462 LAFAYETTE ST - BUILDING INSPECTION (2) f k F
The Commonwealth of Massachusetts CITYBoard of Building Regulations and Stsoxfj�s 0£C 1 9 �
Massachusetts State Building Code,780 CMR A 11:
Lied Mm�2011
Building Permit Application To Conshuct,Repair,Renovate Or Demolish a
One-or TWo-FomilyDwelling
�- This Section For Official Use Only
Building Permit Number: Date Applied; _
V� Building OfSctal(Print Name) Signature Dade
v SECTION 1:S11`E INFORMATION
1 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
462 Lafayette Street 31-0231-0
l.la h this an accepted siraW yea X no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
R1
Zoning District Proposed Use Lot Area(sq ft) Frontage(it)
1.5 Building Setbacks(8)
From Yard Side Yards Rear Yard
Required Provided Requited Provided ItNuired Provided
1.6 Water Sapply:(M.G.L a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public O Private 0 Zone: _ Outside Flood Zone?
Check ifyoD Municipal O On site disposal system O
SECTION 2e PROPERTY OWNERSEIP1
2.1 Owner'of Record:
Nicholas Mosher Salem, MA 01970
Name(Prim) City,State,ZEF,
462 Lafayette Street 978-270-1172 nicholas.mosher@gmail.com
No.and Sweet Telephone Email Address
,SEA`-d„ION 3:DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction 13 Existing Building W Owner-Occupied ® 1 Repairs(s) Cl I Ahandion(s) ® I Addition 13
Demolition 17 Accessory Bldg.13 Number of Units Of= m specify.Reolacement
Brief Description of Proposed WW: Repiacement of 15 windows
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Cow: Official Use Ouly .
and Materials
1,Building $ 26443.00 1, Building Permit Fee:$ Indicate]row flee is determined:
2.Electrical $ 13 Standard City/Town Application Fee
n Total Ned Costa(Item 6)x multiplier x
3.Plumbing $ 2- Ofer Fees: $
4.Mechanical (HVAC) $ LiaL
5.Mechanical (Fine $Sion) Total All Foes:$
Check No. Check Amount. Cash Amount:
6.Total Project Cost: $ 26443.00 13 Paid in Full O Ot#siandmg Balance Due:
12�\q MrafL-s TtjGC itJSAS&
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
90125 10-06-18
Jamie Morin License Number Expiration Date
Name of CSL Holder
List CSL type(seebelow) U
30 Forbes Road
No.and Street Type Deaeripton
Northborough, MA 01532 U Unrestricted to 35,000 ea.R
R Restricted lt2 Family Dwelling
Cityfrown,Stela.ZIP M — Masonry
RC Rooft Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
508-351-2244 rbabostobpermitting(aandersencorp.com I us
ulation
Tel hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 170810 12-23-17
Renewal by Andersen IBC Re gr
HIC Company Name or EEC Registrant Name Mon Number Expiration Date
30 Forbes Rd rbabostonpermitting@andersencorp.com
Nortthhborrooutgh, MA 01532 508-351-2244 Email address
city/Town.Stft ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.0.ISL g 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Faihre to provide
this affidavit will result in the denial of&a Issuance of the building permit.
Signed Affidavit Attached? Yes..........M No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED W1M
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I as Owner of the subject property,hereby authorize Jamie Morin
to act on my behalf;in all matters relative to work authorized by this building permit application.
See attached contract 12/08/16
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWMW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury,that all of due information
contained in this application is tm and- to the best of my knowledge and understanding.
Jaime Morin 12/08/16
Prim Owner's or Authorized Agont's (Electronic Signs=) 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(fBQ program),will not have access to the arbitration
prog ire or guaranty fund under M.G.L.c. 142A.Other®portaot information on the HIC Program can be found at
www.mess.aov/oca Information on the Construction Supervisor License can be found at www.meall.lov/dce
2. When substantial work is planned,provide the information below:
Total floor 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 Opce
3. "Total project Square Footage"may be substituted for'Total Project Cost"
CITY OF SALF1*4 ZVLASSACHUSETTS
BtatmmG DEPAaTmENT
130 W.UHINGTON STEM,r PLOOR
TEL(976)745-9595
PAX(978)740-9946
KIMSERLLY DRISCOLL
MAYOR THOMU ST.PMUE
DIBE=iL OP PLvx PaoPERw/iiLlmmG comas OVER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Coda 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 buisported by:
Renewal by Andersen
(acme ofhaoler)
The debris will be disposed of in:
Renewal by Andersen
(name of iheility)
30 Forbes Rd, Northborough, MA 01532
(oddtm of facility)
signs emdtapplicaut
12/08/16
date
debrintfdoc
Renewal Agreement Document and Payment Terms
byAndemri. dby Renewal by Andersen of Boston Nicholas Mosher
Legal Name:Renewal by Andersen LLC 462 Lafayette Street
HIC#170810 Salem,MA 01970
niaoon se usenrsr 30 Forbes Road I Northborough,MA 01532 H:(978)270-1172
Phone:508-351-22001 Far:(508)986-7072 1 RbABostonOperations®AndersenCorp.com
Buyer(s) Name: Nicholas Mosher Contract Date: 11/19/16
Buyer(s)Street Address: 462 Lafayette Street, Salem, MA 01970
Primary Telephone Number: (978)270-1172 Secondary Telephone Number:
Primary Email: nieholas.mosher®gmail.eom Secondary Email:
Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen LLC d/b/a Renewal by
Andersen of Boston("Contractor'),in accordance with the terms and conditions described in this Agreement Document and Payment
Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which
are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement").Buyer(s)hereby agrees to sign a
completion certificate after Contractor has completed all work under this Agreement.
Total job Amount: $26,443 By signing this agreement,you acknowledge that the Balance Due,and the Amount
Financed must be made by personal check,bank check,credit card,or cash.
Deposit Received: $0
Balance Due: $26,443 Estimated Start: Estimated Completion:
Amount Financed: $26,443 B-10 weeks 3 days
Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on
the date in which we complete the technical measurements.The installation date that
we are providing at this time is only an estimate.We will communicate an official date
and time at a later date.Rain and extreme weather are the most common causes for
delay.
Notes: GS 1162 1/3 $8,814.33; Start 1/3 $8,814.33; Sub comp 1/3 $8,814.33
Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal
understanding changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid
without the signed,written consent of both the Buyer(s)and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this
Agreement,understands the terms of this Agreement,and has received a completed,signed,and dared copy of this Agreement,including
the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this
Agreement.
NOTICE TO OWNER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign.
YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT
OF 1 1/23120 16 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION,
WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN
EXPLANATION OF THIS RIGHT.
Legal Nam=Renewal by Andersen LLC Royals)
dba:Renew b An n of Boston y �J
Signature of Sales Person Signature Signature
David Barry Nicholas Mosher
Print Name of Sales Person Print Name Print Name
UPDATED: 11/19/16 Page 2 / 25
Renewal Itemized Order Receipt
byAndemm dba:Renewal by Andersen of Boston Nicholas Mosher
Legal Name:Renewal by Andersen LLC 462 Lafayette Street
HIC#170810 Salem,MA 01970
WINDOW as uc..eN• 30 Forbes Road Northborough,MA 01532 H:(978)270-1172
Phone:508-351-2200 1 Fax:(508)986-7072 1 RbABostonOperations®AndersenCorp.com
a- ee DETAILS:
101 Living Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: Stone,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Misc: Casing Exterior - Maintenance
Free, Casing Exterior- Maintenance Free
102 Living Window: Picture, Insert Frame, Traditional Checkrail, Exterior
White, Interior Pine, Glass: All Sash: High Performance
SmartSun Glass, No Pattern, Grille Style: No Grilles, Misc:
Casing Exterior- Maintenance Free, Casing Exterior -
Maintenance Free
103 Living Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: Stone,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Misc: Casing Exterior- Maintenance
Free, Casing Exterior - Maintenance Free
104 Living Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: Stone,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Misc: Casing Exterior - Maintenance
Free, Casing Exterior - Maintenance Free
UPDATED: 11/19/16 Page 4 / 25
Renewal Itemized Order Receipt
MAndemen. dba:Renewal Andersen of Boston
- bS• Nicholas Mosher
4� Legal Name:Renewal by Andersen LLC 462 Lafayette Street
HIC#170910 Salem,MA 01970
.usn. se uos.esr 30 Forbes Road Northborough,MA 01532 H:(978)270-1172
Phone:508-351-22001 Fax:(508)986-7072 1 RbABostonOperations®AndersenCorp.com
a • O• DETAILS:
105 Dining Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: Stone,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Misc: Casing Exterior - Maintenance
Free, Casing Exterior - Maintenance Free
106 Dining Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: Stone,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Misc: Casing Exterior - Maintenance
Free, Casing Exterior - Maintenance Free
107 Stair Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Tempered Glass,
Hardware: Stone, Screen: TruScene with Exterior Color
Match, Full Screen, Grille Style: No Grilles, Misc: Casing
Exterior - Maintenance Free, Casing Exterior - Maintenance
Free
201 Bed 1 Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: Stone,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Misc: Casing Exterior - Maintenance
Free, Casing Exterior - Maintenance Free
UPDATED: 11/19/16 Page 5 / 25
Renewal Itemized Order Receipt
byAndemrL dba:Renewal b Andersen of Boston
y Nicholas Mosher
Legal Name:Renewal by Andersen LLC 462 Lafayette Street
HIC#170810 Salem,MA 01970
WINDOW Nc uatMNNt 30 Forbes Road I Northborough,MA 01532 H:(978)270-1172
Phone:508-351-2200 1 Fax:(508)986-7072 1 RbABostonOperations®AndersenCorp.com
a • ROOM:
202 Bed 1 Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: Stone,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Misc: Casing Exterior - Maintenance
Free, Casing Exterior - Maintenance Free
203 Bed 2 Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: Stone,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Misc: Casing Exterior - Maintenance
Free, Casing Exterior - Maintenance Free
204 Bed 2 Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: Stone,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Misc: Casing Exterior- Maintenance
Free, Casing Exterior - Maintenance Free
20S Bed 2 Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: Stone,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Misc: Casing Exterior - Maintenance
Free, Casing Exterior- Maintenance Free
UPDATED: 11/19/16 Page 6 / 25
Renewal Itemized Order Receipt
F7N IdemrL dbu Renewal by Andersen of Boston Nicholas Mosher
X.....
legal Name:Renewal by Andersen LLC 462 Lafayette Street
HIC#170810Salem,MA 01970
30 Forbes Road I Northborough,MA 01532 H:(978)270-1172
Phone:508-351-2200 1 Fax:(508)986-7072 1 RbABoston0perations®AndersenCorp.com
x • a• DETAILS:
206 Bed 3 Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: Stone,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Misc: Casing Exterior - Maintenance
Free, Casing Exterior - Maintenance Free
207 Bed 3 Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: Stone,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Misc: Casing Exterior- Maintenance
Free, Casing Exterior - Maintenance Free
208 Bath Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, Exterior White, Interior Pine, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Tempered Glass,
Hardware: Stone, Screen: TruScene with Exterior Color
Match, Full Screen, Grille Style: No Grilles, Misc: Casing
Exterior- Maintenance Free, Casing Exterior - Maintenance
Free
WINDOWS:15 PATIO DOORS:0 SPECIALTY:0 MISC:0 TOTAL $21
Renewal by Andersen is committed to our customers'safety by
a� complying with the ruler and lead-safe work practices specified by the EPA.
UPDATED: 11/19/16 Page 7 / 25
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Expiration: 12/23/2017. Supplement Card
RENEWAL BY ANDEkSON L .C.
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