320 JEFFERSON AVE - BUILDING INSPECTION (4) -<�I s q Cf— a�e�
The Commonwealth of Massachusetts ?ECEIVEC,
At
' 3 Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 780 CMR
g vi$e. Mar?Ol
Building Permit Application To Construct, Repair,Renovate( �� IiSla u
One- or Two-Family Dwelling
This Section For Official Use Only
M Building Permit Number: Date Applied:
f 11 3 1 Y
i Building Official(Print Name) Signature U% Date
SECTION 1: SITE INFORMATION
`9 1.1 Property Addr.e�s�,� 1.2 Assessors Map&Parcel Numbers
I 537O ..,Lo1-i-,�CSDn Ad
l.la is this an accepted street?yes_ no_ Map Number Parcel Number
f 1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
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:
Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Public❑ Private❑ Check if yes❑
SECTION 2: PROPERTY OWNERSHIP[
2.1 Ow r'of d: ��
� 7 1
Name(Print) City,City,State,ZIP
No.and Street elephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Oth ❑ Specify:
Brief Description of Proposed Work': 001
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official se Only
Item (Labor and Materials)
L Building $ I. Building Permit Fee: $_' Indicate how fee is determined:
❑ Standard City/Town A placation Fee
2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5, Mechanical (Fire $ Total All Fees: $
Suppression)
I Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
rNx�e
n Supervisor License(CSL)
�--�
License Number E i 'on are
:(Print) L Holder
List CSL Type(see below) u Type Description
WRCRoofin
nrestricted(Buiidines u to 35,000—cult)
City/Town,State,-4i+,I,�p, laso
18c2 Far Dwellino
�}-') overinCel hone# nd Sidin
' olid Fuel Binning Appliances
I Insulation
CnnSfrUCtlOn Supervisor i tnre D Demoliden
5.2 Registered H me Improvement Contractor(HIC)
(Print) HIC pan or TUC Registrant Name HICRegistratio ber Ex ra' ate
n .r 4
No.and S
lA ✓a �/ �� / HIC Holders Signature
City/Town, State,ZIP Telephone f�
SECTION b:WORKERS'COMPENSATION INSURANCE AFFIDAVIT Email address
(M.G.L.a 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 Issuance of the building permit.
Signed Affidavit Attached? Yes.........4,0 No...........❑
SECTION 78:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize(print name)_ ,�1/1/t� to
act on my behalf,in all matters relative to work authorized by this building perAt application.
Print Owner's Name ID/ Signature ate
SECTION 7b:OWNER OR AUTHORIZED AGENT DECLARATION OR CSL HOLDER
By entering my name low,I hereby at under the pains and penalties of perjury that all of the information
contained in cation is true an curs to the best of my knowledge and understanding.
i
Sign- o , wner's or Am o ' Agent's/tSL Holder Name Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work or an owner who hires an tuuegistered contractor
(not registered in the Home Improvement Contractor(HIC)Ptogram), 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.mass.gov/oca Information on the Construction Supervisor License can be found at www mass Gov/dos
In accordance with M.G.Lc. 40 §54A. A condition of this permit is that all debris resulting from this work shall be
disposed of in a licensed waste facility as defined by M G.L.111 §150A *Dempster on site_OR removed off
site *Dampster Co.Name
.Address
The Commonwealth of Massachusetts
Deportment of Industrial Accidents
� IQJ Offue of lnvesdgations
1 Congress Street,Suite 100
�. Boston, tYtd 03114-3017
z www.mass.;ov/die
workers' nce Affidavit: Builders/Contractors/ElePtease Print Le e
Compensation insnra bly
t jdormation +
U} i
A lican fV P�/i,47-/A/G
Name (BusinessfOr;aniz"don/Indind"
W ?2^
Add>•ess: C E / r�-� - 3 y - �l
City!State/Zi : W D�uRN N' F L Phone#:
Type of project(required):
Are you an employer? Check the appropriate bos: anal contractor and I 6 New constructionSD ❑ I am a g^
L. I am a empto Yer with bare hired the sub-contactors y �.R.modeling
employees (hill md/or purl- a)•` listed on the attached sheet
2.�] I am a sole proprietor or partner- These sub-contactors bare S. ❑Demolition
ship and have no employees employees and bave workers' 9 Building addition
worI9 for me in any capacity. comp. nslrrance x
o work rs' comp.insurance 10.❑Electr cal repass or additions
5_ � We are a corporation and its ohs or additions
required.] of icers have exercised their 11.]PLunbing cep
} I am a homeowner doing all work tight of ex mption per bIGI, 17,0 goof repairs
melt, [Duo wotkars' comp. c. 152, §1(4),and we have no
13.[]Other---- --
insurance required_]t employees.[No work rs'
comp.irlsrranca tpgtr ced]
oliean[haz•:hecka box 3.must slso lilt Dirt the section below showing dseh rockers'compensation policy mm,moadon.
�..kny ap- ire doin vl work and mem'dae not idn aontcactrr,mu.�m'vmit a sew;'Tdsv2 indicating coca
t Homeowners who membinis afidant mdicaomg may g
tContsactors dint check thu hozmust attached an additional sheet showing din Gmmnof$e sUb-mametors and some whether or Got those eniilies eve 1
employees. Tf tta soh-contractors have employees,they most provide their worYcrs'comp.Policy amber. '
Below is the policy and
I am an employer delis pravidin;workers'compensation nsurance for my employees. ob s to
information. N,yUTGLNGZ v"
Insurance Company Name: LA. 1 J
�l / D Expiration 5,— —J Z
Policy#mSelf-ms.Lic.#:�"rl/��"'}or�D3SOb � � ti Date:c I
Av."— City/State/Zip:
Job Site Address: ge(showilLa. P y iradon date).
u policy de
Attach t copy
of the workers'P tompdeamsderoSection 25A of t�IGL c.a152 can led t tithe imposition of criminal Penalties of a
Failure to secure coverage eq�' imprisonment �well as civil penalties in the form of a STOP WORK ORDER and a fine
fine up to$1,500.00 and/or one-year imp of this statement may be forwarded t the Office of
of up to$250.00 a day against the violator. Be advised that a copy
dons of the DIP.for insurance coverage verification.
Investigations
I do hereby certify under t ins and p ti fP
rite!the information provided above is true and correct it
Date:
Si attire: �/�
Phone#: vv � � '
pfficfal use only. Do not write fre this area,to be completed by city or fawn oJaL
Permit(License# --- -
City or Town.
Issuing
Authority(circle one): Inspector
1.Board of Health 2.Building Department 3.City
/Town Clerk 4.Electrical Inspector 5.Plumbing Insp
6.Other Phone#: {
Contact Person:
I
CITY OF S: INiD NA-kSSAC USE-nS
BUM.DL`G DEPARTNff.NT
120 WASHLL\tGToN STREET, 3AD FLOOR
-0� TEL (978) 745-9595
F.a.-c(978) 740-9W
KlxfBER -.Y DRISCOLL
MAYOR THO3Lts ST.PmnE
DIRECTOR OF PUBLIC PROPERTY/13UMDNG CONWISSIONF—It
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
-
(tom J
(name of hauler)
The debris will be disposed of in :
' (name of facility)
IAV13yt Cr,
(address of facility)
signature of permit applicant
date
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iW—TlPRO OPER4TiNaG, LLC.
THOMAS FOXON )
26 CEDAR ST. t �/
WOBURN, MA 01801 « �'
�Dt " ..,3 Update Address and rotor"card.A%llrk reason for ehan;e•
Address 1] Bene mi n Emptayment ❑ Lost Car:
ffiee ofcaos"oaerA fairs ABaaloeaaRegatatiaa - Lican984rraQisfration ra0diartadivtdul use aniy
before the expiration dat& if fomad retard to:
kFEntrat
E IMPROVEMENT CONTRACTOR Ounce of Consumer Am sad 3nsiness Hagulation
TY�,
Watla APar&Phan-Butte 3174
_1-,� S"Folsmorl Gard Boston,KS 02115
%iEyVPRO OPERAT f i
TH0P41A^s FOXON
''>_@ CEOAd.3T, -
'PlOSU NI.NIA glBGt � Not latid mthootsignatun� -
Undersecretar•+
f
aCiTi:52`uJ?era.^;i^,@---; r�� Public
Board of Build mg Regulations and Standards
Licansa: CS-029090
THOMAS PAUL FOXON
230 WALNUT ST
READING MA 01867
Ccn:miss!on�r 11119/2017
MIMED i
Co CERTIFICATE OF LIABILITY Ih•ISIJRA,I'ICE
I TM3 CERTIFICATE 13 133UED .A3 A MATTER OF INFORMATION OHIS
NL'! .AND CONF RS NO RIGHTS UPON THE FF0RO CERTIFICATE HOLDER. IZ
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ERTI FICATE ODES NOT AFFIRMATIVEL( OR NEGA TIVEL'C AMEND, E"TEND OR Ai TER THE COVERAGE AFFORDED BY THE POLICIES
I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
[he terms and conditions of She?elicy, certain policies may require in endorsament. A itatamenF Dn:hi;ceniflcate does not confer rights;o ih.9
I IMPORTANT: if the cerfitl':a[a holder Is an ADDITIONAL INSURED, the pellry!iesj mus[oe indorsed. f SUBROGATION not confer r suhlect;e
jdertiocata holder'in lieu or such andorsemen[(sl' ',,D AcT .delissa 2flug
PRODUCER NTE: ?>i( tge61365-i?0'_
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11 'v7est Main StreeC AO[hi S9 NAICt
IN9URERISf AFFGRDiNG COVERAGE :24171
.1es r-�or�ugh MA 01531-1331 !NSURER a-Ne lierlands i?'.t139
INSURER B:Liber
INSURED b .IuYual/Peerless
ve•,�rpro Operating LLC ;NsuRERt Acadia Izvrance Co.
NsuRER D
23 Cedar S`
INsuRER=.
01301 INSURER=:
ISION NUMBER:
COVERAGES CERTIFICATE NUMBER:ems='= 15-15
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THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED,AMED AB FOR THE POUCH PERIOD
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INDICATED. ECT TO IAHICH THIS
NOTNRHSTANDING ANY REOUIRENIETMETERM OR
NSU RANCE ADITION OF ANY
FOROEO 3V 7HE POLON aCIES D SCR OR EBEOOHCE REIN S SUBJECTPTO ALL THE TERMS.
CERTIFICATE MA`! BE ISSUED OR MAY PERTAIN,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS 3HC"N MA`(HAVE 3EEN RE QUOI 1YPAIDC�PSi uMlTs
INSR, TYPEOF INSURANCE ! POLICY NLM9ER IMMIOOr II'• MMI001'PPrYI L,000,000
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WORKERSCOMPEN9AmON ! I L,PLH ACCIG@IT i 500,000
ANDEMPLOYERS LUBILITY
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+fry Poo I- IPAATNEPF_•r'-LTPiE —1 NIAI 511I2O1- 15/1/2017 I pISE aE-°A IP'JfE' S 500 000
F°_EPIbdENIRER GL iFC'I i I iC-20-20-003505-02 00 000
C (Mandatory in NH) I a I-DISEASE-P'LC'•-AMC I S 5
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OESCRIFITION OF OPERATIONS 1 LOCATIONS r VERICLES (ACOR0101.Additional Remarks&rtedul-may da attached if more apa
Excluded Officer: Nicholas Cogliani li
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES
WILL BE CANCEL
L D BEFORE
D0RE
THE EXPIRATION DATE THEREOF,
IN
To Whom it M COIICPSII ay ACCORDANCE WITH THE POLICY PROVISIONS.
AUSY.ORIZED REPRESENTATIVE
T _.LUfn;�1'DIiRBI3
OO 1998-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
MA Reg#146589 Contract Y-
RI Rea#0606216 d6wone Federal ID#20-2625129
RI Rea#26463 Home Ion o.ement sot tans
n
C0.Pnres HReGyiiml y.2fi Oadar Si,w::, I u1,(Pl 800 _TZt I r)Tat Bne-9-o2&,vrvavnavm,^n.ram � ���
;,op;,op '
THIS CONTRACT MADE THE - day of [„3(�" T_2T,_L((p— between, al� j(� aSs
-m1L—m -I-2c Zi{t
xcr Piro. A< ±C.,u al:a:ei
of3Z� 9kM/tI eSfl)GY*1 mA . /Z 9
(AJtlressl (QIhi �` ' �--
t°IWe) ��_ 2:ivv
GAG- IDG;LIC�� 1�a ny 1
the"Owner"and NEWPRO Operating,LLC,"N-cVJpRO". (E-Main) for proatotary use owy
NE WPRO hereby agrees that el`si j for the aonsiAern(inn ccreir efter rnewioned,furnish all labor and MOtarial nocEssRry to install the following
described work at the Premises located at:
tJaanddtast/
The lob address is a condomrnium.
TOTALS" NEWPRo I , y^ q tNINDOW OPTIONS`'
WINDOWS G� SERIES# V� i �`" /Y�rQ Gnds: YE'I NCl �,,ONInUR EOl t�rrEURO r-}np11,1ON0
Window color QTY Window color OTY OBSn'llp ca:o� `2TOP ,e+6UTTOM
z3s CY' } $CrER115: I.c�M ti$"vfp,S4'ntiMLl `�4gLF FULL
C� zit Vent Niches: t YES I_f NO
Capping Color DOORS MODEL OTY Relriliar:
PVC I k smooth N N.Capping setting Glass Ooor .�✓'V
MODE`NAME MODEL# OTY Call,
Dethle Hung tr— ID.b scllvs, LI r.ansr Rirn c ._ .,raga ie,ror,:,tr
2 be Slider HDVB: &tJ
3 Cite Sutler r e :n EntryI Style _ ^,cwruu ei.arcdmerar
3 Lite Slider n.. ,-
Casemenl(H gad RigMJ Color in: Ou'. mr I 'aFU x, U
FiberB ass Steel II I s:,a�so wmsm ,L.1. p
Casement(Hlnps;heft) HDWR: SN 66 d'.', AS ORg e r. iaioaip w I.,; p�
T1dn Casement Sideblea le e
StaGone Casement ly } rt.. n m,�• u.�c -
Caor In_ Oo:: ^^-
TripleCasemenl :::-.aa.-+ Storm Door St le _L i
CASH
TriP:e Casement f "l Color ei eo_ (/
Pirdura Window — -+rx J'aio lo:»u ns .nmo'amy, Y
HDWRt tiN Re SGa AB
oasis Orly _ L .Hinaa Hmnl Ringo. FINANCE
Hop er Entry Do style' L
e� �. 'mN eL m>la laicn
A.v11Rg color In: U.m - r
Cotten 1vindow ,_,ter _ TOTAL
B�/JJmdaw ao l ..Mfin How 3N 3s APB LeaLAP ORB CASH'
Co.ViradgW.goo.smm�' OUR Door Style PRICE
Other C w In. P.rt.T DEPOSIT (((Other DWR' WITH )
DESCRIBE WORK&PROM1dO'r06B APPLIED; 'Cc v t+,`Ll I rt ¢'j,411 ORDER
47Lte Y�ie�'G E TOTAL `
DUE AT
MSTALL
Esf..Sfad Date: t) T" /If Fs-Comp rare:1t, `1 ( —Cusomer;mlp.,,Wnds Bus is ar,astIrened date'
Owner has read and agrees to the terms and conditions on the front and the reverse of this Agreement. Owner
Specifically agrees to the(1)Total Cash Price;12)work being performed;and(3)work not being performed. Owner
understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been
orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the
date of this transaction and Owner was provided with two(2)copies of a cancellation form explaining this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY 13LANK SPACES.
(Rhode Island Sales Only): Notice to buyer: (1)Do not sign this r eexent if any of the spaces intended for the
agreed terms to the extent of then available info r t n ar y,a,(r 414-ndLu are entitled to a copy of this
Agreement at the time you sign it. (3)You may ai;S�{n O the full unpaid balance due under this Agreement,
and in so doingyou m �e y led to receive a partlial rebate of the finance and insurance charges. (4)The seller
has no ri ht to umaw)F I r our premises or commit any breach of the peace to repossess goods'purchased
under this Agreement. (5)You may cancel this Agreement if it has not been signed at the main office or branch office of
the seller,provided you notify the seller at or her main office or branch office shown in the Agreement by
registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on
which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.
Seethe accompanying notice of cancellation form for an explanation of buyer's rights.
(Rhode Island Sales Only): Owner acknowledges receipt of required Contractor's Registration and Licensing
Board consumer education materials.. (Owner's initials)
/,('}��n - ..
a _
ProduttSPedalle (PrlydetlN net �Dw,ter
N° ROO ating,LLC(9gnahuaJ O ne '
us Is WHITE Drmcn Copy YEUclic Cuetomel s r.'nny PINK 1.i Cdp, COLD:FlnadceCwy R[)]In
Sim .
Home Improvement Soluti&s CHANGE ORDER FORM
26 Cedar St•Woburn,MA•01801
781.933.4100• newpro.com
Customer Name: Job #:
r�
Job Address: Date:
Existing ntract Date:
�sJ 4- 0 9 70
Phone: rg New Estimated Start Date:
The undersigned hereby authorizes changes in w ork to be done as follows, and agrees that this
authorization shall become part of the original contract entered into between the"parties hereto and
shall be subject to all terms, provisions, conditions,restrictions and obligations of the original contract.
And, further agrees that all monies paid shall be first applied to the aforementioned additional work.
r .
{
J(j4?, )L41 .
I.tG� - t✓ "r/V6 I i EYZaY
~ k /n" e�2��ZtVl
Note: This revision becomes part of, and in conformance w ith, the existing contract.
WEAGREE hereby to make chances asspecified above, at the follow ing priii es:
Previous Contract Am t Revised Am t Addt'I Deposit Balance Due
'
Sale Representative Sig ature Date
ACCEPTED:The above prices and specifications of this Change Order are satisfactory and
are hereby accepted. All workto be performed under same terms and conditions as specified
in original contract unless otherwise stipulated. —
Date: V � Signature:
WD-029A