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B-17-1078 - 0032 BUFFUM STREET - Building Permit tc �� r y L 2 The Commonwealth of Massachusetts 7 '` i ( Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR t'` 1l S LEM Revise M&t ,2 1 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: i >/ �3 Building Official(Print Name) Signature Date. SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 32 Buffum St. I l.Ia 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.46,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone? Public❑ Private 0 — Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Lee Dearborn Salem, MA 01970 Name(Print) City,State,ZIP 32 Buffum St. (415).671-9848 info@themg.us No.and Street Telephone Email Address. SECTION.3 DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑✓ Addition ❑ Demolition 0 Accessory Bldg.❑ Number of Units Other 0 Specify: Brief Description of Proposed Work : Install 6.30kW(18 panels) roof top solar array SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Off, 1 U :e Only (Labor and Materials ' 1.Building $ . 8,984.40. 1: Building Permit Fee:$ I Indicate liow fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ 17,968.79 s ❑Total Project Cost (Item 6)x multiplier x I Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression $ Total All Fees:$ 6.Total Project Cost: $ 26,953.19 Check No. Check Amount: . Cash Amount: ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-103004 04/13/2019 Jason Chretien License Number Expiration Date Name of CSL Holder List CSL Type(see below). 55 Sixth Rd lJ No.and Street Type Description Woburn, MA 01801 U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Mason ry -�� RC Roofing Covering Window.and Siding 617 858-1645 SF Solid Fuel Burning Appliances ( ) permits@bostonsolar.us I Insulation Telephone Email address :. D Demolition 5.2 Registered Home Improvement Contractor(HIC) Boston Solar-Jason C 169698 7/27/2017hretlen HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 55 Sixth Rd: permits@bostonsolar.us No.and Street Email address Woburn, MA 01801 (617)858-1645 City/Town,State,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 Issuance of the building permit.. Signed Affidavit Attached? Yes .......... No I 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 authorizeJason Chretien to act on my behalf,in all matters relative to work authorized by this building permit application. Lee Dearborn 11/1/2017 .. 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. (' nt 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(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. og v/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" E n G in E E R S VSE Project Number:U2246-0318-171 October 24,2017 Boston Solar 55 Sixth Road Woburn,MA 01801 REFERENCE: Jacqueline Ford Residence:32 Buffum Street,Salem,MA 01970 Solar Array Installation To Whom It May Concern: We have reviewed the panel layout and photographs provided by Boston Solar relating to the installation of the solar array at the above-referenced site. Based upon our review, it is our conclusion that the installation of the solar array on this existing roof will not adversely affect this structure.It is our understanding that the structural components of the existing roof framing are in good condition and free of damage. The design of the solar panel racking(mounts,rails, etc.) is by the manufacturer or contractor. Design Parameters ' Code:Massachusetts State Residential Code(780 CMR Chapter 51.,.8th Edition(2009 IRC)) Occupancy Category:II Design wind speed: 100 mph (37sec gust)per ASCE 7-05 Wind exposure category:C Ground snow load: 40 psf Existing Roof Structure Roof Framing and Material:Per plans.prepared for Jacqueline Ford(Dated 10/23/17) Connection to Roof Mounting connection:(1)5/16"lag screw w/min.2.25 embedment into framing at max.51"O.C.along rails Use(4)#10 wood screws at rail ends as required. Racking system:IronRidge Conclusions Our conclusion regarding the adequacy of the existing roof is based on the fact that the additional weight of the solar array is 3 psf or less and the attached calculations.In the area of the solar array,other live loads will not be present or Will be greatly reduced. 651 W.Galena Park Blvd.,Ste. 101/Draper, UT 84020/T(801)990-1775/F(801)990-1776/www.vectorse.com VSE Project Number: U2246-0318-171 Jacqueline Ford Residence 10/24/2017 vEc E n G i n E E R . S The solar.array will be flush-mounted (no more than 6 above the roof surface) and parallel to the roof surface. Thus,.we conclude that any additional wind loading on the structure related to.the addition of the proposed solar array is negligible. The attached calculations verify the capacity.of the connections of the solar array to the existing roof against wind(uplift), the governing load case.Because the increase is less than 10%, this addition meets the requirements of the exception in Section 707.5 of the 2009 IEBC as referenced in 780 CMR Chapter 34, 8th Edition.Thus the existing structure is permitted to remain unaltered:Any non-structural changes to the plans will not affect the conclusions of this letter. Limitations Installation of the solar panels must be performed in accordance with manufacturer recommendations. All work performed. must be in accordance with accepted industry-wide methods and applicable safety standards. The contractor shall notify Vector Structural Engineering, LLC should any damage,deterioration or discrepancies between the as-built condition of the structure and the condition described in this letter be found. Particular attention must be paid to the maximum allowable spacing of connections and the location of solar.panels relative to'roof edges. Connections to existing roof framing must be staggered so as not to overload any existing structural member; except at array ends. The use of solar panel support span tables provided by others is allowed only where the building type, site conditions, site-specific design parameters, and solar panel configuration match the description of the span tables. Electrical engineering E is the responsibility of others. Waterproofing around the roof penetrations is the responsibility of others. Vector Structural Engineering,assumes no responsibility for improper installation of the solar array.Vector Structural Engineering assumes no responsibility for the effects of.snow falling from roofs onto other roofs,property or persons due to the installation of the solar array. VECTOR STRUCTURAL ENGINEERING,LLC R #A,T A i0/24/i017 Roger Alworth,P.E. MA License:47740-Expires:06/30/2018 Principal Enclosures RTA/wic, 651 W.Galena Park Blvd.,Ste. 101%Draper, UT 8400/T(801)990-1175/F(801)990-1776/www:vectorse.com. JOB NO.: U2246-0318.171 OSUBJECT: WIND PRESSURE E n G 1 n E E R S PROJECT: Jacqueline. Ford Residence Com onents and Cladding Wind Calculations Label: ISolar Panel Array Note: Calculations per ASCE 7-05 SITE-SPECIFIC WIND PARAMETERS: Basic.Wind Speed[mph]: 100 Notes: Exposure Category: C Occupancy Category: II Importance Factor, I: 1.0 ADDITIONAL INPUT&CALCULATIONS: Height of Roof, h [ft]: 25 (Approximate) Comp/Cladding Location: Gable Roofs 8<_7° Enclosure Classification: Enclosed Buildings Zone 1 GCP: 1.0 Figure 6-11 B (enter largest abs. value) Zone 2 GCP: 1.8 (enter largest abs. value) Zone.3 GCP: 2.8 (enter largest abs. value) a: 9.5 Table 6-2 Zs [ft]: 900 Table 6-2 Kh: 0.95 Table 6-3 Kt: 1 Equation 6-3 Kd: 0.85 Table 6-4 Velocity Pressure, qn [psf]: 20.6 Equation 6-16 GCP;: 0 Figure 6-5 (largest abs. value) OUTPUT: P qh[(GCP)— GCP; Equation 6-4 Zone 1 Pressure, p [psf]: 20.6 psf(1.0 W, Interior Zones*) Zone 2 Pressure; p [psf]: 37.0 psf(1.0 W, End Zones*) Zone 3 Pressure, p [psf]: 57.6 psf(1.0 W, Corner Zones*within a) (a=3 ft) JOB NO.: U2246-0318-171 SUBJECT: CONNECTION - E n G in E E R S . PROJECT: Jacqueline Ford Residence- Lag Screw Connection Capacity:.. Demand: Lag Screw Size [in]: 5/16 Max: Trib: : 1.6 2 Max.NDS Table 2.3.2 Pressure Max a ClJplift (1.0 Wind) Tributary Area Embedment' [in]: 2.25 (psf) Width (ft) (ft2) Force (Ibs) Grade: SPF (G = 0.42) Zone Capacity [lbs/in]: 205 NDS Table. 12.2A 1 20.6 4.3 11.7 240 Number of Screws' 1 2 37.0 4.3 11.7 433 Prying Coefficient: 1:4 3 57.6. 3.1 8.6: 495. Total Capacity[lbs]. 527 . Demand< Capacity: CONNECTION..OKAY 1. Embedment is measured from the top of the framing member to the beginning of the tapered tip of the lag screw. Embedment in sheathing or other material is not effective.The length of the tapered tip is not part of the embedment length. 2.'Max.Trib Area'is the product of the'Max:Tributary Width'(along the rails)and 1/2 the panel width/height. {perpendicular to the rails). F JOB NO,: U2246-0318-171 E T SUBJECT: GRAVITY LOADS ' E n G I n E E R S PROJECT: Jacqueline Ford.Residence CALCULATE ESTIMATED GRAVITY LOADS Increase due to Original ROOF DEAD LOAD (D) pitch loading Roof Pitch/12 0.2 Composite Shingles 2.0 1.00 2.0 psf 1/2" Plywood 1.0 1.00 1.0 psf Framing 3.0 psf Insulation 0.0 psf 1/2" Gypsum Clg. 0.0 psf M, E &Misc 0.0 psf DL .. 6 psf PV Array DL 3 psf ROOF LIVE LOAD (Lr) Existing Design Roof Live Load[psf] 20 ASCE 7-05,Table 4-1 Roof Live Load With PV Array[psf] 0 w/Solar Panel SNOW LOAD (S): Existing Array. Roof Slope [x:12]: 0.2 0.2 Roof Slope [°]: 1 1 Snow Ground Load, pg [psf]: 40 40 ASCE 7-05, Section 7.2 Terrain Category: C C ASCE 7-0.5,Table 7-2 Exposure of Roof: Fully Exposed Fully Exposed ASCE M5,Table 7-2 Exposure Factor, Ce: 0.9 0.9 ASCE 7-05,Table 7-2 Thermal Factor, Ct: 1.1 1.1 ASCE 7-05, Table 7-3 Risk Category: II II ASCE 7-05,Table 1-1 Importance Factor, Is: 1.0 1.0 ASCE 7-05,Table 7-4 Flat Roof Snow Load, pf[psf]:. 28 28 ASCE 7-05, Equation 7-1 Minimum Roof Snow Load, pm [psf]: 20 20 ASCE 7-05, Section 7.3.4 Unobstructed Slippery Surface? No Yes ASCE 7-05, Section 7.4 Slope Factor Figure:. Figure 7-2b Figure 7-2b ASCE 7-05, Section 7.4 Roof Slope Factor, Cs: 1.00 1.00 ASCE 7-05, Figure 7-2 Sloped Roof Snow Load, ps [psf]: 28 28 ASCE 7-05, Equation 7-2 Design Snow Load, S [psf]: 28. 28 Fb. F,,,o, E. 9 V ®� Abbrev: GRADES (Psi) (Psi) (Psi) (lb/ft') JOB NO.: U2246-0318-171 E rl -G I n: E E R $ .DFL#1- DFL#1 :1,000 180 11700,000 32 DFL#2 DFL1t2 900 180 1,600.000 32 DF1(5X) DFL#1 5X5&LARGER - 1,350 170 1,600,000 32 SPF#2 SPF#2: 875 135 1,400,000 26.2 . PROJECT:Jacqueline Ford Residence SUBJECT: BEAMS SP#2 SP#2 1.100 175 1,400,000 34.3 . • 24F-V4 24F-V4 .2,400 240- 1,800,000 32 - - DESIGN LOADS: Load Types: Snow Live Dead 24F-V8 24F-V8 2.400 240 1.800,000 40 Roof 28 20 7 CRITERIA(LI) .Dn.L480 A wL(ts). LVL(tsxlosE) 2soo . 265 : r,9oo,000, 40 Solar 3.0 A(BLANK) 120 LVL(2.0) LVL(2.OX1o6E) - 2200, 285 2,000,000 42 B 240 LSL LSL(1.3X106E) 1,700 400: 1,300.000 '42C 600 : PSL I PSL(2.oX106E) 1 1 2,9001 290 : 1,300,000 : 42 Point. Point; v DLL DLLarc Add'I Add'I m Live Dead' n (in) (in) Roof Floor Wall Live Solar Point Dist Load Load p. (SEE (SEE 1.5131- . Length Trib Trib Trib Load Load Load D: 'a' 'PLL. 'Poi r- iv m M.b. Ma— Vmax Va- Dn DTLa COND COND GLB Label V(ft) (ft) (ft) (ft) (plf) (plo From (ft) (lb) (lb) m Grade. Size D .C, C6 CF,� Ra(lb) Rb(lb). (ft;lb) (it-Ib) (Ib) (Ib) (iri) (in) 'C') 'C') Comb Check. 9 1.33 4.0 1 SPF#2 2x8 1.15 1.151 1.20 228 2281 512 1521 1971 1126 0:112 0.900 0.059 0.4501 0.34 M t System I n ormation System Rating:. - 6.3 kWdc 6.0 kWac ttFdule: (18)LG 350 01C - Inverter: SE6000-US RGM - - N Racking: IronRid e esl n Factors System Rating: MA CMR 78051.00 .IBC•2009,ASCE.7-05 2005 NDS,.NEC•2017 - - Ground Snow Load: 40 pat ' wind Speed: 100 mph - - - r o. o ' / ! Roof 1 Utility Meter` j' Azimuth: 150°N Tilt:0° Solar Access:61% MS j' 18 Modules-0.73 Utility Disconnect Inverte 1 H E BOSTON SOLAR C O M P A N Y r —.bostonsolar.us I info®BostonSolar.us Drawing Name:. Site Plan Date: October 23,2017. Drawn By: BG Client Information: Reviewed By:. Jacqueline Ford Rev#:. 01 32 Buffum Street' Salem,MA 01970 PV 1,1 (415)671-9848 Arra La out /1 Scale:1/8 T-0" 568" 6 7": : . 595" Cantileve 21 Install note:The allowable rail location for portrait is - detailed above.The bottom - M dimension Is from the edge of11 O �. the,panel to the start of the .lh allowable range-The top - dimension is from the panel edge 16 UF F to end of the.allowable range. O,. :Oa IM N . M. e. co)' Install note:The allowable rat - 48° location for landscape is. 'I 5" - 6" ,detailed above.The listed Cantileve - _ Maximum AIIOWabf dimension Is from the edge of - - Spacing'the panel to the opposite edge - - of the rail.The it must be installed within this 4.7-span.171 Attachment Detail p .Structure Elevation Solar Module—'.'A v scale:N.Ta: . Maximum Allowable Cantilever. IronRldge Rai (Portrait).=29" IronRidge L-Foot SO Max irnum Allowable .Cantilever(Landscape)=38". EaoFastenFlashin • If you are.Unable to maintain the maximum.allowable:rail Lockin'Pocke -- Decd _ _ cantilever of Portrait 29"&Landscape 38", please use the ''Lag Bolt included.decking attachments.on the array ends Rafte ----- Rubber roof Module Specifications Model: L LG 350 01C- 3.5":Rigid foam insulation board Dimensions[LxWxH]: 40-46.93-A.5T Advantec decking 3/4" Weight: 40.78 Lbs Rackin9'Specificallons - - - Roger T.Alworth. Model: IronRldge .Type: Flush Mount MA Professional Engineer . .Weight: 0.68 Lbs/Ft Licence#47740 Array Information- -#of Modules: te. - T e. #of Mounts 47 n n rr rr DVJ.ION:SOVIR: Array Area: 334.65 sq.ft. 2 x12 LVL rr 2.x.12 'LVL �,r C.o r1 P A N'T Array Weight:. 841.49 Ibs: - L08 -Array Dead Load: 2.51 IbsJsq.f1. Array Point Load: - 17.90 lbs. - _ - - wwa.bostonsdar.us info' BostenSolar.us 2"x8" Rafters. 16"oc I � Structure Information Drawing Name: Array Layout Rafter Size: 2-1- Date: October 23,2017 Rafter Spacing: 15•oc I Drawn By: . BG Max.Rafter Span: ISO* Client Information: Reviewed By: 'Roof Pitch: o' Decking: plywood Jacqueline Ford Rev#: Ot Roof Materisl:rL Asphalt.Shingle. 32 Buffum Street Building Height: 25 Salem,MA 61970 PV 2. Exposure Catagory: C (415)671-9848 Scale: As Noted Design Conditions BOSTON LOGAN INT'L AIRPORT AC Rating 6.0 kWac DC Rating 6.3 kWdc Solar Module Solar Edge P370 Optimizer LG 35001C-A5 - Max Input Voltage' -60V . Annual exAme high temperature(0.4%):35°C Normal Operating Voltage 240V Operating DC Current -18A Voltage Max Power(VMPP) 36.4V Max Input Current '13.75A 2%Average high temperature:'32"C Continuous Output Current 25A Operating DC Voltage 350V Current Max Power(IMPP) 9.62A Max Output Current 15A *Annual extreme low temperature:-17"C Maximum System Voltage. 500V Short Circuit Current(ISC) 10.60A Max Output Voltage 66V Temperature at 3.5"above roof.,49"C - - Short Circuit Current 30A Open Circuit Voltage(VOC) 43.5V Min/Max Per String 8115 (3)#10 THWN-2 Wire (3)#6 THWN-2 Wire (1)#10.THWN-2Ground (1)#10 THWN-2 Ground 1"EMT 1"EMT O Meter# 05062197 OOABus P370 P370 P370 100A Load Center • SolaDeck-Pass Integrated DC Inverter SolarEdge AC Manufacturer + — + — + — Through.Box Disconnect 6000-US RGM Interface HALLENGER 1 2 09 Lt J. - . DC+ AC•L DC- N DC Lt P370 P370 P370 EGG - "' • 00000 NEU ' + + — + — - c 1 2 09 Output:6,000W 'Service AC Volt:240V Disconnect Max Amps:25A 60A Switch 35A Fuses #10 PV.Wire '(4)#10 THWN-2 Wire #6 Bare Copper Ground (1)#10 THWN-2.Ground 1".EMT Outdoor THE BOSTON SOLAR w .bostonsolar.us I InfoQBostonSolar.us Drawing Name: Line Diagram Date: October 23,2017 Drawn By: BG Client Information: Reviewed By: Jacqueline Ford Rev#: a 01. ' 32 Buffum Street . Salem;MA 01970 PV-3:.1 (415)671-9848 Scale: N.T.S - .1 DC CONDUCTOR AMPACITY CALCULATIONS: AC CONDUCTOR AMPACITY CALCULATIONS: ARRAY TO JUNCTION.BOX #OF INVERTERS:1 E EXPECTED WIRE TEMP("C):32° EXPECTED WIRE TEMP(°C):32° TEMP CORRECTION PER NECNECTABLE 310.16:0.96. TEMP CORRECTION PER TABLE 310.16:0.96 CIRCUIT CONDUCTOR SIZE:6 AWG #OF CURRENT CARRYING CONDUCTORS:4 #OF CURRENT CARRYING CONDUCTORS:3 CONDUIT FILL CORRECTION PER NEC 310.15(B)(2)(a):0.80 CONDUIT FILL PER NEC 310.15.(13)(2)(a):.1. CIRCUIT'CONDUCTOR.SIZE:.10 AWG CIRCUIT CONDUCTOR AMPACITY:75 A' CIRCUIT CONDUCTOR AMPACITY:40 A' REQUIRED CIRCUIT.CONDUCTOR AMPACITY PER.NEC 690.8(B): R RED RCUIT CONDUCTOR AMPACITY PER NEC .8 A&B - EQUI CI CI. E C 69 1.2 X MAX INVERTER'OUTPUTOURRENT 5 1.25X1.25XIsc= 1.25 X 25=31.25 A 1.25 X'1.25 X 10.60=16.56A. DERATED AMPACITY OF CIRCUIT CONDUCTORS PER NEC TABLE 310.16:. DERATED AMPACITY OF CIRCUIT CONDUCTOR PER NEC TABLE TEMP CORR.PER NEC 310.16 X 310.16 CONDUIT FILL CORR.PER NEC 310.15(B)(2)(a)X TEMP CORR.PER NEC TABLE 310.16 X CIRCUIT CONDUCTOR AMPACITY= CONDUIT FILL CORR.PER NEC 310.15(B)(2)(a)X 0.96 X 1 X 75=72 A CIRCUIT CONDUCTOR AMPACITY= 0.96 X 0.80X40=30.72A DC CONDUCTOR AMPACITY CALCULATIONS: FROM JUNCTION BOX TO INVERTER AMBIENT TEMPERATURE ADJUSTMENT FOR EXPOSED CONDUIT PER NEC 310.15(B)(2)(c):+17° EXPECTED WIRE TEMP(°C):32°+17° TEMP CORRECTION PER TABLE 310.16:0.82 #.OF CURRENT CARRYING CONDUCTORS::4 CONDUIT FILL CORRECTION PER NEC 310.15(B)(2)(a):0.80 CIRCUIT CONDUCTOR SIZE:-10 AWG CIRCUIT CONDUCTOR AMPACITY:40 A REQUIRED CIRCUIT CONDUCTOR AMPACITY PER.NEC 690.8(A&B): 1.25 X 1.25 X Isc 1.25 X 1.25 X 10.60=16.56A DERATED AMPACITY OF CIRCUIT CONDUCTOR PER NEC TABLE 310.16 TEMP CORR.PER NEC TABLE 310.16.X CONDUIT FILL.CORR..PER NEC 310,15(B)(2)(a)X CIRCUIT.CONDUCTOR AMPACITY= 0.82X0.80X40=26.24A THE BM0N SOLAR �^r C O M P A N'7 www.bostonsoler.us I Info@BwtonSolar.us Drawing Name: Wire Calculation Date: October 23,2017 Drawn By: BG Client Information: Reviewed By: Jacqueline Ford Rev#: 01 s. 32 Buffum Street Salem,MA 01970 PV 3.2 (415)671-9848 rscale7 N.T.S The Commonwealth of Massachusetts (4, ,; Board of Building Regulations and Standards x ' `F1O8 kv Massachusetts State Building Code,780 CMR `'' ' `~" ` NIdCIRA LITY USE Building Permit Application To Construct,Repair,Renovate Or'Iagploo a_ RPW?'l 2011: ; �a One-or Two-Family Dwelling Igloo`� ]I - This Section For Official Use Qnly ® Btaildmg Permit Number Date Buildmg Official(Ennt Name) Signature ate SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1.1a 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? Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: tC muv") ' � M 1 012 20 V+ I�arrse(Print) City,State,ZIP —I VNo.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 z: p t_*C t - 1 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials y 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: ' s � 5.Mechanical (Fire Suppression) $ Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ d��6 0• ❑Paid in Full ❑Outstanding Balance Due: . b O _ SECTION 5 .CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ' License Number Expiration Date Name of CSL Holder _ List CSL Type(see below) No.and Street Type Description ' U Unrestricted(Buildings up 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 I Insulation . Telephone Email address D I Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town,State,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 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 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. A,&-Le,&J 7 zZ119711 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(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. og v/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: P 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"maybe substituted for"Total Project Cost"