51 SUMMIT AVE - BUILDING INSPECTION .. . � , ��,��� �
CITY OF SALEM
PUBLIC PROPRERTY ,
� DEPARTMEN'T
��.�nr R�r.r uu�uu
11.waa 12��Ilww.w�r�ow Sn��5.��.ILas�c7 n�7•�x 019TJ
'Cca:97t)aSySq3 �Fnx:y7ti.��OwN6
Wurken' Compeniado� Iasunoce AtfidavIt: Builden/Coatncton/Electriela�u/Ptumbe»
�n�licant Info�matlon Pleaxe Prtet Leaibiv
� ,
Vame�u�u�.�rcx��:�oa�Mu�,�r. �� vc/L: �..,� C�..�s{�e.,��,,,., C� t/�
A�ldreas: I I � �"�r�,••� �' �'�_
c��y�s��z�P: �-ro�Q�� , �.a. v l �3 S� ��ope u:__ T �� , 3 7 3 - 3 a J �
.\ra yoo a�eepbyv?Cleelt eM aPproprla4 Ao�
'ryw��aroJeu(.�.tr.a�.
i.0 I;un o empbyat witY �. 0 1 am a ycmeral coolrxtor and( 6, � N'ew con�ttueti�
tmpl.iyca�(full uuVut paratinu).• havc hir�i�he aub-cwaractors
3.Q 1 am a Yok pmpticmr or�. lie[ed�o�6s attacAed yFxet = 7. ���L
ship and have no amployoa� Ther�b.eOnaaeras luvs tl. �]D�moli[ioo
wohin� far me in�rry capxiry. work 'eomp.inswonca 9.
❑ BwWint'rdditiaa
(I�a wwkcn'eanp. inwrane� S. •sia a wrparaden and ib lO.Q Electrieal repain o�addi[ions
requircd) ot1'tcen have emrciaa!t6eir
3.0 I am a homeownQ Joina all waic riyht of exemption pa MGL I I.Q Plumbin�rcpain or achlitions
inyxlf.[I�o wohen'comp. e. 152.y I(1).aod we hevc iro 12. R�wf ir
ro � pairy
inaunnce requixd.J � �mpbyaes.(l�a worlcen' 13.0 Otlwr
comp. in.wran�ac mquircrl.]
�n��y.ppGwo�ihr elx�iu Ooa MI mw alw filt w iAe.scum b�bw tlioria��Adr wrlo'cw^PnW4�Pd'wy iofur�ios
Il.�u�rrws�w�o�u6mi1 Wir oflldwu iMfoiin�Mry�ur Juiy�dl�ruA me�syq�in aMrW�caixioaon mr�.uAn���wr a/lt�6vi1 ialic��nr.w�.
-(',�arxuw�ilw and dp E�nurt macAi/us addi�im�l Jawf Jari1y�6e naq dtl1��aW�Y�w wuAt�n'ca�0.OdKY inMnrNia
/uiw un aupfoyrr thnt!s provldln,p workirs'eom0enwdon Luuianee joi iny emp/uyres Bi/ow Ir rht puHay and fob a1l�
%lIlWMYf%OR
Incunncr Company Vame: _- .- - _. . .
Pnlicy M or Self-i�u. LiC. p: _ .. .. EepirrUon Date:
lob Sitc AdJress: Ciiy�SirtUZ�p:
�tt�cb y cupy of 11w worksrs'compensat6�a pulley da�lar�Noa pay�(s6owina the peltcy number and e:piraNun dxte}
P�i Iwo w xcurc cocerr�e as requircJ unJcr S�Y�wn?SA uf'�IGL a. 1 S2 eau(ead ro rhe impoaition af eriminal penaltid of s
tine ur d�51300.(M anJ/ar one-ytu impriaonmcn[,�s wcll as civil pcmlliu ia�he form ofa STUP WORK ORDER arn!a fiw
•�(up to 5?30.00 a Jay��uiost the violawr. Ile advi�eJ Mut a cupy uf this.rtatcuum muy bn ('urwarJeJ ta �he UOice�f
I�I\'C�II�JII�/lV JI ittc DIA .°Of iniutaet¢:o��I�;C v�tiFlc�ttutl.
!Ja herrb�rorei/'y ai�Ja�thr � ' uii nu/tirs a/ ry�h�f i��/wa w proriJed ubow is ar�unJ rorreet
<i•t:citi�ra � ��. - d- O �
- � � � 7 3 �-
�. U/Jlrid�x uM/�t /�wW wr/ii!a/h!r aira.tu bi cawp/eM/by dy or M�vw o/Jli•/aL
Ciry or Tnwn: _ Pcrmitll.Iccnse Y
Iuu1nR AWhuriiy (tircls ouc): — -- - .
!. Ilo�rd nf Ilr�lfh 2. 1luildin� Dep�rnncol ]. Cily/foeq Clerk i. Electric�l Insp.tfor S. Plwn6inK Inspcetor
G. O�hrr
C�ndacl Pcrson: _ Phonc p•
Informat�on and Instructions � �
�fassuhu;etts Gctxral [aws chapcet 152 cequura�II employ����Ke anoiha un.kr anyoconc�ad o[hire.
1'ucwaiu ro�his s�:uw�.an�w�fq"K is Qefined as`...evaY P�
eaprcss ar impli�d..xa�ot writtea'
An a�/�Y�d��"u iadividwb P��Y.+�°0fP01itioa ar od�ar►�1 mtiry.a anY nvo ar mar
oi�he fuce�oin�rn�a�ped ia a joiet auerpria�.aod ioclwtir�tLe lepl represenruiva of a leeexaed emptoyer.or�ha
uwciaaoa ar oWat le`al endtY.eanVbY�i�mPbY� However ths
recaiver at uus�as o!m iudivi�lud.P��+P•� e
uwrtiet of a dweltio�6aw 6�vie�mt moce tA�s�Mes ap�rm�ab md wAe reaida tseteie,or�hs ooeu�t o�dr
�iweUi�b°�°ot aaod�et vrl►o e+�PbYs P��m Jo mainrcorocs.c.ioaaucdn►or repair work oo suc6 Jwallias hausr
ur on d�e�ndt or buildins appurtena�t
�Ae+ero shdl sa beauM of a�w�lo�ytoeat be deemed w br�employa.•
�iGL chapu t 52. 4�(6)�O uates dmt"w�ry stW or teeal lionsbt�L��Y�witYYsY tM luruee or
i�tM commo�wtskY fir�ar
re�swal ot�1{eew er per��a o��abM�v'W�ae�ol w���u���kt eovtras�requirN."
�p�ilesN wM W�PfOd
.i�klitwmlly.MGL chapter 133.;2��(7�1 �'NeiaAer�be eonu�me�weadh eoc anY otiu poli�ieal mbdivisioo��Aall
����y� f��� WK work until sccepubk evi<leace uPcanpliaaca wi�h the insuranee
rcquiramenn o[cAis cbaPw haw been presanoed w the conauani autdo�ity.'
�pptle�sq
Pleaze fiil out ehe avorken'compensaaon aAidavit compleoe�Y.bY checicins che boxd�ha�apply w yaur aiiwcoa an4 if
wbconnscwc(�)��).�d�l«)�PbO°°6O1°b°t�s)atoa�with�heir certifkaue(s)ot
naeessary.wPPb � L or Limired Liability PutnenRiW lL.l-P)witA oo employoa ather rhan the
Limitad LiabilitY Compaa� �- � ��, (f m LLC or LLP doa Aave
"�CQ' woilcas'eompensuioa�
membe�s oc pntmesf.�+e aa K9W rad m carry ent of lndusa�ial
employea.a poliry is re4uired Be advised dut�hu atftdsvit may bs submitted w the Departm
Accidenu for coafimudon oP insursnce car`K°Qa Ab°b��un to�Ip aod dute t6e attldavlt n,e orrm�«�+oWa
6e retumed to cha eity or town that the applica�ion for the pennit or li�enss u bein�requested. sW the Depa�ment of
lnJuuaixl A�:.:iJenu. Should you hava�ny qu�s4°°�Ki+�Q��w or if yau are required w obtain u worken'
companatioa policy.PIeW eall�6e Dap�+en�u ehe number lined below. Self-inared compania ahauld aater cheir
�If-irourroee licenae numbar oa ehe ItOQ.
Clry or Tow�OffleVd '
Ptcave bc wra tha[che a�davit is complete aad printed Ic�ibly. The lkpsr►ment he�provided a spaca at the botmm.
ot che aifid•rvit far you tn fill ou[in ehe eveat the OtFea of lnveati�arions has to conwct you rceudin`ths�DV►ican�
�+��a� be sure eo ti11 in�ha paru+iUticec�e numher which will be u.ed aa a reference number. fn addidun,�n app�icant
ih•rt mu�t,ubmit multipk perm�t/l�c�nu�PP���no^r a�ny�iven year,need onty submit one affidavit indiaacin�current
poticy informatinn l if necesssry)�nd under"lob Stte Addrea"�Ae applicant 9hould write"ull tas�ionr iu__(ciq ur
wwn)."A coPY of�la ulTidavit td•rt has tieen o�ciaUy smmperJ or muked by cha ciry w rown may be pro�iJcd to�he
�pplicant s�preoP that a valiJ affi�lavit is on file for future pertniu or licensea. A new atTidavit murt be fllled out ac6
y�. Hry�a hane uwner or ciumn ii abuinio�s licenve or pennit not rclated eo aay buaiaess or commercial vcntura
�i.e.a Ju�{licenae ar permi�w M�*n Iuv°s e�°.)s�d P°iwo u YO'I'required to comptete this affiduvit
I'hc�)i li.v ot Invts�iy�ciuns wuuW (ike w th'rnk you in:.dvanc¢ for yuut coopen�iun and should yuu h�va :u�y questions,
;:c:+ac Jo not hesieate to give w r��II.
The D.psrtmrnt'�aJdress. ce�aPhone anJ fiu numbu:
The Commonwealth of Massachusetts Z�.�
pepaRmeot of Indusotiat Acxidents �
Oala st[�v�Atpden /�—9�
600 WashinQom Sheet lyzA�
Bosoon� MA Q21 l 1
Tel. p 617-727-4900 eut 406 ot 1-877-MASSAFE
Fa:M 617-72�-7749
2.�i>cd i-2G-US WWW.Q114l.gOv/dla
- CITY OF SALEM
PUBLIC PROPRERTY
DEPAx'�EIVT
..u1u..• ar.•��
>1��•� l'1'1.�Y N::J�tf 7�iT�i�t:�414v��t:r �s�1 s::i'
t�1:Y�►7W�lM �f.�7e 97wf�N
r-
-��
cobsc,ru�cb. u�brls utsposa� ama���t
(reyuire+�! !br�II danoWjoe md eviwratia�rradc) �
Ia�oconl�nes w ith tlf� �m adtBoa ottlw Statt�uiWJn�Cod�,�0 C'Alt�actioe 111.! i
pebri�,od df�qovisioro otrtGL e�q! SI�
9uildtn�l�w+ntR• is tawwt�ri��coodtda�t}�at tbt debrii rewldnf �os
chii wae!rhall b� disposod o[ia a proprrty Ueamed w�w dtspa�al fseiliq u d�Mad br �1CR.e
l l t.f tl0/1.
Th�debr9�wili b� cnu+,spoctad bY:
�. �-z`[D �'✓. 5 U s��
— i na�..�r na�M
fhe.lcbrii wil!br di�posed uYin :
G� ?��,�� �J ,���s�/
� �uarnr ui rx�Aty)-
_ l� 2 d C�L �....✓ �1/�� , � �
� ,�
�.J.:rry. .�f f'r:L�y► - '
. �/ ^/
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.,�.._ w:.:l,�:tn.u.r�.t:�.Y
a4f '
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j ,. � The Commonwe�Ith of Mussachuset[s
�� �� Bourd of Building Regulations and Standards � ���� I
, ' NIUMI"IPALI"I'1' �
�� Massuchuset[s State Building Code, 780 CMR, 7"' edition
�,"��� U S F.
[3uilding Permit Application To Construct. Repair, 2enovute Or Demolish u Feri.��rd Ja��u�+���
One- or T�ro-Fnniilv Dti efliri,K l. �UNB
� Seciion For Officiul Use Only
Duilding Permit Number Date Applied: �.
i
Signature: '
� ' 21�� /d'a
BuilJinE Cummissioned L���e�'mr � uilding� Date �
SECTION 1: SITE INF'ORMA'f10N
i
11 P erty :lddress: 1.2 Assessurs Map & Parcel Numbers I
SI �i 5 n.,�.. � /lve 3 3 - �7 a�-o
l.la Is Ihis an accepled stree[7 yes -✓ no_ Mup Number Parccl Number
1.3 Zoning Informa[iun: L4 Property Dimensions:
Znning District� Proposed Use Lot Arcu(sy PU Frontage Zli) .
1.5 Building Se[backs fft)
Frunt Yard Side Yards Rcar Yard
Reyuired Provided Reyuired Provided Rcyuired Pruvi�c�
1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zonn?
Public IY Private ❑ Check if yes❑ Municipal�8�si[c disposal rystem ❑
SECTION 2: PROPERTY OWNERSHIP�
2.1 Q�w ner�of Record: .
//1 tfi •�1-2 j.!,., l�.—c�ef�i���
Naine(� Address for Service: -
�� � �b- s�y. ��s o _
Signature Telephune
SECTION 3: DESCRIPTION OF PRONOSED WORKZ(check all th•rt apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repuirs(s) ❑ Alter:�tion(s) Addition ❑
Demolition ❑ Accessory Bidg. ❑ Number of Units_ Other ❑ Specify: ,
Brief Description uf Propos d WorkZ: C, - ? �'' � � � `�'P^- ��
.� � ♦ ,t1��J��\ ^ �
yli�
'1,4✓f�.�/.l� /S �
SECTION 4: ESTIMATED CONSTRUCTION COSTS
ltem Estimated Costs: OfPeial Use Only ��
(Labor:md Materials)
L Building $ L Building Permit Fee: $ Indicate huw fee is determined: '.
❑ Standard City/T'own Application Fee i ,
2. Electricul $ ❑Total Project Cost} (Item 6) x mul[iplier .x ��,.
3. Plumbing $ �. Other Fees: $ I
4. Mechanical (HVAC) $ ��'�' I
5. Mechanical (Fire � � �,
Su retision) Total All Fees: $ ,
� � Check No. �Check Amuunt Cush Am�wnC
ti. Total Project Cost: `6 � �a Paid in Full ❑ Outstanding Bal:ince Due:
Ma�c. p�Yuwi'� � S � Sutn�vk� �- ie.�G "
L/ "
SECTION 5: CONSTRUCTION SERVICES -
5.1 Licensed Construction Supervisor (CSL) �560�5 3 a �" �' �a ^ �
�' S ('� �j�� � O Liecnse Nwnbc[ Expimtio,n D/ntc
Namc ol CSL- HulJcr (/
��� � .��,����� List CSL'Cypc(scc bcluw)
� ���r`}, f T c Dcscri lion
/( G4r?.�/' ��• �/-r� ve�v /'���dl�Jy �' Unrestric�cd�u co3S.Q00Cu. Ft.i
R Rcstnctcd 18c? F�mil Dwclline
� Signawre M M:uonr�Onl
�'7y' 3� 7- 3��j /y✓' RC Rcsidcntiul Rootin�Cuvcrine
� �Cdephone . � AVS Rcsidrn�ial AVindu�v :mJ Sfdin�
� . SF Rcsidential SoliJ Fucl f3umin_ A>>liance Inuullwiun
� D Residcntial Dcmulitiun
<\ 5.2 Registere�Home 1t�p rovemen[ Contrac[or(HIC) yZ+ C , 3 �-�'�'�'c
0 % /�.v /L���,/Gi Z
HIC Company Nmne or HIC Rcgis�rant Nam� Registra[iun Nwnber : _
I ( d C�ra••,< � s
Address
Z-/'o'-x�i,i✓� l'^/� ��' 3 }' S 7��3 ?�-3 za3 Expiration Date
� Signamre ��- � l'elephone �
�
SECTION 6: WORK RS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6))
Workers Compensation [nsurance affidavit must be completed and submitted with this applicution. Fuilure tu pru<�ide
Ihis aftidavit will result in the denial uf the Issuance uf the buildin� permit. -
Signed Aftidavit Attached? Yes .......... ❑ Na ����-�-�� �N �L�
SECTION 7a: OWNER AUTHORIZAT[ON TO BE COMPLETED W HEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , as Owner of the subject property hereby �
authorize [o act on my behalf, in :ill m:�tters
relative to work authorized by this building permi[applicatioa �
SiKnamre of Owner Date
SECTION 7b: OWNER� OR AUTHORIZED AGENT DECLARATION
I, ��- �� C�'1 r'���- � , as Owner u Authorized Agent ereby declare
tha[the statements and informa[ion on the foreguing applicution are true and acwrvte, to my knowledge :ind
behalf. �� "i��2� � /L1�i+-«''°� ,�J �
Print Name �/ / . , � (, 0
.,/ �' ' � •-.
Signamr wnerorAuthorizc Agent ���t
(Si ced under the ains and enalties of er�u ) � .
NOTES:
L An Owner who obtains a building permit to do his/her uwn work,or an owner who hires an unreaistered cuntractor
(not registered in [he Home Improvemen[Contracror (HIC) Program), will i:ol have uccess to the urbitrution
program or guaranty fund under M.G.L. c. 142A. Other importan[ information on [he HIC Program :md
Construction Supervisor Licensing (CSL) cnn be found in 780 CMR Regulations 1 IO.R6 and I 10.R5, respectively.
_'. When substantial work is planned, pruvide the information below:
i'otal tloors area(Sq. Ft.) � (including garuge, finished basemenUattics,derks ur parch)
Gross living area ISq. Ft.) Habitable room cuunt i
Number of fireplaces Number uf bedruoms �
Number of b�throoms � Number oY hulf/baths �
Type uf heating system � Number of decks/ porches �
Typeufcoolingsystem Enclosed Open �
3. "Totul Project Squure Foot.�ge'" may be substimted for'Totul Project Cust"
. . l ...a . <..:, � ....._ r.. r._.._ ,i . ....�.� e.. I
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'-0 1/ " 14'-0" 8'-9" 20'-2 3/4" -
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FOUNDATION WALL IS ASSUMED TO ! � � O �
�E 12" WI�E, ALL COLUMN JOIST �L �
i 8& BFAM LOCATIONS ARE ASSUMED � N 2x8 JOIST I o� � �
�i FFIELD VERIFICATION IS REQUIRED �0x° �, ^ �' I 45'-0"° � �
� qF ALL BEAMS AND COLUMNS THAT i M U �
� W11LL RECEIVE ADDITIONAL LOADING �3 , ^ ,� CO21 S �
�
. ..._._._..-...,. . ...... . .. —ao v . . � M �
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EXISTING BRICK ' ^ l r�''
I' `' CHIMNEY FACE MOUNT HANGER w/ �' 20'-2 3/4"
_ �p CO21S I�i CONCEALED FLANGES REINFORCE EXISTING BEAM w/ '-0 1/ " 14'-4" 8'-9"
�� EXISTING BEAM.ABOVE nPE HUCQ 1.81-9 BY (1) 1 3/4" X 9 1/ " WL. o I
� _ _ 8 1 2 wd"z 9_tl __ SIMPSON-STRONG-TIE ZEROWS 0 12d�NAI �W12" O.C. • i
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5'-4" I- EXISTING BRICK N • i; �
__ "�` PIER XISTING BEAM ABOV ,i
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� I � EXISTING KITCHEN EXISTING DINING EXISTI G M � '- �
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� � I CO21S �
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NEW CO2l SMOKE DETECTORS �
i EXISTING FIREPLACE TO BE INSTALLED IF NOU'
� EXISTW�
" . DR VNING TITLE
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S' � �
�� g'� IXISTING STAIRS FIRST FLOOR PLAN BASED ON EXISTING DOCUMENTS �
I SOURCE UNKNOWN - ALL DIMENSIONS SHOULD BE V.Lf. ►—� a
EXISTING ENTRANCE HALL a Z
�'—o° �I � �-+ (�
_ I 0 �
� 5'-5 1/2" 14'-6 1/2" g'_g" 14'-0" �
��
40'-6" � �
j EXIS?ING BATHROOM EXISTWG STAIRS HALL E..�
43'-0" c, i �
� EXISTIN 00
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FOUNDATION PLAN � CO2f S EXI TING FRONT �
I , A ` � ORCH ti?
' scnLa.iw^.i�•o^ NEW CO2 SMOKE DEfECTORS "��
! . — EXISTING�TALLED IF NOT I
ISS��JJED DATES
SD 11 /07/07
- SD 12/17/07
, s, , CD 02/07/08
�A �''` R 1 02/12/08
�
�'-o°
5'-5 1/2" 14'-6 1/2" 6'-6" 14'-0"
' � ,._. _ I 40'-6" � �
I • �
43-0
SHEET
B FISRT FLUOR PL�1N
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s�s.�,�,,.,,-0�,
�. 11=�- 1 . 1
.
SCALE:
i AS NOTED
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45'-i"
13'-3 1/2" 18'-0 1/2"
�a'-z �/2' 1�'-5 �/2^ ��_��• �• s�_��^ 4�_��� 3�_�a• 2�_s•
' ' � �/ ' s'-> >l2" �'-�° �'-s
TABLE & IRS
48"'
NE ZG/)
LOVE EAT
70°x 7x34 u Ilk II � � U
E 66"x25"x37.5"h 20.5' �
@ � II � � III BUFFET E W O � N
� �M � pI � _6 I! I 3 II �i �� U N
°° V°° R „ O O � II � � N N U � d-
IIK �
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2'-8" 8 -9 �3 ----� V II — . - ' N � U p\
o � �
M
1 6 II KITCHEN ? � 3'-0° II �! � �
co2 � - z" M r=z--:
� � �' �� �� 3 "x17"x72"h
� ❑ CHINA ❑ "N o
DN ---- --- � � �
�_7� M N
EXISTING Do00R 2�,-8„
AI
C� c��s
ILT I ' � �W
CO2 S BO S SH LF \ �� '3� N w �U Q
_ ___ _ - --- � ❑ BATH �
� � �
EXI5TIN6 STEA RADIATOR � �W ~ Q
, � TO BE REMOV � w +[� � �
I �
BEDRO M i��vj v�, �
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i �- Q
I � �
�I 5�-9"
i A 2nd FL.600R PLAN
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suza a�a^=r.n•
DRAWI��IG TITLE
�/1
A �
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SEE DEfAIL 2
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THRU-BOLTS AT BOTH ENDS OF HANGER.
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l AND NUT OF THE BOLTS
DRAV�VING TITLE
5ECOND FLOOR
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CD 02/07/08
(2) 2X6 H GER, NGAtOKT SEISMIC TIE, MANUFACTURED
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SEE DETAIL 1 ON S-X.X SECURE SILL PLATE TO FLOOR JOISTS.
THIRD FLOOR -
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REINfORCED w/ 2X8 JOIST AT EVERY OTHER JOIST
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SCALE: 1 = 1 -0
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