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0022 REAR WEST AVENUE - BPA-09-370 0 The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code,780 CMR, 7t' edition MUNICIPALITY USE Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised January (� One-or Two-Family DwelZing 1, 2008 `^l This Section For Official Use Only /w Building Permit Numb Date Applied: /0 (�' Oy Signature: ID• 6 6 . M Building Commissioner/Inspector of Buildings Date - /t \ SECTION 1:SITE INFORMATION JI PTe{rty Addre 1.2 Assessors Map &Parcel Numbers y� Ll a 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(4) 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 ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.7 Ow ter'of Record: Name(Print) Address for Service: _ ct1 ,F qq - l,ial Signature Telephone SECTION 3-.-DESCRIPTION OF PROPOSED WORK2 (check all that apply) ",ev:Ccnstru mot: ❑ £xtst:ng Bul:luig❑ Tv.`c^;�'ccup;ed P.epa:rs(s)'. :1Lemt:L:'(s) AL'dtucn ❑ Demolition ❑ 'Accessory Bldg. ❑ TJumberofllnits._.L_ Other ❑ Specify:_. Brief Description of Proposed Work': 1'4 A S V (v u c Gam.v Q A✓LP�S SECTION 4:ESTIMATED CONSTRUCTION COSTS Est tim ated Costs: Item Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: D Standard City/Town Application Fee 2.Electrical $ C-D ❑.Total Project Cost' (Item 6)x multiplier x 3.Plumbing $ d 2. Other Fees: $ 4.Mechanical (HVAC) $ 0 List: 5.Mechanical (Fire $ fi 1 Suppression) lJ Total All Fees:$ (� l Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ l d 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SER ES 5.1 Licensed Construction Supervisor(CSL) � 'a, a-s-v -SA- C t1 ) License Number Expiration Date. Name of CSL-H°Ider T o f �t; S S 4 U�t h t�u vU O t S'� List CSL Type(see below) t 1 tAd&J� T e Description U Unrestricted(up to 35,000 Cu.Ft Signature - R Restricted 1&2 Flunily Dwelling Sy _ M Masonry Only RC Residential RoofingCovenn Telephone. - WS- Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition $¢ Registered PIo}{te Irytproyement C tractor CS/ �ecc...>� l 154 f'11c-le�e�,�5cot-+ j'l1 � nnt` 7 HIC Compa�n.yy Name or C Regi nt N�e� Registration Number O . U+1S d u U a«3� l a ���o Aar s r^ . ` �57j-j —q.(y -69 j. Expiration Date Signature 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 ........... EK7 No...........❑ SECTION7ac:OWNERAIITHORI' ATIONTOBE•COW- 4- 1,ED V:H N OWNER'S AGENT'ADP CONTRACTOR APPLIES FORBUII,DINC PERNIST I> as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner - Date - - S CTIOIN7b:.OWNER' ORAUTHURIZE+DAGENTD C ARAgION }; CU �` taeOuv et,orAuthortzedAumttterehvtteclare: that the stntcn_etits and i ifoniiation on the fore��ein_application are.trl a and accurate, to the best of my k to-wledoe and belia .Print i n . . � o -c7 -oIF Sig ature of Owner or Authorized Agent Date -(Signed under the pains and penalties of a 'u - - NOTES: 1. 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 and Construction Supervisor Licensing(CSL)can be found in 780`CMR Regulations 110.R6 and I IO.R5,respectively. 2. When substantial work is planned,provide the infomtation below: Total floors area(Sq.Ft.). (including garage,finished basementlattics, decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number ofhalf/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" DEBRIS FORM This form is to be submitted with building Permit applications wtiever there is debris to be disposed of. Property Address:. S Pj0—"s AA 4 ® t -e, cm Sty In accordance with the provisions of MGL c.40, 554,a condition of the Building Penh Number is that the debris resulting from this work shall be disposed of in a properly licensed , solid"waste disposal facility as defmcd by MGL c. 111 § 150A. (. This debris will be disposed of in: , 1�eu1 e..�:�i '��f ��eJkS:e� I l� �L U•�xS .Sd_ rrlJO�t-�i��u) (Location.of Facility) VL\-A— r' I S 3 4,. . Signature of Permit Applicant Date Massachusetts Department of Public SafetN. �J Board of Buildings Rezulations and Standards V Construction Supervisor License y - License: CS 99255 Restricted to: 00 SCOTT PHILLIPPI 58 D STREET WH ITI NSVILLE, MA01588 c— �L Expiration: 6F712011 ('ununisshmer Tr#: 99256 Restricted to: 00 00- Unrestricted LG-1.2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: _WWWMass.Gov/DPS ✓/ee �oomnunuiealr/ o�.�omnc�weelD Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration. 149601 _Ezpuataotf=ij2,4/2010 7y h pe`:=Spplement Card - - RENEWAL BY ANDERSOt&'- - g SCOTT PHILLIPP,Tn=-�_O.,.r. 104 OTIS STREET�`'�75 NORTHBOROUGH, MA 01"532 Administrator ACORD. CERTIFICATE OF LIABILITY INSURANCE I GATE IMLVODIYYYYI pnooue¢R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph MCKE)One -ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR JP McKeone Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC 8 1NSt1AED Renewal by Anderson INSURER A4 Hartford Insurance m n J&L Windows, Inc. INSURERB: Hermits e E 104 Olis St INSURER C: Northborough,MA 01532 NSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L POLICY NUMBER POIJCY EFFECTIVE POLICY EXPIRATIONANCF DATE IMMIDumn DATE IMM0DfYY1 LIMITS B GENERAL LL40UTY HCP 507 404 09/07/2008 09/07/2009 EACH OCCURRENCE S 1.000.000 COMMERCIAL GENERALLNBILRY - PREMISES Ea f 100000 CUIMSMADE ®OCCUR MEDEXP(AnY"Pomm) S 00 PERSONAL S AOV INJURY S 1.000.000 GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPICP AGO S 2000000 POLICY PRO• LOC A AUTOMOBILEuaeam 35 MCC XD 6390 10/01/2007 10/01.2008 comomED SINGLE UNIT S 1,000,000 IEa atldent) ANY AUTO X ALLOWNEDAUTOS BOOILYINJURY S (Per Panora) SCHEOULEDAUTOS HIRED AUTOS BODILY INJURY S NON OWNEDAUTOS IPar acc doAl) PROPERTY DAMAGE S (Partt;xvwm) GARAGELIABWTY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGO S EXCESSA MBRELLALULBILITY EACHOCCURRENCE S OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION S S wGRRERseommsAmoNAND 35 WEC PP 1444 02/17/2008 02/17/2009 WC A STATU- OTR EMPLOYERS'LUUUUTY E.l.EACH ACCIDENT S 500 000 ANY IVE FFtCEPJiME BEREEXC UDED ECG E.L.DISEASE-EA EMPLOYEE S 500000 E yaa de=nbe under SPECIAL PROVISIONS oelDx I E.L.DISEASE-POLICY LIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONS ILOGATIONSI VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION INSURED COPY _ DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE DSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 7,ee ©ACORD CORPORATION 1988 ' ACORD 25(2001108) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 U1V www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgmizat on/Individual): RCt)eu) ' 8 013deY.$eYl Address: /OFl City/State/Zip: NOff o rod " Qh.3� Phone #: L�08) J/y O jOb Are you an employer?Check the appropriate box: Type of project(required): 1.&I am a employer with 00 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time)." have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t �• modeling ship and have no employees These sub-contractors have S. Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 1 LEI Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such. iContractors that check this box must attached an additional sheet showing the name of the sub-contactors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ^n ) Insurance Company Name: �I /1/l �eo»2 //�C4IifanCe i Policy#or Self-ins. Lic. #: �J ��Z!� —?? /`/te/ Expiration Date: (02/ Job Site Address:a� City/State/Zip: S�leM Mt+ Utc, D 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 fine up to$1500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$256.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cc u er the pains and penalties ofperjury that the information provided above is true and correct Signature Date y tom— t5 Phone#: J v �/ - U CJ% Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OCT-13-2009 09:10 PM P.01 WhOW Apnement-Page t of 2 J&L Windows,Inc.,rdlbla 104 Oda 9t.,Northborouph,MA01332 n Wal �• `•• MA Hem.lmpprevem.nl Confnetor (50s)a1B•0900•Fax:(SOa)91B•Oa02 ersen. License 0149601(Expires 1124M010) CuaWmer 88ry1G:16001 a7].7s0a Federal Tax 10903-0404201 WINDOW a{l LAere{Ai un Arvimm(bmryq Product Mahapv: es�3f1- Window Aureernent Contract Date: IO 1!- 43 Homeowner("Owner")'e Nama s ' street Atltlress: T Cityrtown: �t.-1 State• /-�Zlp: �/ Nome Phone: / Work Phone: 7� Job 91te Adtlresa pr tlinennry: Eineil Atltlresa: Materlala to be provided and work to be peMorrtled by Renewal by Andersen("Contractor" Contractor will furnish and install Renewal by Andersen•approved materials to the tollowing specifications: 1. Date on which Work Is Schedu,¢d to Begin: ` Expected Dale of Subatantlal Completion: S 2. ContraMor will Install a totgI of�windows in Owners home,using the tollowing Intllvldual quantities: Double Hung IDS) 'Equal sash 0 Cottage sash(1/3 top,2/3 bottom) O Oriel sash(2/3 top, 1/3 bottom) _Casement(CW) 0 Hinge right O Hinge left(as viewed from exterior):OStandaro handle OMetro handle _..__Double Casement(CDW) 0$tandard handle OMelro handle Casement/Picture/Casement(CPW) O 1:1:1 or O 1:2:1 OStandard handle OMetro handle .. 2 Lite Gliding Window(GW) Glider/Picture/Glider(GPW) ❑1:1:1 or 0 1:2:1 _Awning Window(AW) Picture Window(PW) BpWy or Bow Window: 3. ID,Yes O N #Windows to be Custom Fit Replacement: 4. ❑Yes 9 #of sills to be replaced by Contractor: 5. ❑Yes @'No N Windows to be New Construction Full frame(includes new Interior&exterior casings): Exterior casings: 0 Pine O Maintenance-free material 0 Factory applied 908 Fibrex brickmold 6. Glazing to be: �h P rformance 0 Other If other,please specify: 7. Exterior color to be:Cite O Sand O Canvas O Terratone S. Interior color to be: hate O Send O Canvas O Terratone O Wood Note:Interior polo only be white,wood or same color as exterior, Wood Interiors need to be finished by Owner. 9. Hardware: hits 0 Stone 0 Canvas 0 Brass Double Hung: Install lifts? O Yes 0 No 10. 0 Yes c ontractor will remove metal frames or grilles. a of Units: 11. O Yes o Contractor will Install new paint-ready or stain-ready casings. Inside or outside stops#of openings;_ Interior casing#of openings:_ Exterior casings#of openings: 0 Pine O Maintenance free material Owner is awl that Contractor does not do any painting. Owner initials 12. O Yes 13190 Contractor will wrap exterior casings with aluminum coil stock of_ color. Note:Required with storm window removal�,Tmovel of storm windows will llJeavecrew holes In casing. 13. New windows to have: ❑Half or III screens Screens to be: P-Ploerglass O Aluminum 14. Windows to have grilles: 0 Yes Ill If Yes: ❑Grille Between Glass(GBG) O Removable Interior Wood(INTW) ❑Fulljlivided Light(FDL) Grille paMams: B P:1 B P F1 m OH CHI OH DH CW/Picture Glider GPWor GPW 'use ad " nal shoot If needed Owner approved(initials): 15. �s M No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. 16. 61'$e9 0 No A limited warranty shall issue to Owner upon completion of the job and payment in full leas reverse aide). 17. ea O No Building Permit-Contractor will secure any and all necessary permits.The fee for the permit(s)is not Included in the Contract Price and a separate check is required at the time of sale for this fee. 18. Addltlo b details: 19. es O No Owner has reviewed the Additional Terms and Conditions governing this Contract on the reverse side, Including Owners Three-[) ancellatlon Rights pursuant to MGL a 93 e,c 140D§10 or C.255D§14(Sea semen 26). 20. Total Contract Price!$ �V: Regular Re it Price:$ Pa All available discounts applied:O Y0e 0 No 21. Deposit(1/3):$ pal tl by- Cash finance (Account#:— ) Second(1/3)$ to be paid by Cash at start of job on (Estimated start date). Final(1/3)$ to be paid by Cash at completion of job on (Estimated completion date). 22. Yes O No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. _ o Ana/payment shall be demanded until the eonrrect is completed to the satlslacdon of all Iias. NOTICE: All home Improvement contractors and subcontractors must be registered. Any Inquldes about a contractor or subcontractor relating to a registration should be directed to:Registration Division,Program Coordinator,One Ashburton Place, Room 1301,Boston,MA 02108,Tel:(617)727-3200,Webslte:hit :lhvww.maee.govldps The parties hereby mutually agree in advance that should a dispute arlse regarding this contract.Contractor may submit such dispute to a private arbitration service that has been approved by the Office of the Consumer Affairs &Business Regulatlon /nv'rall shaft"gutted utretl to submit to such arbitratl a provided 1p MGL c.142A. Contractor Sic re: .�=6��%___L Owner Signature: NOTICE:T signatures of the parties eves apply only to their agreement to alternate dispute resolution Initlated by Contractor.Owner may Initiate alternate dispute resolution even where this section Is not signed separately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES J&L Win do I la I by Andersen n �� By /L Produo eneger - Own ip eture Product Manager(Print Name) Owner Signature White-Renewalby Andersen Yollow-Installatlon Pink-Homeowner e Q re al flY AMUE0.tP.M WoodNinyl Composite Frame f7�G7nai Fenesbalioti Dual Argon LowE - Rat t gCan°n�'. Glider MENEM ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient 0 . 34 130 ADDITIONAL PERFORMANCE.RATINGS Visible Transmittance 0 , 49 MenuhcWnreflpuMNC INI Mua nllnpSoonlum bapp4pbb NFHC pmcedYnv brtladrminNp wheb pmduet - pvlamunn.NFHC nlingv eR daUrmMad bra Man at olmNmvnmNl cpndltlem and a apedR prvtlud tln. - NFHCdognot noonvtond airy xvaucI and d.a not..I tn.uablury of a,Induct bran,t1.1ft uaa. Camuna anukeurvla 111anwn br etpn product Padonlanel Mbmntb . WWWANC.O I z q J DESIGN PRESSURE(PSF) _ M ��n HS - LC25 100=00296313=006' ' rm.d marsv a1m s±mu.NAfsm. reamena�n. ' eiemwarmaa�m m. rw,lndMaa;e. Maab arncwds M.E.C„CJi.C,AIEG.C.AnlnNnndnn ndubwnmb WDMAHdanelk CadMnibn Pmpmm. , k F� Renewal b)Andersene k� WINDOW REPLACEMENT an Mdwscn Company National Fenestration Wood/Vinyl Composite IF Pang C"Cils> Dual Argon rgon Low E Double Hung 100-00414585-007 ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient 0 . 30 031 ADDITIONAL PERFORMANCE RA-9 tnGS Visible Transmittance 0 . 53 ManuhcWnretlpulare6 WttMes niMgS wnW,m W eppllfaTt NFAC prevMww WrGNennInNP wl,de gotluct ' NMCdocon NFNCmtlnpa Any mduct.nrodefled cetetnt AmvwnW wnElWwantlt ewellkpmtluIX aKa. Nonsuft su nmeshtoenypmduotenddua dano n wewnt NpeveeElllry pteny pn0utt Mreny appdfic uea ConvuttmenubcW nh utpnwn pretMrpnduc[pedpm,enw Nlomutwn. Y . W W VfAttCARe #SEg4 This product meets GCY !! standards Ps endmnmental W p ` standards goyme energy efficiency,hea 's7` erning '. p metals in the frame a14 V sash Instedals,Qpackaging,and consCR,9� education materials. - DESIGN PRESSURE(PSF) _ ' M.iNedu�ee0.vm�m ' l H - LC25 RbA DS Sloped SillDH IN M1. Teamtlb NAFSM rAMfAN.DMAI(SA tlIBIAMOAC Mmvfnwm Imes mvfomuoeem t6u liable xtnvdnds. , MeeW vrvxwetlsM£C.,CEC,hI£C.C.MrinNkvWn nqulnmvna YNMAHaIMeM CeNvatbn Pmpnm.