Loading...
B-19-1182 - 0005 ALBA AVENUE - Building Permit The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY 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.Applied: Building Official(Print Name) Signatur Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street?yeses/ no Map Number Parcel Number N +� 1.3 Zoning Information: 1.4 Property Dimensions: c c� =r Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) ).0 Front Yard Side Yards Rear Yard Required Provided Required Provided Required ProvidedL 4 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? MunicipalA On site disposal system ❑ Check if yes❑ SECTION 2 ;:PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP 1, 5 /!Ifb,4 4A of-W36Z C,A-1-1, S�n �-. No.and Street Telephone Email Address SECTION 3:,DESCRIPTION OF PROPOSED WORKZ check all that a 1 � . _ PPY)" New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other Specify: 1-us;4 a-11 < nS�, Brief Description of Proposed Work-2: V2eAokc 0' &vL 'h S 3'oa-(.( C.,U� I�P��•� tp er �c a-w•- CrA-LGc,t�.-Yr�v,� a �-tr�}e 9,1e� t -SECTION4:'ESTIIVIATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor,and Materials 1.Building $ o o 1'. Building Permit Fee- $ Indicate how fee is determined: ❑Standard City/Town Applicatiori Fee. 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List:. :i 5.Mechanical (Fire $ Suppression) Total All Fees:$ . Check No. Check Amount: . Cash`Amount- 6.Total Project Cost: $ (� ®� p Paid m Full:- ❑OutstandingBalance Due:" C1.t,- LA 1 SECTION 5 CONSTRUCTION SERVICES 5.1 Construction Supervisor License �. (CSL) A-,r r`e 0 '5 J A.-,L 1 License Number Expiration Date Name of CSL Holder 0 l List CSL Type(see below) C�ts��� rrf No.and Street Type," Description S,Ale OA O3 0lr0� U Unrestricted(Buildings u to 35,000 cu.ft. ` / R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofmg Covering WS Window and Siding SF Solid Fuel Burning Appliances qT " L3 -Jq P A-rrt,A 3 145 1$ ®G'K A• I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1 v Z c1 Z Z ZD HIC Registration Number Expiration Date HIC Company Name or HIC Reg' ant Name A-A. No.and Street � Email address City/Town,State,ZIP Telephone SECTION 6 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G L c, 152 § 25C(q) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuan of the building permit. Signed Affidavit Attached? Yes.......... No...........❑ SECTION Za: OWNER AUTHORIZATION,TO BE,COMPLETER WHEN OWNER'S AGENYOR..CONTRACTOR APPLIES FOR.BUILDING PERMIT,,. i I,as Owner of the subject property,hereby authorize D44-r/`e%- S►yy�V� � to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) ate SECTION ;OWNER1:OR AUTHORIZED AGENT_DECLARATION,, By 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. Print Owner'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(1-11C)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. og v/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 haWbaths 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" ,r _ 5 Safety acme nt ; NAeq ��� . a � k L. . i , f r L 7-1 1 t r Y 7 ioms,-1202-0 iss l ' SEW E r ^"<.tell ce of Csu Affairs & Business Regulation HOME.IMPROVEMENT CONTRACTOM, Indi 'dual. iLation } 09122/2020 BL S s,E J. S i ISVV d - f � uWC MAI ,14. ...� � � SM� NH 03079 dry F Rg f. CITY OF SM .N. 4 NL-kSSACHusET rs • BUM131NG DEPARTS NT ' 120 WASHINGTON STREET,320 FLOOR La"i°'f TEL(978)745-9595 FAX(978)740-9846 KINLBERI.EY DIUSCOLL MAYOR T HoMAs ST.PIEm DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMONER Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print LeaibLy Name(BusineWOrganizatiot/individual): /�"� J �r u�►�1 _ Address:__-_-_ �✓��� `� City/State/Zip: )A-le-wt AJ ' d3 h I7 Phone 1#: 9 - �Z 3— Are you an employer?Check the appropriate box:1.�Tairi a employer with_ _ C ❑ Type of project(required):1 am a general contractor and I ❑New construction employees(full and/or part-time).' have hired the sub-contractors 6. 2.❑ I am a sole proprietor or partner- listed on the attached sheet.2 y ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. 0 Building addition [No workers'comp.insurance S. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I t.❑Plumbing repairs or additions myself.[No workers'comp. C. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] 11- Any applicant that checks box#t must also rill out the section below showing their workers'compensation policy infomtation. !I lorneowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such :Comractors that check this box meat attached an additional sheet showing the name of the sub-comnwiors and their workers'comp.policy infermation. 1 am an employer that Is providing itiorkers'compensadon insurance for my employees. Below Is the policy and Job site information. Insurance Company dame:_ A-.m i'Yt e 2VW I C.- Policy#or Self-ins.Lie.q: te Z2,v6 1 11 M U 1 q Expiration Date: Job Site Address: S '� [�''� r�Q City/State/Zip.- 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 cerflfy�un� ai der tthee pains and penalties of perjury that the informadon provided above is true and correct Sign � Date: Phone#: '�g - L f 13- Official use only. Do not write in this area,to be completed by city or town ofciaL City or Town: Permit(License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: _ Phone M ACC>& CERTIFICATE OF LIABILITY INSURANCE DATEiAM,DDMYi 04/19/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR.NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATEMOLDER. 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 endorseme s). PRODUCER CNAM ME:A- Monica.Swaida MONICA INSURANCE AGENCY PHONE 978 454-2577 FAX N : ADDRESS: monicainsuranoel@aol.com 19 MILL ST I INSURERS AFFORDING COVERAGE NAICS LOWELL MA 01852 INSURER A: AMERICAN ZURICH INSURANCE COMPANY 40142 INSURED INSURER B: STURTEVANT DARREN J INSUFWRC: INSURER D: 25 ADAMS TERRACE INSURER E LOWELL MA 01852 INSURERF: COVERAGES CERTIFICATE NUMBER: 392437 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 ADOL SUER POUCY EFF POLICY EXP LIMITST .j TYPE OF INSURANCE POUCYNUMBER D/YY 1 COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE $ G O R NTED CLAtMS-MADE C OCCUR PREMISES Ea occurtence $ FPI MED EXP(Any oneperson) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER T GENERALAGGREGATE s POLICY PRO ❑LOC I PRODUCTS-COMP/OP AGG S iJ JECT OTHER: s SINGLE LIMIT $ I AUTOMOBILE LIABILITY COMBINED IY I (Ea—id ANY AUTO { BODILY INJURY(Per person) s AUTOS dED SSCOEDULED N/A BODILY INJURY(Per acddent) s NON-OWNED I PROPERTYOAMAGE $ HIRED AUTOS AUTOS ! i Per am ent } $ UMBRELLA LIAB OCCUR f EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE i N/A AGGREGATE $ k i DED RETENTION s v $ WORKERS COMPENSATION X PTATLrrE I ER" AND EMPLOYERS'UABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCWDED? WA WA. NIA 6ZZUB1K91138019 03/22/2019 03/22/2020 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes describe under E.L.DISEASE POLICY LIMIT $ 1,000,000 DESCRIPTION-OF OPERATIONS below € j1 { t N/A 1 {f DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD.101,Additional Remarks Schedule,maybe attached ff moro space is required) Workers Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 08 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the Insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration data on the above policy precedes the issue.date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of:Coverage-Coverage Verification Search tool at www,mass.govflwdhvorkers-compensationlinvestigationsl. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DARREN STURTEVANT ACCORDANCE WITH THE POLICY PROVISIONS. 25 ADAMS TERRACE AUTHORIZED REPRESENTATIVE LOWELL NW 01852 Daniel M.Cr4W y,CPCU.Vice President-Residual Market-iNGRIBNlA ©1988=2014 ACORD:CORPORATION. All.rights reserved. ACORD 25(2014101) The.ACORD name and logo are registered marks of ACORD ACC>R& CERTIFICATE OF LIABILITY INSURANCE DATE(MMiDDIYYYY) 3/2112019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO-RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL.INSURED provisions or be endorsed. If SUBROGATION 13 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 endorsements. (PRODUCER CONTACT - - - \ .NAME: MONICA INSURANCE AGENCY (A[ci:.£xtL'_(g $),�54-2577_._�. _ r i�c r±e_._978 441 '1282 T 19 Mill'St E-MAIL _a � L. )_ Anoa„E�s;�monicainsurance1a�aolcom__ Lowell,MA 01852 INSURERjS AFFORDING COVERAGE_ _ _ ^_NAIC 9 ._.__. INSURERA_ ACCEPTANCE INDEMNITY INSURANCE COMPANY _. INSURED DARREN STtJRTEVANT ir�sURER'e; AMERICAN ZURICIi INSURANCE COMPANY _ INSURER C: ---- 25 ADAM,TERRACE INSURER .;_. LOWELL MA01852 INSURERF: 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 ROLICY PERIOD INDICATED. NorwiTHSTANDING.ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. IIVSR+ _- '.AD�L SUER=�� Y—�~ � POLICY FOLIcY EXF; LT TYPE OF INSURANCE POLICY NUMBER MMIDDlYYYY MMIDD . — LIMITS —X COMMERCIAL_GENERAL LIABILITY ..EACH OCCURRENCE S 1,000,000_ GAMAGE70iiEN'rED -:CLAIMS-MADE i"_OCCUR ? i PREMISES Eaoccurre�ceJ_-...;S _1.00,000., . hSEO EXP ir.ny one Pe sori)_--_•;S..__....___ 5 OOO CL00238869 9129/20/9 912912020 PERSONAL B ADV INJURY 'S 9 000,80.0 GEN-L AGGREGATEELI&NT APPLIES PER: ,° GENERT L AGGREGATE 5— w 1000.000 i JECT PRO- POLICY P.RODVCIS C.O.MPIOPAG_.G , - _ 2.000.000 OTHER: AUTOMOBILE LIABILITY J COMBINED SINGLE LIMIT S ANY AUTO BODILY INJURY(Per Person) 5 OWNED SCHEDULED I BODILY INJURY(Pei accident): c __4 AUTOS ONLY __ AUTOS i.HIRED .NON-010.T1E0 '• ' `. i, PROPER DA0.4AGt _ 'AUTOS ONLY ._„AUTOS ONLY s--�_.._„__�.___..__. S - UMBRELLA L1A9 i QCCUR EACH OCCURRENCE M _- ! EXCESS.UA9 — CLAIMS-MADE! s AGGREGATE S. _.- ------_-- DAD RETENTIONS WORKERS COMPENSATION ER P OTh- ,AND'EMPLOYERS'LIABILnY YIN` ctHfU'E_� -ER ANY PROPRIETORWARTNERIEXECUTAJE j E L.EACH ACCIDENT S `OFRCERIMEMBER.EY,CLUDED? Lam.,N TA I (Mandatory in NH) ,E.L.DISEASE_EA EMPLOY.eE 5 it yes.describe under _ DESCRIPTION,OF OPERATIONSbeloiv ' - E.L.DISEASE. POLICY.LIMIT e I s f ` I DESCRIPTION.O FOP ERATIONS I LOCATIONS I VEHICLES (AC OR0 90'I,Additional Remarks.Schedule,maq-be attached`Rmorc.sPace is required) 0 f 1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE t INSURED COPS THE EXPIRATION DATE, THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITHiT�4 POLICY PROVISIONS. AUTHORIZED REP.I ENT J. l5 ACORD CORPORATION. All rights reserved. .ACORD 25`(2416W) The ACORD name and logo are registered marks of AOORD ®goiseCascade I Double 1-3/4"x 9-1/2" VERSA-LAM® 1.7 2400 DF PASSED FB01 (WallHeader) BC CALC®Member Report Dry 11 span I No cant. September 23,2019 13:15:46 Build 7295 Job name: Wall Header LVL File name: Address: 5 Alba Description: City, State,Zip: Salem, MA Specifier: tY eci P P Customer: Designer: Boise Cascade Code reports: ESR-1040 Company: Boise Cascade 1 0 10-00-00 B1 132 Total Horizontal Product Length=10-00-00 . Reaction Summary (Down/ Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live B1,3-1/2" 1200/0 943/0 B2, 3-1/2" 1200/0 943/0 Load Summary Live Dead Snow Wind Roof Tributary Live Tag Description Load Type Ref. start End Lao. 100% 90% 116% 160% 126% 0 Self-Weight Unf. Lin. (lb/ft) L 00-00-00 10-00-00 Top 9 00-00-00 1 Attic Load Unf.Area(lb/ft2) L 00-00-00 10-00-00 Top 20 15 12-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 4877 ft-Ibs 45.1% 100% 1 05-00-00 End Shear 1678 Ibs 26.6% 100% 1 01-01-00 Total Load Deflection U609(0.188") 78.8% n\a 1 05-00-00 Live Load Deflection U999(0.105") n\a n\a 2 05-00-00 Max Defl. 0.188" n\a n\a 1 05-00-00 Span/Depth 12.1 %Allow %Allow Bearing Supports Dim.(LxW) value Support Member Material B1 Column 3-1/2"x 3-1/2" 2143 Ibs 24.1% 23.3% Spruce-Pine-Fir B2 Column 3-1/2"x 3-1/2" 2143 Ibs 24.1% 23.3% Spruce-Pine-Fir Notes Design meets User specified(U480)Total load deflection criteria. Design meets User specified(U480)Live load deflection criteria. Calculations assume member is fully braced. BC CALC®analysis is based on IBC 2009. Design based on Dry Service Condition. Connection Diagram: Full Length of Member b d a c a a minimum=2" c=2-3/4" b minimum=3 d=6" Page 1 of 2 0136iseCascade Double 1-3/4" x 9-1/2" VERSA-LAMO 1.7 2400 DF PASSED FB01 (WallHeader) BC CALC®Member Report Dry 11 span I No cant. September 23,2019 13:15:46 Build 7295 Job name: Wall Header LVL File name: Address: 5 Alba Description: City,State,Zip: Salem,MA Specifier: Customer: Designer: Boise Cascade Code reports: ESR-1040 Company: Boise Cascade Connection Diagram: Full Length of Member Connectors are:3-1/4 in.Pneumatic Gun Nails Disclosure Use of the Boise Cascade Software is subject to the terms of the End User License Agreement(EULA). Completeness and accuracy of input must be reviewed and verified by a qualified engineer or other appropriate expert to assure its adequacy,prior to anyone relying on such output as evidence of suitability for a particular application.The output here is based on building code-accepted design properties and analysis methods. Installation of Boise Cascade engineered wood products must be in accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call(800)232-0788 before installation. BC CALC®,BC FRAMER®,AJS-, ALLJOISTO,BC RIM BOARD-,BCI®, BOISE GLULAM-,BC FloorValue®, VERSA-LAMS,VERSA-RIM PLUS®, Page 2 of 2