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74 WHARF ST - BUILDING INSPECTION The Cummonweallh of Massachusetts Town of Board of Budding Regulations and Standards ismalow Massachusctts State Budding Code, 780 CMR, 1"edition Building ` Building Permit Application To Construct. Repair. Reno v a Or Demolish a fh'10 One-or Tu u-F r!!/P Du eff rig mmia This Section for OITi ul Use nl \\\ Building Permit Num r t li Q �o Signature: Building Commissioner nspector of Buil'dm Due SECTIO IT 1 FORMATION 1.1 Property Address:fA(\1r��y .1 Assessors Map i Parcel Number' __-q \ I.1 a Is this an ace ted street?yes no Map Number Parcel Number 1.4 Pro Dimensions: 1-3 Zoning information: fM�' Zoning District Proposed Use Lot Area(sq it) Frontage IR) \ 13 Building Setbacks(It) Side Yards Rea Yard Front Yard \� Required Provided Required Provided Required Provided I ' N 1.6 Water Supply:(M.G.I.c.e0.154) 1.7 Flood Zone Information: 1.8 Sewsge Disposal System: Zone: _ Outside Flood Zone? Municipal O On site disposal system O Public O Private O Check if s0 SECTION 1: PROPERTY OWNERSHIP' 2.1 Owetpn[ etoid �— in ! 7 Z Name(Prim) Address for Service: 671-7 ,�I� a7i"7 Signature Telephone SECTION l: DESCRIPTION OF PROPOSED WORK'(cheek ad'ots,apply) New Construction O Existing Building O Owner-Occupied O 1 Repairs(s) Alteration(s) O Addition O Demolition O Accessory Bldg.O Number of Units_ Other O Sptoily: Brief Description of Proposed Works: ( a a 11 SECTION 1: ESTIMATED CONSTRUCTION COSTS Estimated Costs: OHlcld Use Only Item Labor and Materiab I. Building f I. Building Permit Fee: f Indicate how fee is determined: O Standard CiryrTown Application Fee 2 Electrical f O Total Project Cast'(Item 6)a multiplier a J Plumbing f 2. Othtr Fea: f a. Mechanical (HVAC) f List- 5 Mechanical (Fire f Total All Fees: S Suppression) Check No. _Check Amount: Cash Amount:_ h Total Project Cost f 0 Paid in Full O Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 Liu Censer cc Supervisor ICSL) qi299 License Number Elpirilloif0jur Nyoa of CSL- fWWJccsr G6�1--�� a �� r` (�f/��t j 5 Ltst CSL Type I+ee Arluwl Address I� 1� '( Desert ton nrestricted u to 17,000 Cu. Ft estricted 1!2 FamilyDwellm a Only sidential Roofing Covering ieleo sidential Window and Stdm [54FResidemial Sohd Fuel Bumm A hence Installation sidential Demolition 5.2 Registered Home-hasprov es o uor HICC or HIC Re tst Repstratton um A �� ab r , Expus iiI Si Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152./ 25C(6)) Workers Compensation Insurance affidavit must be c9terpleted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuanc f the building permit. Signed AlfidavitAltached7 Yes.......... No...........0 SECTION 72:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, sip 1 nl n—t5 i as Owner of the subject properly hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Si nstueofOwner Date f SE ON 7b:OWNER'OR AUTHORIZED AGENT DECLARATION 1, [ e-1, ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application we true and accurate,to the best of my knowledge and beh.lr. VJZ Prin am — tier a A thoriz Agent Dated St u the atria and penalties of r NOTES: I. An Owner who obtains a building permit to do hither own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will Sg have access to the arbitration program or guaranty fund under M.G.L. c. 1 o2A. Other important information on the HIC Program and Construction Supervisor Licensing(CSLI can be found in 780 CMR Regulations 110 R6 and 110 RJ, respectively. 2. When substantial work is planned•provide the information below Total floors area ISq. Ft.) (including garage,finished basemenvattia,decks or porch) Gross living area ISq. FL) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half baths Tvpe of hearing system Number of decks/ porches T�peof cooling syaem Enclosed Open t Total Prgect Syuare Footage"may he suhsmwed for Total Prozcci Cose" ` 02-01-2010 11:46 FROM-THO AT HOMt SERVICES +508 756 8823 T-755 P.GO AU F-301 '•"'••,PLEASE READ'I'H1S Sold,Plum!isbed and Installed by: Branch Name: Boston Date: �3a; t O THD At-Home Services,Tnb. d,b/a The Home Depot At-Home Services Ll ,A 01eettwr,+93$tree[,i.iei[ .'w",tiCcittr,MA 01607 Branch NC,fnlper:31 Tor e(R(M)657-5182; Fax f5081 7.56-$323 Federal iD fr 75-2G994&3;.i•IE LiC r C 02439;P1 Ccnt.Ligl l b'127 p-�[.� S^ CTLi 1161522;)))AAAHomclmp,ove,nfen,Cantracter Rcg.u"12fi393 fnsta73xl"ton Address: � ` { J� 0'Jt i ( � ��'t��` /V{� 0070 ...Ciry state 'Lip Purchaser(s): Work Phone: Home Phone: Celt Fborm: ZAA-vV— 1319 a-7I7 Home Address: (if different front Installation Address) City Stutc Ziu N E--m�7-1 Address(ro tcccive prujen commuuicntious and Houtz Dcpat updates): [E DO NOT wish m teceive any marketing email.From The Home Depot Prniert I an___ nformatip : Undersil m il,("Cusmmet'),the owners of the property located ELL the above installation address,agrees to buy, d THE At-Home Services,Inc.("The I-fome Depot")ae ees to furnish,deliver and arrange for the installation("Installation')of all materials described no the below and or.the referenced Spec Sheet(s), all of which are incorporated into this Contract by this rcfeicnec,along with any applicable State Supplement and Payment Summary aturched hereto and any Change Orders(collectively, "Contract"): Cubit: tonaron rcoi= I Products: Spec Sheer(s)0: Pro'crt.Amount � '7� QRonfing DSiding indoors ❑Insuiatim •ry!, t�1_u, (� i 1 C ^F75`^ ❑Gutters(Covers ElL'nrry Doors ❑ 3 V � ` V ZJ i t t� 1 rly 00r—n Routing Siding Window., �insuladon $ `(L Cutters/Gouts QEnvy Doors ❑ E3Roofine Siding ❑Windows El tn;ula[ion cic vwrS i Covers OEntry Dorm:❑ TE ❑itoofing Siding Q Windows rl]Insuladnr, $ G'Guncrc/Covan, OEnmy Doors El— Minimum 2517 Deposit orCoutruct Amwntdue upon atention ofdhis contract Q r... Total Contract Antnnnt I $ MApe Purchases may not deposit more than enFthird of the Coutruct Amount, CJ Cnstemer dgrccs that immh fiiately upon'eolnpleBon of the :work For each Product, customer w,ih exectne 2-Cmmpletion urtifhcate (one for each Product as defined by an individual Spec Sheet) and pnv any balanee Clue. As appiicsbk,each Casromer tinder this Contract agrees to be jointly and severally obligated and liable hereunder. The Nome Depot reserves the right to issue a Change Order or terminate this Camrri or any individual Products)included Ile;ein.,at its discretion,if Tire Home Depot of its authorized service provider determines that it cannot perform its obligations due to a struetu al problem with the home,environmental hazards such as Link!,asbestos or lead paint,ether safety Cencems,priom5 errors or baraase work required to complete Lie job was not included in the Contract. -)( rn ra Pavmcnt Summary: The Payment Swrunary N-C t�v 1 b 1 , included as part of tti> Contract, se[s ;c:th the tout Contract amount and paymeucv rcquhlud for the deposits and final payments by Prcrinct(as applicable). NOTICE TO CUSTOMER Yon-are entitled to a completely tilled-in copy of the.Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spee Sheets)before work on that Product is complete. - In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expensea and Services provided by The Home Depot or Authorized Service Provider through the date of termintier±, plus any other amounts set forth in this Agreement or allowed under applicable law. TIM HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAY1titENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authoriz timl: Custannsr agrees and understands that this Agreement is the entire agreement between Cusomer and The Home Depot with regard to Liao Product;and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be nssiened or amended except by a writing signed by Customer and The 1-Iome Depot.Customer acknowledges and agrees that Cusmmc has read, un-erstands,voluntarily accept;the terms of and has received a cop),of this Agrecrulit. Aec y; Submitted but: J j x J,0 LiK�e�(2 (.nGCGmeP S$lgnatrlYC - _Pine Sales ConSxit m"s Sienaturt Date L X «I Telephone No. V Customer's Signatti e DatC Sales COnSUI[allt LICCnSC No. CANCELLATION: CUSTOMER MAY CANCEL THIS `"'Pnt'r'htrl AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING N1i1'ITFN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY ATTER SIGNIING TIES AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER`S STATE. NOTTCE:.AD131TIONAL TERb1$AND CONDITIONS ARE STATED ON THE RE VTR5E$1DE AND ARE PART QF THLS CONTRACT &10-09 C-£C :h'Itile-9ranrh Pile YeLcv -Cu,tnmer Pink-5aiesC asulleni Feb 17 10 10: 35a Michael Bedard 1 -401 -246-2868 p. 1 PICKERING'WHARF CONDOMIN W9 ASSOCIATION 23 CONGRM STREET SALEM,MA 01970 (978)740-6990 FAX(978)740-6728 jog � 1b3 00 5-0 February17,2010 Edwardo Gonzalez Ut.J-7,74A Wharf Street Salem,MA 01970 Dear Edwardo: I have been contacted by David LaBelle from the Home Depot with regard to the replacement of your exterior windows. He has indicated that the windows are similar to the existing ones and will not alter tho appearance of the building. Therefore,the condo association will approve the replacement. Please be advised that you will be responsible for any damage that may occur as a result of this work. If you have any quesbuftr,Pleas do not hesitate to contact me. Sincerely, ICatry Cha Matrager rm_� inn nnn � mi_i 7neine�eiq. 9A9r ]osoe 2WH4 A IDES!10 2i-934•01 •,.,..•� ecav aec anc S301AUS 3NOH 1V OH3 94:ST 01OZ-ZT-933 CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT M 1,qt 120 A7.%illl\ti:t).NS(HLET O 5.%I I'\t,b1.Ni.0 III :I l 1�:1'1 918.1449846 Construction Debris Disposal Affidavit (required fur 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 p _ 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 I11. S 150A. The debris will be transported by: (name of haul ) The debris will be disposed of in (name of facilityr P�� ,fl�u (address ul'facility) sygna ore of (xnntt applicant ate The COYrMon.wealth of Massachusetts Department 6flndustrielAcddents m f Office of Investigations rZSt'e St � ,7.,-=. : iorkers' Compensa.irlL-s race `— - — Plea: e P-rirt Leaibl-; , n licanthfumatiou r— �IaTM..1e (3LLsiaesslOroanizatarJlediridcal):�—Address: {� i f � �ba nn�� S I'°'' J° ��' City/State/Zip: OWfi i' C� Phone #: a L ployer? Check the appropriate box: Type of project(required): I >v y 4. ❑ I am a general contractor and I 6. ❑New construction employer with.- LLV have hired the sub-contractorsyees(full and/or part-time).* 7. Remodelinlisted on the attached sheet. ❑ g . a sole props-tor or partner- These sub-contractoas have g. ❑Demolition and have no employees employees and have workers' 9 ❑Building addition ing for me n any capacity. comp.insurahce.t orkers' comp. nsurance We aze a corporation and its 10.❑ Electrical repo rs or add tions ired.] officers have exercised their I I.❑Plumbing repairs or additions a homeowner do ng all work. r ght of exemption per MGL 12.❑Roof repo rs elf. [No workers' comp. c. 152, §1(4),and we have norance requued.]t 13. they employees. [No workers' comp.insurance required] licy froatiOn 'My applicant that checks box 91 must also fill outer a section below showiworkng th then eir work outside pensation moult info a new affidavit indicating such. t omcownc that check this affidavit indicating Y are douig =Coha nctors that check this box must attached an additional sheet showing the name of the sub-eontractors and state whether or not those entities have employees. If the sub-contractors have employes they Must provide their workers'comp.policy number. site I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob information 1 Insurance Company Name; Expiration Date:_ Policy#or Self-ins-Lic.#:__ : 1£�M4 " Sob Site City/State/Zip Address: {'1, �A/ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiation date). Failure to secure coverage as required under Section25A of MGL-c_1.52_ca9_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 certify der h in nd enalties of perjury that the informat on provided above is true and correct. — St ature: J Phone# y 0) 13 -- Official use only. Do not write in this area, to be completed by city or town oJTciai Permit/License City or Town: Issuing Authority (circle one): 1.Board of Health 2.Building Department 3. City(Sown Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other - Phone#: Contact Person: 1/2ACORD,N CERTIFICATE OF LIABILITY INSURANCE 0 MIDD,"""" l/25/10 PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.certrequest@marsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 Fax (212) 94B-0902 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Steadfast Ins Co 126387 The Home Depot, Inc. - — - -------- Home Depot U.S.A., Inc. INSURERB:Zurich American Ins Co 16535 2455. Paces Ferry Road NW .NATIONAL UNION FIRE INS CO OF PLTTS Building C-20 INSURER C. 19445 Atlanta, GA 30339 INSURER D:New Hampshire Ins Co 123841 _— IINSURERE:Illinois Natl Ins Co 123817 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 y1DD'L POLICYEFFECTIVE POLICY EXPIRATION LTR INSR6 TYPEOFINSURANCE POLICYNUMBER DATE fMMIDDIYYI DATEMM D Y LIMITS A GENERALLIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE $4,000,000 X COMMERCIAL GENERAL LIABILITY LIMITS OF POLICY ARE EXCESS MA PREMISES Ea occurs $1,000,000 CLAIMSMADE OOCCUR "OF SIR: $1,000,000 PER CC" MED EXP(Any one person) $EXCLUDED PERSONAL 9 ADV INJURY $4,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLI ES PER: PRODUCTS-COMP/OP AGG $4,000,000 X POLICY F7 PRO-jFQTLOG B AUTOMOBILE LIABILITY BAP 2938863-06 03/01/09 03/01/10 I- COMBINED SINGLE LIMIT $L,000,000 X ANY AUTO (Ea accident)ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Per person) $ HIREDAUTOS BODILY INJURY NON-OWNEDAUTOS (Peraccident) $ I — rX SELF INSURED AUTO PROPERTY DAMAGE PHYSICAL DAMAGE (Pe,.LJ,den1� II GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ H AUTOONLY: AGG $ A EXCESSIUMBRELLA LIABILITY IPR 3757 608-02 03/01/09 03/01/10 1 EACH OCCURRENCE 15,000,000 X OCCUR 171 CLAIMS MADE AGGREGATE It5,000,000 S DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION AND 3566916 (CA) 03/01/09 03/01/SO X TORY LIMITS OER _ D EMPLOYERS'MABILITYART 3566915(AOS) 03/01/09 03/01/10 EL.EACHACCIDENT $1,000,000 ANYPROPRIMB RIPARTNDED? CUTIVE -- E Of FICERIMEMBER EXCLUDED] 3566917 (FL) 03/01/09 03/01/10 EL.DISEASE-EA EMPLOYEE!$1,000,000 db,wByes,IALP OVJSI r SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMIT $1,000,D 0 0 OTHER D Workers Compensation 3566918 (KY, MO, NY, WI, ) 03/01/09 03/01/10 F TX Employers Excess TNSC45694422 (TX) 03/01/09 03/01/10 Occurrence/SIR 25M/2M C Workers Compensation 4BO1323(QSI) 03/01/09 03/01/10 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS -FOR EVIDENCE ONLY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION LATLANTA, GA DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 SHALL RID., N.W. BUILDING C-20 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. 7 AUTHORIZED REPRESENTATIVE `�11�� USA •'J�-j �. ACORD25(2001108)Jthornton hd Q ©A CCORDCORPORATION 1988 14260142 l r _ 6.0 [ wJ (�- I � ..i 7y i' — 8J _ Yn U Faaoc — SOIarNea Cain Coefficient .C.xAdu (urwztada Enrgia:o(ar - 'Q . 32 1 . 6 0 . 29 ADE)MONAL PERFORMANCE RAnNGS LIC.Lua,-roN dl: (EHTJ+k 02 PENObdFNM NsitleTrant.mitunce mr�rJ�+daL�wma 0 . 52 mwRarar .c�a,o nanp oz a,¢pt m io;�c 7—drm hr 4� ,iw pvoa s ftm we rQrp,n ymrtnhed Rf,Rud aal d mkpvrarhl a,D&ra rd.maP4 9�d cs.lF}C doom nrt rammnHd.rrry paaa- andten rut wvrwr cp=%wfy of r7 pald.ar mrPell:UM oath rt ftftraZ oR,r mod.paM+av ':r Em•4b4's®a<4�4^r m''dro a'"d" 'mr v>a daa,f,M� rvr®n1aiW bael rd W—In,— va - Irbwtzksy,•rnwdama ocaLm+;" aaMc-'�lFPG(n rerJr�fa�µn aui®'r ro wnCa y 1 snails aan..ma'n.pro rn m aapzAm CusA an./ .. t6�dd atrtarR>ra d��m rb Ov1Gi!"`.c*�y .' . - Un LC q.a LCL'.0 o6 C'N,EftCY 9 L1R C.n c.a:. :9o...cn 'C��t.a L. /e�Cn•ten. : - cM[a6f$SAA .cam.o�Lana ar LCL Lca pa.a Li ta) . c=q ion l-a) J,lnAa2. ]L'a1t: Noc ti_ Nort:a CanC c,L, '9..c Cant: IL, ' ' IND: fte1n. 40lC L;u J/31 /H-RU- C1' INO: (V t..acro OOfYLdc Lo 2.31 >.nM,R!) ecob,do: ILA ica *- cn .- c , Id 7.73 - H9 Horfun - I331I24. - ••""""'-""---- L�p Me IobJ bf sc¢Bh fHCtGT SUAa n6atu.is lwn rron M rra.mlryrtt¢1m_ .. Garda,rm ar5ry da pan panEld mff&i v QJLUT SDC 7ua cr uath aoim bl ab.�1Ia axc,nlgrtivcgac . ,r _ ,._.. �� Lo�rrzmo�ceal�e �.,Tf�� i Board or Building Regulations and Standards ug HOME IMPROVEMENT CONTRACTOR Registration 126893 Ezpuahon M12010 Type --Supplement Gard k The Home Depot:At-Horn e Service RICHARD FALLONE - RKWAYS Z690 CUMBERLAND PA ,. >-- :\I I�cl:huatt. Dtp.n•nntnt ui Puhlu ti;dctl t Bu trd ul' Buildut. Rc_ul Ihuns and �;t ulilartl. j.. r�nstruction Supervisor Specialty t Icense License: CS SL 99699 Restncoed to: WS ROBERT POCZOBUT 17 BEACH ROAD APT. 45 � ryi.. LYNN, MA 01902 Expiration: 2/6/2012 ( ..nnnix.i�nor Try: 99699 CERTIFIED VINYL SIDING . INSTALLER; ASTtt D4756 - 11 600004816 Spwoared bythe Vogl SWIM Instiane . Poczabut Robert Expires: 07/O1/11 _ - 17 Beach it d Apt aS Adminlstumd W. Lynn;M2a6adhusett 01802 "Ty,.N11,dectunlTestinBanc IP6hlce I