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32 PINGREE ST - BUILDING INSPECTION ,I A The Commonwealth of Massachusetts YYY Board of Building Regulations and Standards CITY y ) Massachusetts State Building Code, 780 CMR• T"edition OF SALEM Ic��/ Revised Ainuury Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This SectfonlFor Official Use nl Building Permit Nu er: 4 Date Ap ied:Signature: (!� //- � o Building Commissioned 1 for of Buird?nagV Date SECT IDN -SITE INFORMATION f.1 Property Addryla: 1.2 Assessors Map& Parcel Numbers I l / cam 5 1.la 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 11) Frontage(11) 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.qo.§54) 1.7 Flood Zone Information: 1.8 Sewage Dbposal System: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if es❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 O neF'of Record/� NaTe`Print) Address for Service: / a1116 &11-N gj�- .- * c - a sa l Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ Existing Building O Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify: tMe,�hanicalo iptiono(ProposedWork': '='^Jmt-•-t\ /v(B�rn csa(4(o (>9a.(IS �l3 �9ffc 3� cJen 7i3 .SnJS(al I Pr�ti c+r�rsr5 'tic e 6 F.ECTION J: ESTIMATED CONSTRUCTIONCOSTS Estimated Costs: Official Use Only Labor and MaterialsS I. Building Permit Fee:S Indicate how fee is determined: S ❑Standard CityRbwn Application Fee ❑Total Project Cost'(Item 6)x multiplier x S 2. Other Fees: S al (BVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees: S `2 Check No. Check Amount: Cash Amount: 6.Total Project Cost: .S ! J 00� ❑Paid in Full ❑Outstanding Balance Due: I � SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) ? S7 ' �3 i ', , CJ . /7�. I�1 License Numtxr Expiration DateName Name ul'CSL•I folder ! Lisl CSL rypetseebelow) Ct 2 ti Address U Unrestricted u to 35.000 Cu. Ft. G��/ R Restricted IR2 Family Dwelling Signature M MasonryOnly q� — ? `/�— ��H RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Buming Appliance Installation D Residential Demolition 5.2 Reghteret) Home Improvement Con ractor(HIC) ,�.ya L2 ti J� e.'('�,@^ Registration Number IIIC Cum Name ur IIIC Re arrant Name �( cr y 5�- 3/n AJJr�s�l �, _�y.�kk 3 Expiration Date Signature Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be cc pleted and submitted with this application. Failure to provide this affidavit will result in the denial of the lssuanSrlof the building permit. Signed Affidavit Attached? Yes :.........ET No...........O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S GENT OR CON? CTOR APPLIES FOR BUILDING PERMIT L as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. signature of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION 1 � L (� na. L ,as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf.,— n Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of du 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 91 have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.115,respectively. 2 When substantial work is planned,provide the information below: Total floors 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 helt%baths Type of healing system Number of decks/porches Type of cooling system Enclosed ()Pen }. "Total Project Square Footage"may be substituted for"Total Project Cost" EIG Fax Server 4/6/2010 3 : 15 : 24 PM PAGE 2/003 Fax Server �?CC CERTIFICATE OF LIABILITY INSURANCE 04/06/2010 PRODUCER (SO8)651-7700 FAX (SO8)6S5-88S3 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Eastern Insurance Group LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 233 West Central Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, MA 01760 INSURERS AFFORDING COVERAGE NAIC# INSURED Atlantic Weat erization LLC INSURERA Arbella Protection Ins. Co. 41360 61 Rear Jefferson Avenue INSURERS: Arbella Indemnity Ins Co. 10017 Salem, MA 01970 INSURER C. INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,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. INSR 4DD'ITP 7ypE OF INSURANCE POLICY NUMBER DATE MMfDDIMPOLICY EFFECTIVE POLICY EXPIRATKN _ LIMITS GENERALLIABILRY 8500042816 03/20/2010 03/20/2011 EACH OCCURRENCE b 1.000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED b 50,000 CLAIMSMADE OCCUR M ED EXP(My we persm) b 5,000 A PERSONAL&AOVINJURY b 1,000,000 .- GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG b 2,000,00 PO.ICY X JE6T LOO AUTOMOBILE LIABILITY 93827400003 03/20/2010 03/20/2011 COMBINED 5INGL11-11T ectldent) $ (Ea ANY AUTO 1,000,00 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUT05 (Per Person) B X HIRED AUTOS BODILY INJURY S X NON-OWNED AUTOS (Per s=werx) PROPERTY DAMAGE $ (Per ecdtlern) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EAACC b AUTOONLY: AGG $ EXCESSNMBRELLA LIABILITY EACH OCCURRENCE S OCCUR F—ICLAIMSMADE AGGREGATE b 8 DEDUCTIBLE S RETENTION b b WORKERS COMPENSATION AND 9111820309 03/20/2010 03/20/2011 X WOSTATu- OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT b SOO,OO A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMIEMSEREXCLUDED7 E.L.DISEASE-EA EMPLOYE b SLID,OO If yes,cewft 011rkr E.L.DISEASE-POLICY LIMIT 1 b 500,000 SPECIAL PROVISIONS bal. OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE31 EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATEO CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, CITY OF SALEM BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 120 WASHINGTON STREET OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. SALEM, MA AUTHORIZED REPRESENTATIVE _ 1 Rosemar Ful ha PMA `.tP� V^'u— ACORD 25(2001108) ©ACORD CORPORATION 1988 CITY OF S.U.E.ti[t NLASSACHL:SETTS BL'ILDLVG DEnaT ENT 120 W.ISNLNGTON STRE6r. Y'FLOOR ems. (971) 74S.9599 FAX(978) 74498" Kl BFUEY DRISCOLL IItOhW ST.PQItRt .UAYOII DIRECroltOPPLaLICPROPERTY/g11VIID ICCONL%aSSIO\ER Workers' Cempensatlos Insurance Affidavit: Builders/Contractors/ElectrlclsnslPlumbers anallcant Informallots Pleast Print Legibly VatTle Itlunrwsrortarrttanenln.Lv.duall' - r0 } Ian✓! V-� , WP_ea-Vei. . '7...FA-�-� Address. L( 12 Suers City/Stste/Zilr 5/d�,� d�'I Phone k `t_�k_ ) yY—,�-(f� Are you• .ewpleywo Cbeck the appropriate boss Type of project(required} I. am a vanployw with •2-� 4. ❑ 1 am a general contractor and l 6 ❑Nary construction .mployeae(Adl and/or part-tine).• have hired rye SL&COntracmrs 2.❑ 1 am a solo proprieer or partner- listed c s the adwAad shtrsa t y Q Remodeling .hip aryl have no employes Thae rub-Comeleson haw e. Q Demolition working ror me in any capoeiry. urorkars'Comp.insaSooa. 9. Q Building addition I No waken'comp. insurance J. Q We am a corpoeadi n and id I O.Q Electrical repairs w additions r moradLl officers have eSmelsed their ).Q 1 am a homeowner doing all work ^aM of eternptioa par MOIL I I.Q Plumbing repain or additions myself.[No workers'comp. c. 152.f 1(4),srtd we haw no 12.Q Reef repairs insurance required.)► :mpkrye, LNe workers' I l.Q Othw comp.insurance required.) -Any anearamt the ansba bs et nrrrt A4tr fie ra the amna beM Aaaiq rbek rafta'ran pool w smlky iwaeerrlee. 'i f.r.u.tra the Submit this rrllteet iMlodng dor a e deice YI rod ate this Mm omrjar ewwaten at�r MA"a nee inhieeil Itrdiendne nrr :C.rwSa•SOSo$tut AM19 Are Ma mum aearMa r adedowd dim Sharima se MEW of the Su►noomm a a"mob-whore'c.NV.penny i.aMre� 1 ow ae eaepleyer tAar At prevld/aP workers'.con larmanderr JMr►ratt rfm nq rayleyers, edetr/s/Ar pNlty awd/f&s/b infNmrodom /J�Q Insurance Company Name: 1 --_ Policy e or Self•ins. Lie.M �l� Espinlion Date 3 ; JubSireAddkess: �- t/'��e e S Cityistawzip: 5'9" .mach a copy of the weritan'compeesatea pogey dorlbntYa pep(Sbowing the Palley aaebw Sad stplratba dab)6 Failure to secure coveralls 1&required under SCcefoa 2JA of NOL c. I52 can Ind to the imposition oreaiminal penalties of fne up to S 1.300.00 and/or one-year imprisoarerrt,as well a civil penalties is the form ors STOP WORK ORDER and a Ate .rr up to S250.00 a day against the violator. Ile advised that a copy ur this statement maybe Sur owded to the 0171ce of Invcsa,dmiuna nrthe MA for insurance cavcrap vaillcatioft f do hereby errdj In the print and pone/der of parjury'Am Ar inforneadow provided ubere is true end correct :,••n.ttnre_ � oars: G bz) P`nre A• 7 � / Y //- k G 0j lC;f1 WI u/af): Dona writo in this rrot to be s ernp/rtd by city or rare qj .iW city at ruwn: Prrmir/Llrenst/__. Issuing .%uthurdy (circle one): I Ilwrd of Ilraftk 1. nudding Deparimrnt 1. cil,trow. Clerk 4. Electrical Inrptctor S. Plumbing Impactor 6. Of her i lo,tlacl rcrson: _ -.- Phones: CITY OF SALEM PUBLIC PROPRERTY 'R DEPARTMENT Ml ' Illr�'11 \t lf N II.\I..�!V)I M kl'T 1).111\1. "."\1 111 J 1.•-1.1 - t'n:v t-7��•�}�! •1:\r:9711.741y1s16 Construction Debris Disposal Affidavit (rcyuired lur all dclr.plition:aid 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 p 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 l 11. S 150A. The debris will be transported by: I name of hauler) I'ha debris will be disposed of in : (name ulaci Ity ladd=s of facility) •lynatwe of pvrmn,ppllcanr tale ATLANTIC WEATHERIZATION, LLC 61R JEFFERSON AVENUE SALEM, MA 01970 June 16, 2010 To Whom It May Concern: Install blown cellulose walls R13, attic R38 Install roof vents Install 3 prehung steel doors Replace facia and gutters front and right side Repair front roof The work is being performed by Atlantic Weatherization, LLC, a NSCAP subcontractor. The work is being performed at 32 Pingree Street, Salem, MA. The cost of$15,000 is being paid by NSCAP, a DHCD agency. Sincerely, Eric Palm, Owner Atlantic Weatherization, LLC Pedro Pena, Owner, 32 Pin 4reetreet, Salem, MA Chuck Gallant, Energy Coordinator, NSCAP Board of Building Regulations and Standards Construction Supervisor License License: CS 87977 Restricted to: 00 ERIC W PALM 3 HILTON ST SALEM, MA 01910 .amt Expiration: 4/23/2012 ('ommissioner Tr#: 22214 _. S ..' ✓Iie-T6ovxnn*m<4ecZGCIc o�✓�'Tdtl¢C�ud4{.�6 � HOME �\ Qin'tt+eof.EotisuOiar tlffiiGirs&:Evsiln�sIVegYl4dibn Registmagtt - 89 Expiry 1122 ., T# 2M,04 Type �_ fY 'or ATLANTIC W — tb�.C. .SMIC PALM rF' . .�L" d1 ,tSlt0g�6970. " i.y UndeesamtsTy i=. I ATLANTIC WL'ATHERIZATION, LLC 61R JEFFERSON AVENUE SALEM, MA 01970 May 14, 2010 To Whom It May Concern: I, Eric Palm, owner of Atlantic Weatherization, LLC authorize my employee, Damian Anketell, to pull permits for my company. Sincerely, Eric Palm Atlantic Weatherization, LLC