1B FLETCHER WAY - BUILDING INSPECTION ' PUBLIC PROPERTY
DEPARTMENT
KIMBERLEY DRINALL
MAYOR 120 WASHINaMN STREET•SALEK MAlZACHLSEI-IS 01970
TE :978-745-9595 0 FAx:97&740-9846
APPLICATION FOR THE REPAM RENOVATION CONSTRUCTION%
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: DAV l D STEEDHIW-i BEW Building:
Property Address: L b
/ 8
Property is located in a; Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: DqVI D (3TEE7D -_i( SE7W 8Ul (ate-�J
Address: B FLE7�-'tfE?e� bzO /
E-1 D19�4
Telephone: g - —
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation New
of existing building
Brief Description of Proposed Work:
g4�LAoE LP u)1A1DbLJS ONE SLI tD) AJ6
G LgSS D 0 e !N—ID OXISDx/6
Mail Permit to
What is the current use of the Building?' '
Material of IBuilding?, " if dwelling, how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone �> )
Mechanic's Name
Address and Phone c2Pd
Construction Supervisors License# �i��CJC� HIC Registration#
Estimated Cost of Pyaject$___Z � Permit Fee Calculation
Permit Fee
$
CG 1� Estimated Cost X$7/$1000 Residential"
Estimated Cost X$11/$1000 Commercial �
An Additional $5.00 is added as an '
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in'processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penaltyof perjury
Date
M li
!U qJ00
a
a+
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
srrawr&nt DRUC=
MAYOR IM WARRk rMStraw a UtFss,M&UACMMM01WO
Ter:W"45.9595 a FAX W 7e0.%*
Worimn' Compensation Insurance Atf3davW BWdwWContraeto
AnDNeant Information PI CAN 1s>4>.e Lately
Name IVCW/P20
Address: CED 577
eityistatemp:_Ujj6ZIPW; M/9 o/eo/phone
Are on as employer?Cheek the appropriate hen
1. I am a employer with y�f 4. 0 I am a 8mma1 contractor and I Ty� ( �
�PbYer+(rho aodlar parFtime).• have hired the wb nmtractws 6. ❑New construction
2.01 am a sole proprietor or partner. listed an the attached sheet.t 7. 0 Remodeling
ship and have so amployeas Thee haw 8. 0 Demolition
working for me in any eapadty. workers'nsmP➢nsmaoa. 9, ❑BurTding addition
(No workers'comp htwraace J. 0 We am a corporation and itr
requiredi y o8tees have exercised ehdr 10.0 Electrical repairs a addk(ooa
3.0 1 am a bomeowner doing all work right of mtempdm per MOL 11.0 plumbing repaln or additions
myself(Nb workers'comp, a. 152,41(4).and we have no 12.0 Roof repairs
insurance requirea.l f CMPWYM .No wakes' 13.0 Other
can*insunoee requited.]
OAMr apptem ut Amb bas et met aloe sn as the settle t M stwsriee aeh wwm'oe.p.wio.
Hmoween who Me"ahamdowlt gwtiaiy sadwmkeattTr.tdieaeldsosarwesmeritwhwnaaweAfdsrY6diosdagwaL
tCoaweeews tdtt duck ads boa mot etmdd a sedlnead met dmwha tte nnn doe eob•eaahetms sad ask wMwm'eeeeF soft tsatmaeaa
dW bPsovldbst wartera'towPoasodoa/assterweiJor my ewpbyeea Bebnr b die po4cy axdjoi sloe
Ixformadam
Insurance company Name %4 8
Policy to or self-ins.Lin,s_ 96 9& Join �; O
lob Sift addrem: Cityistawzip: JALE-7�-1, "Iq 019�0
Attach a copy of the workan'eompeasatbn gooey dedsa page(showlog the gooey camber sad expiration daq)6
Fadum to aeon coverage as required under Sechen 25A of MOL a. 152 am lead to the impositum of erimind pama lttea of a
!no up to 31,500.00 and/or ono year imprisonment,as well ore civil penalties in the form of s STOP WORK ORDER and a Age
of up to$230.00 a day against the violamr. Be advised that a copy of this statement may be forwarded to the OASce of
investigations of the DIA for immin ace coverage vaiAption,
!do hereby cardj&aw/or dFo peaalaiss ojaaP/ary the for IajoraddenP+n►'�� aw and conoet
�64 FwP / o
Phone �R/ 9 �-�/ 6�7
D,fletaf are oe%t no nor wilfi he tw ores,rs be coo~by clip of/owns ofrle/A
City or Towne Permitilleense 0
Issuing Authority(circle one
1. Board of Health Building Department 3.Citylrown Clerk 4. Electrical Inspector S.Plumbing Inspector
&Other
Contact Perron: Phase 0.
Informs le n ana �n� u%;&1��J
COL
is the service o[a
�assacb ou General Laws chapter IS2 regWM an employate to provide wo►ke:s comptmsatiaA for their ct oth h1i°•%'
to this ad« " is defined as",,every person another under any
cContract�
express or impbad.
don or other legal entity.�any mO'0t 10t0es
An eatpfsyw is defined es'en individual.parIla P�jjjjjftlegal vea o[a decried employer,OOYWL or t e
of the foregoins engaged b°a spc at other 1 the d
receiver a teuatne at ingbo ��not �� bUMM to do maiow�ed w�m sneh der
MuseaN"k
° aWmg boom
dwau otbonea �mtba who empbya tharem Ahari oa be a.of employmea-b.derma m be an C1311O c"
at as the grounds orbutlams aPP
also pates tbat"wary$tab or local deanabag agency Shoo`�°��tuoatits at
MOt.elwp w 152.¢2SC(ti) a Msstnae or b eenttred bMdn0 It tie eeeutaenweaMb fer W
ranawel at a fiesates tx PtK�it a°pia evidenes of eompsaw wtti the haanra aea aysrsp "
sett wM W test p er 15 wd aeeaptabM aj ib poWical
silidivisiOUS shall
�pd�d.'etfmally,Melt.chapter 2.$2SC(n stabs"NC1�the commonwealth,acceptable VAC o[eomplianog wdb ins manna*
c�egau,e�meon odds chapm bans Pad w do conlrac�i a1'W
APpMsnb afildev h co ,pMe<y,by chocWM the boxes that apply to Yaw smati m"i
picam fill oot the wadwe comPeowlenn ab addraemit and phone nPa�ps(L��ng with )
other thin do
gams, Limited Liability Compannecessm7l.sup* ies(any c keet.co Liability inoaancL if an U C at LLP does be"
members air Pt!�0�aril not requited m retry vrerke a submitted m the Depart"I"d Of badtuaiai
Why a policy.is s as ad lsed�� me ts Abe bes*s s"date tha affidavit. The a@idevit should
Accidanb for coafi<madam of iniaaanaa the the permit or licence is being regttesbd.north*Departmaat at
be wturned to the cuY a<town that thr application the law at if you ars required toobtain a wodrere•
Induatiiel Aecideoet, ghouid'you bAv say liated below. SaK honed comp °lee glimid eotar their
Compensation policy.Pbew an the Dapprunw t st the number
aft ling
self-htamaoau licon"tmmber'an the -
City or Tews 00clalh at the boMMO
Please be sue that the affidavit is n the event
and printed legibly. The D has o contact
provided a>paas _
of the affidavit for you m I out in the were the Offtic of Investigations lbeuahas r contact you In tl d 4 as
plesas be sue m fill in the permiglicon"°unbar which will lw used a n re only omit o.
applications is any given yeas,need only submit one affidavit indicating earnest
that must submit multiple PO) ounae Job Site Address'the applicant ahatrid write-Ali locations m�(W cc
PO infacmation( or marked by the city a town may be provided m the
town).'A copy of the affidavit that bes been officially stantPad or licenses. A now af$davu must be filled but herb
sppliant s•preof that a valid atf�is to ills ha !�not related m any bttsineee Or commercial vaamra
yeas.Whsss a homy owner a OiBzen.is obbini a is NOT required m complete this affidavit.
(La. a dog been"or"runt m bun lesves etc)said parson
far your
The Office ofinvestifWioas would like to thank you
in advancecoop....and should Yet have buy questions.
please do not hesitate to give us a calL
The Depec;;e s address.telephone ephone and fax number
TINA(,'O MMWealdl Of MaW&dliSetta
D of bditatfid Amdenta
Ofl>a otbvadpu[ofis
600 waabiOOM streae
Bosom.MA 02111
TeL 0 617-727-4900 Wd 406 or 1-877-MASSAFE
Fax N 617-727-7749
Revised 5-26-05 W Ww.IDm&pv/dlg
CITY OF SALEM
ROUTING SLIP
NEW CONSTRUCTION
CERTIFICATE OF OCCUPANCY
LOCATION: /R FL /L 1 EP Z&9 11 DATE
APPLICANT: NGztJP20 - Tb M F6X6)AJ
ASSESSORS
FRANK KULIK DATE:
(93 Washington Street)
CITY CLERK
CHERYL INTE DATE:
(93 W mgton Street)
LICE SERVICES
RUCE THIBODEA DA
(120 Washington Str 4" oor
WATER
DOTTIE THIBOD U ATE
(120 Washington Street)4d'Floor
ROSS CONNECT SUPERVISOR
B THIBODEAU DATE:
( ; Jefferso ue)
PLANNING
VALERIE GINGRICH DATE:
(120 Washington Street) P Floor
CONSERVATION COMMISSION
FRANK TAORMINA DATE:
(120 Washington Street)3 d Floor
ELECTRICAL
JOHN GIARDI DATE:
(48 Lafayette Street)
FIRE PREVENTION
ERIN GRIFFIN DATE:
(29 Fort Avenue)
HEALTH
JOANNE SCOTT DATE:
(120 Washington Street)4 b Floor
BUILDING
THOMAS ST. PIERRE DATE:
(120 Washington Street)3 d Floor
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11/15/2006 14:97 FAX 17819950717 NEWPRO SALES + Service._._. Q 001
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ADDRESS
MST ST DAY TO INSTALL: M T W TM F
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TY,STATE P GC i-- a (please cot*ono)
PRODUCT SPECIALIST t Ge BRANCH: ESTIMATED START DATE --
TOTAL F OF le OF DOORS WINDOW COLOR
WINDOWS i OF BOWAMY/GAROEN St".s itot e" CAP COLOR
OPENINGS STOPSOUT
NO. STYLE W x M U.I. LOCATION RIO SCR IN ADDITIONS OPENING CUT
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Board of Building Regulations And.Standards ONLY AND CONFERSHOW0NT3 ufoNTxe CEA11F1CAM
Amer rAn 8iret Ins AganrY IeC MOLDER.T119 CEM"RCATE OOE9 NOT g0tE01D,EYTENO ON
HOME IMPROVEMENT CONTRACTOR 123 ouim above Drive 'ATERTNE.COVERAGEAFFORUED eYTNE FOUCIEe BELOW.
Rorih QULMY NA 02171- -
'��s Ph0an1 . INSURERS AFFOROINrt COVERAGE :,.
Regishatioh; 148589 611-710-9000 -_ - -• - _ NAtC 9
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_. Expi{atiOD sI6/2007
Sypa Su{ lement Card' '4181A`n0.'
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WoburntTAgD1a01 IA%U1e1 G:
NEWPRO OPERATING ltC `.
a THOMAS FOXON^ . �
covERAOEs
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BOARD OP GUILD! G REGULATIONS ; - :. .
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Lkense: CONSTRUCTION SUPERVISOR r�pwTA#ratma+itrlavum _ #
Number: PS _ 029090 - i A IyiTw¢ 90967005 05/01/06 05/01/07 et.¢waitroiorNr 55001000
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230 WALNUT ST""
READING;.MA 01867 ,<
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ENERGY Qualified
'I Highlighted•1 RegionsSIMI
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e DEVCO PRODUCTS, INC.
f �a� Newpro/Denall 2000 Double Hung
Vinyl frame,.Triple glazed,
s.uvlo, Low E coating(e-0.00{.SI 6 5).
Krypton/Argonlair filled,Dlvidera
e
E84-DEW 13.
ENERGY PERFORMANCE RATINGS
U-factor(U.S.A-P) Solar Heat Gain Coefficient
0.19 0.25
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance Air Leakage(U.S.A-P)
0.36 0.1
Condensation Resistance
7 .
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CT Reg. #1465f39 FIRE
I�NEE ,5C139
CT Reg. #0605216RI Reg. #26463 EPLACEMENiWINDOWPEOPLE Federal ID #20-2625129
Corporate Headquartera:26 Cedar St.,P.O.Box 2696 Wobum,MA 01888 (781)933-4100 1-800-342-2211
-. THIS CONTRACT MADE THE . . . . . . . . ./7. day of. . f� . . . . . .c. 200.(r. between . . . . . . . . . . .
> v. ?/IV I. � 1--, � ° � . . . .')S-. 7N 5 0f¢. . . -5;A -s,l9 - d
/ (Home Owners) (Home Phone), (B Cell Phone) (Mr./Mrs.)
of. . . . . . . ../ . . l�i . ./Z. : 1 : h. '� J� 7. . . . .�.:.�f�L�1" . . . . e� ��r1 )�
(Address) (State) (Zip Code)
the "Owner' and NEWPRO Operating, LLC, "NEWPRO".
NEWPRO hereby agrees that it will for the consideration hereinafter mentioned, furnish all labor and material necessary
to install the following described work at the premises located at
(Job address) . . . . . . . . . . . . . . . . . . . . . . . . . .(E-Mail Address)
TOTAL Additional TOTAL CASH -t
\ Windows Purchased (0 NEWPRO �� Work Style City PRICE -) 5 QQ
Window Color Specify / ]l, -1 Ii, Sliding Glass Door /, DEPOSIT
Capping Color Specify u Qty Steel Security Door WITH ORDER uv
?: Double Hun t
Picture Window Obscure Glass TOP BOTTOM BALANCE S
Stationary Casement Screens RALF FULL DUE AT UUU
Casement - Model # INSTALLATION
2 Lite / 3 Lite Slider NEWPRO* does not do any painting or i
Bay/ Bow Frame staining.
NEWPRO" is not responsible for conditions /CASH Balance Paid to
Garden Window or circumstances beyond Its control Including 1"�
Awning condensation resulting from or due to pre- Installer at Installation
i existng conditions FINANCE
Other Bank Completion
GRIDS jv Colonial"--Diamond Form Signed at Installation
DESCRIBEl WORK:
11 Jd h /�// . 1- 7
�r in
All steel security doors will have a 3/4"aluminum threshold installed over existing threshold.0 Customer Initials
Est. Start Date: ,)-/v-p(. Est. Comp. Date: /3-/J— ut,
It shall be the obligation of NEWPRO to obtain any and all permits necessary under this agreement, as the Owner's Agent. The Owners who secure
their own construction-related permits, or deal with unregistered Contractors will be excluded from the guaranty fund provisions of MGLC, 142A.
All Home Improvement Contractors and Subcontractors shall be registered by the Director and any inquiries about a Contractor or Subcontractor
relating to a registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301,
Boston, MA 02108, (617) 727-8598.
If the Owner is obtaining financing by way of a Retail Installment Sales Agreement, such Agreement shall include a time schedule of payments to be
made under said contract and the amount of each payment stated in dollars, including all finance charges. The Retail Installment Sales Agreement
shall be incorporated herein by reference. If the Owner is obtaining a revolving credit line to pay, in whole or in part, for the contract amount herein,
the terms of the revolving line of credit including interest rate and payment terms, shall be clearly set out on the credit application. The portion of the
credit application referencing a time schedule of payment,to be made under this contract,and the amount of each payment stated in dollars, including
all finance charges, shall be incorporated herein by reference.
NEWPRO represents that it carries Workmen's Compensation and Public Liability Insurance in the amount of$100,000-$300,000.
if the Owner refuses to permit NEWPRO to proceed with the work herein,or in the event of any breach of the Owner of this agreement,for any reason
whatsoever shall cause the owner to pay NEWPRO a sum of money equal to thirty-three and one-third percent of the price agreed to be paid,as fixed,
liquidated and ascertained damages, and not as a penalty, without further proof of loss or damage.
NEWPRO shall not be held liable in damages for delays in the performance of this contract due to causes beyond its reasonable control.
Owner warrants that he is the owner of the property on which the work is to be performed or that he is otherwise authorized on behalf of the owners
to enter into this agreement.
This contract represents that entire agreement between the Owner and NEWPRO and cannot be changed except by a writing signed by both the Owner
and NEWPRO.
You are entitled to a copy of the Contract at the time you sign. Keep it to protect your legal rights. We, the aforesaid
owners, certify that immediately after the signing of the aforesaid agreement, a copy was furnished to us.
You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,
which may be his main office, or branch thereof, provided you notify seller in writing at his main office or branch by
ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the
signing of this agreement. (Saturday is a legal business day).
See the attached notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
The Owner has seen "sample" warranties that will be provided by NEWPRO upon installation.
❑ Sample warranties provided to Owner. J
IN WITNESS HEREOF, the parties have hereunto signed their names this - / day of 200
S f EIN# Signed 141-t
Marketl §Representative Printed Name Owner
Accepted: NEWPRO Operating, LLC
By Signed
Marketing Representative Signature Owner
WOBURN BRANCH OFFICE SHREWSBURY BRANCH OFFICE WARWICK BRANCH OFFICE
26 Cedar Street 151.153 Memorial Drive Businessaark 45 Gilbane Street
Woburn,MA 01801 Suite B-C Warwick,RI 02886
TEL:781-932-8300/EXT:330 Shrewsbury,MA 01545 TEL:401-732.2407
800-242-9974(FROM NE) TEL:508-8428876 800-356-3312(FROM NE)
FAX 781-933-0717 800-456.0555(FROM NE) FAX:401-732-1371
FAX:508-842.9248
WHITE: Branch Copy YELLOW: Customer's Copy PINK: File Copy GOLD: Finance Copy
US—15 100/PKG. 11/05