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7 LEAVITT CT - BUILDING INSPECTION (2) -/4- oa U4 20gp The Commonwealth of Massachusetts RECEIVED ITY Q Board of Building Regulations and Stand ECTIONAL SER ICEOF Massachusetts State Building Code, 780 CMR ALEM �. Revised Mar 20/1 Building Permit Application To Construct, Repair, RenovilivrJotmoVshA 20 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date pplied: Building Official(Print Name) Signature Dat SECTION 1:SITE INFORMATION 1. P perty dd ess• 1 Q 1.2 Assessors Map& Parcel Numbers I.1a 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 11) Frontage III) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood"Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 ate✓r�oT�tec d0 / �e r Via. /e A7 A lit ©/ 9 � Name(P int) `. City,State,ZIP 7 Tea v/ t/- C�_ 3/— Ale 98' No.and Street 'Telephone Entail 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. El Number of Units _ Other ❑ Specify: Brief Des ipti n of Proposed W' rk': ! 7 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materi Is Official Use Only I. Building $ I. Building Permit Fee: $ Indicate how tee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: 4. Mechanical ("VAC) $ List: U 5. Mechanical (Fire $ Suppression) Total All Fees: $ / Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ / g L�I 0 paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor•License(CSL) r9L j� {.Q j�. b' .� License Number Expiration Date Name of CSL Holder List CSL,Type(see below) No.and Street Type Description -3q L) �� Q �� U Unrestricted(Buildings u to 35,000 cu.ft.) ��tt R Restricted I&2 Family Dwelling City/Town, tote,ZIP M Mason ry RC Roofing Covering WS Window and Siding SF I Solid Fuel Burning Appliances I I Insulation Telephone Email address D Demolition 5.2 Registered Home4Improvement Contractor(HIC) ,3 L.A y, er lea h UooY f et1 �'ac,J HIC Registration Number Expiration Date 111C Com ny Name or FI�R/ee istrant Name XS X t✓ No. d Street ! Email address U � trs, A4 - 0i9ore 7ifi/ 3 City/Town,State,ZIP 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 .......... L9-, No........... ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property, hereby authorize to act on my behalf, in ail matters relative to work authorized by this building permit application. pal/I d e l -der /3a11y 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. de Lao9/S boh/ Print Owners or Authorized Agent's Nar M (Electronic Signature) Date 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 M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos �. 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"may be substituted for"Total Project Cost" Massachusetts-Department of Public Safety Board of Building Regulations and.Standards Construction Supen uur Specialh License: CSSL 100624 W[LLIAM J DEI.OG 15 BAMEY STRIM 4i SA,UGUS MA 01406 ' M, Expiration Commissioner 05/05/2016 Consgz i"oururonrr crr�/fi n//...('�f Office of Consumer Affflirs&Busrdess 0e�ulfltiorn T ,LLOME IMPROVEMENT CONTRACTOR i, egistration: 111123 xpirdtion: 17l25/2D14. Type: _ DSA AME91C N DOOR WINDOW&INSULATION WILLIAM DeLANGIS 15 BAILEY AVE SAUGUS,MA 01906 .— Undersecretary DATE(MMMDNYYY) ACORD.N CERTIFICATE OF LIABILITY INSURANCE2014 .00ucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1mbr08e Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE Af' EE�THE POLICIES BELOW. i6 Central Ave. :ynn, MA 01901 INSURERS EAFFORDING COVEiRAGE NAIC# 181-592-8200 INSURER A: and iURED Delangis, William INsuRER B. tectionAmerican Door, Window 6 Insulation INSURERc. Mutual 15 Bailey Ave. Saugus, MA 01906 INSURER D: --- INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TH NSURED NAMED ABOVE FOR E I THE POLICY PERIOD INDICATED.NOTWITHSTANDING DOCUMENT W O ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER WITH RESP WHICH THIS CERTIFICATE MAYAY BE ECT TO BE ISSUED MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH CRIBED H POLICIES.AGGREGATE LIMITS SHOWN MAYHAVE BEEN REDUCED BYPAIDCLAI Poucv EFFEcnvE POLICY EXPIRATION LIMITS 1R Do•L POLICY NUMBER DATE MMIDDM' DATE MMIDO/YY fft NORD IN EACH OCCURRENCE S 1 000 000 GENERAL LIABILITY PREMISES Ea ocarence $ 50 000 x COMMERCIAL GENERAL LIABILITY MED EXP(Any one person) $ 5 000 CLAIMSMADE OCCUR PERSONAL&ADV INJURY $ 1 ,000 000 A WS162282 5/20/14 5/20/15 GENERAL AGGREGATE S 2 O00 000 PRODUCTS-COMPIOPAGG $ 2 000 OOO GERL AGGREGATE LIMIT APPLIES PER: POLICY M jE0 LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANVAUTO BODILY INJURY $ pLL OWNED AUTOS (Per person) X SCHEDULED AUTOS HIRED AUTOS 1020020026 4/4/14 4/4/15 BODILYINJURY $ B (Peraccldenp NON-OWNEDAUTOS PROPERTYAGE g (Peraccltlenident)q AUTO ONLY-EAACCIDENT $ GARAGE LIABILITY EAACC $ OTHERTHAN ANYAUTO AUTOONLY'. AGG $ EACH OCCURRENCE S EXCESS/UMBRELLA LIABILITY AGGREGATE $ OCCUR CLAIMSMADE $ $ DEDUCTIBLE S RETENTION $ TORYLIMITS X ER WORKERS COMPENSATIONAND E.L.EACH ACCIDENT $ 500 000 EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWEXECUnVE 6TC231S389403014 2/11/14 2/11/15 E.L.DISEASE-EA EMPLOYE $ 500 00 oFFICERIAAEMBER EItCLUDEDT E.L.OISEASE-POLICY LIMIT $ 500 000 ims,describounder SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/E%CLUSIONS A------- Carpentry & Insulation ervices, LLC d/b/a National Grid, d/b/a Boston GasCO National Grid Corporate S inc. as additional insureds general liability d/b/a Essex Gas Co. , and Action, only. CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION North Shore Community Action DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL__ DAYS WRITTEN Program NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 98 Main St• MPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGE MS OR Peabody, MA 01960 REPRESENTATIVE Fax: 978-531-1012 AUTHORIZED RE E T ©ACORD CORPORATION 1988 ACORD25(2001108) Work Order I North Shore Community Action Programs,Inc. Job Number: 25298 119 Rear Foster Street,Building 13 Work Order Date: 6/9/2014. Peabody,MA 01960 Ownership: Owner Phone:978-531-0767 American Door,Window,&Insulation Auditor: Brandon Dorrington 15 Bailey Avenue Email: bdorrington@nscap.org Saugus MA 01906 Cell: 781-540-8569 Email:wdelangis@comcast.net Phone:978-531-0767 x121 Phone:781-231-0244 DOE WAP 2014 $3,150.00 Roxann Lamarco NGRID Gas $6,414.19 7 Leavitt Ct Total $9,564.19 Apt.2 DOE WAP 2014 Repair/Health&Safety $0.00 Salem MA 01970 978-239-4098 Safety Issue(s):Lead Paint Possible y - i R-18-20 restricted-slopes/floored 609 $1.55 $943.95 609 $943.95 fiB w/celluluse R-49 unrestricted-settled cellulose 183 $1.80 $329.40 183 $329.40 Roof vent 865(A sq ft NFV)small 2 $90.00 $180.00 2 $180.00 Garage ceiling cavity filled with 200 $2.35 $470.00 200 $470.00 Additions blown cellulose I&Ii li ii1¢ 1V"'d� toy` V Automatic Sweep 1 $26.00 $26,.00 "$26.00 Fixed Sweep 1 $17.64 $17.64 1 $17.64 Weatherstrip s/Q-Ion or equal 2 $5 ..00 $102.00 2 $102.00 Page 1 Date:6/9/2014 Work Order: ,fob Number: 25298 , a t t Domestic water pipe wrap 6 $2.95 $17.70 6 $17.70 Hydronic pipe insulation to 1 in. 50 $3.82 $191.00 50 $191.00 REMEASURE copper pipe R-5 PM 50 CFM bath fan(replace existing) 1 $575.00 $575.00 1 _ $575.00 n w bathroom ligh DC ceiling/hook up to extisting Attic sealing with two-part foam 1 $84.00 $84.00 1 $84.00 Blower door set-up with pre&post 1 $45.00 $45.00 1 $45.00 tests CO Detector(5 year standard) 2 $40.00 $80.00 2 $80.00 2nd ft.halt/3rd Fl.hall Recessed Light Enclosure 6 $33.00 $198.00 6 $198.00 Sheetrock(notape) 35 $3.63 $127.05 35 $127.05 Building Permit 1 $100.00 $100.00 1 $100.00 v . Drill finish patch plaster(dense 165 $2.13 $351.45 165 $351.45 pack) Wood clapboard/shakes/shiugs or 1288 $2.00 $2,576.00 1288 $2,576.00 vinyl(dense pack) p` Prime window replacement w/l0w-e 9 $350.00 $3,150.00 9 $3,150.00 to 74-83 at Total $9,564.19 $9,564.19 Page 2 Date:6/9/2014 Work Order North Shore Community Action Programs,Inc. Job Number: Colter(I) 119 Rear Foster Street,Building 13 Work Order Date:6/9/2014 Peabody,MA 01960 Ownership: Renter Phone:978-531-0767 American Door,Window,&Insulation Auditor: Brandon Dorrington 15 Bailey Avenue Email: bdorrington@nscap.org Saugus MA 01906 Cell:781-540-8569 Email:wdelangis@comcast.net Phone:978-531-0767 x121 Phone:781-231-0244 David Colter NGR1D Gas $3,377.99 7 Leavitt Ct Total $3,377.99 Salem MA 01970 Safety lssue(s): Lead Paint Possible Sill two-part foam w/fiberglass batt 130 $2.46 $319.80 130 $319.80 � t � Automatic Sweep 2 $26.00 $52.00 2 $52.00 Fixed Sweep 1 $17.64 $17.64 1 $17.64 Repair/Refit Door 1 $58.00 $58.00 1 $58.00 Weatherstrip s/Q-lon or equal 3 $51.00 $153.00 3 $153.00 Domestic water pipe wrap t6 $2.95 $17.70 6 $17.70 Hydronic pipe insulation to 1 in. $267.40 70 $267.40 RI.MEASURE copper pipe R-5 Basement sealing with two-part 2 $84.00 $168.00 2 $168.00 foam Blower door set-up with pre&post 1 $45.00 $45.00 1 $45.00 tests Date:6/9/2014 Page 1 Work Order: Job Number: Colter(I) Drill finish patch plaster(dense 165 $2.13 $351.45 165 $351.45 pack) Wood clapboard/shakes/shings or 964 $2.00 $1,928.00 964 $1,928.00 vinyl(dense pack) Total $3,377.99 $3,377.99 Contractor Instructions: Before Starting the Job: During the Job: 1. Please notify us 24 hours before starting or scheduling a job. 1.This residence was built before 1978. Lead safe practices are 2.Obtain required building permit. required. 2.Total for Heath&Safety and Repairs cannot exceed$2500.00. 3.Davis Bacon time sheets required for ARRA work on US Department of Labor Certified Payroll Report Form WH-347. Additional Contractor Instructions: Attic Inspection form attached? Yes N A (Circle One) Certificate of insulation posted? Yes No (Circle One) American Door,Window,&Insulation hereby certifies that this job was supervised and completed in compliance with all Department of Labor Standards and Lead RRP regulations. Contractor Signature: Date: RRP License#:_ I hereby acknowlege that all work has been completed and inspected. Customer Signature: Datc: Fiscal Officer: Date: Energy Director: Date:__ -- Page 2 Date: 6/9/2014