40 PRINCE ST - BUILDING INSPECTION 1
mom
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR, 7'h edition MUNICIPA USELITY
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised January
(-j_ZOl u_ One- or Two-Family Dwelling 1, 2008
— Q Thts-,$ectior! For-Official Use Only
BuildingFRiia umber: Date Applied:;
Signature
uildingCommissi6her/'Inspecto2'ofBuildings Date
'-SECTION"1.
1.1^Px�erty{1dt e Sy 1.2 Assessors Map&Parcel Numbers
A.Ia 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?Check if yes❑ Municipal ❑ On site disposal system ❑
.� ..
"'SECTION 2i PROPI'3RTY OWNFiRSHIP'
2.1 Ownert of Record:
%Ar)eni 0on760e2 d Ar/hCe- S/J- Sa/Pvf
Name n Address for Service:
a& 6i7 -S30 -o3g3
Signature U Telephone
SECTION 3:DESCRIPTION'OF PROPOSED WORK. (cheek all thit"apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Workz:
SECTION A:ESTIMATED,CONSTRpGTIONiCOSTS
Estimated Costs:
Item Pf#iaiaj,'" Jse Daly:
Labor and Materials)
1.Building $ 7 6 7 1 Butldtn'gPertmtFa $ Indtcate'i ow fee is determmed.l
❑ d Stanard Ctty/Toy{u Apphcafion Fee
2. Electrical $ -A
❑Total]? oleo Cost3i(-Iie 6 6}z mulhplier x
3. Plumbing S 2 Other Fees
4.Mechanical (HVAC) $ List
5. Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Atiiount '
6.Total Project Cost: S 7 3R 0 Paid in Full 0 Outstanding Balance Due:" '
SECTION 5: CONSTRUCEIIUlY'SERVICES ....... `_._..
5.1 Licensed Construction Supervisor(CSL)
pp e SS/- 00s ,2y" �S�sJw
I b h d e ,Ca n aI s License Number Expiration Date
Name of CSL-Holder
� t y A✓0— Sa U ql u.S. List CSL Type(see below)
Ayr s //I1T lO :_U e tL., =z. Description - _
11a U Unrestricted(up to 35,000 Cu.Ft.
R Restricted 1&2 FamilyDwellin
Signature q M Masonry Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5 stered H me Im rovsment Contractor(13IC)
c�eCa�'(� i5 I/ 1J23
HIC Company Name o HI Registrant Name Registration Number
t0l///am c�e�lt A1ct/s /din erlcan boor
Address - T / / b 5ll `l
/3 C3a I I e ✓2_ Expiration Date
Signature Telephone
SECTION 6 WORKERS'- MPENSATION 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 Issuanc of the building permit.
Signed Affidavit Attached? Yes .......... No...........❑
SECTION 7awp_ AII• ( TION OBE CU PLE1E 'OI't N
UWPTER' AC;Ri�`'G-U� Ok'OVE IE"S FAt4 1>' .IItMIT
I, r h ;.�l I G o n z Q e -;L. as Owner of the subject property hereby
authorize ( I / !�yv ¢ L a n a l S to act on my behalf,in all matters
relative to work authorized by this building permit application.
a
S ature of Owner Date
SECTION 7b WNERt.ORAUTHORhZE7)AGENT DECLARATLON_- ., .
as-O--
wner 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.
reni G01720 )e2
x Fr'
Signature of wne Au 'zed Aferd Date
(Signed under the pains and penalties of perjury)
NOTES' i
1. 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(RIC)Program),will not 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 110.R6 and 110.R5,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 half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. `Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www,mass gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumtiets
Applicant Information Please Print-Letribly
Name(Business/OrgmiratiohAtdiYidual):/dm iG@{i &0a �-- N/�I 6t _/ w
Address;,�2a i�e 4 y e
City/State/Zip: Phone#: 7J'1-38q X� ',Z
Are oo nn employer?Checkthe.appropriate box: Type of project(retprtred):
1-: Iam a to with 4. ❑ 1 am a general contractor and I
�P Yer � 6. ❑New construction
employees(full and/or part-time).• have hired the sub-contractors 7. n-
2.❑ I am a sole proprietor or parker- listed on the attached sheet.t ❑Remodeling
ship and have no employees. These subcontractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition - � _
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers Have exercised then 10:❑Electrical repairs or additions
3.❑1 am a homeowner doing all work right of exemption per MOL l LEJ Plumbing repairs or additions
myself[No workers'comp. c.152,§1(4),and we have no 12.❑Roof repays
insurance required]t employees-[No workers'
comp.insurance required.] 13.❑Other
'Any applicant that check&box al must also fill out the section blow sbowing thch workers'compensation policy information.
-t Homeowcets who submit this affidavit indicating they am atl work and thm hircoutsidecontrxtors most submit a new affidavit indicating such.
iCormaetan that chock this box must amschod an additional shot showing the now ofdm sob-cmamemrs W their workers'comp.policy inimuration.
law an employer that is providing.warkers'compensation insuraneefor my employees Below is the policy and job site -
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: (J,�33((�-3 3 rp 94 0.- 1? Expiration Date: /
Job Site Address: O PfiNQr S7 City/Statedip:&7/2ilk /q(2 Q/ 70
Attach a copy of the Workers'compensation policy declaration page(showing the policy number and expiration date)..
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fore up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$256.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office.of
Investigations.of the DIA for.insurance coverage verification.
1 do hereby eenif/y under the pains/and attics ofpei' ry that the information provided above is true and correct
Signature:/,( ��Dl ( i . Date: ze b)-
Ag
Phone#: 7�1-389- 7Gbt�
Official use only. Do not write in O ds area,to be completed by city or town of xiaL
City or Town: PermitfUceme#
Issuing Authority(circle oue)S_
1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing inspector
6.Other
Contact Person: Phone M
THE FOLLOWING.
IS ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
JM /A�C( F-
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DATA
WAP Work Order
North SI ore Community Action Programs,Inc. Job Number:Pi .icc St
96 Main ilreet Work Order IN 1 4: 1.1/4/2013
Peabody if1A 111960 Ownership:Pet ::r
Phone: 97t-53 -8810
America i]Dour,'Nindow,& Insulation Auditor:Braid ii Dorrington
15 Baile) Avenue Email: bdorrinf i+uqulnscap.org
Saugus A 1A 01406 Cell;781-540 8!1i) -
Email: w lelaugis@eomcast.net Phone:978-5.11-1'V?x121
Phone: 7 11-231-0244
Arleni G ruzalez - NGRID Electric $7,334.67
41)Princi St Total $7,334.67
Salem M 0 01970
6117-530-1,3:33
+i �.!911P
;
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hr! � ' �i h
Attic,I : rmwall Floo J'ransidon 94 $2.52 $236.88 94 $236.88
Dens-, : +,:k w/cellul,.se
Kneen 78-12 cell,lose behind 396 $1.73 $685.08 396 $685.08 _
perm::: I.:: membrin e
R-30 r . Acted-slol-e dfloored fill 483 $1.48 $714.84 483 $714.84 - KITY W
w/cell(IL s r•,
R-30 r : ,icted-slot e:dfloored fill 257 $1.48 $390.36 257 $380.36 slope iW _
w/cell(l_;I; -
R-38 •a reatricted-s Atled cellulose :328 SIA7 $482.16 328 $482.16 W .
Rem(r .Id falling is reffecsive FG :Z $60.00 $120.00 2 $120.00 -
@ KAY
i, ! ...,•ii,innun. �TuHeu. uGr"a; ,':4tarp-
d�{i�(u�!+.I �al � ,,�!�. .lu �;� i I; r
AS"It f .,.,."li, ..;.2-11��hh�,IhJihlrh�lhli�Nh �.
Sill tv . :dirt foam w'fiberglass butt 124 $2.20 $272.80 124 $272.80
�II �,I- . .[Illi�l!1�I°II II{ I il!if�!Ilil�!Ilrllilll� l ll i�lGh!'i a�'IH01, 15huahhul111, I!II 1111111l11a1! 111
Fixed e!p 6- $15.75 $94.50 6 $94.50 _
R-511(.i +�,ra:p or R-1 aax on door 1 . $51.00 $51.00 . 1 $51.00 W
R-511(t i in ap or R-1 aux ou door 1.5 $5:1.00 $76.50 1.5 $76.50
Repair • c F Door u a $52.00 $156.00 3 $156.00
it _
Date: 1 2013 Page 1
r
WAIF' `Vork Order: Job Number: Pr:inl:e St
Salt'a.I 1 Fit BH dog rand weather 1.5 $60.00 $90.00 1.5 $90.00
pro(I r.BH
Wea t:;.strop s/Q4 m or equal 6 $45.50 $273.00 6 $273.60
We I -!Imp s/Q4, a or equal 1.5 $45.50 $68.25 1.5 $68.25- w,s J rides KW doors
", I Il ilk '1 11 ll : II lid, .: il8l'� 1 I lei' ' tl l
Clot]I al ryer vent ncluding 1 $89.00 $89.00 1 $89.00
Exhl I 11.)act
Vent I I,at:h fan 1 $89.00 $89.00 1 $89.00 W
i-u In `III .: A., I
Dom i ; water pip, wrap 12 $2.63 $31.56 12 $31.56
Hydec ;pipeinsul Ilion In t in. 80 $3.41 $272.80 80 $272.80 moorIt ai,nKW areas
Copp::; Iipe:R-5
EAttic
IMR I[I; t' i'11Mi i!Cvll'i!1�s � 'ia l '�I' i'I,i ti u1111:1111 ;�!1! i p s :Hag with tm o-part foam 4 $75.00 $3010.00 4 $300.00 --
Baser I i sealing wi:h two-part 2 $75.00 $150.00 2 $150.00
foam
Clear Hers/repair clowraspouts 2 $60.00 $120.00 2 $120.00
M I ._,.. ... ili llr 114nnl-�{' 1 -, �:I,:I II �11'_n e a II II'll liiill'l illlll,,' ", I I"' 11 I I'''It'I iII II lI r Ij„,I,4: IjI'1II14, :�11g1. I hill .14 v p U l.,,i a,
I�L61: ,.ilil�la�,la
41Vi�JIiCr �I�I �ii�Iil�L����IIVLl:�1�wi�l��tiillll!I�I�!iihllll��iI�� L. I�li�IiNVI�!6� � �II!� i���l, h ��ul! N��> � �����s1111,� NV !Iie� ;INI'11
Build I Permit _ _. It $100.00 $100.00 1 $100.00 -'•~
ifll��11�4 A'1,�1 1!IIIIINiIIt� g(u�1llli�ftl��!�Illlh l l Il ti i�'1 llUi1 ry� I,pp ) .,,.:tt���IIII, l i "I @��1,� 'I II ,. I"a,lu, •{,�.�pl ,II i ll''l. ryuuu
aJ _ ! �l��il� !i1111 ! tllll �pIMIiI�� 1hI� �I�GiilhiY���IIIIII�'�! a,diq �III!i �a � !� ;��� u��lil
Wood 11
I Aboard/sha<(s/shin,gs or 1386 $1.79 $2,480.94 1386 $2,480.94 vinyl
vinyl t i se pack) - -_-
Date: .2013 Page 2
WAP Work Order: Job Number: Priam! St
Total_ $7,334.67 $7,334.67 _"�
Contr r : nr Instructi,me
raja the Jol : During the Job:
1.PleePtee s:: ,At:y us 24.tours belore starting or scheduling;ajob: 1.Incorporate lead safe prac:ici 3'as applicable.
2.Obt:a .,:qu:ired bui ding permit 2.Total for Heath&Safety anc I Lepairs cannot exceed$2500.00.
3`DavisBacon time sheets r.:qi i i'ed.for ARRA work on US
Department of Labor Certifii I Pcyroll Report Form WH-347.
AdditLi I Contracts r Instructions:
Certili::i: Hof Insulati tr.potted? Yes No (Circle One)- Attic Inspection form arta, h ed? Yes N/A (Circle One)
Where P.: i A:
Contr.<I, r _ _ __Date:_ WAP Auditor: _ Date:
Energ! rector: Date: Fiscal Officer: Date:
V013 AGENCY USE ONLY
We Post Language Other than English neec.�d: Yes No (Circle One)
Dryer( 0.000 _._ If Yes,indicate language: _
Stove C 0.000 ___ Occupany change in last 18 months? i es No (Circle One)
H20'I:i 1 "0 0.000 - Comments:
Heatir; ,stem CO 0.000 Number of windows
Ambn t 'll 0.000 Number of rooms ..
Blowei or 0.00 ---
Date: 2013 Page 3
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supemkor Specialty
License: CSSL 100824
WELLIAMJDE14NGIS.s
15 BAILEY STREET. 's3
SAUGUS MA 01406
1
Expiration,
Commissioner 0 510 5/2 0 1 4
VolOffice ofo Consumer Af(airs&Busi4 RlgulatonME IMPROVEMENT CONTRACTOR
xgistration: 111123TYPe:
piration: 1125/2014. DBA
KCA
AMER CAN DOOR WINDOW&INSULATION
WILLIAM DeLANGIS-
15 BAILEY AVE
SAUGUS,MA 01906 g
Ondersecretary
Commonwealth of Massachusetts
�y�)`' City of Salem
120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641
°,naxrv:no.
Return card to Building Division for Certificate of Occupancy
Permit No. B-2014-0468
FEE PAID: $54.00 PERM101" TO Buti'JUL)"
DATE ISSUED: 11/27/2013 f
t
This certifies that chalifour family Itd ptnrship
has permission to erect, alter, or demolish a building_ 40 PRINCE STREET Map/Lot: 340146-0
as follows: INSULATION INSULATE BUILDING WITH CELLULOSE INSULATION. AIR SEAL WHERE
NEEDED. @ 40 Prince St
Contractor Name: g4
DBA: I k _d
Contractor License No: '
t re1. d
it
IL't $ 1
11/27/2013
r A �
Building Official ig Date
This permit shall be deemed abandoned and invalid unless the work authorized by this.permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials:are provided on this permit.
" x
HI C #: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
Restrictions:
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
Commonwealth of Massachusetts
Citv of Salem
120 Washington St,3rd Floor Salem,MA Ot970(978)7459595 x5641
�r
Return card to Building Division for Certificate of Occupancy
Permit No. B-2014-0468
FEE PAID: $54.00 r � RMIT T00� B mtj" I LB D
]ATE ISSUED: 11127/2013
_�
This certifies that WILLIAM DE LANGIS
has permission to erect, alter, or demolish a building PRINCE STREET Map/Lot: 340145-0
as follows: INSULATION INSULATE BUILDING ITH CELLULOSE INS&ATION. AIR SEAL WHERE
NEEDED. @ 40 Prince St
Contractor Name:
DBA: AMI✓Rlcf-'t,] Pc�oq llJtNDow
Contractor License No: lNS0l,f3°nQ r1- o
11/27/2013
Building Official ., _ Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six monthsafter issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request +" e
coni r _
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of anybuilding and structures shall be in compliance with the local zoningby-lawsand codes.
_ n+v t
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on.this permit.
HIC #: Persons contracting with unregistered contractors do not have access to the guaranty fund'(as set forth in MGL c.142A).
l
Restrictions:
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
Commonwealth of Massachusetts \,
{ X `; City of Salem
� 93 Washington St,Salem,MA 01970(978)745-9595 x5611
PERMIT REPORT BY ADDRESS
Address: 42 PRINCE STREET
PIN -Permit For k = Parcel ID Occupancy Type Building Type L ®Work Description 3 Construct. Fee Paid
f Cost 1'
. :B-20041096 m REPAIR/REPLACE , 34-0145 . Residential .Two Family 1130-2004 INSTALL SIDING TJS 300000 2300
B-2014-0468 INSULATION 34-0145 Residential Two Family INSULATE BUILDING WITH 7334.67 54.00
CELLULOSE INSULATION. AIR
SEAL WHERE NEEDED. @ 40
Prince St
Total Permits: 2 10334.67 77.00
1 of