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3 WALL STREET CT - BUILDING INSPECTION �5I1050 - cr Z00-73 R"" 1 , The Commonwealth of Massachusetts 20I'll DEC 19 A 10' 1 ° Board of Building Regulations and Standards `II1�Y OF Massachusetts State Building Code,,780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling I This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature Date (� J SECTION 1:SITE INFORMATION 1.1 Property Ad Jess: 1.2 Assessors Map& Parcel Numbers W G 1 st CChJ�-r I.I a is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 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: pp y (M. L G. c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if yes[] Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Rec rd: L\r) �Ot-W11C -er.J M >41F c7 1Ct10 Name(Print) C, / City,State,ZIP -3 CaJc� �\ �i CJt °1�co "145 0pc)q 1 Looe-y 9ul1,Jew I © 9e c , No.and Street Telephone Email Address ,Cow. SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building M Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': CO\'T�`.��- e•.r..eG ere` --� y� 1'tou7e . ~g\e It n\\ tnc.,V eleckr ,C,l -,.4 t' O)SG ,J,VM ckrl h +c,-w.. 'fr,w. crc. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ \\5 r� 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee 1 s C�i7 ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 7-O 000 2. Other Fees: $ 4. Mechanical (HVAC) $ ^ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 150, 000 ❑Paid in Full ❑ Outstanding Balance Due: 1 2I t;1 M A\LED jt�- G .Cn, SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 0 6.6 7\- oD wS E I—e-w'S fit" License Number Expiration Date Name of CSL Holder 1 SH List CSL Type(see below) No.and Street Type Description 6�ocd,H WL 14 O\-i by U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 9-7,6 —)-(1 17Lyo -N-c.„.,,� '� �joy3kW_ 1e0,k I Insulation Telephone Email address ems. D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1-13 9L3 II— Ig-1 3a 161Q 1�Uk VA sr`t C cG�+,ocQ e�w� SV1C, HIC Registration Number Expiration Date HIC Company Name or HIC egistrant Name bay3talc build tn� No. nd Street Email address , c.�-. a)eve , W t4 01"-I o Ong -141 F700 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 ..........;. 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 )nov c,g C Lets r S _ J v- to act on my behalf,in all matters relative to work authorized by this building permit application. \lo Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under a ains and penalties of perjury that all of the information contained in thi placation is true and a rate a best of my knowledge and understanding. —tb Print Owner's or Authorized Ageles Na e(Ele tro is Signature) 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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 CITY OF S.0 EM, iNvL-kSS.A.CHUSETTS BUlIDIING DEPARTMENT j 120 WASHINGTON STREET,San FLOOR TEL (978)745-9595 FAX(978)740-9846 [l.,,ffiFRT F-Y DRISCOLL MAYOR THolsw ST.PIEm DIRECTOR OF PUBLIC PROPERTY/BL'ILDLNG CO.MUSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers At) licant Information Please Print Leeibly Name(Business.Organization/individual): Ba`�SIG 1C By��d t�n� Q '(ZCsv,o cQc l\n.Z Sv�C Address: IDK- fT-- City/State/Zip: Salem, r.w* o\c,-ro Phone#: T716 -) -\t ClbO Are 1 you an employer?Check the appropriate box: Type project(required): I.rRA 1 am a employer with 4. ❑ 1 am a general contractor and 1 t 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t ?• JD Remodeling ship and have no employees These subcontractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised thew 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL l 1.0 Plumbing repairs or additions myself.[No workers'comp. e. 152,§1(4),and we have no 12.❑Roof repairs insurance required.)t employees.[No workers' MCI Other comp. insurance required.] •Any applicara that chocks bos al must also fill out the section below showing Their workers'compensation policy infomndom *1 hmeuwmns who submit this affidavit indicating they ate doing all work and then hire oetaide contractors most submit a new anidavit indicating such =Cwnracion that cheek this box must attached an additional shmr showing the name of rho wbwotractors and their workers'comp.policy infommtloo. I cam an employer that Is providlag workers'compensation hisarance jar my employees. Below Is the pulley and jab stirs information. Insurance Company Name: Al rv> ✓vur WC ( Sn C- Policy#or Self-ins.Lie.#: Fi W e--1100--i o T %3�51 -Doi Expiration Date: 3-\5-%-I Job Site Address:_ 3 (.Jtab1 Si C+- City/State/Zip: )CICHs . MA oi9'l0 Attack 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 S 1,500.00 and/or one-year imprisonment,as wall as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DiA for insurance coverage verification. I do hereby cert jy under the pales and penaltles of perjury that the information provided above is true and correct. Sienatnre: Datc• Phone#: OJjcial use only. Do not write in this area to be coutpleted by city or town ofjtciaL City or Town: Permit/Llecose# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#' f CITY OF SMY.M. N'LkSSACHUSETTS Buu.DLNG DEPs.RTNw%-r • 120 W.�sHINGTON STREET, r FLOOR �"b TEL (978) 745-9595 FAx(978) 740-9846 KLNfBE LEY DRISCOLL MAYOR THo"ST.Pmm DIRECTOR OF PIBLIC PROPERTY/BUILDING CONMSSIONER 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 l 11, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in : I (name of facility) I M I« (address of facility) signa re of permit applicant date CONNELL RESIDENCE p o � 3 WALL STREET COURT SALEM, MASSACHUSETTS U W � U ] wO O U Q y W � W W 2 J H SHEET LIST W J Wtn a Z J N AD FOUNDATION PLAN SO FOUNDATION PLAN ZO A 1 FIRST FLOOR PLAN,SCHEDULES S 1 FIRST FLOOR FRAMING p 3 (L} A2 SECOND FLOOR PLAN,SCHEDULES S 2 SECOND FLOOR FRAMING ,, A 3 THIRD FLOOR PLAN,SCHEDULES SO ROOF FRAMING { AO ROOF PLAN A FRONT B REAR ELEVATIONS LEFT&RIGHT SIDE ELEVATIONS AD CROSS SECTIONA AT CROSS SECTION B r x z Of = W } o LL Q COVER 6 m x y 1 Z O Cj7 � 70 32'-3" ri -------------III------------------------------------------------ L I 1 ___________ ------'--------- _____ -___------------_-__ _ 1 I I xi I I I I I I I I 1 I I I I I I 1 I I I I I I i I 1 I I I T I I I I I O Z O I, D I I I I O z elI ,13 I I I ILj I I N r Z I I I Cz� I I I I I I I f I I I I I r"� ory I o I I I I I m I I I I I I I I I I I I I I I I 1 I o I '- II'V L- I J I I L- -----x----- ----- I ----------------------� ------------------ I I I I I 1 32'3" = ND FOUNDATION PLAN CONNELL RESIDENCE W1Al1V1ALR '" � D n 3 WALL STREET COURT O SALEM,MA 1 DUTCHMAN LANE,WESTFORD,MA 9]&Hm& 6 m ' 5'-31/2"— 29'-6" 1 � 13'-6 112" 4'-6 3/4" w o 3R ............- 12'-3 1/2' am 1 CUSTOM £ SHOWER I STALL U H BATH O N PORCH os o BEDROOM IT REAREENTRV 3 R I DN / SLLW T V 6 Sv .11rz—t - N Z I BEDROOM i o OU Q lw � KITCHENIS a' J J O I POSL W J w a. Z @ENLp➢p 9EPH4➢IE a I A J g B 3 T I I A I 6EP9ffim I 61I.BlI l 00 co PANTRY ® ENTRY ` Cj II 1,IVIN II ® j Z I � aI � ID6 _ I I V) I K n I LL I I DATE I pry BQ016 29'-6" i SCALE: SH —1' SnEET: EXISTING FIRST FLOOR PLAN A 1 - Lu X de Z � z-0 18'-11/2 14'-21/2" — i i m 0Z-nrA ,—"—,! ]_T .Lo C LOSET O O N oEMowwL r D - `0 2 i .III m lilt> 11'-10112" � o Ili a' €Illllm 0 r Iliim < Iv 2 nl m ICI p 1 � w ➢ - 4' a-�- F36Q12-I II I, 32'-4" D y Im->0 SECOND FLOOR PLANI-S-SSALEM,MA 1 DUTCHMAN LANE,WESTFORD,MA 978-692-0006 w.w.camblxomeoesgn.am ,na,rz i m x N G� a 20'-002" glop I I I p I I I I Inf I m ilyz ii "x I I I I II °r I I T � w 0 f O : I � I m _ D — m w Z A N W Im ' O i I I I' I ( m I e I I I I\ k� _ 1 4i H m L� --- - --- .._�._ 20'-0I'1/2" m N m m o THIRD FLOOR PLAN CONNLLELL RESIDENCE D n 3 WA STREET COURT SALEM,MA 1 DUTCHMAN LANE,WESTFORD,MA 978-692-0006 «...ca",awom.orgn.oM, m X N 1 Z i I I I i i i i I I I I I I I I rn ' I I O I O n M r D Z I I I I I I I I I N I -1 F= f� _- I� N D ROOF PLAN CONNELL RESIDENCE n 3WALL STREET COURT A SALEM,MA 1 DUTCHMAN LAN E,WESTFORD,MA 9➢8-692-0696 Lila II�I9I� ml {{��RIIII�11� fll�llll��� ••:• •• r rI ONE : MEMO Iu.■ r■ o `i:Li:1 r. im ME ME I:::: + g .dill C) Z1 O I y N N m - - i_ O z D y j D m m CROSS SECTION A CONNELL RESIDENCE 3 WALL STREET COURT SALEM,MA 1 DUTCHMAN I-ANE,WESTFORD,MA 97&692-0006 rme0eeignpm 0 I e y y m n O I Z IN v I - N m m n CROSS SECTION B CONNELL RESIDENCE . . ... .x 3 WALL STREET COURT V "� SALEM,NIA 1 DUTCHMAN LANE,WESTFORD,MA 978-692-0006 0 o t.� 0 c z v 0 z v z TION PLAN CONNELLRESIDENCE 3 WALL STREET COURT i417 m m SALEM,MA 1 DUTCHMAN LANE,WESTFORD,MA 976-692-0006 me�.� T_ T r O O X T D 3 Z O FIRST FLOOR FRAMING CONNELL RESIDENCE � 3 WALL STREET COURT SALEM,MA 1 DUTCHMAN LANE,WESTFORD,MA 916-692-0006 m n O Z 0 T r O O T Z m c A.-AF SECOND FLOOR FRAMING CONNELL RESIDENCE(n3 WALL STREET COURT LANE,WES N y SALEM,MA iDUTCHMAN TFORD,MA 9]8-692-0666 z 0 0 T T 2 G) m w ROOF FRAMING CONNECT RESIDENCE _. 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