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0014 CRESSEY AVENUE - BPA-14-839 rn The Commonwealth of Massachusetts RECE ICE Board of Building Regulations and 06PEDI Nay SERV CITY OF Massachusetts State Building Code, 780 CNIR SALEM �p� �y A ; 0 Revised Mar 2011 Building Permit Application To Construct, Repair, Reg r emolish a One-or Two-Family Divelling Chis Section For'Q. icial Use Only Building Permit Number:_ Date;Applted.t, ". Building Official(Print Name) :.Signature : Date SECTION 1:SITE INFORMATION I.1 Property At/�o erty Address: 1.2 Assessors Map& Parcel Numbers /H 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 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❑ SECTION2:: PROPERTY OWNERSHIP;' 2.1 Owner of Record: y_ �j TQ. 10 r r e S Name(Print) City,State,ZIP - /H Cre 53 e/ 4✓e 97t4- 7`/y wpaq 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) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Descriptilin of Proposed-Work": !' SECTION 4: ESTENUtTED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only,.; Labor and Materials 1. Building 3 7 0 6-a ,O 0 I Building Permit Fee: S ^ Indicate how fee is determined: ❑ Standatd._City/town Application Fee 2. Electrical ❑'Cotal Project Cost",(Item 6)x multiplier. x 3. Plumbing ) 2. Other Fees: S 1. %Jechanical (llv,\C) S List: 5. Mechanical (Fitt $ Sap ressnm) Total All Fees S Check No Check Amount: Gash Amount: G. TOal Project Cost S 1 V7""'d i os / � ❑ Paul in Pull ❑ Outstanding Balance Dui MptL�(J " h 5l t 1 l'-i ��... ._ Q3{-iS TION 5: CONSTRUCTION SERVICES 5.1 CpnstructionSuliervi3o�Licciise�( �L)ayl �Qp /. idJX I11 -02, License Number Expiration Date Name of CSL I lolder f 16; List CSL Type(see below) No. and Street Type Description EDDemolition tricted(Buildings u to 35,000 cu. 11. i n lyQ ` o i9 a G cted I&2 FamilyDwcllin Cityaos State,ZI r Covering w and Siding Fuel Burning Appliances tion Telephone Email address lition 5.2 Registered Home Improvement Contractor(IIIC) " & � HIC Registration Number Expiration Date I I��in 4 N. 'ne or Ifl Re strant Name No. nd Street 0/ G 7d / .2�/ d y Email address Ci / o n,State,ZIP d 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...........❑ SECTION 7a: OWNER AUTHORIZATION TO DE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 99 1, as Owner of the subject property,hereby authorize (s/i (/!of to act on my behalf, in all matters relative to work authorized by this building permit application. r Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNEW 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./ _�illra it �e La h s�is — /x6 /`l Print Owner's or r\uthorized.\;cnt' 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 progr:un or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at oww,m;us. oviocu Information on the Construction Supervisor License can be found at svww.mass.eoLALit 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.)_ _(including garage, finished basement/attics,decks or porch) Gn>s living area(sq. tt.l _ _ Habitable room count — Nuntber of fireplaces._.--- Number of balroums -------_--_ -- Number of bathrooms .__ — __— Number of haltibaths — —. Type of haatiug system . _ - -.--- -- - Nwnbar of Meek,/ porches __.—__--- I'y pe of cooling;y lcnl —._-_ Enclosed — _- __Open -- —_--- i. I JGIi I'rol,'Ct tiIIUIII'C I'(4Mo,,e Illay he inbll ltn(ed 10l' [',dal PI"111eC1 ( UiI CITY OE S:u2m, tiL1SS.\CHUSETTS " ' � + OI:tLDNt:❑EP.►R'C�IE.rT 120 WASNNGTON STREET, 3a`FLOOR TFL (978) 145-9595 P.m%(973) 740-9844 :USIBERIEY DRI5COLL 34AY01 THmwST.P[ us DIRECTOR OF PUBLIC PROPERTY/BI:ILDNG CONNISSIONER Workers' Cumpensation Insurance Affidavit: Builders/Contractors/Electrfcfans/Plumbers lttnlicant informatinis please Print Legibly Mimi:I DmitwwyOrpniraddi�I/n�dividual):lAa1S![tLC�A,,.NI�t�L�toile AdJress: Apof�ZN. yCitylStatc/Zip: ® o Phone M:,�f" ire An employer?Ch the appropriate box: Type of project(required): I. I am a employer with 4. 0 1 am a genaxal contractor and 1 6. 0 New construction etllployees(tlalland/orpart-time).• have hired the subcontractors 2.0 lam a sale proprietor or purtncr• listed on the attached.rhact.t 7. ❑Remodeling .Ship and have no employees These subcontractors have V. 0 Demolition working fur me in any capacity* workers'camp.Insurance. 9. Q 0uilding addition (No workers'comp,insurance J. 0 We are a corporation and its required.( Ofticcrs have exercised their 10.0 Electrical repairs or additions 3.0 I ant a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions myself.(No workers'cutup. c. 1 J2,11(4),and we have no 12.0 Rao[rupairs insurancorequired.Jt amplayees.(No workers, U.DOther Gump.Inruranca required.) - -nnyapplican dtaehv<ksties A mwtalaenll uul the seeeoe below+howing theta wakrn'remprnudunpulley inglannulon, 'It..nvuwm"whosubmit this atltelivit indicming they an doing all work and tAcn Alm oueide eentmeters MWtsulanil anew aMdavil indlsating "lL �Cvnuxwn that cheek this box must aaachee m aadldunal vhet showing the arse of the aut/cdmaactore and their workers'ramp pulpy Inrormedan. /uaar an ampluytr thuNi provldln�Ivarkai'rompnrtedan huuraneejar my rmpluyrrs Below la thepolky undJob site injonnuUon. insuruncu Company Name: Policy 4 or Scl( imt. Liu,0: 1Al C 213 S3 ?y ya.3 0�y Expiration Date:41 c Job Site Address: /1�V/Q 3� A✓(i City/StatetZip: q •SQ le.4.1 Iq q_ .Attach a copy of the$workers'componsutloo policy declaration page(lhowing the Polley number and expiration data). Failure to securo coverage as required under Section 2JA of,LIGL e. 152 can lead to the imPosition of criminal penalties of a line up to SI,500.00 and/or One-year imprisonment,as well as civil panaltius in the form of it STOP WORK ORDER and it line of up to 52JO.00 a day against the violator. Ile advised that a copy of this statement may ba furwarded to the Milos of Invevligulium of the DIA fur insurance coverage wrilieativa f do hereby verr/j andd,lee puler and prnulNrr u/Iprr/ury that rhr Grjurnautfae provldrd above rr true wad earrrck t Data: O a-Al FC 1reiul use lady. Uo not writs in Mich array to barruaapldad by city al.lawn n/Jtr/u! tynrl'nwnt __ _ 1'efmlr/I.ICense,9 I%1UIo{.Autiturily(clrclo one): I. Iluarduf Ilcallh !. Iluildlny Department 1.Citytrowii Clark 1, haectrical Intpeetor i. 1'Iutatbing Inepecror b.Other ._ Contact l'trtnn:_ _ _. . .. 1'hano;i: CITY OF S:UzNfj 1 WS.ICHUSETTS ©l;ILONG DEP.1R-I ONT 120 WAsHCYGTON STREET, 1AO Et pp t I F-L (978) 745-9595 KI1(3E2LEY DRISCOLL F•t't(978) 7-14D-9344 NUY01 TH0S613 ST.PIEau D12ECTOR OF puaUC PR0PERTY/BC(L0LNG CONNISSIO.NER Construction Debris Disposal AFtTdavit (required for all demolition and renuvation work) In accordance with the sixth edition orthe State Building Code, 730 ChiR section l 1 L5 Debris, and the provisions of tbiGL c 40, S 54; Building permit k this work shall be is issued with the condition that the debris resulting from l 11, S ISOA. disposed of in a properly licensed waste disposal racility as defined by NIGL c The debris will be transported by: (name ut'hauler) The dQbris will be disposed of in e (name of FaCIN130 11H1Ql�.ins� J lhll'tS.S Ut to Gl�ll�) 5I jnanl(e Ut pernitt all Gant T / i AMT Massachusetts -Department of Public Safety Board of Building Regulations and Standards Con+traction Sufun Ivor Specialtc License: CSSL-100824 WII,LIAM J DEElf- 15 L.'dVGLS `�BAILEY STREET SAIIGUS MA 01406 b +" 1 Expiration: Commissioner 0 510 5/2 01 4 ;� Office ofC n u�(r Af7ain&Bosi��sR� R.U(IC�(/lC(7l q-_' OMEIMPROVEMENTCO 8ulation • 9 egistration: NT�CTOR 111723 TYPe: _s xplration: 11/25/2014. DBA AMERYCAN DOOR WINDOW&INSULATION WILLIAM DeLANGIS' _ 15 BAILEY AVE _ SAUGUS,NIA 01906 �-----z - Undemecretar3, North Shore Common .`�G/ .� �. e er:24043 119 Rear Foster Street Z ier Date:4/22/2014 Peabody,MA 01960 Owner Phone:978-531-0767 OW American Door,Wind':.- - {randon Dorrington 15 Bailey Avenue wrington@nscap.org Saugus MA 01906 . 0 40-8569 Email:wdelangis@cot. l_ ` 8-531-0767 x121 Phone:781-231-0244 Io M O 5C Rita E Pires ectric $7,052.66 14 Cressey Ave $7,052.66 Salem MA 01970 978-744-6828 R-10-12 restricted-slopes/floored 384 $1.46 $560.64 384 $560.64 fill w/cellulose R-10-12 unrestricted-settled 299 $136 $406.64 299 $406.64 main cellulose R-18-20 unrestricted-settled 96 $lA4 $138.24 96 $138.24 rear flat cellulose Reinforced poly/R-30 cellulose open 504 $2.30 $1,159.20 504 $1,159.20 rafters 4,3 _ Remove ineffective dangerous 2 $67.00 $134.00 2 $134.00 melting pipe FHW insul. Sill two-part foam w/fiberglass batt 85 $2.46 $209.10 185 $209.10 ,— x, E "^x' for a� '• � IN Y Fixed Sweep 1 $17.64 $17.64 1 $17.64 R-5 Ductwrap or R-max on door 1 $57.00 $57.00 1 $57.00 Repair/Refit Door 3 $58.00 $174.00 3 $174.00 Page I Date:4/22/2014 Work Order: Job Number: 24043 Ux v ! r Clothes dryer vent including 1 $100.00 $100.00 1 $100.00 Exhaust Duct Lu Domestic water pipe wrap 6 1$2.95 $17 . .70 6 $17.70 Attic sealing with two-part foam 2 $84.00 $168.00 2 $168.00 Basement sealing with two-part 1 $84.00 $84.00 1 $84.00 foam Blower door set-up with pre&post 1 $45.00 $45.00 1 $45.00 tests Cut/close attic-kueewall access 2 $88.00 $176.00 2 $176.00 Dispose KW FG insul. 1 $67.00 $67.00 1 $67.00 Remove KW FG insul.ineffective 1.5 $67.00 $100.50 1.5 $100.50 .c . P Building Permit 2 $100.00 $200.00 2 $200.00 Jllglmgi n', Y �.. 9jg'o MA Wood clapboard/shakes/shings or 1619 $2.00 $3,238.00 1619 $3,238.00 vinyl(dense pack) E77744 $7,0152666 $7,052.66 Contractor Instructions: Before Starting the Job: During the Job: practicesorate lead sate ltcabie. 1.Please notify us 24 hours before starting or scheduling a job. 2.Totap l for Heath&Safety and Repai s cannot exceed$2500.00. 2.obtain required building permit. 3.Davis Bacon time sheets required for ARRA work on US Department of Labor Certified Payroll Report Form WH-347. Page 2 Date:4/22/2014