47 WHALERS LN - BUILDING INSPECTION (2) T
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The Commonwealth of Massachusetts —
S ° Board of Building Regulations and Standards RECEIVE11 CITY OF
Massachusetts State Building Code,780 CMWMECTIORAL S RIJIGTTEM
Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a 03
One- or Two-Family Dwelling 1015 APR I U
This Section For Officia Use Only
Building Permit Number: Date pplied:
9
1 V Building Official(Print Name) Signature V Date
In SECTION 1: SITE INFORMATION
ll I 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
y7 LJhalys Lcw ie
1 I.I 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(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 a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private ❑ Zone: Outside Flood Zone?Check if yes❑ Municipal ElOn site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner] tecq�d: ,
Name(Print) City,State,ZIP
y7 ulklttm Lus•w 103- 'tfo- Y64
No.and Street Telephone Email 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': -14M04 r a ye a 2 aW
Na u a
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building S-4 o 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ / ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ r 2. Other Fees: $
4. Mechanical (HVAC) $ List: � ��
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: a V ❑ Paid in Full ❑Outstanding Balance Due:
5�-r ql0 Lou3� `� �Z2
4
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
AI A a al4 3 t� 3 16
`e-6,el -Qe I'l)e License Number Expiration Date
Name of CSL Holder
r En.,5fd( List CSL Type(see below)
No..and Street Type Description
�gl,gM MA
./i 6 97d U Unrestricted(Buildings u to 35,000 cu. ft.)
'""r td R Restricted I&2 Family Dwelling
City/T M Masonry
RC Covering
WS Window and Sid in
SF Solid Fuel Burning Appliances
97�^ 5 —730 /17y I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Lo% w. I-bmP Gender) io o i
HIC Reg stration Number Expir lion Date
HICCompan Name-o IT trant Name
1
3 "T�trnol KQ iLj60.rd-ch-do tE 64oty• (Ow -Cosh
N5 tr e` `�� of-7,7
X 6i7-26q-0L(` Email address
City/Town, State,ZI Telephone 1
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
to act on my behalf, in all ma e s relative to work authorized by this building permit application.
I" '504 CA i J b—
Print Owners Name(Electronic Signature) to
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
co ;ne in th ap 'c ion is true an accurate to the best of my knowledge and understanding. I /
Print Owner's or Authorized Agent's Name(Electronic Signature)
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.gov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dos
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"
irnurtweuun uJ tv�ua's�crtaseita t _
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite , 00
I Boston, MA 02114-20I7
k��vtw www.muss.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information ( Please Print Leaibly
Name (Business/Organization/individ``ual): mite blel T->M&
Address: cr7 �f1S}01
City/State/Zip: (+ O 1a7 ) Phone #: `�7Sj' 630-717Y
Are you an employer? Check the appropriate box: Type of project (required):
1.❑ I am a employer with 4.,'❑ i am a general contractorand i
employees(full and/or part-time).* � have hired the sub-contactors
6. ❑ New construction
2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
shipand have no employees j These sub-contractors h • e
� $. ❑ Demolition
working for me in any capacity. 1 employees and have workers' 9. ❑ Building addition
[No workers' comp'. insurance comp. insurance.t
required.] 5. ❑ We are a corporation anc its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work ! officers have exercised lieir i I.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
WTI oyees. [Noworkers� 13.❑ Other
comp. insurance requires;,]
'Any applicant that checks box Al mast also fill out the sectionibelow showing their workers'ecrnpensation policy infonnation.
'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If dte sub-contractors have employees,they,must provide their workers'comp.policy number.
I am an employer that;;providing workers'compensation insurance form v employees. Below is the policy and job site
information.
Insurance Company Name: ( __
Policy# or Self-ins. Lic. #: Expiration Date:_
j
Job Site Address: 4-7 lobs Lame City/State/Zip: SaL'mt m,4 d 976
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
tine up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$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.
1 do hereb certi &u r fie ns arrd enalties o er'u that the in ormation provided above is true and correct.
Signature: Dater
q
Phone #: / 70pp_�30 —7�]�
Official use only. Do not write in this area, to be completed by city or town official
i
City or Town: Permit/Lice e#
Issuing Authority (circle one):
1. Board of Health 2.'Building Department 3.City/Town Clerk 4. Ltrical inspector 5.Plumbing Inspector
6. Other
f"mart Person: Phone if-
" Ofticr of Consumer Affairs,g Business Regulation
:.. . License or registration valid for individul use only
before the cz
�+tsHOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
R Office of Consumer Affairs and Business Iegulatiou
'C," Registration: 148US Type 10 Park Plana-Suite 5170
Expiration: 10/18!2015 Supplement "ard Boston,NIA 02 116
LOWE'S HOMES CENTERS INC
RICHARD CHALONE I
136 TURNPIKE RD.SUITE 100
SOUTHBOROUGH,MA 01772t-Y�
Undersecretary \'ot valid without signature
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A � CERTIFICATE OF LIABILITY INSURANCE °ATEIMMOGmw,
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELYAMENO,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE.CERTIFICATE HOLDER.
IMPORTANT It the certificate holder is an ADDITIONAL INSURED,the pollcy(los)must be endorsed.It SUBROGATION IS WAIVED,subject to the
torms and conditions of the policy,cortaln policies may require an ondorsomont.A statemont on this certificate does not confer rights to the
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CONTACT Brenda Cpzzofino
EA Kelitly &Ne (401)431.9863 ~•.—_ FAF ,T(n07)43f-9869
450 Veterans Memorial Parkway R ss brpndaccakelley.crxn
Eastr 5 PROaUGell tD.
East Providence RI 02514 163601 OMSR14 .,•„_— ,_.-,
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MD Construction WSURERA: Atlantic Ca6urifty ins CO 42646
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L•ISURERB:
5 Bdstd Rd -----• -
Wsu11Ea c
Salem MA 01070
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INSURER F:
COVERAGES CERTIFICATE NUMBER: NUMBER:
THIS IS TO CERTIFY TWAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTH E POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VMICH THIS
CER'I IFICAYE MAY BE 15WED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS,
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OESCRIPro"OF OPERATIONS I LOCATIONS I VEHICLES(Aecch ACORD 101,A4dnonJ Remeps ech,dul..C man spec,Is e.Wind)
It is understood and agreed that towels COmpanif.s Inc.and it's subsidiaries are listed as an Additional insured.
Carpentry Contractor,
CER71FICATEM LOER CANCELLATION
LOAe's COmpenies SHOULDANY OF THE ABOVE DESCRIBED POUCIEG BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Attn:Is Insulance ACCORDANCE WITH THE POLICY PROVIBIONO.
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North Wlkesbarp 28656
Aun+ogiLEO]�REpRESEurunVE "w "AA nn (�
NC: Katherine M. Kelley, AA1, CIC
ACORD 25(2009109) The ACORD name and logo are registered marks of ACOROD9 ACORD CORPORATION.All rights reserved.
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CONTRACT#
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SACHUSETTS tER, E !SOL -10NNSAWSTALLED
ONTRACT LOWE'S AUFHORIZED REPRESENTATIV4 UMBER CUSTOMER
STORE NO.
STNIEET ADORES
65
STREET ADDRESS
!fc P 7-
CI STATE ZIP CITY
STAT+dn �nW E
y T—a
TELEPHONE ELEPHONE
OWE-,E
_r 5
DATE E'S HOME CENTERS,LLC'S MA HIC NO.: 148688 CASH BANK REG
5 CAR LOE1WN 6_074"M CwuGe
n'This is onty a quote for the
u merchandise and sayioga�Pnmedtalcw.'Th This. nt.upoppaynant.t W udingL a so
BY, no gesdomnem,014 Te-5 and yormaRmimom"a vantfihsildEd4ient and any othervadQefjda and attachments heretoa,' nl?l
,
PLEASE'REAP ALEiTERMS:AND CONDITIONS ON REVERSE SID r-QE ANDFo OWNG,!
SIGNING
,
INSTALLATION STREET ADDRESS CITY
STATE ZIP
sal"vo a s.
aO in A/a
41,
NOTICE TO CUSTOMER—PRICE CALCULATIONS: In order to properly perform the installation of certain Goods,the Contract Price may include more
Goods than actually will be installed based on the measured square footage of the Project Area. As a result,the parties agree that the lump-sum Price
stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual
square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste).
By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may
not be refunded once the Installation Services are performed.
Contract Total
Are permits required for this installation?.k] Yes [ ] NO 'applicable tax incuded
NOTICE TO CUSTOMER: Federal law.requires Lowe's to provide you with the pamplet 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 Customer's dwelling unit.
NOTE: if rotted wood is discovered during installation additional charges will apply. You will be given a quote and a change order
must be completed and signed by the customer for any additional charges. -Customer must initial.
*Any work or material not specified is not included in this Contract.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 and independent contractors the right to take photographs of the Premises where
Installation Services will be performed and 611 work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title 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.—[Customer to initial to the left].
Work is to line a U on reasonable availability of Contractor and/or any special order
-711) 7
;5_� r made Good(s)which is anticipated to be
3rp [fill in date].Estimated completion date is i2ule
is�nl the essence.A statement of any contingencies that would materially change said estimated substantial
Said estimated Substantial completion ate [fill in date].
completion date is as follows:
(if applicable, insert a statement of such contingencies),
IF THE CONTRACT TOTAL IS$1,00 L .00 OR LESS Customer must pay in full.
0
�MPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00:
Customer to Pay in Full; OR [ ]Customer to use the following payment schedule:
(1)Deposit $ to be paid upon signing contract. Deposit should be 1/3 the total Contract price;and
(2)Payment of $ to be paid anytime afterthis Contract is signed and before commencement of installation,I/We authorize Lowe's
to do one of the following(check appropriate box below):
Charge my/our credit Card for the amount of the payment indicated above anytime after the date this Contract is signed;
or
Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and
(3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction.
NOTICE REGARDING ARBITRATION AGREEMENT FOR C 41MS COVERED BY M.G.L.c.142A
LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,�THAT
- - -• ^�ugv� ecetpr ui mis nonce and agrees and understands that the Price includes these costs which may
not be refunded once the Installation Services are performed.
Are permits required for this installation?: Contract Total a
]Yes [ ] No applicable tax included fa
NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet 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 Customer's dwelling unit.
NOTE: If rotted wood is discovered during installation additional charges will apply. You will be given a quote and a change order
must be completed and signed by the customer for any additional charges. Customer must initial.
'Any work or material not specified is not included in this.contract.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 and independent contractors the right to take photographs of the Premises where
Installation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right,title 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 pant 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 fore oin Work is to ne a upon reasonable availability of Contractor and/or any special order c t g g [Customer to initial to the left].
T 1/� [fill in date]. Estimated completion date is � ���r made Good(s)which is anticipated to be
Sold estimated substantial completion date is n f the essence.A statement'of any contingencies that would materially change said estimated substantial
completion date is as follows:— liJ�..-.
IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. (if applicable, insert a statement of such contingencies).
�C MPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00:
]Customer to Pay in Full; OR [ ]Customer to use the following payment schedule:
(1)Deposit $ - to be paid upon signing contract.Deposit should be 1/3 the total contract pace;and
(2)Payment of $ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's
to do one of the following(check appropriate box below):
[ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed;
or
[ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and
(3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction.
NOTICE RE ARDING ARBITRATION AGREEMENT FOR CLAIM,5 GOVERED
LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT
LOWE'S MAY SUBMIT SUCH TE TO A PRIVATE ARBITRATION SERVICE WHICH HAS B
AS PROVIDED-INTN:6.1- .14 EEN APPROVED BY THE SECRETARY OF THE EXECUT-
IVE OFFICE OF CONSUME 2 AFF IR AND BUSINESS REGULATIONS AND THE OW SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION
By: "
Lgwe s Home enters,LLB Date: `7r / /
BY:
Y 'I .t / p _ 2.1`. Ct...L ��. Date: r/ / /1 OwnenSignature a
THE-SLGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED
BY LOWE'S PURSUANT TO M.G.L.c.142A.THE OWNER MAYBE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE
SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES.
FCONTRACT.
N THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND
S CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.
BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE
D CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS
. YOU ARE ENTITLED.TO A COPY OF THIS CONT CT AT THE TIME OF SIGNATURE.
HAND( "AN� L(S)BELOW THISte LC c /
Lowe's Authorized tive OwneCustomeracknowledgeipt e a true copy of this dontragf which was completely filled to prior to Custome Co-owner executionilnE
hereof.You,the buyer,may
cancel this transaction at any time prior to midnight of the-third business day after the date of this transaction.See the attached notice , cancellation
form for an explanation of this right.
55102 REV. 12/13 FILE COPY ®2004 by Lowe's.®Lowe's and the
are registered trademarks of LF Co b, design
po abon.
2015-04-17 14:23 Install Sales # 1198 7815375462 >> 9787409846 P 2/2
ghe ..ca
Condominium 7rlwt
April 17, 2015
Linda Serafino
47 Whalers Lane .
Salem, MA 01970
RE: Window Replacement
Dear Ms. Serafino:
Per your request,please accept this letter as Board approval to install windows at 47
Whalers Lane with the understanding that the windows will be the same style as the
existing windows. The Board of Trustees would like to ensure uniformity.
Should you need any additional information,please contact this office at 978-532-4800.
Sit rely,
hil rman
CRO`WNINSHIELD MANAGEMENT CORP.,As Managing Agent for
Hamlet Condominium
slanaF(eci'B�CrowninsftieffAlanap)ement Coip., is CrownimsfieldStreet, Peabody,:ALA 0j96o
Those (97S)532-4.300 fax(978)512-6023 - lrww.n-oi,minshiefd.coin.