52 WEATHERLY DR - BUILDING INSPECTION C�P° �k $ 7
The Commonwealth of Massachusetts
Board of Building Regulations and Standards BE EIV€IY OF
Massachusetts State Building Code,780 CMR mSPECTR 114AL$DICES
Revised Mar 20/1
Building Permit Application To Construct,Repair,Renovate Or Demolishes Mar
01
One-or Two-Family Dwelling ! 1g14 MAI —1 P
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: / 1.2 Assessors Map&Parcel Numbers
S� C.y18✓lS (�ru ,
L la Is this an accepted street?yes no Map Number Parcel Number
-• 1.3 Zoning Information: - 1.4 Property Dimensions:
Zoning District Proposed Use 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:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPEPJY OWNERSHIP'
2.1 PRwner'of�c rd:
"tiNlv3 Milk9 C.�VI iy, 0 4q
Name( int)Ctl� City, tate ZIP
lgtrlc ilvlt & I �poi
No.andstreet Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORle(check all that apply)
New Construction❑ 1 Existing Building Owner-Occupied Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brie es iptio of Propose Wor
£W tv Tu ra Y /2g
SECTION 4: ESTIMATED CONSTRUCTION COSTS e 44(t/�F
Item Estimated Costs: Official Use Only
Labor and Materials
1.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 $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: „
5.Mechanical (Fire
Suppression) Total All Fees:$ _
Check No. Check Amount: Cash Amount: t
6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
Cf-%a,L. *i02 VIL2 �A1TltJV � GDt�IlJO L
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction u ' or Lic (CSL) 90
/;(/4 t/
t License Number x va on Da[e
- Name of CSL Hol
1' \ List CSL Type(see below) ,
No. d eet �(,t Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/I'own,State,Zl P M Mason
ry
RC, Roofing Covering
WS Window and Siding
C SF Solid Fuel Burning Appliances
1 I Insulation
Tile hone Email atl s I D Demolition
5.2 Rl stere o e Improv ent nit t C)
HIC Registration Number E pira on ate
111C Co e or I Regis; qt N e b
No. Street J1��
Email address
City/Town,State,ZIP 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
1,as Owner of the subject property,hereby authorize InA Amt -1 $
to act on my beh. f,in all matters,relative to work authorized by this building permit application.
Print rer's Name(Electronic Signature) U —Die
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby jiftest unde a pains and penalties of perjury that all of the information
contained in this application is t ell accur f the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) to
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.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(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"maybe substituted for"Total Project Cost"
F104/20111
=113 PAM INBT"VEWANA3 DE PVC
YLWINDOW EY USTRTES-3 va varlenavleJa y lee moldurae Intedaea en ton lease let-YH � r E°U 0 en remover les moldume puede pormlOr'
oa ooueLs oLAbar Imegen BA o BB)REPLACEMENT INSTALLATION ra0nc INSTRUCTIONS ow4aARGON 0°UBLENERGY 8TP 0 gBmUBVB MB poises IBa aeblAllae de los hueao0 vleJre y IBB
QUALIFIED ne.el hueoo con aldade de 86re villa 81 io decree,ream
wblerl�vleJ�wncuMerleema NOlAl811ea1amlaede
weir
trlmlempe et aides end top.The b>p trim may need to be cut tdeJeaBenen un tare de PVC o de ehaNNq uea rme pelenca
hen replacing•Cae M removing the Ulm may Bllow you to reuse P (Rater N Debra pare removedes 018e Jembae da M veMane nuava
Rgure � ENEIt�aF PERFORMAN E RATINGS tumho de 31/4"• st a enoho de le eperhne eB mays iBe
el
pww carde end remove lower No. LLFactor(USJI-P) Sola�Heat Gain Coefficient " a Ioa precercoe pare compentar M wteremda 31
tretlot',r�lrme d enaho del eMepaJo de M rprertura ealetelde
nm paring beads at ddes end top ® n O 0.30
una) tbnpN epalturd 4on �uaMe y p►oaer�Don le
t pulley cads end remove top sash. r 4)INa rdvel de Inabtla Pere valAoarla ImAmntADdBd del
move ptdleye,weight cWfjwmv,and weights,RI this top to bottom 3
I Aaeplae et tdvel ueardo ouHes de aredera eq
y wilh 8bergkes Inaulebon.li deabed,replace coverelcover holes with wood. ADDITIONAL PE O MJIINCE RATING5 r dtelmr Iwaa mega emre preaerooa en d eHehar
d algllrel windows have vinyl or aluminum IBmb HMr%Use a 1e1 Pry bar to Ida pee aeegura au enM Vea diagrams BIL
IMa& Visible Transmhtan&a Air Leakage(USJI-SAP) . + r t"ea'B el ensguuea ao" 1mm'a'ee"ax°°ham en"
Son scup dedleMlrotaddpeAgMMrladNanMpedto,ueand014B1ree
1 ► 112"Sue vleltan InotWdos BeHmte el htteco r�IdMItM can
bd'rap8cofvtttytreplacementwlndaw r o*wpamoaeipaarunseeohemtd800•Vesdlagromm
4".If the�adng lanb depth Is gar Mort here 0.55
rMg eb1pB io Maws of bMd ems•q s va^h tHdlfE En oaeo d0 eaculre baleleoldrt de eHetra Plano el
9Jamb depth Is IBM#03.114",Ulm Iorda n*ftahoa I elm o Inbu ea'remov�preserves
on M 000 V ene el
eat rdhpeoerdarmloeppunehbllfAopmoadimaa idolMetMtdOl�pfeoeraaaenleOJ�mbesydlintel
he*dcap. I trim udaluprer 1>FAemtldW�d� rora8mdm�ddaesnot aroedl tNero op�de deNOWACK sUan0elGap *
siLiaaedCauclamnu9maaere dinodaOneMlentsdoflMadoVift fmnblel00104 0e10-
1001y doBn openin and p oceed vdth lnaialletlmt• "�° �ntorotharprodud pvdonaoroebddmmMon
proagt aq�epedRo laid(dmryg�oongrepaalgPoeldolreMvatMnedadmda
yadacdrc�atbtnemerdeoomralo0preoera00• O)Mmpnde
ak the prime dD tar level CompmeeM for out of level aonditlone by ItreMHirlg �.__r — �.— ,fig V vortivOad de Is WOES Dsm*un wvel y ayudei.
as xdawnnnmadnuMldB.eIMBoLe�Rl4�..-_.., olM�edaeUms�aaa EnvenMnesdoOWZ 6nvaecalydo
HARVEY USTRIES-3 HARVEY INDUSTRIES4 `eeoM Erlobaew��� nod a�dre�r
Clesale DH a dd memoyd01e0 hoJa00wi Iguai�00 ke audm talcs
r Dlsealo DH 1lBalO Iowa nxaca oauaue CIA 8 oP9�gONVEaRCAi:UIOIkie lee d0la valMney
ww4r nxaoN DOUBLE du CW WDH Na alleles daMa hAlawee 87e I�tand8oe uMaadas eu Ise
CW WDH I M d pegs gmtamsnM son la store
J 310007 LoW.a nsooa ooua� ENERGY 8TP (qua :sp
1301436 LOW41ARGON OWL ENERGY87P ° QUALIFIED x asessegaagw1 mmmareoyloohl�read110911 laorreda
1408 48 M2412011 QUALIFIED Came T-05 19 10128/2011 BBEIt HbAhraleholaypUebatamllloauhioad00enlre
adaM deredle hula qua pp tbmememe Dan la apawre•
802C08mm-Elaltekmditoff
et4doeutnrgo
ENERGY PERFORMANCE RATINGS ENERGY PERFORMANCE RATINGS deMNalMrree11ep di
I-Factor(USA-P) Solar Heat Gain Coefficient U-Fa 3 U dl-P) Solar Heat Gain Coefficient I a, outdad ae no�bre e�eMr loa
0.30 0.30 0.30 ate'; �°ub ae'' aw
DDITIONALPERFORMANCERATINGS w °' l'f EIaeP 111) OM11100108edlaeen
ADDITIONAL PERFORMANCE RATINGS ea dedeMtermaetmeraa ti)ebt mientotoseemde
talon de Ie vettMna y M epertata Dan alalanl0rda de 8Ma da
IbleTransmittance Air Leakage MAP) Visible Transmittance Air Leakage(U.SA-P) qpoWdedo.ennoeoMe•refnerlaaeepeol WKBIM 12)
----_-- , 0.55 ��aa aaaelmbm,ld�eday n,=be wnno
0.55 ---_-- 3) a e del so dMe Y
I nemdo ranmdtee oldmm ola em pars ho]a de meML 14)
areapulalenl4etaxrrnt6ipe htthan°mdamlloeppHoe�eNFROpt°oedunePordelmmhdlpwhde BYeeOeetaaP deIOee9� mordeagm
odoanloap epapeaduitodemmog nmeofeloMNnatle m(�Ia pars ren de�eraMmtld18)RNmPIe e
mman .NBrdnpn d n pmdudperlormamN,WX musm e
mxawadaodg a
Ma°IeIm.NFnndoean°Irm°mmandenypmduddnddooen°rwarnntNaeuaeb*olony Dndudalm.NRlCdasndmrammradae�0mduotanddoeamlwenentlhaeuanNabdeaY ate„
'mryepodnouee.IbasdtrmnWgahrnrsaenWretor*ffFWuotpakrrmncebdormdlea, pndudlormuSpedaoumcamunmenul ereluenbeehrOWINOW �am��IM�AAaOA 08•2898109 PctM10214,03
0h60ic--- .
NORTHS6 OP ID: DH
CERTIFICATE OF LIABILITY INSURANCE D04104ATE 12014T
o4/oa/zo14
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the ceitficafe holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terns and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsementfs.
PRODUCER Phone:Phone:978-777-93 xcoaME� Dan Hurley
Dan
cehiudtGIBceen SUke Agency
Fax:978-777-3306 PHONE .978-777-9394 Wr No:978-777-3306
Seven Federal Street IL
dan@hurlffjnsurance.com
insurance.com
Danvers,MA 019233620 AODREss.
Daniel J Hurley INSURE $ AFFORDING COVERAGE NAICO
INSURER A:AIM Mutual Ins.Co.
INSURED North Shore Window&Siding INSURER B:
James Sheilds
40 Preston Road INSURER C:
Somerville,MA 02143 INSURER D:
INSURER E:
INSURERF'
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
OISR ADDL TYPE OF INSURANCE B POLICYNUNBER POUDITYYCY NP�O EIIP UNITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY NOT HANDLED BY THIS AGY PREMISES Ea occurrence $
CLAIMS-MADE ❑OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $
POLICY PRO- LOC I $
FMOBIL
E LIABILITY COMBINED SINGLE LIMIT
Ea acdCen
ANY AUTO NOT HANDLED BY THIS AGY BODILY IWURY(Per permn) $
ALL OWNED SCHEDULED BODILY INJURY(Per accidI $
AUTOS AUTOS
HIRED AUTOS AUTOS PPReraccidOPER Y�DAMAGE $
8
UMBREILALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED I I RETENRONS $
WORKERS COMPENSATION ITOC
STATLL X 01TH R
AND EMPLOYERS'LIABILITY
A ANY PROPRIETORIPARIN
TNERJEXECITIIVEY NIA WCd00.702"7l-2013A 0511812013 05/18/2014 E.LEACHACCIDENT $ 500,0D
OFFICERAMEMBER EXCLUDED? Eil(Mandatory In NH) SEE NOTES EL DISEASE-EA EMILOYEE $ 500,00
K yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00
DESCRIPTION OF OPERATIONS/LOCATIONS r VEHICLES(Attach ACORD toy Adamonal Bermuda,Schedule,@ more space is request)
Jim Shields is exempted from workers compensation policy. WC insurance
Coverage applies only to the workers compensation laws of the state of
Massachusetts.
CERTIFICATE HOLDER CANCELLATION
0000000
Northshore Window& Siding SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
40 Preston Rd. ACCORDANCE WITH THE POLICY PROVISIONS.
Somerville, Ma. 02143
617-628-7204a- 1-800-439-7205 AUritommREPREsENTAT rE
Mass.Reg. 101562 (
151988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supen isor
License: CS-M424
JAMES J SffiELDg-
40 PRESTON RW
SOMERVIILLE MA OUs
r �
9511 " "` Expiration
Commissioner 10/01/2014
aas� Once of Coasnmer�B�oess�Re�gu�l�i
THOME IMPROVEMENT CONTRACTOR
Reglstration: .,A01562 Type:
Expiration: 6/26/2014 DBA
ORE WINDOW&$IDING,
James Shields -
40 Preston Road —
.. Somerville,MA 02143, . . Undersecretary
l 1
CITY OF S�UY-.2N1, UNSSACHUSETrS
Buumi IG DEPART.%[&N"r
' 120 WASHINGTON STREET,3iO FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
KI\tBERL.Elf DRISCOI.L ;
MAYOR THomAs ST.P[EM
DIRECTOR OF PUBLIC PROPERTY/BU:IIDING COJL%MIONER
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:
f //uC /lutF I(A/(9 V .
(name of hauler)
The debris will be disposed of in :
R"f 0 k)
(name qf facility)
(address of facility)
si' ,ature rmit applic nt
•
to
debrimITAm
II