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0011 1/2 PEARL ST - BUILDING JACKET 7 . I'he Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code. 780 CNIR SALE,\I Building Permit ll.ri.r.•J.1Grr_'n!l Application To Construct. Repair, Renovate Or Demolish a(fie-or Tm•u-Pinnilt•Dire!!D{%r This clion For Otl)cial Use Petry— Building Permit Number: ate, pp ,Y lZ z Z Building OI eial(Nrint N; c) SignaI Dole SECTION 1:SITE INFOR IA 1.1 Prope f Qa ty Ad rea: r� 1.2 Assessors Map& Parcel Numbers s'�: )his an accepted street?yes no Map Nunther Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 7.ming District Propowd Use Lat Ana(sy Iq - Frontage(Iq 1.5 Building Setbacks(R) Front Yard Side Yards -= Rcar Yard Required Provided Required Provided Required - Provided 1.6 Water Supply:(M.G.1.c.40.§Sa) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Pri%utc O Zone: Outside Flood ZUIM? Chock if yesO m Municipal O on site disposal syste O SECTION2: PROPERTY OWNERSHIP' 2.1 O nert of Rfcord: ��drnt L( /)0z, la i .. A Q N QrJPrint) f City.Statc.I.IP r I/ (zr' S Q7 fiz-2 I o� �gs2 u. d.lm Telephone EmuilAddress SECTION J. DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction 0 Existing Building❑ Owner.Occupied ❑ 1 Repairsls) ❑ Alteration(s) ❑ 1 Addition ❑ Demolition O Accessory Bldg.❑ I Number of Units_ Other ❑ Specify: Brief Descript'on of roposed 1Vork': a SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: OMCIal Use Onl (labor and Materials) y ` 1. Building S 49 0() I. Building Permit Fee: S Indicate how fee is determined: 2. lilatrica( S ❑Standard CityrTosvn Application Fee ❑Total Project Cost'i Item 6)x multiplier _.__x I t. Plumbing S 2. Other Fees: S J. .Mechanic.d 1111.1(') S List: 1u+uessiud) S rotas All Fees: Check No. _ Check Amount: ---Cash \nomot: r,. Total Project Cult S 01 0 Paid in Full 0 Outstanding Balance Dt SE('"PION S: CONSTRUC'rION SERVICES 5.1 Construction Supervisor License(C'SL) F%lirtlioo Date I iecnse Nunlbcr N:une ul'CSI. I InlJ/cr j� �� I ist l'SI. I')Ix Isee helm.)._. 1r �+y r{ t �i - '-_..'-.-- L Description - No. and tired It Unrcstricicd MOM',- kiP It,35,1100tl - 11-1 R Reaic0.'d 1 t2 Fantil Y MWIlillit Ciwil'oenMale./II' S1I Mason RC Rooling C'owrin __ K'S N'indmr;uIJ tiiJin SF solid fuel Ruming APPliamvs 7Rh 89- �GA,2 I Insulation �"- I{mail aJJrcse U Demolition Tck hone 5.2 Registered Ilome t rovenient Contrltctor(HIC) IIIC Regisnution Number I:xPinuion Date I '`tot n'N I�r I1,1}'Raglslmnt Name No. J Stnet _ limail address a �e o , 7.N1�3��-)6� C lfowi, tare IP fek hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.1 M(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...........O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRAC��TOjjR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building penrli plication. Print wner's ume( cela/gie Slgnulure) - Dam I SECTION 7b:OWNER'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. . (�-� fllraw. �P Lavlale dCb Print Ds%ncr'i or Aulhomvl Agent's Niftale I laectrantc Slgnature) ate NOTES: I. An Owner who obtains a building permit to do his.her own work,or an owner who hires an unregistered wnirictur (not registered in the Hume improvement Contractor(H IC)Program).will n)I 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 owe ma,. L;ot .•..I Information on the Construction Supervisor License can be found at%%%%- wa,; Ip, 2 When substantial work is planned,provide the information below: rotai flour area Isq. ft.) _ I including garage, finished basement:attics.decks or porch) (;rut[Mog area(sq. It.I _ Habitable room count \lunberof fireplaces .-- - --_.- -- Number of bedrooms ... .. .. . . 1 Number of hathrooms -- - - - — Number of half baths .. _ I)peydheatingi);tem . . _ . . \tunhcrol'Jecks, parches i Fnclowd (lien I I')pe„fePVhllg i%i1e10 ' t. "fold l'rojecl Square Foolagc-Ina\ be;obstituted for fatal Project Cost- WAP Work Order North Shone Community Action Programs,Inc. Job Number: 120424 98 Maim StreetAWork Order Date:6/17/2013 Peabody, 1-880 Ownership: Owner Phooe:978-531-8810 American Door,Window,&: Insulatio.n Auditor:Brandon Dorrington 15 Bailey Avenue Email: bdorrington@nscap.org Saugus 41A 01906 Cell: 781-540-8569 - Email:wdel:mgis@comcast.net Phone: 781 531-0244 Phone:978-531-0767 x121 Clara Lopez NGRID Gas - $6,402.43 11 1/2 Pearl St Total Salem MA WWII $6,402.43 978-210-6807 Safety Issue(s):Knob&Tube Wiring - 1fIl! l!Ilpn !iCf( !fi t91Zllijli(!P°IO ii' "'l.!J I 1pl,!I s,�s.l�l 9mn:g1 IIh'!Lli's!"-.:' hIJ;1+ ,!, , L..,.. ,t. .,. 1 r •:L:: ti�•:! r.l;l{, I�hIIJ�.,h,�.,1�11,ff!�I,i41„Ii, :I,; 11f, 1: f ,.u,..,P;� Iilil!�I,II, '1.1 (,a, Irr,hlirl I'�!'�4JIn1�>;,I,i f1 (, .l,� i N�+ . ; .,t: =• ;G :, ,@I11 !, : ,'I II I'I,r!h�11'l jlrL I. illlll r 1 `! �r1 } IUI1l�lin I{�II IL,I;111111�i11�1�!!1:h411t11 r�{ I;P:1111:1on414IIiI!IItiI I,�:i�Ij!{1111saLr 1'hi1{!1111i:�i411 �i{iIB�1'fl•11 p�, ii l�I 111�!!1{;!; I:!II 'n:�,@ i,!,fI l !�h: {� I��l-,1�1 i�N,� f .i„ I,{,,I -� A r! :JI!II '"m• 'dd•+glis�llll : r : , ' :trl., It 11L i.,I p:,� I uu� 19!� 15{{;; I•t l�i!! 'I' B�I�l n {. {;Itit �t : I�r i : I� nt� ;• it! t' I� " t m I li! ul+ 1 � �^ .i 1 � III fl h�fll�!IIIG „ ua! F d f. �.,>Sii�fl�:VutiOq����I�`��li �I ��1:11'� h 1 I.1:"�� f�� 11{•! 1 � Nryry :,�I �mp1: I h �i�Nralll ,: i �t { I� 11 i11',I Ilnp, i�� �y�I �liLlt t- 1 W l: f�� 4r lip a t , l ld2unrestricted-settled 704 ce $1.21 $851.84 704 $851.84 cell)1.osc R-i i unrestricted-s:atled eellulose 18aC $1.47 $273.42 186 $273A2 Sub-attics**Take pits** Reiel orced poly/R-•3 I celtulose open 84 $2.05 $172.20 84 $172.20 1st fl.overhead blow raft a s 'h MIII ,'t�kn„:n,N Inlvn!n{N>niTl !p�'nr•Il '., JI I•:I I!It! II� i I '1 f s::1 � '.!! :I ��.r nllu � ; i�(: I t(,II�V tllh ll `Ii{',:,' l,{II!tl- .ii l'�illll,1a.!Il:y;::it l:!Inle.-.n! nnt•t I, ,I,l :!Ix,uil:T_�I�1 . lei:': nl. �, q,:m ::�t :, aw':I'�IM:!: �,- IIlI!41:: h11�'Il'i�Cf i li 1.l!IP4°Ii!!�111I',+'.1�1�1�{I! 'PIi �I' �'lltt111{�Iq I!IJ�11�1i�1{�!� J{I�I Ir!•t�'i !1k1 1 !fl }II�IV:sf�Yl!!11!{il(11:.f.p1' '�II'1111f�irl �m '�I V !:��t:.f - i,1N!:u:Ilt�....:,,ullilfl!Ilu.u1�11l11�111a�1,hl:�ldl� ull�lu�1+�4r: !II�l��miUN��la�i � V�i��rcN11� , .� th�J�� !ifN1'h lin'�I'����,!i Rectangular gable vent 3 $92.00 $276.00 3 $276.00 Rool"'ent 865(A sq ft:NFV)small 3 $80.00 $140.00 3 $240.00 - Roof-,:-,it It •ent 865(.4 sq ft NF V)small 1 $80.00 -80.00 1 $80.00 Add for access sub-attic blow ,1��4µ1 lq Ijn"VI to pl NqJ"ps!f rn:!!aim7; II! I 4�11 !u,!'�j tI1N6.j1.I1I ,1 ru'1 1 I 1u�tfI!,o�,.I Sill hv NF!!:1:I1!.Ir'i1'1i1 P1hI'r1�: fmh`n tk�nN�l1�{1•�g .,;�IIArfnuf �IIN,IN i$2 20 $272.80 124 $272.80 i l J 1':I 1' hN I Nhil I n �•' !I 11:`I'rn! � fi::- 0! :1i .lall JI, �r ,n II�I,I1�IliJ, 1, I u it"'.�' :ldntli,If, IPiiiili!Il�ll''��u i1ill ' '! II'':'I. It l!i'iilllrwy,r uh{il•r lry,11r�� and 'I II:it�,liu�l�!IIuIlI41, M V� ����1• !�u� ��!C>�� ��((t��t, llloan :11 k:i1. I 11 ft1 niBl�lu�h:I�a��tllI.LI!In rz�� l :: rl,N , Iq}I lw�i-ILYN eOU IJ�I I,• AutmnaricSweeP .I $23.00 $23.00 1 $23.00 Fixed 'weep 1� $15.75 $15.75 1 $15.75 Date: 1'] "2013 - Page I WA P Work Order: Job Number: 120424 Wea ti,erstrip s/Q-Ion or oqual 2 $45.50 $91.00 2 $91.00 III_i Ifl 'l!IIM' p1!li_I'n,--r !I,IIib['Ii•P�n lllliJI CI!I!IN�hPi, r!IVI YII�'I'fl!CI,. a!I'l!ht I�!'riIII'71II III:,I J0IrP�':1�.,II!h!�� ! ,,,•I!�, IH� ' tl �� �! " 1 MINE Clot,.s ! dI,CI.I'. t dryer vent including 1 $89.00 $89.00 1 $89.00 Exh1!ist Duct . I � ,HIf,,in121rt tlilill.11 � � !IdlP�I,I !lI!lI!Mill!h 111p0u41111l1111i1 ant C!;h{il};f! •'ll ni!IPI"I! III,' � . L . I lnfl Doma;ov water pipe wrap 6 $2.63 $115.78 6 $15.78 Hydi(nic pipe insulation ro I in. 100 $3.41 $341.00 100 $341.00 copy r-pipe R-5 ! I I I! I "I ��',:.f..:il.. I:ua1�, 'U!If! I! h"jr,j:px i , ult!, -In�!r•;•I !! nP., ! !-, , t::b.r:, ar;. 1i1 .,�.. !�. n'1!1111NII1:,.Islit !Ij191iE,!!,i i,il it-II t,1 . , dl ,rlld!;,:ll tl'g1 +{ !,:III I.it Ihi1!I it !I ioi!�fk�tu!,I!I�!�Il.�!111��114:!�!alsf�h{ull�„11,L�V!I!!!{!Ilil�!�Ilt�l'Ilflal:l' i�� I!1�I�IIII�!��!�II!!t!!'dNl{fal!('!i��1�41���11�191!fedNlUru!Ili�ll�lahilshf!I (!�i'i�{liluit!If�ii Attic sealing with_two••partfoam 3 $75.00 $225.00 3 $225.00 - Base!nenr sealing with tw(-part 1.5 $75.00 $187.50 2.5 $187.50 foam Blow r.•Door set-up with pre&post 1 $45.00 $45.00 1 $45.00 tests bleat»eus!trip(Q-Ion or equal)attic 1 $31.50 $3t.50 1 $31.50 hatch ! ; it 1 A ldnl ➢! r1! I ! - u :� 1 1.o-l� 1 1 t ii'tl'0 , ii.lryl ,i 1;1411 P1iji�nl!!I!I I !IDiI!'I'I!rl'li�!I(pl'!' u+ .lil'II If! I t7lill,I!�n if I`Ir=f.' ,4d11 r1.9 r11...,It jYl! !it .p.!T,! ,rvim1 '•,rl . I' H 11� I II I "�Llf! I!I111 i!If t. I a l I. 1' �I Lny0;1it 11 i'li, ,j j I ,I-�: ,. p,I I".Q�I�!Ilf.l.l.. !F. e. �Illii: I I ,. .I,�u!.i fill ! `1111I1111,�11.J_ I':r{n:j�uw 6!7 nlS,fi a�t �l!dI�,L�I�I�I�ll lu!II��,��:i0; l�,lrm,pu!,�ull'!ll!I I���YIIl'dI��I�IG�tl�k�Ili'Sul.!Iltl lj!1111111 N11A1U,�1!�IIfd�I�ii �1411�ueWal�!,��Fcl'�Idl!'!I ' Build nn Permit :1. $100.00 $100.00 1 $100.00 I�: .I I NII jl L, l.!"1!t.,I I¶F4ii}!! 1 ij rt ?'�I '•i It �1 i i!i 1_i t'I !�'t' 1.:,n,�nt t',i('XI?!;II!!r !, - 'y 4'I..°n-i II['., . ff ,I , . I !.� !t1�II II I,I! -a.y II!!I'itl III 11f! ( - I,.,:;,11-I I n.!!�a!' I ,( I 'l.. N-A ��IIIII!141,_ ?Ilj!II III) !OI C'x.,l!I II�II!i)illi,j.Illuif!1111!l{j!I!!i!�rr,llfll,!!illll1,11, {II! 11111��11I,I ,1;I tlll�.I !f �Ifl +II!!i,}Ij!!„i� III �III15! :d!i I,.il,. .i!I� :, tl 11 �h"S.'1,11+ 3;1!Ihu�� _ 1 I�: .._NL!1.111.! ,t:!�I�Eln.�lLL�111I,I�mL._.!II,,. !I:!:ItIbII�.:tllt�idr��tlllaHl,a!t..,,ll�s'N!, .�Ul��el; ld,i !(�II:IL!ih�,Nd,�k.Ja Wood 1apboard/shakes/shings or 1716- $1.79 $3.071.64 1716 $3,071.64 Vinyl vinyl,(tense pack) Total •r-�� r,402.43 - $6,402.43 Contra d'.ur Instructions - Before �la,ling the Job. During the Job: 1.Plea e r.edify us 24 hours before starting or scheduling a job. - 1.Incorporate lead safe practices as applicable. 2. Obta n,required building permit. 2.Total for Heath&Safety and Repairs cannot exceed$2500.00. 3.Davis Bacon time sheets required for ARRA work on US -Department of Labor Certified Payroll Report Form WH-347. Date: : 1 ?'2013 Page 2 ACOPOns CERTIFICATE OF LIABILITY INSURANCE DATE(MM,/201) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION AmbrosE Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 56 Central. AvE$. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lynn, 14.11 01901 781-592_:8200 _ _ INSURERS AFFORDING COVERAGE NAIC# INSURED 1):31angis, William INSURER A: Northland ienerican Door, Window 6 Insulation INSURER B: Arbella Protection :_5 Bailey FLve. INSURERc! Liberty Mutual 8 ilugus, MA 01906 INSURER D: INSURER E: COVERAGES THE POLICIE S OF INSURANCE LQTE11 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONIIITION OF ANY CCIJTRACT Oft OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE PO'-1CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AC GREGATE LIMITS SHOW14 MAY HAVE BEEN REDUCED BY PAID CLAIMS. e POLICYEFFECTIVE POLICY EXPIRATION LTR NeRD ___'r)'PEOFINSURANI,f_ POLICYNUMBEF. DATE MMIDDNY DATE(MM/DDfYYI LIMITS GENE F AL.LIABILITY EACH OCCURRENCE $ 11000,000 I :nMMERCIAL GENERAL LIABIDtY PREMISES Eecccorence $ 50 QQQ IQLAIMSMADE Gj1OCCIIR MEDEXP(Anyoneperson) $ 5,000 A Binder 5/20/13 5/20/14 PERSONAL aADVINJURY $ 1 ,000 ,000 -._,_, —__ GENERAL AGGREGATE $ 2 QQQ QQQ GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 2 ,000 ,000 1 C ICY PRQ LOG �- AUTO N-)EIII.E LIABILITY /C VALITO (Eaeccdent SINGLE LIMIT $ 1,000,000 1 L—OVIINEDAUTOS BODILYINJURY X C.HEDULED AUTOS (Per person) $ B F11tEDAUTOS 476115400001 8/17/12 8/17/13 BODILYINJURY P C Id OWNEDAUTOS (Peraocident) $ - -- --- PROPERTY DAMAGE $ (Peraccldent) CaARA�d'.LIABILITY AUTO ONLY-EAACCIDENT $ A 4,'AUTO OTHERTHAN EAACC $ AUTOONLY: AGG $ I,)', UMBRELLA LIABILITIEACH OCCURRENCE;URC CLAIIriSMHJE AGGREGATE-)LICTIBLE Y"PION $ $ WORKERS GO,(IPENSATIONAND — TO YLIMITS I IT X ER EMPLOYERS I IABILITY ANY PROPRIEt C�JPARTNER)EXECUIIVE E.L.EACH ACCIDENT $ 5QQ QQQ `+ OFFICEB EMFEiCXCLUDED! WC231S389403013 2/11/13 2/11/14 E.L.DISEASE-EA EMPLOYE $ 500,000 It yes,deeoib)l-,19i' SPECIAL PRC i ISIONS below — - E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF O -RATIONS I LOCATIOUSI VEHICLES I EXCLUSIONS ADDED BY E NDORSEMENT/SPECIAL PROVISIONS Carpentry & Insulation National Grid Corporate Services, LLC d/b/a National Grid, d/b/a Boston Gas Cc d/b/a Es;.eX Gas Co. , and Action, Inc. as additional insureds general liability only. CERTIFICATE F OLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Action, Inc. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL_ DAYS WRITTEN 4" Washington St. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL G-.:)ucester, MA 01930 IMPOSE NO OBLIGATION OR L177 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORI PRESENT NE 4CORD26(200'/38) ©ACORD CORPORATION 7988 1 Massachusetts -Department of Public Safety , Board of Building Regulations and Standards— Construction t" Supervisor Specialty" , License: CSSL_100824 { t W ILLIAM 3 DEL,)NGIS 15 BAILEY STREET f SAUGUS MA 01906 { �1 % „1�` ` Expiration; j„(,,., 05/0512014 Commissioner Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration r= Registration: 111123 r-., Type: DBA { xj -- ' --fir:;; Expiration: 11/25/2014 Tr# 234005 AMERICAN DOOR WINDOW & INSULATIO '1 ; WILLIAM DeLANGIS ti>" 15 BAILEY AVE _� f" SAUGUS, MA 01906 =` Update Address and return card.Plark reason for change. _._. Address Renewal ❑ Employment Lost Card SCA 1 A 20M-05111 -