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68 HIGHLAND AVE - BUILDING INSPECTION (2) The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application-To Construct, Repair,Re to Or Demolish a O -or wo-Family Dwelh I�l This igetigh For Oftic' Use Only Building Pe t Number: D e Applied: 42 Building Official(P me) � Signature 1Date ,6z SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers h q H W) 73h eve. 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 Use Lot Area(sq ft) Frontage(It) 1.5 Building Setbacks(ft) Front Yard .Side Yards 4,y , Rear Yard Required Provided Recta ovided Required. Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information:— -1.8 Sewage Disposal System: Zone: x' Outside.Flood Zone?," Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP. 2.1 Ownerr QQf Record: ! 8 C v �Y _ LC A<_zy Name(Print) Ch , tote,ZIP. „ No.and Street el� Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify: Brie Description of Proposed Work': — L v \ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ , 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 (HVAC) $ List: 5.Mechanical (Fire $ Su ression Total All Fees:$ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ , �� ,�� 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) tit� � lln jf�,Xm c-- License Number Expiration Date Name of CSL Holder Lis[CSL Type(see below) �7 O v� No.and Stree Type Description U Unrestricted(Buildings up to 35,000 cu.ft. e-Vl.('-\. yyyp, cm$.I R Restricted l&2 Family Dwelling City/Town, State,Zl M Masonry RC Roofing Covering WS Window and Siding c SF Solid Fuel Burning Appliances G r I Insulation Tele hone -r Etltail address D Demolition 5.2 Registered Home Improvement Contractor(HIC)\� h �� \ .1 iv--lii ��.ctCLCVI HIC RegistrationNumber Expiration Date HIC Company Narde or HIC Registrant Name No.and Street Email address .. Ci /Town, Stat ZIPr-, 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 ..........EkNo...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this Wilding permit application. � A5'�m �- v\ 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. Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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 can be found at www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/d s 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"maybe substituted for"Total Project Cost" ,� � �`c�s 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: 07/15/11 Primary Contractor: Air-Tight Weatherization Other Contractor: Manchester Electric,LLC #Bulbs installed $0.0o Cost of Bulbs 50.00 Client: Amanda Cutone Inspt$175.00 Max $0.00 Street: 68 Highland Avenue Other In Kind SO.Iri) City; State;Zip: Salem,Ma 01971 Electrical Work S0.00 Telephone: 978-979-4418 $Amount KeySpan S0.00 $Amount National Grid $0.00 Blower Door Test: Yes Other Utility S0.O0 Inspect Knob&Tube: No Date Job Completed: Estimated Repair Total $420.00 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• art Foam(per hour) 4 $75.00 $300.00 Attic Air Sealing 2-part Foam(per hour) 3 $75.00 $225.00 Weatherstrip Window(per side) $5.00 Seal Ducts-Mastic $62.00 W/S&Insulate Attic Hatch R30 $30.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Weatherization Totals: $757.00 $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 R30 restricted $1.41 Attic Flat/Slopes R20 restricted $1.35 Attic Kneewal RI FG $1.25 Attic Kneewall RI Cell w/Membrane $1.65 Attic Kneewall Floor R30 restricted $1.41 Insulate Attic Stairs&Walls 1 $130.00 $130.00 Sidewalls-Vinyl RI5DP 1947 $1.70 $3,309.90 Interior Wall-Plaster RI DP $1.81 1"Rigid Foam Board $1.85 Duct Insulation R5&Seal Seams 190 $2.95 $560.50 H dronic Pipe Insul to I"R5 $3.25 Steam Pie Insul to 1.25"RS $5.25 DHW Pie Insuation R5 6 $2.50 $15.00 Insulate Door w/FB(1"min) 2 $44.00 - $88.00 Sill 2-part Foam w/FG Batt R19 118 $2.00 $236.00 Insulation Totals: $4,339.40 $0.00 11 Amanda Cutone Page DOE 0 Other Measures Est Act Cost Est Cost Act Cost Roof Vent-small 4 $76.00 $304.00 Gable Vent-rectangular 2 $88.00 $176.00 Recessed Can Cover $30.00 Cut/Finish Attic/Kneewall Access $100.00 Test Drill Sidewalls-4 sides $60.00 Blower Door Test 1 $45.00 $45.00 Vinyl Replacement Window,-101 ui $350.00 Faucet Aerator $15.00 Low Flow Showerhead $25.00 $0.00 $0.00 $100.00 Other Totals: $525.00 $0.00 Energy Conservation Est Cost Act Cost Totals: (Max$10,000.00) $5,621.40 $0.00 Repairs Est Act Cost Est Cost Act Cost Clean Gutters&D outs( r hr) 2 $60.00 $120.00 Adjust Door/Rear/Re-fit 1 $50.00 $50.00 Eave Repair 1 $150.00 $150.00 Steel PH Door w/Lite $610.00 Solid Core Door w/Hardware $350.00 Sash Lock $9.25 Glass Replacement-to 64 ui $42.00 Site-built Int.Bulkhead Door w/lambs $415.00 Building Permit Fee 1 $100.00 A$420.00 $0.00 Health&Safety Vent Clothes Dryer to Exterior $85.00 Vent Bath Exhaust Fan to Exterior $85.00 Replace Dryer Hose $38.00 Knob&Tube Inspection $175.00 Bathroom Exhaust Fan $500.06 $0.00 Re air Tot:(Max$2500.00) $0.00 Work Order Sub Total: $6,041.40 $0.00 Measures Est Act Cost Est Cost Act cost Other $0.00 Other $0.00 "Heating System Repair $0.00 **Action approval only Estimated Job Total: $6,041.40 Job cannot exceed$10,000.00 Job minimu m=$50 00 Job Grand Total: $0.00 DITOR: Doug Cranford i NSCAP 98 Main Street _ Peabody,MA 01960 Tax Exempt#a 042-385-280 Agency: NSCAP PROGRAM: National Grid/2011 JOB NUMBER: 0 NGRID Application#: 0 Work Order# 0 Work Order Date: 07/15/11 Job Limit: Primary Contractor: Air-Tight Weatherization Per Unit $4500.00 Other Contractor: Manchester Electric,LLC Client: Amanda Cutone K+T Yes=1 Now Street 68 Highland Avenue K&T: 0 City;State;Zip: Salem,Ma 01971 Telephone: 978-979-4418 Stand Alone: No Fee Code: 0 Blower Door Test: Yes Stand Alone Yes=1 No-0 Inspect Knob&Tube: No Elec.Contractor: Attic Insulation Est Act Cost Est Cost Act Cost Attic Flat R49 open $1.53 Attic Flat R38 open $1.40 Attic Flat R30 open $1.30 Attic Flat R20 open $1.23 Attic Flat RIO open $1.15 Attic Flat/Slope P30 restricted $1.41 Attic Flat/Slope R20 restricted 1 850 $1.35 $1,147.50 Attic Flat/Slope RIO restricted $1.24 AtUcfKW Floor Transition DP-lin.ft. $2.40 Attic Kneewall R13 $1.25 Attic Kneewall Floor R30 restricted $1.41 Finished Attic Access $100.00 Temporary Attic Access $75.00 Crawl Space w/Poly Vapor Barrier $2.53 Garage Ceilin lour R30(w/approval) $2.00 VentDryer/Bath ExbaustFan 1 $85.00 $85.00 Therrnadome S175.00 Roof Vent small $76.00 Turbine Vent S160.00 12"Stack Vent $145.00 Pro pa Vent $3.75 Gable Vent all sizes) $88.00 Soffit Vent $26.00 Attic Air Sealing 2-part Foam(2 Ins max) $75.00 Amanda Cutone Pa e 2 National Grid/2011 Est Act Cost Est 691cost Wall Insulation Single Nailed Asbestos/Asphalt R15 DP $2.10 Double Nailed Asbestos/Aluminum R15 DP $2.20 Brick/Stucco R 15 DP $2.7$ Interior Wall Blow-Plaster R15 DP $1.81 Clapboard/Wood Shingle/Vinyl R15 DP $1.70 Test Drill 4 sides $60.00 Air Sealin Limit: Sin le Family wBlower Door=S400 All Others=5200 Door Kit $43.00 Regular Door Sweep $15.00 Automatic Door Sweep $22.00 Air Sealing 2-part Foam(3 hours max) $75.00 Sash Lock $9.25 Glass Replacement $42.00 Blower Door Setup $45.00 Total Air Sealing Cost: Heating S stem Measures Duct Insulation&Seal Seams(sq ft) $2.95 H drone Pipe Insulation to 1"R5 $3.25 H dronic Pipe Insulation 1.25"+R5 $3.50 Steam Pipe Insulation to 1.25"R5 $5.25 Steam Pipe Insulation 1.5"-2"R5 $6.05 Boiler/Furnace Replacement $0.00 -*Program Repair $0.00 **Action approval needed:Max$500.00 ****Actual Total does not include$175.00 K&T chg. $1,232.50 JEst Total 50.00 Act Total AUDITOR: Doug Cranford �� -�am4nowweald Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration 4 Registration: 165640 Type: LLC �Irt t" Expiration: 3/15/2012 Tr# 294587 Fy i ri 3r ,.4l�e AIR - TIGHT LLC. WEATHERAZATI'Q(V; =;=:n JAMES -FORTIN 10 PINE KNOLL DR. BEVERLY, MA 01915 Update Address and return card.Mark reason for change. ❑ Address ❑ Renewal ❑ Employment Lost Card DPS-CA1 0 50M•04/04 G101216 ✓/t¢ "V/onLllta'/uI/¢aL[R o�.�ddtU.�tW� .,--_- �._. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only uHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registratlon 165640 Office of Consumer Affairs and Business Regulation Expiration 3/15/2012 Tr# 294587 10 Park Plaza-Suite 5170 ,.� Boston,MA 02116 TYPe AIR-TIGHT LL ION - JAMES FOR TIN etc r 10 PINE KNOLL DR,,,` / ��✓--76f.E�'--- , BEVERLY, MA 01915 Undersecretary Not valid without signature d c.ct s i,Drpa t. ,v d P:d:!'. ` :.I'; Bo:.r ut B tildimJ Regrulaiior.s and Standards Ccnsr.rue ic,1 5 iPter✓isor Lie.r;e License: CS 52576 . �. Restricted to: 00 i 1 JAMES E FORTIN 10 PINEKNOLL OR J BEVERLY, MA 01,915 cT E::7irati+l: 10/3/2011 ('ummissiuner Tr#: 200 The Commonwealth efMassachusetts Department of Industrial Accidents Office of Investigations 600.Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): \ { — Address: \ k:) 't rl e., 'l City/State/Zip: e—v e C \ Phone#: Are you an employer?Check the app date box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full andtor part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.It7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. workers'comp,insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10 ❑Electrical repairs or additions required.] officers have exercised their 3.❑ I 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 ME]Roof repairs insurance required.]t employees.[No workers' 13.�Other t v1c,�,\ssl comp.insurance required.] * Any applicant that checks box Yl most oho tgl out the sealon below showing their workers'compensation policy intbrmaden. t Homeowners who sulun(t this affidavit indicating they are doing dl work and then hie outside contractors most submit it new a@idavit indicating such. lContrectors that check this box rust attached an additional sheet showing the ouno of the sub-contractors and their workers'comp.pot Icy infomretion. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site Information. _ 4 Insurance Company Name: $N,) Cp CT j CI`y�) h O L H Policy#or Self-ins.Lie.#: C, a b Expiration Dut, Job Site Address: �z 14 ^ *� —`� _ City/State/Zip: 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 MOL 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 testify under the pains and penalties ofperjury that the Information provided above Is true and correct. Phon e#: Official use only. Do not write In this area,to be completed by city or town offletal City or Town: Permit/Mcense# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: t,