15 VISTA AVE - BUILDING INSPECTION The Commonwealth of Massachusetts �NSPECTIOMAL ERVI
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code,790 CMR 99pp�� 2011
Build' Permit Application To Renovate Cmemolish a
Building PP � Construct,Repair,
One-or Two-Fwndy Dwelling
This Section For Official Use Only
n Building Pamit Number-. Daft lied _
Building Of6cW(Print Nems) - - Date
t SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
15 Vista Ave. Salem, MA 01970 -09 .09-0050-
1.11118"an accepted street?yes no_ Map Number Parcel Number
\1 13 Zoning Information: 1.4 Property Dimensions:
R1 one fermi
Zoning District Proposed Use Lot Area(sq 11) Frontage(ft)
13 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Requnal Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? unicipal Asa s9� E3
Public O Private D Check F M O On site
SECTION 2: PROPERTYOWNERSHIP1
2.1 Owner-of Record:
George Assimakopoulos Salem, MA 01970
Nome(Print) City,Stets,ZIP
15 Vista Ave. 978-744-0519 grkangel78@hotmail.com
No.and Street Tehphooe Email Address
;SEC11ON 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction DF�risting Buildibg Owner-Occupied lif I Repairs(s) If I Ahmation(s) 17 1 Addition 13
Demolition O 1 Accessory Bldg.O Number of Units_ IOU= af Specify:Replacement
Brief Description of proposed Worka: replacing 4 windows- no structural changes
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs-
Items Official Use Only _
1.Building $ 1, Building Permit Foe:$ Indicate how fee is determined:
E3 Standard City/1•own Application Fee
2'Electrical $ O Total Project Costa 01cm 6)x multiplier x
3.Plunbing $ 2- Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (FSra
Suppression)
$ Total All Foes:$
bock No. Check Amount: Cash Amount:
6.Total Project Cost: $ 11,741 O Paid in Full 13
Outstanding Balance Due:
m P► t-Eo to 5t1se
SECTIONS- CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 90125 10-6-16
Jamie Moirn LioenseNumber Expiration Date
Name of CSL Holder
List CSL Type(see below) U
86 Gardiner St
No.and Stmet Type Description
Lynn, MA 01905 U Unrestricted(Buildings to 35,000 cu.ft
R Restricted 1k2 Family Dwelling
City/rown,State,ZIP - M Masomy
RC Roofing Covering
WS window and Sidbut
SF Solid Fuel Burning Appliances
508-351-2214 I 1 Insulation
Tele hone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC) 170810 12-23-15
Renewal by Andersen HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
30 Forbes Rd
Northborough, MA 01532 508-351-2214 Email address
City/TowiL State.21P Tel
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GJI e.152.1 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
L as Owner of the subject property,hereby authorim Jamie Morin
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:OWNERn OR AUTHORIZED AGENT DECLARATION,
By entering my name below by attest under the pains and penalties of perjury that all of the information
contained in this appli ' is and accurate to the best of my knowledge and understanding.
Print Owner's or A Agen's Name(Electronic Signature) Date
tz NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires on unregistered contractor
(not registered in the Home Improvement Contractor(INC)Program),will nor have access to the arbitration
program or guaranty fiord under M.G.L.c. 142A.Other important information on the lIIC Program can be found at
Information on the Construction Supervisor License can be found at www.masjms dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.fL) (including garage,finished basenem/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half7baths
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 SALEbi, 1VWSACHUSEM
BLIMMG DEPAMENT
120 W.WMGTON STREET.r FLOOR
TEL(978)74SA595
PAX(978)740-9846
KDOERLEY DRISCOLL
MAYOR THOMU ST.PMUS
Dmacmz cw PL'HLW PROPERTY/8Lmmc;COADUSS mm
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State BuildingCode 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 firm
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
11 I's 150A.
The debris will berted b :
�� Y
Renewal by Andersen
(same of la<uler)
Tbe debris will be disposed of in :
Renewal�by Andersen
(cams of facility)
30 Forbes Rd, Northborough, MA 01532
(address offacility)
sip permitapplicant
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Renewal ns Home Improvement Contractor
byAndetsen. Renewal b Andersen Corporation License Federal
ax ID 9 12/91841 )
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Y � Federal Tair ID 841.1918413
30 Forbes Rd. Nonhborough,MA 01532
(508)351.2200 Fair(508)-986.7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
Bu e s Name Date:
MARIA ASSIMAKOPOULOS - AUGUST 28, 2015
iB er(s)Street Address City State Zip Code
15 VISTA AVE SALEM MA 1 01970
(Email Address Home Telephone Number Work/Cell Telephone Number
GRKANGEL78G)H0TMAIL.00M 978-744-0519
lBuyer(s)hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation(-Contractor'),in accordance with
Ithe terms and conditions described on the front and the reverse of this agreement and on the attached specification sheets)(Collectively,this"Agreement).
fBuyer(s)hereby agrees to sign a completion certificate atter Contractor has completed as work under this Agreement.
Est,Start Date Method of Payment
Total Job Amount S 11,741 w,.m RuxacedS 0
Deposit Received(33%)S 3,913.67 Depeou et eng.wg S 0.00 &12 weeks ',e Check/Cash
Balance Stan of Job(33%)S 3,913.67 Chock 8
Balance on SubstantialEst Install Time Credit Card
Completion of Job(33%)S 3,913.67 a s �S 0.00
1-2 days D credh card Is selected,please
Na 1me •••e Eeana&KKp,Iw ai ��� sco Cmdit Card form
Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings
changing or modifying any of the terms of this Agreement No alteration to or deviation from this Agreement will be valid without the signed,written consent
of both Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the terms of this Agreement,and has
received a completed,signed and dated copy of this Agreement,Including the two attached Notions of Cancellation,on the date Brat written above and 2)was
orally informed of Buyees right to cancel this Agreement. 00 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Renewal by Andersen Corporationer ) Buyer(s)
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Signature of Consultant - '-Signature '-- -"--"--Signature
x JOHN BEAVER MARIA ASSIMAKOPOULOS
Prceod Nano of Consultant Printed Narm Priced Name
You.TRE BUYERril NAY CANCEL ME TRARI ACTON AT ANY RYE PRIOR TD NIONBM OF ME Von;BUSINESS DAY aFYERTME DALE OF 1116 TRANSAC hl
SEE ME ATUCNED NOTICE OF CANCELLARON FORNS FOR AN E2PIANARON OF CHIS IRGNf.
____________ ____________-_________ ___ __________
NOTICEOFCANCEIJ.UTONROTLCEOFCANr:ELL7T10N
D.uorT actiun 0/119/14 . You moycaacel Wis 1 Doteaf Ttuessnimyn/1'. Yoo may cnmd Wig
umsaetirq without any Penalty or obligatloq wiLLie Wree budgess da"firuen the uvmardee,a iebeut vey pensby or ebligadeo,wWdn three ber"'res du} ream flee
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30 rwbea Rd. Northborough,MA01532. 1 90 fvrbea Rd.NorWberougb,NA OISR.
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Renewal Renewal by Andersen Cofpofadon MA Home Improvement Contmctor
♦v �- 30 Forbes rd Northbomugh.MA 01532 license#170810 (Expires 12/23/2015)
Andersen.
w,woow weeuerrxrna .,,n..l,,.,.c,...,,.• (508)351-2200 Fax:(508)-988-7072 Federal ID#41-1918413
Window Specification Street
Uuvcr(s)Name Date of Alrievnicni
MARIA ASSIMAKOPOU LOS FR I. AUG 28, 2015
I"Phe buvm(s)listed alewc herehyjoiurly:wd.uertxally agree to pu ellasc the gon(is mulhn devices listed lw:lo+q in avowlan v;with rile prices and terms de_.eril,ed
,,it theSpecification Sheat:urd the fmm anti the reverse r.(the:usonl)unving CU1"1'01%1 WINDOW AND DOOR KI?\IOUBIJNC:\l:RliB\Ih:\'f,of Whichflic Slnxifuration Sheet is parr.
WINDOW&DOOR DETAILS
pee, qyy, xpp, EttoriwMta Color He,dwaO IaNrrma LowEe/ Gee Gine Goss
Room a orae �I Ul N(adow/Door Style boost Cesl,,lis Fd-ht Color Style soeno SlnabW Gnliss snhnq a 2 lifts 0lxnM
Uving 201 1Ifi 48 164 CT 1:2.1 full hams Ext.MF 908 White Stendad FAL an wono - No
Uwirq 101 Itll 49 152 CT 1:2:1 full frame Ext.MF 908 White Stadad FAL tae. No
Kitcnn 202 :34 36 70 GW to frame lafo Ext.MF 908 NHINWhite Standard FAL taare yes No
Bad 1 102 •14 53 97 GW full frame rata Ext.MF 908 Niw White Standard FAL knans,,r rave yes No
Total 4 BAY BOW&BUILD OUT DE7•AIIS
stria Ooail/ vn�tlW 4M. Humbw Frmno Window f,,d fmtw lawE/ Rooft Hadaaro
ROOM Count S Dankam ht r...rge Was Intenw M.,Cdw onts9 =P,is :.a51w9 sReans SmatSun Soffit Cdw
SPECIALTY WINDOW DETAILS
FJI/ Apgoa. los/ Arty BAY/BOW ADDITIONAL WORK NOTES
Ramon Count s o Inswt U.I. srturt n GOMs Grit style &Mt Color I C, u—I...,am ih.x411 1n1/6a wwbm:.,u.bv:^_Imrbn
rime:rill A,:.ieellu:w eL..Mv.
ADDITIONAL WORK DETAILS:
I No Contractor will wrap exterior casings with coil stock color of
F
ner a aware#rat Contractor does not do any pain#ng/sreining or remove//lnsfalhdtlon of alarm system w window beafinents/hadware.It is the responsibAly of
homeowner ro have the aRnn system arcl window treafinents/hardware removed prior to installa#on. Wemakemguaranteesstowhetheralamsorwndow
tme WharoN arewill#taftwreplacemenL Cushvnerartaoawareinsamerasestherewillbaglassloss. if thereis,Me amount willba dependent on the type
xising windows,type of irstalfalion and window style.We make no guarantee as to the amount of glass hiss.Customer is aware end understands any and all
een rot is not included in this contract.Should any rot be found there will be an additkrrial charge for time and matedals unless so stated in this eonbaef.
s yes Contractor will Insulate.caulk and seal wallows with 3-print system to prevent water and air irritation.Removal and disposal of all fob related debris,
windows.doors,storm windows and vacuum nightly included. Upon completion of the job and payment in full,a limited warranty shall be issued.
4 Yes Building Peront--Contractor will secure any and all necessary permits. The fee for the permits)is included in the total contract price.
Y. All discounts have been applied to this agreement.
t '1; 1-.:s " No Owner agrees In be present on the final day of installation for final Inspection and to deliver final payment/finance form(s).
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Renewal by Andersen Corporation IAnve:(.a) llule.n,)
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Signature of Consultant ur Signature
JOHN BEAVER RIAASSrMA POULOS
Print Name of Consultant Print Name Print Name
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enpmla, Reno l by Andersen Corporation
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