40 FLINT ST - BUILDING INSPECTION 7 File C'onnnonweallh of Massachusetts
Board of Building Regulations and Standards CITY OF
��(/• } Massachusetts Slate Building Coda, 7S0 CNIR SALEM
Building Permit Application To Construct. Repair. Renovate O nolish a
One-or rtru•fitnlill' Du eMpki;
This Section For 011 icial Use On
Building Permit Number. Date.lpplie -
_
Building 011icial(Print Mane) Siynatu Dute
SECTION I:SITE INFORh1ATl
1.1 Property Add r s! t � 1.2 Assessors %IAp& Parcel Number
I W
I.la Is this an accepted street? -es no Map Number Parcel Numher
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use [Lot Area(sq 11) Frontage(11)
1.5 Building Setbacks III)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
4.6 Water Supply:(M.G.I.c. 40.§Sq) 1.7 Flood Zone Information: 1.3 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal s)stem ❑
Check if yesO
SECTION2. PROPERTY OWNERSHIP'
2.1. gqwnert 4qf Record:
�hr);atnoh� 0noe�nSr2 �Prr/ M4 DI90G
tV;une(r- tint) 7 City.state.ZIP
No.:uuJ Stases relephone Email Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Esistiny Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑- Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Spccily:
Brief Description of Proposed Work':
SECTION J: ESTIMATED CONSTRUCTION COSTS
Item Estin,attd Costs: Official Use Only
(1.abut:rod .\lateriais) Y
I. Building S _3 4-//3„1V I. Building Permit Fee: S Indicate how fee is determined:
'. Electrical S ❑Standard City,Tossn Application Fee
❑Tutal Project C'ostt(Item 6).c multiplier _ -- x
I 1. Plumbing S 2 - -- —
. Other Fees: S
4 Mechanical ill%AC) S List:.— ._—__
Cu+session) S rotal .\II Fees: S
Check \u. ('heck Anio a t: Cash \mown:
Total Project Cuvt: i y/ yy 0 Paid in Full Cl Oulsuwding lialance Due:
(
SEC"PION S: CONSTRUCTION SERVI('FS
5.1 Cbnstructimi Supervisor License(C'SLI
---- ---
I teens¢Nunlher F\pirauon D;ue
Nanw ol'('sl Holder
_li ,�Q✓_I-Q.-/--H✓L----_ ..--- -'--- I'y Pe Description
No. ,n1J Street It 11.)
Say6 vs4 mQRaaricteJl 2P.unil M%ellin
Cit�i 1'o++n.Shoe,/II' SI Slasun
R(' Roulin C'ovcrin
A Window and Sidin
SF .Solid Irucl Iluming \ppliaoces
Insulation
1'cic hone h:mail;IJJress D Dumolitiun
.1.2 Registered Home Improvement Contractor(HIC)
T1lIC'Itegistrntwit N ..nbur Fspirulion Dutc
I IIC'Cum�any Nann g:or I IIC' Iteglstmn Nr�anw -
Nu.w�1I SI7r�ul A L'mml address
rC /Ln�/L✓ �G SQ clQ f�� M� 7P/psi-na yip
Ci /Town, State, ZIP felt hunt
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I.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 lssuan of the building permit.
Signed Affidavit Attached? Yes .......... No...........O
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 (Jr t f1 a m de L2na/B
to act on my behalf, in all matters relative to work authorized by this building permit application.
Print Dwner's Nwne(Elect uc Signature) Date
SECTION 7b:OWNERI 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.
ryf� , _ %le
Print Oaner'.i IMP
c wvtronic.Signature)
NOTES:
I. An Ow=1)
a building permit to do his.her uvvn work,or an owner who hires an unregistered contractor
(nut regurtle Inlprovenunt Contractor(HIC) Program), will nrr have access to the arbitration
programnJ under\LG.L.c. 11?.-V Other important information on the HIC Program can be 111und m1nnnation on the Construction Supervisor License can be found at + +++ n1.1.; II',
2. When substantial lwrk is planned,provide the iitlbrnlation below;
fl+tat floor area I sy. 11.) - __—_.._(including garage, finished basement attics,decks or porch)
Habitable road count
Cross living area I sy. 11.1
\unlberol'lireplaccs ._. \'unlherul'heJnnnns .- .. . .
l Numlherarhathroom5 \tnuheruf'half'hmhs -
I\.pe al hc,uing s)stem _ \umber ot'dccks- porches
Fnclascd Open
� I v pe„I CdPl nlg i\itelll ..
j i, -l',mll lmlccl Square l'ool,lcc 111a\ be UuhStitwcd tor"l allll Proiecl Cost—
Co:mmonul.e_LLA ofM__�csacN
Departrnent oflndustrialAccidents
Ofjcce oflnvesdgatiorxs
600 Washington Street
Boston, MA 02111
www.muss.go�ld_*_a
Workers' Compensation Insurance t �ffidavft: Builders/Contractors/Electricians/Plumbers
A-Pplicmat Information Please Print Legibly
Name (Business/Organizalion/Lndividval): A 1alYR °�
Address: A I
/e eT
City/state/Zip: Q [/ Phone#:
A�re�y/ou an employer? Checkthe approp7WJ
Type of project (required]:
1.5? 1 am a employer with;_ a generzl contractor and I 6 ❑RTew construction h red the sub-contactorsemployees(full and/or part-time).° 7. Remod.elind on the attached sheet ❑ g2.❑ I am a sole prop etor ox pond er— se sub-contractors have g- ❑ Demolitionship and have no employees loyees-and have workers'workk ng for me in any capacity. 9. ❑ Building addti Top. irvsurance.t[No workers' comp. assurance are a corporation and its 0.❑ Elec r cal repass or add lionsrequired.-] cers have exercised their 11.❑Plumbing repairs or additions3.❑ I am a homeowner doing all work t of exem lion sr MGLmyself [No workers' camp. p p 12.❑ Roof rep airs52, §I(4), and we have noinsurancerequued-] t - loyees. [No workers' 13.❑ Otherp. insurance reqused-]
cant that cheek ho:#1 must oso fill out the section below showing thoir worke ma
rs'compensation policy inforlio>
indicating they are doing all work and then hire outside contactors'must subaut a oew affdavit indicating su
*''Homeowners who suh¢Jtthis affidav ch
*My appli it
*Contractors that check this box must attached an add onal sheet showing the nazne of the sub-contractors and state whether or not those eofities have
etnployces. ffthc sob-contractors have employees,they mvstprovidc their worY.crs'wmp.policy number.
lam an employer that isprovidin;workers'compensation insurance for n8 employees. Below s the pot cy and job site
information: — -
'Insurance Company Name: ( ha r 4-o
Policy.#or Self-ins.Lic.#: n o I Ig o(n5 7 3
Expira.on Date:
Job Site Address: 1 t0 r11 N /si S0. P inMG ` _Ci y/Stafe/Zip:c�Q�P r» /t d
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Faihire 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 nepains andpenalties ofperjury that the information_provided above is trueand correct
__g° YI a Date /(�
Si attar:
Phone#: �a
0fficial rise only. Do not write in this area, to be completed by city or town offiei:aL
City or Town: . PermitUcense#
Issuing Authority (circle one):
I.Board of Health 2. Bni]clineDepartment 3. City/lowDClerk 4.ElectriralInspector S.PlumbingInspector
6. Other
Phone#:
Contact Person:
08/2E),'2012 20: 42 17815955820 AMBROSE INSURANCE PAGE 01/01
ACOM CERTIFICATE OF LIABILITY INSURANCE 8/291,901
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
ANIbrose Insurance Agy. , 1ne HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
56 COntral Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lynn, bui, 01901 INSURERS AFFORDING COVERAGE
INSURED
elmngis, 9ii11iam INSURER A:
1]
American Door, Window & Insula.ttio INSURERS: Zj8 Prot®etion i
:L5 Bailey Ave. INSURERC: C
Saugus, MA 01906 INSURER O:
INSURER E;
COVERAGE@;
THE REQUIRI-*GF INSURANCE LISTED BELOW HAVE BEEN CONTRACT
OR THE INSURED MATED ABODE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING
ANY REQUIFlhMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIGH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCFIBEO HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POUCIES,AG'REGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID GLAWIS.
INSR Tyr,EOP INSURANCE POLICYNUMBER p LIw EFF a EXPIo nw+ LIMITS
LTR
GENERAL UASILITY EACH OCCURRENCE $'
tOOL&1L:RCDIL GENERAL LIABILITY FIRE DAMAGE lAny one Fro) $ .I7
(INIVISMADE DOCCUR MED EXP(MY orm P=W) $
A _ CPP0055334-00 5/28/12 5/28/13 PERSONAL&ADV INJURY $
y�.. GENERALAGGREGATE t2,000-000
GEML AOCP:EGATE LIMIT APPLIES PER: PRODUCTS-GOMPIOP AGO $
POLIP2 PRO- M LOC
JLVT
AUTOMOOAE LIABILITY COMBINE nSINGLE LIMIT
ABIS 1,000,000
ANYAITC
ALLOVINEDAUTOS BODILY INJURY $
(Per peman)
SCHEDJLEDAUTOS
B HIRED%UT08 47635400001 8/17/12 8/17/13 BODILY INJURY $
(Par Accident)
NON.YNNEDAUTOS
PROPERTY DAMAGE $
(PW aaoldent)
"RACE LUAILITY AUTO ONLY•EA AGGIOENT $
ANY I'L TO OTHER THAN EA ACC $
AUTO ONLY: AGO a
EXCESS LIABILITY EACH OCCURRENCE S
10 OCCUF CLAIMS MADE AGGREGATE $
a
S
DEDUCTIBLE
RETEN PION $ �,��� ER
WORKERS(:OMPENSATION AND
eMPLOYE111 V UASILm E.L.EACHACGIOENT $
L+ 001606573 12/11/12. 2/11/1.3 E.LDIBEASE-EAEMPLOYEE F5A
Ex,DISEASE-POLICY UMrr i
OTHER
�EaCRIPTION OF SZ TIONSILOCAMNSMi HICLESIEXCLUSIONS ADOED BV ENOORSEMENTISPECIAL PRONSIONB
Carpenisry & Insulation
:ERTIFICATE HOLDER ADDITIONAL INSURED;rNWRER LETTBR CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE
E CCELLEU BEFORE THE fDIPIRATiON
C:3,ty Of Salem DATE THEREOF,THE ISSUING INSURER WILL SINJOVOR TO MAIL.1 Q DAYS WRITTEN
].t:tn. : Building Dept,
NOTICE TO THE CER7�ICATE NOLD6R NAMED TO THE LEFT,SLIT FAILURETO DOSO 6HALL
City hall IMPOSE NO OBLIGATfON OR LIABILITY OF D UPON THE INSURER,ITS AGENTS OR
MA 014.'O fIEPRESF.NTATNE
F;ml em, AUTHORED RE
L "C0RD CORPORATION 1999
V
Massachusetts -Department oi ?uSGc Safety
Board of Building Regulations and Standards
Construction Supers is,r Spccialo
License: CSSL-100824 .
W ILLIAM J DELANGIS ">
15 BAILEY STREET _
SAUGUS MA 01406 _
J..�+ .J� ation
CamrSas:un=_r
05/0512014
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5110
Boston,Massachusetts 02116
Home Improvement�dntfactox Registration
I
me„tetratim 111123
,. ..- —
_ Type: DBA
Expiration: 1,125,2012 Tr# 206381 i
0
AMERICAN DOOR WINDOW & lNSUtA Tt_,_
WILLIAM DeLANGIS -- i
15 BAILEY AVE
w ninr1A 1
SAUGUS, Ni^ v tavv
Update Address and return card.Mark reason for change.
Address ❑ Renewal Empioyment :J Lost Card 1
nosret g OM-�'6MG1�.0,127a �,J /� J
�J Sq {_=.- nw.ulBQlda C!�ti•%/Lpdd¢!JWUEl4 ._.
e..__
License or registration valid for indivldu,.��au.s i
OfOee of Consumer Affairs&Buatoe"Regatadon bpi the expiration date. if Found return to:
Affairs and Business Regulation
ROME IMPROVEMENT CONTRACTOR Office of ConsumerTyne:
_. ®-
c C. Rd$,StrBt:n^,•,`;...::1'!�'!i leiParxr_aso-vwa.....-
Expired i"7 `I .01� - Boston,mA usato
At0ER1CAN DOOR VL!INDQ7A71NSULATION
WILLIAM DeLANG1S .-
15 pAILEY AVE
r C :
�� 'nr�a,.�u�t.rkltnut stEnature,// ,
o hl!nli m NIP.G I7'.0 ---_.c -
,
WAP Work Order
North Shore Community Action Programs,Inc. Job Number: 120618
98 Main Street Work Order Date: 10/17/2012
Peabody,TV A 01960 Ownership: Owner
Phone:978 531.13810
American Door,Window,&Insulation Auditor: Doug Cranford
15 Bailey Avenue Email:deranford@nscap.org
Saugus MA 01906 Cell: 978-335-7154 _
Email:wdelangislgcomcasl'..nell Phone:978-531-0767 x135
Phone: 781.231-0144
Christopher Copelas NGRID Gas $3,413.44
40 Flint St 'total $3,413.44
Salem MA 01970
978-335-77!i9 -
Safety Issue(s): Lead Paint Possible
__ a . 'n•, r ,' l"I!.I'C41"l6fA' 'r 'I'I
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IaII N!I.I I!I MII!II rll' i rl !,{Ii:I!::Clilllluhl.h!nJ!.�l:a��:u�l�l�t{ItlIIII�Ulllrl:ll hIIIIn�hIIIL�{{�I{{u:�rIkLIIIIIIIJI ,,� i IpII111�I'�: „�. I �11,�.��14rlli � I+ill. I nrli ul �;,;n ;,
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lrll ll 41 . 11,� I. t11IIq GI !Qtt. 1 il' pt.��r} IIII I{ IIII ,IiI,MI{ {I p Y16;..! dl'{ij lKa ll.!:
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Ili q 4tlli I;r lmuil p.- .h .f'?'!.,!1LI'd`'rI'ir Y� +II £IN qIp inl r6 , lfiltl't.
I}p:: I l ( u ,101 I1 �'®rl !.:Illln !hl..ifr i'iF.'•. (;�1?, !tl ,I lj d1,
v ia{ 'p U��ilia l :I I�1 Ir Jl" i� tl!IY .i l • IIII{Iil I I .l tl .r• Il:l I:I Ii 1.1 n +.� ..,,Ii l tl,ill� :l� 7..tl.:•ti'
T:dtill ;�,!, IAIl filth{ lil 11171111'IIIii��!I�I�'IIII•:Ill,ll'�Illlnr ll:llllll�n��i�ll�if l�I r�lMill, 111{l�ll{I�klarin1irh �:l��l!il lllh it4�{I�I�r�tS:ll{I,�,I II��,�0.:�rt.:ak{LbItILI�IIIII�h�w JNll!I .lot vl A•n!lril{NII1 114a:a.,,i.d..11 ,�Pr..:
R-30 ❑ioestricted-settled cellulose :;58 $1.37 $764.46
w urL:I!I II
s'll,lIfI ;i}Iljill':I
Rill .! 111111111E lrl litr !II � Illl�,�I�I�IIIIrllillit I,�thl.ilLanlll iJll'I'Iall3! 11�1��1'IiI'III!�1� 3I�ln1l�ll{I!Il�l��ull� .�!�I I�hG UiII���:{IIIId.rI(IC�IL.rW.,ho-. Il G_ .mt,rYllHl<:. 7,l.LII:�.,,io:.11ir„It ..(.tl.. .,:.r..
Prop:i Vent 1.2 $4.00 $48.00
Recta I,lm lar soffit ven.7 6 $27.00 $162.00
Root'veui 865(A sq ft N17 )small '!. $80.00 $160.00
��III ' i:'1 1II, 1.IItI:a l{ l r 1 II�lli:l .,l�.,,l.i!h iIh,1l:i;.{.:II,In:,i,{Ii1 I1 1I1.III! IrIr uIl7I,iI..'!tlAal,l.liSn.'i IIjr,,.tq.,!!+L!,i!ihil Il:yNilI'"I lI!r�nI�f.'il+�lnI"n{'t"Rl)Itlr11l,u yl LiIsa'lr}luih:
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,
Sill tn'?-part foam w/fiberglass batt lib $2.20 $149.60
__ __ rt—,.—^.:,,:, N :: •il• ,, m l•I t�pp�alu.{lItl'�{:I .:I�`.;��LII!!�PiBIpp.III' l nd�P''1q 1u11uI11:'e.,$n1 If11.1,NN6I.htI II Il:ila l l llI�-.t lt:':n,il ll�.I�6-I1I'I{,II 1I�I1III j{nIl!j l l II{l�lIl,!I:Ll:i!i,I:'I2'+ufi.tILH!uI'l.I{g-Il I!I'!IirI,'I Ihn IdI�Il1�1,�I:16";a.i Iu I:b{.IyAiv,l ll illl I'I hL.illl. a,n ,1iL l.i,1IJ.{Ii,rI"p,,!I_ ,II lllIflll'I.ll4I,l�I!tl�UI ll'I:�lr4I Ii�rwI.7I1,F1:!.Iu:;i ryI'!,II 1VII,,II IIII II�II rrI.!iI,I.II.{I1rII{I I',III�!II19IIli-1.Il'1I�b�1nlh!h,,,l;'II��ll'�I,i�i':,L!l,I1,6I•4;.1Ir!ari.il;,!L!�lhh.tI,11{,!,��Iij•IM�Jh!..9pI Ilr"�!�i.,:I'l;I I l!ip11 f'ii�l�'�:y1lk6!,u.it,'IIl Iit LiF1:il II�'!i I6:•6+i 1��,t1771I 4f' !I''4'II�1t?(II4y,fI ItI¢rII IinIr1 lI1l I1nf:.N,,.Lo'"1,it:l.h l;i'?x4'1I.1,4�r,!
• III .
28-3: ',a interior solid sort:door 1 $315.00 $315.00
Fixes-3weep 2 $15.75 $31.50 �',
R-5I>wt'vrap or R-max on door 1 $51.00 $51.00
Weat Let trip s/Q-Ion or.equal 1.2 $45.50 $91.00
Date 10,17/2012 Page 1
WAP Work Order: Job Number: 120618
--' . n
1 !,Ii u, ! 'I an a lnl ? I.l Ili II µ l (I I, il� !' I r I III Il I'�l ij� U{��II j141�I1 I I� II I I: 6'rytlI�� ��III I]I'h.Pl hl�hA�Il±iil�!'
.J �hIG�I?�I�I;I!L�!?!IIIIIIII 811IIIIl�i�ii!illilB�llililiklll9l�l��lllhl�lllJldlulllli?Nll�fll6?IIIII?II�NIii(iI�IIGIIIII�II!Ilrh!11611�o�r,�I�IIIrI�IIh.IPI!�Lilrll� : �llu Il��l� l
Clothes tiryerven7inclu,aing 1 589.00 ;89.00
Exhaus; Diect
I„iI"ll�lI'!;hYIl!I I�I liI lIIl llll1'l1il1 l�ll!I'II!?IIIII�I IaI I?IiI��II'�III'II!�I1nII�!:Iu'�'!l:I!l�IIr?�II>I�tI?'II�1i.N"l11�??I N:I,I!'I>i,l il�IIln{a l lllllli:lI�i I�l�i.Ili1r�,,ll,lIiIl��{i:I I.I;lE'rl�11, ?,isI.J �I?'�IlillI Domes!I:w titer pipe wrap 6 $2.63 $15.78
Hydros i; piipe insulation to l in. 200 $3.41 $682.00
copper {i.lie R-5
Upper'r vei overhang R30 56 $2.10 $117.60
:...L, ,,,,, •IL'r ;il'nr ':h, I'f�'7 II'I!I!1 -!"If lljl'! pI'jj! n11'''11iir'i'I ijl'I IIG•I'ILL�Il�lllhE itJ a!It� i?tM�'li?yI �771�fj,iii
11.{r.l" -.. i" Ir Ipllli,�i:If, IIITTI iJ !":nl'0I 1 ::n11 :17:I. ;,I ? I!r! ^il llr 111 � II i? :r�l? I FI � ��:�Idl liI�Y!9
ly f i.l '..�Iry.l �j �µ,� I'�� ! I !I Iril,li!I�. Ilprll !.I{Llr+q {�I,�I1111 f IIIII lI ''rlllli"I�rlh?LiiIII;; I�II�Ii�IrILlI!I�GN:,��I1YI.44{!N?�:1:,:16�.�pll,lr,li:?11
'll J�;l1l,il'1`11" 1 I'�fil l� � III!I'lill r ljl i, hlll!IIl�lill!I i'Ii.� ,r! IIVI r, I��d�llNlillllllll?illluftl��li.l�hl�il„ellllhh h�l��l�l.11?Il:lllrill�l ail
Attic sI:ling with two-part 1'o am 2 $75.00 $150.00
Basemart>ealing with two-pact 3 � $75.00 $225.00
loam
Blower.l.00r set-up with,pro&post 1 $45.00 $45.00
tests
Cut/fie i ai attic-kneew:all accass 1 $105.00 $105.00
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Page 2
Date, Ki,17/2012