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7 HAYES RD - BUILDING INSPECTION � a514 n The Commonwealth of Massachusetts t'r�rJ CITY OF Board of Building Regulations and Standards I Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: ate Applie Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 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 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 a 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❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 0}��'ner'of Re or c Name(Print) City,Slate,ZIP fJ004 eS tRo� J2) - No. and Stre Telep one 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 W,<pecifv: Brief Description of Proposed Work': li �w SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building $ 6200 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical g ❑ Standard City/Town Application Fee ❑Total Project Cost' (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 6 z6n0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 10-Jqx /- 23-2&3 j gRTp V e License Number Expiration Date Name of CSL Ho d�r List CSL Type(see below) J L 6-J ar--.-- Ty Description No. No.and Street U Unrestricted(Buildings u to 35,000 cu. ft.) _FEZ7—b err �✓ ki Cr�O �� Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances /- j(L�7Zjt� I Insulation Tel w� Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) //1/4-41 / /a _� t(=��^��� HIC R'lr� HIC Reggistra'tion Number Expiration Date HIC om any e or HIC R gistrant Name 7 r AOa fy / ..J No and Street Email address rla M k..` f/1!W �St t3yu-�e to City/Town, State,ZIP 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 .......... m,-' 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_ rl'2p Y e4- ' r / to act on my behalf, in all matters relative to work authorized by this b tiding pe it applica ton. 6Qk-a� L°lme-1 4- "7 - /Z Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' 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. lT_T2L �A �, . -7 ; (Z Print Owner's or AuthoFfed Agent's NNme(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 program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass. ovg /oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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. 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" i CITY OF SALENN itLXSSACHUSETTS • BUEMING DEPART\C&NT ' 120 WASHINGTON STREET, Y'a FLOOR TEL (978) 745-9595 FAX(978) 740-9846 KI%iBERLEY DRISCOLL MAYOR THoaus ST.PIaxRB DIRECTOR OF PUBLIC PROPERTY/BL'ILDL]IG COS12\115SIONER Workers' Compensation Insurance Affidavit' Builders/Contractors/Electricians/Plumbers Annlicant Information // Please Print Leeibllit Naine (Busitws Organizatiowindividual): •4t� !GeaSan/S' byr1A*Asy �st/5u�4 i Ctl.*+/ LL L Address:2d © EP2:�q City/State/Zip: LAA,4Z (MA Phone #: (� � Are you an employer?Check he appropriate box: Type of project(required):, 1.I9 t am a employer with� 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 proprietor or partner- listed on the attached sheet. t 7� ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity, workers'comp. insurance. g. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MOL I LEI Plumbing repairs or additions myself [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.)t employees. LNo workers' 13i r v comp. insurance required.] lyPit7"'� °L.�3C 97 •Any applicam that ducks box el row also fill out the sactioa below showing their worker'compensation policy information. 'I h..ners who submit this aflidsvh indicating they are doing all work and then hire outside ccm set ors most submit a new affidavit indicating sack =C. in tors that cheek that box most anachcd an additional sheet showing the home of rho sub-contactors and their worker'comp.poi icy information. i am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name: �/�" Policy g or Self-ins. Lic. H,,,:,,�++��_ �C173���1 5� Expiration Date: Job Site Address: -7 ��,� ___5 A-, City/State/Zip:._54liep" 61A Attach a copy of the worker ,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 S 1,500.00 and/or one-year imprisonment,as well as civil penulties in the form of a STOP WORK ORDER and a line of up to S250.00 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. l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si lui t tre' 141 [)Are, "• Phone X: Official use only. Do not write in this urea,to be completed by city or town official City or Town: ___,__ Pcrmit/Llccnse# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.CityfFown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: _ Phone hf: 1 i CITY OF S-U.Em, NL1SSACHUSETTS BL'IIALING DEPARTNIEINT 130 WASHLNGTON STREET, 3' FLOOR T EL (978) 745-9595 FAX(978) 740-9846 KIJIBERLEY DRISCOLL MAYOR T HomAs ST.PrERRA DIRECTOR OF PUBLIC PROPERTY/BUI DLNG CO\LNUSSIONER 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 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # 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 MGL c 111, S 150A. The debris will be transported by: i TLagGt M" T-•vC (name of hauler) The debris will be disposed of in : fy���,4t2 7�� AyrPD _ (name of Tacility) (address of facility) SiApfirgp fnit applican 6 - 7 - / Z date Jcbrivl7dw Massachusetts- Department of Public Safeh Board of Building Regulations and Standards. �l Constru6tiq�,Supervisor License License: CS 103471 ' Restricted to: 00 JEFFREY,r MAY0TTE!'' 29 ANDREWS LN i;, EAST KING" CH 03827 ' Expiration: 1/23/2013 ('ununlesiuner Tr#: 103474 (office 0CooumeA�aln $ ne�s aton TEY HOME IMPROVEMENT CONTRACTOR Registration 164554 Type: Expiration '1.DO2013 Individual MAYOTTE � u i JEFFREY MAYOTTE_. 29 ANDREWS LN EAST KINGSTON NH 03827 Undersecretary I ' _. I 03/18!2012 22: 51 1-1815355820 AMBROSE INSURFUJCE PAGE 01/07 I DATE u'�nvDorlY AfXM,a CERTIFICATE OF LIABILITY INSURANCE 3/20/2012 ROOLICER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ambro3e InsUxanCe Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR J 56 Central Ave. ALTER THE COVERAGE AFFORDED BY THE_PO__ ITS BELOW. I Lynn, MA 01901 781-592_820C IN5URERS AFFORDING COVERAGE NAIL# '`ISUREO All Seasons Windows 6 Insulation INSURERA Scottsdale P.O. Box 8229 IIN'BURERB. Arbell�grotection Lynn, MA 01904 INSUR•RC Travelers_,_ INSURER r-- INEURER E: —I :OVERA ES THE POLICIES OF INSURANCE LISTED BELOW HAVE BFEN ISSUED TO THE INSURED NAMED ABOVE POP THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY RECUIR°MENT, TERN OR CONDiTK1N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE IN'OURANCE AFFORDED BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALI.THE TERMS, EXCLUSIONS AND CONCI(IONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN RSOVCED BY PAID CLAIMS. POLIO t ppTNE POLY'Y hggPI A N LFMIT6 `Trt i I, F N E „� POLICY NL'M.b_ER ATE�,• / NY GOTE'MLAII)DNY) FACH OCCURRENCE E 1 QQQ OOrO GFNFRAL LV,NLITY � Or'14AERCIAl-GENERAL LIABILITY I PRGMISE_S�iEO Of¢uon[g) E Sot ��IiLA'IASM•\DE ',xa OCCUR V 1EDEXP(AnYern Penonl A' I — _ CPP0058607 3/19/1.2 3/19/13 PERsaNALaADVN.IURY < . 000 , 000_I — - I IOENE0.PL AGOPE3AT4 E 2 _QQQQQQ I N'�.AG'3PE GA•E LdAIT APcuEs FER PRODUCES-OOMPIOPAGG 3 2 OOO OO� 'CLI._Y I PPO T Ir]LOC. — ' � JEC AJTOSIOBILEUA9IUTy COIANNEO 6N'GL9 LIMIT a 1r000 , QQQ ; IEa eccl2er;1 I ALLONP,DAL'TOS BODILYINJURY E (P a Pa:aPN ' ��SC NHEOULED.LITGS 8 wldRO•urros ! 37797400001 5/15/11 T BDOILVNJUFY s 11 5/15/_3 fPonccltlenU Op OPER1PADAIAAGE �y GrA.cCE'.I<9V.f!V AUTO ONLvEA ACCIDENT 1.5 ANYAI'TO OTHER TH4N. EAACC $ F— ! AVTCONLV: AGO 1 9 FxG?SSI'JVERELLA LIASIL'T �� ! IF EACH OCCURRENCE S OCCUR �I CLAIt,BAlAOE ACiGRF,DATE _ 1— ,S --' 1ET2 nTICN E 6 ' �-•, -�-__�— TWOWVI Ibi1ITS 1 x ERl I \ JRKC S..CMPEN AT LNAND I F4"P aYERs UA 9111ry EL.EACHACC'OHNT E Boo ' 000_, ^R s;oa�. FPtECJnV[ C or/ nasNaeo. Lzcl. > � 4973P69-5-11 12/15/11 12/15/12 EL eiseA,E .BA EMPLDYeF,E_500 000 ' I wa ocu.cr eL.Dlseaee rou.r�unr7& 50 000 SGEGAI.PPOVISONR nv.ow I IL —I _ I C4&'P.I,'TIOr:D'OP[RaTIptiS r LOCnTIGP15IVEHIC LIES I GNCLVFIONS ADDED BY EIODRSF.n1F,N'T i 5PECiAL PROVEON9 ' Carpenr_ry Insulation/Electrical I I CERTIFICATE HOLDER _ CANCELLATION ' SHOVLD ANY CF THE aB')VF OESCIRMED POLICIES Be CANCELLED 9EFORE THE EXPIRATION City Of .Sal@m DA1E THEREOF T'HE IR:i DING INSURER WILL ENDEAVOR TO MAIL 2o DAYS WRITTEN I Attn. : Building Dept. NGI"6G TO THE CERTIFICATE HOLDER NAMGD TO THE LEPT,OUT P.4ILUP.E TO DO 60 GHALL City Ha 11 IMPOSE NO OBLIGATION OR LIAB41TN' OF ANY KNO UPON THE INSURER. i76 AGENT.)OR Salem, MIA 01970 UTM EN Tr\T1VE5 ATHOHONILEO REC TA VF, ' ACORU 25(20CI ICB! -- .. -,�):ACDRD QRPORATION1988 ACTION, INC 47 Washington Street Gloucester, MA 01930 Agency: NSCAP NGRID Application#: PROGRAM: DOE/II 0 JOB NUMBER: 0 DOE Work Order# 0 E.S.C.performed? No Work Order Date: 02/28/12 Primary Contractor:[: A:1IS:eason Windows&Insulation Other Contractor: NA #Bulbs installed _ 0 Cost of Bulbs $0.00 Client: Gerard Lebel 'Inapt$175.00Max $0.0() Street: 7 Hayes Road - Other In Kind %(H)0 City; State;Zip: Salem,Ma 01970 - Electrical Work $2M Telephone: 978-745-4476/Terry: 978-335-1727 $Amount KeySpan $0.00 $Amount National Grid $'0.00 Blower Door Test: Yes Other Utility $0.110 Inspect Knob&Tube: No Date Job Completed: Estimated Repair Total $850.00 Actual Repair Total $0.00 Weatherization Estimated Actual Cost Est Cost Act Cost Door kit 2 $43.00 $86.00 Regular door sweep 2 $15.00 $30.00 Automatic door sweep 1 $22.00 $22.00 Air sealing 2-part foam(per hour) 3 $75.00 $225.00 Anic air scaling z-pan foam(per hour) 3 $75.00 $225.00 Weatherstrip window(per side) $5.00 Seal ducts-mastic $62.00 Seal duct returns-mastic $62.00 W/S&insulate attic hatch R30 $30.00 $0.00 $0.00 $0.00 $0.00 $0.00 Weatherization Total: $588. 00 Insulation Estimated Actual Cost Est Cost Act Cost Attic flat R38 open $1.40 Attic flat R30 open $1.30 Attic flat/slope R30 restricted $1.41 Thermodome $175.00 Attic kneewal R13 FG $1.25 Anic kneewell R15 cellulose w/membrene $L 65 Attic kneewall floor R30 restricted $1.41 Insulate attic stairs&walls 1 $130.00 $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 Hydronic pipe insul to 1" R5 - $3.25 Steam pipe insul to 1.25" R5 $5.25 DHW pipe insuation R5 6 $2.50 $15.00 Insulate door- 1"rigid board R7 2 $44.00 $88.00 Sill 2-part foam w/FG batt R19 $2.00 Insulation Total: $233.00 $0.00 4 DOE Measures Estimated Acutal Cost Est Cost Act Cost f vent-small $76.00 able vent-rectan lar $88.00 Recessed can cover $30.00 Cudfnish attic/kneewall access $100.00 Test drill sidewalls-4 sides $60.00 Blower door test $45.00 Vinyl replacement wiindow- 10lui r$350.00 Faucet aerator 15.00Low flow showerhead 25.00 $0.00 $0.00 $0.00 $0.00 $0.00 Other Total: - $0.00 $o.00 Energy Conservation - Est Cost Act Cost Total: (Max$101000,00) 1 L- $821.00 $0.00 Repairs Estimated Actual Cost _] Estost Act Cost Re I.Ext.wood bulkhead w/PT 1 $650.00 1 1 $650.00 Ad'ust door striker plate 3 $20.00 $60.00 Door entry lockset $70.00 Re air door hinge $25.00 Slide bolt 2 $20.00 $40.00 Sash lock Steel re-hung door w/lite $610.00 Solid core door w/hardware $350.00 Glass re lacement-to 64 ui $42.00 site-bill[[interior LeWUead door wiiambs $415.00 Clean gutters( er hour) $60.00 Building ermitfee 1 $100.00 $100.00 Health & Safe Vent clothes dryer to exterior $85,00 Vent bath exhaust fan to exterior $85.00 Replacement window Icad-safe pranicea $20.�0 Repair/H&S Total:(Max$2500.00) $850.00 Work Order Sub Total: $1,671.00 Measures Estimated Actual Cost Est Cost Act Cost Other $0.00 Other "Heating System Repair '•Action approval only Estimated Job Total: $1,671.00 Job cannot exceed $10,000.00 - Job minimum =$500.00 Job Grand Total: $0.00 AUDITOR: Brandon Dorrington � l-��V^ NSCAP 98 Main Street Peabody, MA 01960 Tax Exempt#: 042-385-280 Agency: NSCAP PROGRAM: National Grid/2012 Sob Number: 0 NGRID Application#: 0 Work Order# 0 Work Order Date: 02/28/12 Job Limit: Primary Contractor: All Season Windows&In Per Unit $4500.00 Other Contractor: NA Client: Gerard Lebel K+T Yes=1 No=O Street: 7 Hayes Road K&T: 0 City; State;Zip: Salem, Ma Telephone: 978-745-4476/Terry:978 Stand Alone: No Fee Code: 0 Blower Door Test:FYTs---1 Stand Alone Yes=1 No=O Inspect Knob&Tube: No Elec.Contractor: Attic Insulation Estimated Actual Cost Est Cost Act Cost Attic flat R49 open(elec heat only) $1.53 Attic flat R38 open 960 $1.40 $1,344.00 Attic flat R30 open $1.30 Attic flat R20 open - $1.23 Attic flat R10 open $1.15 Attic flat/slope R30 restricted $1.41 Attic flat/slope R20 restricted $1.35 Attic flat/slope RIO restricted $1.24 Attic kneewall R13 $1.25 Attic kneewall floor R30 restricted $1.41 Attic/kneewall floor transition DP $2.40 Finished attic access $100.00 Temporary attic access $75.00 Crawl space RI w/poly vapor barrier $2.53 Garage ceiling/floor R30 $2.00 Thermadome $175.00 Roof vent-small $76.00 Roof vent-large $95.00 Pro pa vent $3.75 Gable vent-all sizes SUM Soffit vent $26.00 Anic slope R30 cellulose w/membrane $1.95 Attic slope R20 cellulose w/membrane $1.75 Anic kneewall R15 cellulose w/membrane $1.65 Attic air scaling 2- art foam $75.00 Ventdryer/bath exhaust fan $85.00 1 N Page 2 National Grid2012 Estimated Actual Cost Est Cost Act Cost Wall Insulation - Single nailed asbestos/asphalt R15 DP $2.10 Double dcd ubcnoslalummum RI5 DP 915 $2.20 $2,013.00 Brick/slucco RI5 DP $2.75 Interior wall blow-plasterR15 DP $1.81 Clapboard/wood shingle/vinyl R15 DP $1.70 Test drill 4 sides $60.00 Sill 2-part foam w/FG ban R19 124 $2.00 $248.00 Sill insulation R19 faced $1.50 Perimeter wrap R5 $1.82 Air Sealin Door kit 2 $43.00 $86.00 Regular door sweep 2 $15.00 $30.00 Automatic door sweep $22.00 Air sealing 2- art foam $75.00 Sash lock $9.25 Glass replacement $42.00 Blower Door Setup 1 $45.00 $45.00 Total Air Sealing Cost: Heating System Measures Duct insulation&seal seams(sq ft:) $2.95 H dronic pipe insulation to 1"R5 225 $3.25 $731.25 Hydronic pipemsulation 125"+R5 $3.50 Steam pipe insulation to I.25"R5 $5.25 Steam i e insation 1.5'' 2"R5 $6.05 Boiler/fiunace ul replacement $0.00 Program repair $0.00 Actual Total does not include $175.00 K&T charge. $4,497.25 Est Total SU.UU Act Total AUDITOR: Brandon Dorrington