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LOT 212 MARTIN LN - BUILDING INSPECTION No � City of Salem ward _ 1 r APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUC' IMPORTANT-AppArant to conwilaft aR No. In smtkw 1, A �, N, and IX L AT&0GATK" OraiRlf.T _ LOCATION Or BETWEEN AND LaT ��) ` 1 sups smar �olade SWKWO0N u✓ I Tfi� LOFT Z—Z�Suxx Sam L TYPE AND COST Of BULGING-AI applkwts compete Paris A -O A. rfPW OI NiROVEMEIET 0. PROPOSED USE•FOR"OEMOUMW USE M0.4f RECENT USE t CEI MM aldMM MonpuM En1Y 2 ❑ AddMM(#Mz"wAflanrrrwmer&n t1%ably /9 ❑ ANINOWFARk ' ,p1r Aw"in9 WWN ad114 E.^K a ow a 131 13 ❑ Is ❑ OMMK d1W-NOMM 3 ❑ Ai.aean Mm 2 aeo�y hvI A OrnY,-ErrW nunren 20 ❑ 1n�tr y❑ Ra& upbM wr 1 14 ❑ Tlrr NWO leer,rroMA w dorwAm- 71 ❑ Perkq Ifp.99 3 ❑ Wradriq d rrrreanr7 nYfnn.1 w+r.rruaer 22 ❑ N1dS L' ce uniY n Outlrq rt Art 4 r3! ld n � 24 ❑ 0Do4 Ort Prafriorr 9 ❑ Mm&V Patacadanl 19 0 crport 25 ❑ tua9f uva 7 ❑ rolrrdudon ph, 2• ❑ Sd1a - aaarl',orW err 17 ❑ 09r SprrJ� 27 ❑ SbMM mw- I IL O sar 2s ❑ �ba.r. 8 PrWate(InagwalJort elm) .corporatbn.nonpraw 29 ❑ OVw Spreft 9 ❑ Public(Fedw SO*w toeel 9arurnwd C-.COST K17 POO Mtdrrr-13dou l n dME papard ur d bU*M M ap.bad pn C8@@bVI WY. a Mort dmp.Irrrdy r nafpdil fYrrwary adwal ascardwv scnaaA 0~. 1 tl Car d Y.lprprrrw4 — -- ad"pw" IhrdMMr iwsptr pMnL 9 uw d bAWq Y b"tlwr9eA 0m ap n.r pad tw rW irc4%d in do abwu cow a EOebtcat. .n w.n" . % 11. TOTAL COIST OF IMPROVEMENT IL SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L.'demolition, can to on Parts J s M am Odws S*ip to/V L PRINCIPAL TYPE OF FAAMS F. PRIC TIM OF IEAT9M AAL G- TYPE OFM WAGE DISPOSAL L TYPE OF MECMAMCAL 7O r`t(��y-Jf/}y'Mamorry(-at bavrW JS Gw a0 ❑ PIw prn+f campanT �am,.be r 32 Cf S6Yctvr~ 37 ❑ Els y " ❑ Pr Iaaple Link*t.) M � 430 73 ❑ RO.00"d corm ft x (] Car K TYPEETOF WATER SUPPLY ❑ la ❑ Othw-Spcq. 79 ❑ Ottw-Spw-4 •2 U R�9e w prigab cope" 46 a+M es an M.r47 ae ❑ w .7 __ .3 I] P*N (..L cirMt - J.onsnuors Al DEMOLITION OF STRUCTURES: a mwrew of storm ,a '�w","low a%W use Has Approval from Historical Commission been received r smr►brew on..+ tot any sire ture over fifty(50)years? Yea__ No— Dig Salsa Number SQ 'W MOYr.>4R .. _..__ i s r+t am or orFernQT P*A"A sWss Pod Control sl Erc`wd __. __. .. __. . _.._. ... HAVE THE FOLLOWING llT1UTIES BEEN DISCyes ONNE No a.eoa. _.._._..__.--------____--__._- *MMOOCrAL eraoeroe Orel Electric Gm FJ___—_______.._ Sewr: 54 's~d DOCUMENTATION FOR THE ABOVE MUW BE ATTACHED bagwoom r sr_----__....__ BEFORE A PERMfT CAN BE ISSUED. N. COMPLE M THE FOLLOWNG: Historic DisWW Yes— No— (ti yes,pieaee enclose documentation from Hiet Can.) Conservation Ares? Yes— No_ (if yes,piam ancbee Order of Conditions) Has Fire Prevention approved and stamped plans or WO cations? Yea__ No_ la properly located in the S.RJL dtsWct? Yes_ NO_ Comply with Zoning? Yee_ No— (it no,enclose Board of Appeal decision) Is lot grandfathereV Yes___ No— (ti yea,submit docunwtatl)n/ff no,submit Board of Appeal decision) If new construction,has the proper Routing Slip been enclosed? Yes— NO_ Is Architectural Access Board approval required? Yes_ NO— (If yes,submit documentation) Massachusetts State Contractor Licenses 7 6 7 Y& Salem License * Home Improvement Contractor a Homeowners Exempt torn(if applicable) Yes— No— CONSTRUCTION TO BE COMMENCED WITHIN SD((a)MONTHS OF ISSUANCE OF BUILDING PERMfT ti an extension is necessary,please submit CONSTRUCTION IS TO BE COMPLETED BY: in writing to the Inspector of Buddinga. V. IDENTIFICATION. I•o be completed by all applicants yy,r wrq IddM= vuror.snow err.nor vas ZIP coat '.�Na C > :.asss z e.wrrs 1 �.crrtn�r E.�prr I hereby certiy that the proposed Mork a audtorized by the owner of record and tat I have been authorized by lie cwner to-make this v0kabcn a his authonzed agent and'we agree to cor:forrn to all kable laws of this,unsdeioft Sigrature ^ � Address Application cafe DO NOT WRITE BELOW THIS LINE VL VALIDATION FOR DEwwTk*W use oMY Building Pe"number um crow Building 19 Fide Gnm*V Permil issued Building LAO Lou** Permill Fee S oocUPwVV LOW Cef4fica0e of Occupancy f Approved by. _ Drain Tile f �- Plan Review Fee f tr/GQ/v ✓vs e rme NOTES AND Data• (For department use) S Cit- PERMIT TO BE MAILED TO: DATE MAILED: Construction to be started by. Completed by. A ZONING PLAN EXAMWERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES 3frE OR PLOT PLAN•For Appic&W Use O N BeamChek v2005 licensed to:DMS design, llc Reg#5234-65564 The Belmont Beam#1 Date:3/26/12 Selection (3)1-314x 9-1/4 1.9E TJ Microllam LVL Lu=0.0 Ft Conditions Min Bearing Area R1=3.5 in2 R2=3.5 in2 Data Beam Span 13.0 ft Beam Wt per ft 12.48# Reaction 1 TL 2616# Reaction 2 TL 2616# Bm Wt Included 162# Maximum V 2616# Max Moment 8502 W Max V(Reduced) 2306# TL Max Defl L/240 TL Actual Defl L/397 Attributes Section (in) Shear W) TL Defl in Actual 74.87 48.56 0.39 Critical 37.88 12.14 0.65 Status OK OK OK Ratio 51% 25% 60% Fb(psi) Fv(psi) E(psi x mil) Fc L (psi) Values Base Values 2600 285 1.9 750 Base Ad'usted 2694 285 1.9 750 Adiustments CIF Size Factor 1.036 Cd Duration 1.00 1.00 Cr Repetitive 1.00 Ch Shear Stress N/A Cm Wet Use 1.00 1.00 1.00 1.00 Cl Stability 1.0000 Rb=0.00 Le=0.00 Ft Kbe=0.0 Loads Uniform TL: 390 =A Uniform Load A 0 R1 =2616 R2=2616 SPAN= 13 FT Uniform and partial uniform loads are Ibs per lineal ft. BeamChek v2005licensed to.DMS design, llc Reg It 5234-65564 The Belmont Beam#2 Date:3/26/12 Selection (3)13/4x 11-114 1.9E TJ Microllam LVL Lu=0.0 Ft Conditions Min Bearing Area R1=8.0 in' R2=8.0 in' Data Beam Span 13.0 ft Beam Wt per It 15.18# Reaction 1 TL 6014# Reaction 2 TL 6014# Bm Wt Included 197# Maximum V 6014# Max Moment 19544 # Max V(Reduced) 5146# TL Max Defl L/240 TL Actual Deft L/311 Attributes Section ink Shear(in) TL Defl(in) Actual 59.06 0.50 Critical [110.74 89.42 27.09 0.65 Status OK OK OK Ratio 81% 46% 77% Fb(psi) Fv(psi) E(psi x mil) Fc1(psi) Values Base Values 2600 285 1.9 750 Base Adiusted 2623 285 1.9 750 Adiustments CF Size Factor 1.009 Cd Duration 1-00 1.00 Cr Repetitive 1.00 Ch Shear Stress N/A Cm Wet Use 1.00 1.00 1.00 1.00 Cl Stability 1.0000 Rb=0.00 Le=0.00 Ft Kbe=0.0 Loads Uniform TL: 910 =A Uniform Load A RI 6014 R2=6014 - SPAN=13 FT Uniform and partial uniform loads are Ibs per lineal ft. BeamChek v2005 licensed to.,DMS design,Ilc Reg#5234-65564 The Belmont Beam#2 Date: 326/12 Selection W 8x 15 36 ksi Wide Flange Steel Lateral Support at: Lc=4.2 ft max. Conditions Actual Size is 4 x 8-1/B in., Min Bearing Length R1=0.8 in. R2=0.8 in. Data Beam Span 13.0 ft Beam Wt per ft 15.0# Reaction 1 TL 6013# Reaction 2 TL 6013# Bm Wt Included 195# Maximum V 6013# Max Moment 19541 W Max V(Reduced) N/A TL Max Defl L/240 TL Actual Defl L/366 Attributes Section i Shear i TL Dell(in) Actual 11.80 1.99 0.43 Critical 9.87 0.42 0.65 Status OK OK OK Ratio 84% 21% 66% Fb(psi) Fv(psi) E(psi x mil) Values Base Value Fy 36000 36000 29.0 Base Ad'usted 23760 14400 29.0 Adiushnents YP Factor, Lc 0.66 0.40 Loads Uniform TL: 910 =A Uniform Load A RI 6013 R 606013 SPAN= 13 FT Uniform and partial uniform loads are Ibs per lineal ft. BeamChek v2005licensed to:DMS design, llc Reg#5234-65564 The Belmont Beam#3 Date:3/26/12 Selection (3)2x 10 SPF South#2 Lu=0.0 Ft Conditions NDS 2001 Min Bearing Area R1=6.5 in' R2=6.5 in' Data Beam Span 6.6 ft Beam Wt per ft 10.11 # Reaction 1 TL 2178# Reaction 2 TL 2178# Bm Wt Included 67# Maximum V 2178# Max Moment 3594 # Max V(Reduced) 1670# TL Max Defl L/240 TL Actual Defl L/919 Attributes Section m Shear(i TL Defl in Actual 64.17 41.63 0.09 Critical 50.59 18.55 0.33 Status OK OK OK Ratio 79% 450A 26% Fb(psi) Fv(psi) E(psi x mi) Fc L (psi) Values Base Values 775 135 1.1 335 Base Ad'usted 853 135 1.1 335 Adjustments CF Size Factor 1.100 Cd Duration 1.00 1.00 Cr Repetitive 1.00 Ch Shear Stress N/A Cm Wet Use 1.00 1.00 1.00 1.00 CI Stability 1.0000 Rb=0.00 Le=0.00 Ft Kbe=0.0 Loads Uniform TL: 650 =A Uniform Load A R1 =2178 R2=2178 SPAN=6.6 FT Uniform and partial uniform loads are Ibs per lineal ft. BeamChek v2005licensed to.DMS design, tic Reg#5234-65564 The Belmont Beam#4 Date:3/26N 2 Selection (2)1-3/4x 9-1/4 1.9E TJ Microllam LVL Lu=0.0 Ft Conditions Min Bearing Area R1=5.2 in' R2=5.2 in' Data Beam Span 6.6 ft Beam Wt per ft 8.32# Reaction 1 TL 3888# Reaction 2 TL 3888# Bm Wt Included 55# Maximum V 3888# Max Moment 6416 W Max V(Reduced) 2980# TL Max Deft L/240 TL Actual Defl L/692 Attributes Section(ink Shear m TL Defl in Actual 49.91 32.38 0.11 CriticalF570/o 28.58 15.69 0.33 Status OK OK OK Ratio 48% 35% Fb(psi) Fv(psi) E(psi x mil) Fc!(psi) Values Base Values 2600 285 1.9 750 Base Adjusted 2694 285 - 1.9 750 Adiustments CF Size Factor 1.036 Cd Duration 1.00 1.00 Cr Repetitive 1.00 Ch Shear Stress N/A Cm Wet Use 1.00 1.00 1.00 1.00 Cl Stability 1.0000. Rb=0.00 Le=0.00 Ft Kbe=0.0 Loads UniforrmTL: 1170 =A Uniform Load A 0 RI =3888 R2=3888 SPAN=6.6 FT Uniform and partial uniform loads are Ibs per lineal ft. Generated by REScheck-Web Software Compliance Certificate Project Title: Lot#211 Martin Lane Energy Code: 2009 IECC Location: Salem, Massachusetts Construction Type: Single Family Glazing Area Percentage: 16% Heating Degree Days: 6268 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor: Lot#211 Martin Lane Salem,Massachusetts Compliance:4.7%Better Than Cade Maximum UA:299 Your UA:285 The%Better or Worse Than Code index reflects how close to compliance the house is based on code trade-off miss. It DOES NOT provide an estimate of energy use or war relative to a minimums de hone. Gross Cavity Cont. Glazing �UA Assembly Area or R-Value R-Value or Door Perimeter U-Factor Floor:All-Wood Joist/Truss Over Uncond.Space 1272 30.0 0.0 42 Ceiling:Flat or Scissor Truss 1272 38.0 0.0 38 Wall:Wood Frame, 16in.o.c. 2025 21.0 0.0 95 Door:Solid 21 0.200 4 Door:Glass 42 0.300 13 Window:Vinyl Frame,2 Pane w/Low-E 290 0.320 93 Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2009 IECC requirements in REScheck-Web and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Title: Lot#211 Martin Lane Report date: 03/22/12 Data filename: Page 1 of 4 CGenerated by REScheck-Web Software �J( Inspection Checklist Energy Code: 2009 IECC Location: Salem, Massachusetts Construction Type: Single Family Glazing Area Percentage: 16% Heating Degree Days: 6268 Climate Zone: 5 Ceilings: ❑ Ceiling:Flat or Scissor Truss,R-38.0 cavity insulation Comments: Above-Grade Walls: ❑ Wall:Wood Frame, 16m.o.c.,R-21.0 cavity insulation Comments: Windows: ❑ Window:Vinyl Frame,2 Pane w/Low-E, U-factor:0.320 For windows without labeled U-factors,describe features: #Panes—Frame Type Thermal Break? Yes No Comments: Doors: ❑ Door:Solid,U-factor:0.200 Comments: ❑ Door: Glass,U-factor:0.300 Comments: Floors: ❑ Floor:All-Wood Joist/Truss Over Uncond.Space, R-30.0 cavity insulation Comments: Floor insulation is installed in permanent contact with the underside of the subficor decking. Air Leakage: ❑ Joints(including rim joist junctions),attic access openings,penetrations,and all other such openings in the building envelope that are sources of air leakage are sealed with caulk,gasketed,weatherstripped or otherwise sealed with an air barrier material,suitable film or solid material. ❑ Air barrier and sealing exists on common walls between dwelling units,on exterior walls behind tubs/showers,and in openings between window/doorjambs and framing. ❑ Recessed lights in the building thermal envelope are 1)type IC rated and ASTM E283 labeled and 2)sealed with a gasket or caulk between the housing and the interior wall or ceiling covering. ❑ Access doors separating conditioned from unconditioned space are weather-stripped and insulated(without insulation compression or damage)to at least the level of insulation on the surrounding surfaces.Where loose fill insulation exists,a baffle or retainer is installed to maintain insulation application. ❑ Wood-burning fireplaces have gasketed doors and outdoor combustion air. ❑ Automatic or gravity dampers are installed on all outdoor air intakes and exhausts. Air Sealing and Insulation: ❑ Building envelope air tightness and insulation installation complies by either 1)a post rough-in blower door test result of less than 7 ACH at 50 pascals OR 2)the following items have been satisfied: (a)Air barriers and thermal barrier:Installed on outside of air-permeable insulation and breaks or joints in the air barrier are filled or repaired. Project Title: Lot#211 Martin Lane Report date: 03/22/12 Data filename: Page 2 of 4 (b)Ceiling/attic:Air barrier in any dropped ceiling/soffit is substantially aligned with insulation and any gaps are sealed. (c)Above-grade walls: Insulation is installed in substantial contact and continuous alignment with the building envelope air barrier. (d)Floors:Air barrier is installed at any exposed edge of insulation. (a)Plumbing and wiring: Insulation is placed between outside and pipes.Batt insulation is cut to fit around wiring and plumbing,or sprayed/blown insulation extends behind piping and wiring. (f) Comers,headers,narrow framing cavities,and rim joists are insulated. (9)Shower/tub on exterior wall: Insulation exists between showers/tubs and exterior wall. Sunrooms: ❑ Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U-factor of 0.50 and the maximum skylight U-factor of 0.75.New windows and doors separating the sunroom from conditioned space meet the building thermal envelope requirements. Materials Identification and Installation: ❑ Materials and equipment are installed in accordance with the manufacturer's installation instructions. Materials and equipment are identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. 0 Insulation R-values and glazing U-factors are clearly marked on the building plans or specifications. Duct Insulation: Supply ducts in attics are insulated to a minimum of R-8.All other ducts in unconditioned spaces or outside the building envelope are insulated to at least R-6. Duct Construction and Testing: ❑ Building framing cavities are not used as supply ducts. ❑ All joints and seams of air ducts,air handlers,filter boxes,and building cavities used as return ducts are substantially airtight by means of tapes,mastics,liquid sealants,gasketing or other approved closure systems.Tapes, mastics,and fasteners are rated UL 181A or UL 181 B and are labeled according to the duct construction. Metal duct connections with equipment and/or fittings are mechanically fastened.Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with a minimum of three equally spaced sheet-metal screws. Exceptions: Joint and seams covered with spray polyurethane foam. Where a partially inaccessible duct connection exists,mechanical fasteners can be equally spaced on the exposed portion of the - joint so as to prevent a hinge effect. Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in.w.g.(500 Pa). Duct tightness test has been performed and meets one of the following test criteria: (1)Postconstruction leakage to outdoors test:Less than or equal to 101.8 cfm(8 ctm per 100 ft2 of conditioned floor area). (2)Postconstruction total leakage test(including air handler enclosure):Less than or equal to 152.6 cfm(12 cfm per 100 ft2 of conditioned floor area). (3)Rough-in total leakage test with air handler installed:Less than or equal to 76.3 cfm(6 cfm per 100 ft2 of conditioned floor area). (4)Rough-in total leakage test without air handler installed:Less than or equal to 50.9 cfm(4 cfm per 100 ft2 of conditioned floor area). Temperature Controls: ❑ Where the primary heating system is a forced air-fumace,at least one programmable thermostat is installed to control the primary heating system and has set-paints initialized at 70 degree F for the heating cycle and 78 degree F for the cooling cycle. ❑ Heat pumps having supplementary electric-resistance heat have controls that prevent supplemental heat operation when the compressor can meet the heating load. Heating and Cooling Equipment Sizing: Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code. F-1 For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2009 IECC Commercial Building Mechanical and/or Service Water Heating(Sections 503 and 504). Circulating Service Hot Water Systems: O Circulating service hot water pipes are insulated to R-2. ❑ Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: Project Title: Lot#211 Martin Lane Report date: 03/22/12 Data filename: Page 3 of 4 HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-3. Swimming Pools: Heated swimming pools have an on/off heater switch. ❑ Pool heaters operating on natural gas or LPG have an electronic pilot light. ❑ Timer switches on pool heaters and pumps are present. Exceptions: Where public health standards require continuous pump operation. Where pumps operate within solar-and/or waste-heat-recovery systems. ❑ Heated swimming pools have a cover on or at the water surface.For pools heated over 90 degrees F(32 degrees C)the cover has a minimum insulation value of R-12. Exceptions: Covers are not required when 60%of the heating energy is from site-recovered energy or solar energy source. Lighting Requirements: A minimum of 50 percent of the lamps in permanently installed lighting fixtures can be categorized as one of the following: (a)Compact fluorescent (b)T-8 or smaller diameter linear fluorescent (c)40 lumens per watt for lamp wattage<=15 (d)50 lumens per watt for lamp wattage> 15 and<=40 (a)60 lumens per watt for lamp wattage>40 Other Requirements: Li Snow-and ice-melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting off the system when a)the pavement temperature is above 50 degrees F,b)no precipitation is falling,and c)the outdoor temperature is above 40 degrees F(a manual shutoff control is also permitted to satisfy requirement'c'). Certificate: ❑ A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R-values;window U-factors;type and efficiency of space-conditioning and water heating equipment.The certificate does not cover or obstruct the visibility of the circuit directory label,service disconnect label or other required labels. NOTES TO FIELD:(Building Department Use Only) Project Title: Lot#211 Martin Lane Report date: 03/22/12 Data filename: Page 4 of 4 ® 2009 IECC Energy Efficiency Certificate Ceiling I Roof 38.00 Wall 21.00 Floor I Foundation 30.00 Ductwork(unconditioned spaces): Window 0.32 Door 0.30 NA Heating System: Cooling System: Water Heater: Name: Date: Comments: �o f Ziz `;— CI`I�l UE 5i1LEml l L,SS.1CHt SETTS t r BUILDING DEPAKTNW-ST °4 120 NVASHNGTON STREET, 3'a FLOOR ;�`M. TEL(978) 735-9595 FAX(973) 7•149946 KI.,,iDERL.EY DRISCOLL INtAYOR THonits ST.Pimus DIRECTOR OF PUBLIC PROPERTY/sumorNG C0N611SSIONER Workers' Compensation Insurance At7idavit: Builders/ContracturslElectrlctans/Plumbers AnAn tit lnfnrmution Pleane Print Legibly Mum:lliatine..aUrgtntratiunIndividual): S rt L tM M r> y J r ��✓ $ G Address: l O g City/Sratc/Zip: Yl2nc 0191 Phungll: 77,r - 7v"L ZS `fY ,ire you an employer?Check the appropriates bass r ype uLprojeet(required): 1.Cl I am a employer with 4. AIJ I um a general contractor and 1 rL�"]J�New cunatruction cnuployees(111and/orpart-time).• have hired thesub-contractors 2.C] .❑ I am a solo propdotor or patner• lisldd on the attachad.rhevL i ❑Remodeling shipandhavo nu employees These sub-contmetors have ❑ Demolition tVeking terme in any capacity. workers'comp,insurance. building addition (N o workero.comp, insurance !. (] We are a corporation and itsrequired.) officers have exercised their 0.0 Electrical repairs or additions 3.❑ 1 mn a homeowner doing all work right of exemption per MG L 11.0 Plumbing repairs or additions myself. (No workers'Gump. c. 152,§1(d),and we have no 12.❑ Roof repairs insurance required.) t employees.(No workers' comp.insuraneerctI -d.J il.(]Other ;.My appliuun dos Owks boa A mail afro all oul Ihv welioe Wtdw ahowina dlalr ra4rn'tompnudun Pulpy inMrmndon. I Lvnsuwtvurs who ruhmit this utldevir indleaint they an Joins all work and then him oui,149...Imrters meet eohtnit a new affidavit indicuint cud, (' mr:wlon that chalk this bvx most mashed an aJdiriuwl.hat shuwint the Owns orlhe eub.aalml ns eats their workers'wimp,policy infoemadae. lain un employer rhur/r pruvlJ/rrX workers'cumpe trarlun lnsurancefor my infuraruNen unp/uyrrs @e/uw/s lbe po//ry and/ub rite Insurutwo Company Name: 1LA J 0 .1.Ls✓n 4n6 e, co Policy 4 or Salf--ins. Liu. 4: dh 1�0 L_0 S 7 Zi Expiration Dote: !L I/S//Z Job Site Addruss: /0 Sayd1y;,tort Cily/Stute/Zip: (0IcI70 Altaeb a copy of the workers'compensation policy declaratlon page(showing the polity mum be and espirulaq data). Kiduru to wcuru coverage us required under Section 23A ot'XIGL e. 132 can lead to the imposition of criminal penalties of a tine up to 31.500,00 und/ur one-year imprisonment as well as civil penalties in the r'orm ufa STOP WORK ORDER and a line of tip m S2J0.00 a Jay against the violator. Ile advised that a copy of this>ratement may be furwurded to ilia OI'ITeo of In vvA i gat ions ai the r)IA for insuranca co veragc vcri t)aatiun. 140 hr re6y cerlify anJr der pubis urd pensltler afperjury llwl the b1fururullme pruv!JeJ above iv frue and correct ii••n.iture: 4 tI UafJ: PT,p_A, c� 97 ------------ t y�L zs�y 00tiol see mdy. the rtnl wrife in thrk area, to b♦cuurpleled by airy ur town njlit'i0i Gtynr l'uwn;._ .._._ Per m"IT.lac rile.I h.uinK,\uthurily (circle one): —._. .. ..---- . ... I. lluaN ul'lleahh '. [Iuildln Drpurltuc,u .L ('ilyi fawn Clerk 4. Electrical rn,livOur i. Plunthinq lusp¢etur 6.011wr Cnnlad l'ercn°' ...._.__� Phone d: r� L p CITY OF SALEM ROUTING SLIP New Construction V Certificate of Occupancy LOCATION 7. 1 Z, f*4141ti /mne.DATE al 2 ASSESSORS DATE 93 Washington St. CITY CLERK DATE 93 Washington St. PUBLIC SERVICES DATE 120 Washington St. WATER DATE 120 Washington St. CROSS CONNECTION DATE 5 Jefferson Ave PLANNING DATE 120 Washington St. CONSERVATION DATE 120 Washington St. ELECTRICAL DATE 48 Lafayette St. FIRE PREVENTION DATE 29 Fort Avenue HEALTH DATE 120 Washington St. BUILDING INSPECTOR DATE I� . 120 Washington St. CITY OF SALEM ROUTING SLIP N'ew Construction 1/ Certificate of Occupancy LOCATION /gnb DATE ASSESSORS W DATE �- 93 Washington St. CITY CLERK DATE 93 Washington St. /giw �j� 6��PU/13 IC SE:RVICES�DATE �OR 2 ^� 120 Washington SSt.,// v WATER (, WL �— DATE i L— ✓J w�rK ��/�j��h 120 Washington St. # S."l s� " s13 a , CROSS CONNECTION DATE 6' 'T'v^01, r%* 5 Jefferson Ave vv PLANNING Apw2,Qg —h )k,, LDATE q J161 f? 120 Washington St. CONSERVATION 120 Washington St. ELECTRICAL DATE 48 Lafayette St. FIRE PREVENTION DATE (d 29 Fort Avenue ,, HEALTH e---, Y� DATE 120 Washington // BUILDING INSPECTOR o.�BATE 120 Washington St. � �n�340�i1 bnOd ��p�0� 0�3�30Q��0�3a �QQo Professional Land Surveyors Er Civil Engineers ESSEX SURVEY SERVICE. 1958 - 1986 OSBORN PALMER 1911 - 1970 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN S�LLB9 MASS. �L!�/ C/I/lr�/lf'✓i7 �lrr�/l C�i 132.60 �c7 Z12 i 36 t to Sl� -Z,i 2 l/ I i2,ao. . l6 162TIAI L 4 kC CL�S TrvC nn qq,� I hereby certify to the SdLCIh ZONE: ICI LOT AREA: /Vd& LOT FRONTAGE: Building Inspector that the pro- posed construction shown conforms FRONT YARD: SIDE YARD: REAR YARD:.3Gl/' to the dimensional zoning of l Gl;�G SflLE6LI Mass. SCALE. q� ✓L�� DATE: • /'/'� 23 ZO�Lq REFERENCE: BK PG / Christopher R. MelW P .3 7 MELLON . J y 104LOWELLSTREET PEABODY, MASS.01960 q- k 's: (508)531-8121 FAX:(508)531-5920