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117 MASON ST - BUILDING INSPECTION (2) ,5 The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM ` Revised Mar 2011 Building Permit Application To Construct, Repair,Renovate Or Demolish a f One-or Two-F Dwelling This Sectio or fficial Use Only V 1 Building Permit Number ate Applied: �'o Building Official(Print ame) rgazure Daze SECTION 1: 1 INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers l.la Is this an accepted street?yes no Map Number Parcel Number 13 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(it) 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 ifyes❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner(/ ecord: I 7 W/_.ZJ Rct fla , 7G j`�P,l.�'1. 04j 015�r Name(Prnt) I"t -1— City,State,ZIP ) 7 /►' A50-,J Fig '7 5=2reZ. No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Constriction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other fY54pecify:f fpfit`2 .�"..ro�.J Brief Description of Proposed Work2: E>6�^) e,a./L,1©5e ct-yctl e4 egg SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ G1 r 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (BVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression) v Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ DO ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES ` 5.1 Construction Supervisor License(CSL) )if j2 ItItA torte License Number Expiration Date Name of CSL H Idcr List CSL Type(see below) U No.and Street Type Description Unrestricted(Buildings up to 35,000 cu.ft. fr/ N Restricted 1&2 Family Dwelling City/ cnvn,State,ZIP M Masomy RC Rooting Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) `<t'v r ExpDae tion umbe HI�CG Company ame or HI Registrant Name :2 rANO Li✓ No.and Street Email address �ST/�d�- Ste,✓ .=uff CJ��27 7t�!-gyQ-gu Ci /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.......... - No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR"PLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize j Eff ie e-Y MW Yd t to act on my behalf,in all matters relative to work authorized by this building permit application. S-.t y� // l 1 LG paY / - Print Owner's Name(Electronic Signs ) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION 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 the best of my knowledge and understanding. Print Owner's or A ori�d A Cs Name(Electronic Signature) Date NOTES: 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.gov/oca Information on the Construction Supervisor License can be found at www.mass. og v/dos 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 halUbaths 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" i CITY OF S.U.&NI, NLxss kcHusET rs BU DL\GDEPAR71MNT 1 120 WASHLNGTON STREET, 3'o FLOOR TIEL (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR T HOMA.c ST.PIERM DIRECTOR OF PL:BLIC PROPERTY/Bumi)LNG COMWSSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A_ The debris will be transported by: I��f1�rL�2 �N.c (name of hauler) The debris will be disposed of in : gv✓C (name of facility) OFF�5"e- ))uvH (address of facility) Ih f9W4 sighatge o permit app cant date dcbrivffdoe `SUi O Alo-m,gGi4•ii5 .�� [)ITur nF Cn e:umcr.{R.:�.& Ro..wc as Rq,Jq non l.ice»st rd'regiy-trriioe ♦'alfd tnr icdividul [ue only HOME IMPROVEMENT CONTRACTOR uefere tAc 1113irati0c dace. 1(([,00d rctm�[a Regisrtrago : 1 468y omcc of Consumer Alieirs and Bwlecu Rcgt:Falion Exyretion 10i21T2ol i Tr4 189821 itt Par4 PFnza-Suite 5170 TYPO" lodfviloal r B0xto0,MA 02116 JEIREY MAY O T TE JE r- R✓_Y MAYOTTE 29 AN,()REWS LN EAST HINGSTON.NH 03827 o[ id+iUOrt[ ignacurc �'� \la..ai hu.rii. - Ur�I:n-I IIIciII ,.( PubG. �,;Yrn I;O;II'II ,�( IiuilJin" Itc_ulalin. CS 103474 Rrstrir n:•!Iu: 00 JEFFREY MAYOTTE 29 ANDREWS LN t EAST KINGSTON, NH 03827 t E'll".Ill—, 1/23/2013 103474 IJ4rr071 2011 22:5_ 17615955820 AMBROSE INSURANCE PAGE 111!0= A. C% RTIFICATE OF LIABILITY INSURANCE �_ - 4 I:fMMlnl.Yl'v�' A•'abrOse Insurance q THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION N� 56 Central A enCy, InC. ! ONLY AND CONFERS NO RIGHTS UPON THE C i, AVrp. III HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND A.fR Lynn, MA 01901 i_ALTER THE COVERAGE AFFORDED BY THE POLICIES 81.1592,-A^0 �_'::--- 6EL�W- .� �' ____I INSURERS AFFORDING COVERAGE ------- 3eascns L4indowg & Insulation �NyunrNA: '— NAIC# P.O. Bcx E229 Lynn, NIA 01904 1 _ �a Pzotect.ion..__„_�__._- INallRrr:e Ch az tis "-' — RA'�'OVE ... 'DES r I_ 'E5 7F IS RFNCC LI TF,D EF I.OV, HAVE BFISN IS5JED TO TFIE INB.�RED NAMED ABO'JE FOR iNt'POLICY PERIOD INpIOA Tf^^! CEMENT T. FM OP, OIN%TI N V, 1 I r TAIN THE INS•.R/.N OF ANY CONTRACT OR CTPEH DUCUMF_NT W17P REc PECT TO WI•i!DH THIS CERTIFICATEED. gyrV✓THSTANp♦,� RGGRr.CA 7F LI:MITS SRC F ryq�gy:By THE.➢pllClfs DESGR!3En I IEHI-IN 15 SUBIECT TO ALL THE'TER;vIS, EXCI-IJSiON Ur I:i-V.",n 0., i, .— /b^9EEN RFDUCt;D BY PND:..AI'v15. SAKI;GONUI 1„Ns.IP sUCn I YECI: Pplaf.Y rrp rC II\/r ._—.—..__ I` OL CYI' Iq qe 1110N CATI%MIA/,n Yr"I 1:C'N7 r ry LVQ$—_.. .— ...__ n 0-c9EN n p p DER" X CCM RLV C_efRA I•/,Ii ICI"v 'ACH r•T^�rFTT"— t 1 �cMlscs A - - �__ I CPPOOSS607 I a urr EYr(Arrfo a e_ 5 000 1... 3/19!,.1 3/19/12 rHSCrinl—tAOVWI,Hy�{ 1C_00,�Op_„- rN" -cr;eGr_E .IxuT n r 1Es �r-.a I OEW-rk AGGRfCATF ., -2_ O , 00'� 1... OC Pic- rnonuc*s coLu 2 000 O 'ornee s ., �O.J i -.— 'Ci fY ccr I,rp - - ;:I �MO9l LlAglll'!Y I _ _ �I .UYAUTO ,. COAnrlr,r�91t GLG I,IfAJ !rn. rl,r+uTnE I ! 1 ,OOp , J001 ! m rRerec,l s _. 37797400001NoN ! 5/15/10 5 1 -/ 5/11 ---_._-. i j I Ron'L YIwuaY I . rR 1 PRTY C/M/(, t 'naYrll. OTHER�— I1.N . ,Y 1ACC I'J ONIv, nCP 5 P- r:SS/IIMyA l/ LAD 1.i --- —_"("' i n .. C/rH p CLIRR NCC ![ I ; n( H Cr' IP T tilt M1.Nli N l OP/r`nOY CI�A I,ITIIII an is,r � 652368E 12 i . �i CIr UcI nVnIy„I�u.I rt�rl!T]r,(>r r/rRr__I�_ .. p �000 12/15/71 r olsr\sr 500, 000 �hi 191-1 1Pol. YLo-n'r15 00 003 1 '-1 ..::.'11 :.O°OrFrvtl NB",.,.:n'n J6S VAl rer1:3.1'(r..UeIUNB A!ipCG aY. LNCOI<Sr A/�CNT;BPrcIAL PROVIJ:ON$ -- P�zpentry/Insulation/Electrical sRTi F!CaTE HOLDER — '----- ANCELLATION City of Salem I sn^ui.n NNV Or Tt:r A,,CV6 r! �cvinro rG,.Ir rs nc rw ll -'�---- Attn. ; HUilding Dept. Ua'CE TI V'R1'nP TI{E to 9UIN INS:JPF_R l4pL C'!nl(AVOr rO .M. Zp nA o;e11:n City Hall Np'ncc TO nr:FN vu,Or:ICLnF3 NA. en TC�r:.a 1r I A Pru a Salem, mA Dlg7p 'MI'09CNO rLIGATIJN OR LIAC:I„1TY IfnNY KING LPON 71 . 'm9L'rl'i rS F+o:SJx I1r.PVE3.NT17Ib SS ALI I? :D AGORD COR POR.4TION'gccp The Connnonwealth of Massachusetts Department oflndustletalAccildents Office of Investlgatlons ` 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidasit: Builders/Contractors/Electricians/Plumbers Applicant li formation Please Print Leelbli r'�o[pe (Business.'Organi2ation/Individu�a}l):Jf�J �iro���a�/5 (,fir���� d' j-,�,pfv�47 U �✓ Cir,iS'rate/Zip l�v �Tw Vl/l� / �jDa{ Phouek}, 7ZE1 -Ee{y .are ro an employer? Check the appropriate box: 'Type of Project (required). am a employer with_ 7�7_ 4. ❑ I am a general contractor and I j employees (full and/or part-time).* have hired the sub-contractors 6' Now cons[nredon ! am a sole proprietor or partnzr- listed on the attached sheet. t 7� ❑ Remodeling � ship and have no employees These sub-contractors have 8. Demolition +v orking for me sn anv capacm workers' comp. insurance. fNo workers' comp insurance 5. 9. ❑ Building addition ❑ We are a corporahon and its _ r'-gnlrzd_] officers have exercised Utou 10.❑ Electrical repairs or addinoo.; I_I I am a horrito-,,nee doing all wer:t nght of exemption per hIGL I I-❑ Plumbing repairs or addinan; mgse!f. FNc workers' comp. c. 152 §I(a), and we have no t nsurance requlredl ' 12.0 Roof repairs employees. [No workers' / �,�' comp. insurance required,] 17.�Otlter lM3_-tl�iG✓Gzti �pl� fit r a a c: muse also fit out the s«iron below showing their workers'cemi,cmanan policy inrorm rice. ! ern o+rncrs tines_,,Ir.s a*,dzvn ndiczting th<y a.•,doing all wort and then hire outside eontraelors muse submit a no+ Conrz clors n t Yc .tots oos must attached an additional sheet showing the name of the su6Kouvacmre a»d theu worlan'tom,a it rnrieating Bach t colic mfortnar,oc. !am en emplgrer that is providing werA'ers' compmtsahon insurance for my employees Beloit, is die police and job sir no anon. .r1SLLianCc C0111n ail.. lN�Inn :rseltn� Lie / _% I =^,V/f Expualton Date L r 2- 5 (� Y ICI .?.reach a cop} of the workers' compensation policy declaration page (shoeing the policy number and capiration dater. secure cc,'erage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a - = ' F to S1,:!�0.00 and%or one-year Irnprisonment. as well as civil penalties in the form of STOP WORK OP,DCR and a fine ai S250 00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of _uzattans ,-(the DIA for insurance coveree reefication. !do hereby cerrvfy infer the pains and penalties ofperjury Utar the trt/orvnadon provided above is true arlrt correct r ,- ----_ Date �� Q;l7.Lr( usz nnlr. De nor write in dtis nrza, rob ----- —., e completed 6v cite or to tin officinL ' Cyr; crTonn -----------_---._ _ PermiULlcense P Issuing Author-Inv (circle one): I. Board of Health 2. Building Dcparnluent J. Cio,/Torun Clerk 4, Electrical Inspector 5, Plumbing Inspector 6. Other it C'ontael Per,on:_— Phone q: ACTION, INC 47 Washington Street Gloucester, MA 01930 11, Agency: NSCAP NGRID Application.#: PROGRAM: AARAWAP 0 JOB NUMBER: 0 DOE.Work Order# 0 E.&C.performed? No Work Order Date: 04/22711 Primary Contractor: All Season Windows&insulation: - Other Contractor: All Season Windows&Insulation #-Bulbs installed. S0.00 " Cost of Bulbs .$0.00 Client: Elizabeth_Rapaj _ hispt,$175•.00Max < $0.00 Street: '117 Mason Street _ OtherIn Kind i `$0'.00 City; State;Zip: Salem;MA _ 01'970 Electrical.Work: $0:00 Telephone: (978)745-2102 $.Amount KeySpan .$0M Amount National Grid. $0.00 Blower Door Test: Yes - Other Utility $0.00 Inspect Knob&Tube: Yes Date Job Completed: Estimated'Repair Total $87050 Actual'.Repair Total $0.00 Weatherization Est Act ,Cost - Est Cost Act Cost Door Kit 4 - $43.00 $172.00 Regular Door Sweep . - 4. �', : $15.00; i< $60.00 Automatic Door Sweep - `.; ': $22.00, { - Air Sealing2=part Foam(per hour) - .3 $75100 $225.00' Anfv Air sealing 2.pon Foam(per hour) - 3 :".$75A0 $225•.00 - Weatherstrip Window(per side) 41, $5.00 Seal Ducts-Mastic ' '$62.00 W/S &Insulate Attic Hatch R30 1 $30.00 '$30.00 $o.00 $0':00 ,. $0.00 , $0.00 $0.00 $0.00 Weatherization Totals: $7.12.00I 1::$0:0:0:� Insulation Est Act Cost'. <' Est Cost Act Cost Attic.FlatR38 open l°. $L40 Attic Flat R30 open r $1'i30 Attic Slopes R30 restricted `"' $1'.41 Attic Flat/Slopes R20 restricted - ''$1".35' Attic Kneewal R13 FG $1.25' Attic Kneewall R15 Cell w/Membrane '" $1.65 - Attic Kneewall Floor R30 restricted C i $'1:41' - Insulate Attic Stairs&Walls $130.00 SidewaEs-Vinyl R15 DP jr, $E:70 Interior Wall-Plaster R15 DP 1"Rigid Foam Board �$1.85: Duct Insulation R5&Seal Seams $2:95- - DHWPi eInsulR5 6 I t $2i50` ,'$15:00 Steam.Pipe Insul to 1.25"R5 100 $5.25' $525.00- Stem-Pipe lnsul'tor.5"-2"R5: 80 $&05 `"$484.00 Insulate DoorI $44.00 "'1."..;$44'.00' Sill 2-part Foam w/FG Batt R 19 129' -- i;. ;_ $2:00 $258.00 Insulation Total's: i ; +$1;326:00 Elizabeth Rapaj Page 2 DOE. 0 Other Measures Est Act Cost Est Cost Act Cost Roof Vent-small $76.00 Gable Vent-rectangular 2 $88-,00 $176.00 Recessed Can Cover $30.00 Cut/Finish Attic Access 1 $100.00 $100.00 - Test Drill Sidewalls-4 sides $60.00 Blower Door Test 1 $45,00 - $45.00 Vinyl Replacement Wiindow- 101 ui 7 $350.00 $2,450.00 Steel Pre-hung Door w/Lite $610.00 Solid Coor Door wMardware $350.00 Faucet Aerator $15.00 Low Flow Showerhead - $25.00 $0.00 $0.00 $0.00 Other Totals: $2,771.00 $0.00 Energy Conservation - Est Cost Act Cost Totals: (Max$10,000.00) - $4,809.00 $0.00 Repairs Est Act Cost Est Cost Act Cost Repair/Refit Door $50.00 Adjust Door Striker Plate - $20.00 Door Threshold $40.00 Repair Door Hine $25.00 Slide Bolt 2 $20.00 $40.00 Sash Cord 1 $17.50 $17.50 Glass Replacement-to 64 ui $42.00 Site-built Int. Bulkhead Door w/jambs 1 $415.00 $415.00 Building Permit Fee 1 $100.00 $100.00 $0.00 Health & Safety Vent Clothes Dryer to Exterior 1 1 $85.00 $85.00 Vent Bath Exhaust Fan to Exterior $85.00 Replace Drver Hose 1 $38.00 $38.00 Knob&Tube Inspection 1 $175.00 $175.00 Bathroom Exhaust Fan $500.00 $0.00 Repair Tot: (Max$2500.00) - $870.50 Work Order Sub Total: $5,679.50 $0.00 Measures Est Act Cost Est Cost Act Cost Other $0.00 Other $0.00 "Heating System Repair $0.00 $0.00 "Action approval only Estimated Job Total: $5,679.50 Job cannot exceed $10,000.00 Job minimum=$500.00 Job Grand Total: $0.00 AUDITOR:. Doug Cranford _ NSCAP .. 98 Main Street Peabody,MA 01960 Tax Exempt#:642-385-280 Agency: NSCAP PROGRAM: National Grid/2011 JOB NUMBER: 0 NGRID Application #: 0 Work Order# 0 Work Order Date: 04/22/11 Job Limit• Primary Contractor: All Season Windows&maul Per(Jnit $4500.00 Other Contractor: All Season Windows&Insul ` Client: Elizabeth Rapaj _ K+T Yes=1 No=0 Street: 117 Mason Street K&T: 0 i City;State;Zip: Salem,MA 01970 Telephone: (978)745-2102 Stand Alone: No Fee Coder 0 Blower Door Test: Yes - Stand AloneYes=1 No=0 Inspect Knob&Tube: No Elec.Contractor: Attic Insulation Est Act Cost Est Cost Act Cost Attic Flat R49 open $1.53 Attic Flat R38 open 515 $1.40 $721,00 Attic Flat R30 open $1.30 Attic Flat R20 open $1.23 Attic Flat R10 open $1.15 " Attic Flat/Slope R30 restricted 264 $1.41 $372,24 Attic Flat/Slope R20 restricted - .: $1.35 Attic Flat/Slope RIO restricted $1.24 AmcfKW Floor Transition DP-[in, ft. $2.40 - - Attic Kneewall R13 $1.25 - Attic Kneewall Floor R30 restricted $1.41 Finished Attic Access - $100.00 Tem orary Attic Access $75.00 Crawl Space wfPoly Vapor Barrier - $2.53 Garage Ceiling/Floor R30(w/approval) $2.00 Vent Dryer/Bath ExhaustFan $85.00 lhennadome $175.00 Roof Vent small $76.00 Turbine Vent $160.00 12"Stack Vent $145.00 Pro pa Vent $3.75' Gable Vent(all sizes) $88.00 Soft Vent $26'.00 Attic Air Sealing 2-part Foam(2 fors max) $75.00 Elizabeth Ra a' Page 2 National Grid/2011';: .. Est Act Cost Est Cost Act Cast Wall Insulation Single Nailed Asbestos/Asphalt RI DP $2.10 Double WIi dMbes,os/,Vuminum RIS DP $2.20 Brick/Stucco R 15 DP $2.75 Interior Wall Blow-Plaster R15 DP $1.81 Clapboard/Wood Shingle/Vinyl R15 DP 1482 $1.70 $2,519 A0 Test Drill 4 sides $60.00 Air Sealing Limit: Single Family w/Blower Door=$400 All Others=S200 Door Kit $43.00 Regular Door Sweep $15.00 ' Automatic Door Sweep $22.00 Air Sealing 2-part Foam Q hours max) $75.00 Sash Lock $9.25 Glass Replacement $42.00 Blower Door Setup $45.00- Total Air Sealing Cost: Heating System Measures Duct Insulation&Seal Seams(sq ft) $2.95 Hydronic Pipe Insulation to P R5 $3.25 H dronic Pipe Insulation 1.25"+R5 $3.50 Steam Pipe Insulation to 1.25"R5 $5.25 Steam Pipe Insulation 1.5"-2"R5 $6.05 Boiler/Furnace Replacement $0.00 **Pro ram Repair $0.00 "Action approval needed:Max$500.00 **"Actual Total does not include$175.00 K&T chg.. - $3,612.64 Est Total 50.00 1 lAct Total AUDITOR: Doug Cranford . i