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16 HIGH STREET - BUILDING JACKET - --- -_ ---= Paul R Lessard,Architect -- 18 Leavitt St. Unit 2, Salean, lvla 01970 - (978)210-1960 paul(i4mu➢architect.com May 4,2017 Md Michael Shaidan 16 High St. Salem,MA RE: Repair of joists in basement at 16 High Shed aesiden= Upon inspection in Ilse basement I found three(3)AM ftorjoists that had been cut to allow / plumbing pipe installation. Repair ofthis condition requires sistering the joists with same depth 2X hmrber between the oeater bascment be=and the wood sill plate on the kundation wall. The sistering joists would be fastened to existing joists with 3"Tech screws placed at 9"o.c. . aheanaung between the top and bottom of the joists-(See ski below) Siy, Paul Lessard,RArch ' TJW ai Sum si 5f � Zx �� Silt IIV j• • r �_ r • Teuv FXjsf.k �uwdwf��, do 0e >J °f 4: Vii'�✓ '• StiaEe'v��y� < T v�Qy�'aLea8g9 a� e ��yS�ANa,py{,"1 S G GJ- o RL. n Thal of it�tt1Em, massar4usttts . tlublic propertg 19epurtment iguilbing Department (One dalem Green 599-745-9595 Ext. 380 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer February 4, 1994 Dear Property Owner: The following notice is in regard to your property located at: / 16 High Street , Salem, Mass. It is your responsibility to have snow and ice removed from your sidewalk within six (6) hours after the snow ceases to fall. Failure to do so will result in a fine being posed on your property. Please contact this office upon receipt of this letter as to your course of action. Leo E. Tremblay Director of Public Property Commonwealth of Massachusetts ALO N T . �. City of Salem � 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 PERMIT REPORT BY ADDRESS Address: 16-U4 HIGH STREET PIN Permit For Parcel ID Occupancy Type Building Type Work Description Construct. Fee Paid Cost B-14-1491 Windows 25-0585 Residential Single Family Condo REPLACE FOURTEEN(14)-NO 18929 138 STRUCTURALCHANGE G-16-379 Remodel and Repair 25-0585 Residential Single Family Condo BSMT: 1 WATER HEATER 0 30 P-16-474 1 Plumbing Fixture 25-0585 Residential Single Family Condo BSMT: 1 WATER HEATER 0 15 Total Permits: 3 18929 183 Commonwealth of Massachusetts tl ONarT,r City of Salem 3 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 PERMIT REPORT BY ADDRESS Address: 16-1.12 HIGH STREET PIN Permit For Parcel ID Occupancy Type Building Type Work Description Construct. Fee Paid Cost G-16-113 Hot Water Tank 25-0585 Residential Single Family Condo install w/h 0 20 P-16-125 1 Plumbing Fixture 25-0585 Residential Single Family Condo water heater 0 20 Total Permits: 2 - 0 40 0016 HIGH STREET 508-2002 GIs#: 10372 COMMONWEALTH OF MASSACHUSETTS Map: 25 Block: 801 ' CITY OF SALEM. Lot: 0585 ermit: Building `' Category: STOVES,Wood,Pelle BUILDING PERMIT ermit# 508-2002 roject# JS-2002-1198 Est.Cost: $500.00 ee: $20.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOMEOWNER Lot Size(sq. ft.): Owner. Christoher Cruger Zoning: Applicant: Christoher Cruger Units Gained: Units Lost: AT: 0016 HIGH STREET ISSUED ON: 31-Jan-2002 EXPIRES ON. 31-Jul-2002 TO PERFORM THE FOLLOWING WORK: Install wood stove. F.R.D. POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Foundation: Rough: Rough: House# Rough Frame: Final: Final: Fireplace/Chinmey: Insulation: Gas Fire Department Board of Health Final: Rough: Oil: Treasury: Final: Smoke: Excavation: THIS PERMIT MAY BEREVOKEDBY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. �6�a Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: BUILDING REC-2002-001269 25-Jan-02 445 $20.00 GeoTMS®2002 Des Lauriers Municipal Solutions,Inc. Titq of �ttljem, fttssar4usetts n � Publir trupertg i9epurtment Nuilbing Department (One 6alem Green 588-745-9595 Ext. 388 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer February 4 , 1994 Dear Property Owner: The following notice is in regard to your property located at: 16 High Street , Salem, Mass. It is your responsibility to have snow and ice removed from your sidewalk within six (6) hours after the snow ceases to fall. Failure to do so will result in a fine being posed on your property. Please contact this office upon receipt of this letter as to your course of action. Leo E. Tremblay Director of Public Property ....._..__... ......_....._.. { Paul & Lemrd,Architect __= 18 Leavitt St Unit 2, Salon, Ma 01970 (978)210-1960 paul(a)Iaulaeoifitect.corn www.pauiatcki&xLwm May 4,2017 Midinael Sheffidan 16 High St: Salem,MA RE- Repair of joists in basenient at 16 High Sit residmm. Upon insp� in the basement l found three(3)first Iloor joists that had been cut to allow plumbing pipe installation. Repair of this condition requires sistering the joists with same depth 2X hmd=betwom tine wimer bamnent beam and the wood�i11 oft on the ftmdatm ruall. The sistering joists would be fastened to existing joists with 3"Tech sews placed at 8"o.c. . alternating between the top and bottom of the joists. (See sketch below) Paul Lessard,RArch wed .51- Te iTc r Scow FO tf 14 Cd 1614 cot of Ea i `yt�RaLe�g9��� t 34 mi ��4ptp a.P.vt, S e- GJ- n 0016 HIGH STREET 508-2002 GIs#: 10372 COMMONWEALTH OF MASSACHUSETTS Map: 25 map: Sol CITY OF SALEM Lot: 0585 . Permit: - Building Category: : :.STOVES'Wood,Pelle BUILDING PERMIT Permit# - %'i 508-2002 &` Project# z JS-2002-1198' . Est. Cost: $500.00 ee: " $20.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOMEOWNER Lot Size(sq. ft.): Owner: Christoher Cruger Zoning: Applicant: Christoher Cruger Units Gained: Units Lost: AT: 0016 HIGH STREET ISSUED ON: 3I-Jan-2002 EXPIRES ON: 31-Jul-2002 TO PERFORM THE FOLLOWING WORK: Install wood stove. F.R.D. - POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Foundation: Rough: Rough: House# Rough Frame: Final: Final: Fireplace/Chimney: Insulation: Gas Fire Department Board of Health Final: Rough: Oil: Treasury: Final: Smoke: Fxcavation: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. f j� Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: BUILDING REC-2002-001269 25-Jan-02 445 $20.00 e Ir° il,Li7i..2 t Upon 00111r)IINt ) 745-958o axt. 385. GeoTMS®2002 Des Lauriers Municipal Solutions,Inc. CO M CITY OF SALEM BUILDING PERMIT Commonwealth of Massachusetts N�➢NDI},r City of Salem r 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 U�V�PERMIT REPORT BY ADDRESS Address: 16-1.12 HIGH STREET PIN Permit For Parcel ID Occupancy Type Building Type Work Description Construct. Fee Paid Cost G-16-113 Hot Water Tank 25-0585 Residential Single Family Condo install w/h 0 20 P-16-125 1 Plumbing Fixture 25-0585 Residential Single Family Condo water heater 0 20 Total Permits: 2 0 40 1 oft Commonwealth of Massachusetts MOON➢fP,�� City of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 PERMIT REPORT BY ADDRESS Address: 16-1.114 HIGH STREET PIN Permit For Parcel ID Occupancy Type Building Type Work Description Construct. Fee Paid Cost B-14-1491 Windows 25-0585 Residential Single Family Condo REPLACE FOURTEEN(14)-NO 18929 138 STRUCTURALCHANGE G-16-379 Remodel and Repair 25-0585 Residential Single Family Condo BSMT: 1 WATER HEATER 0 30 P-16-474 1 Plumbing Fixture 25-0585 Residential Single Family Condo BSMT: 1 WATER HEATER 0 15 Total Permits: 3 18929 183 1oft CITY OF SALEM L��F 6 / = � BOARD OF APPEAL One Salem Green t( � SALEM,MASSACHUSETTS 01970 FEB-1101 + F Q ,3 4 EE t u.SIj . OSIA�%W It 83460?8 MOVED - LEFT NO ADDRESS 1 , EMPTE - NOT KNOWN .9m4-0C�AT' UNCLAI ED ❑REFUSED ❑ VAC NT ❑NO MAIL BOX UNITE ECEASED s ❑ NSUFFCI ENT ADDRESS�� N UNDELIVERABLE AS ADDRESSED s�s9 [-] NO SUCH STREET 13 NUMBER (PEEL OFF-UPDATE CUSTOMER LIST) 73 �. � �... `. �� _.., r � ; _ ''. �. � _._. �� r ' r J:\, The Commonwealth of Massachusetts y�y Board of Building Regulations and Standards Town of Massachusetts State Building Code, 780 CMR, 71h edition Wilbraham Building Dept Building Pemiit Appli To Construct, Repair, Renovate Or Demolish a 413-596-2800 One-)or Two-Family Dwelling Ext 118 L T 's Section For Official Use Only \lOn\ Building Permit Numbe Date Applied{ 0 0 Signature: L- 0� Buildin ommis Doer/1 � ctor uildings Date I SECTION 1:SITE INFORMATION 1.I (Property Address: 1.2 Assessors Map& Parcel Numbers }11C3 A I.to Is this an accepted street'? ves no X1ap Number Parcel Number I 1.3 Zoning Information: j 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(tl) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check if yes❑ SECTION 2., PROPERTY OWNERSHIP' 2.1 Owners of Record: Name(Print) Address for Service: !i Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: r=cf Description of Proposed Work': a Phil r2 f2f-)o f Z STl ,Q br pcL I<f- SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials ' 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List:��'"1� 5. Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ .C>- -❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES .I Licensed Construction Supervisor(CSL) 5o2-5-.2 I t . I .08' M (J I W License Number Expiration Date Name of CSL- Holder ��N, ist CSL Type(see below) Address GF'i bC J Type Description U Unrestricted(up to 35,000 Cu. Ft.) R Restricted 1&2 Family Dwelling Signature M Masonry Only RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) o b b !�/aut~N1a L,) ( ��15� l 1 ii HIC Com ny Name or HIC Registrant Name Registration Number �_ u rJ C't'• __ 27 Q Address / ( 7 ("7 Expiration Date Signature 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 .......... ❑ 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 ,peiative to work authorized by this building permit application. Signature of Owner Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION 1, ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of perjury) 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 not have access to the arbitration program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1 I O.R6 and I I O.RS, respectively. 2. When substantial work is planned,provide the information below: Total Floors 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" Bn6,72- s Construction Supervisor License License: CS 50252 BIMii6W:. 11AA945 EIz_ f%1/2008 TrA 4544 R6aiU16tlui1i'00.. MARTINS KAUFMAR'' 5 BUXTON ST PEABODY,MA 01956\ Commissioner �. �/ee 1°�ommwnue¢/.AL; o�,/�aeaadjiioepi .. Board of Building Regolatiovs and Standards HOME IMPROVEMENT CONTRACTOR .h Registration: 119540 Expiration: &W009 Tr# 132907 Type: DBA - KAUFMAN Construction ' MARTIN KAUFMAN 5 Buxton st � ` CITY OF SALEM it PUBLIC PROPRERTY a DEPARTMENT .IVIli NI I'Y:)Nri('.t It I \I]:t In I-) W AittlNra ON S'I'ALL r 1'N,M.\n.\(-I It 'a 11\J197- 11.1.: 978-'45-9595 • P.\x. 978-7+1^:1846 Workers' Compensation Insurance :'Lffidavit:. Builders/Contractors/Electricians/Plumbers Please Print Le ibly -\n )licant Informrlion Name l0ucnxwvt�rganuatinNlndlvulual): Address: t) 67 UX'CC) Lf— �A", // City,Starc,%ip: (SIN Phone 17 7 Cf Q Are)ou all employer:' Check the appropriate box: 'Type of project(required): i 4. El I am a general contractor and I 6. ❑ New construction 1.❑ I :tin a employer with have hired the sub-contractors unpluyces(full an(Uur pun-tinlc). 7. ❑ Remodeling listed on the attached sheet. : jun a sole proprietor or partner- These sub-contractors have 8. ❑ Demolition ship and have no employees workers' comp. insurance. 9. ❑ building addition \working for me in any capacity. . ❑ We arc a corporation and its [No workers' comp. insurance 5officers have exercised their 10.❑ Electrical repairs or additions required.] 1 I. Plumbing tc, airs or additions 3.❑ 1 am a homeowner doing all work right of exemption per NIC ❑ b ,p. myself. [No workers' comp. c. 152, j 1(4),and we have no 12.❑ Ruuf repairs insurance required.] t anpioyces. iNo workers' 13.❑ Other comp. insurance required.] •Any cant dmt checks box dl nAaa at>U IIII ow the 4U how IJII Iw Ow sing III workers'cumpenaalion pulicy imormatiun. .�ppb ' I lomaiwmn who summit this affidavit indic:uing Ihey am doing all work alwl dlen hire outside caxurxtom moat auhmil a new al fslavit indiwong.ucA. ( tur,that dtvck this box maul mtxhcd.In additional slxvt h g the lame of the subcontractors atilt Iheir workers'cooly policy information. l am an employer thus is providing workers'c•onrpensatioo insurance for my employees. Below is the policy and job site information I Irourauct:Company Name: Ia/ 1 u]3�Ob � IDS - ..-------- I4,-GI' 4 ._ . Expiration Date: Pulicv n or Self-ins. Lie. r- - ' / .Wts,� S� City,Stateizip: Job Site Address: --' Attach a copy of lice workers' compensation policy declaration pale (showing the policy number and expiration date). 1'ailwc to secure coverage as required under Section 25A ul'>IGL c. 152 earl lead to the imposition of criminal penalties of a tine up it S1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine S250.00 A day against the violator. lie advised that a copy of this statement may be forwarded to the Office of of up to 111\'iatlt'dllUllS UI the DIA for ioittru:ce co%cragc \criticanun. l do hereby certify amter the pains mid penu/ucs of perjury that the ntfortnadon provided above is true mod correct Official use only. Do not write in this area, to be completed by city or town oJjlci" City or Town: Permitil.icensc 0._ Issuing:whority (circle one): I. Board of licalth 2. Building, Department 3.Cityi fow it Clerk a. Electrical Inspector 5. Plumbing Inspector 6.Other Phone M: Contact Person: -- Information and Instructions Massaclluietls General Laws chapter 152 requires all eillployers to provide workers compensation for their employees. Pursuant to this statute,an einplgree 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 tither legal entity, or any two or more „t the t recoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of .ui individual, pannership, 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." `IGL 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, �bIGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpuhlic work until acceptable evidence of compliance with the insurance requirements of(his 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-contractors) name(s), address(es)and phone nuniber(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 contimlation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should he renlrnetl to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Ofnelals _ Please be sure that the affidavit is complete and printed Icgibly. 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. I'Lase be sure to till in (he pennitilicense number which will be used as a reference number. In addition,an applicant that must submit multiple penmidlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is oil 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 burn leaves etc.)said person is NOT required to complete this affidavit. I he 0i7ice otlovestigations would like to thank you in advuicc fur your cooperation and should you have any questions, please do nut hesitate to give us a call The Deparnnent's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax #617-727-7749 www.mass.gov/dia CITY OF SALEM PUBLIC PROPRERTY - �' DEPAR'I'�IENT i.'IGvS I tC 11-3 V: 111., construction Debris Disposal Affidavit (1'ctllliicd 1t)r all dcI110IIt1Ull .Ind rcnov a tni work) In accordance t�itll the sixth edition of the State Building Code, 780 CTIR section I 1 1.5 Debris, and the provisions of'vIGL c 40, S 54; Building Permit k is issued will, the condition that the debris resulting from this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c 111. S 150A. The debris will be lransportcd by: manic (it hauler) I he debris will be disposed of'in A S I-s IQ (-v AT (nalnr ut laelhty.) tz r i. I:ulJre.. Ilt l�cllnvl 1^` ^ (1/ v� \ �IL'Ilalnl l' Ut p.•n rt ap hcant 22 0 � ,late Condominium Association 16 High St. Salem, MA 01970 The Condominium Association of 16 High St. Salem, MA approves the following work to be done to the deck: • Permits • Demolition • Roof • Frame • Deck • Rail and balusters • Trim and Lattice • Paint and Hardware • Replace Outside Stringer and treading of main stair • Labor At the estimated cost of$8,900. This bid had been awarded by the condo association to Martin Kaufman, of Kaufman Construction, 5 Bu%ton St Peabody MA. The Condo Association and Martin Kaufman agree to the above scope of work and costs. Any increase in the scope of work and/or costs will be reviewed by both parties and agreed upon as per this agreement. �r 16 High St Condo ssociation Martin Kaufinan 8-12-08 4 The Commonwcalth of Massachuscus Town of Board of Building Regulations and Standards '�� Massachusetts State Building Code, 7SO CMR. 7'a edition Building Dept Building Permit Application To Construct. Repair. Renovate Or Demolish a Amos One. or Tu'u-Famtli-Dwelling This Section For Official Use Only Building Permit Nu /c/ Date Applied: Signature: Building Commissioner/ specter of Buildings Date SECTION I: SITE INFORMATION 1.1 Property Ad res : �,�. 1.2 Assessors Map& Parcel Numbers M Number Parcel Number 1.I a Is this an acce led stro Cr yea no Map 1-3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use La Area(sit RI Frontsge IM 1.5 Building Setbacks(fl) Front Yard Side Yards Rest Yard Required Provided Required Provided Required Provided 16 Water Supply:(M.G.L c.40.154) 1.7 Flood Zoso loformsdon: 1.11 Sewage Dbposal System: Zone: _ Outside Flood Zone? Municipal Cl on site disposal system O Public O Private O Cheek if wsO �S�ECTION 2: PROPERTY OWNERS.— 2.1 Own re- 1✓jeeord& aJrtL _ � S �4 Name(Print) Addreu for Service. !Sag_C�t.� Q7o 817Q Signature Telephone SECTION J: DESCRIPTION OF PROPOSED WORKS(cheek ad that apply) New Construction O I Existing Building O Owner-Occupied O Repairs(a} Alierotion(s) O Addition O Demolition O 1 Accessory Bldg.O 1 Number of Units_ I Ot O Speeiry Brief Description of Proposed Work : SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Casts: Ofllclal Use Only Item Labor and Materials I. Building f .�— I. Building Permit Fee: f Indicate how fee is determined: O Standard City/Town Application Fee 2 Electrical S O Total Project Cost'(Item 6)it multiplier x Plumbing f 2. Other Fees: 11 I^/h a. Mechanical IHVAC) f List: s Mechanical (fire f Total All Fees: f Su ression Check No. _Check Amount: Cash Amount: 6 Total Project Cost f 0 Paid in Full 0 Outstanding Balance Due: VI SECTIONS: CONSTRUCTIONSER CES S.I Licensed Construction Supervisor(CSL) / 170?p �r1 �i nr1a �/1 j S Lweme Number E�pirat n ate N. S - Hylder 4•r, List('SL Type(Kv Ica local A,l,lre T'oc I Description U I Unrestricted u to J3,000 Cu Ft. R Restricted 1!2 FamilyDwellrrr Sig e M 1 Masonry Only ' Uo�9a`a� RC Residential RooOn Covermis Telephone Residential Residential Window and Sidra SF Residential Solid Fuel Sumins Appliance Installation D Residential Demolition 5.2 Registered Ho rap vemeot Crocco (HIC)4 kilt LAR IS raffidavit r HIC Regr Registration Number Expiration Dat Telephone' WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 1S2.J ISC(Q) n Insurance andavit moat be completed and submitted wiN thin application. Failure to provide lt in the denial of the Issuance of the building permit Signed AfIldavit Auached7 Yes.......... No........... O SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, �2 CO YIt��,� 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. Signature of Owner Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION I, R , Vii-1611-0 , as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. �^ Print Name Signature of Owner or Authorized Agent Date f OF Sr under the ains and penalties ofperjury) NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who him an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program), will Zg have access to the arbitration program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110 R6 and 110 R5, respectively. 2. When substantial work is planned,provide the mformation below; Total Goon area(Sq. Ft.) - (Including garage, finished basement/anics,decks or porch) Gross living area(Sq. FL) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half.baths Type of heating system Number of decks/porches Tspeof Cooling vyslem Enclosed Open 1 "Tool Project Square Footage"may he.whsotuied for-'Total Project Cost" iNl:ssachuscits - Dcparhurnt nr Public SafctI . 3 Board of Building Rc�ul:Uions in,: Standards �A Construction Supervisor License License: CS 74722 Restricted to: 00 KOSTANTINOS S VAITIS 16 HANSON ROAD ei SAUGUS, MA 01906 All Expiration: 7/5/2011 (- unnissimn'r _ Tr#: 19412 ✓/ce -�omrmeoosuiealllz o�.'..'�omac/woetla � Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration 129206 Expiration: 122/2011 Tr# 290357 Type QEA AEGEAN CONSTRIJOITI Kostantinos Vaitig. .f`"_ - 16 Hanson Road Saugus,MA 01906 Undersecretary • 4 NOV-13-2000 06:43AM FROIFHOkE DEPOT +9784863717 T-170 P.001/004 F-604 PLEASE READ THIS M, Sold,Furnishad and Installed by: Branch Name: Buston. Date: �-W 2! eJ - THD At-Rome Services,Inc. d/b/a The Home Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Branch Number:31 Toll Free(800)657-5182; Fax(508)75G8823 pedeml TO#75-2698460:ME Llc#C 02439;RI Cont,Lick 16427 ii CT Lie#565522;MA Hnme Tmpmvemrnt Contractor Reg.#126893 Installation Address: 1[DW cykf-nik- -' -5, 3aD.0-in mfr okg�C> City State Zip Parehaser(s): Wark Phonzi Home Phone: Cell Phone: /i A it's $e [ ] [ ] [fie,] �� l/ -) Lupip ] Szl+l Home Address: 6amit, Qb I taL as-a 8 W (If different from Installation Address) . City State Zip E-zpail Address(to receive project communications and Flom Depot updates): a kn00.tom I DO NOT wish to receive any marketing entails from The Home Depot Eroiera Inforgmtion: Undersigned("Customer,the owners of the property located at the above installation address,agrees to buy, d THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced Spec Sheet(s), all of which are incorporaled into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contruat"): Job#: awrw a awl acre: Spec Sheet(s)#: Prodeot Amount hng LJSiding MWindows LJ insulation ❑GatersICovax ❑Envy Doom El a—r—1 C1 Li $ 5 -�. arm Siding —Wind ows LJ Insulation ❑Guitars/Covers QEnuy Doors ❑ $ Roufmg Siding LJ Windows El Insulation ❑Goners/Covers [3Enhy Dears❑ $ ❑Roofing Siding tl Windows Ll Insulation $ ❑Guncrs/Covers OEntry Doors n Mn0nam 2s%Deposit a(Cautrart Amount due upon eaeation of this ounract Total Contract Amount $ /;� cm Mainepord asmeylmtdepasitmoredtmonNkkdafthe CtamvaxAmount. -5 Customer agretsltut."inim`ediately upon coinpleciodof the work for each Product, Customer will execute a Completion Cenifcaw (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to bejointly and severally obligated and liable hereunder. .� Thu Home Depot reserves the right In issue a Change Order or terminate this Contract or any Individual Product(s)included herein,at its discretion,if The Home Depot or in authorized service provider de[ertnines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety,concerns,pricing errors or because work required to complete the job was not included in[he Contract. —7 Payment Summary: The Payment Summary # i TS- included as part of this CnntracC sets forth the total Contract amount and payments required for the deposits and foal payments by Product(as applicable). NOTICE TO CUSTOMER You an entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event or termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and Services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acce tance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer an The Home Depot with regard to the Products and Installation services and supersedes all prior discus-,ions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer ha cad,understands, voluntarily accepts the terms of and has received a copy of this Agreement Xtp b� Submitted by: t%1i� Cx•� i Customer's Signature Date r1 Sales Consultant's Signature Date �1 X /6rt 0 k It Pel�- \'� C'Z'- -1 Telephone No. � 1.-, CuuiWrWs Signature Data Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS ias apphrable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS- DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAI.TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 5-10-M C-SC Whne-Branch Re yellow-Customer Pink-Saios Consultant The Commonwealth of Massachusetts Department ofln dustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information µ� Please Print Legibly Name (Business/Orgmization/Individual): I Ile= t IE ��L Address: Y�/ City/State/Zip: Phone #: Are you an ployer? Check the appropriate box: Type of project(required): 1.❑ a employer with__A V 4' E] I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. Q Demolition working for me in any capacity. employees and have workers'comp.insurance.# 9 Building addition [No workers' comp.insurance We Electrical repairs or additions required.] 5. ❑ We are a corporation and its officers bave exercised their 11.❑ Plumbing repairs or additions 3.❑ I am a homeowner doing all work. right of exemption per MGL myself. [No workers' comp. 12.❑ Roof repairs insurance required.]t c. 152, §1(4), and we have no S �th employees. [No workers' 13. er comp. insurance required.] *Any applicant that checks box d 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. tContractors 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 worltets'compensation insurance for my employees. Below is the policy and job site . information. Insurance Company Name: Policy#or Self-ins.Lic. #: �;L l�7 Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation olicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,5eo.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der h in nd enalties of perjury that the information provided above is true nd correct. S' afore: Date: 07 ' Phone# Official use only. Do not write in this area, to be completed by city or town o�ciaL 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 Phone#: Contact Person: AC082 CERTIFICATE q c ] N ] � *dC o-TE(MMIDDrrml. .. S✓������1�>•'1�� ©1- LIA�I���� IIY�ll��1,`J� / 02/20/09 PaoouCER 1-104-993-3000 '(HIS CERTIFICATE IS ISSUED AS A MATTER OF IMFORMATICN -rsh USA, Inc. ONLY A.ND COidFF;RS W'.) R!,._'I(1.•-i UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMcA10, E:STEAID OR ALT=R u': 7:1= A::LBnta., CA 313n'9: I •r o-. �—_—\L (' _� _—___ '.y?,„•] —__..__ (z1�) 10Rr IrISURER -- - ---- ----- - r I _u 0- — 14suRza> er - �ns1 TI Go 2r I J Ac:_Lc_On—i.ne CO !2::90 CwnS:rl a.i_ Pu rk:+?y Ir6L:RL'it f..:N:.1'1O H.?T. IINTON FiRF: INS CQ OF PI'1"'ti 19415 I it. 300 -----.—_--_--__.---- INSUREFIM Mew Hampshire Ins Co 23841 \C leenta , CA 30339 INSURERE'.Illinois Natl Ins Co 23817 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR.CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH TH45 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH .POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBR DO' POLICY NUMBER POLICY EFFECTIVE POLICYEXPIRATION LIMITS T0. NOR OAT M 00 AT MMIDO A CENERALUABILITY IPR 3757. 608-02 .03/01/09 03/01/10 EACHOCCURRENCE $4,000,000 AMA H =1,000,000 X COMMERCIALGENERALLIABILITY LIMITS OF POLICY ARE EXC SS PREMISES eoccurence ! CUIM.S MADE ❑% OCCUR "OF SIR: $1,OG0,000 PER CCe MEO EXP(Any one person SEXCLUDEp PERSONAId AOV INJURY S 4,000,000 GENERAL AGGREGATE S4,000,000 GEN'L AGGREGATE UMITAPPLIES PER: PROOUCTS-COMPIOP AGG 51,000,000 X I POLICY PRO LOC. H AUTOMOBILE LIABILITY HAP 2938863-06 03/01/09 03/01/10 COMBINED SINGLE LIMIT (Ea acciden0 S1,000,000 X ANYAUTO ALL OWNED AUTOS BCOILYINJURY S (Pe r...SOIII SCHEDULED AUTOS . HIREOAIAOS 80CILYINJURY S (PHaeeidenl) NON OWNED AUTOS X SELF INSURED AUTO PROPERTYOAMAGE S (Peracodnm) PHYSICAL DAMAGE VI/ TOONLY-EA ACCIDENT S LARAGEUABIUTY ANYAUTO HER THAN EAACC S TO ONLY: AGO S A IPR-3757 608-02 03/01/09CH OCCURRENCE 1, 5,000,000EXCESS/UMBPe LU LABILITYX OCCUR CLAIMS MACE GREGATE t 5,000,0003fDEDUCTIBLE ' SRETENTION S WC STATU- OTHG WORHERS COMPENSATION ANO Y566916 (CA) OJ/01/G9 T RT IMIIiDEMPLOYERS'LIABILITY 3566915(AOS) 03/01/09 .L.EACHACCIDENT y1,000,000ANYPROPRtETONPARTN ENEXECUTIV F.E OFFICERIMEn:eER EXCLUOED7 3556917 (FL) 03/O 1/09L.DISEASE-EAENIPLOYEE 11,000,000I(I.a,dmcribeUnder .L.DISEASE-POLICY LIMIT t1,000,,000SPECIAL PROVISIONS below OTHER 01/O1/09 O Workers Compensation 3566918 (KY, NO, NY, WI, ) F TX Employers EXC e.A TNSC45694422 (TX) 03/01/09 03/01/10 ceurrence,/SIR 25M/2H C Workers Compensation 48al323 (OSI) 03/01/09 0]/01/10 DESCRIPTION OF OPERATIONS I LOCATIONS(VEHICLES I EXCLUSIONS ADDED BY CHOORSEMEN71 SPECIAL PROVISIONS - RE: EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION 3HOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIMLION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN THO AT-NONE SERVICES, INC. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 5HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR 2690 CVMHERLAN"D PARKWAY SUITE 300 - 0.EPRES ENTATIVES. ATLA_NTA, GA 30339 - AUTHORIZED REPRESENTATIVE USA n nrnvn MRvnR ATION 1986 ' f 4dT r11 ;,i.`+ It✓t It<�if�I..'D t'.\Z c Ill U-Favor — Salar her Gain Coefficient - .F�rU .CmAc'�CwuQ�da d¢EJxryi3`nlar . '0 . 32 1 . 6 0 : 29 ADOCTIONAL PERFORMANCE RATINGS evuufaor+wvt�a(Qrrutu oe Pt3+au(tfxto 0sibleTrammnittance 1}anmitlan de LaV4m4 - 0 . 52 w",t' iar tep,wt t f mfas raGna raEam t t*9b W* wand t Per*vm* y-fnh podd perfamrca.NBC ' rm;,ta w ilfrmtr»kr r And.t rl antrpmm�ral a:am,rd t rd�prvarl b.MPt doe.rot ncvmw^d sry Qaact � ad d�cart wwr"av alrocmr of r f a0d4,tr mr T-*ua arwt n.:mrri arms a oerr 70*4 pw%rrr o ,tiy ®.ray ya�c.'ntrs dmrla on top mn drtmrrr v rrw.*TIWib kftW . pod a�la Nb�r uaaRa oa ffi"NC rn erramtr¢a xr sy.tl n jo 6 its TfllrOlr y un Wrcro do pe,sa =Wffm IR+G no return r*V} rtad2n'f-9& =4a Otaffi a sa,ade pfa un uo W'J%m Ce`a mt .. - mro m,'hea . pR d--mo W`-OOm do eN Pr'O.GI."`uQCap :. - UnLC 4';¢LLr Laa rot @{LRcy frxR - c¢giort'(a, Lo<Cni<n, No,tm Gont.a L. fo..in awn. c_r+E r6 r SfM Lam. ugLC-ad an u'i Lcn .pa.a Li(.) . c.q Len l•II tn+onaz erm= Noct.- NocCa CenC c¢L, '9.c Cantcal, 9,.c_ ' IND Go/CLlaa 3/31-/x-R13 . � �? .. Cited 9l t: 3G• . CS' p INO: &2f,tc.o Od/VLd<Lo x .39 y /XH R43 " D-C. . y/15 /,— [� � LUurto pcob,ao: 91.f cn .-ica c-a'- E595C96j 0?. 40773 - I(3 Norra�n hu IInW1 i 9=6 QILtLY SUR•i k n.To Irmn mon M wvr.—Ttt¢9m'.. — Lund.xta rfhNAo para gaaElu rMnd¢6nt QILt6Y SUC hm mrocu nm aofm dr ak,thllt wx tnlgrtacpoc .. -.� .�/�ie Lomtmo¢uc��c o`'✓Z�aaaac/rr�dPlfa i . Board of Building Regulations and Standards `I HOME IMPROVEMENT CONTRACTOR Reglstra6on:, 126893 I r Expiration. ;8/3/207 0 Type:i_-Supplement Card - The Home Depot Al Home SewiC6 ` RICHARD FALLONE p 2690 CUMBERLAND PARKWAY S XTA'M, GA 30339 Administrator _ CITY OF SALEM • PUBLIC PROPRERTY i���i DEPARTMENT .l\II:.. MI h.l 1'NIti 1'•l1 1 2CI W.%,III%f..o.N$I'NLrT • SA I l'rt, 1)78.743.9595 • 1°.%r:978.7449846 Construction Debris Disposal Affidavit (required I'or all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit p is issued with the condition that the dcbris resulting from this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c I11. S 150A. The debris will be transported by: Ow Utame of hauler) 'I'lle debris will be disposed of in : �L�� � (name of haul Ily 11c1n�.,J, la dressUtlacillty) dAd .ig a re of lknnit applicant klaadat Ic I111 vt1 LAN GK ol-7 - 4' t RECFIyFn The Commonwealth of Massachusetts INSPECI TONAL SERVICE Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR Z114 PlljAE r�fe 09h Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Ptamit Number: Dace Applied:- Building Official(Print Name) - 8igaet re .. - Date Levy SECTION 1:SITE INFORMATION 1.16 HIGH ST dress:UNIT 4 1.2 Assessors Map&Parcel Numbers 25 25-0585-804 Ma H this an accepted street?yea_ no Map Number Parcel Number 13 Zoning Information: CONDO 1.4 Properly 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: 1.8 Sewage Du 1 pose System: Public 0 Private❑ Zone: _ Outside Flood Zone? 'i Mun 0 On site Check if esO disposal system O SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: KALI LIGHTFOOT SALEM, MA 01970 Name(Print) City,State,ZIP 16 HIGH ST UNIT 4 207-831-5370 No.and Street - Telephone Email Address ;SEa '91ON 3:DESCRIPTION OF PROPOSED WORIO(check all that apply) ,_ New Construction 0 Existing Building W Owner-Occupied MKI Repairs(s) UK I Alteration(s) El I Addition ❑ Demolition 0 Accessory Bldg.El Number of Units_ I Other M<sNcify REPLACEMENT Brief Description of Proposed Work': REPLACE 14 WINDOWS- NO STRUCTURAL CHANGE SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official,Use O and Materials my 1.Building $ 18,929.00 1, Building Permit Fee:$ Indicate how fee is dotermined' 2.Electrical $ 0 Standard Cityffowa Application Fee - t 0 Total ked Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees; $ 4.Mechanical (HVAC) $ USL - 5.Mechanical (Fire $ Suppression) Total All Fear:$ 6.Total Project Coat: $ 18,929.00 Check No. Check Amount: Cash Amount: 0 Paid in Full D Outstanding Balance Due: C( /I i SECTIONS' CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 90125 10-06-14 JAIME MORIN License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 86 GARDINER ST .and Street ' Type Desalptnon LYNN, MA 01905 U tl"resh''cted Wdipp up to 35,000 m ft R Restricted lt2 Family Dwelling Cm'trown•State,ZIP M Mum my RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliences 508-351-2214 I 1 Insulation Telephone Email address D Demolition - 5.2 Registered Home Improvement Contractor(HIC) 170810 12-23-15 RENEWAL BY ANDERSEN HIC CCa�m m Name or HIC Registrant Name MC Registration Number Expiration Date 30 FOI�BEYS ROAD No.and Street Email address NORTHBORO,MA 01532 508-351-2214 City/Town,State,21P Tel one SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MG.L.e.152.1 2SC(ti)) 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..........X1 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 T6�-VM f, (AD[%n to 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:O UTHORIZED AGENT DECLARATION- By entering my name below,I here attest and a pains and penalties of perjury that all of the information contained in this application is tru to the best of my knowledge and understanding JAIME MORIN �! r II Print Owner's or Au&Dn#A (Electronic Signature) Dar NOTES: 1. An Owner vvto o a building permit to do his/her own work,or an owner who hires an unregistered contractor (not ragia Hone Improvement Contractor(EEC)Program),will net 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.mess.¢o I=Information on the Construction Supervisor License can be found at moyEmass.eov/dos 2. When substantial wolf is planned,provide the information below: Total floor area(sq.fL) (including garage,finished basement/attics,decks or porch) Gross living area(sq.S.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halUbaths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost' CITY OF SAU EN4 NLASSACHUSETTS BLMDL%tG DEPAMENT 120 WASHINGTON STRmT,3'a FLooR TSL.(978)745-9595 FAX(978)740-9846 KIMBERLEY 023COLL MAYOR Tl OM"ST.PMUR DMEcroa Of PUBLIC PR0PEMY/ELmnrt4G Co.%moSSMn 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 Mole this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111,S 150A. The debris will be transported by.- RENEWAL BY ANDERSEN (tome of tggler) The debris will be disposed of in : RENEWAL BY ANDERSEN (name of facility) 30 FORBES ROAD NORTHBORO MA 01532 (address of facility) of permit applicant 14li� date Jcbri®iLdoa Renewal MA Home Improvement Contractor bYMderse License#170810(Expires 12/23M2015) ....... . Renewal by Andersen Corporation Federal Tax lD#41-191 B413 .... �..,,..a 1040g3 St. 00 Fax(508 MA 01532 - (508)351-2200 Fax f5081-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT Buyer(s)Name Date: KALI P LIGHTFOOT JULY 17,2014 Buyer(s)Street Address city State Zip Code 16 HIGH ST UNIT 4 SALEM MA 1 01970 Email Address Home Telephone Number Work/Cell Telephone Number LIGHTFOOT44@GMAIL.COM 207 831 5370 Buyer(s)hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation("Contractor'),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheets)(collectively,this"Agreement-). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount $ 18,929.00 areave Rowse$ 18,929.00 Est Start Date Method of Payment Deposit Received(33%)$ 0.00 5-13 weeks O Check/Cash ' Balance Stan of Job(33%)$ 0.00 Dalol al ag,mg$ 9,464.50 Check# Balance on Substantial At SUMISMal Est Install Time 13 Credit Cam Completion of Job(33%)$ 0.00 Comp rs-$ 9,464.50 2i3 days Ifkecriefit Cacama rhyme Plastics rm see Oman CentP Payment loan Buyer(s)agree.and understands Nat this Agreement constitntes Me entire Understanding between Ile partles,and that Mere are no verbal understandings changing or modifying any of Me forms of this Agreement.No efteratlon to or deviation from title Agreement will be valid without the signed,written consent of both BuyaHs)and Contractor. Buyer(s)hereby acknowledges Mat Buyer(s)1)has read this Agreement,Understands Me forms of this Agreement,and has receinad a completed,signed and dated copy of this Agreement.Including Me two attached Notices of Cancellation,on Me data Bret written above and 2)was orally Informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal by Anderson Corporation Buyer(s) Buyers) Signature of Project Manager Slgn tore Signature JOHN HARRISON KALI P LIGHTFOOT Primed Name of Pmjed Manager Primed Name Primed Name YOU,ME BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUNNESS DAY AFTER THE DATE OF THIS TRANaACHON SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN IXPIAHATgH OF TNN T.RIGH NOTICE OF CANCPLATION NOTICE OF CM'CHLIATION Date of Tnm¢dw 7/17/1+ .St.-,-1 dab. 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I a,w,bayuWe RF,riim Rn I 9-Ia6[P,en.e RMNmw wa Irene Renewal by Andersen Corporation MA Home Improvement Contractor tj! ndersen. 104 Otis St. Northborough,MA 01532 License#170810 (Expires 12/23/2015) sow ameucewawa .,,n.,,w-cao,,.n (508)351-2200 Fax:(508)-986-7072 Federal 10#41-1918413 Window Specification Sheet Buyer(s)Name Date of A reement KALI P LIGHTFOOT THUS JUL 17, 2014 The huyer(s)listed abmre hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on the Specification Sheet and die front and the reverse of the accompanying CUSTOM N7NDOW AND DOOR REMODELING AGREEMENT,of which the Specification Sheet is part. WINDOW DETADS Appmx. Extedor#merbr co Harassers br Hawre a Harewm al tE</ areaGNIm Glass Room 4 U.I. Wndow/Ooor SaysDelail Csslns EH-lot Cekv We Waves amaea Gdlls We 1M smN2 Uhs cations Doing 5 83 DB s rail equal insert sloped sill No HM White Slandsrd FFG wma Gee W 3n No No Bath 1 1 65 DB s rail equal insert sloped sill No HAN White Standard FFG ensu Gee a/2 W No Obs-Tern Kitchen 1 63 CS:L Insert No HA4 White Standard FFG overcast GeG 3/4 No No Bath 2 1 73 DB s rail equal insert sloped sill No Wi White Standard FFG manse cea 3n 3n No Oba-Tan Hall 1 73 DB s rail equal insert sloped sill No HAv White Standard FFG measu the 3n 3/2 No No Bed 1 3 73 DB s tall equal Insect sloped sill No IIAv White Standard FFG ensu cec 3n 3n No No Office 2 73 DB s rail equal Insert sloped sill No Hrw White Standard FFG manse GeG 3n 3n No No Total 14 BAY&BOW DETAILS *See Ba /Bow Meaelue sheet Style cetall/ Apomx. Apson Number Fromm window EM Center LmsE/ Roof/ Hardware Room Court Flakere U.I. Ceel m Attila lit® IMerlar ExVhd Color Gritas Reis memes Scream Smarlaun Sent Cone SPECIALTY WINDOW DETAILS Full/ Apmx. IewE/ Specleny BAY/BOW ADDITIONAL WORK NOTES Room court Inroad U.I. Sears- at. cells Strys Eq/IM Color (.homer is aware tieexd,bn/1ow-&--&,12iewho th-will bed ificam lam 1- ADDITIONAL WORK DETAILS: Orel nbncu,e Wl,-.vhnn Wh bah xmdmx same mr�enm w;m ar,. mnnare";,rein mra.eaa I No Contractor will wrap exterior casings with coil stock color of Owner Is aware that Contractor does net do any paintirg/stlning or removel/Installation of alarm system or window Imatme not hardware.It Is the responsibility of to homeowner to have the alarm system and window Inu finents/erdware removedpdr to Installation. We make no guarantee se t asel will N aftereepiacerment Custioneris also aware in some Ones,them 2 '� whether s window nde n t a e type o� g windows,type of installation and window style.We m ke no guarantee a ls to�mou t will be dependent o he amount otglass loss. Customerls aware and understands any and all unseen nu is not included In this contract.Should any rot be found there will bean additional charge for time and nowsmals unless so stated In this contract. 3 yes Contractor will Insulate,caulk and and windows with 3-poled system to preset water and air InfiXration.Removal and disposal of all job related debris, windows,doors,storm windows and vacuum nightly Included. Upon completion of the lob and payment In full,a limited warranty shall be Issued. 4 Yes Building Permit--Contractor will secure any and all necessary admits. The fee for the permh(s)Is net Included in the Contract Price and a separate checkisr ulmdatthetimeofmietrthlsfee. Check# 2673 - $ - 181) - - - 5 Yes All dISCOUMS have been applied to this agreement. 6 5� Yes 1 No Owner agrees to be preset on the final day of Installation for final Inspection and to deliver final payment/finance form(s). It is agreed and understood by and betwem the pzedes that this Specification Sheet,along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,constitutes the entire understanding ba men the parties,and there are no verbal understandings changing or modifying any of the mans.This Specification Sheet may not be changed or in terms modified or vaned in any way unless writ changes are in writing and signed by both the auyet(s)and Contactor. suyens)hereby acknowledge that euyer(s)has read this Speafi neon Sheee. Renewal by Andemene Cueposadon lhawT(s)/�/pp II Buyers) Signature of Project Manager Sig azure Signature JOHN HARRISON KALI P LIGHTFOOT ^•^-- - - - F-Prim Name of Project Manager Print Name - - Print Name -- - - - - — -- VAite, Megan From: Gillian Yahoo <gilliankirste12003@yahoo.com> Sent: Tuesday, September 02, 2014 4:23 PM To: White, Megan Cc: lightfoot44@gmail.com Subject: Re: Kali Lightfoot 16 High Street Unit 4 Salem, MA 01970 Yes approved! I'll try emailing the first page again Sent from my iPhone On Sep 2, 2014, at 4:08 PM, "White, Megan" <Megan.White.( andersencory.com> wrote: Hi, I did receive the picture of the signed approval but only the bottom half. Can you try to send it again. I have sent it through as approved. If you want to just email me that it is approved I will attach that with the signed form. Thanks. :Megan lVh.ite Sales Administration Renewal by Andersen Ph:508-351-2200 ext 56437 Fax:508-986-7072 From: Gillian Kirstel [mailto:gilliankirstel2003(awahoo.com] Sent: Thursday, August 28, 2014 4:09 PM To: White, Megan Subject: Fw: Kali Lightfoot 16 High Street Unit 4 Salem, MA 01970 Hi Megan would you let me know you got my signature for the window project? Thank you! Gillian On Wednesday, August 20, 2014 7:23 PM, Kali Lightfoot<Iightfoot44(7@gmail.com>wrote: Thanks! Kali On Aug 20, 2014 5:15 PM, "Gillian Yahoo" <gilliankirstel2003(0ilvahoo.com> wrote: Wierd! Will do when I get back from vaca on satdy! Sent from my Phone On Aug 19, 2014, at 8:17 PM, Kali Lightfoot <lightfoot44(cbgmail.com> wrote: Hi Gillian, It looks like the window people did not receive the signed approval from you for my new windows. Could you please send it again to Megan White? t Thanks! Kali Lightfoot ---------- Forwarded message ---------- From: White, Megan <Megan.White cDandersencorp.com> Date: Tue, Aug 19, 2014 at 4:06 PM Subject: RE: Kali Lightfoot 16 High Street Unit 4 Salem, MA 01970 To: Kali Lightfoot <lightfoot44(a)gmail.com> Can you please send the signed approval. Thanks so much. Megan White Sales Administration Renewal by Andersen Ph:508-351-2200 ex156437 Fax:508-986-7072 From: Kali Lightfoot[mailto:lightfoot44(a)gmail.com] Sent: Friday, July 25, 2014 2:16 PM To: White, Megan Subject: Re: Kali Lightfoot 16 High Street Unit 4 Salem, MA 01970 Hi Megan, It is possible to return the Lightfoot.doc approval as a pdf attachment rather than a fax? Kali On Wed, Jul 23, 2014 at 4:23 PM, White, Megan <Megan.White c(D.andersencorp.com> wrote: Good Afternoon, I am contacting you in regards to window replacement approval for Kali Lightfoot at the address listed above. I have included with this letter our Certificate of Insurance, product specifications and the request which upon approval must be signed, dated and faxed back to me at 508-986- 7072. The order for the above property is as follows: (13)Double Hung windows — Inserts /White exterior and interior/with grilles (1)Casement Single window— Insert/White exterior and interior/with grilles " Should a scissor lift or police detail be required, this approval acts as authorization as needed. The association is responsible for a location to store the lift overnight if a lift is needed. 2 If you could confirm receipt of this request and let me know an expected approval date so we may keep the customer informed it would be appreciated. If you need any further information, please contact me at 508-351-2200 X 56437 or email me at megan.white(a)andersencorp.com. Thank you for your prompt response. Megan White Sales Administration Renewal by Andersen Ph:508-351-2200 ex156437 Fax:508-986-7072 3 Signature of Condo Association Representative and Title Date Print Name (In lieu of this form, a letter stating the same purpose as above, on the Condominium Management Company stationary may be substituted.) 104 Otis Street Northborough,MA, 01532 Phone{508) 351-2200 Fax(508) 986-707? Website: %vkir%v.renewalbwt7iderseu coin CITY OF SALEM, MASSACHUSETTS # !Inv BUILDING DEPARTMENT \4 L ✓ 120 WASHINGTON STREET,3 FLOOR �... -' TEL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER February 26, 2020 John Faussell House Condominium Trust 16 High Street Salem ma. 01970 Re; Incident on 2/25/20 Dear Owners, At approx.. 2130 on February 25th, I was called to the above address by Salem police. I was asked to look at the section of railing on the second-floor exterior landing on the Gedney Street Court side of the property. The individual, that was injured,was already on-board the ambulance. I was able to look at the approximately three-foot-long section of horizontal rail and balusters that were on the ground. I checked both ends of the railing section and could not see any nail holes or screw penetrations where fasteners would have secured the rail section to the upright posts. I asked the Salem Police street Sgt.to document this fact which he did with a Department camera . You are directed to make at least a temporary repair and within 30 days a permanent repair to this railing section. A building permit will be required(permit and repair to be done by a licensed Construction Supervisor). If you have any questions,please contact me directly. Sinceply, ! / 41frui-k) M-44-41____ Thomas St.Pierre