14 PURITAN RD - BUILDING INSPECTION (3) � S ��—
The Cunurn>m%eulth of Massachusetts
l t Board Of Budding RegulationS and Standards I1 )It
hlussah cun ses State Building Code. 7SI1 ('N1R. 7°i edition I .til: I
(� Building Permit Application To Const,uct. Repair. Renocdte Or Denwlish a 2rrnr,l /wm,u'i
v� One- or Tu o-FutniA, 1)n elling 'nub
This Section For Official Use Only
Building Permit Nun •r: Date Applied:
liwl nu Cunmu...unr.7 Iroprctor of Buildings D;uc ___
SECTION 1: SITF: INFORMA I ION
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1.1 Pr e ess: 1.2 Assessors Nlap & Parcel Numbers -----
I.la Is this In a sued'"ept•d Yes o0 Map Number P:ucel ,NwInher
1.3 Zoning Information: La Property Dimensions:
"Z.uning DtsImI Proposed Use Lot Area (sq It) Frontage (it)
1.5 Building Setbacks(ft)
j Front Yard Side Yards Rear ford
Required Provided Required Provided Required Prodded
I
1.6 Water Supply: (,I.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? %luniei �I ❑ On site dis i�rsal s stem ❑
Public ❑ Private❑ Check if yes❑ P' I- }
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ownv Reap
Y '�.1K2.
Namee`tPrin� Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairsls) ❑ Altcration(s) ❑ :Addition El
Demolition ❑ Accessory Bldg. ❑ 1Number of Units Other ❑ Specify:
Brief Description of Pr rsed Work:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
(Labor and Materials)
I. Building S I. Building Permit Fee: S Indicate how lee is detl'rnllnCd:
❑ Standard City/Town Application Fee
2. Electrical S
❑ 'total Project Cost 3 (Item 6) .x multiplier x
7. Plumbing S ?. Other Fees: Sr_
1, iYlechanical (HV:1C) 5
List:
5. Mechanical (Fire S
5u� cession) Total :AII Fees: S
Check No. Check :Amount: Cash Amount
0- Total Project Cost: $ �6 0 Paid in Full 0 Outsrmding Bal:mce Due: _
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor (CSI.) —
License Number F\pu:wan Dale
,Name of CSL- Holder
I-i et CSh l\pr Ixr hrlol�I
VJJress I v c Dcscn riion
L Cmrstn cted (Lill to 35,000( a HI
R 12esu'ictcd A2 F.unlh D„elhme
Slen:uurc ..\I Nl:l.onr\ Onh
RC RCTIJCIIIIalRwllne Cu,enne
Telephone \1'.S RC>IJC nIIpl \1'm Ju„ .:nJ SiJine _
SF Re,iJrnu.Il SnIiJ Pncl Iturnnlc \ ,l lliau.'r Iu,1.J Ltl.,m�
D Readcutr.Il Denwhulm
5.2 Registered home Improvement Contractor (HIC)
HIC Company Name or HIC Registrant :Name 12egutrauun .Nlllnber '..
Address
Irpiratiun D:ac
Signature Telephone
SECTION 6: WORKERS' CONIPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. F:ulure 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, mail nutters
relative ntative s�z by tks boill;Wng permit application.
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
1. as Owner or Authorized Agent hereby JCClare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf:
k�PrintNameure of Owner or Authonzed Agent Dale
d under the _wins and enalties of er u )
NOTES:
n Owner who obtains a building permit to do his/her own work or unolvner who hires an uneistered contractor
not registered in the Horne Improvement Contractor (HIC) Program), will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Progr:in and
Construction Supervisor Licensing (CSL) can be found in 730 CMR Regulations 1 IO.RG and I IO.R5. respectively.
l ' When ubstannal work is planned, provide the intoi mation below:
TUtol floors area (Sq. Ft.I (including garage, finished basement/auks, decks ,t porch)
Gross living mea (Sq. Ft.) Habitable room count _
Number of fireplaces Number of bedraon.s
Number of hathroorns Number M hall/hash, -- —_ —
F\pe of heating system dumber of decks/ poMles
l ype of cooling system 1:11c1nsed open
3. "Total Project Senate Footage" may be substituted for 'Total Project Cost—
CITY OF SALEM
' f�t� PUBLIC PROPRERTY
�f"•I DEPARTMENT
Construction Debris Disposal Affidavit
(required for all demolition cued renovation work)
In accord:mce with the sixth edition of the State Building Code, 780 CMR section 1 l 1.5
Dcbris, and the provisions of N1GL c 40, S 54;
Building Permit # _ is issued with the condition that the debris resulting from
;his work shall be disposed of in a properly Licensed waste disposal facility as defined by 7V1GL c
I11. S 150A.
The debris will be transported by:
\
t name of hauler)
Vhc .!�:bris will be disposed of in
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KI�nc��ry rvw•ly
WAYM 130wA"NGTM ftW=•Snte4 NAssAOa'ssra 01970
7?197a-73S-959S* FAX 978-740.9&*
HOMEOWNER LICENSE EXE.MMON
Please Print {y�
Date 9 7(/ `'�
Job Location `i �G \�
Home Owner Address
Home Owner 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 license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)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 one or two family dwelling, attached or detached
structures accessory to such use and/or farm structures. 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
Official, 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 "homeowned'certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
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PLAN VIEW MOYNIHAN LUMBER OF BEVERLY
CUSTOMER -- 82 RIVER ST.
DATE 04/22/08 REF Deck08113 BEVERLY, MA
1-978-927-0032
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LOAD AND SUPPORT: Your deck will support a 61 PSF live load. Posts have 48" below-ground
post support.
DECK AND POST HEIGHT: You selected a height of 84" from the top of decking to level ground.
The top of the deck support posts will therefore be 73.25" above ground level. Your salesperson
can provide information for uneven or sloped ground.
JOISTS Set joists on top of beams. 12" center to center.
NOTE: The design may require knee braces and bridging between joists. Your materials list includes
the necessary items. The suggested design is not a finished building plan. You are responsible for
all measurements being correct, for verifying that the design land any substitutions or modifications
that you make) meets all local building codes and requirements. To verify that the suggested design.
and any substitutions or modifications. is consistent with conditions at the construction site,
review the design with your architect. Also consult your architect for proper construction and use
of materials in the structure
Be sure to follow the deck construction detail available from your store salesperson.
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