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12 BARNES CIR - BPA-16-813 REPLACE 8 WINDOWS • � �Z c-K 112 1. 2 The Commonwealth of Massachusetts a. Board of Building Regulations and St SALEM CITY OF Massachusetts State Building Code, 780 CMR 1 '• Revised Mar 2011 Building Permit Application To Construct, Repair, R��twa�ll7ett olish a f' One-or Two-Family Dwelling n This Section For Official Use Only l / Building Permit Number: Date Applied: Building Official(Print Name) - Signature Da e 1 SECTION 1: SITE INFORMATION CD 1.1 Property,4 dt�a�: 2 1.2 Assessors Map&Parcel Numbers �`�' L l a 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: PROPERTY OWNERSHIP' 2.1 Owner of Record: c--- �& m 4 Name( fff' City,State,ZIP No.and Street �Telephoiie Email Address SECTION 3:DESCRIPTION OF PROPOSED WORW(check a hat apply) New Constmction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Erl Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units LQther ❑ Specify: Brief Description of Proposed Work : SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ 1. Building Permit Fee: $ —indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town App ication Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (BVAC) $ .List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ ❑Paid in Full ❑ Outstanding Balance Due: hnP�tt_C-_1) 10 sus TO tt.p SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Silpervisor License CSL) ffLicenss umber Exp' on Date Name of CS Holder List CSL Type(see below)M No treet Type Description U Unrestricted(Buildings up to 35,000 cu.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 1 Insulation Telephone Email address D Demolition 5.2 Registered ome mpro met ontractor(RIC) HIC Registration umber E pir lion Date HI a e or IC Reg isu t e No.and St re �t Email address L / City/Town, State,ZIP ele hone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c.152.g 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 IssuanSpdf the building permit. Signed Affidavit Attached? Yes ........rtrNo........... ❑ 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 work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contain in this a licatio i e and accurate to the best of my knowledge and understanding. ne ed Agent's Name(Electronic 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 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. o—�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,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 SALEM, NLxSSACHUSETtS • Bu .DLNGDEP\RTJtErNT 120 WASHNGTON STREET, Yo FLOOR oP TEL (978) 745-9595 FAX(978) 740-9846 KI-,IBERLF-Y DRISCOLL MAYOR THosw ST.Pmm DIRECTOR OF PUBLIC PROPERTY/BUII.DIDIG CO\LUISSIONER 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 (name oil ty) A& (address of facility) sign tune of permit applicant date debni ff.doc The Commatawedth ofMassrtedtuseffs Depaftmrof1Adusiri ACCidMdS Off"ofInw-m4adons 600 whshgrtgtox S&eet Bosfois MA,02I11 wwli at"Agovldra Workers' Compensation Insurance Affidavit: Bugders/Contractors/Electsicians(plm nlbers A HeantInformation Please Print l Name BusroPssrorP==tIonandbidnao: Address: City/Stat&7Z p: , Phone#: Arey an employer? Check the-appropriate box: --~ L I am a employer with�_ 4. ❑ I am a general contractor and IFE] RemodeUng (required): =PkYew(Stn and/or pant time): have hired the sub-rams acummuc6m 2.C] I am a sole proprietor or partner- listed on the attached sheet t ag ship and have no employees These sub-confracwts have wotkmg forme isatrycaPaca3'- works s' COMP•IDsmance(No workers' COMP. Insurance 5. ❑ We ate a corporation and its ddition req¢ned I offieers have esermed their 10.0 Electrical repairs or add 3. I am a homeowner doing all work tight of exemption per MGL 11-0 Plumb' r myself(No workers' cO 2,§ ( ) mg repairs or additions tap. c 15 1 4 ,and we have no ME Roofrepaus insnrauce required.) t employees. [No workers' y comp_insurance rognh,*CLJ 13.2,Other t°Axy applie tthu eb=ks boX 1 mtssi aiso 8ll a�the actionbelow Flvmmwnea Mo ubmit this affidavit �rya>e shaav�&es�ta'oompry�tloa polity iafotn»tivy,. iCoaerstots dtt cbedc this b nuts attached as additioad sheet eII workmmd rhea him outside mneattm mast submit a sew SM&VM' sbow*Qx M—oftbe sat•-oenttncratsmmd theirworkem,r am sumo-Po�RS' an employer that is prop informarion. iding worker'compensmron bt.surance for my employees. Below is the policy and job sue rr Innu ceCotapanyNarne: POliry;r or Self-ins.Lic ?� ie6• l l 'i—� ��-- v Expiration Date:- Job Site Address: . &ttach a copy of the workers' co w mpensatioa policy declaration Page(showing the policy number and Faihse to secure coverage as required tinder Section 25A ofMGL c;52 can lead to the ' eaPpertal inuou dates Fine up to$1,500.00 and/or one-year impriso�ent as well as civil Mtposition of crinmmal penalties of a tf up to$250.00 a Penalties in the form of a STOP WORT{ORDER and a fmc nv day against�e vioiator. Be advised that a COPY o Ms statememt may be forwarded to the Office of estigatioas of the DIA for insurance coverage vetifiradM 'do hereby cer fy u e e .mitres o fPerJury char the injormarion provided above is true and correct l' use• D 'hone - Q Jciai use only. Do not write in this area,to be completed by city or town offlcieL Clly Or`Ibwa: Permwuoease# Issuing AMorhy(drele one): I.Board of Health 2.Building Department 3. 6.Other (3tylTown:Clerk 4.Electrical Inspector S. Plumbing Inspector Contact Person: Phone#: i i i I MassachusettS Department of Public Safety Board Of Building Regulations and Standards License: CS-072772 �ors;.r_' iVon Supervisor ,dK JEFF C STEELE ' 24.SHERWOOD AVE . DANVERS MA 01923 I Commissioner Expiration: 04/07f2018 Office Of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration:. 166045 Type: Expiration: 4112l2018 LLC WINDOW WORLD OF'.BOSTON.LLC. JEFF STEELE 24 CUMMINGS PARK SUITE-15-A' WOBURN,MA 01801 Undersecretary I I f� I i _ Li registration valid for individual use only befo expiration date. If found return to: of consumer Affairs and Bul iness-Regulation Plaza-Suite 5170 ' Boston,MA 02116 7A � Not valid without si natu B i i Window World of Boston, LLC MA HIC Registration Offices &Showrooms Number. ,t ❑15A Cummings Park ❑295 Old Oak Street Federralal 1 1660250 e D Woburn, MA 01801 Pembroke, MA 02359 I5 w(�La•ri 6 (781) 932-4805 (781) 826-6281 27-148166 "Simply the Beat for Less" ww,,w..WindowWorldofBoston.com 1 Customer: tC'0.,^ & J G,i / J Phone (h) qY43 `,1ft S02 �l Install Address: / �{ i �S ra�'? Phone (w) ,81— city: 'S'x/ f" State: MA Zip ©,L Y :rO E-mail u ` WINDOW WORLD GLASS OPTIONS _1000 Series Single-hung All-Weld $189 SolarZone Elite $99 2000 Series DH Mech/Welded Sash $195 Triple Glazed TG2* $175 gOOA 4000 Series DH All-Weld $205_&3g (*Series 6000 Only) 6000.Series DH All-Weld $240 WINDOW OPTIONS l Warranty $151 CLUDED I Glass Breakage tnY � 2 LiteLd Slider $33 3 Lite Slider (imirs.lis) ota, m,,/4) $525 rr 1/2 Screens $91NCLUDED _Picture/Fixed Lite $334 Foam Insulation on Jambs and Head sit INCLUDED Awning $260 Double Strength Glass $15 INCLUDED _Casement $ 290 _LDouble Locks (> 26") $5 INCLUDED Cas 22 575 Full Screens _2 Lite Casement $ Colonial Grids (Contoured/Rat) $45 R_Y, 860 _ Casement t vat va.,f2,va) $ 1 3 Lite Caseme t o. , m t Prairie Grids $5 _Basement Hopper $334 Diamond Grids $69 —Bay Window-Soffit Mount/INS Seat $2660 Simulated Divided Lite $182 _Bow Window-Soffit Mount/INS Seat$2785 Tempered DH Sash (BSO) (TSO) $65 _Garden Window $1880 Obscure Glass (BSO) (TSO) $35 —Specialty Window $ Oriel Style (40/60 or 60/40) $30 —Beige i Almond $40 Foam Enhanced Frame $35 - - -__Wood'Gram Interior(Series 4000/6000 onlY) $100 � HOMES""( ederaf"Lead CdrftnmentLaw)p (LightOakl Dark Oaki Cherry/ Fox Wood Lead Safe Practices Required $25 20 Rich Maple) MY HOME WAS BUILT IN THE YEAR Initia _Brown Exterior(Arch.Bronze I American Terra)$100 MISCELLANEOUS _Designer Color Exterior $155 46 Custom Exterior'Aluminum Cladding O Textured$75 erS ooth G-8 $75 $ 16400 Window Color 4JL t. // Facing Color �+t inside outside Metal Window Removal $50 ----- _New Construction Vinyl Removal $175J 1 95 Specialty Window Exterior Trim $ 95 Mull to Form Multi Unit $30 io -717 Install Interior/Exterior Stops $50 j0d:0_ 35 Install Interior Casing. Starts At $95 35 Insulate Weight Boxes $20 35 Roof for Bay/Bow Windows $500 io Existing New Const. Ext.Retro Fit $150 *S0 '5 Removal of Existing Bay/Bow $250 ';s _Repair Sill,Jamb or replace sill nosing $50 15 Full Sub-Sill (Single) replacement $150 15 Mullion Removal $30 5 Bay/Bow Conversion Ext. Retrofit $350 i $ (New Siding Will Not Match) �-Building Permit $15o- � UWD-UP FOR 1 jKDW"jDRLD-1CARE9: Customer declines exterior wrap and understands painting and/or repair may be required Initial Customer declines grids on windows/doors Initial DISCLAIMER:Customer is responsible for the following in connection with!his contract:Painting,Staining,Alarm System disconnect/reconhect'Building Permit fees in excess of$25.00,Homeowner and or Condo Association Approval,Historic District Approval.City of Boston parking&sidewalk Permit fees in connection with installation. NO EXTRA WORK IF NOT IN WRITING! Customer agrees to the terms of payment as follows: Extra Labor&Materials $ 6t 713 Site Set Up, Disposal &Delivery Fee $ $195.00 Total Amount $ 6-388 Custom Order Deposit 50% $, /3 " Ck# 0.? Balance Paid to Installer upon Completion $ Amount Financed $ Window World of Boston anticipates starting this work on and being substantially completed in days.Security Interest:Yes No Any deposit required in advance of the start of the work SHALL NOT exceed 331/3%of the total contract price or a actual cost of any material or equipment of a special order or custom made nature,which must be ordered in advance of the start of the work to assure that the project will proceed on schedule.No final payment shall be demanded until the contract is completed to the satisfaction of both parties. All home improvement contractors and subcontractors shall be registered and that any inquires about a contract or subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,Ten Pterk Plaza,Suite 5170 Boston,MA 02116.Phone:(617)973.8700 No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. Window Wodd of Boston under provision of Chapter 142A of the general laws is required to apply for and obtain all construction-related permits.Window World of Boston shall not be deemed responsible for delays In the work described in this agreement caused by regulatory,permit granting agencies,authorities or individuals. Notice:if the PURCHASER(S)obtains his own construction related permits for the work described under this agreement or deals with unregistered contractors, the PURCHASER(S)is hereby advised that in the event of a dispute,judgement and nonpayment,the PURCHASER(S)will not be entitled to make a claim or collection from the guaranty fund established by chapter 142A,M.G.L You the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Notice of cancellation must be in writing postmarked no later than midnight of the following third business day. JtJJj S M r This Window World®Ranchise is independently owned and operated by Window World of Boston,LLC,under license from Window World.Inc. a Owner:.Do n (here»- r O blank spaces. to 6 ot Salesman:Do not sign if there are any blank spaces. Date Owner:Do not sign if there are any blank spaces. Date Boston 07-15 White Copy-Original Yellow Copy-File Pink Copy-Customer Hayos armnnaaeeasr-me