HomeMy WebLinkAboutMiscellaneous - 28 FERNVIEW AVENUE 4/30/2018ro
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MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617) 723-3800 Ma OnIv (800) 392-6108, FAX (800) 851-8424
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws, Ch.139, Sec.313
NORTH ANDOVER HEALTH DEPT.
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Re: Insured: MARIA EVANGELISTA
Property Address: 28 FERNVIEW AVENUE, NORTH ANDOVER, MA 01845
Policy Number: 1257405
Type Loss: Water Damage: All Other Water Damage
Date of Loss: 09/01/2014
Claim Number: 325780
CMA00021
9/3/2014
CEIVED
SEP U 9 2014
TOWN OF NORTH ANDOVER
46�—LTFI
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed $1000.00 or cause Massachusetts General Laws, Chapter 143, section 6 to be applicable. If any
notice under Massachusetts General Laws, Chapter 139, Section 313 is appropriate, please direct it to the
attention of the writer and include a reference to the captioned insured, location, policy number, date of loss
and claim or file number.
MPIUA Claims Division
MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION
Two Center Plaza
Boston, Massachusetts 02108-1904
(617) 723-3800 Ma OnIv (800) 392-6108, FAX (800) 851-8424
Form of Notice of Casualty Loss to Building
Under Mass. Gen, Laws, Ch. 139, Sec.313
NORTH ANDOVER BUILDING COMMOSSIONER
NORTH ANDOVER TOWN HALL
NORTH ANDOVER MA 01845
Re: Insured: MARIA EVANGELISTA
Property Address: 28 FERNVIEW AVENUE, NORTH ANDOVER, MA 01845
Policy Number: 1257405
Type Loss: Water Damage: All Other Water Damage
Date of Loss: 09/01/2014
Claim Number: 325780
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed $1000.00 or cause Massachusetts General Laws, Chapter 143, section 6 to be applicable. If any
notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the
attention of the writer and include a reference to the captioned insured, location, policy number, date of loss
and claim or file number.
MPIUA Claims Division
CMA00021
9/3/2014
I N
Date ... ...........
N2 3', 9 .... .... ......
0 TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ... C-
74 . ...................................................................
has permission to perform .; ............ . .. ... ... ..................................................
wiring in the building of ....................................................
at North Andover, Mass.
......................... ........................
Fee..O� ............. Lic. No . ............. .......
.........................................................
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
W
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Offlicial Use Only
Permit No. _3r�R
Occupancy and Fee Checked 1�5_
I[Rev. 11/991 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CUR 12.00
(PLEASE PRflVT flV INK OR UP.E ALL kVFORMA TION) Date: �1 -So -<)I
City or Town of- N 10 . ^t - To the Inspector of Wires:
nd6\Jt(
By this application the undersigned gives notice of his or her intention to perform die electrical work described below.
Location (Street her) - ?
&,auiv eA f�u n vi cw Atr-e-w-L A -p+ I I
Owner or Tenant -rpn an mau
Ak Telephone No.
Owner's Address U
Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead [I UndgrdE] No. of Meters
New Service Amps Volts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: I I -A elr I A /Th
ConiDletion afthe fn1lowing, table mov be waived hy the 1—pector -I*Wi—
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool Above o In-
grnd. grnd.
No. ot Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
INo. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
in
Heat Pu 1)
Totals:
1 N!!M.b.er
Tons . ......
1KW
I ................
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local [] Municip�fl [I Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:
No. of Devices or Eq ivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
lNo-
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Atta additional detail if desired, or as required b�, the Inspector of Ivires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [I
BOND [] OTHER
Q
0 (Specify:)
1P i -ti— nt.N
Estimated Value of Electrical Work: 31 �4 (When required by municipal policy.) 'IF
Work to Start: Z' JO -0 1 Inspections to be requested in accordance with NEC Rule 10, and upon completion.
Icertt&, under thepains andpenallies ofperjury, that the information on this application is true and complete.
FIRM NAME: ADT Security Services III Morse Street, NoR)vooA, MA 02062 LIC. NO.: 1533C
Licensee: John S. Bassett Signature,,11� J LIC. NO.: 1533C
(Ifapplicable, enter "exenipt " in tile license nuinber line.) Bus. Tel. No.: 781-278-1169
Address: ( I �lt. Tel. No.: 781-278-1131
OWNER'S INSURANCE WAFV—ER.- I am aware that the Li'densee does not have the liability insurance coverage noniially
required by law. By my signature below, I hereby waive this requirement. I am the (check one) E] owner [I owner's agent.
Owner/A(yent
Signaturc�' Telephone No. FERMIT FEE: s
i
I
TOWN OF NORTH ANDOVER WELDING DEPARTMENT ---
APPLICATION TO CONSMUCr UPAIR, UNOVAM CHANGE nM USE OR OCCUPANCY OF, OR DEMOLIM ANY BUILDING
. . III OTHERTHAN AONE 0k TWO FAMILY DWELLING
EEMMJ�Section for OfricW Use OnIAMEMENMEMEMM
BURDING PERMIT NUMBER: DATEISSUED.-
&. A 3aT 1
SIGNATURE:
1.1
//Aj ,Ae- 1,6
1.3 Zoning Information:
ZmmgDidnct proposed Use
1.6 BUILDING SETBACKS (ft)
Igs Date
1.2 Assessors Map and Parcel Number.
- �)
Map Number Parcel Number
( ki C, C1 C9 Co 10 , 0
1.4 Property Dimensions:
Area
Z.2A*horized.A
/ (C--
qame Print
,ipatum
1.1 Licensed Cr
q -q
Wdnm
Telephone
Address for Service.
relephone
tion Supervisor
Not Applicable 0
06 �A,�r
UZwseNumbw
lWervisc, - 2-
Z
--Wn Djatc
Z -
Telephone
-.2 Registered Home 1mpwmwpt Con J? I / Not Applicable o
154-11 lee�!-Oi-44YOL,-
:ompanyName
a lea h f 5 J�-
ipature
//-'7 lleg�n Numba
E*ration Dale
Telephone
ic
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0
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Workers Conipensation Insurance affidavit must be completed and submitted with this application.
Failure to provide this affidavit will result in the denial ofthe
issuance of the building permit.
Signed davit Attached Yes ....... 0 No ....... 0
Olt F �J- w
ji,
0 �k
j
PE, V W, . .... omz, �tV
5.1 Registered Architect:
Name:
Address
Sijnature
Telephone
Area of Responsibility
Name:
Registration Number
Address:
Expitation Date
Signature
Total
Not applicable 0
Name:
Registration Number
Expiration Date
Address
Signature Telephone
Area of Responsibility
Registration Number
Expiration Date
Name
Address
Signature Telephone
Area of Responsibility
Registration Number
Expiration Date
Name
Address
Signature Telephone
Not Applicable 0
Company Name:
Responsible in Charge of Construction
171r,, T7077. MIT" = 117771WRI.. M
New Construction 0
Existing Building
0
Repair(s) o
--��alions(s)
[I
ddition 0
Accessory Bldg., 0
Demolition
0
Other 0 Specify
Brief ption of Proposed Work:
0/
USE GROUP (Check as applicabfe)
CONSTRUCTION TYPE
A Assembly 0
A-1 0
A4 0
A-2
A-5
0 A-3
0
0
1 A
1 B
0
0
B'Business 0
2A
2
2C
0
0
0
C Educational 0
T Factory 0 F -I 0 F-2 0
H High Hazard -0
3A
3B
0
0
1 Institutional 0 1-1 0 1-2 0 1-3 0
M Mercantile 0
4
0
R residential 0
R-1 0
R-2
0 R-3
0
5
5B
0
0
S Storage 0 S-1 0 S-2 0
U utility 0 Specify:_
M Mixed Use 0 Specify:
S Special Use C1 Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE
Existing Use Group:
Existing Hazard Index 780 CUR 34:
Proposed Use Group:
Proposed Hazard Index 780 CUR 34:
BUILDINGAREA EXISTING (if applicable)
PROPOSED
Number of Floors or Stories Include
Basement levels
Floor Area per Floor (sf)
Total Area (sf)
Total
3endent Structin-al En
Peer Review
Yes 0 No 0
SECTION 10a Owner Authorization - TO BE COMPLETED WE[EN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 1 as Owner of the subject property
Hereby authorize to act on
My behaK in all inatters relative two work authorized by tins btiilding pernut application
I
Signature of Owner
IM
I
MOMMA" �5
as Owner/Authorized
=ft6W da�. are t the itkleml; eents an ffiformation on the foregoing
application amtrue and accurate,
to the best of my
knowledge and belief.
Sigmed under the pains and penalties of pe�ury
PAN ' e'
W61
D afe
Estimated Cost (Dollars) to be
Completed by pennit applicant
(a ee
,— Multiplier
(1,) Estiniated Total Cost of
Construction (6)
5 Rim Protection
6 Total (1+2+3+4+5)
BASENIENT OR SLAB
SEE OF FLOOR ITSIBERS -eD
DF14ENSIONS OF SILLS
DEWNSIONS OF POSTS
DMENSIONS OF GIRDERS
BEIGHT OF FOUNDATION
MCKNESS
SIZE OF FOOTING
—x
MATERIAL OF CHNINEY
IS BUILDING ON LID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
$Md
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09/28/2004 12:55 5088656809 LEO TURNER PAGE 02/04
TEST RESULTS
Harvey Manufactured Windows and Doom
U -Factor in accordance with NFRC-100-97, Air infiltraton in accordance wfth
based on *xAe rAndow value ASTM E 283 0 1.57 PSF (25mph)
Harvey vinyl windows and standard size H**vey vinyl Patio doors with Low-ElArgon
qugdffy for the ENERGY STARO pmgram thmmahout the United Statm.
F` vw'Yl winums INFM l-W&-WArW WiNIVY W 90 ENMY STAR program twoughotd the MS.
The use ot tenVered Low -E glan may effed ENERGY STAR (wlffimtion in your region.
AN Vdlueb are S*ed to ohange Wthout nodoo dtm to pwiodic na-WOV.
Iq
Chu Insiddid
Low -E
Low-VAron
Air
U-F&dw
R-Vdm
V-Pader
11-Vehim
U4?adm
R-Valm
111MR0012
dWV
ANYL
Classic Double Hung (Mechanical)
0.50
2.00
0.37
2.70
0-M
2.94
.10
CUsWq Duul:ft Htnwj (Welded Sash & Frwne)
0.49
2.04
0.30
2.70
0.33
3.03
.14
Classic Acoustcal Double Hung STC40
0.33
3.03
0.25
4,00
0.24
4.17
.17
signature Double Hung (Mechanical)
0.50
2.00
0.37
2.70
0.34
2,94
.041
Slimline Double Hung (Welded Sash & Frame)
0.50
2.00
0.37
2.70
0.33
3.03
.16
Sfirrifine Single Hung (Welded Sash & Frame)
0.50
2.00
0.37
2.70
0.33
3.o3
.16
Mnyl Casement/Awning
0.47
2.13
0.34
2.94
0.31
3.23
.04
Vinyl Casement/Awning and Thermal Panel
0.31
&23
0.25
4.00
0.24
4.17
.04
Vinyl Designer Shapes
0.49
2.04
0.33
3.03
029
3.45
Vinyl Hopper
0.47
2.13
0.35
2.86
0.32
3.13
.03
Vinyl Picture Window
0.47
2.13
0.32
3.13
0.28
3.57
.01
Vinyl Roller - 2 Ute and 8 Ute
0.50
2.00
0.36
2.78
0,33
3.03
.09
Too imuNs are based on arrawmW sbw
MW TW MSL*S for orw A* Wdmw mmaye Won wim
Terapered
llempnxd
Temperied
DbL Temp.
Air
Clear
LOW -t
Low-E/Argon
Low E/Arg
InfdWsUon
U-Fkdw R-VWkw
V-Fackr
R-Vahw
U46Aft
R-Valm
U -Fodor
R-vaim
-wiv
0.50 9.00
0 - 4 1
1!
.,U
2..Q 4
().35
2.88
.06
F` vw'Yl winums INFM l-W&-WArW WiNIVY W 90 ENMY STAR program twoughotd the MS.
The use ot tenVered Low -E glan may effed ENERGY STAR (wlffimtion in your region.
AN Vdlueb are S*ed to ohange Wthout nodoo dtm to pwiodic na-WOV.
Iq
09/28/2004 12:55 5088656009 LEO TURNER PAGE 03/04
AitcmummAL
Vinyl Patio Door
Model; Vinyl Pao W"
Appilicatkms: Resklential
Light Comiinercial
Distrigulshing Features
Otmitom ManLiflaftred to Size
Welded ElaUi Oorner�
Reinforced Sash Panots
Size Lin0adons
Standard Sizes: SM, 6M, 8M
Custom Sizo — Max. Opening;
24ite MM W Height 92* Max Ul 180
34'ft YVmb 144' Height 92" Max Ul 228
4-111te VWb 19Z Height Or Max Ul 276
ARCHIMTURAL SPECIFICAMNS
Germ : ManufticWred by Harvey Industries, Inc.
Operation: Operating panel shall glide an todem r*n
w4pilublu yriltmis. YAwels " glide gn a Wid amKked
aluminum m"rall. Stationary panel Shall be fixed at
head and sill with an aluminum angle- Panels shall love
posillve irdarlook at the nvK*V rail when in the eltood
posman.
MaUMob: Frame octruslon shall be 100% vk* PVC.
JaMb hame stiall have a minimum of 8 hollows, and have
a nominal wall thickness of 0,100".
Frarin ConstuWart: Corners shall be fitled w"h a dosed
cei foam s&Whg pod, butjoiried and mechanicalily
fa*rsed with four shftew steel sow" per comer,
snoharod 1r& intWall oxtrution to" bog*ee. Screen
track wW nag M m kftgrW to The from. The heed and
Aft wdrusion shall hwe a rrjrjrnum of 8 hollmn, and
have a norninal wail thicitnew of 0,1100*. The sift shall have
six tubular hollows and a nominal wall thicitness of 0.1 OV.
A vinyl cover "I be snapped onto the fixed jamb inside
leg to give jamb a finished a*earanc*.
Sub Construe": Sash panels shall have mitered and
fision welded cmnem Sash proffes shall have a nominal
W211 t6olaw" of 0.100". Sash tame shall have five
lubular hollows and "I be reinforood with a 0. Wthick
extnxled iWumkwm channel in the meeting nsk and
lockim Win. A un1we Pocket Perimeter on the door panel
sMIl dose the door around the jamb tame adding
additional security and tightness. The sash shall have a
rerna"We intarlor srsap-in glazing bead, which will allow
reWoement of glass without taking the entim sash apart,
A Vmyl snap an interlock cover shall be applied to each of
the meeting rail styles.
Screm Construd1on: The door soreen ftme shall be of
heavy kkular aluminum, reinforced at the comers with
extu6od comer keys for maximum torenoth, ln.wl
screening shell be 18 x 16 non -glare fiberglaw meeh hold
in place with a vinyl screen spline,
AY414116 Flinishes: Shall be solid vinyl throughout in
white and almond,
MatherMpping. WeethembippiF19 011 the inalvi Fiume
perimeter shall be silicone treated woolpile with a
polypro"one fin in $e centtr. Each sash meeting rail
"I caftain one courve of fin -We woaherWpping and a
positive interlock for a tVIe seel.
Hardware: A variety of hardware and locking systems are
available. See options.
G111aft., Insulating glass shall have an overall thickness
or 711Y' %ft a rrdnlmurn W air spew. Insulating glass
sandwich shall use a one-piece steel U-channell design
glass "ww, and shall have a desiocent matrix extruded
irft 1he be" of the LL -channel. A buY sealant shall be
extruded around the entire perimeter of the spacer to
achieve a *@W. All gism WWI be tampered type B
domestic float We. A dual durometer snap In glazing
bead shall woure the glass in place Wong the inside
Perimeter.
01111114111hs: Grids - colonial contoured aluminum In -gum.
Glazing - Low -E, Argon -filled Loyr-E, and beveled gkm. 3
tibe Unft 4 Lite Units we available. Hardware - White,
airnond or bright bran fteh handecot with dual -point
locNng system and krylock, standard, Opfional rnwlO-
Point locking System also available. Flush mount
deadbolt. Corromsion resistant stainless steel rollers are
avawe.
InStWkldM; Installation shall be in aocordance with tho
ManUlZictarer's printed ffmucaons,
Vftrranty Ifftrumfon; Available upon request
RaW to HaryW trydiusvift semi wNr9"fy
for compleft doWls.
REV07R4
09/28/2004 12:55 5088656BO9
LEO TURNER
PAGE 04/04
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ACORD. CERTIFICATE OF LIABILITY
DATE (MM1DD/YYYY)
_�_R0_DUe'm_- (617)472-3000 - FAX (617)472-7248
INSURANCE 10/2S/2004
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Burgin, Platner. Hurley Insurance Agency, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
I
14 Franklin St.
HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Quincy, MA 02169
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Joanne Pilling
INSURERS AFFORDING COVERAGE NAIC #
INSURED B & M Restoration & Contracting, Inc.
INSURERA: Employer's Fire Ins Co 20648
107 Orleans St
INSURERB: One Beacon Insurance 20621
East Boston, MA 02128
INSURER C: AIG N
INSURER D:
INSURER E:
VERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 —
-
Im
a
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
—DATE IMMMUFM
POLICY EXPIRATION
LIMITS
0DITEItIlm/n23DONOYSI
GENERAL LIABILITY
FBR4409SS
03/17/2004-
EACH OCCURRENCE $ 1,000,000
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $ 100,000
MADE OCCUR
rpnepi
MED
A
�_jCLAIMS
EV (Any one person) $ S'000
PERSONAL & ADV INJURY $ 11000,000
GENERAL AGGREGATE $ 2,000,000
GEHL AGGREGATE LIMIT APPLIES PER-.
PRODUCTS - COMP/OP AGG S 2,000,000
POLICY _1 PRO-
F r
JECT LOC
AUTOMOBILE
LIABILITY
QBXB26SIO
12/13/2003
12/13/2004
ANYAUTO
COMBINED SINGLE LIMIT
(Ea accident) $
ALL OWNED AUTOS
00,000
BODILY INJURY $
(Perperson)
B
SCHEDULED AUTO$
HIREDALrros
BODILY INJURY
(Per accident) $
1771
NON -OWNED AUTOS
PROPERTY DAMAGE
$
(Peraccident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
NY AUTO
OTHER THAN EAACC S
AUTO ONLY. AGG $
EXCESSIUMBRELLA LIABIUTY
OCCUR D CLAIMS MADE
EACH OCCURRENCE $
AGGREGATE $
$
7
�ETENDEDUCTIBLE
R T TION $
$
WORKERS COMPENSATION AND WC7687928 V
EMPLOYERS, LIABILITY
06/10/2004 06/10/200S $
xi
C ANY PROPRIETORIPARTNER(EXECUTIVE
OFFICERIMEMBER EXCLUDED?
EL. EACH ACCIDENT
— $ 100,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - EA EM 100,000
OTHER
E.L. DISEASE - POLICY LIMIT $ S00,000
DESCRIPTION OF OPERATIONS / L OCA'nONS I VEHICLES I EXCLUSIONS ADDED By ENDORSEMENT I SPECIAL PROVISIONS
OB: HERITAGE GREEN CONOMINIUMS,
N ANDOVER, MA
rURTI
rA1M1rF:I I ATInU
AFFINITY REALTY & PROPERTY MANAGEMENT LLC
63 ATLANTIC AVENUE
BOSTON, MA 02110
Ak;01RD 25 (2001108)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY VJND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Michael renderqast/DFM .14& 2dAx—�
@ACORD CORPORATION 1988
BOARD OF'BUILDING REGULATIONS
License: CONSTRUCTION SUPERYISOR
k
Number: CS 065281
Birthdate: 09/28/1961
Expires: 09/28/2005 Tr. no: 6728.0
Restricted: 00
PAUL BRUNO
184 1/2 SUMNER ST
E BOSTON, MA 02128
Admi i
n strator
DUUUMg LOMMM M Mr ot Bujadings Date
1.1 Property Address:
M""T 1.2 Assessors Map and Parcel Number
Map jq�ber Pared Number
1.3 �g information: 1.4 Property Dimensions:
Zming District � Proposed Use Lot Area (sf) Frontage (ft)
1.6 BUUDING SETBACKS (ft)
Front Yard Side Yard Rear Yard
Reqaired Provide Regaired. Provided Provided
1.7Waw Svpp1yhLQLc.40.q 54) 1.5. Flood Zow hifammadm: 1.9 ScwaWD4oWSya=
Public 0 Pchmm 0 zone Oubide Flood ZOM 0 M=*P4 On Site D4osd Syum 0
2.1 ��rof Record
Addrew for Service:
Z.2 �� Agent
%lame Print
,ignature
Telephone
I Telephone
Address for Service:
1.1 Licensed C7!UCion S
a 770'? " e C-7 5 A 4a7
-.2 Registered Home
:ompanyN&m
ai
Not Applicable 0
//,) A � 0 C'-- )
License Number
7,
92- n to
Not Applicable 0
Registration Number
lea
)a Date
Telephone
01
M
z
0
�z
M
go
0
Work.ers,Compensatibn Insurance affidavit must be. completed and submitted with this application. Failure to provide this affidavit will result in the denial ofthe
issuance,oithe budding permit.
Signed affidavit Attache& Yea ... �...O No ....... 0
ft,,V
00
F
5 RXII
5.1 Registered Architect:
Name:
Address
Signature
Telephone
Area of Responsibility
Name:
Registration Number
Address:
.
Expilation Date
Signature
T otal
Not applicable 0
Name:
Registration Number
Txpi;ition Date
Address
Signature Telephone
Area of Responsibility
Registration Number
Expiration Date
Name
Address
Signature Telephone
Area of Responsibility
Name
Address
Registration Number
Expiration Date
Signature Telephone
Company Name:
Not Applicable 0
Responsible in Charge of Construction
rn,- =m E—nm. Err
New Construction 0
Existing Building
. . . . . . . --------
0
Repair(s) 0
Alterati(
kddition 0
Accessory Bldg., 0
Demolition
0
Other 0 Specify
Brief D
,P�tion of Proposed Work:
'
M,
ME
USE GROUP (Check as applicable)
CONSTRUCTION TYPE
A Assembly
0
A-1 0
A-2
0 A-3
0
IA
0
A-4 0
A-5
0
1B
0
B'Business
0
2A
0
C Educational
0
2
0
F Factory
0
F -I 0
F-2
0
2C
0
H High Hazard
0
3A
0
1 Institutional
0
1-1 0
1-2
0 1-3
0 3B
0
M Mercantile
0
4
0
R residential
0
R-1 0
R-2
0 R-3
0 5A
0
S Storage
0
S-1 0
S-2
0
5B
0
U utility
0
Specif�:
M Mixed Use
0
SpecifY
S Special Use
0
L!pecify:
COMPLETE THIS SECTION EF EXISTING BUI]LDING UNDERGOING RENOVATIONS,
ADDITIONs AND OR
CHANGE IN USE
Existing Use Group:
Proposed Use Group: ....
Existing Hazard Index 780 CMR 34:
Proposed Hazard Index 780 CMR 34:
Basement levels
Floor Area per Roor (sf)
Total Area (st)
Total Heikht (ft)
Independent Structural ER&ecrir al Peer Review -Required
% Structur
SECTION 10a Owner AuthorizAtion - TO BE COMPLETED WEIENN
OWNERS AGENT OR CONTRACTOR APPIF.YFq MR 1RIFTYiF imywi, 1
Yes 0 No n
as Owner of the subject property
Hereby auffiorize
to act on
My behA in all matters relative two work authonzed by dus buil(ling permit application
I
Signature of Owner
0
4
M
Owner/Authorized
Arge b,4P4 �V
tj
ereby declare the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief
S�� under the pains and penalties of pe�ury
Print
all
A
I f - WMI 0--'e 1 R/
Sif/ature of Op"fa M -r. /V
ba—W /7
Estimated Cost (Dollars) to be
X.T�
Completed by permit applicant
(a) Building Permit Fee
Multiplier
A
(b) Estimated Total Cost of
Construction from (6)
Mrs
5 IFireProtection
6 Total (1+2+3+4+5)
BASENIENT OR SLAB
SIZE OF FLOOR TIMBERS iST 2
ND 3�-k
DEU�SIOMS OF SlI-LS
DEMENSIONS OF POSTS
MENSIONS OF GIRDERS
BEIGHT OF FOUNDATION
MCKNESS
SIZE OF FOOTING
x
113009". WOM 9*118010
IS BUILDING CONNECTED To NATURAL-GAS LINE
0
F=4
C—
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09/28/2004 12:55 5088656809 LEO TURNER PAGE 02/04
www&-��
TEST RESULTS
Harvey Manufactured Windows and Doom
LJ -Factor in accordance with NFRC-100-97, Air infiltraten in accordance with
based on whole window Mue ASTM E 283 0 1.57 PSF (25mph)
Harvey vinyl windows and stariderd size Harvey vinyl Patio door$ with Low-ElArgon
qualify for the ENERGY STARII program throughout the United Stales.
W 4y WHewwwa witu LwAmr4wgcn qu4uny wr us EtfEMy STAR pmgrarn ftmoout the U.S.
The Me ot WNOW Low -E gtm rnoy effied EN016Y STAR quaftation in your region,
AN 901� am "ed Io chunp vviftut no6co due to pwkxfic rebw".
RA
Fy
LOW -E
Low-ElArson
Air
U-FkW
R-V*x
V-Pader
RNA-
U -Pd.
R-Vh.
1111MUS11"
Cho/W
ANYL MNDM
Classic Double Hung (Mechanical)
0.60
2.00
0.37
2.70
0.�14
2.94
.10
C4m-.,jir, Dauble Htxwj (Welded Sash & Fnwm)
0.49
2.04
0.30
2.70
0.33
3.03
.14
Classic Acoustical Double Hung ST040
0.33
3.03
0,25
4,00
0.24
4.17
.17
Signature Doutdo Hung (Mechanical)
0.50
2.00
0-a7
2.70
0.34
2,94
.04'
Slirriline Double Hung (Welded Sash & Frame)
0.50
2.00
O�37
2.70
0.3'3
3.03
.16
Sfimhne Singie Hung (Welded Sash & Frame)
0.50
2.00
0.37
2.70
0.33
3.o3
Au
Mnyl Casement/Awr9rig
0.47
2,13
0.34
2.94
0.31
3.23
.04
Vinyl Casement/Awning and Thermal Panel
0.31
&23
0.25
4.00
0.24
4.17
.04
Vinyl Designer Shapes
0.49
2.04
0.33
3.03
029
3.48
Vinyl Hopper
M7
2.13
0.35
2.86
0.32
3.13
.03
Vinyl Picture Window
0.47
2.13
0.32
3.13
0.28
3.57
.01
Vinyl Roller - 2 Ute and 3 Ute
0.50
2.00
0.36
2.78
0.33
3.03
.09
Tow msults am b9seo on arreaWssins
*A-- TW rasuft & 00W W* "ft" Alimus won Mqum
Toupend
TMPM*d
U�red
DbL Temp.
Air
CIftr
Low -h
LoW-E/Argon
Low KtArg
IMMUOD
V-AnIm R -V"
V-Fadw
R-Vmhw
U-PadOr
R-Vidoe
U-FIKIw
R-VAbe
Cw1v
P-60'
O -Al
L
4AA
(W -,U
2-94.
0.35
.86
.00
W 4y WHewwwa witu LwAmr4wgcn qu4uny wr us EtfEMy STAR pmgrarn ftmoout the U.S.
The Me ot WNOW Low -E gtm rnoy effied EN016Y STAR quaftation in your region,
AN 901� am "ed Io chunp vviftut no6co due to pwkxfic rebw".
RA
09/28/'1004 12:55 5088656809 LEO TURNER PAGE 03/04
10��
CEUTECTVRAL
DUM A SUMM
Vinyl Paltio Dwr
mow; vinp PWO ow
Appilloation: Resildier"
Light C-9FMwrds1
Db#ngWs" FeaWres
Custom Manufactured to Size
vWded 8691 C;omerb
Reirribroed Sash Panob
Size Unihatlons
Standard ftes. SM, 6M, 8068
customake— max. Opening;
24fte oft W Height 92" Max Ul 180
3 -ft Wift 144. Height 97' Max Ui 228
44ft V&b 192' HeigM Or Max U1 276
ARCHIMCTURAL SPECIFICATIONS
Gorwai: Manullacturvd by Harvey Industries, Inc.
P010011: Operating Partel shall glide on twdern nylon
WkFatmblu v011eallu. VAY0616 " glide on a Wid anq4tod
aluminum rrionoraill. SuMommy pmel 9W be fixed at
head and ell with an aluminum angle- Panels shall have
P0210ve irderlook at the n-meft rall when in the 6mad
position.
Frame extrusion shall be 1000A ** PVC.
Jamb frame shall have a minimum of 8 hollows, and have
a nominal wall tWoknew of 0,100".
Fraime Constucem: Comers shall be fted with a closed
eel foam sealing pad, but -joined and mechanically
fastened with fbw SUWM $1961 screws per comer,
wu�hamd 1r& intelyul Wtution wmw boat". Seman
tack wW nall fin am intogral to The term, The head and
Oft Wdruslon shall have a rrdnimum of 8 hollms, and
have a nominal wall thickness of 0.100'. The sill shall have
six tLftAw hollows and a nominal wall thicknew of 0.11W%
A vinyl cover shall be snapped onto the fixed jamb inside
leg to give jamb a finished appearance.
Sub Construeftn: Sash panels shall have mitered and
Wsion Welded cmem Sash profiles shall have a nominal
wall tkftwe of 0.10T. Sash frame thall hwe fte
liubular hoillows and "I be reWorood with a 0.01W'thick
extruded aluminum channel in the meeting raile and
Weft 90". A uNwe poeW "rime*r on the door panel
shall dose ft door around the Jamb frame addng
additional secuft and tightness. The sash shall have a
removaWe irift-rior srop-in glazing bead, which will allow
replacement of glass willhout taking ft endre s"h apart
A Y" snap an Interlock cover shall be applied to exh of
the meeting rail styles.
$Orem Construedon: The door screen frame shall be of
heavy tubulw aluminum, reinforced at the comers with
extruded comer keys for nvximum gtrpnoth. ln-q�
screering shall be 18 x 16 non-glwe fiberglass mooh hold
in place with a vinyl screen spline,
AVAWe Fftdshes: Shall be solid vinyl throughout in
white and almond.
MadwrOApping. Wvathatrali1pping on the inaln riisniv
perimeter shail be silicone treated woolpile with a
poMxopylone fin in the oentor. Each sash meeting rail
"I contain ons, courw of fm -typo wouthemtopping and a
positive interlock for a triple seel,
Hardware: A varietf of hardware and locldng systems are
available. See optiorm.
Gkdng: Insulating gIM shall have an overall thickness
of 7/w, wfth a minimum sar, air space. Invulailng glass
sandwich shall use a one-plees s" U -channel design
glass spacer, and shall have a desiccant matrix extruded
into #%e bmw of the 1-11-channef. A butyl sealant "I be
exllrudW around the entire perimm of *the specer to
whieve a s@W, Ali ghm vitall be terVered type B
domestic flout We. A dual durometer snap In glazing
bead shall mcure the glass in place along the inside
perimeter.
OPOOns: Grids - Colonial contoured aluminum lnl$ws.
(Aazing - Low -E, ArgonAed Low -E, and beveled glass. 3
Lft Units, 4 Ute Units are available. Hardware - Mite,
almoncl or bright brow S*h hande'vet with dual -point
locking system and Wy1cck, standard, Optional multi -
Point IOOWV system also available, Flush mount
deadbolt. Corrosion resistant stainless steel ronere are
Wallable.
Installiation; Installation shall be in accordance with the
manutacturers printed ffistructions.
ftcranty Inionnalon. Available upon reqjest.
R@ftr to Harvey kidusWes acmal W&TOW
for compbft doWls.
REV07X4
09/28/2004 12:55 5088656809 LEO TURNER PAGE 04/04
Harvey Industries, Inc.
Vinyl Patio Door
(1/2 ScWe)
4 9/16,
REV. 1104
I=
0
.8
0
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In -
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1-cl SEL6 998 809 1 98HAIN 8 131wua eoc:Bo to t,2 das
al 0�1
BOARD OF BUILD ING REGULATIO S'
N
License: CONSTRUCTION SUPERVISOR
Number: CS 065281
Birthdate: 09/28/1961
Expires: 09/28/2005 Tr. no: 6728.0
Restricted: 00
PAUL BRUNO
184 1/2 SUMNER ST
EBOSTON, MA 02128
Administrator
,
A R2
% . CERTIFICATE OF LIABILITY
DATE (MM1DDNYYY)
INSURANCE 1
PRODUeE-R (617)472-3000 FAX (617)472-7248
'
10/2 S/2004
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Burgin, Platner, Hurloey Insurance Agency, Inc.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
14 Franklin St:
HOLDER. THIS CERTIFICATE DOES NOT AMEND, 8(TEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Quincy, MA 02169
Joanne Pilling
INSURERS AFFORDING COVERAGE NAIC #
INSURED 8 Restoration & Contracting, Inc.
INwRERA: Employer's Fire Ins Co 20648
107 Orleans St
IN1suRERB: One Beacon Insurance 20621
East Boston, MA 02128
INSURER C: AIG — -% �s
/ ; rr �
INSURER D: I F— VI
I
INSURER E: U U I
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 hDD`1
— TYPE OF INSURANCE POLICY NUM13ER
�Poucy WW POLICY EXPIRATION LIMITS
GENERAL LIABILITY FBR4409SS
03/17/2004 —03/17/200S EACH OCCURRENCE $ 1,000,000
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $ 100,000
CLAIMS MADE [71 OCCUR
nw I
MED EXP
A
(Any one person) $ S'000
PERSONAL & ADV INJURY $ 11000,000
GENERAL AGGREGATE $ 2,000,000
GERL AGGREGATE LIMIT APPLIES PER:
POLICY f --j PRO-
F-1
PRODUCTS - COMP10p AGG S 2,000,000
JECT LOC
AUTOMOBILE
LIMLITY
QBXB26-51-0
—12/13/2003
12/13/2004
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident) $
ALL OWNED AUTOS
1,000,000
BODILY INJURY
(Perper") $
B
SCHEDULED AUTOS
HIRED AUTOS
BODILY INJURY
(Per accident) $
ON
N -OWNED AUTOS
PROPERTY DAMAGE
$
(Ptir acciderd)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
ANYAUTO
OTHER THAN EA ACC $
AUTO ONLY. AGG $
EXCESSfUMBRELLA LIABILITY
OCCUR DCLAIMS MADE
EACH OCCURRENCE $
�GGREGATE $
DEDUCTIBLE
$
— T
RET�ENn�TION $
_H;t
$
WORKERS COMPENSATION AND WC7687928 V
EMPLOYERS' LIABILITY
06/10/2004 0-6/10/206S Vrw—csm i
o�]TORYHMM
C ANY PROPRIETOR/PARTNIERIEXECUTIVE
OFFICER/MEMBER EXCLUDED?
-11T
E.L. EACH ACCIDENT $ 100,000
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - EA EMPLOYEE, $ 100.000
OTHER
E.L. DISEASE - POLICY LIMIT 1 $ S009000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES J EXCLUSIONS ADDED 13Y ENDORSEMENT I SPECIAL PROVISIONS
1OB: HERITAGE GREEN CONOMINIUMS,
N ANDOVER, MA
HOLDER
rQgRUF_ICATE
('AlMd1=I I A'rlf%Li
AFFINITY REALTY & PROPERTY MANAGEMENT LLC
63 ATLANTIC AVENUE
BOSTON, MA 02110
AL;UKU 25 (2001/08)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THERE -OF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAJL SUCH NOTICE SHALL IMPOSE NO 013UGATION OR LIABILITY
OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES.
AUT14ORMW REPRESENTA
Michael renderqast/DFM oe- 2L�F-�
@ACORD CORPORATION 1988