Loading...
8 GRANT ST - BUILDING INSPECTION The Commonwealth of Massachusetts i Board of Building Regulations and Standards CITY OF SALEM 111 Massachusetts State Building Code, 780 CMR Revised.t/ur 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Tivo-Fuurily D)i e((11 This Section For Official se On Building Permit Number: Date A plied:, z0 h Building Ol7icial(Print Nine) S natuWIO Date SECTION I:SITE INFORI.I Proyrprty A J ss: 1.2 Assess I.I a Is this an accepted street?yes__ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: /.oning District Proposed Use Lot Area(sit It) Frontage(It) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I-c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal ❑ On site disposal s stem ❑ Public❑ Private❑ al Check if yes❑ P P y SECTION 2: PROPERTY OWNERSHIP' wner I of Record, Naine(Print) City,State,ZIP 9&nz fL 91 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(s1 ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other Specify: Brief Descripti n of Proposed Work': SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building g 4,47 I. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee '_. Electrical S ❑Total Project Cost (Item 6)x multiplier x i, Plumbing $ 2. Other Fees: $ q. Mechanical (IIVAC) S List: 5, \Icxcss chmtical ionl (Fire i S Total All Fees: S Su Check No. _Check Amount: _—Cash -- (i. Total Project Cost: S / O��. 5//�( 0 Paid in Full 0 Outstanding Balance Due: r , SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) _ License NumberIf cpi'mioi Dane Nance ol'C:SL Ifolder /uPN List CSL Type Isce helowl I=sr. �/ - No. titreet Type Description ��0� J/e�• O/ -- U l I stri dcJ(Buildings u' o t 35,000 cu. Il.l Cuyl1'oan.Stale.AII' R Restricted I&2 Fmnil Dteellin M Mason RC Roolln,C'ovcrin W'S Window and Sidon 17511 Z7/ 72 SF Solid Fuel Buming Appliances I Insulation "I'elc hone Fntail address U Demolition 5.2 ReWstered Ilom Improvement Contractor(HIC) I IICC 1 11�Lce �srant i 1: iratit Date n ._cp Nq,v� cAt7k y and ,V 9 n 1727-712277 Email address Ci /TowAn, State,ZIP Telc hone 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 lssuanZ of the building permit. Signed Affidavit Attached? Yes .......... 1K No...........❑ 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 14 M /e�A/ LA17 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner s Nance(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, 1 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. I rmt Otsner s nr Authonzed Agents N one(I:[cc troll Ic Sl 811nure) Ic 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 program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at tsttw.m;o.. , .-......_____ -'.c.t Information on the Construction Supervisor License can be found at g)tte.ncus.�,,�.,111s 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. 11.) Habitable room count Number of lireplaces _____-_ Number of bedrooms Number of bathrooms _ _-------- ------ - Number ofhalf,'baths 1)pe of heating system N ._-- -- ----------------- _ - ---_--.__ umber of decks, porches_ .. 1)pcofcoolingsystcm -.. -.------------- —_. Enclosed O en---------------- ---------- 3. "Total Project Square Footage-may be substituted ror-rot:d Project Cost- ACTION, INC 47 Washington Street Gloucester, MA 01930 lax Fxs%mnf It 042-�AA_332 Agency: NSCAP NGRID Application#: PROGRAM: AARAWAP 0' JOB NUMBER: 0 DOE Work Order# . 0 E.S.C.performed?s No Work Order Date: 09/20/11 Primary Contractor: A&M General Contracting I r 1 Other Contractor: Manchester Electric - #Bulbs installed ', 0 . - -- Cost of Bulbs $0.00 Client: Jean McCarthy •""` Inspt$175.00 Max "_ $0.00 . Street: 8 Grant Street „; _ Other In Kind $0.00 ` City;State,Zip: Salem,Ma 01970 Electrical Work $0.06 + Telephone: 978-744-8339 $Amount KeySpan ,: $0.00 $Amount National Grid S0.00 Blower Door Test - No �� _ '.Other Utility ,•,,., , $0.00 s Inspect Knob&Tube. No- P x* Date Job Com_ pleted: `. + _ Estimated Repair Total $340.00 ° S - v Actual Repair Total $0.00 Weatherizatiotr -Estimated'.. Actual'. Cost Est Cost Act Cost Door kit 4 $43.00 $172.00 Regular door sweep 3 $15.00 ' $45.00 - • "• ' Automatic door sweep $22.00 gtl'tdi .. a,i Air sealing 2-part foam(per hour). • 3 $75.00 $225.00 Attic air sealing 2-part foam{per hour) 2 - $75.00 $150.00 '• i •.r Weatherstrip window(per side) - - $5.00 :_i kills' Seal ducts-mastic $62.00 Seal ducts returns-mastic $62.00 W/S&insulate attic batch R30 '- + 2 $30.00 $60.00 .. ' $0.00 $0.00 wr_ls* $0.00 .. n "ti;riti'J aeKlj4' ' $0.00 Weatherization Total: $652. 00 $0.00 r Insulation ' 'Estimated ', Actual Cost # - Est Cost Act Cost Attic flat R38 open $1.40 inn_t tt' aSrpmr. Attic flat R20 open 400 $1.23 $492.00 •r r': Attic slopes R30 restricted - 84 - $1.41 $118.44 Attic flat R20 resin 200 $1.35 $270.00 �• +�'' Attic kneewal R13 FG $1.25 ..i:vkfj'- Attic kneewall R IS cellulose w/membrane $1.65 •-enj ,.'rrb Attic kneewall floor R30 restricted $1.41 Insulate attic stairs&walls $130.00 ,ikslil Sidewalls-Cedar Shingle R15 DP 1362 $1:70 $2,315.40 Interior wall-Blow R15 DP 160 $1.81 $289.60 1"rigid foam board. - $1.85 Hydronic pipe instil to 1.25"R5 40 $3.50 $140.00 `A H y dronic i instil to l"R5 280- $3.25 $910.00 +'n• Steam pipe insulto 1.25"R5 $5.25 7rktir, DHW pipe insuationR5 6 $2.50 $15.00Ei Insulate door-1"rigid board R7 e $44.00 ,GKt111 r z Ig.,Fa Sill 2-part foam w/FG batt RI9 104 -_ $2.00 $208.00 ' �r1. u Insulation Total: $4,758.44- $0.00 l D.__ OE 4 Other Measures Estimated Acutal Cost Est Cost Act Cost Roof vent-small ? 2 $76.00 $152.00 Gable vent-rectan lar .2 $88.00 $176.00 Recessed can cover - $30.00 V'i Si. Cut/finish attic/kneewall access $100.00 Test drill.sidewalls-4 sides $60.00 Blower door test - $45.00 .:'!ttli+ :•Yt.ct Vinyl replacement wiindow-10lui $350.00 >i•:Fn tiwO Faucet aerator $15.00 • .{l- :;h. °. ` Low flow shoiverhead $25.00 `. .1=4' +r If J $0.00 N $0.00 s .:a; ese il:r - $0.00. ) ge tLr, Other Total: _ a• a $328. 00 w .a Energy Conservation Est Cost -Act Cost Total:(Max$10,000.00)� . 1 A x. - a-• -- 1 .$5,738.44 LL $0.00 Repairs - `Estimated' Actual Cost_t Est Cost Act Cost 00$120 $60.00 . a .l,. Clean Gutters( r hr ) - 2, ,- Clean Debris/Move storage pr hr 2 $60.00 $120.00 °. Door en lockset $70.00 liPIC, ` r`#' a' Repair door hinge $25:00 +<•' '' ` t"^" Slide bolt F - $20.00 41 Sash lock $9.25 ;'?} ii'' Steel pre-hungToo,wAite " $610.00 > ;iitr ^ - Solid core door w/hardware $350.00 Glass replacement-to 64 ui $42.00 Site-built interior bulkhead door wfjembs i. $415.00 +itr;0) Building permit fee 1 $100.00 $100.00 $0.00 uiS1.F:r Health&Safety Vent clothes dryer to exterior'-.. $85.00 Vent bath exhaust fan toeAedor 1 - - $85.00 $85.00 Replace dryer hose $38.00 Repair/H&$Total:(Max$2500 00) - - - $340.00 $0.00 F Work Order Sub Total:[ t= $6,078A4 , $0.00 Measures Estimated I Actual Cost Est Cost Act Cost Other W.00 Other $0.00yre�4- **Heating System Repair $0.00 `Yts.• $0.00 Action approval only - - Estimated Job Total: $6,078.44 Job cannot exceed$10,000.00 lJob minimum=$500.00 Job Grand Total: $0.00 AUDITOR: Doug Cranford. CITY OF S.UE.NI, %L�SS.�CHL'SETTS EILILDLYG DEPARTMENT 120 W.ISHLNGTON STREET, 3i0 FLOOR Tm (978) 74S.9595 FAX(978) 740-9846 Kl1®ERLEY DRWOLL MAYOR THomu ST.Pma n g DIRECTOR OF PLBLIC PROPERTY/BULDLNG CMMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section l l 1.5 Debris, and the provisions of MGL c 40, S 54; Building Permit It is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by b1GL c l 11, S 150A. The debris will be transported by: (name of hau er) The debris will be disposed of in fil W 6 oyR (name of facility) (address of facility) signature of permit applicant J.1te I•bn vl(,Lu CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT .I NI a:1 Y:1MKli'1 1. \L\t'r N1 11_.WASHING I US SIXELT 4 S,1t FA MANSAC111 i1 I VS0197.', 978-715-9595 n P.vc.9711-7167846 Yorkers' Compensation Insurance :ILt'ridavit: Builders/Contractors/Electricians/Plumbers itimlicant Inforinalion Please Print Le ibly Nalne IBucilxsslOrQBanirarinNlnJjt`duuOq: Address: /// �or n �/ Cily;Slatc;/.ip�860� &4 �/y 6 0 Phone is % 7� 7V / Z-77 :\re A su air employer! Check the appropriote box: 'Type of project(required): I. 1 am a employer with 02. O 4. ❑ I am a general contractor and 1 6. New construction (full andlur part-unto).• have hired the sub-contractors 7. ❑ Remodeling 2.❑ 1 am a sole prnprictor or partner- listed on the altachcd sheet. : ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. Building addition i No workers'comp. insurance 5. ❑ We are if corporation and its 10.❑ Electrical repairs or additions required.] otTiecrs have exercised their 3.0 1 :mt a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑ owf repair• insurance required.] r employees. (No workers' 13.VOther / ft) romp. insurance required.] -Ally:ytphmnl that chucks but All must also fill out the suction Wait showing(heir w'urkras'contpentitiwu policy intianrotiva 'I fumvuwrcrs whu suumil this affidavit indicting they are doing all work and then him outside coniractors must.uhmil a new affidavit indicating.,tell. -fonorruurn Jim check this box must auachud an addilionul shvel showing the"Into of the suh.conuxrors and their+vvrkun'comp.policy information. /run un employer fhat lr pruvidinx workers'c•ompensaliotr insurance for my etnplayecr. Below is the policy and job.rife ia/urnwtion. / /l Imurancc Company.Name: ----- Policy;t or Sclf-ins.Lic.>3: 7 / .S_p5 �J / _. .._ Expiration Date: LB (�q Job Site :\ddress: C'dytState/"Lip / ` Attach it copy of Ilse workers'compensation policy declaration pale(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ul':vIGL c. 152 can lead to the imposition of criminal penalties of a tine up to 51.500.00 andlur one-year imprisonment,as well as civil penalties in the farm of a STOP WORK ORDER and a fine of up to 5250.00 if Jay against the violator. lie advised that a cupy of this statement may be forwarded to the Office of Invcsngatnnm ul'thc OIA for insurance coverage scritication. /do hereby certify it fall• set 'err onrd pent!tics of er}try shut the inforinullon provided abuse,is truer rsd correct ,i.•aattre Date: abuse,is rho w- FFOfficialuseuitly.ursly. Do not write in this urea,to be cumpletedby city ur fotvnoffiriuLwn: Permitfl.icensc d_thurily(circle one):Ilv:dth 2. Building Mpartlucut 3.Cilyi Polar Clerk 4. Metrical Inspector i. Plumbing Inspector nun: _ _. Phone r'l: Information and Instructions ,Massachusetts Gcneral Laws chapter 152 requires all employers to provide workers' compensation fix their employees. Pursuant to(his-statute, an empfgree is defined as"...every person in the service of another under any contract of hire, express or implied. oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more or the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or(rustee of:m individual, partnership,association or other legal entity,employing employees. However the owner of-a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or oil the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." `1GL chapter 152, §25C(6)also states that "every state or local licensing agency shall withhold the Issuance or renewal of a license ur permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the Insurance coverage required." Additionally, NIGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall anter into any contract for the performance of public work until acceptable evidence ofcompliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please rill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors) namc(s),address(es)and phone nuniber(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please he sure that the affidavit is complete and printed legibly. The Department has provided u space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to till in (he permit/license number which will be used as a reference number. In addition,an applicant - (hat must submit multiple pennitilicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and tinder"Job Site Address"the applicant should write "all locations in (city or town)."A copy of the affidavit(hat has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. it dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. I lic of lice of Investigations would like to drank you in advance for your cooperation and should you have:my questions, please do nut hesitate to give us a call. The Dcparnncru's address, telephone and fax number: ` The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Kcvi-scd 5-26-05 www.mass.gov/dia _ OP ID:SM ACORD" DATE(MMIDD/YYYY) �.� CERTIFICATE OF LIABILITY INSURANCE 03/21111 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 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 endorsements . PRODUCER 781-224-5700 CONTACT NAME: Mazonson LLC www.mazonson.com 789-244-5777 PHONE FAX 701 Edgewater Drive E-MAIL o Ert: AC No: Suite 230 ADDRESS:PRODUCER A&MGE-1 Wakefield,MA 01880-6236 CUSTOMER ID N: INSURERS AFFORDING COVERAGE NAIC N INSURED A&M General Contracting, Inc. INSURER A:Peerless Insurance Co Norman Dube INSURER B:ACE-USA 11SIR Foster Street INSURER C: Peabody,MA 01960 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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 I TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICYNUMSER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL L'ABILITY EACH OCCURRENCE $ 1,000,00 ERTEIT— A X COMMERCIAL GENERA LIABILI Y CBP8762001 03/20111 03/20/12 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE FK OCCUR MED EXP(Any one person) $ 5100 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000r00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00 POLICY PRO LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea acadent) A ANY AUTO BA8762301 03/20111 03/20/12 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Peraccidenl) X NON-OWNEDAUTOS $ $ X UMBRELLA LUAB X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS LIAR CLAIMS MADE AGGREGATE $ 1,000,00 A CU8762501 03/20/11 03/20/12 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY I TOR LIMITS ER B ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICER/MEMBER EX NIA C46275251 03120/11 03120/12 E.L.EACH ACCIDENT $ 500,00 CLUDED? ❑ (Mandatory In NH) ELDISEASE-LEMPLOVEE S 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT s 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SALEM-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATIONTHE City of Salem ACCORDANCEW TH DTHE POLICYNOTICE WILL BE DELIVERED IN PROVISIONS. 93 Washington St Salem, MA 01970 AUTHORIZED �REPRESENTATIVE /— ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD { T� 'f!'om-lnOHa a&, ol.. ��a.AMIGR(WAI�d Office of Consumer Affairs&Business Regulation I HOME IMPROVEMENT CONTRACTOR l c9-sv Regitttratlon: 141124 _Expiration: 1/1212012 Type: Supplement Card A+M GENERAL CONTRACTING INC. MICHAEL FITZGERALD 5 SOUTH RIDGE CIRCLE LYNN,MA 01904 Undersecretary \la..arhu•rtt� Della rrr lilt:nt 111 Puhlii Natrt) Guard ul' Builtlim_ Rc_ulatim. ,uul Ncan&I"(1% . anstruction Supdowisor Specialty License License: CS SL 99933 Restricted to: RF,WS,DM,IC MICHAEL FITZGERALD 9 WINCHEST COURT GLOUCESTER, MA 01930 Expiration: 6/19/2012 Tr 99933