219 LAFAYETTE ST - BUILDING INSPECTION (2) f
The Commonwealth of Massachusetts RECEIVED r Board of Building Regulations and Standards INSPECTIONAL SU CITY
EPV M
Massachusetts State Building Code, 780 CMR, 7 edition Revise uary
Building Permit Application To Construct, Repair,Renovate /. 2008
°I tdrf0
One-or Two-Family Dwelling "u t )� A
This Section For Official Use Only
Building Permit Number: Date Applied: /S
Signature: ^la+w. �� ��
Building Commissioner/Inspect r of Buildings Date
SECTION 1:SITE INFORMATION
1.1 Prope Address: 1.2 Assessors Map&Parcel Numbers
�l T.
1.1 a Is this an acc ted beet?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
_ Zoning District Proposed Use Lot Area(sq it) Frontage(It)
1.5 Building Setbacks(ft)
t
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 Reco
f-)A It At dc
Name(Pont) Address for Service:
S ature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Pther JW Specify:
Brief Description of Proposed Worllz: '
[n to t nt 1 a Pt ! 91 t1 a o,LLL� IN J nt )s0
SECTION 4:.ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1.Building $ 1.-Building Permit Fee:$ - Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost;(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $ /)
4.Mechanical (HVAC) $ List: �/ n
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount: -
6.Total Project Cost: $
®� ❑ Paid in Full ❑Outstanding Balance Due:
C qN'�-� t 1 2-0 '1 Z57 i %A / 20
SECTION 5: CONSTRUCTION SERVICES
' 5.1 Licensed Construction Supervisor(CSL) `'s (-)I c)c)� �n
�- - l J� A ,V PJ 1 ��l `License Number Expim ion ate
Name of CSL-Holder List CSL Type(see below) U
Addres Type Description
U Unrestricted(up to 35,000 Cu.Ft.
R Restricted 1&2 Family Dwelling
i atu7e M Masonry Only
RC Residential Roofmg Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition -
��egistered Home lmprovemeo o�tractor(HIC) j
-I�C -C47om�pany Nam or HIG Registrant N e Registration Number
adres_ <l�cyct� l� ta . hNt / S
� . s cpiratio Date
'grra um elephonT e
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 ..........P No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
.
1, as Owner of the subject property hereby
authorize to act on my behalf, in all matters
relative to work aut ized by this building permit application.
ature of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
C
rbehalf.
112 21 dIZ. ,as Owner or Authorized Agent hereby declare
the statements and informatiorlon the foregoing application are true and accurate,to the best of my knowledge and
Print Name i
.Suture of caner orA on n Date-7—
(Signed under the rains and e a tie
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 110.R6 and 110.R5,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.Ft.) (including garage,finished basement/attics,decks or porch)
Gross 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"may be substituted for"Total Project Cost"
Department of Industrial Accidents
Office of Investigations
600 Mashington Street
Boston,MA 02111
tvrvw.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/EleetriciansiPlurnbers
Applicant Information Pleat Print I c t=ibh
Nattie (Bus 6Iess:�.-!rganizatioa'tndit ivuall:_-t-.�2 .�.(�V
Address:_:DsLo —
JZ�a''�--u�---itw�MSaA-Re.r _-----.. --
City/State/Zip:_ Phone 4:
Are you an rmplot er'. . ec U the.appropriate box: Type of project (required):
I an a cfttpktyc'r with_. 4. ❑ I ant a gcnetal contractor and 1
rurployres(lull and:br part-11 16." have hired the sub-contractors 6- ❑ New construction
2[] 1 ;un a sole picipriclor or pan.ncr- listed on the;coached shcet 1 7. ❑ Rrmodchug
,hip and have no cmployces Those sub-contractors have S. l._J Demolition
working for me in any capacity. workers' comp, insurance, 9, Demong addition I
[No workers' comp. insurance 5. ❑ We arc a txJr)mration and its 4
required.] officers have exercised their I0.[] Electricalrepairs or additions
3. I am a homeowners doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. (No workers' comp. c. 152,§1(4), and we have no to
RoofrtpaJrs
instuancc required.)t cmployces §cruets' *� _
comp. insurance rtgttfred] 13 0 Other
Any sPPlicmr thus chrek>Iva 41 mnet,ds0 WI opt the th it workers'corz>Frnmtiuo IwdicY•inf rmwtioa
t Homeowners t th sulmnf[his nihd+ntt ched mg tiny ere doing nli work cold ttn:n hire outside Curthydurs m,ut sul'n trit a pen nfJ itLrrii indices ing such iConlleclors Ihnl check this b+a mubt attached nr,xdditionnl;Lett showing the name of the sul*ceuttuctcrs xnd their warkcts'tong.,ywiicp infornrstir+n.
I am an entplgrer that is providing workers'compensation insurance for n!V employees. Below
information. is the policy m:d•job sire
Irutfrance Company Namc:_0A_V4_ A A S� 1 A- fo
Policy k or Self-ins- Lie, il: �— `-OA_aI la N Expiration Date:_
Job Site Address:
'—1 t z1 \Cit;/StateiZip:...
Attach a Cory of the workers, compens tion policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required trader Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine UP to$1,500.00 and/or one-year imprisomnent, as well as civil penalties in the fonn 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 D1A for insurance coverage verification.
I do hereby cerrrfy rn er the pains and penalties a pepurJ•that the information provided above is true and correct.
Signature: _— Date: �/ / / _7') --
Phone#___��
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: PermitJLicense#
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3.Cityr town Clerk 4.Electrical inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#'
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aOMEIMPROVEME14TCONTRACTOR
r egistmUOM 128634 Type:
Expiration: 502015 DBA
ED BYRNE WINDOW CO
EDWUND BYRNE
756 WESTERN AVE
IYNN, MA 01902 _ UVdtrsecretsry
i
E" E.B. Window and Sidinq Co. Proposal
756 Western Ave. (Rt 107)
Lynn MA 01905 Date Estimate#
11/15/2014 42736
Name/Address Ship To
Brandon Tarricone 219 Lafayette St
22 Sylvia Rd. Salem, MA
Peabody, MA 01960
504-913-4254
Rep
Description Qty Cost Total
Furnish and install 36 Doublehung Replacement Windows. 0.00
Windows to have Low E/Argon Gas and a.30 U Value.
Remove existing windows and prepare opening to accept new vinyl 0.00
replacement windows
Insulate weight pockets 0.00
Seal Windows in and out using Tite bond lifetime sealant 0.00
Cover exterior casings with custom bent aluminum - 0.00
Take away all job related debris 0.00
All windows are to have Low E glass,Argon Gas and carry an 0.00
Energy Star rating
Any building permit required to complete project to be added at cost 0.00
to the final payment
Total 24 windows in stock. Will install first phase. 12 Windows
installed on 2nd phase.
0.00
acceptance of proposal
authorized signatureb
deposit at start of job_$500 .00
balance on completion_$5000.00+permit fee
Install Windows 10,000.00 10,000.00
Thank you for your business.
Subtotal
Sales Tax (6.25%)
Total
Phone# Fax# E-mail Web Site
781-592-9747 781-592-9746 ebwindow@msn.com www.ebwindow.com
Page 1
E.B. Window and Siding Co. Proposal
756 Western Ave. (Rt 107)
Lynn MA 01905 Date Estimate#
11/15/2014 42736
Name/Address Ship To
Brandon Tarricone 219 Lafayette St
22 Sylvia Rd. Salem, MA
Peabody, MA 01960
504-913-4254
Rep
Description Qty Cost Total
All Window to carry a lifetime warrantee to the original owner 0.00 0.00
including glass failure and breakage
All Windows to carry a 10 yr warrantee on Labor to original owner 0.00 0.00
Thank you for your business.
Subtotal $1 Q000.00
Sales Tax (6.25%) $0.00
Total $10,000.00
Phone# Fax# E-mail Web Site
781-592-9747 781-592-9746 ebwindow@msn.com www.ebwindow.com
Page 2
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TeSt Method: ---
AAMA/WDMiVC SA 101/1S.2/A440-08
and CSA A440£1-09 -
Max Test Size 5D(96 - — - -
-_—_.-_
Window Size:.17.ix52.25
PG30 —— 214-900767
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HI_SIOE
NFRCJ WJNuC)W COMPRNY
MODEL L20! - DOUBLE HUNG
Narmal Fenestraihr CPO' Rf.P-9-11-05982-00002 "
Rating Councim SOLID UINYL — UELUED — DOUBLE GLZD
3/4 IG. SS LO—E. RRGON, GRIOS < 1"
ENERGY PERFORMANCE RATINGS
U Factor Solar Heat Gail Coefficient
0 . 30 , 1 . 70 1 0 . 28
(U.5. (WtOC/S �.
AL?DITICINA,'. PERFORMANCE RATINGS
IeTransmittance
0 . Ei0
Manufacturer Stip
ulates ates that l�_,P ...e safie d c rmizirm fn applicable NFRC procedures for tleterminin whole
product performance.NFRC r ring;are omin'i�red h,a fired set of em"irenmental conditions and a ot=
specific product size.NFRC dr snot c=emnmeud any product and does not warrant the suitability of any
product for any specific use C,nsu't manufacturers to Other product Performance information.
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Salem Deeds - Deeds Online Page 1 of 1
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