16 FORRESTER ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code,780 CMR, 7th edition OF SALEM
"I Revised.7anuary
Building Permit Application To Construct,Repair, Renovate Or Demolish a 1, 2008
One-or Two-Family Dwelling
This Section For Pfficial Use Only
Building Permit Number: I I bate Applied: ` Z• `- D
Signature: Z . 4--lo,
Building Com sio / ns ctor of to s Date
O 1:SITE INFORMATION
1.1 Prop Address: 1.2 Assessors Map&Parcel Numbers
S I
Lla Is this an accepted street?yes t/ o Map Number Parcel Number
13 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?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 ,,g�wnerr of Record:
Name( y-- Address for Service:
Signatur Telephone
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units Other ❑ Specify:
Brief Description of Proposed Workz:�JQ �I'za;�.c>" !wf /<ie.✓
�u.cc arts T•- Sr• r
('Et2- A'['Z.!.r,�,tc-�
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ j5�000 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: •$
4.Mechanical (BVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 0) 000 1 ❑Paid in Full ❑Outstanding Balance Due:
�7461- P4- go70 - h L
r
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) /® 1474
_ 2e o 11 V ame License Number Expiration Date
Name of CSL-H Ider
n1A f�y L..1/ �9ilt` t 7V�n/ y# List CSL Type(see below)
Addres TYW Description
U Unrestricted(up to 35,000 Cu.Ft.
Si R Restricted 1&2 Family Dwelling
_ M Masonry Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(MC)
HIC Company Name br H C Registrant Name Registration Number
A�a ss44" r/ o"e. L...i � s,- tt'r� .ssT61" duN /O- 2/ ' 201l
_ 7A-1—hVgq-A:)70 Expiration Date
SiofiWe 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 .......... q/ No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 1 SA)n v N7 5 eT , as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to work authorized b is building rmit application.
� — L
SignlnurdotoOwner Date
rrSECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
M in YD7 Te as Owner or Authorized Agent hereby declare
that the statements and rmation on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
JEFF�V l�ltAyorr�
Print Name
(VIA IAA,40
Signatu or uthori Agent Date
Si ed unde th 'ns and penalties of
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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq.Ft.) (including garage,finished basementlattics,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"
1 '
' The Commonwealth of Massachusetts .
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leetbly
. Name (Business/Orgonization/Individual):_ AI/ S pC, C 0,j t L(`N/_
Address: 20
-----may
City/State/Zip: ! Phone #:_7z R t — gyp)p
Are you an employer?Check the appropriate box:
1.�m a employer with Type of project(required):
� 4. ❑ I am a general contractor and I 6, ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietoror partner- listed on the attached sheet.t 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for mein any capacity. workers'comp,insurance.
9. E3 Building addition
[No workers' comp.insurance 5. ❑ We.are a corporation and its
required] officers have exercised their 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.] t employees.[No workers'
comp. insurance required.) 13.❑Other
Any applicant that checks box#1 most also fill out the section below showing thew workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
(Contractors Thal check this box must attached an additional sheet showing the name of the subcontractors and thew workers'comp.policy information.
,ram an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: M i.f t uel j ey
Policy#or Self-ins. Lic.#: V-W 6120!rQ 20 LR 00 r Expiration Date: / — 7 ` !Q
Job Site Address: I r Go Pk issma 5T City/State/Zip: .SS lenj „ MG 0e4 70
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 imprisoninent, 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 the pains and penalties of perjury that the information provided above is true and correct,
Si nature: All Date: — 13
Phone#: —
[Contact
only, Do not write in this area, to be completed by city or town official
n: Permit/License#
hority (circle one):
Health 2. Building Department 3. City/Town Clerk 4, Electrical InspectorfiblngInspector
son: Phone #:
+a•c�t A sou{Nrw010121e
� 0/&4". s1d yf �aaaaa(aed� . .. , ..
Office of Consumer Affairs&11"n.es RetaWtioa License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration. 184504 Oftfee of Consumer Affoirs and Business Regnlatldn
. 10 Park Plata-Suite 5170
EaplMWre 10f21/2011 Trf 289821 Boston,MA 02116
Type: Individual
JEFFREY MAYOTTE
JEFFREY MAYOTTE
29 ANDREWS LN.
EAST KINGSTON,NH 03827 Undersecretary
of id wltha i
�. i�lassachusctts - Dcparhnent ur Public Snfeq
9 Ifnard nl' (3uildint Hc_rJations ;Ind SCuul:ud,
Construction Supervisor License
License: CS 103474
Restricted to: 00
JEFFREY MAYOTTE
29 ANDREWS LN
EAST KINGSTON, NH 03827
Expiration: 1/23r2013
('nnmisinner Tr#: 103474
04/09/2010 22: 59 17815955@20 AMBROSE INSURANCE PAGE 01/02
PATS(MMJDDIYWV)
ACQBQTR CERTIFICATE OF LIABILITY INSURANCE 1 10
'RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ambrose Insuranc® Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATfi
d Y r HOLDER. THIS CERTIFICATE DOES NOT AMEND, H%TEND OR
56 Central Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lynn, MA 01901 �-
781-592-8200 INSURERS AFFORDING COVERAGE NAIC#
NGURF_D Delan JlB, Thomas C. INSURERA ProVidence MUtT2a
All Seasons Windows & Insulation INSURERS Ar�bella Protection
P.O. BON: 8229 INSURER D: AIM M11t_73_al
Lynn, MA 01904 INSURER D:
INSURER E:
:OVERAGES
THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEC ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO'WHICH T HIS 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
art s SR
P1I I. C E PO I YEMPIp ON LIMITS R POLICY NUMB ER
GENERAL LIABIUIY - EACH OCCURRENCE S 1 .000,000
7C COMMERCIAL GENERALLIABILITY 7G!;KERAL
En acc 0. A 5 1
CLAIMSMAOE ®OCCUR =,gl ) .5 _000 1
A CPPOOSS607 3/19/10 3/19/11 AOVINJURY s 1 000 0001
GGREGATE 6 2 00O OO
ff'L AGGREGATE LIMIT APPLIES PER: IP0.0DUCTs-DOMPIOP AGO 9 Q OO OO
POLICY j0.0. LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LNd
� ° 1 QQQ 000
ANYAUTC I (Es aCCCanB , , I
ALLOWNEDAIJT08
SODILYINJURY
g SCHEDULED AUTOS (Par Pariah)
e HIRED AWOS � 37797400001 5/15/09 5/15/10 SODILYINJURr
i NONJ1,VNEDAUIO6 (Pnroridxa)
PROPERTY DAMAGE
I (PoraPArkraj °
GARAGF,I,VBILITY AUTOONLY•BAACCOENT 5
ANYAUTO FAADC IS
SIR
THAN
AUTOONLY AGO 9
EXCEBSIUMBRELLA LIABILITY EACH OCCURRENCE E
OCCUR CI CLAIMSMADS 1 AGGREGATE S
D2DVCTIBLE I i °
RETENTION S °
WORXERS COiaPENGAT10NAN0 jj
I.
EMPLOYERT LVIBILrTY F—}�
ANY PR0KMTOMART"Rffl4W" E.L.EACH ACCIDENT S SQO 000
C xFexNOCER6X=090' VWC6009502012008 9/17/09 9/17/10 E.L.DISEASE,EA EMPLOYEI $ 500,000
B E oLobxunor
A 07EEI PROVISIONSDaIaw El-DISFJISE•POLICY LIMIT $ 500,Q00
PYER
I
)ESCRIPTION OF OPERATIONSJLOCATIONS/VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Carpentry & Insulation
i
CERTIFICATE HOLDER CANCELLATION
City of Salem SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORC WE EXPIRATION
DATE TNERBOF,THE ISSUING INSURER Wl"ENDEAVOR TO MAILlO DAYS WRITTE.^1
Attn. ; Building Dept.City Hall NOTICE TO TNF,CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 30 SHALL
-Salem, MA 01901 IMPOSE NO OBUOATION OR LABILITY OF ANY KING UPON 11E INSURER. ITS AGENTS 0R
REPRESENTATIVES.
AUTHORIZED REP 9 N
f
0.CORD23(2001108) (DACORD CORPORATION 1088
ACTION, INC
4T 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; 02125f1b .
Primary Contractor: All Season Windows& Insulation
Other Contractor. NA :.it.Bulbs installed so.oc.
':. Cost 01 Bulos so,I)CG
Client: De'njin Set(Ineligible) Inspt$125.00 Max $0.00
Street: 18 Forrester Street :Other In Kind $c.00
City; State;Zip; Salem, me 01070 ..Electrical Work $0.00
Telephone: 978-745-6707 S Amount KeySpan s0.0n
'$.Amount National Grid $0,00
Blower Door Test: No Qt;hez utility 4%0.CIO
Inspect Knob&Tube: No
Date Job Completed: 01/00/00 Estimated Repair Total $172.75
Actual Repair Total $0.00
Weatherization Est Act I I Cost I Est Cost I Act Cost
Door Kit 2 37.00 1 $74,00
Door Sweep 2 1 $12.25 k $24.50
Automatic Door Sweep $19.25
Air Sealing (per hour 3 $55.00-T $165.00
Attic Air Sealin 2• art foam er hour 5 $60.00'1 $300.00
Weatherstriv Window er side $4.25
Seal Ducts-Mastic $54.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0,00
Weatherization Totals: $563.50
Insulation Est Act Cost Est Cost Act Cost
Attic Flat R35 open 1432 $1.12 $1.003.84
. Attic Flat R30 open $1,05
Attic Flat/Slopes R30 restricted $1,14
Attic Flat/Slopes R20 restricted _ 1.0B
Attic Kneewal R13 FG $1.05
Attic KWall RI Cell w/Membrane $1.33
Attic Kneewall Floor R30 rest. $1.14
Sloped Mansard Soffit Blow R30 1312 2,50 $3 280,00
5walls•DSI.Asbestos R13 DP 310 1 $1.62 $471.20
Drill/Plu •Wood R13 Dense 77 $1.34 103.18
Test Drill Sidewalls-4 sides $53.00
Duct Insulation R5&Seal Seams $222.
H dronic Pie Insul to T'R5 $2.80
Steam Pipe Insul to 1.25"R5 $4.68
DHW Pipe Insuation R5 6 $2.05 $12.30
Insulate Door 36.50
$0.00
Insulation Totals; $5,470.52 $0.00
NSCAP
98 Niain Street '
Pesbody,N1A 01960
'I'as Exempt 9!042,7$$-28()
Ageney' NSC:AP
PROORAM'. National Grid/2010
JOB NUMBI.'.R: 0 NGRID Apellication M 0
Work Order 8 0
Work Order Date: 02/25/10 Jnb Limit:
Primary Contractor, All Season Windows&Insul I'er Unit $4500.00
Other Contractor Manchester Electric,I.,I.0 _
Client: Kathleen Rouchard K+T Vca l No=0 -
Street: 16 Forrester Street '�'.K&T; 0.
City;State;Zip: Salem,Ma 01970
Telephone. 978-979-9463 Stand Alone: ..No
Fee Code: 0
Blower Door Test l No Stand Alone Yes=) No=0
Ins tcct Knol>&"fuhe: No Elec.(:antrnctor:
Attic Imulntion fst Act SH4gJ &SL.G.RSI L ! .VYS
AtUC Flat R49 open $1.25
Attic rmt R;g upen _ $i.12
Auie Flal 1t30 o en $1.05
Attic Plat R2U o rot $0.99
Allie Foal RI Qo ca $0.91
Attic FluVSIo a R30 rest)Avd $1.14
Attic FladSlo re R20 restricted $1.08
Attic Flat/Slope R10 re5lricled $0.99
Attic/K`A'Floor'17ansilion DP $2.00
Attic Kncawall RI3 50.91
Attic Kneewull Floor R30 rest. $1.14
1`ini5hed Attic Access $84,00
'Pent orar Attic Access _ $62.00
C'a"l a,('nmol Vawts,mi'r $1.81
Unra eCeilol Fluor R30 bt ltha roval) $1,21
Vnn Drvc lath I'nn I $70.00 $7U.00
'Oternnuioow $152,00
Ruol Vent small $66.00 _
'I urbiuo Veal S 13$.00
12" Stuck Vcnlnt $126.00
I' >a veto--- 26.00 ---
Gable Vent(zll sizes) $76.00 --
Soffit vent $23.00
Attic Air Sealing 2-purl Coum('_hr5 inn%) $60,00
Knthleeo Bouchard Pa c 2 Nalionul Grid/2010
•\\'nll la.ul� f
-� t CoL c it
Silt Nailed Asbestos/As)halt DP S150
7 I ailed Asbesto' Alwnin"a1 UP 1227 $1.52 ,SI,865.04
prick/$Uicco DP S2,23
1werior Ball 13)ow-Plaster IM - $1.4U
Cla 16mnrd/Viand Shin'.It/Viutl I,]I? $1.99
Tcm Drill 4 sides
$53.00
Air 'ealin Limit:
Sinde Fnmil w/Blower Door=$400
All Others=$209
boor Fait $3700
Door$wee $1225
Automatic Door$wee $19.23
Air Stalin (3hotusmax) 3 $55.00 $165.00
Sash Lock $7.75
Glass Re laeentent $36.50
Blower Door Set" $45.00
'I oul Air Stalin t Cost'
Ileatin -�' teal Menv"res
Duel Insulation&Senl Scams(s(I A) 80 $2,22 $177.60
I1 dronic pipe Ilsulalion to 1"1't5 $2,89
10"wNw Insulation 1.25"+ 9 $3..37
ea Pi1 Insulation 15"to 2.5"R 6BI$tJ 1
SIQBnI Pipe Insulation 2.5"+Rfl
Hoilcr/Pomace Ilt tamale°t $IAO
^•Pro ram Re $1.00
—Action approval needed:Max S5o11.00
"""Actual Total does not include$1ZS.00 K&T chg. $2.377.64 Est Total
r .
$0.00 Act Total
' AUDITOR: Brandon GordngtOn
'E::
LG
CTION, INC
ashington Street h
ester, MA 01930
t :
Agency: NSCAP NGRID Application#
PROGRAM: AARAWAP 0
JOB NUMBER: p 5
1
DOE Work Order# .0' . E 5 C performed? No
Work Order Date: 02/25/10
Primary Contractor: All Season Windows,& IMUlation
Other Contractor Manchaster Elecfnc LC�'
Bulbs Installed :'$r(),JO
t3Qibs 'S0.DD
Client: Kathleen Bouchard n9pt$125.00 Max $O.DD
Street: 16 Forrester Street Other In Kind
City; Slate;Zip: Salem, Ma .D1970 Electrical Work
Telephone: 978-979-9463 $ Amount xeyspan SD.Dri
Amount National Grid :$O,DO
Blower Door Test: No other uti=ty p( .G0
Inspect Knob&Tube: No
Date Job Completed: 01/00/00 Estimated Repair Total $0.00
Aetudl Repair Total $0.00
Weatherization Est Act Cost Est Cost Act Cost
Door Kit 3 37.00 :$111.00
Door Swee 3 $12.25 $36.75
Automatic Door Swee 19 25
Air Sealin er hour $55.00
Attic Air Sealin 21 art foam(per hDvrF. 60.00
Weatherstri Window erside $4.25
Seal Ducts-Mastic $54.00 `-
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00 -
Weatherization Totals: $0.00 $14775 $0.00
Insulation Est Act Cost I I Est Cost I I Act Cost
t Sill Insulation R19 Faced FG 40 $1.20 $48.00
Attic Flat R30 open 1.05
Attic Flat/Slo es R30 restricted $1.14
Attic Flat/Slo as R20 restricted $1.08
Attic Kneewal R13 FG 1,05
Attic KWall R13 Cell w/Membrane
Attic Kneewall Floor R30 rest. $1 A
Drill and Plu -Wood R13 Dense 77 - $1.34 41103.18
Sidewalls-Vin I R13 DP $1 39
Interior Wall R13-Plaster R13 DP 1.40
Test Drill SideWNIS-4 sides 53.00
Duct Insulation R5&Seal Seams $2 22
H dronic Pi a Insul to 1"R5 $2 89
Steam Pi a Insul to 1,25"R5 4.58
DHW Pie Insuation R5 6 $2.05 $12.30:'" -
Insulate Door.___ $3t3.50
$0.00
nsulation Totals: $163.48 $0.00
YwSAANC4k S-t\\ go-il 4,w4
-Kathleen Bouchard Page 2 DOE 0
Other Measures Est Act Cost Est Cost Act Cost
Roof Vent-small $66.00
Gable Vent $76.00
Vint Re Iacement Window-73 ui $312.00
Vinyl Replacement Window-e3 ui $327.00
Vinyl Replacement Window•93 ui $336.00
Vinyl Replacement Wintlow-101 ui $353,00
Vinyl Re I. SSm't HoOnef Window $212,00
Steel Pre-Hung Door 2 $490.00 $980.00
Solid Core Door w/Hardware 330.00
Faucet Aerator . $15.00
Low Flow Showerhead $25.00
Blower Door Test $45.00
0.00
$0.00
Other Totals: $980.00
Ener Conservation Eat Cosl Act Cost
Totals: Max$10,000.00 $1,291.23
Repairs Est Act I Cost Est Cost Act Cost
Re all`/Refit Door $37.75
Adjust poor Striker Plate $20,00
Door Threshold $33.00
Re air Door Hine $25.00
Slide Bolt $20.00
Sash Lock $7 75
Glass Replacement to 64 ui $36,50
$0.00
$0.00
$0.00
Health & $afet
Vent Clothes Dryer to Exterior 70.00
Vent Bath Exhaust Fan to Exterior $70.00
Replace Dryer Hose $32.00
$0.00
$0.00
$0.00
Re air Tot: Max$2500.00 $0.00 $0.00
Work Order Sub Total: $1 291 23 $D 00
Measures Est Act Cost Est Cost Act Cost
othez $0.00
ocher $0.00
_"Heating System Repair $0.00 $0.00
^'Action approval only
Estimated Job Total: $1,291.23
Job cannot exceed $10,000,00
Job minimum =$200,00 Job Grand Total: $0.00
AUDITOR Brandon Dorrington
�NSC.AP; ,I
v, r 5798 Me in Sft'¢er^i I o'it? 1 rll{l
Peabody MA'OY960 : @1 � I ` 1*
Tax EXem t N:032
Ageucy: NSCAP
PROGRAM: National Grbd/2010
A hcation p 0
JOB NUMB6R:.0 '„ +a a GR NID:`, _:,. ...
4Yi °i 9f I;41 IfI tFW ^p't+ykrx�:
Wtirk Order# 0
Work Order Date:02/25h0 Jop],(gfit
Primary Contractor All Season Window,&Insui • ' Per, aif�34SOt1.00 ' F,�G; t "1 • ': .:
Other Contractor: NA •re:
Clietiti Denjin Set(lncliobie) ,I K+ Yes4I N1ra0 '" °iI Strcci 18Forrester$b'eot` `.:'; l " ''i'" et` 6T•"� r,y0 �'.tt .
b.
City State:Zip Salemi,Ma Q197A j �4ull ,v M�r, e8" 9Yelbi tl5n a In,
Telephone 978745r6707 4tt�9{•a+�I�I'NP'''
Cu .Y , 0
e,
Slower Door Test:No ^:5 ': 3ta d Alone Ye�aT No=O
An, ect Knob&Tube: No Elce.Contractor, 'i-1 7 r �h.mil arng � .. . :
,; ,t k ar,;.tt�P'I,t „a;. U1 I k+ �kg '•Ni'rl.arl��:, f i,
Attic lnxulati
... E51 , Abt" t ir° SUSS''. a 1 Est Cost of Ost
Attic Flet 1249 o on'
Attic Flat R38 open $1.12
Attic Flat R30 open -
:. ': -..... ''$1,05
. .
Attic Flat R20
.Or '!i,x°300tI
Attic Flat751oeR30 rrdvicted
Attic Flat/Slo p c'R20 restricted
Attic Flat/Slo a R10
restricted— •"'"' 'C 5'S0.9'9; 1
AttiC/KW Floor Transition DP..
1 • ,w'�$x,00 ,
Attic Kneewail R13 " ,pg'aa're''IjY fix! "!l 1011V, g; "t,
Attic Kneewall Floor R30 rest
Finished Attic Access 4''U'(1i•
Tem ora Attic Access !'�il ,r + s62o
.
a'.
Crawl sate w/Poly�a or nan'ier i �f;'$1.81'! p
Odra eCeilin FloorR30 th'approval) pk, 'lSL21`
Vent D er/Bath Fan
1'hetriiadome ,� I,.•,i;;4r ,��.$152':00,1 ° � � .s..•, '
Roof Vcnl smail .',"•i I�'i 366 ;1r
'Purbinc Vent . ' 41381b<S•I
12"Stack Vent t, $126,00
Pro pa Vent " $3.25
Cable Vent(all sizes) ""�i''': .`:`$76.00
Sot Vent .,. t" h7;' :,-
Attic Air Sealing 2 art tbam 2 hrs trout i lo'i,:." '� ), 'bO.OQ'I °" °'. ..I` ,''.'
'war
D6n�i'n:Sek(Ineligible), Paget .'DOE p `
th'et Measures Est Act Cost t!NEst Cost Act Cost
Rodf Vent;-"small>. ''. ' 4 00 •' -"' 264W .
Gable Vef t i' 76 0
Vin I Re"Iacement Window-73 ui 312 00 'ii
Vm i RepIacement window-83 ui !::1327,00,,
Vinyl Replacement Window-93 ui $338.00
Vinyl Replacement Window-101 ui 353.00
Vinyl Re I. Bsm't Hopper Window $200,00
Steel Pre-Hun Door 1 $490-00 1r$490:00
Solid Core Door w/Hardware $330 00 111.1 ;n+
Faucet Aerator 15 00
l-ow Flow Showerhead $25.00 ."i""•?U-':?i�"::'I'
Blower Door Test $45.00
$0.00
$0.00
Other7otals r'`$754.00 $0.00
U p.
Ener Conservation ^"� T �;;5' "dEstCost ACt Cost
Totals: Max$10,000.00 ¢ '$6,788.02 $0.00
Re airs Est Act' Cost Est Cost Act Cost
Plane/Mit Door 1 $37.75 ? 3b.75
Frame Out Door 1 $100.00 _" ,II$100.00
Foamboardl PI ood Bsm't Door 20 $1:75 " °'$35.00
Repair Door Hine $25.00
Slide Solt $20.00
Sash Lock $7.75
Glass Replacement to 64 ui $36.50 Y
0.00
$0.00
0.00
Health & Ssfet
Vent Clothes Dryer to Exterior ;,r.$70 00. :•-:
Vent Bath Exhaust Fan to Exterior
Replace Dryer Hose $32.00
$0.00
$0.00
Re air lot Max$2500.00 : 172.75 $0.00
;i
$6 , .
Work Order Sub Total: 960.7 7 $0.00
Measures Est Act Cost I Est Cost Ad Cost
Other $0.00
other $0.00
"Heatin $0,00 0.00 ,
-Action approval only r:
Estimated 407otal $6 960:77
Job cannot exceed $10,000.00
Job minimum a$200.00 Job Grand•Total $0,00
AUDITOR: Brandon Dorrington