33 HAZEL ST - BUILDING INSPECTION $ 25 Cn— S(A
a.
` The Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Number: Date Applied: Building Official:
SECTION 1:LOCATION (Please indicate Block#and Lot#for locations for which a street address is not available)
No.and Street City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ Repai Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ 1 Chan of Occupancy ❑ Other ❑ Specifv:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Description of Proposed Work: r q1
- V1 - — \':D
If
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Factor F-1 ❑ F2❑ 1 H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1 ❑ I-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R-4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
[A ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public ❑ Check if outside Flood Zone❑ Indicate municipal ❑
A trench will not be Licensed Disposal Site❑
required ❑or trench or specify:
Private❑ or indentifv Zone: or on site system ❑ permit is enclosed ❑
Railroad right-of-way: Hazards to Air Navigation: 1\-UA Listoric Commission Rex tc,•Pw,c,s:
Not Applicable❑ Is Structure within airport approach area? is their review completed?
or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
+Name and Address of Property Owner 01 97D
C e l � z�el mA
Name(Print) No.and Street / City/Town Zip
Property Owner Contact Information: ZH
Dwnle�t 6(7-a1��H
Title Telephone No.(business) Telephone No. (cell) e-mail address
If a li able,the PPropper owner hereby authorizes
�jl ( h[tf6 15 l 0frowi[ Lt aC4 (v� J� D IF,,(
Name Street Addre City/Town State Zip
to act on the pro2erty owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 33,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1
10.1 Re 'stered Professional Responsible for Construction Control -
Name(Registrant)- Teleph n No. e-mail address Reg c
g4. Registration Numbeor
' J��•-rt, t h�1� �UM'h�b(dU4 t�'r
Street Address' City/Townf State Zip Discipline Expiration Date
10.2 General Contractor
{l
CompannName
S1t�h/t I tl(aCh ��h
Name of Peen on Responsible for Construction icense No. and Type if Applicable
la IU(kQ:S VJc. AI M1+ 0
Street Address City/To State Zip
Telephone No. (business) Telephone No. cell - e-mail address
SECTION 11:WORKERS COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§ 25C 6)
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes❑ No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ ( IDU,p(�
Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ i appropriate municipal factor)=$
3.Plumbing $
4. Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other $
$ j[)� � Enclose check payable to
6.Total Cost (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pa' s and penalties of perjury that all of the information contained in this
applilica�tiio�n,iis�true and accurate to th be of to knowl e a understanding. �J l�
( bhp.— \ 6,� �'�1-OlLt6 (b '�-II11
Please print and sign p me Tit Telephone No. Date
1/11H- o17'7
Street Address City/Tow �jStattee Zip I '
Municipal Inspector to fill out this section upon application approval: ` 4 l/Cis �/
Name Dat
i
Renaissance Condominiums
At 33 Hazel Street
Salem, MA '01970 _
The Owners/Trustees of 33 Hazel Street, Salem. MA request a permit to
install a new front entry door to the building. We are replacing the
existing door and are not altering the structure in any way.
` All 3 owners are in agreement and approve of this work. If you have any
questions please feel free to call 617-212-9298.
Thank you,
Saande,Sprin�ger, Um
Emily Shea, Unit #;2
Suzanne Tomarchio; Unit#3
„ V r ere e.V/111111rrrvetftlit W !r/mmacilocNeto r...
Departmew n1,111(histrial r ecidews
Office j Inlresllg!!t!Y ns
= � I Congress Street, Sltitel 100
l Bosun, MCI `02114-2017
— ivivturtruss.,;>oerlrlia�
NVorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information j Please Print I-evibly
Nxine (Business(Ors;tniznli0nan(iiridual)•�� q�-� �"� �_ _-- —
Address.__
C'ily/Sfale/Zip: �2O�WVf m4 Ol`16o Phone '_I ._.. -----
Are roll an employer*.' Check the appropr I rte hoc. -- --
y r cneral eunuack�r and I 1 ype of project (required)-
I.IYI I .rrn a unpk y er x rdr j _ -j. Q I am I
unplojccs 0111i ind impart-tune).* have hired the sub condactors ❑ :Nell constru.lu.>r.
2 ❑ I am a We iinjinoor or panuer- listed on the au.rched sh1Ct. T ❑ Rrn,odrlinf,
ship and have no employees these sub-unuractors Nave R. [� DenhAllion
wlAing for mein any capacity. employees and have wdlkc•rs
e imumme 9. ❑ 13urldur ndduion
(No crnll.crs' comp m comp.I
cqui red.] We are a corporation and its 10.[] Elcun.ai rcpnn's or ailddiom
3.❑ 1 am a homeowner doing all work officers have exercised ificir I I.Q Piunnbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
Insurance 2quiretl.] '
c. 151 Y 101 and we Nqv no 2 ❑ Roof repairs
emplovees. (No worked' 13-[-1 Other
comp. insurance required.]
'`rAm rpp(umI that chcda lumill must dso Jill our rlic creation below shoo me their a 'Ams ci,n l n arilar p, hcti mGmn:m rn.
Hmllcowncrs•sho subillit thi-diid.rcn indimmy Win Amng all a r6 and rlu❑m e outxh n mnuan rn mum Mum n tc;dlidam( n di -r such.
C'un❑ it fn> ih;u Ch ck thr:bo-; nursr nulrohul:m additional,lieu,.I1PN ung I w mmti of rlrc sumo Mello-,and suac” wdla or nut Me CnImc, me
cmpluyces. I rdu soh-colacunors havr employecs.MY muse provide dwir wurkeN cutup.policy number:
i
1 nor arc ernpture•r that is providing workers'coropeasoliun in.sarance fir nti'entplarees. Le(om is the polirr arrd job she
n%urouunm.
Instil race Company Nnmc. -.1-WurQ('jCe._.COmp
Policy 11 or Sell ins. 1,ic. 1,._ A _�_V oS_{ �L.Z_�3 ------.- _—i -- B.vpnatiun Detc: 1D/-21
.lob Site !\ddress: q Q I CW _CrtsrStatc,`Zij Sale-no M q _o jg10
Attach a col ) of the war leers' compensation police declaration page isb�wing the policy number and expiration date).
Failure to secure coverage as reWdred under Section 25A of MG-L c 152 car Icacl tit the imposition MAMA inrinal prnalriea of,r
fine up nl 5I.5t)Q pt} and/or one-year innprisonnicm, as well as civil pc hicq in the form of a STOP WORK ORDLR and a fine
of up to S2511 M it dray ag amsl the viol rton Be adlised that a copy of ous skincm may he forwarded In the Ofl ice of
Investilalion:;of the DIA tar insurance coverage setification.
/ten (rerrdiP certi/i, r r the rains and terra/1ie.s of ter'arr that the inlarnaatiol:provided above is nwe and con".1.
Si,nat III c: D:ue I
Phone
(J/icird Ilse only. Do not write in this area, hi be cortrpleted br Chr or errI ell q/71cial.
CH) or Town: Perruit/Liceine i
!suing Authority° (circle one): r ---
1. Board of Health 2. Building Department 3. Cilyri own Clerk 4. Electrical inspector 5. Plunrbin" Inspector
6. Other
Contact Person: PhoIe #:
,J. r
7� (Jfficr of Consu mer:\ffa i,,& ftusine>s Rrrulnlion L.ICCn\C e(Tl'gISI(atlne tland for Ind1V1f)nl usr nnW
+ %HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
`Registration: 148688 T Office of Consumer Affairs and Business Regulation
" Expiration: 10/18!2016 Su Iemene'and 10 Park Plal,•Suilc i 170
pp Boston..NIA 02116
i OWE'S HOMES CENTERS INC
{ICHARD CHALONE I1
136 TURNPIKE RD.SUITE 100
SOU'i H60ROUGH. MA 01772
IindtrnrcremrS Not talid xithout�i�n azure
i
I
1 Massachusetts Department or Public Safety
Board of Building Regulations and Standards
License, CS-071187 y '
ONALDEWAC `\
R �N
12 TUCKERS CT;3RD FL c
FEABODy MA 61960 ;•
Expiration
commis voner
08/04/2015
%�i: 'tf L U:nHuk:���< 17.��2fd <Y!./aC✓J .__.. i_
tlgna r f t'onemner Aftnirs x IiuRu�+s Itr�ulxhan LiCrnsp of rr ish•ntion valid for inStcidut use only
$J4a' OM-IMPROVEMENT CONTRACTOR LClore�lhr expiration dale. Iffoundreturntn:
r ,ieq:eyistrMlon 113,114 Type: Uf(iec i�f<onsnmcr Af67ir5:nul Business kegulatlat
t 10 Purl:Plaza -Suitu 5170
;t ,,",`f.•Explratlom, 627/2015 - riea ISnston! Il9A ll'_tl(
RONG 0 CONSTRUCTION;
RONALD WAGHLII'Y
'i2 TUCKERS T.
i�J+CrOUY,fAi+019r5p 'undcreerrewy Not valid without +iQtlnlure
,
i �
STORE COPY
INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR
LOWE'S OF DANVERS, MA., STORE# 1094 STORE PHONE: (978) 646-9099
153 ANDOVER STREET SALESPERSON: EDWIN VELAZQUEZ
DANVERS, MA 01923-1450 SALESPERSON ID: 794346
Document Print Date : 10/03/2014
This is only a Quote for the merchandise and services printed below. This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree-
ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any
other addenda or attachments hereto, shall be referred to herein as this"Contract."
PLEASE READ THIS ENTIRE DOCUMENT INCLUDING THE "TERMS AND CONDITIONS." BEFORE SIGNING
Lowe's Registration or Contractor License Number/Lowe's Contractor Name
Lowe's Home Centers, LLC's MA HIC NO.: 148688 Lowe's Home Centers, LLC's FEIN: 56-0748358
Customer Name Home Phone
S SANDE SPRINGER 617-212-9298
O Customer Address Other Phone
33 HAZEL ST UNIT 1
L City State/Province Zip/Postal Code
D SALEM MA 01970
Installation Address
T 33 HAZEL ST UNIT 1
O Installation City Installation State/Province Installation Zip/Postal Code
SALEM MA 01970
MERCHANDISE AND INSTALLATION SUMMARY
MERCHANDISE SUMMARY
39686 : PRODUCTCODE : SOS : SOS RB DECORATV FBRGLS-DORFAB TC : ENTRY/EXTERIOR SINGLE UNIT, HAMPTON CENTER ARCH ***15% OFF
RETAIL ON ALL SPECIAL ORDER ENTRY DOORS FROM 10/01/14 THROUGH 10/21/14*** : DOOR FABRICATION SERVICES INC - QTY 1
1053 : 87566 : STK : 1X6X6 RED OAK BOARD : 1X6X6 RED OAK BOARD : BABCOCK LUMBER - QTY 1
1553 : lX10X16 FGRJNT PRIME :.STK : 1X10X16 FGRJNT PRIMED 4 SIDES : lX10X16 FGRJNT PRIMED 4 SIDES : FLETCHER WOOD SOLUTIONS -
QTY 1
131207 : 131207 : STK : 1X8X16 PRIMED FNGR JNT(+333358) : 1X8X16 PRIMED FNGR JNT(+333358) : IRVING FOREST PRODUCTS (MAINE) - QTY 2
Materials Price $ 461.06
Store 1094,Project No. 422708797 for SANDE SPRINGER Pagel of 8
STORE COPY
INSTALLATION DESCRIPTION
Stock or SOS : SOS Door Type : Exterior
Select Location : Front Door Select New Door : Single Pre-hung
Number of Doors to Install : 1 Side Lights or Transoms : No
Hardwood (Mahogany or Oak) Door : No Hidden Damage Description : None
Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No
Install Storm Door : No Lead Safe Practices : No
Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door: Yes
Customer Understands Scope of the Project : Yes Permit Required : No
Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None
Local Disposal Fee : None Describe Other Work Needed : oversize/custom work
Other Work Charge : Yes Comments : No Comment
Labor Charges $ 643.0
Detail Deduction $ 0.00
Additional Specifications:
Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop-
erty is governed by Historic District Regulations.
Additional Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right: Important Lead Hazard Information for Families,
Child Care Providers and Schools. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing
Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit.
PHOTO RELEASE: Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photograghs of the Premises where In-
stallation Services will be performed and all work performed at the Premises related to this Contract, and irrevocably grants to Lowe's all right, title, interest in
and to the photographs for use in all markets and media, worldwide, in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in
print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, including, but not limited to, marketing, advertising, publi-
city, illustration, training and Web content. By initialing here, Customer agrees to the foregoing. [Customer to initial to the left].
NOTICE TO CUSTOMER-PRICE CALCULATIONS: In order to properly perform the installation of certain Goods, the Contract Price may include more Goods
than actually will be installed based on the measured square footage of the Project Area. As a result, the parties agree that the lump-sum Price stated in this
Contract is calculated upon both the value of the estimated Goods required to fulfill the Contract (including waste), which may exceed the actual square footage
of the Project Area, and the labor which may be estimated based on the amount of Goods required to fulfill the contract (including waste). By signing this Con-
Store 1094 Project No. 422708797 for SANDE SPRINGER Page 2 of 8
STORE COPY
tract below, Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the
Installation Services are performed..
TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES where applicable
SUB-TOTAL $ 1104.0
*TAX $ 0.0
DELIVERY $ 0.0
ORDER TOTAL $ 1104.0
BALANCE DUE
Work is to commence upon reasonable availablity of Contractor which is anticipated to be �' 5 _ I [fill in date].
Estimated completion date is rQ0 [fill in date].
NOTICE TO CUSTOMER
All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing
on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation
necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to custom-
er.
IF THE CONTRACT TOTAL IS $1 000 00 OR LESS Customer must nay in full
O PLETE THIS SECTION QNLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00:
'llefCustomer to Pay in Full; OR
[_) Customer to use the following payment schedule:
(1) Deposit of $ to be paid upon signing contract. Any deposit collected at the time this Contract is signed will not exceed one-third (1/3)
of the contract price; and
(2) Payment of $_ to be collected upon or after the commencement of work. I/We authorize Lowe's to do one of the following (check ap-
propriate box below):
[_] Charge my/our credit card for the amount of the payment indicated above upon or after the commencement of work; or
Sto,e 1094 Project No. 422708797 for SANDE SPRINGER Page 3 of 8
STORE COPY
[_] Deposit my/our check for the amount of the payment indicated above anytime upon or after the commencement of work; and
(3) Final payment of$100.00, to be paid upon completion of the installation to both parties' satisfaction.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CON-
TAINED IN THIS CONTRACT AND WHICH FOLLOW THE SIGNATURE PAGE(s). BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU
HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH IN THIS CONTRACT. YOU ARE ENTITLED TO A COPY
OF THIS CONTRACT AT THE TIME OF SIGNATURE.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L. c 142A
LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CON-
TRACT, THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRET-
ARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUB-
MIT TO SUCH ARWRATION AS PROVIDED IN M.G.L. c.142A.
Date:
L s Hom e
Date:
Ow r
By: Date:
Co-owner or Witness
THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION
INITIATED BY LOWE'S PURSUANT TO M.G.L. c 142A THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION
EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTIES
WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS - DAY OF
Lowe's Home Centers, LLC
gy; -✓` �/ ` � (Seal) �
Print Name: Ct —2, r
f` (Seal)
Address Owne
Sto?e 1094,Project No. 422708797 for SANDE SPRINGER Page 4 of 8