8 WYMAN AVE - APP FOR B-12-761 The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
\ Revised Mar 20!1
Building Permit Application To Construct, Repair, Renovate Or Demolish a
IIYp-I One-or Two-Family Dwelling
This Section For Official U Only
Building Permit Number: 1pate Ap ted
n!_t •%4 L„z: 1 l¢
Bwl` .;Official(Print Name) re Date c q,
SECTION 1:SITE IN ORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
1.la Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Propoed-fSe Lot Area(sq tt) 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:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 caner'of Record:
I��T✓ZtC_9 KDV4'L)37ry ,ci �.1 �E 44 4'Io9 (3T`�'7G
Name(Print) City,State,ZIP
�
w��I-mow
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other W .1pecify: /.t/�.Fi.'ITi.e/Ii�`@J
Brief Description of Proposed Work': ��CirJ'�✓ Ge/j u�ote L4�2S� �r4—�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1. Bui ig $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List: /`,-/�-/��)
5.Mechanical (Fire $
Su ression Total All Fees: $
Check No. Check Amount: Cash Amount:__
6.Total Project Cost: $ DODO ❑Paid in Full ❑Outstanding Balance Due:
1r
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 0 p!4 2 y
JcAFAL6( )yre License Number Expiration Date
Name of CSL Hold r
2—q List CSL Type(see below) (>
�GL/S Lw
No.and Street Ty Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
CIS• r�i�'S�7Zf�✓ A1,� G 3$Z 7 Restricted I&2 Family Dwelling
City/town,StateIZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) / / o/5-10 V `B—Z/ 3
� 7 .�Y�rir-C HIC Registration Number Expiration Date
IC Company, me or HIC Registrant
Name
��i dae,-4 L,w
No d Street Email address
1� 5L -16 sral, w/(3$Ll 2&LAA1 iX
Ci /Fovm, State,ZI 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 .......... faJ--� 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 JEFF12 y } OIA-e
to act on my behalf,in all matters relative to work authorized by this building permit application.
?arrz,r«,. Kwucrrm 3-zo- IZ
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 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.
3& i.-rise /LtA3/nr cne_ 3 —Zo - Z
Print Owner's or Auth rued AName(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
m .mass.aov/oca Information on the Construction Supervisor License can be found at www.mass. ovg /dns
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"
i CITY OF S�UEN4 AXSSACHL;SETTS
BUIMING DEPAEMIENT
• ' 120 WASHLNGTON STREET,Asa FLOOR
\ TEL (978) 745-9595
FAX(978) 740-9846
KI\fBERLEY DRISCOLL
MAYOR THObLtS ST.PIrxa6
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONLUISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Annlicant Information Please Print Legibly
Name (Busitxss.Organizatiowlndividual): (a / 56A50,VS X�6a1t,Tb,./ LLC
Address: R> 922-a1
City/State/Zip: Lv.... t. - 44 (I f'104 Phone #: —7R l -f'-V4-8070
r
Are you an employer?Check the appropriate box: Type of project(required):
1. am a employer with k, 4. ❑ I am a general contractor and 1
employees(full and/or part-time).• have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
workingfor me in an capacity. workers'comp.insurance.
Y P Y• 9. ❑ Building addition
(No workers'comp. insurance 5. ❑ We are a corporation and its
required.) officers have exercised their 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL l 1.0 Plumbing repairs or additions
myself(No workers' comp. c. 152,$10),and we have no 12.❑Roof repairs
insurance required.)t employees. [No workers' I3 � /t/eL+'7-C rq !Q,
COMP. insurance required.]
•Any applicant that chucks box At must also fill out the sectim below showing their workers'compensation policy information.
'I to neownwa who submit this affidavit indicating they are doing oil work and than hire onside contractors must submit a new affidavit indicating such.
2.mtmcton that check this box must attached an adelitiorrul sheet showing the come of tha subavntracton and their workers-comp.policy information.
lam an employer that is providing workers'compensation lnsur once for my employees. Below is the poly and Job site
information.
Insurance Company Name: ((fi�t rC��1.dGLPrr.�S
Policy#or Self-ins. Lic.#: s-),'' e-12 Expiration Date::
Job Site Address: r W`/N+.g,r✓ A le— City/State/Zip: 6QIeA.. ..'v ,4 Qre7' Z0
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 S1,500.00 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 u(the DIA for insurance coverage verification.
/do hereby certify tr er the pains and peas/t/es of pedury that the information provided above is true and correct
Si am t Ir • p •�'Lp �(
P 1111SL
Official use wily. Do not write in//its area,to be completed by city or town o1cioL
City or Town: __,__ Pcrmltit.lcense#
Issuing Authority(circle one):
L Board of Ileallh 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: _ Phone#:
I
03/19/2012 22: 51 17815955820 AMBROSE INSURANCE PAGE 01%07
', OATE(NMIDD�Iml; �
ACOM CERTIFICATE OF LIABILITY INSURANCE 3 zo1
awuD R TM15 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
r Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Ambrose Insurance Agency, HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
56 Central Ave. ALTER THE COVERAGE AFFORDED BY THE_POLICIES BELOW.
Lynn, MA 01901
781_592-9200
INSURERS AFFORDING COVERAGE NAI68
NsoR`-0 All Seasons Windows 6 Insulation INSURER Scottsdale
P.O. Sox 8229 IINSURERB: Arbella Protection
Lynn, MA 01904 22
1
T raveJ.
INsu R¢R D� —�,
INSURER E
:CV ES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY RECUIRIMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO V IHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INCURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS S'J&1ECT TO ALL THE TERMS, EXCLUSION3 AND CONCITIONS OF SUCH
FOLICIES.AGGREGATE LIMITS SHOWN MAY HAVE SEEN RBOVCED BY PAID CLAIMS. -
;aF .L POLID E EECCTNE POLH:V hgPIRAT N LIMITS —,
;iF r a aNCc POLICY ' fA�L y SAT MMIOOm)
3FNERAL LIABILITY I— EACH OP 1 1_— OOC 0 Q
X I 'CMMERCIAl GENERAL 1ABILITY PREMSES!Ea RPoa z) S SO_�000
:LA:M5MnOE � OCCUR vzD EXPfPnY ero eareonl 11 S nn
A! '', ____ CPP0059607 3/19/12 I 3/19/13 �ERSDNALsnwlN.n_� AR. 1 000 000
I GENERAL AGGRE3ATR IS 2 .000 ,000_
I GEN nGGREGATF.LNIT AF= 111 .ER. PRODDcrs•OOM>I0� F SG 2,0 rQD�
I�1 PP.O T
POLICY JECT LOC _
-" —ALTONODILELb191LITY COIABINF.DBINGLF LIMIT �s 1r000 000
'^i 4NYaVTD (En hccitlerl) __� _)
I
A.L OVANF,D AUTOS BOD 1/0.Y.Mn j 1
Scne DOLED ALTOS (Per Pe!wn] ;
B NREO Av OS : 37797400001 5/15/11 5/15/12 EDCIL"INJURY s
fPoacclticnt)
N NCN•OWNEO AUTOS
r
I I_ I PhOPER 'DAMAGE
rPw.p�elAEnq I
'GARAGE IIARVJTY AUTO 0 NLV.EA ACC IDE NT 5
ANYAUTO OTHERTHAN v_EAACC 11
AUTOONLV: AGO 9
�- —�— ! EACH OCCURRENCE i 9
EXC9S5lUP/BRE:LA LIAR4'TY 'i —
OCCUR Ci CLAIMBMADE PC�C�RF,GATE I S
' � OECViCTIBLE '
—T'JQ RKSpS CGMPEN?ATIGN aNO WCy-IA1
_ IMITSU
X
r AVOYERS LIASILITN F.L.EACHACC05NT S 500 0001
MY'YV P616iOPP4RiN RiP.XCC'JT�
C O I NCF.R MEIEY En0.1iJE0 4973P69-5-11 12/15/11 12/15/12 1 E.L.DISEASE EA EMPLOYE'9 500,000
a!A..c,ecU.aer E,L.DISea9e POLICY 500 000
SEbSI VROVisI]W<3e_aw _
—
I
p_.SC,i^TION OF OPERATION;I LOCATIONS I VEHICLEB!EXC:UFIONS ADOEO BY ENDORSEMENT I SPECIAL PROVI£IONS
Carpentry/Insulation/Electrical
I
i
_ I
CERTIFICATE HOLDER CANCELLATION
City GE Sul®ID SHODLOANYCFTHP.A"VEDBSCR5EDPCLICIEe UECANCELLE09EFORFTI•IEEKriR T10N
y DATE THERF,OF,T4E IFAUING INSURER WILL FNDEAVOR TO MAR 20 DAYS WRITTEN
I
Attn. : Building Dept. NOTICE TO THE CEQTIFIGRTE 1+04DER NAMED TO THE LEPT,BUT r.AILUP.E TO DO SO GHN.!
City Mall IMPOSE NO OBLIGATION OR LIARIUn OF ANY KIND UPON.THE INSURER. TA AG'Nlr OR
Salem, MA 01970 REPRESENTATIVES
AUTHORIZED REP TA E
ACORU25(2(H11108) ---�:pcCrRDCORPORATION 798E
i CITY OF SiUEM, IrLkSSACHUSETTS
BUUM NG DEPARTMENT
• 130 W{SHNGTON STREET, 3e FLOOR
'ICI.. (978) 745-9595
FAX(978) 740-9W
KIaIgERLEY DRISCOLL
MAYOR THomAs ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BuI DCVG CONMSSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in :
(name of facility)
(address of facility)
1 permit applicant
date
JcbrivO.Jx:
Massachusetts- Department of Public Safetc
Board of Building Regulations and Standards
Construction.Supervisor License
License.CS 103474a
Restnctedto .00 N l
. JEFFREY{ MAYOTTE;y a
29 ANDREWS LN, r G
ON, J •.
1.I
EAST KINGST `INH 03827
Expiration: 1/2312013
('unm+iasiuner' ..ai Tr#: 103474
Office o oosumer ears smess ego ehon� i
HOME IMPROVEMENT CONTRACTOR
Registration 164564 TYPa: k
Expiration 10/21f2013 Individual
J EY MAYOTTE 3r,X, C?
JEFFREY MAYOTTE._.,-
29 ANDREWS LN +
EAST KINGSTON NH 03827, Undersecretary {
I, }
ACTION, INC
47 Washington Street
Gloucester, MA 01930
Agency: NSCAP NGRID Application#:
PROGRAM: AARAWAP 0
JOB NUMBER: 0
DOE Work Order# 0 E.S.C.performed? No
Work Order Date: 01/13/12
Primary Contractor: All Season Windows&Insulation -
Other Contractor: NA #Bulbs installed 0
Costof Bulbs $0.00
Client: Patricia Knuuttila Inapt$175.00 Max $0.00
Street: 8 Wyman Avenue Otherin Kind $0.00
City; State;Zip: Salem,MA 01970 Electrical Work $0.00
Telephone: (978)740-9841 $Amount KeySpan $0.00
$Amount National Grid $0.00
Blower Door Test: Yes Other Utility S0.00
Inspect Knob&Tube: No
Date Job Completed: I Estimated Repair Total $1,770,00
Actual Repair Total $0.00
Weatherization Estimated Actual Cost Est Cost Act Cost
Door kit - $43.00
Regular door sweep $15.00
Automatic door sweep $22.00
Air sealing 2-part foam(per hour) 3 $75.00 $225.00
Artic air sealing 2-pnro=(per hour) 2 $75.00 $150.00
Weatherstrip window(per side) $5.00
Seal ducts-mastic $62.00
Seal duct returns-mastic $62.00
W/S&insulate attic hatch R30 $30.00
$0.00
$0.00
$0.00
$0.00
$0.00
Weatherization.Total: 1 $375.00 $0.00
Insulation Estimated Actual Cost Est Cost Act Cost
Attic flat R38 o en_ $1.40
Attic flat R30 open - $1.30
Attic flat/slope R30 restricted $1.41
Thermodome $175.00
Attic kneewall RI FG $1.25
Attic kneewall R 15 cellulose w/membrane 96 $1.65 $158.40
Attic kneewall floor R30 restricted 96 $1.41 $135.36
Overhead DP R-30 Under Add'n 133 $2.00 $266.00
Sidewalls-vin lRI5DP. 1069 $1.70 $1,817.30
Interior wall-plaster R15 DP $1.81
1"rigid foam board Under Add'n 133 $1.85 $246.05
Duct insulation R5&seal seams 216 $2.95 $637.20
H dronic pipe insul to l" R5 .$3.25
Steam pipe insul to 1.25"R5 $5.25
DHW pipeinsuationR5 6 $2.50 $15.00
Insulate door- 1"rigid board R7 $44.00
Sill 2-part foam w/FG batt R19 108 $2.00 $216.00
Insulation Total: $3,491.31 $0.00
DOE
Other Measures Estimated Acutal Cost Est Cost Act Cost
Roof vent-small $76.00
Gable vent-rectangular $88.00
Recessed can cover $30.00
Cut/finish attic/kneewall access 2 $100.00 $200.00
Test drill sidewalls-4 sides $60.00
Blower door test1 $45.00 $45.00
Vinyl replacement wiindow- 101ui $350.00
Faucet aerator $15.00
Low flow showerhead $25.00
$0.00
$0.00
$0.00
$0.00
$0.00
Other Total: $245.00
Energy Conservation Est Cost Act Cost
Total: (Max$10,000,00) $4,111.31 . $O.DO
Repairs Estimated Actual Cost Est Cost Act Cost
Repair/refit door 3 $50.00 $150.00
Adjust door striker plate $20.00
Door entry lockset $70.00
Repair door hinge $25.00
Slide bolt $20.00
Sash lock $9.25
Replace glass sliding door 1 $1,400.00 $1,400.00
Solid core door w/hardware $350.00
Glass replacement-to 64 ui $42.00
saa-bads Imerfor bmlU,.d door w/pa ba $415.00
Clean gutters(per hour) 2 $60.00 $120.00
Building permitfee 1 $100.00 $100.00
Health & Safety
Vent clothes dryer to exterior $85.00
Vent bath exhaust fan to exterior $85.00
Replace ,window lead-safe practices $20.00
Repair/H _S Total:(Max$2500.00) - $1,770.00 $0.00
Work Order Sub Total: $5,881.31
Measures Estimated Actual Cost Est Cost Act Cost
Other $0.00
Other $0.00
"Heating System Repair $0.00
Action approval only
Estimated Job Total: $5,881.31
Job cannot exceed$10,000.00
Job minimum=$500.00 Job Grand Total: $0.00
AUDITOR: Doug Cranford
NSCAP
98 Main Street
Peabody,MA 01960
Tax Exem t ht: 042-385-280
Agency: NSCAP -
PROGRAM: National Grid/2012
Job Number: 0 - NGRID Application#: 0
Work Order# 0
Work Order Date: 01/13/12 - Job Limit
Primary Contractor: Al]Season Windows&In Per Unit $4500.00
Other Contractor: NA
Client: Patricia Knuuttila K+T Yes=1 No=O - -
Street: 8 Wyman Avenue K&T: 0
City; State;Zip: Salem,MA
Telephone: (978)740-9841 Stand Alone: No -
- - Fee Code: 0
Blower Door Test: Yes Stand Alone Yes=l No=O
Inspe--Knob&Tube: No Elec.Contractor: -
Attic Insulation Estimated Actual Cost Est Cost Act Cost
Attic flat R49 open $1.53 -
Attic flat R38 open $1.40
Attic flat R30 open $1.30 -
Attic flat R20 open $1.23
Attic flat RIO open - $1.15
Attic flat/slope R30 restricted 640 $1.41 $902.40
Attic flat/slope R20 restricted .$1.35
Attic flat/slope R10 restricted - $1.24
Attic kneewall R13 $1.25 -
Attic kneewall floor R30 restricted $1.41
Attic/kneewall floor transition DP $2.40
Finished attic access $100.00
Temporary attic access - $75.00
Crawl space R19 w/poly vapor barrier - $2.53
Garage ceiling/floor R30 $2.00
Thermadome - $175.00
Roof vent-large $95.00
Roof vent-small $76.00
Turbine vent $160.00
12"stack vent $145.00
Pro pa vent $3.75
Gable vent-all sizes - $88.00
Soffit vent $26.00
Ridge vent(per fin.tt.) $22.00
Attic air sealing 2-pan roam(z hours max) $75.00
Ventdryer/bath exhaust fan 1 $85.00 $85,00
Page 2 National Grid/2012
Est Act Cost Est Cost Act Cost
Wall Insulation
Shale nailed asbestos/asphalt R15 DP $2A 0
Double nailed ubesms/aluminum RI5 DP $2.20
Brick/stucco RI5 DP $2.75
Interior wall blow-plaster RI5 DP $1.81
Clapboard/wood shingle/vinyl R 15 DP $1.70
Test drill 4 sides $60.00
Air Sealing Limit:
Single Family wu0ower Door=Sa00
.All Others=$200
Door kit 2 $43.00 $86.00
Regular door twee 2 $15.00 $30.00
Automatic door sweep $22.00
Air sealing 2-pert foam(3 hours man) $75.00
Sash lock $9.25
Glass re lacement $42.00
Blower Door Scrap $45.00
Perimeter wrap R5 $1.82
Total Air Sealing Cost:
Heating System Measures
Duct insulation&seal seams(sq ft) $2.95
Hvdronic 2ipe insulation to 1"R5 $3.25
Hvdronic pi2e insulation 1.25"+R5 $3.50
Steam pipe insulation to 1.25"R5 $5.25
Steam pipe insulation 1.5"-2"R5 $6.05
Boiler/furnace replacement $0.00
Program repair $0.00
Actual Total does not include $175.00 K&T charge. 51,103.40 I lEstTotal
SO.00 I lActlotal
AUDITOR: Doug Cranford