The URL can be used to link to this page

27D MARION RD - BUILDING INSPECTION (3) ' r The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, 7m edition OFSALEM Revised Jumrun• Building Permit Application To Construct, Repair, Renovate Or Demolish a /. 20AY One-or Two-Family Dwelling !� This Section For Official Use Only ` J Building Permit Num r: Date Applied: c� Signature. / r //O Building Commissioner/ for of Buildings Date SECTION 1:SITE INFORMATION I.i Property Addna: 1.2 Assessors Map& Parcel Numbers �7D l'�/i9i�r'/6nl �A L 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 11) Frontage(11) 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: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if es❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Reco d: J /^�) M[ 'V,960 6` � p ) 1 C►. N me( ri Address for Service: 9� 78 -.836 - $5�ff� i rc " Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied Cl Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ 1 Number of Units_ Other ' Specify: C p 9 i5N% Brief Description of Proposed Work': -770 //FrRrr �CL / ��L ,acz�+-ice c ZAo� EJ xis�� 1 / rf.F.T VZfy V/> � ID Do c� SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building S 77r6(). 1. Building Permit Fee: S Indicate how fee is determined: 2. Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (IiVAC) S List: r 5. Mechanical (Fire S Suppression) Total All Fees: S Check No. Check Amount: Cash Amount: 6. Total Project Cost: S 7 �6b. oQ ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(C4SF iResidential 3 V��r2FEY � /" / S f-f r l:tpimlion DalName ul'CSI.• I folder T (o 3Isee below)6 a r Description stricteJ u to 35,000 Cu.Ft.ricted f&2 Famil DwellinOnldential Routin C'overinI"clephone dential Window and Sidinential Solid Fuel Bunting Appliance Installation D I Residential Demolition FX6 Registered Ho,m. 1e Im rov meat Contactor(HIC) / 3 Q 8 8 / VIJOmo /A! a r�3 "gistrant rune Registration Number C! �A*t7�� o�y� / -� /o Es nation Date 'relephune SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152. 1 ISC(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 Issuers 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 * 1//D C /yA as Owner of the subject property hereby 4authonze = E to act on my behalf,in all matters or uth h6Q this bu' ingpermit application.I Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION 1, � t"/g• f --w 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. Prim e Sign o uthorized Agent Date (Signed under the pains and penalties of '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 ggL 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 110.116 and I l0.R5, respectively. 2 When subslantial work is planned,provide the information below: Total lloors area(Sq. Ft.) (including garage, finished basement/aaics,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"maybe substituted for"Total Project Cost" CITY OF S.U.E.`(, >tiLIsSACHL•SE 9L MD1.VG DEP.%A-MViiT 120 WAMiNGTON STRMM. )"FLOOR I'm (978)745-9599 F%x(9711) 14498" K1JmEALAV DRMC)LL I110"ST.pQaaR HAYOR 011= oa or F eLR:PROPEaTV/>K ILDLVG CO-NWU'CL%ER Wurhars' Cotnpetasatle• Insuraaee AMilavit: Ouildera/CONfratterwElectr(elana/Plumbers annllca it InfarmatlOw Plemm Mid Legibly vmna tse,urvrUryruranawlnJry dtrall: 1�D Lef/^4b 6 Q Address: �jeaX SAD h 3 0 cilyfstale/zip �P4 Hj. days Peon.M.. mere you am emplayw!Clink the approprlan Mat T!y pe ofpro1ad(regd►e4 1 am a cmpkeyw with Fs a. ❑ 1 we a arnrnl coatarata as01 s ❑Now conesruetim amployeas Ow mww pan-dare).• have liked tie arbtartaaeaum 1.❑ 1 am•eels peepcieaw or prurm` 16wm ltwartarhd r1weL t 7. ❑RetreotMling ..hip ail have no amployeem Theme mile-gmtraearas have e. ❑f3 molidam; waiting fir me is any caway. woAan'comp ins mms 9. ❑Ouimims a"Wm I No workers'comp• inaurmrme S. ❑ We ere a eapasefea and is 10. FJil or sdditierse required offam haw etoaeyad their ❑ acaw �s y:❑ 1 am a hm mm doing ad work �,I(4 I /kaw L 11.Q phttnhkrg mpwm or ad&iom myself.(No working'comp 11 12.0 RoeTrapsirs insurance required.)► jrnplsyaer LNewodme 12.❑Othw camp ins rancletegsirad.J •Aq,npua a thr dwna as Of rear tar la m ow MOM below aI . do r wbm'm"pm*m ply irlrw.rr► ►th.wu.w,use sul are ab,Mdwb WMmkg t�mo Joint all merle as ese War astir eaaon nt rare crass a moor a11hMa iw/leriwa ei i•.rtra,rn ar•a..a iW 6ra ear aeeahee sew at/tiwt.Ar Jw6y the siee dAr wtbeaaeaewe W Jrb mwaw'reT trb(aaaraeai Igo ar nrprylr rAar 6 prer/I/wg twrAles'elwplwaedre InearraWJir aq eayfrywa Sdbr1 A/Ae p/fey Iw//Yi sftu inIereealif& ems L1A 14Y In%urance Company Vome: policy a ur se►f--ins.Liam#'. Eepiratlom rare: 6 — 9 Iult Sir@ Address: 9 7p Q^l J�p StA fir� cilyislurz. A49, of 1p 7© Arlaeh a cep of else Wei Mrs"eompawaws perry dsebratkre pop(ahswlsg the peft mumbW and espiratNa daft} Failure to secure coverage m required undw.1mlim 25A of NGL a 132 can Ind to the imposglan of criminal ptmaldes of a fine up to 31.500.00 and/or one-yow imprisonnwm,as wall of civil penelries is"form ate STOP WORK ORDER art/a am Of up to 11230.00 a day+tptin m the violator. I advised that a ca"of this ataleurhtnt may be forwarded to the OIMee of Inrc.rryaoiorre ur nta nlA for i,t.rrawce coveralls.%milk-ti ma /d1 hereby CINVA0,u the and wa/Nee a/per/a,q IAN 1A1/wlwetadea preodakd US~jis�rnw ead a wrres P` t ,1• �d o' O/�a'id a•I mdp. Oe not write im this rreo,to Ise•atnphMl Ay ei/yW/Imw r//fr•irf city erruwn: permiNl.Ieenul__ laurne Aulhortly (circle use): 1 ilanrJ ut 11•altlr 1. Iluwldlna Mpartment 1. City/fame Clerk A. flectricd Impector 9. Plumbt/R Impeela► 6. Other L., tua Penan: _ Phone e: gI�Jjb CA Reg.123088 Prowindows Inc. www.prowindows.com P. O. BOX 540630, WALTHAM,MA 02454 (781)647-9225 j O FAX(781)647-9392 LICENSED...................................................................................................... INSURED h l/-/d NAME: David Charak C7 j1, � fikfv 7� DATE: 4/13/10 ` ADDRESS 27D Marion Rd. Salem, MA 01970 PHONE # WORK CELL 978 83 8536 # EMAIL dcharak(.&comcast.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 • 16 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. 16 double hung @$390.00/window $6,240.00 1 1 HARVEY VINYL GLIDING PATIO DOOR,6'6"X 6' 10",WHITE EXTERIOR AND INTERIOR, WHITE HARDWARE, SLIDING SCREEN. INSTALLATION INCLUDES REMOVING EXISTING DOOR AND FRAME,AND INSTALLING DOOR LEVEL AND PLUMB. INSTALL DRIPCAP,RETRIM EXTERIOR TO MATCH EXISTING D$COR. CONTRACTOR RESPONSIBLE FOR REMOVING ALL DEBRIS. $1,750.00 Less discount ($290.00) Total cost of qualifying windows $6500.00 Total cost of labor and materials $1200.00 Estimated time to complete is 1-2 days ✓ OTAL INVESTMENT = $7,700.Og 7 /Go t`?�/�os 7- . 7L MAKE CHECK PAYABLE TO PROWINDOWS INC. Estimate includes cost of all trash disposal. Painting is responsibility of the homeowner.ra AI(workmanship is 0 vob 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 pullsn )e6 permits if necessary. Work to beg, weeks following receipt of deposit. Contract is good for 30 days rift, ' contractor signature below. I accept the terms of this contract. date: 5t S r.n iv�e- d�' Cohlra.civ,/ `LI aa '/v JUN-04-2010 (FRI ) 15 : 45 MALCOLM @ PARSONS INSURANCE ( FAX) 17813441425 P. 001/002 'ACORD .CERTIFICATE OF LIABILITY INSURANCE 06/04/2 0 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 6 Freeman St. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 527 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Stoughton, MA 02072 INSURERS AFFORDING COVERAGE NAIC# INSURED ProWin ows Inc. INSURERA' Western World Insurance P.O.Box 540630 INSURERB: ACE Property & Casualty Waltham, MA 02454 INSURER C: 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. II T R DR TYPE OF IN POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY NPP1233696 07/23/2009 07/23/2010 EACH OCCURRENCE s 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGETORrPId ENTED S SO,OO CI-NMSMADELxl OCCUR MED EXP(Any one Person) 5 5,000 A PERSONAL S ADV INJURY S 1,000,0001 GENERAL AGGREGATE 5 2,000.0001 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGO 5 1,000,000 POLICY PET LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT ANY AUTO (Eaaccident) 5 ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY 5 NON DW NEO AUTOS (Per Aooitlem) PROPERTY DAMAGE S (Per amideno GARAGE LIABILITY AUTOONLY-EAACCIOENT S ANY AUTO EA ACC S OTHER THAN AUTO ONLY: qGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR ❑CLAIMS MADE AGGREGATE S 5 DEDUCTIBLE 5 RETENTION $ S WORKERS COMPENSATION AND C46312533 06/09/2010 06/09/2011 X wC STATU- OTH- EMPLOYERS LIABILITY B ANY PROPRIETORIPARTNEWEXECUTIVE - E.L.EACH ACCIDENT S 500,00 OFFICEWMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE 5 500,00 R yes.describe under SPECIAL PROVISIONS Below E L.DISEASE-POLICY LIMIT 5 500 000 OTHER DPSCRIPTIOV OF OPERATIONS I LOCATIONS I VF,H14LES I EXCLUSIONS ADDED BY ENDORSEMENT 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 NO OBLIGATION OR LIABILITY Insureds Copy OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Evidence of Insurance AUTHORIZED REPRESENTATIVE �y7 David Parsons ACORD 25(2001108) ©ACORD CORPORATION 1988 I lugp Massachusetts - Dcp:u'uucut of Public SafelI Board of Building 12cuXutiuns ;uul til:uul:u ds �J Construction Supervisor License License; CS 66853 - Restricted to: 00 JEFFREY P FISHER 'S PO BOX 540630 y WALTHAM, MA 02154 �.,-;y Expiration: 4/27/2011 .. c'ununi.�iuuer Tr7A: 13562 �� Boefavt"�Y0iTM9f�+"K'��uryttto(Y54uYFsi'flSttYPF'd'�° } s HOME IMPROVEMENT CONTRACTOR r• Re ratton; 123066 ExpixPirdtlon; 1,274/2010 Tr# 276232 Type: Private Corporation - PROWINDOWS INC JEFFREY FISHER MAIN ST WAL WALTHAM,MA 02451 �! - Administrator