160 WHALERS LN - BUILDING INSPECTION --- I Ile Commonwealth of Massachuscus
y; }� Board of Buihding Regulations and Standards CI"I'Y OF
,I
Massachusetts State Building Code, 780 Ch1R SALL
I Building Permit Application To Construct, Repair. Renovate Or Demolish a
(Are- or Tn a-f iunih Duelling
fill
This Section For Otficial Usc Only
Building Permit Number. Date, plied: J
Building Otlicial(Print Mane) S—isnature Date
SECTION I:SITE INFORNIATIO
1.1 Property Address: 1.2 Assessors Alap& Parcel Number
140 W ha icerS L rin e
I.Is Is this an acce ted street?yes no Ntap Nuntl+er Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(It)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Privale D Zane: _ Outside Flood Zone? Municipal❑ On site disposals)stem ❑
Check if jesD
2.1 Oe SECTION2: PROPERTY OWNERSIfIPt
5'' f R
i F or-ecord•�i✓)K21S le Salem M,0 0
N:une(Print) - City.Stale.ZIP f
Ibo whJVrs 7k—W5-$zSq
Nu.and Steel Telephone Email Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Alteration(s) D I Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units_ I Other D Specify:
Brief Description of Proposed Work=:
Y17D( / � G( n ALrc ini M!5
!a (rJD wl &r—
SECTIO 4: ESTI;iNIATED CONSTRUCTION COS
Item Estimated Costs: Official Use Only
ILahor and ..\laterialsl y
I. Building S 300.Dy I. Building Permit Fee: f Indicate how fee iIdetermined,
'. Electrical S ❑Standard Ciry?own Application Fee
❑Total Project Cost'(hens 6)x multiplier — .x
j J. Plumbing S Other Fees: S J. Mechanic.11 ill\AC) 5 List:5. \Itch:mic;d iFirccu++res;ion) S Total .\II Fees: SCheck No. ('heck Amount: Cash �\mu
n Tidal Project Cost: 5 y 3 ob.o`� ❑ Paid in Full ❑Outstmtding Valance Due:
SECTION 5: C'ONS'1•RUCTION SFRVIC'FS
5.1 Construction Supcn isor License(C•SI.) C 97 y C
j I icellse Nwnhar I pirnliu U:I
Name ul('SI. I hddcr .. ...-__—_
—r^ �y ( I ixt CSI. 1\Ixt Isee helu,ll.__,______
jz 1[IL _Q/5 V'1'• _'--..-_--. '_---'--_"---- 'I\pe Description
N. .u1J Street — .__
y U 141rcstnctcd(Dui)din ,ut,(n TT555 cu. it.)
R Re.tricted 1&2 f.unil D"ellin
'inifo„n,S(at .-LII' �I \Imuu
RC R,wlin Cucerin
VA Window:md Siding
SF Solid fuel horning Appliances
------rj�Irk — (53 I huulutiun
S'etc hone f.nwil address U Dcnwlitia
5.2 Registered i(ume Improvement Contractor(HIC) cii /. / /3
61J�1
` \-x',t'Ft'�FnCS (%- I IIC'Registration Number F%piruliun Wit:
I II�'Co npan) Valli .pr 1IIC �tegistrunt Nanw
No. ;mJ t nLL
()ISV-4'1�6((SJ5t7 dYI R O /7e2
C-
i� liown.State/ZIP reh-rilin.0
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.1 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...........O
SECTION 7a:OWNER UTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR C NTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property,hereby authorize 9i'fkJ4rJ C k4l on.I
Ia'ct�on(myrbehl/all, in all matters relative to wLork authorized by this building permit application. (,
JLI
Print U,vner's Nwne(Ekctru w S1 inure) DJIC
SECTION 7b: OWNERI OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true an occur e o e best of my knowledge and understanding.
�i 1-v re` Plralal•ts_ �I � � (1k 1�
Prim 01,ncr's or:\uthorircJ.\ge t'. Nanw l l.lcct •Slgnauue) Dutr•
NOTES:
I. An Owner who obtains a building permit to do his,her own work,or an owner who hires an unregistered contractor
Inut registered in the Hunie Improvement Contractor IHIC) Program),will nu have access to the arbitration
program or guaramy t'm1J under%I.G.L. c. 1 2A. Other important information on the HIC Program can be liwnd al
o,.1 Information on the Construction Supervisor License can be found at "%,., nl.l.: ��% ,qt.
2. \\'lien substantial work is planned, provide the information below:
rotal flour area(sq. R.) - (including garage. )finished basement attics,decks or porch)
(lrosi living area I sq. It,I - _ Habitable rount count
� Norther ul•lircplaces .- Norther of beJnxnus
Number kit'bathrooms . . _ . _ . . Numberofllall'halhs _ -
I%pe of heating sy stem Norther nl•decki• porches
I\pc nl 0101111_L' iy'te111 - 1!Ilclosed ..
Open
1. "rotol Project S,1mne Folltuge•IIIay he suhstiutled lilr"1'otal Project('list..
r The Commonwealth of Massachusetts y114-4 `
Department oflndustrialAccidents
VJV Office of Investigations
I Congress Street, Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information 1- Please Print Legibly
�1
Name (Business/Organization/Individual): RarAla c`'l llh
Address:. ,1 )ucKers CA .
City/State/Zip: [9 D Phone #: 9_1?- 51-2- 03.$,2
Are you an employer? Check 1he appropriate box: Type of project(required):
1.,541 am a employer with_�_ 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
shipand have no employees These sub-contractors have
8. ❑ Demolition
working for me in any capacity. employees and have workers 9. ❑ Building addition
[No workers' comp. insurance comp. insurance 1
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 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 13.❑ Other
employees. [No workers'
comp. insurance required.]
Any applicant that checks box Hl 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 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 the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. /�
Insurance Company Name:_ ..Arse A -1mericon nwroncG I//11
,omnahV
Policy # or Self-ins. Lic. 4: 6 t b Z Ulf-4 To 5 P01r2. Expiration Date: 161agla n
Job Site Address: ( 60 [L aws L C.,tg City/State/Zip: Sct,1Pm mhr 0676
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 $1,500.00 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.
I do hereby certi under the ains and penalties ofperjuiy that the information provided above is true and correct.
Sivature: Date
6 �-
Phone#:
Official use only. Do not write in this area, to be completed by city or town ofiiciaL
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#:
Q. ✓� �iom�, l7/ ,,� tl�a�
. \ Office of Consumer Affairs&Bfiness Regulation License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 133414 Type: Office of Consumer Affairs and Business Regulation
-F Expiration: 6/27/2013 DBA 10 Park Plaza-Suite 5170
I��',..� Boston,MA 02116
RONCO CONSTRUCTION -
RONALD WACHLIN .a
12 TUCKERS CT. q � � �• �iZ�� _ /�_
PEABODY, MA 01960
Undersecretary Not valid without signature
�t•twtthusctts - Dep:u'l ment of Public `afch
BOMA of Builtlin_ Nc�ulatium and Standards .
Construction Supervisor License
License: CS 71187
RONALD E WACHLIN
12 TUCKERS CT, 3RD FL '
PEABODY, MA 01960
��- -�
Expiration: 8/4/2013
( .nm,i..iner
Tru; 20503
Office of Consumer Affairs&Business Regulation
VwOME IMPROVEMENT CONTRACTOR
Registration: 1,48688 Type
/
ExpiraGen: 40/78i2013 Supplement
LOWE'S HOMES CEN.TtRS INC
RICHARD CHALONE t
136 TURNPIKE RD.S€ FE 100 --
SOUTH BOROUGH,MA01772 Undersecretary
e
1'l-01-11 ; 16: 12 ; patrick-J-woods-insurence 19788800023 ;9785318617 # 2/ 3
RAJHL4 CERTIFICATE OF LIABILITY INSURANCE 1 ioioaiioii
PROW"R 979.531.2777 FAX 978.531,8617 THIS CERTIFICATE IS ISSUED A8 A MATTER OF INFORMATION
P.J. Woods Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
40 Main St. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 3S3
Peabody, MA 01960 INSURERS AFFORDING COVERAGE NAIC S
INSURED Ronco Construction, Ronald Wachlin D a INSURERA COMMERCE INSURANCE COMPANY 347S4
12 Tuckers Ct. - INSURER O:
Peabody, MA 01960 INSURER C'
INSURER D:
USURER 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.
LTR D' TYPE OF INSURANCE POLICY NUMBER POLICYEFPECTIVE POLMYEMRAMON
um"GENERAL LIABILITY NV7121 11/03/2011 11/03/2022 EACH OCCURRENCE S 500,000
X COMMERCIAL GENERAL LIABILITY DA M TO RENTED $ 50.000
CLAIMS MADE a OCCUR MED EXP(Any one person) $ 51000
A PERSONAL S AOV INJURY $
GENERAL AGGREGATE S 1,000.0
GENL AGOREOATE LIMIT�APPLIES PER: PRODUCTS-COMPIOP AGO S 1.00010
X POLICY JpECT UDC
AUTOMOSI.E LUUALnY VK0743 02/14/2011 02/14/2012 COMSINED SINGLE LIMIT $
ANY AUTO (Ea atW ant)
ALL OWNED AUTOS BODILY INJURY
X SCHEDULED AUTOS (Pal Pear) $ 100 Q
A X HIREDAUTOS BODILY INJURY
X NON-OWNEDAUTOS (Pali em) $ 300
PROPERTY DAMAGE $
IPer ecoldw) 100,000
GARAGE LIABILITY AUTOONLY-EAACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
FXOSIMUMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR a CLAIMS MADE AGGREGATE $
a
DEDUCTIBLE S
RETENTION $ $
WORKERS COMPENSATION AND WC STATU- OTH-
EMPLOYERS'UAMIm
ANY PROPRIETORMARTNERIEXECUTINE E.L.EACH ACCIDENT E
OFFICERIMEMBER EXCLUDED? E.L.DIBEABE-FA EMPLOYE $
Ryes,daealbe agar
SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMB $
OTHER
OE$CRIPTIDN OF OPErr��TIONS/LOCATIONB(VEHICLESlEXCL11910N8 DEP B}'ENDORSEMEHTl9PECIAIPRO Ng ,
's Companles,Inc & any and all subsidiaries are named as add71 insured as respects to general
liability and auto liability.
DOS Ford FSSO Super Cab, 1FDAXS7Y15E55445 2005 CARMATE TRAILER SAKOIGD4SL0104538
000 CARMATE TRAILERS, SA3C6105XL0004012 2002 DODGE DURANGO. 1B4HS78X62F118138
CER nFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
LOWS'S COMPANIES, INC, 10 DAYS WRITTEN N0rCI?TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
IS INSURANCE BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
P 0 BOX 1111 OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATNIES
WILKEBORD, NC 286S6 AqapftDREPRESENTAMF
ACORD 25(200110B) FAX. 336.658.2308 ®ACORD CORPORATION 1938
1'l-01-11 ; 16: 12 ;patrick-j-woods-insurence 19788800023 ;978531861 /
_.................. ..
PRODUCIR 'I'HI S d:KKI1VKX1'E IN IYSUED AN A MAI-MROY INl4)MMSTTON dNR.Y
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PEABODY,MA 81.90
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STORE COPY
INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR_
LOWE'S OF DANVERS, MA.,STORE# 1094' STORE PHONE:(978)646-9099
' 153 ANDOVER STREET SALESPERSON: DENNIS GLENNON
DANVERS, MA 01923 SALESPERSON ID: 1227928
Document Print Date :06/14/2012
This is only a Quote for the merchandise and services printed below. This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree-
ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any
other addenda or attachments hereto,shall be referred to herein as this"Contract."
PLEASE READ THIS ENTIRE DOCUMENT,INCLUDING THE "TERMS AND CONDITIONS." BEFORE SIGNING.
Lowe's Registration or Contractor License Number/Lowe's Contractor Name
Lowe's Home Centers, Inc.'s MA HIC NO.: 148688 Lowe's Home Centers, Inc.'s FEIN: 56-0748358
Customer Name Home Phone
S V FINKELSHTEYN 978-745-5259
O Customer Address Other Phone
160 WHALERS LN
L City State/Province Zip/Postal Code
p SALEM MA 01970
Installation Address
T 1160 WHALERS LN
O Installation City Installation State/Province Installation Zip/Postal Code
SALEM MA 01970
MERCHANDISE AND INSTALLATION SUMMARY
MERCHANDISE SUMMARY
1049 : 87548 : STK : 1 X4X8 RED OAK BOARD : 1 X4X8 RED OAK BOARD : BABCOCK LUMBER - QTY 4
7056 : 94710PINE : STK : PNE STOP 947 3/8"X1-1/4"X10' : PNE STOP 947 3/8"X1-1/4"X10' : EMPIRE COMPANY, INC. (THE) - QTY 12
31143 : J : STK : PFJ BKMD 180 2 X 1 1/4 10' : PFJ BKMD 180 2 X 1 1/4 10' : EMPIRE COMPANY, INC. (THE) - QTY 12
62151 : 748171590516 : STK : 6 THERMASTAR SLIDING DR SCREEN : 6 THERMASTAR SLIDING DR SCREEN : PELLA CORPORATION - QTY 4
131207 : 131207 : STK : 1X8X16 PRIMED FINGER JOINT : 1X8X16 PRIMED FINGER JOINT : IRVING FOREST PRODUCTS (MAINE) - QTY 8
391799 : 1000006800 : STK : 6 TSTAR DR ADV LOWE NO SCR : 6'TSTAR DR ADV LOWE NO SCR : PELLA VINYL PATIO DOORS EAST- QTY 4
Materials Price $ 1974.0
Store 1094 Project No. 356197076 for V FINKELSHTEYN Page 1 of 7
STORE COPY
INSTALLATION DESCRIPTION
Stock or SOS : Stock Door Type : Patio
Select Location : Front Door Select New Door : Sliding
Number of Doors to Install : 4 Side Lights or Transoms : No
Hidden Damage Description : None Number of additional holes bored for accessories : None
Install Specialized Mortise Hardware : No Lead Safe Practices : No
Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door: Yes
Customer Understands Scope of the Project : Yes Permit Required : No
Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None
Local Disposal Fee : Yes Describe Other Work Needed : 2nd and 3rd.fls...custom wrk.
Other Work Charge : Yes Comments : detail [4] patio drs.in unitr.///////dg4
Labor Charges $2361.00
Detail Deduction -$ 35.00
Additional Specifications:
Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop-
erty is governed by Historic District Regulations.
Additional Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right: Important Lead Hazard Information for Families,
Child Care Providers and Schools. 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.
TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES 'where applicable
SUB-TOTAL $4300.0
'TAX $ 0.0
DELIVERY $ 0.0
ORDER TOTAL $4300.0
BALANCE DUE
Store 1094 Project No. 356197076 for V FINKELSHTEYN Page 2 of 7
STORE COPY
Work is to commence upon reasonable availablity of Contractor which is anticipated to be [fill in date].
Estimated completion date is [fill in date].
NOTICE TO CUSTOMER
All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing
on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation
necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom-
er.
IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must Day in full.
COMPLETE 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 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.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON-
TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU
HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY
OF THIS CONTRACT AT THE TIME OF SIGNATURE.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS 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 CON-
TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET-
ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB-
MIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L. c.142A.
Store 1094 Project No. 356197076 for V FINKELSHTEYN Page 3 of 7
1/�Vz -,7 4 lr,'l' STORE COPY
By: Date:
LowErdrHom Centers. Inc.
B v (�� Date:
ner
By: Date:
Spouse
THE SIGNATURES 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 MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION
EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY IGNED BY THE PARTIES.
WITNESS OUR HAND(S)AND SEAL(S) BELOW THIS DAY OF
Lowe's LeCenlers, Inc
By: (Seal)
Print Name: Jy\
Address
(Seal)
Owner
City State/Province Zip/Postal Code Print Name
Co-Owner or Witness (Seal)
Print Name
Customer acknowledges receipt of a true copy which was completely filled in prior to Customer's execution hereof. You the customer may cancel this transaction
at any time prior to midnight on the third business day after the date of this transaction. See the attached Notice of Right to Cancel for an explanation of
this right.
Store 1094 Project No. 356197076 for V FINKELSHTEYN Page 4 of 7