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10 1/2 MALL ST - BUILDING INSPECTION The Commonwealth of Massachusetts Town of ►� Board of Building Regulations and Standards a oa Massachusetts State Building Code, 780 CMR, 7's edition Building Dept Building Permit Application To instruct, epair, Renovate Or Demolish a One- Two-Fmnily welling is Sectio or O tcial Use Only Building Permit Number: D to Ap lied: / Signature: i ���"�' ' �P Building commissioner/inspect B Date ° SECTI 1: SITE INFORMATION I.1 Property Add re 1.2 Assessss\ors Map& Parcel No ben Ma bar Parcel Number 1.la Is this an accepted street _ no P'?yes 1.3 nin Information: 1.4 Pro ertyDimensions: ,1� I Zoning District Proposed Use a, Lot�Area( q R) Frontage(R) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1. ate Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: /S Zone: _ Outside FIoo4�Tdna? Municipal l�On site disposal system ❑ Public f9' Private❑ Check if esO SECTION 2: PROPERTY OWNERSHIP' ' ^ 2�/nYr�ll%ecoVilf/ ()In Io 1V ��U/,N17 n �f�O41 ame 6P in) 1 Adfiress for Service: QWA Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0!( 111KExisting Building❑ Owner-Occupied ❑ Repairs(s) 11Alteration(s) ❑ Addition 1 K Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Wor ': O Q O J J SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: OMcial Use Only Item Labor and Materials I. Building 5 000, I. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical S 000. " ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing y S a0e% 2. Other Fees: S 4. Mechanical (HVAC S Ltst. 5. Mechanical (Fire S Total All Fees: S- Suppressionj Check No. _Check Amount: Cash Amount: t 6. Total Project Cost: S ❑ Paid in Full ❑Outstanding Balance Due: 8��5 �y0 i 1 SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Super isor(CSL) .t n fO Z�y /Jl�/.� a Exp aeon Date Ngmc of CSL- H9Wer /J (sec below) Address � ' Descri tion AJJress © stnctrd u to 35,000 Cu. F, I Sign, ricted I&2 FamJ Dwrllin on Onl dential Roofin Covering Telephone dential Window and Sidinential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2_R��egyy/is�fomf�pr vem1. „e�nt o�Srector HIC) HIC Company Na or I egistrant Registration.� 77/ Number Expiration Date Signature Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 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 AMdavit Attached? Yes .......... ❑ No...........❑ L N 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN RS AGENTORCONTRAACTOR APPLIES FOR BUILDING PERMIT I���n v( . 1 1 t V r i as Owner of the subject property hereby S �'Y to act on my behalf,in ail matters o work authorized by this building pe 't application. 1 -�2 DL,0o9of Owner ° 1 Date ' SEC ON 7b:OWNEW OR AUTHORIZED AGENT DECLARATION 4 U ,'U, Int 1) as Owner or Authorized Agent hereby declare that the statements and information on the foreg ng application are true and accurate, to the best of my knowledge and behalf. Print Name D � Signature of Owner or Authori ed nt Date (Signed under the pains and penalties ofperjury) NOTES: I. 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 no have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations i I O.R6 and I I O.R5,respectively. 2. When substantial work is planned, provide the information below: Total floors 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" CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT ,nl�', M'1\ rNhl rnl 5l:(LL I' • 5,\t I'?t, hf.\1.1.\t III \t 1 IN 3197: ID.I. 178.715-9393 • f\x 97)1.711 1.446 Workers' Cumpensation Insurance Afftddxit: Builders/Contractors/Electricians/Plumbers Il )licant Inronnalion Please Print Le ihllt O/I7 /DC V:IITC l au.uw•>v17r;;an✓.UioNlndl,uluul l: Ndtlress: City,scacc.7ip I'honr ;' .\re you all employer!Check the appnryriate b 'Type orpruject (required): 6. LJ I am a general contractor and I, E3 1 :un a employer with 4. Q New construction employee,(lull and,'ur part-tine).• have hired the iuh-coniricturs 2. ❑ I .,,it a sole proprietor or partner- lised on the attached.vhect. 7. (9Remodeling ship and have no employee. These sub-contractors have S. Q Demolition working for me in any capacity. workers' comp. insurance. 9, ("pudding additiun No workers"comp. insurance 5. Q We area corporation and its I P 10.[ffElecrrical repairs or additions I rcyuired.] otticerx have excrctseJ their 3, Q I ant a homcuwner doing all work right of exemption per fvtQL- I I.[Plumbing repairs or additions myself [No workers' comp. c. 152, ¢1(3),and we have no 12.Q R1wf repairs Ill>uranca requlred.j r cmployecs. (No workers' 13.Q Other comp. insurance rcyuircd.J -\u. .gi1ilicant That checks boa ill murl:II>a fill UUI IhV+CCI WrI iI luw ahawmit Ihelr WorkY1 eumpen Lrriun lu.bcy ulbnrt9liva ' IlomJuwrwn whu+ubmil lhis aflWavif indiuriny They are doing all work aril Then hire uublde cwur.,ctan mu>I.ubmit Anew alrdavil indiubny.Imh. d..nrcwurn Ihm ah¢k Ihu boa corm coached..n addeimal.Iw•eI.hawmy raw n:nne of thv iub"aanlrwlom and their.>erken'comp,policy mrurmanim l aan on employer that fv pro riding workers'rumpensruion in.rurnuce jar my eurplul,ecs. Befinv is the policy and job>ite iufunnurioa ,Q. p In trance Company Name: ///Z44 z/tJ.(' -- - ----.--- vtwlicv is or Sclf-ins. Lic. 0: _-_ . . .. __ Expiralion Date: Job Site Address;�� if d Cny;Slate/zIp. Attach a copy of the workers'compensation policy declaration pulse(showing the policy number and expiradun date). Failure to secure co\erage as required uodcr Scc001125A ul'\IOL c. 152 can lead to flit imposition of criminal penalties of a line op to 51.500.00 anJlur une-year imps isamncnt, ax well as cis11 penalties in the furan of a STOP WORK ORDER and a fine of up aI 51'30.00 it J,ry .Igain>t the violamr. Be advl.acd that a copy of thu sialcinum may be Iurwarded to the Oltice of Im:au•,au nt>ul :hi; DIA for oNmarce c&ncr.lgc \cr ilic.Wun. Id,herby t.rtifv under utiv and paruhicv of perl'i ry lhur the infunnution provided above is true and correct FI// rue mdy. Do rtat writ!in thi.v areu, to he corny/etre by ai9r ur town u�/iciu/. I loo's: _... _ - Per miul.ia•nve p.\uthuri ty (circle noe): of IIc.Jl6 ?. ISuddiu;; Ucparunent {. Cih."fuwu Clerk J. L•'Iectric.tl Llspecfor i, plwubinq lu\yector _l'enmr. Phone 1: /a y 0 Ga�I laC 7 ia� Fi % fug 1017 sow Information and Instructions \f.,,icI,u,clis ucneral Laws ihjitter 152 requires all employers to provide workers' compensation 6)r their employees. i'unu.mt to this ,litule, an emplutee Is dclmcd as * .eery pekoe in du service of another under Any contract of hire, %press or Implied. oral or wntten. . \n employer is defined as "an individual,partnership, associatwu,corporation or other legal entity, or any two or snore ..t the h,regoll;g engaged it a joint enterprise, and including the legal representatives of a deceased emplurer, or the recaser or trustee u -at Individual,patt»cnhnp, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house ,19'01. the..-rounds; or budding appurtenant[hereto shall not because of such employment be declined to be an employer." NIGL chapter 152. �S25C(6)also states that ',every state or local licensing agency shall withhold the issuance or renewal of u license or penuit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally. MGL dutpter 152, j25CM slates"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfomlance ul'puhlic work until acceptable cvidenec of compliance with the Insurance requirements of this chapter have been presented to the contracting authority." Applicants Plcase fill out the workers' compensation affidavit completely,by checking the boxes;that apply to your situation and, if necessary,supply sub-contractor(s) name(&), address(es)and phone nullbef(s)along with their cerlllicate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial \ccidents for confimnation of insurance coverage. Also be sure to sign and dale the affidavit. The alf idavit should be rcnirncd to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you an required to obtain a workers' compensation policy,please call the Depu=cnt at the number listed below. Self-insured companies should enter their Jf-insurance license number on the appropriate line. ti-icy or Town Officials please he sure that the affidavit is complete and printed legibly. The Department has provided a Space at the bottom of the affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant. flame be sure to till in the pcnniulicense number which will be used as a reference number. In addition,an applicant that must submit multiple pennitllicelsc applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file f'or future pciTnas or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture t i.e. a dug license or permit to bun leaves etc.)said person is NOT required to complete this affidavit. 11, i)I the of lot estigatiuns wuuld line no diank )flu In advance fur your coJperal1011 and Should you ha,c .my questions, please do nor hesitate to give us a call. ncc Dcpamnent's address, telephone and fax number The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. q 617-727-4900 ext 406 or 1-877-MASSAFE Fax M 617-727-7749 www.mass.gov/dia J ]�J J iJ T #7�®r JJ U �T fj i7 qT1 1 + l r 11 - �� j J 41JJ 1 L 1T11r�'r rJr' r r rl T -1 jj I I I IIi T Tj1 T T ®, . .. •, .... [. .^... a ... -.YV, SIDE ELEVATION T r � ® n THESEc C^,W,fI\!^5 TO 8E � r° 1 � KE��_/✓� G� G INS ECT6e a. BUILDINGS C17 TIT r I Contract InLj g �� 918-531-3113 I -T 19 Rainbow orcle, Peabody, MA. 01960 _ PREPARED FOR DAN CEDERHOLM KERRY MURPHY ELEVATIONS , �,�i,�i���/ � � � •��• \ �� 10% MALL STREET ;� � SALEM, MA SHT. I OF 4 REAR ELEVATION JANUARY, 2009 SCALE: NOT TO SCALE I 20'-4j"f 20'-4j"t 9'-9i" 2"x12" (TYP) { ray. 200 O STEP -71 M 2 e 2"x10" FAMILY ROOM 16" O.C. (TYP) DN 2"x8" PT LEDGER 0 0 LO 0 20 v 10 2"x8" PT 3 16" O.C. (TYP) O \ M r 2"x1 O 2" STRINGER (TYP) 8"0 SONA TUBE & 24" 4"X4" PT POST (TYP) 2"x12" PT EXISTING STRINGER (TYP) STRUCTURE 1 st FLOOR PLAN 1st FLOOR FRAMING PLAN 20'-4j"± 10'-24- " I II � � IlIIII II REMOVE EXISTING --c 3 -8' r --- ---"-- -------- ------- ------ a aI r- ------ ---------------------------------- r .. I - -d OPENING TO SUIT ANDERSEN STYLE I I 2817 SERIES 200 BASEMENT WINDOW OR SIMILAR (TYP) I I , I I I I I , REMOVE EXISTING SLIDERS " o AND APPROX. 2'-8" OF 4 CONC. SLAB I I I , EXISTING EXTERIOR WALL to REFRAME AND ADD HEADER AS REQUIRED FOR 12' OPENING. 10"x2'-0"CONCRETE10" CONCRETE FOOTING FOUNDATION WALL I 1ST FLOOR DEMOLITION PLANT EXISTING OPENING F LALAYKSTEP UP WINDOW SCHEDULE DOOR SCHEDULE " tract 1nainbow Circle, Peabody, MA. 01960 MATCH(SIMIILAR TIOTING DBL HUNG ANDRSEN TW2416) OW OA 36"x80" INSULATED STEEL DOORPREPARED POR FOUNDATION PLAN ANDERSEN STYLE TW2446-2 O 24°x80" INTERIOR DOOR ERHOLM KERRY MURPHY DBL HUNG WINDOW (MATCH EXISTING STYLE) 48"x80° BI-FOLD DOOR10% MALL STREET FOUNDATION 4 FIRST FLOOR PLANS OD (MATCH EXSTRGR S0LE) SALEM MA BHT. 2 OF 448"x80" INTERIOR DBL DOOR OE (MATCH EXISTING STYLE) JANUARY, 2009 SCALE: 1/4" = it—oll 20--4j"± 20'-4j"± co ih { O1 v° MASTER BEDROOM ao O O 2"x10" 0 16" O.C. (TYP) in in O O co 4 dw ..w. CLOSET \ 'i EXISTING RELOCATED WINDOW STRUCTURE 2nd FLOOR FRAMING PLAN BATHROOM 4= BEDROOM U— / I REMOVE AND RELOCATE REMOVE EXISTING WINDOW L EXISTING WINDOW AND REFRAME AS REQUIRED F — — _ BLOCK OPENING FOR NEW INTERIOR DOOR CLOSET PULL DOWN STAIRS (ABOVE) REMOVE EXISTING DOOR AND FOR ATTIC ACCESS PORTIONS OF INTERIOR WALLS REFRAME AS REQUIRED FORS NEW HALLWAY f / 2nd FLOOR PLAN FLOOR DEMOLITION ,I C o n t r act I g 9"18-531-3113 I' 19 RaInbcw Circle, Peabody, MA. 01960 PREPARED FOR DAN CEDERHOLM KERRY MURPHY 10% MALL STREET 2nd FLOOR PLANS SALEM, MA SHT. 3 OF JANUARY, 2009 SCALE: 1/4 n = 1'-0" CONTINUOUS RIDGE VENT�� \ 2"x12" RIDGE BOARD APPROXIMATE SLOPE 12 25 YR ASPHALT SHINGLES 9 #15 FELT 5/8" CDX 2"x8" 0 16" O.C. SHEATHING 2"x6" COLLAR 2"x8" ® 16" O.C. TIE 0 16" O.C. R-30 BATT INSULATIO 2"x8" 0 16" O.C. 1"x3" STRAPPING 0 16" O.C. (TYP) SOFFIT VENT 1/2" BLUE BOARD W/ SKIM —Z VENEER OF PLASTER TYPICAL ON ALL WALLS AND CEILINGS 0 2"x4" 0 16" O.C. 00i R-13 BATT INSULATION MATCH EXISTING SIDING Q3/4" T&G SUB FLOOR p (MATCH EXIST. FLOOR) 0° 1/2" CDX 4"X4" PT POST � o SHEATHING EXIST. GRADE Cq 2"X10 ® 16" O.C. X a N o. a: 8" 0 SONA TUBE o Z -H I v 2"x4" ® 16" O.C. v ° R-13 BATT INSULATION ., \\,\\ \\;\�... 3/4" T&G SUB FLOOR DECK SUPPORT DETAIL (MATCH EXIST. FLOOR) R-30 BATT INSULATION 2"x10" ® 16" O.C. - -" ` EXIST. GRADE 2"x8" PT SILL ON SILL SEAL WITH ANCHOR BOLTS 4'-0" OC NOTE: a \\ \\N\\ \\nom\ EXISTING ROOF TO BE REMOVED AND REPLACED. < i -H c' ROOF FRAMING PLAN 10" CONCRETE FOUNDATION WALL o 4" COCNCRETE SLAB v ° FDANCEDIERHOLM L A L A I K O C o n t r a c t i n g 978 531 3113 "��< !a: ainbow circle, Peabody, MA. O 960 PREPARED FOR 4" CRUSHED STONE KERRY MURPHY 10"x24" CONCRETE FOOTING0% MALL STREET PLAN, SECTION 4 DETAIL SALEM, MA BHT. 4 OP 4 BUILDING WALL SECTION JANUARY, 2009 SCALE: NOT TO SCALE I I� �FZ_, '; CITY OF SALEM PUBLIC PROPRERTY DEPART'.VIENT I I I ')'8.-i;.l;-i; • 1 \\l 'i78-V= Construction Debi-is Disposal Affidavit (recluired lirr all demolition and renovation work) In accordance \%idi the sixth edition of the State Building Code, 780 CMR section 1 1 1.5 Debris, and the provisions of MGL c 40, S 54; Building Permit K is issued with the condition that the debris resulting from this work shall be disposed of in it properly licensed waste disposal Iacility as defined by MGL c I 11, S 150A. The dchris will be transported by: 1 name uC huller) I he debris will be disposed of in (name ut lacilav) (address ul ISclhlv) n A si�uatwc of pcnun arplicaut y`o�q'oL�09 chic