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13 HUBON ST - BUILDING INSPECTION
� � �. ���� �d�/ �` ;� The Commouw�alth of\4assachusetts ��. ,-, Buard of Buildiug Regulations and Standards CfCY OF 3 � ' ��1�( Massachusetts State Building Code, 730 CMR S��LE�[ 1 Xavised rLfar 2U11 � J Building Permit Applicatiun To Construct, Repair, Renova r Demolish a 1 One-or Two-Family Dwe!ling - 'Chis SectionForOfficiat Usa�Only. Building Permit Number: . Date Appli�d•,', y`1c�; '�.r (.:� Building0(ficial(PrintNama) , . �. �Signat �� � fi SECTIOY L SITE [�YFORiV TION. LI Pro erry Address: L2 Assessors hlap 3� Parcel Yumbers L� -�t u f3 t� �k��� l.I a [s this an acceptzd street?yes_ no Map Number Paral Number 1.3 Zuning[nformation: 1.4 PrapertyDimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(ft) 1.5 Uuilding Setbacl<s (ft) Front Yard Side Yards Reaz Yard Required Provided Required Provided Raquired Provided ' 1.6 Wa�/ter Sy{�ply:(�I.G.L c.40,§54) 1.7 Flood Zono Informntion: l.8 Sewage Disposnl System: Public H Private❑ Zone: _ Outside Flood Zone? N[unicipal O On site disposal system ❑ Check if yes� ' SECTI 2; PROPERTY'O�YNERSHIPL'': 2.1 Owner��R�qrd: L an 2i �/1-/t///f1R..t' �'f �� . Namt(Print) City,State,Z(P ,�'D C�—rrfi��'�, G/g 74(3/�i No. and Street . Telephone Email Address SECT[ON 3: DESCRIPTION OF PROPOSED WORK'(check all that applyl New Construction ❑ Existing Buifding❑ Ownet-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Dzmolition 0 Accessory Bldg. ❑ NumbarofUnits Other Specify: Brie escri�tion uf Propgsed�V�;; CKS&� Z Y' lF I ` tKP'� � • �Sa Lr�a v � , SECT[O�F l: ESTI�LaTEDCONSTRUCTIONCOSTS , (cem Estimated Costs: Officlal Use Only. Labor and �faterials L Building $ ��Q, B� � Building Permi[Fee�$ indicate haw Fee is determined: �. fileccrical $ Q Standaid,City/'Cuwn Application Fee ' V �� .O'Cotal Pioject Cost�(Item 6)x multiplfer x J. Plumbin; i 8l�Q 2_ pther FeeS: $ L \lachanica! (IfV.\C) S �� LisL• i. :�Icchanir:il (Firt $ Su , �rc;si��n) _ I'ot�l :Vl Fces: .S I /,� �� Chtck�Io. Chc�k rlmount C;�sh ;\uioimt--- --- n fnfal Prn'eet Cust: S � � � ❑ I u�l in Pidf ❑ OutsCinding 13:il,tnce Du::: ' - — ---- _ _ _ _ — — ---- ---- ------------- — `=__ `_-. __.. �/�%�/G 1�G �o'�''T�c-�z� - src�r�o�v s: co:vs�rizuc rio� sH;avicH:s S.l Construction Sipervisur Licciue(CSL) �fs+,�„��-- �� �7' �j �n - l��//�1G�� _ Licensa Numbcr Gspiratiun Ducc Pn' L Nnme uf CSL I lo dcr List CSL'Type(sez bzlow) 6 � �� �m �� rypz Descriptiun Nu. and S'trczt L�ar J �� o ���'v U Unrcstrictcd DuilJin s u to Ji,000 cu. R. R Rcstrictcl ISc?F;unil Dwallin Cit Pown,Sta LIP� �I �9asonr �. � — 2C Ruotin Cuvcrin� lV5 �Vindow nnd Sidin• �//a� ./� ,r�� SF Sulid Fu�l Elurning Appli;mc�s � '�'2'2�/ 1 ZU u�O)��(� ! �U-✓�� M'`�L [ Ins-ulation Tcla huna Email uddmss D Demolition 5. Registered�mne Im rovement Contractor(H[C) /� 3 3 d 3 / � �r l{/� O�' FI[C Rtgistratian Numb'er.�1 Es irati U e ' 11 ' i an� � naar J{CRc 'strant��l'_� �_,�,✓�m (j___//y�n��^A, ' r L� �� (W .lXL 7 (S! � N� � � �� \ /U���!v Email�ddress 1/ /!� tG� Ci /Tuwn,State, ZIP Pale hune SECTIOY 6: �VORKERS' COMPEYSA'C[ON [NSURAIYCE 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 wilt result in the denial of the Issuance of the building permit. Signed Affidavit Attached7 Yes .......... ❑ No ........... ❑ SECTIOIY 7a: OWNER AUTHORIZATIOIY TO BE C0h[PLETED WHEN OWYER'S AGEYT OR CONTRACTOR APPL[ES FOR BUILDING PERD'[IT [, as Owner of the subjzct properry,hereby authorize to act on my behalf, in aU mutrers relative to work authorized by this building permit application. Pr' t Owner's Nxina(Electronic Si mture)V � �te SF.CTION 7b: OWYER� OR AUTHORIZED:\GEN'C DECL:\R:�TIOY �y zntering my nnme balow, [ hereby attest under the pains and penalties of perjury Ihat all oFthe infarmatiun cuntained in this �pplication is true and accuratz to the best of my knowlzdge and understandiny. IPrint Ownar'i or Audwrired:\gtnt't Numc([fcctronit Signaturc) D.itt NOTES: PI. ;1n Owner whu ubtiins a bailJing permit ro do his/her own work,ur;m u�vner who hires an unre�istare�l contnctor (iwt re;istzre� in tha Hoine linprovement l'untractor(HIC) Proyram), will r�ne have access to the arbitratiun progr:un ur gunr�nty tund undcr\L(i.L. c. Ia2A. Other important infunnation un tha HIC Proyram can be found at �a��w.m:u..��uv ora Intbrm:uion on the Construction Suptrvisor License can be found�t�r�vw.m;is;.,:u�d�r: 2. 1b'hen substantial �vurk is plu ed,proviJa tha information baluw: Tut:�l flour aroa(;y. R.) _��Y _(including gar:ige, tinishad basement/:utics,decks or purch) ���o;; living:�rca(;y. ft.l �� � � _ Ffabicibk room touut _ J� NuinbaroFtircpl.ice,--C9 -------- �'umbtrofb�Jcooms -- Vumb�r��fbathr��um; .3 Numhcrofh.�lbbaths _�. '�.-- — _ _. I'vpc of ha uiug,yurin zs' ��i��i, � iumbar ut dack�'�,���chcs � \ - -- — f}pe��f uinlim� ,}':�cm ___ �r_ iclu;cd __.OPcit �� --- -- -- -- — -------- --- � } ..�'��i il Pr��j��:t�yu�iro F�,�,I i,r„ uny� h� �nb;titut I I;�r� I,�i d I'iu��ct l'��;t" 13 I�6� �� � �� ��- �3s � � 3 CITY OF SALEM .�,�,�, # 5, 713 s� ROUTING SLIP 37-o�g6 �y �l'f r+� (Z`i2fl1 Ne« Construction /�(3oU ��� Certiticate of Occupanc� LOCATION /3 I�Jv6at Sr DATE ASSESSORS DATE S G 2� �3 93 Washington Sr, CITY CLERK ��L ATE ✓� � y/�� 93 Washington SL PUBLIC SERVICE DATE �1'��S 120 Washi n SL � WATER � DATE ����� 7 120 Washington St. caoss coNNECT�oN ' a,rE 6 't l3 µ!o ty���,.:- �,.,.�� 5 Jefferson Ave PLANNING J DATE /3 120 Washington St. CONSERVATION TE , 120 Washington St. ELECTRICAL - DATE , 48 Lafayette St FIRE PREVENTION �„l� �P.,`�t DATE s �a �3 29 Fort Avenue �� HEr1LTH � DATE �� 120 �Vashington S . [3UILDING INSPECTO DATE G � 1?0 N'ushington St. � < E Registry ID: /� `y,// q 3 `j',.�!��,(.g�cq/ ,��3'��� . g RatingNumber. EH0183 � � � n.111, �,��{,�� s.� / � , ������� + Certifed Energy Rater: lan Rex � ��.�� Salem 13 H�ban . ��i,r � Rating Date: 05/21/2013 73 Hubon St " gy . � Rating Ordered Foc Frank Lanzillo ' S21em,�MAQ1970 �� � �- , ,�,�� � � /�\ � _ill�' ;'1 i � � �t�i;�i�d�rk,� ���",��������.�."�£u�"���� � ������ � � � . �y {EstimatedAnnual Energy�Cost . 4 �_I Projected Rating 5 5tars Pius � Use MMBtu Cost Percent Projecfed Rating � Heating aa.s $888 36% Cooling 2.5 $131 5% ' 500-qam En�00-30�tin 300-251 250-201 � 20 - 5 0 1 � n�r E ' ie t � 9Y 9 Y � � ter 20.0 $380 15% �' 1 Star 1 Star Plus 2 Stars 'I 2 Slars Plus S r ar I, � SWrs f St PI s ta s 5 t rs PI s Li pl ces 16.4 $864 35% � � 1 0-91 0- 6 ' -7 7 r Le HERS Index: i ' me o rison - %a etG Ph t v I i s -0.0 $-0 -0°�/0 s� ice rges $190 8/0 Gene�al�liiformation�'�"�� '�'�' r+���� P �t '-'�`+�,t �'�;� "y�'?��� p �"�� " �, �� � $2453 100% `w...��u�,w...�a.,a...w..mu. �. .�� �'y, u. ��.ek�� sa�..'�..�i�i�dort�+���'Yd 9.'f,'7+��"is i�_i;�{4t�.s'd�iJ�3��r�'��k'. � � ConditionedArea 1560sq ft Ho s Type efa il et he �����„���,.���,�� Conditioned Volume 12088 cubic u a�o : c diti $ b eme � � � %k�� ��^'�"i Bedrooms: 3 . .� . . � �T home meets or exceeds the mtnimum � ""T^�` ^"+ �";"�'��P'��"'Y�"'4'"� ' `� t'� . criteria for all of[he followin : � � �6Mec�hanicalSystemsFeatures� -s�siM u�,,.�_,ti . ��"�'�`�^��'����,'��"� '';'�°.''�`�'!,� 9 �,.. .��. �.i.�,u��..�xu�.... m,.,x s�&:r�.i`�� � aia�a�'�t �� � a' '�. � Heafing: Fuel-firedairdistnbution,.Naturalgas,90.0AFUE. :.: :, _ � . , Cooling: Air conditioner,Electric,13.0 SEER�. � � - . :� - � ' ' Water Heating: Conventional,Natural gas,0.67 EF,40.O�GaI. - �� � � ' . ...__,.t...:,.. ...,.. , ..._..._ .,.�... . Duct Leakage to Outside: 50.00 CFM. � � � . VentilafionSystem: ExhaustOnly:49cfrn,82watts.-� �_ • -� �� � ' � e - � Programmable Thermostat: Hea6ng:Yes Cooling:Yes �� � - p Bu�IdI g Sliell'Feai e"5�''}„m�:t°`��.'�T:�'�' s '�r`. " ��1�' ,t�` s. ` , ';.�`x"� *,� - .;�:'.v: � w,., m�s.arseu�:s;,.a,�-�..�.,uvr��3s� �"� ^+ ul�a'�u,c< .� � �����b�v :... . Ceiling Flat R-33,R-5 _ _ �Exposed Floor.' �, R-30 � - � � � � � Vaulted Ceiling: NA Window Type: U:0.30,SHGC:0.30 Above Grade Walis: R-21,R-13 Infiltretion: � � Foundation Walls: R-OA � Rate: Htg:4.00 CIg:4.00ACH50 ' - Slab: None . Method Blowerdoortest � , � � .�.�,.�� � . � Lights and Apptlance Feafures . � . ., ; ;.j _ - � �� '' e �.a 'i�� _ Energy Rater: Percentlnterior Lighting: 100.00 Range/Oven Fuel: Natural gas - � lan Rex - Percent Exterior Lighting: 4.00 � � Clothes Dryer FueL Electric . � ' The Energy Hound Refrigerator(kWh/yr): 555.00 , -„ . . �ClothesDryerEF: 3.01 11 Broadway,Suite3 . Dishwasher Energy Factor: 0.00 .Ceiling Fan(cfmMlatt): 0.00 . Bevedy,MA01915 - � The Home Energy Rating Standard Discbsure for this home is available irom the reting providec . 978-233-1433 � ' -� REM/Rate-Residential Enerqy Analysis and Rating Software v13A � � This information does not constHute any warranty of energy cost or savings. , � � m 1985-2012 NchRectural Energy Corporation,Boulder,Colorado. ' � � Certifie er Rater - _... � .... : ., . . � , . r � . , ,�:�°� Ccr�r o� 5:u��t 1�L-�ss�lcHLSErrs . ,: � , : , aLa.orvc Dea.,K-n�.�r ,�)�.�`: �_� . l3O CV.iSHL�1GTON$TREET, 3�F[.00R � ;�' T�i. (9�8) 7�5-9595 F.�.e(97s) I�SU-�B-{6 ;v��pRr�Y DRISCOLL 'h{pyL+SST.FIE.RAB �1c1YOR - DIRECTOROFPL'OCICPROPERTY/BCII.DNGCOSL\IfSS[O�ER � � Nurkers' Cumpensatton Insurance,\ftTdavlt: Duilder�/Contracturr/Electricians/Plumber� ,1 i ilicant fnfnrmuNon Plcate Prfnt Le ih( .. V;1117C lDusinesyOry�nieaiumindividuull: uS� 0/� Q' � , f�l�(�lCSS' 'l . . . City/Sratc/Zip: � � C�l�t6'1—� [�honp:N: "� 1��2-�Z �;1.�� _. ,1rc ynu+�e cmployer'�Cheek lha appropdata boX! ^ 'Pyp�oP p�of cet(rcqulreJ) � . � I:Q��i'amacmployorwitd :,�. .,��agcna�tcontnstaf.anJl-�� '6. nw�comtius�idn � ' , .. �. ` muployeef(tLli adJ/or part-tima}.a " have hin�c7�hu subconfsacwn . , • ` ( 2t� 1 mn a sole propdctor ur purmar- lis�ed on ihe uttanc�d.rha¢t.Y . 7. ❑[Femodeling ` . . '� � .rhip�nd hava na amployeei� � � . . .These su�con�ruton hava. � : 8., (]�emoli�ion ..�' ...' . . . wurkfny Wr ma in uny capaairy. �vorkars'comp.Inmrnnca : �7. �[?uilding addiuon " � . (?lo tvorkcri comp.ineuranee 5. Q Wa oce a corpomtton anJ iia� .. ��' � � - .-.. � ���_ �- '�- rcyu(rcJ.) - � � � � ufRcen hove exnrcieed Ihnit �0.�Etectrical repairf or aJditione . . _ � },0 1 am a homcuwnuF doing all wark cight�o(exemptiun pe�MGL � ��•0 Plumbing repuin�or udditlona - ' myxlf.(\o workcn'cump. a I S4,�1(41.nnd we have no 12.0 Raof mpuua , insuranea«yuircd.J t vmployeqe.[No;evaritera' . - � . . cump.inxuranca requlntd.� 13��O�her •Anyappllc:uqlluteh�k�baxllmus�ntrulillaW�ihvaw�iunh.low�howinyiAa4warkan'mmpenwfonpullry�niLimotlan .• . . ..- •. . �16unvuwn�r�wAu�u6mi�ihla�Illdavi�inJieafn�ihry am doiny oll wah.u�d iAm hI�C nuqid�eenlmtron mwl mhmll a naw a(IlJaril ind(oifny wcly .•. , �Gimrxwnihulch«kihbEuamrola�WcAodma�WitlwmlxhwlehuainyihonwnuofiAam6.vNtutonanJihob'wurYan'mmpyullryjnfi�nwHoa. � /um un.srnploy���huNs provldln,�ivork�n'camptm.adan ln.rprnnee jor wy rmp/uyers �Bduw L�hipo!!cy und fub o•!t� - -- ix�onnulloro v",,�� ' � _/ ,�/ � . Inwr�nceCompuny V�me: /'�s�"Zld�'G� �W/OV� � d-� Pulicy 4 ur ScIC-iiu. Lic.d: W CC D / e b " ^t-6 "� F�cpim�ion Dota: ( !ub Sita AJJrcay:4+' �.� ���6f� O�i CitylSt�tr/2ip:��►�y�L . � .\ttach a cnpy uf lha worlura'companwtlom pulleJ�decl�raUan puKe(ihowlna tha pollcy�numhor�nd axpintlon data� f'ailuru tu sccuru covenya ay rcquireJ unJor SadanlJd uP,L(CL c 132 em�aaJ ro the impwi�ion aferiminal penaltiaa ofa rinc up to SI,SUOAO unJ/ur one•yaar imprieonmcn4�u wcll an civil pcn�INas in thn Fartn uf a STOP WORK ORDEA anJ a line of up�o S?JO.qO�Juy�gainst dia viulamt Ile aJvlauJ that�c��py uf�hiY vmtumcnt may b�r turward�d m�he 011ica oP . � Invesiigwimty ui tlia OIA Wt insunnea envcrayo vcnlic�liun. - /Julrnrby •r !j �uJeiJir uLrt iJpu dr r�/urydruuhiL��unnul/aeproviJrJnbuv isauruuJcurrrat - � ; ., , u:��J: �4 �6�13 r „ ,�� ( 2l?.-.�� i UI/iriu!use unly. 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