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45 PERKINS ST - BUILDING INSPECTION
133 3d� 3 The Commonwealth of Massachusetts I WEBoard of Building Regulations and StandardsC� Massachusetts State BuildinCode, 780 CMR SALEM 6— Building Permit Application To Construct, Repair,Renovate Or Demolish a One- or Two-Family Dwelling 1 This Section For Official Use Only Building Permit Number: Date plied: - (� Building Official(Pont Name) - Signatdre Da e SECTION 1: SITE INFORMATION 1.1 Pro er r s • ^ 1.2 Assessors Ma & Parcel Numbers I P tY Ad li F � p L 1 a Is this an accepted street?yes no Map Number Parcel Number 13 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 L6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Public❑ Private❑ Check if yes[] P P y SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner' eco� �L Name(Print) City,State,ZIP YI6 S� �M��iQ �?r� No.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 ❑ Accessory Bldg.❑ Number of Units Other Specif Brief Description of Proposed SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials L Building $ © 1. Building Permit Fee: 5 Indicate how fee is determined: ❑ Standard City/Town Application Fee. 2.Electrical $ D Total Project Costa(Item 6)x.multiplier - x 3. Plumbing $ 2. Other Fees; 4. Mechanical (HVAC) $ List: - 5. Mechanical (Fire $ Suppression) TotalAll.Fees:$ - - CheckNo. Check Amount: Cash Amount: 6.Total Project Cost: $ 0 paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Licen a Number Exp t n Date Name of,SLL HIIoI��derL�['�— 1�11W_bT� List CSL Type(see below) N d Street Type Description ,c U Unrestricted Buildings u to 35,000 cu.ft.) N R Restricted 1&2 Famil Dwellin City/Town, tate, IP M Maso RC Roofm Coverin WS Window and Sidin Signature SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Regist ed orae Inn ov nt Contractor(RIC) H1C Registration Number Expir do ate HI a or RIC Registry N e[ Signature Email 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 Issuanc,5,6f the building permit. Signed Affidavit Attached? Yes ..........fill, 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 ork-�autb�oriz d by this building permit application. lit f/�G� Print Owner's Name Signature Date SECTION 7b: OWNER' ORAUTHORIZED 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 be of rtowledge and understanding. Print Owner's or Authorized Agent's Name Da NOTES: 1. An Owner who obtains a building ermiW 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 H1C Program can be found at www.mass.gov/oca ov/oca/oca Information on the Construction Supervisor License can be found at www mass._ oviddss 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basementiattics,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"maybe substituted for"Total Project Cost" CITY OF S-UI ENl. AXSSACHUSETCS • BUILDING DEPART%mNT 130 WASHINGTON STREET, Y°FLOOR TEL. (978) 745-9595 FAx(978) 7.10-9846 KI�IBER i Y DRISCOLL LiAYOR 'IHoatAs ST.PI£ItRfi 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: (name of hauler) The debris will be disposed of in 0. ( e of facility) ��Ot1Ps (address of facility) signature of permit applicant date Jebriwir.dix The Commonwealth of Massachusetts Department of Industrial Accidents 1 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 PERMITTING AUTHORITY. Applicant Information It I Please Print Legibly Name (Business/Organization/Individual): Address: ry City/State/Zip: Phone #: Are you a mployer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 10 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 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required]t 10E] Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation imumnce or are sole 11.[:]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]RXf repairs These sub-contractors have employees and have workers'comp.insurance.[ 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also 611 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-comractors 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: Policy#or Self-ins. Lic.#: Expiration Date: _ Job Site Address: y _City/State/Zip-.— Attach ity/State/Zip:Attach a copy of the workers' compensation policy declaration page(showing the policy number s nd expire 'on 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. Ido hereby certify an ties of perjury that[he information provided above is true and correct Si nature: Date: Ph jftcial 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#: 303rd ;;-3jidi:i^y Rac';;at,0-s and 3[andard3 _ic�ess CS-072772 JEFF C STEELE 24 SHERWOOD AVE _ DANVERS MA 01923 -�Mni33ioner W0712018 ----,,Office of Coasumer Affairs 3c Rusfaess Regulation --_ HOME IMPROVEMENT CONTRACTOR -.-. Registration: 166025 Type: Expiration: 4/1212018 LLC WINCOW WORLD OF BOSTON,LLC. JEFF STEELE 24 CUMMINGS PARK SUITE 15-A VVOBURN,MA WWI Undersecretary Lir registration valid for injividual use only -�, befo expiration date. If found return to: of Consumer Affairs and Business Regulation 11c Plaza-Suite 5170 ` Boston,MA 02116 1 A i I ;Not valid without signature CEPT I FfC A T5 0F I At BlL I-Fy i�' 45"A NICE i W-Ocr-177-1 1170�, — 13 MMED,A. 711; -AND T �41G ,,j Upo'N .110i . .... .-A7,— DF DOE- �7z- - __ -. )'�t �oP�E_D 5-r TH� AND-1,jl� 8 S3VING ills uFtFR[si. AL_;7.,jr,_ 13 p0jivi.zsarfam a vrrIdern azr_5wos222nd-3 �Enr ando.-.- et rl -M. I S-nn i3�nn GS:) I" ,5 Elm s-- I M�k-_ Co I irlothy Ward, Nu _r4iss am-336-M-71-3-1 Timochy ward.cpcu,c1c 1 NArard@senndunn.com 4INSURED Winclow iA CNI HIS CO of AmaHo forld Of U OstalL LLC 118 shaver StreetAIW.�Q i31534 MOrth Ofilikesboro,NC 28659 COVEDAGGs CERTIFICATE AIU,,.Or INSURM F- 7 OF 1, : :�7Alp-ICE�USI�93st-Lo THIS is TO CERTIFY THAT THE POUCI N- TED_ Dlo-npjl-,;q REVISION NUMBER: CERTIFICATE _rANDING ANY ReQUIRBIFN I.T_�,M OR CO�j.D W HAVTO hiE E I I 61AMM A50VEFOR.THE POLICY PERIOD MAY MOM OF Co��_ - BE ISSUED OR MAY PERTAIN.THE imsLIR&qCE I ACT TC)RC)'HE-9E)OCWAENTIMTHRESPEC�-TOIJVHICH.-rHis HM -AFFORDED 8'( "4E POLICIES DESCRIBED KEREIM 15 SUBJECT 1-0 ALL THE TERA,13. L_Lf 771 TYpr_OFIuSU._.__ k4AY HA-VE SEDI--IEDUCEr V PAID CUJMS. I 01S11111PAMI PiUCY.Num En. Paucr, POLICY m I P. I LIMITS 1 LLj InS9790251707 Sh�� 1 j 0d11 OA1 3'DO,00,1 Fl --- 4 5.000 -HAL I AMV n,_�Ijgl 13 1,000,0100 =�:Ucy SS'ERAL AG';� 000 17 -S-_'l2!CF-GG 1,3 2,110 100 __�Lc "Z DL R*CP�G 3 i 3 2,00o,000 3 5C'l 1;4,Au I qwEr a siwwn-,Ljmr 1 1-900.900 D, t UNIBRE1 LIAR x —ICESS 1.000.000 A aalas�lAcg86790 oft WORKQPZ 'n LO AN YEW LIARiu7y PEI B62 L'1-Nps yt 111JECU2635 Iffiandwary In NH) L 0112711018101127/2017 EL acn ACCIDEN7 500,000 d=nba M�.r L OIS5kSE-EA�IF,a,;- �3 500,000 OISEASE-P=C.LIMIT 3 500,000 OFaPiEtATjUnS LOCATIONS fVEHICIZS (A:ORO 1".Adcfl�nj "n'liars I ll.iMdl CERTIFICATE HOLDER CANCELLATION A�011E D:ESI;(PR M POU SHOULD 0 OF THE ": OA F. NOTICE THE POLICY 74 Tlo�� I Yp OVISIONS CE�v T'VE TA I F�z SHOU L�DAWY Or THE ABOVE DESCFUB ED POUCI ES S E CANCELLED a=Fo R a T'4r EXPlItATION DATE THM�.ao,. NOTICE WILL BE 0MJVE,,ED IN ACCORDANCE ACCOPOAuCE W[Tli THE POLICY PROWsIoN AIJMIORIZ.ED.lsPRE3eNTAT,,, !CORD Z5(2014/01! ' ©1408-2014 reaf,,,d The AGORD 1999-2014 ARiRRPORATION. All righ�D ME and 1090 are remfo.re.i Window World of Boston MA HIC Registration • 15A Cummings Park Number: e Woburn, MA 01801 f (781) 932-4805 • Fax: (781) 932-x828 Federaleral ID# www.windowworldofboston.com 27-1481665 "Simply the Best for Less / r Customer: LA to-ria v t 4r Ou Z2 Phone (h) CQ?9) a2 1.0.— Install d —Install Address: Y�— 6,1c,"t} ,s1L Phone (w) Bill Address: �w�ew "A q E-mail ORDERVINYL SIDING PURCHASE AREAS TO BE ED PRODUCT COLOR 3 Front Siding . ww 200o � /�4000-EP Left WW 4000 t—d� Prodigy B Outs a Corners Gv G. Back Other 3 STD ❑ INSULATED Rights Other PROFILE INSULATION Clapboard Laror Dutchlap❑ rs ❑ FULLBACK HOUSE WRAP Yes ❑ NO FRIEZESOFFIT, FASCIA, • - ; ck Fascia AREAS TO BE COVERED Un er Gutter Front Left Back Right Other *Color* 0 Y ❑N New utt s Sofit&Facias & Dow outs Fri a Board ' K tOn - 6 Fascia Only Yes No 1 Cover Frieze Board with: G8 Aluminum Coil ❑ or Vert. Soffit ❑ * * 2 New Gutters and Down Spouts to be in ed.in existing locations, unless noted otherwise oelow. Remove Existing Siding Yes No ❑ If yes Vinyl/Wood LW Aluminum ❑ Only where new siding is to be installed.Window World will NOT remove asbestos material. If rotted wood is discovered AFTER removing the existing siding, I Customer to Indicate there will be an additional charge of$3.50 per Sq. Ft. accentance b initialin M . i REMOVECUSTOM WRAP WITH G8 ALUMINUM #of Frames Oty *COLOR' ft. Wi dows/D Storm Windows Burglar s* Garg Patio oors S Doors Existin Sh ers Double g0 Door _ \wn;lIs- to 8' in markets,Burglar BaBuild Out Frame s-Ove can be removed,but not reinstalled. nt Beaded Soft Color GABLE VENT I rsal Locati clan lecny. OLOfi* 9Ba r Y/NN *COLO tPorch s 1 Porch Posts j_J TTERS - . - Y/N *COLOR* #OF IRS *COLOR* uvered lsed Panel • 9 1 • • To be replaced in the following locations: SPECIAL CONSIDERATIONS`. ir7 oKe u it [)af l a - I Drop Location: Customer agrees to the terms of payment as follows; �L //��/'j Total Project Cost $ f��f if 1 f Amount Finan ed $ —' Window World of Boston anticipates starting this work on — we*3and being substantially completed in �Vdays.Security Interest Yes No Any deposit required in advance of the start of the work SNALL NOT ezcee aG Ttf a aioTT—contract price or the actual cos[of any material or equlpme dof a special aNer arcuslom ma e�naWre,wFcTi must be ordered in advance of the start of the work to assure that the prolI'ect will proceed on schedule.No final payment shall be demanded unit the contract Is cont letedto the satisfaction on all parties. All home Improvement contractors and subcontractors shag tie egiste eti and that arty squires about a contract or subcontractor relating to a registration should be Smulat to:Office of Consumer Affairs and Bushurss Regulation,Ten Park Plea,Suite 5170 Boston,MA 02115.Phone:(61 71973.8700 No work shall basin prior to the signing of The contract and transmittal to the owner o a copy of such cantracl. Window World of Bosron under provision of Chapter 142A of the general laws is required to ap Ip y for and obtain a5 construction-related permits.Window World of Boston shall not be deemed responsible for delays in the wok described in this agreement caused by regulatory,permit Wrig agencies,auBmrNea or individuals. Rdce:II fie PURCHASfA(S)obtains his own coaslmctien raised ppermits forme work described under this agreement ordeals with unregistered contractors,the PURCNASER(S)is hereby advised Nal in the evert of a dispon,Judgement and nonpayment,Ne PURCHASER(S)win not be erred to make a maim or collection trete the guaranty fund established by chapter 147A MAL a/ / O ner:Do not sign if there are an ask spaces. Date `I SateerR :Do not sign if there are any` taf r spaceDate I Owner:Do not sign If there are any blank spaces. Date Cosco Siding 08-13 White Copy-Original Yellow Copy-Re Pink.Copy-Customer