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15 BRADLEY ROAD - BUILDING JACKET CITY OF SALEM o l PUBLIC PROPERTY DEPARTMENT KINTERLE.Y DRISCOT-L MAYOR 120 WASE NGTON STREF_T♦ SALEM,MASSACI-IUSE.-ITS 01970 TFL:978-745-9595 4 FAX978-740-9846 REQUIRED INSPECTION c®gip PROPERTY ADDRESS 15 Bradley Road Mr.Lucien Oullette 15 Bradley Road Salem Ma.01970 Dear Mr. Oullette , The above referenced property has come to the attention of this department for the following reason(s): A report has been made to this office that there is an illegal apartment unit being created in the basement. For this reason an inspection must be conducted by our inspection team to assure compliance with the code and city ordinance. Under the provisions of 780 CMR, Section 115.6, the State Building Code, access to this property must be granted for the purposes of this inspection. Please call this office upon receipt of this letter to schedule this required inspection. If this property has rental units, these tenants must be notified in advance of this inspection, so that access to these spaces may also be accomplished. This inspection must be completed on or before,May 26, 2008; failure to respond to this notification will be construed as non- compliance, and as such an Administrative Search Warrant will be sought, so as to allow the lawful inspection of this property. If you have any further questions regarding this letter, please call this office at (978) 745- 9595, extension 5643. Since y, CC: file,Health Dept., Fire Prevention, Mayor's Office, Councilor O,Keefe ®Boise Cascade Double 1-3/4" x 9-1/2" VERSA-LAM® 2.0 3100 SP Floor Beam\FBO1 Dry 1 span No cantilevers 1 0/12 slope Friday, September 13, 2013 BC CALC®Design Report-US Build 2565 File Name: RJ MADISON 15 SALEM JOB Job Name: RJ MADISON Description: Designs\FB01 Address: 15 Specifier: City, State, Zip: SALEM, MA Designer: Customer: Company: Code reports: ESR-1040 Misc: r _ � E 10-00-00 BO B1 Total Horizontal Product Length=10-00-00 Reaction Summary (Down/Uplift) (lbs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 1,300/0 69810 B1, 3-1/2" 1,300/0 698/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 126% 1 Standard Load Unf.Area(Ib/ftA2) L 00-00-00 10-00-00 20 10 13-00-00 Controls Summary Value %Allowable Duration case Location Disclosure Pos. Moment 4,548 ft-lbs 32.6% 100% 1 05-00-00 Completeness and accuracy of input must End Shear 1,565 lbs 24.8% 100% 1 01-01-00 be verified by anyone who would rely on Total Load Defl. U768 (0.149") 31.2% n/a 1 05-00-00 output as evidence of suitability for Live Load Defl. U999 0.097" n/a n/a 2 05-00-00 on building Output here based ( ) on building code-accepted design Max Defl. 0.149" 14.9% n/a 1 05-00-00 properties and analysis methods. Span/Depth 12.1 n/a n/a 0 00-00-00 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guideor ask questions,please call BO Post 3-1/2" x 3-1/2" 1,998 lbs n/a 21.7% Unspecified (800)232-0788 before installation. B1 Post 3-1/2"x 3-1/2" 1,998 lbs n/a 21.7% Unspecified BC CALC®,BC FRAMERS,AJSTM, ALLJOIST®,BC RIM BOARDTM,BCI®, Notes BOISE GLULAMT",SIMPLE FRAMING Design meets Code minimum (U240)Total load deflection criteria. SYSTEM®,VERSA-LAMS,VERSA-RIM Design meets Code minimum (U360) Live load deflection criteria. PLUS®,VERSA-RIMS, Design meets arbitrary(1") Maximum total load deflection criteria. VERSA-STRAND®,VERSA-STUD®are Calculations assume Member is Full Braced. trademarks of Boise Cascade wood Y Products L.L.C. Design based on Dry Service Condition. Deflections less than 1/8"were ignored in the results. Connection Diagram b d a • • • c a minimum =2" c= 5-1/2" b minimum = 3" d = 24" Member has no side loads. Connectors are: 16d Sinker Nails Page 1 of 1 The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF \ Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demobs a n^1J One-or Two-Family Dwelling This Section For Official Use Onl Building Permit Number: Date App h ,. 'Building Official (Print Name) Date SECTION 1: SITE IN ORM 1.1 Pro)erty Address: 1.2 Assessors Map& Parcel Numbers 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 OWNERSHIP' 2.1 Owner'of Record: 1 � LAI AS f yy ache��C L-0 �� -Sci.6n MA e l 9 7a Name(15rmt) City, State,ZIP p I � ��eU rD 97f -79-YS0 Q 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': ro NJ UC ' S CTION 4: ESTIMATED CONSTRUCTION COWS Item Estimated Costs: Official Use Only (Labor and Materials I. Building $ 570 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: 5. Mechanical (Fire $ Suppression) Total All Fees: $ 6. Total Project Cost: $ 3) Check No. Check Amount: Cash Amount: (� 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) L &�93 /a a /3 df( aq/ r /p License Number Expiration Date Name of CST Hol er / ee,,(( List CSL Type(see below) 6 $Pf�S'7'd� UT- -No.and Street Type Description x�eF� MR 6/9�� U Unrestricted(Buildings u to 35,000 cu. ft.) City/?"own,, SArk, R Restricted Covering Family Dwelling M Masonry RC Roofin CoverinWS Window and Siding /r/ SF Solid Fuel Burning Appliances 536T 1 Insulation Telc hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) N w)7 LowtS HoMioul, HIC Registration 0 ber "xpi 'o/nJD e HIC Company Name r HIC egistrant Name No. an Ihce s u Df ( 17W 01776L 17' -ovt4 City/Town, State,ZIP V 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 Fer'lla.4 GhaUnr to act on my behalf, in all matters relative to work authorized by this building permit application. Lou? �Ynichlt/4i L 6 4 , I a4-rP-4 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 i tru and curate to the best of my knowledge and understanding. Print Owner's or Authorized Ag is ame(E ctronic Signature) ate 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 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.eov/oca Information on the Construction Supervisor License can be found aowtictiv.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 halfibaths 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" The Commonwealth of Massachusetts ° Board of Building Regulations and Standards CITY OF 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. IDate A lied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 15 Bra d if y �°� L l a Is this an accepted stre t?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(11) 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: (.evil L.oaro t �pypl yr)(I• 01170 Name(Print) `(� City,State,ZIP 15 bra�l1ey �4' 91 b-766-4 j o.and-Stree��Fl Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ 1 Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': QrnowQ (W 40 -eLt 91rw tt)t /JS D SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials Official Use Only 1. Building $ 7 5 7— 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: $ ��� 1 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Su ression) Total All Fees:$ I Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 7 5 7-- ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supnenrvis r License(CSL) /HlP�4t 7 20 'I lie License Number Expiration Date Name of CSL Holder 5 q��I 1 List CSL Type(see below) No.and Street Type Description `yalem, f11F} 0►97� U Unrestricted(Buildings u to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,Sta M Mason ry � RC RoofinWindow Covering g c WS Window and Siding 9 7 U_73�_717 SF Solid Fuel Burning Appliances 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ItiAOd to•t8. 15 ��.) dome "�' ' HIC Registration Number Expiration Date HIC Company Na a or HI Registrant Name - richbrA •c}talona s+ere.for�a3•tph No.and Email et Email address b=fbijh, CAP- at-7-7a &-j 36 -oY City/Town,State!Z1P 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 ..........YJ No........... ❑ SECTION Tat OWNER A THORIZATION 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. L r)v �W(6 7.34 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. 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.eov/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" The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Xtnr 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Ottioia) Use Only Building Permit Number:% Dat Applied: Building Official(Print Name).: Signa Date - SECTION I-'SITE'INFORMATION I.l Pro erty Address: 1.2 Assessors Map& Parcel Numbers I.I a Is this an accepted street?yes /moo Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(11) 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❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑ SECTION2: PROPERTY OWNERSHIP' 2.1 Ownert of Record: i 1y�ckE�� GouRy 15 dP/ID� Nhme(Print) City,,State,ZIIPP�(7 Nj t b L E`/ �G(0 No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK:(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ r Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Des�r n of Proposed Work'-: 41 Y SECTION 4: ES t 1ATED.CONSTRUCTION COSTS Estimated Costs: Item Official Use Only Labor and Nluterials - I. Building S a 31/�' 1. Building Permit Fee:S Indicate how fee is determined: ❑.Standard City/Town Application Fee 2. Electrical S Zg�`G• ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S g jU• C�-d �. Other Fees: S 4. Mechanical (HVAC) S List: . 5. Mechanical (Fire S Suppression) Total All Fees:S Check No. - Check Amount: Cash Amount: 6. Total Project Cost: S 33 835:O'd 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Q 30� ...-7_ S Rt C E-1 h/ o n/�}�is d l`( License Number ExpirationDat—e Name of CSL Holder � List CSL Type(see below) 3 b11L)150n' E9�r No.and Street Type Description, - /i f�. U Unrestricted(Buildings u to 35,000 cu. It.) G 41-o U eLZ 61D M'/ G/2S?q R Restricted 1&2 Family Dwelling Cityffown,State,ZIP M Masomy RC Roofing Covering WS Window and Siding _ �'+// SF Solid Fuel Burning Appliances 5�3 7(nY 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) l r6 '505 S 3 J1. 2, L(J HIC Registration Number Expiration Date FIIC Company Name or HIC Registrant Name 4 f/7fa brsun� rG No.and St-utreet ELH/V/� Email address C' u 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 Is§ ce 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 1,as Owner of the subject property,hereby authorize K,,kX rD ) R OV I—!ff tj 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. RIC,Nhr0 $1Af) D19/yRt564-� F —/0 -J? Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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 not have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at www.mass.eovYoca Information on the Construction Supervisor License can be found at www.mass.aovidns 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" 1 I 184" 3,, 21;6" 36" 36" 36" 36' 1711-e' 11 a" 3 38 N N i N W361224 MW3630630 OW, 63 0 W3630 0(V cb M r U188424R TEP2484WD 36;-EF2 2D '" NV Y D618 4R BFRID 636RT BTCI2LRNB18L m 1 l6 q 39,6" 8,3 5,e, !All limensions sim designations This is an original design and must Designed:6/26/2013 - j given are subject to verification on not be released or copied unless Printed:8/5/2013 job site and adjustment to fit job applicable fee has - -------- 1 J J order been paid or job conditions. order placed. - I __ __ 1 6160480d EI ] Drawing#: 1 No Scale: 7 104 4" 12 4" 271 30 # 33" 1 lie CV CV W3012 W2 T 0 W3330 o Mr W HOOp o I 130 CD B18RTL KD9 30-RANGE1 B33FHRT F330 M i 3 ngo12 rr 4 18n "oIf 33 �y 3 11 n 111 4 .7 2 i I All dimensions_size designations Michele Louro This is an original design and must Designed:8/5/2013 given are subject to verification on 15 Bradley Rd not be released or copied unless Printed:8/5/2013 job site and adjustment to fit job Salem Mass.01970, applicable fee has been paid or job --"----"---"-- i conditions. 978-587-5010 order placed. 6160480d EI 1 Drawing H: 1 No Scale. El 0 CO B` F1 .5WDISHW SB36 BWB18 t") M � 1 n 1094 i I A11 dimensions_siu designations Michele Louro This is an original design and must Designed:8/5/2013 i given are subject to verification on 15 Bradley Rd not be released or copied unless Printed:8/5/2013 ' Job site and adjustment to fit job Salem Mass.01970 applicable fee has been paid or ob Icondirions. 978-587-5010 order -------- --- placed. I 1 6160480d EI I Drawing#: 1 No Scale. The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Xtnr 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Ottioia) Use Only Building Permit Number:% Dat Applied: Building Official(Print Name).: Signa Date - SECTION I-'SITE'INFORMATION I.l Pro erty Address: 1.2 Assessors Map& Parcel Numbers I.I a Is this an accepted street?yes /moo Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(11) 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❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑ SECTION2: PROPERTY OWNERSHIP' 2.1 Ownert of Record: i 1y�ckE�� GouRy 15 dP/ID� Nhme(Print) City,,State,ZIIPP�(7 Nj t b L E`/ �G(0 No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK:(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ r Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Des�r n of Proposed Work'-: 41 Y SECTION 4: ES t 1ATED.CONSTRUCTION COSTS Estimated Costs: Item Official Use Only Labor and Nluterials - I. Building S a 31/�' 1. Building Permit Fee:S Indicate how fee is determined: ❑.Standard City/Town Application Fee 2. Electrical S Zg�`G• ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S g jU• C�-d �. Other Fees: S 4. Mechanical (HVAC) S List: . 5. Mechanical (Fire S Suppression) Total All Fees:S Check No. - Check Amount: Cash Amount: 6. Total Project Cost: S 33 835:O'd 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Q 30� ...-7_ S Rt C E-1 h/ o n/�}�is d l`( License Number ExpirationDat—e Name of CSL Holder � List CSL Type(see below) 3 b11L)150n' E9�r No.and Street Type Description, - /i f�. U Unrestricted(Buildings u to 35,000 cu. It.) G 41-o U eLZ 61D M'/ G/2S?q R Restricted 1&2 Family Dwelling Cityffown,State,ZIP M Masomy RC Roofing Covering WS Window and Siding _ �'+// SF Solid Fuel Burning Appliances 5�3 7(nY 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) l r6 '505 S 3 J1. 2, L(J HIC Registration Number Expiration Date FIIC Company Name or HIC Registrant Name 4 f/7fa brsun� rG No.and St-utreet ELH/V/� Email address C' u 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 Is§ ce 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 1,as Owner of the subject property,hereby authorize K,,kX rD ) R OV I—!ff tj 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. RIC,Nhr0 $1Af) D19/yRt564-� F —/0 -J? Print Owner's or Authorized Agent's Name(Electronic Signature) Date 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 not have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at www.mass.eovYoca Information on the Construction Supervisor License can be found at www.mass.aovidns 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" 1 I 184" 3,, 21;6" 36" 36" 36" 36' 1711-e' 11 a" 3 38 N N i N W361224 MW3630630 OW, 63 0 W3630 0(V cb M r U188424R TEP2484WD 36;-EF2 2D '" NV Y D618 4R BFRID 636RT BTCI2LRNB18L m 1 l6 q 39,6" 8,3 5,e, !All limensions sim designations This is an original design and must Designed:6/26/2013 - j given are subject to verification on not be released or copied unless Printed:8/5/2013 job site and adjustment to fit job applicable fee has - -------- 1 J J order been paid or job conditions. order placed. - I __ __ 1 6160480d EI ] Drawing#: 1 No Scale: 7 104 4" 12 4" 271 30 # 33" 1 lie CV CV W3012 W2 T 0 W3330 o Mr W HOOp o I 130 CD B18RTL KD9 30-RANGE1 B33FHRT F330 M i 3 ngo12 rr 4 18n "oIf 33 �y 3 11 n 111 4 .7 2 i I All dimensions_size designations Michele Louro This is an original design and must Designed:8/5/2013 given are subject to verification on 15 Bradley Rd not be released or copied unless Printed:8/5/2013 job site and adjustment to fit job Salem Mass.01970, applicable fee has been paid or job --"----"---"-- i conditions. 978-587-5010 order placed. 6160480d EI 1 Drawing H: 1 No Scale. El 0 CO B` F1 .5WDISHW SB36 BWB18 t") M � 1 n 1094 i I A11 dimensions_siu designations Michele Louro This is an original design and must Designed:8/5/2013 i given are subject to verification on 15 Bradley Rd not be released or copied unless Printed:8/5/2013 ' Job site and adjustment to fit job Salem Mass.01970 applicable fee has been paid or ob Icondirions. 978-587-5010 order -------- --- placed. I 1 6160480d EI I Drawing#: 1 No Scale.