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27B MARION RD - BUILDING INSPECTION (3) The Commonwealth of Massachusetts i�y Board of Building Regulations and Standards Town of kY Massachusetts State Building Code, 780 CMR, 7"edition Building DeptBuilding Permit Application To Construct, Repair, Renovate Or Demolish a ! ,r(�\ One- or Two-Family Duelling O This Section For Official Use Only Building Permit Number: Date Applied: Signature: Building Co issioner/finspector of Buildings Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers — T1 aN I.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of�tecord: d e r d 7 OA( RD S;1 Ilan G 15' Name int) Address for Service: 17�- 7yr, a6�� Si re /' Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Usting Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ I Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': ,V' tS L SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Ofilclal Use Only Labor and Materials 1. Building $ S7Q I. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical g ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: b � 4. Mechanical (HVAC) $ List: �D e CrCl 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ � (� Q C1 ❑ Paid in Full ❑Outstanding Balance Due: �� 0 G4`rcNj/L�, SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) (?f0// 85,-g -I — �— J� TF -P 17715 H E-R License Number Expiration Date N.4me of CSL- Hglder �[ ///, //q- �o,-�/f. List CSL Type(see below) P,0 del �T O nV T Description ype Address 0 Z-' �'F U Unrestricted(up to 35,000 Cu. Ft.) R Restricted 1&2 FamilyDwelling Signature M Masonry Only '7 Er 6 L/7 _ 9aZ5- -RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Ap2liance Installation D Residential Demolition 5.2 Ijegiisst`eered ome Improvement Contractor(HIC) /,0 3 0� 40 S 1�r Registration Number HICK an Namee orr HIC R7Je ist�t am Address 7�� 67- ��d- Expiration Date Signature [Telephone 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 .......... ❑ No........... O SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Pr Z-V-/if A4=�;�l as Owner of the subject property hereby authorize `7Ei� _T x `,� � to act on my behalf, in all matters relative to work authorize y this building permit application. Signature of Owner Date SEC7JION 71b: OWNERI OR AUTHORIZED AGENT DECLARATION ( authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and Lchn am / 'I 3—A rized Agent Daterw de he ains an enalu"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 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 I I O.R6 and I IO.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" CITY OF SALEM >.. . Az PUBLIC PROPRERTY DEPARTMENT rJyI�E irr.' I'C'\X.\,lII\i.. IN S IN 1:1 T # !,A1 I'M. NIA,S\t P. 'i I', I ) _ I I:I. .).y-'4n-�)g)5 ♦ I \%:'i'B.N 9846 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 1 1 1.5 Debris, and the provisions of MGL c 40, S 54; Building Permit Af is issued with the condition that the debris resulting from di this work shall be sposed of in a properly licensed waste disposal facility as defined by MGL c 111. S 150A. The debris will be transported by: Iname of hauler) I he debris will be disposedf o in All (name of facility) (address of facility) n xnnit al plicant (late SAS CHUSETT T-'DRIVERS-LICENSE' NUN ER A 524494611 SOB I.I8 �FM 7�RMT NG o4 2 A4 {j A � 5 REST NGi �SEy- R P D R S11 M ' :T� 'FISHER . JEFFREYP F ' 59 GILMAN RD WALTHAM,MA 'l to Qb 02452-IB1,9.. 11 y�� - Massachusetts - Department of Puhlic Saferc 64);trtl of Huildinr Rchulations and standards Construction Supervisor License License: CS 88853 Restricted to: 00 - JEFFREY P FISHER PO BOX 540630 y WALTHAM, MA 02154 Expiration: 4/27/2011 ._ ('mmui"iuner Trl;, 13582 <� Boe�6�t�afR"arf�+arE�41�(�tn(t�au�St��Rfi�t�d�0 �r HOME IMPROVEMENT CONTRACTOR Registration. 123088 Expiration. 1274/2010 Tr# 278232 Type: Private Corporation PROWINDOWS INC_.., JEFFREY FISHER 1377 MAIN ST WALTHAM,MA 02451._:. - Administrator Reg. 123088 i ProWindows Inc. ;l www.prowindows.com OS I; P. O. BOX 540630, WALTHAM MA 02454 ' (781)647-9225 FAX(781)647-9392 LICENSED INSURED ...... ........................ NAME: Brenda Zielinski DATE: 5/13/10 ADDRESS 27*Marion Rd. r>7-6 Salem, MA 01970 PHONE # 978 741 2607 WORT{ CELL 978 430 1668 EMAIL Zielinski.bin)verizon net Furnish and install the following,all to include LowE/Argon filled glass, .30 u value, .20 SHGC,windows are Energy Star Rated and will qualify for Federal Tax Credit for 2010. • 6 HARVEY CLASSIC VINYL FULLY WELDED REPLACEMENT WINDOWS, WHITE, DOUBLE HUNG,TILT IN,HALF SCREENS,NITELOCKS. REPLACEMENT INCLUDES REMOVING EXISTING WINDOWS AND HARDWARE. INSTALL NEW WINDOWS LEVEL AND PLUMB. CAULK AND INSULATE ALL CRACKS AND SPACES. CONTRACTOR RESPONSIBLE FOR REMOVING ALL DEBRIS. 6 double hung @$420.00/window $2,520.00 • 1 HARVEY VINYL GLIDING PATIO DOOR,6'6"X 6' 10", WHITE EXTERIOR AND INTERIOR, WHITE HARDWARE, SLIDING SCREEN. INSTALLATION INCLUDES REMOVING EXISTING DOOR AND FRAME, AND INSTALLING DOOR LEVEL AND PLUMB. INSTALL DRIPCAP,RETRIM EXTERIOR TO MATCH EXISTING DECOR. CONTRACTOR RESPONSIBLE FOR REMOVING ALL DEBRIS. $2,300.00 Total cost of qualifying windows $4500.00 Total cost of materials and labor $320.00 Estimated time to complete is I-2 days OTAL INVESTMENT = $4,820.00 3 /ay 10 as /T APO 7.'o Ck3` Vi MAKE CHECK PAYABLE TO PROWINDOW Estimate includes cos[of all trash dis disposal. Pain[in p ty •b 13 QC warranted for life. Payment terms are 1/3 up front,and balance dueuponcompletion nof contract workmanship is \�� otherwise spccitied. 10%holdback of Balance Due for 90%completion. Any and all extras will require separate contracts and are payable prior to start of work. Contractor,to be reimbursed by homeowner,will pull permits if necessary. Work to begin 3-6 weeks following receipt of deposit Contract is good for 30 days after contractor signature below. I accept the terms of this contract. ,' date: Signature of contractor. date: MAR-22-2010 (MON) 10: 12 MALCOLM & PARSONS INSURANCE (FAX) 17813441425 P. 001/002 DATE IMMfDDIYYYY) ARDN CERTIFICATE OF LIABILITY INSURANCE o3/zz/zolo CO PRODUCER (781)344-3200 FAX (781)344-1425 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Malcolm & Parsons Ins. Agcy. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6 Freeman St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 527 1 Stoughton, MA 02072 INSURERS AFFORDING COVERAGE NAIC# INSURED ProWindows Inc. INSURERA Western World Insurance P.O.Box 540630 INSURERB: ACE Property & Casualty Waltham, MA 02454 INSURERC: INSURER D INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR OD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY NPP1233696 07/23/2009 07/23/2010 EACHOCCURRENCE S 1,000.000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S 50,o00 CLAIMS MADE [)�j OCCUR MED EXP(Any one person) S 5,000 A PERSONAL S ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 1,000,000 POLICY ECT PRO LOC J AUTOMOBILE LIABILITY COMBINED SINGLE LIMB S AW AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY (Per Person) S SCHEDULED AUTOS HIRED AUTOS BODILY INJURY S NON-OWNED AMOS IPef accident) PROPERTY DAMAGE S (Per aoddeM) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG fi EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE 5 OCCUR ❑CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION 5 S WORKERS COMPENSATION AND C45787436 06/09/2009 06/09/2010 X Wa.STATu- 02- EMPLOYERS'LIABILITY E.L.EACH ACL'IDENT S 5O0 000 B ANY PROPRIEfORIPARTNERIEXECUTIVE OFFICER)MEMBER EXCLUDED? EL.DISEASE-EA EMPLOYE S 500,000 If yes descuee under E L.DISEASE-POLICY LIMIT I S 5()0,000 SPECIAL PROVISIONS I 10IP OTHER DFSCRIPTIOV OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Tndow installation and sliding doors CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NOOBLIOATICN OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. - AUTHORIZED REPRESENTATIVE David Parsons ACORD 25(2001108) ©ACORD CORPORATION 1998