18 AMANDA WAY - BPA-12-647 NEW, SINGLE FAMILY HOME mc��'�wz � G ov,,
tN The Commonwealth of Massachusetts
°t r Board of Building Regulations and Standards CITY OF
i Massachusetts State Building Code,780 C SALEM
eSised Mar 2011
Building Permit Application To Construct,Repair,Re vate Or De o
One-or Two-Family Dwelli
This Section For Official Use Only
Building Permit Number: Date Applied: '//
Building Official(Print Name) Signature
SECTION 1:SITE INFORMATION
tro 1.2 Assessors Ma &Parcel N n rs tr-��22
d •esn 'p � vJ Q- I
1.1 a Is this an accepted'street?yes_ no Map Number ' - Parcel Number
1.3 'ng Information• ( 1.4 Property Dimensions: ;
D J 5i 31�
Zoning District Proposed se Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
IL) � I ' 15F5 I LA O � '
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'
caner'ofeco I I S �'G I T I ru Sf � )q'I/o
Name(Print) City,State,ZIP 6
No.andStreet Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction' Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work :
P ln? u2y ,r-,� 0l I I h
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building !7S®O $ 1. Building Permit Fee:$ Indicate how fee is determined:
�O ❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ 00 List:
5.Mechanical (Fire
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
aaa��d
SECTION 5: CONSTRUCTION SERVICES
5 Construe on Supervisoor License(CSL) I . I (1 1 13
Cluj `` I✓I a Sly License Number'i Expiration Date
Name of CSL Holder /)
—7 I q l/
j�(,^ I I /� _ (_� ,.\J `7 %1 List CSL Type(see below) IL,
No.and Street /C� Type Description
U Unrestricted(Buildings u to 35,000 cu.ft.
`� q(.�
l UL l R Restricted 1&2 Family Dwelling
Gown,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
I,, jj /�(/.� I SF Solid Fuel Burning Appliances
7 I' 4''1"T �1 ItV�L�� 'U�Q � �(.L I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or MC Registrant Nam HIC Registration Number Expiration Date
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 Issuan9p 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 Own the subject property, ereby authorize (
�� L G l X—Y m(;(5-y�—�
to act beha ,in a Fria ative to wor authorized by this building permit application.
Ainter's Name(Electronic Signature) O Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By enter in name below,I hereby attest under the pains and penalties of perjury that all of the information
contain in is ap ica' n is a and ace a to the f my kn wledge and understanding.
Owner's or Author' Signature) Dale
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/dos
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 1 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"
('q c I ab- - 10JJ-- • coy-49 lr F/Z 795- - I
` Professional Land Surveyors Et Civil Engineers
ESSEX SURVEY SERVICE. 1958 - 1986
OSBORN PALMER 1911 - 1970
BRADFORD & WEED 1885 - 1972
PLOT PLAN OF LAND
LOCATED IN
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I hereby certify to the Sh,�E!°1
Building Inspector that the pro-
ZONE: LOT AREA; ,{/pJl!�- LOT FRONTAGE: �GNiC posed construction shown:conforms
to the dimensional zoning of
FRONT YARD: IS!`t SIDE YARD: IJJI31` REAR YARD: �JST riLCr`rf Mass.
SCALE: QS t
/ syDATE' J fJA/ U �G l Z HER `4eN-
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REFERENCE: EK 9GZ PG Chr' opher .R. Mel 17 /
9Fc'
104 LOWELL STREET
PEABODY, MASS.01960 S r 3
w
(978) 531-8121
FAX:(978)531-5920
4'-O" 32'-o" dormer/in i'-O" Ii61-01" 1
Center on door below center on windows below
a �-- ._.roof . . . I �0
roof
L D `�
I
13'6x11-t- .. ... sloped �4
T wall 4fo 10-6=4 1 _ I I Storage
—cl0 I Z/6 12/4 . 12/6 .. . . . .�
ip, chase
�i/4Bath 2/6 IH .
locate stair as
do per 1st Fl Plan
Ian
rgh cig HT
access
sloped - . INOTE handrail /
Mof. _.._
n
._roof
_Attic Plate Scale 1/8"=1'-o"
S: smoke detector
roof-sheds
444f —
01/31/201.2 10:12 FAX 617 527 4078 Eastern Ins Newton Lgj 0001/00a1
INSURER'S AFFIDAVIT AS TO WORKERS' COMPENSATION INSURANCE
I, Robert A Herterich,Vice Presdent—Eastern Insurance Group LLC 130 Rumford Avenue,Newton,MA
02466 am:
❑ an authorized representative of Insurance Company
(a producer"in the voluntary market)'
X❑ an authorized agent of Acadia Insurance Company(an agent in the voluntary market,
authorized to sign on behalf of a producer)'
❑ an authorized signatory of the the Prime Contractor
(an insured of a producer in the voluntary market pool)t
❑ an authorized signatory of ,the Sub-Contractor an
insured of a producer in the involuntary market pool,group, or otherwise insured)'
and do hereby aver that effective Feburary 23, 2011,DiBiase Corporation is insured for Workers'
Compensation insurance with Acadia Insurance Company under Policy WCA0286788-12,pursuant to the
attached Certificate of Insurance, and in accordance with Massachusetts General Laws, Chapter 152 and
Subsection 7.05A of the Standard Specifications 4forkghwuys and Bridges of the Highway Division of
the Massachusetts Department of Transportation
Vice President
COMMONWEALTH OF MASSACHUSETTS
On this 31 day of January,31,2012,before me,the undersigned notary public,personally
appeared.Itobert A Herterich,proved to me through satisfactory evidence of identification,which
was/were MA Driver's License,to be the person who signed the preceding or attached document in my
presence,and who swore or affirmed to me that the contents of the document areputhfiil and accurate to
the best of their knowledge and belief.
C� Swm P. 8CIMAN Notary
NoWn A='IC
Samuel Sclafani
=9,20
A producer is an insurance company that provides insurance policies directly,not an insurance agent.
t For Prime or Sub-Contractor companies insured through the voluntary market,this Affidavit must be completed by
the insurer or an authorized agent of the insurer.
t If the Prime of Sub-Contractor is insured through the involuntary insurance market,a pool,such as the Worker's
Compensation Inspection and Rating Bureau,or is otherwise insured they may provide a Certificate of Insurance
and this Affidavit which may be signed by an authorized signatory(company officer)of the Prime or the Sub-
Contractor.
"0>""' ®��w�wreumart�.commmmnurvrcnmaniime
CITY OF S.0 ENI, L LxsS.XCHUSETrs
BUl DLNG DEPARTatENT
130 WASHINGTON STREET,3'0 FLoop.
T EL (978) 745-9595
FAX(978) 740-9846
KI\ISERI Y DRISCOLL
i�fAYOR THoms ST.PIE m
DIRECTOR OF Puauc PROPERTY/BUTEMING COMSIISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
h5ide- Cc, V10� I,nc
(name of hauler)
The debris will be disposed of in
r /
nC � ?lr2)s n
(name of facility)
(address of facility)
signaturo of permit applicant Q�L�
/Ai
date
debrlulTda:
.�
ENERGY STAR VERSION 2 HOME VERIFICATION SUMMARY
Date: January 31, 2012 Rating No.:
Building Name: McIntyre Model Rating Org.: Conservation Services Group
Owner's Name: Osborne Hills Realty Trust Phone No.: 508.836.9500
Property: PO Box 780 Rafter's Name: Nicholas Abreu
Address: Lynnfield, MA 01940 Rater's No.: 8368122
Builder's Name: Paul DiBiase
Weather Site: Boston, MA Rating Type: Projected Rating
File Name: McIntyre Model.blg Rating Date: 1/23/2012
Building Information
Conditioned Area(sq ft): 1660 Housing Type: Single-family detached
Conditioned Volume(cubic ft): 14365 Foundation Type: Unconditioned basement
Insulated Shell Area(sq ft): 4862 HERS Index: 70
Number of Bedrooms: 3
Building Shel l
Ceiling w/Attic: R37,CE10",8-16 U=0.029 Window/Wall Ratio: 0.13
Vaulted Ceiling: None Window Type: U:0.30,SHGC:0.35
Above Grade Walls: R21,FG1,6-16 U=0.058 WindowU-Value: 0.300
Found.Walls(Cond): None Window SHGC: 0.350
Found. Walls(Uncond): Uninsulated Infiltration: Htg:4.50 Clg:4.50 ACH50
Frame Floors: R30,FG2,X-16 U=0.040 Duct Leakage to Outside: 45.00 CFM @ 25 Pascals
Slab Floors: None Total Duct Leakage: 45.00 CFM @ 25 Pascals
Mechanical Systems
Heating: Fuel-fired air distribution, 100.0 kBtuh,95.0 AFUE.
Cooling: Air conditioner, 30.0 kBtuh, 13.0 SEER.
Water Heating: Conventional,Gas,0.58 EF.
Programmable Thermostat: Heat=Yes;Cool=Yes
Note:Where feature level varies in home,the dominant value is shown.
This home MEETS OR EXCEEDS the EPA's requirements for an ENERGY STAR Home.
REM/Rate-Residential Energy Analysis and Rating Software v1297
This information does not constitute any warranty of energy cost or savings.
0 1985-2012 Architectural Energy Corporation,Boulder,Colorado.
CITY OF SALEM
ROUTING SLIP
New Construction
Certificate of Occupant)•
LOCATION 61/ DATE
ASSESSORS A� v DATE:-7- a- t2-
93
Washington St.
CITY CI?ERK' a. DATE '` "
193 Washington St.
PUBLIC SERVICES i// pATE
120 Washington St.
WATE DATE
120 Washington St.
CROSS CONNECTION ATE
5 Jefferson Ave del
PLANNING .d.,, i �lU DATE Z/.31l Z
120 Washington St.
CONSERVATIO, E ^3
120 Washington St.
DATE',
48 Lafa=yette St. " a
FIRE PREVENTIOi DATE
29 Fort Avenue
HE �LTH�+�-fv� rt _. .._DATE•.
i'20•Washington St:'' '
BUILDING INSPECTOR DATE
120 Washington St.