5 SAVONA ST - BUILDING INSPECTION (pq 312-01201L�
The Commonwealth of Massachusetts
Board of Building Regulations and Standards RECEIVED ICEITY OF
Massachusetts State Building Code,780 TIpNpI SER ALEM
�- , C+ Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate ftjhOr Demolish Zb
One-or Two-Family Dwelling 0
This Section For Official Use Onl. • -
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
5 Savona St, Salem
1.1a 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(11)
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? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP[
2.1 Owner of Record:
M�3 CiviPllo Salem,MA 01970
Name(Print) City,State,ZIP
5 Savnna St, 978 745 2815
No.and Sneet Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) E_
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Altera[ion(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ® Specify:Tnsulation
Brief Description of Proposed work': Walls R15-Attic R38-Air-sealing-Weatherstripping
and other weatherization measures
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 7,121.13 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ El Standard City/Town Application Fee
❑Total Project Cost'(Item 6)xmultiplier x
3.Plumbing $ 2. Other Fees: $ 119 (f
}ti
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression)
Total All Fees:$
7121.13 Check No._Check Amount Cash Amount:
6.Total Project Cost: $ 0 Paid.in Full 0 Outstanding Balance Due:
i
i
-y l✓lGR .G>K)I)f.IH4't'Ll�lt U��--Y"lALS9QgfOu' -
Mee of Coasnmcr AM""&Business Requlaf On License or registration for ind ri ul use Only
- � before the expiration date.te, If found return to:
ME IMPROVEMENT CONTRACTOR ' Office of Consumer Affairs and Business Regulation
A wtstration: 163106 Type: 10 park plaza-Suite 5170
* xpiraffon x,5111/2015 i LLC Boston MA 02116
3E
AMERICAN BUILDING TECHNOLOGtES
a- ' G�ax air r
JOSE ALVES-SA
2NEPTUNERD.SURE^439 _
BOSTON,MA 02126 - Undersecretary i Not aid ithouk signature
j
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
101378 11 /27/201fi
Jose Santos License Number Expiration Date
Name of CSL Holder U
Lis[CSL Type(see below)
17 W Miltnn St
No.and Street Type Description
Hyde Park MA 02136 U unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Bunting Appliances
617?i9 R704 jose@americanbuildingtechnolog Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
lose Santos - American Buildin Technolo tes 163106 5/ pi /ion D
g g HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
2 Neptune Rd #439 jose@americanbuildingtechnologics.com
No.and Street Email address
Boston.MA 02128 781598 7125
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'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 Issuance of the building permit.
Signed Affidavit Attached? Yes .......... Q No...........❑
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 Jose Santos- American Building Technologies
to act on my behalf,in all matters relative to work authorized by this building permit application.
Mary Civiello 7-0 I'1
Print Owner's Name(Electronic Signature) fi5ate
SECTION 7b:OWNERS 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.
/ L
lose Santos 3 2- 1 i
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
.'.: NOTES:
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(HIC)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 can be found at
www.mass.pov/oca Information on the Construction Supervisor License can be found at www.mass..ov/dps
2. When substantial work is planned,provide the information below:
Total floor 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"
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Supemkor j
License;M101M
s w.rr.
JOSS A SAYfOS?
37 W.Mgtm Stroh, s
Ely&Park MA Ott
Expiration
Co nissioner 11127=5
WAP Work Order
North Shore Community Action Programs,Inc. Job Number:26254
119 Rear Foster Street,Building 13 Work Order Date:2/26/2014
Peabody,MA 01960 Ownership:Owner
Phone:978-531-0767
American Building Technologies Auditor:Brandon Dorrington
263 Western Avenue Email:bdortington@nscap.org
Lynn MA 01904 Cell:781-540.8569
Email:restrecktroq limall corn Phone:978-531-07671121
Phone:781-598-'7125
Mary Clvlello DOE WAP 2013 $7,121.13
5 Savona St Total $7,121.13
Salem MA 01970
978-745-2815
R-30 restricted-slopes/floored fill 52S $1.48 . .5777.00 525 $777.00 _
wice0ulose
IN-.-
R-30 resMeted-slopes/floored RB 33 51.48 $48.84 33 $48.84 Front OR
wlcellulose
R-30 unrestricted-settled cellulose 743 $1.37 S1,017.91 743 $1,017.91
Recessed light covers 8 S30.00 $240.00 8 $240.00
Thermodome or Magnetic pull 1 S180.00 $180.00 1 S180.00
down stairway box
Garage ceiling cavity filled with F$15.75SIS.75
318 Sti67.80
blown cellulose
Adjust Striker plate 1 $20.00
Automatic Sweep 1 $23.00
Fixed Sweep - 1 $15.75
Weatherstrip s/Q-ton or equal 2 $45.50 S91.00 2 S9].00
Date:2126i2014 Page I
WAP Work Order: Job Number: 26254
Clothes dryer vent Including 1 $99.00 $89.00 1 $99.00
Exhaust Duct
Vent kit/both ran 2 $89.00 5178.00 2 $178.00
Domestic water pipe wrap 6 52.63 515.78 6 $15.78
riydronic pipe insulation to 1.In, 70 53.41 $238.70 70 52.38.70 20'DH WI SO'FH W
copper pipe R-5
doom
A/C Coverl quilt FM
.$25.00 $25.00 1 525.00 adj.if needed
I,
Attic sealing with two-part foam $75.00 $262.50 3.5 $262.50
Basement sealing with two-part 575.00 $75.00 1 S75
foam
Blower door set-up with pre&post 1 $45.00 $45.00 1 $45.00
tests
Move storage 2 560.00 $120.00 2 $120.00
seem
Building Permit 1 5100.00 1100.00 1 . $t00m
Wood dapboardlshakestshings or �1615 $1.79 7$2,8"A51615 $2,890.85
vinyl(dense pack)
Total 57.12I.13 17,121.13
Contractor Instructions:More Martine the Job: During the Job:
1.Please notify us 24 hours before starting or scheduling a job. 1.Incorporate lead safe practices as applicable.
2.Obtain required building permit. 2.Total for Heath&Safety and Repairs cannot exceed$2500.00,
3.Davis Bacon time shceu required for ARRA work on US
Department of Labor Certified Payroll Report Form W H-347.
Date:21262014 Page 2
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(BusinesvOrganizabonnndividuap: Jose Dos Santos - American Building Technologies
Address: 2 Neptune RD #439
City/State/Zip: Boston MA 02128 Phone#: 617 233 8704
Are you an employer?Check the appropriate box: Type of project(required):
1.9 I am a employer with 5 4. ❑1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-coutractors
2.❑ I am a sole proprietor or partner-
listed on the attached sheet.t 7. ❑Remodeling
ship and have no employees These subcontractors have & Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
requital officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am homeowner doing all work _ right of exemption per MGL I LE]Plumbing repairs or additions
myself.[No workers'comp. c.152,§1(4),and wehave no 12.❑Roof repairs
insurance required].I employees.[No workers'
comp.insurance required:] 13.®Ottierinaulatifkn
•My applicant Nat chocks box al mall also fill out the section b ks.showing theg workov'compensation policy mrmmation.
Homro musts who submit this affidavit indicating tluy me doing all work and awn hire outside conttazmss must submit snow affidavit indicating such:
7Contmemrs undo chock this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information.
I am an employer thin is providing workers'compensedon insurance for my employees Below is the poacy and job she
information.
insurance Company Name: Hartford
Policy y#m Self-ins..Lic.#: 6BO2483-5-13 Expvation Date: 5/29/14
Job Site Address: :] ,'�avona- 9-t City/State/zip: S a, Un 0197a
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 MGI.a 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well m 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 herebyc Iy he and penabies of perjury that the information provided above is True and correct
i nature: Date:
Phone#: 6 23 7
OfjScid we only. Do not write in this area,to be completed by city or town offWal
City or Town: Permit/License#
Issuing Authority(circle once):
1.Board of Health 2.Building Department 3.CityrFlawn Clerk 4.Fleetrital Inspector 5.Plumbing Inspector
6.Other
Contact Person: phone#: