0007 ALBION STREET - BPA-13-194 INSULATION 7, fhe C'unununsveahh of Massachusens - -
y; 1� Board ot'l)uilding Regulations and Standards CI'F)' OF
Massachusetts State Building Cute, 79B CNIR SALGNI
21)11
Building Permit Application To Construct. Repair. Renovate Or Demolish a
One-or Tun-bluni(r UucRint;
This Section For Olfcial Use Only
Building Permit Number: Date Applied:
Building Gllicial(Print Muriel Sianature pate
SECTION 1:SITE INFORNIATION
I.1 Property Address: 1.2 Assessors blap& Parcel Numbers
I.la Is this an acce ted street?yes no Map Number I'urcel NuntM:r
1.3 Zoning Information: 1.4 Property Dimensions:
Znning Dmlit l'" - NWposed tJse Lot Area(sit It) Frontage(It)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: I.G.I.( c.40,§Sq) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public O Private❑ Zone: _ Outside Flood Zc Municipal❑ On site disposal s)stem ❑
Check if usCl
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Cat� in �� / �do _U;JLn. ,Sa/[lvr /�Jra
Name(Print) r City.State.ZIP
7 / IIninh -V• 979 -7-/R/- 7179-
Nu.rent.treat Telephone Etnuil Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building O Owner-Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ 1 Addition ❑
Demolition Cl Accessory Bldg. ❑ Number of Unin_ Other ❑ Spccily:
Brief Description of Proposed Work':
SECTION a: ESTINIATEO CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
I Labor and.\laterialsl n y
I. Building S y 7 7.1,S9I. Building permit Fee: S Indicate how I•ee is determined:
'. Flecuical S ❑Standard City•Tusvn Application Fee
❑Total Project Cost I Item 6)x multiplier
1 Plumbing S '. Other Fees: S — -
J, Ml Chanical III% W) S List:
�u,uc:siun) S TatalAll Fees: S_
n Total Project Cu+C S Ch"k No. _.---('heck Antknmt: - ---- Cash \mmml:
❑ Paid in Full ❑Outstanding Bal:utce Duc:
.1C /off
SE("PION 5: ONS I-RUct-ION SF.RVI( FS
5.1 Construction Sul)ur%isor License((Si.)
cviisc Nwnhcr rah"I Datc
1-009
Name ul L SL I Iolder I ist L St. 1)PC licc
.I..�PC J)eivriplion
No. mid Street
4L ),%,.It
Aile- R lic.,Iricled l&2 Tamil (0%%ellin
R(' Rix1fin Omcrin
%S Window.aid Sidin
eY SF Solid Fuel llurningAppliances
I I insulation
D DemolitionI vlcrllonc Finail addrcsi
5.2 Registered I Ionic Improvement Contractor(IIIC)
I lIC 11eligrglun NonK F%piraiiiiii Dite
I Name upon iwv or I 11C ltegistrani Name
fiat e Email�jddrcss
U'Nid Sim it
V90SId.
City/Town.State,ZIP
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152.1 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...........0
SECTION 7a:OWNER AUTHORIZATION TO iE—COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize (J/ rip L a ngv'c
to act on my behalf,in all matters relative to work authorized by this building permit application.
A a Date
L,"wai i efit:6c tim, 4
it i c'si a n ut u re)
SECTION 7b:OWNEWOR 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.
A)Nvilcr,i it ALI I horilvj Ag�lit .4 11�ectrolk lattira) Duce
NOTES:
1. An 0%�iier%�hu obtains a building permit to do his her own work,or an owner who hires an unregistered vontractur
u ,
1.
(nut registered in the Hume Improvement Cuntractur(HIC) Program),will 1a) have access to the arbitration
�'r (I
program or guaranty fund under M.G.L.v. 142A. Other important information on the HIC program can be round at
I Ilift w.,,, �;o% information on the Curistruction Supervisor License can be round at ttw% �w+ 111,
2. \%hen substantial%�urk is planned,pros idt the information bclo%v:
flour
ilabit.ible rouin count
Groii li%ingarea(iq. it.) Number ol'bedr001115
\tm)h%:rot*lirvl1l.:i%:es
Numberot hathrooms \i1mber oflialfhatfis
I pc of heating Njlijiherofdccki, porches
1) ofCooliI16 S.�0011 Fjiclo,�d —011en
1. 1 oi.il Protect Stlumc Fool,ige"Illll Jc+ub,wutcd ilir, 1'oial Project CoNC
'w
WAP Work Order
North Shore Community Action Programs,Inc. Job Number: 100124
98 Main Street Work Order Date: 8/23/2012
- Peabody,MA 01960 Ownership: Owner
Phone:978-531-8810
American Door,Window,&Insulation Auditor:Doug Cranford
15 Bailey Avenue Email:dcrasi&rd@nscap.org
Saugus MA 01906 Cell:978-335-7154
Email: wdelangis@comcast.net Phone: 978-531-0767 z135
Phone: 781-231-0244
Conceicao Cunha NGRID Electric $4,773.59
7 Albion St Total $4,773:59
Salem MA 01970
978-744-7172
Safety [ssue(s): Lead Paint Possible
11i,
C1��Ill ,Il : nIII�i ' li111
PGIIE iIIII II4u 14 Y�i!II�� I mill �ni t II ! I ' I I IIII �6II' II l:nl lit a.Ic IIII L4;IL Idlll �.IH. ,�:,11 hJ w1:
R-18-20 restricted-slopes/floored 300 $1.42 $426.00
fill Wee]lulose
R-18-20 unrestricted-settled 358 $1.29 $461.82
ceflulost
p.�'GII'r'IIhI'"Ir��IP;yn�,apl:ryr�a:lil::gl luo Ii i 'I' I llll I 1 :1,1 i II' (IIII"hi IIiP9IlI�l i' ! „I "'?iI j"I7111i I! 'lis iI1
Ilhl�h',°jl,l����ll"I::Itl111u1 i1110�1 :. Lu NIoloi IIIIII IINI�i�116111,II���IIIuIiNli�l IIII[�IIIINq�II�IIIIIII�I ��III IIILIIdIuuiIIl�Illllhllllll111 t,lll 111R.11111019111:I. jIll�igl�;I�llpl t�h:Illh� h,ulh���,
Rectangular gable vent 2 $92.00 $194.00
�:ml ,.t.I�ii�-gala�y ry!"rl�l>;ul::,.8:nl lilnyil�pnnn 'II� II '; :j��i ili�"III;iIr I ��'I. it I�' Vii II TI illlll� II;ilI III'. I:uI I��C
�I I1 E 111�I III IIui,1 111" l i1,I:�1111�111Il i 11 ll�li!'I� �I I�II II�II�1�611�II�il1.IIII���n H II�IIdhI IrlGill:�"h,I�llll il�I��I�IIII1111I hLI��IL�I IIu11��II��III All I"ill����I���I
Sill two-part foam w/fiberglass batt 110 $2.20 $242.00
��y�����llhiiba��I�II�,�I���;I;lII�II�IIIti�I�IIIhIlI�14.1������161idlilu116,,I�IVII���i�18��ll�ld'�!�I!II�I:!� ��! ,IIV�I�!�NI��I!I�Iili���l(�Itl�III��I��ill�u!i��� l� _�IY��I' � �IH�1G��Mr�I�I��:Ci��lllllr�lj
Fixed!,weep 4 $15.75 $63.00
R-5 Ductwrap or R-max on door 1 $51.00 $51.00
Weatherstrip s/Q-Ion or equal 4 $45.50 $182.00-
Date: 13.2:3/2012 Page 1
1
WAP 'Work Order: Job Number: 100124
Domestic water pipe wrap - 6 $2.63 • R5.78
Duct insulation R-5 20 $3.10 $62.00
Attic sealing with two-part foom 1 $75,.00 S75.00
Basement sealing with4wo-part 2 $75.00 5150.00
foam
Blower door set-up with pre&post 1 $45.00 S45.00
tests
Seal ducts with mastic or butyl 1 $65.00 $65.00
backed tape
I,,q ill IMP I°."' m� I li �;�'fll!1"' I I III '�lu� I I;IIi;�'I�II 'il II I'fln '�� i� I ( nl'IIIIII' nu� �i:'k"'li;.i; i�I t, .,� �;inr'u� 'Ij••'•' �rII ,�i i
MI NI Ii ill lip la �",1vil lllllill �i�I�Idl�i� �,�! !1111611:IItiI��P�NII!IIIl111V I llll�l lilhi�„ia�,�II�I IhI�I�IH��N,{nili��Gi�ill�,� I�� ��V�IG d,ului i��llhll���(a� :�llutl����, Ilia: L �'�����I�I�� �l�ill> ha I �G�u �:l:
Building Permit 1 $100.00 :3100.00
EI��I�Iu ip�l fi°i' 'o�'Itilm �lll (I��I� ICI '.I ,r'�Illl�lii'4��It�h' �''�1111 y'IflI�i,1:J,��!Il�llfl�,,'i I�liilr'I�I�I�l�ill'I� IlBf hlhi! flll�'� II�'� d �RI
Wood clupboard/shakes/shings or 1481 $1.79 $2,65.0.99 .
vinyl(dense pack)
Total $4,773.59
Contractor Instructions:
Before Starting the Job: During the Job:
1.Please notify us 24 hours before starting or scheduling a job. 1.This residence was built before 1978. Lead safe ractices are
2.Obtain required building permit. required.
2.Total for Heath&Safety and Repairs cannot exceed$2500.00.
3.Davis Bacon time sheets required for ARRA work on US
Department of Labor Certified Payroll Report Form WH-347.
Date: 3.23/2012 Page 2
1
08/28/2012 20:42 17815955820 AMBROSE INSURANCE PAGE 01/01
DAM
ATOM CERTIFICATE OF LIABILITY INSURANCE 8/29M100 1
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Ambrose Insurance A
4Y- , Inc, HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
56 Central Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lynn, MA 01901 INSURERS AFFORDING COVERAGE
INsvRED Delangis, William INSURERA' PrOVIdence Mutual Fire Ins;,_C9
American Door, Window & Insulatio INSURER B: rbe,
15 Bailey Ave. INSUkERC: C
Saugus, MA 01906 INSURER D;
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 OLAIMS.
INBR POLICY
EFFE U YEXPIRATION
TYPE OF INSURANCE POLICY NUMBER p p UMITS
GENERAL LWOILITY EACH OCCURRENCE Al.0AU0
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any Ina In) 15 0.a-Q
CLAIMS MADE ❑OCCUR MED EXP(Any In ppamen) S
A CPPOOSS334-00 5/28/12 5/28/13 PERSONA.S ADV INJURY B
GENERALAGOREOATE $2,000,000
GENL AO ORE LIMIT PLIES PER; PRODUCTS-COMPIOP AGO $2 ,000 ,000
POLICYEGAT AP PRO- LOC
AUTOMOBILE LIAB&ITY COMBINED SINGLE LIMIT
ANYAUTO IBMAmIdem) s1,000,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Perpmecn) B
B HIRED AUTOS 47635400001 8/17/12 9/17/13 BODILY INJURY s
NON-OWNED AUTOS P.wddmt)
PROPERTYDAMAGE $
(PAf P�Pdem)
GARAGE LIABILITY AUTO ONLY•EA ACCIDENT $
ANYAUTO OTHEEA ACC $
AUTO ONNAN
AUTO ONLY. nGG S
ExcEBS LIABILITY EACH OCCURRENCE $
OCCUR J CLAIMS MADE AGGREGATE S
$
DEDUCTIBLE S
RETENTION S $
WORKERS COMPENSATION AND T 8 ER
EMPLOYERS'UASILRY
E.L.EACHAOCIOENT $
-000
C 001606573 2/11/12 2/11/13 E.L.DISEASE-EA EMPLOYE s5A
E.L.DISEASE-PGUCYL",r $ 00
OTHER.
3ESCRIMI NJ OF OPERATIONS/LOCAnQNSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTSPECWL PROVIBIONB
Carpentry & Insulation
:ERTIFICATE HOLDER ADOITIONZ INSURED;INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Salem DATE THEREOF,THE ISSUING INSURER WILL BNIOVOR TO MAIL.1 n DAYS WRITTEN
Attn. : Building Dept, NOTICE TOTHE CERNPICATE HOLDER NAMED TYJ THE LEFT,BUTPAILURETO DO SOSHALL
City Hall IMPOSE 140 OBLIGATION OR LIAORM OF IND UPON THE INSURER,ITS AGENTS OR
Salem, MA 01970 REPREBENTA
AUTHORIZE RFP
ACORD 25-S(7197) O ACORD CORPORATION 1988
_. ainF
c
N !Mx
` N
99vKw/�Ce of Consumer Affairs and Business Regulation oM
10 park Plaza Suite 5170 I ,
Boston, Massachusetts 02116 s o
Horne Improvement.ContY_actor Registration i
a!9t9'i
- heyiSitatiuii: � �-
Type: DBA Tr# 206381
Expnation: 1 tl25/2G12
AMERICAN DOOR WINDOW & INSULATIO —
WILLIAM DeLANGIS _
15 BAILEY AVE
SAUGUS, MA 01906
Update Address and return card.Mark reason for change.
CPSOgt C, SOM-041e4ZIDI to
U Address Renewal Employment %i Last Card
✓ice '�naatwxa>eut a�..��aseac�uvndlL
License or registration valid for individul use only
f Office of Consumer Affairs&1lnsiness Regulation before the expiration date, If found return to:
office of Consumer Affairs and Business Regulation
HOME IMPROVEMENT CONTRACTOR Type!
Registration ^111123 to park Plaza-Suite sti0
D6A Boston,MA 02tib ExP��han ..,1�125/2Q12
AMERICAN DOOR WIt�DOK' INSULATION
• WILLIAM DeLANGIG
15 BAILEY AVE ut signature/
• SAUGUS.MA 01906 Undersecretary Not valid withoI