31 PIERCE RD - BUILDING INSPECTION 1
I'lie C'omI11011weaIt lit)1'Masm ichuselIs
Board of Building Regulations and Standards CI'I'1'OF
m S,\LI:\I
Massachusatts State Building Code, 730 C NIR
�r
Building Permit Application To Construct. Repair. Renovate Or Demolish u
o(y One-or Ticu•fiunily Divelling
This Section For OlFicial,19se Onl
Building Permit Number: Date Applied:
Iluilding 0111cial(Print Muriel salure TVA
Duic
SECTION I: SITE4NfQM ON
2/p Property
L I Prop Address: n 1.2 Assessors Slap Sl Parcel Numbers
�iP Pet P. K(Xi�
I.la Is this an acce ted street?yes no Slap Number Parcel Numhcr
1.3 Zoning Information: 1.4 Property Dlmenslons:
/oning District Proposed Use Lot Amu IN 11) Frontage(It)
1.5 Building Setbacks(It)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:IM.G.I.c. 40, §sq) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public D Private D Zone: _ Outside Flood"Lune? Municipal D On site disposal system D
Check if esD
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record•
rSvzanq�_ Ne P�� ileg .S' n7gyD
N;une(Pont) T' City.state.ZIP
f r72
Nu.—nmet relephune Finail AJdrcss
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building D Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) D Addition D
Demolition D Accessory Bldg, D Nwnber of Units_ Other D Speci ly:
Brief Description of Proposed Work-':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
ttcnl Estimated Costs: Official Use Only
(tabor and \IalCrials) y
I. Building S ,� 1. Building Permit Fee: f Indicate how I'ee is determined:
'. Glecirical S ❑Standard City,Tossn Application Fee
❑Total Project Cost'(liens 6)x multiplier _..— s
ap
Uiher Fees: SJ. >techenical ill\ \(') 5 st:ssion) tal .\It Fees: Seck No. ( 11"k :\nunun: ('ai h \mount:
n Tulul Project Cov1: ) aid in Full O Omsianding Bat:mce Due:
0-� � fr
SECTION 5: CONSI-RUCTIONSERVI(TS
5.1 ('onstructioiiSul)enisor License((.'SL) T--
1:4-WL -Je
Name of 01. 1 lolder I
PC Description
L
No. and.sirevt . 0 d(Iluildhigs ki-D to lillresIricle
R 141c,tricicd e
NI %Llsoll
4( R,xilin C---
0hq 19 'Xindow.1-1 k!iJ;....
SF Solid Fuel Burningi%PvliJilcCY
Insulation
Felvi,holic I In.5 adare, D Demolition
5.2 Registered llome Improvement Contractor(111C) t
I
A ma r i ea 061- IIIC Registration Nuairer FNpiralwn I.Tire
I-11C G Ntipp Name or II)IL 411i.strujil Nallig
Email N� S��11 t4� E ,01 address
IL 9 Zfe;fL
CjtvfT&w—n.State 71P relephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L C. 152. 1 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this atYidavit will result in the denial of the Issuance of the building permit.
Signed A Mdavit Attached? Yes .......... No...........C3
SECTION 7s:OWNER AUTHORIZATION TO BE COMI—PLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
f. as Owner of the subject property,hereby authorize t"Z
�
to act on my behalf,in all matters relative to work authorized by this building 8 permit application.
4,/CP/
Date
SECTION 7b:OWNEWOR 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 t9 the obc!Llt or my knowledge and understanding.
11rini 0micr'i or tic silinalultrDate
—
NoES:
I. An 0\%Lncr %Nhu obtains a building permit to do his her own work.uran owner who hires an unregistered contractor
(nut registered in the Home I inprovelilent Cuntrac lot (H IC) Program).will!W have access to the arbitration
program or guaranty fund under M.G.L.%:. 142A. Othcr important information on the HIC Program can be round at
ttua ,,.I Information on the Construction Supervisor License can be round at
program
substantial
lien stibitantial%Nurk is planned. proN ide the information below:
r"Jal JJ,,urJra I, finished basement attics. dcvl�s or porch I
row 11our,11'ea(44. It 1 1 including garage.
(buss li\ing area iiq. l1.) Habimblo room count
\mnbcr0l'lircplaccs \tunher ol'bedrooms
N11111herot hathrooms \tjliibvr ot'half hallis
I 1w,11*heating SN Stem Number o(Jecks, 1wrOics
11, J,k:ol,coolllla iy Stoll 1,11NIt"ed
X,
lrkqvCt Squarc Foolacc' 'MaN he suhstimrcd 11or fatal 1'roic"Coil"
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supenisor Specialth
License: CSSL-100824
WILLIA 4JDEG
15 BAILE'N STREET 4f
SAUGUS MA 01506
n is
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Expiration
Commissioner G6/05/2014
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Office of Consumer Affairs and Business Regulation 01 ,
s' to Park Plaza - Suite 5170 N 2. -;
''•... O ;0
Boston,Massachusetts 02116 p
Home ImprovemgntContr04.g.Registration -
Registration: 111123
TVpe: DBA
Expiration: 11(25I2012
Tr# 206381
AMERICAN DOOR WINDOW & INSULATIO _----
WILLIAM DeLANGIS i
15 BAILEY AVE — —
SAUGUS, MA 01906
Update Address and return card.Mark reason for change.
Address Renewal ❑ Employment iJ Lost Card
OPS.CA1 0 50M-04104.G101216 I
�ILC '(OOMlnli6?eUJ80.G1/U 0�✓�/�a�4aGt[NC�
License or registration valid for individul use only
go
O(fice of consumer Affairs&Business Regulation before the expiration date. If found return to:
HOME IMPROVEMENT CONTRACTOR Type Office of consumer Affairs and Business Regulation i
Registrepon 111123 D8A to Park Plaza-Suite 5170
ExpiratLon 11012012. Boston,MA 02116
AMERICAN DOOR W.INOOW 81NSULATION
n
WILLIAM DeLANGIS
15 BAILEY AVE /'��
Not valid without signahv
SAUGUS,MA 01906 Undersecretary
i
I
NSCAr
98 Main Street
Peabody, MA 01960
A�enc NIISCAP Client!AQpiac�t}gn#
P QCiRAM: ' Kay1'10M:
7a6'OAPuxniaer•: ,,;� 0 � " '
Work Or&r �---'
Wor1k1�lydgn At
05/YOl12 qk 1Grmtt
Primro'Y c.QRtaactat: ' Amen cast Door Window,$c Insal�tton Per. Jntt $45Q0 Q0
Qt4tet'Contnagtart Manchester electric;
It
C1te nt: 5u?anr�e ISensiey K+T;Yes 1�^p ..:,
Street: 31 Fierc 1.e Road
Cif}; State;7 ip; ' a1em,MIA O 910,
"
Tel bone: 1tI,(47$�,'Z'45-4453 „ OTT
r No
, ....
eP
Fee Cade: :2
B1ott er�Joar Zr>st !, Yes=, Sfes ) Np 2
I In eeE i'. 2b& Tolhe Iva Fllei:. Contraetprt: -
At rp 1n�u�llation Estimated Actual Cost Est Cost Act Cast
Attic flat A I8 open $1.47
Atttcflat CIO;apen.
4E0' $137 $65T60
Ante$lai L'O�apen ' '
$L•2
Attie flat U O'open $1.21
7Yttrc flatf.dcope R90 restricted FfiO $1.418
?.ttte flack lope R20 restricted'
Athcflat( liape R'10 restefeted $J3p
knee sil1R13
?the w
}t48 $18).4q L
Attic kne a w� l floor R30restricted 1.8
Attie
4lmex wall floor transitioniDEl $2.52 $80.64
Fihishad<rtleaeeess $1'Q5•.00
Tem orarI :ttticaccess
Crawls aceoItl4 w/poly-tailor barrier $2.53
Gara eCelhltg/floarR30
Ti erMadcrr, $180.00
Roofvetd barge $95.00
Roof veld-amail
Tuebme k.rit', $168?0077
12" staci ka nt S152 00
Pro a vent 12 $48 00
Gable ve r i f,allsizes) $92..Q0
Soffit vent $27!00
Ridge ve t r lin.ft) $23 00
Attic air sealijt 2�oart foam $75:00 $300.00
Vent et/l ath exhattstfan
$89400
v I
III{GII I I
Bsttmated Aetual Cost Est CpstS AEt Cost
�f+all lnstttan
Stu la ailedAsbEstos(asuha11.2.L51DFt ,
■�lquble. anilahlaslaestQslalymtRum`R1511EP'
1360/3 n g R15 L?P $2'.8N
Yntenoi �,tly>hlow.RlaeterlrlSAl?. EE80 $1.40 $1672.00
Cla bastrd/wpgd sht!gl'glymyll"Rk5 DP' 002, 1f.- 4 : $t202:8& "
1 est do I A sides $60.00
peri.. wra R5
'I
RE alai lop;swee $1•$•:7S '
AuYomst c door sweep
E'A r s a ' t " -! 1 2'u t ar t'p
am
Sash loci.—
$75.00'
450
'G9assre laaemenu I �
$44.00
Hlawer daor(se $aSaIO
T6 tall Air Sealgn�Cost:
Heatin .Su stem.11Qeasunes
buct nsi wain&seal sus(sq.Ft.j $3.10
lydroml pipe insulation to 1"'1t5
IL.drotw ai�aetnsulaticn; 2S"+RS $3.6&
St �i sal 'on -`2 an tc 1.Steam ip insulation 1:5' -2"R5 $6.3'S
Boiler/i mice Iaceacemsnt $0 00
Pro atn AEait($SOOinax)
$0,00
Actual'1'ntaF'does no include$175.00 K&T cpar;e. $t„467 36 Egt Tyfal
AUDITOR: Luis DAvila $O.QO' ' tict atai
06/20/2012 20: 51 17815955820 AMBROSE INSURANCE PAGE 01/01
.A-MM. CERTIFICATE OF LIABILITY INSURANCE 6121M201
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Ambrose Insurance A gy. , Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
56 Central Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lynn, MA 01901 INSURERS AFFORDING COVERAGE
8J--5-92-8-2nn
INSURED nelangis, W1111am INSURERA: PjZQyjLde5,�,lZal 1r0�p,�CO
AmE$riean Door, window & Insulatio INSURER a: rbella Pro e�tioA.�.11SL Co
15 Bailey Ave. INSURERC: ChArtim
Saugus, MA 01906 INSURER D;
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITMSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR TYPE OF INSURANCE POLICY NUMBER FOLICYEFFECTIVE P LIMITS
LTR DATE MM/DO DAT MM D
GENERAL LIABILITY EACH OCCVRRENC£ a QQQ1-0-0-0
}[ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) F
CLAIMS MADE OCCUR MEO E- (Any ene pereen) $ 90()
A _ CPPOOSS334-04 5/28/12 5/28/13 P£RSOn!: AOVINJURY $ 000�-O0
GENERAL AGGREGATE S 0
GEWYAGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOPAGG S
POLICY PRO- LOC
JECT
AUTOMOBILE LIABILITY COMBINED SINGIJ31.IMIT
ANYAUTO (Eeaccldent) a1,000 ,000
ALL OWNED AUTOS BODILY INJURY.x SCHFOUI,FD AUTOS (Per Dereon) $
B HIRED AUTOS 47635400001 8/17/11 8/3-7/12 BODILY INJURY
NON-OWNED AUTOS (Per ecddenI)
PROPERTYDAMAGE F
(Per 9oole t)
GARAGE LIABILITY AUTO ONLY•EA ACCIDENT 9
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AOG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE a
F
DEDUCTIBLE g,
RETENTION a $
WORKERS COMPENSATION AND TORY MIT F
EMPLOYERS'LIABILITY
E.L.EACII ACCIDENT a500�000
C 001606573 2/11/12 2/11/13 E L.DISFA61i-EA EMPLOYEE $
E.L.DISEASE-POLICY LIMIT S
OTHER
DESCRIPTION OF OPERATIONSILDCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTMPECIAL PROVISIONS
Carpentry & Insulation
CERTIFICATE HOLDER ADDITIONAL INSURED:INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City Of Salem DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20_ DAYS WRITTEN
Attn.: Building Dept, NOTICE TO THE CERTIFICATE HOLDER NAMED TO T,HJE� LEFT,BUT FAILURE TO DO SO SHALL
City Hall IMPOBE-NQTOBEiGATTON'bR°EFA"B NV KIM UPBN THE'INSURER,ITS AGENTS OR
Salem, MA 01970 REPRESENT E4.
Fax: 978-740-9946 AUTHORIZE T T
ACORD 25-S(7/97) - , .,,,-. , _+^ 'O"ACOR6'CCSRPORATION 1980