LAFAYETTE PL - BUILDING INSPECTION The Commonweampai&ikiAWMSW
Department of Public Safety
Massachusetts State Bu' ��gg RRde f7�CZ 4
Building Permit Application for any BuildinFlSe�YhYan a One-or Two-Family Dwelling
us Section For Official Use Only)
Building Permit Number: Date Applied: Building Official:
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
No.and Str t City/Town Zip Code ame of Building(if applicable)
�— SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building.. Repair❑ 1 Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
r, Change of Use ❑ Change of Occupancy ❑ Other ER Specify:
MAre building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No
_r ,= Is an Independent Structural Engineering Peer Review required? Yes ❑ No
Brief Description of Proposed Work:i,n c3�) ( ,o, ��\ C
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed (See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5 ❑
1: Institutional 1-1 ❑ I-2❑ I-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use ❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public bk Check if outside Flood Zone❑ Indicate municipal A trench will not be Licensed Disposal Site B4
required Ivor trench or specify:
Private ❑ or indentify Zone: or on site system ❑ permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Conunission Review Process:
Not Applicable 19 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed ❑ Yes❑ or No® Yes❑ No
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
64--\ L I" F0IZ. V .U ,
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
S C K%<,Vl^ '�1 M Cw�ri\'J C`l
Name(Print) No.and Street City/Town Zip
Property Owner ContactInformation:
Title J Telephone No. (business) Telephone No. (cell) a-mail a dress
If applicable,the property owner hereby authorizes
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor \\
Company Name J r `
1-��Y � C k,
Name of Person Responsible foTr Construction License No. and Type if Applicable
f\�o (� :'�,� lLv�g\\ n� _ Ceti vc vim\ `a
Street Ad ress City/To State Zip
Telephone No. business Telephone No. cell e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes 0 No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)—$
1.Building $ 1 cry Building Permit Fee=Total Construction Cost x (Insert here
2. Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note: Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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. l�
lwn-r S.� F�-C�'\V\ �tx Yv� - f1l�JV�r.( c3�5'�`_3 -9 -t���ia 1
Please print and sign name Title ,�� �/T�elep�.h�o�nee No. Date
Street Address City/Tow to Zip /
Municipal Inspector to fill out this section upon application approval: ir-w H 11 � ` t
Name Date
Weatherization Work Order Facility ID: 900091499 Work Order Date 10/22/14
Action Energy 47'Washington St, Gloucester,MA 01930L Auditor&Email: Barry Moir,bmoir@actioninaorg
Project Name Salem HA Pioneer Ter Auditor Phone(s): O.978-283-2131,C.978-879-6929
Address Lafayette PI,Salem Me 01970 Wx Contractor *Air TightWealherization -
Owner/Sponsor Salem Housing Auth Contractor Phone. ,(978)998-4684 .
Primary Contact Diane Boulay, ,978-744-4431xl 17,dboulay@salemha
Other Contact Mike Fitzgerald,978-423-1301,maird super #Bldgs,Apts&Area: 13 Blois),104 Units,54288 SFt.
Lead and Contact Notes: Facility Notes: Construction Type(s) Wood frame platform
Brick ext walls scan insul,Attic under hip roof scans
93 buildings 8 1 BR apt each partly insulated,Wind cooling is evident,need Foundation Type
propavents7 - IPartial Crawl Space
Unit Qty. Energy CcnseMng Measures
Energy Conserving Measures Descriptor or Location Unit Est Actual Unit Cost Est Cost Act Cost
Wall Insulation
Wall con9 ctlon Typels) Secdon 1: - Wall Type Sect 2: r -
Wood cIa b.ani/shakes/shin les or Nnyl dense pac so ft .ar $1_79
Single nailed asbestos/asphalt(densepack) sq ft $2,21
Double nailed asbestos/aluminum(dense pack so It $2.31
Drill rough plaster patch or finish wood plug(de sq ft $1,82
Vinyl over asbestos(dense pack) so It $2,31
Test drill 4 sides flat rate $60.00
$2,50
CenVactorVWd itor K&T
Knob&Tube Wiring �- Findings and iowtion
Door Measures
Weatherstrip w/Q-Ion orequal back porch doors ea 104 $45.50 $4,732.00
Fixed Sweep vmite ea 104 $1575 $1,638,00
Automatic Sweep ea $23 00
R-5 Ducbvra or t-max ore uivalent on door ea $51_00
Repair/Refit Door ea $52 00
Window Measures
Weatherstrip Wintlow/Schle al orequivalent per side $6.00
Glass Replacement to 64 ui as $44.00
Top Sash Lock as $9,50
Miscellaneous Insulation
),
DisVibutlon Type lRatllBnl . Secondary Type
Duct insulation R-5 sq it $3.10
Domestic water pipe wrap in ft $2.63
H tlronic pipe insulation to 1"copper pipe R-5 In ft $3 41
H tlronic pipe insulation 1.25"-1.5"copper pipe In it $3 68
Steam pipe insulation to 1,5"-2"iron a R-S�- In ft $6.35
Steam pipe insulation 3"iron pipe R-5 In fl $7 61
Water Conserving Measures
Spa 2000 showerhead orequivalent SH installs at turnover as $30,00
Aerator 0.5 GPM bathroom ea $15,00
Aerator 2.0 GPM kitchen swivel/dualspray as $21.00
Auditor Notes-Page 1
Heating Energy Service
National Gritl Gas Heat
Attic Insulation
R-38 unrestricted-settled cellulose sq ft it' $1,47
R-30 unrestricted-settled cellulose cut access to check exill sq It 27144 $1 37 $37,187.28
R-18-20 unrestricted-settled cellulose sq It i°i $129
R-18-20 unrestricted-settletl cellulose sq ft $1.29
R-10-12 unrestricted-settled cellulose sq It '.n $1,21
R-30 restricted-slopes/floored fill w/cellulose sq ftR' $1.48
R-18-20 restricted-slopes/floored fill w/celluloE sq ft ni $1.42
R-10-12 restricted-slopes/floored fill w/cellulo sq it _si... $1.30
Therfnodome or Magnetic pull down stairway b Be $180.00
Attic/Kneewall Floor Transition Dense Pack vs/c units donee dlow with teed b In it $2.52
Attic Ventilation
Rectangular gable vent ea $92,00
Roof vent 135(1 sq ft NFV)large as $95.00
Rectangular soffit vent ea $27.00
Pro pa vent In. O.O. Rader$ acing as $4.00
Miscellaneous Measures
Weatherstri Q-Ion orequal)&R-30 attic hatc as $33.50
Blower door set-up with pre&post tests Be $45.00
Attic/basement sealing with to-part foam Attic,see penetrations notes man/hr 26 $75.00 $1,950,00
Attic/basement sealing with two-part foam Bsmf see penmeter Locnote marift $75 00
Seal ducts with mastic or butyl backed toe hr $65.00
Cuttimish attic-kneewall access as 13 $105.00 $1,365,00
Vent kit/bath fan as $89 00
Clothes dryer vent includin Ezhe st Duct Be $89.00
Labor only charge man/hr $60.00
Basement Insulation
Garage ceiling cavity filled sq it $2.10
Sill two- art foam w/unfaced fiberglass ball In it $2.20
Perimeter Wrap R-5 reinforced foil or vinyl face SCI ft $1.91
Perimeter 2"T-max orequivalent foam board sq ft $2.50
6 ml poly on ground sq it $0.75
Air Sealing Descriptions Hours
Bulk head door treatments
Other door or window repair Block and insulate winrlow at
Other Program Repair
Penetrations Penetration Codes lBectricel/Plumbing):CV=chlm neyhent pipe,EP=Electrical penetrations,PP=Plumbing penetrations, Hours
Location(s)Des caption: Wp=^'all plates,RL=Races sod lights,E9=Electrical bores,ForD= Fansorduch,
PP EP WP F
By Pass or Perimeter By-Pass Codes.FKT=under kneewall, CM:: ceilingAvall intersection,Sint=soffit interior,Cnto=cantilawro.emang,SSL= Hours
Locaticn(s)Description: Berl
Auditor Notes-Page 2 Air Sealing Costs Estimated $9,686.00 Actual $ -
Facility Notes:
Brick ext walls scan insul,Attic under hip roof scans partly insulated,Wind cooling is evident,need propavents?
Completion Date: $46,872.28 1< Estimated Total Costs $0.00 lActTotal
.._�..-- a
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 165640
Type: LLC
Expiration: 3/15/2016 Tr# 248557
AIR - TIGHT LLC. WEATHERAZATION
JAMES FORTIN
10 PINE KNOLL DR. ,"-
BEVERLY, MA 01915 >f+s - ---- -_ --- --
Update Address and return card.Mark reason for change.
SCA1 r 2000.05111 Address El Renewal Employment (J [..as(Card
rr J7-1f
Office of Consumer Affairs R Business Regulation License or registration valid for individul use only
GHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration: 165640 Type: office of consumer Affairs and Business Regulation
- JExpiriltion: 3/15/2016 LLC 10 Park Plaza-Suite 5170
-Fr Boston,MA 02116
AIR-TIGHT LLC.WEATHERAZATION
10 PINE KNOLL DR.
BEVERLY,MA 01915 Undersecretary Not vn id without signature
1 Massachu SOUS • Deuartment of Publ:c 5a4ty
`-1 Board of S.ijamJ Regulations a:'.rt Standards
f'unaruc Uon tiupcnt'nr ,
t..ccnse: CS-052576
JAMI;S L• FOR'"n=
III PINEKNOIA,DR
IlcverIY MA 019115
Cnnnnsstoner
10/0312015
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
b 1 Congress Street, Suite 100
Boston, MA 02114-2017
www massgov/dia
Workers'Compensation Insurance Affidavit: General Businesses
Applicant Information c Please PrintLegibly
Business/Organization Name: k
Address: Q _
City/State/Zip: Phone CC-1�s q�,- ('0C �)
Are you an employer?Check the appropriate box: Business Type(required):
LN I am a employer with employees (full and/ 5. ❑ Retail
or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment
2.❑ I am a sole proprietor or partnership and have no 7, ❑ Office and/or Sales(incl. real estate,auto, etc.)
employees working for me in any capacity.
[No workers' comp. insurance required] S. ❑Non-profit
3.❑ We arc a corporation and its officers have exercised 9. ❑ Entertainment
their right of exemption per c. 152, §1(4),and we have 10.❑Manufacturing
no employees. [No workers' comp. insurance required]** I I ❑ Health Care
4.❑ We are a non-profit organization,staffed by volunteers,
with no employees. [No workers' comp. insurance req.] 12.❑Other
-Any applicant that checks box#] must also fill out the section below showing their workers'compensation policy information.
**If the corporate officers have exempted themselves,but the corpomtion has other employees,a workers'compensation policy is required and such an
orgammion should check box#1.
I am an employer that is providing workers'comp tmation insurance for my employees. Below is the policy information.
Insurance Company Name: y"�,
Insurer's Address: \- ',r\ , \�O (�>4
City/State/Zip: � Q�A-
Policy#or Scif-ins. Lic. # OILY S-hy L 3 Expiration Date:
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 MGL 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 certify, under the pains and penalties ofperjury that the information provided above is true and correct
Signature: (� �"'" Date,
Phone#• ��o �c " LIC C-4
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
Commonwealth of Massachusetts
6t A 'b
Citv of Salem
YT
120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641
Return card to Building Division for Certificate of Occupancy UZ
Permit No. B-14-1368
1111111111101
FEE PAID: $15,510.00 PERMIT T 0 MALD
DATE ISSUED: 8/22/2014
This certifies that SALEM HOUSING AUTHORITY PIONEER TERRACE
has permission to erect, alter, or demolish a building 0 bldgl0 PIONEER TERRACE Map/Lot: 330529-0
as follows: Repair/Replace PIONEER,TERRACE REPLACE WINDOWS, APARTMENT DOORS, SCREEN
DOORS, DEMO & REBILD COMMON STAIRS OF ALCwLDINGS '
.c ~�
Contractor Name: NEW ENGLAND BUILDERS & CONTRACTORS fiWl
NER
Contractor License No: 60600 lir , ,y
.,�,, �•,
,k p `,�; � Building Official � r;� �xr Date
,k r fi
This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within siz months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon writtegrequest ,�,,- r.,;°--� " •: ,,
p S
,2,'t 4PHi
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the locaal zoning by-laws and codes.
This permit shall be displayed in a location clear) visible from access street or road and shall be maintained open for public inspection for the entire duration of the
PY a
work until the completion of the same. „i ; r{:. „
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
d
># fit; '-,ui �, M" r, rp-•ssc'�'--!nS-3`�`�SS k4, i^Id 1 i,: f '�. t
HIC#: Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
m 5,
Restrictions: fT
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
Commonwealth of Massachusetts
e� b
` 15 City of Salem
,. .� 120 W ashington St,3rd Floor Salem,MA 01970(978)745-9595 x5641
III,A! P
Return card to Building Division for Certificate of Occupancy -
Structure CITY OF SALEM BUILDING PERMIT
Excavation PERMIT TO BE POSTED IN THE WINDOW �.
CTn
Footing INSPECTION RECORD
Foundation
Framing
Mechanical
Insulation INSPECTION: «� r BY ,i , DATE
H"ry
Chimney/Smoke Chamber
r qx 35
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Final
Plumbing/Gas
Rough:Plumbing
Rough:Gas
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