21 1-2 CROSS ST - BUILDING PERMIT APP r ,
I'lie C'onmtonw'ealth of Massachusetts
Board of tuilding Regulations and Standards CITY OF
a 4r i; Massachusetts State Building Code, 730 CMR SALENJ
'1.�.. /lrri.red.I Lv 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One- or Two-Fumilr UnYllhe,
This Section For Official Use Dill
Building Permit Number: Dale Ap ted:
Building 0111cial(Print Name) Signature v�D7a�✓ Q Date
SECTION I:SITE INFORMATION
1.I opetlty�AddCress: 1.2 Assessors Nlap dtr P c umbers
TT lac S5T-
I.la Is this an accepted street?yes_ no Map Number I'orccl Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District I'n,poscJ Use Lot Area(sy It) Frontage(11)
1.3 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40,§Sy) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check if 'es❑ Municipal O On site disposal system Cl
SECTION2: PROPERTY OWNERSHIP'
2.1 Ownerl of Record: ,/ ,p
N;une(P'"n 5 City.State,ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s)-jP Aheration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Spccily:
Brief Description of Proposed Work: in a. � �--o"r x!j� ,t.`G baoA �a
�bV Y-6t�R5�, /� r2 ,/e. � D t?ee� t✓1". = 5 �i DVU
W3 +..Foos i.r:•t s wa ve_ r-(ajt.L o
SL--a e SS ,
SECTION a: ESTINIATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and .\laterials) Official Use Only
I. Building S (,pp o. I. Building Permit Fee: 5 Indicate how fee is determined:
'. Electrical S ❑Standard City/Town Application Fee
O Total Project Cost'(Item 6)x multiplier
3. Plumbing S 2, Other Fees: S
a" Mechanical i111':\('1 S List:—
Fire
.Su masiunl S Total :\II Fas:
t,. Total Project Cmst: S r (coo� ('heck No.
'heck :\mount: (';uh -
❑Paid in Full ❑Outstanding Bul:mce Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 C'unstruction Supervisor License(CSL) _101'24 5 `6' ICI 12-
-L , V L+l lPl-1�K License Nuu,ber I'spIN' n )ote
._-.rL —__——__. .___—______.__._._-.—.____.__—
N;uncofCS'I II lul1�tierI .M, p ``'I ''
5 �►t Lstl SVl1 /> -- List C'Sl. f pe(see heluwl .G_ 1]L�
No. :utJ Slrcct ------ 'I- -____—____ 'ISPe Desc plion
tl I Inrestricted(11u n's aildi to 35,0IID eu. 11
O (. .)
R Restricted 1&2 Family Mwllin g
C.itai tots n.Slate.ZIP M Ma.,onry
RC Rtwlin Cuvcrin
WS Window;mJ Siding
/ SF Solid Fuel liuming Appliances
co I Insulation
l'elc hone 1[maiI ad ress U I Demolition
5.2 Register Home lmprov ment Contractor(HIC) I S3ea-bn 21 f 2_,
Xd (k �''1-w' 1I C'Registration Number .pir; it'll Date
I IIC' t unto nrJ II C'ItggN tr ?ntc 5�� LO N-�
No,and Street � �� .-(ooRl Email dJrcss
I av�cr ,
C /Town,State,ZIP Telc hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,e. 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.....-.— O
SECTION 7a: OWN UTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CO TRACTOR APPLIES FOR OM DING
[, as Owner of the subject property, hereby authorize N (,ett.tr OC 4c-q— S lttw
to/act
(on my behalf,in all matters relative to work authorized by this building pe mit application.
Print Osanvr s Name(Filed is Signatures ate
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering Illy 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 Fr t
Print Ossner's or Au N thow, ,\gent's line(Electronic.Signature) ate
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 Hume Improvement Contractor(HIC) Program),will ,w have access to the arbitration
program or guaranty fund under.M.G.L.c. 112A.Other important information on the HIC Program can be found at
t,tt is n1,11.,.t;,t Ok I Information on the Construction Supervisor License can be found at dpt
Wien substantial work is planned, provide the information below:
Total floor area(sq. ft.) _ __--_I including garage. finished bosentent attics.decks or porch)
Gross living area(sq. tl.) __-- _ - -- Habitable room count
Number of lireplaces_-- .-- `'umber ofbedr ones
Norther of bathrooms - _ Number of half hatlu
I)pe of heating slstcm .. ._ . _ ._ Number oftlecks, porches.
F�pe of eoulhlg s)stem Ir.nclosed _ _. . . -_-Open
i I
i "folal Project Square Footage-m;q be substituted for-Fot:d Project Cost'
• t
yt
NSCAP-Home Enerey Report
Jobk Date Buildin Performance ec Spialist i }gyp /Contractor Telephone
Doug Cranford
(978)335 7154 Cell
fti� - oZ
Building Type: , S�. a Q Q Siding Type: G
Attic Inspection: N rtificate gf,lnsulation: �- - Blower Door TesL• YesIQN
,. ....
Install Bath Fan:QE)Nalwring Required:Yes gonclude Light.4 bN3 o Existing Fan: iZ�No Existing Light Fixture:YesM Wall Mount: Y s
Location/Notes: �•r- RA,%X w. Date Sent:
Knob&Tube Inspection: Needed: e - No Comp efed:,Yes; No''- Where. -Date Sent:
v m
A m N
a � ;f
m
Door/Location Notes ;� a
ra"t-- c4�1..__. __E:<F............... - -
Q. �a r-r'� wJ�J9 G - - �«�R t•. �0. one ��
_ is 73_R p�rL �• w I �e C� ���.� _ - - X
110
Notes:
on
Clean Gutters:
ohs. 6c�•—
Schlegel Placement 1
I" Floor Wall Height g
C B D
Number of Existing Storms �2
n Switch Gaskets Needed <M No
Starting Point: - -> L to R • size
w
oQ -
G
^ Location / Notes
1 x
2 x
3 x
4 x
5 x
6 x
7 x
8 �— x
g x
10 x
11 x
1z / X i
13 x
First Floor Walls
(
I
I I I I
I I
I
I I I I
r 'I
Schlegel'Placement 1 ry
Floor Wall Height �(2
c a c Number of Existing Storms
A Switch Gaskets Needed Yes No
Starting Point: -- > L to R size A
Q. V R Ip ry r. 0
0 7,F =
� H
x
y Location / Notes w
1 t W x
2 1i4e olt X _
3 X
4 Ir , [ Ir ' �[ [, X a
5 Jb G l O k X
6 u X
7 n ,I X
H X
9 X
10 G�kw 5 x = ;`
11 1 x
�m � k oor Walls �0[ Gable End Walls_
II CIO
i c
l 'I
i I 5°P 1
_ I _
wI I i
I I I I
5
E.--- V7 ` ---
v '
Recessed Lighting: a No Knob & Tube in Attl Yes o Unknown 2
Location: Z°"� rI &o-r Ill Amount: Location:
Attic Access. Yes Type: Location:
Install Attic Access_ Insulate Attic Hatch YwJV25, Weatherstrip Hatch__LZ In late Attic Door_
Insulate Attic Stair Well Walls: Yes: ho
Insulate Attic Stair Well Stairs: Yes No �wvess Cr(C� sulato
Notes/Attic Air Sealing: P— -% `r—
r Ca at
usud L C ,&;
Attic Area Insulation
Attic Flat L x W Attic Slopes L x W Knee Wall L x H Knee Wall Floor L x W
�>L
l tO x3. '
O Floored Partial Open Floored Partial
(.rl Add: Add:
Total:
"SQ FT ��� SQ FT SQ FT SQ FT
Existing -1 1• Gx e
Insulation:
Existing Vents:( a,�y(¢. L6x Zt? Vents Needed: 't— -r`^- GkL.C� CV
Roof Color:
Diagrams
I i
I
I I
I j I I
J
Basement
Conditioned_ Unconditioned_ Unintentionally Conditioned_ Finished_ Crawl space_ Heated_
Vent Dryer to Outside Yes Already Done Notes:
Penetrations /Air Sealing:
W- J —
U tr w
daq It
�nivr
# Basement Windows Starting Point: ------> Left to Right
1 6.
2 7:
3 8.
_y—�
S 10.
Hot Water Tank Carbon Monoxide Testing Heating Svstem
co Type:
Insulate Pipes: Hot Water Tank @ Flue FHA, FHW, S eo , Gravity, Elec.
Ambient Air
es NO Other
Heating System @ Flue 0
uel: Ambient Air Fuel: Gas Oil Electric
as Oil Stove_ oven 42j, — Efficiency Test Results
klec. rank less Dryer Ambient e,� _ Net Temp % f4 Fa Smoke L
Superstore Asbestos in %ement 02 % CO2 %
Back Drafting: Q No Efficiency $6 % Draft -01.Iwc
Yes nob&Tube in Aasement
Ye No Replace .Yes No
Recommendations or Notes: Pip / Duct Insul:.
Existing Insul: r
W i a01 JD Add: —(r w. aj
Footage: lio
J
Health & Safety Issues
Asbestos: Ve No
Where: Attic osemen Living Area Other:
Moisture Problems: Yes
Where: Attic Basement Bathroom Living Area Other:
Dangerous Lead Paint: <D No
Back Drafting: Yes OZ
Where: Heating System, Hot Water Heater Other:
Volatile Organic Compounds: Ye No Where:
Site Plan
1't Height: Wall: 2n Height: Wall: 3` Height: Wall:
1" Floor Wall Total SQ FT f Floor Wall Total SQ FT: 4.7q 3` Floor Wall Total SQ FT:
Existing Insulation: Existing Insulation:) Existing Insulation:
Exterior Blow Interior Blow Exterior Blow Interior Blow Exterior Blow Interior.Blow,
Wall Insulation Totals
Interior Blow: Exterior Blow:
r
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:=Hec
07/13/11
Primary Contractor: Quest insulation -
Other Contractor: ester Electric,LLC #Bulbs installed $0.00
Cost of Bulbs $0.00
Client: Marjorie Reynolds Inspt$175.00 Max $0.00
Street: 21 1/2 Cross Street Other In Kind $000
City; State;Zip: Salem,Ma 01970 Electrical Work- $0.00
Telephone: 978-744-8854 J$Amount KeySpan $0.00
$Amount National Grid $0.00
Blower Door Test: No Other Utility $0.00
Inspect Knob&Tube: No - . -
Date Job Completed: Estimated Repair Total $1,890.00
Actual Repair Total $0.00
Weatherization - Est Act Cost Est Cost Act Cost
Door Kit 4 $43.00 $172.00
Regular Door Sweep 4 $15.00 $60.00
Automatic Door Sweep $22.00 -
Air Sealing 2-part Foam(per hour) 3 $75.00 $225.00
Attic Air Sealing 2-pan Foam(per hour) 2 $75.00 $150.00
Weatherstrip Window(per side) $5.00
Seal Ducts-Mastic $62.00
W/S&Insulate Attic Hatch R30 1 $30.00 $30.00
$0.00 "
$0.00
$0.00
$0.00
$0,00
$0.00
Weatherization Totals: $637.00 $0.00
Insulation Est Act Cost Est Cost Act Cost
Attic Flat R38 open $1.40
Attic Flat R30 open $1.30
Attic Flat/Slopes R30restricted $1.41
Attic Flat/Slopes R20 restricted $1,35 -
Attic Kneewal R13 FG - - $1.25
Attic Kneewall R15 Cell w/Membrane $1.65
Attic Kneewall Floor R30 restricted $1.41
Insulate Attic Stairs&Walls - $130.00
Sidewalls-Vinyl R15 DP $1.70
Interior Wall-Plaster R15 DP $1.81
1"Rigid Foam Board $1.85
Duct Insulation R5&Seal Seams $2.95
Steam Pipe Insul to 1.5 to 2"R5 80 $6.05 $484.00
Steam Pie Insul to 1.25"R5 80 $5.25 $420.00
DI IW Pipe Insuation R5 6 $2.50 $15.00
Insulate Door w/FB(1"min) 1 $44.00- $44.00
Sill 2-part Foam w/FG Batt R 19 132 $2.00 $264.00
Insulation Totals: $1,227.00 $0.00
Marjorie Reynolds Page 2 DOE 0
O+therMeasures Est Act Cost Est Cost Act Cost
Roof Vent-small $76.00
Gable Vent-rectan lar - $88.00
Recessed Can Cover 1 $30.00 - $30.00
Cut/Finish Attic Access Hatch 1 $100.00 $100.00
Test Drill Sidewalls-4 sides $60.00
Blower Door Test $45.00
Vinyl Replacement Wundow-10lui 2 -$350.00 $700.00
Faucet Aerator $15.00
Low Flow Showerhead $25.00
$0.00
$0.00
$100.00 - -
Other Totals: - - - $830.00
Energy Conservation Est Cost - - Act Cost
Totals: (Max$10,000.00) $2,694.00 $0.00
Repairs - Est Act Cost .Est Cost Act Cost
Handle 1 $15.00 $15.00
Lockset 1 - $70.00 $70.00
Ext.Bhead w/PT/Pr'imed 1 $500.00 $500.00 -
Steel or FG PH Door . - 1 $610.00 $610.00
Solid Core Loan Door w/Hardware 1 $350.00 $350.00 -
Clean Gutters(Pr Hr) 2 $60.00 $120.00
Slide Bolt 2 $20.00 1 $40.00
sae-built tre Bulkhead Door wnambs $415.00 -
Building Permit Fee 1 $100.00 $100.00
$0.00
Health &Safety
Vent Clothes Dryer to Exterior 1 $85.00 $85.00
Vent Bath Exhaust Fan to Exterior $85.00
Replace Dryer Hose $38.00 -
Knob&Tube lns action $175.00
Bathroom Exhaust Fan $500.00
$0.00
Repair Tot: Max$2500.00) $1,890.00 $0.00
Work Order Sub Total:1 1 $4,584.00 $0.00
Measures Est Act Cost_ Est Cost Act Cost
Other $0.00 -- -
Other $0.00
"Heating System Repair $0.00
rr Action approval only
Estimated Job Total: $4,584.00
Job cannot exceed$10,000.00
Job minimum=$500.00 _ -Job Grand Total- $0.00
AUDITOR: Doug Cranford