28 WHALERS LN - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards Town of
Massachusetts State Building Code, 780 CMR, 71b edition Building pep'
Building Permit Application To Construct, Repair, Renovate On Demolish a
IOne- or Two-Family Dwelling
I) This Sectio or Official Use my
UViI Building Permit Number: D e App ' d: /
Signature:
Building Commissioner/Inspector of Buildi gs Date
SECTIO 1 SIT INFORMATION
1..`Pr,Sperty Ad ress: V 1.2 Assessors Map& Parcel Numbers
L l 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 R) 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:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'o Record:_
�Dl�n VA Ile SC-h; —y WhAle,�-f L4-1i f4lCiol �J
Name(Print) Address for Service:
,Gels P d dY 11 �sc.h 1. 9?Y -7L/Y Lo ip
Signatur ^t ('. Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)'
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) V Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work: J—
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor andMate_ri_als _
1. Building $ S 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 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
r Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ SS J %I 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES 1
5.1 Licensed Construction Supervisor(CSL) r� '/ 7...3 1_
� � - /ti ✓/������ License Number Expiration Date
Namc of CSL,-H(,.I_der' "J List CSL Type(see below)
'1q '��,. S 7 �''I bLrl
Ad 091s Type Description
U Unrestricted(up to 35,000 Cu. Ft.)
R Restricted 1&2 Family Dwelling
nature / . M Masonry Only
?p 7 7� t% RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Rez4istered Home Im rovement Contractor(HIC) V3 ( c�
1. 1 C ✓hq / =1 J
HIC C any ame or HIC Regjstrant Na a Registration Number
J 7i1tJ2�1 t h4 ` Z
Ad _5
7y� y7 f�� Expiration Date
CJft'hature 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 .........Na- No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, c- ( LeS C_1.1 as Owner of the subject property hereby
authorize M glK;.1 IL in//I/', n to act on my behalf, in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
1, (2A as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf. �1 t
1
Print me )
ature of Owner o Au orized Agent Date
(Signed under the pains and penalties ofperjury)
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 I IO.R6 and I IO.RS, respectively.
2. When substantial work is planned,provide the information below:
Total Floors 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"
JOHN WALSH INSURANCE Fax:9787459557 Nov 30 2009 13:07 P. 01
q�p 'CERTIFICATE OF LIABILITY INSURANCE OA11 3DD/Y 9
PRODUCER THIS CERTIFICATE IS ISSUED A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
John J Walsh Ins Ageaay, Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
.4407 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
-
A"
O HOR, ,.. A"
Salem 2'�_Ol$7'b.,6` 07 I� :'. . . . ..>
1?hon®_ 978 745-33,0,0 Fax .978 745-95�57 INSURERS AFFdRDING'CDVERAGE
. .. .. ..
w$urCED . .. .. ..... .. „ .,... .... . „ ..,.... .._... ., ., INs4R A: ..NauEilus 'xnau>ra><ice Company '
.. ... INSURERB:„ 'Travelers .
... . .... ... .... ....:. , ,. .., '
Sig,TAhT R,r•ia ..JNSURERC ., •.
.' >DANVEIRSr[.N7L
wsuRi`RE " .. :-
COVERAGES
THE POLICIES 0F INSVRANCELISTEO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE FORTHE POLY PERIOf)INDICATED.NOTWfTHSTANDING'
....
ANY REQUIREMENT,TERM OR CONDITION OFANV CONTRACT OR BITTER DOCUMENT WI RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAJN,THE INSURANCE AFFORDED BY THE POLICIES oESCRIBED HEREIN IS SUBJECT To THE TERMS,MLUS16NS AND CONDMONS OF SUCH
POLICIES.AOOREGATE LIMITS SHOWN MAY HAVE BEEN,REDUCED BY PAW CLAIMS.
LTR N$R TYPE OPINSURANCE POLICY NUMBER BATE MAW TE MY LIMITS .
GaNERAL LUUpLfiY FACH:OC411RRENCa:: $;1. .. ..
A X cOMMERCInL.cENERAL-IBtLITY NC930746 10/03/09 10/03/10 PRWISES(Ea o raz ) $5b000
CVVMS,MADE OCCUR '•. .. ': EXP(IW rn+n perso) $>SOOO ADD..
.PERSONAL B,pOV IN.NRY $1G0.0000
. GENEwiL'AccR�rp?e $24:DOD00; ' '
Gl3'LAGGREGP.TE'l1Mfl'APPLIES f!ER 'PRODVCT9-CQNS'IOP,AGG' aadab10�0`Or %
;POLICY ijERGo-Y ..EOC.
'AUTOMtl�V.B LUIBILnY OOMBp•IEOTSBiGLr:T�.BT $ I, ''
. ANY AkFTO (ERGIA[)
ALigWNEO AUTOS aOOB:YINJURY
.SCHEDULED'AUTOS �vPn) $
'HIRED AUTOS:'.': abbItAwJURY s1.
' .. ,ecgdanU
.I
'NON-0WHEOAWR75
' PROPERTY DAMAOE.�
GARAGE LIAORM�', ::AUTOONLY:F(i'ACCIDENr{ $ . '..j `l
ANYAUTO '; .OTHER THAN "rFAACC• $
AGG
. 'EXCESS I UMBRELLA LWBBJTY f, ... . .. .
. .EACH OCCURRENCE:.. $ �•. :•'
OCCUR: -a ClASh9 MADE ' .':, '. $ .•
AOGItEGATE
7.
DEUCITBCE $
NOW PENSATION ILL STORY Lams ER
B oFFIPCREwPAffnmET<ExC�uDRD' :�
. .,.I, .. . s si soANwwpLOYERYW9LLlTY YN � OB 31 09ANY H�203X968 2-09
` 4100 �
1)MelMebrT:bINH) x $LGIB�A61 E Eq;EAiPC � 60.Tt00
'N•yes,':dron.meEr ' ,.OTHER
,sPEC1ALPRDVLSIONSTIelcw E,L.dl$EASE PoucrTJMd� $�SO'OQOD I A '•
i rt� F r d
D"CRIPTION OF OPERATIONS LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY MOOR$EMFNT/SPECIAL PROVISIONS.
CERTIFICATE HOLDER CANCELLATION' ""-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOfi THEMUWOWBURE LENDEAVORTOMNL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO ME LEFT,BUT FAIWRE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF MY KIND UPON THE INSURER ITS AGENTS OR
JO WHALERS REPRE AbITATrvFs JOHNJ.WALSHINSURANCEAGENCY.INC.
SAIM4 NA 019'10 John J UP Walsh Ins. Ag
ACORD 25(2009101) (51988-2009 ACORD CO TION. All rIghWFft6WCr.
The ACORD name and logo are registered marks at ACORD
CITY OF S.U.EM. AASSACHL;SE=
BL'Q.DLNG DEPARTNIE. T
• 120 WASHINGTON STREET, Sou FLOOR
TEL (978) 745-959S
7 98U
FAx 97 �
KI.,BERI-EY D RISCOLL
T?iOhtAi ST.P[ERRi
MAYOIt
DIRECTOR of PtgL[C PROPERTY/et¢DtvG coSartss[oNe2t
Workers' Compensation Insurance Aflldavit: guilders/Contractors/Electricians/Plumbers
-k[tallcant Information Please Print Legibly
Name(gusincv.Organtrpiomindevtdawl): _ ,# C�I 0,n 0#07 U/Jh`
Addresa: ait S 7— p /
city/state/zip. b A', ✓&T M,-9 Qlq 213 Phone
A
rem an employer!Cheek the appropriate boa: Type of project(requlri:Q:
am a employer with 464. 01 am a general contractor and I
(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.0 I am a sole proprietor it parer- listed an the attached sheet. : 7. ❑ Remodeling
>hip and have no employees These subcontractors have g. 0 Demolition
workingfor me in an capacity. workers'comp.insurance
Y P ty 9. 0 building addition
requited.]
workers'comp insurance S. We are a corhave
exercised
and its 10.0 Electrical repairs or additiom
regatirad.) ot7lcas have ertereiaed[hair
3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing termite or additions
myself.(No workers'comp. c. 132.f 441 and we have no 12.0 Roof repairs
insurance required.)t employees. (No workers' 13.0 Other
comp insurance required.)
•Any appacam that epoch beer 01 mtap also fill w/thr sectice below showieg their workers'conp000do o policy inWrmadoa
'I hmwnertrae who submit ibis anitkvlt indicating they am doing all work ang thus him outside ,,ancese mop rhnk a new afl[devit iodiorina tuck
:C,mtrstore that cheek this ben mud anachoa an s dilio d rhea showing the—e/rap ar►eomrecaore sty their wwksm'camp.palicy iarpmsuoo.
f arse an employer that Is providing workers'comprosadon banrotecr for my emp/oyees. Qafaw/s/bs psiley andles star
inf0rmtedAM1. —•�' - 1
Insurance Company Name:
Pnlicy N ur Self-ins. LicljN: P1 Expiration Date:: f1 ` r1 ' / 0
Job Site Address: (1 11/h I e L< City/SaatdZip: J 4/GM /M 01 70
.tnsch a copy of the workers'compensation policy declaration page(showing the policy number mad eaplrsdon daft).
Failure to secure coverage as required under Scclion 23A of MGL c. 132 can lead to the imposition of criminal penalties of■
fine up to S I.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tit»
of up to $250.00 a day against the violator. Ile advi..s d that a copy of this statement maybe funvarded to the Ot71ce of
Invnhgationa ul the DIA for insurance coverage verification.
I da hereby carif undernd penakles of perfury tAer the:nformarlon provided above is true and car►r
n/fle ial use only. 00 nor write in this area, to be'unpfeted by wiry or town a fc-isd
iI
City or fawn:
Nsuing.whurity (circle une): - --
I. Ilu:ard of Ilealth 2. RuildlnL Dcpartmunr 3. Cilyfrown Clerk a. Electrical Inspccto► 5. Plumbing lnapeefor
6.Other
l ontact Person:, _ __. _. Phone N•
Milssachusetts - Department of Public SafclN
Board of Building; Re ulations and Standards
Construction Supervisor License
License: CS 20014 .
Restricted to: 00
IRA G MALKIN
180 DAYTON ST
DANVERS, MA 01923
i�G_ yi1J� Expiration: 7/31/2011
( n...... „nei. Tr#: 18087
lie
40dPolfoluilding Regulat�Ons and tandar s
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Registration: 100554
Type: Individual
Expiration: 6/22/2010 Tr# 267871
IRA G. MALKIN
Ira Malkin ---.---
180 Dayton St ---- ----------- — -
Danvers, MA 01923
Update Address and return card. Mark reason for change.
Address Renewal Employment ---- Lost Card
]PS-CA7 0 50M-07/07 PCB490 -- --- -
SPECIAL SERVICES CUSTOMER INVOICE Page 1 of NO. 2686-195627
Store 2686 SALEM,MA Phone:(978)741-9299 -- ------------ -- - - - ---------------
�e 50 TRADERS WAY Salesperson:8SH7DY
ti
SALEM, MA 01970 Reviewer:
v_ [Aft-
28Hoes Phma
LLESCH) JOHN (978)744-6098 REPRINT
WHALERS W wax PhmeSALEMJabUss Wm PATIO DOORS
MA as 2009-11-3012:D4
019706813 �emM1
INSTALLER DELIVERY #1 MERCHANDISE AND SERVICE SUMMARY dr "usa"n' lmBihequantifreselmerchandfse
N
REF 4 113
STOCK MERCHANDISE TO BE DELIVERED-
REF . SKU QTY UM DESCRIPTION
R02 616-240 2.00 EA E/O 200 GLIDING PS510L KIT TAX OR EXTENSION
R03 321-257 4.00 EA SCREEN FOR 200 PS510 DOOR WHITE Y o 553.79 1 107.58`
R05 163-613 4.00 EA 1X8-8 PT APPEAR WEATHERSHIELD 10270 10.80'
R06 464-567 96.00 LF STOP WM917 PINE 318X1-1/4 �91 $19.64`
107 966-471 4.00 EA 9X33.3 WINDOW&DOOR SEALING TAPE Y $0.63 $60.48`
ROB 715-499 8.00 RL E10 2"XIWX48' MIP INSUL RL 5.338OFT Y $15.85 $63.40'
R09 746-322 1041 EA 15116 X 42 ALUM DRIPCAP MF Y $3.24 25 92`
Rio 515-516 1.00 EA LIQ NAILS HEAVY DUTY 10 OZ VOC Y 1.00 10.00`
Y
R11 617-334 28.00 LF 1X6 R/L RED OAK S4S 2.03 2.03-
R12 158-305 96.00 LF BRICT<WM180 PFJ 1-1/4X2 Y 2.52 0'60'
R15 616-241 2-00 EA FJO 200 GLIDING PS5 R Y $1.31 125.76`
N Y $553.791 $1,107.58-
$3,003.75
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Check your current order status online at
www.homedepoLcomlorderstatus
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ge 1 of 3 No. 2686-195627 ` Indicates item markdown
Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE-Continued Last Name: PALLESCHI Page 2 of 3 NO. 2686-195627
INSTALLER DELIVERY#1
REF 9113
INSTALLER WILL DELIVER MDSE T0: SITE OF INSTALLATION #113 AT TIME OF INSTALLATION.
a
INSTALLATION #1
REF# 113
ii ESTIMAT
MERCHANDISE TO BE INSTALLED: ED INSTALL BEGIN DATE: 11127I2009 ESTIMATED INSTALL END DATE: 12/27f20D9
REF# - SKU QTY UM DESCRIPTION.
R02 616-240 2.00 EA EIO 200 GLIDING PS51OL KIT
R03 321-257 4.00 EA SCREEN FOR 200 PS510 DOOR WHITE
ROS 163 6i3 4.00 EA 1X8-8 PT APPEAR WEATHERSHIELD
FIOe 464,567 96.00 LF STOP WM917 PINE 318X1-1/4
R07 966-471 4.00 EA 9X33.3 WINDOW&DOOR SEALING TAPE
ROB 715-499 8.00 RL EIO 2"X76'X48" MIP INSUL RL 5.33SQFT
R09 746-322 10.00 EA 1 5/16 X 42 ALUM DRIPCAP MF
R10 515.516 1.00 EA LIQ NAILS HEAVY DUTY 10 OZ VOC
R11 617334 28.00 LF 1 X6 R/L RED OAK S4S
Rig 158.305 96.00 LF BRICK WM180 PFJ 1-1/4X2
R15 616-24i 2.00 EA E!O 200 GLIDING PS510R K]T
BASIC INSTALLATION LABOR:
- DESCRIPTION - _ UM-
235 045 PATIO DOORS NATIONAL!SLIDING PATIO DR UP TO 72 X 80 QTY T PRIGEEACH --EXTENSION
OPTIONAL LABOR SELECTED INCLUDES: 4.00 EA N 1 $469. $1,876.00
OPTION , _ -DESCRIPTION
13I...HAUL AWAY EXISTING DOOR QTT UM TAX `PRICE EACH EXTENSION
CUSTOM LABOR SELECTED INCLUDES: 4.001 EA1 N 1 $30.001 $120.00
OPTION : DESCRIPTION s - CITY UM _ TAX PRICE EACH EXTENSION
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ige 2 of 3 NO. 2686-195627 Customer Copy
SPECIAL SERVICES CUSTOMER INVOICE- Continued Last Name: PALLESCHI Page 3 of No. 2686-195627
INSTALLATION #1
LL (Cwffnued)
REF#t13
1 CUT BACK SIDING ONLY AT 60.00 EA THIS IS WITH 25.00 OFF EACH DOOR INSTALL PER il (l)
EA N
KAREN AT MALKIN.,. $60.00 $240.00
2 DIFFICULT ACCESS TO BOTH BALCONY DOORS...
INSTALLATION SITENAIAC. PALLESCHI JOHN N 125.00 $125.00
ADDRESS: 28 WHALERS LN INSTALL LABOR CHARGE: 2361.00
CITY: SALEM STATE: MA TRIP CHARGE: .00
COUNTY 7AX R ZJP: 019706813 CREDITFOR DEPOSIT/MEASURE: 0.00
SALES ATE; 6.250 TAX: Merchandise- Y LABOR- N
PHONE: 978 744 6098 ALTERNATE PHONE: $2 361.00
INSTALLER SPECIAL INSTRUCTIONS: THIS IS THE INSTALL THAT IF CUST PURCHASES ALL 4 DOORS THEY GETS 25.00 OFF INSTALL PRICE..
N ...PRE-INSTRLLAT[ONJOBSITE INSPECTION BASIC INSTALLATION LABOR INCLUDES:
0
c
UNLESS STATED ABOVE THIS INSTALLATION DOES NOT INCLUDE:
m ._INSTALL PATIO DOORS OVER 9E•IN HEIGHT OR 96•IN WIDTH
ti
-HOW THE PROCESS OF PURCHASING AN INSTALLATION WORKS: SPECIAL NOTES:
-END OF tNSTALL�1 . _-
TOTAL CHARGES OF ALL MERCHANDISE & SERVICES
$5.364.75
SALES TAX $187.74
TOTAL $5552.49
-- ORDER No:2686-195627
BALANCE DUE $0.00
;END OF
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CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
I II..m.;oN 51'14LET 0 S.\I -
FFI:978-,74 9995 • 1°.\s:979.74119f146
Construction Debris Disposal Af idavit
(required lur all demolition mid 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 N . _ is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
111. S 150A.
The debris will be transported by:
M ,41 Ksn 1- So /1 S
(name of hauler)
The debris will be disposed of in
,4�✓�S -�-lt,,.n errs�-4�:�/� ,
(name Uf Zac ITny)
M(k 0I52,)
IaJ cress of Iaclluy)
%ignature of Ixnnit applicant
date
DEC-15-2009 08:50 From:SWRMPSCOTT SCHOOLS 7815992502 To:9787409846 P.2/2
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American Properties Team, Inc. r\
I
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TO: Lois Palleschi, 28 Whalers Lane j
i
FROM: Jill Fama, Property Manager j
i
RE: Replacement Sliders —Sanctuary Condominiums
DATE: November 11, 2009
1 am pleased to advised, that the Board of Trustees f'or the Sanctuary Condomiiiums,
approved your request to replace your sliders,providing that they match in appbarance
from the existing doors, thcy must slide and not open like a French Door, and an fit in
the existingopening. The will not allow 'ids or decorative inz erts.
Y � �
We also require the permits be pulled in advance, and that a copy of the final approved
Permit once completed is also submitted to our office. We also require that your hire only
a licensed contractor, with adequate insurance.
You will most likely need to show a copy of tlus letter to the Building Depa . ;gent.
Should you have any questions or require additional information, please feel fr a to call
me directly tit(781)932-9229.
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Son WEST Ct)MMING5 PARK • SUITE 6050 • WOBURN • MA • 01801 • 781-932-9229 • FAX 781-935-4201)
a
DEC-15-2009 08:50 From:SWAMPSCOTT SCHOOLS 7815992502 To:9787409846 P.1/2
207 Forest Avenue
SwampswtL MA 01907
Phone-781-596-8800 Swampscot
Fax 781-599-2502 Schools
Fax
TO Salem Building Dept. From: Kathie Leonard for Lois P31195c111
Pax: 978-740-9846 Date 12l191o9
Phone: Pages 2
CC:
Re Installing Sliders at 28 Whalers Lane
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