30 RAVENNA AVE - BUILDING INSPECTION r,o. City of Salem we.a �
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� APPLICATION
_ " _--. . ;,. _ _ FOR_ ._-�
PERN9IT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Appllcant to complete aU/tema/n sectbns:l, 14 11� N,and U(.
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L „ `� AT.0.0CAilONp- �CJ " E Kl IU C�. V;���. . .. � DI�S7RICT�
IOCATION �"o' `•' '� ':-' � . - -
OF eETwEeN "rio
BUILDING �c�oasrru�n . : ic�ssLsso nn
SUBDMSION LOT BLOCK SIZE
11. TYPE AND COST OF BUILDING •All applfcants complete Parts A -D
A TYPE OF IMPROVEMENT �� D. PIiOPOSED USE-FOR"DEMOLITION"USE MO5T RECEM USE - � -
t �'1�i�w Iwlldl�p . . . M�IO�ntW. . �. . . . .. NonrNltl�ntlY.. .
� 4 Q AdtlltlonlXiesidenNal.enternumbe�olirew�� -- 12 �One-famtlY. . �78.❑ Amueemn4recreational . _ .
/re
� Iqusing unifs adEetl,il anY�in part D.731 19 Q CNuch,.olher rNipious .
; 13 ❑ Two a more(amilY'En7er�numDer � � 20 ❑ Induetrlal �
'. 3 Q Atleretion fSee 2 a6ove) . _ - o/units�....._.�_ - � .-- -'
4 Q ReOeir re0lacemenl -� �14"Q T�analent tw0a1;motel,w Owm�WrY'.. . 21 ❑ Parking garape. . _ . .
'. ,
� Enter number d unrta . - . - 22 ❑ Service alatlon.repair gerape..
, . . . . ..... .._.—
5 Q Wledtin8(M mulMamiy resifentlal,enAar number . „k..y. ,-_. . . - 23 ❑ ibeV?�4 irretilN'aW . ,.
.. W unifa in buildfrp in Pert D, f31 . . . :. 15 �GeregB .. . . .. _ 24 Q.OXke.hanl�professiorml .
8 ❑ Mwinglrebcatqn) 18 ❑ CarP�� � . , . . . .. 25 �.Publku(BiIY . .
� 7 ❑ Fourwauon onN. . . .. . . . - . . . 26 Q.Schoa.�i0ran.other eaucatioral . . .
- �� ❑ ONer'SPee�1Y . . 27 � Stae0.rtierean�ile
B.OWNERSHIP . . . - 28 Q Tenke,towere. .. .
8 � Prnrate(intlrvitlual.corpaation.ranP�N . 29 Q��011im-SPeclA'
InsUlutbq etc.) ' . .. ..
9 ❑ Pudic(FeCeral�Stete,a bcal govemmeM � � - . . ..
C.COST . (Omif cantsl . Navesidantial-Deecribe in datai proposed uve ot buiWingo,e.g,tood v��mB Wa!�C
•�. � .. machine shoP�'�uiidry builAinp 8t IaeP�.ebrtientelY�hod.secandarY schobL�w0e9e.
� 10. COst d imProvement __._.�._ 5 Daraehiel xhod,"Derki�0 9era9s lor tlepaNneM etore.ron181 oMk:e Euiltlirp.oMCB budtlirg
.. at induatriel OWnL M uae al existinQ huildirtg re be�n4 changed.en0er Wopwed uae.
� ' . . . . . . . .. F
� To De in5ta0ed Dut nof incluCed .. . . . . �
in Nie aDove cost -
a Electrieal..._. _._.._._...._........._...._..._....__ � �-.�
� b. Plumb'ag....._..........................._._..._.........___..._.__ �`'C..1.�(Sl) :. -. .. - :,
. � e. Heetiig,air wrWilbnin9..__....__._.__...._...__"' . O� . � . . � .
tl. On�er(elevaror,e�c.)._.__.._._..__,_""'_""_'. .
o'r
11. TOTALCOSTOFIMPROVEMEM D�
111. SELECTED CHARACTERISTICS OF BUILDING -For new 6uildings and additions, complete Parts E-L;demolition,
com ete on Parts J 8 M, a/l others ski to/V- �- -
E PRINGPAL TYPE OF FRAME F. PRNCPAL TYPE OF MEATING FlIEL G. TYPE OF SEWAGE DISPOSAI 1. TYPE OF MECNANICAL
30 � n�«.r�weu o«N,a� ss p c� m � won�a.o�m e«�a�,r wn n,�oa�,a�a:
a� �-weoa name 3e Q �+ a� Q ari�am(sew�aNc e�c.> ca.wroonirpl
32 Q Struclurel ateel 37 ❑�Ebctricily - �-� YJ�� - � ' � 0 �O�
a� p a�ea�� ae p c� H. rraE oF warat su�r . w�n,�e er���rr-
34 a Otl�e.-�Pe�Y 39 O Otl�e,-��h' 42��Publk a W�e�canP�y � � a .� ��4� � No
a3 ❑ Private(we14 cistem) •. .
� � :�-
�' �•°�E�� i M. DEMOLITION OF STRUCTURES:
� ��a��..._....._2..:5....._.:....._.._..._.. , j . . :e.
' as. rom�sawe�a eoo�a�, � Has Approval from Historical Commission been received
�o+aax nasm m e� c��J..�.....__. �.,�J Z.b 'fa any structure over fiflY(50)Years? Yes_ No_
�. afinensms r-._..._...__..._.. . .
� 56 Tolal IeiM area.sG R._.._._ .._ ._..._...'_ ��'�� �` Dig Safef Number
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K NU116ER OF OFF-STREEi VMKING SPACES � ..•.�Pest Contrd:
s,. Encbsea ..._.._.....__._...__.............._......._.._...._...--
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` i',';HAVE THE F04LOWING UTILRIES BEEN DISCONNECTED?
.�-..
sz. aneoas........._............._..._...._.__.._...................-- "P. �.:�� � Yes No
�xesioex�u�euawtws orur, YV2ter: _ , ,.,•-, . - '� . ;€ - ,
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.� ....
. , , : . . .
sa e1,cwsm'``- -----:.: :.-- --....- --- , •
` Electric:" , . ` , �
- A._ ; , . Gas: .- ,-.� q ,;.,. . -£r`
Fw�,. -.___...__ - � Sewer: _ . _
s`' �`°�' DOCUMENTATION FOR THE ABOVE MUST BE ATfACHED
oam.00ms . . varom.._.._._......_._...._..._.. � - � �
BEFORE A PERMR CAN BE 1SSUED.
.. �
N. COMPLETE THE FOLLOWING: � ' : :'��: � _'->
,. ; , _ _
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Historic DistricY�_ Yes__ No�� pf yes,please encb§e documentafron from.Nist.Cam.)._ � _ _.� . ..- . ..
. . j fl -:u..,:.� '� � �4�J �< ._v�r.. ,.y �.�...2u rvl� w .. ..�.. . � ..
. . .. ._ . .. .. ..
Conservation Area?.,,Yes_ No`,�_ : (H Yes;Please enclase Order of CondRrons)"" -�w r
, r.� . _ _ ±e;,. .rs ,� . . w, , .
Has Fire Prevention approved arid 'stamped plans or applications? Yes�� No_
Is property locatetl in tlie S.R.A disiricY? Yes_ No_- � ' �
,.,, r
- � "
Comply with Zoning7" Yes� No_ (If no,encbse Board of.Appeal decision)
1, Is lot grandfathered? Yes_ No_ pf yes,submit documentationlrf,no,submA Board of Appeal decision)
'� If new construction,has the�proper Routing Slip bcen enclosed9 Yes_ No_
Is Architectural Rccess Bbard approval required? Yes_ No� (If yes,submit documentation)
Massachusetts State Contraotor_License # C S 0�'l►u3 Salem License #
� o 53�3 �
Home Improvement Confrador# "C��� Homeowners Exempt torm(if applicable) Yes— No_
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT ' � '
� - - . � � - If an extension is necessary:Please submR
, CONSTRUCTION IS TO BE COMPLETED BY:`� 'p� in wriUng to the Inspecta ot Buildmgs. '
V. IDENTIFlCATION • To be completed by all applicants
. �� .. . - Matlmg aEdress�Number.sbeef,cM,and st�a � LP Cade TeL Na
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tessee
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Mt�itectw . .
. Enginear . . . _ ' .
I hereby certi(y that the proposed work is authorized by the owner of record and that I have been authoriz bY�e owner to make this application
as his authorized t and we ee to conform to all licable laws of thi jurisdidion.
ig re of '� ' Address O e¢c Applicati date
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DO NOT WfiITE BELOW THIS LINE
VI. VALIDATION - -
FOR DEPAFiTMFM USE ONIY .�
Building _
P�mit number use craw
Building ���,e L_ �_
Piermit issued r�� 7 ��p0 7 Fxe cra�no
Building T/�j/D✓�'"� ��a�+B _
. Ferma Fee $
oaupencr lo�
Certificate of OccupancY $ MP� bY
_Drain,Tile_ _ $ _ `� -
1, Plan Review Fee _ $ _ _ . . � �Si i3G.tx. i.�lSs? -
_ " _.. TrTtE
�,„.. � .. . _.. . . .. . . . ._ . .
NOTES AND Data•(For department use)
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PEFMIT TO BE MAILED TO: � � f
DATE MAILED:
Construction to be started by. � Completed by.
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VI 20NING PLAN EXAMINERS NOTES
i
DISTRICT I
_ , _ ;
USE �
FRONTYARD �i
f
SIDE YARD SIDE YARD .
REAR YARD
NOTES
.. . s _ . • "i:.. " ..
SfTE OR PLOT PLAN-For Applicant Use _
s �
_ ON
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CITY OF SALEM
ROUTING SLIP
NEW CONSTRUCTION�
CERTIFICATE OF OCCUPANCY
LOCATION: 3 b '�\YJU 6 �h1 Fa- V� DATE O�-1 �a b�—
APPLICANT: �l�t�w L'� f� i4 ti,zc ��d
ASSESSORS
FRANK KULIK ( � DATE�� d'a' G�
� (93 Washington Str
CITY CLERK � � �✓
CHERYLLAPOINTE �%dZlL .. ��%L�E'__— DATE:.�����-
(93 Washington Street) �
PUBLICE SERVICFS
BRUCE THIBODEAU DATE:
(l20 Washington Street)4'"Flo r
/
WATER
DOTTIE THIBODEAU � � DATE:
(120 Washington Street)4tb Floor
CROSS CONNECT SUPE�SOR . `�p�I � 7
BRIAN THIBODEAU i-� ''LGW�- ' DATE: li
(5 lefferson Avenue)
PLANIVING ,/r�.
�u^�(nyr /"�"l DATE: � �o� ���"
(120 Washington Street)3id Floor
CONSERVATION COMMISSION
Ca�� _ ___.._. �'� DATE:
�a�u�I (120WashingtonJtreeq3"r�oor � .�
ELECTRICAL
JOHN GIARDI ��T���l.�� DATE: .Z .2 O��
(48 Lafayette Street)
FIRE PREVENTI
ERIN GRIFFIN /��P��^'S �� �.�• DATE:
(29 Fort,Avenue)
, HEALTH � � � ^� � �^ ..7 a -4 �f
JOANNE SCOTT_����--�-^ DATE:
(120 Washingron Str t)4t6 FI
BU[LDING
THOMAS ST.PIERRE � DATE: 3 7 U
(I20 Washington Sveet)3 oor
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i 03/01/2067 . 14:16 9785351894 LINDA THOMPSON PAGE 02102
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CITY OF SALEM �G�`d �(���-
Co l� -L� Z ���63
ROUTING SLIP
NEW CONSTRUCTION�,
CERTIFLCATE OF OCCUI'ANCX
LOCATION: 3 6 �I�u s cJ1�1 M�. V� DATE �1' �a' r b I
ApPLICANT: � �l-w l� � ✓� n;z,, ��d
ASSESSORS
FRANK KULIK DATE:
(93 WasNng[on Saecc) - i
CITY CL�.RK
CHEItYL Ir1POINTE DATE:
(93 Washington Street) -
PUBLICE SERVTCFS
BRUCE THIHODEAU � DATE: ���—
(120 Washington Street)41°F7oor � b�'/°� D���,y�,_L_,.,�j 1 ���,�Si (p/�
t �V � (i
ww�x m �t�ow� orrR''��
DOTi'IE THIBODEAU 0�-/ � • - DATE:Su� �O l(�R��`�"S�'��f
(120WashingconSvext)4'�Fiow Hr{S"f �aal� /�l+ct "rro pN Cyr{sr �;.j-��,,�PP�JJ�./ (��'p�
iy�' rP� �' 4�, o� _ ^
CRO55 CONNECT SUPERV7SOR �''�� "� �p'
BRL1N 1'HZSODEAU DATE: ,,,�p
(5 letfersoo Avenue) �
ef- D,l'G l.�J7C�S��
PLANNING ,/�,,q- / ^�. /�rI'
�G..m.� /"Y'/ DATE: � daC /o /
� (120 Washington Strcct) 3'�F7oor ,
CONSERVATION COMMISSION
Ga�'FY �_ DATE:
. �4t�f (120 Washington Streei) 3'�Yloo�
ELECTRICAL
� JOHN GIARDI .DATE:
(48 Lafaye[te Streeq � ,
F'IRE PREVENTION
ERIN GRIFFIN---,.----... __
--..... .__._...... DATE:
(29 Fort Avenue)
HEAI.TH
JOANNESCOTT DATE:
(i?0 Washington Skeec)4'°Fioor
BUtLDING
THOMAS ST.PIERRE DATE:
(120 Waahingcon Street) 3i°Floor �
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� f FIRE DEPARTMENT GERTIFICATE ON APPROVAL FOR A BUILDTNG PERMIT
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�-� IN ACCORDANCE WITH 'fHE PROVISYONS OF THE MASSACHUSETTS STATE BOILDING CODE
AND TfiE SALEM FIRE CODE, A?PLICATION IS HEREBY AfADE �FOR THE APPROVAL OF PI.ANS
AND T8E TS5IIANCE OF A CER?IPICATE OF APPROVAL FOR A BUILDING PERMIT BY TF1E
��4I.EM FIRE DEF'ARTASENT. ( Ref. Section 113.3 of the Mass. Bld�. Code)
� SOH LOCATION- ��� � �
��� OvINER/OCCt7PAYT: . :
�
��.. ELECTRICAL CONTRACTOR: _a f�yy�,�i�i�Z�
FIRE SUPPRESSIO CON7:RACTOR:
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APPLICANT:�F '%'�. � �i,� � PHONE d: _ �.2C�!(/3
�;��.� ADDRESS OP -� _// � � � . CITY OT .
� APPLICANT: ��,�(J �, xowx: GY
���� APPROVAL OATE:� . . � . ..
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� Cezcificate oF approval ia herebq granted, on apprnved p2.ana or eubni.ctal oF
�� project deta3ls, by the SALEH FIRE DEYARTMEN'C. All plana are approved solely
� for identification of tppe aad laeation of fira protection dev3ces and equipmeac
F;� All plan� are subject Co ttpprova2 of aay ochez authority havfng ,juriedietioa.
� Upon completfon, the applican[ or installer(s) shall ,request an inapecti�n and/or
- keat of the fire protection devices and equlpmen[. (ADDITTIONAL REQUIti&*1F,NT5,
�; . SEE ftEVERSE SIDE ***) -
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�, TION OF APPROV$9 F:IRE ALAAM DEVICES. TAE 0'+FNER Of' Tf1IS PRO-
� ��RTY IS .P.vQUIRED TO OBTATN CO.�IYLLA:iG. AS. A CliNDITION OF
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€ OBTATNTNG A BU:LDING pERMIT.
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Pernut Number
MECcheck Compliance Report
Massachusetts Energy Code
MECcheck Software Version 32 Release la Checked By/Date
TITLE:REVENNA AVE.
CITY:Lynn
STATE: Massachusetts
HDD: 6573
CONSTRUCTION TYPE: 1 or 2 Faznily,Detached
HEATING SYSTEM TYPE: Other(Non-Electric Resistance)
DATE: 02/21/07
DATE OF PLANS:FEBRUARY 21,2007
PROJECT INFORMATION:
FRANK LANZILLO
30 RAVENNA AVE
LYNN,MA.01970
COMPANY INFORMATION:
CUSTOM BULT CORP.
262 CHATHAM ST.
LYNN,MA. 01902 DAVID C. WYCKOFF
NOTES:
28 X 36 GARRISON TWO STORY
COMPLIANCE: Passes
Maximum UA=329
Your Home=299
9.1%Better Than Code
Gross Glazing
Area or Cavity Cont. or poor
Peruneter R-Value R-Value U-Factor UA
Ceiling 1:Flat Ceiling or Scissor Truss 1080 30.0 28A 19
Ceiling 2: Cathedral Ceiling(no attic) 320 30.0 28.0 5
Skylight 1: Wood Frame,Double Pane with Low-E 19 0.032 1
Wall 1:Wood Frame, 16"o.c. 2060 13.0 I1.0 82
Window I:Wood Frame,Double Pane with I,ow-E 304 0320 97
Door 1: Glass 120 0320 38
Door 2: Solid 20 0320 6
Floor 1:All-Wood JoisUTruss, Over Uncondirioned Space 1080 19.0 0.0 51
COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,
specifications,and other calculations submitted with the permit application. The proposed building has been
designed to meet the Massachusetts Energy Code requirexnents in MECcheck Version 3.2 Release la.
The heating load for this building, and the cooling load if appropriate,has been determined using the applicable
Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be
no greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4.
;
Builder/Designer Date
J
MECcheck Inspection Checklist
Massachusetts Energy Code
MECcheck Software Version 3.2 Release la
DATE: 02/21/07
TITLE:REVENNA AVE.
Bldg. �
Dept. �
Use �
�
� Ceilings:
[ ] � 1. Ceiling 1: Flat Ceiling or Scissor Truss,R-30.0 cavity+R-28A continuous insularion
� Comments:
[ ] � 2. Ceiling 2: Cathedral Ceiling(no attic),R-30.0 caviry+R-28.0 conrinuous insularion
� Comments:
�
� Above-Grade Walls:
[ ] � 1. Wall I:Wood Frame, 16" o.c.,R-13.0 cavity+R-11 A continuous insularion
� Comrnents:
�
� Windows:
[ ] � 1. Window 1: Wood Frame,Double Pane with Low-E,U-factor: 0320
� For windows without labeled U-factors,descnbe features:
� #Panes Frame Type Thermal Break? [ ] Yes[ ]No
� Comments:
I
� Skylights:
[ ] � 1. Skylight i: Wood Frame,Double Pane with Low-E,U-factor: 0.032
� For skylights without labeled U-factors,describe features:
( #Panes Frame Type Thermal Break?[ ]Yes [ ]No
� Comments:
�
� Doors:
[ ] � 1. Door 1: Glass,U-factor: 0320
� #Panes Frame Type Thermal Break? [ ]Yes [ ]No
� Comments:
[ ] � 2. Door 2: Solid,U-factor: 0.320
� Comments: �
�
� Floors:
[ ] � 1. Floor I:All-Wood JoisUTmss,Over Uncondirioned Space,R-19.0 cavity insularion
� Comments:
�
� Air Leakage:
[ ] � Joints,penetrations,and all other such openings in the building envelope that are sources of au
� leakage must be sealed.
[ ] � When installed in the building envelope,recessed lighring fixtures
� shall meet one of the following requicements:
� 1. Type IC rated,manufactured with no peneh�ations between the inside of the recessed fixture
� and ceiling cavity and sealed or gasketed to prevent air leakage into ffie unconditioned space.
� 2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944
� L/s)air movement from We the condirioned space to the ceiling caviry. The lighting fixture
� shall have been tested at 75 PA or 1.571bs/ft2 pressure difference and shall be labeled.
i
� Vapor Retarder:
[ ] � Required on the warm-in-winter side of all non-vented framed ceilings,walls, and floors.
�
� Materials Identification:
[ ] � Materials and equipment must be identified so that compliance can be deternuned.
[ ] � Manufachuer manuals for all installed heaung and cooling equipment and service water heating
� equipment must be provided.
[ ] � Insularion R-values and glazing U-values must be cleazly marked on the building plans or specificarions.
�
� Duct Insulation:
[ ] � Ducts shall be insulated per Table J4.4J.1.
�
� Duct Construction:
[ ] � All accessible joints,seams,and connecrions of supply and return ductwork located outside
� condirioned space, including stud bays or joist caviries/spaces used to transport air,shall be sealed
� using mastic and fibrous backing tape installed according to the manufacturer's installation
� instructions. Mesh tape may be omitted where gaps are less than i/8 inch. Duct tape is not permitted.
[ ] � The HVAC system must provide a means for balancing a'u and water systems.
�
� Temperature Controls:
[ ] � Theanostats aze required for each separate HVAC system. A manual or automatic means ro
� partially resuict or shut off the hearing and/or cooling input to each zone or floor shall be provided.
�
� Heating and Cooling Equipment Sizing:
[ ] � Rated output capacity of the heating/cooling system is not greater than 125%of the design load as
� specified in Secrions 780CMR 1310 and J4.4.
�
� Circulating Hot Water Syetems:
[ ] � Insulate circularing hot water pipes to the levels in Table 1.
�
� Swimming Pools:
[ ] � All heated switnming pools must have an on/off heater switch and require a cover unless over 20%
� of the heating energy is from non-depletable sources. Pool pumps require a time clock.
�
I Heating and Cooling Piping Insulation:
[ ] � HVAC piping conveying fluids above 120°F or chilled fluids below 55 °F must be insulated to the
� levels in Table 2.
�
�
Table /: Minimum Insulation Thickness for Circu[ating Hot Water Pipes.
Insularion Thiclmess in Inches by Pioe Sizes
Heated Water Non-Circularin� Runouts Circulatine Mains and Runouts
Temperature(Fl Un to 1„ Un to 1.25" 1.5° to 2.0" Over 2"
170-180 0.5 1.0 1.5 2.0
140-160 0.5 0.5 1.0 1.5
100-130 0.5 0.5 0.5 1.0
Tab[e 2: Minimum Insulation Thickness for HVAC Pipes.
Fluid Temp. Insulation Thicloiess in Inches bv Pine Sizes
Pipin Svstem Twes Ran e F 2"Runouts 1" and Less 1.25" to 2" 2.5"to 4"
Heating Systems
Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0
Low Temperature 120-200 0.5 1.0 1.0 1.5
Steam Condensate(for feed water) Any 1 A 1 A 1.5 2.0
Cooling Systems
Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0
and Brine Below 40 1.0 1.0 1.5 1.5
NOTES TO FIELD(Building Department Use Only)
�— —
�,:
CITY OF SALEM
. �; PUBLIC PROPRERTY
DEPARTMENT
IC�I.EILLEY DR�C«L
S/A1�
!20 W�mv�pN STtEBT�L►I�M.YtwssnC�tUm'C[S 01970
'RL•97f.7{S9S9S �F�x:97i71698�6
Worl[ers' Compen�atlon Insnraace At'ABdavir Bnilder�ICuntnetor�/EIe�{�Voypbm�
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Name l ' . .�): U5'� -
A��•�� ��i� �h,� �: �
c�ryisffiwz;p: L n/�v i`I.� o��z, ���: �G��i ��83 '
An yo�a�empby�r?CSeek tA�appropclab bozi
1.0 i am a employar with 4. �I am r imenl coa�acoor md I ���1�(�:
employca(Rili and/or put-time).� have hired the sub-concaaocs �' �Near cmaauctIm
2.� 1 am a aole�nopiieta�a p�mar. liaad on the awchad aheef._ �. �grmodelin�
ship snd L�ve no empWyea Thae�ntractars have 8. ❑Damolition
worlons for me in a�r capuiry. worlcas'comp inauance.
[Na worlcen'eomp.imueance s. � we ue a caporuion and io 9. CD ei'��addiao�n
n4�dl oBReaes have mcenieed thais 10.0 Electrical ropain or a�itiau
3.� I am a Lomwwaar doin�all worlt riSht uf eumptim par M(iL 11.Q Plumbini reP+i��a addiNom
myaelf.[No worlcen'comp. a 152,�l(4�aad wro have no ]2. Root
108�°°CQ��� �P�oY�.[No workms' ❑ ttP�
comp.uracance requir6d,] 13.0 Othar
f�Y wv��er dreb boz r1 mme a4o�m aut�.eetla 6doir�hovie��r�art�n• . . . . .
- Nmro�oa�rhe a6dt�af�dwk mmatly ihry w do(ei�p�adt md 0�I�auuldr mo���it�
1Coau�em�W�t e6aek mb bmt muq�IErard�e adINebe�l�hNt�Aooin�qr e���� �� .
�md�hefr voAoep eomP P�Y�m�tlaa
!as ow�erPloyn dlrat 1s provldlnj warX�s'coeip�naadow inarranc
!n/'onwatlow.- _ _ � �Ior nry swplayres Below 4 thi paltry awdJob,rAAr
Inaurance Compsuy Name:_ d/'A/8�,'�6R�j ,(/ S
Policy M or Salf-ia�.Lic.�Y:�S�o cr�g-�Z��cd�t i�o -06 �p;�,,;oo n.ce:_ rro._a�-G 8'
__ 1ob s;ce aadress: ci �s
ry aee/Zip:
Athch�eopy o[tiw workerr'eampea�atlo�po0ey deeluatlo�WM(���eh�potley nomber and e:
Failure w yeeure coven a� �bO���'
ie n9�d under Secrion 25A of MGL c. 132 un lad to the impositi�o[c�i��(p��p of s
fine up ro 51,500.00 aad/a onaypr imprisonment,a�weU ss civi!penaldp in th4 form oPa STOP WORK ORDER and a Hne
of up to 5250.00 a day againu die vio�r. gQ�,��s copy of t6is statemeat may yQ Pora,ard�d w the O�e ot
Investigariom oP the DIA tor insuc•mce coverdq,e vaifieadoo.
/do Ssieb�e�mt an0i� paL�t naldn olP�i/yry diat the Injonsadow provlded abowli trw�n/eornet
. ' �`L ?-�l0'�--
Phone p�: [�Z�— 2�2-g�� � Da�
O,(jfcld eu onl�t Do�ot wrllt 1�rhL areq m be toarPlstd br c!!r ar fows o,Jle/ol
C(ry or?ows: PermitlL(eems N
I�suln�Aut6o�tty(c(rele one):
1. Board of Hedt1 2.Bulldine Department 3.Cify/I'ows Clerk 4. Electrieal Inspeetor S.Plumbla`Imptetpr
6.Other
Coatact Penoo• P6one M•
Information and Instructions
He�chuseus Geneat Laws chapta 152 requins all employecs w�������°thec onder anY CO�°°�°��
����ytaaye,an twployst is defined as ...evaY Pecwn
exp�ess��Pli«I,aa1 oc w�iaeo.'
as an individual,Pa�m��P.�seoeistiu4��06°f°�tegal ea�tY.a�Y two a mwe
An�"'P1M'a'��f10i0d � aod imludin�ths leqrl repram�vd ot a dxeased emP1�Y�.or tht
of�hs fcceia�ni�i�i�ia a joi�eotap�. �or otha[1e;a1 ena�Y.�°P�Y�i�P�Oye°�. Howeva the
���a a���houfe���°6�and arho raide�thaein.or ths ooeua�t ot� �
dwellini b°'v°ot�oothec��Y+P�oo do maintenaoee.c� wodt oo weh dwellinf
owner of a dweRint oc Rpair
oc on tha�a buildini aPP�°°i°��to shzli not beausa of suc6 emPtoy��b°�Od to be m empbyar.•
"avery stW er ioed tlee�si�f���Y�wlt6Yota tht luaue��
MGL chapta 1 S2.425C(��°sntes th�t h th�eommoawaMY tor W
�easwd ot s i{ams or perd��oP�a a busleaw or b eo�td'ad Aa1Wis0
aeeephbM evidew ot eomptl�aa wkY th�fo�uraau�'��Nsubdivisions�iull
iPpry�aat vrYo has not prodae� Neith�ehe commonwwlth mr anY P�
pdditiooallp.MGL¢h�P�152.$23C(7I suoes" widt the imunau
¢on�ad far des perfocmance�P�lie work�wdl ac�epmble avidence of eomplisoce
, • C�tC�OY d11f C�PtO[biVQ bLQII�W t�16 COO4tChfl�IUt�Ofll�'�
�
pppUeaab
Pleaae 9ll out the wodcen' co�°°afAd�vit comPktelY.bY ehx�°°i�boza thrt apP�Y�Y�:��°d'�
neceseseY.wPPb!�O�O�a)name(s).ad�ea(a)snd P�numb�(°)�ODi`�.��otLet than�he
insurance. Limioed LiabilitY Co�►as(I.�.CI ar Limited Liab�itY PaimenhiW(L�Lp)
����pumen,are not cequixd�°ca�sY a'O�•CO���0� If an LLC or LI.P doa have
���,���, ge sdviaed that thv affidavix mty be aubmiaed w the Depa�°t°f In�s�
�PI�Y� of iaausnce covaraQe. Al�s M�nn to�ip and date th�a�davlf. '!'ha atHdavi��1d
Aceidenu fac wnScmation ���licadon f�the pecmit�lieense is beinQ requesad.not the Depa�om�
be roauned w the cicyShoutd Yon luve saY 9u�KY��the hw a if yw are required to obain�a a�� �
�ompenwfion policy.P�eall th�D�pa��numbar liued below. 3elf-insurad companias
self-inaaaoce licm�e mimbac on the _
Ciq or Tow�OMelals at the bottom
the affidavif is wmplete and priuted lepbly: 'fhe Depeccmmt ha+pro�ded s space _
p(ease be sure�ha� yas w contact you regardin�the sPPu�
of the affidsrit for you w fiA out in t6e�`'e��O 08ice of Investigacious
Please be wm w fill in the patmiNlieeme number whic6 will be uaed as a esference numbar. In additio4 ao aPP��
�hat must subm�t multiPb P��OO°Q°��n°°�in any�vm year,need ody submit one aflidavit iodieatmi cu+s'°°R
�p�y�j�p[��tIOII�It OO��f/Qy�����IOb SltO A�EM�t�0 S��CBGt i�011�W[1L0�Su IOCAhON IO����
or marked bY tlu oity or towu may be pmvidcd to ths
wwn)•"A copy of the aPfida�that iw beaa ofHcialtY� �lieeosa. A new af"udrvu muR be fiUed cwt ach
aPP�lcant ys proo4 that s valid aPlidwit is on lile for fiuuro Pe�min iai vauaro
yeu.Wheee a homa ow�r a eitum is obuinini s li�enu°�P�na rolated w any buaiaeu ar eommere
(i.e. a doQ
ticenae or Pecmi�ro bum leava ex.)�aid penon is NOT required to eomplete this atHdsvit
ns would lilce eo thank you in advance for your eoopusden and s6ouid You have any que�ns. .
The Ofti¢e of inveaa�aOo Q�a eall.
please do eM hainte w giv
'il�e Depacamea�'s ad�es�.u►�P�°°and fax number.
T�LO���th Of ML43iG�lUSCdS
�8t4IIEOL Of 1Ld118![1v ACCIdCIILt
Otsa ot Iavatlpttons
60o w��sa�e
��o�iii
TeL #617-727-4900 ext 406 or 1-877-MASSAFB
Fax!�61'l-?27-7749
RavixJ s-1bOs �yQyVy.mess.gov/dis
. -
� _ __ --- ____�_.�-_•- -..:_.__:_.__._
VDAC
' � ���
WORKERS COMPENSATION
, AND
EMPLOYERS LIABILITY PpLICY
TYPE AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (6S60U6-824X691 -0-07)
RENEWAL OF (6560UB-824X691 -0-06)
INSURER: -HARTFORD UNDERWRITERS INSURANCE COMPANY .
1. NCCI CO CODE: 80411
INSURED: PRODUCER:
CUSTOM BUILT CORP , DUFFY INSURANCE AGENCY
262 CHATHAM STREET 317 BROADWAY .
LYNN MA 01902 LYNN MA 01904
InsUred is A CORPORATION � �
Other work places and identification numbers are shown in the schedule(s) attached.
2. The policy period is from 01 -ot -07 to 01 -01 -08 12:01 A.M. at the insured's mailing address.
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s) listed here:
MA
��
�=
= B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in
�= item 3.A. The limits of our liability under Part Two are:
�=
o— Bodily Injury by Accident: $ 100000 Each Accident
o= Bodily Injury by Disease: $ s00000 policy Limit
o= Bodily Injury by Disease: � 10000o Each Employee
_ C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here:
�'� COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A
m�
u�
o�
= D. This policy includes these endorsements and schedules:
�
o� SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
aC
-= 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating
u` Plans. Ail required information is subject to verification and change by audit to be made ANNUALLY.
DATE OFISSUE: 01 -08-07 WC ST ASSIGN: MA
OFFICE: ORLANDO DA HTFD O5G
PRODUCER: DUFFY INSURANCE AGENCY 7525W
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- � � GENERAL MANAGER . � (
- . � . . . . ' . - � _, � - V '�.
Frank Lanzillo February 23, 2007 ��
30 Ravenna Avenue Page 1 of 5 '
Salem, MA 01970
l '
Soecification �,
Twa Story House
1 s'Floor 28' x 36
2"a Floor 30' x 36' .
With One Car Garage,
One Story lb' x 14'Rear Addition
Total Living Squaze Feet 2312
Excavation: Excavation for foundation as needed
Back fill foundation as needed
Insta114" of 3/4" stone in basement & out side perimeter walls
Install perimeter drain
Damp proof foundation
Foundation: 18" x 10" Concrete footing
10" x 7-6" Concrete walls
Concrete Slab: 4" concrete slab
All concrete 3000 PSI
Framine: (2) 2" x 6" Pressure treated sill
(4) 2" x 10" Girts
3'/�" Lally columns
2"x 10" Floor joists 16" on center
Plywood 1 layer 3/4" tongue in groove (glued &nailed)
2 x 4 Exterior studs 16" on center
7/16" OSB wall sheathing
2 x 4 Pre-engineered roof trusses 24" on center 5/12 pitch
5/8 CDX Roof sheathing
, � 1" x 3" Strap ceilings
2" x 4" Interior walls
1" x6° x 1" x2" Rakes
1" x 8" Facia
Plywood stairs ready for carpet
�_
�
262 CHA�THAM STREET • LYNN , MASSACHUSETTS 01902 .•" ( 7g1 ) 595 - 5389
1 1
� 1
: ` \ �
. .� � - ,% _. .. _.._ __.. . . , . � _ .._..
Page 2 of 5
Roof: 8" Dripedge on facia&rakes
Ice &water shields 3'up from facia
25 yeaz Owen Coming Roofing Shingles
Ridge Vent
Front& Rear Stairs: All.lumber to be pressure treated
4" x 4" Post
5/4" x 6" Pressure treated decking and treads
2" x 4" Pressure treated railings
1%i' x 1'/i' Balusters 5" on center
Reaz porch 22' x 16'
Sidin : Brand name Crane American Dream
Viny14" to the weather
Cover all facias and rakes with white alluminum coil stock
V-groove soffit panels
Tyvek paper under all siding
White alluminum gutters and down spouts
(6)Pairs shutters
Windows & Doors: All windows are Andersen with grills
(2)NLGD 6068 (SR)
(1)NLGD 6068 (LS)
(2) 3032 (AA)
(6) 3052 (AA)
(1) CTCW2 / CW25 (F/LR
(1) CN235 (LR)
(8) 3046 (AA)
(2) 30-DHP 41052-18 (BAY)
(2) Velux#FS304 Skylites
(1)Front Door 3068 CCM709 w/ 2-12"
(2) 3068 Steel Gazage Door
Water& Sewer: (1) 3/4" Copper water line
(1) 4" PVC sewer line
Electrical: Outlets & switches according to code
Smoke detectors according to Salem Fire Department
(1)Door bell system
(3) Exterior lights
_ (2) Light and fan combination in bathroom
(1) Three way stairs
(1) 200 Amp service
(4) Porcelain lights in basement
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Page 3 of 5
(1) Porcelain light switch in attic
(5) Recessed lights in kitchen
(1) Overhead light in kitchen
(1) Switched outlets in bedrooms
(6) Telephonejacks
(5) Cablejacks
Wiring for furnace and zones
(1) Exterior GFI
Liaht Fixtures: (2) Hall
(1) Kitchen flourescent
(1) Globe over sink
(1) Dining six light brass chandelier
(2) Front door brass
(1) Back door brass
(2) Double head flood
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Ptumbine: (1) 5' White fiberglass tub & shower unit
(1) 48" Fiberglass shower
(1) Jacuzzi 6'with faucets
(2) Simmons non scold valve
(3) White 2 piece water closet
(4) Delta single lever laboratory faucets '
(1) Stainless steel single bowl sink (under&mount)
(1) Delta single lever with sprayer kitchen faucet
(1) Washer&dryer hookup
PVC Drains
Copper water lines
(2) Exterior sill cock
Gas lines for heating, stove and laundry
Vanities Bath Misc.: (2) 36" Vanity with drop in lavatory sink
(2) 48" Vanity with molded top sink raised panel White
(3)Medicine cabinets with light bar Zenith TRI View
(3) Paper holders chrome
(3) Towel bars chrome ,
(2) Shower rod aluminum & chrome
Insulation: R 19 - 6" Gazage, ceilings and lrnee walls
R 13 - 3%a" Exterior walls
R- 30 -10" Ceilings and roof
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Page 4 of 5
Blueboard & Plaster: 1/2" Blueboazd & 5/8 blueboazd in garage
Smooth walls
Sand textured ceilings
Sponge float closets
HVAC: (1) Gas fired forced hot air fumace with air conditioning ,
(1) 60 Gallon gas water heater i
Interior Trim: All doors 6 panel molded doors with split jams �
2 %z' FJ Primed colonial window &door casing
3 'h" FJ Baseboards
(2)Newel post
F - 5035 Balusters
Metal closet shelving �
F - 6010 Handrails �
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Interior Paint: (1) Coat primer(Walls &woodwork)
(1) Coat paint (Walls &woodwork) �
Same color throughout (Neutral white)
Exterior Paint: Paint exterior doors �
Kitchen Cabinets/Tops: Brand Name Legacy, White raised panel with granite tops �
Floor CoverinQ: 1/4" Underlayment in kitchen&baths �
Tile floors in bathrooms i
1/2" Pad Rebond f
32oz Carpet Key Collecrion Ambience in bedrooms, halls & stairs ;
Oak floors kitchen, first floor and stairs, also second floor hall '
Annliances: (1) G.E. Self clean Electric stove model # JBP21 WCWW i
(1) G.E. Dishwasher model # GSD2030F ,
(1) Range hood Microwave model #JLTM1631 WB
(1) Disposal ISE Badger 5
Hammer: Allowance: $ 15,000.00 (ledge brakeing)
Landscaoin�: Allowance: $ 6,000.00
Asphalt Pavin� Allowance: $ 1,800.00
Trash Removal: Remove a11 construction rubbish
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Owaers Res�onsibilities: Building Pernuts, Paid by Owner
Engineering& Survey
l Water meter
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Total Stock& Labor $ 200,000.00
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Frank Lanzillo David C. Wyckoff ��/u
Owner General Manager 3 � . �
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BLANCHE E. FRANCULLO MINIMUM LOT WIDTH 100.00' „�+a°'rs
PARCEL ID 08-0029-0 N�F MINIMJM FRONT YARD 15.00'
JAMES A. & MINIMUM SIDE YARD 10.00'
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PARCEL ID 04-0030-0 MINIMUM REAR YARD 30.00'
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