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4 HAYWARD ST - BUILDING INSPECTION \�Lx The Commonwealth of Massachusetts FOR Board of Building Regulations and Standards Massachusetts State Building Code,780 CMR, 7th edition 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: Signature: Building Commissioner/Inspector of Buildings Date _ SECTION 1:SITE INFORMATION I I P operty Address: 1.2 Assessors Map &Parcel Numbers �i'Iywnrsi �1 . Salem AMA U1ci1t7 1.1 a Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoninglnformation: 1.4 Property Dimensions: 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: Pulilic❑ - Private❑ Zone: _ Outside Flood Zone?. Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2. PROPERTY OWNERSHIP' 2.1\\Owner'of R��QQrd: SI�2kt _A ANr-L J he �S 1�2yw0. cQ `Sc. L vt �Vl�- ot41b Name(Print) Address for Service: `I - (0 c, Signature - Telephone SECTION 3:DE6CRIPTION OF PROPOSED WORK=.(check all thatapply) ;'ev:'wcnsructic:: ❑ Existingl3uild. og 0 'ac �ccapied ❑ f.e.pai;s(sl-ED,- ';^.ae:aticn(s) ^' Add c ❑ Demolition ❑ 1 Accessory Bldg. ❑ TJumberofllnits._.__ Other 0 Specify: __.: Brief Description of Proposed Work': SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 9 (p 3 1. Building Permit Fee:$ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ D ❑.Total Project Costl(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: 4.Mechanical (HVAC) $ O List: 5.Mechanical (Fire $ Total O Suppression) All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: 0 Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) � 5 C,0+4 AA � l ` d1 � j License Number Expiration Date. Name of CSL-Holder F O Q-L S SU J✓4 l tj r t7 U t S List CSL Type(see below) t. A r ss � Type _ - DescriptionU UStri, 000 Cu.FtJ �" ed , . Signature� - R Restricted 1&2 FamilyDwellin�- _ ri(.� _0-A(r.) M Maso Onl 'Y r RC Residential Roofing Covering Telephone. WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 2 Registered Home mp ovement Contract (IIIc� IC Company Name or HIC Regisfi t are Registration Number C 0 ' ' Sd. : wc) Ol l � d L/ & Ad ss S u (q -01'q• Expiration Date 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 ........... B' No...........❑ SECTION 7ac:OVVNER AUTHORIZATION TO BE COMPT ETED OWNER'S AGENT OR CONTRACTOR APPLIES FORBUILDING PFRIVIIT I. . 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 - f(SE``CTiON 7b:OWNER' OR AUTHORIZED i1GENT DFGL�N . :. k 'lC-O 4t (!1 �yp ae-Ovroernr AUthcntzed At ent hecebv rteclllC that the statements and information on.the fl:etoin g application aie.fru�and accurate, to the besl of iry knoe l dbe and . behalf. . .Print N• i - . . . . . 1 t I - ca fY O Signature of Owner or Auth rized Agent Date (Signed under the pains and penalties of a '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 I I O.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 ofhalf/baths Type of heating system Number of decks/porches ' Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost' DEBRIS FORM This form is to be submitted witil building permit applications whenever there is debris to be disposed of. Property Address: �t��W ✓ S Vyl/� O I O 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.c. 111 § 150A, nn p This debris will be disposed of in: �e✓�e/ � I td d in�e<< � 1ON f)-yes Ntri- 6ro mN 4- OZY3� 'ocation of Facility) Signatt=of PeihdApplicant Date Massachusetts - Department of Public Safety V Board of Building Re�,ulations and Standard's V Construction Supervisor License a License: CS 99256 • Restricted to: 00 SCOTT PHILLIPPI 58 0 STREET WHITINSVILLE, MA01586 Expiration: 6/7/2011 ('n nm�isaiunrr Tr#: 99256 Restricted to: 00 - oo- Unrestricted 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 rP� ✓ree 17oomarloaawea/� a�..�amoc�u+oeUd �\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Rec gistratiOAL, 149601 Exptratson_ 172 4120 1 0 11.j1W Tjrpe eipplement Card RENEWAL BY ANOERSOI -' SCOTT PHILLIPP,L �.y 104 OTIS STREET�� `' -ice'` NORTHBOROUGH, MA01'S32 .Administrator `ACCRD. CERTIFICATE OF LIABILITY INSURANCE GATE IMMIDDAYYYI PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph McKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR JP McKeone Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC 0 INSURED Renewal by Anderson INSURER A Hartford InsU Ce Company J&L Windows, Inc. INSURER B: Hermitage A 104 Otis St NSVRER C: NGnhborough, MA 01532 !NERER D: 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 CLANS. L MWZ TYPE OF INSURA110E POLICY NUMBER PIMEFFECM POLICY EXPIRATION DATE(MMOrM LIMITS B GENFA L LIABILITY HCP 507 404 09/07/2008 09/07/2009 EACH OCCURRENCE S 1,000,000 Cwho OMMERCIAL GENERAL LIABILITY PREMISES Ea oaowrcs1 100000 CLAIMSMADE ®OCCUR MEDEXP(AAym pe) S 0 PERSONALSADVINJURY $ 1 OQ0000 GENERAL AGGREGATE S 2,000,000 GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG E 2000000 POLICY 1 LOC A AUTOMOBLELIABWtt 35 MCC XD 6390 10/01/2007 10/01.2008 COMBINED SINGLE UNIT S 1.000,000 ANYAUTO (Ea Dctlaen0 X ALLOWNEDAUTOS BODILYINJURY ' SCHEDULEDAUTOS - (Per Parana) S HIRED AUTOS BODILY INJURY NON-OMEDAUTOS Iperamaam) E PROPERTY DAMAGE (Pwa m) E GARA�LIABO AUTO ONLY-EA AraoE T S R OTHER THAN AUTO ONLY: AGC S E%CESSNMBRE1I LIABILITY EACHOCCURRENCE S OCCUR E-JCLAdMS MADE AGGREGATE E f DEDUCTIBLE E RETENTION $ $ A wONNERScommsATIONAND 35 WEC PP 1444 02/17/2008 02/17/2009 WC STA7U- OR S'EMPLOYER LIABILITY ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT f SOO OOO OpFpFICER,MEMSEREXCLUDED? E.LDISEASL•EAEMPLOYEE S SOO.000 SPECAL RWSIIONS babes - E.L.CISEASE•PoUCYLIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION " SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION INSURED COPY DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR To MALL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO GO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY RIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) ©ACORD CORPORATION 1989 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UIV www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly j� Name(Business/Orgmizadon/Individual): J)ehp iJ&1 y N/'1 de-rs e n i Address: j0J/ Q/i S L3�renl- City/State/Zip: I rA bo ro , A4 Phone #: Are you an employer?Check the appropriate box: Type of project(required): LaI am a employer with 00 4. ❑ I am a general contractor and I 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 ?• modeling ship and have no employees These sub-contractors have S. Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ 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' 13.0 Other comp. insurance required.] *Any applicant tharchecks 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. //// Insurance Company Name: -,I ? /J/^^//��C n 2 o r)2 e' Policy#or Self-ins. Lic.#: 3J Expiration Date: I ;L j7/DT_ Job Site Address: l `�y W G Y 4 �V' . City/State/Zip: SGt 1 e,N1 �sQ o[G 1 o 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$1500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$256.00 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 cen_U er the pains and penalties ofperjury that the information provided above is true and correct Signature: Date: L( -4.0 - 0 Phone#: _0 - 0 CF% 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#: 11/10/2008 11:23 0000000000007 MADDEN & ROBBINS PAGE 01 ,Window Agraam6nt-Paget oft J&L Winds",Inc.,t#bla 104 Otis at.,NeMborough.MA 01532 MA Homa Improvement Contractor (902)a19-09go r Fax:(50a)919.ONS Renewal _ Llcsnae Y108001(Explroa 1I2412010) Customer Service Federal Tax ID e03-e404201 /�n�1 Indio.ticeneaa:John Ester Ica#74251). (300)573.7806 �AI IUQ'CSen• "ibW n elarchard(049601) wr saw ana�e[wsar ."w.,4...",c,rwrr Product Manager: Window Agreement Contract DOW Homeowner "Ownee,'a Na e( e Street Address: CI n: 5 Ste ZI Home Phone: a work Phone: Job Site Address(if different): E4nall Address: Materials to be Provided and work to be stformed b Renewal to Andersen("Contractor" Contractor will furnish and install Renewal by Andersen- ro ed materials to the following specifications: t 1. Gate on whleh Work is Sehe d to Begin: Expected Date of Substantial Completion: iiontractor will Install a t�ot�hof windows in O ar's home, using the following individual quantities: c�Double Hung(DB) equals sh O Cottage sash(113 top,2l3 bottom) Q Oriel sash(2/3 top,113 bottom) _Casement(CW) l7 Hinge right Q Hinge left(as viewed from exterior):QStandard handle Metro handle _Double Casement(COW) 17Standard handle Metro handle Casement/Picture I Casement(CPW) D 1:1:1 or Q 1.2:1 ❑Standard handle ❑Metro handle 2 Lite Gliding Window(GW) Glider/Picture I Glider(GPW) O 1:1:1 or ❑ 1:2:1 Awning Window(AW) Picture Window(PW) or Bow Window: 3, ea O Nyy #Windows to be Custom Fit ReplacemenC 4. ❑Yes �'No of sills to be replaced by Contrector: S. ❑Yes �• #Windows to be New Construction Full frame(includes new interior&exterior casings): Exterior casings: ❑p ine ❑Maintenance-free material O Factory applied 908 Fibrex brickmoid 8- Glazing to be: ag'Rlgh P rformance u Other If other,please specify: 7. Exterior color to be: hite O Send O Canvas ❑Terratone 8. Interior color to be: hlte Q Sand ❑Canvas O Tevatone ❑Wood Note:Interior can only be whlte,wood or same color as exterior. Wood interiors need to mished by Owner. 9. Hardware: Whlta ❑Stone Canvas Q Brass Double Hung: Install lifts? es Q No 10. Dyes nbactor will remove metal frames or grilles. #of Units: it. ❑Yes o Contractor will install new paint-ready or stain-ready casings. Inside or outside stops#of openings: Interior casing#of openings: Exterior casings#of o ❑Pine O Maintenance free material Owner Is a�'I^��that Contractor does not do any paintiner initials 12. O Yes %Ao Contractor will wrap exterior casings with mum coil stock of color. Note:Required with storm wmyyow removal;removal of storm windows will lqavS�screw holes in casing. 13, New windows to have: p flalf or O Full screens Screens to be: 0-Fiberglass O Aluminum ❑TruScene 14. Windows to have grilles: ZXes O No If Yes: t],alljle Between Glass(GBG) Q Removable Interior Wood(INTW) ❑Full.Oivided Light(FDL) Grille patterns: #: B El ❑ m DH DH DH DH CW/Picture Glider or GPW 'use a tional sheet if needed Owner approved(ini 15. s Q No Contractor will insulate,caulk and seal windows with 3-point system to prevent air infiltration. - 16. � O No A limited warranty shall issue to Owner upon Completion of the job and payment In full(ace rsvoras sidet. 17. QAers Q No Building Permit-Contractor will secure any and all necessary permits.The fee for the permit(s)is not Included in the Contract P'ce and a Sep rate check is to uir t t e ime f sale fart is fee. 18, Addlllon 'a d ils 19, grYes wne a gvlA offal Terms and Co one v ing this Contract on the rave A side. 20. Total Contract Price: $ Regular Re rice:$ / II avauablo con ,a plied: a No 21. Deposit(113);$ / paid by O Cash manta (Account#: ) Second(1/3)$--�—to be paid by Cash at start of job on_ (Estimated sari date). Fin (1/3)$ �;;;'to be paid by Cash at completion of job on (Estimated completion date). 22. GrYes O No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No final a men(shall be demanded until the Son(recl Is completed to the satisfaction of all parties. NOTICE: All home Improvement Contractors and subcontractors must be registered. Any inquiries about 9 contractor or subcontractor relating to a registration should be directed to: Registration Division, Program Coordinator,One Ashburton Place, Room 1301 Boston MA 02106 Tel: 917 727.3200 ext.25239. The parties hereby mutually agree in advance that should a dispute arise regarding this contract,Contractor may submit such dispute to a private arbitration service that has been approved by the Office of the Consumer Affairs &Business Regulationt..8Wo Owner shall beirqul to ubmit tto such arbitratlo s(provl e ,742A. Contractor Signature �1`�(!� •nhrSignatu NOTICE: The signatures of the parties abovply only to,their agreement to to dispute resolution initiated by Contractor.Owner may initiate alternate dispute resolution even where this section Is not signed separately by the parties. *du O NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES all a anew I!bnosrsorh By: t Naxos) gnsture White-Renewal by Andersen yellow-Installation PInk-Homeowner Renewal go NFRC byAndersen. '-- WINDOW REPLACEMENT qn MdamnC—P-nY tvazanalfenastraFan WDodNinyl Composite IF bortal cremation Dual Argon Low E RadarDouble Hung 100-00414585-007 ENERGY PERFORMANCE RATINGS U-Factor(U.S)A-P Solar Heat Gain Coefficient 030 0 . 31 ADDITIONAL PERFORMANCE RA-1 irl Visible Transmittance 0 . 53 MenWvouaa tpuleM MelMw Rtlngi conb,mroeppll.bb NFPC pNeaduna foldabmaNMe".1a pmduel perbmun—NMC retlnes ma deW.h-d fore MW calel emlmmnaMel--dwoneuM a'oodflo Pmtluct'on" NMC does not racommarod any pmEu ntand doasncl moantthe euHebNq ofar,product annoy apaclflo usa. Cmeunmanulecbnfa H.W.bralbarpmtluot pa,folmenw Nloimetlory P . W W VI.ntm.org 5 w- This pmduet meets Gr I I � Sears endmvernin �b a standards governing"- energy of lciency,h4 metals in the frame anYy sash materials,educaug'onmaterialsu - DESIGN PRESSURE(PSF) w Me�- 1 C a l H - LC25 RbA DB Sloped Sill DH IN T.db NAlSdfarMMAMDMAl.5AIOI IAMOAI Mmofncmrera, Imam fomm ooto the fimble nmdnrde Maaboraawotls MEC-CEC,61£.C.C.AtrInfllMlbn nqulmmanb WPMAHellne�k CanMmtbn Pmpmm.