47 MEMORIAL DR - BUILDING INSPECTION the Commonwealth of Massachusetts
+f hoard of Building Regulations and Standards CITY
h �n OF SALEM
bassachusetts State Building Code;730 C•MR, 7 edition Herixcd Jrrnuurt•
�I M
f Building Permit Applicatiun '10 Construct, Repair. Renovate Or Demolish a
One-or Two- 'iunily Dwelling
This S54ion For Official Use Only
Building Permit No er. 4 Date Applied:
Signature: ` lO`
BuildiVig'rummissionegIs for of Buildings Date
SECTION 1: SITE INFORMATION
I. Property Address: 1.2 Assessors Map& Parcel Numbers
I.la 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(11)
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.4u,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private❑ Check ifyes❑ F p y
SECTION 2: PROPERTY OWNERSHIP'
2.1 caner of Record•
�r( L �l�
xNa a rint) Address for Service:
. iture 'Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(,) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specity:
Brief Description of Proposed Workz:
W W L
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
I. Building S I. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cosh(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: $
4. Mechanical (HVAC) S List:
x5. Mechanical (Fire
Su ression Total All Fees:$
C ck No._Check Amount: Cash Amount:_
6.Total Project Cost: S Paid in Full ❑Outstan ing alance Due:
t1�Sr / GY//•vL1`//�C/ /�l�r`�f^
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
I.icense Numher Fxpiralion Date
Name of(.'St.-I loldcr
List C'SL'I'ype(see below)
F ve Description
Address II Unrestricted(tip to 35.000 Cu. Ft.)
It Restricted 1&2 Family Dwellin
Signature M klasonry Only
RC Residential Roofing Covero
Telephone WS Residemial Windwv and Siding
SF iming Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(H►C)
IIIC Company Name or HIC Registnmt Name Registration Number
Address
Expiration Date
Signature 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 .......... ❑ 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 all matters
relative to work authorized by this building permit application.
Si azure of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
1, , I C . 1�,Xvx ,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.
i'GyU
Print Nam
Signature o Owner or Authorized Agent Date
(Signed under the pains and penalties ofperjury)
NOTES:
I. An Owner who obtains a building permit to Jo 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. I42A. Other important information on the IIIC Program and
Construction Supervisor Licensing(CSL)can be found in 790 CMR Regulations 110.R6 and 110.115, respectively.
2. 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.) Ilabitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of haif%baths
Type of heating system Number of decks/porches
Type of cooling system flnclosed Open
3. "Total Project Square Footage" may be substituted for"Total Project Cost"
Building Permit Request for 47 Memorial Drive Salem
Prepared By Homeowner, M. Tranos
April 4, 2011
•
• Job Scope:
• Frame and install window unit facing rear of property(Collins Cove)
• Replace bearing interior wall with spanning composite LVL beam
• Install door unit and stairs exiting to rear of property
• Update heating system from furnace to boiler/baseboard
• Install new 3/4 bath in current breezeway(requires partition wall)
• Supporting demolition (dumpster to be located on property)
• Repair/replace vinyl siding and trim as required
• Replace/install insulation as required (minimal expected)
• Repair of interior walls/floors
Estimated Cost
• $16,000
Contractor:
• All work to be coordinated by homeowner _
Attachments:
• Attachment 1: Frame detail, Main living room floor beam
• Attachment 2: Frame detail, Rear window
• Attachment 3: LVL structural tables,GP Lam, Window header
• Attachment 4: LVL structural tables, GP Lam, Uniform Floor Loads
• 47 Memorial Drive
Building Permit Overview
NApr 11
Page 2
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Attachment 3
GP LAM'
1.5E GP Lam® LVL Window and
Patio Door Headers, 2-Story
Two-Story Applications 2,rd
This table shows the srse Jag,211W=2 plies of IW x itY:l of beams needed
ro sappprtflre combined loads Emma wa4 second story floor N of foml floor J
joist span)and various root lonmol sales with a 2'soffit fl the soft escapes T.
additional design is necessary. _
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• 1.5E GP Lam® LVL Window and
Patio Door Headers, Roof Only
�,k Mft aA
Roof Application
This table he.the sea(ag,2-11 W=2 plies of IW x i l INI of headers nodded to support
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• 47 Memorial Drive
Building Permit Overview
Attachment 3
04Apr 11
Attachment 4
GP LAM"
Allowable Uniform Floor Loads (PLF) - 100%
Ilan be applied to the beam in addition to its own weigh[)
ZOE GP Lama LVL
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• 47 Memorial Drive
Building Permit Overview
Attachment 3
04Apr 11
Q
CITY OF Sm.E.NI, ,\fL1SS.ICHUSETTS
• BL:ILDLNG DEPARTMENT
130 WASHLNGTON STREET, 3 °Rom
TML (978)74S-9595
FAX(978) 740.9846
KI\(BERLEY DRISCOLL
MAYORIHO.titAs ST.PtERRs
DIRECTOR OF PUBLIC PROPERTY/9umoLNG COMMISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
f1'1o✓c T�ivL �/lln✓�����6c)
(name of hauler)
The debris will be disposed of in
(name of f cility)
(address of facility)
signature of permit applicant
state
1cAna.,lf dk -
CITY OF S.U.EIM
PUBLIC PROPERTY
DEPART.. LENT
w.oursv n�auru
wwa 130 wxsw.c m MEM•s u-- Mmmcwsarrs o11b
ra.9,11.745-9s"a FAX 93-7+0,9646
HOMEOWNER LICENSE EXE..NMION
Please Prlst
Date rP I
Job Locadas 4-7 Mnirii8t/v-'v
Home Owner Address
Home Owasr Telephone
present Mailing Address
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeowners to engage an individual for
hire who.does not possess a licenser provided that the owner acts as supervisor.
DEFiNMON OF HOMEOWNER
Persons)who owns a parcel of land on which he/she resides or intends to reside.on
which there is, or is intended to be,a ow or two family dwelling,attached or detached
structures accessory to such use and/or farm structuree. A person who constructs more
than one home in a two year period shall not be considered a homeowner. Such '
"homeowner"shall submit to the Building Official,on a form acceptable to the Building
Oi icial, that he/she be responsible for all such work performed under the Building
Permit
The undersigned "homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned '•homeowner•'certifies that he/she understands the City of Salem
Building Department minimum impaction procedures and requirements and that he/she
Mill comply with said procedures and r quiremen
HOMEOWNERS SIGNAT(M -
APPROVAL OF BUILDING DiSPECTOR
See other side for state code