers'comp.policy norther. { .j is ; r - •.. - ,;-,
Lam an.employer that is providing orkers'compensation:insurancefor'iny eiriployees.;Belo"is he po*andjob site
information q
Insurance Company Name:-- - �C� (� C��i .
- d tit / �,,.
Policy#or Self mr Lic:# ''"I/1/f Ei Eipiration Date:' Q3
Job Site Add
ress / l/lJac`' 6�Ug� City/State/Zip Hr" 1YA
rs
.,
Attach a copy of the worke ' 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 die imposition of crimmalspenalties of a„
Fine up to$1;500 00 and/or one year wtpnsonnient,as well as civil penalties in rile form of a_STOP WORK ORDER and a fine
of up to S250 00 a'day against the violator.' Be advised theta copy of this statement may be forwarded to the Office,of
6t . 1• { f11 J. -A 4I f:1' {) '.J;
Investigations of the DIA for.insurance coverage verification.
I do hereiG eehify under the p "" bit inahtes of perjury`that the information provided above is true and correct
91
Si tore:" Date:
Phone#: (�®Y 0 T/ Cl 56
Official use only. Do not write in this area,to be completed by city or town gf)4cial.
City or Town: Permit/License#
Issuing Authority(circle one): •
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
United United Home Experts & 4011re6
Home E®�perts' United Painting Co., Inc. ►, ��
01MIM9
200 Butterfield Dr. Suite I TiliG
Ashland, MA 01721 MA HIC License#157108
Full Worker's Compensation Coverage 508-881-8555 FAX 508-881-5584 MA Constr. Supervisors License
$4,000,000+Liability Insurance Coverage RI REG#22948
Industry leading Warranties www.UnitedHomeExperts.com RRP License#NAT-28008-1
Flexible Payment Plans available
Family Owned and Operated
Project: Windows Bid Date: 8/21/2014
Attn: Wendy Miaskiewicz Phone#: 978 744-1293
Company: Work#:
Address: 12 Vista Avenue Fax#:
Email:
City, St. Zip: Salem, MA 01970
Base proposal as per attached scope of work:
Remove and replace existing(4)windows on home with Marvin window system
$3,283
Prices good for 14 days
PAYMENT: A non-refundable deposit of 1/3 of ALL ACCEPTED PROJECTS is due upon authorization in the amount
of $1,094 with 1/3 of EACH PROJECT due upon half of completion of EACH PROJECT, and the balance of
EACH PROJECT due upon completion of EACH PROJECT along with any additional work requested by customer.
DISCLOSURE: State law requires us to inform you of contract liens. Any contractor, supplier, or subcontractor-may
lien your real property if you or the general contractor fail to pay for goods or services delivered or installed at the work
location. Some contractors and suppliers automatically send letters of notification similar to this notice. At your request,
we will provide original lien release documents from anyone who provides said materials or service. Please call if you
have any questions regarding liens.
ACCEPTANCE: The signature on this proposal reflects acceptance of the proposal as per the attached scope of work,
authorizes commencement of the work, and hereby guarantees payment as outlined above. Any amounts not paid within
thirty days of invoice are subject to service charges of 1 '/2 %per month(18%APR). All costs of collection, including
reasonable attorney fees are to be paid by the customer. You may cancel this transaction at any time prior to midnight of
the third business day after the date of this contract. United reserves the right to assess a service charge equal to 25%of
the contract amount if the job is cancelled by customer AFTER three business days.
PERMITTING: The signature on this proposal authorizes a representative of United Home Experts to sign for and obtain
any permitting necessary to complete this project.
Contractor signa Date \ Date — BBB
QISCGNER'
Addendum to Proposal and Scope of work
Contract Price: $3,283
To be paid: 1/3 down, 1/3 at half completion, 1/3 upon final completion
Contractor: United Painting Co. & United Home Experts Inc.
200 Butterfield Dr. Suite I, Ashland, MA 01721
Fed ID # 04-3541521
MA HIC License 130101
Work scheduled to be started: 9/10/14
Work to be substantially completed: 10/01/14. Add any days where
inclimate weather made the work not possible.
Notice: All home improvement contractors and subcontractors shall be
registered and that any inquiries about a contractor or subcontractor relating
to a registration should be directed to;
Registration Divison, Program Coordinator
One Ashburton Place Room 1301
Boston, Ma 02108
Tel: (617) 727-3200 ext. 25239
Liens: a lien or security interest HAS NOT been placed on the residence
as a consequence of the contract.
Permit Notice:
a. A Building permit IS required for this project
b. It shall be the obligation of the contractor to obtain such permits as the
owner's agent.
c. Owner's who secure their own construction-related permits or deal with
unregistered contractors shall be excluded from access to the Guarantee
Fund.
Arbitration:
The contractor and the homeowner hereby mutually agree in advance that in
the event that the contractor has a dispute concerning this contract, the contractor
may submit such dispute to a private arbitration service which has been approved
by the Office o Consumer Affairs and Business Regulation and the consumer
shall be requWoubmir such arbitration as provided in MGL c 142A.
Own
0
Contractor:
NOTICE: The signatures of the parties above apply only to the agreement of the
parties to alternate dispute resolution initiated by the contractor. The owner may
initiate alternative dispute resolution even where this section is not signed
separately by the parties.
NOTICE OF CANCELLATION 8/21/14............................. (Date)
You may cancel this transaction, without any penalty or obligation, within
three business days from the above date.
If you cancel, any property traded in, any payments made by you under the
instrument executed by you will be returned within 10 business days following
receipt by the seller of your cancellation notice, and any security interest arising out
of the transaction will be cancelled.
If you cancel, you must make available to the seller at your residence, in
substantially as good condition as when received, any property delivered to you
under this contract or sale; or you may, if you wish, comply with the instructions of
the seller regarding the return shipment of the property at the seller's expense and
risk.
If you do make the property available to the seller, and if the seller does not
pick such property up within 20 business days of the date the seller receives your
notice of cancellation, you may retain or dispose of the property without any further
obligation. If you fail to make the property available to the seller, or if you agree to
return the property to the seller and fail to do so, then you remain liable for
performance of all obligations under the contract.
To cancel this transaction, mail or deliver a signed and dated copy of this
cancellation notice or any other written notice, or send a telegram to: United
Painting Co. Inc. & United Home Experts Inc. 200 Butterfield Dr. Suite I
Ashland, MA 01721.
Not later than midnight of......8/24/14.................................... (Date)
I hereby cancel this transaction...............................................(Date)
..........................................................
Buyer's signature
We ha a ived a py of this notice.
.... . .. . ................................... �z�.�ry........................
s) gnature Date
............................................................ ..................................
Buyer (s) signature Date
4Mtegrity.
fmm IMMN
Wlndows and Doors
r
O.S.
eneigystar.gov
41�t t
/ •a
01.
MCualified
dw
20NE N NC
N t Y.�� 4 r ey
® In egnty Trad'I Double NUng t
Fi erglass° Wood! '¢
xFxd V rtical.Sliddr;
1 .16 IG LOE 17Z AROON i
National Fenestration 3.1mrn LoE 27211Q 5mm argon 13.1nin,
Rating Council® etr
f ,
ENERGY PERFORMANCE RATINGS
U-Facvul-P) Solar Heat Gain Coefficient
0 ,29 0 ,32
1 ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0054
ufahnar:dlpulson that thus rannp conform to tpplluble NFRC inventories for debrmining whole
prohnoperldinacces. NFM ratings in determined fir efhed set A endronmeMd conditions and a specific
fortluslofti. NFNC don not rocommend any product end don not womed the sulablllry dam product for
vj specific ids. Consult mcoufectuna literature for oea product performance Interaction. www.dm.or
Meets or exceeds C.E.C.Air Infiltration Standards
Mimi
ASSOCIA
WINDOW 8 DOOR Hallmark Certified
N OW DOOR TION
/� /D n /�A L Manufacturer
#407�
VV I V I anuladurerstipulates wnformance
www.wdma.com to the applicable standards
Integrity Double Hung
DP +401-50
H LC40 43 5X75.75
ITe ted to AAMAIWDMAINA110111 S 21A44� 05-08
Tested to ANSIMAMAINWWDA 10111:821NAFS-02
D
inst act maybe covered by one or more of the foifinv ne.petentn;6116696,
A21 442,7591108