0007 HARDY STREET U1 - BPA-16-14 CK 103sq $ I9(o°� _
The Commonwealth of Massachusetts RECEI
VLU a Board of Building Regulations and St h"UT10NAL SE RVI E9 CITY OF
Massachusetts State Building Code, 780 CMR SALEM
,,AA�� P ) 'wised Mar 2011
Building Permit Application To Construct, Repair, Renc ��ef71 De oItsh a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
CCD tN n c 7 U t t _I_ I I
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
-rdu . +
1.1 a Is this an accep ed street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
C� 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: _
?LGL` W-lx I tom_ \[ex:rA rr .��f 1 Yt VU� A&I C N
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units I Other lX Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ D — 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost' (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: /
5.Mechanical (Fire $
Suppression) Total All Fees: $
G Check No/035i Check Amount:l I-(, Cash Amount:
6. Total Project Cost: $ 0 � � — Paid in Full ❑ Outstanding Balance Due:
M f-,,t L- TD L,D " 7 - I 112
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 0.� o I O C�( -o
�6P A A � `' )p I r p License Number w Expira ion D e
dame of CSL Holder ��-"'��- F
�a '� �,\) �� `}(� List CSL Type(see below)
"` '- ' - �-' Type Description
No. and treet
t�
1�,t vY-\,� Q 1 ��� U Unrestricted(Buildings u to 35,000 cu. ft.
V R Restricted 1&2 Family Dwelling
Clty/T wn, State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I CJ' SG a L- mil ( 1 I ' Y I Insulation _
Telephone Email address D Demolition
5.2 Registered Home I?, Improovve nt_Contractor(HIC) C s� a
1 - 1 HIC Re istration Number `E.. irati Date
C Company Name r HIC egistrant Nam
lbw; s LdDo 6) s n .
No.and Street Email address -y"
Ci Town, State,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
I,as Owner gf the subject property,hereby authorize LALn t
to.act n my behalf, in al afters relative to work authorized by this building permit application.
i
�
PrJnt O t
ner's Name ectronic Signature) I D to
SECTION 7b: OWNERI OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained i this a plication is true a a ate to the best of my knowledge and understanding.
rint Owner's or orized nt' ame(Electronic Signature) I Da e
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. og v/oca Information on the Construction Supervisor License can be found at www:mass.aov/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"may be substituted for"Total Project Cost"
CITY OF S.U.ENl, MASS.AI HL SETTS
•'• BUMDLYG DEPAR'T%mN-r
120 WASHIINGTON STREET, 3ae FLOOR
TEL (978)745-450S
FAX(978)740-9846
IQNtBERLF-Y DRISCOLL
MAYOR THOMAS ST.PMRRE
DIRECTOR OF PUBLIC PROPERTY/BUIIDLNG CO%L%USSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant information Please Print Leaflbly
Name(Busim�Organization/Individual);
Address: eL�Cn r\--
City/State/2ipt —C1 0 Phone #:
Are you an employer?Check the appropriate box:
���yyy
Type of project(required):1.0 1 am a employer with (-0 4. El am'a general contractor and I 6. [Q New construction.
employees(full and/or part-time),* have hired the subcontractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet: 7. [D,Remodeling.
ship and have no employees These sub-contractors have S. E3 Demolition
workingfor me in an capacity, workers' comp.insurance.
Y9. Building addition
[ workers'comp. insurance 5. 0We area corporation and its 10❑ Electrical re au-s or additions
required.]
.
officers have exercised their P
3.❑ t am a homeowner doing all work right of exemption per MGL 1 I.❑Plumbing repairs or additions
myself.(No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs n
insurance required.)t employees: INTO workers' 13 Other L �-
comp. insurance required.]
Any applicant Char checks box pl most also fill out the section below stowing their workets'compensation policy ittrurmation. —
s I hwneowneis who submit this ifttdavit indicating they an doing an work and then hire outside connactoru most submit a now,affidavit indicating such.
-ContmsYon that chick this box must attached an additional shoe)showing the name of the sub-eontraewn and their wmttera`mmp,policy infarm um.,
�CY.9
l am an employer that is providing workers'compensation hrsurancefor my employees. Below Is the policy andTab vita
information.
Insurance Company .Fame:-T V J11(A�yYlA/l-Q -��
Policy k orScif-ins.Lic.H: F _1�1: � �� Expiration Date: aJ� - \-0�/_�_ �/� �•�
Job Site Address: -- City/State/Zip:L� T
Attach copy of the workers'compens tion policy declaration page(showing tine policy number and expiration drlte).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penaltieo of
fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fins
of up to S250.00 a Clay 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 certify render the pains and penaltles}vjperjury that the in/brmatlon provided above i true a rd correct
phone 4,
0JTc4d use oily. Donor write in this area,to be completed by city or town official
City orTuwa: Permit/1.1cenxe
issuing.Authority(circle one): �~
I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
CITY OF smy-m, TNL.Nss.kCHusf=r_0
ism
$utmn1G DEPART1f:&SET 120 W.AsHiNGTOfi STREET, 340 FLOOR
7'EJ (978) 745-9595
FAX(978) 740.9846
KIMBERLEY DRISCOLL
11dAYOR. T Hontas ST.PtERRE
DIRECTOR OF PL IBLIC PROPERTY/B1-'1LDKNG COMMISSION ER
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 of facility)
(address of facility)
signature.o" enntt ap a
date
debrisatY.dw
[(.JHiJJI`J/H'f//���5/��(IIJNJfJ(I/..f7J -
Office of Consumer Affairs&Business Regnintion
1-d �F
-HOME IMPROVEMENT CONTRACTOR
Registration: 128634 Type:
Expiration: 502017 DBA
ED BYRNE WINDOW CO
EDWUND BYRNE
756 WESTERN AVE
LYNN,MA 01902 Undersecretary
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
C..n.iruiY...n Sneers�.,,r
License:C"10870
EDMUNDjBYRf,
59 C-
t8 Woodrow TerrAce 7fMf'J%
Lyao MA 01904 =
w Expiration
Commissioner 0710w"17
BERKSHIRE HATHAWAY Worker's Compensation and Emolover's Liability Policy
UAR® OMPAN INSURANCE NorGUARD Insurance Company - A Stock Company
Policy Number EDWC643855
Renewal of NEW
NCCI No. [25844]
Policy Information Page
[1]Named Insured and Mailing Address Agency
Edmund Byrne ADMIRAL INSURANCE AGENCY
756 Weston Ave 70 Munroe Street
Lynn, MA 01905 Lynn, MA 01903
Agency Code: MAHARRI2
1
Federal Employer's ID 20-1160335 Insured is Individual i
Additional Names of Insured
(N2) Ed Byrne Window Company
[2] Policy Period
From December 13, 2015 to December 13, 2016, 12:01 AM, standard time at the insured's mailing k
address.
[3] Coverage
A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation
Law of the following states: Massachusetts
B. Employer's Liability Insurance- Part Two of this policy applies to work in each of the states listed i
In item [3]A. The limits of our liability under Part Two are: I
Bodily Injury by Accident . each accident $1,000,000
Bodily Injury by Disease - each employee $1,000,000
Bodily Injury by Disease - policy limit $1,000,000
C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in
item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming.
D. This policy Includes these endorsements and schedules:
See Extension of Information Page - Schedule of Forms
[4] Premium
The Premium Basis and, therefore, the premium will be determined by our Manual of Rules,
Classifications, Rates, and Rating Plans. Ail required information is subject to verification and change by
audit. (Continued on another page)
Total Estimated Policy Premium $ 10,055
Total Surcharges/Assessments $ 54S.00
Total Estimated Cost $ 10,600.00
MIExNAt- is g Page - I - Information Page
MGA : EDWC643655 WC 000001A
Date : 1i10412015
MANOTE
Issuing Office: P.O. Box A-H, 16 S. River Street,Wilkes-Barre, PA 18703-0020 • www.guard.com
E.B. Window and Siding Co.
756 Western Ave --
s Rt 107 Date Invoice#
Lynn MA 01905
10/7/2015 51771
Bill To
Katherine Stauner
7}lardy Street
Salem,MA 01907
P.Q. No. Terms Project
Description Qty Rate Amount Y
Remove all non essential items from wall.Non working alarms,dead O.00T
cable wires ect.
Prepair exterior of building to accept Vinyl siding including leveling 0.001,
wall by screwing existing siding in tight using all wether screws
where needed
install 38 Airlock insulation to complete sidewall area. insulation to 0.001
be used both as an insulator and wall leveler
Install vinyl soffit. soffit to be installed as per manufactures 0.00
specification for high wind installation.
Cover all fascia and rake boards using Aluminum trim stock custom 0.001
formed on the job.
install custom trim cover full on all windows. Window trim to be 0.00 f
installed in such a way as to provide flashing over top and sides of
windows
Furnish and install Charter Oak Vinyl Siding to complete wall 0.001
area.Use 25'panels(compare to standard panels of IT)where
required to eliminate as many seams as passable.Charter oak is
Alsides top of the line panel and is rated for wind resistance of 160
M PH
Take away all job related debris 0.00'1
rp7to be working with you soon
Subtotal
Sales Tax
Total
Payments/Credits
Balance Due
Phone# Fax# E-mail Web Site
781-592-9747 781-592-9746 ebwindowCamsn.com www.ebwindow.com
E.B. Window and Siding Co. Invoice
756 Western Ave —
" „ Rt 107 Date Invoice#
Lynn MA 01905 10/7/2015 51771
Bill To
Katherine Stauner
7 Hardy Street
Salem. MA 01907
P.O. No. Terms Project
Description Qty Rate Amount
Total siding projehouse* 1 29.500.00 28,500.00
acceptance or pro
0.00 6.001
authorized signat
Hope to be working with you soon
Subtotal g28 Soo a1
Sales Tax
a0.00
Total $28,500.00
Payments/Credits 419.500.00
Balance Due $9.000.00
Phone# Fax# 1,-mail web Site
781-592-9747 781-592-9746 ebwindowamsn.com www.ebwindow.com
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r T, we yx. t��. �•. ic`yS#:zh'�ie�.'3 .. -y; i.. .v�'• .Rl r•�:' 'tS.�v`1;��'q:'.4�J`Y':'vM1°'�. .'3�.
' 1
7 7 Ya Hardy Street Association
Salem,MA 01970
To Whom It May Concern,
The vinyl siding project at 7 Hardy Street has been approved by the con association.Please feel free
to contact Katherine at 781710-8699 with any questions and/or conce t As.
s.
Respectfully Yours,
*erineStauner
Arde Petty
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