B-19-1116 - 0014 BERTUCCIO AVENUE - Building Permit The Commonwealth of MassachMd
�,Board of Building Regulatro`n" ` i � -ds ` r .rw u CITY OF
Massachusetts State Building Code, 780 CMR SALEM
y n ^^�� � 3: �} Revised Mar 2011
Building Permit Application To Construct, Rego, Q ovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
1 Building Permit Number: Date Applied:
0-4
Building Official(Print Name) Signa Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
- �rturn ) Cave, #a
1.1 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
I 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?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
( ( Ln& 0hp Viz I�,(Alom, =A n1ct-In
Name(Print) City,State,ZIP
-L`f lA-W_ .C) 12 Alej jt,�A a_-A afiQ aa k:3 Isla) IOU R h L -r rr)
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
f Descriptiorl of Proposed Work2:
do -
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official U Only
(Labor and Materials) : Use y
1.Building $ ��yt 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost;(Item 6)x multiplier x
r4.
.Plumbing $ 2. Other Fees: $
Mechanical (I-fVAC) $ List: f ��
5. Mechanical (Fire
Suppression) $ Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ / { {Q ❑Paid in Full ❑Outstanding Balance Due:
d �
SECTION 5: CONSTRUCTION SERVICES
5. Construction S rvisor License(CSL)
NLi
1 it License Number Expiration Oate
Name of CSL Holder
List CSL Type(see below)
If- gt,% ram rd-
No.and Street Type Description
(�,IP,I��,( 1AR O 1 �`zh R Unrestricted(Buildings u el ing cu.fr.)
h1111/ �1 ' I I 1` l JCJ R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1 (,1.1t * -_K • , 11(4Je �l, I Insulation
telephone Email address D Demolition
5.2 Registered Home Improvem t Contracto CHIC) q 4 t q Z Li �r�1+'�, I�� � �(U HIC Registration Number Expiration Date
Date
HIC pany Name HIC Regi nt Name
CJ��CLiRC '1 �.�U'K�C, u
No,and Street r Emau address
rAig
1 `� D3 C,113Lp cotr�
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 ..........10 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
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 penalties of perjury that all of the information
contained in this applicaf i true to to the best of my knowledge and understanding.
I C) 1
Print Owner's or Authorized Agent's Name(Electronic ignature) 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dpss
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 halfibaths
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
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston, KA 02114-2017
www.mass.gov/dia
I orkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORIT V.
Applicant Information Please Print Legibly
Name(Business'Organisation individual).DiPietro Home Energy Solutions
Address:5 South Summer St
City/State/Zip:Bradford, MA 01835 Phone 4:978-2OM736
Are you an emptoyer4 Check the appropriate box: Type of project(required):
LE J I am a employer with 30+ employees(flail andtor part-time).*
7. ❑New construction
2.3 I am a sole proprietor or partnership and have no employees working for me in $, 0 Remodeling
any capacity.[No workers'comp.insurance required-1
.301 am a homeowner doing all work myself.[No workers'comp.insurance required.)t 9• ❑Demolition
4.01 am a homeowner and will be hiring contractors to conduct all work on my pmp". I will. 10 O Building addition
entire that all contractors either have workers'compensation insurance or are sole I L[]Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
50 l aria a general ctmuactor and I have hired the wb-contractor:,listed on the attached sheet.
These sub-contractors have employees and have workers'comp.insurance,: 13.0Roof repairs
6.Q We ace a corporation and its officers have exercised their right of exemption per MGL c.
t 4.E]Other Weather¢abon
152,�1(4),and we have no employees.(No workers'comp.irourarroe required)
'Any applicant that checks box#1 must also hill out the section below showing their workers'compensation.policy information.
1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new afliddvit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and static whether or not those entities have
employees. If the sub-ootttractors have employces,they must provide their workcrs'comp,policy number,
t am an employer that is providing workers'compensation insurance for my etnploy�ees. Below is the policy and job site
infortt�tation.
Insurance Company Name:Costello Insurance
Policy#or Self-ins.Lic.#:WC 0856525 Expiration Date: 4/20/20
Job Site Address: 14 /(��(�r' DAAa,� 1±a City/State/zip: (2alf M ., 2nA p)of BCD'
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
l do hereby certify tinder tie pains and penalties of perjury that the Information provided above is true and correm
Signature: �L,t _ Date: ) (a 1 1 al
Phone##:
Official use only. Do not write in this area,to be completed by city or town ofciaL
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone Al,
• COP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY'O
Sa� 04/16/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT Emily Costello
Costello Insurance Agency,Inc. PHfAJONE
Et I: (978)374-6352 AX No)- (978)521-5127
2 S.Kimball St. ADORIess: ecostello@costelloinsurance.com
PO BOX 5248
INSURER(S)AFFORDING COVERAGE NAIC#
Bradford MA 01835 INSURER A: Colony Insurance
INSURED INSURER B: Commerce Insurance Co. 34754
Dipietro Home Energy Solutions,Inc. INSURER C: Star Insurance
5 South Summer St INSURER D:
INSURER E:
Bradford MA 01835 INSURER F:
COVERAGES CERTIFICATE NUMBER: CL1941601490 REVISION NUMBER:
THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WUV51 POLICY NUMBER MM/DD MMIDD LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 50,000
MED EXP(Any one person) $ 10,000
A PACEP308383 04/25/2019 04/25/2020 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY ❑JERCOT- ❑LOC PRODUCTS-COMP/OPAGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
ANY AUTO BODILY INJURY(Per person) $
B OWNED SCHEDULED HS6326 05/09/2019 05/09/2020 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED Ix
NON-OWNED
AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $
Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000
A EXCESS LAB CLAIMS-MADE EXC4245322 04/25/2019 04/25/2020 AGGREGATE $ 2,000,000
DIED RETENTION$ 10,000 $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN x SPER
ERH
C ANY PROPRIETORIPARTNER/EXECUTIVE N] NIA WC0856525 04/20/2019 04/20/2020 E.L.EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUE
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
B yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
For information ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE p
�'q'l�
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
Permit Authorization
rMSS saw Form
Site ID: 3892074 Customer. Linda Salvo
X ._ ,owner of the property located at
(owners Nam%OrRed)
14 Bertuccio Ave*2 Salem, MA 01970
(Property Street Address)
hereby authorize the Mass Save Nome Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on.my prop".
Ownees'Signature: CS
Date:
�.o�.s.�.......�s.�...��a...�s� �...�o�®.�so:®..®mo�.00..®o�•.s .o.00�
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
Participating Contractor Date
r
Name: Revise Energy
Phone: 800-885-7283
Email-hello(oreviseenergycom
Page 1 of 1 For use ay
Rev.102MS
Pege 1 of 2
aREVIS-E.- ENERGY ►
PARTNER
1, f#VYdtKTO BEPl3�QR�
REU�EA�(,Y wl pecan a to be M � wodc on dro wdomel's ed�ess befaw,b e ptof�aiatal nwrewr end b►aoeardarce�the lama d�
Ca bs4 b►eku%do attaeheP mwomWalwalmi order dssAhV ft work In dated OM VMI M&h me wed Mrsin by Weems. reflected Wu may be
ei►1 to o4u*ft*M propnm pftg oral o#erk,ge and Is floated for 90 dq$km to deb Ow Contrdd is p&&d.
Cus+toftw Nam:Unda Salvo
SIW:Not provided
Phone:978-270-2313
Premise Address:14 Bertucdo Ave,#2,Salem,MA 01970
Mang Address;1 a Bertuodo Ave,#2,Salem,MA 01970
Prq Hh-3893333
bate:Sept 18,2019
Job Description
Aft Floor-8"Dense Pack Cellulose 1380 SF � $3,933.00 $393.30
Sheathing Access 2 each $80.04 $8.00
Bath Fan-Vent to Roof 1 each $141.30 $14.13
Damming 22 each $52M $5.26
Roof Vent-12" 1 each $150.06 $15.01.
Soffit Vent(4"x1.6")Aluminum 10 each $344.40 $34.44
Attic Floor 8"Dense Pads Cellulose 36 SF $89.64 $8.96
Walls-Interior-4"Dense Pack Cellulose 104 SF $264.16 $26.42
Door-2"Thermal Barrier Polyiso 1 each $90.44 $9.04
2 CueEarrer egmea to pay REM ENMGY fa Ore work es fobwa:
-A mwfdwd"Deposk by aedd and Odertard.Via or Dum m%Q or ehed is due at tlw firm Ote Wak is scheduled.RagxW payrrro A i hone don wl be cotieded at
the in d sdw6ip�Doped is sotto eased 10 of do IDW mftd eon.
AdMond P"nuds ad Find h miw.
,40m l paw for the Work"be due upon twWledw dthe WKk and wl be bnwaaed to tlw eusiam fa payment by dock or dwrged to the aedd trod on lie wft 24
han of 6Mry dOr Feel haaica ff M aedd ead dwrpe is de"ha any roaaon, ' kart VI GY you wl bo rosponsbk+fro pruWkV vats adenwf%s
erect id�n to ore ods p9prie t.
faete�- R BE Date
Mkyw dREMSE ENERGY Reprewla%e
The Terms of this Agreement are contained on tooth sides of#ft page
R#*s Eu W-5 8"Btmw St-F*rla MA 010.M I185-SAVE 4wk em-P4*sE►ergk can
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Page 2 of 2
REVISE ENERGY "Y
mass suave ;-
a Saudi Swmnw8t.lranerhilLK►o1838 PARTNER
1. Q906 t O WORK TO BEpI3tFORidHt t F c
REWM ENEWY wid perhan at cam to be pe d fa f work on tlw ermwrner'e address below,Ina profeseforml inemer and h accordance retlY the tame old"
Cawbact tAe�p the aagtfiad mconin dsrmnd wark orb describing go work In dated(ihe'Wo*J which are incorporeled heroin by refererrce 9 reflected 6ekwmay be f i
and
for 30 days from fro date f»Cordreet is printed
le ec�rtrente in Dr'ogrom pricing andet�Os is�aterdeed �• ' .
Customer Name:Linda Salvo
Email:Not provided :::':•w4s
Phorm:978-270.2313
Prwrdse Address:14 Benucclo Ave,82,Salem,MA 01970
Me"Address:14 Bertuccao Ave,1YL,Salem,MA 01970
Project ID:3893333DaW
Sept.18,2019
,y•4ti
Project Total $5,145.62t'=?.,
Weatherization incentive ($4,631.06)
Total Program Incentive -$4,631.06 `
Customer Total $514.56 : '' a
„ryas,,•
� .at.�c
Gg
s�4•�
2 PAYktEM:Cum agmee to pay PEASE ENERGY for the work as tobwe
PeyrrreuYdN�eposij;ti `:.,;,;c
-A rorHAndabb Deposi by M&card(Mastwead vim.or Discover card)or dud(is due al the tine the Work is scheduled.Re*W petne tt udamwfienwBl be cam at
do fine of schedi fag.Depot is notto exceed 1/3 of the total Wilmot cost :3
AdNwW Wgsnerds and Fula!Invoice:i
•,AdMiaml paymada for the Work shall be dire upon ca VdW of the We*and wig be invoiced to the customw for payment by check or charged to the credit curd on fife wihkl 24
boos of dalha ry of Ore Find Invoice.Hthis credit card chaps is&*ad for any reason, lice Iran NSE ENERGY you will be rosporua�b for providing valid atfar�ti+s
credt nerd cesaary is txrrpbte payrrtetd
�4
g Date REat E re Date t c
eorREMSE ENERGt ReVenlative
The Terms of this Aarsement are contained on both sides of this page
R@I&MR^5 South Sumter St 4immfK AAA 01035 M W-SAVE Rmitst6tergy,com>Raviu&wW.ean
�� � � `r'' � ��•ry r a , '�+tar ,�f„ �, .,,��'��;�s`"�,� �a-:�"' "
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r 1 , '' yy 3Y.n ,:F, i�w k•; r !..u r t - 1 �' ({> .^, -,4 n s,3 r . fi{.�
•Y �.•4 t5;, r1.4 to ^y Nj u�, ,'��. } .�• rY^w t r� 1 ��}�?s` k •�.ii�•'�'L , -t { ..
•' •. ,.-.0 yC r tr.R..a..t..-..t!�h...,..>,_••.r.Y."1' ..y.L.,♦ r.t+1r}:,.!i.. • S,Y �.f�'.. _ i.A.�M�.\L'Z•.. ...:�ti.�e�.+lr_ .. .... .. �:: _• ,.
• • Energy PlanviewDiagrarri
Customer: _�-) th Q►u_,1 t2 Aj,i, Advisor Name: _► `G Shy.. _
Address: �.. ,- � ,,r> , _ Any limitations to access by truck N
Town: ' ,r
Site ID: *Use the greater of the two BAS#'s when calculating for MVR
#of stories 17 1:5 1 2 1 2S 1 3 1 BA51 15 cfm X#occupants X n-factor - 6 ,
n-factor 1 16. 1 15 1 14.4 1 13.7 BAS 2 .06583 X area X height X n-factor = 11.-))
Mechanical Ventilation Recommended:BAS>final CFM50> (0.7 X BAS) Mechanical Ventilation Required:(0.7 K BAS)>final CFM50
Is this part of a multi-unit worksco ?Y o INS Muitipiie >$"Loose insulation Gross-Batt >6"Moc Loosehc-bat Truss
Sty . ra_.., �.J �v- i ti �,) ��• )�`
.Any work scoped outside of best practices/approved by?
qw- mob ft. Nit ;
6
Page- of„_,_,
. J bo .-1
°wGGfG .:
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Eton, Massachusetts 02108
Home Improvement Contractor Registration
Type: Supplement Card
DIPIETRO HOME ENERGY SOLUTIONS Registration: 185083
D/S/A REVISE ENERGY - `- Expiration: 04/24/2020
5 SOUTH SUMMER ST.
BRADFORD,MA 01835 -
SCA t g 2pM-05/17 Update Address and Return Card.
Office of ConsumerAtfahs A Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for indhddual use Only
TYPE.Suoctemerit Card before the w9iratlon date. n found return to:
R gistriett{art r i� Office of Constaner Affairs and Business Regulation
tB50&9�. W24 2= One Ashburton Race-Suite 1301
DIPIETRO KOME Fa-fSOLUTIONS Boston,MA 02108
D/B/A REVISE E€V�`
STEVEN POUSSARt7
5 SOUTH SUMMER ST. [ v
BRADFORD,MA 01M UndefseCrotaly Not Valid Without Signature
i
® Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
onstroctlon Supprvlsor
CS-104464 EApires:03/06/2020
JAMES G dDOMOPOULO$0,"T � <'
26 SEVEN SISTER RD V`a= y � � ~
H AVERMLL MfA,01830
Commissioner C,4
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