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B-19-714 - 0008 BORDER STREET - Building Permitr , e t - It" _ The Commonwealth of Massachusetts 31 - � Board of Building Regulations and StandardsFOle VIt Massachusetts State Building Code,780 CMR,7"edition MUNICIPALITY USE r Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised January t One-or Two-Family Dwelling I,2008 This Section For Official Use Only " Building Permit Number: Date Applied: ` Signature: ^ Building maussioner/Inspector ngs " Date Approved O-Q SECTION 2:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 8 Border st 10 94 ! 1.l a Is this an accepted street?yes X no Map Number Parcel Number i 1.3 Zoning Information: 1.4 Property Dimensions: e � Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) i Front Yard Side Yards Rear Yard i Required Provided Required Provided Required Provided i 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?Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: PATEL MAHENDRA V 8 Border St Salem MA 01970 Name(Print) Address for Service: .See attached contract 978-395-5933 Signature Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) E New Construction❑ Existing Building IN Owner-Occupied M I Repairs(s)]h I Alteration(,) ❑ Addition 0 Demolition ❑ Accessory Bldg.❑ Number of Units Other 11 Specify:_ REPLACEMENT Brief Description of proposed Work2: Replace 2 windows, 1 door Type Foundation Exterior Walls - Type Roof y .. Roof Covering Interior Wall Interior floors Type Well Solar system Other SECTION"4 'ESTIMATED,CONSTRU 01 C6 Official Use Only Building Permit Fee: $ Determined b r Estimated Costs:Labor& riai Total Boors area (Sq. Ft. #Stories 1. Buildin $ 8508 Gross Livinq area 'Sq. FLY Type Heafing System 2. Electrical: $ ,.. #Fireplaces Fuel 3. Plumbing: $ #Bathrooms Cooling System 14. Mechanical(HVAC)$ S le of house #Bedrooms . 5. Mechanical Fire $ Decks' #Garages Suppression) Bonus IRoom I Att/Detached 6.Total Project Cost: $ 8508 Other Permits Required Porches Plumbing P mt Redd: j.k9 cash © VVidng Date Rec'd: o 011/Gas burner Inspections t� other Final B f 9 i i SECTION 5: CONSTRUCTION SERVICES i i 5.1 Licensed Construction Supervisor(CSL) 90125 l 0/6/2 0 JAIME MORIN License Number Expiration Date Name of CSL-Holder 30 Forbes Rd., Northborouah. MA 01532 List CSL Type(see below) Address Type Description U Unrestricted(up to 35,000 Cu.Ft. Si R Restricted 1&2 Famil Dwelhn Signature M Masonry Only 508-351-2277 RC Residential Roofing Covering_ i Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.'�: Registered Home Improvement Contractor(BIC) 170810 � _RENEWAL BY ANDERSEN HIC Company Name or HIC Registrant Name Registration Number 30 FORBES ROAD NORTHBORO,MA 01532 12-22-19 f Address 5 0 8-3 51-2 2 7 7 Expiration Date Signature Telephone SECTION 6:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) i Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide i this affidavit will result in the denial of the Issuance of the building permit. i Signed Affidavit Attached? Yes ..........19 No.... SECTION 7a:OWNER A,UTHORIZATION,TO BE COMPLETED WHEN O�YNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Rene Arsenault 8 Cathy White as Owner of the subject property hereby authorize JAIME MORIN to act on my behalf,in all matters relative to work authorized by this building permit application. See Attached Contract 07/03/2019 � Signature of Owner Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION i JAIME MORIN ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. _ JAIME MORIN j Print Name 07/03/2019 ' Signature of Owner or Authorized Agent Date (Signed under the pains and penalties ofperjury) 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. I I i i i i i E I L_ Renew(aal Itemized Order Receipt byAnders0n. dba:Renewal by Andersen of Boston Shara Goolsby&Dan Kaiser Legal Name:Renewal by Andersen LLC 8 Border St HIC#170810 Salem,MA 01970 WINDOW NE IACEE'IENT 30 Forbes Road I Northborough,MA 01532 H:(978)395-5933 Phone:508-351-2200 1 Fax:(508)986-7072 1 rbabostonbooking®andersencorp.com C:(978)979-8568 ' • DETAILS: 101 kitchen Window: Gliding, Double, 1:1, Active/ Passive, EJ Frame, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, No Pattern, Hardware: White, Standard Color Pull, Screen:TruScene with Exterior Color Match, Full Screen, Grille Style: No Grilles, Misc: None 102 kitchen Patio Door: Gliding, 200 Series Perma-Shield, 2 Panel, Stationary/Active, Exterior White, Interior White, Glass: All Sash: Tempered High Perf. SmartSun Glass, No Pattern, Hardware: Anvers@, Oil Rubbed Bronze, Auxiliary Foot Lock Color Matched, Screen: Gliding, Grille Style: No Grilles, Misc: None 103 bath Window: Gliding, Double, 1:1, Active/Passive, EJ Frame, Exterior White, Interior White, Glass: All Sash: High Performance SmartSun Glass, Obscure, Tempered Glass, Hardware: White, Standard Color Pull, Screen: Fiberglass, Full Screen, Grille Style: No Grilles, Misc: None WINDOWS:2 PATIO DOORS:1 SPECIALTY:0 MISC:0 TOTAL $8,508 f' Renewal by Andersen is committed to our customers'safety by complying with the rules and lead-safe work practices specified by the EPA. UPDATED: 06/22/19 Page 3 / 20 The Commonwealth of Massachusetts Department of JndusuArl Accidents 1'Congress Street;Suite 100 Boston,MA 02114-2017 www massgov/dia IF— Compensation Insurance.Afllidavit:'Budders/ContractorsMectriciains/Plumbers. TO BE FILED.WITH THEPERMITTI,NG,AUTHORITY. Anglican Information Please Print Legibty Name(Business(Organizatiou4ndividualy RoneWal,by Andersen Address:30 Forbes Rd. City/StatelZip:Northb.orough,MA 01532 Phone-#:508-351-2277 Are you an employw'd Check:rheapproprkle box: Type of project(required). I,Qlama employer with.`� employees(tau'aoarorparttimel•• 7. QNeweonstruction 2' l am a sole proprietor or partnership and have no employees working for me in any c�nY [NoworkcW b imtuaoee 8:Q Remodeling gyp• �1�:) 10I am a homeowner doing all work myself[No workers'comp.,insurance required.) 9. El Demolition 4.[]l am a homeowner and will be .�:Building.addition hiring contractors to conduct all work m my property. ]will 10 ensure that all contractors either have workers'compensation insurance or are sok 11.0 Electrical repairs-or additions proprietors with no employees. 12.0 Plumbing repairs or additions SC3,1 am a gcaaal watreetor and I have hirod the sub-caotruxion listed on the unwhed sheer. 13.�Roof repairs Thew su6varammr s have empioyees'and have workers'eanp.utsuram:� 6:0 We scan corporatism:and its olfioas have exercisod their riYht of cxemptioo per MGL c. 14.godler Replacement IS2,i:l(4j:aod.we have no employees..[No workers'comp:iruurance'*uifed:J Any applicant that,chockstax A must also fill.ow the-section below,showi►rg rhea'workers'compensation policy information. t Homeowners 4hoAubmi t this-afrWavit indicating they arc doing all work and then hire outside controcton must submit a new affidavit indicating such. :Couinactars iliac check#his box must atuohed as addaianal sheet showing the acme of the subtonvacioss and state wbetherornot chow eotitia have goployccL If tqe sub-caatratxors bave employees.they must provide their workers'a mp..policy rwmbtr. I am an employer that is providing workers'compensation insurance for.my,employees Below-is the policy and Job site information. Insurance Company Name:Old Republic Insurance Co. Policy-#.or Self-ins.•Lic.#: MWC 31431500 Expiration Date: 10/1/19 Job Site Address: 8 Border St. City/State/zip: Salem Ma 01970 Attach a copy of the workers'compensation policy declaration page:(sbowing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is.a criminal violation punishable by a fine up,to$1500.00 and/or one-year imprisonment,as well-as civil penalties in theform 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 Dln for insurance coverage verificat 1 do hereb d►t3ify under thOdns and penaldes of perjury that the information provided above is-true and correct Date: 07/03/2019 Phone# - 1'2277 iVictal use only. Do not tvrite.in this area,to be completed by city or town qffciaG fi City or Town:. PermiUldcense q Inning Authority(circle one): I:.B0ttrd7of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector a; 6.Other Phone#: Contact Person: Page 1 of I ACCWDO DATE(MM/DDIYYYY)CERTIFICATE OF LIABILITY INSURANCE 10/02/2018 L.� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFI(:ATE 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 REPRESFENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTi NT: If the certiflcate 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 certiYicate does not confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCER CONTACT - NAME: Willis of Minnesota, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd AIC No: EMAIL certificatesBwillis.com P.O. Box :J05191 ADDRESS: Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIC0 INSURERA: Old Republic Insurance Company 24147 INSURED INSURER B Renewal by Andersen LLC 30 C Forbeu Road _ INSURERC: Northborough, NA 01532 USA INSURER D: INSURER E: INSURER F: COVERAGkS CERTIFICATE NUMBER:W8317748 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 - ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE —JAMPOLICY NUMBER MMIDDIYYYY MMIDD LIMITS X COIYiMERCWL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ,CLAIMS-MADE Fx_]OCCUR DAMAGE TO RENTED 500,000 PREMISES Ea occurrence $ A MED EXP(Any one person) S 10,000 NWZY 314161 10/01/20.18 10/01/2019 PERSONAL BADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY JET LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED nt SINGLE LIMIT $ 5,000,000 accide X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED MWTB 314159 10/01/2018 10/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERsCOMPENSATION PER OTH- AND EMPLOYERS'LIABILITY y/N X STATUTE I ER A ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED9 IN01 NIA NWC 314159 00 10/01/2018 10/01/2019 1,000,000 (Mandatory':In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,desaibe under - 1,000,000 DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) This Voids and Replaces Previously issued Certificate Dated 10/01/2018 WITH ID: W8291089. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED 1RRE-PRESEN/TTAATIV E Evidence of insurance C." ©1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID, 16836288 BATCH: 892974 Conanonwiettfl of wilssadaumm DMC*n of Professlonet Ucensere Boar®01 0 ft ons and Ift dam 3 r Cons sor i CB-090125 '. JAMM L i Commissioner unrestricted. 0n SuPer+rlsor Nss than 36ADO �a et use '"' 'caa m � meterp Of errdossd � 1 SPOM t .I Faihea to possess a ounant edl�on oNhe aetrusetfs ; gate suefto Cade b cum f a oftFor 0 . this BcaW Can(011)7V4M or vbm*rr J vlrtpt OffMCIOXOMMAMMOW Ono A -&ft l3M WENEVOL BY AN ON LLC. 19 l 30I40RB!{�W . 11t�0 i�DRf1lsDibQ(JOi#MR 01m _ F dAi�8A9 b � CAE t[0r `I t A -ftas " VIVO 1 ti 1 Pt 111 t Utz�!A In= i rn 4 i a PRODUCT PERFORMANCE Ahd m•NRC CmrtMed ToW Unft Perfanwnea(WMWWO map* *A oJo aft OLM ' BattDuelRm DA6 DEO Oa3 Ce'�Du:1P�ueeab .Dr4��.. Db8 D,� 9YbiCea las•_wfita_ am, an l�{arfd$ iy9E�s' .:ate @79. 9m: :� DmA il� aA8 Bai aee a®aacr a�rcioalt�id�`si�. 'dt6 aSd as'+' faw$ LL3O Lin zili"Wollm Lu on an Om+W� OM Q.fi3 OX _ IWRgMw• dmpoetP�na .',Atma laDEvlDi6$� 02T• LLSO 0.�,: .� __..AegAiA,Pma na OAD: 060, amawAwimaft am UA AM /� ImFE> 6� 02D: Q79 DAB.M!:I. W to El Q3D` 421'. om ..L �. an am 'MA ML 0eerDiidPiae AM. 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MW ^gym 9 mod" am 036 ftIoDam tolaw LL32. so.ea= MW aeS on,: Dla O IofE am Lid lotra:9ay19noeA_� am 034 01 N Renewal ewal Agreement Document and Payment Terms ldeml1' dba:Renewal by Andersen of Boston Shara Goolsby&Dan Kaiser OW, Name:Renewal by Andersen LLC 8 Border St HIC#170810 Salem,MA 01970 H:(978)395-5933 WINDOW RE LACEbIEIIT 30 Forbes Road I Northborough,MA 01532 Phone:508-351-2200 1 Fax:(508)986-7072 1 rbabostonbooking@andersencorp.com C:(978)979-8568 Buyer(s)Name: Shara Goolsby & Dan Kaiser Contract Date: 06/22/19 Buyer(s)Street Address: 8 Border St, Salem, MA 01970 Primary Telephone Number: (978)395-5933 Secondary Telephone Number: (978)979-8568 Primary Email: sharagoolsby@gmail.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen LLC d/b/a Renewal by Andersen of Boston("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement').Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $8,508 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $0 Balance Due: $8,508 Estimated Start: Estimated Completion: Amount Financed: $8,508 8-10wks 1-2 days Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: 2835,@signing; 2835@start; 2838@completion Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the 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 Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER:Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE,BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 06/26/2019 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Renewal by Andersen LLC dba:Renewal�derosron Buyer(s)n Signature of Sides Person Signature Signature Duncan Fields Shara Goolsby Dan Kaiser Print Name of Sales Person Print Name Print Name UPDATED: 06/?2/19 Page 2 / 20