The URL can be used to link to this page

92 COLUMBUS AVENUE - BUILDING JACKET IV �92 COLUMBUS AVENUE "b''� (�i#� of �ttlem, �ttss�ctljuse##s n ',�__•'s PnttrD of (�ppenl F LP N DECISION-ON THE_-REQUEST FOR AN EXTENSION OF VARIANCES GRANTED TO 92 'COLUMBUS AVENUE (R^-1) At a hearing held June 16, 1993, the Board of Appeal voted unanimously, 5-0, to allow a six (6) month extension for Variances granted allowing a temporary boat shelter to remain in this R-1 zone. Said extension shall be up to and including January 25, 1994. Stephen O'Grady, Member U Board of Appeal Oar 26 3 as FM T-1 it of �afvin, � as5arljusdt# !LEn GITYGLE,t1 .5e.LF!<_ !4f.Sf.. s varb of PPexz1 °pun.,MT DECISIO14 ON THE PETITION OF WILLIAM & SALLIE CASS FOR A VARIANCE ATZ9COLUMBUS AVENGE (R-1 ) A hearing on this petition was held October 7, 1967 with the following Board Members present: Janes Fleming, Vice Chairman; Messrs. , Bencal, Luzinski and Strout. Notice of the hearing was sent to abutters and others and notices of the hearing were properly published in the Salem Evening News in accordance with Massachusetts General Laws Chapter 40A. The petitioners, representing themselves, are requesting a Variance from setback requirements to allow for the construction of a temporary boat shelter at 92 Columbus Avenue, which is in an R-1 district. The Variance which has been requested may be granted upon a finding of the Board that: a. special conditions and circumstances exist which especially affect the land, building or structure involved and which are not generally affecting other lands, buildings and structures in the same district: b. literal enforcement of the provisions of the Zoning Ordinance would involve substantial hardship, financial or otherwise, to the petitioner; c. desirable relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent of the district or the purpose of the Ordinance. The Board of Appeal,. after careful consideration of the evidence presented, and after viewing the plans, makes the following findings of fact: 1 . There was strong neighborhood support for the petition expressed at the hearing, including the approval of all the abutters; 2. The plans proposed are in harmony with the neighborhood are relate to the ship building history of the area. On the basis of the above findings of fact, and on the evidence presented at the hearing, the Board of Appeal concludes as follows: 1 . Special conditions exist which affect the subject property but which do not affect the district generally; 2. Literal enforcement of the provisions of the Zoning Ordinance would work a substantial hardship to the petitioner; 3. The relief requested can be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent of the district or the purpose of the Ordinance. •DECISION ON THE PETITION OF WILLIAM & SALLIE CRSS FOR VARIANCE AT 92 COLUMBUS AVENUE, SALEM, page two Therefore, the Zoning Board of Appeal voted unanimously, 4-0, to grant the requested Variance, subject to the following conditions: Y 1 . The temporary boat shelter is to be built as per the plans submitted; 2. A building permit must be obtained fron the Building Inspector; 3. This Variance is to expire on December 31 , 1990. VARIANCE GRANTED t /'� 9✓1✓ � `� 7 �;i�c..yt a es M. Fleming, Esq. , Vice airman A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK 1 THIS CE: .I - '= ,..,. SBAU EE ;,.r^E PERSUANT T\3C� SECTION 17 OF THE 1::1-1CE:C,F.I` L C4L�.?i E% 52i.. Sti'.'_! _ h�._: 1......,, iii DAI'S AFTER THE DATE OF "nL11;3 M;S;-; t:: THE ORC.E OF Ti;-- Ci—f CLERK. P -.,- .. _ -. C Sc:.i7[i 11. THE VAP;S: CE 0. SPE^. ,� •:%7 r E T _ ;S -. E,/'::E� n b..r EtI F—' Et C.ci. Ir, Tv S.,u H ESSEX P.ESiS n, C7 DE--JS F.:ID IF:CcXED !iZ:R THE r',?;.E OF THE 0," Of REC6RD OR ISR CORDED At,' NOTED Qi. THE OCinER'S CERTIFICATE OF TITLE. _. _ - BOARD. OF APPEAL ' _ (Citn of �Jttlem, �4tt9sar11usetts 'Eattrd of A*Al 3 2 19 FII 91 C17Y cF ASS DECISION ON THE PETITION OF WILLIAM & SALLIE CASS FOR A VARIANCE AT 92 COLUMBUS AVE. (R-1 ) A hearing on this petition was held June 26, 1991 with the following Board Members present: Richard Bencal, Chairman, Richard Febonio, Edward Luzinski, Mary Jane Stirgwolt and Associate Member Ronald Plante. Notice of the hearing was sent to abutters and others and notices of the hearing were properly published in the Salem Evening News in accordance with Massachusetts General Laws Chapter 40A. Petitioner, owner of the property, is requesting a Variance to allow a temporary boat shelter in this R-1 district. The Variance which has been requested may be granted upon a finding of the Board that: a. Special conditions and circumstances exist which especially affect the land;: building or structure involved and which are not generally affect other lands, buildings or structures in the same district. b. Literal enforcement of the provisions of the Zoning Ordinance would involve substantial hardship, financial or otherwise to the petitioner. c. Desirable relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent of the district or the purpose of the Ordinance. The Board of Appeal, after careful consideration of the evidence presented, and after viewing the plans, makes the following findings of fact: 1 . The Ward Councillor spoke in favor. 2. There was strong neighborhood support. 3. A variance was originally granted allowing this temporary boat shelter in 1987 and was extended for six months. 4. Petitioner was unable to complete construction of his boat in the time alloted by the original variances due to financial constraints. 5. There have been no complaints received by the Building Inspector or the Ward Councillor regarding this boat shelter. On the basis of the above findings of fact, and on the evidence presented at the hearing, the Board of Appeal concludes as follows: 1 . Special conditions exist which especially affect the subject property but not the district in general. 2. Literal enforcement of the Ordinance would involve substantial hardship to the petitioner. DECISION ON THE PETITION OF WILLIAM & SALLIE CASS FOR A VARIANCE AT 92 COLUMBUS AVE. , SALEM page two 3. The relief requested can be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent of the district or the purpose of the Ordinance. Therefore, the Zoning Board of Appeal voted unanimously, 5-0, to grant the Variance requested, subject to the following conditions: 1 . Temporary boat shelter is to be built as per the plans submitted. 2. A building permit is to be maintained. 3. This Variance will expire on July 25, 1993. 4. All requirements of the Salem Fire Dept. relative to smoke and fire safety are to be strictly adhered to. Variance Granted June 26, 1991 �Qp) IX,4 Frdnald G. Plante, Associate Member Board of Appeal A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK 17 Appeal from this decision, if any, shall be adel ba f ant to n tion days of and the Mass. General laws, Chapter 808, n atter the date.of filing of this decision in the SfiS section11, heCVar ante Pursuant to Mass. General Laws, Ch-nna `' of the ^n w ranted herein shall nat take effect until a copy ave or Special Permit f' �-- _ — decision, bearing the cerii tication or ita Clb Gif Su�haappealahis hbeen cn' elapsed and no appeal has been tiled, or that, _.D filed,that it has been dismissetl or denied is recorded in the South Essen filed Registry of Deeds and indexed under the name er the owner of record W the owner's Certificate of Title. b retarded and noted en BOARD OF APPEAL - J � ry Nix APPLICATION FOR PEFWW TO I e" fi¢ i/rcar.� LOCATION QZ /:e/rJ,n4Js Aim PERMIT GRANTED IV ZzL CTOR MAZ- OFiZ � MWIPUINAllikV0 APmveD RsV Im 2W=MB PRIER TD A.PUW 3JM GRAwfD CITY OF SALEM No. _ .l5, 6 5 wad `,� n, Mr oftic OYblm Ya Ib Lastlw of /� �•a 7 a &2mevs w NOWRY tooted in :• ftCMU MMAws4 . YN No— BULOM�Ki PERBAIT APPLICATION FORM R'armR to: (Cleft whkh wr apply) Rod, Raroof, Install SW4 Con@WW DwK Shad. Pool. Rapaidpaplaoa, Other: PL EAME R.L.OUr LEMLY a COMPLETlLY TO AVOID OKAY$N PROCagan TO THE INR;PECTOR OF BUILDING&The -nder '. hw* appbs br a pam k to blend aoo ditto tAa,%iwmbq speomosaw Owners Name L uh( VS Addrou a Phom 19WI _12 - 7610 Arohitaot's Name Ad*eu a Phone c Maohania Nana - j is Aftmu a Pto ip AL `2� K , 7�T, G7S y what M a■vupow it kdmw 7)u/csz c/K.� c rr"m d euldMgm Z/2,4wr N a dwoanp,for how mm Imam wA bAdq oailons to Irw7 Are.r_es EdhoW=d Cad►Limm• two Uo O 2 0 `� am I un. // D t Sly OR Applicaht UWAK;��fIPl OF WORK TO RN: DONE aF PR:RruRY i�6U!OY�6Z L ltzj/ noDNZ S (�Cf l S71) e� _ �LU 7VZ L •cJ v �irr�J�carv�, MAIL PEW TO: jELr-TeW-ate mTr,� CITY OP 3ALSMa MASSACHUSETTS PUNUC PROPEM 0EPANIVENT i 120 VAMNIMOTOM s7f1�. Sao Puma SALsM.MA OI W70 T!L (07 61 7494 6" Eat. 300 PAR (670)740.96" sTANLty A x J& DMPOM OF DBB=A mAv1? Is aooardm s wib tba provi&=4(mm 6 44 3341 admowb*that n s eeadi M Of 9saft P .- 0 .ad d&b Im1t am the eoma wda.a *** dmowd by thia Bwwbs Paz*d a'be d qm d a[ia s p waly Iiamad NH&wmb diapoad hcMW.r ddoed by MM e 9L SIX . 1b debris will be dlapoaad ofst w LOCI"dFaeiligr Sipla 0t Appl c FULLY compboe the d1amigs MEASE PRIM CLB' XLY �' f t�ZL -� Name O[Pamit AppHeaat Fire Namar ' asy Addtarr City A Stale Ilm abow Stamm requires(hat debris Am(he demoliuM rmov&UM rehab or olbar &aatfaa ofbaildby or Muca n be diapmed is a pmperly_&AwW Solid-wuo&Wosd fadq ar&&W by Mtn,ca SI soup and the boldiM ptaWts or)access an m "epanarem W tnausrrm eectaenrs O la of bsvest sadoes 9 606 Wn kingron Shrd Bosloay ill.! 02111 wwtaanansew la Workers'CompeMdOR Insurance AM"vit: BuBderlIContradora/Eledrtd&nLMumben Applicant Ipfprtnatto>. Plan Eft Len361v Name fe 9 122donandivialso. T G�TIf � c L Addrm: //o R&�tr,U Avf- �yu City S��4, � reaps :_ �/ 76 7f 5- 7, y Are On an evert Cieelr Hr appropriate boss Type of Prolaet h a9dredl: 1. I sm a capktyer wits 1 te_ 4. 1 am a oaal oanaaclor sod I employees(IA savor part-time o have head On wbcoWAdM & ❑New conadocdon 2.01 an a sole Foluichn or pama limed 03 the spaehed sAeet t 7. ❑ Remodeling ship and have no employees Tbese sob owwraeson bm 8. ❑ Demotidon working tw me ins spy cspecily. workers'comp.i mmoce y Building add dam [No workers ocs* msor ee 5• ❑ We are a corporation sod fig 10.Q Electrical 3.❑ II am a bbomeoamm doing an work right ofofesemptine per MM 11.0 Plumbing repsks or w1dMoms myself[No worltas'comp, r 152,11(41 and we have no 12.[]Roof rapaks insaresoe n4oced I t eapbyea.INo workew 13.E O � V'mamaDCe�) dw ;Any appHuN tot cbwb bom of mot dso®om err ncdm brow"Orir wgtr bn Hmmowo w mhmit O n�vit idco iea my m do"tit wok Md Oro bim oultds' VO=Uramda POMW off", abnka tCmwaetow Ora dish Ode box mot varbed a edMjooal shut dnwiq Or omr of an mAeweadm sed oak Twodma' each v�4 per mronrrtior, ["Monvi0yw rlrt kproviav workns'compacmlow braanotee jer my owpkyKs Be,b,�n`e b,d�hrPdlb j awlJobalb ��1f1" 6Z 6'GrS i l /�LCD S lasmamaC yNattira4lv yn? Policy N or ScMins.Lic.tt Expiration Date lob Site Address City/serMOMp• Attach a copy of the workers'compensation policy derlaradw pate(siewlag the panty,rumba mad espiradon data} Falme to seams ooversae st requked unda Set�on 25A of MGL c. 152 can k•ad to the imposition ofainond penalties of a Sae up to$1,5w.00 ad/a one-yew hVrisonmea;as wen m civil peaaltim in the form of a STOP WORK ORDER and a fine of up to$250.00 a day agaimt the violaor. Be advised that s copy of tbis smtemeat mY be forwarded to Opga of Investigations of the DU for imsttraoce or vasp verification, I do ba yeen& rbepsbns and perjury lbarAU kfsrsaabtworovw/ b awl eerrret Sionalum z O,olebrl gar owl. De iwt wrlar br rAb mice,b br rewplds!y d4'er awnt sote6ti Cky or Torw rermMiucense/ Ismhq Aatitorlh(drde on): 1.Board of$eaki L BuMag Department 3.CkYfrowa Clerk 4.Eleetrlesl Inspector S.Plumbing Iwpector 6.Odwr Coated reign&: rhoee IF. u Of ano Massachuscna General 152 requites all culPloyas tD provide workcn- mr=u -..W -,,.... ay s,d apw is defined as"•••tvay person in the service ther nda my conaad of bens, 1'tsrsuant to ibis stantte. i Cxpm"or shed,oral err ar o wrb Qaion;oom ther bti coti�Y.or any Iwo or mere s detieed of as mdnrtdnal. &a b�Wpmd of a deceased employer,of ttae An i m a Join emerprsaR aed mckdmg Ilo"Ma the of the forvoft D y�pClitinal er other Iedaho Tesi a dwe mt c dst o cu receiver or irn•IOa of htwae haunt °° em throe>pastm�s who reside•tbclaaR et the o0tatpast of>be �� owner of•dwetmt _who employsW1 to do mmtemoa+eonsuu�or n7w ww#on sec►dwelliot as*C boust Of roomids of WO 09 Ina"motb0�of wd emPbY �deem°d ra be as emP3oya 15z 4�6)•tie Stara tsar"every stye err lent tee.d�seem imir Is the ea t or MGL chapter for aq remwal of a taws or pad evidenced �Inwrame eoKra r reqube ahsll WMACNAnooa�.b a cea IWO ma vtett JSZ 125C()sOM"neither the W ua waltit�.OW of o gpj"pOVd wb eater into any contrast flu the P ofpublie wCA mt7""able evtdeers otO0O4�aril the iawrame Of this d ptsr bavebcea preaated to the.oomssedat relimbemeas Om that apply to Y�SiW1*M"tf please fit out the wo*en' affidavit completely,by chec>m wi*d wtr cadfiaoa(s)of necaaay,Supply s)nane(IN addaess(n)and PbODe mroba(s) gj other there de ksumoa L nioad �a(Il O or Limited Liability parmembiPa(�wrth n0 E00Pdo members or p , an not re4n�to can work9W oompeosadotr im n me. If as LLC err hidusatlal embe�a 4MU„y is requited Be advised that chi•affidavit may be sabmined ID the DRarlmmtshould Accidents fa oo "of immwoe coverage Ave be sire to dp ad date the aftidavlt. The eparO it M Of be rentrmd b the city or taavn the appliatioa 6tr the pang am law of if you �10 oob�s of Industrial Accden4• M.yo revsounng d�p nomba listed below, Self-ioaued coarp�d=U oar their �mpeawtiau policy.p� toe Self-inmr�SomeUnwbar O°60 Clq or Tower O16daba a sPUG at the bottom is lees and printed lcoly. The Department bss DrwidW Man be sore that the affidavit comp tron bas io contact you mgard1ag the applieaot of the affidavit fm you m fin out in the evem the Office of htveatig• In addimm,an app�ffi please to be sme fit in the permNticenk mmiber wbseh wM be used err a reference • applicadms in MY given yew.nead o*subsmt°�affidavit��cauren &at Una d°d(d*Ic�ayy)�miler"Job Site Address"the apphcam Should wdw"an location is (dy m Policy that bat been ofctalN smQed or morW by rho city Q town may be provided to the towsco s copy Jamof faffidavit is m file fm fbmre pamft or&am A new affidavit moat lre fMed oIIteadla appliea>it sr in�f atfmn»obt•miot a liceom or permit not mated to any bummer or oommeacid yes.Where•Loma owns a bt�a leaven etc.)said paSmt n NOT nquired>D coaspbxe this atfidttvit (ic.a dog license or 1>� ,I and should you have any 4nertion. a Office of Imt on would lure w tbaok you in advame fa yow cooperation please do not liable 10 Oft us•call. Ter Depumem'a addtda.talepbom and fan==ba: The Commonwealth of Massachusetts Dqm med of lndostrial Accidents Ofm of favestvstioos 600 WL*Mgtots Stred Bosroa MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Ravised 5-2" www.mass.gov/dia GK lO`f3 The Commonwealth of Massachusetts W Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM - Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature V - DeTa SECTION 1:SITF INFORMATION ys a 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers N �Z l Ur9btz f; �� Cr m 1.1a Is this an accepted street?yes no Map Number Parcel Number m ro ® 1.3 Zoning Information: 1.4 Property Dimensions: -ftJ � �^ Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) / 1.5 Building Setbacks(ft) t Front Yard Side Yards Rear Yazd 1� 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: _ Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system ❑ I SECTION 2: PROPERTY OWNERSHIP"'--" 1— — 2.1 Owner'of Record: Name(Print) City,State,ZIP 92qie, 978-7'/�f-76%/> No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg.❑ 1 Number of Units_ I Other ❑ Specify: Brief Description of Proposed WorO: Ke SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials) Official Use Only 1.Building $ 1 Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard"Cityt Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire Suppression) $ Total All Fees:$ /M u Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ W b(4 1 ❑Paid in Full O Outstanding Balance Due:- VA , 0 b11-31 R - -7qq l l SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) P,vtAi.f ?.o;n License Number E.PiratiA Dale Name of CSL Holder / List CSL Type(see below) .'and Stream Type Description � rA Unrestricted(Buildings u to 35,000 w.ft. �2 J Restricted 1&2 FamilyDwelling City/Town, Stat ,ZIP M Masonry RC Roofing Covering ' WS Window and Siding SF Solid Fuel Burning Appliances (leNNi sjvinrao I Insulation Tele hone Email address 9d D Demolition 5.2 Registered Homee/Improvement Contractor(HIC) C Regis Number xiniTation Date HIC C mpany Name or HIC Re strant Name 1�c2 1 /y✓,,- p,Fo .61, P No r.and Sir t Email address ;14 Ad, a2l�/ ff/-&VT99 Ci /Town State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... l- No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT . 1,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. S&l ' Coss Print Owner's Name(Electronic Signature) S/2lDate SECTION 7b OWNEW OR AUTHORIZED AGENT DECLARATION I By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained t,0application is true and accurate to the best of my knowledge and understanding. PiCt er or Authorized Agent's Name(Electronic 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 www.mass.govtoca Information on the Construction Supervisor License can be found at www.mass.eov/dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,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" The Commonwealth of Massachusetts Department oflndustrfalAccidents I 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 PERNIITTING AUTHORITY. Applicant Information �/ / Please Print Le ibly Name (Business/Organization/Individual): gy-q�L�/) (7/-1, L Address: City/State/Zip: D Phone#: 7 V— Q - Are you an employer?Check the appropriate box: Type of project(required): 1.02"I'am a employer with employees(full and/or part-time).' 7. ❑New construction 2.❑I am a,sole proprietor or partnership and have no employees working for me in $, ❑Remodeling any capacity.[No workers'comp.insurance required.] - 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. El Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. Iwill 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ROOF repairs These sub-contractors have employees and have workers'comp.insurance.t 6. We are a corporation and its officers have exercised their right of exemption 14.❑Other ❑ �p gh p per MGL c. 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: Yu L' �I-.S A f. Policy#or Self-ins.Lie.#: /7� Expiration Date: Job Site Address: 7 2 t-n�([ �r�S /f riv- City/State/Zip: �Q Attach a copy of the workers'compensation policy declaration page(showing the policy number an expiration 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 certifyr nder the pains and penalties ofperjury that the information provided above is true and correct. sign aturc: Date: Phone#: t=Q- 8.�l�` ft3l 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),addresses)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 Department of be returned to the city or town that the application for the permit or license is being requested,not the De p 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 permit/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 infomtation(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 QTY OF SALSA MASSAaiUSEnS BUILDING DEPARTAENP 3 ` ' 120 WASHNGTON STREE T,3' Flom TEL. (978)745-9595 KIM ERLEYDRISCOLL FAX(978)740-9846 MAYOR THomAs ST.PIERRE DIRECTOR OF PUBLICPROPERTY/BUILDING COMMISSIONER 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 c40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: _/I P540 J//n (name of hauler) The debris will be disposed of in: (name of facility) (address of facility) Signature of applicant Date CHARGE COPY JB Sash & Door_ Co., Inc. Ord f,:: 16646U-0 DOOF`.%INDOW li%kORK U2 1 Q i Route: NONE Fax ,!7')88-142$8 1 Page: I Qt I HOME OF THE WINDOW BOYS Order: 04/13/15 To: CAS591 Ship To: Sched: SALLIE CASS INSTALLATION 02 COLUMBUS AVINUE 92 COLUMBUS AVENUE Printed SALEM MA 01970 SALEM - MA 01970 Date: 05/20/15 Time: 11:15 AM Phone: (978) 744-7640 Phone: Attn: / Cell -du—tT5 ____Te`En Terms;: COD —7-tud: EOD In 15: Cust PC#: Customer Instructions Lire 174 Item Desl-rintion Quancjty Comments..Number Shi ped p 0001.00 Remark BSMJ 0062.66 w188460002.00 CUSTOM MARINV HAMPTON SAG' 3.00 CLAD DOUBLE HUNG UNIT M/D 44 X 41 1/2 PRE WISHED n« T E P I NE I NT LCE7266 ARG MIS GLASS: 718 SIM DIV LITE - NO SPACER 8/1 LAYOUT 14A2H) SATIN TAUPE SASH L Cc,K BEIGE JAMB LINER 4 9116 JAMB BRICKMOULD APPLIED 3114 X 3/4 QUARTER ROUXD INT I-RIM 'EXISTING 7" PLASTER RETURN) FULL SCREEN -------- INS-,ALLAT.ToN 6F'Asbvt� Loo INC REMOVAL DEBRIS FROM JOB 0004.00 INSTAL BLOC E R M I f-FEE < i,00 Received BY: J A CERTIFICATE OF LIABILITY INSURANCE °°'E(MMA=""") 1 13 15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS 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(es) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen PRODUCER T Shenkel Insurance Agency, Inc. PHONNE 1017 Turnpike Street 412E EmaL 781 575-9111 PAX . (781) 401-9995 Canton, NA 02021 A°DiE33: INSURE SAFFORDINGCOVERAGE NAIC0 INSURER A:Western World Insurance (SUED RestINSURERS:Nautilus Insurance 1000 Tunuro Group StrLLCeet INSURERC:Arbella Protection Cant Turnpike Street INSURER D:Travelers Canton, MA 02021 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCES 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OF INSURANCE POLICY POLICYEFF POLICY EXP POl1CY NUMBERM4DN DINTS A GENERALLIABILITY NPP8202204 4/5/14 4/5/15 EACHOCCURRENCE $ 1,000,000 1,CERCIALGEE PALLIABNTY DAMAPREMIGE TO RENTED nml $ ZOO OOO CLAIM1S_MADE OCCUR CEDE (Anrorep=cn) $ 5,000 PERSONALSADVINIURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 G'EN'LAGGREGATE LIMITAPPUES PER PRODUCTS-ODMPADPAGG $ 1 000 000 X1 POLICY P LOC E C AU70MOBRELIABBDY 1020028883 4/ie/14 4/18/15 OWMINED aemmn SINGLEIM R $ 1 000 000 ANYAUTO BODILY INJURY(Per penan) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per ardent) $ HIREDAIfT05 X WNED AUTOS PROPERTY DAMAGE $ E B UMfEUAUAe X OCCUR AN014998 4/5/14 4/5/15 FACHOCCURRENCE $ 1 000 000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1 --- --- DED RETENTION D ADRN@S COMPENSATION 7PJUB-2E58702-5-14 11/13/14 11/13/15 WC STATU- OTHANY - AND ROPRI EMPLOYERS' NEPJILITYEXECUTPA YIN OFFICERMEMSER EXCLUDED? NIA E.L.EPGH PCOLEM Is 500,000 IMyamndabry In NH) EL.DISEASE-EA EMPLOYE E 500,000 DESCRIPnoN CF aPERAnoNS Debw E.L.DISEASE-POLICY LIMB 500,000 CESCPoPnONOFOPERATHMSIL=71MIVEHICLES(Alvah ACORD 101,Addrd"I Remdw Sc1eAAe,ff o Spam IS mgdmdl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Somerville ACCORDANCEWITH THE POLICY PROVISIONS. residence at 19 Grand View Ave AUTHOR®REPRESENTATIVE Steven M. Shankel 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: (781) 575-9111 Fax: (781) 401-9995 E-Mail: steven@shenkel.com Office of Consumer Affairs and Bu§iness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 176586 Type: LLC RESTAURO GROUP LLC. Expiration: 9/3/2015 Trk 244517 STEPHEN WICKS 1000 TURNPIKE ST CANTON, MA 02021 Update Address and return card.Mark reason for change. SCA 1 G eou.os/ii ❑ Address Ej Renewal Employment ❑ Lost Card C�JrC !(nI>uungrnen�/�O`�',r[lrJJrrr�rrJr//J Orrce of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR - before the expiration date. If found return to: egistra0on: 176586 Type: Office of Consumer Affairs and Business Regulation xpiration: :9/3/2015.. LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 RESTAURO GROUP LLC. STEPHEN WICKS 1000 TURNPIKE ST Q o CANTON,MA 02021 —�— Undersecretary of valid without signature - Massachusetts -Department of Public ��lll Board o Safety f Building Regulations and Standards Construction Supervisor License: CS_101141 DENMS ````at A STEEPI- rY 9ALGONQUINRb CANTON MA p2a21 Commissioner Expiration 04/12/2016 Gt--w--- •, t S° J 3 - --- I'hc C'onununftr;tld) of blas,achusctts �" is "l Board at Building Regulations ;Ind Standards CI'I'1' OF j r :+ 15"chwcits Stale Building Coda, 7SO C NIR S,\LI;.�I J L, l7•ri,,rJ Building Permit Application Construct,onstruct, Repair, Renovate Or ulish a Il,u _q// Urrc- or Tnn-Piurnls Un'ellin,q This Section For Dllicial :e Onl Building Permit Number. Uaro. plied: ITdidmg 01110a1(Prnl V,une) .tilgllalUK OuIC SECTION 1: SITE INFORAIA ION I. open I1Jres#: 1.2 Assessors ep ureel Numbers I.la Is this an acre led street? •es no Nap Nnnfher Parcel Number 1.3 Zoning Infortnatlont 1.4 Property Dimensions$ /.uning District I'n,posed l/—"' Lot Arca(s4 It) 1.1 Building Setbacks(R Fronlag 00Iq) • Front Yard Side Yams Required Provided Ruar Yard Required Provided Required Provided 1.6 Water Supply,IM.G.I.e. JU, §54) 1.7 Flood Zone Information$ Public❑ Private❑ Zone: _ Outside Flood"Lune? 1.!SewaEe Dlaposal System: Cheek if es❑ Munieipd❑ On 2 pG of& rdt SECTION]: PROPERTY OWNERSHIPI 'its disposal s)sem O • S Name J ` Avr L'iy,Slato,%IP 3 �lad .7�'1 .7L4C NO..mJ Street felrpbune Emuil Address SECTION dt DESCRIPTION OF PROPOSED WORK$(eAeck all that apply) New Construction❑ Existing Building❑ Owner-Occupied CIRepatrs(s) ❑ Alteratfonls) ❑ Addition ❑ Denwlition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ .Speedy: Brief Descriptiol of proposed Work"., C. e „DD SECTION 4: ESTIJIATED CONSTRUCTION COSTS Ilenf Estinmted Costs: I L.1hur;Ind.\laterials) Official Use Only I. Building S L Building Permit Fee: S Indicate how fee if determined: 2. 1:1wrlcal S O Standard Cirffusvn Application Fee $ I'lunihi,tg S ❑Twill Project Cuftl Iltem 6).v multiplier - '. Other Fees: S 11. \IcOanic.J ill\ %C) S List: _ \lach,mic,d -- Su1q,rYs;ionl S focal 111 Fcef: — n I'ut:rl Projccl Cos i Chrd \u. _ .__CIIccA .\nluunt: C,Ish \nnnnn: 7 O P IiJ ro Full Q Outstanding Il.11.ufce Due: E` r r Si: 41ON S: ('1)Ntil'Rli("fl(1N ti►'HVI('ES S.I fmsstructr' nir License Si-) nnn01 upr bate ho ,ll'l'�I. ILdJur 11. . -. .._.. .. Iutl'SI. I')pe(•xhulu,ll.--' - - - � L 1\pc Description No. .u1d Sucet 1 l l l4,rcstrielcJ I IlwWin s ti to 1t,1A10 al..lt.l Nlasoil Cigi f+n,l '11+ KC Kot lin Ctnerin µ S N'induw al SiJin SF solid Fuel llurning,\ppiianees �Yvr)t t '�` @�m�� I institution �('\ 'nail aJJreai D 17cnu,litian - 'elc hone S Regist red lionle Imprw Irut untrnctor lHl�) �h Y2 a IIIC' It¢gisu;aiun Number Egnrwitc IIIC '1, pun) Nanl 0 if I(uyistranlNanw �� -\ g�^may@LQHG • Liman address elyl -L rel.. hone 1 frown, tote ZIP OMPENSATION INSURANCE AFFIDAVIT(M.G.L C. I57. 15C(6) SECTION rls WORKERS' Workers Compensation Insurance aMda ' must be completed submittedand with this application. Failure to provide this atfldavit will result in the denial of the uance of the buildingPermit- No ...........Cl Signed Affidavit Attached? Yes .......... SECTION Tat OWNER AUTHORIZATION TO BE COf1IPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property,hereby authorize to act an my behalf, in all matters relative to work authorized by this build in permit applicattiion' �)— Dote Print QNIIM s Nulne(Electronic Signature) SECTION 7b:OWNER1 OR AUTIIORIZED AGENT DECLARATION By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information conttiI d in this application is true and accurate to the best or my knowledge and understanding. j 1 `CLI G1n AS II eta I'riut Uancr's,+r \u0,anred,\guu +Nanw 11 Icctr my Sign,tIIN) No FESs l nut mistercd in—TuobhelHurne In prove nrnting perinil lCulur Ictt)r iHIC) Programti�111!U)iler nave„`ass to thearbitration tracwr reg iniportant inform prograin ur guaran 1 Il l fomru furs an he CunlsiructionhSupery f License or cation on the an be found atC,program'can`brlfound at t\'hen substantial,wrk is planned. prwidr he inl'u inat u n bclo%v: e. finished basement attics, decks or porch g g• b rotal hour area 1 sy. Il.l - -----"- habitable Will count Grui; lieing •ireauy. tl.l --... _. . .. \unlhcr kit'bedruunli \un,beral'linplaccs .. -- _ .. Nomberofhaltl+ulhs \twlherot'hathnwms . . \un,herol'Jaki parches iI')pe of he.ltutg i).hin, _ltl+m,I'nclo.cJ I\re of oohng a uem 1 ..l,,,I $tube h N'LI4'C Intl) he HIhJliltpl 11ir fatal Project CO,1'• ie CITY OF S:u.E. I, \/'LNSS:ICHusETTS BUILDING DEPARTMENT 120 WASHINGTON STREET, 3-FLOOR ' TEL (978) 745-9595 FAx(978) 7.0-9846 KIJ[BERLEY DRISCOLL MAYOR T HobtAs ST.PiERRa DIRECTOR OF PUBLIC PROPERTY/SUMDLNG CONLMSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractorv/Electricians/Plumbers A i licant Information L Please Print Le ib1 Name(Business,Organlzati wIndividuai): �� Ll 6d city/state/zip: Phone H: ire you an employer?Chec the appropriate box: '!'ype of project(required): I. I am a employer with 4. 0 1 am a genLral contractor and 1 6. 0 Ncw construction employees(full and/or part-time).* have hind the sub-contractors 2.0 t am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These sub-contractors 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 their 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers'comp. C. 152, §1(4),and we have no 12.0 Roof repairs insurance required.) t employees. [No workers' 13.0 Other comp. insurance squired.) •Any applicant that chs:ks box AI must also till out the section below showing their worked compensation potiuy inl'ormatiom I hvneawnem who,uhsoit this amdavit indicating they are doing all work and then hire outside contractors must submit a new anMdavit indicating such. 'osorwhsa that climit this box must attached an additional sheaf showing the Owns:of this sub.camrscton and their workers'comp.policy infomtatien. I um an employer that 1s providing workers'corn nsatlgn lusurunee for my employees. Below Is the policy and Jah site information. I h Insurance Company Name: / ` S Policy 4 or Scif-ilts. Lic. 6. 51e J D� p� Expiration Date: art— ( _ JobSileAddress vto V� �1 -.) City/State/Zip:� l _ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration data). Failure to secure coverage as required under Section 25A ot',,IGL c. 152 can lead to the imposition of criminal penalties of a One up to S1,500.00 and/or one-ye imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to 525 .0 a Jay against the v olator. Be advised that a copy Of this statement may be forwarded to the Oft ice of Investigate ut a he A insura ice coverage verification. /du here y �,e�rzis V t/ point at /ties of pc 'ury that the hsfurmullun provided above is it and correct. t �j —•� Darn• P o V Q//icial use e111y. Do"of'write in dris urea,to be completed by city at,lawn official City or'I'uwna .____ Permit/License p Issuing Aulhorily(circle one): -- _ 1. Board of Health 2. Building Department .3.Citylfown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: _..__ Phone 4: ) l 10/15/2012 10 : 58 FAX 1 978 777 9280 CASSIOV ASSOCIATES Z 001/001 AcoRd CERTIFICATE OF LIABILITY INSURANCE DATE(MM(DD(YYYY) 6.� 10/15/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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(8), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A Statement on this certificate does not confer rights to the esrtlfi0sts holder in lieu of such endorsemen a . PRODUCER Office Aocount Cassidy Associates Insurance Agency (701)598-0300 1 FAX , (TS11199-1e90 232 Humphrey Street "IL R AFP RDINGCOVERAGE NAIC4 Swampscott MA 01907 INSURER A,TJ7QVQlQr& INSURED , g Alan F Hayes INSURER C, 2 Fitzgerald Way INSURER Beverly MA 01915 COVERAGES CERTIFICATE NUMBER:CL1210504343 REVISION NUMBER: 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, 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE ADDLOUER P LIDY EFP amylapmlLIMITS LTA GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIASILITY 6 CLAIMS-MADE OCCUR MED EXP(Any pro arson 9 PERSONAL&ADV INJURY 5 GENERAL AGGREGATE E GEN'L AGGREGATE LIMIT APPLIES PER! PRODUCTS-COMPIOP AGO 1 POLICY P LOG S AUTOMOBILE LIABILITY IE,COMBINED ANY AUTO BODILY INJURY(Per Person) / ALLOWNEO r7 SCHEDULED BODILY INJURY(Per eculdent) $ AUTOS NON-OWNED P TY DAMA 6 HIRED AUTOS AUTOS 1 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMM-MADE AGGREGATE 1 ED I I RETENTIONS A WORRERO COMPENSATION X. WC STAT.0 H. AND RMPLOYERS'LIABILITY YIN nA OfFICEROMEM9ERE%CLUDRIEECUTIVEIK ED? NIA E.L.EACH ACCIDENT B 100,000 (Mundwtoq In NH) 009942408 9/12/2012 0/12/2013 E.L.DISEASE•EA EMPLOYEE 1 100,000 110y dewrlbe untlef OE6dRIP IO F DFERATIONa E.L.DISEASE.POUCY LIMIT 8 500,P00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANAdt ACORD 101.Addlllcnal RemArRe Schedule,if more epece is requled) Reference actual policies for coverages, excludicna, terms and conditions. CERTIFICATE H2LDER CANCELLATION (978)7d0-9845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Salem ATT Building Inspector AUTHORIZED REPRESeNTNTIVE 120 Washington Street Salem, MA 01970 ifJ Cassidy/JLM ACORD 25(2010108) 01960.2010 ACORD CORPORATION. All rights reserved. ,.,...,...--.�-. TH..Anmon name and Inn^Ara mnlatarad marku of ACORn I Nlassacltusctts- Department Of Putllic Safch 1 Board Of Building Rr uLttinns and Standards Construction Supervisor License i One.and Two-Family 9s 92258 �"""°"' License CS Z;;, ALAN F HAYES 2 FITZGERALD WAY I a BEVERLY, MA 01916 _ ' Expiration: 9/1212013 TO: 1336 ('ommisyi,mrr' ....- -. 6. Office of�Ce meo°'amA{{ & sin, Regulation officeLio -� HOME IMPROVEMENT CONTRACTOR Type,-- _ Registration 148598 DBA Expiration 10/1112013 a BUILDER ALA F.HAYES CARPENTER&il' ,ri ! ALAN HAYES 2 FITZGERALD WAY: i-i t .:�� — Oa etary erse BEVERLY,MA 0191ffa> CITY OF S.UEM, ANSSACHUSETTS BI:ILDNG DEPAIUM&NT 3 p + 130 WASHNGTON STREET, 3-FLOOR TEL (978) 745-9595 F.♦x(978) 740-9846 KI.%fBERLfiY DRISCOLL AWOR THomis ST.PtERRs DIRECTOR OF PLBLIC PROPERTY/BCILDNG CONLMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris wi be transported by: (name of hauler) The debris will be disposed fin : luy��W t S 6-t (name o facility) (undress of facility) signature of pa mit applicant bj a(e drbrumt:dx LICd 092258 ' _ FuOy Insured HIC B148598 ,�+Zlj?etllt� taf1 v�RY: Complete Home Remodeling Kitchens' Baths`Custom Cabinetry Fine Finish Work Design/Build Solutions for your home *2 Fitzgerald Way Beverly,MA 01915* October 3, 2012 Sallie Cass 92 Columbus Ave Salem, MA SECOND FLOOR BATHROOM REMODEL *demo the existing tub area remove the the to the frarpa de o the existing tub reframe as needed for the new provided-tub LYI0 -f c I e W- e� _ nva�l Insulate all open exterior walls with no less than R 15 fiberglass batt type insulation wit h�att c vapor barrier *cement board install by others *remove the vanity patch walls as needed *install new provided vanity and hardware *remove the existing flooring to the sub floor re fasten existing flooring repair/re place as needed *cut in provided recessed medicine cabinet and install *install new trims to match the existing using stock moldings *work with the other trades as needed for their access needs *leave job site no less than broom clean at the end of each day of work *clean and haul away all debris made by this.project *take out all proper and needed permits for this project k Yem�ve, o(c4 ce(( un� 4-. in5�6e� nG4� bic�eF3rcA Lece�� . Estimated project costs:- $4200- $4800 all carpentry as described $1150 all electrical as discussed onsite PLUS the cost of all permits Actual costs will vary depending on the true scope of work that is needed to complete this project Rates of pay: $60.00 per hour lead carpenter$55.00 other carpenters/laborers $75.00 per hour electrician Terms of payment: $500.00 deposit/first payment due upon signing this contract $2000 second payment to be made on the day this project starts $1000.00 third payment to be made on the day the demo is completed Final payment to be made on the day this project is completed LICOHIC 092258 �e� FuAy Inwred L:c€i�t�Cfis i��+t October 3, 2012 A start date for the week of October 15th can be scheduled based on all other trades and project materials being available I will be working on a time and materials basis with the rates of pay outlined above and will update this project budget by email as needed for your review. Please review this contract and get back to me with any questions you might have. Please print and sign this contract and mail to me along with the deposit to: Alan Hayes 2 Fitzgerald Way Beverly, MA 01915 Please make all checks payable to Alan F. Hayes Thank you Alan F Hayes Home owner / Date Contractor Date The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF J, Massachusetts State Building Code, 730 CNIR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Divelling This SecttonFor'Official Use Only Building Permit Number Date A ptic&,. f G. Z92- al(PrintName) Si nature ; Date SECTION L SITE INFORINL ON ddress: 1.2 Assessors Map & Parcel Numbers %r 6✓s ,4 t✓ 1.1 a 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 ft) Frontage(ft) 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: 1.3 Sewage Disposal System: Zone: _ Outside Flood Zone? ❑ Private❑ Check if yes❑ Municipal ❑ On site disposal system ❑ SECTION 2:,'PROPERTYOWNERSH1Pt. 4Public .1 Owner'of Record:6 tlCv� SSte/ /r7o Name(Print) City,State,ZIP arC'o.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK"(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ AccessoryBldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: . I Official Use Onl Labor and Materials Y. 1. Building S I Building PermitFee S Indicate how fee is detertitined: Electrical S ❑ Standard City/Town•Application Fee 2. I Total Project Cost'(Item.6)x multiplies x 3. Plumbing S 2. Other Fees: S x h 1. %Mechanical (HVAC) S List: 5. Mechanical (Fire S _Suppression) "Coral All Fees: $_ c f� Check No. Check mount: ;\mount. 6. 1•ontl Project Cost: S O �yv z ❑ Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL/) k e 5' -r.+ (5, 2 6 9 t�� j h . �3y✓�4(i?i� I _ License Number Expiration Date /11111 me of CSL Holder p List CSL Type(see below) Type _ - Description No. ar d Street U Unrestricted(Buildings up to 35,000 cu. ft.) y-/ 4—r— C 1 $O 3 R Restricted 1&2 Family Dwelling try/town, Stat 0, P bt Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning e\ppliances rDemolition Telephone Email address 5.2 Registered Home Improvement Contractor(HIC) G E f-- o- n 6 <5�h f LbcnC Cc) t h C r vt.�..o.,v� 1- on Number ExpirationUatHICCompany Name or Fll ' Re istrant Name � a Sc c� ?No.A�td Str try (s� , r !' Email address Cit /,Town,State, ZIP Tele hone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property,hereby authorize ;tofobehatf, in all matters relative to work authorized by this building permit application. /3 amz(Electronic Signature) Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained 'a 's . plication is true and accurate to the best of my knowledge and understanding. Pri Dw e s or Authurized Agent's Name(Electrof 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.O.L. c. 142A. Other important information on the HIC Program can be found at wway.niass,govioca Information on the Construction Supervisor License can be found at Www.ntass.eoV'(10 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. III Habitable room count Number of fireplaces- Number of bedrooms _ — Number of bathrooms _ Number of half/baths type of heating system _—-- Number of decks/porches -- -- - -- - --- I'ypeofcoolingsystem_---_----_— Fatcloscd- _..-------_Open 3. `'total I'noject Squaro Footage„ may be substituted fix.. oml Project Co,[" ' I _ Mr �r CITY OF SALEM) &LaSSACHUSETTS 13U=INGDEP.1RTNtENT t c 130 W.ASHCYGTON STREET, 3" FLOOR TEL (978) 745-9595 KINMERLEY DRI_SCOLL FAX(978) 740-9845 ibL�YOIt Tfiosw ST.PIERRa DIRECTOR OF PUBLIC PROPERTY/BUUm0tG CONNISSIONER Construction Debris Disposal Affldavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section l t 1.5 Debris, and the provisions of NfGL c 40, S 54; Building Permit #this work shall be is issued with the condition that the debris resulting from ill, S ISOA. disposed of in a properly licensed waste disposal facility as defined by MGL c The debris will be transported by: (name ofhauler) The debris will be disposed of in : (name of facility) q (address oftacihty) signature of permit applicant Z - Z 5= /� Mate adn .,itd.x CITY OF S:1ILE,),I ANSSACHL'SHTTS s BUILDING DEPART\IEDIT 120 WASHIINGTON STREETS 3'e FLOOR T EL (978)745-9595 PAX(973) 740.9844 KI\fBERL.EY DRISCOII . I1iosL+s ST.p1E aRs 1VUYOR DIRECTOR OF PUBLIC PROPERTY/BUIIDLNG CO3LMISSIONER Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly Name:(ousilx•,&Orpniratiorulndividual): _J ,J S�fJ"O y` 1-s; V Address: �� City/State/Zip:aAu�QA_/�'w" ' �Phane�: �i / � 6 if le � � p Are ou an employer?Check the appropriate boar Type of project(required): 1. I am a employer with 4. ❑ I am a gomaal contractor and 1 6. ❑New construction employees(Ball and/or part-time).* have hired the sub-contractors 2.❑ I am a solo proprietor or partner- listed on the attached sheet t 7. ❑Remodeling ,hip and have no employees These sub-contractan have B. ❑Demolition working far me in any capacity. workers'comp.Insurance. 9. O Building addition (No workers'comp. insurance S. ❑ We are a corporation and its required.) officers have exercised their 10.0 Electrical repairs or additions 3.❑ i am a homeowner doing all work right of exemption per MGL 1 I.❑Plumbing repairs or additions myself.(No workers'cutup. c. 152,§1(4),and we have no 12.❑Roof n pairs pp insurance required.] t employees. [No workers' IJ [ 91her �iC-/d i camp.insaranca required.) -Any uppIi,aM that vliwkt boa sl must also fill uut This savtioa be ow,thawing their warkan'orni nudun policy infurmatiom 'I t wguwma who sltmil this affidavit indicating Thay,am doing all work and dust him"laid,contmaron main submit a mass arridavit indicting such. :Cumrautcn that chT.<k This box must ollachad an"ddidutwl abut showing The awns of the tub;,atintrsclon and Thalr workers'amp.polity InrwmaHan. l tun en employer that Is provldlnR ivarken'compwasadoe Gtsurrrnce for my employeez Below/a floe policy and Job slot infaranaflotc Insurance Company Name: �.el `J 7 Policy A or Self-his. �Lic.0: Af if Z �2 4 J 3 SI U/�tion Date: 7— Job Site L Address: Z eel /UxN k,Z;T Ciry Zip:Gl f70 Aleach a copy of the workers'compensation policy doelaration page(showing the policy number and expiration data). Failum to sucuru coverage as required under Section 254%of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a lino of up to$230.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Ohico of Investigutium ui tha DIA for insurance covcrago vcririealiom /do hereby eertlf t tar palms auJ perruldes ofperfury that the Gtfunnudoo providdd above is true and correct Tien Iture: / f�C( �^� Date: 2- /3 — 2 5 — 6 PFunei; /(!f7 f/ U � YG q/Jrcfar ass auly. Oa naf rvrile in r/r6r unay m de camp/ddd by city ur lawn n/flr,a i city or'rown: __. Prrmlt!►.Iccnsek Ixsuing,kulhurily(circlo one)! 1. dourd of health 1.fiuildlnp Ileparnnent .1.CilyMmn Clerk J. Electrical fospectur 5. Plumbing inspector 6.01her I iContact I'ersnn:. -_... .._ Phona B• CHARGE COPY JBSASHtB Sash &-Door Co., Inc. Ord #: 165479-0 Manufactures&Distributors A-do'%- OR DOOR-WINDOWS -MILLWORK geD%.9p 280 Second Street:Chelsea;MA 02150 Route: NONE (617)884-8940 1-800-648-9339 Fax#(617)884-9288 Page: 1 of 4 HOME OFTHE WINDOW BOYS wwWjbsash.cora Order: 01/23/13 o: CAS591 Ship To: Sched: ;ALLIE CASS INSTALLATION )2 COLUMBUS AVENUE 92 COLUMBUS AVENUE Printed >ALEM MA 01970 SALEM MA 01970 Date: 02/21/13 Time: 10:44 AM 'hone: (978) 744-7640 Phone: Attn: / Cell : Entd: EOD In: 15 / Out: 15 Terms: COD Cust PO#: SALLIE CASS Customer Instructions salliewcass@comast.net Line # Item Number Description Quantity Shipped Comments 0001.00 Remark: REVISED 1/10/13 0002.00 Remark: 1ST FLOOR KITCHEN 0003.00 *165479003.00 CUSTOM MARVIN HAMPTON SAGE 1.00 CLAD AWNING WINDOW UNIT VENTING CASE TO CASE 67 3/4 X 57 3/4 PRIMED PINE INTERIOR LOE-366/ARGON INSUL GLASS 7/8 SDL-NO SPACERS 28 LITES (7W4H) SATIN TAUPE FOLDING HANDLE SATIN TAUPE SCREEN 4 9/16" JAMB BRICKMOULD CASING APPLIED 5/4 X 5 FLAT PINE HEAD CASING 1 X 4 FLAT PINE SIDE CASING AND APRON 6" STOOL CAP (EXISTING R/0=66 112" X 56 112 CLAPBOARD SIDING) 0004.00 Remark: DINING ROOM CHARGE COPY JR JBSash &Door Co., Inc. Ord #: 165479-0 Manufactures&Distnbutcn DOOR—:W[A'DOWS -MILLWORK &D.4,0R, 280 second Street,Chelsea,MA 02150 Route: NONE (617)884-8940 1-800-648-9339 Fax#(617)884-9288 Page: 2 of 4 HOME OF THE WINDOW BOYS w w lbsash.com Order: 01/23/13 To: CAS591 Ship To: Sched: SALLIE CASS INSTALLATION 92 COLUMBUS AVENUE 92 COLUMBUS AVENUE Printed SALEM MA 01970 SALEM MA 01970 Date: 02/21/13 Time: 10:44 AM Phone: (978) 744-7640 Phone: Attn: / Cell : Entd: EOD In: 15 / Out: 15 Terms: COD Cust PO#: SALLIE CASS Line # Item Number Description Quantity Shipped Comments 0005.00 *165479005.00 CUSTOM MARVIN HAMPTON SAGE 1.00 CLAD AWN PICT UNIT -STATIONARY UNIT-CUAWN6456 STATIONARY CASE TO CASE 67 3/4 X 57 3/4 PRIMED PINE INTERIOR LOE-366/ARGON INSUL GLASS 7/8 SDL-NO SPACER 28 LITES (7W4H) 4 9/16" JAMB BRICKMOULD APPLIED CASING LOOSE, CUT AT JOBSITE 5/4 X 5 FLAT PINE HEAD CASING 1 X 4 SIDE CASING AND APRON 6" STOOL CAP (EXISTING R/0=66 1/2" X 56- CLAPBOARD SIDING) 0006.00 Remark: 2ND FLOOR BATH 0007.00 *165479007.00 CUSTOM MARVIN HAMPTON SAGE 1.00 CLAD AWNING WINDOW UNIT- CASE TO CASE 55 5/8 X 31 112 PRIMED INTERIOR LOE-366/ARGON INSUL GLASS 7/8 SDL-NO SPACER- 18 LITES (6W3H) SATIN TAUPE FOLDING HANDLE SATIN TAUPE SCREEN 4 9/16" JAMB BRICKMOULD APPLIED 1 X 4 FLAT PINE INTERIOR CASING PICTURE FRAMED (EXISTING R/0=54 X 30- CLAPBOARD SIDING) i 1B Sash & Door Co., Inc. CHARGE COPY JBSASHOrd #: 165479-0 Mauufactu m&Distributors =00 DOOR—WINDOWS -MILLWORK 280 second street,Chelsea;MA 02150 Route: NONE (617)884.8940 1-800-6489339 Fax#(617)884-9288 Page: 3 of 4 HOME OFTHE WINDOW BOYS www.bsash.com Order: 01/23/13 To: CAS591 Ship To: Sched: SALLIE CASS INSTALLATION 92 COLUMBUS AVENUE 92 COLUMBUS AVENUE Printed SALEM MA 01970 SALEM MA 01970 Date: 02/21/13 Time: 10:44 AM Phone: (978) 744-7640 Phone: Attn: / Cell : Entd: EOD In: 15 / Out: 15 Terms: COD Cust PO#: SALLIE CASS Line # Item Number Description Quantity Shipped Comments 0008.00 Remark: BEDROOM I/BEDROOM II 0009.00 *165479009.00 CUSTOM MARVIN HAMPTON SAGE 2.00 CLAD DOUBLE HUNG UNIT CASE TO CASE 31 5/8 X 55 112 PRIMED INTERIOR LOE-366/ARGON INSUL GLASS 7/8 SDL-NO SPACER-6/6 LAYOUT SATIN TAUPE SASH LOCK BEIGE LINER HAMPTON SAGE SCREEN 4 9/16" JAMB BRICKMOULD APPLIED 1 X 4 FLAT PINE INTERIOR CASING (SEE PICT) #1268A STOOL CAP (3 112") (EXISTING R/0=30 X 54- CLAPBOARD SIDING) 0010.00 Remark: BEDROOM I 0011.00 *165479011.00 CUSTOM MAVIN HAMPTON SAGE 1.00 CLAD DOUBLE HUNG UNIT CASE TO CASE 39 3/4 X 66 PRIMED PINE INTERIOR LOE-366/ARGON INSUL GLASS TEMP 7/8 SDL - NO SPACER-8/8 LAYOUT SATIN TAUPE SASH LOCK BEIGE LINER HAMPTON SAGE SCREEN 4 9/16" JAMB BRICKMOULD CASING APPLIED 1 X 4 FLAT PINE INTERIOR CASING (SEE PICT) #1268A STOOL CAP (EXISTING R/0=38 X 65 1/2") A Sash & Door Co. Inc. CHARGE COPY JBSASHt Ord #: 165479-0 M rnanufa m 8 Disafbmlars 00 RDOOR-WINDOWS -MILLWORK 280 Second Street,Chelsea,MA 02150 Route: NONE (617)884-8940 1-800-648-9339 Fax#(617)884-9288 Page: 4 of 4 HOME OF THE WINDOW BOYS www.Ibsash.com Order: 01/23/13 To: CAS591 Ship To: Sched: SALLIE CASS INSTALLATION 92 COLUMBUS AVENUE 92 COLUMBUS AVENUE Printed SALEM MA 01970 SALEM MA 01970 Date: 02/21/13 Time: 10:44 AM Phone: (978) 744-7640 Phone: Attn: / Cell : Entd: EOD In: 15 / Out: 15 Terms: COD Cust PO#: SALLIE CASS Line # Item Number Description Quantit Shipp ed Comments 0012.00 *165479012.00 CUSTOM MARVIN HAMPTON SAGE 1.00 CLAD ROUND TOP FOR ABOVE DH DOUBLE HUNG UNIT-CN3221 CASE TO CASE 39 3/4 X 21 3/4 LOE-366/ARGON INSUL GLASS PRIMED INTERIOR 8/8 SOL NO SPACER-SUNBURST 6 RADIUS LITES 4 9/16" JAMB BRICKMOULD CASING APPLIED 1 X 4 FLAT PINE INTERIOR CASING (SEE PICT) 0013.00 INSTALL INSTALLATION OF ABOVE 1.00 INCLUDING REMOVAL OF DEBRIS FROM JOBSITE 0014.00 INSTALL BUILDING PERMIT FEE 1.00 Received By: > --------- -- .. ._.. - JBSASHJB Sash & Door Co., Inc. Quo #Pro9319z Manufacn¢en&Dismsiurors j DOOR—WINDOWS -MILLWORK &"OOR 280 Second Street Chelsea,MA 02I50 1 j Route: NONE (61-)884-8940 1-800e48-9339 Fay=(e17)884-9288 page: 5 of 5 HOME OF THE WINDOW BOYS cNm.ibsash:enm Quote: 12/19/12 To: PR0300 Ship To: Sched: j SALLIE CASS INSTALLATION 92 COLUMBUS AVENUE 92 COLUMBUS AVENUE Printed SALEM MA 01970 SALEM MA 01970 ; Date: 01/10/13 Time: 12:37 PM_-__; Phone: (978) 744-7640 Phone Attn: %Cell: — i Entd: AALM In: 15 ! Out: 15 Terms: COD Your Order: SALLIE CASS I 1 JB Sash & Door Company is a Lead-Safe Certified Firm. has fulfilled the requirements of the Toxic Substances Control Act (TSCA) Section 402. and has received certification to conduct lead-based paint renovation, repair and painting activities pursuant to 40 CFR Part 745.89 as required by the United States Environmental Protection Agency. Certification # NAT-21346-0 J.B. Sash & Door Co. takes no responsibility for unforeseen deterioration of structural j members in walls in which new window or door units are to be installed. We also will not be held responsible for changes to plumbing or electrical systems. Furthermore, existing shutters. storm windows, and shades may not fit once your new replacement windows are installed, and as such is the responsibility of the homeowner. Payment in full is to be collected by installers at the conclusion of all jobs. In situations where punch list items exist at the completion of installation, JB Sash will determine a reasonable amount of the balance due to be retained by the customer until punch list item(s) have been completed. Any and all costs incurred in collection of outstanding balances, whether or not resulting in litigation, including but not limited to reasonable attorney's fees are the responsibility of the undersigned. We PROPOSE hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: i EIGHTEEN THOUSAND FOUR HUNDRED EIGHTY-FOUR DOLLARS AND 27 CENTS 18,494.27 I c I Payment to be made as follows: 33 1/3% DEPOSIT BALANCE DUE C.O.D. Authorized Signature: 11 I JBS MASS. HOME IMPROVEMENT CONTRACTOR REGISTRATION #152085 ACCEPTANCE OF PROPOSAL - The above prices. specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be ade as outlined ov . Date of acceptance: 3 / Signature: PRICES SUBJECT TO CHANGE '+WITHOUT NOTICE Merchandise. . . : 17.822.55 Tax. . . . . - . . . . : 661.72 Misc Charges. . . 0.00 Quote Total. . . : _18,484,27 i Client#:'131473 JBSASHDOOR ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE`MMfUDNYYY) 5/0912012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS 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 terns and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER CONTACT HUB International New England NAME:PHONE - FAX — 600 Longwater Drive E-MAIL, 781 792-327T _ _ ac,Ne): 866-799-2460 _ Norwell, MA 02061 ADDRESS: 781792-3200 INSURER(S)AFFORDING COVERAGE NAICk — ------- — INSURER A:Hanover Insurance Company INSURED J 8 Sash&Door INSURER B: 280 Second Street INSURER C: Chelsea,MA 02150 INSURERD: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICYEFF POLICY 113T LTft TYPE OF INSURANCE INSR MD POLICY NUMBER MMR10 MM/DDIYYYY)_, LIMITS A GENERAL LIABILITY ZDN908109900 D3/23/2012103123/2013 EACH OCCURRENCE $10001000 _ X1 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurtence s500,000 CIAIMS-MADE F XI OCCUR MED FXP pA yore Pa.) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 POLICY X FE� LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aWdaq $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA A x x OCCUR UHN9045697 3/2312012',03/23/201 EACHOCCURRENCE _ $3000,000.. _ EXCESS LIAR CLAIMS-MADE AGGREGATE $3,000 000. DED I I RETENTION$ _ - __ __ S WORKERS COMPENSATION - T WC STATU- OTH- -------- - - OFFICEWMEMBER EXCLUDED'+XECUTNE NIA EL.EACH ACCIDENT $ ANY ROP R ' ABILITY Y I NIM (Mandatory in NH) i ', E.L.DISEASE-EA EMPLOYEE $ N yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S - I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Operations usual to the insured. CERTIFICATE HOLDER CANCELLATION J.B. Sash &Door Co., Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 280 Second Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN J A ACCORDANCE .k ITH THE POLICY PROVISIONS, I Chelsea, MA 02150 I I AU HORIZED t 26 CZOHOAIS, _, .. , ^s-•.:. e. - 3 :-. 'tEa't Client#:635081 JBSASHDO ACORD,. CERTIFICATE OF LIABILITY INSURANCE DV201z/DDolz2 zo/ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 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.H SUBROGATION IS WAIVED,subject to the terms and Conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT USI Ins Sery of MA, Inc PHONE FAX -- Mal EXI:781 938-7500 __ " Nap 781-376-5035 12 Gill Street EMaL ---_. - ---- - Suite 5500 ADDRESS: Woburn,MA 01801 INSURER(S)AFFORDING COVERAGE NAIC A INSURER A:Liberty Mutual Insurance Compan 23043 INSURED -J B Sash&Door Co Inc INSURERS:First Liberty Insurance Corpora !33588 230 Second Street INSURER C: Chelsea,MA 02150-710 INs'1' O: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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, 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR pDOL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE - INSR MID POLICY NUMBER_ MM/DDIYYYY MMIDO LIMITS GENERAL LIABILITY --- ' - - _-- ----- EACCHH OCCURRENCE f COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED .__.I__-, PREMISES Ea vwrreneel.-. CLAIMS-MADE f-_ OCCUR ! M_E_D EX_P(My one person) PERSONAL S ADV INJURY S GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG E POLICY PE0 LOC S B AUTOMOBILE LIABILITY AS6Z11243358032 01/0112012l01/0112013 EOM�BIINNE�DISINGLELIMIT 51,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X. UMBRELLA LIABII AUTOS BODILY INJURY(Per acddenl) $ HIRED AUTOS iX NON-OWNED PROPERTY DAMAGE AUTOS _LPer arvd t 1 OCCUR EACH OCCURRENCE _ E EXCESS Late - -_--- _-- CIAIMS-MADE AGGREGATE S DED RETENTION$ A S COMPENSATION X AND EMPLOYERS'UASILITY WClZ11243358012 710112012107/011201 'X YIN WOC STATU- TH- EIR ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT ESOO,000 If yes,describe under OF NH) EXCLUDED? NIA _— (Man,fa[ary in E.L.DISEASE-EA EMPLOYEE SSDD DDD ntl DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT fSDD,DDD DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,IT more space Is required) Operations usual to sash and door manufacturing and installation. Blanket Waive of Subrogation Applies to Workers Compensation when required by written agreement. CERTIFICATE HOLDER CANCELLATION J B Sash &Door CO Inc- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 28O Second Street ` ACCORDANCE WITH THE POLICY PROVISIONS. y Cher sea, DNA 02150,710 f f I AUTHOPJZ£D REr'RESENTP.1'!VE I i © Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 152085 Type: Private Corporation j - Expiration: 7/28/2014 Tr# 226411 J B SASH & DOOR CO, INC. RICHARD BERTOLAMI 280 SECOND STREET CHELSEA, MA 02150 _ Update Address and return card.Mark reason for change. U g P SCAT 0 20M-05m ❑ Address ❑ Renewal ❑ Employment Lost Card ! Cafes mer Affairs&Business Regulation of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration •.152085 Type: Office of Consumer Affairs and Business Regulation xpirahon 7J28/2014. Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 J B SASH&DOOR CO,1NC _ r RICHARD BERTOLAMI x, 2 280 SECOND STREET CHELSEA,MA 02150 Undersecretary INKt valid without signature n nu - i n �upcn i. i ,F : F-.: n CSFA-067268 RIMARD L BE$TOLAAH - 35 SUNSET DR ',{ 2 ' BURLINGT6N MA Itl l - - =Fr: Commissioner CXUifatiCr' 1 1/2112 01 3 Restricted-One-and two-family dwellings or any accessory building thereto, irrespective of size. Failure to Possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS licensing information visit: www.Mass.Gov/DPS December 12,2011 To Whom It May Concern, Gary Troy is authorized to be an agent for Rick Bertolami and 1B Sash and Door Company as it pertains to the application of permits. Thankyou, P� Rick Bertolami 1B Sash and Door Company 617-884-8940 The Commonwealth of Massachusettsi` , Board of Building Regulations and Standards kIQfB, l '. Massachusetts State Building Code, 780 CMR Q� 2$ Lt�vt SALE 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a a One-or Two-Family Dwelling _ This Section For Official Use Onl Building Permit Number: Date Applied: „9 Building Official(Print Name). - Signature Date SECTION is SITE I141FORb1ATIOW I.1 PrTrty Address: 1.2 Assessors blap&Parcel Numbers R t l-a Lu r-v a ? I.In Is this an accepted street?yes 110 M1lap Number Parcel Number 1.3 'Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq t)) Frontage(11) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided L6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system [3 Check if ycsO SECTION 2: PROPERTY OWNERSHIP!'' 2.1 Owner of Record: 5A LA-ie sA City,S IRt1me(Print) State,ZIP �Z, Cp LAJ,wibus N1,14 . yt� ltn�A Cf1LLICWtikp.0 C0rrr..A51, it No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Altemtion(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work : cA \Wclir SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials) I. Building 3 1 p 3 1. Building Permit Fee:S Indicate how fee is determined: ❑Standard Cityfrown Application Fee 2. Electrical S ❑Total Project Costt(item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 1 ' 4. Mechanical (HVAC) S List �'`l 5. ,Mechanical (Fire S 'Fetal All Fees:S Su ressiva Check No._Check Amount: Cash Amount_ 6.Total Project Cost: S "t ❑Paid in Full ❑Outstanding Balance Due: Mf 11- s-0 � 101 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) pfp? (p It Li 1 l License Number Esp union ate Name of CSL Holder List CSL'rype(see below) R '3ri �v.,riCP� �R -Types - - Description . No.;md Street U Unrestricted Ruildin s tip to 35,Ou0 cu.It. Restricted M21'amil Dweilin City/I'own,Slalc, IP — Masonry RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances Insulation �17g��yr9�yo �{��t�y3 q ,;ore Email address I Demolition 5.2 Registered Home Improvement Contractor(HIC) , 5 2 D g ! ' (�,� Gta Vt4C, HIC Registration Number Er 'ration ate f IIC Company Name or HI` Registrant Name 2a4 Se t-t w lh cyr 1�iC tG SCi S�iS.� C0(A No. and Street Email address Ci /Town,State ZIP Tel. hon. SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GL c. 152.§ 25C(6)).. Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Isluance of the building permit. Signed AtTidavit Attached? Yes ..........❑ No...........O SECTION 7a:OWNER AUTHORIZATIONTO BE COMPLETED WHEN: OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize t9 act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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 nut 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 wvww mass i:tWoca Information on the Construction Supervisor License can be found at www.mass.aov:'dos 2. When substantial work is planned,provide the information below: "fotal fluor area(sq. ft.) (including garage, finished basement/attics,decks or porch) Gross living area(sq. ttJ Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Ty1 x of heating system Number of decks/porches Enclosed Open Type of cooling s stem P YV Y 3. "ii'mal Project Square Footage"may be.substituted for"rural Project Cost" chycFSAmm MmAQiimn inr�at�rr unw,�m�vs�rsD � �+�-ems. • Ir A MIM L EM AD-0 b �� 7trousS�.P�ae Dmec m a rpumia"WOM[ MMcaomamcm Construction Debris Disposa/Affjdavit (required forall demolition and renovation worki In amordence with the sixth edition of the state Burins code, 7tv am, section ills mtri; and the provisions of MGL c40,S 54; auii ft Permitif is Issued with the condition that the debris nesul ft from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c ill,S 150k The debris will be transported by: 5,� � MtJD �ea,q, (name of hauler) The debris will be disposed of in: (name of facility) (address of facility) Signat e/ applicant to The Canrntontateallb of Manakuseib PERMIT N o. - Dgarf WoflndW&WAccldsnb j C.09a of Invadgadont 1 Congress Sbeg Suits 100 Barton,MA 02114-2017 Workers'Compensation InjmnceAUdav�ib BBgt��Contractors/Eleetriclaoa/pinmbers �prslicaat InformaHoo Unam Plea.+ Pri * r t,ti Tame(BO�ni>adodlnmdauai) T( S _ arm — Address Ci /State0 :Chr � VA a � •Jhone#: . Are you an employee?Check the appropriate be v t. I am a employer witk� 4. []I am a$octet contractor and i Type of proJwt(required): employee+(&U sad/ar parkum)a have hkW the 6..C]New n 2. I am a Bole proprietor .ur parmer. listed on the attached shear. 7. - - shrp and Gavd uo ampbwry _ ZLe� wmidng for me in my capacity. employes and have wad m 8• ❑Demolition [No workers, comp.inacmce comp h m nems 9. C]Building addition required) . s• Q We at a coepoead n and its. Io.C]Elecnical mrepakr or additions 3.❑ I am a homeowner doing allwodt : aft"haw a arched thde r"LE (No wod ai comp,. right of mtamptlon Perm,: . I I.C]Phmsbma tepaira or additions iusorimce r«luireji r. a 15Z 41(4)�and we haw no, I2.C]Roof tepan employaeer(No wa carI 13.[]Othm. kum>xr f Homeoweam•hs mhmk uds dsdwaWo e t eta do saris bore tirelns theiwuida' l r maatmatiaa �Commmtactehatkmkteammlamrketia�ing �alao�diirtW mlltr.kiwegt<dapae�ae , ymoetwhsYasewa®dnittadicadaa : �ObYaa► UtW ma•oomwamhaw eo4lorata,:yr tart Pp* ihdt��cehmm'�ft 116400fteem end a.awhon w Or am to"ao[hia has °®F Pdb!®bar am am sntPloyq LW&provibg WWI,Odra beaaaaoe infonnadm% lff a4 wPloyeaL Before le rM po(kr and Jot af# Inn inusce Company Ntma_ f t��Ty Policy#or Self-his.Lla# — n— Expkadan late JobSitaAddremLpo 92 1 okay V S ire �' c� Attach a copy of the workers' compeatatlm Polley de istatloa taterLi Fatltue to seetae wverage a.requited tinder Section 21A of MaL pap jpdgtp� �number and expinHon date). fine up to S 1 300.00 mdla oat year impeiaottmmk u well u civil mtpoaitica of aimmal penalties of a Of up too S 1'00 a day against the violator: ea Pis in the-form of a STOP WORK ORDER and a fine Investigatiaoa of the DIA for @ vend that a mPY of ttda statement may be forwarded to,tha office of imruance wverage veriflcatlad !Jo bnebr crrriJj undo Wo Pw=and P afPpl+ry that I"Inforarsb:e �ed P+ above is hue and correct Si C) Offfcfof use only. Do not wrfrg in!big area,Is be co "tPlad by city orWwa ofJlclaL City or Town: Permlt/Liceass# Issuing Authority(circle one): t. Board of Health 2. Building Department 3.City/rowa Clerk 4. El 6. Other ectrical Impector i. Plumbing lnepectoe 11 Contact Person: Phone#: JBroposer JBSAS.H' ,Sash & Door Co., Inc.tnc. Quo #: 112354 Manufacturers&Distributors D06-3C=WINDOWS -DMUWORK &'hDOOR 280 Second Street,Chelsea,MA 02150 Route: NONE (617)884-8940 1-800-648-9339 Fax#(617)884-9288 Page: 1 Of 3 HOME OF'THE WINDOW BOYS www,bsash.wrn. Quote: 08/24/16 IQ: cAs591 Ship TO: Sched: SALLIE CASS INSTALLATION 92 COLUMBUS AVENUE 92 COLUMBUS AVENUE Prin ed SALEM MA 01970 SALEM MA 01970 - Date: 08/25/16 Time: 08:58 AM Phone: (978) 744-7640 Phone: IAttn: / Cell : Email : CALLIEWCASS COMCAST.NET i Ento : AALM ! In: Out: 15 Terms: COD Your Or er: j -riictnmer. r_nctrurtaonc salliewcass@comcast.net I Net LLint; # Item Number Description - Quantity U/M Net Price Extended U SQMA RVIN CUSTOM MARVIN HAMPTON SAGE 1.00 EACH 4. CLAD D/H NEXT GENERATION WINDOW TO MAINTAIN OM SIZES OF ULTIMATE D/H UNIT R/o=38 1/8" x 64 9/16" (c/c=39 3/4" x 66) PRIMED PINE INTERIOR ppppppYY,,,��^,,,,, �(�. LOW E-3/ARGON INSUL GLASS �` (�`tII. 0 7/8 SOL - NO SPACER p C hbI 1t 8/8 LAYOUT SATIN TAUPE SASH LOCK BEIGE LINER HAMPTON SAGE SCREEN j 4 9/16" IAMB � b eI� n cd P�( CUT AND APPLIED AT ]OBSITEf ` �1'!Fk PVC SILL NOSING l rJ j 1 X 4 FEAT PINE INTERIOR 6-b _._ j CASING #1268A STOOL CAP (EXISTING R/0=38 X 65 1/2") j i I Proposal JB SIQ AAS- 1B Sash & Door Co., Inc. Quo #: 112354 NW�Facturss&Distributors OOR DOOR-,tV1NDOGVB -MILLWORK &D 280'Second Street,Chelsea,MA-02150 Route: NONE (617)884-8940 1-800-648-9339 Fax#(617)884-9288 page: 2 Of 3 HOME OFi"THE WINDOW BOYS www.ibsash.com Quote. 08/24/16 IQ: CAS591 ship Sched: SALLIE CASS INSTALLATION 92 COLUMBUS AVENUE 92 COLUMBUS AVENUE Prin Pd SALEM MA 01970 SALEM MA 01970 Date: 08/25/16 1 Time: 08:58 AM Phone: (978) 744-7640 Phone: Attn: Ce Email: CALLIEWCASS COMCAST.NET - Ent : AALM li In: , Out: 15 Terms: COD Your Order: - Net Line # Item Number Description Quantity U/M Net Price Extended SOMARVIN MARVIN HAMPTON SAGE CLAD ROUND EACH 2,779.35 5' TOP TRANSOM ABOVE D/H UNIT- ] CN3221 - R/o=38 38" x 21 3/4" LOW E-3/ARGON INSUL GLASS �r PRIMED INTERIOR--_� - � ul, f!, 7/8 SDL NO SPACER- F SUNBRUST 6 RADIUS LITES 4 9/16" JAMB-NAILING FIN 6ry PPk LOOSE ��j f{� 1 X 4 FLAT PINE INTERIOR ,0A So 't14 I CASING C INSTALL INSTALLATION OF ABOVE 1.00 EACH ! INCLUDING THE REMOVAL OF DEBRIS FROM JOBSITE AND THE BUILDING PERMIT FEE *OWNER AUTHORIZATION# I, [ as Owner of the aforementioned property hereby authorize (print name of owner) JB Sash&Door Co.Inc.to act on my behalf during the work authorized pursuant to this application. Owners pulling their own permit or dealing with unregistered contractors do not have access to the Ai titration Program or G r my Fund(as set forth in MGL c.142A) i / Signature of Owner:. Date: 4:1 I I I I Proposal JB Sash &Door Co,, hic. Quo #: 112354 JB S. WTlattateis&Dislnbato s H. ... .DOOR-,w4NDDWS - MLLWORK &DOOR 280Second Street,Chelsea,MA 02150 Route: NONE (617)884-8940 1-800-648-9339 Fax'#(617)-884-9288 Page: 3 of 3 HOME OFITHE WINDOW BOYS www.bsash.com Quote: 08/24/16 in: CAs591 ship To: Sched: SALLIE CASS INSTALLATION 92 COLUMBUS AVENUE 92 COLUMBUS AVENUE Printed SALEM MA 01970 SALEM MA 01970 Date: 08/25/16 Time: 08:58 AM Phone: (978) 744-7640 Phone: Attn: cell : Email : CALLIEWCASS COMCAST.NET Ent : AALM IIn: Out: 15 Terms: COD Four order; JB Sash Door Company is a Lead-Safe Certified Firm, has fulfilled the requirements of the Toxic Substances Control Act (TSCA) section 402, and has received certification to conduct lead-based paint renovation, repair and painting activities pursuant to 40 CFR Pant 745.89 as required by the United states Environmental Protection Agency. certification # NAT-21346-0 J.B. Sash & Door co. takes no responsibility for unforeseen deterioration of structural members in walls in which new window or door units are to na ifista a we a so will not be si o plumbing or electrical systems. Furthermore, existing shutters, storm windows, and shades may not fit once your new replacement windows are installed, and as such is the responsibility of the homeowner. Payment in full is to be collected by installers at the conclusion of all jobs. in situations where punch list items exist at the completion of installation, JB sash will determine a reasonable amount of the balance due to be retained by the customer untjil punch list item(s) have been completed. Any and all costs incurred in collection of outstanding balances, whether or not resulting in litigation, including but not limited to reasonable attorney's fees are the responsibility of the undersigned/purchaser. We PROPOSE hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: SEVEN THOUSAND THREE HUNDRED NINETY-SEVEN DOLLARS AND 25 CENTS 7,397.25 Payment to be made as follows:- 33 1/3% DEPOSIT -- BALANCE DUE C.O.D. i Authorized Signatur JBSIMASS. HOME IMPROVEMENT CONTRACTOR REGISTRATION 20 ACCEPTANCE OF PROPOSAL - The above prices, specifications and Conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined :1, Dateof acceptance: 2c Signature: I I PRICES SUBJECT TO CHANGE WITHOUT NOTICE i Merc an ise. . . 7,izz.65 Tax. . . . . . . . . . . : 274.60 Mi sc charges. . : 0.00 Quote Total . . . : 7,397.25 �� v . Office of Consumer Affairs a1d B,uslness.Reglation -10 ParkPla�a- quite 5170 _: -- Boston, Wang usetts 02.116 Home x ut Ctor Registration Registration:. 152085., TYpe: Private Corporation Expiration: .7/2B%2b18 Ti a19291 J SASH & DOOR CO, INO: w R�4CHARD 'BERTOL/�Ml y a 0 0 SMOND STREET ^; w G ELSEANA 02150 C Update Address;and return card Mark reason£oi•ckarrge. scat 0 20M-o5ni Address ;Renewal EmPloyment p Lost Card.. QT/W WPdnvMx �o�F ooccca�uueLb Offi. . fCbasumerAffairs&Basinesslt2golap6n - Litenseor registration.valid,for fiidWdual:use'only - before the ez H E IMPROVEMENT CONTR/CCTOR plration:date. Ifiougd return to: Re istrafio 52085' Type: offlee oT Consumer Affairs and Business Regulation ExpiraV 18 . Private Corporation. Y0 Park Plaza-Suite 5170 �I Boston,MA 02116 J B SH&.,DO©.. . . ... - _ . FUCK AD BERTO: 2805 ND S ARE - t,a.-s-rt •+--$ - _ CHE F11,MA 150 — Undersecretary to aaersecteta�ry Not Yalid without signature i III ul ' I�I (I II� I I! III Massachusetts Department of Public Safety `I Board of Building Regulations and Standards License: CSFA-067268 g Construction Supervisor 1 2 Family `9f,I I RICHARDLBER7AM2 35 SUNSET DR - BURLINGT4N r (-�-�n CA, Expiration: ; Commissioner 1112=017 i I �f I -- Oec-ember 3,2-035 — --- To Whom It May Concern, Gary Jenkins is authorized to be an agent for Rick Bertolami and JB Sash and Door Company as it pertIains to the application of permits. I Thank you, Rick Bertolami JB Sash and Door Company 617-884-8940 n r 1 4 I