10 MASON ST - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
I Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
" a 4 s, This Section For Official UseOnly x:
Building PermitNumberc- Date Applied:
Bud'dmg"Official(Print Name Sign a Date ?'
.m .,.a.�., BECTION"1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& reel Numbers
10 Mason Street, SALEM
L Is 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 ft) 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❑
-z SECTION 1: PROPERTY OWNERSHIP'
2.1 Owner of Record:
Cruz Batista Salem MA
Name(Print) City,State,ZIP
10 Ma.gon ctrppt 978 406 3728
No.and Street Telephone Email Address
z v, SECTION 3: DESCRIPTION OF PROPOSED WORKZ(check all that apply) , lk
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other ® Specify:Insulation
Brief Description of Proposed Work': Walls R15 -Attic R38 - Air-sealing -Weatherstripping
and ollfer wea eriza ion measures
A :F � t °, .SECTION,4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only,_
Labor and Materials ,.
L Building $ 4789 1..Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ 3 �
❑Total Project Cost-(Item 6)x multiplier x �I
3.Plumbing $ 2 Other Fees $ �
4.Mechanical (HVAC) $
5.Mechanical (Fire
Supression) $ Total All Fees: $ '
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 4789 0 Paid in Full ❑ Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
96385 10/08/2012
Romain Strecker License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
Noo..and Street Churchill Place Type Description '
L MA 01902 U Unrestricted(Buildings u to 35,000 cu.ft.
Ymt� R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
791 710 6637 rostrecker@ ail.com I Insulation
Telephone mail address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
169145 5/20/2013
Romain Strecker- American Building Technologies HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
2 Neptune Rd #439 rostrecker@gmail.com
No.and Street Email address
Boston, MA 02128 781 710 6637
City/Town,State,ZIP 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 .......... IR No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN f,
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDINGPERMIT . #
I,as Owner of the subject property,hereby authorize Romain Strecker-American Building Technologies
Fc_noln�es
to act on my behalf,in all 7tters relativ to work authorized by this building permit application.
Cruz Batista c' _ 2 Z 2 2
Print Owner's Name(Elec ro ' tgnature) I Date
' P4
•= SECTION 7b: OWNERt OR AUTHORIZED AGENT DECLARATION
x.c..
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to thpbLqst of my knowledge and understanding.
Romain Strecker
Print Owner's or Authorized Agent's Name(Electronic Signature) to
"' 'NOTES, pr
1. 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 can be found at
www.mass.g_ov/oca Information on the Construction Supervisor License can be found at W1NmLmass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor 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"
The Commonwealth of Massachusetts
Department of lndustrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.govldia
Workers'Compensation.Insurance Affidavit; Builders/Contractors/Electricians/Plumbers
ADPlicant`Information Please Print Legibly
Name(Husiness/organintionandividuap: Romain Strecker - American Building Technologies
Address: 2 Neptune RD #439
City/State/Zip: Boston.MA 02128 Phone#: 781 710 6637
Are you in employer?Check the appropriate box: Type of project(required):
T 9] 1 am a employer with . ❑. am,a general contractorand I
� 4 1 e tt
_ 6: ❑thew construction
employees(full and/or part-time).'' -have hired the sub-contract=rs �: ❑Remodeling
❑I am asole proprietor or partner listed on the attached sheet..
ship and have no employees: 'These subcontractors have & -❑'Demolition.
working forme in any capacity. workers'comp.insurance. 9. ❑Building addition.
[No workers'comp.insurance 5. ❑'We are a corporation and its 10:0 Electrical repairs or additions
required.] officers have exercised.their
3.❑ I am a homeowner doing all work right of exemption per MGL 1.1.0 Plumbing repairs oradditions
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.] -
.kny applicant eat checks box#1':inust also fill out the section below showing their workers compensation policy information.
tiHomeowners who submit this eilidavit irdicating'they are doing all work and,then.hne outside contractors mast submit a new affidavit indicating such:.
'Contractors that chtek this box most attached an additional sheet showing the name of the subrcontractors and their workers'comp.:policy info m ttion.
T am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
InsuranceCompady.Name: Liberty Mutual Group
Policy#orSelf-ins.Lic.#: WC231 -S372122 :ExpirationDate: 3/10/12
job Site Addrem 10MaannStrpptt CityiState/Zipr4alem,.MA
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.25Aof MGL-c. 152 can lead to the imposition of criminal.penalties of a:
fine up to S1.,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$25,0 00 a day.agaiihst 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...
1'doherebycenify undeM I uspains bnd penalties of pmrjary that the information provided above is true and c rrect'
ergiiature: Date' X
Phone M 781 7M 6637
Ojrcidt.use only, Do not write is this area,to be completed by ci(y or town official
City orTowm Permit/License#
Issuing Authority,(circle one):
I.Board of Health 2.Building Department 3.CityiTown Clerk 4.Dectrical Inspector 5.Plumbing Inspector
6.Other_
Contact Person: Phone.#:-
`rl )4melliti:w fit
' failxfic rFt
e O � O'uValt 1. ness ulltion T
}lino t{rt{ Rtatrdi+a � ttr'iteS tISE31i0 atni7 �r ttttla
HOMEIMPROVEMENTCONTRACTOR �
-.+ Construction Suporvisar License
Registration 169145 T
rpe
Expiration 5/20/20013 LLC f� { `t-�censr c:S 98385
M CAN BUILDING TECHNOLOGIES LLC
ROMAIN STRECKER
d f
aROMAIN'5TRECKE
R ` z � '. 1Q GHURCHILLL PLACE
" �-N'^
2 NEPTUNE RD 43g LYNN, MA 01902
aBO
L $TON MA 02126
-� Untlerserrefnry,.
EXPtra?ion: 101612012
Tr4; 4344
r
FAmerlcan
n Buifdin Technolo "fEn�s.an ,.:.Ei+,LirJt:age��rt�Gehsbifanr
ftoiixaRrs 51r8clrmr
.. rt,:nir�ing�artrer.
r
4�m1 R?A ncrs �'Ya6xiytSrnG.`y`cl,%tin
t
LAC - INSURER e: Arbella Protection
..2. Neptune Ad. , #439 INSURER G Liberty. Mutual
Boston, mA 02128 iNGum D; Nation Union of. Pittsburgh
. _ iNSURBR 8..
THE POLICIES OF INSURANCE LISTED.SELOW'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONOrT10N 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.AkREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
R off. POLICY NUMBER ICMY EFFDEGT P 1 N - LIMITS
TR D
GENERAL LIABILITY EACH OCCURRENCE 8 1.000.000
COMM"CW.GENERALUTABILRY PR IS (Ea-D P _. .I 50 000
CLAIMSMADE :M OCCUR MEDEAr w.P�Al 8 5.000.
-A . L0.35-009067 '10/17/11 10/17/12 PERSONAL&NCV INJURY S 1.000.0001
GENERAL AGGREGATE $ _OOO OQO
GENC AGGREGATE LIMIT APPLIES PEA PRODUCTS•CUMPIOP AGO S 1,000,OVA
POLICY: P T LOC
AUTOMOBILE LIABILITY - .COMBINED SINGLE LIMN
wYAUTO IS.mddeM ; ,1,000,000
AL OWNED AUTOS aODIJURY S
X SCHEDULED AUTOS. IPAr LY LY Bd IN)
B HIRED AUr0S 90393400003. 3/9/7.1 3/9/12 BODILY INJURY
Nog-owrSiO nuroB .. '(Pw aeGaeN)
_. _. PROPERTY DAMAGE
(Per ewl II
GARA08 kARLRY ALRDONLY-EAACCIDENT
ANYALRO.. /:.. OTNSR THAN EAACC
'8
• AUTOONLY:
EXCESS I UMBRELLA LABRRY EACH OCCURRENCE S-.1 000 QO
OCCUR E'CLAIMSMADE ._ - AGGREGATE
n oEDucTraL ' EBU-019084283 10117/11 '16/11/12 B
':.REYENTION. 5 . . . . _.S :.
WORKERS COMPENSATION TYLIMRS R ER
AND EMPLOYERS'LIA&0.m YIN
ANY mcOPMER7wP eimws - E.IEACHACCIOF.NT S. 500 000
ORTc a PseuloPm ®' WC23IS372122 3/10/11 3/10/12 E,L.DISEASE-EA EMPLOYEE s. 50O 000
C INAPAMeryle NNI
ByDAdeeer0elMWet - - - E.L. ISEASE•POLICYLIMIT S 500,000
SPECIAL PROVISIONS bel -
OTHER -
OPSCRIPTION OF OPERATIONS/LOCJ4TIONS I VEHIOLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Carpentry & insulation
National::Grid Corporate Services, LLC d/b/a National Grid, d/b/a Massachusetts .
Electric, d/b/a Boston Gas Co.. and Action, ..Xnc. as addtional insured. Nstar.
and Action £or Boston Community Development, Inc. as additional insured ..
CERTIFICATE HOLDER ` CANCELLATION -
''._ .. SHO=A OP YNEIAaOV6 DESCRIBED POUCIRS DR:CAmF,,%LPO PFF,OM T UPIRTIBN.
Tri-Cap Community Action program 20
OATBTNBRROP.Tli'®eDiNC meVHER XnLL EfmsAVDR TO wJl �DAYIO YIflITTFN
Energy:Conservation .. NOr1eB rO TxE etl0lntATR NOLCOR NANW TO T"j VYT.UUTPAR.VR6T0 W 3O SHNI.L
110 RleaQant St. I,. 3rd Floor b08E ND OmaAY ON OR MARL}Y er WB UPON IRS INSWq L I'mAaENM OR
Malden, k)Pf 02149
__. 'AEPREHENTATNE6. � •, :
..-. .. ,._ : AUTfiORIZE NT
ACORD28($009107) - •2009ACORDCORPORATION. All rigrtsM$Orved: -
.- ThG ACORD name!and logo are:iegletered f ACORID
" tOSNUMSER� e
' :
11
DOE Work Order# ,er 0s sp S f performed? " c s
Work Order Date =« O131/12
rPrimary Contractor .;�, Amertean Smldmg:Technnlotes at _ y
' Otbcr Contractor: I canon Wuidowh ,hI tian.r �a ': 'rF nlbsin Called ' 0 --
... c 3 s,n
r .I {"a '! .'r- a � _ Co of 13ulbss� y„`atY t10
, s Client =3728iDa'u
ndnpar «qPrStreett II n6or 1'2 [)her7aKmd ° 1 Stl PtltatC Ltp. a° 01970' i lutrrcal�t orL ,t r)v elephone liter Liz 978 3n ° S,Amount KevI 1 3n
�a t
,�� k�� � � •��� ry� 3n �� �' „n r$Amount NationalLrr[d +r SWAY, `��.
SIOWer nor Test t' ,Nn' fi a Otnef Ut[Itty z `0 M �
ra,rF to x4C • 4 m t x a r q
P ,I" Inspect Knoh $7 ubC �O Ptl�a q 1 a� +
l� «D8t£�JOb"C4nipleted cs�s .,x` s r " ��" ` `'+ Bituated Repair oral�= .-
., ,.Iu±eurrr r :Ie
Actual Rcpaira Total• .,.. :
Vcutherizatiorv, n �` 'ti. :e �Estimaled .; .Actual aCost Est Cost "-` Act Cost -
,Door kit i °=. :" "rah- s' - •5 • $43A0 $215.00 '4 -
t,lolar doer sN•ea ' 5"' " �' "$15.00 't $75.00 R
ai ID UAtlCdoo7 S.�Oep -` ,� :h 2y. '.'ilra,£ r ? x F , `I. A22.00
A
-Air sealing2=artfaazn(per,hour)#_,� '';;;. 3x,,. 3 $75.00 -' $225.00�
"Aittu av ntbling^:partlown per hoiv)s r:l"�. -�«$i_=�`Sm.�, c
lYeatltcPStxip`wrudow(per4idC) ,r ^�."',{ •nr5�"r "I 5.00 I'd ".=e�iµ'�;`!d � -
Seal`4ctsr nastte :`' .$62.00 < ,•'a,
Seal ducts rettirns mastic,'- ".•��, ,, a ""_$62.0W - "•i' `:z- :<�+^€r
IVrS�:'iniela[e attic hatch Rao
p'"� R1��;;" «.:«?.,, Yll� :'., a. ` ,r�d.= t`Po'`=^n:t „ r- . , • ",= izf .$0.00� ".�. .td. k g -,.�:"
k.e .`al.•.>$O.t)Q y 4 .^=e r K:° &.+h,u ts;. -
$4�I�
` QQ $ I rb;`Y,r`, `u [ v'sA3k '
Wcathcrization Total:.; "; ,. " ° '.w - $515.00 . $0.00
51
'€nsulation ': ? .« _' -�'"'Fstimated` ,w Actual.':A ,m'lrCost ;�,, .tr>' 'Fst Gust , _I AbtCost, ,,
`:AnicFlatI�Bo en•"
f1L*ic tIuY.K30o en _,$1.30a�! .,
An[G iat/slo`es k30 a stricted° €tk xr t+. .< $7.41 .; .,,,.' _ ,4
rI'h[ItnUd note;'PPs-sP"..Z,.o`ifs(i=F`u.,a;{, i,;f,,fril k . .r i iS �t M,€§e.+ I r t x Itr<$175.00' "><(", a s"` .,rt „,-_ «t,
iltnc Aroe ue all[LI>cetlubu uhn rzibrar,e ,., & a",'::hl t( iZ,', It -.:.9 $1:65•r ',fit?,a,wy-ids :�£'
wilue•knceivap�tloor R30 restricted"`,e 'r1 ,�a�,r.r't'�-`� a.'tiv't ,..'` ,-. •.`,,,$1.41' „� r '`^_, d, 'P=s „.',.,, ?;
IInsrilate attic stain&cvnits. , $130.00
Slde,&As"-aluminum 105 i670,1 v r"_. s: " ;Y:,M,$2.20 ':" "$7•474 00 _lzm,
Intertor}vaft''lasterR15 M�r>it =i .Fi:..h, •t198 'E9,,p• ,,,,,;'r _: aI"••$.t.$1- km s�-.$35$.3$ `' i;�ks" `"m y.wa".:
1 ri dioam:board' rre�, q R 9{3aia:. Sz t./? t $t.$5 cuMim • 's. k ,+Csr .14,
.4 .:1U
pact nnsutation &se R� i+l s4 sins to - ltttsr,r,
tivdmnic pipe insul to 1„RSA % k': RING w e' ` ±, ,. $3.25 K° + $780:00 ..
4 tiY y U N S ": R`v -4 fyf tfa#'t lS
Steun 'i"insulm1.25'tR5 ur a,�,- +^ I. ,rt$5:25 s .rt a »
b11W i `e`'nsuation R5 x. . .. 6 „as,F• . a' ,y $2:50 1 ? . $15:001
Insula[ei`dobT:'• 1'r[�id'bot iiL�9i ra$44,00 t :`,$44-00
ZU,00,
insulation`.?oral u .. s n• _ 1 °°$2;499.38 $0 00.
...... ........ 111:1� ,I rz 1-�S�,�,Vwvv
w 5X
*�00`o.w show dl�ei Z
N R$25 -4r'lbn
7 75',,q -
,-'$0.00,'
-SO.00,
$E00
06� ra. '.P R";-� W-�4w',
a
1-1 J 77,,u,' W, 7F-777777:-I-
w j,� T
0 fc
X
;j 50
SO.00
rO
00.00) ,J`j
n.
--,7srm ,Estimated i "'Actuolr,: cost l-,g ;41-,Fstqosi:0�
lac -,I- qpvo�qg �i
0`� ,MO�O(Y $50.00
rstnc V606� 7T4,T-N F4 $1 25M S 125.00 -i,T,Jl V41
1� 'i�bbr-` l eri tiy cicksci N P, � 00.00
Can) Otters less $8.00 OY,: S32000"I"'
............
1! S4.00 $200.00�
d8lin,dritte`rs•(.pr $60.00 W).00-4 4
1,0.00 im
-4 '$350:-
V '17�1 k: &3,50 TIM: 0�j .60
wis4ep acement P
415,W
t'!�;;"sj'00,00 U00; PE•n,G
"7,7, o� "N 14 k"
Health&Safet
Vent clothes drvcitD exterior 185.W
Vent,bath-exhaust fan to exterior. $85,00
$eplave d ryw:h We f$38.00 `i l
7 Sl 275;00 7 1
4 -,r f-k v
Work Order Sub Total:
-n "IWIC,
11 rw A
!;T" 3,40 Ur 4�,
4
P, t,;jpv";gr�E
'A
,", "'A, ,,�X, A
01-Cost `Est Cost n, &t-C6,st,,41-Actil T`T`
-jX-�04�
Z
at OV
4-
6t A. gom?;U,�,
X
n -78938';'
J06 IF46 1:
p
Z-M
'AR
`Job Grand.L.Tdt.
rW
ord k,' i'M