28 JAPONICA ST - BUILDING INSPECTION (2) , ' �/�-O�
AC�RD_ CERTIFICATE OF LIABILITY INSUI2ANCE OPID E DATE�MM/DDM'YY� �
BAYST-1 03/02/07 �
PROOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA710N
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Kaplansky Insurance Brookline HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
119 Harvard Stteet ALTER THE COVERAGE AFPORDED BY THE POLICIES BEIOW.
Brookline MA 02446
Phone: 617-738-5400 FaX:617-738-8214 INSURERSAFFORDINGCOVERAGE NAIC�#
MSURED INSUkERA Nor£olk 6 Dedham Group 13943
IHSUnEP.B:
Ba ystate Basement Systein LLC INSURERC.
D/S/A owens Corning Finishing
960 Turnpi02021 �nsuaeao�
canton MA
INSU2ER E:
COVERAGES
tHE PoLICiES OF INSUWW�:E LISTED EELUW HAVE BEEH 155UED TO THE INSUREG NMnED ABOVE FOR THE PGLICY PERIOD INDICATED.fdOTWITHSTANDiNG
PflY REGJIkEMEnrt.TEken OR CO�iTICM�OFlwY COMRACT OR OTIiER DOCUMENT WITi RESPECT TO WHKH THIS CERTIFICATE MnY BE i55UED GR
MA�PFRTRIN,TME I:JSUiiM�CE PFFORDED 8'I TIiE POLICIES DESCRI6FD MEREIIJ IS SUBJECT TO ALL ME TERMS.EXCLUS�CWS n+JD COFOITIIX�S OF SUCH
POLIQES.FGGkEGATE LIMITS SHOIM�I M4Y H4VE EEEN REDUCED BY PqID CIAIMS.
lTR SR TYPE OF WSURPIICE POUCY NUMBER DATE(MFVDOfY'! DATE(MMIDD/YY� LIMRS
GENERALLIABLL!(Y EACHOCCURRENCE S IOOOOOO
COhNAERCL4LGENERYLIABILITV PREMISES Eaoccurence) 51000�0
cwimr r�we XO occua MED FYP(My one Derson) s 5000
A X Business Owners R0309626 02/06/07 02/06/08 PERSOWLBPDVIN.ANY s1000000
GENEruLnr..�REGArE $ 2000000
GENIAGGREGATEI.IMITPPPLIESFEA' PRODUCTS-COMP/OPAGG a Excluded
]{ Pp�ICY ��i LOC
pU(OMOBILE LIABILRV � �
COMBIt�D SINGLE LIMIT $
w,n,py�� (Ea acaaert�
nLl OWNED PUTOS BODIIY IN,ARY
SCFIEDU�ED/WTOS , (Perperson� $
HIRED PLJr05
BODIIY INJURV x
Iv'Ol10NTJED MI105 (Pm eccitler4)
PROPERiY DAM4GE f
(PerecaGert)
GARAGELIABILf1Y PllTO0f.4V-FAACCIDEM $
?NYAlf�O OTiERMMI EAnCC 4
PIfrOODLY: AGG $ �
EXCESSNMBRELIAlInB0.T' El,CHU;CURFENCE f
P;CUR � CLSIMShNDE AGGRECATE $
S
pEp(KnBLE F
REIEMION 5 g
WORKERS COMPENSATONAND TORV LIMITS ER
EMPLOYERS'LIABIIT'
ANr FROPRIEfOR/PARiNEWF�:ECVfIVE
E.L.FACHACCIOETf� $
OFFICER/1.LMBER�JCCLWED� E.L.DISEPSE-EAENRIOYEE $
Ii yes,daScnDe wEer
SPECIM1L PRJVi51GNS Delrnv E L.DISEASE-POLICI'LIMIT $
OTIER
DESGRIPTION OF nPERATIONS/LOCATIONS I VEHIGLES/EXCLVSIONS PDDED BY ENDOPSEMEI�R(SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF TfE ABOVE DESCRIBED POLICIES BE CAN�ELLED BEFORE iT1E E%PIRAiION
� DA7E THEREOF,ii¢ISSUUlG BJSURER WRL ENOEAVOR TO MAIL lO DAYS WRITfEN
NOiICE TO TME GERi1FICATE/W�OER NAMED TO TIE LEFT,BVT FAILURE TO DO SO SHALL
&IPOSE NO OBLIGATON OR LIABILRY OF FM'KIND UPON TV1E WSURER,ft5 AGENf6 OR
. REPRESEMA7IVES. �
n�
ACORD 25(2001/U8) � OO ACORD CORPORATION 1986
♦
MAR 02,2007 12:40 , page 1
ACORD_ CERTIFICATE OF LIABILITY IIV•SURANCE OPID $ DATE(MM/DDM'YY�
SAYST-1 O5/24/07
pa��� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
p,qdset,• p. Gordoa, Iac. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
680 MaiII' Stieet HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
PO Box 299 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Norwell I+II. 02061
Phoae: 781-659-2262 FaX:781-659-4725 INSURERSAFFORDINGCOVERAGE NAIC#
INSURED iNsu�an Aeaaissance Group
Bay State Sase�eat
Systems, I.LC iruuaErze:
dba Owens Coraing Finished iNs,w�ac:
Basemeat Syst�
Canton�t02021 �����
INSURER E'
COVERAGES
hE POLICIES OF INSLRPIJCE LISTED BElO'rV WIVE BEEN ISSUm TOII-E INSUFiED kNAED PBOVE FOR TF�POLICY PQtIOD IrDICATED.NOTWITH'TMDING
P7JY REWIREMEM.IERM OR COI�ITION CF AIJY COM{7HCT IXt OTHER DOCI.�.IEM WITH RESPECT TO WHICH 1HI5 CERTIFIfATE M4Y BE ISSUED OR
M4Y PERIAIN.T1E INSIhLWCE PFFIXtDED BY TFE PClIqES DESCRIBED FEREIN IS SL6.IEGTTO PLL TME TERMS.EX0.US�ONS.WD CONDfT10N5 OF SUCH
POLICIES.AGC�ftEGATE LIMITS SHOWN MHY H4VE BEEN REDUCED BY PAID CLAIMS.
LTR SR T9E OF Ri5U2FNCE Pa��� �A'fE(�.9NDDM') DA7E(MMlDD/Y» ��
G@lEFALIJNBILIfY EACIIOCCAIRRENCE � S
CpRp,EpCIPLGEI�ESiN.LIPBILITY PREMI�S(Eaar.ciience) S
C1.aM5 MroE �OCCUR ��(�Y�Garso�l S
PERSIX1�18 PDV INJURY S
GEI�ERPLAGGREGATE S
C�N�pGG{EEGAIELIMITPPPLIESPQt: PRODUC�S-COAP/OPMG 5
POLICY � LOC
AVfOMOB��ELIFBILT' - COh�I1�DSINGLEIIMIT
Mry PAI�O (Ea ecciAert) S
AU-ONrt'ED PNOS BODILV IN,AIRY
��A��� (Perperson) _
HIFiEDPNOS BODIIY INJURY
NOµQ���� (Perecciaer[) s
aaoaEmv w�.v.cE S
(Pazecci0ert)
Gq��q���qgp,�}y N.f�OIXJIV-EAACCIOEMr S
NJYAU�O OTHFRTIVN FAACC S
P1J�OOr1V: p�G S
E%CESSM11616RaLA LUIBY.RY EACH OC�I�ENCE S .
OCQ1R �CWMSMPDE AGGREWTE S
S
pEpUGTIBLE s
REfEMION E s
WORK9tStOWEN5A7�ONAND TORYUMRS ER
A °"PLO1'�S'`"B""'� WC 0371527 OS/24/07 os/24/oe ELENCMACCIOENi s i000000
PNY PRCPRIEfORNMRdER/F%EGUriVE
o�ic�r.�R�ee��n+ e.i.oisense-En�.v�or� S 1000000
��Y���'�"�� E.L.DISFASE-PoIICYIIMIT ilOOOOOO
SPECWL PROVISIqJS Ce�on
orne+
DESCRIP710N OF OPE(LITONS/LOCAl10N3I VB9CIES/E%CLUSpNS ADO�BY BiDOftSEMENf I SPECV�I PROVISIONS
CERTIFICATE HOLDER CANCELLATION
MISCELI� SHOIILDNA'OF7F¢ABOVEDE8CPoBEDPOLIC�SBECFNCELIIDBEFORETHEE%PRATON
DAIElHEREOF.7I�ISSIANGBAURERWl1ElAEAYORTOMWL 10 onrswrarreN
Say State Basements N0110E TO TIE CEKf61LATE HOlOER W1M�TO TE LffT,BUf FAILURE TO DO SO SHILLL
fOI record purposes �,pp�Np pgUG,qTON OR LL4&LITY OF IWY KUID UPON 1TIE PISURER�AGBff6 OR
NBRESBJTA7NES.
AVRIORIZED REPRESENTAi1VE
House Account
ACORD 25(2007/08) �ACORD CORPORATION 1988
2
� �
'� '�^� NOTES:
' �_,,
c?l,� Bruce and Jane Daigle DEALER: Bay State' 11FT 71N X15ft 11N CATHEDRAL
4 28 Taponica Street ship to: Canton, MA COLOR: WHITE
I.��. SunSuites ; Salem, MA JOB NAME: DAIGLE ELECTRIC: YES
4,.-���,,,� insta�l date: SWITCHES: YES
rnr su�aoo�+ ���::,� � �.� �,- — DATE: o�i�5�zooa RevisioN � GLASS: LOWB3
�, _i. � i I I I .�— � � �, i�r�•r—,�{.,.. . _ _-i _ y-I—.�I JI- �1-,
-. . _ ......� .:_� r��.�re� .e - ��r-+±..r .. ��..��.i m�-�r,.- .�^a�.�.
I�� � �� I i_L� I i i I I I � �
I !I � i__ � _�� I I I I I � � � , I ;,'
� � I � �i� � � � � I I �!� I I i � .,.� I � I I I I LI ' I ;
--! � i I I_ ! j_ route electric � ; �-�I -i I;
' � i � �'i � i I i 12.0" up from � �� I_,__: i_
� � I �_ � I � ! i
�fl00� i I �
� I I � _i \ \ � ! i �� i i � � I � : -i �- .
- � i i �\ \ \ �\ I � I ! I I_ �. II I � \\ \ \ - � _T-
i 7., i i
' I�__I I �i I I_ I� IJ� tempered / � �',.
�II� � . � I �I I � I I� . ' .I--
�.L—�� �' �/ i�` � I � � li . I I � , // i � ;
i I I I I I I ' � � , ' --'
� � � � � � i �
' lass sideiite and la f
Wall•'A•". (1) 38.75' 9 9 ss tran 1 I I
- som, (1)69.375" � i Wall "C": (t)22.250" giass sidelite and glass transom, (1) -
-�window with giass kick panel and glass transom and (1) 22.250"glass � -` 69.375"window with glass kick panel and glass transom and (1) -
-sidelite with glass transom. 96.00" header height and 141.50"wall � I 38.75" Swing Door(OSLI, In-Swing, Right Hinge, Type B). 96.0" --
�width. �_�_. y header height and 141.50"wall width. ---
� � �
— ___- - - _.._._._ �_
--
----- --- - ---- - ----
! I I i � I ' ,Wall ��A„ i I �I � i � I I I � � � � I �Wall ,.�,� I I I �
, � ,...• ,,_ . - - � . .; .� ..�< . : � _ :R _::_, < .�„
�— '-L I �-� I I� 'rn!I I �� � I � I I � � ',--I I� , I I : . I� I � I I , I1
I �I � � � �I � � I � I � � i � ��_ � � � I ����� outiet locations(12" up from floor)
Wet Sea l Require d: Y E S 1 N O I_ � 'switch location - ' -
State Seal: J ��-� �
i--�-�-�-
--Wet Seal kick-off request: �j � I I i' i � � i j i�-j� I j -'-=,--
� I
- -i�I f_� i�i I�-I--j Ij-i-i i-r'-i--�i-i---
- -1 �I I I _ _ __I__-_._.____
-_ i I � ' � � � I i--I�- ��-I_ �'-'�-�___;_.-
i i i
Room Concept approval sign-off: _�_.� � � i � ' ,_I � I__i ___ !__
_ r� �i �� � � � �
- -�� � !-�' � \� � � � � \� i II �r-�
_-Approval sign-off of room for PRODUCTION: ��1 � ii t I i��� ��� - ; --- -
_�;�� ��p� ' `--
'�_ -��-� � �-� `' '� Ci '� �� � ��-' -
' �� ���_l�Li � i !L I�j �� I
not to scale ;-{ - � __
� � _
� �_r �� --,-- ;
, � � ---�--�- �
, - , I I WALL n 2 22.250" lass sidelit � I 1 1 I-�1 I - - -
betwee I ;
i _
B": 2 61.00"windows with glass kick panels, centered '
' -- -
- - -- - - --; �I ( ) g s on corners. 181.00 wall width, -�� -� i___� _._.
' '� i ' ' � �__,_ � i � _ g3.1875" header height and 118.0" peak height(does not include roof ;I �
, � �
-'— -----�-L �-- i I , __, �-- _�__
- i� panel thickness). Glass traps above header. -��
� F J
�_ J
-'R;�k> NOTES:
��� Bruce and Jane Daigle DEALER: Bay State 11 FT 71N X15R 11N CATHEDRAL
3 28 Taponica Street ship to: Canton, MA COLOR: WHITE
.S U IZ S U 1 t C',S �� f Salem, MA JOB NAME: Dni��E ELECTRIC: YES
.';�
�•� instal�date: SWITCHES: YES
'��� •��"tO9" "' "'''"''„- DATE: olns�zoos REvisloN � � GLASS: Lowe3
�. ,.�,� ._ I-I_-al-i,, I-_.. I-,•��a . -n I - . ,—t��_i- I -r.��^�.^�.�i�.^-^^t��
.r ,i. . �- �I���,�.i�I I I I _� I ���I I � � -� -!-
_�� — � � � ��
i � _ _ ��
I � I i I I i � _ � ���� � � � i =--
�— � J—I �_ i I _ '
� i i �
-- L i �I I I I ' ' �-'—,
,
� ---..
' �� I!- I f '' � route electric i ' I I_'i_ �'_
' ; I' I-�-+-- 12.0" up from � , i _I,....�=—�, --
'' � -�L-. floor i i i 1_,_� i
' � i \ \ i I �� I I � �- -
I, — — � i � � I_�,.--'--
I�i--; �\ \ \ �\ � iSl i '_l-, ; '� \\ / ---
I I : I � � _��� I ; tempered � � I!-
�� �� - I I� I �, ! —� i i --I_
'. I I I �/ f: � I I , , — i I l..� // _e i ___
I a ' �
I Wall 'A'". (1) 38.75' giass sidelite and gla � � ( � I i I i I , .- � O, , � , �'i ; ;
i i
� � � � �
- ' ' ss trensom, 1 69.375" � - Wall "C": 1 22.250"giass sidelite and glass transom (1) --
i window with glass kick panel and glass transom and (1) 22.250"glass ��-, -_L 69.375 window with glass kick panel and glass trensom and (1) -
�sidelite with glass transom. 96.00" header height and 141.50"wall � 4 38.75" Swing Door(OSLI, In-Swing, Right Hinge, Type B). 96.0" -
width. � _I header height and 141.50"wall width. --
T' -
i i � ; i i �. .� i- � I � I --- -
T , � ; I � .� , �Wall A i �� � I I � � � ` � I � I ; �Wall ���,� ' I I — I -- -- —
� � � , .0 .... � � � � . ti � �", i ,�_ y�_� ��� _
_�.� _. w r-, .,� � e�,�'. .v • �..� _ _ :-�, �' �-_
� � � � � i �� i i �.
-1 ' � �__ � � I � � � � I � I I � I � ,�
-}- � I �
_ I � � � � � I i I I � _��_I � ���I � � ���� �_;��� tlet locations(12" up from floor)
I ,switch location-T
Wet Seal Required: YES I NO � � !
State Seal: ! � I � �
-Wet Seal kick-off request: � � � I f I i � I � i � I � I� i i � � �,
'- i - -� -
- -I,� �r � I �� � � � I I ��_i�i '—�-=- �'�--�'--
— �' I ' I I I � -
- � ' � --�-=-�r-'-'--'--- --
Room Concept approval sign-off: � � �� ' � � � � ' ;
i i i i
- ��i i� =I i il --, I---- i
i ; - _
� ��I ��-I'; � � � � � I ' -i- �
_Approvai sign-off of room for PRODUCTION: �I�, �-II I�__�� \� \ \ / / \� j� I, `- � -� -
r � � ��p� (�/J�//��```��� j! i Ii I i � LI I
— C/1 lµ�—C�� �I� l � i % �� ( � i� i I � i I __ ._'_'_ '�
j I I II I I �—�"_—
-not to scale ' � ' J- I I _;_J � ' I � I ' � I � _� ';_ I
'�' ������� � �����i I�'�I---'--�
� � � � � � ,
, �-WALL"B": (2)61.00"windows with glass kick panels, centered �J' � ,-
- -- - -- - �- between (2)22.250"glass sidelites on corners. 181.00"wall width, i -� � � -�
1 � i
- - �'_-! '
'---. ! :_ ! I-I___�_.� : i_�_�_� � � I
�83.1875" header hei ght and 118.0" peak hei ght(does not incl u d e ro o f i -- - --
panel thickness). Glass traps above header. -�
- -� �
� '
�
i Va• a O� VAi.C� . .
� PUBLIC PROPRERTY
DF.PAIt'MENT
..�:.r�.T• ar.�i
aL�u� t!C'f.�N::JNf 1fsT�f.�t:�+4�vpt::w�a��s::ir
�1:YO'N+�'�!M�f.�7C 97�J�61W
-�
Construcdos Debrts Dbposat a►t'Itdsvit
(reyuinat Aot all danolitioa aod emovatia�.rocic)
����w ith �ls� sixts editiae ol dr Sntt Huildte�Cod�7�0 Ci�l�sactioa 11 l.S
pebri�,�ud t!�provisions ot�IGL e 4Q S Sk
Buildi�y P�wtnit � _ . ia i�wtad wi�h t�eoAdLtloo dlot td Aeb�i!rewidn� �as
�hii wott shall b�diapo�ed ot in a peoparly lteansed wast�dispospl fSeiUry as delined b�r�1CA,e
«<. s �son.
Tt,e eebr,.W;u be tr�nspo�ed�Y�
!/l1G(/� /llin(s e G►r 07
l of ifoul�
rna dcbri, w�n b.aispo.ea urin :
n�+me�i fx�c�cy)
^ ,+.M:rrs.. .H't'x:t.iy�
��A��� " �/
���...tW:�N,1CIl.R.H�.IiJ.11
6Z/2E/Oe�
- .�, -
CONTRACT TO INSTALL OWENS CORNING FIBERGLASS SUNSUITE .
Owena Corning Sunsuito Dlvlslon(the wnVactor)hereby submiLs t�is pmposal to sell antl instell ihe Owens Coming Fiberglass Sunsu�e .
antl rela�etl items as tlescnbetl herein at the resitlential premises sel lotlh below.This propasal shali no�become a binding commiMen�unless
antl until i�hes been signetl by the Contractor antl the Customer. ' ,
Convattor: '
Owens Coming Sumulles Olvislon ,
a tliNslon o/Bay State Basement Systems,LLC.
60 Shawmul floaQ Canron,MA 02021
� Teiephone N(]81)82LOOfi0 �
• , FacsimileNQ81)821-8552 '
FeAeral T�ID N 141855291
Mass.Home Improvement Contrac�o�Reg.N 13]943 �
Oate �Z�/O� -
Customer: ��7 /� �
Customer Name k1/�- -'/� t� � '�-G //C�'s�'G
SVeet Adtlress ��' �KQ ✓J O H / G 4 .S�
�
ciry,s�ate,zip 4 �rG�t/a'7 (s �/�•
Telephone( / ?J 1 7 % S �'�-�� ,
This is a conVact�etween�he ConVactor antl�he above nameA Customer ro sell enA install ihe Owens Coming Fi�erglass Sunsuite entl �
reletetl i�ems specifetl herain et Oie Customefs resiGenFal premises itlentified below:
Installa�lon Premices: / // .� - . . .
SVeet Atltlress �l�P�%
Ciry,S�ate,zip
Scope of Work: � �
Are Sketches anG/or speci(ca�ion sheets attachetl? BYes' ❑No
'NI a1laNunmis ere umrGweb!h�m eM Eevm'e e ps�al NU wnVecl . .[� L
DeunplionolWorWSpecifiwtions: �Z :X- /J G SC//L .$�✓�/ f ' cS�U �S7�j,� _
�'t/��r r�-, r�.�� a rf' . Ca.;lt a- ✓�/o�u�.-c �
,�/�/l_- [� s . /�.�� S4i:1�.�p-r��%�io fi�7`/�J�S_ . . � .
�/I//�� S_ 36'�� �?eEt/X�i �i�JYt 6'�'/ � � Lllrl� �
/7tcwc a�tS � cS� -LG G` dv G t/�� Sp 1 -/'.aO Goc=-��d*-� .
Work Schetlule^: -
Appmzimate Commenceman��ate:
Approxlmate Completion Date:
"The pmposed woiic sMetlule is approximaie and subl�to changa
Contratl PAce: �(
Total ConVacl Pnca: $ —/ � /��� - . . .. ,/ .
Deposit wdh ortlec $ ��Z>�7� �ash ❑Chxk# �/"1 �
Balance Due: � / $ �� `r-f�
Terms: �Cas� ❑Finance �
(Cash tertns are 10h tleposit,30%at pre-installation inspection,30%on�mmer�cemen[,30°h on comple[ion) � . _
5 �Z ��L Due on P�alnstalta�on Inspec0on
$ �Z ��l' Due on Canmencement
$ /2� � Due on Completion I
DO NOT SIGN THIS CONTNACT UMIL ALL APPLICIIOLE BLANKS AHE COMPLETELY FlLLED IN AND UNTIL VOU FIFST REAO
AND UNDEHSTAND THE ENTIRE CON�HACT,INCLUDING ANV ADDENDUM ATTACHED HERETO,AS WELL AS ANV ATTACHED , �
SKETCHES,MATERIAL LISTS OH THE LIKE,AND T1E TENMS AND CONDRIONS ON THE BACK OF THIS CONiAACT DOCUMEM.
YOU ARE ENiRLED TO A COMPLETE,FULLY EXECUTED COPV OFTHIS CONTB/A�CT ATT1E TIME OF EXECUTION.
Witness ou�henC(s)and seal(s)below on Nis (�� day ot /ICGC/��— . ZA�7
Ba Sta/�e/q�_�sem�ent �sJtems,LLCIAuthonzetl Re rese!n1ta�tive: -
Y✓i'4l��/ �rr{���iJCS7 rRt_ . .
se�ewre/�/a rue "� / �
/"��� �S Lsh�'!� .
Pnni Name
W NOT SIGN THIS WNTRAGT IF THERE AHE ANY BLANK SPACES - - �
C�s er'••: ���
�n 1�
�i Mersie�ewre
f�2 D���
Pnnt
Cust r SlgnaNre
.,.� rJ�3/.
Pnnt Nama
Contrecror may have certain lien nghLs in ihe premises unGl Oie pnce is paitl in tull.Yvu have ihe ngM[o cancei Mia conVac[,withou[any
penal�y o�oEligaGon,at any Ome pnor lo midnigh�ot tl�e�hird businass eay afler ihe tla�e you signeE Nis conirzcL See ihe no�ica o�cancellation
below for an explanation of this nght.
•••Gustamer ecknowletlges recapl o�a Ime moY ot iM1is coninct w1iiM wes mmplMey nlle0 in pnor W customels execution M1ereol. - .
�
�
� oonqs.,�,<.� -�-- -�'
tr �.� ;.Y:.�.� >,� ,_ -o�rsu�:��ox��a�:o =_sa�rx
� � � =�.� ' sac�esa#!�Sfa#e:B�"dm��-oue?(78Q�An�endi=' r 'ec'uo - - ).»�
� The Massachusetts State Building Code �iBD C�) includes provisions to ensure that houses and
house addirions meet energy ernciency standards. This supPlemental CONSLTMER INFORMA'I'ION
FORM is to be ziled as pazt of the building pe:mit application when a builder/contractor or homeowne:,
oonsauctinJinsralling a house addition with vez}' lar�e percentage of elass to opaque walhouse(780 CMR,
special ener�y conservauon exemorioa option for 'sunsoom' additions to an exisrin� .
�n�endix I, Secuon Jl.l?.3.1). This FORM is noc intended to prevent a homeowner from selectin� a
"sunroom" oi.any size, confiwration, orientarion, form of consuvcnon or percant glazing, but rather is only
intended to assist homeowners in becoming awaze of some of the impor[ant energy conservation and year-
iound comfor[cnnsideraaons involved in selectin� aud utili�n� a"sunroom" addirion.
The connection of "sunroom" structuras to residenual. buildings mav create comiort and eaersy
cnnsumprion issues due to.unconaolled solar gain or uncontrolled radiation cooiin� of the main house. In
the selection and consmicuda/insrallation oi"sunrooms", included below is a non-iequired, ope:i-ended list
of product and desiffi considezations thaz a homeowner may wisn to consider before acivally
consiructin�/ins�ali�ng a "sunroom". It is re�ommended that consumets carerully review these oprions with
their designe:, builder, or contractor, in order to minimize potenual ene� consumption and/or house
discomiort issues_ In addinon, tha 4ualuicarions and reputanon of the c�mpany or individuals to be hind
ar� imporrant considerations•
` PRODUCT AND DESIGN CONSIDER�TIONS RE7.A'I'EI� TO "Si7NROOMS"
. Solar Orieatatian and Natural Sfiadins
. Type of Gla�ag
e Insulating value �
e Solar heat gain
. Frdme materials
. GIarins to frame s�iIing and gaskeriny�terials/seal durability and/or
weather�u��ess of the sanroom _
. Adeqnate venuIation-Ope�hle windows and faas
o Annlie3 Shading Systems
. Insnlation levei ia IIoors,walls,and ceiiings
. pQssible Sunroom isoiation from the maia house via a tvail aad/or door or suder
. Hearing and CnoIing Methods: Efficieacy>Zoning and Controls
Homeownen c�l�owle3ament � � uiree tfrat the actual rnvnertv owner (not the
'Ihe Massacfiuserts State Building Code, Setion .ill_.�.1, req riorto
owner'> a2ent or represenranve) acknowl�e rec..ipt oi this CONSiJIvfER INFORMATION FORM p
. _,,.,.. . . . . .
:2nr�. .�_fi� • .-... _. .. ...;:',t;..
issi iee o�f a'"Builaing Periiiit for-a�piroje:E<-that-^.includes-"sunr�om'.' addiuoas..t4:::an �,,:snn�:.�s 9nv::
building. In accordance wirh this requirement, the undersigned h�reby ac,knowiedges thai she.�he has read
�� iniormazion in this,document concerning sunroom comiort and eneroy conservation_
U' )n �iP. mC\�� � � � OZ�' � �
�Sl�anue of Acmal Buud g Owne: Date
�jruC�- K�c�L� d�Ja,00,Ut�� sf �'�err �''l�
print 2v'ame
Addrss oi Pe:miued Projeet
�, �, 7�5- �83 /
pwner Address(if dirierent than p%1
� jo�on) Gwner's tedephone number
ENFRGY CONSERVATIOivx APPLICATION FORM FOR
LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS
_ : , . . . 780 CMR.Appendix J . .
ApplicantName: Site Address:
Applicant Address: City/Town:
LTse Group:
Date ofApplication:
Applicant Phone: Applicant Signature:
Compliance Path (check one):
❑ Prescripfive Package (Limited to 1- or 2-family wood frame buildings heated with fossil fuels only)
Package(A through KI{ from Table J5.2.1b): Heating Degree Days(HDD6g) from Table J5.2.1a:
(For itertis d. through i., fi11 in all values that apply from Table J5.2.1b:)
a. Gross Wall Area sq.ft f. Wall R-value R-
b. Glazing Area� sq.ft. g. Floor R-value R-
c. Glazing% (t oo x b*a) % h. Basement wall R- ,
d. Glazin�U-value U- ,. i. Slab Perimeter R-
e. Ceiling R-value R- j. Heating AFUE
❑ Component Performance: "Manual Trade-OfP' (Limited to wood or metal framed buildings only)
ClimaYe ��;e (from rigure J6:2.2) � Zone 12 ' 0 Zone 13 ❑ Zone 14
Attach Trade-Off Worlcsl�eet from Appendix J, [and HVAC Trade-0ff Worksheet, if applicable]
❑ MAScheck Sofrivare
Attach Compliance Report and Inspection Checklist printouts
❑ Home Energy Ratin;System Evaluation _ ' ' . ,
,.Attach Home Energy Rating Certificate(HERS ratino score must be 83 or hi�her)
❑ Systems Analysis OR ❑ Renewable Energy Sources
Attach Mass Re�istered Architect or Eneineer Analvsis
,� ALTERNATIVE FOR ADDITIONS ONLY:
a. Gross Wall+Ceilin�Area sq.fr. b. Glazing Area1 sq.ft.. c. Glazing%�(100 x b=a) %
_ _ _ . .
❑ ADDITION with Glazine % (c.) up to,40% may use 780 CMR Table Jl.1.2.3.1 below:
� -value - M -V I e �
� Fe e r tio 2 e'li o3 Wall oor - a e en Wall lab Perimeter De t � �
� 0392 ' � �� R-37 R-13 - 9 R-10 . � - 0 4 ft �
I Glazin�Area may be either Rou�h Opening or Unit dimensions.
2 Based on NFRC listing. Applies either to every unit,or to area-wei�hted average of ail units.
3"'R-30 cciiuig insulation may be"used in place of R-37 if the insulation achieves the full R-value overthe entire ceiling azea
(i.e.-nofcompressed over exterior walls, and including any accesg openings.) :
❑ "SUNROOIVI" addition (greater than'40% glazing-to-wall and ceiling gross area)
Attach "Consumer Information Form"from 7S0 CMR Appendix B. n
OfficiaPs Name: Official's Signature:
Application Approved ❑ Denied ❑ DateofApprovaUDenial:
• Reason(s) for Denial: (provide additional details as needed on back side)
� The Commonwealth ofMassachusetts
Department of Industvial Accidents
O�ce of Investigations
, 600 Washington Street
Boston, MA 0211I
www.rnassgov/dia
Workers' Compensation Insurance A�davit: Buiiders/Contractors/Electricians/Piumbers
AF�licant Tnformation Please Print Le�iblv
Name (s�s�,ess�orr�n�zarioc,�nai�iaua�): UliJF1S (,�P�L'/AIC�a��.�?�l/T�YS'��9
Address: 6� ��`�� �"�G'�� ��
City/State/Zip: C�w 7Zyt� . /Y�/� !�%!X l Phone#: 7�1-�Z l^UQ'o0
Are you an employer? Check the appropriate boa: Type of project(required);
1.� I am a e lo ez with 2 4. ❑ I am a general contractor and I
mP Y �— 6. ❑ New construcuon
employees(full and/or part-rime).• have l�ed thc sub-contractors
2.� I am a sole propriewt or parhier- listed on the attached sLeet $ �• ��em°delwg
ship and have no employees Thase sub-contractors Lave 8. ❑ Demolition
worlang fot me in any capacity. worke�' comp. insurance. 9, �guildmg addition
(No workers' comp. insurance 5. ❑ We are a corporalion�d its •
requued.]
officers have exercised their ��•0 Electrical repairs or aildirions
3.� I azn a homeowner doing all work right ofexex�tion per MGL 11.� Plumbing repairs or additions
myself.[No workeis' comp_ c. 152,§1(4),and we hade no 12.� Roofrepairs -
insurance requued:] t employees. (No workers' .
camp. insurance requued.] 13.[] Other
. •Avy applicent that cbecks boz#1 must also fill out 8ie section below showing thea workas'cort�ensetion pulicy infoimetioa' � ���
t Homeowvers wlw wbrnit this aCfidevit mdimting thry aie domg e11 work aod then hirc ouTside contractors must subcmt a new a8'idavit'n�dicating-such �
iContrecwrs that cLeck this box must ettachad en edditiond sheet showing the amne of tLe subcontreqors and the'v woticeis'comp;pulicy inforix�atfon. �
I am an emp[oyer that is providing workers'compensation insurcnce jo�my employeex Below is the policy and joblsite
informalion. / � . . .
lnsurance Company Name: —St�°�V .Ldi,//�rq y o �,-, y.�qv, �
Policy#or Self-ins. Lic. #:_ W C ('� ,�7 J,� 2 7_ Expuation Date: dS�2 �`�d�
IobSiteAddress: `8 .��lloGi�r�a JfY2e!- xiGP-G,, �iY Ciry/StarelZip: d/�/ 70
,
AttacL a copy of the workers' compensation policy declaration page(showing the policy number and ezpiration date).
Failure to seauc covengc as requued under Section 25A of MGL c. 152 can lead to tbe imposition ofcrimmal penalues of a
fine up to SI,500.00 and/or one-year i�risonmeny as well as civil penaltics in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Ofl'ice of
Investigations of the DIA for insurance mverage verification
I do h y cert�unde the �ofperjury that the injormation provided above is true and correct
Si a e: Dau: OZ�1' ,�� Od'
Phone#: 70�-�T�- ����
OJfrcia!use only. Dn not write ix this areq to be compteted by eity or town o,fJ'rciaL
City or Town: PermiULicense#
Issuiug Authority(cIrcle one):
1.Board of Aeatth 2.Building Department 3.City/Cown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Persou: Phone#•
/ � ��B�ard o ui mg egulatibns�an ar s
One Ashburtorrr°Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor ReQistration
Reqistration: 137943
Type: SuDPlement Card
- E7CpIf8t10f1: 1l29/2�9
. " __ ".. ... ..
OWENS CORNING BASEMENT FINISHiNG ----..-.. -- .-..
DANIEL WALSH __._.,_ _. ..
60 SHAWMUT PARK
_ --.�.. ....... .. . ._ ..
CANTON, MA OZOZ'I Update Address and return card.Mark reason for thange.
"" Address " �� Renewsl � Emptoyment � Lost Card
5-CAt O 5oM-05/OB�PC84�1
, i
"'"'��---"s^-�..`�-_.a ".�."'..."- ,« _- I
��� B��i�o . a dmg i2egul�idns�.�t8nt ards ;
- � Construetion Supervisor Lice�e �
� Lio�nsa: CS 7g893 �
BiMhdalO: 70t511962 �'.
E�+� 1�01�/2009 Tr# 4794- -
iiestr]ctfan: �'
, , ,�_� ,
_._ .._ . . - - - � -... .. DANIELF WALSN .7. . ---" ' - — -.- ...--' ....�, .._ ._. . . .
498 KENDALL RD� , . � �`�� ���
TEWKSBURY,MA07876 ' Commissioner
�-��zy��� � C�� e�fc_ � �� 5 � �-- � �rq . a � � '��
I � The Commonwealth of M•rssachusetts �.��R
�, Bo�rd of Building Regulations and Standards MUNIc'IP:�LI"I'1'
' `� \,�,�� Massachuset[s State Building Code. 780 CMR, 7i6 edition ��5�
Building Permit Application To Construct. Rep•rir, Renova[e Or Demolish a R�'�'+i�•��N�����i�:�'
One-or T�+�o-Fa�nrlv Dx•e!lii�g
This Section For OfficiafU'se Only
Duilding Permit Numbe .� Date A plicd� �-
Sign•rWre: /� �
Building Commissiuned I spector of BuilJings/ � ute
SECTION 1/: SI ORMATION
��p perty Address' J.� `P�f �9 Of� �� •Z Assessors Map & Parcel Numbers
a n�c ' i� C
� � � Map Number Parccl Number
L la Is this un accepted street'. yesJ� nu_
1.3 Zoning Information: 1.4 Pr�pe��Dimensions: �D /
�Y'
Zoning District Pro{wsed Use Lot Area(sq ft) Frontage(fl)
1.5 Bullding Setbecks(!t)
Fron[Yard Side Yards Re;v Yard �
Reyuired Provided Required Provided Required Pruvi�ed
1.6 Water Supply: (M.G.L�.40, §54) 1.7 Flood Zone Ioformallon: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zorjel� Municipal O On site disposal system ❑
Public❑ Pri�ate❑ Check if yes0/
SECTION 2: PROPERTY OWNERSHIP�
2.1 O}xnii'cf+Rec4�GY/ � G� 20 �u��iniGa )�sttF �W[f(�, �A: (��970
�,S.j—.--��---- �
Name(Prine) Address for Service:
9�� - ��s�- 8�3� i
. Signature - Telephone � � .
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction ❑ Existing Building O Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Additiun O - ��'
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other .t$' s���ry:3 Sea.ra.. u�a�M�
Brief Description uf Proposed Work2:
�.oG� v4 G G / 7�• �S � .� C�" !ra
4 1n { OD �hC �Mf6 .� �N GI� � H4 ' 00 K! �
tl e_
SECTION 4: FSTIMATED CONSTRUCTION COSTS
Estimated Costs: p((i�ial Use Only
Item (Labor and Materials)
I. Building $ I. Building Permit Fee: $ Indicate how fee is determined:
O Standard City/Cown Applicxtion Fee
2. Electrical $ p Total Project Cost� (Item 6) x multiplier x
3.Plumbing S 2. Other Fees: $
4. Mcehnnical (HVAC) $ Lisr.
5. Mechanical IFire $ Total All Fees: $
Su ression)
-�7 Check No. Check Amounr. C�sh Amuunt
6. Total Project Cost: $ �Z / 2Z ❑Paid m Full O Outsmnding Balance Due:
�t� ,�( fi0
I
J. \ . .,
SECTIO!�l S: CI'�NSTRUCTION SERVICES
5.1 Licensed Construcdon Supervisor(CSL) G� 7g �t�3 �p f p�--/0�
y� �✓ l � `
,�y�.�L ! c� .( License Number Expiratiun D•r�c , >
Nqmc o( SL-Ho1Jcr /�
(,�O ,{�� w�,., � Cli.,�N �/� �2021 List CSL Type(ser helow) l.�
� � T Descri tion
�rcss � ` U Unrestricted 1u to 35,00p Cu. FL 1
i
—��' Resuicted I.@^_ Fumil DH�cllin
� Signuwre ' OO 6 o M Masun Onl �
��/ 8L RC Residen[ial Ruulin Coverin
� Tclephone WS Rcsidential WinJuw and SiJin
SF RcsiJenlial Solid Fuel Bumin A linnca IIINJIIJlIU11
� � D Residrntial Drmulitiun
�; Sn2 Registered Homelmprovert�eW.,Co�racto�(�11C)• /S / / �37,� y 3
riwt�yfCa.-.�:� � fseaPa.o.ff/L�i�I /iu ��d�.rG� `�'RL�L�
�,\ H C Co an N•r C Re ist •, t N Registration Numbrr
l �o .�'�u��..,.. �f g�`�'��,� /`'l , 0 20 2 i //2 9 / 2 a.� 9
AdJ esl s ' � p
�,,,,h � J 7�� p 7 � daG✓r Expiration Date
Signamrc Telephone
SECTION 6: WORKERS' COMPENSAT[ON INSURANCE AFFIDAVIT(M.G.L.c. 152.$ 2SC(6))
Workers Compensation Insurance affidavit must be complered and submitted with this applicrtion. Failure tu pruvide
this uffidavit will result in the denial of the Issuance of the building permit.
Signed Affidnvit Attached? Yes ..........�' No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
[, Y�+c �Cai `C� , as Owner of[he subject property hereby
authorize (�viti � �ov.,i�" r r.�, fC[% C.t' �i "v/`f i O�, to aet on my behalf, in all matters
relative to work authorized by t is building permit application.
Si nature of Owner � Da[e
SECTION 76: OWNER�OR AUTHORIZED AGENT DECLARATION
/�� , �� / /�
I, OGl Lti C�rn�H � /'� u�C.— ���f''2— ,as�Awneror Authorized Agent hereby declare
that the statements and in rmation on the foregoing application are true and accurate, to the best of my knowledge and
behalf. �•G �L / �L� /i�
s �� c_ r v[
Print Name - � GP X�� �� ��( 2� l � �
X�
Signamre of Owner or Authorized Agent Date '
(Si ned under the ains and nalties of r'u
� NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contr•rctor
(not registered in the Home Improvement Contracror(HIC) Program), will not have access to the •rrbitration
progrnm or guaranty fund under M.G.L.c. 142A.Other important information on the HtC Program and
Constructian Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 1 IO.RS,respectively.
2. When aubs[antial work is planned, provide the information below:
1'u[al Floors area(Sq.Ft.) (including g•rrage,finished b•rsemendattics,decks ur purch)
Gross living area(Sq.Ft.) Habitable nwm rount
Number of tireplaces Number of bedrooms
Number of bathrooms Number uf halt7baths
Type of he•rting system Number of decks/porches
Type uf cooling sysrem Enclused Open
3. 'Total Project Square Fcmtage" may be substimted for"Torrl Project Cost"
�,�,� ( �e��,�� �—�
`�
NOTES ' `
a REFERENCES
�
DEED: BOOK 6654 ; 337
A� PLAN: PLAN IN BOOK 5 ; PLAN 41
� Ne�o,��o PLAN BOOK 113 ; PLAN 99 ,
�Ac9ti PLAN BOOK 202 ; PLAN 1
,
�
FIELD BOOK PAGE INSP. BY DRAFT. BY CHECKED BY
T6 28 C/T TPB GCC
� CERTIFICATION
� 1 CERTIFY THAT THIS PLAN WAS MADE FROM �f�1.1H OF�qs
AN INSTRUMENT SURVEY ON THE GROUND � S9c
- N 30°20'02" W 80.01' - W BETWEEN THE DATES OF JANUARY23 AND �o GECRGE yT'`.
i � � � JANUARY 27, 2008 AND ALL STRUCTURES ARE �oLLINS
I� LOCATED AS SHOWN HEREON. r 4 � 4�784 v�
SHED � 9 90p P
ACCORDING TO THE FEDERAL EMERGENCY y� SFSR�E�� f
No.30 JAPONICA STREET MANAGEMENT AGENCY(F.E.M.A.)MAPS, THE
POOL No.24JAPONICASTREET MAJOR IMPROVEMENTS ON THIS PROPERTY
BEVERLYMCSWIGGIN LOTS 42& 43 N/F w
� SEAN McCULLOUGH � FALL IN AN AREA DESIGNATED AS ZONE "C"
BOOK 6831 ;PAGE 302 W 64 70 � �
O S'E BOOK20Cc0 ;PAGE289 0 (NOT IN FLOOD).
t �� w � CERTIFIED PLOT PLAN
� U
h PROPOSED O O m LOCATED AT
2 o POftCM � � f a 28 JAPONI CA S TREET
" SALEM MA.
/ EXISTING ORIVEWAY Z � J
OECK .- SCALE: 1 INCH =20 FEET DATE: JANUARY 31, 2008
1.5 STORY wiF �� 8 �
/��/ �� � w PREPARED FOR: BRUCE DAIGLE
No.2S � � 28 JAPONICA STREET
j j SALEM, MA.
2.0� � LL�
�
PORCH
� - 2.8' 80.00' � !- 226.52' - �
N 31°03'00" W f
~ BOSTON
JAPONICA �PUBLIC-40.0'WIDE) STREET SURVEY, INC.
UNIT C-4 SHIPWAYS PLACE
CHARLESTOWN, MA. 02129
(617)242-1313 I
1 JOB # 08-00120 FILE#OS-00120-1/31/OS
_ _ _ — � _ _ . _ _ �
�-'����.
/l n�`.�' `4+..
/�yfJC� ��
t
( �' K�C' �k5. ..
. 5 'i}J�G � ''
�r�
l'l C •
c`�� ?EdciC� !
��y�-�_r
.
� ;F� , ``
^�__-p-«,=`
NOTES • -
REFERENCES
�
DEED: BOOK 6654 ; 337
A�q PLAN: PLAN IN BOOK 5 ; PLAN 41
�e
�o PLAN BOOK 113 ; PLAN 99
; ��
�2q�,N PLAN BOOK 202 ; PLAN 1
,
FIELD BOOK PAGE INSP. BY DRAFT. BY CHECKED BY
T6 28 C/T TPB GCC
CERTIFICATION
� 1 CERTIFY THAT THIS PLAN WAS MADE FROM ,,,���111��.1H OF�qs
AN INSTRUMENT SURVEY ON THE GROUND � s9C
- N 30°20'02" W 80.01' - W BETWEEN THE DA TES OF JANUARY 23 AND � GECRGE ycH,�
i i � � JANUARY 27, 2008 AND ALL STRUCTURES ARE �LL�NS v�
f— LOCATED AS SHOWN HEREON. � q ��477gq �
� 9
SHED 9 �,c P7;.,
'LO FSSIOc' ,J. /
ACCORDING TO THE FEDERAL EMERGENCY S Rv E�'
No.30JAPONICASTREET MANAGEMENTAGENCY(F.E.M.A.)MAPS, THE
N/F � POOL No.24 JAPONICA STREET. W MAJOR IMPROVEMENTS ON THIS PROPERTY %�
6EVERLY MCSW/GGIN LOTS 42& 43 wF o FALL IN AN AREA DESIGNATED AS ZONE "C„
BOOK 6837 ;PAGE 302 W 6470 �% SEAN McCULLOUGH �
O S'F' BOOK20C20 ;PAGE289 0 (NOT IN FLOOD).
�� � CER TI FI ED PL O T PLAN
�� W
e- U
h°p PROPOSEO a a m LOCATED AT
2 o POFCH � � f ` 28 JAPONI CA S TREET
EXISTING ORIVEWAY Z ,� SA L EM, MA.
OEOK SCALE: 1 INCH = 20 FEET DATE: JANUARY 31, 2008
1.5 STORY wiF �
/��� 11.8
�� W PREPARED FOR: BRUCE DAIGLE
No.2S � 28 JAPONlCA STREET
/ ; SALEM, MA.
2'01 PORCH �
1 - 2.8' 80.00' � !- 226.52' - �
N 31°03'00" W
~ BOSTON
JAPONICA (PUBLIC-40.0'WIDE) STREET SURVEY, INC.
UNIT C-4 SHIPWAYS PLACE
CHARLESTOWN. MA. 02129
(617)242-1313
JOB # OS-00120 FILE� 08-00120-1/31/08