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5 WHEATLAND ST - BUILDING INSPECTION (3) (03ba c.K 5c � The Commonwealth of Massachusetts ` Board of Buis Re dards CITY OF gula. SALEM Massachusetts State VWS Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One or Two-j r f"61"A Ck . ' This SBtYion For Official Use /i Building Permit plumber Applied y �� $urldmg Of&Gial(Ptmt Name) Srgnature SECTIOlY 1.SITE;INFORl1�IAT10N .. 1.1 Property Address. 7 1.2 Assessors Map &Parcel Numbers �5- ti�i e,; 41-4 'K,z l.la Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(R) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone. _ O h�i k Flood Zone? Municipal❑ On site disposal system ❑ SECTION-2 PROPEBTYOWNERS$B? 2.1 O ert of R rd: Name(Print) II ccity,State,ZIP ��Bn1"�✓Y �iZr / 7�- ���-all S3 No.and Street Telephone Email Address z SEGITO.N 3:D$SGRIPTIOLV OF PR©�S>$D Wt)RI�(check aB t6at ePPl3') New Construction❑ Existing Budding❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Descri lion of Proposed Work : SECTION a FSTMAx�D:caxsrRucTloN costs Item Estimated Costs: Use Ong (Labor and Materials 1.Building $ I Building Pemtii Fee $ "..' I�icate lttrw fee is•detemuned 2.Electrical $ Cl,Standard Crty/IownAppicatron•fee ❑Total Protect Cast'(Item 6j x multiplier x 3.Plumbing $ 2. Other fees 4.Mechanical (HVAC) $ List 5.Mechanical (Fire $ Total All fees:.$ S ression �y Check Na CheckAmount: Cash Amount: 6. Total Project Cost: $ 9 yb ❑Paid nFu11 Outsttindi.g Balance Due. "tN-%t_ZO T-C) epww s�cTLDN s:;:cDrlsuCTTortsFa�v>«s 5.1 Construction Supervisor License(CSL) CS' -oco )-7 6 / rr, �(���J�q✓� License Number Eitati D Name of CSL Holder r Lis[CSL Type(see below) - No.and Street SU Unrestricted to 35,000 cu.ft. � / �� 7 g Restricted l&2 Family Dwelling City,Town,State,ZIP M Masonry RC RoofmA Covering WS Window and Siding ®���Vt.c`� SF Solid Fuel BnrilingAppliances lXl ✓7 I f Insulation Telephone Emait4dilress D Demolition 5.2 Registered Home Improvement Contractor(RIC) o,.�e �r�� �, l yy6 /o 7 HIC Company 7me �qC Registrant Name HIC Registration Number xpi on Date a.Pheej /o-��/-l{P �'`�6o -�—Zq -2/3? Email address Ciiy/Town, State,ZIP Te bone SECTrOPI 6 WORKERS'Cf)MPENSATLON LNSIIKE[AIC�A)RFIDAVL'F(AL6I..e.i52-.§ 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...........❑ SECTIQN?a-QWNER A T:THORIZATTON TO BE VOW PLETEDiWHEM OWPIER'S Atrlsl f UR'CONTRACT(TR iIPPIdL+�S FOR$III[DLPT('cFERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Elechomc Signature) Date SECTIDN 76:OR NERi 4R ALITHORLZED AGERT HECLARATIDN By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this �appliication is true and accurate to the best of my knowledge and understanding. /�q�, JxI0ry,� � Z c (3 Print Owner's or Afithonzed Agent's Name(MaraqN6 Signature) Date „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 mr% .A ss.Qov/oca Information on the Constriction Supervisor License can be found at www.mass.aov/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 balf/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" 'oil •Z Imo///* "J � � M ome Contracting, LLC Jo6 a 9�i'� ` + ,�1 /y , Date ^ ` ` Name j7/� �QI JUC ( ?/)" ' Thankyoufortakingthetimetomeetwith mean dc 1PERMIT-REMBURSEMENT to tell3oua6out► .9 Home Contracting,anclwhyyous6ouldchooseusforyourremodelingproject My Home Contracting Protects your Property 6y coveringyou with $2,00o,000.00 of lia6ility insurance. Workmen's Compensation Insurance covers all of our employeessoyou are not exposed to any lia6ility. We are proud mem6ers of the getter business Bureau (ggg).We maintain this affiliation to provide you with the highest level of confidence and customer service.All of our employees attend pre- approved on-going training to keep them up to date on the latest technological advances in replacement windows. 56ouldyou elect to make your home improvement investment with My home,we shall strive for 100% custo m e r sati sfa cti o n Ver trulyyours, Donald �. Lucciano Owner myHOME CONTRACTING,LLC Registered In Massachusetts & New Hampshire P.O. Box 969 * Methuen, MA * 01844 * Tel. (978) 682-9052 P.O. Box 144 * Deerfield. NH * 03037 * Tel. (603)463-8898 ®L j T;,=' Toll Free Telephone: (800) 921-9052 * Fax (603) 463-891 I J l MEMBER www.myhomecontracting.com t Job# This project has been specified in accordance with local building codes, industry standards and manufacturers'specification requirements.All work will be installed by certified craftsman to assure qualifications for the long-term window warranty. GENERAL SCOPE OF WORK a Remove existing storm windows. n Remove interior stops from the sides and top of windows. (Care is taken to cut the paint line to minimize chipping of the interior finish.) > Expect paint to chip at joints. Touch up paint of the interior trim is not included. n Remove the existing sashes. > Remove the parting bead if existing at the sides and top. n Remove the existing balance systems and fill with fiberglass insulation as required n Apply caulk sealant to the interior of the exterior stops. n Install the new double hung replacement windows plumb and square. Screw the new window to the original wood frame. a Adjust the expander on both sides to remove any bow in the master frame. 3 Caulk both sides of the new windows. This will prevent air movement at the perimeter of the windows and reduce any drafts. ?? 1 r!rJ J f tf /f� Y-S INTERIOR FINISH Are we installing new interior trim? A-)CD > Caulk the perimeter of the interior with paintable caulk sealant. > Vacuum work area when done. n Canvases are used during installation when needed. Any painting or staining is not included in this proposal. EXTERIOR TRIM DETAILS Are we wrapping window casings? > > Fabricate PVC coated aluminur tri stockto cover the window casings,joining the corne with45- degree angles. Color us%9i Qty �s7ir a Use#900 SOLAR SEAL for caulk around all window trim. This advanced aulking is based on terpolymer technology, which offers an alternative to silicone and urethane sealants. Its high performance terpolymers impart exceptional weather-resistance, adhesion, elongation and color fade resistance. Color to be matched to exterior trim color. myHOME CONTRACTING,LLC Registered In Massachusetts & New Hampshire z F4 P.O. Box 969 * Methuen, MA * 01844 * Tel. (978) 682-9052 ,.$r; P.O. Box 144 * Deerfield,NH * 03037 * Tel. (603)463-8898 �` T �x MEMBER Toll Free (800) 921-9052 " Fax (603) 463-8911 t7yww.myhomecontracting.coin 2 r r Job# GENERAL DETAILS > Drop cloths will be used for areas of installation. Dispose of all debris and scrap materials. n Work area shall be kept neat and clean on a daily basis and returned to normal upon completion of the project. n A written materials warranty shall be provided upon receipt of final payment. a All work will follow local building code requirements and My Home Contracting will obtain any permits required. All Permit Fees are the responsibility of the customer and will be reimbursed to myHome Contracting. > We maintain a current General Liability and Workmen's' Compensation Insurance Policy. A copy is available upon request to verify coverage. n Also followed are special considerations set forth by the manufacturer for the application of the specific product line. Local and National Affiliations Certifications — Massachusetts Better Business Bureau (BBB) — Authorized Alside Window Dealer — Energy Star Retail Partner — Authorized Thermal Industries Dealer —Advanced Alside Installation Certification Your investment with My Home Contracting includes the following — > Double strength glass is standard on all windows Limited Lifetime Warranty on windows All windows priced with double low-E glass and argon gas with warm edge spacer unless otherwise noted > Glass Breakage Warranty on qualifying windows myHOME CONTRACTING, LLC Registered In Massachusetts & New Hampshire n 4 BBB P.O. Box 969 * Methuen, MA * 01844 * Tel. (978) 682-9052 P.O. Box 144 * Deerfield, NH * 03037 * Tel. (603)463-8898 `$p MEMBER Toll Free (800) 921-9052 * Fax (603)463-8911 wiviv.rnyhomecontr•acting.corn 3 Job# INVESTMENT TOTAL FOR SPECIFIED PROJECT WE HEREBY PROPOSE TO FURNISH ALL LABORAND MATERIALS IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS �1 G FOR THE SUM OF Deposit Payment Options Deposit $ S29 • Cash Visa MasterCard Deposit Due on Re-measure $ �SL/ Acct. #: Balance Due On Completion $ � Exp. Date: Security Code: Indicate payment m PERMIT REIMBURSEMENT Balance Due On CotuPIciwi i -- -�••-•`•`""•'•""`�y'de to allow My Home Contracting,LLC to charge the above referenced credit card for the amount indicated above. heck Credit Card Finance Cardholders Signature Date K: Authorized ature of My Home Co r cting p entativia. Signature: V2z Date: horizedSignature: Date: ,v a 0-9 bs pleas __�P myHOME CONTRACTING, LLC Registered In Massachusetts & New Hampshire Y 1 _ P.O. x 969 * Methuen MA * 01844 * Tel. 978 682-9052 , T. P.O. Box 144 * Deerfield, NH * 03037 * Tel. (603) 463-8898 +7m MEMBER Toll Free (800)921-9052 * Fax (603) 463-8911 ji,w-tv.nlyhomeconlrac(ing.com 4 Terms&Conditio,is 1. Parties:'You'refers to the buyer or buyers.'We or"lie refer to the seller, My Home Contracting, LLC. 2. Cancellation:Should you atlemptto cancel orrefuseto perform underthe terms ofthis contract.there shall be agreed upon damages.The base amount of agreed damages shall be 25%of the contract price.If any part of the work has been done,the agreed damages are the proportionate price ofthework done plus 25%ofthe balance ofthe contract price.In additiontothe base amount of damages,you shall pay necessary attorney's fees,courtcosts and interest.Interest rate shall be 18%of the unpaid balance or the highest permissible rate by law.You will pay interest from the date of breach of rxmtract.You will pay It at the highest legal rate. 3. Insurance:We agree to carry Workmen's Compensation and Public Liability Insurance.They cover the work to be done under this contract. 4. Debris:We will remove all construction debris from thejob unless specified otherwise.It is agreed that we shall not be liable or responsible for any damage that mayoccuras a result ofthe use,delivery orremoval ofdumpster receptacles or anyfacsimile there of,i.e.,driveway,lawn damage,sidewalks,etc. 5. Interference with Performance: We are not responsible for any interference with the performance for reasons beyond our reasonable control.This includes strikes,fire,weather, inability to obtain material,extra work requested by you,failure to pay for extra work you authorize us to perform,ads of God,or withholding by you of any or all progress payments due us.Should work be stopped by more than three(3)days by any or all of the conditions set forth in this paragraph,we may terminate this contract and collect for all work performed plus the agreed upon damages for breach of contract. 6. Warranties: The following refers to warranties: a. We warranty all workmanship for a period often(10)years from the date of substantial completion on all work performed by us. b. Our warranty does not cover damages or deterioration from causes beyond our control. Examples are:Collisions with foreign objects,ads of God, misuse or failure to follow maintenance instructions. c We will provide warranty service and warranty remedies only where there has been no breach of obligation to make payments under the contract. d. If a replacement product is unavailable we will provide a substantial product of equal grade at our option as determined by us. e. For warranty service,write us at P.O.Box 989, Methuen, MA 01844. In the event of an emergency,call our local office. f. You may not withhold any portion of any payment of the contract as a holdback for guaranteed performance by us under this warranty. g. All material warranties are provided by the manufacturer. 7. Limitation of liability: These limits apply to our liability: a. We have no liability for incidental on consequential damages. b. We have no liability over the amount of the contract price. c We have no liability for any interior damages to the building or contents if normal application procedures are followed. d. The limits apply to all claims whether for breach of express or implied warranty,negligence, or any other reason. 8. Entire Agreement: This contract is the entire agreement,and it is agreed by the parties that entire understanding is contained in this written contract between you and us.It is further agreed that any subsequent changes to this agreement must be in writing and signed by the parties.No oral agreements or understandings not specifically stated in this written agreement will have any force of effect 9. Compliance with Law: This document is intended to comply with all applicable laws and rules.This includes,federal,state,and local laws,rules and regulations of every kind.If any provisions or part does not meet any such requirement,that part may be considered Ineffective; nevertheless,such portion shall not affect the validity of the remaining portions of this contract. 10. Verifications:Our construction specialists check the measurements and calculations made by thesales representative in determining the work involved.ffthere was a significant mistake or special construction problems are involved,we reserve the right to cancel the contract without liability.Any down payment shall be refunded if the contract is cancelled under this provision. 11. Alterations: You agree to pay us our normal selling price for all additions,alerations or deviations from the agreed upon specifications. No additional work shall be done without prior written authorization by you.Any such authorizations shall be on a Change order form approved by both parties, which shall became a part of this contract.Where such additional work is added to this contract. It is agreed that all terms and conditions of this contract shall apply equally to such additional work.Any changes in specifications or construction necessary to conform to existing or future building codes,zoning laws apply equally to such additional work.Any changes in specifications or construction necessary to conform to existing or future building codes, zoning laws or regulations or inspecting Public Authorities, shall be considered additional work to be paid by you. 12. Payment schedule: Payments shall be made by you,as per the attached or separate payment schedule.Acceptance of the Public Authority shall be conclusive evidence that the work has been complete.Such completion entitles us to the complete progress payments according to the schedule set forth.We have the right to stop work and keep the job idle if payments are not made to us when due. If any payments are not made to us when due,you shall pay us an additional charge of 10 percent of the amount of such payment 13. Survey: You are solely responsible forthe location of all lot lines and shall,iifrequested.identify all comer posts of your lot.If any doubt exists as to the location of lot lines,you shall provide,at your own cost,a survey.If you wrongly identify the location of the lot lines of property,any changes required by us shall be at your expense.This cost shall be paid to us prior to continuation of work. 14. Subcontracting:We have the right to subcontract any percentage of work agreed to be performed. 15. Landscaping: We shall not be held liable or responsible for damage to landscaping or grounds,trees,shrubs and/or vegetation arising out of the use of any vehicles or heavy equipment or related equipment that is used to perform its obligation and duties under the terms and conditions of this and/or all agreements between the parties.We shall be responsible to provide a rough grade finish only,which does not include loam,seed,or sod,unless otherwise specified in the contract 16. Payment of Invoice:We shall pay all valid bills and charges formaterials and labor authorized by us arising out of the construction of the structure and will hold the owner of the propertyfree and harmless against any liens of laborand materials filed against the property. 17. Legal Costs: Should it be necessary for us to bring suit to enforce provisions of this Agreement or to recover damages or judgments,it is agreed that you will pay reasonable fees and court costs to us. 18. Job Signs: You grant us the right to display a job sign and advertise at the job site during the construction process and 30 days after completion.The sign will remainourproperty. 19. Workmanship:We agree to complete the work in a substantial and workmanlike manner,but are not responsi for failures or defects that result from work done by others 'or,at the time of subsequent to work done under this agreement 20. Da ties:W II not be re Bible for damage to existing walks,curbs,driveways,cesspoo septic ,sewer lines,water or gas lines,arches,shrubs, lawn ,doth ne ,teleph a ectric tine etc. by us or any of cur subcontractors or suppl in d in a performance of ry of rc rke ' Jrve materia fo e j b. o x x , L,,r... myHOME CONTRACT G, LLC 1 Registered In Massachusetts & New Hampshire ._ P.O. Box 969 * Methuen. MA * 01844 * (978) 682-9052 —� P.O. Box 144 * Deerfield, NH * 03037 * Tel. (603)463-8898 '� ;o MEMBER Toll Free (800) 921-9052 * Fax (603)463-8911 wwlar.myhomecontracting.com 5 Job# IN HOME SALE OR SERVICE NOTICE OF CANCELLATION YOU MAY CANCELTHIS TRANSACTION,WITHOUTANY PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS OF THE DATE OF THE CONTRACT.IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN 10 BUSINESS DAYS FOLLOWING RECEIPT BY SELLER OF YOUR CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELED.THERE WILL BE A SERVICE CHARGE EQUAL TO TWENTY-FIVE PERCENT(25%)OF THE CONTRACT AMOUNT IF YOU CANCEL THIS TRANSACTION AFTER THE THIRD BUSINESS DAY FOLLOWING THE DATE OF THE SALE. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THE CONTRACT,OR YOU MAY COMPLY WITH THE INSTRUCTIONS OF SELLER REGARDING THE RETURN OF THE GOODS AT SELLER'S EXPENSE AND RISK. IF YOU MAKE THE GOODS AVAILABLE TO THE SELLER BUT THE SELLER DOES NOT PICK THEM UP WITHIN 20 DAYS OF THE DATE OF YOUR NOTICE OF CANCELLATION,YOU MAY RETAIN THE RIGHT OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OR IF YOU AGREE TO RETURN OF THE GOODS TO SELLER AND FAIL TO DO SO,YOU WILL REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT, TO CANCEL THIS TRANSACTION,MAIL A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE TO MY HOME CONTRACTING,LLC AT 14 COFFEETOWN ROAD,DEERFIELD, NH 03037, NO LATER THAN MIDNIGHT OF �- ILA-i CO Acknowledgement of Receipt of Notice of Cancellation IIWe hereby acknowledge receipt of Notice of Cancellation set forth above and that Seller has orally informed melus of our n right t can .I.n�,,� /Y Date ElG /J Customer's Signature Date X /6L�_�i/ //�J/�� r Customers Signature J I HEREBY CANCEL THIS TRANSACTION Date Signature I HEREBY CANCEL THIS TRANSACTION Date Signatur z myHOME CONTRACTING, LLC u B$$ 3 Registered In Massachusetts & New Hampshire 3 14 Coffeetown Road * Deerfield, NH * 03037 MEMBER Toll Free: (800)921-9052 * Fax: (603)463-8911 tinN,tin.nsyhomecona•acting.com 6 2 -7 Job# WINDOW SPECIFICATIO_ S Total Windows Purchased �—I Qty Qty j / Double Hung Bow Window 4 Lite / 5 Lite Picture Window Garden Window 2 Lite Slider Patio Door 5ft. / 6ft. / 8ft. / 9ft. / 12ft. 3 Lite Sli / Entry Door Tra itional / Equal / Single Casement Storm Door 2 Lite Casement Window Capping 3 Lite Casement Mullion emoval Awning Screens Half / Full Basement otid / Steel Colonial Grids Bay Window Metal Window Conversion 30-Degree / 45-Degree ADDITIONAL NOT S �J rrl vleC-e— D Homeowners' Initials � l��s?� My Home Representative's Initials myHOME CONTRACTING, LLC Registered In Massachusetts&New Hampshire} 8$$ P.O.Box 969 ' Methuen,MA • 01844 • Tel. (978)682-9052 a P.O.Box 144 } Deerfield,NH • 03037 Tel.(603)463-8898 �r s MEMBER Toll Free Telephone: (800)921-9052 ' Fax(603)463-8911 www.myhomecontracting.com 7 C, C. Job# My Home's Guarantee (Installed Products Only) 1. TEN YEAR WORKMANSHIP WARRANTY All workmanship is guaranteed for ten (10)full years from the date of the installation of windows. There will be no charge labor or materials due to faulty workmanship in that 10-year period. 2. THREE YEAR INSPECTION WARRANTY My Home also guarantees that for a period of three years, My Home will make an annual inspection of the products they have installed to ensure you, the customer, the product is in proper working order. Customer's obligation is to call My Home to set the inspection appointment, and My Home will make the inspection within fifteen (15) working days. 3. MANUFACTURER'S WARRANTY My Home also guarantees that it will provide upon receipt of final payment, all manufacturer's warranties for the type of product purchased from My Home Contracting, LLC and also guarantees that each type of product purchased will carry a manufacturer's warranty. 4, GLASS BREAKAGE WARRANTY (ON QUALIFYING WINDOWS) All windows include a Limited Lifetime Warranty for coverage on accidental glass breakage. GLASS BREAKAGE WARRANTY INCLUDED ES NO My Home Authorized Signature'-- ' Approximate Installation Date Vvpcnugpr myHOME CONTRACTING,LLC i Registered In Massachusetts & New Hampshire EMB P.O. Box 969 * Methuen, MA * 01844 * Tel. (978) 682-9052 s` < - ;,-1� P.O. Box 144 * Deerfield, NH * 03037 * Tel. (603)463-8898 ., 1 MEMBER Toll Free (800) 921-9052 * Fax(603) 463-891 1 wvviv.myhomecontracting.can 8 Job# m;HCenrrmcting,ome LLC AFFIDAVIT I, the undersigned, the owner of the property located at Hereby verify that I have authorized n"omne Contracting, LLC to apply to the Building Department in the city/town of c 2/e<07 , zO- To act as my agent in obtaining a building permit and/or zoning requirements to obtain permits. Sig ure of Property Owner Date myHOME CONTRACTING, LLC Registered In Massachusetts & New Hampshire P.O.Box 969 * Methuen, MA * 01844 * Tel. (978) 682-9052 �- P.O. Box 144 * Deerfield, NH * 03037 * Tel. (603) 463-8898 MEMBER' Toll Free (800) 921-9052 * Fax (603) 463-8911 wianv.mj,l:onzecontracting.com 9 -F. Massachusetts -Department of Public Safety `Board of Building Regulations and Standards License: CS-060607 MARC R SYLVAIf.Y y - a Iris Avenue' S f Salem NH 03079� z r r�.S. r�aoa Fx-i bon: .:. J c 06fp6f2ft11 omnllssioner - � � _ aFiF r :i i Homes Tools IG Guideline Grid/Muntin FAQ Links QIculated Specs I Min./Mar. I Shane Cahaulator i CwMensation i Chemiml Oom®rieility i GlossarvofTam jWjndSveWlFnerqvSjpr Rwmt• Region Series Model Glass Package East Coast m 13001 jaimatech ThennD+ iE-Liner Model: 30011 Series Mezzo,(Double Hung) s Composite Reinf.r Steel Reinf. Performance Overview Parts Installation Search U-Value Search DP/PG i/ U-Value=R-Value Energy Star Map Window Effiden ` `Model GfassPacli GlassThickness Description UEa_t SHGC CR ER 3001 CtI atech ThermD+M Liner Double Stren 4" DS LAE-iE-liner Argonr ThermD 0.27 030 0.551571221t 13001 ICIlmatech ThermD+iE-Liner Triple Strength /4-IG,TS LOE-M-Liner,Argon,Therml) 1 0.29 10.30 10.541561201 Structural Test Results {Model Width HejghjDPjPgAir Load FBC IPA Descri n R rt No. 3001 36 72 SO 0.08 7.52 +/-60 FL11720- WX Steel Reinforcement D2492.02 [201 36 60 50 .OS 7.52 +(-90 FL11720- Steel Reinforcement 02492,02 3001 36 78 45 0.14 7.52 +J-67.6 FL11720IMM Steel Reinforcement D3479.06 R12 1952 I I FL11720- WIM- 13-0128-03- i 3001 44 75 35 0. 7.52 +/-52.5 R11 1952 Steel Reinforcement 8 . 3001 36 60 35 0.04 5.25 +/-60 Composite Reinforcement D5496.02 l 3001 36 65 35 0.04 4XO +/-60 Composite Reinforcement D4018.07 3001 52 62 35 0.1 6.06 +/-51.6 F1.11720- Mi W Reinforcement wJ Stile p4961.06 R12 M2 Reinforced 3001 41 60 30 .04 4.60 +/-40 Composite Reinforcement 04018.07 3001 46 84 30 .1 6.06 +/-45 F111720- 7NHd_ Steel Reinforcement D2492.02 R12 1952 3001 44 75 25 0.04 3.76 +/-37.5 Composite Reinforcement 290 i 3001 44 96 25 5.43 +/-37.5 IF R1ZA- Steel Reinforcement D3b73.02 13001 48 78 20 CLO41 "0 +/-30 Composite Reinforcement D4018.07 FL11720- Steel Reinforcement w/Stile 30D3 52 96 15 14 3.13 +/-22.5 R12 Reinforced D4961.06 r - ' f i i �jie �o�nnwn+nealllc .�l.,�ar./aoella ' Office of Consumer Affairs&B siness Regulation License or registration valid for iodividal use oalyj 7 IM HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:_ Office of Consumer Affairs and Business Regula Re Registration: .:144679 Type: Expiration: -1027/2016 Ltd Liability Colpor 10 Park Plaza-Suite 5170 - - - Boston,MIA 02116 MOME CONTRACTING LLC - DONALD LUCCIANO 128 KLONDIKE AVE HAVERHILL,MA 01832 --- Uoaersecrewry Not valid without signature E i F 4 t 1 C t ' l 1 The Commonwealth ofMassachuselts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information - Please Print Legibly Name (Business/Organization/Individual): Mu 14oC ,1e Address: Cc��ee A:"., n City/State/Zip: �I)f'et—pe U N K 0_?(33 7 Phone M („03 - <GO — 02/3 K Are you an employer?Check the appropriate box: Type of project(required): 1p5(IJ am a employer with employees(full and/or pan-time).• 7. ❑New construction 2,F— I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 LEJ Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. 1 am a general contractor an have contracors d I h hired the subt listed on the attached sheet. ❑ 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.[ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] -Any applicant that checks box#1 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: :77yA/r'le,S � Policy#or Self-ins.Lic.#:� D U —//cFo 'IC?-2' C) �C Expiration Date:_._._.. ._- 7 Job Site Address: �//�iGrr'f /wry City/State/Zip: P.�^^I Attach a copy of the workers'compensation policy declaration page(showing the policy number and ex iration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided abov is true and correct. Signature: �I Date: Phone#: 3 6 0 — pL 13 P Official use only. Do not write in this area,to be completed by city or town official 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pernvt/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFMA71VELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NDT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate hailer is an ADDITIONAL ISURED,the poles) must be endorsed. I SUBROGATION S WAIVED,subject to the terms and cond-Itiols of the Policy,certain Policies may require an endorsement. A galerne t on this certificate does not confer rights to the certificate holder In lieu of such erdorsame R3000CEi NNAAME, Eric Jansen Rasbany 8 Regan Insurance PHONE 978 685-3188 FaxNd, (97e) 685-9460 254 Pleasant Street E-MAIL ADMERISI : eric@hashany.com Methuen, MA 01844 INsdrE AFFORDING COVEtAGE NAICa INSURERA:Tador Insurance Company INSURED INsuRE3B:Travelers Insurance CowpauV MY BOMB COINTRACTING, LLC INSURBic: C/O Don Lucciano INSUREBD: 14 CoffeetoTrn Road INSLIREEE: Deerfield, RR 03037 1INSURIERF- I I COVERAGE CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR AID POLICY EFF POLICY E7IP LTR TYPEOFINSURAMCE POUCY NUMBER MMD/Y HOW 0/TYYY ULM A GENEBALUABAITY NPP8102099 1/26/16 1/26/17 EACH OCCURRENCE $ 1,000,000 X COMAERCIALGENERALLIABIDTY DMMGETORENTED $ 100,000 CLAIMS-MADE OCCUR MEDSP(ArVere �) $ 5 000 PERSDMLMADVIN RY $ 1 OOO OOO GENERAL AGGREGATE E 2,000,000 GEd'LAGGRrTE LIMT APPLIES PER PROmcrs-ODw10P AGG s 2 000 000 POLICY PRQ LOC $ F OMOBILEUABMITY COMBSNGLELNIT S ANYAUTO BODLLYINJURY(PerParson) S ALLOWED SCHEDULED BODILY[NAM glN amdenq $ AUTOS AUTOS HIRED AUTOS _q OSS� �YD � S PROPE $ UMBRELLA UAB OOCUR EACH OCCURRENCE S E)CESSUAe CLAIMS-MADE AGGREGATE 8 D® RETENTION B VIORKESCOMPENSATION 6MM-4904P77-0-16 1/1/16 1/1/17 X WCSTATu orH- AND EMPLOYERS'LIABILITY ANY PROPNEIORPARTNEA fD EXE1VE Y') N/A EL.EACHACODEW $ 100,000 OFRCERIMEMffE2 EKQU DED7 IMadaWry In NEQ EL.DISEASE-EA EMPLOYEE S 100,000 If yes deaibe ender DESCRIPTION OF OPERATIONSbebw L.DISEASE-POLICY LIMIT 500 QQQ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(AUech ACORD IM,AOMbnd Rena"®Sd)NAie,If n apam bregdred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES 13E CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N For Permit Purpose ACCORDANCE VRIH THE POLICY PROVISIONS. AUMDR®REPRESENTATIVE Eric Jansen 0 1988-MID ACORD CORPORATION. All rights reserved.