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49 SUMMER ST - BUILDING INSPECTION (2) l �� 2�= cK1218 The Commonwealth of Massachusetts Ulf ALEM Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SdMar Revised Mar 201 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date pplied: Building Official(Print Name) Signature Date ' SECTION 1: SITE INFORMATION 1.1 Property Address: 49 Summer Street 1.2 Assessors Map& Parcel Numbers I.I a 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: Zone: _ Outside Flood Zone? Public❑ Private ❑ Check ifyes❑ Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Frank Camarda Salem,MA 01970 Name(Print) City,State,ZIP 49 Summer St (978)888-5515 pmarehand79 a gmail.com No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units I Other M Specify: Insulation/Weatherization Brief Description of Proposed Work': Blown in cellulose to exterior walls,air sealing SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ 6,209.10 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical g ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ Suppression) Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 6,209.10 ❑Paid in Full ❑ Outstanding Balance Due: M0-1l_E.D 3ILA SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-052576 10/03/2017 James Fortin License Number Expiration Date Name of CSL Holder U 50 Rundlett Way List CSL Type(see below) No. and Street Type Description Middleton, MA 01949 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry � � 5: ;.• RC Roofing Covering WS Window and Siding • SF Solid Fuel Burning Appliances 978-998-4684 phi]@air-tightweatherization.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 165640 3/15/2016 Air-Tight Weatherization, LLC James Fortin HIC Registration Number Expiration Dale HIC Company Name or HIC Registrant Name 50 gun Jett Way phi]@air-tightweatherization.com No. and Street Email address Middleton, MA O1949 978-998-4684 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 .......... EX No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property, hereby authorize James Fortin to act on my behalf, in all matters relative to work authorized by this building permit application. Frank Camarda fe 1, CA..a.e"(a. Feb 25, 2016 Rank eanmma(Feb 25,2016) Print Owner's Name(Electronic Signature) Date SECTION 711b: 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. James Fortin 6—� s-�^ 2/26/2016 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/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" maybe substituted for"Total Project Cost" The Commonwealth of Massaehusetts - > Departmeut of lurlustrialAcehleuts a 1 Congress Street, Suite 100 13ostou, MA 02114-2017 t yt wmj1.Drass.gov/(pia Workers' Compensation Insurance Afficlavit: General Businesses. 1.0 BC WILED WITII TIIE PERMITTING AU'I 1IORITY. ADDIic•uit Information Please Print Leiibly 13usiness/Organization Name: Air-Tight Weatherization, LLC Address:50 Rundlett Way City/State/Zip: Middleton MA 01949 Phone Jt: 978-998-4684 Are you an employer? Check the appropriate box: Business Type(required): I.Q 1 ana a employer with 30 employees(full and/ 5. ❑Rctail or part-time).* 6.6. ❑Restaurant/Bar/Eating Establishment 2.❑ 1 am a sole proprietor or partnership and have no 7. ❑Off ice and/or Sales(incl. real estate, auto, etc.) employees working forme in any capacity. [No workers' cop. insurance required] t3. Non-profit m 3.❑ Noe are it corporation and its officers have exercised 9. ❑ 1-:11lertainment their right ol'excmption per c. 152. §1(4),and we have 1011 Manulacttlring no employees. [No workers' comp. insurance rC(]Liiredl*l I I.❑ I-Icalth Care 4.❑ We arc a non-profit organiz<Ition• staffed by volunteers, with no employees. [No workers' comp. insurance req.:1 12.0 Other Insulation/Electrical _ 'Any a pplieam that checks bum 81 must also fill out the scetinn below showing their workers'compen,adiau policY in fivmnl ion. " u the cxlwnlle ul'I leers haec exempted Ih<nl5elves.Fm the<nrpor alien has other employees.a worker, compensation pnlicy is 1u,Jmted anti such all mrganinliun should chuck bos NI. 1 ore an enrp/nrer I/ol ix providing wnrkerc'cnrapensnlion insurance tiff mp enrp/gyees. /feGnv is Ilse patio,irr fnnnnlinn. Insurance Company Name: Guard Ins. Co. Insurer's Address: P.O. Box AH / 16 S River Street City/State/Zip: Wilkes Barre PA 18703 130licv it a'Self-ills I..ic. H AIWC 693663 Expiration Date:7/1/2016 Attach a copy of the workers' compensation policy declaration page(sbowing the policy number and expiration dale). Failure to secure coverage as required under Section 25A of MGI. c. 152 can lead to the imposition of criminal penalties of a line up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of it STOP WORK ORDI?R and it line of up to$250-00 a clay against the violator. Be advised that it copy of this statement may be 1'01-vaided to the Office of Investigations of the DIA to- insurance coverage verification. l do hcrehv cerfiff,, under the pohm tit emi ies iof perjury float rite in(nrrnnriun provided above is true mrl a correct. Sss�nnuue' C►-^-�^fitDate: — Phone If- 978-998-4684 Ofrciol u.se onto. Do not write in this area, to he completed hp city or town official. City or Town: Permit/License tt _ Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Towu Clerk 4. Licensing Board 5.Selectntcu's Office 6. Ofhcr . -_— Contact Person: Phone t/: www,mtassguv/dia r'%fir- `tGc/iiriirr�irrve<rf/>/ r,J����r.i.irrr•��r.ir�//.i Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 165640 Type: LLC Expiration: 311512016 Tr# 248557 AIR - TIGHT LLC. WEATHERAZATION JAMES FORTIN 10 PINE KNOLL DR. BEVERLY, MA 01915 Update Address and return card.Mork reason for change. sCA i 4 :4EIMv Address Renctral Employment Lost Card Orpce or Consumenlffairs A Businesx RcCulaiion License or registration slid for individul use only iHOME IMPROVEMENT CONTRACTOR before the expira/ion date. If found return to: 2 ttIOM trIMPR 1MENT Typo: Office of Consumer Affairs and Business Regulation y`Expiration: 3I7512016 LLC IO Park Pinza-Suitc 5170 �"-F' Boston.,NIA 02116 AIR-TIGHT LLC.WEATHERAZATION FORTIN 10 PIN \\ f0 PINE KNOLL OR, d"�_ v ��• BEVERLY.MA 01915 Undersecreian' Not ca id without 5ignnta re Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-052576 Construction Supervisor JAMES E FORTIN.� 60 RUNDLETT WAY w > , MIDDLETON MA-01i " nnII Expiration: Commissioner 10103/2017 J