8 OSGOOD ST - BUILDING INSPECTION What is the current use of t e Building?
Material of Building? to It dwelling,how many units?
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phoneme
Mechanlds Name Y lI
Address and Phone _ '/'
Construction Supervisors License 0 6,2,2, HIC Registration i/
Estimated Cost of Projed i_ , �6�permit Fee Calcutafbn
Permit Fee S Estimated Cost X 117/311000 Residential
Estimated Cost X$`11/111000 Commercial
An Additional$6.00 is added as an
Administrative charge.
Make sure that all fields are property and legibly written to avoid delays In processing.
The undersigned does hereby apply for a Building Permit to bu777-1
specifications. Signed under penalty of perjury /� �—
Date 7
- I
N
yjV
1�
Q 9 �.
oo C7 o a�
96 a
- 4 - _ _.
BOISE" Quadruple 1-3/4" x 9-1/2rr VERSA-LAM® 2.0 3100 SP Floor Seam1FB03
BC CALCO 9.3 Design Report- US 1 span I No cantilevers 10112 slope Tuesday, July 10, 2007 11.56
Build 057
-off
File Name: BC CALC roject
Job Namc: Johnson Description; FB03
Address: _ - --- ----
Specifier: Bruce _ -
Gily, State, Zip: , Designer: Guy Poisson
Customer; Gove Lumber Company:
Code reports: ESR-1040 MIsC,
2•00.0ll0llill...-_ � � I '� IlII Ilgll111III' I I���II �I �IIII19PII'���III�I � l .� _._. . i lul'IIi '�IUj'''ll
I I ' iilll iI' ! Il
130.3-1/2"
U 240 Ibs LL 240lbs
pl-3172 Ibs DL 3172 lbs
Total Horizontal Product Length=12-00-00
Load Summary Live Deaid Snow Wind Roof Live
Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib.
1 Standard Load Unf, Area (psf) Left 00-00-00 12-00-6o 40 10 01.00-00
2 8" Block Wall Unit. Lin. (plt) Left 00.00-00 12-00-00 0 500 n/a
Controls Summary value %Allowable Duration Load Case Span Location Disclosure
PCS, Moment 8804 ft-Ibs 35.0% 90% 1 - Internal Completeness and accuracy of Input must
End Shear 2599 Ibs 22.901 90% 1 - Left be verified by anyone who would rely on
Total Load Deft. U610 (0.227") 39.30/0 1 1 output am evidence of suitability for
Live Load Defl. L/8674 (0.016") 4.2% 1 1 particular application.Output here based
Max D fl o on building code-accepted ted design
e 0.227" 22.7/0 1 1 p g
properties and analyses methods-
Span/Depth 14.6 n/a 1 Installation of BOISE engineered
wood
products must be In accordance with
%Allow %Allow current Installation Guide and applicable
Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide
BO W all/Plate 3-1/2"x 7" 3412 Ibs n/a 18.6% Unspecified or ask questions,please call
61 Wall/Plate 3-1/2" x 7" 3412lbs nla 18.6% Unspecified (6D0)232-0788 before Installation.
Notes BC CALCO.SC FRAMER®,AJSTM
ALWOIST®, BC RIM BOARCr-,BCI®,
Design meets Code minimum (U240) Total load deflection criteria. BOISE GLULAM*M,SIMPLE FRAMING
Design meets Code minimum (U360) Live load deflection criteria. SYSTEMO,VERSA-LAM®,VERSA-RIM
Design meets arbitrary (1") Maximum load deflection criteria. PLUS®,VERSA-RIMO,
Fastener Manufacturer: Simpson Strong-Tie, Inc. VERSA-STRAND®,VERSA-STUD®aretrademarks of Boise Wood Products,
Connection Diagram L.L.C.
n
I
4 '
a minimum = 1-1/2"c = 6-1/2"
b minimum = 4" d = 6"
e minimum = 1"
Bea ins 7 inches wide will be assumed to be elthar lop-loaded only,or equally loaded from each side.
Install screws from both sides,staggering screws by�/v of the spacing to avoid splitting.
Member has no side loads.
Connectors are:SDS 114 x 6
Page 1 of 1
r / Crry OF VALEm
- PUBLIC PROPRERTY - --
DEPARr.AE T
A.VSr ttl ar• /�a'1L
at.t+•a i!C tt.�eiLw':JNf 7taT�i�tt�1.9L�vgcr.t t1a;:9
'11A:10r7�6+hlIb�F.�e 9�aJ�p�hfM
Construction Debris ®isposst Affidavit
(requited for all danoli m and hasovatian wall)
fa.saonlance with the sixth edidon otilw Sim Buddint Cods,7S0 CAIA section It LS
Debris,had dw provisions of%fGL a 40.S 54
8uiidiiB Proms 0 _ _ is issued with dw condition dish the debris nwuldnj km
ibis wat shall be disposed of in a peopnrty licensed wash disposal &dHty as defined by%IGL a
t l 1.S llfl/1.
The debris will be transported by:
_ (name e(hsutst)
rho debris will be disposed orin :
(,gases of rxility)-
...ivas. ,�i Yx:htyt
{
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
:,t\tnr'atFr uetn:slu
M srtla 12:\Irasw.%t:•rM Stt =T a S.s
r eu,lltnrsact n:lF'.'r'tY 01970
The:9711-743-911" a FAX:97e-740.99b
Workers' Compensation Insurance Affidavit: Builder/Contractors/ElmrideaWPMmben
Apalleant Information Ellan Edut Legibly
._..,..�.. Name tkluaituss!(kgmrintiavltw►tvwhml)� .« s /� — ""7 .,
Address: �l
City/Stami Phone#: 761
Are yo m employer?Check the appropriate boa: FC] R*m�od*IjjNftS
(required):
1. 1 am a employer with 4. ❑ 1 am a gcmteal contractor and Itruction
employees(full And/or part-time)-• have hired the sub-contractor
2.❑ I am a sok proprietor or partner- listed oo the attached sheet t ing
ship and have no omployuoa Them sub eontraaots haw nworking for me inany capacity. workers'comp insurance. addwat
(No wonted'comp insurance 5. ❑ We arc a corporation and its
required] officers have exercised their 10.❑ Electrical repaid or additions
3.❑ I am a homeowner doing all work right of exemption per MOL 11.0 Plumbing repairs or additions
myself.(No workers•comp, c. 152,§1(4),and we have no 12.0 Roof npaia
insurance required.) t employees. [No workers'
comp insurance required.] 13.❑Other
n y.ppl caul the checks boa el mop also fill rut the aCeriaa comp
dwwioa their warken'culnpsaweek a pWhy infiarewl{ae,
1 Wtraalwr who subaol tar amdevd indiminS awry,are&*a as wort steel then hke out"eammrtms mwl aubrnd anew amdevd ntdradi wh.
•Cauractlea this cbmk n11a bm must Lraehad en an eddlrlal atop dtowuy the mane of aer WbKmWapOre sad#liar WYfkele•Cp11P•Policy mtlot nu L
l am an employer that lr providing workers'compenwdon Ltsaranee for my employees. Below is the policy and/ob sits
Insurance Company Vame: 11r
Policy A or Sclf-ins. Lic. 0: Facpirauon Date:
Job Site Address: t�� St D(/ C� CityiSlatu2ip: St�27
Attack a copy of the workers' mpcssatlon pulley declaration palls(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of.%AGL c. 152 can lead to the imposition of criminal penalties of a
up tyl S1,500.00 and/or,one-year,imprisamncnt is well as civil penalties in ibe'forti ore STOP WORK ORDER and a fins
of up to 5250.00 a day against ilia violator. Ile advised[hut a copy of this slatcuunt may be forwarded lathe 0131ce of
Inresnguwlls oi'ilia DIA Cor insurance � •riftcation.
/Jo hereby ramify under/ pains and peno/t4s per ry/hYt the inform /on provided above is Ys mild reef.
reef.\iva:rtir•• 2/ /
-------------------------------------
09kid use only. Do woe wrin!n thk oreo,/o be crrsrpleted=11honc#:
aL
cityor 'fown: __. Pe
luuing Authorily(circle ore):I. hoard of ivalth 2. owiding oupartmcut 3.Cilyffoaa CInspector 5. Plumbing Inspector
6.Other
C nttaet Persolc _
Information and Instructions
Atassachuscus General Laws chapter 152 requires all employers providein the evice another under n for wk c of hz�
pursuant to this statute,an esapfoyee is defined as"•••every person
express or implied,oral or written."
An exyWeyw is defined as"an umhvidu•4 pan eersbW anoctatsot.,corporation or other legal entity.err say two a more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a decersed employer,or the
association or*that legal entity,employing ernployea- However the
receiver of tntsux of ao individual,psrtoerahtP. and who residns d wmimt.ac the occupant of the
owner of a dwelfift house having not more than throe aparossutds or re work on such dwelling house
_ dwelling house of another who employs Persom to do maintenance.construction Pair
or on the groun
ds or building appurtenant thereto shop trot because of such employment be deemed to be an employer
►iGL chapter l52 42SG(6) a stares that"wary state or bed I(ceasfng agency shall withhold the issues"or
too rate a business or to construct bulldlep In the commonweaW fee any
restowd of a Iiterst or permit Pe
appl(esat who hag trot Prodtresd sec°ptabM w a of a commoeo with the anyinsurance
its coverage.subdivision
Additionally.MGL chapter 152.;2SC(7)stabs"Neidter the eonuttatwealeh nor any of its political subdFrisions 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.' `
Applioanta
Please rill out the workers' compensation affidavit completely.by checking the boxes that apply to your situation anti if
necessary.supply sub-wntractox(s)nan*s),address(a)and phone number(s)along with their certificatc(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnership(LLP)with no employees other than the
members or partners,are not required to tarty wockeW compensation insurance. If an LLC or LLP does have
this affidavit may be submitted to the Department of Industrial
employees,a policy is required Be advised that
Also W sure to sign and dose the affidavit The affidavit should
Accidents for confirrnation of insurance coverage
be returned to the city or town that the application for the permit or license is being requested. not the pepartneat of
laduswitul Accidents. Should you have any questions regarding the low 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 Tows Offlelsb
Please be sure that the affidavit is complete and printed legibly. The Department has provided o sputa at the bottom.
of the affidavit for you to felt out in the event the office of Investigations has to contact you regarding the applicant
t'lease be sure to till in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple Pc 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 tnay be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A now affidavit must be tilled out.cub - -
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
ise.`a ildiY-license or permit to bumdaves.etc.):eadd.peersuu_tsY NOT�required� to complete this affidavit.
Cho Oi rice of Gmves[igatiuns would Cue to thank you in❑dvanec fur your cooperation and should you have any questions,
pleuoc do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Oak*of lavesdestle"
6001WashinSM Sired
Boston, MA 02111
Tel. # 617-7274900 ext 406 or 1-977-MASWE
Fax 0 617-727-7749
2cvised 5-26-05 www.ams.gov/dia
EIT�C oFgALE�
PUBLIC PROPERTY
DEPARTMENT
KI\OIFJLGY DRww
NAYM 120 WALUNGUM SIMMr•
InLeY.YAssatHl:S6TiS 01970
TI L•97&74S-9"S#PAZ M740.9646
APPLICATION FOR THE REPAIR RENOVATION, CONSTRUCTION,
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: «S Building:
-
d55� S -
Properly Is located in a;Conservation Area Y/N Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land I
Name: CO !( ,,u
Address:
as rq
D!/
Telephone: q 78 Z S 3 33.�I—
3.0 COMPLETE THIS SECTION FOR WORK IN ElpSIIfsIL;l BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of L
a per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
n
VC /sue
-- -- _--Mail Permit to: --- --