56 WHALERS LN - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards
10
Massachusetts State Building Code,780 CMR iNSPI'Ji Q) Y]C ES
ReMvised ar
Building Permit Application To Construct,Repair,Renovate Or Demolish—
One-or Two-Family Dwelling 11114 SEP 2 5 A If: 0q
This Section For Offici#1 Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Ad" &k3 1.2 Assessors Map&Parcel Numbers
f:��C2 1 (4014e —
I.Jals this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning-Distfict-- Proposed Use Lot Area(sq 11) Frontage(ft)
1.5 Building Setbacks(it)
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 0 Private 13 Zone: Outside Flood Zone? Municipal 0 On site disposal system 13
Check if yesO
SECTION 2: PROPERTY OWNERSIRP',
2.1 Owner]ofh4l Pecor&—.
vo U kin �44�_
Name(Print) City,State,ZIP
I;& AL6514o ,_ —
No.and Street Telephone Email Address
A" 'SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 13 Owner-Occupied 0 Repairs(s) 2Alteration(s) 13 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units _ I Other 0 Specify:
Brief Description of Proposed Work2: k
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only,
(Labor and Materials) --t-
1.Building 1. Building Permit Fee: Indicate how fee is determined:
13 Standard City/Town Application Fee ,
2.Electrical $ 0 Total Project Cost'(Item 6)x 'multiplier X
3.Plumbing $ 2. Other Fees:
4.Mechanical (HVAC) $ List;
5.Mechanical (Fire
Suppr ssion) $ Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ tz&)o 0 Paid in Fall 0 Outstanding Balance Due:
932 dE64
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction u ervisor License(CSL) �j
Im Licenseense Numl" ber Ex rati Date
Name of CSL Holder
List CSL Type(see below) '
No.and Street Type Description
r U Unrestricted(Buildings u to 35,000 cu.ft.
City/1�a�� ` R Restricted t&2 Famil Dwelling
M Masonry
RC RoofingCovering
WS Window and Siding
la�� SF Solid Fuel Burning Appliances
1 I Insulation
e e hone Email address D Demolition
5.2 Registered Home Improvement ontractor(HIC) `� t �� —�
HIC Regi�stmtio�n Number Exp f n Date
HIC Cc an A istrain Mitre
No.an t Email address
City/Town,Sthie;4fP 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 the building permit.
Signed Affidavit Attached? Yes ..........All, 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 a40 6d
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application i e and accurate to the best of my knowledge and understanding.
Prinl Owner's or Authorized Age is Na a(Electronic Signature) =3 Oate?
117 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 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 halfibaths
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"
• 0 W S Q U •
Matt Rotondi (978)604-4262
Zen Windows Boston LLC 0
W r N o o W e
15 New England Executive Park " matt@zenwindows.com
Burlington, MA01803 relax.window quotes in5minutes 4azenWindowsBoston.com
Customer Name: Customer Email: Address:
Mike Dunn --� mikedunn0203@gmail. 156 Whalers Lane
com _
Salem Massachusetts r01970
Nirvana yTodayDate 08/12/2014
,.
.niNi ._ltems s "'": .... ",.. ...a s,: Descrilltiorl ,M� . Price
Furnish & install 2 GLASS PACKAGE: 2 Panes of Double Strength 1798.00
custom Zen "Nirvana" Glass, Low E Plus, 1 Chamber of Argon Gas
2-lite sliding windows.
COLOR/FRAME: Interior& Exterior to be White,
100%Virgin Vinyl, Fusion Welded Corners, Foam
Filled, Metal Reinforced frames and sashes
HALF SCREENS: Extruded Screens for Strength -
>->->Gdds:NONE
WARRANTY: Comprehensive-LIFETIME warranty
on windows, installation,glass and screens
included.
i
DEPOSIT: No deposit required to place order.
Payment not due until immediate completion of
installation. All Financing Options Available
New Construction Windows will be new construction with nail fins U
windows channel if vinyl siding) New casings inside
(unpainted) & outside (capped or j channel)
Total Investment:
$1,798.00
No Down Payment i equir nd all Financing Prdc a s a aiiaf3le —
WHAT'S INCLUDED:
• Price includes all tax, labor, materials and picking up and hauling away all job related debris.
• Price includes all construction needed to convert current openings.
WARRANTY:
All windows to carry a TRANSFERABLE LIFETIME WARRANTY on all labor, materials, glass and screens.The
product we install must meet all of these requirements:
• All windows to be custom made.
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j•��e (IlLSIn's,,/OigMi•>atic.rA vidLal): �l{�,� T
-
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'. Address:___
City(Stge/Zlp
. Type a)I project(ragnlra�d):
a�re a19 e�+ployer7 Check t pip ToF I am a general c,n for and I 6 tram cn�>r rchon
1 LJ a am a employer vVi11i (_ _. have hired the sub-contractors
mployees(full and/or part-time).' 7. R�todeling
e
listed on the attached sheet.
2.❑ I am a,sole proprietor or partner- These sub contractors have []Demolition
ship and have no employees employeesdhaye workers' a, [].Building addiran
working'for me in adp capacity.
comp iristrrance.t 10.❑Electrical repairs or additions
[No workers' comp.insurance 5 we=a cost oration and its
required:] El officers have exercised their 11.❑Plumbing repairs or add fions
3•[] I am a homeowner doing all work right of exemption per MGL l2.❑Roo r pa rs
myself [Noworkers' comp. c. 152,§1(4),ehdwebaveno
inswante requited.]j' 13.[�Other �
employees.[No Vvorkers'
�...— comp.insurance required.]
ensation
*Any applicant that checks boxtil must also,Hll oat the sectionioombgl�lw showing Leo hise ouLside�u�c�-g moist subm�Dev aflddavit mdicaing such.. .
t Hoineownees who oubinit thisaffidavtt indicating they _
tContractocs,that Glieek this bdx must atlacbed an addidooth provide beirt'.Notkers�'comps policy oumberand state ghefltei or not those entities have
employees. If the aIut+cautrectois Lava employees,they P f c 6o ees: .;8eiow is the policy and job site
I am'an OV. toyer that is P Viaig workers'coaaapeaosaatioaa iws¢tvweace or act errap y
infortmitiora
Instuance Company Name:
. rCti�IGi fly i _ Expuati* Date:
Policy#or Self lrts.Lic.#: ` t
,� t`�h�� ti,�►�Z. _City/state/Zip: `—
Job Site Address the o9nc ®mnamee and eaptpatao®date).
,kftC,t a copy of the wor9cets'co�peotsatnoa policy.declaratioae page(stoovruoeg p y _
Failure,to secure coverage as required under..SecSon s5well aac vtl penal5es in the forme of a STOP WO1tIIC O1ZVERtand a fine
fine up to$1,500.00 and/or nne•year iraprisomnent
of up too $ 00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office'of—
Investigarions of the DIA for insurance coverage verification
.e 'rib
jndpepiqlties.of P jay t1lat the,infovaraaatton provided at
I do Deereii oP a is y'ae ea�carp
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Date:
ID ou' #: —
pffceial use only. Do not write in this area,to be coanpleted 6y city or Town ojficiat
PeramieLicemse
City OC'heYdn:
TecenemU Authority(circle alle): _... _ ._ a r.e...,o-,.:....1 rm�cvnartmW 9-�•t:�AfiA1�IlIL1a ln£paeCtS:r
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THIS CERTIFICATE IS ISSUED AS A MATTER OR WbRMAtON ONLY AND CONF€RS NO RIOM UPON THE CER11FIGATE
HOLDER. THIS OERTIFIOATT OCES NOT AFFIRMATIVELY OR NEGAMPLY AMENDe EMNO OR ALTER TFE COVER,AQ€
AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF IHSURANCE DOES NOT CONSTI7UTE;k COh`TnAee B�i'h'EEE
iHElSBUING(NSURiR(SLAUSHORI EDREPRESENTATIVEORPRODUCER,AND TNE CERTIFICATE HOLDER.
IMPORTANT; Hlh9certitieateholdarrGnADMIONALINSURE1%Ihepollcp(is)mu5tEeendecued. if SUBRO*ATIONISWA!VO,
EUD)EEPt®lhEler:tTeandcopriiii ofthepDllcylcertzWpollclenPr,P .r9gui:Osn.'ncuse�wt. RElc�mc=terihlzc���ffectsUe><.=
not confer rigHtE to tiffs o duicsta I1DWSr in IiEu of suer;End9ErEment E): -.- -
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PO BOX 222
HUNTINGTON,MA 01000 .xsuRER�:
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THIS 13 TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED
ASOVE FOR THE PODGY PFAI00 IIdOICATED. 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 POUCtEB DESCRIBED HEREIN.IS SUBJECT.TO.ALL THE TERMS,.EXCUJSIONS AND
CONDITIONS OF SUCH POUCIES.LIMITS SHOW N MAY HAVE BEEN REDt10E0 BY PAID CLAI PAS..
IN SR TYPEOvINSURAI]CE AW SIR POLICY N UST u1VUOWO/Y v WELr up Poum @TP IPRTB
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OFFICERMEU{ER EXCLUDED? N10. 7PJUS 03.15.2014 03-ISZOI5 EL 06tJSE•EA EMPLOYEE $500.000
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RONALD CRAIG-
PARKRIDGE DR-
HUNT-1 W.070 N, MX01050
CITY OF SM ENI, XWSACHUSETTS
BUILDLNIG DEP,,RT%mNT
130 WASHINGTON STREET,3" FLOOR
TEL (978)745-9595
FAX(978) 740-9846
KI�tgERLEY DRISCOLL
MAYOR THomAs ST.Pmms
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMSSIONER
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 wi II be transported by:
(name of hauler) T—
The debris will be disposed
of in :
(name of fatility) /
(address of facility)
i atwr o permit applicant
L
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