111 MASON ST - BUILDING INSPECTION ......_.... o
Board of Building Regulations and Standards. /� �U CITY OF
Massachusetts State Building Code. 730 C'NIR . !! (0 �•\LL'�I
Building Permit Application To Construct. Repair. Renovate Or Dcnlulis D y f
_ ! One-ur Trsvr-Fainih-Du•dUlrq O sj
This Section For Olrteial Use Only
IBuilding Permit Number: ate, plied: —_
Building 0111cial(Print Name) Signal Dale
SECTION is SITE INF601ATIODYZ
L I ro erty)dd ress: Si 1.3 Asses Parcel Numbers 11W00
on 8s
I.I a Is this an,accepted street? -es no baap Numhcr Parcel Number
la toning information: 1.4 Property Dimensions:
/.oning District 11roposed Use Lot Area Isq It) Fronmge(11)
1.3 Building Setbacks(R)
Front Yard Side Yams Rcor Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:tM.G.I.c.40.§Sa) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check tf -csO
wner'of
SECTION2: PROPERTY OWNERSHIP'2.11,,O Record: r
/faSPM kQ I—V OCoaaoy- SQ >1am lA q 0/970
n e�Printl C,ur State.zip
No.and Street relephone Email Address
SECTION 3. DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition (3 1 Accessory Bldg.❑ Number of Units Other ❑ Speciry:
Brief DiFscription sed Works: 7D
SECTION 4: ESTIdIATED CONSTRUCTION COSTS
Itcnt Estimated Costs: Official Use Only
I Labor and Materials) n y
l Building I. Building Permit Fee: f Indicate how fee is determined:
Elcctrical S ❑Standard City,Tutvn Application Fee
❑Total Project Cost'I Ilem 6)x multiplier _._x
I ?. Plumbing S ,. Other Fees: S
41—Mcdt.nical ill\'.\(') S List:
hanical (Fire
1um+ression)
I, Total Project
Check _.—No. Owck Amuunl: - —.---..Cash \mount:
Cult: S p
5 / 0 0 0 Paid in Full 0 Outstanding Balance Due:
CERTIFICATE OF LIABILITY INSURANCE 15TE(MWDDIYYYY)
/20/2011
PRODUCER —�� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ambrose J::-lsuranae Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDEFIL THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
56 Cunt al. Avq. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lynn, N. I 01901
781-5 2 :y200 __ INSURERS AFFORDING COVERAGE NAICO
INSURED F !7J.angis, William NSURERA• Northland
1; :.C,riaan Doar, Window & Insulation INSURERS: Arbella Protection
o
i 'Sailey Ave. NSURER C: I4ibet Mutual
IT7gus, NA 01406 INSURER0:
INSURER E:
COVERAGES
THE POLICIE . :W INSURANCE WITEE,BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REOUIR : IIE:HT,TERM OR CONDITION OF ANY CONTRACT OF;OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAII "rh,E INSURANCE AFFORDED BY THE PO;JCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AC :tIi13ATELBYQTS SHOWN MAY HAVE BEEN;1EDUCEDBY PAID CLANS.
low WFE7 MIA
LTR MRO _;.,(PE OF INSURANCE _ POLICY NUMBED ZMEW PDOM DrWNLIMBS
GENE IL.,.IABILITY EACH OCCURRENCE i 1.000.000
g Mro.ERC1ALGENERAI LIAS:LH PREMIS
Y E (Es oaue a 6 5 OO
:UtINIS MADE G:J Ok:CI IR MEOW(AnYoneperso I) 6 51000
A Binder 5/20/13 5/20/14 PERSONALSADVINJURY 1 1,000 ,000
GENERAL AGGREGATE 11 2,000,000
GENT GIAEGATE LIWAFPLIEI:P-?Et PRODUCTS-COMPIOP AGO 6 210001000
I ;L.li PR
AUTO 11FhL ELIA81U1 Y COMBINED SINGLE LIMIT
.AuITO (Eeamident) 6 11000,000
I .0.1INEDAUTOS
BODILY INJURY S
g ; : KE jULED AUTOS (Per Peen)
B r.I:E:.AUTOS 47635400001 8/17/12 .8/17/13 BODILY INJURY
n N.1I111NEDAUTOS (Permldot)
PROPERTY DAMAGE _
(Pereeddent)
GA W;:LL�,BILITY AUTO ONLY-EAACCIDENT 6
A I!';. TO OTHERTHAN EAACC e
AUTOONLY: AGG 3
__]
EXCE.: i IUI.ISRELLA LIABILIT. EACH OCCURRENCE 0
CLAhMMlDL AGGREGATE i
S
r. :nI TIBLE
a
H • E_`t r1ON I __ VkPCBTATU-
WORNERBO ,.7r;�NSATIONAND TORYLIMTI S I X I ER
EMPLOYER: IAB-LRY E.LEACHACGIDENT ti 500.000
AW PROPRIE !/VwRTNEREMUTIVH
C CNIMERA1e1n111 `CLUDM WC2313389403013 2/11/13 2/11/14 E.L.DISEASE-EA EMPLOYEI s 500 ,00()
If Yn deearit, 'ah,
SPECWLPRI ;I5,!)N3beloN - - E.L.DISEASE-POLICY LIMIT 3 Soo 000
OTHER
OE8CRIPTI0N0Ft•. ?R�-.TIONB/LOCATIOIIS I VF]41CLESI FXCLUSIOI49ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Carpenti. S Insulattion
Nation (.).rid Corporate Services LIdc d/b/a National Grid, d/b/a Boston Gas Cc
d/b/a Zv :ex Gas Co. , and Action, Ina. as additional insureds general liability
only.
CERTIFICATE •OLDER .r, _ _ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
A I.L.,On, Inc. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
4' Washington S t. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 60 SHALL
Q' ;ylacester, Nh (11930 IMPOSE NO OBLIGATION OR Lbr OF ANY HIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES. Is
AUTH PRESENT IVE
(;(�,Y_,V,��
4CORD28(201 I)B) ®ACORD CORPORATION IYOU
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards _ 1
_ - Construction Supervisor Specialh'
License: CSSL-100824 }
W ILLIAM J DEL�NGIS ;
15 BAILEY STREET '�
SAUGUS MA ( - t
1„�� Expiration;
05/05/201414
}
Commissioner .
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
z---- Registration: 111123
l -- Type: DBA
� ---�' .------>t., Expiration: 11/25/2014 Tr# 234005
AMERICAN DOOR WINDOW & INSULATIO l
WILLIAM DeLANGIS
15 BAILEY AVE
SAUGUS, MA 01906 '
f y
Update Address and return card.Mark reason for change.
--- Address Renewal Ej Employment D Lost Card
SCA 1 0 20M- l I
WAP Work Order
North Shore Community Action Programs,Inc. Work k Order Date:969 7/23/2013
98 Main Street
Peabody,MA 01960 Ownership: Owner
Phone;978-531-8810
American Door,Window,&Insulation Auditor: Brandon Dorrington
15 Baile Avenue Email:bdorrington@nscap.org,
Saugus MA 01906 Cell:78175410-8569
Email:wdelangis@comeast.net Phone: 97$-531-0767 x121
Phone: 781-231-0244 -
Rosemary Oconnor is Gas $5,912.42
111 Mason St, Total $5,912A2
Salem MA 01970
978-745-3281
t!�a^Ir4'M rut�C eI f�Irl,I 4,rI7-!l dhr��:h I,IljI�Y 1iF IlIni"((LpiIrl;�!t',,,pA,,,'l.''�,iti'.t,l!�:rl l,.tl I1l;.jl;':!:-lIii;),I;G1'•.G.ru;I.:,�1,�♦iIr�.xyyr�,1 4'�rtJ GdIlSlIrI?g'U�illl'l.iy�,I�l:'.LfIl,�I f A;ti I;,7.1:t�I"e,y`;I.n,{"u,I)j".4ryy:r„tl..rN�,I N'"a y'Iy t��6,ll�i�'tI`�1'i'r'.'�.I!h9II�.!u.H�r::!V•l��'f,•�,,.r�4ll,{IlW u�i.-..iI�f!"i,'.�iINFpalII i'I lNl l,lGl f�.rIj f��1�IIl�li�M,1l�l.�h�i-�;l,JI.u.hp�i(Gl.!�I f(�I�l,rVlI�Ir'I�l�Id�Il•iIllaI f�n„l'iI�:�tl lIU�rI..I l�1�j�rx��'7I,I'L I��):4Ir�l;fSl!���i"u�lI�II eFiN:�,�ir f�lI;l,l rIllC��l����ft�+fi�i��r{l�./i'rliI l r t�uqqH(yI I�!il��:Il'(I��l'II Jl•u'iiIl r��t lI�l�lJ 1��tl�I!):,.II�II,YjI!�I�f,f.'lI!'1tl�li�1"lI�'1I l-l'Ii.'lI lI�:!,i 61I11Ir{x1fI 1 L'{t I ll:,ll 1l l,1I'�I�11�'II).'�'��!t I�S�I�Uitl'l rIfd 1J1Id.'1n'6I!�P'f1tdfI ll t�.t'l'„�lErf'ir1r!r�t,l fl'T tF''I'I�"IC I�!f�t i jt'ii.�l!lIiNI4.I-IIf1II�iI III'III',iJ�.lfI:!Ii".�I flI'riI�II��1(t.I 1ry�i'�1''�1,.,I�!lIH���II�I1 I(1NuI1i����1Itl��l,�f�{1.a 9jj�If��jII 1I1)lI.(u1l�hI�'f�1��Jt1'l�!'';,�llJ4ill Till
I1�l.L�Ii1IlM�,'14lt1�I;Jl�iJ'�III �4II�U1iJi{t��YI1tI1lfIl1�'III(�i1Ilb r�ll,4lr.IP)i ll'..i,(t,lIl.jx�hL,N�:iJl.
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R-18-20 restricted-slopes/floored 293 $1.42 $416.06 293 $416.06
rill w/cellulose -
R-38 unrestricted-settled cellulose 215 $1.47 $316.05 215 $316.05 Rea sub-attic
R-38 unrestricted-settled cellulose 330 $1.47 $485.10 330 $4135.10
,,'q:_-il I Ci;i•ii am.11l :'.'P 'xi ildp 'I i1'I I'I Pn 11 jvlll:ilJ lhl!i lr.i'IFIpp;) I II I+:11f!I lli fll l'I!1111 -ip Ili IjltPlli,I?it
nnIq p •it i9lil i "V„ pipp':,,:Q�• lh I, . LM +Iljl „�Ilfd'f; I'.1 u. i!ffI I!i. r lliryl t�'Y) Pllr l�Ir I��N I N!14. Glr ill 19I1..I; II Itl ! Ir1 "!, I!I�n lil l tl . .1Ct
Ilfrq"fr 1, Ut'` itt 7;Ilp ll'ii III! '!il hl:l�,a;!�I)� Illy lrV �I�I.i� II r 1.Ii{�l lI I I III I'll ills IIUI IIIflKlll�) ih:lt,z
fil)IuIIpWas WII ((u�' ' �16•II Ir� lr!I��Ill6IILll��l����rhr•::Ldi�..,�rfl-I 11.JI 9l�,�t:.11 lj.`f) iI,.u.'. of -�.�:
Rectangular gable vent 2 $92.00 $184.00 2 $1•84.00
Roof vent 865(A sq ft NFL small 1 $80.00 $80.00 1 $80.00 Rear sub-attic access for blow ''V 1 KE
PICS**
'm,�-AI'IlIl�II'rllG,_'�TI!;''.!Nl;JagP.a�;srgdded Nl f:l!7•hNN IN'°'fl'ifW'aW7l"lYIaAiL.l @N(w. „-
Wlilll M1 O ' Ip''. 1��1r1''I,fi,y I IrIkurll
,rIg!idril�iiJir :u �LI�NL IIv��i lllfl Jr; .li�:�� d rrn��.:- 'ul ' tlrrFt�l _
Sill two-part foam w/riberglass batt 130 $2.20 $286.00 130 $286.00
. rx xr: rF ub'ni O'r -id'"'1'i••n L:1n r. I I,, !it,i 'I'II tl.rll Illiti .III J(!Il IIIlI'Nlii' f r'L'• II"Illi,fI N9� - pldill'i'I "t'I
;�IFlllur ly!r!tf; 'I IfCllul : .l, �. .I!.14r!11'III,ItI
r l+ri � +�.(tT.;ry�n1911 Ibo'� I M,I: Li l„Iri!l . ,ill.h:�:, III{lt.l(I II� ��{l{I ,!��{{��,yylh.,r•,.Nllll,�lt+.la�, !II pull
lil--^i,�u���!�L�II"FI��$LjlldNr4lN:�l° 4��rfa��.fh'�17��11:illilla lll�p2,�t!iJ6d91ll ide�l�,1�I'�:'!II�IAuI.I��IRIri��lA::1 n1 I„IIL�t�Btalixf �ta�f�ijlll.l-L,.Af��l f�'.II�R.JI;'lEl hI�IJIJ��J III�i a',I. •'�I- a-. 81:1!Li�i.
Automatic Sweep 1. $23.00 $23.00 1 $23.00
Repair/RefitDoor 1 $52.00 ��$52.00 1 $52.00
Weatherstrip s/Q-lon or equal 1 $45.50 I$45.50 1 $45.50 s
Date:7/2 312 0 1 3 Page I
a
WAP Work Order: Job Nunaber: 2,9694
i,I I 'a 71N I I I , p, II ;I rl , :,III III iTrj!II 5 I ! i lk I aI II I: 1 II
u, Viz! a tea ho Idi!c��i i :!�f rl;I�, ! I� I�!!,I 1 I INaI"I!'NIi V'!N�ul�!!�1!1211,I:�i!
Clothes dryer vent including 1 $89.00 $89.00 1 $89000
Exhaust Duct
-. r�I 11211
, � L
, Il 111110,11114
Domestic water pipe wrap 6 $2.63 $15.78 6 $15.78
Hydronic pipe insulation to 1 in. 125 $3.41 $426.25 125 $426.25 �^ ^
copper pipe II
nI1,!�1�ll�ui1,irl•1i'Ibt'�ll�:!i.appj l�l'!I'.IJ,;.:Iiri., N..,1:pIlL::yu'I:,,LV"L.,dJ:i:"illl lG��,l.lit._tll!in.l.lr�;�'-Ili'Il CY1' 'I u'�'1 -��11�r ir"el Lgnr' IihIllli,llpAy,il1 l:I,l,I,IIIrIl)I�II�I,!''I:iI ia lll ill nl1l-�rI,.:I1n'r 11 1InorI LILpI,Lt IIl'11
Ir{lIli. +I I.,ILn geilluf rrIrl l.�I,1{1dhis, ,J 1!1,!
;
Attic sealing with two-part foam 2 $75.00 $150.00 2 $150.00
Basement sealing with two-part 3 $75.00 $225.00 3 . $2''5.00 -11
foam
Blower door set-up with pre&post 1 $45.00 $45.00 1 $45.00
tests
Clean Gutters 1.5 $60.00 $90.00 1.5 $90.00
Cut/close attic-kneewall access 1 $78.75 $78.75 1 $711.75 _
:+9uu1ll-lll1l1 1 Il,IIII IIf 114111111111
41 l I!!p!I,� ..hI,II!IIr',t0I:;�.1�,1IfMn M11,1111
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,�..Building Permit 1 $100.00 $100.00 1 $100.00
l'Iµ,'nh 11��
1 I11 I1 . l 111�5 l .''W lI� l Ill
���IItII�;:ll l��l l,!':! 'Ii;L�j l�,j�!!III _.:€!, �PI NIR
Wood clapboard/shakes/shings or 1567 $1.79 $2,804.93 1567 $2,804.93
vinyl(dense pack)
Total $5,912.42 $5,912.42 � T
Contractor Instructions:
Before Starting the Job: During the Job:
1.Please notify us 24 hours before starting or scheduling a job. 1.Incorporate:lead safe practices as applicable.
2. Obtain required building permit. 2.Total for Heath&Safety and Repairs cannot exceed$250111 t.
3.Davis Bacon time sheers required for ARW,work on US i
Department of Labor Certified Payroll Report Form-WH-,,.4_
Date:7/23/2013 Paie