0026 MOFFATT ROAD BPA-17-212 �L4 �-
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY 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
This Section For Official Use Only
Building Permit Number: Date A lied:
Building Official(Print Name) Signature l5aie
i
SECTION 1:SITE INFORMATION
1.1 Property o / 1.2 Assessors Map&Parcel Numbers
` = 7 rAT
1.1 a Is this an accepted
��
pted street?yes L/— 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:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: Outside Flood Zone?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Name(Print) C9ty,State,ZIP
�2i( �Fi�i�% lid- _W dW-36;D
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other A Specify:�j'8C//jy
Brief Description of Proposed Work 2: vi L,> R1°SSYQP -R / �✓ D�
401 f')°R PlorvS �g,�)�J
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 2 �,� 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(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: $ c7U ❑Paid in Full ❑Outstanding Balance Due:
G4r
e/06 A- �( to/A
7
SECTION 5: CONSTRUCTION SERVICES
' 5.1 Construction Supervisor License(CSL) D-�>IqLi 1 !5 9-30-
Lai)-r- V,1 j oat rz- License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
n I\� 51 V
No.and St e Type Description
�J g ✓ rnA ao I U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZfP M -Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) /0q
C►2-,�,C KP(z sr)/Ias W• 1 n/L HIC Registration Number Expiration Date
HIC ComRany Name or HIC Registrant Name
g I Y 1!;727 S t. C+2,-,t KeRSn41K P Coe,---C /.Br C-YI
No.and Str ee t
&V&"& , M� Email address
Ci /Town,,SNIP T/elet7hone
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
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my n;'I
b ow,I hereby attest under the pains and penalties of perjury that all of the information
contained in this ' tion is true and accurate to the best of my knowledge and understanding.
Print O er's or Authorized Agent's Name(Electronic 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. ovg /oca Information on the Construction Supervisor License can be found at www.mass.gov/dpss
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"
4*0—
2x8 pt ledger=—d into the existing structure
composite rail system
C 4';
steel all decking will be max composite or similar decking
joist
hangers
1'4•
d.W P.A.OM joists
4.6 PA.post
fi
post base
rotation offwtfng
doubled W pt rim joists
2x12 pt stringers
.—t.footing
3'8"
Foo a I,0—�
26'Lat Rd.
Salem,Ma
4.0
k 10'A
-010—A
2.8 pt ledger screwed into the existing structure
S
composite rail system
4-
steel all decking will be trax composite or similar decking
joist
hangers
dbl 2xI P.t.rim joists
T
4x6 p.t.post
fi
It, post be"
............... location of foofing
.......... ..
..... . .... ......
................ ......
...... doubled 2x8 pt Him joists
2x12 pt stringers
1'2"-
commle footing
Fiola K--VO—A
26 Moffat Rd.
Salem,via
RENEY, MORAN & TIVNAN MORTGAGE INSPECTION PLAN �
REGISTERED LAND SURVEYORS NAME FIQLA, STEPHEN & NICOLE w
75 HAMMOND STREET — FLOOR 2 �
WORCESTER, MA 01610-1723 LOCATION 26 MOFFAT ROAD
PHONE: 508-752-8885
FAX: 508-752-8895 SALEM, MA 1
RMTCHSTGROUP.NET
A Divrsian of H. S.. & T, Group, Inc. SCALE 1' 30 DATE 11 -7- 16
REGISTRY ESSEX SOUTH DEED BOox/PAOE 31475/197 W
BASED UPON pOeum"maN PRpVI m REOum MEASURE-
MENTs wERE MAOE or THE FRONTAce AND BUltnl�(S sm"'t mm wox/P1AN 4034/50 & #240 OF 1! 574'"
ON THIS UGJff AOE INSPECTION PWT,IN OUR MIXIAW ALL ��N OF L"t�
OF ZO EASEMENTS ARE sHOUIN ANO THERE ARE No O PROP tv � WE CERTIFY THAT ME BUS.M(S)ARE NOT WMM THE
OF XONINO REQUIREIr,QIfIS F1EtiARpN1D STRUGIURES TO PROP �.
TUNE OFFSETS{JKM OI} aE NOTED IN ORAWUNG BELpW). 0AN1EL SPECIAL FLOOD HAZARD ARTA.SM R%k MAP:
NOTE:NO/DEFINED ARE ABOVEMOUND P00L5 DRFVEWWYS,
OR SHEDS MTH NO FWWAMNL THIS 1S A WdiiAOE cs J. �• 532G DTD{}7—�8-1
WSPEcrm"%. NOT AN FNSTRLWW SURVEY.00 TAT USE to v TIVNAN u'
ERECT r"es,OTHER BOtNNtiw SIRUcnmm OR To P" N . 40TM7
SHRUBS. LOCATION OF THE ST8UC71lRE )SNDWN HEREON IS ERNER nWO WARD ME NAS BEEN DEAE1110M BY SOME AND
IN CoMP41 a WITH LOOT AAL XONFNO i01t PROPpit1 Lk1E OFFSET IS NOT N EECESSAWY ACCURATG UHFtt OMONE PUNS ARE
REgUFR WMER, A , 3-TIT flip.VFOL,U iiSM 7.09
UM ISSUED BY HIAA AND/OR A VERACAt.CONMK SURVEY IS
ACTxIN UNDER WFSs,OL TITLE VU.ClrAP.ODA,SEC. 7.INN.EA.+ �'
OTHO NSE NOTED.THUS CERTIM31ON IS NON•TRANSrERABLE PERiTNtMEO,PREMEIEVATfONS CANNOT BE DETERMDtEO.
THE ABOVE CERTM 'MONS ARE MW WITH THE PROVISION THAT
THE DWOMMVION PROMDED LS ACCURATE AND THAT INE MEASURE-
P OPEXM USED
D ARE ACCURATELY LOCATEA IN RELATION TO THE
CERTIFY TO.CROSSCOUNTRY MORTGAGE INC,
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MOFFAT STREET
REQUESTING OMC$:LAW OMCE OF SIJZAN A. 4AE'$SINA DRAWN BY.CA
REQUESTED BY: rXFWIW n nv.