192-194 NORTH ST - BUILDING INSPECTION r . o-rL}Pc12 'Tb4AI4 I It Z r-A941L7
The Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(780 CMR)
k�v Building Permit Application for any Building other than a One-or Two-Family Dwelling
N (This Section For Official Use Only)
Building Permit Number: Date Applied: Building Official;
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
tIL- N4 OakTf}, C.T. SU&w ' MA ON70 Cswt 0*4 TUt2 5WA
iNo.and Street City/Town Zip Code Name of Building(if applicable)
_^ SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ Repair❑ Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other �Z Specify: IAV-thwTt CA AXA.K-
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No 16
Is an Independent Structural Engineering Peer Review required? Yes ❑ No X
Brief Description of Proposed Work: OL.0V-4 14 C-tUAL-&61t> I"—U A-,n0t4 n 4!t2.4otZ.
lA2A-tA.f- .
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 3 L , -;ft
Total Area(sq.ft.)and Total Height(ft.) 23 '
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ I H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-S❑
I: Institutional 1-1❑ 1-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV O j VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Debris Removal:
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Licensed Disposal Site❑
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be p
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA flistoric Commission Review Process:
Not Applicable, Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
S4�ar11 Rou5tacf dv'I S-T—
Name(Print) N .and Street City/Town Zip
Property Owner Contact Information:
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
At 71t4t1T bJkq !uAj_4Ttoa I.VG 4 1 �{ti. y4rl t.�1 � d 1415—
Name Street Address City/Tokvn State Zip
to act on the 12roperty owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.h.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Tt&L%T k(fr�-ft+QtttZk-ttot� I.1,1_i
Company Name
T&a tes Pa. 0S2-57'74 •, 1+1tI iLos44o
Name of Person Responsible for Construction License No. and Type if Applicable
I �kriw AA. 011157
Street Address City/T wn State Zip
m. lie 4(ye _= AIR7wpTLw�lsN+41r- covet
Telephone No. business Telephone No. cell e-mail address
SECTION 11:_WORKP.itS'COlvtf'13NSA"PION,INSURANC17 AEFIDAVII M.G.L,c.152.§25C(6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes❑ No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE .
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ 6(0 0 0S
Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ Enclose check payable to
6.Total Cost $S(p t Qq , O (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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 b t of knowle a and understanding.
wttwn Makti1 t aF ate—TiquT r1t8 � �_'_`f_'
Please print and sign name Title Telephone No. Date
q s-roav
Street Add City/Town State Zip
1 n
Municipal Inspector to fill out this section upon application approval: �y `�Mi 1 6_
Name Date
e'4 yr�T'eg./ 't
To Whom It May Concern,
I, James Fortin, do authorize William M. Crowley to act as my agent in the process
of applying for building permits and other necessary documentation pursuant to
the conduct of my business by Air-Tight Weatherizaiton LLC.
ignature
State of Massachusetts
County
On this �cA_ day of 1 � , 2014, before me personally appeared
to me known to the person (or
persons) described in and who executed the foregoing instrument, and
acknowledgement that he/she/they executed the same as his/her/their free act
and deed.
C.- OVRT A. MONAHAN
Notary Public Notary Public
COMMONWEALTH MASSAC S
My Commission Expires
Print Name: Ulf September 17, 2021
My commission expires:
E � � ir- �rfur�irnitrnr�rr /� r� rr:i,;nr• rrr.lr�//�
r
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Flome Improvement Contractor Registration
Reqistration: 165640
Type: LLC
Expiration: 3/15/2016 Tr# 248557
AIR - TIGHT LLC. WEATHERAZATION
JAMES FORTIN
10 PINE KNOLL OR.
BEVERLY, MA 01915
Update Address and return card. Mark reason for change.
Address Renewal Employment f.ost Card
F--= [Office of Consumer affairs S flosiam Ncg[daiinn License or registration valid for individul use only
i ._HOME IMPROVEMENT CONTRACTOR before the expiration date. I((ound return to:
"'F,,,r"`^r Registration: 165640 Type: Office of Consumer Affairs and Business Regulation
`�. � �>Ezpimtion: 3I75f2016 LLC 10 Park Plaza-Suite 5170
Boston,A7:A 02116
AIR-TIGHT LLC.WEATHERAZATION
� 10 PINE KNOLL DR.
BEVERLY•MA 01915 lndasrar[ov`" Not va i[I without sign:LLurc
`np' •�• ' '
CS-052576
JANIES h, FOR 11)
Ia PINEKNOI.I,Im
Bm'crls NIA 0191?
101031"L01 a
The Commonwealth of Massachusetts
Department of Industrial Accidents
f_ Office of Investigations
1 Congress Street, Suite 100
G `• % Boston MA 02 11 4-2 01 7
www mass gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print I e ihly
Business/Organization Name:—_- _ ,- VA Q(.
Address:
City/State/Zip: Phone #:— CM "+'(K,
Are you an employer?Check theme appropriate box: Business Type(required):
I, I am a employer with_ _-_employees (full and/ 5. ❑ Retail
crpart-time).» 6. ❑ Restaurant/BarlEating Establishment
2.❑ 1 am a sole proprietor or partnership and have no ?, ❑ Office and/or Sales(inei, real estate, auto,etc)
employees working for me in any capacity.
[No workers' comp. insurance required] 8. ❑ Non-profit
3.❑ We area corporation and its officers have exercised 9. ❑ Entertainment.
their right of exemption per c- 152, $1(4),and we have 10.❑Manufacturing
no cmpioyces. [No workers' comp. insurance required]"
4.❑ We arc a non-profit organization, stuffed by volunteers, I LE] I-lealth Care
With no employees. [No workers' comp. insurance rcq.] 12.0 Other
"Any applicant that checks box ill must also till out the section below showing their workers'compensation policy infou,ario, —-----
••Ifthe corporate officers have cxempted themselves,but the corporation has other e,nployces,a wni-kcrs'compensation policy is requireel and such an
organization shoukf check box lit
-
I out an employer that is providing workers'comp rrsation insurance fin my employees. Belo is fire policy information.
Insurance Company Name:_
Insurer's Address: r
t 7 �
City/State/Lip: _A`(..cS �C. .j
Policy#or Self-ins. L,ic.i1 - A (.�,( , _- Expiration Date: —_-
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 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this suncment may be forwarded to the ORice of
h"vest igations of the DIA for insurance coverage verification.
I do hereby certify, under the pains and penahies of perjury that the information provided above is true and correct
Si mature
Phone#: C 1 CC ` t L____
Ojjcial tts'e Y.
Do not write in this area, m be completed by city or town offretal.
City or Town: Permit/License #
Issuing Authority(circle on
1.Board of Health 2. Building Department 3.Cityn'own Clerk 4. Licensing Board S.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.govldia
I SS
Weatherization Work Order Facility ID:900001106 Work Order Data 03/12/15
Action Energy 47 Washington St, Gloucester,MA 01930 Autlitor&Email: Barry Moir,bmoir(gpactioninc.org
Project Name Garden Terr SHA Auditor Phone(s): 0.978-283-2131,C.978-879-5929
Address 192-194 North St,Salem Ma 01970 Wz Contractor rir TigMWeatherizatlon
Owner/Sponsor Salem Housing Auth Contractor Phone: J(978)998-4684
Primary Contact Diane Boulay, 978-744-4431xl 17,0
Other Contact Rarely Comito,978-023-1300, N Bidgs,Apts&Area:8 Bld(s),32 Units_,27520 SFt.
Lead and contact Notes: Facility Nobs Construction Type(s)'CW_ood frame platform
Towwnhouse style 4 units/bldg, 192-194 North 8 buildings,4 units each,most 2 storys,have to wart for Foundation Type
St Salem-address of first and last unit snow malt
Full Basement
Unit cty. Energy ConseNng Measures
Energy Conserving Measures Descriptor or Location I Unit Est Actual Unit Cost Est Cost Act Cost
Wall Insulation
Wall Con cdon Type(s) Section 1: Wall Type Sect 2:
Wood clapboard/snakes/shingles or uin I(dense pac sq It t) $139
Single nailed asbestos/asphalt densepack) handy plank siding sq ft 23335 $2.21 $51 570.35
Double nailed asbestos/aluminum dense pac,k sq ft $2.31
Drill rough plaster patch or finish wood plum(de brick-faced walls sq ft 1785 $1.82 $3,248.70
Vinyl over asbestos(dense pack) sq ft $2.31
Testdrill 4 sides - Flat rate $60.00
$2.50
Centra=rW ditor K&T
Knob&Tuba Wring - Findings and m®tiao
Door Measures
Weatherstrip w/O-Ian orequal as $45.50
Fixed Sweep ea $15.75
Automatic Sweep as $23.00
R-5 Ductwra or t-max or uivalent on door as $51.00
Repair/Re t Door as $52,00
Window Measures
Weatherstrip Wndow/Schlegal ore uivalent perside $6.00
Glass Replacement to 64 ui ea $44.00
Top Sash Lock ea $9.50
Miscellaneous Insulation
Dismbution Type i- secondary type
Duct insulation R-5 Tin
_-, .. $3,10
Domestic water wrap $2.63
H ronic a insulation to 1"copper pipe R-5 Intl $3.41
Hydronic a insulation 1.25"-1.5'copper i lnft $3,68
Steam pipe insulation to 1.5'-2"iron a R-5 $6.35
Steam pipe insulation 3"iron a R-5 In
$7.61
Water Conserving Measures
Spa 2000 showerhead ore uivalent as $30.00
Aerator 0.5 GPM bathroom ea $15 00
Aerator 2.0 GPM kitchen swivel/dualspray as $21.00
Auditor Notes-Page 1
e _
Hearing Energy Service
National Onto Gas Heal
Attics scan ok lets cut/drill some ceilings to confine. Walls ale newish Hardi Plank siding,walls scan empty.
Attic Insulation
R-38 unrestricted-settled cellulose sq ft 4 $1.47
R-30 unrestrcted-settled cellulose sq It (1) $1.37
R-18-20 unrestrcted-settled cellulose sq ft O $1.29
R-1 B-20 unrestricted-settled cellulose sq It a $1.29
R-10-12 unrestricted-settled cellulose sq ft (i? $1.21
R-30 restricted-sla esRlcored fill w/cellulose sq It U $1.48
R-1 B-20 restricted-slopesffloored fill w/cellude sq ft F) 1 $1_42
R-10-12 restricted-slopesMoored fill w/cellulos sq It 1 4? $1.30
Thermodome or Ma nefic pull dawn stairway th as $180.00
Attic/Kneewall Floor Transition Dense Pack w/c Drill s dense omwwith read b In It $2.52
Attic Ventilation
Rectangular gable vent as $92.00
Roofvenl 135(1 sq ft NFV)large Be $95.00
Rectangular soffit vent ea $27.00
Pro pa vent In.O.C.Rafter Specie ea [1 $4.00
Miscellaneous Measures
Weatherstrip Q-Ion orequal)&R-30 attic hate as $33,50
Blower door set-up with pre,8.post tests as $45.00
Attic/basement sealing with two-part foam Attic,see penetrations notes man/hr a, $75.00
Attic/basement sealinq with two-part foam Bsmr,see perimeter Lac note man/hr 10 $75.00 $750,00
Seal ducts with mastic or butyl backed toe hr $65,00
Cut/finish attic-kneewall access to check adds as 5 $105,00 $525.00
Vent kit/bath fan ea $89.00
Clothes d er vent includin Exhaust Duct ea $89.00
Labor onl ch man/hr $60,00
Basement Insulation
Garage ceilin cal filled sq It $2,10
Sill two-part foam w/unfaced fiberglass bad In ft $2.20
Perimeter Wrap R-5 reinforced foil orrinyt face sq ft $1,91
Perimeter 2"T-max are uivalent foam board sq It $2.50
6 mil poly an ground sq It $0.75
Air Sealing Descriptions Hours
Bulk head doorireatments
Other door or who"repair Block and insulate window W
Other P ram Repair
Penerrati Penetration Codes(9actricaMiumbing):CV=chin neyhent pipe,EP=Electrical penetrations,PP=Plum ding penetratons, Hours
Location(sj Oescnption: Wc=wsldimtes,RL=Receesedlighb,EB=Elecincalboms,F.,D= Fansorducts
Only 3 buildings have basements EP PP
By PaaSor Perlrrreter By-Pass Codes:FKT=under kneewall, CM=ceiling&all intersecton,Sinb soffit interior,Cm,0=cantilever o,erhang,B$L= Hours
Locadon(s)Description: Bemt Sill.
Auditor Notes-Page 2 Air Sealing Costs Estimated $1,276.00 Actual $ -
- J
Facility Notes:
8 buildings,4 units each,most 2 storys,have to wait for snow melt
Completion Date: $56,094.05 j< Estimated Total Costs 1 $0.00 jAct Total
- g
je of Owner Dat me Company
Signature of Contractor(Agen Date
- w c, Arig-Ttaq-T 1 .4ZtFruea7 -1 tot4
Printed Name Company