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46 HATHORNE ST - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code,780 CMR, 7° edition MUNICIPALITY USE Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised January One-or Two-Family Dwelling 1, 2008 This Section For Official Use Only Building Permit Number. Date Applied: U ? D Signature: ` G Buildin ommissioner/InspectorofBuildings Date SECTION 1:SITE INFORMATION } Pro ert: Address: 1.2 Assessors Map &Parcel Numbers "Ilo l 4 by-x".- S! ScA f.-A C) 9Tl o 1.1 a Is this an accepted street?yes_ no - Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: x ir'M.......... ..;,.nr Zoning District Proposed Use Lot Area(sq fi) Frontage(fi) 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'o Record: �t� \e.r �o<<slaS tl(v 1 �rtllGrv�o Sd . .5� 1. t>l�� ta Name(Print) ° Address for Service: . Signature Telephone SECTION 3;DESCRIPTION OF PROPOSED WORK22 (check all that apply) ;;ea Ccastrc mac:: ^ Existing Ei ildm;,*❑ r`—knr'Oceupied Repairs(s)'. ::heia:ien(s) - .. Demolition ❑ Accessory Bldg. ❑ Number off}nits L. I Other ❑ S.pccifg:_. Brief Dcscripliun of Proposed Work': d, SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ cK 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical tJ ❑Standard City/Town Application Fee $ ❑Total Project Cost' (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ "" 4.Mechanical (HVAC) $ List• 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ $ 13 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTIQNSERVSCES t 5.1 Licensed Construction Supervisor(CSL) aSC� Co l I St o a-+ P�- ' ( (�/� License Number Expiration Date _ Name ofCSL-Holder 1 0 0+( SA v pr/J L h 015 List Type(see below) A , . T Unrestricted _ . Description d8�esCs s¢ 1��n ton n ; U Unreseted(tipto 35,000 Cu.Ft. Signature ,( X — - R Restricted 1&2 Family Dwelling cllCl M Masonry Only RC Residential Roofing Covering Telephone. WS- Residential Window and Siding SF Residential Solid Fuel Burning Appliance lnstallation D .Residential Demolition - Registd Hotdt�e Imprpvernent Contractor(HIC) _e.^e tere a\ 1�y u" Nl A-c�r r,,, I �-1 CI G clI HIC Company Name or HIC Registrant Registration Number ao'Nuk A t l �ulll�A r ss r �U�— ^/LC/—U �'ga Expiration Dale Signature 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 ...........'H'� No...........❑ SECTION lac OWNER AUT110AIZA.TION T.O BECOMPLETED�VBEN.. . OWNER'S A GENT AR.CONTRACTOR APPLIES FO.RBTMAM VG PER1YIiT h 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 Date - ((SECTION 7b..OWNER' ORAUT7<URiZED A6E1� ( DCLARi1T10N 1 ,il i k T�i F 1 ae�uhter or Authentzed At ent fii'erebv teGlaY.c,: Ilia( the.5faicmetits mid information n Lie fo _Loitn application ate.true and accurate, to the best of nay kttowledge and behalf. .FriniNan - . . Signature of Owner or Authorized Agent - Date -(Signed under the pains and penalties of perjury) 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 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.). (including garage, finished basementlattics, decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halLIbaths 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" DEBRIS FIRM[ This form is to be submitted v41h building permit applications whenever There is debris to be disposed of. Property Address: to oawe_ C�. �Sc. -e.v VA 0127.D in accordance with the provisions of MGL c.40, §54,:a condition of the Building Penoit Number is that the debris resolt ng from this work shall be disposed of in a properly licensed , solid waste disposal facility as defined by MGL c. 111 § 150A Th�is debris will be disposed of in: ���e we f b�l I lncterS�� IcJN 6-ks U iuC),j ilMvt� tioa of Facility) hY1 4 O I S• 34 Signatlue of Permit licant � — l — C) e1 Date Massachusetts- Department of Pub lie Safet} Board of Building Regmiations and Standards Construction Supervisor License •� License: CS 99255 Restricted to: 00 SCOTT PHILLIPPI 59 0 STREET WHITINSVILLE, MA01586 Expiration: 617/2011 ' ('ummisidner Tn:: 99256 z Restricted to: 00 - 00-.Unrestricted - iG-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 +e >°Oommznrivaa/.f/ a�./�-neaac/umelA Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR RecIstrafiooy 149601 EkplgdI0 02412010 Iul� Type -Supplement Card RENEWAL BYANDER50N= =1 SCOTT PHILLIPP,S;� 104 OTIS STREET�` �.� y ' - NORTHBOROUGH, MA"01532 .Administrator etor` ACORDry CERTIFICATE OF LIABILITY INSURANCE OATH(MMUDONYM PRODUCER 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 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 333 Ann Arbor,MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC# INSURED Renewal by Anderson INSURERA: Hartford Insurance Company J&L Windows,Inc. INSURERS: Hermitage n 104 Otis St - INSURER C: Northborough,MA 01532 NsuRER D: 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 REOUIREMENT, 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. INSR ADOL POLICY NUMBER POLICY EFF.1633L -ME OF INSURANCEEC7IYE POLICY EXPIRATION LIMITS B GENFJUIL LIABILITY HCP 507 404 09/07/2008 09/07/2009 EACH OCCURRENCE s 1 000 000 COMMERCIAL GENERAL LIABILITY - -079MPREMISES Ear s 100000 CLAIMS MADE ®OCCUR MED EXP(,"oM peNon) S -_ 00 PERSONAL B ADV INJURY 3 1000 coo GENERAL AGGREGATE S 2.000.000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPX)PAGG f 2000000 17 POLICY JECT PRO. LOC A AUTOMOBILE LIABILITY 35 MCC XD6390 10/01/2007 10/01.2008 COMBINED SINGLE LIMIT 3 1,000,000 ANYAUTO (Ea as Wq _ _.. XALLOWNEDAUTOS 00DILY INJURY ' SCHEDULEDAUTOS .. (Per P61=1) f HIREDAUTOS BODILY INJURY NON-OWNED AUTOS (Per acriaora) S PROPERTY DAMAGE (Pm aoeaem) E GAMOELWBILITY AUTO ONLY-EA ACCIDENT f ANY AUTO OTHER THAN EA ACC f AUTO ONLY: AGO 3 EICESSIUMINIF, LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE f f DEDUCTIBLE S RETENTION S 3 A WORMS COMPENSATION AND 35 WEC PP 1444 02/17/2008 02/17/2009 NGaBzum' °Ti` EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERAD(ECUTTVE E.L.EACH ACCIDENT 3 500000 OyFFICERMEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYEE S $OO OOO SPECIAL R IO PROVISIONS berm E.L.DISEASE-POLICY LIMIT I f 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONSIVENICLESI EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION INSURED COPY GATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR To MALL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 1 ACORD 25(2001108) - ©ACORD CORPORATION 1989 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 ApAllcant Information / Please Print Legibly Name (Business/Orgmizadon/Individual): Ref)POal �V ;�Y1<�IeYS eYI Address: /0/l Qfi 5 �1fYe�� City/State/Zip: 6(Aboro , _ 1n Q15�� Phone.#: & 010 '/f O�Loo Are you an employer?Check the appropriate box: Type of'project(required): I.aI am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7 modeling ship and have no employees These sub-contractors have S. tj Demolition working for me in any capacity. workers'comp. insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑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.] 'Any 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. LCont,actors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 1/ Insurance Company Name: �I /nqnn// /Kean)- InC1'yCr)ce i Policy#or Self-ins.Lie. #: ` 9 J e-a /y Expiration Date: �2-/ Job Site Address: 1 u A (OfVc City/State/Zip: SCA-c-w. ,/Ul4 D[Ct1-D 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 cer y ui er the pains and penalties of perjury that the information provided above is true and correct mature Date ' ( a O 1 Phone#: f y - U co 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#: Jan 07 09 12'.52p richard 6033629918 - p.1 Window Agreement-Page 1 a12 CF11 4.- 104 Otis 51.,Northborough,MA 01532 J&L Windows,Inc.,dfbla 7 R OQ V (508)819-0900•Fax:(sea)919-0903 MA Home Improvement Contractor Renewal - License#149601(Expires is it ioi, Customer service {„ p_ l..rcV Cl Federal Tax ID 983-0404201 (800)573.7606 �+yA ,de,sene Indio.licenses:John Esle r(CS#74251), WINO-W YEVLAC-W.l •e AiJrn„n Cumyinr Kathleen eledChard(#1496o1) produel Maria er:_ " �' 4 ' C s � .t. Window Agreement Contract Date: '{J Homeowner("Owner")'s Name(s): VI Street Address: N �, ]. M City?own: Slat Zip: O/970 Home Phone: l,� f tt Work Phone: (�'7 Job Site Address(if different: E-mail Address: Materials to be provided and work to be performed by Renewal by Andersen("Contractor"): Contractor will furnish and install Renewal by Andersen-approved materials to the following specifications _ 1. Date on which Work is Scheduled to Begin: 71 f Expected Date of Substantial Completion: 2. Contractor will Install a total of windows in Owner's home,using the following individual quantities: Double Hung(DB) ICXEqual sa h ❑College sash(1/3 top, 213 bottom) O Oriel sash(213 top, 1/3 bottom) Casement(CW) O Hinge right O Hinge left(as viewed from exterior):OStandard handle OMetro handle _Double Casement(CDW) ❑Standard handle OMetro handle Casement I Picture 1 Casement(CPW) 0 1:1:1 or O 12:1 OSlandard handle ❑Metro handle _2 Lite Gliding Window(GW) _Glider/Picture I Glider(GPW) 0 1:1:1 or O 1:2:1 Awning Window(AW) Picture Window(PW) _—Bay or Bow Window: 3. Yes O No #Windows to be Custom Fit Replacement: 4. ❑Yes No #of sills to be replaced by Contractor: 5. ❑Yes WIND #Windows to be New Construction Full frame(includes new interior&exterior casings): li Extedorcasings: ❑Pine 0 Maintenance-free material O Factoryapplied 908 Fibrex brickmold 6. Glazing to be: t�l-ligh Performance O Other If other,please specify: 7. Exterior color to be: grWhite ❑Sand 0 Canvas ❑Terratone B. Interior color to be: §&Whhe 0 Sand O Canvas O Terratone O Wood Note:Interior color can only be white,wood or same color as exterior. Wood interiors need to be finished by Owner. 9. Hardware: (White O Stone O Canvas O Brass Double Hung: Install lifts? O Yes []No 10. O Yes �No Contractor will remove metal frames or grilles. #of lJnAs: 11. O Yes No Contractor will install new paint-ready or stain-ready casings.Inside or outside stops#of openings: Interior rasing#of openings: Exterior casings# rings: ❑Pine 0 Maintenance free material Owner is aware that Contractor does not do any pai t ner initials 12. 0 Yes VNo Contractor will wrap exterior casings wl a ummum coil stock of color. Note:Required with storm window removal:removal of storm windows will leave screw holes in casing. 13. New windows to have: ❑ Half or Paull screens Screens to be: 11!FFibergiass 0 Aluminum ❑TruScene 14. Windows to have grilles: O Yes DdNo If Yes: ❑Grille Between Glass(GBG) 0 Removable Interior Wood(INTW) ❑Full Divided Light(FDL) Grille patterns: DH DH DH DH CW!Picture Glider or GPW use additional sheet if needed Owner approved(initi 5J: I1� 15.Pas O No Contractor will insulate,caulk and seal windows with 3-point system to preve d air infiltration. 16. as O No A limited warranty shall issue to Owner upon completion of the job and payment in full(see reverse side). 17, Yes O No Buildinq Permit—Contractor will secure any and all necessary permits.The fee for the permit(s)is not Included in the Contract Price and a separate check is required at the time of sale for this fee. 18. Additional job details: 19. es O No Owner has reviewed tq ddilional Terms and Conditions oa, r ing this Contract on the reverse side. 20. Total Contract Price: $ _ Regular Retail Price:$__S 0 All available discounrs aPplad: files 0 No 21. Deposit(1!3):$ 9 a 7 paid by O Cash ❑Finance (Account#: ) Second(113)$ to be paid by Cash at start of job on (Estimated start date). Final(113)S 1 to be paid by Cash at completion of job on (Estimated completion date). 22. WYes ❑NO Owner agrees to be present on the final day of installation for final Inspection and to deliver finaf payment. No final payment shall be demanded until the contract is oom feted to the satisfaction of aB parties. NOTICE: Air home improvement contractors and subcontractors must be registered. Any inquiries about a contractor or subcontractor relating to a registration should be directed to: Registration Division, Program Coordinator, One Ashburton Place, Room 1301 Boston MA 02108,Tel: 617 727-3200,ext.25239. The parties hereby mutually agree In advance that should a dispute arise regarding this contract, Contractor may submit such dispute to a p ' arbitration service that has been approved by the Office of the Consumer Affairs &Business Regulation, rid Ow er shall be equired to sub such arbitration as provided in//MGL c. 142A. Contractor Signature: Owner Signature: " L f� NOTICE: The signatures o e parties above apply only to their agreement to alternate dispute {fesolution initiated by Contractor.Owner may Ini late alternate dispute resolution even where this section is not signed separately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES J Wind ws,Inc.d/b/a Renewal by Andersen BY: 4 f r[ �� Pr anager '-- Owner Signature roduct Manager(Print Name) Owner Signature R 1 Renewal .;.. fNFRC— wAndersena WINDOW REPLACEMENT pn And..Compmy National Far�sva>ian WoodNlnyl Composite IF �ng�rilc. Dual Argon Low Double Hung 100-00414585-007 ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient 0n30 0m31 ADDITIONAL PERFORMANCE RAi muS Visible Transmittan 0 . 53ce portonnMvnuhcWmaupulvlvsmel MacymMpvvenromimeppYwekiro cnM oon idmr and a spoo cprouct udt NFRCd as NFacmmea A eammmaarod.matlamnantahomnanmwneiaa PrdU avpany productch:.. Nrac aovs not nwmmentl em pmaad.ne ed.analwenamMe pmbeurcy m.ny pnauderor.ny ap.difid Jw. C.ncullmanubcWn�6111.mW m rorotlwrpmtludlpnremunw Nbmulbn. k wvw.n0e.org SE.a, This product It a 11r a• standards governing energy efficienq,he O metals in the frame an i W sash materialspaccmaging,an, CE1111 -education a mate als -Y i DESIGN PRESSURE(PSF) 1 Mmvu JLw 1 II MeiulxyimAvndNm H - LC25 RbA DB Sloped Sill DH IN y.l ies¢eb NA15m orAAMAN1DMArL4AIMMIA4M,' MwNncWew A' InlesmvNmm ce�v the tiahle slnvderde • �: Mwb ormwves M.EC.CE.C,61E.C.C.AIr InIWvaWn nQuhamenb WDMAXVIvnaA CaNPwWn P,.pivm. 1 a