B-17-714 - 0002 BERRYWOOD LANE - Building Permit ' ill
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
ALEM
Massachusetts State Building Code,780 CMR SdMar
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section ForOfficial Use Only
Building Permit Number: D e Applied:
Buildin Official Print Name ' Si "afore
g ( _) Signature., Date
( SECTION`1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
t 1.1 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:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIPt
2.1 Owner'of Record:
Daheue SC I, o-t. C a
Name(Print) City,State,ZIP
a &, rM WOO& LLIVIO q_7q-alo 71 99S
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': - j ' avId , 4
SECTION 4:ESTIMATED:CONSTRUCTION COSTS
Estimated Costs:
Item Official Use'Only
Labor and Materials
1.Building $ 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: $ $ ❑Paid:in Full ❑Outstanding Balance Due:
i ,
SECTION 5: :CONSTRUCTION SERVICES
` 5.1 Construction Supervisor License(CSL)
0.3 $ .3oZ 10/13 /i :T
Cot} V eqx f�`e�1 License Number Expiration Date
Name of CSL Holder J —7—
List CSL Type(see below)iQ' � --}-
No.and Street Type Description
M U�Eo�d. �A ®� S-S" U Unrestricted(Buildings u to 35,000 cu.ft.
►YI R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
331q SF Solid Fuel Burning Appliances
U ICJ '7 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 1 8 1 1 3 S 3/a Jl4
HOFY,e We)EC S f he t-01 q HIC Registration Number Expiration Date
HIC Company Name or HIC Regis an Name
161 5-latbn landih!l
No.and Street 3J �(i Email address
City/Town,9tate,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 Iss�uannce 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:OWNER'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.
0() v)dc)arl VIM 7-
Print Owner's or Authorized Agent's Name(Electronic Signa re) �- 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"
PLAN VIEW
Name. t c y� Cf � Site tC?; Years in, .
lorne:
PhonelCO _
Year of Noose: I _ Electric Acct#: $ 711�— j' G f`
. Address: CS Pr ry yrQ a d #of Floors: Gass Acct
• �'"' 1`1 0)CA- d #Occupants; Fuel Costs:
interested in solar Y/ ' Interested in Wind'ows. Y/ #of Single Pane�_ Kiiowrn Knob and Tube?Y/i�J tdat sure
iioi Cold ai eas iii home?Y I Where?
Molar Renovations?
"` teicles t€e lamrrin ?Y/ where? MriisYure Issues?
y Other Concerns?
HIiATlNG SYSTEM ANp'HOT WATER
�.
Furnace Age:
Last Service EFficiendY.
Notes. 1 �'
DNW:Storage/Indirect/Tankless Coil/t n demand
DtIW Age: Gas°Nome/Street f None
Bsrnt: x x BASEMENT INSPECTION
Existing S c'rng LnfSq.Ft.
Bsmt Rim Joist
Bsmt Wall (AG) ��=>r
Crawl Celling
Crawl Rim joist,
Vapor Barrier. sgit esmt Door-, b yF
Y N Blower Door
WA�Ll.S&GARAGE Drill locations:
C '. er ht . Existing Spec'ing Ft. Framing.
Exterior Wall x x: Balloon/PlatformExteriorWall 2
x X BaloonJPlattorm
Overhang
Garage tVatli �' ... x B, loon P a arrn
" Garage Ceiling x x eta Lathe N
t
W
i k �Ysz RRR,�
crew Notes; ROAD BUCKS
r .
K&T Y
�K ' Vrm+cul'rte Y/
Moisture Y �P
Motd t}asgft y/
iI5 ` i S rJctt�rai
V` X ;Y/[
r CST
t, s W�
C0 Detector Y
l
1
!WALL AMO KW FLOOR KW SLOPE AND GABLE ENO
• Why? Why?
FRAMING EX TING SPECING S .Fr. ,$ r•RAMING EXISTING SPEONG SQ,FT ,
WALL x X SLOP x X .
c ; �
FLOOR X X GABLE X
ACCESS X g TRANS x X
r 9
+ 'BANS X X' ATTIC h
ATTIC SLOPE X .,.X
SLOPE X x EMIST`1NG:VENTIN
EXISTING VENTHIGi EXISTING PIP YI N
EXISTING PIPES? Y/N 7ENTIN BLIND SP []
MA'Venn¢ Stem OF 8F H,,,e Oam—nH Efieaihing azKess en ci�x I dV'+Frniv'2.: $n.HF\, :.mo access
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Aar=iandaer an Ternn arcesx a T a Dun t3own pO5•:Hach:M; WA Hatch ".' Dow a� b'R«r`vam WM'J' ` VOf.' �X.0dJ$'
x 6. Attic 1 BLIND SPEC? o X X Attic 2 BLIND SPEC? C3 'at:�i�`Yi .r
.X is.a pz rosy!
Existing S ec'in Sq ft Existin Sec!n S ft Lat start!1
R
• Un oared p Unfloored
F]Q red FlOO(Ed Tiusses �aors9asiing
.c3" ,n,:t:�. M�-+siriaeAdn Dnn Wzarkarw,m+t '
Cat# Slaps Cath ante M n�
Vrlaffs t - -
Walls
Access : Access
VenCin PropaventS Vent BP BF Hot! OarnmIng Ventin ; Pro ave Vent 8F Nose Oammi f I
�� ,� Y �3,ry
y fti U
a a, �. em»Acewe 6 -„ 'w.
sa ctJ300 IFAUL NF Vendnai= (a�deu sgFt i (e:bt,HfA vam nt( Fe+eaaad R.E. r4rs: r.
Existing Venting? "FaYan°^�i Existing Venting' V a1fAWm0nrp Roof Type: