15 BAY VIEW - BPA-14-184 ROOFING \� The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
r Massachusetts State Building Code, 780 CMR SALEM d
Revised,Mar
Clot 2011
Building Permit Application"ro Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For.Cdficial Use Only, _
Building Permit Number: f Date Applie :'
Building Official(Print Name). - " Si a e *D,
SECTION I:SITE INFORtNIATION
1.1 Pr�eyy Address: 1.2 Assessors Map&Parcel Numbers
/5 J5; Ut tree./
I.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 tl) Frontage(It)
IS 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❑
SECTION2: PROPERTY OWNERSHIP'.
2.1 Ownert of Record}•�
/yCY(�MecVl l 01 ✓ r N
@me(Print) /n� City,State,ZIP
��(� I Vl crLI43
No.and Street JTelephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': 't`'
( lat k Jd
SECTION 4: ESTINIATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
Labor and Materials)
1. Building S 3 _ 1. Building Permit Fee:$ Indicate how fee is determined:
2. Electrical $ .—� ❑Standard City/Town Application Fee.- -
- ❑Total Project Cost'(Item 6)x multiplier x
3, Plumbing S 2. Other Fees: $
4. Mechanical (HVAQ $ List:.
5. Mechanical (Fire S
Su ression) Total All Fees: S
Check No. Check Amount: Cash Amount:
6. "total Project Cost: $ 3 DO ❑Paid in Full ❑Outstanding Balance Due:
�fo�r e 4�h
SECTION 5: CONSTRUCTION SERVICES
5.1 Can tion Su sor License(CSL) 080-rl 3
-h t.t Pi St t. L� _ License Number Expiration Dale
Nance J;111older
r(/ dt/lJ � 'List CSL"Cype(see below)
y fa
No.and Street Type . Description
AA( �/ 03Qt51(, U Unrestricted(Buildings tipto 35,000 cu.It.)
2 Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Nlasonry
RC Roofing Covering
WS Window and Siding
Solid Fuel Burning Appliances
/NjJS6t7t-( zoo
li Insulation
Telephone Email addre s I D Demolition
5.2 Registered Home Improvement Contractor(HIC) �,S6Z �.5
� /Cf
A94 C m(2y,sks, m L HIC Registration Number Expiration Date
11 Coi ray Name o IC Registrant Name
Lom
No. {neCn �N 1{- 0�7 7 S 4$o .W.33 Email address
lJ S^
City/Town, Stare,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L..c: 152. ¢ 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'
1, as Owner of the subject property,hereby authorize
t9 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:OWNEW OR AUTHORIZED,AGENT DECLARATION'- -
By entering my name low, I her ntt= t under the pains and penalties of perjury that all of the information
contained in t ' icatioi ' tru .ccurate to the best of my knowledge and understanding. /
Print Owner's Authorized Agent'. Nan (Electronic Signature) .�Date
NOTES:
I. 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. I42A. Other important information on the HIC Program can be found at
www.mass.�,ov%oca Information on the Construction Supervisor License can be found at wsvw.mass.��o�:4los
2. When substantial work is planned,provide the information below:
Total tloor area(sq. R.) (including garage, finished basement/attics,decks or porch)
Gross living area(sq. R.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
"Cype of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for""focal Project Cost"
081/21/2013 16:55 FAX 16034852333 NH EXTERIORS IA 005/007
CERTIFICATE OF LIABILITY INSURANCE °"' '°Q"°°""""'
1 3/25/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
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(8), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ,
IMPORTANT, If the Certificate holder is an ADDITIONAL INSURED,the polity(ies)must bG endorsed. If SUBROGATION IS WANED,subject to
the terms and conditions of the policy,Certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsema e.
PRODUCER NAMACT John Flynn .
Sohn J. Flynn Ina Agy Inc PHONE (503)740-0140 FAX '(603)743-3310
No:
810 Central Ave R:Jo11n,Fly=@Flyaninsuranee.net
INS11 AFFORD,Ne COYEPAOE NAIL•
Dover NH 03820 weURERAConnectiout IInderwritars Inc
INSURED INSURER 9'Assictned workers Coup 0030
NA Exteriora, Inc INSURERCI
Presidents Professional Park wsuRlAo:
50 Pinewood Drive INsuREn¢,
Suncook NH 03275 wsuJulaP
COVERAGES CERTIFICATE NUMBER:CL1332515512 REVI5(ONNUMBER:
THIS IS TO CSRTIPY 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.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
FUEL.MEIR L 1YP2 OF INSURANCE LICY NUM9eR POULI'EFF ROIJCY EO[P UNITS
GENeRALUAMUW EACNOCCUR(1ENCE i . 1,000,000
X COMMERCIAL GENERA-Un Al P FNI F RL S 80,000
A CIAILIS-MADE ®OOCUR Pa069901) /23/2019 /23/2014 MEO E'XP ens S 5,000
FERBouALsaov lwum 3 1,000,000
OMERALAOOREGATE S 2,000,000
GEHL AGGREGATE LIMIT APPLIES PER PRODUCTS.COMPIOPAG'G S 1,000,000 ,
X PoUCY UJC 6
AUTOMOBILE!LIABIUTY -
EMU
ANY AUTO BODILY INJURY(Pwpe ) S
ALL AUTOSA
EO SroESIIL
A ID BODILY INJURY(Pw 66MMU i
HIRFOAUTOS AUtN OG D P DAMAGE i
i
UNBREUA UAB OCCUR EACH OCCURRENCE 3
EXCESS UAB CWMSA1AOE AGGREGATE S
DED I I RETEMIONS 6
VJORNEftS COMPENSATON x VIC STATW OTFF
AND EMPLOYERFLIAMUTY YIN 883004446 /e/2039 /0/2014
ANY PROPRIETOR+PARMERIEJQ:CUT, NIA EI.EACH ACGDEM i YOO OOO
B OTFIOERMEMBER EXCLUDED?
(Ift" twYln NH) EL.DISEASE•EA EMPLOYEE S 100,000
1(yy4P�d4Fa1b4 "
DES[RIP'fIONOPOPERATION6 b41P4' E.L.DISEASE-POUCY OMIT S 500,000
DEeCRIPnON OF OFERI1nONS I LOCATIONS I WIDCLES(AMch ACORD 141,AdWN PwI04TAe SM94 1q IF zpacelz regW,M)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DEaORIBEO POLICIES BE CANCELLED BEFORE
THE EXPIRATIOIL DATE THEREOF, NOTICE WILL BE DELNERED IN
Sample Certificate ACCORDANCE WITH THE POLICY PROVISIONS.
Proposal Purpose only
AUTHORQEO REPRESENTATIVE
John Flynn/JJF _�
ACORD 25(2010105) 019884010 ACORD CORPORATION. All rights reserved.
IN5023lM1NYt1M Tim ADP)RD reran arW lnnn am.onlafnro,l mReta of Af71RD�+.
0021/2013 18 :54 FAX 16034852333 NH EXTERIORS 2 003/007
New Hampshire Exteriors Inca - . .
4 Presidents Professional Perk•Washington Building- Suncook,NH 03275
(603)48a-3833• (800)R44-3624 - Fax(603)485-2333 •E-Tall:nhextCpaol.eom
Mesa.Reg.#163642
Me,the Owner(s)of the premises mentioned below,herebymmraotwlth and authorize you ae cwdraao,to lUmlah all netpeseiy
materials,labor end workmanship,to install,construct and place fhe Improvements according to the following spedllwtlone,terms
and condtdons,on promises below described with reference to whloh we warrant are the tawrd holders of title.
OwneYa u Nsms% n2w14A) �nc_lrt;! Hanle Plane 97F'-7YIF—`f4�S�7
JobAddreas V 16— B Vl' I City SAkAlY1 state 1&4_Woriphone 97e-SPA-�2yoy
Malting Addnsa(t diteram),,.. E+nalft
ACCORDING TO THE FOLLOWING SPECIFICATIONS:
1. Remove,replace or repair any rattan wood is nsteded only where now,materials are to be inatalled.This does not Include 4"
roof decift.
2 Shuthe tabvalls designed for el ling with IneaLvtblt
5 C�Cover Rated areas with New Hampshire Exteriors approved solld Any!sift except doss areas noted below.Color to be
Pattern to be Include all custom'J'chemal ban for window and door
lacings,color to be All madom comarPaz%color to be Ad atemrsblp
and exetorn bush ism to match siring color.
4. Custom wrap window elk 0 mulls: =aides: =hsadsm. Color to be -
1 6.Q Cover window facings with alding and elm wNt'J'aharnal.
n / ' a.p Cudom wrap Wools areas W home except those noted balmy. Color to be
7_[=Cover sofa area of home with New Hampshire Exterlaa apprmed solid vote oath system.except ease noted below.
Cobra be
&O Cover patch coatings with New Hampshire anadon approved wild yW calling material,except those noted balm..
Cobrto be
e. Wrap beams,except those noted below Color to be
1 PavldB end enter pain New Hampddm Eorbm appmmd polyelyreta dwmm. Color b be
11.11 Remove and relnatSWolapoee of existing
12. Clsalrup at job related debris and hW away-
is. Mad Customs,walmxy after soft a M oorrpbann
14 Q Additional wadr to be completed:
16. At new and work not mrnpiebd:No Palm Applied:
NDIE:AxryeNhgele)yglroywiexiD,heaab Makesspecification an aoalaetbowePPM21 rot cue hob eddaa stool eY bna1PeaaaPrior to
� � wmrlrwwwaaed wpden4tlnabMNentt(s aoeawxkenerrgs,epee Oenp sines slid bewnr apM tlYaAdroeaM.
MATERIAL L 9 d^rE l6VEY�or LJfa47itE9P Y1 t*Exdsene I N Redeck wilh ale'Plywood Y IR
Main RoolS4:r.4 !W� ar4S hslvae Bay Windme Eldsnelons
Porches:Front Skis Rear Other Roofs
NOTE:Replacement of miselna or dv%c vw 1pmher ie not Ino[W W,norm motel Wpinp,unless epeclflW ly elated.910pq InwmamntmrzM1l^plea will M
em•na any wren apeerom under r.aw siepehmpmtmkuil om roan mrmM gaimtl gulid lcondlWne,heal bee,end peer ve mvnon
�^ new Nempcnlre Exteriors does notwerrerd egei,re!Ice eund up.
/fit y� R cover the low slope roots specified here wah:
Roofs1s to
to be ooVarsd color
Cash Pico $ (,3p0 you aa,,wpaycmhtawdng loft lemur dxwnems,eu ayew aediweppiwed,mdnma
mew pmdeed byw Mpaymardd Ye wnatmttme.You aheatywmeprlaoenpatNn aahmmm
Down Payment cNa.R9LL$ 3d 'p01 ro1xpleaonotM xak tyro tesmmaw pgalwlewM owyaro dhla,ewnw.may�ars-
dxay enp awL We ray does to not 04 sea aWYI wda you are owrax web m pgnwM
Upon V20ompletion $ and� sWronaomlNngmreallyetpnymMe.gMrestli aasdrduamlha
pma�gi mafi drlsymM aptam�sAy enaNm dabdwkYlrBNaul.
Payable on Completion S a00 PaymandufarduroeN lndembAEwnrdSM kvemn6llmM d9bps)MM1.dw9the
"we a,of 107E arable mvdnoc Isp 0� to.xMddnmrta cos.mtersa yin aerM this son,Balance, $_. 0 oaeeanyN,era+a of"Oaa foxiness day rdlswwag*g stints Av«alex.
you
awed pod dot koMpa4e to PAY
w as re"In"aaA M or on"N's wnwB�
�_211 Ibn,for dI nxeMaY and Itlor vela 9A%ar M Agwmwt PIM as raaaoa�la 2WIdWd
v\ dmtsMNrtMW.m Ikwest B RKof th hir acted forNeoi muneudhnendela
Ne W unpaid•may
dal a atdx axe eo WW as N be ad ood&O ettom P net.e
4ddohl.You redehded tlat R'lalinp b pay etamdmg to m aeries lMn,Na osier rhl�true a dim aWkrd Yea wmim tsar be soloed opriNt yes prgnhy m
aaorde ca dorm applaaN Item has.
Newawnpdae Bndon WamlaAN LAW For A-yee•10 FMYW RWM RsaTI*vvW18)VM Mange tWA{HY.Yaw loft ewtymtrie auart0e/aoltta rmrWa
- - oebnxedmtlkapptebN roapWedmroN nehelgtWenpeRnihaiwe wmyWpMIMYeCmpalnWbnxMPUMeLIetlYyhlerrxo110e anwsdil0aooalddd.rids.
ALL RESIDENTIAL CONTRACTORSAND SUBCONTRACTORSARE REOUIREDTO BE REGISTERED WITH THE MASSACHUSETTS
_ BOARD OF BUILDING REGULATIONS AND STANDARDS UNLESS SPECIFICALLY EXEMPT FROM REGISTRATION. INQUIRIES _I
CONCERNING REGISTRATION SHOULD BE DIRECTED TIO:DIRECTOR.HOME IMPROVEMENT CONTRACTOR REGISTRATION
ONE ASHBURTON PLACE,ROOM 13012,BOSTON MA 0201E• of 7 -wile,THIS AGREUMO MAY ONLY C[immkE0 aj
WRITING SIGNED BY BOTH PARTIES.THIS AGRCI9IENT IB BY NEW HAMPSHIRE LAW.
YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY PARTY THERETO AT A PLACE OTHER THAN AN AD-
DRESS OF THE SELLER,WHICH MAY BE HIS MAIN OFFICE OR BRANCH THEREOF PROVIDED You NOTIFY THE SELLER
IN WRITING AT HIS MAIN OFFICE OR BRANCH BY ORDINARY MAIL POSTED.BY idFGRAM SENT OR BY DELIVERY,NOT
LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWINQ 114E SIGMNQ OF THIS AGREEMENT
BY 810NINO BELOW,YOU ACKNOWLEDGE THAT YOU OWN THE ABOVE PROPEF(TY,AND THAT YOU AGREE TO ALL OF THE
TERMS OF THIS CONTRACT.YOU ALSO ACKNOWLEDGE THAT YOU HAVE RECEIVED A FULLY COMPLETED COPY OF THIS COPE
YO HTAND RIaRTTTo CANCEL SEETHEATrACHEONOTTCE OFCANCEL1AFION FORM FOR AN EXPLANATION COPES OF THE NOTICE OF CANCELLATION AND ITUIT YOU HAVE MEN OBIS INFORMED Or
00 NOT SIGN THIS cONTRACr we THERE ARE ANY BLANK SPACES,
W WITNESS wHEflEOR the pediea have heleumo signed their names la �/ dthis
-r .20—o—
Accepted:
N PSHIRE EIrTERIORS INC-
Signed
aerlhMn'x1eBRANIg Rae
WNITa:ORada1AL COPY YELLOW:0U6TOM9R COPY
Office of Consumer Affa' and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 021116
Home Improvement Contractor Registration
Regisitration: 165642
Type: Supplement Card
NH EXTERIORS, INC. Expiration: 3/15/2014
PHILIP BUSWELL
50 PINEWOOD RD. -
SUNCOOK, NH 03275
Update Address and return card.Mark reason for change.
'a-CA1 CS 50*04/04G101216
Address Renewal Employment ❑ Lost Card
✓- L/O'pY/Y[O�L[//Q2Lr/L o�✓[�G(N06GM[det b
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
. Office of Consumer Affairs and Business Regulation
Regfstratlon 165642 Type: 10 Park Plaza-Suite 5170
Expiration 3/15/2014 Supplement Card Boston,MA 02116
NH EXTERIORS,i)
PHILIP BUSWECL..
50 PINEWOOD RD; � �Massachusetts -Department of Public Safety
"���°n�— �✓ Board of Building Regulations and Standards
SUNCOOK,NH 03275 - Undersecretary valiqg*
Construction Supcn'isor 1 & 2 Family
License: CSF,-, 1130851
1
PfULIP B BUSW EELJIM
7 RYAN WAY S r-, c
Nashua N1I03063 �E{
Expiration
Commissioner 01/17/2015