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34 PRINCE ST - BUILDING INSPECTION e Commonwealth of Massachusetts R CEIVED ° Boar i of Building Regulations and Standards INSPECT DNACIVWCES Mass ichusetts State Building Code,780 CMR SALEM Revise aC,2pZ1 Building Permit Application To Construct,Repair, Renovate Or Demo4 jJ4a b IC 3 C One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:I Date Appli Building Official(Print Naime) Signature Date I SECTION 1:SITE INFORMATION . 1.1 Property ddress: 1.2 Assessors Map&Parcel Numbers 14 � . 1.Is Is this an accepted sheet?yes no Map Number Parcel Number -1.3 Zoninglnformstionl----= ----- '- 1.4 Property Dimensions: Zoning District Proposed Ust Lot Area(sq ft) Frontage(it) 1.5 Building Setbacks({t) Front Yard I Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.1,c.40,§ 4) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 qw4erlofRecord: lar" /, r7 019"JG Name(Print) _ City,State,ZIP x Z G17 .357. 170 No.and Street I Telephone Email Address SECTIONS: ESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing B jilding❑ Owner-Occupied ❑ Repairs(s) ❑ eration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other Specify: Brief Description of Proposed Wo k2: 1 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item I Esti mated Costs: Official Use Only Labo and Materials 1.Building I $ 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical I $ 3 ❑Total Project Cost,(Item 6)z multiplier x 3.Plumbing I $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: L3 )C Ut� 5.Mechanical (Fire I $ Total All Fees:$ Su ression Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due: (U1 A 1 t_ P�iti_ LO tol-�'7� . SECTION 5: CONSTRUCTION SERVICES .5.1 Construction Supervisor License(CSL) 13 License Number Name of CSL Holder ETIC W.P2)tB Expiration Date Hilton Street List CSL Type(see below) (� No.and Sneet Stem MA 01970 Type Description - U Unrestricted Buildin s u to 35,000 cu.ft. Cily/I'own,State,ZIP R Restricted I&2 Family Dwelling M Maso RC Roofin Coverin WS Window and Sidin . l 44-314 SF Solid Fuel Burning Appliances I Insulation Tele hone Email address D Demolition 5.2 Registered Homei Improv ment Contractor(MC) / HIC Company Name or>IIC egi e + HICRegistration Number Expiration Date . •� ' Od a�GIICfSbll 11YCIIUO No.and.Street I leg 1MMA 01970 q Y_F/ J^5 Email address Ct /Town,State,ZIP Telephone SECTION 6:WORKE 'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 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 Issuan of the building permit. Signed Affidavit Attached? Yes.......... Ef No...........❑ SECTION 7 :OWNER AUTHORIZATION TO BE COMPLETED WHEN OWN R'S AGENT OR CONTRACT�O`R APPLIES FOR BUILDING PERMIT 1,as Owner of the subj Ict proper ,hereby authorize `- (Y G PG_[vvwn to act on my behalf,in all matte[ relative to work authorized by this building permit application. Print Owner's Name(Elec trohic Si tore) - Date S CTION b:OWNER[OR AUTHORIZED AGENT DECLARATION By entering my name b low,I h by attest under the pains and penalties of perjury that all of the information contained in this application is p te and accurate to the best of my knowledge and understanding. 1114 Print Owner's or Authorizr;d Agent' Name lectronic Signature D ' Date NOTES: I. An Owner who obtains a but ding permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home I provement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund un let M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass goy/oca Informal on on the Construction Supervisor License can be found at www mass ov/dns 2. When substantial work is pl ed,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/atfics,decks or porch) Gross living area(sq.ft.j Habitable room count Number of fireplaces ( Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3 "Total Project Square Footag "may be substituted for"Total Project Cost" i� I � f y I Weatherkation Work Order Facility ID: 900084039 Work order Date ;;;;,Q %1f1t14 :-;;,:. AcSonEnergy 47 Washington,St, Gloucester MA01930 Auditor&'Email: Barry Moir,brnoir@actiortinc.org Project Name NSCDC 34 Prince Auditor Phone(s): O 978 283-2131 C.97"79.69129 Address .34 Prince st,Salem Ma 01970 Wx Contractor e I� Y tlo.# � gall Owner/Sponsor North Shore Community Dev Corp Contractor Phone: „ i : ' ! q, f!� ; Primary Contact Steve McCarthy,mngr,617-557-1700x32, i Other Contact #Bldgs,Apts&Area 1 Bld(s),8 Units,7) S t. !�hr'�I" [ "^fir,7 x �- Lead and Contact Notes: Faelli Notes: Construction Types)i �F.�, �,'�F $ p] 4foral v' n. r r ' l1Yn'i li a ,'I'vf'y r�1a:'I<S S�1 eprr t'll'€.,a t ry ', s.. ,� i f I .t•:f f,: , a ... V �'f tr Sir r.. t >fr ;[ ! U •tu�,�t�3i�€� 1 �F F�[ SS4[ lr� s +[h f, �{aark Pfc�^y "7 `�,J�lj�� ��,I�r 1tl � fr,n ��rFf�.,ar,��M,�i� ns'cD(d.,�Tsfslbarj4�blP�Xk41FN4��,t4rbsles; Foundation Type '�:�kr':�if�LF �' '"�'U,'Clf { 1'�T Gam!;M,.,- s�� 4 t .1 •^hP S.ly ��ta, i9.`�€SF .:• k$ f� � 3' ija I4 � +a h�f E�[i 'YLI��Se � �'E�� i S [i[ii 1.. o Unit aty. Energy Conserving Measures ' Energy Conserving Measures Descriptor or Location Unit Est Actual Unit Cost Est cost Act Cost v Wall Insulation m Wert Construcoon Type(s) .Section 1; Wall Typa Sect 2: e u o S:Fljei4R.e a•. I. P 9 t P 6.idif3l°Li; E�'�. Wood cla board shakes/shin les orN I dense eC ft 5t !.•',; ,5.ve; $1.79 i o Single nailed asbestos/asphalt decreepack) ft $2.21 aDouble nailed asbestos/aluminum dense k ft $2.31 Drill rough plaster patch or finish wood Plun(derSq ft $1.82 Vinyl over asbestos(dense pack) sq It $2.31 N Test drill sides BRICK flat rate $60.00 m $2.50 ContractorAuditor K&T Knob&Tube Wirin Findings and Iocaflon Door-Measures N Weatherstrip w/O-lon or 2gual ea 9 $45.50 $409.60 Fixed Sweep Be 9 $15.75 $141.75 Automatic Sweep ea $23.00 I N D_q T,r1vron nr I_..,vv nr one mrolnnY nn Nrr�r vo, It" nn O, Q r- O \i v 0 Basement Insulation Garage ceiling cavity filled g it $2.10 � Sill two-Part foam w/unfaced fiberglass ball In ft $2 20 Perimeter Wrap R-5 reinforced foll or vinyl face ft ! $1.91 Perimeter T'T-max orequivalent fcam board ft $2.50 6 ml poly on ground scl ft $0.75 Air Seal in Descriptions Hours Bulk head door treatments °'f� yf41��tf '.: C 3„[r�41 i p. Tr 4 FI r i xs,_ r im x,F saw P ' .. W u + .i1 t� r I - +j fI.13 :' i , i idi tr,t� m Other door or wirafovr repair t < yr , "n ° Block and Insulate NnndOW at ' :l d I s ` U g� > Other Program Repair pn4 Mr lit+t Yf" r£4'3� '.('� 5 r r,oa r I' ° E�'tlr` - h fa ! r .:.al C,.�I .�,_, "',.. I?.,r, lei +, ..id .1i t' .r.: c CI .';F. .. ,: L. •i'i.n,�,i '.. rr Penetrations Penetration Codes(ElectricalrPhu bi CV=chimne ^gl yNent pipe,EP=Electrical penetraaona,PP=Plumbing penetrations, Hours WP well fetes RL Recessed lights,EB Electrical boors,F or O Fans or duds" p, Location(s)Oescnpaon P 9 1 tw, br N di �l(o G Flab IIle 1!19„l(13iill 'Y,lT„�'�'r.r",'"Si":€idil!F'aiflk9, IiilSG l"�r�!tt 33fe6i 1: =ri�rsh i77<�+'hrr3f�V,{FIIE EIi N}I°'C�f Y�f {Y F' 'd iF '�'cn�rR P�..I•_SI J1tin t1 3f1 r, r �{ 7!lS I i 1 i I'J t,Sr.r...t_ :'.:,fi. - .wr•. ,.nut, �. aL�.I^.:A r p,.r/�% yt Dior ..•t,..,i ;:.•, .(:: o, By Pass or Perimeter By-Pass Codes:FKT=under kneewall, CAIV= ceilingAvall Intersection,Sint=soffit Interior,CntO=cantilever overhang BSL Hours uLocellon(s)Oescnpdon: Bsmt Sill. Iry YIUR�tC�YIGr�+�. ' Ft Ills Y:. Mfa�t 1' P ........ ... o. ^ Auditor Notes Paget Air Sea ling Costs Estimated 31 7aopi Actual r � i�'�'IFrI SILt,!Si far r�l'r^.,rw�rir6ivSLd� S�i,.�'��p ,..,.r. 5��°(ll3s r''•ti+lu Y r ',. I�3 r e i ? i r� JN,Plr+ 'S r� U'� h` o .1'li,.,.Hilyq§^d!€C'SI F, r).r�SFJe i 3i;r'�r �"�i'lif�'C '"r'`P,i li�k9� k.+.1.bJ�'lu �fl Bira'.:'t� iS'1'A'!yB J,,'v enRi¢�SIil4dt d s1l,t�i,,it r,h i'll`p'r rr rf .1' it Ce IfI + + u . .. 5 to i3'E, I, 'Ij3i3 rr +l r + n.;aa.•:3! J ..v .,.'.:Y ,tui.�€rP itf f ,l T.r•._.,,..., l ..:.,:'',rnY. w. Facility Notes: 4 I 0 Completion Date: < Estimated Total Costs $0.00 Act Total c I I d 0 o , 0 51fe,Qur s' .A.A q lia,145Jr [k :AW:e!u:.ln ha!lAV4 J Jd i.!r: ;:FJ9x.P.Yecn�,' . ell+ lv. av ew�y:oa, �olavalc•I,RNl^. .0 v , •s•..,.•c,".e.,a. ,,. .: ...r:;e: :....u.i , 9 Attic Insulation R-38 unrestricted-settled cellulose sq ft . .,� wa .i $1.47 R-30 unrestricted-settled cellulose s ft W.N $1.37 t, ^. R-18-20 unrestricted-settled cellulose sq ft � $1.29 R-18-20 unrestricted-settled cellulose may be no ca-Aty s ft " $1.29 $2,554,20 R-10-12 unrestricted-settled cellulose posib roof deck insul sq ft $1.21 R-30 restricted-slopes/floored fill w/cellulose sq ft $1.48 r+u R-18-20 restricted-slo s/fioored fill w/cellulo sq ft �"„���' � � $1.42 I R-10-12 restricted-slopes/floored fill w/cellulog sq ft $1.30 Thermodome or Magnefic pull down stairway b ea $180.00 Attic/Kneewall Floor Transition Dense Pack W/C Drill&dense blow with reed b In ft $2,52 ti w I d v, Attic Ventilation wRectangular gable vent ea $92.00 m m Roof vent 135 1 sq ft NFV)la a as needed ea 2 $95.00 $190.00 o Rectangular soffit vent ea $27.00 Pro a vent G° a ^ Miscellaneous Measures ^ Weatherstrip O4on or equatl&R-30 attic hat c ea $33.50 V o Blower door set-upwith re 8 t tests ea $45.00 Attic/basement sealingwith two-part foam Attic,see penetrations notes marithr ;4!. ' $75.00 $300.00 Atfic/basement sealingwith two-part foam asmt,see perimeter t.oc note manthr ell, �;.,U $75.00 $600.00 ., Seal ducts with mastic.or bu I backed toe hr $65.00 v Cut/finish attic-kneewall access ea 2 $105.00 $210.00 Vent kit/toath fan ea $89.00 Clothes dryer vent includi Exhaust Duct ea ,a $89.00 Labor only charge {faleE fd m .,, p 3 !rn r? ma rVhr $60.00 0 O I . i n-u vua.rwte ut i-u mn ut mm,(wi%uuwt .D C IN � p%)3i�:11 S55 irP IE• '� !q �t OG J t.VV R@ air/Retit Door i l.l.�is7{ „4 ��xVFlr ikl�il j.,l ;• ea $52.00 Window Measures Weatherstrip Window/Sch ai or equivalent per side $6_pp Glass Replacement to 64 ui ea $44.00 Top Sash Lock as $9.56 Miscellaneous Insulation Dlsraibutlon TypONOe ` 1 �i ' fi' m JPfiEy Seconds type a i "R o . Duct insulationR-5 s ft ;..,t•'syE:ri' $3.10 a Domestic water-pipe wrapin ft $2.63 n _Hyg ronic pipe insulation to 1"copper pipe R-5 copper 314" In it 24 $3.41 $81.84 rn d - Hydronic pipe insulation 1.25"- 1.5"copper pipe 1.5"copper In ft 224 °a $3.68 $824;32 c Steam a insulation�to 1.5"-2"iron i R-5 In ft $6.35 0 u Steam i e insulation 3"iron pipe R-5 In ft $7 61 a Water Conserving Measures S 2000 showerhead orequivalent irpossible ea 8 $30.00 $240.00 Aerator 0.5 GPM bathroom ea 8 $15.00 $120.00 not r use wpo Aerator 2.0 GPM Idtchen swiveVdual s dishwshr ea 6 $21,00 $168.00 4 I I I, I Auditor Notes-Page 1 V I s Heating Energy Service F16Si 3 C la 7( i rV� J rl� + ✓a�hnn'e+scbm 1+aohu'bn Nenhrui:.4•hMmnri..nsi�tnn+.m�r+ti�tn huen rhennbai.nbocu tneF�dafa all hots Iwe1 Wino Ic E 1 .�;��t� I� dl � t ai i a fa`, CITY OF Sa1�I`Y4 i NT LAtSS �CHli'SETIS Bumb!DIG DEPAMIESiT 130 WASHINGTON STREET,r FLOOR TEL (979)745-9595 FMX(978)140-9846 KIN[BERLEY DRISCOLL THows ST.PIEm MAYOR DIRECTOR Of PUBLIC PROPERTY/IlVn DLNG COM%USSIONER Workers' Compensation Insurance Affidavit: Builders!ContractorslElecrlcians/Pluritbers Annitcan't [nfortnatinn Please Print LeWbiv Atlantic Weutlicrization,LLC NamelOusioxssOiganizarioNindividualj: Avenue Address: Salvo MA 010M City/State/Zip Phone#: 9?9- 70- a/ V3 Are yo n employer?Check the appropriate boat Type of project(required): �.5`. 4. ❑ I am a general contractor aad,l i I am a employer with 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2 El1 am a sole ptopcictor or partnot- listed on the attached sheaf t 7• [].Remodeling ship and hav one employees These sub-contractors have g. © Demolition working for me ti any capacity.: workers'comp msumnoe ', q• Huildmg addition (No workers'comp.insurance' S. Wa are a corpomhon niid Its- (No Electrical repairs or additions required J officers hbve exercised[halt. - 3 [am a homeown rdoing all work right of exemption per MGL. 11.❑Plumbing repairs or additions myself.[No workers'comp, C.I.52,§I(4) and we have no 12.❑ repairs insurance rcgmrcd.j t mployees, [No workers' 13. Other Sul et comp.insurance required.) dn'1AnyaPplla that ohcekeboa_if mW[atsu nit uw me thetimbclowihowingihea m wwk 'compeosation policy infimmunion. - I inmeuwtaitwhu submit this iftidovh indicating they ace doing all woh and then him qutiido eantradma most submit new affidavit indicating,such. - :Cumrxton that chock this boa mustanachadan the name of the sti"nteciois and lhelfworkent'comp.policy infonnaaon. . lam as employer that Ispravldhtg workers'rompeasadan,insurance jot sty,employers: BelowIs the jolfcy and joh site fnjormwforir _ InwranceCompany?lame: _ G✓1. - Policy q or Self-itic Licc. Expiration Date: 3 �Q 5— Job Site Addre" ✓ N f PO�. �� City/Statclz :5/ op?X . 6 Attach a¢opy of the ivorkers'compensation policy declaration.page(showing the policy numbor and expiration date). Failure to suture coverage as required under Secdait 25A of,IGL c.;152 can lead to the imposition of criminal penalties of a fine up to St•500.00 and/or one-year,imprisonmcnt,as well as civil penalties in the fotm.of a STOP WORK ORDER and a fine of up.to.$250.00'a day against the violator. He advised theta copy of this statement may be forwarded to the Office of Invesfigadons ufthc DIA for insurance cavcrage verification. - l de hereby certljy under the pulirs and pesallicr ojperjury that the iajormgtion provided ubov :is rrae mrd correct $0.n uurc• ^has - Date: �N y Phoned` oval Fbse only. :Do not write in this urea,to be cornpleted by city of/own ofjlclaL. City or,ruwn: Permit/1.1cense N _ Issuing Autborily(circle one): 1.Board of lieallh 2.nujiding Department 3.Cityfrown Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other --- Contact Person: Phone B: Massachusetts-Department of Public Safety Board of Building Regulations and Standards - - Construction Supervisor I - License: CS-087977 ¢ „a ERIC W PALM 3 HILTON ST - - Salem MA 01.9707 954,,.,rll-"eCiv.. " "� Expiration Commissioner 0412312010. ' — --'--...--- �/re`Ftc+nunoirrserr(!1 of^.l�auar/n.:e!! —_. -___—'------'---- W�E e of CoasamerAffnirs&Business Regulation License or registration valid for individul use only IMROVEMENTCONTRACTOR before the expiration date. If found return to. ita rail 142089Type: Office of Consumer Affairs and Business Regulation iration: 3/1 J2016 Ltd Liablity Corpo- 10 Park Plaza-Suite 5170 ATLANTIC WEATHERIZATION LL.C. Boston,MA 02116 ERIC PALM 61R JEFFERSON AVE 49. SALEM,MA 01970 — T�- Undersecretary Npiva[idty put signature