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38 NORTHEND AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusett�E EIVE© WBoard of Building Regulations aJ �p INAL SERVICES CITY MMMassachusetts State Buildingj�ee;J'77 CMR SdMar Revised�Llar 2011 Building Permit Application To Construct, Repairj0%n eM D,Qeto%P One-or Tivo-Family Dwelling This Section For Official Use Only Building Permit Number: : Oate A hed Building Official(Print Name) ignature. Date �j SECTION f SITE INFORMATION I. P operty Add s: 1.2 Assessors Map& Parcel Numbers l3 or7�end I.l a 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 yesO SECTION 2: PROPERTYOWNERSHD?L 2.1 wne of Reord: � Qh �eV A; ko Sa Anm . /fda 01270 Name(Print) City,State,ZIP .ifs All)r/4er►ell A - 975- ZY11- 67/�/ No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply): New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work": t SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Rem Official Use Only, Labor and Materials I. Building 3 416.9 7, L Building Permit.Fee: S Indiddie how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical ❑Total P1rolci:t Cost' (Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 1. Mechanical (IIVAC) 'S List: 5. Mechanical (Fire $ Sn� ressioi� 'Cola\:AIl Fees: S Check No. Check Amount: Cash :\mount•. 0, Twat Project Cost: S //� { �� 'D d � ❑ Pail in Fall ❑ Outstandim, (0 Ilal;lncc Du pwrvtti w Ciz)NTV P 7 SEc'rION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL,) f License N / / �e�a License Number E.epiration Data Name of CSL Ifol folder j I List CSL Type(see below) rYPe Description No. and Street �^ U Unrestricted Buildin s u to 35,000 cu. lt. y(g clef// S /�4 oa'g'0 R Restricted 1&2 FamilyDwellin C�.ity/r n, State, ZIP iv§ Masonry RC Roofing Covering WS Windowand Siding SF Solid Fuel Burning Appliances 389-76 e [ Insulation Tale hone Email address D Demolition 5.2 Registered Hone Improvement Contractor(IIIC) / f c? {-(-� •�+� s}- ! ���+��nJ HIC Registration Number Expiration Date I II Company Name or fill Registrant Name Ar/e- No. an Street Email address S l Cii /Town,Sta� 06 7P1-_3A9-�G�_ Tele hone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. M. § 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 APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property, hereby authorize it ),14m do Lana/ to act on my behalf, in all matters relative to work authorized by this building perQ mit application. Print Owners Nama(Electronic Signature) Date 7SECTION 7b: OWNER' OR AUTHORIZED:\GENT DECLARATION enteringme below, I hereby attest under the pains and penalties of perjury that all of the information pplication is true and accurate to the best ofmy knowledge and understanding2 ethorizr��ent's Hama(Eleen'onit Signature) Date NOTES: I. 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 find under NI.G.L. c. t42A. Other important information on the H[C Program can be found at tow w.niass.,,ov ca Information on the Construction Supervisor License can be found at www.m;us.su�rdL 2. When substantial work is planned, provide the information below: Total floor area(sq. ft.) _ _- _(including garage, finished basement/attics, decks or porch) dross living area(Sq. ft.) — _ Ifabitable room count,— Nuntber of tireplaces._.--- Number of bedrooms Number ofbathrooni.i of bathrootts Number of h;dt'baths -- _ -------- --- I'�pc of heating system . _ -.-_ _-----_-- Number ofdecks/ porches 1'\peofcoolingsy;Ien __-----_"—.--_- Foclosed --- - --Upon ;. "[,)I'll Proj.Ct Syutre Fuoto_,c" Inay ,be nubshu 1 itc, for. fntll 1 m:lcct C'o;t" ins CITY OF SM—Emlo iL15S.1CHUSETTS ` SCUMNO DEPARTNONT I30 CN.19HL�IGTO14 S-171EET 3�°FLOOR T EL (973) 745-9595 ELK(973) 7-t0-9&1S Iu1t13F..RLEY DR[scoLL NL-ma THamos ST.AERm DimmiR OF pusLIC PROPERTY•/9UMnLNG CO\LNOSSIOYE. Construction Debris DIsPosal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Coda, 730 CMR section 111.5 Debris, and die provisions of lNIOL c 40, S 54; Building Permit f# 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,NIGL c I I t, 3 150A. The debris will be transported by: b�ante ufhaulcr) The debris will be disposed ot'in rl (nama if facility) —+ (J r.',Of fileilit�. i 4 _ siynatureufparmitapplic It — 04�j CITY OF S,1LE,,I, NL1SS.\CHusFnTS BUILDING DEPARVUENT I'_O W.1SHLSIGTON STREET, S"FLOOR TEL (978) 745-9595 Rut:(973) 740-9846 m NfDRRr FY DRISCOLL ANY04 THoatAs StPiEans DIRECTOR OF PUBLIC PROPERTY/BUM-DING CONNISSIONER Workers' CuinpensatIon insurance Affidavit: 13ullderi/ContractorWE lee trlclans/Plumbers ,%milleant infirrmation Please Print Leeltity �Ia111C l0uaitnwt.Oryniratiotvindividual):�7� .� 1 /iire/Yw2.J Address: City/State/Zip: /9 06, Phone#: 2,U.399- 9<a�eZ �r�e you an employer?Check the appropriate bast 'rype of project(required): 1.L� t am a employer with J`/ _ ;• El I am a gcntoat contractor and 1 empinyea(fLll and/arpart-time).• have hind the subcanlnctan 6. ❑New construction 2.❑ lain a sole proprietor or partner. listed on the attached.sheet.t Z ❑Remodeling ship and have no employees These suit-contractors have V. 0 Demolition working for me in any capacity. workers'comp.insurance. 9, 0 Building addition (No workers'comp.insurance 5. 0 We are a corporation and is required.) officers have exercised their 10.0 Electrical repairs or additions 1.❑ I ant a homeowner doing all work right of exemption per MOL I I.❑Plumbing repairs or additions myself.(,No workers'comp, C. 152,51(4),and we have no 12.(]Roof repairs insurance required) t employees.(No workers' I5.0 Other Bump,insurance required.) SAnyappliwes nWvilmliaba all nuatalsenll uuUM uctiue balowahewlne tha4 wa4as'mmpnuden pulley inlLrmollaM1 'I f,"v,aurm" he mhmit this affidavil in licalne they an dome all work and tAw Alm oanide eenlmcbe ImW mhmll a raw antdovil tndiodne ruck <]tntrnrters tAal ch,xk this box mtarlVt4achod an addidurol ahoy showing Iho nano or the mN.avunutan and thatr wurkass'comp.policy Infomtneon. I am am employer thatIs providing Ivcrkfrs'r ontpfnsadon insuronee for my fmplayefsl Below li the pollry andtab site Inurrn0A Insurancece Company Name: 121BM& Ad Policy it ur Sdf•im. Lic, n: (.[� C,2.3/fS q/�$y0 �O/y Expiration Onto. JubSiteAddress:38 Nibidhenel five Cily/Statr/2ip: d�/I!®r�{97jj .\th¢is a copy of the Ivorkers'earnpansation pulley declaration page(showing the policy number and expiration data). Failure to seeuru coverage as required und,:r.Section 23A oeNIGL c. I J 2 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonmen4 as well as civil penalties is the farm of STOP WORK ORDER and a lino of up to 1210.00 a day against ilia violator. Ile advised that a copy of this sl3wirunt may be furwardod to the Oft ice of Inveotgaduns urthd MA for insurmlea coverage writleutiun. /du Irfrrby crrt/J/y11 rur�dor ate pubis rapid pdnultles aJpdrlary r/ruf the brJ'unnuNonprovided above is true mid Corrre4 c n arse 9- 7460A i 01Jrciu1 rue only. 0e lltlr I✓rllf lit I'My arra,10 be Cm1111INCd by city ur fawn a/JTr(ut i City or'I'uwn: FermirR.1cerne.9 hsululliAulhurity (circle una): _-- ---- 1. Iluurd of Ifealth L Iluildiny Ucportomnt .l.Citylrntvn Clerk 1. I?leetrleal 6tylectoe S. 1'luulbint,+ Inspector 5.Olhcr I Contact Permit: _ ... . .. Phnna ll: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 111123 Type: DBA Expiration: 1112512016 Tr# 260215 AMERICAN DOOR WINDOW & INSULATIO WILLIAM DeLANGIS 15 BAILEY AVE SAUGUS, MA 01906 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card scn i e, zone-as/n 9LOZlSO/SO Jouoissnuwoo uoi;elidx3 .610 VW Sf ofivS 1321us AT'IIVa Sf - SIf)N$'f3Q r PM'1-IIM of 4ZSOOL-ISSD :asuaoll .yluuadS.iosl.uadns uou3n.Usuoj a, splepue3S pue suoileln6aa 6uippng;o pieog " Aja;eS oilgnd ;o luaw}ledao- suasny3esseW Work Order North Shore Community Action Programs,Inc. Job Number: 29207 119 Rear Foster Street,Building 13 Work Order]Date: 11/12/2014 Peabody,MA 01960 Ownership: Owner Phone: 978-531-0767 American Door,Window,&Insulation Auditor: Brandon Dorrington 15 Bailey Avenue Email: bdorrimgton@nscap.org Saugus MA 01906 Cell: 781-540-8569 Email;wdelangis@comcast.net Phone: 978-531-0767 021 Phone:781-231-0244 Stanley Lojko DOE WAP 2014 $3,650.64 38 Northend Ave NGRH)Electric $2,013.53 Salem MA 01970 Total $5,664.17 978-744-6714 DOE WAP 2014 Repair/Health& Safety $58.00 Safety Issue(s): Lead Paint Possible t F t pb. Sill two-part foam w/fiberglass butt 157 $2.46 $386.22 157 $386.22 Basement/outside door-w/jambs 1 $488.00 $488.00 1 $488.00 Fixed Sweep 2 $17.64 $35.28 2 $35.28 R-5 Ductwrap or R-max on door 1 $57.00 $57.00 1 $57.00 Repair/Refit Door 1 $58.00 $58.00 1 $58.00 Weatherstrip s/Q-lon or equal 2 $51.00 $102.00 2 $102.00 I Clothes dryer vent including 1 $100.00 $100.00 1 $100.00 Exhaust Duct nat.� F .d`f l �Yt'•� - Domestic water pipe wrap 6 $2.95 $17.70 6 $17.70 Hydronic pipe insulation to 1 in. 150 $3.82 $573.00 150 $573.00 copper pipe R-5 Date: 11/12/2014 Page 1 Work Order: Job Number: 29207 k d r. '��b•.'n i+5�'.4yki-'F e'�.. Sul .:n--.. Basement sealing with two-part 2 $84.00 $168.00 2 $168.00 foam Blower door set-up with pre&post 1 $45.00 $45.00 1 $45.00 tests CO Detector(5 year standard) 1 $40.00 $40.00 1 $40.00 Building Permit 1 $100.00 $100.00 1 $100.00 OWN Double nailed asbestos/aluminum 1238 $2.59 $3,206.42 1238 $3,206.42 (dense pack) Drill finish patch plaster(dense 135 $2.13 $287.55 135 $287.55 pack) Total $5,664.17 $5,664.17 Contractor Instructions: Before Startina the Job: During the Job: 1.Please notify us 24 hours before starting or scheduling a job. 1. This residence was built before 1978.Lead safe practices are 2. Obtain required building permit. required. 2.Total for Heath& Safety and Repairs cannot exceed$2500.00. 3. Davis Bacon time sheets required for ARRA work on US Department of Labor Certified Payroll Report Form WH-347. Additional Contractor Instructions: Altic Inspection orm attached? Yes NIA irc e One Certificate of Insulation posted? Yes No (Circle One) Page 2 Date: 11/12/2014 Work Order North Shore Community Action Programs,Inc. Job Number: Carrick(]) 119 Rear Foster Street,Building 13 Work Order Date: 11/12/2014 Phone: 978-531-0767 Peabody,MA Ownership:Renter -076 American Door,Window,&Insulation Auditor:Brandon Dorrington 15 Bailey Avenue Email: bdorrington@nscap.org Saugus MA 01906 Cell: 781-540-8569 Email:wdelangis@comcast.net Phone: 9-540-8569 7 x121 Phone: 781-231-0244 Melinda Carrick NGRID Electric $6,963.16 40 Northend Ave Total $6,963.16 Salem MA 01970 Safety Issue(s): Lead Paint Possible t qq t t tg 1 R-30 restricted-slopes/floored fill 1325 $1.59 $2,106.75 1325 $2,106.75 a w/cellulose wf i Roof vent 865(A sq It NFV)small 6 $90.00 $540.00 6 $540.00 Follow Energy Report! Fixed Sweep 1 $17.64 $17.64 1 $17.64 Weatherstrip s/Q-loa or equal 1 $51.00 $51.00 1 $51.00 ' t < Domestic water pipe wrap 6Y $2.95 $17.70 6 $17.70 Hydronic pipe insulation to 1 in. 100 $3.82 $382.00 100 $382.00 copper pipe R-5 F' 9-1 Attic sealing with two-part foam 3 $84.00 $252.00 3 $252.00 Date: 11/12/2014 Page 1 Work Order: Job Number: Carrick(I) CO Detector(5 year standard) 1 $40.00 $40.00 1 $40.00 Double nailed asbestos/aluminum 135 $2.59 $349.65 135 $349.65 (dense pack) Double nailed asbestos/aluminum 1238 $2.59 $3,206.42 1238 $3,206.42 (dense pack) Total $6,963.16 $6,963.16 Contractor Instructions: Before Starting the Job: During the Job: 1. Please notify us 24 hours before starting or scheduling a job. 1. This residence was built before 1978.Lead safe practices are 2. Obtain required building permit. required. 2. Total for Heath& Safety and Repairs cannot exceed$2500.00. 3. Davis Bacon time sheets required for ARRA work on US Department of Labor Certified Payroll Report Form WH-347. Additional Contractor Instructions: Attic Inspection form attached? Yes N/A (Circle-0 e) Certificate of Insulation posted? Yes No (Circle One) American Door,Window,& Insulation hereby certifies that this job was supervised and completed in compliance with all Department of Labor Standards and Lead RRP regulations. Contractor Signature: Date: RRP License#:_ I hereby acknowlege that all work has been completed and inspected. Customer Signature: Date: Energy Director: Date: Fiscal Officer: Date:- Date; 11/12/2014 Page 2 U