9 AMANDA WAY - BPZ-09-650 ADD ON TO DECK � 1
The Commonwealth of Massachusetts Town of
AQk Building Regulations and Standards
Board of Bui eguons
W „ Massachusetts State Building Code, 780 CMR, 7m edition Building Dept
Building Permit Application Construct, epair, Renovate Or Demolish a
O or Txo-Fmrtill Dwelling
This Sec n For fficial Use Only
Building Permit Number: Applied:
Signature:
2 0
Building Co issioner/Ins t rioIdin Date
C 1 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
9,1/l9AA>DA �nlAx
Ma Number Parcel Number
1.la Is this an accepted street?yes_ no. p
1.3 Zoning Information: 1.44 p1 rty Dimensions: 819 t
Zoning District Proposed Use Lot Area(sq tt) Frontage(R)
1.5 Building Setbacks(ft)
Front Yard
Side Yards Rear Yard
Required Provided Required Provided Required Prroo/vided
/ 51r61
1.6 Water Supply:(M.O.L C.40,?,, 1.7 Flood Zone Information: 1.3 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private ❑ Check if Xes13
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owners of Record:
Name(Print) Address for Service:
Signature Telephone
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:
B ief Description of Proposed Work2. e i iN e�C
l i9DDin/G /r7 XAr7�
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
t. Building S 1. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire S Total All Fees: S
Suppression)
Check No. Check Amount: Cash Amount:
6. Total Project Cost: S y90 _ ❑ Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) _ <,
License Number Fxpiranion D t
N,4mc of CSL- Hplder ' /^�
List CSL Typr Isce below) r✓y
Address T Description
U Unrestricted up to 35.000 Cu. Ft.)
Signature R Restricted 1&2 Family Dwelling
M Mason Onl
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Buming Appliance Installation
D Residential Demolition
5.2 Rel13tered Home Improvement Contractor(HIC)
�� PWQ L)n C-a iss�is
HIC Company Name or HIC Registrant Name Ac(t(' Registration Number
/09�1,�TFaRnA RD N�tODCEiDNEMA- 6/09
Addrc s
998?.5-0 -Y909 Expiration Date
Signature Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 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 ..........J3i No........... ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
). 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
A /;/,4) -, , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
1��EZ � l��f)•17"DEGs1
Prinl Na e
Sig azure of Owner or Authorized Agent Date
(Signed under the Pains and penalties of r 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(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 and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and I IO.RS, 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.) 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"
CITY OF SALEM
<� ( PUBLIC PRc�PRERTY
Ir'-
. F"
DEPARTMENT
Construction Debris Disposal Affidavit
(rcclimed litr all demolition and renovation work)
In accordance itll the sixth edition of the State Building Code, 780 C'MR section 11 1.5
Dcbris, and the provisions of MGL c 40, S 54;
Building Permit ft is issued with the condition that the debris resulting from
this work shall he disposed of in a pruperly licensed waste disposal lacility as defined by MGL c
111, S 150A.
The debris will be 0ansported by:
a• /*�
(name of hauler) ,
The debris will be disposed ofin
(name of facility)
(��G�DIl c�?c�..✓nl� M r4
tnJdres. ul I�cllilvl
,Ignamlc of penult applicant
ate
CITY OF SALEM
PUBLIC PROPRERTY
moo.
DEPARTMENT
,I V 1'. M 1 1 10M I'I I
12C Wdst 11\,;I,^S1xLL Is SAI 1'N, Ms».e[ III H I IN 3197('.
I IA. '')78.713-1395 a 1's.x 97d-71G'h346
'liVurkers' Compensation Insurunce Afftducit: Builders/Contractors/Electricians/Plumbers
%plllicant Information Please Print Leeibly
V 81ne: lliu.uw wl�r;;an l7.uioNlnd/n�.luul l: � / G',` /�'/�y�
Vldre.ss: yy
City.Srarc.Zip: y�1W104)CeS? A�� X019" 1'hunr i': 9,P8 �Jr� � Y9o9
_%re you art employer:' Cheek the appropriate box: 'Type of project(required):
1. ❑ 1 :un a employer with 4. ❑ 1 am a general contractor and 1 6. ❑ new construction
2.�tployccs(full .mrL'ur part-lone).• have hired the sub-contracture 7. ❑ Remodeling
n1 a sole proprietor or partner- lured )it the knichcd sheet.
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me in any capacity. workers' comp. Insurance. 1). ❑ Building addition
Kn workers'con insurance 5. ❑ We are a cniparation and its
I P
required.] of 10.❑ Electrical repairs or additions
officers axerciscJ their
3. ❑ 1 nn a homeowner doing all work right of exemption per MOIL 11.❑ Plumbing repairs or additions
myself. (Ko workers' chip. c. 152, j 1(4),and we have no 12.❑ Rtwf repari�rs
insurance required.] t onployces. LKo workers' 13.❑ Other //CC fL
comp. insurance required.]
•e m .,gntu,d that checks box ill muss:dau Till ow the v:amu I.Iuw.howmy the,r wurktss eunlpvnau[iwt ltuticy ntli,rmatiun
' I lumeuwmn who ,dhmit this alndavit indiu,ina,hey a,e doing all work mvl then hire",side cuwrxrors marl.uhmil a new atrdarlt inJiW ma.uch.
-r-,•ntewu,n that[heck this boa mtlal.maehad.m Idd,li.mai..heel.11„-ma dw u]nhe of Iho tub.ontractors and then wurken'cutup.policy irate manon
/,un un employer that is pruviding workers'cuinpenyntimt insuranae/br lny eniplayeas. Below is the pulley altrl%ob rile
iafurusatiuts.
Ir.>urancc C'(mpaoy Vmne: _.__ .. -- - --
Folicv is or Sclf-ins. Lie. n: __.. . _ __ Enpirulwn Date:
)ub Site Address: ---. Cray-51ate/Llp:
Attach it copy of the workers' compensation policy declaration page (showing the policy number and expiration date). i
Failure to sccurc coserdge as required under SCLIton 25:\of VIOL c. 152 can lead to the imposition of criminal penalties of a
rite op to S1.500,00 dnd/ur one-year imprisonment, J4 %tell as ci.11 penalties in the furor of a STOP WORK ORDER and a fine
,if up m S250,00 It Jay against the violator. lie advi.,:d that a copy of thu ntutcinew may be furwarded to the 011ice of
Im:am,an.,na ul-ac Mt% :or atst[[oCce etncroge Icnti,.dl:un.
/u hrrrhy[.rri[v wr.lrr the p ens d )elf ill uf %cry that the br/bnnalian pro viJa•J above is true coo!correct.
_.� Dart,— jr 19
I)/jisial rue unly. Do not write in this area, Iu Ar cutup/a•Irt/by rile ur lawn a//iris/. I
( ilv ur l'mwn: _... _ Permityl.ieclive 4
Issuing; .\uthurov (circle one):
I. W..[rd of Ile-Jilt E. IfuJdin:. Dep.Iruueul 1. Citi.1ooij Clerk 4. Llectric.11 to.pector 5. Plumbing Inspector
4. Olher _
Contact l'criuo: -- _- Phone It:
Information and Instructions
♦I.,_s.,dhusetts General Laws chapter 1 i2 rcgutre) a I I enipha)crs to provide workers' compensation for their employees.
I'u consult to this .lalule, an empluree is defined as" eser) pclson in file service of another under •illy contract of hire,
,prey or implied. oral or ,vntten."
\n eimpluper Is defined as"in individual, partnership, .lssociatiou, corporuron or other IcgaI entity,orally two or more
,,I the 1 ,CC goIng engaged it a joint enierpnse. And including the :egad representatives of a deceased c nip lu)cr, or the
reee,%er or Iru)(ee of All Individual, palinerih,p,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
.I%velling house of another who employs persons to do maintenance,cunstructlom of repair work on such dwelling house
or 0I1 he.,,rounds or building appurtenant thereto shall nor because of such employment be deemed to be in cmplo)cr."
\tGL :hupter 152. $25C(6) also states that "every state or local licensing agency shalt withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in chi commonwealth for any
;applicant %.bo has not produced acceptable evidence.of compliance with the insurance coverage required."
\ddiuonully, MGL chapter 152, a2517(7)states"Neithu the commonwealth nor any of its political subdivisions shall
enter into any :untract for the performance of puhlic work until acceptable cvidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Pfensc rill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractors)namc(s), address(es)and phone nuniber(s)along with their certificale(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
.\ceidems for confinnat ion of insurance coverage. Also be sure to sign and date the al'tidavil. The affidavit should
he retuaied 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 are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
)F-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 fur you to fill nut in the event the Office of Investigations has to contact you regarding the applicant.
lll:asc be SurC to fill in the pennil/license number which will be used as a reference number. In additiun, an applicant
that must submit multiple permitllicerise 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
townie"A copy of file 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 far 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.c. a dug license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
)thee of lllveSrl.atnons would iiwc to thank )flu in adv:alcc fur your couperatio❑and should you ha%c :my que Jtions,
I,lease do nut hesitate to give us a call.
nc,: Department's address, telephone and fax number'
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. r'I 617-727-4900 ext 406 or 1-877-MASSAFE
Fax 0 617-727-7749
x:•.:..d -'n-n' www.mass.gov/dia
i Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
t Registration: Tr8 255168
4126/2
Expiration: 412612009
Type: DBA
MADDEN BUILDERS
PETER MADDEN
107 FLINT FARM ROAD Administrator
MIDDLETON,MA 01949
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March 18, 2009
Inspector
To: Salem Building Ins p
Contractor: Peter Madden
Re: Addition to existing deck at the residence of
Robin Lang and John Flom 9 Amanda Way Salem, MA 01970
Dear Sir/Madam:
We are requesting that Peter Madden pull a permit to construct an addition
to our existing deck at our residence located at 9 Amanda Way in Salem
Massachusetts.
If you have any question or concerns please don't hesitate to contact me
on my cell phone at 508.331.1179.
Thank you,
Robin Lang
John Flom
� }I
Professional Land Surveyors B Civil Engineers - 1986
ESSEX SURVEY SERVICE 1911 1970
OSBORN PALMER 1885 1972
BRADFORD & WEED
PLOT PLAN OF LAND
LOCATED IN
5/JLa� MASS.
0Z.00
61d
LLB 4Z
I,
pQ&'-z'
0U L .L /Jl
I hereby certify to the SF/L�l
Building Inspector that the pro-
ZONE: k'( UT �A: X'� LOT FRONTAGE- � � posed construction shown conforms
to the dimensional zoning Q;,,,
FRONT YARD `. SIDE YARD: I0 / REAR YARD: �nf cJi,i cf Mass
. .
SCALE:
DATE: �'%� � l ,,
Christopher R. Mello .PLS:3lT3i7 -
REFERENCE: gK PG
104 LOWELL STREET
PEABODY, MASS. 01960
(978) 531-8121
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PROPOSAL
PROPOSALNO.
- SHEET NO.
- i DATE
PROPOSAL SUBMITTED TO: 1',`- WORK TO BE PERFORMED AT:
NAME �t ADDRESS - t
ADDRESS
DATE OF PLANS
PHONE NO. ARCHITECT
We hereby propose to furnish the materials and perform the labor necessary for the completion of
: C Cj U
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All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifi-
cations submitted for above work and completed in a substantial workmanlike manner for the sum of c�
Dollars
with payments to be made as follows.
Respectfully submitted
Any alteration or deviation from above specifications involving extra costs
will be executed only upon written order, and will become an extra charge Per
over and above the estimate. All agreements contingent upon strikes. ac-
cidents.or delays beyond our control. Note—This proposal may be withdrawn
by us if not accepted within days.
ACCEPTANCE OF PROPOSAL
The above.,prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work
as specified. Payments will be made as outlined above.
Signature
Date Signature
GAcl NC 3818-50 PROPOSAL
MADE IN USA