29 WOODSIDE ST - BUILDING INSPECTION (2) t t t
The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CMR
Revised Mar 2011
1 Building Permit Application To Construct Repair Renovate Or Demolish a
One or Two Family Dwelling
This Section'For'Offs Use Only
SuildingPemittNmnber;t , _^� #$' Dai Applied
` d S
oil dmg Official(PnntName) t� ,�,s " �„a`:�t ;Signature `+:,:. " "' ''Da"te '
F; t,,y
,a�SI+GTION 1:SITE INFORMATION,
1.1 Property Addr 1.2 Assessors Map&Parcel Numbers
1.1 a Is this an accepted street?yes no Map Number Parcel Number rQ r1i
1.3 Zoning Information: 1.4 Property Dimensions: ,om
Zoning District Proposed Use _ Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) O n
Front Yard Side Yards Rear Yard
Required Provided Required .Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check ifyes❑ Municipal❑ On site disposal system ❑
i i ": „ SECTION 2 PROPERGX OWNERSHIP
2.1 Owner'of Record•
Svsao. l.ynLh "S'a Ie, I°1'70
Name(Print) ICity,State,ZIP
alq �P,I- ro9$ 3a �3
No.and Street Telephone Email Address
SECTION 3 DESCRIPTTDN QF PROPOSED WORI{2(check all that'apply)',
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) b Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work2:
fP0C;rAI0L chgn 2S
SECTION 4 ESTIMATED COjVSTRUCT ION COSTS
Item
Estimated Costs:
&_ Official Use Only '*
(Labor and Materials
1.Building $ 3 C� 9 131uldmg Permit Fee $ "Indicate how fee is deterrnmedi
2.Electrical $ �❑Sta�idazd:CityiTown-APPl�attonT''ee � , •' �,
tip Total Protect Costa(Item 6)x multiplier z
3.Plumbing $ .;2 Othe'�r Fees $ '� * �" ` 11-
' a l a7 x`',a F
4.Mechanical (HVAC) $
5.Mechanical (Fire " " m� ..,. r' y ,
Sup essioa) $
Checkllo '_ a' Check Amount :' CashAmoant
6.Total Project Cost: $
g 74 O Patd m Full ❑outstazidutg Bahmce Dore
SECTION 5: CONSTR.UCTIONSERVICES
5.1 Construction Supervisor License(CSL)
"'(O h,Q,i-�- r o(-Z uh>J Imo- License Number Expiration Date
Name of CSL Holder
1 -7 , \ I_c 1 fC,��� List CSL Type(see below)
No.and Street W r` .. Type Description
JC� U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I• (D� - �35' I Insulation
Tee hone Email address D Demolition
5.2 Registered Home Imp�rP�vement Contractor(HIC) ` 'd�f q3 g _2)_ f 6
t'-t/ le 'fie b r HIC Registration Number Expiration Date
HIC�ompany Dame or HIC Registrant Name
D'a w i V -
No.and Street Email address
S t\re V),Sbar r✓)A o lsy5 ybI- (,`ly-C?
Sty/Town,State ZIP Telephonic
SECTION 6:WORKERS,COMPENSATION SURANCE AFFHlAVIT(M G.L.c.15Z.§ 25C(6)) `
Workers Compensation Insurance affidavit must be ompleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issu a of the building permit.
Signed Affidavit Attached? Yes .......... No...........❑
SECTION!a:. OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S.AGENT•OR NTRACTOR APPLIES:FOR$UILDING PERMIT
I,as Owner of the subject property,hereby authorize I � d/-I,ty'o r
to act on my behalf,in all matters relative to work authorized by this building pelmit application.
CS?-9- C,y,-tv-r c ,N 9 -z z-/S
Print Owner's Name(Electronic Signature) Date
SECTION 7&-`OWN£Rr OR AUTHORIZEWAGENT 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 is true and accurate to the best of my knowledge and understanding.
M,- K Ali Ab.444 e c.,I( I -r-L-.c, 01- .22 -/-Y
Print Owner's or Authorized Agent's Name(Electronic Signa e) 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
wtivw.mass.eovloca Information on the Construction Supervisor License can be found at www.nmss.<aov/dns
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"
1 i
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor Specialty
License:CBSL 09@689 _
RO);BRTP V)"
in w>Salem MA 019 L,
,
,I to Expiration` ;
Commissioner 0II/08=18 .
f
r,
::.•e. •� /�)' V'J✓(/Ylf�'ii•Jf 4�'�'!!'C:�t��I/ 'N L/ •V'J GC•i 6
I ,I' OK'd ice aE' Cai�sunaner F�.tfanns aimd Busi ness �_egulatiola
%i 10 Park Plaza - Suite 5170
Boston, A/.assachusetts 0.2116
Home Iniprover4p t.gonatractor Registration
Registration: 126093
r...
TUpe: Supplement Card
EGrpiration; 0/3/2016
THD AT HOME SERVICES, INC.. ::..
MARK NIADNA : --•-•--..._..__..___...__,.__._...__..___..._._..._...._...
2690 CUMBERLAND PARKWAY SUI7L;30.0 :;
ATLANTA, GA 30339 :::.: .:. .....
Update Address and return cord.Marto reason for change.
sCA I 0 2010•05111 Address (_j Renewtl Employment �_I Lost Card
n;%/r Yf•rvrruroruarrr�//r�(?.l�rw;nr/rrr�r://.l '
•�, -.3Officc of Consumer Atrnirs tic Business Regulation License or registration valid for individul use only
,� before the eupiration date. 1f found return to:
ra ,OME IMPROV•FrMENT CONTRACTOR Office of Consumer Affairs and Business Regulation
Registration:. 126093• Type: 10 Park Plaza-Suite5170
h Eaplratia.k;6/3/2Q1.6.,, . Supplement Card Boston,MA 02116
THD AT HOME S$RvICE$;,INO:
-. THE HOME DEPOT.. SERVICES -
MARK NIADNA '�• `'�`''`:'
2690 CUMBERLAND PARKWAY S 'S<-a--761-f �
Xff5 9W A,GA 30339 �—
Undersecretary Not valid withou signature
I
i
I
r -
a�
• I
MON _ The Comtnonweaith of Massachusetts
Department oflndustrW Accidents t
Office of Investigations
606 {3'ashingfon;Street a
Boston,MA 82111
www.»rassgov/dia i
Workers' Compensation I®surt Fmde Affidavit: Benders/Contractors/Eieck eiaas/Plumbers__
DlicantInformation� /Please
`Print Legibly
Nance(Business/Organization/Individual): t-ome,
Address:_
3
City/Stale/Zip: S v o/SyS' Phone #:
so 9yZ
Are you an employer?Check the appropriate box: "
F6.
ype of prroject(regatred):
1.❑ 1 am a employer with 4. ®I am a general contractor and I
_ employees(full and/or parvtimey. have hired the sub-contractors ❑New construction
listed + . r
ship and have no employees These sub-contractor's have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. []Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised the 10. Electrical i
y repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL i l.EI Plumbing repairs or additions
myself.[No workers'comp. c.152,§](4),and we have no 12.0 Roof repairs
insurance required.)t employees. [No workers' ME]Other ;kar(Wn
comp.insurance required.] —I
'My applicant Wet cheeks box#1 must also fill out the section below.showing their workers'compensation policy mforraation. I
t Homeowners who submit this affidavit udicating they ate doing an work and Wen hire outside conhscmts must submit a new affidavit indicating such. h
:Codtraetms that check this box now attached an additional sad showing the name of the sub-contractors eodtheir workers'comp,policy information, j
0
I am an employer that is providing workers'compensation Insacrance for my enw1oyees. Below ds rhepolicy and job sire
Information.
Insurance Company Namc: `� //�Ml v`�l rr C. ll$ CO
Policy#or Self-ins.Lic. 17 3 N 3 Expiration Date:
11
Job Site Address: I W 0 ol'S'd e S T. City/State/Zip: Sc I.e. n--� vvl ra-
Attacha 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$I,SOO.DO sector one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 4
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification. i
i
I do hereby cerdfy under the pales and penaldn ofperlary that the itefornmtiaa provided above Is bare and correct
t e: ��l /�z 'Iv``� Date: cZa
Phone#: 525$ '
e
Oj/icia/use only. Ito not write br fhlr arcs,to be completed by city or town official
Cityor Town t
Permit/License# ,
Issuing Authority(circle one):
t
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector "
6.Other E
Contact Person: Phone#:
' ACIORDO CERTIFICATE OF LIABILITY INSURANCE DATE(MMR DM WJ a
02242015 f
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,_EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. .THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE_CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require adendorsement. A statement on this certificate does not confer rights to the
i
certificate holder in lieu of such endorsement(s). - - - E
PRODUCER - - CONTACT s
_ ... - -.-----MARSH-USA-,INC"'-"'_-- .�__ ._ ......, r..- .._.,�.-..._-..ems..,,_ -NAME ..--.,_.-.....__.__.a _ .�.-.-^^"___._. _--•_ _ _-
TWOALLIANCECENTER PHONE FAX
EO)356D LENOX ROAD,SUITE 2400 �.. a xo
ATLANTA,GA 30326 ADDRESS ;
NAmeimn
S AFFORDING COVERAGE NAIL!
_ 100492-HOmeD-GAW-15-16 .. _ .._..__ _ _...___ .INSURER A;Se Congron _ _ - - - 26367 - #"
INSURED INSURER B:ZUMnce CO 16535
THD AT-HOME SERVICES,INC.
DBA THE HOME DEPOT AT-HOME SERVICES INSURER c:Ns Cc 23641
2690 CUMBERLAND PARKWAY,SUITE 300 - - ixsii :Illurance Company 23617
- ATLANTA,GA 30339 - . ... .. _... - - _„
INSURER E:- i
INSURER F: T
COVERAGES CERTIFICATE NUMBER: _ ... . ,__.ATL-=242665-09 REVISION NUMBER.7
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED-ABOVE FOR THE POLICY.PERIOD
INDICATED--NOTWITHSTANDING ANY REQUIREMENT, TINS URA CONDITION AFFOD M ANY CO By TI HE leIE OR DESCRIBED
170CUMENT VNTH RESPECT TO WHICH THIS
HER- nt
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - -
INSR POLICYEFF POLICY UP
SU
LTR TYPE OF INRANCE Tuon POLICY NUMBER 1MMDDNYYYI I HWWDDJYYYYILIMITS
A GENERAL LIABILITY - GLO48ST714-05 OW012015 ID3101016 - MF�ACH�URRENCERENCE $ 9ED X0•0X COMMERCIALGENERALLIABILITY oauirenre $ 1.000,OD0CIAIMS-MADE O OCCUR LIMITS OF POLICY XS one person) $ EXCLUDEDOF SIR:$1 M PER OCC DV INJURY $ 9,000,000REGATE $ 9,D00,000
GEN'L AGGREGATE LIMIT APPLIES PER: OMP/OP qGG $ 9,000,000 [
X POLICY PRO_
EC LOC $
B AUTOMOBILE LIABILITY BAP 2936863-12 03/012015 03512016 CEOMaB`NEEDISINGLE LIMIT $ 1,000,000 -
X ANY AUTO BODILY INJURY(Per Person) $
ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG `
AUTOS AUTOS
BODILY INJURY $ /
HIREDAUTOS NON-0VJNED PROPERTY DAMAGE I
AUTOS Per acdtklnl $ I
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESSLIAe CLAIMS-MADE AGGREGATE $ ,
DEC RETENTION$ I I $
-—C- -MRKEReCOMPENSATON— --WC017731493-(AOS) 031012015 - 03N12016 WC fi ATU- OTH- j
AND EMPLOYERS'LIABILITY Y I 1 OOD.O�
C ANY PROPRIETORMARTNER/EXECUTME YIN WC017731495(AK,KY,NH,NJ,VT) OW12015 C3l01!2016 E.L.EACH ACCIDENT E
D OFFICERMEMBER EXCLUDED? NIA -
(MandalorylnNH) W001 T731494(FL) 03MI2015 03N12016 E.L.DISEASE-EA EMPLOYEE $ 1.000.000
Nyes,dmcnhe under Connnued on Arid4ioml Page
DESCRIPTION OF OPERATIONS eel. E.L.DISEASE-POLICY LIMIT $ 1.00D,000
i
9
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AKach ACORD 101,AOdXlonal Remarks Schedule,N more apace 1.required)
EVIDENCE OF INSURANCE i
e
i
f
CERTIFICATE HOLDER CANCELLATION `
THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
245 THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
455 PACES FERRY ROAD ATLANTA,GA 30339 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORMED REPRESENTATIVE
Of Marsh USA Inc. s
Manashi Mukhegee _3+LVLuaper,l"
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
2015-08-24 05:40 EXPDTR 9787390618 >> Home Depot A_HS -P-2/8-
_ - - - - - - - - - - HOME IMPROVEMENTC)NTRACT
,r PLEASE READ I'll IS
r7 Wit/ Sold.Flnnishcdand Installed by:
Brunch Name:Raamt Nm-th&Sta+th Dute:�aV (./ THD At-Home ServicoN,Inc
d/h+a The Honne Depm At-Horne Scivicis
Branch Number:31 and 33 90X Roston Turnpike,Unit L Shrewsbury,MA 01541
Toll Free 877-9(13-37M
Fodc at ID#75-269M(il;ME Lie 0 C 02439;RI Cone I.icA 1(427
_�'�"'CT'Lit#I II( 05(5522;MA Humc hupruven alit CmJn�mcr�ar Reg 8 126893
InvlaRation Address: 1 1q WOOP$Ipc- "' ` � Ern lJ
(V\A- ' --i. Q
City State Zip
Pur�chaser(n): Work Phone: Hume Phmic; Cell Phone:
I �V� L�IhJC4.1 flgl)8$k- '73 I� III
Home Address: - —
(If different lmm Itv;i lalion Address) City SIAM Zip
E•umtl Address(to rca:ise project communications and Home Depot updat s);
❑I DO NO'I'wish to receive any marketing cmails from The Home Depot
Promw Information: t)ndeisigned("Lhstuffee),Wo owners of the pr a ty located at the above it st llatitm address,agrees to buy,
mid Tlm At-Home ('T Scrvicos,Inc. he Home Depot")agrees to famish, IclivCr and orange for the installation(-Installation')of
- all materials described on the below and on the referenced Spec Shect(s) all of which are inawNmterl into this Comrract by This
reformer,along with any appliwhle Stale Supplement and Payment Saran ry attacheel h=ut and any Change Orders(culieetively,
'Contract"):
Job A: n—aaa ) pp#pem: S Sli s #t Petaled Amoual
I Ruuhng [-jSiding Ll Windows E]Imulabim �
1�S`g65Q3 ❑(tuners/Cover. ❑Entrylkaox
Ruu1.x ❑Siding Wmd.ws lnsulatitm S I
❑(.loners/Ciw. ❑Lulry IWits ❑—_ _
7rTRa+ufing❑Siding Windows Inxnlannn
❑(carnets)Coven ❑r•.nrry,,dcw
❑Rmfing Siding Windows Insulnlion $
❑Gutters/Covers ❑bntrry Doors El-
Total Contract Atttotmt $ �y. (�
Maimpurcharmrray ate depm m ilmetlmn mre4h'nd ofthe CmuractArramN. C� 1
Customer agrees that, i n,.Lihately upon a+mph:tion of the work for wch Nodua.Customer will execute a Completion Cci-ificate
(one for eitch Pnducl as defined by an individual Spec Sheer)and pay at f balance due. A,applicable, each ('usuaner under this
Contract alffms to be jointly and sevcraily obligated and liable hereunder.
The Home Dept*reserves the right to is%uc a Change Order or nnoninsue Contract or any individual Product(s)included herein,at
its discretion,if The Hmne Deport car its mtthtuiv xi service provider dLat-rrti es that it cannot perftmtt its obligations clue to A structural
prohlan with the home,environmental hazards such u%mold,asbestos in I•ad paint,otter satcty cimartla,pricing etrors car li cause
work rapured to complete the job was nor included in the Contract.
Payment Summary: The payment Summary#_j OS-1 S—fP(5 hncludecl as part of this Contract, .cis% Iorh dye mrnl
Contract amount mid paytnenu reyuirul tin the deposits and final paylocirs bit Pnahmt(as applicable).
NOTICE TO CUST
viau are entitled to a completely filled-in enpy of the Contract at the tiff you sign. Do not sign a Completion Certificate(note:
there is one Com pletlon Certillrste for each limed Product as defined I y individual Spec Sheets)before work on that Product
is complete.
In the event id termination of this Contract,Costumer agrees to pay" e[Ionic Depot the costs of materials,labor,expenses
and services provided by The home Deed or Authorized Service Yr vider through the data of terminaton,plus any other
ammmis set forth in this Agreement or allowed under applicable law. HE HOME DEPOT MAY W I'IHHOLD AMOUNTS
OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYM :N'1' OR OTHER PAYMENTS MADE, WITHOUT
LIMITINC THE HOME:DE:POT'S OTHER REME:DIFS FOR RECU IERY OFSUCH AMOUNTS.
Acre Lance and Authorization: (,)runner agrees and undcrsmnds thin I us Agrecmcnl is the entire agreement between Customer
and The Home Uepot with icgard to the Products and Installation on
services d superiolcs all prior discussions and agreements,either
ors)+a written,relating to.said Products and Installation.-'his Agreement nol be assigned or nmanlal except by a writing sigau1
by Custmmer and The Hmne 1),".Customer acknowledges and agrees th it Customer has read,uadcTstands,voluntarily ncccpc%the
terms ,I..if has received a..Py of t/h�1.Agreement.
Acre (�-/�xd��r°° ) /,/ Sub iH y:
X p (Jt.VG .\l 1�/v1n O ZA X _—
CLstsrmer's Signature Oa Sal C sulmnrs.Sigtmtu Date
)f Telepho, No. Q�V '71C1 -cI�3757 —
Customer's Signature Date Sales Cosultant License No
CANCELLATION: CUSTOMER MAY CANCEL THIS as'1'Ptl=+gel
AGREEMENT WITHOUT PENALTY OR OBLIGATION
BY DELTVERFNG WRITTEN NOTICE 11)THB ftOME
DEPOT BY MIDNIGHT ON THE THIRD BUSINESS
DAY .AFTER SIGNING THIS AGREEMENT. THE
SPATE SUPPLEMENT ATTACHED HERETOI
CONTAINS A FORM TO USE IF ONE IS
SPECIFICALLY PRESCRIBED BY LAW IN
CUSTOMER'S STAT&
NVOCP.:ADDITIONAL'traits ANDCONDITIONB ARE SPATEDON111 RENERSE STINK.ANO ARE PART OF THIS CONTRACT
410-07-14 White-Rraroh FlB yaaow- uatomet
-
- Simonton Windows
a` 6500 VantagePointe
�axC Double-Hung Vinyl 1/8"Glass Argon Low-E No Laminated Glass
No Grids
Ventana de_doble guillotlna._.Vlnllo -.3.18.mm Vldrlo Argon Low-E..Sin --. .. .._ ,-
ftaUrgtoimUt_ _,4,a,,,_ T,•,{,�vldrio_la Inratl9 SIfl,fellla5 _
CPD:SBP-A-44-21042-00001 - 07-75 DH
_ . -
ENERGY PERFORMANCE RATINGS
--EVALUACIONDERENDIMIENTOENERGETICO __„_-- ...—:-
.. U-Factor - Solar Heat Gain Coefficient .
Faclor-U Coos ante.Gensrcia de Enelgis Solar
0.29__ :.. _ 1 .65 _0.27 .
(U'SJI P) (Melriw/So - -
ADDITIONAL PERFORMANCE RATINGS #
- - EVALUACION SUPLEMENTARIA DE RENDIMIENTO - -
_. __.-Visible Transmittance
i
<0.50
4
me molsclaror stlpu Ialas last came amp Conrnlm 10 simf eat I NFRC procedures for Coterie in ing Whole product pellormaM_6.NFRC r tin pare
delel'mined'or a fived set on sw1ronml ens[con None and a specific product Sue.NFRC dam not fecom memd eny'produ d end deep not sarranl It
911T2bIIty of any prodUo10r any speck IHe.(:oR9n I I manufacturer'911Ei0t11le for other product pelR4lmawe muormali wow_mind.prQ
Este roommate mlipula que veto res cum men car,as prxadirnianled said a I m de NFRC pare delerromr el iendi mienlo lob del products.Los valorm E
u3ados por NFRC son merminadspor tun dolijrmo 6io de mndr-Ion s am bierlales y un tam a no do product e pz-i'iw.NFRC no recall iends 8
nlnatin prod in l Y no 9ararle aqua_el product sea adacl,ado pa ra un use alpa,hll:o.CC Mille ion el leludo do fsbr.,t,pare el use apl'o plod.do
Cothe pro du wlurnlcorg
iyy
Unit qualifies for ENERGY
STAR®,region(s): Northern, $
North Central,South Central, ' c
Southern.
2
STC 28 �
i
DU£f:dled
IND. Rein DO/Glass Pro Solar/H-LC25
DP:+25/-25 4
Tested Size:48"x 80" SS6p
F
Florida Product Approval:FL5167 e_
2
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i
Applicable Test Standard(s): ANSI/AAMA/NWWDA 101/I.S.2-97,AAMAANDMA/CSA
101A.S.2/A440-05,AAMAANDMA/CSA 101/I.S.2/A440-08,
A440S1-09 Canadian Suppl
8971158/03 g0465 HS Gerlach 6860223
Keep This label for possible ENERGY STARS rebates.To learn more visit wvw energyslarSoe.
Guards esla etiquetel species reembolsos ENERGY STAR®.Para toner mzs access de eslo,virile vww.energyslar gov.
1 3
CITY OF SALEA MASSAC HUSE M
BuI.DING DEPARnamr
120 WW9W4GTONSTREET,3'DRMR
IkL(978)745-9593.
KIIvOERLEYDRISQ7LL FAX(978)740-9846
MAYOR 7hT MAs ST. )MM
DIRECTOR OFnzucPROPERTY/BuIDm omsmomR
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 00, S 54; Building Permit d is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
(name of hauler) J
The debris will be disposed of in:
(name of facility)
(address of facility)
Sign of �plicant
Ip Date