17 VALLEY ST - BUILDING INSPECTION (3) 'rite Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CNIR SALENI
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revi.ved,tlur?011
One-0r 711`0-Family Dwelling
Building Permit Number: This Section For Otiicial Use Only
Date Building;Official(Print Name) l l7 r/y
Signature
SECTION L•$1TE INFOR:NATION Date
IA l operty At dress:
1641 Al
ev S 1•2 Assessors N1ap&Parcel Numbers
1.In Is this an accepted street?yes_ no iblap Number a rcel—Nu1-3 Coning Information: 1.4
—
Property Dimensions:
Zuning D�_ proposed Use—--
Cot Area(sy tt) Frontage(R)
LS building Setbacks(ft)
Front Yard Side Yams
Provided Re
Required Provided Rear Yard
Required aired
y Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information:
Public❑ Private❑ Zone: Outside Flood Zone?
1.8 Sewage Disposal System:
_
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION2: PROPERTY OWNERSHIP'2•I/pw�rt of Recor
Nyhme(Pant) �----
\l!A �S-t/ate,ZIP
No. and Strut b'9
S�/�C�
Telephone onali Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s)Demolition ❑ Accessory Bldg.❑ Number of Units Addition ❑
'ef scriptio ofPropos Work=: Other [Ispecify:
vie r uSc� o
SECTION 4: ESTIMATED CONSTRUCTION COSTS t
Item Estimated Costs:
Labor and Materials) Officiul Use Only
I. Building Labor
1. Building Permit Fee:3—Indicate how fee is determined:
2. Electrical S Zs� ❑Standard City/Town Application Fee
3. Plumbing b b Cl Total Project Cost'(ftem 6)x multiplier x
2. Other Fees: S
4. \Icchcmical (HVAC) S List:
5. �Nfechanical (Fire
Su ression) S Total All Fees:S
6. Total Project Gust S /'J`ZS� Check No._Ghee
—Cash Amount:_
❑Paid in Full ❑Outstanding Balance Due:
fn
�� �
SECTION 5: CONSTRUCTION SERVICES
5.1 Cun ruction Supervisor tcense(CSL) / 2 _.
License Number Expi ati n Date
�� List CSL Type(see below)�—
N anae o f_�r
Type Description
No,and Street U unrestricted Ouildin s u to 35,000 ea. It.)
-_ R Restricted 1&2 FamilyDwellin
nAJUer5 V"yYT Nl Mason
City/town,State,LIP RC Roofin Covering
WS Window and Siding
!i SF Solid Fuel Buming Appliances
I Insulation
p Demolition
Email address /
reie hone 17
j,2/cgis�red Hometprov'emt Contractor(HIC)
HIC Registration Number E'xpirutiun Date
II Comp Nit he or 111C Re istranl N.hme
•Cry � Email address
NN�and Street _ _ 1 A l�- � �� q/
7iJ 'role hone -
Ci /Town,State,ZIP
SECTION&WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M•G Failure 2SC(6)).
' this application.
insura
nce affidavit must be completed and submitted wtth
om ensation �permit.
Workers C p the building
this affidavit will result in the denial of the IsSuan ce o
Signed Affidavit Attached? Yes ..........
No....... ... 13
T�TION.TO BE COMPLETED WHEN
SECTION 7a:OWNER AUTHORI r"
OWNER'S AGENT OR CONTRACTO APPLIES FOR BUILDING PERMIT'
I,as Owner of the subject property,hereby authorize
S u l4z-
t9 act on my behalf,in all matters relative to work authorized by this building permit application.
Date
Print Owner's Nmue(Electronic Signature)
AUTHORIZED AGENT DECLARATIO
SECTION 7b:OWNERh OR
N
6y 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.
Date
Print Owner's or Authorized r\gent's Name(Electronic Signature)
NOTES:
g will not have access to the arbitration
I Aner who hires an unregistered contractor
n Owner who obtains a building permit to do his/her own work,or an ow
(not registered in the Home Improvement Contra tor(HIC) Pro gram),
the F Program ' be;ound at
programorgrotyifott io olrmaion on Construction Supervisor Lirtant cense can be found wN` ii0
a
2. when substantial work is planned,provide the info n at oding garagn below: e,tinished basement/attics,decks or porch)
'total floor area(so. ft.) Habitable room count
Gross living area(sq. ft.)�-- Number of bedrooms
Number of fireplaces Number of half/baths
Number of bathrooms Number of decks/porches
Type of heating system Enclosed Open
'Type of cooling system
.3. "Total Project Square Footage"may be substituted for"total Project Cost" �.
ncc�v" CERTIFICATE OF LIABILITY INSURANCE 7171212 n4YY'
vlvla
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DO ES N OT AF FIRMATIVELY O R N EGATIVELY AM END, E XTEND O R ALTER T HE C OVERAGE AF FORDED B Y T HE P OLICIES
BELOW. THIS C ERTIFICATE O F I INSURANCE DOES NOT CONSTITUTE A C ONTRACT B ETWEEN THE I SSUING I NSURER(S), A UTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 endorsement(s).
PRODUCER Lauranzano Insurance Agency NAME CONTACT Berkley Assigned Risk Services
107 Dodge St uC.No_Ext 800 634�589 fac.No.): 866 215-8118
ADDRESS: Poli Services berkle dsk.com
Beverly,MA 01915 INSURERS AFFORDING COVERAGE NAIC#
INSURER A.
INSURED Zachary Fellows INSURER B:
INSURER C.
PO Box 155 INSURER D.
INSURER E'
Danvers MA 01923 INSURER F:
COVERAGES CERTIFICATE NUMBER: 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.
INSR LTR TYPE OF INSURANCE INSR MID POLICY NUMBER MWDDIYYYY MM/DD/YYYV LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED $
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence
❑ CLAIMS-MADE ❑ OCCUR ❑ ❑ MED EXP(Any oneperson) $
PERSONAL S ADV INJURY $
GENERALAGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $
PRO- $
POLICY ❑JECT El LOC
AUTOMOBILE LIABILITY ❑ ❑ Ea accident $
ANY AUTO BODILY INJURY Perperson) $
ALL OWNED ❑SCHEDULED AUTOS $
AUTOS BODILY INJURY Per accident)
HIRED AUTOS ❑NON-OWNED PROPERTY DAMAGE $
AUTOS Peraccidant
❑ $
UMBRELLA LIAR ❑OCCUR ❑ ❑ EACH OCCURRENCE $
EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $
DIED RETENTION$ $
WORKERS COMPENSATION X WC STATU- E:iOTH-
AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER
ANY EACH ACCIDENT $ j00000.00
R R A OFFICEMEMBEREXCLUDED?REDDTIVE O E
NIA ❑ WC-20-20-004793-00 5/24/2013 5/24/2014 .L
rando .,In NH) E.L.DISEASE-EA EMPLOYEE $ -100000.00
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000.00
❑ ❑
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 10,Additional Remadis Schedule,if more space is required)
Election Category Election Status Name All Entities/Insureds:
Sole Proprietor Exclude Zachary Fellows Zachary Fellows
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City Of Salem EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
120 Washington st
AUTHORIZED REPRESENTATIVE
Salem Me 01970
CITY OF SALE,,I, NL-kSSACHUSETIS
tc� BUff DING DEPARTSIE.`1T
Y7'!t 120 WASHLNGTON STREET, 3'FLOOR
d T EL (978) 745-9595
F.sox(978) 740-98.16
KINIBERLEY DRISCOLL
VTAYOA THOMAS ST.PMR.RE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
Workers' Cornpensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
An flicont Information Please Print Legibly
Value (BusincssOrganization,'Individu,d): /i{^/C.'I\�TY�V (���(rit.r�� p
Address:
City/State/Zip: _N(611^'f 1 Q/0/13 Phone #:
Arc you on employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction
- uiployees(full and/or part-time).' have hired the sub-contractors
2 1 atn a sole proprietor or partner• listed on the attached sheet, : 7• ❑ Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me in any capacity. workers'comp. insurance. 9, ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation mid its
required.]
officers have exercised their 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I,[] Plumbing repairs or additions
myself. [No workers'cutup. C. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' . (},❑ Other
comp. insurance required:l
Any applicant Jut chocks box Al most also fill out the neclion bdowshowing their workeri com ati penson policy inninnaI!on.
;A.
I hxncuwncrs who submit this affidavit indicating they arc doing all work and then hire oudide contractors mot submit anew airdavit indicating such
:C,mimetom shot check this box muat attached in additional sheer showing the none of the subKanuactom and their workers'comp.puIicy information,
l ant un eutpluyer that is pravidin vorkers'conipeasadan insurance for my employees. Below is the policy andjub slid
iuformurion. /
Insurance Company Name: `//L(/ �75
Policy A or Self-ins. Lic. 7:�11L�d-7 '-Ooy_7�' �� Expiration Date: V
Job Site Address: City/State/Zip: U 11 g
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
In vestigut ions oft lit: DIA for insurance coverage vcri fication.
1 do hereby cerrify gaddr th uhts and ei dlperjury that the iufurmurlun provided above is true and cor ecL
aLoi ore: y Date:
Phonc;/: "t 75-7<v7 —0 9 Z
OJficful use may. Do not write its this area,to be completed by city or town officiaL
City or fmva: ____.. . .__ PcrmitA,Icense M
Issuing Authorily(circle one): --
I. Board of licanh 2. Buildln, Department 3.C'ilyyfuwu Clerk 4. Electrical laspcctur 5. Plumbing Inspector
6.Other __..
Contact Person: _ _.. . . Phone It:
]
CITY OF SiUI Eld, tiL1SS.ICHUSETTS
Buimvgc;DEP-ARTMEIiT
120 WASHCYGTON STREET, 3'FLOOR
- TEL (978) 743-9595
KIIIBERT Y DRISCOLL FAX(978) 740-9M
NLAYox IHObLAs ST.FmRRS
DIRECTOR OF PUBLIC PFL0PERTY/8UILDLNG CONNISSIONER
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 1 l 1.5
Debris, mid the provisions of tbfQL c 40, S 54;
Building Permit Ik is issued with the condition that the debris resulting from
this work shall be l 11, S I SOA. disposed of in a properly licensed waste disposal facility as defined by 11VfGL c
The debris will be transported by:
y t��
(name: of haulur)
The debris will be disposed of in
name of facility)
eq�y-jCxuti
(addre of Facility)
i
signature of permit applicant
(laic
� �
,, ,
��
� ,
- � ! b� ,�
��
,� h 8 _�� _
,�
Z. Fellows
Fellows Construction LLC. Estimate
t DANVERS,MIA 01923 I ..Date Estimate No..
1.1/22/2013 1037
(97R)767-0792 �
.fellowsconstructionllct@gmail.com Exp. Date
I — i
;Address
I Patrick Schultz
17 Valley
salent, ma.
--- --- -- --. —_ - _ F_ Amount —
Actroity Quantity Rate
• Cut opening in existing wall into sun roorn. Install laminated beam as specified by i 2,500.00
supplier rough carpentry and material only
• Frame knee walls for new windows and doors height to be decided on site. Prancing 2,900.00 j
skylight. stock and labor
Install exterior vinyl siding and trim windows to match existing house 2,450.00
• Electrical estimate with material could range from$1500$2500 2,500.00
• Plumbing including material $150043000 3,000.00
•disposal 350.00
•Paint interior material included 1,500.00
• refinish hardwood Floors 400sgft 725.00
•blue board and plaster 1,200.00
•insulate all exposed areas including underneath 1,200.00
• Framing underneath room installing proper supports and joist hangers and fixing 2,500.00
any rotted wood will cover frame with pressure treated plywood
• All glass windows,skylight and door 200 series upgrade 4,600.00
• interior finish including material and installation of all windows and doors and all 3,500.00
patching old to new areas
• rool'restofhouse 3,200.00
I
II
I
— Total -- $32,125.00�
A ccepled 13Y Accepted Dale 7 �--
Boise Cascade Triple 1-3/4" x 14" VERSA-LAM® 2.0 3100 SP Floor BeamIF601
Dry 1 span I No cantilevers 10/12 slope Monday,January 13,2014
BC CALC®Design Report-US
Build 2627 File Name: BC CALC Project
Job Name: Description: Designs\FB01
Address: Specifier:
City, State,Zip: , Designer:
Customer: Company:
Code reports: ESR-1040 Misc: 47 UAiJ 6`1
I I I I I I I l l z l I I I I 1 1 I I I I I I I I
I I I I I I I I l l l i l l j l l I i I l I 1 1 i
... _. .. 17-00-00
BO B1
Total Horizontal Product Length=17-00-00
Reaction Summary(Down/Uplift) (lbs)
Bearing Live Dead Snow Wind Roof Live
BO, 3-1/2" 4,080/0 691 /0
B1, 3-1/2" 4,080/0 69110
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125%
1 porch roof Unf.Area(Ib/ft^2) L 00-00-00 17-00-00 40 15 04-00-00
2 outside wall Unf.Area(Ibfft42) L 00-00-00 17-00-00 80 0 04-00-00
Disclosure
Controls Summary Value %Allowable Duration Case Location Completeness and accuracy of input must
Pos. Moment 19,198 fl-Ibs 44.1% 100% 1 08-06-00 be verified by anyone who would rely on
End Shear 3,952 Ibs 28.3% 100% 1 01-05-08 output as evidence of suitability for
Total Load Defl. U504 0.394' 47.6% n/a 1 08-06-00 particular application.Output here based
( �) on building code-accepted design
Live Load Defl. U589(0.337") 61.1% n/a 2 08-06-00 properties and analysis methods.
Max Defl. 0.394" 39.4% n/a 1 08-06-00 Installation of BOISE engineered wood
Span/Depth 14.2 n/a n/a 0 00-00-00 Products must be in accordance with
current Installation Guide and applicable
building codes.To obtain Installation Guide
%Allow %Allow or ask questions,please call
Bearing Supports Dim (L x W) Value Support Member Material (800)232-0788 before Installation.tnlnBC
BO Post 3-1/2"X 3-1/2" 4,771 IbS rite 51.9% Unspecified CALC®,BC FRAMER®,AJSTM,
r Bt Post 3-1/2"x 3-1/2" 4,771 Ibs n/a 51.9% Unspecified ALLJOISTV,Bc�RIM BOARD- eCl®,
BOISE GLULAM ,SIMPLE FRAMING
SYSTEM®,VERSA-LAM®,VERSA-RIM
Cautions PLUS®,VERSA-RIM®,
Member is not full supported at post BO. A connector is required at this bearing. VERSA-STRANDse VERSA-STUDS are
Y PP P q 9• trademarks of Boise Cascade wood
Member is not fully supported at post B1. A connector is required at this bearing. Products L.L.C.
Notes
Design meets Code minimum(U240)Total load deflection criteria.
Design meets Code minimum(U360)Live load deflection criteria.
Design meets arbitrary(I")Maximum total load deflection criteria.
Calculations assume Member is Fully Braced.
Design based on Dry Service Condition.
Deflections less than 1/8"were ignored in the results.
Page 1 of 2
-L Casmde Triple 1-3/4" x 14" VERSA-LAM@ 2.0 3100 SP Floor Beam1FB01
Dry 1 span No cantilevers 1 0/12 slope Monday, January 13,2014
BC CALL®Design Report-US
Build 2627 File Name: BC CALC Project
Job Name: Description: Designs\FB01
Address: Specifier:
City, State, Zip: , Designer:
Customer: Company:
Code reports: ESR-1040 Misc:
Connection Diagram
+db d
a
• • •
o � o
c
a o 0 0
a minimum=2" c=9"
b minimum=3" d=24"
e minimum=3"
N,eiNftg schedule applies to both sides of the member.
Member has no side loads.
Connectors are: 16d Sinker Nails
Page 2 of 2