1 LIGHTNING LN - BUILDING INSPECTION '-,tzS CK 10`46�,;
ILI
The Commonwealth of Massachusetts Mit
4 q Board of Building Regulations and Standards +Fr t CT
Massachusetts State Building Code, 780 CMR Wv `'s"
Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate Or Demolish ddl SEP 2 1 P 1: 5
One- or Two-Family Dwelling
This Section For Offtci Use Only
Building Permit Number: Datepplied:
Building Official(Print Name) Signature Da
SECTION l:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
IrrI`•� 1.I a Is th an accepted et?yes no Map Number Parcel Number
1-' 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: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP[
2. Owner of Record 7-C)ame(Pnnt � ,^ _„
CiTy, e, fP � i' - ^! CSC e
No.and Street Telephone Email Address
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: t
Bf�ef Description(Proposed Work :
i l t I (A41 Lam^ Til 3 L� e�lo ,n�2r. w i e<on-�
SECTION 4:ESTIMATED CONSTRUCTION COSTS
[tem Estimated Costs: Official Use Only
(Labor and Materials
1. Building $ l — 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:
5. Mechanical (Fire
Su $ Total All Fees: $
ression
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ a I — ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) L,—_-� D I gQO ?6 ,
(O
( °i(" ?� � I V It �p License Number ExpirlaC n to
ame`�of CSL Holder —=��� /�{,,gyp List CSL Type(see below) tJ
` 0�aC�
No.and Street Type Description
�.,�c� U Unrestricted(Buildingsu cu. ft.).)
R Restricted I&2 Family Dwelling
C71iynbwn,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
(��j l J �,� SF Solid Fuel Burning Appliances
. 1 0 a —I���,( 1 .1�u4�'Y1s17 I Insulation
Telephone Email address D Dern lliittion�c:�
5.2 Registered Home Improvemet Contractor(HIC)
HIC Registration umber 4piratfon Date
OrL
C Company ame r HIC egis[rant ame
v. and StreetS /.� Email address el�
in
Mi y/Ilown, 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 .......... 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 �r K..nCll._� ,1YZI
to act on my behalf,in all matters relative to work authorized by this building permit application.
Pr wner's Name TElectronic Signature) Dale
SECTION 7b: OWNERS 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 i is application is true and accurate to the best of my knowledge and understanding.
/02
Print Owner's or Au rized Agent' (Electromc Signature) 6ate
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.gov/oca Information on the Construction Supervisor License can be found at www.mass. og v/dus
2. When substantial work' planned,provide the information below:
Total floor area(sq. ft.) e 7/�n (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"
CITY OF S.3LE.NI, %LkSSACHUSETTS
BuiLDLNG DEPARTMENT
• 130 WASHLNGTON STREET, 310 FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
KINIBFRt F.Y DRISCOLL
LIAYOR THOMAS ST.PtERRE
DIRECTOR OF PUBLIC PROPERTY/BCILDLNG COMMSIONER
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 will be transported by:
601 -+YLkCJC-
(name of hauler)
The debris will be disposed of in :
A1C�g-- ';
(name of facility)
ue r
(address of facility)
signature per ap
e
Jcbrivlr.JGx:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations J
^ o I Congress Street, Suite 100
I
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu Ii s
Applicant Information Please Print �' ]J 1
Name (Business/Organization/Individual): EB Window and Siding CO `��
Address: 756 Western Ave
City/State/Zip: Lynn, MA 01905 Phone #: 781-592-9747
Are you an employer? Check the appropriate box: Type of project(require J q
1.0 I am a employer with 6 4. ❑ 1 am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction i
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. E] Demolition
working for me in any caPacity employees and have workers'
[No workers' comp. insurance comp. insurance.[ 9. ❑ Building addition i
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs o jd +tions
officers have exercised their f ��
3.❑ I am a homeowner doing all work 11.❑ Plumbing repairs o,e I-A-1—
I
tions
myself. [No workers' comp. right of exemption per MGL I2.❑ Roof repairs l`
insurance required.] t c. 152, §1(4), and we have no employee
s. [No workers' 13.❑■ Other 'comp. insurance required.] tJi r
Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. qµ
r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indican r I ' h.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities tw
employees. If the sub-contractors have employees, they must provide their workers'comp.policy number.
I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and j s ";'te
information.
Insurance Company Name:Berkshire Hathaway Gaurd Insurance Co %I
Policy#or Self-ins. Lic. M EDWC643855 Expiration Date: 12/13/16 f I
Job Site Address: U Ai1 ( fX City/State/Zip: e/ 1t 6 C]
Attach a copy of the workers' compensattoln policy declaration page(showing the policy number and expirati ;, i te).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal pens i of a
tine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDS ir 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
Investigations of the DIA for insurance coverage verification.
-1 do hereby certify under the pains and penalties of erjury that the information provided above is true and corre
Si nature: Date: C _
Phone #: 781-592-97,
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 Inspe t
6. Other
Contact Person: Phone#: ;
��r Y nii.iuruinrrr�//o�FY��dJ!C�rur//�
OfOceofConsumer Affairs&Buemecs Regulation
}iOMEIMPROVEMENT CONTRACTOR
Registration:
128636 Type:
Expiration:. 5/2/2017 DBA
ED BYRNE WINDOW CO
EDWUND BYRNE -
756 WESTERN AVE
LYNN,MA 01902 Undersecretary._
Underseecretcret ary
Massachusetts-Department Of Public Safety
Board of Building Regulations and Standards
C�actru.,;an Surar i...r �i�
License:CS-010870
EDM'UNDJBYBi0
18 Woodrow e 1 Y f '
Lynn MA 01909904 ;7= '
Expiration
Commissioner 07/09/2017
9/21/2016 Outlook.com Print Message
Print Close
FW: window replacement - 1 Lightning Lane
From: Phil Sherman (psherman@crowninshield.com)
Sent: Tue 9/20/16 8:49 AM
'To: ebwindow@msn.com
Cc: 'Charlie' (cfgsalcm@gmail.com)
To Whom It May Concern:
Please be advised that the Hamlet Trustees approve window replacement at 1 Lightning Lane (Grigoreas)subject to the
replacement windows being identical in appearance to the existing windows to maintain uniformity throughout the property.
Thanks,
Phil Sherman
CROWNINSHIELD MANAGEMENT CORP., As Management Corp., As Managing Agent for
Hamlet Condominium Trust
From: Charlie [mailto:cfgsalem@gmail.com]
Sent: Tuesday, September 13, 2016 2:15 PM
To: Phil
Subject: window replacement
Dear Phil,
I am replacing 3 windows on the street side of my unit. I recieved the following from E.B Window and Siding
Co. in Lynn,Ma
I am working on getting a building permit for your project and 1 need a letter from your condo association stating that they approve the work
being done.Could you please send one along when you get a chance.
https://blu172.mail.live.com/d/mail.mve/PrintMmsages?mkt-en m 112
9/21/2016 Outlook.com Print Message
Thank You
C. Grigoreas
1 Lightning Lane
vl
https:/tblul72.mail.live.com/ol/mail.mvc/PrintMessages?mkt=emus 2/2
E.B. Window and Siding Co. Invoice
756 Western Ave
Rt 107 Date Invoice#
Lynn MA 01905 9/1/2016 53284
Bill To
Charlie Grigoreas
I Lightening Lane
Salem, MA 01970
P.O. No. Terms Project
Description Qty Rate Amount
Remove existing windows and prepare opening to accept new vinyl 3 0.00 0.00
replacement windows
Furnish and install Mezzo 2 light sliding windows 3 0.00 0.00
Extruded Full screens 3 0.00 0.00
Clima-techplus insulating glass including low e/Argon gas,double 3 0.00
strength glass
Seal Windows in and out using Fite bond lifetime sealant 3 0.00
"fake away all job related debris 3 0.00
Cover exterior 908 and sills 3 0.00 0.001'
'fake away all job related debris 0.00
Any building permit required to complete project to be added at cost 0.00 0.00
to the final payment
'Total Project 2,186.00 2,186.00
0.00 0.001'
acceptance of proposa
authorized signatu
Thank you for your business.
Subtotal $2,186.00
Sales Tax $0.00
Total $2.186.00
Payments/Credits -$730.00
Balance Due $1,456.00
Phone it Fax 4 E.-mail Web Site
781-592-9747 781-592-9746 ebwindowrymsn.com www.ebwindow.com
E.B. Window and Siding Co. Invoice
im
756 Western Ave
Rt 107 Invoice#
Lynn MA 01905 2016 SEP21 ful l6 53282
Bill To
Ronnie Freeman
19990 Sawgrass Lane
Boca Raton, Fl,33434
P.O. No. Terms Project
Description Qty Rate Amount
70 Weatherly Dr#405Ɨ,Salem
Remove existing windows and prepare opening to accept new vinyl 7 0.00 0.001"
replacement windows
Furnish and install Harvey Slimline Replacement windows 7 495.00 3,465.007'
Colonial Grid between glass per sash 14 15.00 210.001'
Full screen upcharge 7 7.50 52.501
Low E glass,Argon Gas and carry an Energy Star rating 7 0.001
Seal Windows in and out using Tite bond lifetime sealant 7 0.00
lifetime warrantee to the original owner including glass failure and 7 0.00
breakage for 20 years
Fake away all job related debris 0.00
Any building permit required to complete project to be added at cost 0.00 0.00
to the final payment
All sizes on file ready to order
Subtotal
Sales Tax
Total
Payments/Credits
Balance Due
Phone# Pax# E-mail Web Site
781-592-9747 781-592-9746 ebwindow Dmsn.com www.ebwindow.com
A�& CERTIFICATE OF LIABILITY INSURANCE D�tz�/zDl6
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
PEPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: H the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement an this Certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER I CONTACT C
NAMcamearcial Lines
E:
Admiral Insurance Agency,Znc. PM° (781)599-2000 FAX
/pJ&.JI_EXu....
. ............ ........_...... ._'____.,_,........ "SAIL Nol:_._-
70 Munroe Street
ADORE_$,,_ ..�....._>__
Suite D INSUREREI)AFFORDiNG COVERAGE I __.NAM q_
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Lynn MA 01901 INSURERA Providence_Mutual Fire CID 115040
................ ____-. _..
INSURED INSURER a Guard Insurance_ E
EDMUND DBA BYRNE 6 ED BYRNE WINDOW COMPANY INSURER C: I
766 WESTERN AVENUE
INHURER E:. _
LYNN MA 01505 nusuRERF-
COVERAGES CERTIFICATE NUMBER:CL1631522.634 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 REOUIREMENT,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.
_..._.._.._ ___..............."__._......_..._" .............. ............
INSN` .____....:......:..........._._.._.._......._.. _�ADOL'SURRI ....... ........... ....-..1 POEICY ETI- POLICY EXP
LTR: TYPE OF INSURANCE POLICY NUMBER IRMN] m W V I LIMITS
X I COMMERCIAL GENERAL LIABILITY I {EACH OCCURRENCE S 1,000,000
OaaAGE'TO-RERTEO 000,""'I""" ..
A ._ i PREWSEStE-_ mlmL___ _. 1 000.0080
CLAIMS �XOCCUR � I j � S _,
'WPOO63101 612112016 . 6/21/2017 MED EXPla+Y aro Pataan) �S 5,000
t .__._ __. __• .__� � ' � i � _ ..
t PERSONAL 8 ADV INJURY S 1 000 000
GENL AGGREGATE LIMIT APPLIES PER' ( GENEFIAI-AGGREGATEµ S 2,000,000
X POLICY PRO- ( ...I LPC I I PROOUGTB COMPiOP AGO S w 2,000,000
.!CCT �,,,..."_".
OTHER. t ( I FU. S 50,000
AUTOMOBILE UAINUTY l 1 COMBINED SUWLE LIMIT S
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ANY AUTO ( i p BODILY INJURY(Perpa n) S
I AUTOS�ED SCrILITOSULED I E i-BODILY NJURY Ue atemem) S
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NON 6"811 I E PRwO t-D"-h1AGE
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EUMSRELLAUAHOCCUR E ( EACH OCCURRENCE Is
EXCESS LIAR I OCCUR
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WORKERS COMPENSATION 1 SRN"
AND EMPLOYERS'LIAWLITY Y I N i ([ I $TATUTN
ANY PROPRtETORIVARTNERIEXECUTIVE I=NJA IE0NC643855 12/31/15 € 12)21/36 IEL EACH ACCIDENT S 1,000,000.
DFRC£RRAEMBEP E%CLVOED7 i E ! EL DISEASE-EA EIRPLOYE S 1,000,000
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DESCRIPTION OF OPERATION$I LOCATIONS I VEHICLES IACORO VN,AtlEmo.Pal Remarks SeAeeleb,may tin amelvae If mem spaea is repe eXIi
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHDRIZEO REPRESENTATIVE
d w Scho].n.i.akltdPB fi -
01988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS025 rsnrentl