23 WALTER ST - BUILDING INSPECTION (2) r
IIZA The Commonwealth of Massachusetts
} Board of Building Regulations and Standards CITY
t m OF SALEM
9,Aar Massachusetts Stole Building Code, 730 CMR, 7 edition
Revised Junuun•
Building Permit Application To Construct, Repair, Renovate Or Demolish a /. -1008
. One-or Tu•o-Family Duelling
This Section o Official Use Only
Building Permit Nu ber. Date Applied•
� /.2/d�/io
Signature: 'i
Building Commissioner/Inspector of Buil i Date
SECTI ITE INFORMATION
LloyS�y res i _ 1.2 Assessors Map 3t' Parcel Numbers
I Taa 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 Il) Frontage(Il)
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:
Zone: _ Outside Flood Zone?
Public C3 Private❑ Check if yes❑ Municipal❑ Onsite disposal system 13
SECTION 2: PROPERTY OWNERSHIP'
2.1 (��nerr qF Record:cz
� /f �1 _ _ _( —
Name((Print) res4o(for Service: ICY T
Signature 'telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ I Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 umber of Units_ I Other ❑ Specify:
Brief Description of Proposed Work2: 1 6r►'h -` �'
«W.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1. Building S l FS�`b . r) l� 1. Building Permit Fee:S Indicate how fee is determined:
2. Electrical S [3 Standard City/Town Application Fee
❑Total Project Cost' (Item 6)x multiplier x
3. Plumbing S ? Other Fees: S T 7�
4. Mechanical (IIVAC) S List: �/ C.JIJ
5. Mechanical (Fire S
Suppression) Total All Fees: S
��� Check No._Check Amount: Cash Amount:_
6.Total Project Cost: S r C)6 ❑paid in Full ❑Outstanding Balance Due:
i � �6N1,P
SECTION 5: CONSTRUCTION SERVICES
5,1 Licensed Construction Supervisor(CSL) ;�,(7e,-1 q �
LA- � License Number L- I{cpiatiun I Tate
Name ofCSI_J lulder ��_
List CSL I'%pe(see below)'I\ Description
\J •ss
m��C�_ ND
Unrestricted u w 3s,1100 Cu.Ft.)
Restricted 1&2 Famil Uwellin
Signature -7 • ' Mason Onl
`�-� Residential RootingC'overin
Telephone Residential Window and Siding
Residential Solid Fuel Burning Appliance Installation
Residential Demolition
5.2 Regtgered Home Improvement Conj- t j
�1 )Cs 60-7SrHIC
tom' r
I IIC Cpy.Ahune or HIC Registrant Name Registratio Number
Gspimti nDate
Sign• 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...........0
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.
Signature of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application arc true and accurate,to the best of my knowledge and
behalf.
Print Name • ,(_ _ C f J f
Signature, ner or u 'zed Agent �`•�-fi`— Date -1
_Signed under the pains an enalties of er'u
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(FITC)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 and
Construction Supervisor Licensing(CSL)can be found in 750 CMR Regulations 110.116 and 110.115, 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.) Ilabitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Typc of cooling system Enclosed Open
3. "Total Project Square Footage"may he substituted for"Total Project Cost"
b CITY OF SALEM, ILL
• 9t:IMLNG DEPARTMENT
130 WA.SHNGTON STREET, Yo FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
KIJtBERLEY DRISCOI1.
THo
MAYOR w►s Sr.PIr:Itas
DIRECTOR OF PUBLIC PROPERTY/BCILDIING COMMISSIONER
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 l l 1.5
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
I 11, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in
(name of facility)
SL, Se--a I+
(address bf facility)
signature of permit applicant
2 I q tp
date
d.hnvdJw
Information and Instructions
.Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to tris statute, an emploree is defined as"...every person in the service of another under any contract of hire,
rapress or implied, oral or written."
An employer ii defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
ort the tbregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee ul all individual,partnership,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 horse
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, Q25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit 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. NIGL chapter 152, a25C(7)states"Neither the commonwealth not any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of cunlpliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary, supply sub-contractor(s)name(s),address(es)and phone nunlber(s)along with their certificate(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
Accidents for contimiation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned 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 aro required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City 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 fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be.cure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
iliat must submit multiple pennitilicense 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
tuwnl."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 for future permits 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
(i.e.it dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
I'hc 0i Incl'of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a Call.
The Wpartment's address, telephone and fax number:
w
The Commonwealth of Massachusetts
Department of Industrial Accidents
Otflce of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
R,e.i.scd i-16-(15
www.mass.gov/dia
CITY OF SALEM
taPUBLIC PROPRERTY
DEPARTMENT
.1k,1 14:1'Y:)xl{I:ol 1,
s l N s,al l2^.WASMI.\d I oN SI XEhl' •SALEM,MAss.w:til it r IN 0197
718-715-9595 • I:.lac 1778.140•7346
Yorkers' Compensation insurance Afftduvit: Builders/Contractors/Electricians/Plumbers
konlicant Information �1�1/)� Please Print Leeibiv
Vatlne (nu+nkss i)r8miralinNlndlvldualY. ✓
Address:
City.Slarci%ip��� ` . Thune i?: —Oy '—f
Felliployces
ou an employer!Check the appropriate box: 'Type or project(required):
I I ant a employer with 4. 0 I :un ageneral contractor and 1 6. 0 New construction
. full andJur art-tulle)., have hired the sub-contractors( P 7. Remodeling
2.❑ 1 ;un a sole proprietor or partner- listed on the anachcd sheet.
ship and have no employees These sub-contractors have 8. 0 Demolition
working for Inc in any capacity. workers' comp. insurance. 9, 0 Building addition
I No workers'comp. insurance 5. 0 We area colporution and its 10.0 Electrical repair or additions
required.) o. icers have exercised their
3.0 I ant a homeowner doing all work right of exemption per N(GL I LE] Plumbing repairs or additions
myself. [No%workers'conip, c. 152,¢1(4),and we have no 12.0 Rout'mpa \\
insurance required.) t :inployces. (No workers' 13.0 Other��\�J
comp. insurance required.)
•Ally apphcaut that checks box BI must also Wiwi the section Iwluw showing(heir workws cumpenWiun pulicy inliurtutiun
I luma)wmn who adrmil this a171davit indi",ing Ihc)are doing alt work and Then hire outside caurxtoa must ouhmu a new afrrWvil indie ing wlnh.
-C'l,mrwlorr,Ihm chuck Ibis box mast at1whed an additional ah,tel.hawing tho nano of the subrontrwton and their wurkerx'comp.pulicyinformanun.
/am an enydayer that It providing workers'compensalion insurance jar ury employees. Below is the policy and job site
infonnutium
Imuraoce Contpauy Name:
Policy 4 or SclGins. Lie.n: Expiration Date:
Job Site Address: _ City;Steteizip:
Attach It copy of lite workers' compensation policy declaration pale(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A ul'.NIGL e. 152 can lead to the imposition of criminal penalties of a
rind up ha 51.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 it day aguinst the violator Be advised that a copy of this smtcment may be lorwarded to the 011ice of
Invesngauons ufthe INA for insurance coverage seritieation.
/da hereby certify
u _ rudert!eI tireand penalirs of perjory that the infornnallan provided above is trite
rue��an
d correct.
tii,:corc' vv� Date
1'h reyG Z� 9-07
Official use only. Do not lvrire in this arra, to be cwupleted by city or rolvn ojJiciaL
(:it Y or fawn: Permit/License d_.
Issuing liuliturily(circle otic):
I. hoard of Iicallh 2. Building Department .f. Cit. fossa Clerk 4. Llectrical inspector 5. Plumbing; Inspector
6. 011er
Couluel fcrwn: _ _ _ I'honc#:
Uniformly Loaded Floor Beam[2006 International Building Code(05 NDS)1 Ver: 7.01.14
By: Dan Lynch , Lynch Engineers on: 12-11-2010: 10:19:03 AM
Project -Location:
Summary:
1.75 IN x 7.25 IN x 10.0 FT /Versa-Lam 2800 Fb OF-Boise Cascade
Section Adequate By: 17.6% Controlling Factor: Moment of Inertia/Depth Required 6.87 In
Deflections:
Dead Load: DLD= 0.07 IN
Live Load: LLD= 0.28 IN=U423
Total Load: TLD= 0.35 IN=U341
Reactions(Each End):
Live Load: LL-Rxn= 700 LB
Dead Load: DL-Rxn= 169 LB
Total Load: TL-Rxn= 869 LB
Bearing Length Required(Beam only, support capacity not checked): BL= 0.66 IN
Beam Data:
Span: L= 10.0 FT
Unbraced Length-Top of Beam: Lu= 0.0 FT
Live Load Deflect. Criteria: U 360
Total Load Deflect.Criteria: U 240
Floor Loading:
Floor Live Load-Side One: LL1= 70.0 PSF
Floor Dead Load-Side One: DL1= 15.0 PSF
Tributary Width-Side One: TW1= 2.0 FT
Floor Live Load-Side Two: LL2= 40.0 PSF
Floor Dead Load-Side Two: DL2= 15.0 PSF
Tributary Width-Side Two: TW2= 0.0 FT
Live Load Duration Factor: Cd= 1.00
Wall Load: WALL= 0 PLF
Beam Loading:
Beam Total Live Load: wL= 140 PLF
Beam Self Weight: BSW= 4 PLF
Beam Total Dead Load: wD= 34 PLF
Total Maximum Load: WT= 174 PLF
Properties For:Versa-Lam 2800 Fb DF-Boise Cascade
Bending Stress: Fb= 2800 PSI
Shear Stress: Fv= 285 PSI
Modulus of Elasticity: E= 2000000 PSI
Stress Perpendicular to Grain: Fc_perp= 750 PSI
Adjusted Properties
Fb'(Tension): Fb'= 2961 PSI
Adjustment Factors:Cd=1.00 CF=1.06
Fv': Fv'= 285 PSI
Adjustment Factors:Cd=1.00
Design Requirements:
Controlling Moment: M= 2171 FT-LB
5.0 It from left support
Critical moment created by combining all dead and live loads.
Controlling Shear: V= 764 LB
At a distanced from support.
Critical shear created by combining all dead and live loads.
Comparisons With Required Sections:
Section Modulus(Moment): Sreq= 8.80 IN3
- S= 15.33 IN3
Area(Shear): Areq= 4.02 IN2
A= 12.69 IN2
Moment of Inertia(Deflection): Iraq= 47.24 IN4
1= 55.57 IN4
'UAAd9.
ASH OF
DANIEL 9�y�
O G
N .
LYNCH
No.23331
10
FSS/O NAL EAG
i
I
t tt. t t
'v He Desgn Modules Wities Window Help -
Sbuchnal Coomodte 9o¢e Cascade Vema-Lam 2990 Fb DF Dim siorW Lumbm
0'/ Notch Depth t" D Sbev Values
Uve Load Defl. 390 M. t 1. - 1 —
Project
900 %9 me@Ofl
Spon Length
UWm=ed Lw*h-T 650 -
Shear
(mss 0
Floor Live Lead J50
Fier Dead Load
Tributary Wndth 900
3000 2171 It I.@ 51t
Wag Load
15100
Moment
mil o
.1500
3
15
DeOeclion
rml 0-
.15-
3- MinCa
.153 5
S -left
CantwOng Load Cam»Shear.CMcal shear creased b7 carebmerg al dead and love loads.
Laeatiare Fs CaladMe»>. Shear.E--:::::l Lb ll m Ft-lb Deller.4ma In
Con affmg Show/Moment/Deflection Diagram, HudClose
I
ase By 17.9 X Cwhaffimg Factor.MomeM of Inmtia/Depth Required 9.97 In
Duiekhelp»»»>» InpN a dslance along the beam(meamed from 0c a endl and cickthe calMate>>>bdlmm to she igit to view the ahemlmomerede0ectimn v4b at that point
Q OPi,D4 Edi, eak>�g1�... Encarta ♦ POW
Uniformly Loaded Floor Beam[2006 International Building Code(05 NDS)]Ver: 7.61.14
By: Dan Lynch, Lynch Engineers on: 12-11-2010
Project: -Location:
Summary:
1.75 IN x 7.25 IN x 10.0 FT /Versa-Lam 2800 Fb DF-Boise Cascade
Section Adequate By: 17.6% Controlling Factor: Moment of Inertia/Depth Required 6.87 In
LOADING DIAGRAM
A B
Span = 1 Oft
Reactions
Live Load Dead Load Total Load Uolift Load
A 700 Lb 169 Lb 869 Lb 0 Lb
B 700 Lb 169 Lb 869 Lb 0 Lb
Span
Uniform Loading
Live Load Dead Load Self Weight Total Load
W 140 Pit 30 Plf 4 Plf 174 Plf