4 JANUS LN - BUILDING INSPECTION GK 313� 5(o 00
I I q -12 .RECEIVED
INSPECTIONAL SERVICES
The Commonwealth of Massachusetts
i Board of Building Regulations and Standards , Lrl4 Jug 2u AF
Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
F 29 1
Building Official(Print Name) Signatdre W Date
SECTION 1:SITE INFORMATION
1.1.Ptrerty Address: 1.2 Assessors Map&Parcel Numbers
L I a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: - 1.4 Property Dimensions:
Zoning Disnict Proposed Use Lot Area(sq it) Frontage(it)
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:
1Z�1A 1414ehn4ovt Sa&-UA, 1VL6-
Name(Print) City,State, P L/ -S000r Lkrni_ CIW- FQ--6/Z/
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Buildin Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': .ir C G(/i c(d cal Ci
LJ) Ct7(-. I S r n lAJv /I
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building 1. Building Permit Fee:$ indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $
❑Total Project Costa(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: $ �.S-5� 0 Paid in Full ❑Outstanding Balance Due:
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Massachusetts -Department of Public Safety'
Board of Building Regulations and Standards
Construction Supenisor
License: CS-105983
BRIAN F KENNEDP
Wahham MA 02451 -
Expiration
Commissioner 0 310 1/2 01 5
�� ommeo7voea�¢��/�a .c�iuoe�.
ce of Consumer Affairs&Business Regulation
VR,egistration:-
ME IMPROVEMENT CONTRACTOR
i 131704-.,
_ Type
Expiration ---- 014. ., Supplement r
DLM REMODELINGt-
BRAIN KENNEN
101 IRVING ST.
Undersecretary
WALTHAM,MA 02451
SECTION 5: CONSTRUCTION SERVICES
t 5.1 Construction Supervisor License(CSL)
�4 0—
�/�G10LL License umber 'Ex6irrition Date
ame of C�L Holder
bc) Liar CSL Type(see below)
IN/o.'and Street Type Description
YV n Ili,U(/fit /n a z C/1^--7 U Unrestricted(Buildings u to 35,000 cu.ft.
rl Pal / s l R Restricted 1&2 Farinly Dwelling
City/Town,Strait,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
y SF Solid Fuel Burning Appliances
334jzzy/ ` ,S,CJ2C6 � //,1W4War(•r0� I Insulation
TeI hone Emailaddress D Demolition
5.2 Registereddd Home Improvement Contractor(HIC)
0`//tt 611 HIC Registralion Number �Exp3ction Date
Inc Com any Na¢�e or 1Y]Lygis�an[Name y�
No7 a�nd�/gg //v[ J r �1c t�Y aje,/,o 4, � l�li� cy-cow
G11( .6tR41- 02�/C � c/ r�Za' Fanat dl�dcess
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 of the subject property,hereby authorize &� )�Fyt Ol'P!A
to act on my behalf 'n all matters relative to work authorized by this building permit application.
Print Owner's ame(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
c tamed in this a ication is true and accurate to the best of my knowledge and understanding.
W : ze/y
Print Owner's or thoriud Agent's Name(Electronic Signature) Date
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.massgov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch)
Cross 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"maybe substituted for"Total Project Cost'
i CITY OF S�UFA 1, XaSSACHLSETTS
• Bt:MDING DEPmLI-S EINT
' 120 W.tsHiNGTON STREET,Ya FLOOR
TEi- (978)745-9595
FAx(978)740-9846
KINJBERL.EY DRISCOLL
MAYOR THOMAS ST.PIEm
DiRECCOR OF PLBLIC PROPERTY/BL:=LNG COMMISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
/ f
Name(Busitm organiiatiorvindividtW):
t
Address: /fT_�/.(r
City/State/Zip: ka/81(/N�114fi—e?q C,�_ Phone#:I)fl HC/ FFZ—
Arq you an employer?Check the appropriate box: Type of project(required):
I. am a employer with Z 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(fall and/or part-time).0 have hired the sub-contractors rf��77�Dml
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet: 7• �todeling
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 thew
3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I.[]Plumbing repairs or additions
myself.(No workers'comp. a 152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees.]No workers' I3.❑Other
comp.insurance required.1
•Any applic rri that chrslu box of must also fill out the section bdow clawing their wakaa'm.Mcnion policy infumutioo.
I unnewreors-rho alwnthis affidavit iediotiog they am doing all work and then hue ataide connoc n,no submit a awe allfdavd sash.
:Cutntoston that check this brat mua anached on 3MUCrca)shed showing the icon of am suhNmtacMta and their workoa•comp.policy infommdoa.
i am an employer that Is providing workers'compensation insarance for my employees. Below is the pulley and fob site
information. t� 11�1 /
Insurance Company Name:!�(JVl 0a V6
Policy#or Self-ins.Licc..#: S-W c V} 0dC� CJ Expiration DaterE&�/C—
Job Site Address: y C411J C ��! (M1 0 City/State/Zip: J�Ltl K _
Attach a copy of the workers'compensation policy declaration page(showing the policy number an expirstion date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties oi'a
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 fine
of up to S250.00 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.
l do hereby certif tder the ins and penalties ofperfury that the information provided bove�I7s true and correct.
Siemnure• r.,.....� �/// CC7��
Po # 3� ZZc 244
Official use only. Do not write in this area,to be completed by city or town official
City or Town: PermitUcense#
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#:
BERKSHIRE HATHAWAY Workers' Compensation and Emplover's Liability Policy
INSURANCE NorGUARD Insurance Company - A Stock Company
19GUARDCOMPANIES Policy Number STWC586278
Renewal of STWC470080
NCCI No.[25844]
Policy Information Page
[1]Named Insured and Mailing Address Agency
Stephen Ventola PAYCHEX INSURANCE AGENCY
154 Boardman Ave 150 Sawgrass Drive
Melrose, MA 02176 Rochester, NY 14620
Agency Code: NYPAYCIO
Federal Employer's ID 27-2499080 Insured is Individual
Additional Names of Insured
(N2) DLM Remodeling
[2] Policy Period
From May 8, 2014 to May 8, 2015, 12:01 AM, standard time at the insured's mailing 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
in item [3]A. The limits of our liability under Part Two are:
Bodily Injury by Accident - each accident $100,000
Bodily Injury by Disease - each employee $100,000
Bodily Injury by Disease - policy limit $500,000
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
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Premium
The Premium Basis and, therefore, the premium will be determined by our Manual of Rules,
Classifications, Rates, and Rating Plans. All required information is subject to verification and change
by audit. (Continued on another page)
Total Estimated Policy Premium $ 5,983
Total Surcharges/Assessments $ 191.00
Total Estimated Cost $ 6,174.00
INTERNAL USE xx - Page - 1 - Information Page
MGA : STWC586278 WC 000001A
Date : 04/08/2014
MANOTE
16 South River Street•P.O. Box A-H•Wilkes-Barre, PA 18703-0020 •www.guard.com
Sanctuary Condominiums
c/o Crowninshield Management Corp.
18 Crowninshield Street
Peabody, MA 01960
(978)532-4800
May 19, 2014
Mr. Ronald Landman
4 Janus Lane
Salem, MA 01970
RE: Replacement Windows—Sanctuary Condominiums
Dear Mr. Landman:
Thank you for your inquiry regarding window/slider replacements at your unit. Please be
advised that the Board of Trustees for the Sanctuary Condominiums does not object to
the replacement of these windows providing that they match in appearance (no crank outs
or French doors,unless replacing a crank out, etc.) from the existing,they must fit in the
existing opening, molding size must remain the same and they will not allow grids etc.
We also require the permits be pulled in advance, and that a copy of the final approved
permit once completed is also submitted to our office. We also require that you hire only
a licensed contractor, with adequate insurance.
You will most likely need to show a copy of this letter to the Building Department in
order to obtain your.permit.
Should you have any questions or require additional information, please feel free to call
me directly at (978)532-4800 ext#232.
ncerely,
a, MCA
egional Property Manager
Crowninshield Management Corp.
Managing Agent for the Sanctuary Condominiums
cc: file