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6 LANGDON ST - BUILDING INSPECTION S �, The C'onnnomceahh of Massnehusc 4KKal SER ICES .�9 3 Board of Building Reg ulations%vmbards CITY OF r Massachusetts Slate Building Code. 73B C NIy 2 '� %10 SALEM 11,,pp L A Building Permit Applic;ltion 'ro Construct, Repaiamil tE«to Or Demolish a One-or Two-Funlil- Uwdllin,lr This Section For 013 ciul Use Only Building Permit Number: Date Applied; IIuilJing 011icial(Print N;une) S anaturt Data SECTION I:SITE INFORIIIATION rope ty Address- 1.2 Assessors blap& Parcel Numben L` aha ��h I.la Is this—an n d street? -es no M1lap Number Parcel Numlxr I.J Zoning information: 1.4 Property Dimensions: Inning District I'n+pnscd Use Lot Area(sq It) Fronluge(II) pl.6Water uildinISetbacks(n) ard Side Yards Rcar Yard uiredProvided Required Provided Required provided Supply:(M.G.I.c.JU.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System; O Private O Zone: Outside Flood Lone? Municipal❑ On site disposals)Check it' nsp P posal s stem (3 SECTION2: PROPERTYOWNERSHIP' 2.1,. 9f�wnert.of Record: L �Jc�ir/ro�S[?N7 U S �Q�tM , 114rZ 01270 ttt mu(Print) C it)'.State.LIP L� d rJ19n IL qn- 2yI, yM?L/ % No.and Street rele hone P Email Address SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repoirs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Speciry: Brief Description of Proposed Work: SECTION 4: ESTIMATED CONSTRUCTION COSTS Item ted OfRcial Use Only I. Building I. Building Permit Fee: S Indicate how fee is determined: '. Electrical ❑Standard CirytTuwn Application Fee❑Toml Project Cost'(Item 6)x multiplier _ _.xS '. Other fear. S - ..-__.a. .\Iech:mieul till 1(') SLisl: C/�J� /X\S . V. \Icdtanir:d it-ireStiu++rcssionlTuBd .\Il Fees: S Cheek No. _('heckAmount: C,uh \nuun: Total Project CnsC S ❑p;:id in Full ❑Outstanding Bul:mce Due: (�G ox) m ray -\D zs 3 SECTION S: C'ONNTRUci-ION SF.RVIC'ES 5.1 C'unstructiun Supenisor License jC'S,J, j , r, 1. 40 VP I ic.nsc Nur P�pvatian Date Nameul'C.\I. Ilulder j`�A i! mhc Iial C'SI, f)pc(s.c 116M)_(„�.,5�/�__ Na. and Sired 107 PC Description ll Unrcstricl.J IUuiWin s li to 1y,0110 cu. ILI Rcntricled Lr2 F.unil Dssdlill Cigifoo n. ale.LlP Shuon RC Roolin C•ovcrin _._. A'S w'indow;mdSidin SF Solid Fuel Ilurning Appliances Insulwiun I'dc hone Finail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) Q i i, g I/R�,n tt / Tilt.L�l_-� I r �.._< _ __ _ r r O P LQ /s •Itegistratiun Numhcr I:. ,iruuun bum IBC'Con an) Na lie nr I IIC Itegutrant Name N an trcet Email address I /T n,State,ZIP "fde harm SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152.1 25C(6)) Workers Compensation Insurance aRtdavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuanc of the building permit. Signed Affidavit Attached? Yes .......... No...........O SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED W HEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize /iJ /�/nt IN LA n A/s to act on my behalf,in all matters relative to work authorized by this building per t application. M�r �el Samos Print Omier s NW➢e(beet unlc Signature) D'JlC SECTION 7D: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. dr/rl'I S12)i Print()skncr's or:\uthurireJ Agent's Name Il.lcctrunlc.Slgnanuel Date NOTES: =0\viitr%0,o obtains a building permit to do his.her own work,oran owner who hires an unregistered contrnoor n the Hume Improvement Contractor(HIC) Program),will no have access to the arbitration ranty fund under.M.G.L.c. 142.4. Other important information on the HIC Program can be found at Ok l information on the Construction Supervisor License can be found at 2. \\'hen subslantial work is planned,protide the information below: total Iloor area I sy, fl.) - (including garage, linished basement attics,decks or porch) Gross liting area l sq. 11.) _ Habitable room count \umber of fireplaces .... _. Number of bedrooms Nuulhcrofhathroonls . . — Nunlben)fhall'h:nhs II)pe of healing s)stem Number of daks, pordle.s IspeofC"olng iiilelll l'ndoied .01len , ). "folal Project Square Footage•'mar be itibimutcd li r I'olal Project Cost' ice_._ CITY OF S,V-&Ni, AkSS.,CH(:SETTS JLII.DLNG 0EP.1RT1lE,\T I'0 IX7.ksmLNGTON SrXW, J1e FLOOx K1113FAl Y DUXOLL P,lx(919) 1JQ93{d MAYOR MOMA1 ST.PMUS Dll WrC&OPPLSUCPROPffATY/3t:Mn ,4GCOJOIISSIONE11 Conitructioa Debris DISPOS21 Affidavit (required for all demolition and renovation work) In accordance with the sixth edition otthe State Building Cade, 730 CMR section I I I.J Debris, and the provisions ofMGL o 40, S 54; Building Permit lil is issued with the condition that the debris resulting from (his work shell be disposed of in a properly licensed waste disposal facility as defined by,MGL e III, S IJOA. The debris will be transported by: (nama of hauler) The debris will be disposed ofin (name Of faciliry) (�ddreu of �aluy) — r _ u04fure01;rrmit hc�nr !ta ti Massachusetts -Department of Public Safety Board of Building Regulations and Standards Comtrucrion Super%isor Slxcialtb License: CSSL_100824 W I,LIAM 3 DELANGIS s 15 BAILEY STREET ` SAUGUSMA 01406 Expiratiodl J 0 510 512 01 4 commissioner Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 111123 Type: DBA Expiration: 1 1/2 512 01 4 Tr# 234005 AMERICAN DOOR WINDOW & INSULATIO WILLIAM DeLANGIS 15 BAILEY AVE SAUGUS, MA 01906 Update Address and return card.Mark reason for change. -SCA r G ZaM-05/11 Address I] Renewal ❑ Employment ❑ Lost Card A.OQM CERTIFICATE OF LIABILITY INSURANCE DaTE(Nmvoo 14 RODUCER' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ambrose Insurance Agency, Inc:. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE g Cyr HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 56 Central Ave. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lynn, MA 01901 781-592-8200 INSURERS AFFORDING COVERAGE NAIC# 4SURED Delangis, William INSURER A: Northland American Door, Window & Insulation INSURERB: Arbella Protection 15 Bailey Ave. INSURER[: Liberty Mutual Saugus, MA 01906 INSURER D: I INSURER E. :OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS, sR POLICY FFECTIVE POLICY EXPIRATION rR MeeoTYPE nr INSURANCE POLICY NUMBER DA E MMID DA WDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 OOO 000 X COMMERCIAL GENERAL LIABILITY PREMISES EacocNMe $ 50,000 _ CLAIMSMADE OCCUR MED EXP(Any one person) S 5,000 A WS162282 5/20/13 5/20/14 PERSONAL$,ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 000 000 !. GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2 000 000 !. POLICY F JER LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (EaecGtleln) $ 1,000,000 ALLOWNEDAUTOS BODILYINJURY S OL SCHEDULED AUTOS (Per person) B HIRED AUTOS 1020020026 4/4/14 4/4/15 SOOILVINJURY $ NON-OWNEDAUTOS (Pereocidenl) PROPERTY DAMAGE S (Peramldwt) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTOONLY: AGO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CI CLAIMSMADE AGGREGATE $ S _ DEDUCTIBLE RETENTION $ $ WORKERSCOMPENSATIONAND LIMB X R EMPLOYERS'LIABILITY E.L.EACHACCIDENT S 500,000 ANY PROPRIETOR?ARTNERIEXECUME + oFF!CERIMEMSEREXCwoEOI WC231S389403014 2/11/14 2/11/15 E.L.DISEASE-EA EMPLOYE $ 500,000 .. 11yea,eeecrlbeun r E.L.DISEASE-POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER I 9SCRIPTION OFOPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONSAODED BY ENDORSEMENT I SPECIAL PROVISIONS Carpentry & Insulation National Grid Corporate Services, LLC d/b/a National Grid, d/b/a Boston Gas Cc d/b/a Essex Gas Co. , and Action, Inc. as additional insureds general liability only. ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CAPIC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL_ DAYS WRITTEN 100 EVerett S t. Unit 14 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Chelsea, MA 02150 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Fax: 617-889-8110 REPRESENTATM . AUTHOR17E0 R T E a- CORD 25(2001108) .�m - ©ACORD CORPORATION 1988 WAP Work Order North Shore Community Action Programs,Inc. . . Job Number: 130624I 119 Rear Foster Street,Building 13 Work Order Date:3/15/2014 Peabody,MA 01960 Ownership:Owner Phone:979-531-0767 American Door,Window,&Insulation Auditor:Brandon Dorrington 15 Bailey Avenue Email: bdorrington@nscap.org Saugus MA 01906 Cell: 781-540-8569 Email:wdelangis@comcast.uet Phone:978-531-0767 021 Phone:781-231-0244 Muriel Santos NGRID Electric $7,044.39 Total $7,044.39 6 Langdon St Salem MA 01970 978-741-4984 Safety Issue(s): Asbestos Siding/lnad Paint Possible t � i R-30 restricted-slopes/floored fl11 621 $1.48 $919.08 621 $919.08 w/cellulose R-38 unrestricted-settled cellulose 161 $1.47 $236.67 161 $236.67 1st fl.front sub attic Reinforced poly/R-30 cellulose open 109 $2.05 $223.45 119 $223.45 CRAWLSPACE OVERHEAD rafters Thermodome or Magnetic pull 1 $180.00 $180.00 1 $180.00 down stairway box Root vent 865(4 sq ft tNFV)small2 $80.00 $160.00 2 $160.00 6 mlpoly on ground 109 $0.75 $81.75 109 $81.75 Sill two-part foam w/fiberglass batt 112 $2.20 $246.40 112 $246.40 Automatic Sweep 2 $23.00 $46.00 2 $46.00 R-5 Ductwrap or R-max on door 1 $51.00 Tim1 $51,00 Date: 3/15/2014 Page 1 WAP Work Order: Job Number: 130624 Repair/Refit Door 1 $52.00 $52.00 ] S52.00 Slide bolt 2 $22.00 $44.00 2 $44.00 Clothes dryer vent including 1 $89.00 $89.00 1 $89.00 Exhaust Duct Vent kit/hath fan 1 $89.00 $89.00 1 $89.00 IN I l I Domestic water pipe wrap 6 $2.63 $15.78 6 $15.78 i Attic sealing with two-part foam 3.5 $7s.00 $262.50 3.5 $262.50 Basement sealing with two-part 3 $75.00 $225.00 3 $225.00 foam Blower door set-up with pre&post 1 $45.00 545.00 1 $45.00 tests Reconnect all disconnected 1 $60.00 $60.00 1 $60.00 downspouts J � Building Permit 1 $100.00 $100.00 1 $100.00 Vinyl over asbestos(dense pack) ]696 $2.31 $3,917.76 1696 $3,917.76 $7,044.39 $7,044.39 Total Page 2 Date:3/15/2014 l