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11 ROPES ST - BUILDING INSPECTION ,: ;►: The Commonwealth of Massachusetts �'• lyf Department of Public Safety Massachusetts tittle Building Code(780 C AIR)Seventh Edition City of Salem Building Permit Application for any Building other than a 1- or 2-Family Dwelling (This Section For Official Use Only) Building Permit .'Number: Date Applied: I Building Inspector: SECTION 1: LOCATION (Please indicate Block N and Lot N for locations for which a street address is not available) S 6- /n a 1976 No. and Street City /Town Zip Code .Name of Building (if applicable) SECTION 2: PROPOSED WORK If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair ❑ 1 Alteration ❑ 1 Addition ❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑-�� Brief Description of Proposed Work: fi Pa.'s 5Ss✓t ' gi n 131vw , czGl4(os�_ Watj- 19-i.,f- � N c - V �- s Ja // a Sa c r l 3✓5 /a.kw) boe l-s — 40,7 ,,, S SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION, OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑ Existing UseGroup(s): -3 4�'.A 'fx Proposed UseGroup(s): Y Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: SECTION 4: BUILDING HEIGHT AND AREA Existing Proposed No. of Floors/Stories(include basement levels)&Area Per Floor(sq. ft.) Total Area (sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as a licable) A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 CI A-4❑ A-5❑ F3: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ 1H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H4❑ H-5❑ 1: Institutional 1-1 ❑ 1-2 ❑ 1-3 ❑ 1-4 ❑ M: Mercantile❑ R: Residential R-10 R-2 0 R-3❑ R-4❑ S: Storage S-1 ❑ S-2 ❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ 1118 ❑ IV ❑ 1 VA ❑ VB ❑ SECTION 7: SITE INFORMATION (refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public ❑ Check it outside Flood Zone ❑ Indicate municipal ❑ A trench will not be Licensed Disposal Site❑ required❑or trench or ,pecifv: I'r n'a to ❑ or indenlily Zone: or on ,ite at:atertt ❑ permit is enclosed ❑ Railroad right-of-way: Hazards to Air Navigation: \I:\ I li,h-m Covrtmi„wot Ii vie„ Nut \pplical,le ❑ I, tiIrocttnr,c uhin a1rpu rt appwoch area.' Is their rev ivw completed' of ( 1ct,cnt h, Build enCIO,cd ❑ 1 'c, ❑ ,r.No❑ Yes❑ Nn ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY I:.iio,m ul Cude. C,e Grnupl,l: . rt pent Con,lruchun: Occupant Load per I loor: I)ne, the budding Contmnmi Sprinkler?r.tem.': Special Stipulation, SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner ' SSn-bet ��tqd 1� r2n�5 sf- S/t�iG✓I /��— c�lg7� Name(Print) Nu. and Street City/Town Lip Property Owner Contact Information: Title - Telephone No. (business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes Name Street Address City/Town State Zip to act on the pri pert y owner"s behalf, in all matters relative to work authorized by this building permit a p tlication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) (I I uildin is less than 35,LXX)cu. tt.of endos\sf s pace and/or not tinder ConntnlCtion Control then check here O and eki Section le.11 10.1 ie istnered Professional Responsible for Construction Control E�. L ("a.�� 9lk -71'� - �SI`y;3 TP.►.r.') alt�.r�c�sf- %��a€f� Name(Rwgistrant) Teln7 No - e-mail address Registration Numbe�C, Street Address City/Town State Zip Discipline Expiration Date 10.2 General IContractor f-t , t .1 -NAo-✓\to L- w .k fly Zct Tl,a-,'1 Coin an Name: LA Name of Perso espunsible fur Construction License No. and Type if Applicable - 3 H"`1I., sf- Swl � 01970 Street Address City/Town State Zip /yam sLi _ 72C - /03r TP © i (2-cj,2 s� Telephone No.(business) Telephone No. (cell) e-mail address SECTION 11: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 2506)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes O No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE. Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6) =$ 1. Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)=$ 3. Plumbing $ 4. Mechanical (HVAC) $ Note:Minimum fee=$ (contactmunici a 'ty) 5. Mechanical (Other) $ Enclose check payable to // 1 6.Total Cost - $ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I hereby attest tinder the pains and penalties of perjury that all of the information contained in this application is 4true and Occur tte to the best of my knowledge and understanding. fleas pr nt and sign name title Trhrphune .No. Date Ca+ el 9 7!3 r— titrvet Address Ca.%/Totyn State Zip Municipal Inspector to fill out this section upon application approval a� \'ame k A U, Mal i i The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 UV www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Atlantic Weatherization, LLC Address:61 R Jefferson Ave City/State/Zip:Salem, MA 01970 Phone #:978-744-8143 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 26 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g_ ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Chartis Policy#or Self-ins. Lic. #: WC1616071 Expiration Date:3/20/2012 Job Site Address: '( 40Un, S 14— City/State/Zip: /�/O�_ 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 fine 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$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 certf undergLogains and Een aides aeErj=that the in ormadon provided above is true and correct. Signature - — - Date ;X- `f Phone#:978-744-8143 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: AC06Q CERTIFICATE OF LIABILITY INSURANCE r DAM(MMJDDNYYY) 03/16/2011 PRODUCER 508.651.7700 FAX 508.655.8853 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC - Main 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 Weatherlration LLC INSURERA: Arbella Protection Ins. Co. 41360 61 Rear Jefferson Avenue INSURERB: Arbella Indemnity Ins Co. 10017 Salem, NA 01970 INSURER c: Charlie INSURERD: Nautilus Insurance Company INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,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. ILTR N fl TYPE OF INSURANCE POLICY NUMBER DATER ADD' CMMIDD DATE MIDD/YYTN LIMITS GENERAL LIABILITY 8500042816 03/20/2011 03/20/2012 EACHOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES jEa occurrence E 50,000 CLAIMS MADE Fx-1 OCCUR MED EXP(Any ana parson) $ 5,000 Aff-- PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000 000 POLICY X JECT LOC AUTOMOBILE UABBnY 93827400003 03/20/2011 03/20/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 2,000,00 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per Person) $ B X HIRED AUTOS BODILY INJURY $ X NON-0WNEO AUTOS (Per accident) PROPERTY DAMAGE E (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO It EXCESS/UMBREUAUABILITY 4600047820 03/20/2011 Q3/20/2012 EACH OCCURRENCE $ 1,000,000 X OCCUR CLAIMSMADE AGGREGATE $ 1,000 000 A $ DEDUCTIBLE $ RETENTION S $ WORKERSCOMPENSATION WC1616071 03/20/2011 03/20/2012 X AND EMPLOYERS'UASIUTY Y/N TORV LIMITS ER ANY PROPRIETOR EXCLUDR/EXECUTIVE❑ E.L EACH ACCIDENT E 500,000 C OFFICERNAEMBER EXCLUDED? (Mandatory IR NH) E E.L.DISEASE- L.DISEASE-EA EMPLOYE $ 500,000 II yyes,JeacdW under SPECIAL PROVISIONS Wow POLICY LIMIT I$ 500 000 1 OTHER OLLUTION LAIBILITY CPLO152189210 10/01/2010 10/01/2011 General Aggregate - $1,000,000 D Each Pollution Condition - DESCRIPTOR OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISgNs $1,000,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYSWnrITEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR CITY OF SALEM REPRESENTATIVES 93 WASHINGTON STREET AUTHORIZED REPRESENTATIVE SALEM, MA 01970 Rosemar Fulham/Pm `✓] p ACORD 25(2009/01) a 1988-2009 ACORD-CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Restricted to: 00 Massachusetts- Depailment of Public SarctN 00- Unrestricted 9 Board of Building Regulations and Stantlar(Is 1G-1 2 Family Homes Construction Supervisor License _ License: CS 87977 Restricted to: 00 Failure to possess a current edition of the IC W'PALM ,q:+!o Massachusetts State Building Code ER is cause for revocation of this license. 3 IC AL ST SALEM, MA 01970 Refer to: W W W.Mass.Gov/DPS --G— ----- Expiration: 423/2012 ('uminissianer Tr#: 22214 ARM eouvEn�!/e _P�Zf� tr�(td + License or registration valid for individul use only ooiurosa `7' before the expiration date. If found return to: %&ROffice of Consumer Affairs&Business Regulation Office of Consumer Affairs and Business Regulation HOME IMPROVEMENT CONTRACTOR 10 Park Plaza-Suite 5170 Registration.,,,142089 Boston,MA 02116 Expiration: 3/122012 Tr# 292174 , Type: Ltd Liability Cgrpor ATLANTIC WEATHERIZATION L.L.C. ERIC PALM 61R JEFFERSON AVE. g t--�61� o ff Not valid without signature 'k SALEM,MA 01970 Undersecretary ,;1 Atlantic Weatherization, LLC 61R Jefferson Avenue Salem NIA 01970 To Whom It May Concern, I, Eric Palm, owner of Atlantic Weatherization, LLC authorize my employee, to pull permits for my Company. Sincerely, Eric Palm Atlantic Weatherization, LLC Subscribed and sworn to before me This day of 2010. Notary Public M_y + om#nission Expires:�7 � ' .2o 0 ACTI=INC47 WashiGloucester >�k Tax t d �. i Agency'tto -CAP,- , NGMD A y i pplication# t i t r o r '. i b 'ifs 5`f - r n r fag. s t „� � PROGRAM AARAWA)3 9" twx t.,,� sri rh; �'1 =„-�,0tt .� ` JOB NUMBER � O' ' • '• , at;kn r s , 0 '', '"`p e i' ("z• ' -&S C perfonnednl- 'Work Order Date >w05/19/11yi ,', 4 Primary ContTaetor , ' Atlantic rr Weathezation '"fir z+ i. yOCherConteactor a - ,"}.¢r= ManchesterElectrtc�ffiLC ier �+�,,.,t#IBulbs`m"sCalled �, =r$000 Y . : b4 s �„ G .� f�u, i. 'i •, �«-..t ,,I1,13....+6i ' 1'a+'s .., rr`.r..e r't°h i .Cos£o£Bulbs, .i >rvr Chent Nicole w Matthes i w lnspi$175 00 Max y$$.. $0 00 r r" 4v Slzeet ltl`Ro es eV- �t`3/Plooi`3� f f' .� s 'f r' 1 Other�In�Kmdl t"'a i 0 00 ' P � i b' awy :kv ,rt ? v f' :. $ b e w P City State Ztp Sa]ern Main i+x r �-'� 'S" ' 01970 % Electrical--Work t ni si x w. ; i s 1a,i t n a�., A 'Jd r i's, t +mr s v tk n zTelephone 97,i8:304 9,93'S i " +f` I` ",r m$ $.AmountKeySpan+ „sit. $000 � .l ,o- 0. ia,#ny 11'c� �{ 3 , Iyl,t . fie.+ a,;. ,:.. ,_• $•:9`munt National'Grid.ria,l- `f$0.00 Other`_'Utrlrty .. + ' IhspectKriobe&Tube � N'o= 1`p �, nl Da,Ie',Job7COmpleted CIF i' r i"1 ' e.�ix P ry k ° *" ` ":'tit F Eshmatrcd°Repair Total $38000" ,d x. i . ' s,s!r + �.1 �Ach+al,Repair,,'To[ah 7�.: 'l'- w`is ov WeatheGmatiou B'kt ij 1 Act, Cost EstCbst ,R, .:Act.Cost +,7F j n"f 4.. (Legular $15'.00tj,.j a a.... ,+ a.. :k.:,y'^ !P:iii;Seahng,2-gars EoamR(per'tour)l ,pi E.:�. ., li ...,,",'.,� 1 r $7.500 anio n�sesung;2p2rt roemr cr n ur) iWeatheretnptRiFndow('per side')" '¢'' ` $5 d0 _ �Sea1' ucts-Mastic - - $62:00 !Vd%S&Insula{eiAttic,FIatc}iiR30 + ';r.5.' i CI ,y $30 00 s, r,or {P v $O OO $0'00:6`4"fa 7 L $0.00 el ,ffi Weathenzatlou,Totals -=,4� $1P50�0.0rvk + M ,_ '" M:4L3b w. ° i-. a ..x ri,., uy..rt ` . u.+ : of ..Yk-I Act„ Est` Est Cost !Act Cost tticFlaYR3,'8to "�"i.,a.; 4'" tv' �,$J p40,iii�n ,tY4 n, R nsr; w A .,v Attic FlaYR30io en }tMiksFlat/Slo&R30estiibtedr +' " P'i° ,C F Attic.F,laUSlo`es R20 restricted -r w,al , 4.3r i ° ° ' 'Attic Kneewal(Rl3 FG 'Aft tclKneewall,Rf5,Cell w/Ivlembrane,;'y i. 345.. �Attibd{neewall%F.1'ooe,R30 res[Y.icted.., - $I+41, j'se _.cam. 3- �°� InsulatelAttici ?airs:&Walls - ;Sldewalls $2 10:'i"'- - In[enorWall!'FPlasterRlLS�D) Ili"Ri'r d Foam?Boazdr ":. .. $1.85. Duct InsulatiomR'S&Seal Seams, $2.9b SteamcP,i e�lnsul?to 1r25,�R5;s i»:f:r!'.„k^ t ri,a - i' sa ,4$525.r'ari e4`1 HW'Ei 'e'lIiisuationRS+as Wyk.. Y64r $150, j `G . $.1d5.00Tr4 . .t #k>r€ _ Jnsulate Door'w/xF,B n_sulatipn Tlotals .,,..,sr..+;:r u7 i,}; 3 ^", � �, s at t�,:;':a to �+dib'J:11�8F1?�$672*.25,+= i I `' a1$Q99j;r,;. NiBole`MatthewsF` i;T P3ge 2 - dam, 'DUE O_" `"'� Est ':;;A'ct_ 1 =,+ Cost " IEst Gost X ;p!Act Cost;; i,Other Measures ag,� ;'��,s-n_ , t=.'= � +, a • '—$76,00 iGableUent,=irectait �ltecessed,Can�Cover. ,.rG '��.al l ..:ra,,, 1 .a "'• ae .4 .Cut/Fm[Sh,Attic;6lccess ,-,':a2 u„-ti::"'!,;.-._ _„-. {a __ •,. $100:,0+0��E=` r � °+x";:.�.r-rr•�r+ r^^�i�e ,e .t">tirnarr> Blowei DgOr T;est'""" !'--_. $45.00f-6 a Vinyl°Replzcement W[mdowr-+:JOIu[ l� ." ' •r-=�4 ,�� rra;$350 OOL �: 's ?i=+ :.r ';, ,'l :h�< ,� .I•+? SYee]Pre hu�'ng�poorrw/Lite:'_ - -$610's00 ;Solid'•Core D'obrw/Hodwaie ,r , !_�„:. " , tt.: '`,`.-:$35000,• ;"" ? • ,-Y F::a"_,o.w € _„M.._ ...i'�s,?.: Faucet Aerator`• ,. ,. , : , $1'5 .00' . .,. Low Elow Showerhead - .. - i $25 601I L I, 1•:` Irv••_ _ l 1 $000. r �I ,E Lis � ,. �: '- _ ,A 4v e.3 .N 10000 ��� � � „•IIS [ JI tip .,:f3(� v,l,'"t. Moo�. t Y:.1?Ls'Nw�.+,� '•� Y � �i.-...fi4:.n�i . lal ,r �a a,." � .J .�:ia; h'., 'F., '.: � �! .�'= ,w _ is � , Ener7,Consevyahonl oEals (IMa .$fl10 000rtP'$822TZSr $Or00�,'-' ri» y 3 1 y ' ' Est . -'Act _, Cost -, l-StgoSt a Act Cost[. 'Ytepau's - xt_';i r n 'a±w:r ...ry R`e'au/r Re:)uname DOOL x'k�'i:,roeii' s ,1 :-i '1 `$100 00 "'3 ,$,L10000 'Rem6ve.Falle6tPGj( rhr.,);::? ',z'�I`ri '.' 1' - ;:';e°$60.0,0„aS ,` ,N $' 0100' ps ose,of.EGt r�L):L9 >>,4"_, . ra 1' ; : $60 OOa- :r $60:OOr !a i1r s' Zte"`ur DoorHipge 'Slide Bolt'"r;:rai"a 'r�a ..Eti] �i,fit-Inl"x:. 31 `t " $20.00'ar�' L,..36000 ,SashrL'ock -r. , a...,*...e-. a -;:. _. r.1 - i•I ,I._, .$9,23.l;k?1 ;GI'ass R•e lacementl `,lo-s�,l[mr_.selrr,eaan o,�wn�„bs.3ir,rrr '�' �t „$•4i15".00.. ,.r^ k' �r �x aYyl� p � ll�rt:sLL 'IBuildm PermitFee , L,..'i'-;;;zx rr r 1100.00 dd{'a ra ,',$IIOOi00'r°G; pi-I� " $0.00 I3'ealth&!Safet, Wig �&�i�,i>�t1F 31v`'.-:; ,��rl� I Irl1;111�k„IrF��I'�",t .),°.=.L -t"�"','�d,Ur,.,;U'enttGlothes.Dr,er to Exten ors -- $85 00 jUen't,Bath EzliBu`s(Fanto,Exfe i,Rs:n - Re IacesDryerfIose'�rt $U.00: 5allil�a+t 4iiob&T.ubedm ectron ' ":: 6 ;{ V .., .] - `$175.60' P - B'atluoomExliaiist''Fan,,....r"„ ,*•. ' ," - ,e'I +$500 00 4`p%.::. , r Y.' i• �, nx�' + - ay i i r y WockOrder.Su6Total r ,, _ ,, , 'tt, .,, .� ;: 1., $1,202-.25 f < wE t4 ,b - ✓ ( A , - I , '',a as . z aw 1.. 1Vlea , It st-'sures a ..tr ^ it Est.C+J: cCo , cC05Gq r - - Other In a,e so.ow ' $0100, '.y�.�. , •ui,**HeaL'n �System'Repaie-f'-nr, 14�: y:.' s� 4'i ;r$O.00Z�; Mf°'Xl 1 .I`:. � ,?r? a:v$000.�„'�.'i i e.�chon ap�rwal'Lonly .n 4 Estimated lob Total $1,202 25 Joticannoteaeeed,$S`0v000OOF'r" , }lay trrf'a 1 34 Joti mmtmum—$500 00 r Job Grand Total , �, $0 00 L. t 1 1 4 rl,� u '" "` ,- e I '� '" �? xr A hT©R ��Brand011�Offlh bh ,��ji :' `f u SN 4, a ,g, 1§ vo e{.t r,r r•! bqr' , : 'vr l4 !ai NT'� ),t+ y4` s :, t s a'rn >rL aax a 1 4-is pd^ " 5 v Peabody M9 01960 v i s �., z a + i�Agency NSCAP -Y ) : PROGRAM NhttonellGrid/2071 aW"nI gg A) ,[`'� �}� +nA'-.'i *, , k : 67 a`k'+,4 ' t4": t` Frs ii5 afi " ��� WoF O[dCi#e01ii' �'i�F b` :��✓t�> 1 ` SY vt�' �G ae+'Y)v ri3l, yt) ,11 3Work Order.Da[a O5/L9/�1slp , P f) JobLrmrt 1. 4 a Primary Contractor Atlannc Weathengqzatton a Per.Umt $4500 00 1 f r hr a ifs+Ghent�Nrcole Matthews " v $ # +T Yes l7 No 0"+nkii,+.+ E, e ' y'.lNr r `v"' y T � j; ra,a + Ws FGtiyyState Ztp Salem Maass:' daa 019170 .c 'F 5k it sAg'>'�vil i '� fi:- Ser ril:� asp a� 7 !k°x .; IcleLone 97$ 3049935 a 7 Stand Allone No P sik .r r's-taaH a'v "".��p lM��' ,�p , F h m owerpoor,Test 'i ; qw a >• t-� k fri °° w aa ma yy, r S[andiAloae�res 1 Now ;IIAW.'i <s"rr F hr, ;.'�;;.. `£ ,a k,:;t'S.InspectlKtio0&,'l:ube' '%YEi S� - --EIce.Contractor` ''i'�Mzoches[er Electrt,,IZ.LC+ate �'.'^?`-a77757 Est:CosG.hsw ("-'i .:, ..i kAcGCost. ,' 1Fahc Flat R49;_o em. 1:..- -'":, .602 {.. „r $.1:53;.,.: $921:06. V.4011 Y6ttnc,�lat,R38'yo-enl r A**_,°.n 'u .v - ,=' v -' I$ Fi !Attic FIat+R30Yo Pen , r;'e. '`Y ,x i m ;Fw; "-+$L 30+:i 's:`^ N, ."+a '`: J�`,i'`,�+,1 1.;�( ,._A� e , s FA![llC^ElaR207or'en4t +1 ;fx n. z I=i w",t','lI $I23 . o- t= F'F$ ° ,) E'Stik EIaGS1o�R30¢e'stribl t ,s,r#-i t. '' !. a"'did- a.:e;r ) F , rts-: $4 4111 (,§:- f �-��#t?' aF :Athc,Flat/SIo"eiR204estricted:` .,aa A9 '1,q.,,:,.,538 Td4rf $1E35_°>i le F _.;$726 30+7�., =.,I *xa ..i, Atiac F,lmysl5"e!A101restnlc'te'dl n t . I $1k24.,. �Attw/KWPlour`-IliansmoniDA;lirt ft a<u� !' 1 86• '�r .,�: ' '� `: �:,.l $240; s:',' S`�4 '. $206`40. .w.w. gittcllCnee`wall;FilSar R30 restnctedltr"i F t va c. ++: 430+ L`3 :.4ta<�r,ad skF'F't7es $ $698 30t FiatShedYAthcAcce55 fs.$�:a`, : ,w ,� y�...�ri(CjBg,. •L'` '` - : p4 - Tein AttiypAecess . ^'ufs, ea+x Aj,.:. , , ,.� 51M:r r.,r.. ed'kn. 'ea$r).00 +!i�hrz- �•;aa �.:.'a.A-h1 . p.w.,,�sfiav� Cawl'S a`ce;w olY V,a oi1B'arrter,'t,!+a�n i; si'+, - k•..;:_ C. a:.; "",r, ,+ i'Xi- "'$2.53�� ,.0 t}. ;Garage CeilinpJFl6or R30+(w%�aPproval) @;:+X(i .ifrixa+kvLMmr�f '4+ � r ` ,.,c. .. $8� tTti rermadomeiDaxvnT0.��rk:514,.:t5. .,l E d.P4� x+�.,,� rx .3::- 'A.41!., r:.�tgu"IJ'R :'✓s$:�$;1;7r),003 'I ,.,g�+. i•: Root-Uea[+smalh ._w' .r,ar2. - _¢I &W, n . _ . ... 60 _ - r r �,'* '�'.� -.. �`C Yh k P'n •ny, i 'Y .r _ — -. 3 ✓k a -fie &t9F PaO a1,Uent ur^.r " yin -ea+ fur Ana t . ,lj.. ;. S7,'k!"k $3+751 2 92', yr p+�,c Diable Vent(all saes): r ;.S$8 3400 F t$1r76 00 'f V „�J;, Soffit Yent 1 - - AtticAnSeahngR'pzrt+Eoami(2lhrs ';i to q r-ILL ,,,i 5.7 51001 FT'44m .,s:frh-$1'5 i:s r,•."F .a„-: v'a.'.: ..h.i vas ` U u- Lo„..a( �aut�o 2 1 at'-'i'A-V 'Cvc s"1.-7 ZA wal fi-lati-o" 'P. z Single Naded'A"stiestosU'As vkff� tjf�� 3-W ff�4--nm�tJ fwl IS 4. Z-M, 2�200�Dbubl kt�=��Y tAiiDP� $ "Z Brack 1xN`Lcco-Rl,5jDP:� $1,75 InAZ� Willlfilo'tw` i'bbo'X'N rl'T' 4§5 $6 WWI H7 t2 4't WIIIIO,iher,=4200. le."Art, &A j ' 3.001,$4 "I 5'00k jtc r00,7 j, J'jk�4,j 5 9*25,'U�asbir '?J,7942:W 1, 1"� efu 4 5 bi'oQrDbor, p,7,.� j,j 't L 4 qj tt. ti-o'n, ffge +ft 17:r. 66 i ip ip ein s1d ati tore 6d,TTq,,,R-5!', 6 i a6oiV gwL iF6'zli'i&&l 6u.r.5 ,W " 4,, W� oij F.-' t,'I.-t4n�e�I tit. N-h"T' k,31113.01t, �—Est;.T'ot ),QV *40$�I' 14, 44 L v woo' !��t Totals t--.,T';y� ACTION, INC 47 Washington Street Gloucester, MA 019:30 r r r a2;,1 r YU'.'-,Fa;nT�o `g X l �._:I :.,�F m��k',-:,•. + s A t . y i. F.v r r 14'}av e I i � S �. ty -Agency NSCAP'+ c I i ,� = r xra ,v a -NGRID Application# 9 usPROGRAM gAARAW'AP r ,h p5zr a , 5�ya ay ! 0 P 'a €. t°,a�r f; :- ,! • b JOB NUMBER� 4 lit. DOE Work Order# 0 ^ 4, performed�r No1 � ro u A 1 L +Ik a fi{l 1 i �E 1. .� Work Order Date t c= a , v 05/19411 ,' '� `r a 't ` " :t c ' r 3 , rd .r. x.o-g,?,'u r s. t s r '6 ct .,,ir qe �, ,4,h•..a ? a° i �.Prrmary'C'ontraetoi: i . ,. .'Atlantic Weatherizatioml, IL, - Other C ontrac.tor Manchester Electric I EC d Butbs instalted �$0 00 . Cost.;ofBulbs .rX - Client: lsabel.Lugo(L) .,; '? „ .x y ' Inspt '= $0 00 Street. 111 opes+StreetApt l4loor l .'3' ia;. Other m`InKd m�: Ctty-Sfa[e Ztp Saltlam Ma °'' ;'`'a ' 0+I970rh,+` ` r 1,Electrtcal°Work ail 71 ,E T'el'ephone 7&I 632 75�6;. x y -''t�. �r to+t.,. E,y 'n'v }�t$Amo uunt �i ; ys„t31ieP -rs- 2yA4-ry ',N, rt "t �' t $A"tnount Nahorial G(nd $0 OOt + 4 uA+; , ' e< �d al a �k v Div-;" :�7k ©the>`IItnity !!ii9. $0 00 Oii Blowar Cf6or Tast No , s< Inspect Knob4&Tube " "dz'4 aYes �" t d '*' e °� ra +S,r, 1 'Date Job Coin laced ' : I � , y + i bE9fimated Reparr Total f'f>v+I r$735 OO' t �f�i r<.rye,r a l,.:y., .nr 4r, a. , 3u .tit, '',.L.'�"iActualtRepam Tiotal 00?:. weatherization Est • 'Act, Cos"t` Est Cost ,. [ !ct-,Cs �'ha„l 4fb_mlini ,Door Swee s ' - - r;;+. �,$22 OQ;' ",� , '; ,, M $2' - 5, j $75 00"'I ,115;0100 `s w Atr Sealmg,2partT6am�(per`hour) ,t ,'Aa c Air SeaLng!211 rt:F,oem(P rLhour) V✓eatheislrrp•:Wtndow(perside) $5`00':'ix Seal Ddcfs.-Mastrc ' *; - ` 2 °'' N� 'I',$62%40&: e r_'r$124.00 W/S&Iniulate AtticHatch R30 $30 00?, p ."'i''�;r+„v`,, s r±.M y ,•'SN ti"?.. - -` 'x•:. - "S'8; rs$0°.OQI'. r. t'.-.' .•,- - I?X_ n $0:00. Cld aw.:"��t �riv .F, t-": ti1N4f v. `$0'.00 'I au i 5 I;ij7$o;001.. �,�. t 4 j�4 .,aj Iq k �ai3 �'6'�AifQ,':;. -$0F00 :$o'.00 i It.. i, I " 4t. -41 {',iY",n"$! v ;W.eatherizationtTtitals:" r >L°it n ,r >?; , i$2�74'00r h .a.. u�._;' ,r Y.✓r ?'.vr.,1 �i tl'vi�:a r$ '+ a� J,s.a;e ..:q,, Insulation -_ "' Est .::;,. - s'h'.-?Act ,4„`�AEst?Cost . j Attic'Flat'R3'8o en' rs^t;t;-w, wtyi,'•t ai " , i ti4it.F;:N' F ;,-,.h,;':h -•�r.� ,..9:w sr,:'ze.=, ,+7 k.z.Hrm i ,e v "' $"-3�"Y:it Yk F,:p.i i�i� 4r �-'`":Atttd�,F.�labd330 o en �F.tttetF,]aUSlo"'esR30trestricted" . :,'-' ,tic .r'icrz„f .r, , r $1F4slh";,rll .r '��*"�zi _,' ,. r-.,{.,� � Cr R°+ . ' YK`P4,,t. A i r #$1. .;21, Attic Knecwal R13 FG I h25 ����� a. 4ttic:ICneewall,RlS Cell�w/Membr'ane;f 4 .r1 1{.654 ea r{I^t a''rq q,r "�.rk,,WJ i`-^,a„�Yk.,4p�.x�`.ffuk t +Attic Kiie'Qll!FI or R30riestncted : - �;fi;�;, "$1'""41�"'.,"'o rc '„`" � .!I',•,:` I ?f."'��' din" r. . ' . r•-: �y ' $P.70:•: vt -„$6222�vzw,da.j.�'i Stdewall's=%Wood'ShakerR•15'DP 366 ,. '�, � + �Stdewalls in,1 R15 DP a ,. 101'2. ±1- �'i: .a'$P:70p; ,,r$1,720 40,.�n :Interior Walli=P,laster:R]?5!DP r � ''r'- `",s yy%i! `�'$1r•81;'a rt >„,.Sj]y'„ ,t" +1Ic:,. t` 1ar <"' jlt tRlgld+$OaraBoards cd�.. ck t s• 3 'te h$1�$5:.. 5 I .rP.' �+.�i _i b' I{z� '3�vp7Yr"'u,�lhF Duct Insulatwn RS&SeaLSeams -: $2 95=',s' - ,,,�,jZ;,�z � dmme.P.i"e lnsul,[oT;'R5 v. `j': -- - ':�,? .,�`$3125r. 99'a .3, .>.�al i; �,., ��' ou,°a�w�e.tG' b• Steam Pi�P,e'rlii`sul!to 1f25tR5e,4 R„>> , ".'' � , . raol,, ..$5•.25v c, s�.--v„,. -*,;*al�pi(� xe , -', 1DHW P.ipe'lnsuanon RS";� `'' ` 6 I ° ' lnsulme Door w/FR('I"min) 44.00 u It �� a,1�F.$SO':QOtI " �5 .as cG�'r iv Shc-2 art Foam w/F.G2Bktt.R19: 25 $2.00" g.( rp �' k,, ,�1y1,,,,;p. lnaulatwm I0[als.a,'.,.,t.,;,,. :-a i .+ v:., l.w.t IMe tl'yl_vtms , H++^,.(,?- A ,.,,� =i'+ S e 1 c$2;,4;07 604➢n € :G, r$0+00 ?'. irnbel "Page 2 :.orx"DOE Other.Measures e t �.� Est ' . ,,a,. .nAct ,. :�.� ,,Qost. .. EstCost , �, ActCbst',.'.`-, IRno Yentr„smNllb i+r.::i.µ is , s M;t'r::. 'Gable Vent'- ectan tar""` " s"t - •'. �'"' + in i , RecessedlCartCover i1$30'.00"l ?-" :Cut/Fmisli;Attio/Kneewall"Access; Test6ri111Sidewallst 4,siites� + .�r""'�.': t ,t'xl ,'v !' , $60'00'-.". A @°dk ,1 5 �r• ,kls.t i'i:i ,'^�^ BI'ower➢oorTest, Vinyl keplacement Wundow' 10161' $350.00-:, v7 {Y S . t ;_ r I r SblidtGoie Door`w/Hardware ^`. j.'"t t-: !Faucet-Aerator iY' t ;i'.a, -r '"'"it- Low Flow.Showerhead - -$251.00 ; F.. $0�:00� $Q;00 OtherTotalS -� "''' ' F ,'I x � ^ ,1 -'iIL „r 'I>IS .rh i.:d tri,:.:�•t +, }♦ ,:. - 1. r'" 1}ak'. Energy:Conservation a,.;�., , `' ; , ,;° 'r,."r, ' ";^` , :.,EstaCost °ActlCostn7 Totals'(Ivlaa'$FQ,000:00) ve li'-,' • -'s,^•i=- , t 'ry'Sd' r". Est;;' '-';;Act i'.. Cost'::'.. { EsfCost , j;=; Act COst Fiamc Out Dow 1 '$125.00 $1:25-00L Steclon.EUDoor, Door Thresliold s $40:00' Re au.Door Amge $25:.0.0.- ' . . _.. ISlide Dolt. � C Epn� Sash Lock :r .$9:25;';T ° F ?�,.... 'Glass e I'acement'tto 64 ut ";i!s - a?`�:.,=_''x•,o-i 'd,ke ,$42'.00' fr r'4°Id '"rat"0"'.,R.: hE'r' 1 'J'tPi,� slse-b*at mr a„Ikneed Dc.,wn.b - J:._$415.09 ik; .v�,,,t.Ac� ',.r` Buildin Permu Fea. .: ,'l PtF eAealYh'8c+$afe 1LrwlaNkW" V+ ', iMti> ,..'�E1ti.rt '- .Ir L11kA:vw_, hi !.7-nJ ISYsi(tnk.P�'flp`i't-'9�rfayei°p«37 �p„, 'Hers. , "i`': :Vent Clotfies=Ll 'erto`tE.ztenor' s "-'t r. '= ' !li - '""'' ^'$85.001` ,a"Y`+P'49 l°'.;{1,F i; h"`< .; ': ¢VcnCBath!Exhaust F,an.[b.Ex[enor , „q +a$851Q,Ot. , , T aym rz�r,' s-�s'w" �•:. Re lace�D�..er Hose;s..:�.,_" psv-.: • do_,. .z 'r -' ±r.;;�.$38.00>:{ ,s .�3,"��.tu .. ,..:r. �s, ..Edt ;R;+S MA Kriob&"1'utie ins ecttgns,,`._ l tip: ''' +" - t f' $175W0`. i, ''s):,:i',`"', 9t„R ,. ,Y.�1�. ..I,u! ^Bathroo`m Exhaust Fan ,;';n ,t e. .,�u�.'x..-ri. $500,00�':1! i e. 53 5i:+., `$0:00:- `Re atrToti;. 6 ..$735W0 i ' si !^$000;?r �' €�y� ` '1`t ' W{.,eri rs ' ' { F ,i.,'w !us'��'P"HP" ,.vy,' i.,t l `2.t J 4 , Y .i i{'., i ',P�.iia„.ra a='Ibt e,' .Wnirli p .q tt g i m vw 9 pr^ 1 Ft» 4 e[ $3;471`i6'r60i $0 00 111 .:S 4 �,.,„,. 1 Measures"' -Est— • ''j";Act" Est Cost fs�: i ct Cosii ul. „Other ,>G r 1%$ I� eOther, Yh,, s;• " 3- $0.00.7.. dLf!., r, -sA xw-�x „"+n**Iiesting:Sy's[em3Repau,N s+ lt, '" ;p,,'. z rill $0+.00' .,.-:. ira !+ry •.>w¢ x1 tk'yjr� `$0!OOs rrr °*A�uon a [oval onl n -= r PP_ Yt.*:: r",., .mot '•'H' - qyi" 19 EstnnatedrA Total ', Job Caunot'exceedl$10,000100k -�j��'r- "�`` ���' �1 �,r>f,�'��`"�y n' :� ,7� ,y. "�'`'"' � — �+r,.,Ii '- t d ✓•�"' � 4 Job mrbimum" $500 00' ,,„` "I �� •�'� � J ob Grand`ToCal r+a by +a*s e r t�^vl! "'t {glarci .aW,ZrL�UDITwOR1