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12D RUSSELL DR - BUILDING INSPECTION C The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF (� j W Massachusetts State Building Code,780 CMR SALEM Revised Mar 2011 tlgy / Building Permit Application To Construct,Repair,Renovate Or molish a One-or Two-Family Dwelling This Section For Official Use O Building Permit Number: Date plied Building Official(Print Name) Sign! Z Date i' SECTION 1:SITE INFO 1. Property Add ss: 1.2 Assessors Map&Pareel Numbers � 2 - 17 ai �� Ql� Dr. ILz - oRZ Sr 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information Tt'L k mnn E �1nfb'i 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 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.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record, �/.Q m G �- �1 r\ fF P< A q 6n dS< Name(Print) City, tale,ZIP No.and Street Telephone Email Address _ SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ 1 Existing Building❑, Owner-Occupied ❑ 1 Repairs(s) Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work": , n vl oc5 n J1 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ ( 5' 0 = 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 1 t' O ❑Paid in Full ❑Outstanding Balance Due: y��, . J �t7 �foh�rGc�o ✓ SECTION 5: CONSTRUCTION SERVICES 51 Construction Supervisor License(CSL) d 3 2 3 7. ' (0 lot 3 CLicense Number Expiration Date Name of CSL Holder L A L/A� I I^- e f, Lis[CSL Type(see below) /) No.and Street ( •*'•h Type Description r A ^Y^ o 3 eb 3 3 U Unrestricted(Buildings u to 35,000 cu.ft. +� 'V '" 0 R Restricted 1&2 Family Dwelling City/Town,State,ZI M Masonry I�Rw.lh Io 9l�rlth �v)l� RC Roofing Covering WS Window and Siding 3 3 �1 Owl 2 SF Solid Fuel Burning Appliances G a I Insulation Telephone Email address D Demolition 5.22 Registered Home Improvement Contractor *3tractor(HIC) 1 6 t 9 c.' �Z f® I ' L i� t. L W �'t. RIIC Registration Number Ekpiration Date /p HIC HIC Rt rstm t e 4 t 2 wv\. cR 6 0n4u��PnM(�et rJl¢av Ur orw N . d Stre� ��1��� /,/�� 03�d 3`3 603 311 Cp y2 Email address City/Town,State,ZIP 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 ..........IV No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRA T R APPLIP7 FOR BUILDING PERMIT I,as Owner of the subject property,hereby auth to act on my behalf,in all matters relative to work'affd orized by this buil i permit application. cV A V`aq CAbs4 m c 1 b7, L0i3 Print Owner's Name(Electrons Signature) —� SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Autho ' d Agent's Name(Electronic Signature) — F Date NOTES: 1. 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 not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dt)s 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,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 Project Square Footage"may be substituted for"Total Project Cost" i The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mdss.gov/dia Workers' Compensation Insurance Affidavit: Kuiltiers/Contractors%b'lectricians/Plumbers plicant Information Please Print Legibly 1 Na Me ittu.mn ., l>r. niz-aeon It dil-dual I: �2� � G lM iN\-. �dcir . 12 (1/1 LY City 'State lip:_ C k l '/L✓ / /VV 0 3_ 3 tone #: 6o 3 . 3 q `1 t b L/ 7i Are you an employer? Check the appropriate box: Type of project(required): I.❑ I am a employer with 4• ❑ I am a general contractor and 1 6. ❑ New construction employees(full an&or part-time).* have hired the sub-contractors 2.� I am a sole proprietor or pa listea on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y F tY� 9. [] Building addition . [No workers' comp. insurance comp. insurance.*� a are a cur F required.) 5. !b' oration an 1d its 0.[] Electrical repairs or additions 3.[� 1 am a homeowner dome all work officers have exercised their 11. Plumbing repairs o, additions myself. [No workers' comp. right of exemption per M01- 12.❑ Rout repairs insurance required i r C. 152, §1(4), and we have no employees. [No workers' F i.Ixf Other 2 J4_ colnp nsurivc';required.; HLl.w wi...r ... .._Jul n�. ,aeveva. a u,a;off u. u,..t i1...h...iC J.A..¢tC<J�I(IllGl.6 u.dLl..ub�nd a ilCN dltl.lili it J.uumlJ,.eL�u. ,- ,.r, ' r .,� .. th_1-_ f i} yy.. it. .:Inr :'9 r- .,.h...,�r nr r t th... -min-:.fi^�.• I ant an employer that is prodding workers'comprimation hriarance Jor mj :.mploy evs. Below is the polity and joh �itr information. ;M,w mL. Company Name: i'oiicy - or Self ins. Lc K; , Cxpira'on Date. Job'We Address:..-- —_. . _ - _. _ _ _Cny(Statel/in: Attach a copy of the workers'compensation policy declaration page(showing the policy number and cxpiratton dace). Failure to secure coverage as required under Section ''S A of MC;I c 152 can lead to the imposition of crimin..i nrnJdvi of fine up to S1,500.00 andior one-year imprisonmcot,as well as civil p,naltic- in the form of a S rOP wURK ORDER .nd nine of up to 5250.00 a day apainst the violatnr Be adei^ed that a copy of this statement ntay be for'.carded to the nffirc of Inocsnga6oi:s of the DIA for insurance cm rake .,,rification. !du hereby ccritfy ender the :ns a_d p�enwalrles of perjury,tlsat lttc infotntatiurt providcd abo y is true mil correct. SliRar.,n_--- —/C 2�(ti V/�- ^i,- �J Date: �' J 3 ----- Phone _- -- v 0 1� _3 L l�_.�U 1.Z Official use only. Do not write in this area, to be completed by city or town official Citv or Town: PermittLicense# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. C'itylrown Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: V. Y Y �fi3 Engfand Green Butld ,� ¢ h rmanwe.h466 dnd addmons rCateb Ewing ' CALEB EWING vLEY ST,EXETFX NH 03833 #15I943 MASS CSL 103237 .k� r " "' Rampton }Vt303643 603 394 5042 - - eats\c�uEnglandGreeo Build�com ' PROPOSAL Proposal Submitted To : Date Work To Be Performed At GLNA RAGONESE 05/10/13 same 12D Russell Drive Salem_MA 01970 PROJECT DESCRIPTION, OPTIONS, Start and Finish Times DEMO/REBUILD DECK AS FOLLOWS 1. DEMO--EXISTING'Sx12 P.T. DECK. HAUL AWAY ALL DEBRIS. -- 2. REBUILD DEC K.AS--':EXISTING, AS SHOWN IN DETAIL, WITH PREMIUM PRESSURE TREATED DECKING. 3. 'REBUILD STAIRS AND RAILS AS EXISTING, ALL PRESSURE TREATED MATERIALS. BUILDERS CHOICEOF FASTENERS. ..:. 4.7.EXCLUDES STAIN. NOTE: This proposal assumes HOUSE RIM JOIST IS 100% SERVICEABLE. Start date is MAY Completion expected WITHIN TWO WEEKS OF START DATE, weather permitting. Total for all is $3150.00 Any additional work billed at $350/day plus materials. All material is guaranteed to be as specified,and the above work to be completed in a workmanlike manner for the sum Of $3150.00 THREE THOUSAND ONE HUNDRED 1711717Y. Payments to be made as follows: 30% DUE AT CONTRACT SIGNING, 30% DUE AT DEMO COMPLETE, 20% DUE AT FRAME COMPLETE, ALL BALANCES DUE IMMEDIATELY UPON COMPLETION. Respectfully Submit d, Note: This pro maFbe wn if n accep withi g/ >31 0 30 days. CERTIFICATE OF LIABILITY INSURANCE a/7/20 3MYYI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER NACT AME. Nancy Bird CISR ACSR CIC - Foy Insurance - Exeter PHONE . (603)772-4781 PAX No): 64 Portsmouth Ave %pAuLss,nancy.bird@ foyinsurance.com PO BOX 1030 INSURERS AFFORDING COVERAGE NAIC4 Exeter NH 03833 INSURER A Merchants Mutual Insurance 23329 INSURED INSURER B: _ New England Green Build INSURERC: PO BOX 453 INSURER D: INSURER E: Hampton NH 03842 INSURER F: COVERAGES CERTIFICATE NUMBER3daster 4/2013-2014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN'R ADDLISUBR TYPE OF INSURANCE POLICY NUMBER MO1DD`rf F MP�pYEXP LIMITS L GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE To, X COMMERCIAL GENERAL LIABILITY PREMISES Ea orsyrtenca $ — 50,000 A CLAIMS-MADE Y OCGUR PW375481 /30/2013 /30/2014 MED EXP(My one person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 lFrT X POLICY PRO- LOC $ - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E4,trident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURV(Per accident) $ AUTOS AUTOS.ON-0WNEO PROPERTY DAMAGE $ 4 HIRED AUTOS AUTOS Peraccident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIM'-MADE AGGREGATE -$ DED I RETENTIONS I E WORKERS COMPENSATION N/C STATU- OTW AND EMPLOYERS'LIABILITY ANY PROPRIETORJPARTNERIEXECU➢VE I YIN NIA EL EACH ACCIDENT E OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE E If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEA'E-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aaaeh ACORD tat,AddiUonal Remmlo Schedule,if more apace w®quhed) Operations usual 6 customary for Carpentry. CERTIFICATE HOLDER CANCELLATION insurance@homeadvisor.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Home Advisor Inc 14023 Denver West Parkway Bldg 64 AUTHORQED REPRESENTATIVE Golden, CO 80401 M Foy, CIC/MCAROL ACORD 25(2010/06) ©1988.2010 ACORD CORPORATION. All rights reserved. INS025 mmonsl nt The Arnpn namn and Innn of ACrTRn CHECK THISAREA FOR STRUCTURAL DAMAOE DUMNO DEMOLITION Z/�•*, o Be REPAIRED BY DTNERSI �: I FFfY riFz. '"r fie`� i 1 Xu' .fiF F,f q iFa 9 Rd e i_r e��T';3-,+fi.f !' 'g''f.3'#`�``f?,r�'�z'a�i+'r. •1°.ei- :ors( }�, f + � •;•= ♦ r �do�•: 91' INSTALL 1"x 4"PT SPACERS WITH GALV.LAG BOLTS WASHERS IN EACH BAY Oc 95-112' 3!4"Overhang 3/4"Overhang 94" 138-1/4' REPLACE EXISTING 2"X 6"KD JOISTS 99-114 WITH 2"X e"PT JOISTS 16' C MAX.(TYP) 138.3/4" INSTALL SIMPSON STRONG TIE 2"X 8"JOIST HANGERS EACH END(TYP) G 34-1 rz HEAVY DUTY ANGLE IRONS __ 36' EACH CORNER(-IYP) — -- 1. EXISTING CONCRETE -- - ------ TO BE REPAIRED AS NECESSARY A __ 1-0rz" 55" a LAG BOLTS AT CORNERS (TYP) Top U co-To1 -1Top of Joist R= 1114 A- 1 " iS2 i D ' = id 1Id" PICKMAN PARK CONDOMINIUM SALEM, MA PROPOSED REPAIRS TO REAR DECK 12D Russell Drive FIELD VERIFY ALL DIMENSIONS PRIOR TO START OF WORK 140 SCALE y , Y h. 36" 24> f2" 1 gg .35 ( 1 w `__ Bottom3 Face of D . eck _.>. Ii t MOTE:NUMBER OF STEPS VARIES "-r-r--^----r�---------:s' - FIELD VERIFY PRIOR TO CONSTRUCTION I"Standoff 4 Brackets'-. Top of Existing Concrete Step 315-1t2 deg. A' T 1.3t4" ; — 32.,3Ta 29-314 33-1/2" � 29-314' 28414 Support Intermediate Stair Baluster Baluster Baluster PICKMAN PARK CONDOMINIUM SALEM, MA PROPOSED REPAIRS TO REAR DECK came gL yM 3 NO LE 9w, HEIGHT VARIES VERIFY BEFORE DEMOLITION S EXISTING CONCRETE PIERS TO BE REPAIRED REAR ELEVATION 144" -�( F 5" O. C. HEIGHT VARIES VERIFY BEFORE DEMOLITION LLLJ SIDE ELEVATION PICKMAN PARK CONDOMINIUM SALEM, MASSACHUSETTS PRPOSED REPAIRS TO REAR DECK DRAWN BY: CALEB EWING DATE# Imes 0 3 6 9 # # # # R R # # R R # R R R R R R SCALE CITY OF S.0 EMV TNL-ksSACHUSETTS • BUILDNIG DEPALRT%ELNT 120 WASHNGTON STREET, r FLOOR TEL (978) 745-9595 FAx(978) 740-9846 (j-,{gFRT EY DRISCOLL MAYORTHO.'�IAS ST.PIERR& DIRECTOR OF PUBLIC PROPERTY/BUHMLNG COMMSSIONER 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: k (J 4 L (name of hauler) The debris will be disposed of in : i V D ewv- I S IO • _ nn (name of facility) 1' r Oe— 0 n ') M (address of facility) signature of permit applicant (VI.� I q- I 10 ( -3 date dcbn.utldm