117 HIGHLAND AVE - BUILDING INSPECTION 1
� QV 2-
The Commonwealth of Mas=Or,�e#Milt
RECEIVEOF
Board of Building Regulations aERV
Massachusetts State Building CoC f10NAL Revised,thir 2011
Building Permit Application To Construct, Repe#Milt % 142
One-or Two-Family DwU NUS
(� This Section For Official Use Only
\ (_l Building Permit Number: Dato Applied
�✓ ll Zo
Building Otticial(Print Name). Signature . . Date
r SECTION 1:SITE INFORNIATIOW
�1 1.1 Proper A d ess: W 1.2 Assessors Slap& Parcel Numbers
- I.I a Is this an accept street9 yes no Map Number Parcel Number
1.3 'Lotting Information: 1.4 Property Dimensions:
'Coning District Proposed Use. Cot Area(sq tf) - Frontage(It)
1.5 Building Setbacks(it)
Front Yard - Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.0 c.40,§5d) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private O Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yesO
SECTION2: PROPERTY OWNERSHIP'.
2.1 vnert of Recor .
tin �� CityState, I
�.
mNo.and S el �— Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK](check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration($) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other Specify:
BriefDescr' tionofP posed Work': repe1rvD0
V/ s i
SECTION a: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materia )
I. Building S I. Building Permit Fe e:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Totai Project Cost'(item 6)x multiplier x
3. plumbing S �,Qther Fees: S
d.Mechanical (HVAC) S List:
5. Mechanical (Fire fatal All Fees:S
Suppression)
Check No. Check Amount: Cash Amount:
6. Total Projcct Cost: S �Q ❑Paid in Full ❑Outstanding Balance Due:
S.E (U'D TO CSb N-1 V4:4C .
s ( z( z
SECTIONS: CONSTRUCTION SERVICES
5.i C ustructi ti Sup i istir License(CSL) Zl b
f G � License Number Espimti n Uale
Npmc ofC LHolder
List CSL Type(see below)
No. ;u J Street U Type Description
U Unrestricted(Buildings u to 35,000 cu. 11.
//YTi./V�w/ •_r'/ �� _ R Restricted l&2 Family Dwelling
Cityrrown,State,ZIP bt Masonry
RC Rooling Covering
WS Window and Siding
SF Solid Fuel Bruning Appliances
I 1 Insulation
Tcle hone Email uddr ss U Demolition
S.2 istered a Improvement Co tructogr(HIC)„ /-'7�&� Z r
4d L �� HI egislratio umber pi uti n Date
HICC gr� I n)or Fl tegistmnt #e
Nu. nd Stre t O, / Email add ss
Ci /Town State ZIP Tee 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 Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No........... ❑
SECTION 7a:OWNERUTHORIZATION.TOHE COMPLETED WHEN' r
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING ERMIT
1,as Owt er of the subject property,hereby authorize
t9 act o ny behalf,in all mat rs relative to work authorized by this building permit application.
vt `
Print Owner's Nwne( lectmnic Signature) ulate
SECTION 7b:OWNEW 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 applicati is true and accurate to the best of my knowledge and understanding.
X
Print )wner's m Authorized Agent's Name(Electronic Signature) Pate
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 I.G.L.c. 142A.Other important information on the HIC Program can be found at
www mass eov'oca information on the Construction Supervisor License can be found at www.nmssj ov.!dM. .
2. When substantial work is planned,provide the information below:
Total floor area(sq. R.) (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 lor"rued Project Cost"
ofC�%n.f�a�b.e»!'�
Once of Consumer Affairs&Besiness Regulation
ME IMPROVEMENT CONTRACTORp
egistne0on: 't153660 �pBA TYPe•
upiration 12I2112014
Y" -HEAT QUEST INSULATION CO LLC,,'� -
a
ALLAN VEILLEUXJR
5 SHAWSHEEN RD ,y �„ y i
LAWRENCE,MA 0`1843 r `tludenecretary
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor Specialty
i
License: CSSL-099215
t IN
q ALLANM VEII.L -
{ '5 SHAWSHEEN BO - t
t LAWRENCE Mir 01 r
�. . � A. Expiration'
' �Commissioner
081191201B° .
I
HEAT QUEST INSULATION CO. LLC. ESTIMATE FOR. ANDREA COHEN
ALLAN VEILLEUX ADDRESS: 117 HIGHLAND AVE.
5 SHAWSHEEN RD. CITY/TOWN: SALEM, MA. 01970
LAWRENCE, MA 01843 TELEPHONE: 781-913-282S
TELEPHONE: 1-888-886-0052 APPOINTMENT DATE: 11/25/14
TERMS:
THIS PROPOSAL IS QUOTED FOR ACCEPTANCE WITHIN THIRTY DAYS. THIS PROPOSAL BECOMES
CONTRACT UPON SIGNING BY BOTH PARTIES. ONCE THE CONTRACT IS SIGNED, ALL PRICES ARE
FIRM. ALL WORKMANSHIP IS UNCONDITIONALLY GUARANTEED FOR 1 YEAR. OUR MASSACHUSETTS
HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER IS 153660. PAYMENT WILL BE MADE
AS FOLLOWS: 113 DEPOSIT, 1/3 UPON DELIVERY OF MATERIALS, 1/3 UPON COMPLETION, OR UNLESS
OTHERWISE SPECIFIED.
NOTE: HEAT QUEST INSULATION CO. LLC CANNOT BE HELD LIABLE FOR ANY PRE-EXISTING,OR
POST-EXISTING MOLD ISSUES. NOR LIABLE FOR)ANY ICE DAMMING ISSUES.
PROPOSAL:
WE ARE SUBMITTING THESE SPECIFIATIONS FOR YOUR APPROVAL AND ACCEPTANCE; OUR
AGREEMENT INCLUDES MATERIAL AND LABOR FOR*HE FOLLOWING WORK:
1) INSTALL 3 THERMAL SLIDER VINYL REPLACEMENT WINDOWS IN THE BASEMENT. WINDOWS ARE
LOW-E ENERGY STAR RATED WITH A U-VALUE OF .33 ADD STOPS TO WINDOWS AS NEEDED. COST
INSTALLED WITH WINDOW INCLUDED FOR EACH $250.00 $750.00
2) INSTALL 2 THERMAL DOUBLE HUNG VINYL TILT IN REPLACEMENT WINDOWS IN THE BASEMENT.
WINDOWS ARE LOW-E ENERGY STAR RATED WITH A U-VALUE OF .34 . COST INSTALLED WITH
WINDOW INCLUDED FOR EACH $325.00 $650.00
TOTAL JOB COST DUE AT COMPLETION $1,400.00
GENERAL SPECIFICATIONS: COMPLETE LIABILITY AND WORKERS COMPENSATION INSURANCE WILL
BE CARRIED BY THIS COMPANY UNTIL COMPLETION OF WORK. OWNER TO CARRY FIRE, TORNADO, AND
ANY OTHER NECESSARY INSURANC AS WE CANNOT BE RESPONSIBLE FOR ACTS OF GOD OR OTHER
CASUALTIES BEYGF3D OUR CONTRO HAVE THE RIGHT AT ANY TIME WITHIN THREE BUSINESS
DAYS AFTER THE DATE OF XACCEE CANCEL THIS AGREEMENT, PROVIDING YOU NOTIFY US BY
PHONE, EMAI4 '1R BY ORDIESTIMATOR: AL VEILLEUDATE: 11/25/14 TOTAL: $1,400.00
APPROXIMATE START DAT APPROXIMATE COMPLETION DATE: 11/25/14
ACCEPTANCE BY OWNER: DATE: 11/25/14
s
Diamond Windows
& Doors MFG. Inc.
2300 Series
National Fenestration J�
Radrg Council® ="°'7gyS Vinyl,Mechanical Frame&Welded Sash
Low-E(Solarban 60)/Clear
snencvsraa Product Type:Slider
ENERGY PERFORMANCE RATINGS ,
U-Factor(U.SJI-P) Solar Heat Gain Coefficient
0=33 0.29
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance Air Leakage(U.SJI-P)
Om53
Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole
product performance.NFRC ratings are determined for a fazed set of environmental conditions and a
specific product size.NFRC does not recommend any product and does not warrant the suitability of any
product for any specific use.Consult manufacturer's literature for other product performance information.
www.niraorg"
i
CITY OF SALEM, MASSAmUSE M
;tom Ali BUILDING DEPARTMENT
120 WASERNGTON STREET,31D FLOOR
TEL. (978) 745-9595
FAX AX(978)740-9846
MAYOR THOMAS ST' TIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
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 c40, 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 deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
Rv�I�D
(name of hauler)
The debris will be disposed of in:
/(name of facility)
4kS,-
(address of f facility)
1W
Signature of applicant
ate
T° CI"I'Y OF S.�LE��I, NLAssi: CHUSETTS
BuimwG DEPAR M&NT
3 § l l 120 W.uHL\1GTON STREET, Sae FLOOR
br. T L (978) 745-9595
FAx(978) 740-9846
KI%(gFRf FY DRISCOLL
TrI, OAfAS ST.PiFARH
-L-%Yox
DDtECiU0.OF PL'BLIC PROPERTY/BC1IDl11G CO�L�1ISSfONER
Workers' Compensation Insurance Affidavit—nu lders/Contractors/Electricfans/Plumbers
A 1 ileant Informatinn -Pfcase Print Le ibt
y S
V:1111C(Business Organiration'Imlivi : `
Address: LW
/±
City/State/Zip: O Phone#:.V{,,,R l6aq/
Me ou on employer?Check t e appropriate box: 'type of project(required):
I. I am a cm I with 4. I am a general contracJ
I
p 6. ❑New construction
entpinye fun nrUor pa -time).' have hired the sub•com
2.❑ i m a sol2�rbpnctor or partner-
listed on the attached 7• ❑Remodeling
ship and have nu employees These sub-contractorsS. ❑Demolition
working fix me in any capacity. workers'comp. insuray, 0 Building addition
I No workeri camp. insurance 5. 0 We are a corporation arequired.] officers have exercised10.0 Electrical repairs or additions
3.0 1 am a homeowner doing all work right of exemption per 11.0 Plumbing repairs or additiens
myself.(No workers'comp. c. 152, §1(4),and we h 12.0 Roof repairs
insurance«quired.) t employees. (No workc13.0 Othercomp. insurance requir
•Any applieam nw ahru:ks bus 11 mass also NI uul the secnun below showing their workers'eumpmxall"puliey infmmallon.
'I Inmeuwm".eho,uhmif this atndnvit indicaing ihey arc doing all work and then him outride contractors most submit a now alndavif indicting such.
1c.msmutun abut check ibis bus must attachd an addidonut AM showing the name of the sub•eomnclurs and their workers'comp.put icy infmmalion.
I oar an employer thut is prevldJn tvorkr s' ntprnsadon irrsurmicefor my etaployres. De/uw/s dbe policy and job site
irrforutution.
Insurance Company Name:
Policy it or Self-ins. Go. d: z9 Expiration Date:
Job Site Address: City/State/zip:
Attach a copy of the workers'coApensalloo pulley declaration page(showing the policy number and explrallon data).
Failure to secure coverage as required under Suction 25A ofSIGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S1.500.00 and/or one-year imprisonmcn4 as well as civil penalties in the farm of a STOP WORK ORDER and a line
of tip to S250.00 a Jay against file I r. a advixed that a copy of this statement may be furwirded to life 011ice of
Invesligalione o/the MA i ri c v rage verilicaiiun. -
/du hereby err f rd r t/ u! u enables of perjury then the infunuurlex Pro y/ded u we!•true and c orrect
so-11 1 Date: L�� 1�
4
of/iciul use a ly. Ou nut evrue in this area, to be completed by city ur rosver n/Jleiul
City nr Town:
Issuing Aulhurity (circle one):
1. livard of Ileallh Z. Building Departnfem .1.(filyffawn Clerk A. Electrical luipectur 5. Plnobing htipeetor
6. Other
Cvnfict Perim:_. ___._.__ __ Phonc;r: