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33 FORRESTER ST - BUILDING INSPECTION The Commonwealth of Massachusetts FOR ® Board of Building Regulations and Standards t Massachusetts State Building Code, 780 CMR, 7°i edition MUNICIPALITY USE Building Permit Application To Construct, Repair, Renovate.Or Demolish a RevisedJanuory One-or Two-Family Dwelling 1, 2008 \ s Section For Official Use Only Building Permit Number. n 1. Date Applied: S '' Cf� Signature: ���1/6 Building C t n / ect of Buildings Date SECTION 1:SITE INFORMATION 1.1 Property Address: y /0'r� 1.2 Assessors Map &Parcel Numbers 1.1 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?.Check if yes❑ Municipal❑ On site disposal system ❑ - ' SECTION 2: PROPERTY OWNERSHIP' 2.I Owner'ofTitecor Name(Print) Address for Service: - C�17) Y). Signature - Telephone SECTION 3:.DESCRIPTION OF PROPOSED WORK2 (check all that apply)' 1•lev:Coast:�:io ^ Exis s Buileli.i�..^. :?•, ^xu;.icd ❑ - Pepa::s(" "� ...:icn(s) ❑ Add:uo;i ❑ I�enuilitinn ❑ !AClcs snryBidg. ❑ Number ofl-Inits_._._ Other ❑ Specify:__. -- Brief Description of Propos d Work'-: G 'e SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Offrcia!se Only (labor and Materials) I.Building $ 3 vJJ 1. Building Permit Fee:$ 1,1. Indicate flow fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost' (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: S 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Su ression) Total All Fees: $ 2� Check No.i f( Check Amount: Cash Amount: 6.Total Project Cost: $ aid in Full ❑ Outstanding Balance Due: f'l�IL pcMu,.�T /dTTi�-eu3'+r t�NVSci.1�z2_ SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) �Ai Ili ap7 License NumberCl Expiration date Name of L-Hold List CSL Type(see below) Address _ _ T e Description .Unrestricted(u to 35,000 Cu.Ft. Signs 6e .� R Restricted 1&2 Family Dwelling 17 dr! _ M MasonryOnly Telephone. RC Residential Roofing Covering WS Residential Window and Sidiri SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition . Register Ho `G eI pr vern tCo tr ct (HIC) f//x7 e a YW l Ln 1 HIC Company Na a or Hl Regis ant Name - Registration Number /Q N-h/lore Address , � C. 6q/(r /r /7 ',� - Expiration Date - Signature Telephone - SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152_ § 2SC(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 ..........&a No...........❑ SECTION 7ac,OWNER AUTHORIZATION TO BE•COMPLE,ITD WIFIEN:. . OWNER'S AGENT'OR:CONTRACTOR APPLIES FOR BUILDIIVG'PERMIT 1, 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. - Signature of Owner Dale - / SECTION 7b: OWNER' OR AUTI30R.I AGENT DECLARATION } r NFU = ae� ber AUthotized At ent fierebv eleclare' that the statements and information On ti— fore uut_ applt atinn ate fine and accurate, to th— e best of siy,knoeledae and belialf A ` .Print iJame D•. - _ . . . . �7 16S7 Signature of Owner or Authorized Agen Date (Signed underthepains an en er'u 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 I10.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: tz- Total floors 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 ofhalf/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" a . DEBRIS FORM This form is to be submitted vith building permit applications whenever there is debris to be disposed of. Property Address: In accordance with the provisions of MGL c.40, §54,:a condition of the Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed , solid waste disposal facility as defined by MGL e. 111 §150A. Tbis debris will be disposed of in: . (Location of Facdity) Signature of Permit Applicant /4 Date Renewal byAndersen® WINDOW REPLACEMENT an Andersen Company August 7, 2008 Building Department Town of Salem One Salem Green Salem, MA 01970 To Whom It May Concern: Attached is approval letter from condo board to replace windows at 35 Forrester St., Until 3, Salem, MA. Permit was applied for on 7/8/08 If you have any questions, please contract me at (508) 919-0992. Thou Carol O'Brien Permit Manager Renewal by Andersen 104 Otis Street 1 Northborough,MA,01532 Phone(508)919-0900 Fax(508)919-0903 Website:www.renewalbvandersen.com CONDOMINIUM PERMISSION FORM FOR BUILDING PERMIT We, 33 -3r F.r,C574e, Ski CAael" 7iJST, of 53 -Jr Fee.-Ca/e' .5-2!. Ss 4e+. Name of condo association or management company address Being the duly authorized representatives of 33 - 3s �re�e S��aoa/i -/,tvram Name of condo association have reviewed the plans and specifications for improvements to 35 Forrester St., Unit 3 Salem, Address and number of condo unit owned by Brian Gerwitz and Joeli Barone-Gerwitz. Name of condo owners The condo association or management company agree that the above owners have permission to seek permits and to carry out the proposed work. y a, r G4 ✓rGr p /�/? Si j"e of condo association relpesentative and title Date / 192Y PrintPrint Nan" (In lieu of this form, a letter, stating the same purpose as above, on the Condominium Management company stationary, may be submitted.) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� / Please Print Legibly Name(Business/Orgmization/lndividual): Ren e tJt-l Z v HY) derSe n Address: /b ' G �Tee-� City/State/Zip: f o ro (/ Phone#: C �� 9II 0 g(Jry Are you an employer? Check the appropriate box: Type of project(required): 1.�I am a employer with �U 4. ❑ I am a general contractor and I 6. ❑New construction employees(fall and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t �• Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work. right of exemption per MGL I LE]Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. - I am an employer that isproviding workers'compensation insurance for my employees Below is the policy and job site information.Insurance.Company Name: J :? ✓/I/M�/f r& nw J/75 UYa C-ee Policy#or Self-ins.Lic.#: �9^ ���//C�� 1^�yT_ Expiration Date: -�_ Job Site Address:CK( P/ y/ . l l/li�� City/State/Zip: t, G� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to.$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby erhJy under t pains and penalties ofperjury that the information provided above is true and correct. Si afore: J Date: UO Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: '= Massachusetts- Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License •, License: CS 99256 Restricted to: 00 SCOTT PHILLIPPI 58 0 STREET WHITINSVILLE, MA 01586 r ' Expiration: W2011 Commissioner Tr#c 99256 . Restricted to: 00 00- ITnrestricted 1G-1 2 Family Homes Failure to possess a current edition of the - Massachusetts State Building Code is cause for revocation of this license. - Refer to: WWWMass.Gov/DPS ✓J+e fao�umoawe2i o��amor/u4eta lq Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Re istra`tin�� Board of Building Regulations and Standards 9 a 149601 Pti ti�nnt 2010 One Ashburton Place Rut 1301 q Boston,Ma.02108 GTyp pplement Card _ RENEWALBYAMpERSA y CAROL O'BRIEf�.l;� n 104OTISSTREET �'` NORTH BOROUGH,MA Oi532 Administrator Not valid without signature ACORD CERTIFICATE OF LIABILITY INSURANCE 02/13/2008 PaoaucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph MCKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JP McKeone Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR g cy�P.O. Box 333 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC 0 INSURED Renewal by Anderson INSURER A: Ijartford insurance Co an J8L Windows,Inc. INSURER B: Hermitacie 104 Otis St INSURER C: Northborough,MA 01532 NSURER Y I INSURER E: COVERAGES ..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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICYNUMBER POLICYEFFECTNE POUCYEXPIRATION LIMITS B GEBERALUABILRY HCP 507 404 09/07/2007 09/07/2008 EACH OCCURRENCE E 1,000,000 COMMERCIAL GENERALLNBILITY - PREMI S Eaem�anen S 100 QQQ CLAIMS MADE �OCCUR MEO EXP( one Ix man) S 55 QQQ MRSONAL SADV INJURY S 1 0 000 GENERAL AGGREGATE S 20110000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO S 2 QQQ QQQ POLICY PRO. LOC A AOTOMOBLELIASILRY 35 MCC XD 6390 10/01/2007 10/01.2008 COMBINED SINGLE LIMIT E 1,000,000 ANYAUTO (Es eatloenq X ALLOWNEOMAOS BODILY INJURY SCHEOULEDAUTOS (Perpa n) S HLREDAUTOS Ber uc:i NJURY S NONLWNEDAUTOS (Parameam) _ ' PROPERTY DAMAGE S (Perecoaent) GARAGE LIABILITY I AUTO ONLY-EAACCIDENT E ANYAUTO OTHERTHAN EA ACC S AUTO ONLY: AGO S EXCESSNMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE E RETENTION S - - S A WORKERS COMPENSATION AND 35 WEC PP 1444 02/17/2008 02/17/2009 we sTATu- OTH- EMPLOYERSLIABIL Y ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ rjQ QQQ OFFlCERAIEMIiER EXCLUDED? - E.L DISEASE-EA EMPLOYEE S 500000 tlyyeess oeSP4"01 aer SPECwL PROVISIONS below - I E.L.DISEASE.POUCYLIMIT S OTHER DESCRIPTION OFOPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE THE EXPIRATION INSURED COPY DATE THEREOF,THE ISSUINO INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE To DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATVES. AUTHORIZED REPRESENTATIVE Qy1ij.�Cea'n_�. ACORD 25(200110B) m ACORD CORPORATION 1988 Jun 16, 2008 8: 23RM MIKE SIDMRM 6039345514 P. 2 renewal® eY4N0a� . Customer Service$00-573-7606 rea 00r St.Nmi000wilh W eta]3•Wrc1a0Ei etgOYS•f.c(60A 91400a] . .. JlL wnaaNa,Mnaw RewNe eYAnawtan•DRNedwtbewnAAs\e•e,atlAlaM MwOw}aRooe WINDOWAGRREEMENT BOLD TO: -ra lily C.)t 1_a�1L re1✓i/TL DATE � IY-B ADDRESS: :?'r f0?�r`� S� U� PHONE.Home: CRY. L&Az STATE- of 4,7 0 PHONE-MM: Jos SrTE ADDRESS(MeIINNeny: Appro:lmsia Start Does: Apprwdmate Completion Dale: /Ys. SPECIFICATIONS Rarowerby Anderson approved MNWWS will be fumiahad end IMAROOdto Bless spa ANHOW: i, INmA total Ob a7 window!. 2: Quer ubl otwhad(D I Seal U Coael sash(113mp,2J3 botlan) O Oriel seen(213 top.113 bot oirhI ,. Double Ht(C(DS) _Caeerperrt(CNQ tlHaga right tlNllhge kit lee vowed fiom erdenw):OStaMerd haaSa tlfAeoe Rendb _ _0&jbIa Csssmern(COVvt OBUMard handle.O1,11e1ro MndIS C�,aµsamant f Pime,I Cesermnt(CM) 01:1:1 W 131:2:1 OSrandsrd handle OAsety handle Gltlbry Window(OM Ostler/Poswo I Claw(GP" 0'1:1:1 or 01:21 Awnag 11Wndaw(ABM . PPkhwo VVIndaM(P 9. G'Yss.Q N3M YNndows td beCualom Fk Raplaoerro A. O Yes ag-0 of sills to be replaced: a. 0 Yes a./1Mndtma to be Nm 0onsaurbonfW lame{MaNdas new IM"TW S atieror mslnpe): EztateT vesingd: Q;Flna OM1MInlsnmlcsMas mebrial QFaCAwP applied`eDe Plarox etldanok a. Gla¢Up to bs Ojigh PglformanO D OUer Mgthw.$e O PBdIY 4, Exmoor cWw to be:p(S.'`jn�ir'n� D Bend 0 Carves 0 Tensions a. mmrbl color to be: tta 0 Sand 0 Curves m O Tetche 0 Wood Own Interior n only be weMa,wood W erne color a seeder. VVQOd bterbm nasato be finished by oust g. ttwdwam le 0 wom O'Cmm 0 Braes Oeuble Hung: In tall ale? ea 0 No 10.DYea ���"'RRRRRN al of mew Karnes Menses aOf unit: 11.0 Ym nwr pa w afalmeady easYhpe. Inside or evabde stops P of epownp: drienMtanirp Mod opanlnpr Exlaior wa'eSaaelepeninga: DP ins ❑Nelnlelance tree mamrtef. {(�^Clammar:wLA lRb4 ddo saypa�mg. Cust.mltlals. P 12.0Yaa ®�Go Wiap e>tmnM memos with aBllNnum cull stock color. Note:RequAad wah.emm window toigssas,Rowww of steno vnndaws tilipseav,senor home In casing 13.N1m imnoVwe lO have: D Hoff or I[Mrporeena SOMM to be: bbergbsn DAluminum 14,W Widows to have 701e0: D Yes 0-44,1f Yso: 0 Grole Between Grose(GSG) 0 Removable Interior Woad(INIW) 0 Full Dhdded Ugm(FUL) Gera pia' R ❑ M 71 DH��������/� ON DH - DH CW/plcture Gamer CPWwGPW hba YOA)a�R016haehaneedld Custprtrorapprovev(InitlelaY- 13.. ❑No WUIsa;Oeugt and seelwlndows wth h)WpolN System to pmventweles and air lnfl"lon. 13. Y ❑N0 Remove anti dispose Of exlNkhg wlntlows and Serra 1 0 No CiamUp. All job related debrb removed.Vacwm Rightly. 1A" No msumr. AO wolaera oompaaoarwn and eab0ly Nrunnwmatrrmined 19, as ❑No Wonsan•.GNen to emsomer upon cm*l al and nocelptof ful Payment 20.AddNonel Information'. 21.Regular Redas Price'$ 22,TOW PVoWAmevnt;$,;t ...._AIMvellable dwcouns have been applied: ei�T s O we 23.Is Project to bs P�In 0 Cssth Fad O Combination of Caen and Feliffm 24.Caen Diposil(113):B ^✓14 113 of baler due at Stan oflob and Anal ty3 am at completion otpb. w ?9esymanrn nrdaeyeredr eMd mrMydeorw N31LMSbeaddsdb wtarlse a by OadACaM 26. No Financed. 4Yss,Arhb, Rnarrud: -r (Aewml O 1 ABO.Z.S-r.�,(s 1. 23. OHO Cusmnhmameaelobe gesentcotl»AaW ollnealleBanWsntl-napgdlon:endte daaerfllal psyrreM. 27.fBY 0 No HomeOwnorgMe R84 aPpmvS1 m place A Yard Sign On their ISwn at the time of meewre. - 26..,_._ee D No Me ronveltbnce ble company wig 3eWre on building penult The fee for IM perirllf 6rierlmYWad In ee ni'{lljebalfd'ofepaism Ofiedcle rtipeAeo"Verne'oNeam'fbterlaTca---"—"""_._ . 'reW~QVANwmW a NOT R4611014MO a P:R ANY WRTMO a{{pCe6M, Y"Want OR OOra oo"s rNAT OOlap NM MA PEEN BHW PRmR TO . 'YITLPMNIa Ai1eI9TPN AIWY�ROe WNOO�VIa NCO eOPRBPaba fOOTwIgaMLLAIONOFYOat mOPA&nd1Nl Affllmw REetDNemFrORn14RBaNla OR earAlU11QIMTMESE eewlfEW.'SAaeaANNAa NOAVnpWNl10NnD ONANOe AtMmNe Gllruxa, ' ANYraP1a�NFATKYM OfIB1TINNeONfNNEaWT11e.Ka Qtr/JOT/MIaR'aV11aeEM8lrMf NCIEi IPON eaYY'AOrMNNe!•Y W eeM flEREYMCnR lPD fO ACrONM4MRE.'Tf0.aiYll FeA AIFNDDWiN nCR1aOtaTO1YPTT WNe+PLeY0.N4lWa9E MCd.TRMetARe9 Nal!OTTORA LWKR ONV, ®ONTnPflRSGWaa. Thile weneb.1SNdPoue.nt.AtmM YAL aubmnrntwrraelMhpw angatalwn OhPIvnllp enaNdmYMuiNPol W:REMSaRcAem9NOi OMMO N,PROGRAM GOOR.NOANNAnTOtRe,boONda:ASHBNaRMTO N PA6 BOON t>01.9oaT0N MA 0a1m.Yer,IM IwnwmergM aeaae 4M?wneam aPu undw MOL cw F ABMta.P ttm a 10 a MOL e2e60 r 1t. D w NOTStM,ne IS wrens ACTImwaleewtlu PaNWn BILANKa Pate S. a1N1A. DONOT SIGN TXIS C.ONTRACTIF ERE "ANY BLANKSPACES. / RbANap.Slgnat.— s..--Data: b^ 7 O C1bMnmr S:neWm: usmmer Signature: wTM-RmwwteYMeeraw YNmw-4vrtrBRn Phk-Nuveaw+Nr is osse • re al WoodNioyl Composite Frame , MalSriNFxs>tNaEcr Po - Dual.' on'etc o E Low Pxt C� e — Double Hong - *- ENERGY PERFORMANCE RATINGS V-Factor(U,S)/I-P Sofar Heat Gain Coefficient ® 32' . -, r 3' :.ADDITIONAL PERFORMANCE RATINGS ' ;Visible Transmittange__ Mnn nelupntlrw�WWa 0.tM•. mfq.••n�nim le yplknpb P'£PCpwNUn•b.!•WTJay'nNb p.dw NFnC+.n•.. Ncpcllu•y..n F WnNP.d 4rl Mla.v.r.n•Nom..nnLe Md.n•Wd:.prl(<p.dwl+n•. NF11f.b•.MfrK•r•P`•^d•nr PndM•nd!••.ryIYVRPI�•rdmN;pb•I•I�[pr•lwlb.•rytlp.Nlrw•. _ � , • C•AW.tlMnebcbAr'•%NnM.bl n6�np•dwry.Nll7ni!a{tlRv�F DE SIGN PRESSURE(PSF) E� L C 2 �00-0027 239•612 i..rd u.lrN t' tic�. 'Pll. IU�nitw; `is.Gi rA•n.w• N.. lur••�WR. ` .'. ' M..Le..m.da ll6.C�GEc.11.60.F YrIMWbwf.OpfIFMPnn YlUK6 haY�AfidNainlsDr•w�. - "• ... 1 � !. � .. - .� .. III Renewal byAndersen- WINDOW REPLACEMENT an Andersen Company To Whom It May Concern, Enclosed is a permit application package for a project we have been contracted to do in your town. Thank you in advance for receiving this package by mail. As we work in every town in the state, it greatly helps us in our process. We have also enclosed a self addressed and postage paid envelope and would request that when the permit application has been processed, that you would mail it back to us. Enclosed for you review in this package is: ❑ Permit Application ❑ Home Improvement Contractor License ❑ Construction Supervisor License ❑ Proof of Insurance ❑ Proof of Energy Efficiency Rating ❑ Signed Contract from customer ❑ Permit Fee (if accepted at time of applying) If you have any question regarding this application please call me at 508- 919-0992 or e-mail www.cobrien@renewalboston.com. Best Regards, da(wU iw� Carol O'Brien Permit Manager 104 Otis Street 1 Northborough,MA,01532 Phone(508)919-0900I )a Fax(508)919-0903 Website: www.renewalbyandenen.com