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11 CHURCH ST - BUILDING INSPECTION (21) /& to ccs� U — /05 y J rj-.60 CKRECEIVFQ INSPEQfWA�I W ealth of Massachusetts I ( Department of Public Safety 1014 _n�j j ata�cl+p.31,ate Budding Code(780 CMR) Building Permrt pphca 'on or a uilding other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) 11 MU2EH Sr. 54LEw) 6197 a No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below Existing Building l" Repair❑ Alteration ❑ 1 Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes ❑ No d Brief Description of Proposed Work: P_EmOVisiq Two EytsTlu� Ltjmwvm wlN6owS , s;a i�j 7lUa � A Lv lri ti vet 7 1+E/LaAAL ��PA WI vAOWse 0oLere ujl4 ;TF- w�rH SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4[IA-5❑ 1 B: Business ❑ E. Educational ❑ F: Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ HA❑ H-5❑ I: Institutional 1-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-111 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ r Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed❑ Railroad right-o way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: IUD"A �o L NEW ENGLAND , WINDOW SYSTEMS, INC. � c Greg Sees 30 H Street Voice: 617-269-6397 South Boston,MA 02127 Fax:617-269-8053 Greg_Sees@newenglandwindowsystems.com i www.fiberglasswindows.com SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner ALEK HASraA cLo !/ n4vKw sT 0 705 SA LU" MA NJ I is Name(Print) No.and Street City/Town Zip Property Owner Contact Information: MR. ALEX M STRAiko 79 UA- 3�1 2 Gtr hasfatngeleC�(forM cc». Title Telephone No.(business) Telephone No. (cell) e-mail add ss If applicable,the property owner hereby authorizes MA,- 0-r4 INGF-to 7� COVNTRK C1,us 4a9'r ri;NICH M& 01q$g Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control RuxELL 14 A 4,7-9_ b3U CS 6o8 4?Z& Name(Registrant) Tel& hone No. e-mail address Registration Number r-e.lclP_.o Sr' �.,,.��y NWA D��r� 61�-IS' 16 Str ee t Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip Tehi hone No. business Telephone No. cell - e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes 9 No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor jO a and Materials) Total Construction Cost(from Item 6)=$ 1 1 1.Budding $ I a '7$ ><o p Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ contact munici ( t3) 5.Mechanical Other $ Enclose check payable to 1 6.Total Cost $ 1 "'(50 - LID (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Please'prinfaud,sign name Title - Telephone No. Date Street Address City/Town State Zip [Municipal Inspector to fill out this section upon application approval: fAL Name Date Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen isor " License: CS-008628 y RUSSELL S HAD A '' rY 9 TRURO ST QUINCY MA 02€69 i J2.+ rs Expiration Commissioner 06/15/2016 Appendix 2 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing include local connections 9 Gas Natural,Propane,Medical or other 10 Surve ed Site Plan Utilities,Wetland,etc. 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investi ation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town/Town State Zi Discipline Expiration Date Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block # and Lot# for locations for which a street address is not available) No.and Street City /Town Zip Name of Building(if applicable) For the above described property the following action was taken: Water Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) NEW ENGLAND WINDOW SYSTEMS, INC. 30 H Street Voice: 617-269-6397 South Boston, MA 02127 Fax: 617-269-8053 March 27, 2014 Mr. Alex Mastrangello I 1 Church Street Unit 705 Salem, MA RE: replacement windows We will furnish labor and material required to remove the existing windows and install two (2) Series 8101 aluminum thermal break double hung windows. The windows will be a heavy commercial grade HC-50 window. Color of windows will be b=nmr GcJ�h75� Windows will be glazed with insulated Low-E glass. The windows will be supplied with screens. Windows will be installed square and plumb using all necessary shims and blocking. The perimeter will be insulated . The exterior will be sealed with a high grade sealant. Old windows and job debris will be removed from the premises. _1 aueL r-@es 4evet-t ► �oGcwrA L �ieityS Cost is $ 1,750.00 Manufacturing time is 3-4 weeks. A deposit of$ 600.00 is required. ong'I completion. v� Alex Mastrange do Systems, Inc. Dated: 03 Z_ Member CAI-Community Associations Institute AEE--Association of Energy Engineers NEEC--Northeast Energy Efficiency Council NESEA-Northeast Sustainable Energy Association NEXUS-Green Building Resource Center The Green Round Table Celebrating our 25`"year in business With a combined experience of 65 years and over a quarter million windows sold and installed NCW CIYV L�II rLr�Cllnrvrw ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM DDYWV) `� 1 412 412 01 4 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(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 certificate does not confer rights to the certificate holder in lieu of such endorsements). CONTACT _— PRODUCER NAME _ Kathleen Redmond �Deland,Gibson Insurance Associates,INC. PHONE-- 1I76 23 ) 1 7 1515—_. 1a_N1 No 781�237-1805 AIC No Ext t . . _. _ _. — _ . ... _. . 36 Washington Street E-MAIL Wellesley Hills,MA 02481 ADDRESS INSURERIS)AFFORDING COVERAGE NAIC p INSURER A:MaXUm Indemnity Company _ INSURED INSURERB:Arbella PfOteC110n Ins CO _ '41360 New England Window Systems,Inc. INSURERC:National Union Fire Ins Co_ of Pittsburgh PA _ - P O Box 205 - INSURER D:Hartford Casualty Ins Co _ ._ _129424 Boston,MA 02127 INSURER E: INSURER F: COVERAGES 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. LTR. � - -ADD�BRr POLICYEF�' INSR TYPE OF INSURANCE POUCYNUMBER MMIDD MMIDD LIMITS A X $ 1,000,00 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMSWADE . X OCCUR IBDG300168902 04/0612014I04106I2015 PREMISES(Eatoccurrencel_ _$__ lOQ,00 MED F�(P(Any one Parson)__ $ _ _ .5 00 I PERSONAL BADV INJURY ! $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER. : GENERAL AGGREGATE $ 2000,00 PRODUCTS-COMPIOPAGG__i $ 2,000,00 _.. - PoucY'L�ePEcr �u_ Loc ''I BLANKET ADDITIO $ OTHER: AUTOMOBILE LIABILITY ! COMBINED SINGLE LIMIT $ 1,000,00 B _ _ ANY AUTO 11020020349 1 04120120141 0412012015 BODILY INJURY(Per person) $ ALL OWNED ( SCHEDULED I BODILY INJURY(Per accident) $ _ _ AUTOS AUTOS X HIREDAUTOS X' AUTOS ON-OWNED 'i, PerOawdan DAMAGE - $ X UMBRELLA LIAR 1 X OCCUR EACH OCCURRENCE :$ 5,000,00 DED_._X RETENTION . i it !'I � —_—._ ._.. CAGGREGATE $ S DOO,OO ExcEss uae I I cv+IMs MADEI IEBU018438070 ! 04I06/2014 04/O6/2015! $ WORKERS COMPENSATION X ! PER OTH- AND EMPLOYERS'LIABILITY _ ., STATUTE _ER_., D ANY PROPRIETOR/PARTNER/EXECUTIVE YIN ' 108WEC.EG7712 ', 1110312013111103/2014 �' i E.L EACH ACCIDENT $ 600,00 OFFICERIMEMBER EXCLUDED'! 1 NIA (Mandatory in NMI 1 E.L.DISEASE EA EMPLOYEE! $ 500,00 If yes,describe under L _ DESCRIPTION OF OPERATIONS below 1 E.L.DISEASE-POLICY LIMIT ''i $ 600,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may ba attached if mores space is required) Y Pa rag ) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence Of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD