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4 NURSE WAY - BUILDING INSPECTION (2)
� `� � d� : . ��-l� � 6aY CE,�-�-�_ � �� � The Commonwealth of Massachusetts °� Board of Building Regulations and Standazds CITY OF Massachusetts State Building Code,780 CMR SALEM Revised Mar 20II Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling _ ' Ttu�s SecEion For Offi ' e Only Buildiag Permit I�h�bex;. Date pplied; ; /�-� �cJ : �/�/ ' g,��a;�g orr�;��c rx�„e> s��� , " �cm�o�v i:sz�nv�oz�n�rTo�v -• ' �, �- _ _ � 1.1� roper[y Address: 1.2 Assessors Map&Parcel Numbers � � / / ! /�' `� � c'��f . 1.1 a I this an accepted street. yes_ no Map Number Parcel Number a `''�" ' � 1.3 Zoning Information: � 1.4 Property Dimensions: t. y:: �:; r . Zoning District Proposed Use Lot Area(sq ft) Frontage(fl) ��.-�.� 1.5 Building Setbacks(tt) ++� � Front Yard Side Yards Rear Yazd � :� .� Required Provided Required Provided Required Provided �' , 1.6 Water Supply:(M.G.L c.40,§54) 1J Flood Zone Information: 1.8 Sewage Disposal System: � Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal O On site disposal sys[em ❑ , Check if yes� SECTION2: PR01'EItTYOWIVERSkIIP' 2 O er'otRecord• � ' k�r�i'b/ Q���r/n�e ti �$�� m � . C� �=i 7 c�. Nazn (Pnn� City,State,ZIP �C,,S ;6 7��`�'' - `�2��[aL[��- - No. d S t Telep one Email Address SECTION 3:DESCRIPTION OF PROP03ED WORKs(check all t6af apply) � New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ � Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: � � BriefDescri tion ofPro osed Worl�: ei d P p �ECTION 4:ESTIII�ATED CONSTRUCTIOiV COSTS Item Estimated Costs: Of5cial Use Oniy Labor and Materials - 1.Building $ 1• B�ilding Farmi!Fea:$ Iadicatelhow fee is determined`, 2.Electrical $ ❑��'d City/1"own Application Fee : ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Ofl�er Fees; �$� , . � '. . . . � � . . . 4.Mechanical (HVAC) $ List: - .. .. . . . . .. 5.Mechartical (F've $ Total All Fers:$ Su ression � Cheek Aio. Check Amount: C9sh Amount: 6. otal Project Cost: S `��i� �py�d��{ p p���$g��ce IIue: . — �° --- �� �. I `-i � &ECTION 5: COlV�TRUCTTOAi SEi2VIC`PsS ' 5.1 Construction Supervisor License(CSL) ��� �� ���� �� � � T� �„�� ,� `'/ �1 � , T n/ _a 3-isl � tJ License Number Expuation Date Name of CSL Holde� Lis[CSL Type(see below) No.and Street Type �Descai�tion. � . , U Unrestrided uildin u to 35,000 cu.ft. � R Restricted 1&2 Famil Dwellin CiTy/I'own,State,ZIP M Maso RC RooSn Coverin WS Window and Sidin ����2� f� SF Solid Fuel Bmning Appliances J � I Insulation Tele hone Email address D Demoli[ion 5.2 Registered Home Improvement Contractor(HIC) y HIC ReBstration N�anber Exp'ualion Da[e ''HIC Conlpany Name or HIC Registrant Name No."and Street Email address Ci /Town;Sta[e,ZIP Tele hone SECI'ION 6:WORKERS'COA4PE11ESATION II�ISIJRAIVCE AFN7DAVIT(M.G,L.c.152. ¢25C(�) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failwe to provide this affidavit will result in the denial of the Issuance of the building peimit. Signed Affidavit Attached? Yes .......... ❑ No...........❑ - SEC1`TON 7a: OWN�R AIJTHbRIZA1'ION 7'O BE C0113PLETEA WHE1V QVVIVER'S AGENT R�Q11iTRACTQR APPL[ES FOR BU7�.DING PEIL]VI1T I,as Owner of[he subjec[property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(ElecVonic Signature) . Da[e ': SECTION 76:OWNIER' OR AUTSORIZED AGENT DECLARATION � By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information con[ained in Uils applicafion is Uue and acwrate to the best of my knowledge and understanding. ��d>`n/ rv�,. v�/a��`c� Co'�cl`/� Pnnt Owner's or Authorized AgenYs Narne(ElecVonic Si�ature) Date NQT�S: , ]. 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 xot have access to the arbitra6on - program or guaranty fund under M.G.L.c. 142A.Other unportant information on the HIC Program can be found at �titivw.mass.gov!oca Informafion on the Construction Supervisor License can be found at www.mass. ov�d�s � 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basemeaUattics,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 Projec[Squaze Footage"may be substituted for"Total Project CosP' �� : �_.� ���,e �a�sa�o�2 z�e�,�� ��C�G�c��:�.c�u:�e� � Office of Consumer Affau�s ��i Busuress Regulation 10 Park PIaza 5uite 5170 Boston, iViassusi�s`��tsb2116 Home Improvement Cor�trractor Registration . . Regislration: 108392-� _, , _ TVPe: IndividuiU ...�.�., ----'--'-.��--- - - ExPiraUon: 8l18/2�?'� Tr# 255164 THOMAS A. LEONARD Thomas L�anerd --___ 45 GARDE�1 �T — au--- .. �n�FCT AlChfll@.� , . — .. _—. . . .�,1RY_M�-0_1.9R5.�. �.. � r_::: -- . � Update Address and returu cerd ��k reason for cLange_ scn i G zomos�i i ----.-- - - .... � . � Address C Renewal r; F-3�Yment � Lost Card .. - � ---�---- —._.... ..a �/� Y r ik rrmzri//�o/`^..�li::ne�.or/4 .. ___ ._—� _ '._____. ... . _ _�...\_Oftiec of Consumer _�irs S Bosi6ess RegulnNon Licenseocregistration�•alid for individul use only - � l� -.=�ME IMPROVEMC �,CONTRqCTOR . � before�he�expiration date. If found retvrn to: - � �� ���?88���on �pg '.� � Type: Office d£onsumer Affairs and Business Regulan � � - ���FE``xpiratlon 8I18/2 ;. � Intlivitlual 10 Par Pleza-Suite 5170 � � THOM�A.LEONARD. ' `B�'toMiYl'8:.�2]16 � � � _ . - . . : ' .y -. . . . _ �_._,_—__.._..._. .. ;/�'� - Thomas Leonard � �'"� ��^ 45 GARDEN ST �� � ��` "� -. �� WESTNEWBURY,MA01985 ' �—�"`�� � ��m��� � �� ` � �r��rG � Undersecretary � � . : Not valid without signature . , � � .. . . .. _ .._ .. .. . � Massachusetts Department af Public Safety � �� Board of Building Regulations and Standards License: CS-057808 r;,;yy' ��onsiructicn 3u��;vfsor j�� q - >P� �n: THOMAS A LEONARD � �� �� 45 6ARDEN STREET NIEST NEWBURY MA 01986 � � t�f.......�1�n �../L-- �::pration: �ommissioner 02/2312018 ''1:,�; ' ..� ' �, The Commonwea/th ofMossachusetts Depardnent oflndustrialAccidexts '� I Congress Street,Suite I00 Bostox,MA 02I14-2017 www mass.gov/dia Workers'Compensation Insurance�davit:Builders/ContraMors/Electricians/Plum6ers. TO BE FILED WITH 1'�PF,RNLITING AUTHORITY. A licant Information Please Print Le bl Name(s„smess/o,gamza' n/In�vi `ra/ /l�lt/ LL � 1 �- AaaTCSS: / L z City/State/Zip:_c%/�ilt�wi ✓�'1,d,�_C> ! �/� Phone#: � d 3 jc J�o Me yoo an employerY Check fLe approprlate bo:: �.O 1 mn s loya w�m � �'Pe o roject(required): �P r�(tunand/orpan-rime).• 7. Newcon.struction z. a aole wnarietor or pnrmvsnip ma nwe oo eemylor«s wmldng ror me in 8. �Remodeling °�Y�W��N�INo workvs'�comp.ms�uance n9imed) 7.a 1�a h wnv aoing elt wmic myself.[No warken• 9. ❑�olition � comp.maivance requ'ved.]t 4.�-��,6omeowna eoa w,71 ye 10 Q B�rilding addition YQ h�in8 wntrsctms W conduct all work on my�aoperry. 1 will w�ve that all cu�ac[ms eifha 6are workers'compensalion:•,a,.+�.�or ere wle 11.❑$]CCtIiC81 TeJ)8115 07 8dditlOns pl0}PIEIOt6 WRL 00 CII�IO}�CO. 12.Q Pl�bing repa'vs or additions 5.❑I am a 8ene.ral conhactor end I have L'ued the sub-coauacrors listed on the etlached aheet. 7Lese su+bcontractors have employers and have wo�kay'rymp,jny�uancGt 13.�Roof repairs 6.�We me a wtpora0on md itc o}Lcas Leve exucised t6e'v right of uanption pcMGL c 14.Q�f]1ei Is2,§1(4�and we have no employees.[No wmke�s•ca�p.inno�ce re9��] "�Y aDPlirmt that c6ecl¢6oa pl must alsa 511 out the swtim below s6owrog the'v wmkas'co�sapon PulicY mfametim. t Aomrowners who subimt Poia afTidavit rodiceling thry ere domg all work end thm 6ire ou�ide�o�ectms musl suLit a new a6davit indirating such =Contraclnn t�t c6eck Wis 6oa must ettazhed m�addiGonal shcel showing the n�e oftbe subc�haams md s�te afiet6a or not ihoae mti0es have wployea. ifthe sub=cantrauors have empluYees.Wey must provide Mefr workers'comp.policy aunber. I1 am au en+ployer[ha1 is provfding warkers'compensation insu�anre jor my employee.t Belnw is UsepoGcy andjab sife tnjormatioa Insurance Company Narne: Policy H or Self-ins.Lic.#: E�cpiration Date: Job Site Address: LyTy,/StateJZiP: Attach a copy of tLe workers'compensatlon policy declaratfon page(showing the poticy number and eapiration date). Failiue to secure covaage aa required�mder MGL c. 152,§25A is a criminal violation pimishable by a fine up to$1,500.00 end/rn one-year imprisonment,as well as civil penalties m the form of a STOP WORK ORDER and a fine of up[o$250.00 a "� day aga'vis[the violator.A copy of this statement may be forwazded to the Office of Investigations of the DIA for insurance coverage veri5cation. I do hereby c �under Ihe pains and enalt�es aj er�ury that the uejorma(ioa provrded abnve ia true md eonect s���: '�L..� �D na ��./� Phon #: O�cra!wse only. Do no1 write in this area,to be complded by city or rown o�cial City or Town• Permit/License# Issaing Authority(circle one): 1.Boerd otHealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbtng Inspector 6.Other ContaM Person• Phone#: -- �� Information and Instructions II Massachusetts General I,aws chapter 152 requues all employers to provide workers'compensation for tLeir emploYees• Pursuant to this statute,an employee is de5ned as"...every person in the service of another uader any contrad of hire, express or implied,oral or written." � An employer is defined es"en umdividual,parmership,association,cmporation or other legal entity,or any two m more of the foregoing engaged in a joiut enterprise,and includ'mg the legal repres�tatives of a deceased employer,or the receiver or m�stee of an individuel,parmershiP>association ar other legal entity>employing employees. However the owner of a dwelling house havmg aot more then three apartrnenu�d who resides therein,or the occupant of the dwelling house of anotLer who employs persons to do meintenance,construction or*epav work on such dK'e11'mg house or on the groimds or build'mg appurtenant thereto shall not because of such e�loyment be deemed to be an employer." MGL chapter 152,§25C(6)also s[ates that"every state or local licensing agency shall wlthhold the issuance or renewsl of a Hcense or permit to operate a business or to constraM boildings in tLe commonwealth for any applicant wLo has not produced aaeptable evidence of compliance wkL the insarance cwerage required." Additionally,MGL chapter 152,§25C(�states"Neither the commonwealth nar any of ifs political subdivisions s1�a11 enter into any contract for the perfom�ance of public work until acceptable evidence of compliance with the ms�asnce req�rirements of this chapter have been presented to ihe contrecting authority." Applicants Please 511 out the workers'co�ensation affidsvit completely,by checlong the boxes that epply to yo�u situation and,if necessary,supply subcontractor(s)name(s),address(es)and phone number(s)along with the"vi cerb5cate(s)of ins�uance. Liimted Liability Cou��ies(LLC)or Limited Liability Pmtnerships(LLP)witb no employees other then the members or parmers>are not required to carry workers'compensation insur�ce. If an I.LC or LLP does have � employees,a policy is required. Be advised the[this affidavit may be submitted to the DeparimeiR of Indushisl Accidents for�confirtnation ofinsurance coverage. Also be sure to sign aod date the a8ldavit T6e af5davit should be retumed to tLe ciTy or town thet the application for the pertnit or license is being requested,not the Deparlrnent of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' - comprnsation policy,please call the Departrnent at the manber lis[ed below. Self-insured compsnies should enter their self-insurance license number on the appropriate line. City or Town OlLcials � Please be s�ue that the affidavit is complete�d printed leg�bly. 1t�e Depar�ent has provided a space at ihe bottom of tLe afSdavit for you to fill out in the event the OfSce of Investigations has to contact you reg�ding the applicant. Please be sure to 511 in the pemtiUlicense number which will be used as a reference number. In addition,an applicant that must submit multiple petmiUlicense applications in any�v�ye�,need only submit one affidavit indicating current � policy information(if necessary)end under"7ob Site Address"the applicant should write"all locations in (city or town).^A copy of the effidavit tl�at has been officially sfamped or marked by the city or town may be provided to the applicant as proolthat a valid affidavit is on Sle for future pemrits or licenses. A new aflidavit mus[be filled out wch year.Where a home owner or citizen is obtaining a license or permit not related to mry business or conmmercial vent�ue (i.e.a dog license or pemut to bum leaves etc.)said person is NOT required to complete this affidavit. The Depaztment's address,telephone and fa�c number: � The Commonwealth ofMassachusetts Deparlment of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02 1 14-20 1 7 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/di8 � �TY OF SALEIV� MASSAQ�E T75 , B[�vBr�xr ]20Wa�ID�7�1S7R�T,3mFi.oa�c T�L(l78)7�5-9595. • Fex(978)7�4f9B1i6 BIb�LRiEYDRISaDIl MAYOR TY�uSST.P�E Dacaca++�z o�r�uc�dst�vna�ao�� Construction Debris Disposa/Affidavit (required for all demolition and,.renovation work)� In accordance with the sixth edkion of ihe State Building C�e, 780 CMR, Secdon 111.5 Debris; � and the provLsions of MGL c40, S 54; Building PermFt�1 is issued Wlth the condiiion that the debrfs resulting from this work shall be dtsposed of in a properly licensed waste depos�t facfiity as defined by MGL c ill,S i50A. - The debris will be transported 6y: � �✓'�P5 ��l��rP Q ' • (name of hauler) � The debris will be disposed of in: . � (name of facility) ������ (address of facility) � X�-.-�:�ii % , - Signature of applicant / %%� Date � 1 � Lot 3 �� �� � 2s• s � � ��� \ \ o,.��' ,6, � \ FOs 0 � � e�e'f \ LOT 216 � 17,390 S.F.f � \ � o`� \ � \ O� ,ti0 ec`' � 6'6, � �F �• `L �v°y 0'y � �, 60' 20 Lot 215 � N PROPOSED � 'fl- DWELLING �. M 24' "� �2� a' 19' Lot 217 � t° 20, 15' 1 PROPOSED �y FARMER'S PORCH I I� I �=3a �g' 31 .06' R=147.55' � i.vrr`��� '��Y"' t /' N U R S E W A Y ,..� ' 3�P�`N �F MAssqc ' �` DAVID yGn = PHILIP � PLOT PLAN OF LAND v TERENZONI y No. 38720 SALEM MA. A py �Np ES ��� PREPARSD FOR: �z/�6�j KEVIN 0'DONNELL LOT 2 >6 — NURSE WAY SCALE:1"=30' DATB: DBCEMBER 16, 20 t 5 Proposed Lot Coverage = 119 t DAVID P. TERENZONI, P.L.S. Plan Reference: Land Court Case No.856-13 4 ALLEN ROAD, PEABODY, %A. 01960 P15-103 � ������� ����s-� w�y ,�� �� �� � 3a�- ���,� � II� � � ��y� � � CITY OF SALEM ROUTING SLIP New Construction � Certiticate of Occupancy . �q,��IG-I ��5�c LOCATIO v✓�C' DATE /� ASSESSORS DATE -3 .�� I � 93 Washington St. C1TY CLERK G- DATE 3I�� I��u 93 Washington St. � PUBLICSERVICES ,�/ DATE � 120 Washington St. WATER r /�11 ` DATE S 16 I� 120 Washington St. � n < < CROSS CONNECTION ��DATE ��� � "� � �`"����� �� efferson Ave r� PO� . PLANNING �N�An�� Ci�'�`1�ATE l.�I��J�P 120 Washington St. CONSERVATION DATE -� 120 Washington S. ELECTRICAL ATE 48 Lafayette S . FIRE PREVENTION � ` DATE cP ��o 29 Fort Avenue HEA�LTH DATE D 6�0�20� 120 Washi gt • BUILDING INSPECTOR TE !� a�I p 120 Washington St. a ' � Certifed Energy Rater: ian Rex Kevin ODcnnell , Rafing Date: Raling Ordered For. � Salem,MA „ N y 7 .�. .��:-x.. ���i,::,,- �". s._�... . i .,.':,.:::. .. . , J � Estimated Mnual Energy Cost �..>�� ." �� ��. '.,, ���� , Projecled Rating ��\1 5 Stars Plus use MMBtu Cost Percent Heating 58.9 $1266 42% Projected Rating: Based on Plans, Field Confirmation Required Cooling I, 2.a $izs a°io '� Un'rform Energy Rating System Energy Efficlent Hot Wate� 192 $364 t2% 1 S(ar 1 S�ar Plus 2 Stars 2 Stars Plus 3 Stars 3 Stars PNs 4 Stars 4 Stars Plus 5 Stars 5 Slars�'Plus LighLslAp�pliances 21.9 $1043 35°/ L 500-401 400.301 300-251 254201 200.151 �. 150-101 100-91 90-86 BS71 70 or Less photovoltaics -0.0 $-0 -0°/ HERS Index: -60 � SeNlce Cherges $190 6% � General Informat n - ��' '� �,-'� � -�- -�`'� -�- % �k �` " Total 102 4 52989 100% . M '� w.. . ..�. .a.,a.&,.,..w x�:s. ..:..-� f� , r::+i'r1' .a..t.,.; �` ,t�'.;a..s„µ.�s,. I � � Condi6onedAreaz 2130sq.ft HouseType: Smgle (amilydefached ( -� � �_ ��; y-. CondiGonedVolume: 20068cubicfl. I Foundation: Unconditionedbasement � �^-����`���„' �."�� ^_"'''"- �•-�'��'"'^' ' TFiis home meels a exceeds lhe minlmum Bedrooms. 4 I I .,r, __y, zy �..��£ h , ,�,�,...g�� .�_r ,�, #�. , .�„�K. crilerla tor all of the fol�owing: �Me,chanical Systema Fea�Wr.es � �,� yE ,��' � k � "� � # .,��� . , . . �_- _. «.�f d ..��,< ��i. -x=: __.avv�+.. -� ,�.w'."+3....s <k��.�+:3 �.e:r' ' Heating: �Fuel-firedairdistribution,Naturalgas,92.0AFUEj �� - � Heating: Fuel-fired air distri6ution,Natural gas,92:�AFUE. ' Cooling: Air condiGoner,Electnc,i�13.0 SEER. _ . , DuctLeakagato0utsida BO.00CFM25. i �' - I� �; Ventilation System: Ezhaust Oniy:59 chn,8.0 watG. I Progremmable Thermostat Heating Yes Cooling Yes . ._,.� ,��, �wp ^�n p+ x r � . ':BuildingShellFeaWres, r-.: �.: , �. � y,�.��. f�,.�, y,.';�-�. h�,�� . _ . �....��. . _ tx r, . �. , . Ceiling FIaC NA Slab: None . �� SealedAltic: NA Exposed Floor. R-30.0 Vaulfed Ceiling: R-01.0 �/.,L � Window Type: U-Value:0320,SHGC:0.320 Above Grede Walls: R-21.0�%��� Infiltration Rale: H�q:3.00 CIg:3.00ACH50 Founda�onWalls: R00 Melhod: Codedefault x= x���' � � �k'� � ' 'LI hts end- iance Features �� `�f ' °� '� '+- �'� � � '_ _ � ��`�� � � � � ��R 9 APP� . es �� � - I ��� . „,_, z�.. IanRex � PercentlnleriorLigh6ng: 100.00 I RangalOvenFuel: NaWralgas TheEnergyHouod Percent EMerior Lighting: 2.00 � Clothes Dryer.Fual: Electric 11 Broadway,Suite 3 � Refrigerator(kWhlyr): 777.00 Clothes Dryer EP: 3.01 Beverly,MA01915 . . Dishwashar Energy Factor. 0.00 i Cailing Fan(cfmNJatt): 0.00 978-233-1433 " The Home Energy Ra6ng Slandard Discbsure for�hs home is available frqn the refvig pmvider. aywryayrcdnrwa. � REMIRate-ResldenlialEnergyMalyslsandRatingSoftwarev14.5.1 y'� Q a��w��% � Th's infortnatbn dces not consl�ute any warranty of energy cosl or savhgs. I�1 1 RGX""1°'�TM`F"`�"ain°.°° . �1985-2014Mchileclural Energy Corporation,Boulder,Cobrado. 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