22 LINDEN ST - BUILDING INSPECTION The Commonwealth of Massachusetts '';jf10
Board of Building Regulations and Standards )' `3M F
( w
Massachusetts State Building Code, 780 CMR SALE
^ ' ev� d�t�r 2011
l v Building Permit Application To Construct, Repair, Renovate Or J§6ndiJ6}t'ds
(� One- or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
1'`rI SECTION 1:SITE INFORMATION
1.1 Property Address —
: 1.2 Assessors Map& Parcel Numbers
Jeh
�
l.la Is this an Y
accepted street? es no Map Number Parcel Number
P
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'
2.1 Owtr`a ecorq _
Name(Pnnt) — �/Ci�ty(,-S�'tpa—telppr �
No.and Street Telep6fne� Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ 1 Repairs(s) <Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Speci
Brief Description of Proposed Work':
1�
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:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Su ression Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
C .
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Yum epi' Expi ti Date
19
Name of CSL Holder
A�aList CSL Type(see below)
No.and S Type Description
�t U Unrestricted(Buildingsg u to 35,000 cu.ft.
City/Town,State,ZI I"� R Restricted 1&2 FamilyDwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
Ig� � 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home,Imp rovemen Contr ctor(HIC) /��X/�1�
1 ) HIC'RegistrationNumber E u ion Date
HIC o Naor HIC Registra t
No.and Street Email address
WA
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 Issuan 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
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: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 in this applic ignis a and accurate to the best of my knowledge and understanding.
Pri ner's z d 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/ds
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
ate\ �.... ...........,.......,...... � �.�..,,�...,......,......,
Department of Industrial Accidents
Office oflnveshgations
UIP 600 Washington Street
Bostol,4 AM 02111
wsvw.merssgovldia
Workers' Compensation Imsurance Affidavit: Bu lders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Orgmuzatibnandividual):
Address:
City/State/Zip: � Phone#:__ ` W i Lwl_
Are yo employer?Check the-appropriate bog: Type of project(required)_
I. am a employer with J0 4. El I am a general contractor and 1 6. []New construction
employees(full and/or part time).* have hired the sub-contractus
Z. I am a sole proprietor or partner- listed on the attached sheet t I. 0 Remodeling
ship and have no employees These sub-contractors have 8- 0 Demolition
working forme in any capacity- workers' comp.insurance. 9- ❑ Building addition
(No workers' comp-insurance 5- 0 We are a corporation and its -
required-] officers have exercised their 10.0 Electrical repairs or additions
3-❑ 1 am a homeowner doing all work right of exemption per MGL 11-El Plumbing repairs or additions
myself. (No workers' comp- d 152, §1(4),and we have no 12❑ ans
insurance required.] t employees-[No workers' J
comp.insurance required-] 13.L7 Odt
*Any applicant that checks box#1 must alsotMotathesection below showing flairwofl=s wmpensffioaPolicy,fifDnoRbon:
t Homeowncrs who submitffiis a$idavit mdicstmg they are doing all work sod then hire outside contractors must sabovt anew affidavit indicating such
"Contractors that check this box must stlached an additions'sbcet stowing Ste name ofthe sub-cont Rdon and their workers'comp,policy information
I am an employer that is providing workers'compensation insurance for my employees Below it the policy and job site
information
Insm-anceCompany Name:
Policy#or Self-ms.Lic-#: z �l 1���( � i Expnation Date:
Job Site Address: � h — (�/��ip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A ofMGL c 152 can lead to thy imposition of criminal penalties of a
fine up to$1,500.00 and/or onc�-yrai 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
hivestigations of the DIA for insurance coverage verification.
Ido hereby certify under p ndpparda ofpedury that the information provided above is true and correct
Si afore: Date:
Phone#:.
F
use only. Do not write in this area to be completed by city or town offwW
own• Permit/License#
uthority (circle one):of Health 2-Building Department 3.City/Town Clerk 4-Electrical Inspector 5.Plumbing Inspector
Contact Person: Phone#•
Massachusetts Department of Public Safety
-� Board of Building Regulations and Standards
License: CS-072772
Construction Supervisor
JEFF C STEELE
24 SHERWOOD,AVE ,rt
DANVERS MA 019231;.. ,.
#t
�—JZ77 CA— Expiration:
Commissioner 04/07/2018
1,',............r...
office Of of Consumer Affairs&Business Regulation
V, —�'
HOME IMPROVEMENT CONTRACTOR -
Registration: 166025 Type:
Expiration:- 4/4212018 LLC
WINDOW WORLD OF BOSTON,I.I.C.
JEFF STEELE
24 CUMMINGS PARK SUITE,15-A.
WOBURN,MA 01807 Undersecretary
License or registration valid for individual use only
before the expiration date. If found return to:
Office of Consumer AffairsandBusiness Regulation
10 Park Plaza-Suite 5170
Boston,MA 02116
of valid without signature
CITY OF S�U.&N1, NLASS.kCHUSETTS
BUILDING DEPARTMIENT
•• i • 130 WASHL�IGTON STREET, 3"FLOOR
'�.a oar TEL. (978) 745-9595
PAX(978) 740-9846
1CI.\{BEyj FY DRISCOLL
MAYOR T Hoatns ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUUMLNG CONLMaSSIONER
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:
(name of hauler)
The debris will be disposed of in :
6165, r
(name of facility)
(aadies-s of facility)
igna (ue of permit applicant
r
—date
dcbrisaIf.doc
e
® Window World of Boston, LLC MA HIC Registration
Offices & Showrooms Number:
O 15A Cummings Park U 295 Old Oak Street Federal
I 27-14816655
i Woburn, MA 01801 Pembroke, MA 02359 Federal D
9 (781) 932-4805 (781) 826-6281
"Simply the Best for Less" www.WindowWorldofBoston.com
Customer: N Y'N o`\f' , MIN I0\ A Phone (h) QUA=210"8d 9 9
Install Address: 22 L1f1(�i°C1 it Phone (w)
City: SMr\ ft State:.MAZip.
WINDOW WORLD GLASS OPTIONS
/
1000 Series Single-hung All-Weld $189 "Triple Glazed Elite $$95�—I
-_2000 Series DH Mech/Welded Sash $195
_L%5'4000 Series DH All-Weld $205 O (*Series 6000 Only)
6000 Series DH All-Weld $240 WINDOW OPTIONS
_2 Lite Slider $334 r Glass Breakage Warranty $15 INCLUDED
3 Lite Slider jim 112,112) (1/4.112.1/4) $525 1/2 Screens $91NCL DED'
_Picture/Fixed Lite $334 _Foam Insulation on Jambs and Head $11 INCLUDED
Awning $260 / Double Strength Glass $15 INCLUDED
- Double Locks (> 26") $5 INCLUDED
_Casement $290— Full Screens $22
2 Lite Casement $575 Colonial Grids (Contoured/Flat) $45
3 Lite Casement (113.1m im (114.112.114) $860 Prairie Grids $51
_Basement Hopper $334Diamond Grids $69
_Bay Window-Soffit Mount/INS Seat $2660 Simulated Divided Lite $182
_Bow Window-Soffit Mount/INS Seat$2785 Tempered DH Sash (BSO) (rSO) $65
_Garden Window $1880 Obscure Glass (BSO) (TSO) $35
—Specialty Window $ Oriel Style (40/60 or 60/40) $30
_Beige/Almond $40 Foam Enhanced Frame $35
_wood Grain Interior(Series 4000 l 6000 only)$100 PRE 1978 BUILT HOMES (Federal Lead Containment Law
(Light Oakl Dark Oakl Cherry l Fox Wood /j Lead Safe Practices Required $25 3 T
Rich Maple) MY HOME WAS BUILT IN THE YEAR /800 Initial.X)Cn
_Brown Exterior(Arch.Bronze(American Tena)$100 MISCELLANEOUS
_Designer Color Exterior $155 Custom Exterior Aluminum Cladding
U Textured$75 O Smooth G-8 $75 $
Window Color t�G, / ��` � Facing Color.
Inside outside Metal Window Removal $50
NON CUSTOM DOORS New Construction Vinyl Removal $175
_Vinyl Rolling Patio Door 5ft.or eft. $995 Specialty Window Exterior Trim $
_Vinyl Rolling Patio Door 8ft. $1095 Mull to Form Multi Unit $30
_Add to base price for Custom Rolling Patio Door $1150 Install Interior/Exterior Stops $50
_French Rail Sliding Patio Door 5ft.or Eft. $1295 Install Interior Casing Starts At $95
_French Rail Sliding Patio Door Sit. $1395 Insulate Weight Boxes $20
_French Rail Sliding Patio Door 9ft. $1495 Roof for Bay/Bow Windows $500
_Custom Exterior Cladding $150 Existing New Const. EM. Retro Fit $150
SolarZone Elite or ETC Glass $175 Removal of Existing Bay/Bow $250
_Grids Patio Door $129 Repair Sill,Jamb or replace sill nosing $50
_Woodgrain Interiors $29 5 Full Sub-Sill (Single) replacement $150
_Exterior Designer Colors $395 Mullion Removal $30
_Interior Casing 272 3112 $175 Bay/Bow Conversion Ext. Retro Fit $350
Handleset Options $ (New Siding Will Not Match)
$ _Building Permit $150 /S9
Door Color / 47.-N ROUND-UP FOR WINDOW WORLD CARES
Customer declines grids on /4 G` windows/doors Initial o tem
DISCLAIMER:Customer is responsible for the following in connection with this contract:Painting,Staining,Alarm System disconnecVreconnect Building Permit fees!h
excess of$25.00,Homeowner and or Condo Association Approval,Historic District Approval.City of Boston parking&sidewalk Permit fees in connection with installation.
NO EXTRA WORK IF NOT IN WRITING! Customer agrees to the terms of payment as follows:
Extra Labor& Materials $ 50 g
b7M41 <( MS., e d dG
i Site Set Up, Disposal &Delivery Fee $ $195.00
?0 C Total Amount $ .502 e o
Custom Order Deposit 50% $,96410 Ck#
Balance Paid to Installer upon Completion $J6 tt O
Amount Financed $
Windowworld of Boston anticipates startingthis work on wee�f and being substantially completed inL,�Uays.Security Interest Yes_No_
Any deposit required in advance of the start of the work SHALL NOT exceed 331/3%of the total contract price or the actual cost of any material or equipment of a
special order or custom made nature,which must be ordered in advance of the start of the work to assure that the project will proceed on schedule.No final payment
shall be demanded until the contract is completed to the satisfaction of both parties.
All home improvement contractors and subcontractors shall be registered and that any inquires about a contract or subcontractor relating to a registration should be
directed to:Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170 Boston,MA 02116.Phone:(617)973.8700
No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract.
Window World of Boston under provision of Chapter 142A of the general laws Is required to apply for and obtain all construction-related permits.Window Word of
Boston shall not be deemed responsible for delays in the work described in this agreement caused by regulatory,permit granting agencies,authorities or individuals.
Notice:U the PURCHASER(S)obtains his own construction related permits for the work described under this agreement or deals with unregistered contractors,
the PURCHASER(S)is hereby advised that in the event of a dispute,judgement and nonpayment,the PURCHASER(S)will not be entitled to make a claim or
collection from the guaranty fund established by chapter 142A,M.G.L.
You the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.
Notice of cancellation must be in Writing postmarked no later than midnight Of the following third business day.
This Window Wodd®Franchise is independently owned and operated by Window World of Boston,U.C.under license from Window Wodd Inc.
Owner.Do not sign if there are arty blank spaces. Date
C9 jt 8/l,6
amen:Do not sign if there are any blank spaces. Date Owner:Do not sign a there are any blank spaces. Date
swWn or-u White Copy-original Yellow Copy-File Pink Copy-Customer Hayes Printlnge &6/.111e