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B-20-527 - 0014 BENTLEY STREET - Building Permit The Commonwealth of Massachusetts OF Board of Building Regulations and Standards SIA CITY Ulf Massachusetts State Building Code,780 CMR Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section'Foofficial-:Use Only. Building Permit Number. -Date Applied , Buil ' Official ruitName Si ature : g i ate SECTION 1 SITE INFORMATION ` z 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street. yes no Map Number Parcel Number 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: PRO PERTY.OWNERSI3IP 2.1 Owner' A Record: Name(Print) City,State,ZIP ig No.and Street Telephone Email Address SECTION 3:DE W SCRIPTION'OF PROPOSED,, ORKZ(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other wlsoecify: Win d uwS Brief Description of Proposed orlcZ: .� SECTION 4:1STIMATED CONSTRUCTION COSTS Item Estimated Costs: Official`Use'Only Labor and Materials 1.Building. $ oU 1;: Building Permit Fee $ _ Indicate how fee is determined:.; 2.Electrical $ ❑Standard City/Town Application Fee = ❑Total- 1 Plumbing. $ ► 2 Other 4.Mechanical (flVAC) $ List: y ��J S.Mechanical (Fire $ Su ression Total All Fees: $ b� Check No Check Amount Cash Amount 6.Total Project Cost: $ °� ❑Paid in'Full 11 Outstanding Balance Due: i t , SECTION 5: CONSTRUCTION SERVICES F51 Construction Supervisor License(CSL) �e�� C. ^� -�� License Number Expiration Date Name of CSL Holder ` 1 C List CSL Type(see below) V T e ` Descn rion _': No.and Street P w.. �f�r���,� M 1��� U Unrestricted(Buildings u to 35,000 cu.ft. ` 1 R Restricted 1&2 Family Dwelling City/Town,State,ZIP' M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances C LDMC_0.S� I Insulation Telephone I Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Lip d�aayy ' l CO 5�1� R � S V � 0-z.A. W, V HIC Registration Number Expiration Date HIC.Company Name or IHO Registrant N e Cl No. I d St51 reet �0='D , ` ,. 93 �i B 6 Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G L.c.152.§ 25C(6)j 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 jai OWNER AUTHORIZATION'TO BE COWLETEO WHEN OWNER'S AGENT, R CONTRACTOR APPLIES FOR BUILDINGTERMIT I,as Owner of the subject property,hereby authorize ow W o(\A to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owned s Name(Electronic Signature) Date SECTION 7b,..OWNERr ORAUTHORIZED.AGENT DECLARATION By entering my name below,i hereby attest under the pains and penalties of perjury that all of the information tained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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/dos 2. When substantial work is planned;provide the information below: Total floor area(sq.ft.) (including garage,fmished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halfibaths 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" 1 iAz ir'flralitata►zw.ealth of MZ-3achzsez 1- DIEpar•item qfIn dustrualA ce"dents 't •flj, ce of In vestig aeons (". 600 Washington Street �+ Bostof;AIA 02111 ry w;v.rta crass.go v/diva Workers' Compensation l;asu>rance:kf adav'it::Builders/Contractors,Mectrieiaas/'1'laamlhers ARplicaut Information Please Print L,eaibly Name(Business/Organizadon/Individual):.L GS G` /Ct, }� It f/YLOGA0 00A'( 06 / 0D� Address: % U rna'n,r.' S Pa rle City/Stateilip:kVG 00,r'(� I `12 . �! ��Q Phone#: �� " ��- 4cl) Are you an employer?Check_the appropriate box: ❑/ Type.of project(required): 1. 'v i am a employer with SU ¢. ❑ I am a general contractor and I employees(full and/or part-tirne).,` have hired the sub-contractors 6. ❑New construction m Z.❑ I a a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling es These sub-contractors have g, ❑Demolition ship and have no employe working for me in any capacity. employees and have workers' 1 o workers' co co insu rance.t 9. []Building addition ['`l mp, insurance comp. required.] 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions t 3.❑ I am a homeowner doing all work officers have exercised their U.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL L2.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.[9'6ther i�tn�O�S comp.insurance required.] '.Any applicant that checks box#i must also fill out the stxdon below shoving their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 4Contmctors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those cntitics have mployccs. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and Job site infor►►tatiom Insutrance Company Name: ks S G L° 1 a,--.,2 G� rlt 'G L,.e rs Policy#or Self-ins.Lic.#: 5 V P yCf Expiration Dater Job Site Address: �Y' City/State/Zip:,. Y: t, Attach a copy of the workers' compensatioA policy declaration page(showing the policy number and expiration date). Failure to.secure coverage as required under Section 25A of IviGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andlor one-year imprisonmenk 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 -Investigations of the D for insurance covers a verification. I do hereby certt&, tt, n pen of �utry -iqo-- 'on provided above is true and correct Si attne: .✓' Date: AID Phon 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.oue): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: «` CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 98 WASHINGTON STREET,2ND FLOOR TEL: 978-745-9595 KBOERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER Construction Debris Disposal Affidavit (requiredfor all demolition & renovation work In accordance with the sixth edition of the State Building Code, 780 CMR,Section 111.5 Debris, and the provisions of MGL c40,S54; Building Permit# .. is issued with the condition that the debris resulting from this work shall be disposed of in a properly licenses waste deposit facility as defined by MGL c 111,S150A. The debris will be transported by: (name of hauler) The debris will be disposed of in: (name of facility) (address of facility) Signature of applicant . � today's date) WttldoW WOrid Of Bostoth MA Hit Aegistretton t'tiiZt Offices:&Showrooms Numher: a1:5A Cummings Park: 0 295 Old Oak Slfeet. O 1000 Boston Turnpike 166025 Woburn,MA 01801 Pembroke,MA 02359 Shrewsbriry,MA 6(545 Federal ID (784)'992-4805 (781):826.6281 (508)z845-6876- 82=4898432 www:WlndowWoridofBostgn.com Customer: ML�rY it' ll e �1t+ Phone(h) COPY Install Address: f�� F�✓rt��'�t Phone(6)CY76- City:Sr�O,,<. Stale;.MA,Zip 0 RyD_E-mail:.._.. . WINDOW..WORLD' GLASS OPTIONS : _1000'Banes Single-hung All-Weld $219 :SolarZone;U-Factor..27 or Cower $129 t�90. ,2600.Series-DHAll-Weld $259 s 4000 Series DH Ail-Weld $2ti9 A 6. TripwPane $29W 4 _6000 Serves DH All-Weld S309 WINDO.N!OPTIONS 2 Lite:Shder $429 V ;Glass Breakage Warranty(100016000) $15`INCLUDED i _3 Lite Slider nit.rn VIA (ui in,U41 $669 V.:1/2 Screens $91NCLUDED Picture/Fixed.Life (0 83 UI) $419 Foam insulation on Jambs and Head $11 INCLUDED _Picture:/FixedUte (84.130 UI): $539 Double Strength Glass.(4000/6000) $15 CLU ED _Awning $359 Double Locks(>26") $S INCLUDED t _Casement Plus.$49(DN Sash'RaiQ'$379: _j)p F611 Screens $25 YO ,.. _2 Lile:Casement W59 Colonial.Grids(Contoured/Flat). W _31.iteCasement .:jin,rnihr tug in,1:4) $1029 PrairteGrids $75. Basement Hopper: s469 Simulated Divided U)e $182 Bay Window-Soffft Mount!INS Seat$2859 Tampered OH Sas O) S $75 �ti0 i Bow Window-(Soffit Mount/WS Seat$2999 _Obscure Glass(BSO)(TSO); 475 f _Garden Window $2179. _One)Style(40/60:or 80/40) $75 !' —Bay,'Bow,Garden Oversize.(+109 l)I}$979 Foam Enhanced Frame $35 t _Beige/;Almond $49 pRE 1978 BUILT HOMES(ARPSAFE RENOVATION). _wood.Graln Interior'Series 4000,16000 an $100 f N). MY HOME WAS!BUILT IN THE YEAR.1S 70..Initial (L1gh1:0ek10ark 0akl Cherry{Foxwood r Rich Maple) MISCELLANEOUS l _DesignerColorExterior $179 _Custom:Ex[eriorAluminumCladding(fcvo•Band) 1 copy L]Texlur Color ❑G•8 Smcoln u�99 �rJ _Speciality Window $. tt t � Facing Color C t)�k5+rrl Window:Color /J'it I _Multi-BendGladdfng $201. 1 m§rdo ornsrde ^Installlntedor/EMerior+Stops $Sit i - Install Interfor/Exterfar Casing Starts At$95 NON CUSTOM DOORS ) _vnyi Rolling Patio Door 5n.or:6ft:: $1219 Repalr Sill,Jamb or.replaca sill nosing.S75 _Vlnyt Rolifftj Palfo Doer'8B: $1329..: _Full Sub.=Sill(Single)replacement $175 ` _Add to base price for Custom lloAing Patio Door 51259 Insulate Weight Boxes $25' 9 _French'Rail Sliding Patio Door 5D:or 6n $1539' Mull to FormMultl.Unif ..$30 _F•ench;rtell Sliding Patio Daorli(1:. St639 Mullion Renrodal $50' French Ran Sliding Patio Door gift. St 14s' ;Metal WinAow.Removal .$75... AustomExtedorCladding $30D _SolarZone 5309: _New ConstNctfomPlailnum Installation $749. Grids Patio Pana Door $21 p _New Consl Ext Retro FitlRein 1 $325. Woodgraln Interiors , Roof.(or Bay/Bow Windows $500 `ExteFiat Designer Colors $599: ^Removal of Uisting Bay/Bow $250 _lnledor Casing 21R 314 S279 Bay/Bow Conversion Ext.Relro Fit $450 f _Handleset Opifons: $< New SIdinj Will Not Match _Interior 1311nds(SI%yi0ei only): $95si 1 It Customer cancels after:three.(3) bustrtess'days;_Window :( $` World shalibe entitled to6canceieitlan lea equalto33%percent of the contract price as reimbursement for the expenses Door Color r Inside 114sspoiate,dwithia.dustorwmeid6 order.Initial Customer declines'exterfor.wrap and understands ainting and/or repair may be equired.Initial Customer declines grids on (....windows/doors initial` DISCLAIMER:UsfomerIs respocsibis for But 160oxing In connection wild M contract Paln$op SlaWng,Alarm System disco ectkeconeect 0u0duig Perm t leas In excessof$25.00,HomeowoerandorCondeAssriclaeonApproval;HistoricDistrictApproval'cityof Boston parking&shlarialkPindlessInconnectien whit Installation. ' > (: NO EXTRA:WORK IF NOT IN WRITINGL Customer agrees to the terms;of payment as follows: t Extra Labor&Materials $. Stte Set Up,Permit,Disposal&Delivery,Fees$. $39900 a. TotalAmount $_ U Custom Order Deposit33% OTCka . Pro)ect Stait.Payment 33% $. i. Balance.Due Day of Installation Amount Financed $ r s Window World or Boston anticipates starBng this vrork 66 and being subslan0aby completed In f spays Secilli Brest Yes Na�{— Any:deposit required 1n advance Of the start of the work SHALL NOT exceed 331/13%of the'In tel conliacl'price or the actual cost o1 any inateriat or equfpment special order or custom made nature,wtdch must beorderedIn advance of die slartmOle work to ass ore lhstthepro)ectMRproceedonschedule.Nofinatpaym ///���+++ shall be demanded until the contract is complialw to the satisfaction of both paflres. COPY PY Ali lame Improvement contractors and subcontractors shall be registered and IAaI airy inquires about a:contracl or subcontractor relating to a reolsballon should ` ); directed 16:office of Consumer At to its and Business Regulation;Ten Park Plaza,Suite 5178 Boston,MA;02116.Morin(617)973af700- (; the work shalt,begin prior the signing 61lke;contract and transmittal to the owner of a copy of such contract Wn&v World of Boston under provision of Chapter 142A of the general laws is required to apply tot and obialn all conslrucDon•related.permds<tY v wif of Boston shag not be deemed responsible for delays in Iha work described in this agreement caused by regulatory,permit granting agondes;authon0es or.tndividuals. C: Not ter 11 the PURCHASERS)oblallis Ids own conshuction related permits for the work described under this agreement or deals with unregistered contractor.%. i the'PURCHASER(S)Is hereby advised That In the evert al a dispute;(udgemenl and npnpay(pehl,.Ihe;PURCHASER(S)will not be"enlilied to make a eleim;or !> collection Iram Iho guaranty fund eslabllshed eychapter 142A,M.6:1. You the buyer:rnaV cancel ihls transaclion at anytime prior to midnight of the third'bus ness day alter the ate o this transaction. nonce of cancellation must be in writing'poslmarked:no ialer than midnight the fo8owing Ihfrd buslness day: TdajaAOSJqMOIDER 0 F0 LE! ftAind(wi—Woitd*fra=Mseish*pbetngy.oivifed and operated D L&P BostonOperallng.InQ underficanstifrortiftrIcnYUrid,lnc. �t Alrh_ atjthill here are any biank'spaees: 545 ao2rj :Cons/ nCpp,not atgh Ihere aro any blank spaocx Oato -owner:Do not sign it thereara any blank apaces. Data eoran o}:o- whne Coov-CrfninRf YrA1rwv:Cnnv-;fln Pinkrtim.:ramtomw i ' -� +=pnmv;z;�,_alfti or::iassacltuselt; Prof•' s it)na Ltt.aSnsttrr- 3oarct ai:ButlJiitr;±�gulaiir�t ,,pith'SfSnd,iril= :rtl;:!-j S-0)7277 JEFF C$Tc_ EELE 24 Si ERtIWOODAVE Ff '�omrris:,ioiter Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 197574 L&P BOSTON OPERATING,INC Expiration: 01/02/2022 15A CUMMINGS PARK WOBURN,MA 01801 Update Address and Return Cana. SCA 1 O 20W05/17 ... .. .................................... .............. ..... ........... ..................... ................... �f� f!i(J/Y1177.(.SiEJ/Jf4i/.,CG/b n,�/�!>CJi�/I,CYC1�iP�fs' Office of Consumer Affaifs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Sugolement Card before the expiration date. If found return to: logliMa Lion 9Wration Office of Consumer Affairs and Business Regulation 01/02/2022 1000 Washington Street -Suite 710 L&P BOSTON.OP..:EEW17 lO_IN Boston,MA 02118 J JEFF STEELE 15A CUMMINGS PARK=`= ��•� / . WOBURN,MA olgdi=_= Undersecretary valid without signature DATE(MAI/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER3THIS0 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this cettificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: M.P.Roberts Insurance Agency Inc. PHONE FAx 1060 Osgood Street A/c No Ext: 978-683-8073 AIc.No): 978-683-3147 North Andover,MA 01845 E-MAIL AooREss: mike@mprobertsinsurant:e,com INSURER(S)-AFFORDING,COVERAGE NAIC q INSURED wsuRSR A: WESTERN WORLD INS COMPANY INSURERB: MERCHANTS INS COMPANY L&P BOSTON OPERATING,INC INSURER C: ASSOCIATED EMPLOYERS DBA WINDOW WORLD OF BOSTON 15A CUMMINGS PARK INSURERo: NAUTILUS WOBURN,MA 01801 INSURER E: COVERAGES INSURER F: CERTIFICATE NUMBER: 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 REQUIREMENT.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. INSR LTR TYPE OF INSURANCE I WVD POLICY NUMBER POLICY EFF. POLICY EXP x COMMERCIAL GENERAL LIABILITY MM/DDIYYYY MM/DD/YYYY LIMITS CLAIMS-MADE OCCUR EACH OCCURRENCE 5 1,000,000 ® AGE TO RENT PREMISES'Ea occurrence S 100,000 A MEO EXP(An one erson) S 5,000 Y NPP8525379 04/05/20 04/05121 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000;000 X -POLICY❑PRO- ❑ 1ECT LOC OTHER: PRODUCTS-COMP/OP.AGG S 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO 1E..ccident 1,000,000 OWNED 60OILY INJURY(Per person) S B AUTOS ONLY AUTOSULED MCA1002569 04/05/20 04/05/24 BODILY INJURY(Per accident) S x HIRED NON-OV/NED AUTOS ONLY x AUTOS ONLY PROPERTY DAMAGE S Per accidentl X UMBRELLA LIAB XS OCCUR D EXCESS LIAB ' EACH OCCURRENCE S 1,000,000 DED RETENTION S CLAIMS-MADE AN065362 04/05/20- 04105/21 AGGREGATE S 1,000,000 WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N STATUTEOERH C OFFICER/MEMBER EXCLUDED? N❑ N/A 5018609 E:L.EACH ACCIDENT 5 1,000,000(Mandatory In NH) 04105/20 04/05121 It yes,describe under E.L.DISEASE-EA EMPLOYEE S 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S 1,000,000 A BUSINESS PERSONAL PROPERTY NP,P8365971 04/05/19 04/05l20 340,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,.Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN EVIDENCE OF INSURANCE ACCORDANCE WITH.THE POLICY PROVISIONS. AUTHORIZED REP EF}TATIVE ! ©1988-2015 ACORD CORPORATION. All eights reserved. ACORD 25(2016/03) The ACORD name and logo are.registered.marks of ACORD