14 ROBINSON RD - BUILDING INSPECTION RECEIVED
INSPECTIONAL SERVICE$
i he C'onun0ltwetdth ot•MeSSachusettS AUG 221 A & 3q
Board of Building Regulations and Standards I I'S'OF
Massachusetts State Building Code, 780 C NIR SALGM
Revised.l fur•_'0//
Building Permit Application 'ro Construct, Repair, Renovate Or Demolish a
One-or 7'un-Fami1 Du ellheq
This Section For OtTicial Use Only
Building Permit Number: Date pplicd: _
G�
B �Si
Building 011icial(Print Marc) SSignature -
Dote
SECTION I:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Nlap& Parcel Numbers
I.la Is this an accepted street?yes no Map Number Parcel Nmnlnr
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District I'nrpuscd lJsc Lot Area(sy ill Fmnmge.(Il)
L5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Reyuircd I'revided Reyuircd Provided Required Provided
1.61Vater Supply:(M.G.I.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public O Private O Zone: _ Outside Flood Zone? Municipal❑ On site dis sal s stwm ❑
Check if ycsO P Po' )
SECTION2: PROPERTY OWNERSHIP'
2'1 0 �tert of Record:
el
oe rs f 6l)Q;e
N;unelPnnl) _ City,State,Z.IP
Nu.and Street Telephone Finail Address
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other 0 spccit :: n J,0!2
Brief Description of Proposed Work-:
oc✓n— r n CP (ls ,Q—
rP
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Itc(tt Estimated Costs:
I Labor and \taterialsl Official Use Only
I. Building S 3c/ or) I. Building Permit Fee: f Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
❑Total Project C'oslt(Item 6)x multiplier — — x
7 Plumbing '. Other Fees: S — n
4. %lab;u,ic.d (II\':\(') S List:
S. \Icehanical (Fire -- --- ----- �—(�
15 nessionl S Total \II Fees: S_
733y - ('heck No. _('hcek:)mounr (',uh ,\maunl:
oc
o. Total Project Cost: S ❑ Paid in Full ❑Dutst:ilding Ilal:mce Due:
q I Z P, 0 . t3 XA (A v5w-r 1--0 iZ
97P-5 3D�PQas
r
SECTIONS: CONS"I'RUC"rION SERVICES J
5.1 Construcimt:Sup�n'is it license(CSL)
Llcensa Nunlhar Fspiration Date
Name of l'Sl. l lolder
list CSI. I)pe lscc helical"(�� � 'rtif-ke
Mi. and Strict I)Pe Ueicriplian
G 11 UnrestrictcJ I BuilJin n li ul i5,11110 cu. Il.l
�.. . .-- N I Rc.tricicd I C? Find Diwilin
Cilsi Foen,State./I' NI Masonry
KC R,nnin C'uvcrin
WS
.SF SoliJlveIIhuni fig Appliances
7 rf:,-J 041 'n I Insulation
l'elc hone Ifnlail address D Demolition
2 Reglsfcred Home Improvement Contractor(HIC) 1,��� 2�� ` �
P ITAJ Con l rGLlr4 III Ragistrat —ion Numlxr Fcpuatwn Dale
I IIC l'om,qq,wyNunc or I IIC'Regictrmu Na A;:
J�R iC i aSi� 5 i ✓lucre .L/eo�i�G T,'� ,k�Veri7an
No,r ld Street Finail a •ss
XKAIOo A ll
City/Town,State,ZIP 7elc' hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.1.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 Issuance of the building permit.
Signed Affidavit Attached? Yes ..........❑ No...........Cl
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property, hereby authorize IY tl ctlae d ��
to ct on my behalf,in all matters relative to work authorized by this building pey it application.
l ' „� 7-2-b �1
Print caner' cane( '� t nic-signatum.) Dute
SECTION 7b:OWNER'OR 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 to the best of my knowledge and understanding.
k&r,,d
Print Owncr'.i it A horiicd Aye 's Na I lilcclnn� ;uuro) Data
NOTES:
1. An Owner who obtains a building permit to do his.her own work,or an owner who hires an unregistered contractor
(nut registered in the Hume Improvement Contractor IHIC) Program).will nu have access to the arbitration
program or guaranty fund under I.G.L.c. 1 42A.Other important information on the HIC Program can be found at
11 k1\1 n .1., n • ..I Information on(he Construction Supervisor License can be found at"o,, fit,,,;�.s Ip.
2. \\'hen substantial%cork is planned,provide the information below:
7omi Iloor area Is,+ tt.) _ (including garage, finished basement attics,decks or porch)
Groii lis ing area(sq. It.) . _ Habitable roost count
\umber of fireplaces...... .\tallier of bedromus
Number of balhroutni \unbar of half h;ulu
1)lie tit hcatingstsicnl . . _ Number ofdecks, porches _.
i
I" pe"I'Cooling I'%itelll l,llcloscd _ _ . Open
1, "lotal Project Square Pomage•'Ina) he substituted I'or"Total Project Cost-
I
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street.Suite 100
Boston,MA 02114-2017
quo) w~rnass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
I Name Iliusiness.grganitatinn IndisiduaG:
A&M General Contracting, Inc.
Address: 119 R Foster Street BLDG. 14
Ci /State/7.i :Peabody. MA 01960 Phone p;978.741-7777
Are you an employer?Check the appropriate box: Type of project(required):
I.S I am a employer with 15 4. ❑ I am a general contractor and 1 6i ❑New construction
employees(full andrbr pan-timet* have hired the sub-contractors
?.❑ I am a sole proprietor or partner-. listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingcapacity. employees and have workers'
for me in an •> 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.•
required.I 5. ❑ We are a corporation and its 10•❑Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions
I myself. [No workers' comp. right of exemption per MGL 12,❑Roof repairs
j insurance required.]' c. 152.§1(4).and we have no 13,C]Other
employees. [No workers'
t comp. insurance required.[
'Any applicant that checks box-1 must also till mg the xenon helms showing then mirken compensation polml mfumuaon
'Homeowners why suhmh this atlidasll nalwaung they arc doing all mark and Cher,hae mm-ide contra.T,u:must suhmu a new anidnit indicating such
1 :Conrmctors that check this Mix must attached an Wdalonal,htt9.h,amg the name of the sub- MLra%or>wd,13W whether or not thineentihcs have
employees. U the sub-cnnuaaton base employees.they must preside their wtn4r.,"axnp puhc)number
I am an employer Thal is providing workers•compenzation insurance for oil'employees. Below Is the policy and job.ate
informatlon.
t
Insurance Company Name:TGA Cross Insurance Inc.
Policy=or Self-ins. Lic. _::AMWC345622 Expiration Date: 'March 20 2025
Job Site Address: I LI 7\C1d i Q�0 11 (� CitvState'Zip:SCJ-e M A q7C)
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
tine up to S 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$250.00 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.
I do hereby certify u e psi �nalfie �perjuiyt the Informadon provided above Is true and correct,
Dal c
PhoneP7 C'79 - 7y/ - 7777
1 Official use on&. Do not write in this area,to he completed by eery•or lawn official.
City or Town: Permit/License q
Issuing Authority(circle one):
I.Board of Health 2. Building Department 3.C(ty/fown Clerk 4. Electrical Inspector 5,Plumbing Inspector
6.Other
Contact Person: Phone k:
W1irk"Order c` �"�."-"'.�Ez
North Shore Community Action Programs,Inc. Job Number:22532
119 Rear Foster Street,Building 13 Work Order Date:8/13/2014
Peabody,MA 01960 Ownership:Renter
Phone:978-531-0767
A&M General Contracting Auditor:Brandon Dorrington
119R Foster Street Email: bdorrington@nscap.org
Peabody MA 01960 Cell:781-540-8569
Email:Atlanticpavingcorp@verizon.net Phone: 978-531-0767 xl21
Phone:978-532-8025
Raquel Diaz MAJOR REPAIR FUND $750.00
14 Robinson Rd NGRID Electric $6,584.79
Salem MA 01970 Total $7,334.79
978-744-8462
Contact Phone:603479-8163
Landlord Name:Angelo 2 llo
Landlord Phone: 781-593-308-3082
Safety Issue(s):Asbestos on P' e
Authorized Actual
Measure Description price Total t y ..;Total Comments
w t, Qty• Q Y ,,
" 'Attic Insulation -'" " '- ,�'� •" - - -,�
R-30 restricted-slopes/floored fill 180 $1.59 $286.20 180 $286.20
w/cellulose
R-30 restricted-slopes/floored till 89 $1.59 $141.51 89 $141.51 slopes
w/cellulose
R49 unrestricted-settled cellulose 305 $1.80 $549.00 305 $549.00
Attic Ventilation .., A6 ;r .. art. �, .}�,w,: ;�r '.y, tp 40. ltgr 4,. I; , ...a, -:xr ..�' atx xr- •=uo-•ca�`—.-a,.,:r, -.s. .,
Roof vent 865(A sq ft NFV)small I MI
1 $90.00
4 '' iBasement lOSnlatl0n 4y (a `}y§Y ' zlji 'A'M,:�0 e�:`» ti`�
Sill two-part foam w/flberglass Batt 93 $2.46 $228.78 93 $228.78
Doors
Automatic Sweep 2 $26.00 $52.00 2 $52.00
Fixed Sweep 1 $17.64 $17.64 1 $17.64
Repair/Refit Door 1 $58.00 $58.00 1 $58.00
Date:8/13/2014 Page I
Restricted To: CSSL-RF-Roofing >� _'assac-.se-s - _e_s-- ^: :- = - = 5J'e.
CSSI-IC-Insulation Contractor .:.a^_ _-3_ a -_ Ze_. .2,.
CSSL-WS-Windows and Siding , - „-+'.. , .
CSSL-DM-Demolition _ .a^sa CSSL-099933
MICHAEL P FITZCERALD�
119 R FOSTER STREET ti
Peabody MA 01%0
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license. ��- -
_w ...
For DCS licensing information visit: www.Mass.00v/DPs —^ -- - 06/19/2016
- / ,�4� <l /� t? �' �C �/1ll
�ffic oCfonsumer Afars�d usmess Regulation
f4> a 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 141124
Type: Supplement Card
Expiration: 1/12/2016
A+M GENERAL CONTRACTING INC. _
MICHAEL FITZGERALD �r T
5 SOUTH RIDGE CIRCLE "- --�
LYNN, MA 01904 - -- --
Update Address and return card.Mark reason for change.
Address E Renewal � Employment ❑ Lost Cat
SCA1 G MA-05,11
_• nMee of Consumer Affairs&Business Regulation License or registration valid for individul use only
I' ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
j., Office of Consumer Affairs and Business Regulation
' "Registration: 141124 Type: 10 Park Plaza-Suite 5170
=r.• Expiration: 1/12/2016 Supplement "ard Boston,MA 02116
A+M GENERAL CONTRACTING INC.
MICHAEL FITZGERALD
5 SOUTH RIDGE CIRCLE g`--.-�---�—
LYNN,MA 01904 Undersecretary Not vali ' houLei 're
A&M General Contracting Inc.
119 R. Foster St.
Peabody, Ma. 01960
1(978)532-8052
Fax (978)532-1033
Jan. 1, 2014
To whom it may concern,
Neil Moore has authorization from 1/01/2014 until
12/31.2014 to pull permits for this company using my
licenses. Any questions, feel free to call our office at
number listed above.
Sincerely,
Michael Fitzgerald
Signed this � ? day o ,2014
Nota expire date 04/01/2020
Unofficial Property Record Card Page 1 of 1
Unofficial Property Record Card - Salem, MA
General Property Data
Parcel ID 06-0014-0 Account Number
Prior Parcel ID --
Property Owner MONGIELLO CARMINE - Property Location 120 SWAMPSCOTT ROAD
MONGIELLO ANGELO Property Use Res./Comm.
Mailing Address 55 EASTMAN AV Most Recent Sale Date 1/1/1900
Legal Reference 11130-124
City SWAMPSCOTT Grantor
Mailing State MA Zip 01907 Sale Price 0
ParcelZoning I Land Area 7.800 acres ,
Current Property Assessment
Card 1 Value Building 100,300 Xtra Features
Value Value 6,800 Land Value 1,031,300 Total Value 1,138,400
Total Parcel Building 634,400 Xtra Features 14,500 Land Value 1,031,300 Total Value 1,680,200
Value Value Value
Building Description
Building Style Repair Gar. Foundation Type Flooring Type Concrete
#of Living Units 1 Frame Type Steel Basement Floor N/A
Year Built 1970 Roof Structure Flat Heating Type Steam
Building Grade Average Roof Cover Tar+Gravel Heating Fuel Oil
Building Condition Average Siding Conc.Block Air Conditioning 0%
Finished Area(SF)3655 Interior Walls Minimum #of Bsmt Garages 0
Number Rooms 0 #of Bedrooms 0 #of Full Baths 0
#of 3/4 Baths 0 #of 112 Baths 1 #of Other Fixtures 0
Legal Description
Narrative Description of Property
This property contains 7.800 acres of land mainly classified as Res./Comm.with a(n)Repair Gar.style building,built about 1970,
having Conc.Block exterior and Tar+Gravel roof cover,with 1 unit(s),0 room(s),0 bedroom(s),0 bath(s),1 half bath( ..
Property Images
5 f !
- Et 1 tjtl i {4
6t t A t�A
tel:
y f ie IiIE W
3aiM
Disclaimer:This information is believed to be correct but is subject to change and is not warranteed.
http://salem.patriotproperties.com/RecordCard.asp 8/28/2014