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31 PICKMAN RD - BUILDING INSPECTION The Commonwealth of Massachusetts QX71 Board of Building Regulations ancL:Sfa# tFd 't sf�"rfs CITY OF SALEM Massachusetts State Building Code, 780 CMR 7� Revised Mar 2011 Building Permit Application To Construct,Repair, NJII [� W Dir tolls'h1al One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: ate Applied: Building Official(Print Name) Signature Date 1 SECTION 1: SITE INFORMATION LI?��rtytldd�s�� /"� 1.2 Assessors Map&Parcel Numbers I 1.l as 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: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check if yes❑ �SECCTI,O/N 2: PROPERTY OWNERSHIP' 2.1 Ci/ Name(Print City,State,Z[ T4 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) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other pecify: �- Brief Description of Proposed Work': /i rte ✓tr .. L 0 KJ�t-L L SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: S 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire S Total All Fees: $ Suppression) Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 17, ❑ Paid in Full ❑ Outstanding Balance Due: 0\/13MI " 5ASe SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Sue isor License(CSL) , /O yZ / o �� /� o/-�/,eCd . License Number— Expiration Date Name of CSL Holder Cl List CSL Type(see below) No.and Street Type Description Q.- 7 0 R Unrestricted(Buildings u 35,000 cu. R.) O-� R —Restricted 1&3 FamilyDwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 9 Insulation Telephone Email address D Demolition �j 5.2 Registered Home improvemme�nt Contractor(HIC) //'7 �J UI L 9//y� Urte" HIC Registration RegistrattionuN`umber Expiration Date HIC Company any Name orH1�Registrant me ��1 �41/y ttJeetC��7 -�J Email address 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 .......... No ........... 13 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 to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and enalties of perjury that all of the information contained diin this application is true and accu 1te to st of my knowledge an�%erstandi Print Owner's or Authorized Agent's Nam Elect is S' ature) 22 C((q� 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.euwoca Information on the Construction Supervisor License can be found at www ma:s gov/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" • �,0�0®0 EeergD de jb'c�e m m This agreement is made by and among: } i PARTICIPATING CONTRACTOR Yvonne Martin 31 Pickman Rd Salem,MA 01970-4359h"`+•..�.,d Site TD:S00050213082 Project ID: P00050244453 f�mHeWorits Customer ID:C00050214582 VV ��,��✓✓++ Contract ID:20160701_WORK 68 Cummings Park Dr.,Woburn MA 01801 Office:(781) 305-3319 Ext. 120 Contracts can be sent to:inbox@homeworkseneroy.com Description Quantity Location mile:Floor Open Blow Cellulose 9' 624 Living Space $1,035.84 Hatch:Thermal Barrier Polyiso 2 inch(Attic) 1 Hallway 541.71 Damming24 N/A $52.56- Install 3.5"Fiberglass Batting In open Kneewall 238 Living Space $404.60 Install 2'Thermal Barrier Polyiso On Kneewall 238 Living Space 51.04720 Kneewell Flow Enclosed Cellulose Dense Pack 8" 624 Living Space $1,622.40 Sheathing Access 1 NIA $36.14 Door.Thermal Barrier Polylso T_(Agic)- 1 Hallway $81.37 Insulate Wood Shingle Sided Wall With 4"Dense Pack Cellulose 1,176 Living Space _$2,540.16_ Dense Packr Cellulose In Garage Ceiling 308 Living Space $825.44 Insulate Rim Joist With 2"Thernal Barrier Polyiso 32 Living Space $140.80 Sub Total: $7,828.22 Utility Incentive Share $2,000.00 Customer Contribution $5,828.22 Total Contract Price and Payment Schedule: Printed:71112016 Page 1 of 1 HomeWorks Energy agrees to perform the above described work,furnishing the material and labor for the listed total price. Payment of the customer contribution is expected upon completion of the work. �) Customer Signature: �yv-0� !' i Date: 15kAky Cell Phone#(usedfor scheduling purposes only): Q�iY.r �1�fi/ICr�G7 (�G{�J Contractor Signature: ([}/J/],, � � �JJ Date: y LIMITED TIME OFFER:The prices and incentives offered in this contract are subject to change in accordance with the sponsoring utility Mass Save Home Energy Services Program offers. o°Ao�6 Energy gejbxc'I's w� 0 This agreement is made by and among: PARTICIPATI I { CONTRACTOR Yvonne Martin e 31 Pickman Rd Salem,MA 01970-4359 Site ctID: 050213082 5024* H`meWo ProjectlD:P00050244453 (v� s Customer ID:C00050214582 Contract ID:20160701_ASEAL 68 Cummings Park Dr.,Woburn MA 01801 Office: (781)305-3319 Ext. 120 Contracts can be sent to:inboxPhomeworksenerov com Description Quantity Location Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 6 Living Space $505.92 6mm Poly Vapor Barrier 390 N/A $351.00 Exterior Door Weather Stripping 2 N/A $55.18 Door Sweep 2 N/A $46.36 Sub Total: $958.46 Utility Incentive Share $958.46 Customer Contribution $0.00 Total Contract Price and Payment Schedule: Printed:711/2016 Page of I HomeWorks Energy agrees to perform the above described work,furnishing the material and labor for the listed total price. Payment of the customne�rt contribution is expected upon completion of the work. Customer Signature: .1 3-v� L-V- IL& /Vv� – r Date: 1 a 01 Cell Phone#(used for scheduling purposes only): ( tom Contractor Signature: Date: 0 1( LIMITED TIME OFFER:The prices and incentives offered in this contract are subject to change in accordance with the sponsoring utility Mass Save Home Energy Services Program offers. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations i 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibly Name (Business/Organization/Individual):jR 1 f%17!J1l Address: / y' r A'!?`GyA X !Jp�r �,,7 7 City/State/Zi !-r M 636GPhone #: b C3 - 7��lJ Are you employer? Check the appropriate box: Type of project (required): 1. I am a employer with oW 4. E] 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.t 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 11.❑ 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. Other 1'VSUL�/moo comp. insurance required.] Any 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. tContmctors 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. /� e� a �/ CO,Insurance Company Name: /'7. /CIS Db6/ �' 5- Od — Policy#or Self-ins. Lic. #: y�y/� l/�/�'J �,,/� -/9 463 V& Expiration Date t-/�/72 qe Job Site Address: -9 f / / Y,�CJT'/ A City/State/Zip: % /wt- Attach w QI 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 certify under t e aims a allies ofperju hat the information provided above is true and correct Signature: Date: Phone#: ✓��/ 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#: ........ ... .......... ® Massachusetts Department of Public Safety Board of Building Regulations and Standards License CS-104159 q- "nst'4Crt on Ja0„°. SW ANTHONY J GRIECO 1 42 WHITTIER STREET `va HAVERHILL MA 01830 jto ss.o'+e• 0212512018 r/�� lrAll't(1/111"J /6 Office of Consumer Affairs and Business Regulation t 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 1 come Improvement Contractor Registration Registratiow 167942 Type: Supplement Card ` BUILDING EFFICIENCIES, I.LC Fapvation 11117/2010 ANTHONY GRIECO 18 1ANGUAY AVE. NASHUA, NH 03054 Update Address sail return card.Mark reason for change. SCA 10 2W 05111 Address Renewal Fluployment IAmCard Ire of(oewise,A16in&8a,ines Nes+hliMa Lieeme er registration valid for individal use only E IMPROVEMENT CONTRACTOR before the eapiralion date. 1rFinad return to: Office of Cassumer Affairs sad Bustaeu Regulation rlt tetrdIm 187942 Two: 10 Part Plaza-Sake 5170 Explradan: 71Hmme Supplement Cent Been MA 02116 8111101NG EFFICIENCIES.LLC n ANTHONY GRIECO 18TANG {y to TANGUAY AVE.HASHM :�/—yLi� /L"U, •�•_— ' 03054 lhdrneeetlw H wkltoat siaaature