1 ROSEDALE AVE - BUILDING INSPECTION t2S-7 C*, `To 2
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only ,
Building Pi mrt Number-", Date plied
w j �. 9/e X
Building Official(Print Name) t. Signature D
" f
SECTION 1:SITE INFORMATION.
1.1 Property Address: 1.2 Assessors Map&Parcel Num
1 ROSFDALF AVF SAI FM,MA 01970 g1 1
Us Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
R1 ONE FAM
Zoning District Proposed Use Lot Area(sq fl) Frontage(it)
1.5 Building Setbacks($)
„a
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Providela - - 7"
1.6 Water Supply:(M.G.L a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: ,F
Zone: _ Outside Flood Zone?
Public Private 0 Check if es0 Municipal E3 On site disposal system ]
SECTION 2: PROPERTY OWNERSHIP
2.1 Owner'of Record:
PAUL FRANCIS SALEM, MA 01970
Name(Print) City,State,ZIP
1 ROSEDALE AVENUE 978-594-0566
No.and Street Telephone Email Address
SHP-I,ION 3.DESCRIPTION.OF PROPOSED WORK=(check all that apply)
New Construction 0 Existing Building 1!f Owner-Occupied 19 1 Repairs(s) Vf I Alteration(s) 0 I Addition 0
Demolition 0 Accessory Bldg.0 Number of Units_ Other 9 Specify:Replacement
Brief Description of Proposed Work :
RFPI ACF 1R DOORS - Nn STRI ICIURAL CHANG
Cie
C4ATED CONSTRUCTION-COSTS „
Item Estimated Costs: Otlici
(Labor and Materials al Uae Only
1.Building $ 35 254.00 1, Building Permit Fee;$ Indicate how fee is determined:.
2.Electrical $ 0 City/Town Application Fee
O Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Othei Fecs: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. _Check Amount: Cash Amount:
6. Total Project Cost: $ 35,254.00 0 Paid in Full 11 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 90125 10-06-16
Jamie Moirn License Number Expiration Date
Name of CSL Holder U
86 Gardiner St List CSL Type(see below)
No.and Street Type Description
Lynn, MA 01905 U Unrestricted(Buildings u to 35,000 on.ft.
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2214 I 1 Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(RIC) 170810 12-23-17
Renewal by Andersen HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
30 Forbes Rd
No.and Street 508-351-2214 Email address
Northborough, MA 01532
Ci /Town Stat ZIP Telephone
_ SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.4 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Faihue to provide
this affidavit will result in the denial of the Issuance of the building permit
Signed Affidavit Attached? Yes.......... No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Jamie Morin
to act on my behalf,in all matters relative to work authorized by this building permit application.
SEE CONTRACT 2-S--Ifo
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 application is true ac to the best of my knowledge and understanding.
JAIME MORIN 8 — >6_"ly
Print Owner's or Authorized Agent's lectromc 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 nor 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 wnlrw.mass.gov/dns
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"maybe substituted for"Total Project Cost"
,i CITY OF SM.&M, MASSACHUSEM
&m=G DEP.44 at NT
130 W.WWQTON STREET,310 FLOOR
TSL(978)74S-9595
FAX(978)740-9846
KINDU RY DRLSCOLL
MAYOR THOU"ST.Pulnite
DntECTOR OP PUBLIC PROPERTY/BLMMING CO',%aa%MER
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
1 11,S 150A.
The debris will be transported by:
Renewal by Andersen
(name ofhauler)
The debris will be disposed of in :
Renewal by Andersen
(name of facility)
30 Forbes Rd, Northborough, MA 01532
(address of facility)
signatum of permit applicant
date
debriuff.dw
I rt a�1' Agreement Document and Payment Terms
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YOU,I TMi> SLI "Elk,.MAY CANC13LTM TRAN$ACTION AT ANY TIM NOT LATER TkIAN ll'iiDMGMT
OF 081''1112016 ORTBE TMRD BUSINM DAY AFTER TEAR II ME OF THIS TRANSACTION,
wmcHEvER DATE Is IATER.sEE THE rrmAcRED NoTiu of cANGELLATioli FORM FoR,r N
1111M Ac11v RIGHT.
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ft-W50&-3$1-22
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Frame, BrUmouldITraditional, EAl lEftln While. iNTEBJOR
While, Glers Sash All:High FetforManee Smad5un Glass, No
Pattern, Hairdwatr:VAhite, Corrosion Resistant Hardware,
Stream. TruScene witill itteflorr Color Ubtrfr, Grille Style No
GrMles, Mist: Casing Interior-Wood, Casing Interim-Wood 2'
702 colonial pre primed white pin
102 Harbor view 11 ndnaa;Casement-Triple, Casemen41-2:1,Vented,E1
frame, Brltkmoul'dA Traditional, EXTERIOR While. INTERJOR
White, GI&49: Sash AM:High'Pmlbrmawe 5rnarl5un Glass, No
Pattern, Hardware-While. Corrosion Resistant flardwvare.
Sawa; TruSoene witty Interior Color hila". Grillo Style:.No
Grilles,hillso Casing interim-Wood, Caskq Interior-Wood 2
102 colonial pre primed white pJn
103 Harborltiew Whine w:Casement-Ttaple, Casement. 1:2.1,Yanted. El
Frame, Rrlc4moutd0 Traditional, E:YtTERIOft Mice, INTERIOR
White, Glass; 589h AM: High Perfurmance StnailSurl GIaSs, No
Pattern. Hardwares.Wlbite. Corrosion Resistant Hardware.
StrAena TruScene whit Intevor Color IrWd4. Grille Style:.No
Grilles, Mise Casing interior- Wood, Casing:Interior-'4Wood 2
V2 colonial pre primedvwhite pin.
OBatGr3rgS rage 41 14
RMwa' Itemized Order Receipt.
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&rickmmuld I Tiad'r ixmiall, EKTERd}R White,MTEMOR White,
Glasz Sash Alt; F igh Perimrmanee 5martSun Glans,No Patterns
Hardware White, Corrosion Resistant Hardware; Screen:
TmScene with Inttrinr Cmtrw Matdi,Grillw SqR4e'Mo brillies,
Misc.-Casing Intedar-Wand. Casing Interier-Vinod 2 1/2
colonial pre primed SsQ W pin
Master bedtc9m VArrdow.Casement-Daa&e, Casement„Vanted EJ frame,
B&kmmrld I Trad"ttional,EXTEMOR White', dITEMOR White,
Qt"v Sash All High Perfomaanre SmartSurr Gly Mo Pattern,
Hardware: White_Cnrzodon'IZesislant Hardware:Screen,.
T13tScgne with Interior Cokw Match, GAN Styf* NO Grilles„
Mlilur rasing tnterbw-VOoad, Casing Interior-VAad d 2 112
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5rr 17:TruScsne tr1&tt Yltevor Colne Matdr,WHO 54yW No
:Grilles, Misc Casing Interior-Wood, C asirrgry kruNior-MbDod
102 colonial pre primed white pine,Full frame art in no
header, rull :ranee cert it Elndud es Header
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Hardware-White Counsion Resistant Hantwmi, Ureen,
TmaScene wf th Inttrior Color;Mauch,Giillo Stec,Na Grilk-%
Mist, Casing tntetior-Wood. Casing iraeaior-Wood 1112
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page 6 1 ]A
RenewalMR
Renewal by Andersen Corporation
36 Fwlac� Rn rd•Nocrthbotoet2h, Ma9molitt as 01932 4 A Pkat c bnraakwneiM Omm iclar
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foreeand edfCO.. :11N imeodr mi[lcrL*Jf' ttoline"as,neadvtmulIflonsmfthe,l,,iwntvni., '111t dollourin¢udMticodoa AwmNatla,avdekl:lan9
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#1161,063,1.67,1704,Wil E'be24X410 OB Full'F'armates
#26 1-2136 24X42wiLf'IOe.DR Tul6 Fraares.
#267 aqui#2114 24.X48 will bo.01B Fall,Frames,
#104 uutd 4IGG will he 23X46 will,'be DB Fplti'franma
#10'caa.l#0718 24X40 wit'i be luNV Full.Fimmes
#169 46XAO will k PW Full Feanxis
#270,424X48 will be PW Full'Fram¢s
#21'0 dwrd circk sievni tiO'6lfaidl-l:.GBCe'asnlfbarst..
,411 DB,unit have aradibacal:checkenLl.All!temhtt aM aSrHM7h With 619rAll C/Bs are full,Ti uSceiie Srm='uith "G'?!2.WP SaA
only.
All PW no grills.All windews glass Typo is smart sun amd majitionmmce i}ea Casing.
As at resmll ref kheae churn _41w, frn"viny lernlo,of Ilse Agar eira*.irl as also cbaa iae 1I1 there Is am Clue urn.Witswlil l ILA blank naJa'k{h'l as..°,vI.4.',.knd3eaElayi;thdi 60 cl tayge a07Fl w
,yaf 1 WTralal rob nlnlomith $3542&l.ac Payment.Mothud.
hkw➢upwdt Ribociroed!$11,751 $9,414AP ulueuty chwIled lue 45rcw4ky ac W waL
$2,337MO V%il f be chmrgo to CrmemShy accoune upon noudra
Maned.
NLW ftl'ltica ac Suui efJau::$1.i,. la2.t.?[Y CrnnSky,Finamce
1 LwC,disnctan CieccnS,kyFirawo
."iubvia,pliat Cmq,*tim Of Job:$11,711 A0
ft Es Wood drtd andaxrtood by and hctmert the padic,the this Amcndmamt and libc ce(gfuwl Agreanaol atematlhato die c rtim undealendi AS be-
Swan the past o,and*=ace m vatul a ndmfta tw ckw*ielg or lmod Wng,xM of-ft rosea of dda Ameatd Nwerfal kczdy Sckna4v1-
e!dga3 lhrt llMmr(t)has read thio Amcndan4ol:and has acuaimed a PwTlded,s*cd,anddataxl evpyof this Ams:mikuwd oat Ow dev was'**lvlaw, '
Ficnmsd by Altdmm Carporaf[am. Bar=W
:py. r.srpnad a Weap201602!6s ON e4Le9c _
S4OUIIurer3CNnotWil111M er Pauly, A. Fra'n'cis Wile
cc0.f.hpcCa�aA .�.
M!2ad9L9e�
Raba"F§t,nW aC�;! t $/3.'laf'I-M'10
0tri40 Name-60 hmduct MR
The Commonipea/th of Massachusetts
Department ofladustrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
vt WWIP.ntass govIdla
Workers'Compensation Insurance Affidavit Builders/Contractore/Electricinns/Plumbers
Applicant Information Please Print Leefblx
Name(BusinemOtganizationlmdividuni): Renewal by Andersen
Address, 30 Forbes Road
City/Statc/Zi : Northboro MA 01532 Phone#: 508-351-2200
Are ou an employer?Check the appraprhnte box:
1.1 i air a employer with 30 4. C] 1 am a general contractor and I Type of project(required):
employees(full and/or part-time}* have hired the stub-contractors 6. D New construction
2.❑ I am a sale proprietor or partner- listed on the attached sheet. 7.'tRemodeting
ship and have no employees These sub-contractors have S. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers'comp.insurance comp.Insurance= 9• Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11,❑Plumbing repairs or additions
myself.[No workers'comp. right ofaxemption per MGL 12.E)Roof repairs
Insurance required.]r e. 152,41(4),and we have no
employees.[No workers' 13.❑Other
comp. insuranceregaired.J
•Any applicem that checis hoz p1 moat atso an aid the region below shrnriog Ilteir workers'compemation policy iofmacgios
t Homeowae,¢wipiehmii this amdavit Indic iliag they are doing alt wok and liters tdrc oolside contrwo5 nwt su mtit a new Mrdavh hagating i ech
*Contractors that check this but man attached an additional sheet shaving the mate of the subcuntmcton and stma whghm or not dun entities have
employees, of cite subcontrastom lime employces,they most pmvMc their voikeis'comp.policy number.
lemon eiaployer fiat k proWding tpor&era'compensnfton Beloip/s the polley am/job site
hl bruarflon.
Insumnea Company Name: Old Republic Ins. Co.
Policy it or Self-ins.Lie.8:_MWC 30543700 Expiration Date: 10/1118
dobsiteAddress: 1 ROSEDALEAVENUE City/Stawalp: SALEM, MA 01970
Attach a copy of the workers' compensation policy deelaratlon page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can land to the imposition of criminal penalties of a I
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine i
of up to MUD a day against the violator. Be advised that a copy of this statement may be rewarded to the Ofilec of
Investigations of the DIA ror insurance coverage verification, t
f do hereby cert ' it palls end petelaes ojperIVY drat rile hrjarmalion prodded abope is true and correrl. t
OMM
—Fimne#: 508i el-9201)
Q eisf use only. Do not sprite/n thls area,to be ronryleted by city or totpa official,
City or Town: Perm IVLtcumw a
Issuing Authority(circle one)l
1•Board of Reatth Z Building Department 3.Cllyfrown Clerk 4.Electrical InspectoElnspeet�or
6,Other
Contact Person: Phone p•
t
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS4)90125
IN p
JAIBMM L
8d GARDINER
LYNN MA 0190
r' ...333 -erf• ``� I
�,�„•��f , )I pit Expiration
Commissioner 1011=0116I. I
k1fRegistration:
e of Consumer Affairs&Business Regulation
ME IMPROVEMENT CONTRACTOR
:=I..,ty0gf0 �
Type: t
Expirati¢t?( y, Supplement Card
RENEWAL BYAND -' ;
• JAIME MORIN �_ i
30 FORBES RD
NORTHBOROUGH,MA 01582
Undersecretary
I
i
�c +yinderser..
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Commonwealth of Massachusetts
City of Salem .V!V
120 Washington St,3rd Floor Salem,MA 01970(978)745,9595 x5641
Return card to Building Division for Certificate of Occupancy
PermFEE
No. B-16-963
FEE PAID: PERMIT TO. BUILD
$Y57.00
DATE ISSUED: 916/2011
This certifies that FRANCIS PAUL A FRANCIS ELIZABETH A
has permission to erect, alter, or demolish a building ,.l ROSEDALE AVENUE Map/Lot: 310241-0
as follows: Windows REPLACEEIGHTEEN (18)WINDOWS - UPDATED 9/14 TO REFLECT THAT ONE
WINDOW HAS STRUCTURAL CHANGE.
(Drawing on file)
Contractor Name: JAIME MORIN t
DBA: RENEWAL BY ANDERSON
}
Contractor License No: CS-090125 r
9/6/2016
Building Official Date
This permit shall be:deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request..
- All work authorized by this permit shall conform to the approved eppfication and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public Inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued until allapplicable signatures by the Building and Fire Officials are provided on this permit.
HIC#: 170810 "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth In MGL c.142A).
Restrictions:
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
Marcia Kirkpatrick
From: Ballon, Elaine <Elaine.Ballon@andersencorp.com>
Sent: Wednesday, September 14, 2016 8:44 AM
To: Marcia Kirkpatrick
Subject: FW: Emailing: lowering sill height onlyjpg
Attachments: lowering sill height onlyjpg
Marsha
Attached is the drawing for 1 Rosedale Avenue illustrating that the window will be lowered. Please send the amended
permit to Renewal by Andersen
30 Forbes Road
Northboro, MA 01532
If you have any questions, please do not hesitate to call me.
THANX
Elaine Ballon I Renewal by Andersen
Permit Department I Greater Boston
30 Forbes Road Northborough, Ma 01532
3: 508.351.2082
5: Elaine.Ballon@Andersencorp.com
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