176 MARLBOROUGH RD - BUILDING INSPECTION (2) � , d
The Commonwealth of Massachusetts
J , Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CMR, 7N edition OF SALEM
Resv'.rrr/Janson•
Building Permit Application To Construct, Repair, Renovate Or Demolish a /. 21RAY
One-ar Two-Family Dwelling
This Section For OlBcial Use Only
�> Building Permit Numbe Date Applied: AL4 d D
O11 Signature: Gr 0
Buildin Co missioneN Inspector of Buildings !Yale
SECTION 1:SITE INFORMATION
1.1 Property Address:' 76 h q0r/4LV'aN A 1.2 Assessors Map& Parcel Numbers
1.1 a Is this an accepted street?yes no Map Number Parcel Number
IJ Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(0)
1.3 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) 1.1 Flood Zone Information: 1.3 Sewage Disposal System:
Zone: Outside Flood Zone?Public❑ Private O — Check if es0 Municipal❑ On site disposal system O
SECTION2: PROPERTY OWNERSHIP' / /
2.ljOwnerrof Record: 17 r / b�I�Ou 4 son 2l eNa oa
Name(Print) Address for Service:
<' � -.? _ S° I
Signature Telephone
SECTION 3: DESCRINT N OF PROPOSED WORKS(check all that apply)
New Construction O Existing Building St Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) Addition ❑
Demolition O Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': P t k
Can >L4 I � C a '0
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building IS Q 1. Building Permit Fee: S Indicate how fee is determined:
�. Electrical S ❑Standard Citylrown Application Fee
O Total Project Costs(Item 6)x multiplier x
3. Plumbing S 2. Other'Fees: S
4. Mechanical (IIVAItSE
$ List:
S. Mechanical (FireSu rcssion Total All Fees:S
�� Check No. Check Amount: Cash Amount:
6. Total Project Co 0 Paid in Full 0 Outstanding Balance Due:
r
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) iSF
-710w - �(d �t umber Expiration Wit
Name �C ,.� Type(see below) Descri ion
Address ILlM /t, 4 O I y �dUnrestricted u to 35,000 Cu.Ft.{�-1Restricted IR2 Famil DwellinSignature ` M OnlResidential Roulin CoverinI'dephooe q C, Residential Window and Sidin( 7d - Z (]_ S( � Residential Solid Fuel Burning Appliance Instal lalion _
D Residential Demolition
5.2 Reghle7 Ho mprove st Contra (HIC) 3 1 00
a or t 'Registrant Name Registration Number
I IIC Cana
uh Mpe / � �a �ao�o
Address Z � a�D -�S� Expiration Date
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.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 ..........O No...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 / G p /n /✓�l Z— I YlC as Owner of the subject property hereby
authorize r7 A to act on my behalf,in all matters
relative to work authorized by this building permit application.
g- -20 - -20/6
signature of Owner Date
SECTIO 7b.- OWNER'OR AUTHORIZED AGENT DECLARATION
1 / . ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
!'C dl�ww !i"t Lind .S'e
Print Name 4 - U
S ignitions of Owner r- shoorirized IigJcnll-- - Date
iSigned under the pains and nalties of 'u
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who him an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will W have access to the arbitration
program or guaranty fund under M.G.L.c. I42A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 790 CMR Regulations 1 IO.R6 and I 10.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 half7baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
). "Total Project Square Footage"maybe substituted for"Total Project Cost"
:y CITY OF SALEM
r PUBLIC PROPRERTY
`�- '" D E P A RT'.10 E N T
Construction Debris Disposal Affidavit
(reyuirCd litr all demolition and renovation work)
In accordance \kith the sixth edition ofthe State Building Code, 780 CN1R section 111.5
Debris, and the provisions of k1GL c 40, S 54;
Building Permit it is issued with the condition that the debris resulting front
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
111. S 150A.
The debris will be transported by: /1
Inane of hauler)
I he debris will be disposed of in :
CZ f G1nn / a N S�/ S��L �Cvlit
(name of facility)
Inddress of facility)
�ienaurre of permit applicant
date
CITY OF SALEM
* , ,, i PUBLIC PROPRERTY
' DEPARTMENT
,1%W;`NI.1:Y 1)KNCt'[.I-
NiN)olt 12C Wrttira�i;tom 5'ftcehT SALl;M,M,%ss.%c:rtl:,%r iSGI97e
978-743-9595 • 1-:tx:978.740-9846
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
it fplicant Information Please Print Leeibly
- Name (Busi neworgani7ationil ndividual):
Address:
Cityistale,'%ip: Phone 0:
Arc you an employer?Check the appropriate box: "Type of project(required):
4. ❑ 1 am a general contractor and 1 6. New construction
I.❑ I am a employer with ❑
yin)lo cos full undlor art-time).` have hired the sub-contractors
2.❑/ 1 Y ( p' 7. ❑ Remodeling
] an,a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity, workers' comp. insurance. g, ❑ Building addition
No workers'cum 5. ❑ We are a corporation and its
l P- insurance officers have exercised their 10.❑ Electrical repairs or additions
require).] a
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing S repairs or additions
P-
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.) r employees. LNo workers' 13.0 Other
comp. insurance required.]
'Any:,pplicuul thus checks box 01 must also till out the wclion W.ow showing iheir workers'compensation policy ionumation.
'1 Wmeuwrwrs w•hu submit this affidavit indicuins they are doing all work and then hire outside contractors must auhmit a new al'fdavit indiWmg such.
-Commaon that check this box must 311whed an additional.sheet showing the ,.line of the subcontractors and their workers'comp.policy information.
I ant air employer that is providing workers'c•umpen,sadon insurance for myenoplayees. Belot,is thepu/tcy andLob.cite
i«jorinatiom
Insurance Company Name: _._..._
Policv 4 or Self-ins. Lic. *: .._.------— Expiration Date:
Job Site Address: City/Stateizip:
:\uach at 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.NIGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S1.500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S230.00 a day against the violater. Bc advised that a copy of this statement may be forwarded to the Office of
Investigations ul the DIA for insurance coverage verification.
/da hereby ccrlijy trader r/�`lins m prna/tie ry I!g ra!II+e injurmurimr provided above is truc'e1 and correct. /1
Date,
phume;e:
Q/fic-ial rue u«ly. Do toot ivrite in this area,to be completed by city or folvn officiaL
City or Town: Permit/Licensc'�--__—_--
Issuing whorily (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other ,—
Contact person: --_-_ Phone 0:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees.
Pursuutt to this statute,an emplotee is defined as "...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of:m individual,patmership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
§2 "every 1•• ' h issuance or
152 _SC 6 also stales that a er state or local licensing agency shall withhold the JiGL chapter , � O y b R Y
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required." -
Additionally, NIGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please rill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary, supply sub-contractor(s) name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP) with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for continuation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Offlcials
Please he sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to till in the permitllicense number which will be used as a.reference number. In addition,an applicant
that must submit multiple pennit'licettse applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be tilled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
"fhc bn ice of Investigations would like to thank you in advance fur your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
OfHee of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-NIASSAFE
Rz.vi.cd 5-26-05 Fax#617-727-7749
www.mass.gov/dia
33'-9"FINISH DIMENSION
15'-34"FINISH DIMENSION
S BEARING WALL TO BE REMOVED
- - - - - - - - - - - - - - - - -
w —
El I
A
S-2
Z
LL
f7
ro
N
1st FLOOR PLAN - EXISTING CONDITIONS
4,,,-0"
33'-9"FINISH DIMENSION
3"
15'-3- FINISH DIMENSION
4
0 4x4 POST — L 3I L �I_ �_41 4 x 9 2 LVL 4x4 POST
�'" II JII II II A
Z II II II II S-2
II II II II
2x10,CUT&FRAME TO
LVL BEAM
$ �C
8 Cl/ARLES 96A
PUSTIZZI
u No.Z9475 w
4
NAl Ea '�
2nd FLOOR PLAN
4.=,.-0"
C E R A Ds n Associates
71 Cross Street PLANS 176 MARLBOROUGH ROAD
Norton„ MA 02766-2318 SALEM, MA
scale: AS NOTED Mrawn bY: CP Mate: 08/07/2010 Fxavlsed: PROPOSED RENOVATIONS
15-34"
OPENING
BEARING WALL TO BE REMOVED
2xio
W10
ELEVATION A EXISTING
2"=1-o S-1
PLYWOOD SUBFLOOR
4-1 g x 9 2 LVL 2x10
DETAIL A A23-FRAMELONG /
LEG TO LVL BEAM---///
A23-FRAME LONG
LEG TO POST
4x4 POST 4x4 POST
15'_4"t
`kk OF hj,(�r`�7 f.
CHARLES 'cam
4 PUSTIZZI
s No.29475
O
A23-FRAME LONG
1@TS LEG TO POST
laAL�'Q'
A23-FRAME LONG 2x6 VERTICAL BLOCKING
LEG TO POST SYMMETRICAL WITH POST
2x10
WOOD NAILER
W10
ELEVATION A
2"=V-0" S-1
C E R A Design Associates BAZINET RESIDENCE
71 Cross Street ELEVATIONS 176 MARLBOROUGH ROAD
Norton„ MA 02766-2318 SALEM, MA
N scai®: AS NOTED prawn by: CP gate: 0 810 7/201 0 PROPOSED RENOVATIONS
3
14 3" 2'-0"SPACING FOR EWS338
12"
oily
4-1 g x 9 2 LVL's
IV 5-EWS005 EACH LVL BEAM FRAMING
OUTSIDE LVL TO
THE CORE LVL's 2-ROWS EWS338 @ 24"O.C.FOR INTERIOR TWO
A23-FRAME LONG LEG LVL's ONE SIDE ONLY.RECESS HEADS TO
44 POST TO THE POST. ALLOW FOR CLEARANCE WITH OUTSIDE LVL's
2-ROWS EWS338 @ 24"O.C.EACH OUTSIDE LVL
DETAIL A TO THE INNER DOUBLE LVL CORE.
1.=V-0.
GENERAL
STRUCTURAL DRAWINGS SHALL BE USED IN CONJUNCTION WITH ALL OTHER PROJECT DRAWINGS AND SPECIFICATIONS FOR COORDINATING
INFORMATION NOT SPECIFICALLY SHOWN ON STRUCTURAL DRAWINGS SO AS TO COMPLETE THE INTENDED WORK.
THE CONTRACTOR SHALL VERIFY AND/OR OBTAIN FIELD DIMENSIONS,ELEVATIONS AND OTHER PERTINENT INFORMATION NECESSARY TO
COMPLETE THE WORK.FIELD INFORMATION UNCOVERED DURING CONSTRUCTION THAT IS FOUND TO BE INCONSISTENT WITH THE
CONTRACT DOCUMENTS SHALL BE BROUGHT TO THE ATTENTION OF THE ENGINEER BEFORE PROCEEDING WITH THE AFFECTED WORK.THE
CONTRACTOR SHALL BE RESPONSIBLE FOR COORDINATING THE ABOVE INFORMATION WITH THE RESPECTIVE TRADES.
SECTIONS AND DETAILS SHOWN SHALL BE CONSIDERED TYPICAL FOR SIMILAR CONDITIONS.
CODE
COMMONWEALTH OF MASSACHUSETTS STATE BUILDING CODE.
DESIGN LIVE LOADS
` SECOND FLOOR: 30 POUNDS PER SQUARE FOOT
f ATTIC: 20 POUNDS PER SQUARE FOOT
LUMBER
LUMBER SHALL BE SO HANDLED AND COVERED AS TO PREVENT MARRING AND MOISTURE ABSORPTION FROM THE ELEMENTS.
LUMBER SHALL BE VISUALLY GRADED LUMBER AS DETERMINED IN ACCORDANCE WITH THE PROVISIONS OF ASTM STANDARDS D245-88 AND
D1990-91,
LUMBER SHALL BE IDENTIFIED BY THE GRADE MARK OF,OR CERTIFICATE OF INSPECTION ISSUED BY,A LUMBER GRADING OR INSPECTION
BUREAU OR AGENCY RECOGNIZED AS BEING COMPETENT.
WOOD FRAMING SHALL BE IN ACCORDANCE WITH THE 1991 EDITION OF"NATIONAL DESIGN SPECIFICATION FOR WOOD CONSTRUCTION.,
NEW WOOD FRAMING AS BILLED ON DRAWINGS REFERS TO THE RESPECTIVE STANDARD NOMINAL SIZES.
THE FOLLOWING GRADES AND SPECIES OF LUMBER SHALL APPLY AS APPLICABLE,AND HAVE THE INDICATED BASE DESIGN VALUES
CONSISTENT WITH NORMAL LOADING CONDITIONS NOT EXCEEDING A MAXIMUM MOISTURE CONTENT OF 19%:
04 POSTS
SPECIE:SOUTHERN PINE
GRADE:NO.2 OR BETTER
NEW GANG-LAM LVL BEAMS SHALL BE AS MANUFACTURED BY LOUISIANA-PACIFIC CORPORATION,PORTLAND,OREGON,OR AN APPROVED
EQUAL. MINIMUM FLEXURAL STRESS RATING SHALL BE 2,600 PSI,AND MINIMUM MODULUS OF ELASTICITY SHALL BE 1,900,000 PSI.
THE FOLLOWING METAL HARDWARE SHALL BE AS MANUFACTURED BY SIMPSON STRONG-TIE CO.,INC.,SAN LEANDRO,CALIFORNIA:
1. JOIST HANGERS:MODEL NO.1-1.28,20 GA.,GALVANIZED,USING SD9112 SCREWS.
2. FRAMING ANCHOR:MODEL NO,A23:18 GA.,GALVANIZED,USING SD9112 SCREWS.
NAILS SHALL BE COMMON WIRE NAILS. MINIMUM EDGE DISTANCE SHALL BE EQUAL TO 1".
NAILING REQUIREMENTS NOT SPECIFICALLY SHOWN ON DRAWINGS SHALL CONFORM TO THE NAILING REQUIREMENTS OF THE
MASSACHUSETTS STATE BUILDING CODE,ARTICLE 34,TABLE 3403-2. PVIt1 OF 4(
g� CHARLES yc
c PUS TIZZI
u No.29075
ICAL
C E R A Design Associates DETAILS BAZINET RESIDENCE
yl 71 Cross Street GENERAL NOTES 176MARLBOROU ROAD
Norton„MA 02766-2318 SALEM, MAA
W Scala: AS NOTED orawn by: CID oata: 08/07/2010 Ravisac: PROPOSED RENOVATIONS