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27C MARION RD - BUILDING INSPECTION (2) The Commonwealth of Massachusetts Ifi Board of Building Regulations and Standards Town of 6 ; Massachusetts State Building Code, 780 CMR, 71b edition / Building Dept /) !� Building Permit Application To Construct, Repair, Renovate Or Demolish a One- or T» umily Dwelling This S96clft For Official JJse Only Building Permit Numbe . t plied/: Signature: ? /ul rw, Building Commissioner/I pector of Buil iWWI 11Date SECTIO*;K§VFE INFORMATION 1.1 Property a7 Addc ress i'9.a,!!Kla nr• 1.2 Assessors Map& Parcel Numbers J�'�'� . 1.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 if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: / /'�'rCH�ry L shy' a 7 C M Ft r;iD Name(Print) Address for Service: ,s'/eiGF�`7i /".4, O/ Y 70 978 -- 7-<1J'-- 6 3 a/ Signature Telephone - SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other Specifyl9C jj—'q GE' E Brief Description of Proposed Work : ..f G LfS/A/ O Y EX 1// %L C, f t 'D 7n 0 0 7V SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Ofticlal Use Only Labor and Materials 1. Building $ 6O �(,®r7 1. Building Permit Fee: S Indicate how fee is determined: 2. Electrical g ❑Standard City/Town Application Fee Cl Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:S Check No. Check Amount: Cash Amount:_ 6. Total Project Cost: $--:5�660 Od ❑paid in Full D Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) +•. , \ ��f-v License Number �Expirauon Date Ngmc of CSL- Helder �{/ M List CSL Type(see below) �Pd Tex �s�o 30 �� z T ype Description Address + U Unrestricred u to J5,0t)D Cu. FL) R Restricted 1&2 FarmIX Dwelling Si nature` e3'0=� M Mason Only RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Bu in Ap2liance Installation D Residential Demolition 5.2 Registered HomeImprove r§eat Contractor(HIC) AtC— Registration Number VECT?n Isyemg,r� +/d'6 �� L�._7�/ 6Y f2� Expiration Date Telephone OMPENSATION 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........... ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I , as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I Tr-�Agp/ 5 '� ,as QWfiff OF Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf 9whoob 12rint N Sign ad Agent Date Si d uties of er'uNOTES: I. An 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 I0.116 and 110.115, 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" SHAY, MIKE.doc Page 1 of 2 Reg, 123088 Pro indows Inc. - www.yro,vindows.com P. 0. BOX 540630,'WALTHAM, MA 02454 l4( (781)647-9225 Co �1� FAX (781)647-9392 i /, LICENSED INSURED O� L�� // X 11941 NAME: Mike Shay DATE: 9/4/09 ADDRESS 27 C Marion Rd. Salem, MA 01970 PHONE # 978 745 6321 WORK# CELL EMAIL micbaelsha c,acm.or& Furnish and install the following, all to include LowE/Argon filled glass, .30 u value,windows are Energy Star Rated and will qualify for Federal Tax Credit for 09 • 8 HARVEY CLASSIC VINYL FULLY WELDED REPLACEMENT WINDOWS, WHITE,DOUBLE HUNG, TILT IN,HALF SCREENS,NITELOCKS. REPLACEMENT INCLUDES REMOVING EXISTING WINDOWS AND HARDWARE. INSTALL NEW WI"sJDOWS LEVEL AND PLUMB. CAULK AND INSULATE ALL CRACKS AND SPACES. CONTRACTOR RESPONSIBLE FOR REMOVING ALL DEBRIS. 8 double hung @$420.00/window $3,360.00 • I 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 https:Hmail.google.com/mail/?ui=2&ik=303 fc50829&view=att&th=123 84872f2eaa9c7&att... 9/4/2009 '�)rlA 1, IVII& .uoc Page 2 of Estimated time to complete is 1-2 days TOTAL INVESTMENT = $5,660.00 MAKE CHECK YABLE TO PROWINDOWS INC. Estimate includes cost of all trash disposal. Painting is�responsibility of the homeowner. All workmanship is warranted for life. Payment terms are 1/3 up front,and balance due upon completion of contract unless otherwise specified. 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 beigin 3-6 weeks following receipt of deposit. Contract is good for 30 days after contractor signature below. i I accept the terms of this contract. 'C/ date: 9 /6 (/LA-19 01- Signature of contractor. dale: (q"?_ 0 f https://mail.google.com/mail/?ui=2&ik=303fc508 9&view=aft&th=12384872f2eaa9c7&att... 9/4/2009 American Properties Team, Inc. it /\ TO: Michael Shay — 27C Marion Road FROM: Jennifer Pappas, Property Manager RE: Window Replacement DATE: August 31, 2009 i Please be advised that the Board of Trustees for Pickman Park has approved replacement windows and sliders for the above referenced unit. This approval is contingent upon them matching the existing windows/sliders and that they fit in the,existing opening. They must be the same in appearance from the exterior. The Board will not allow windows/sliders with grids, crank outs, etc. We also require that permits be pulled in advance (regardless of what your contractor may tell you), and then a copy of the final approved permit once completed must be sent to APT for the unit file as well. We also recommend that owners obtain a certificate of insurance from the licensed contractor. You will need to bring a copy of this letter to the Salem Building Department in order to receive your permit. Should you have any questions or require additional information, please feel free to call me directly at (781)932-9229. i cc: Unit File I i 500 WEST CUMMINGS PARK•SUITE 6050• WOBURN MA O}801 781-932-9229 •FAX 781-935-4289 CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT T 0 SAH M, N1\11\t r. 'i I ,' 'P) I iq # 1:\X:'),8 74-- 9846 Construction Debi-is Disposal Affidavit (required fior all demolition and renovation work) In accordance %vit I i the sixth edition or the State Building Code, 780 CNIR section 111.5 Debi-is, and the provisions of MGL c 40, S 54; Building Permit ff — — is issued with the condition that the debris resulting front this work shall hcTispTLscd of a property licensed waste disposal facility as defined by NIGL c I It, S 150A. The debris will be transported by: ( ianie ot'hauler) I he debris will be disposed of'in (name of facility) (address of facility) perm applicant /0 8_ date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street F Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Let=_ibly Name (Business/Organization/Individual):RU W 1&/ dLAI Address: 06Y Z/40(,3 <1 �T City/State/Zip:Gc%t� /"),9, 6a,7 Phone #: 7f/d 6%7 f d—d Aon an employer? Check the appropriate box: Type of project(required): P Y 1 I am a em to er with 4. ❑ I am a general contractor and 1 6. ❑ New construction Yemployees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # 7. ❑ 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. [:1 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.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'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 [Contractors that check this box must attached an additional sheet showing the name of the sub-cou tractors 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: �0 Policy#^^s=rc^ - Lic. #: C4!!��87 (y Expiration Date: Job Site Address:,_4 /Wi��e l,yel, 5AZ IEI/"f City/State/Zip: Z/A, O/ 2 7 d 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 ce un a the poi and penalties ofperjury that the information provided above is true and correct SiRnature7 Date: - U Phone#: c3�� Official use only. Do not write in this area,to be completed by city or town offeciaL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4:Electrical Inspector 5..Plumbing Inspector 6.lhher Contact Person: Phone 4: AUG-10-2009 (MON) 13 : 52 MALCOLM & PARSONS INSU8ANC0 (FAX) 1 /6134414L7 T. Out/ UUL CO N CERTIFICATE OF LIABILITY INSURANCE 08/10/2009' 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 Stoughton, NA 02072 INSURERS AFFORDING COVERAGE NAIC iF INSURED PrOWnn ows Inc. INSURERA Western World Insurance P.O.Box 540630 INSURERB. ACE Property & Casualty Waltham, MA 02454 INSURERO: INSNSUREEURRR D: I E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 IDD- TYPE OF INSURANCE POUCY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY NPPI233696 07/23/2009 07/23/2010 EACHOCCURRENCE 5 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S 50,000 CLAIMS MADE [X]OCCUR MED EXP(Any one person) S 5,00() A PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE 5 2,000,006 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 1,000,000 POLICY PE7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO (Ea awident) ALL OWNED AUTOS BODILY INJURY (Per perwn) S SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Perawidenq S NON-0WNED AUTOS PROPERTY DAMAGE S (Per awldenq GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHERTHAN FA ACC S AUTO ONLY: AGO S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE 5 OCCUR CLAIMS MADE AGGREGATE S 5 DEDUCTIBLE S RETENTION 8 S WORKERS COMPENSATION AND C45787436 06/09/2009 06/09/2010 WL aTAnI- OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S 500 000 B ANY PROPRIETORIPARTNEWEXECUTIVE OFPICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE S 500.000 It yes.desI under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 5 SOO OOO OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I V4HICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS indow 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 NO OBLIGATION OR LIABILITY Insured's Copy OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. Evidence of Insurance AUTHORIZED REPRESENTATIVE David Parsonsry ACORD 25(2001108) ©ACORD CORPORATION 1988 ` r Nlass:tchusetts - Department of Public Sitter% Board of Building, Re!,ulations and Standards Construction Supervisor License _ License: CS 65853 Restricted to: 00 JEFFREY P FISHER ... , PO BOX 540630 ',"_`°' WALTHAM, MA 02154 - - ��-- --s"� Expiration: 4/27/2011 ('ouuuiwiimer Tr#: 13582 Boafi6Nf�(ifiAHt�'ICf�Uldirn(�n�fF'St'(itiYUdYQ� og HOME IMPROVEMENT CONTRACTOR Registration 123088 Expiration 1274/20I2010 Trll 278232 Type -d a e Corporation PROWINDOWS INC JEFFREY FISHER ` 1377 MAIN ST WALTHAM,MA 02451 Administrator