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28 LINDEN ST - BUILDING INSPECTION (3) m 1 The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF SALEM Massachusetts State Building Code, 780 CMR, 7's edition ii ReviseJJunuury Building Permit Application To Construct, Repair, Renovate Or Demolish a =0014 One-or T)vXFVmilv Dwelling Thin ection kor Official Use Only, Building Permit Number. . Signature: jya,/%a Building Commissioner/Inspector of Buildi gs Date SECTIO :SITE INFORMATION 1.1 Property Add�ras< I S 1.2 Assessors Map& Parcel Numbers 61 a Is this anaccepted strecl??yeses, no Map Number Parcel Number 1.3 Zoning Information: IA Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(B) 1.5 Building Setbacks(R) 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: Zone: Outside Flood Zone? Public O Private C3.n — - - Municipal O On site disposal system O s Check if esO SECTION 2: PROPERTY OWNERSHIP' 2.I Owner'of Reeord: /wry tcCyu Il / ` �+ sl /Y Name(Print) gg �' Address,for Service:. _ G'�.Sr - 37t- YV35 Signature Telephone SECTION 3:DESCRIPTION OF PROPOSED'WORK"(cbeck atl that apply) NewConstruction,O 'Existing Building 0 Owner-Occupied O `Repairs(s),13 Alterations) O Addition O Demolition O; Accessory Bldg.0 Number of Units Other.:dSpecily: Brief Description of Proposed Work-:- �7 5 J I /B/.),.✓ -i r-t Q a sz- A W.� Ndd 2-30 � , G SECTION C ESTIMATED CONSTRUCTION COSTS Estimated Costsi Item OIIlcial vse;Only Labor and"Materials ' _ - I. _Buildin Permit Fee S - Indicate-how fee is determined: I. Building °S 5 B O Standsrd Cityffown Application fee 2. Electrical S O Total Project Cost'(Item 6)x multiplier x ). Plumbing S 2. Olher Fees: S 4. Mechanical (HVAQ S List' 5. M "am cal (Fire S Su ression Total All Fees:S Check No. Check Amount: Cash Amount: 6. Total Project Cost: S 3pBQ, a ) 0 Paid in Full 0 Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES S.1 Licensed Construction Supervisor(CSL) License-Number Ispiraliun Date Name of CSl.•I IuIJer UsI CSL Type(see below) u� F5 PC Description U - Unresuicted. u to 35,000 Cu.Ft. 0. Restricted IR2 Family Dwelling Signumra M M "only q J� 7yy—rs'iY3 RC RoolinxCoverinit Coverin felcphone WS Residential Window andSidin - -SF I Residential Solid Fuel`Burning g Appliance Installation D I Residential Demolition 5.2 Registered Rattle Imp v(men Coo FactorZ1 fC) y� a /t ri i s ewrutA,'zalz Nu IIIC Company Nameor HIC Registrant Numc /,, Regui{�a1ion Numtier"' CD 1 Q �err�S..-. 1461 � S 3 //j-// .7- Address gib- TyY-B'lY� Expiration Date Signature Telephone SECTION 6:._WORKERS'COMPEN�4TION INSURANCE AFFIDAVIT(M.G.L,e. IS2.f 2SC(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 ..........0 No...........0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, Lan n y 6 e G)0,c., / iL , as Owner of the subject property hereby authorize A;E"- to act on my behalf,in all'matters relative to work authorized-by-this.building permit,application. Si lure ofown r .- Date SECTION 71b:OWNEW OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the,statements and information on the foregoingapplication are true and accurate,tothebestof my knowledge and behalf. Print Name Signature ofowner or AuthonzedAgent Dale - Si edunderthe ainsand- naltiesbf 'o NOTES: rl. An Owner who obtains a building permit to'do his/her ownwork,or an owner who hires an unregistered contractor (not registered in the'Homelmprovement Contractor(HIC)Program),will.ij I have access to the arbitration program orguaranry fund under M.G.L.c. 1d2A.Other important information on the HIC Program and Construction SupervisorLicensing(CSL)can be found in 780 CMR Regulations I I O.R6 and 110.RS,respectively. When substantial work is planned,provide the information below: Total floors 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 he system Number of decks/porches Type of cooling system - Enclosed Open 3. "Total Project Square Footage"may be substituted for-Total Project Cost C Action Inc. 47 Washington Street Gloucester,MA 01930 Tax Exempt Number: 042-389-332 Agency: Action Inc. PROGRAM: National Grid ELECTRIC JOB NUMBER: NE-ARC06 Work Order# NE-ARC06 Work Order Date: 09/28/2010 Job Limit: Contractor: ATLANTIC Wx Per Unit $4500.00 Client: Northeast ARC K+T Yes=1 Now Street: 2-8 Linden Street K&T: 0 City; State;Zip: Salem,MA 01970 Telephone: Larry LeGault: 978-375-4435 Stand Alone Yes=1 Now Stand Alone: 1 Blower Door Test: YES Inspect Knob&Tube: NO -Contractor- Attic/Insulation Act Cost Est Cost Act Cost Attic Flat R38 open $1.40 Attic Flat R30 open 608 $1.30 $790.40 Attic Flat R20 open $1.23 Attic Flat R10 open $1.15 Attic Slope/Flat R30 restricted $1.14 Attic Slope/Flat R20 restricted $1.35 Knee Attic Wall/Floor Transitionr F $2.40 Kneewall w/Membrane R12 $1.65 Kneewall Floor R30 $1.41 Attic Access Finished $84.00 Temporary Access $75.00 Crawl Space R19 w/poly vap barrier $1.81 Garage wiling/floor R30(with approval) $1.21 R5/RMax on door $44.00 Vent Bath Fan 1 $70.00 $70.00 Roof Vent $66.00 Turbine $138.00 .Stack 12" $126.00 Pro pa Vent $3.25 Roof Vent#135 $84.00 Gable Vent all Sizes $76.00 Soffit Vent $23.00 Rid a Vent $18.00 Attic B ass 2Hrs Max 2 $75.00 $150.00 Northeast ARC Page 2 ional Grid ELECTRIC 0 r Est Act Cost Est Cost Act Cost Wall Insulation Single Nail Asbestos/as halt $1.50 Dbl Nail Asbestos/Aluminum $1.52 Brick Stucc o $2 23 Interior W $1.34 Cla board $1.39 Test Drill $53.00 Air SealinSin le Fa0Multi-Fam0 Door Kit $43.00 Door Sweep $15.00 Seal ducts with mastic $15.00 Air Scaling Per Hour 9 $75.00 $675.00 Sash Look 21 $7.75 $162.75 Glass Li t $36.50 Blower Door: re/ ost test data I $45.00 $45.00 Total Air Sealin Cost $882.75 $0.00 Heating Systems Duct Insulation&Tape Seams Sg Ft 360 $2.95 $1,062.00 H dronic Pipe Insul up to 1" $3.25 11 dronic Pi a Insul 1 U4+u $3.33 Steam Pipe up to 1.5"+1.75" $4 68 11 Steam Pipe Insul 2" +u $5.48 Building11 Permit 1 $0.00 Action Approval needed. $2,955.151 Est Total $0.00 Act Total CITY OF S.U.E.tit, N L-kSSACHL'SE-M SumDLNG Dann ENT 1_0 W.gimINGTON S airs'. Y FLOOK T EL (9711) 745-9599 F.sx(975) 71498" K1.NBEA"lf DRACOLL INOMASST.Pmlls UAYOA DIRwM&OF R BLIC PROPEATT/gL•11DOIG COaL%aSSJO-%ER Wurkers' Compensatlon Insurance AMdavif: guilders/Contractors/EltletricionsiFlumbers _aunlleant Informado• /n�LI e t %ease /riot L.ealbbt Vatnt Iauur.Iv.ort�uanaelr.rvlaraall: YI T f�✓�. �%cam W e��l� .'2�_'c...�-. Address' C I /Z Cily/State/Zip PBons N� L? 7 yy y- /y 3 ,ire sae ewpMyer!chock Rho Appropriate besa Type stprojen(requiredlt 1. I am a cmpleyw witb D-Y— El I am a yen mid cownwor and 1 b ❑New censmresion emplayees(Adl and/or puFtior)•a have hired the subsaltraeas 2.Q I am a salt prspriety II(panerr� listed m dhe asached ahaet t 7. ❑Remodeling .hip and have no ampbyeo That su►eentetaeaa have s. Q nerntoliaioe ,,actingfor me in as c worker'comp.Inswaaeoa 9 y apas:iry. ❑IltriWing addition 1 No workers'tomµ insurance J. Q We errs•carpersdtis and i0a r m0rwL( odka have teweird their 10430 ectrical repairs as'additiaris a 1.Q 1 awn a homeowner doing ad work ^lib orex�ioe per UGL I I.Q Phunbing repairs or additions mynit.(Ne worker'tomµ c. 13Z 110),and we haw no 12.0 Roof rpair insurance required.)► c'np� iNe waf�a• 17.Q Other tomµ ineuance negsiad.J -n.7 ylrYor Its aMsaa 6a al etttrl air 110 Ina etc rrnla eelaw lwfa/ed/wrera'oat*wla/ee plky fYarwanaw 't6wwuwom she PA"ei rrlldwb iodkoin Iho as doins All week a11M No wmwb cerewes e1Yr w16wb a sew arlhbk irteis iq SOL : ,w,i r dr.hrL IW bes mod an"W rt a"dwW AM Jrwlly dw rao r/Ma r►ewewraw aY/drlr waaw'm'7.Pe4r jYaalwW� /eer ew erwy/sJM rber tr Jrev1/fwE twraer'cew/eraaedre/waeaewn/ir aq eaP/iJses Sellsw 4 rMpNtrl aNp1 star :n/entrerlew,Insurance Company Name: /9 e Ge-1(a Policy 0 or Self•ina. Lie.M: 9 l/�$zo 36`l Expiration E Job SireAddnae 2 g Lt n `'"'r S � r{"�( City/Jtateltip: g�,O .%nacb t cop of eke werken'compassafts pelky declanli n pap(awwing the pNk7■umbor and explrnsles dsp). Failure to arcurt coverap=required under Iallon 2JA of MGL e. I52 can lead to the imposkion of criminal penalties of An up to S 1.500.00 and/or one-year imprissnnwttt,al wed as civil penalties is des farm at it STOP WORK ORDER and a Ant Of up to 11250.00 a day adainst the violator. Is@ adviwal the a copy of this statement may be forwurdd to the Ol71ee of Invvvuaariuns of it*nfA for insurance cov.rap v.ritieatioa /Je hllliy l'Ilti/y YnIM the prlM Ylyd weA/er Y/Jn/Yq rAYI rAe inlMwadM�rYW/O�Yleva is Irv*Ynd:weves 77�7 7 Y L(— S-�/y� Off/avel urr an/y. Oe LW wrim is this rreay n SI.YtwJ/iM/6J r'ifJ ere rwww.r//AriYL City or fuwa: ecraniNl.kenre 1 Ltuint.\uthnrlly(circle une►: . 1. Ituard of Ilealtk 1. nuddlna nrpartmene 1. Cltitfown Clerk J. Electrical lntpector S. Plumbing Intpeetor 6. ther _ l..nFact Person: _ _ ., Phone s: EIG Fax Server 4/6/2010 3 : 15 : 24 PM PAGE 2/003 Fax Server DATE ACORQ. CERTIFICATE OF LIABILITY INSURANCE 04/06/20 OI PRODUCER (S08)6S1-7700 FAX (508)65S-8853 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 233 West Central Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, MA 01760 INSURERS AFFORDING COVERAGE NAIC# INSURED Atlantic Weat erization LLC INSURERA Arbella Protection Ins. Co. 41360 61 Rear Jefferson Avenue INSURERS: Arbella Indemnity Ins Co. 10017 Salem, NA 01970 INSURER C. INSURER 0: INSURER E: COVERAGES 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 SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR kDD'L TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS GENERAL LIABILITY 9500042916 03/20/2010 03/20/2011 EACHOCCURRENCE $ 1,000,00 )( COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 CLAMSMADE FX]OCCUR MED EXP(Any ane persm) $ 5,00 A PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-CCMP/OP AGG S Z 000 00 POLICY X J O.ET M LOC AUTOMOBILE LIABILITY 93927400003 03/20/2010 03/20/2011 CON BINED SINGLE LIMIT $ ANY AUTO (Ea actldem) 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS IF.,Perwnl $ B X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per eWden[) PROPERTY DAMAGE $ (Pe(swideM) GARAGE UABIUTY AUTO ONLY-EAACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG $ EXCESSIIIMBRELLA UABIL17Y EACH OCCURRENCE S OCCUR FICLAIMSMADE AGGREGATE S g DEDUCTIBLE $ RETENTION E S WORKERS COMPENSATION AND 9111820309 03/20/ZO10 03/20/2011 X I^'C STATU- O H. EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 500,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,00 dyes,Cesalbe under E.L.DISEASE-PO.ICY LIMIT S 500,00 SPECIAL PROVISIONS belay OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSKONS ADDED BY ENDORSEMENT)SPECIAL PROVISIONS CERTIFICTE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TIHEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL "DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, CITY OF SALEM BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 120 WASHINGTON STREET OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. SALEM, MA AUTHORIZED REPRESENTATIVE �� 1 Rosemary Fulha PMA ACORD 25(2001108) ©ACORD CORPORATION 1988 CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT 1'.11: AIII ' �Iv 111 1 \I .n Alt LC�{'A4N�t''b'M'J.4./W� •tP Jx: C0111`3iu tf0nur ll Dmmo1 I unDld m-novu iunw it ork) In acconlatxe with the siult edition of the State Building Code, 730 CMR section 1 11.3 isiuna of MGL a 3U. S u Debris, and the prov is issssu MGL c ed with the condition that the debris resulting Hrom M - l Ucettstd wnsta disposal facility as Building Permit datined by this work shall be disposed of in a proper y 111. S 130A. The debris will be Imnsported by: P a ` ' C �� Insrtta ut hauler) -1'Ite debris will be disposed of in : ptlrtNt ut xl a� ./ Ia,klmso xduyl .1/nature of Iwrmit,Ipplkant date `��`� \, �'. �,.� �` .�,. ., �\�_ . ' ,� \ •.. � /`�� , �� �� . ��� 1 T } �i Action Inc. 47 Washington Street Gloucester,MA 01930 Tax Exempt Number: 042-389-332 Agency: Action Inc. PROGRAM: National Grid.ELECTRI JOB NUMBER: NE-ARC06 Work Order# NE-ARC06 Work Order Date: 09/28/2010 Job Limit: Contractor: ATLANTIC Wx Per Unit $4500.00 Client: Northeast ARC K+T Yes=1 Now Street: r 23 Linden Street K&T: 0 City; State; Zip: Salem,MA 01970 Telephone: Larry LeGault: 978-375-4435 Stand Alone Yes=1 Now Stand Alone: 1 Blower Door Test: YES Inspect Knob&Tube: NO Contractor: Attic/Insulation Act Cost Est Cost Act Cost Attic Flat R38 open $1.40 Attic Flat R30 open 608 $1.30 $790.40 Attic Flat R20 open $1.23 Attic Flat R10 open $1.15 Attic Slope/Flat R30 restricted $1.14 Attic Slope/Flat R20 restricted $1.35 Knee Attic Wall/Floor Transitionl F $2.40 Kaeewall w/Membrane R12 $1.65 Kneewall Floor R30 $1.41 Attic Access Finished $84.00 Temporary Access $75.00 GYawl Space R19 w/poly vap barrier $1.81 Garage ceilingffi or R30(with approval) $1.21 R5/RMax on door $44.00 Vent Bath Fan 1 $70.00 $70.00 Roof Vent $66.00 Turbine $138.00 Stack 12" $126.00 Pro pa Vent $3.25 Roof Vent#135 $84.00 Gable Vent all Sizes $76.0011 Soffit Vent 1 $23.00 Rid a Vent $18.00 Attic B ass 2Hrs Max 2 11 $75.001 1 $150.00 Northeast ARC Pa e 2 ional Grid ELECTRIC all Insulation Est Act Cost Est Cost Act Cost W Single Nail Asbestos/as halt Dbl Nail Asbestos/Aluminum Brick/Stucco $2 23 Interior Wall Blow $1.34 Cla board/Wood/Vin 1 $1.39 Test Drill 4 Sides $53. 00 Air Sealin Limit: Sin le Famil =$400.00 Multi-Famil = MOM Door Kit - $43.0015 Door Swee $ .00 Seal ducts with mastic $15 Air Sealin Per Hour 9 $62.00.00 $675.00 Sash Lock 21 $7.75 $162.75 Glass Li t $36.50 Blower Door: re/ iost test data I $45.00 $45.00 Total Air Sealin Cost $882.75 $0.00 Heatin stems Duct Insulation&Tape Seams Sg Ft 360 $2.95 $1,062.00 H dronic Pi a Insul $3.25 14ydronicPi elnsul11/4+u $3.33 Steam Pi e u to 1.5"+1.75" $4 68 Steam Pi a Insul 2" +u $5.48 Buildin Permit 1 $0.00 Action Approval needed, $2,955.151 Est Total $0.001 Act Total