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481 LORING AVE - BUILDING INSPECTION i fLO61 WIDEfKfi9yWD APPROVED f3Y im pmpj I B FWA TD A P.Ef31 T BEING GRANTED CITY OF_SALEM in laoatum ft- M 'F [Y,~ Yq _No_ no""" �-Lea � rl Is Piawly Loaabd In ass Ca =rA*n Am? Yaq.No BU LD" PER W APPNCATION F Parma to: (Circle +w Whowr apply) Hoof ReW lrwW SWWO COnWW 0" Shed, Pool, Rpawfiloplaoa• Odw. PLEASE RLL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESBMW TO THE INSPECTOR OF BU LDING& The wrdaraWsed hereby aWI w for a W t to buNd aowxft to ttw bNovW9 opeckadow OWWs Nam. Plwlely&"t C006"j Address & Phone ge/ Logn✓Gfw6 jSdY177y gGoy ArdAea's Nww Address & Phone f 1 Machanim Name PmQyl P&s WT SY Feet - DAXIaI Address & Phorw 4/o7'ao*jei&Sr ('4„n6 A k&V L,1r/ 18L/10060 No is an wpm a bWWYIp? SlvfrcFl io+[y wWW Of b~ II a dwaanp,for how mmy b mi"? L/_ MIN b A ft omdaml to law? Aft"? 77t2t�mvummo N� X Lie. I of Applicant SIGNED UNDER THE PENALTY OR PAY DESCRIPTION OF WORK TO BE DONE F,N,sK Bv6weAlr' AS/:i4 & 4gow1914 &6f'm .rSYSn�, 3r4 sairr l— Zy7(2U� UQ�� l Ele14V& G/NISW f 7 169m n de U,SW RS 49 MNL TO 9Go ? Rr�6 s1' zoz No. d1 APPLICATION FOR PERMR TO --No eSfiv� l�o�rrc ,¢cc �a — LOCATION PERMIT GRANTED dJP�em�,c�.F CF 2.0 Dom' APPROVrED OF BALD OS " 1 4 - CITY OF SALEM9 MASSACHUSETTS • PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM. MASSACHUSETTS 01970 STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380 MAYOR FAX: 978-740-9846 Salem Buildina Department Debris Disposal Form In accordance with the provisions of MGL c40 S 54, a condition of your Building Permit is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL Chapter III, S 150 A. The debris will be disposed of in: 000'&'Y L'63&ot (Location of Facility) fignatuXreof Applicant Date CONTRACT Customer Name �hor no/ /Cn �us Customer Signature L��✓ SKETCH Contract Date G Sales Representative Signatur ATTACHMENT Customer Phone / 78 7-/W 4170SZ Contract Price a0 779 t Y, 13 n p ., u I---- — c�Fllnaz•. I l s, �� — tv� Y> -Q — as - t �� + 7 j 13 1 �I_ 1. 1 I r V00k' — 3 -4 fi — �— z: ----- --------- -i------ m b -+ - NOTES: h t - - t 1 j �oo.? m W 'Each box equals one foot unless otherwise noted.This sketch is a good faith representation of the work to be done, it is understood that all dimensions �J eJ.NOV derived from this sketch are approximate,and Mat all locations of outlets,light fixtures,plugs,jacks and/or switches are subject to Chang¢it necessary. CONTRACT Customer Name Ph0r nq/ /C" 4es Customer Signature_ SKETCH Contract Date 97Jgc/f o Sales Representative Signature _er ATTACHMENT Customer Phonel 978 7-�W 41 70!f Contract Price 5"0779 avmnfad pt n+ T ,5 16 R - -- c,I k I.% I I _I If 71 17 27 3 � i f I r o d — I � I 4 �4 �! — -- s-- - E — —.� — - NOTES: t - t 1 i y¢? .n Each I equals one loot unless otherwise noted.This sketch is a good faith representation of the work to be done,it is understood thal all dimensions derived from this sketch are approximate,and that all locatlons of outlets,light fizMes.plugs,jacks and/or switches are subject to change 0 necessary. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 WJ www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): oWeWS CORNING BASeMekIT SYSTEM Address: 9(,,D 'Tit,eA)PI KE STKEC-7- City/State/Zip: ( fAV 74A) - Phone#: 7Yl'921-0a6 Are you an employer? Check the appropriate box: Type of project(required): 1.9 I am a employer with 2-1 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t ?• Remodeling 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 required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.[:J Roof repairs insurance required.] t employees. [No workers' camp. insurance required.] 13.❑ Other *Any applicant that checks box#I must also fill out the section below showing their worker;'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, tContmctors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ,^ Insurance Company Name: �g(ry A�u72tRL Policy#or Self-ins. Lie. #: W C 2 -315-.344359^ OIS- Expiration Date: $'Zq.O6 Job Site Address: 4P tDIUAIC Ave City/State/Zip: t Mug Of 76 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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. I do hereby ify=Mr. aides ofperjury that the information provided above is true and correct Si ature. �,! Date: L D�'OJr Phone#: IL'?/'Q0o0 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# 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#: '•OS/26/2005 13:04 FAX 1 791 659 472S Andrew G Gordon Inc 1&001 --- �r cvr avers 1G:LJ PAGE 002/002 ILK) I3terty Mutual Gnap HINWtv PO Bo:7202 Por mwWk M&UO2-7202 Tcleptse(800)653-7893 j Faa(W3)431-5693 i Mmy26,2005 i NAUGHTON CO 960 TURNPM ST CANTON,MA 02021- RF— CertificateerrWmlc Csmpemcdj=Inawrafce Iavarede OWENS GDORKM FDMBED BASEMENT %0TIIIRNFDMST CANTON,MA 02011 Po6ryNomber WC2-3IS-3443SMtS Effacfim 524aW Eipeaum 5242006 Coverage affadcd NOW WatmCmpCOafim Law of&c&Swiw6stal,(* MA Emolwvs liaEiffr Bad;lyhjusyByAeeidse S 50Q000 Each Accident Bod5ly7ajmybyDiwam S SOQ000 Eme1kro m BodIIy3ymybyDfwa= S 500,000 PoSglm;as Asd6ia4ad;meaboro poieyl,aidermmacd LyL-6rriy]fwhmlFae LfmaneeCemdri like polity Tirled sbmm, The msmamm afforded bydLe rated poieyis sabject to all the tans`cadmaaes and emadifiamr,and is mot altemd bya"ragmavenk term or em6fim damyor od =doeuumuts sink loped to*me&his macate mayDnasoed. This cm"cdc is armed as a saWQ dmbmmm omlyaad cmf®mmri jt wpm yv%6eeafilvile holder. IbisomhfiWeisandmlaammcopoieyamddo aAanaemdritmd,oraberthemv�a�atiadedby6e Paley listed ab ro— If his policyis eaccaod be5aethe stated eapeat"date LbatyMasat and adearar a nofityyyuw dsmch nmo�mim. l AMR)R MaDVMWA7IVE 1A9MYl4LUn4GIIBIiAmM Qea1P iLeaib6aey[lFIIT1QfIwu.rtaQAREe�Oor��gsay�eaid�Iy���lrt x lmmed: PtodocaofRoDord: OWENS CORMOG FINISWM BASEMENT ANDREWGGORDONTNC 960 TURNPBX Sr P O BOX 29,9 CANTOK MA 0=1 NORWETZ,MA 02061 05/25/2005 TAR 12:35 ITI/YX N0 5144I 0002 . .., , .acoRo' CERTIFICATE OF LIABILITY INSURANCE °"'06/1910S BAYST 1 OB/19 OS !RDDIxEN THIS CERTIFICATE IS ISSUED AS A NATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Raplansky Insurance Brookline HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 114 Harvard Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Brookline INA 02446 Phone:617-738-5400 Fax:617-738-8214 INSURERS AFFORDING COVERAGE NAIL9 NNMAEn INSIAERA Norfolk 4DedhaIN Group 13943 INS1XtER B� pp§sfate Basement System LLC wsratc D B/A Orwnepns Corning Finishing 960 Turnnpi02021 '�D Canton HIL ' INSIAER E: COVERAGES TIE POLICES OF N9JWJCE LISTEDBF10WHAVE BEEN ISSm TOTIE rtsrmrvN,En ABOVE fOR THEPOLICYPERIW f ATED.NOTWn6ADW ANY RERTAKTE.TERMORC RIONOF THE POLI SOROIIEft°OCWFNf WDNECT TO A TOE M; *. CERDPIGTEAAY BE 6Y mOit MAYPERTaG,REATE L MNCE SHOW�ORN A H VE POLICIESDESCMDED HEREIN oMA&5SLBJECT TO ILL THE/EMAS.EkLLUC.IONS AND COIDRIONS OF SUCH POLICES.AGGREGATE LABS 3pYNt MAY fNYE BEEN REd1Cm BY PNO CUSAS. LTR T OF NDURANCE NWULYNUNBER DATE(11101.Y) DATEPAWODYPN - LAArs GENERAL LOBOMY EAcHoCDnRENCE f 1000000 CONTERCCM G ON E,ERA LLIIY PREMISES E..vvece f 100000 �Aswm ❑occR MEDEXPWNNrf ) f 5000 A X Business Owners R0309626 02/10/05 02/10/06 PERSONAL a ern BLAAtY f 1000000 GENEROLACG EGTE f 2000000 GENLAGGREGAIELAVTAWP PER: PRODUCTS-COMPIOPAGG $2000000 EU AUTOMORLE LPAI CAFSPED SOIGNE LINT = ANYAUTO IEI ScdOxlj ALL OWIEDAUOS IXXXLY rum F SG®IAfDAU IPV INrs.0) NPFDAROS BOULY rum f NON-0MIEDN/R),B (P.rAW ONq PROPERTY o~GE . (PPx opm GARAGE UASM AUfOO1Y-EAAmDEE f ANYAM EAAGC OTHER THAN AUTO O.LY: AGG EXCESSAA48REIlA IABlf1Y EAGII ocmmwf f Occul CLAIMS MALE AGGREGATE f f DEDUCHWE f REHMPON f = WDW®t6 COMPENSATION AND EPL01T3tS UmmffV' TORY LRRTS ER ANYPR0PRlM0RIPNNlEME)ECUfNE EA.EAONADDDEE f 0FFKBVMEM0ERE)QIDED? ELME/SE-EAEMPLOYEE f %r yes 0.axi.IIYM! SPEI]A PRONSIO16 pN.N - E.L.DLSFASE-POLICY LIMB i ORIEL DESCRPIION OP OPERATIONS/LOCATIONS/YEMX:LES I EXCLL510f15 AOOEO BY ENDORSBiCNTI SPECML PROVLSIONS CERTIFICATE HOLDER CANCELLATION SIIOUD ANY OF TIE ABOVE DE3CR0®POl)CES BE CINCEl1F9 BEfORE TIE EIIPMTgN DATE TIEf .TIE MWNG RISUER ALL ENDEAVOR TO NAL 10 DAYS VmTrE1 NOTICE TO THE LHTIEICATE HOLDER NAMED TO THE LEFT.SW FALIIRE TO DO SO S L r.PO3E NO OBLX AWN OR IMBIITY OF ANY MND UPON THE WSIIRER,RS AGENTS OR REPRESENTATNES. THE AC C ACORDCORPORATION1988 II BOCA International Evaluation Report 0 oi' ICI pt/0 A 1111141� - evaluatlo scope condition of use Research Report Cotnphance with the followhig codes This report is limited to applications and 21 .24 ',B6CANati6nal Burldtn ,Cbde11999 ' products as stated herein. BOLA-ES intends that this report be used by the code official to ■ .Section8032Classi5cahon determine that the report subject complies with �.,Section 803:6 Carpet and carpet=like the code requirements specifically addressed, MANUFACTURER: ` wa1L coven_ngs ` provided that this product is installed in accor- eohon s ""� dance with the following conditions: OWENS CORNING `5 706. Al 4 ternative matenals - and equipment ■ OWENS CORNfNG Basement Wall Finish- ONE OWENS CORNING PKWY ■ .Section 2603 7lntenor tnm ing SystemTM is intended for finishing walls TOLEDO,OHIO 43659 in basement applications.Other applications e -SectJnn 1301.1 3cope,( nergy are outside the scope of this report. ".,conservation] DIVISION 7—THERMAL AND ■ The maximum permitted area of the PVC MOISTURE PROTECTION 199$Intern udonal One-"arzd 7ivo moldings shall not exceed 10 percent of the {amity Dwllmg Cade aggregate wall and ceiling area of the room. Section 07200—Insulation ■ Section 31 81 Wall and Cerhng ■ Installation of the Basement Wall Finishing (flame,spreatimdex) SystemTM shall be in accordance with this ■ Seenoa318.2 Smoke=developed report and the manufacturer's installation DIVISION 9—FINISHES index manual. Section 09540—Special Wall a� Secfion 3183 Tes$ng,;; ■ Basement Wall Finishing SystemTM shall be Surfaces installed over cast-in-place concrete or concrete masonry unit walls, or wood or description metal stud framing. Supporting structural EVALUATION SUBJECT: systems shall conforming to code require- OWENS CORNING Basement Wall Finishing ments for that system and are outside scope BASEMENT WALL FINISH SystemTMisanaltemativetoconventionalwall of this report. SYSTEMTM framingand gypsum wallboard.TheBasement The electrical wiring in the chase at the Wall Finishing SystemTM consists of PVC the Basement Wall Finish Sys- support lineal , base, batten, and cove mold- bottom of temTM shall conform to the requirements of ings, and rigidd prefinished fiberglass panels. Panels are prefinished with a fabric cover. the code and is outside the scope of this Basement Wall Finishing SystemTM is primar- report. ily intended for installation in residential applications. Refer to Figure 1 at the end of items requiring this report for illustrations of the Basement verification Wall Finishing SystemTM. The following items are related to the use of the The Basement Wall Finishing Systeni''M shall report subject, but are not within the scope of be installed in accordance with the manufac- this evaluation.However,these items are related turer's installation instructions and this report. to the determination of code compliance. Installation typically consists of either me- V Concealed electrical,mechanical,orplumb- charucal fasteners or adhesive fastening or a ing components shall be inspected prior to combination of both to the supporting sub- the installation of the Basement Wall Fin- strate. Thermal resistance (R-value) for the ishing SystemTM panels to verify compli- fiberglass panels is 11. ance with related code requirements.Evalu- Basement Wall Finishing System*"+ panels ation of these components is outside scope meet the requirements for classification as a of this report. PRINTED AUGUST, 2000 Class I interior finish as tested in accordance ✓ Framing supporting the Basement Wall with ASTM E84 and also has demonstrated Finishing SystemTM shall beinspectedprior Page f of 2 that it will not spread fire to the edge of the to the installation of the panels to verify Copyright02000, specimen or cause flashover in the test room in compliance with related code re uuements. accordance with the testing requirements Evaluation of this framing is outside scope BOCA Evaluation Services, Inc. specified in Section 803.6(2) of the BOCA of this report. C- A Participating Member National Building Code11999. of the NES, Inc. Page 2 of 2 Research Report No.21-24 information submitted product identification ■ IntegrexTM Testing Systems,Report No.73143,dated April 17, All OWENS CORNING Basement Wall Finishing SysterrsTM 2000,containing results of physical testing. manufactured in accordance with this research report shall bear ■ IntegrexT"' Testing Systems, Report No. C423-99065, dated the following identification: August 19, 1999,containing results of physical testing. ■ "See BOCA Evaluation Services, Inc. Research Report No. ■ Omega Point Laboratories,Report No. 13060-103216a,dated 21 24. May 14, 1999,containing results for fire testing in accordance r with ASTM E84 for rigid fiberglass wall panels used in All Moldin Basement Wall Finishing SysteraTM, Snaps g nto Existing Foundation Wall ■ Omega Point Laboratories, Report No. 16218-106644,dated PVC or Interior Partition April 13,2000,containing results for firetesting inaccordance Support '. with ASTM E84 for moldings used in Basement Wall Finish- Grid ing SystemTM. ■ Omega Point Laboratories,Report No. 13060-103213a,dated 2.5"Glass `. June 7, 1998, and Report No. 13060-104470a, dated March Fiber Board '. 24, 1999,containing results for fire testing for full-scale room Panel with corner testingin accordance with requirements Facing t ements contained in PV 9 C Section 803.6(2)of the BOCA National Building Code/1999. Cove PVC Su Molding ■ OWENS CORNING Product Literature, dated May 1998. up Lineal ■ OWENS CORNING Submittal Sheet for Basement Wall (top, bottom, Finishing System (BWFS), dated April 2000. vertically ■ OWENS CORNING Basement Wall Finishing System every 48") Installation Manual, dated January 2000. application for permit To aid in the determination of compliance with this report,the PVC following represents the minimum level of information to Molding accompany the application for permit: Vertical PVC Batten Molding ■ The language"See BOCA Evaluation Services,Inc.Research Base Report No. 21-24"or a copy of this report. - ■ Plans indicating the aggregate area of the room and the area of the PVC moldings being used. Figure 1' ■ Plans and specifications of any electrical, mechanical, or Sketch of Basement Wall Finish SysteraTM Showing Typical Components plumbing items installed within the wall system. 'THIS DRAWING IS FOR ILLUSTRATION PURPOSES ONLY.IT IS NOT ■ Details and specifications of the supporting construction to INTENDED FOR USE AS A CONSTRUCTION DOCUMENT FOR THE which the system is to be applied. PURPOSE OF DESIGN,FABRICATION OR ERECTION. NOTICE TO REPORT USERS This report is subject to annual certification.Reports that are not certified shall not be used or referred to.To determine the status of certification of this report,contact BOCA Evaluation Services,Inc.,or consult the latest edition of the BOCA International Product Evaluation Listing published periodically in the BOCA magazine. This report is subject to the conditions listed herein and to the specific product,data and test reports submitted by the applicant requesting this report. Independent test were not performed by BOCA Evaluation Services,Inc.and BOCA-ES specifically does not make any warranty,either expressed or implied, as to any findings or other matter in this report or as to any product covered by this report. Evaluation reports are not to be construed as representing aesthetics or any other attributes not specifically addressed nor as an endorsement or recommendation for the use of the report subject.This disclaimer includes,but is not limited to.merchantability. Please contact BOCA Evaluation Services,Inc.,with any questions you may have regarding this report.Additionally,please contact us if you have any information on the performance of the product described herein which is contrary to this report. 4051 West Flossmoor Road•Country Club Hills, IL 60478-5795 telephone (708) 799.2305•fax (708) 799-0310 e-mail: boca-es@bocal.org 0 http://www.bocai.org �` ✓fie .-P o���!a�czc��u�Ge� Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 137943 Type: Supplement Card Evkafi= 1292007 OWENS CORNING BASEMENT FINISHING DANIEL WALSH 960 TURNPIKE ST. CANTON, MAU2021 Update Address.and return card.Mark mason for ehang SCA7 6 50Y0401G101278 Address Renewal ❑ Employment Lost Card 1k 7L1o1�Nlt0/rlLGafUi� a10 Board ofBaWag Regulation and Sh.dards License or registration valid for iodWal use only HOME IMPROVEMENT CONTRACTOR before the expiration data If found return to: Roy�d0p'N 137943 Board of Building Regulations and Standards One Ashburton Place R 1301 � pB`—.�Card Basfoa,Ma 0210g OA6 & owENs coRNMG nsEbi 10 CANTON,MA02021 Administrator Not valid without signature