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21 AMANDA WAY - BUILDING INSPECTION (2) The Commonwealth of Massachusetts CITY OF Board of Building Regulations and Standards l 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 OfficjaJUse Only Building Permit Number: Da -/Applied: 71)111 - Building Official(Print Name) Signature _ Date SECTION 1:SITE INFORMATION l.�lt Property Addre1s:�t 3, 1.2 Asses ors Map& Parcel NuO qts_ a9 I.la Is this an accepted street?yes—&= no Map umber Parcel Nuumber 1.3RRZoning Information: 1.4 Property Dimensions: ZoftinglDistrict Propose se Lot Area(sq 8) Frontage(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provid Required Provide 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 O WNERSHIP' 21 COwnertof'R RPrt� . Tv��st n,n � v il( ()`� Uq4o ( nt)Name City, e,ZIP ED &ae '7t3(p -76i-Bt1q- 102(1 JO )&-dlhta!! S No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKS(check all that apply) New ConstructionW4 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units I I Other ❑ Specify: Brief Description of Proposed Workz: _ W - cc) � r rni hh SECTION 4:ESTIMATED.CONSTRUCTION:COSTS Item Estimated Costs: Labor and Materials 'Of6eialUse Only 06.To ilding $�Jl? /-00' 1. Building Permit Fee:$ - Indicate how fee is.determined: ctrical $ f ^✓ - "Q ❑Standard City/Town Application Fee. ❑Total Project Cost'(Item 6)x multiplier x mbing $ 0 Li chanical (HVAC) $ � oO(� List: chanical (Fire $ ^' ession ! `t /1q Total All Fees:1$ tal Proiect Cost: Check No: Check Amount. Cash.Amount: W d ❑Paid Fin-Full ,❑Outstanding.Balance Due:. t SECTIONS: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 0 C 27-1 14--1 Thk x� � ` S License Number Expiration Date Name of CSL Holder Type ( ) �j 71+1 LC:1�f El ( 5� � 50 List CSL T see below No.and Street \ `J Type _ Description r n n nn �? ' �l y"H D I TLIO U Unrestricted2 Fai(Buildings u el ing cu. ft.) wn, 1 ' Lt t I t t R Restricted 1.$2 Famil Dwelling City/T State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I IInsulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Regi HIC Registration Number Expiration Date �t�t T�am� 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 1,as Owner 0911e subject property, hereby authorize I J Ct'SjL, to act of y ehal in a ative to work authorized by this building permit plicationn.. P t Owner's Name(Electronic Signature) D Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By enteri y name below,I hereby attest under the pains and penalties of perjury that all of the information co nna ed' this. pplic 'on i e and accurate Lope best 9f my knowledge and understanding. int Owner's or Authorized Agent's Name(Eledmnuc 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.eoav/oc 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.fL) (including garage,finished basement/atticsdecks or porch) Gross living area(sq.ft) Habitable room count Number of fireplaces Number of bedrooms 7j Number of bathrooms - Number of half/baths Type of heating system Number ofdecks/porches / Type of cooling system (�DIj� Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" ,< CITY OF SOU E`I, 1d.-kSSACHUSETTS BUMI)LNG DF-PILRTNMNT 130 WNsHINGTON STREET.3�FLOOR WmC TEL. (978) 745-9595 FAX(978) 740-9846 ICIMSFRr FY DRISCOLL MAYOR THmus ST.PiFim DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMSSIONER 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: �Iof } h-s wig CA nn I,nc, (name of hauler) The debris will be disposed of in �ff�QbQQ E-,rd5 I n (name of facility) i C-)W -Pri . r , for (address of facility) signature of permit applicant ®� date JcbriutT.Ja: 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 Raters 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 it): 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 Shell Ceiling w/Attic: R37,CE10",8-16 U=0.029 Window/Wall Ratio: 0.13 Vaulted Ceiling: None Wirdow,Type: U:0.30,SHGC:0.35 Above Grade Walls: R21,FG1,6-16U=0.058 WindowU-Value: 0.300 Found. Walls(Cond): None Window SHGC: 0.350 Found. Walls(Uncond): Uninsulated Infiltration: Htg:4.50 CIg: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 v12.97 This information does not constitute any warranty of energy cost orsavings. ©1985-2012 Architectural Energy Corporation,Boulder,Colorado. �/Z795 - ��4�� band. �3npoo� o��oQ��o�� Bono Professional Land Surveyors & Civil Engineers ESSEX SURVEY SERVICE. 1958 - 1986 OSBORN PALMER 1911 - 1970 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN S1ILE11/ MASS. 57 �(lo(�aSeO I �� 1(L'L LlAL . F /5 > .43,D L3ra,' I AvAaA CL USTEl2 I hereby certify to the (�?&,l/ Building Inspector that the pro- ZONE: LOT AREA: A&1)1,1 LOT FRONTAGE: /rl4 posed construction shown conforms / to the dimensional zoning of FRONT YARD: /Jr'4 SIDE YARD: REAR YARD: jV7 S�L��?� Mass. SCALE: DATE: Z"//Z REFERENCE: YG BK 90 Z PG X Chrfzf5pher R.�&llo PBS 313 `7ag yy MELLO rid 104 LOWELL STREET �r No.373i� PEABODY, MASS. 01960 <9 �sTEF (978) 531-8121 _ FAX: (978) 531-5920 Ub/ZZ/ZU1Z (16:04 B'AA till DZ"( 40'15 L Blern 1n5 NeWton I¢j UUUZ/UUOZ A� Q®' ' CERTIFICATE OF LIABILITY INSURANCE ix2/2�'012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO:RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.' THIS-CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A-CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holler is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain Policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder In lieu of such endorseme s . PRODUCER CZEcy Busan Donnell _ Eastern Insurance Group LLC PHONE EXII. (506)651-7700 FAX 233 West Central Street Ao airs:sdonnall@easterninsurance.c= PRDDucER _-- Natick MA 01760 WSU S AFFORDING COVERAGE NAICC INSURED MSURERAAcadia Inauranca Company 1325 INSURER S: DiBiase Corporation, DBA: DUC Residential LLC INSURERC: P 0 Booc 780 DNSURER D: INSURER E- LyrulPield MA 01940 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1262212770 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, NN66R EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS. L TYPE OF IN916lANCE POLICY NUMBER NN DY IF jMWDDdYM1 LIMITS GENERAL LIABILITY EACHOCCURRENCE $ 1,000,000 I ' . dAAM�E-YO RENTED % COMMERCIAL GENERAL LIABILITYt ! ' SE E�oe n n e - $ 250,000 A CLAb1Sdw]E FZ OCCUR cwLO191229-16 2/23/2012 I2/23/2013 y7ED EXP�MY mepaeon) S 5,000 `f PERSONAL 8 ADV INJURY S 1,000,000 GENERALAGGREGATE_.._ 6..__ 2,000,000 GEN'L AGGREGATE LIMIT APPLES PER: I I I PRODUCTS-COMP/OPAGG t _ 1,000,OOO POUCY % j PIi LOC $ �OYOBHE LIABILITY G i COMBINED SINGLE WWT $ ANY AUTO lEe a:rJtlentl �DILY INJURY(Pa palm) $ ALL DINNED AUTOS I --- I. SCHEDULEDAUTOS i I BODILY INJURY(Pora¢idmp:3 PROPERTY DAMAGE $ HIRED AUTOS i (Pa seeders) NONOWNED AUTOS $ UMBRELLA ea LIAB OCCUR EACH OCCURRENCE is I LIAB CLAIMS-MADE i AGGREGATE $ DEDUCTIBLE � $ RETENTION S IsINO — AHL)EM LOY MPENS4npN WC STATU- OTH. AND EMPLOYERS LIAaILIIY x .TORY ANY PRDPRIETDWPgRNNER/EXEOUnVE YIN WCA286788-13 102/23/2012 D2/23/2013 E.L.EACH ACCIDENT $ 100,00 OFFICERAAEMBEIi D(CLUDEDY �IN/AI A '@7An6ebry in NMIE.L-DISEASE-EA EMPLOY $ 100,00 ' IN ,dascMo uitler DFa RIPTION OFOPERATIONS bet" E.L.DISEASE-POLICY LOM S 500,000 1 � OESCRW7ION01FOPERATIONSILOCATIONS)VIDICLES (AMWh ACORD10/,AddlavlMRemsts Schadubh8mitespaceisrequtmM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN E93Washirigton alem ACCORDANCE GIRTH UCY PROVISIONS. Street 01970 D vE ACORD 25(200&Og) 1 CORD CORPORATION. AU ri hts reserved.INS025(2oosos) The ACORD name and logo are registered marks of ACORD 9 37-39 LINDEN STREET 558-12 GIS# ,' .s190. COMMONWEALTH OF MASSACHUSETTS Map 33 Block ., `-.f - � - CITY OF SALEM Lot = 0379 Category: INSULATION t Derr t# 558-I2 BUILDING PERMIT Project# JS-2012-0014731 Est. Cost: , -$21,145.99 �: Fee Charged: "$25.00 Balance Due: $.00 ;, Is PERMISSION IS HEREBY GRANTED TO: Const. Class: . -;- 'Contractor: License: Expires: Use Group: —1�".! .;__ ` Next Step Living Inc/Brian F Hassion CONSTRUCTIO SUPERVISOR-91377 Lot Size(sq:It.):'4481 8884 ��`;Owner: Michael Griffin ning: yo..,,' Zo R2 !— pr„zn•'v..,: Units Gained: 1 `-"' 'Appltcurnt: Next Step Living Inc/Brian F Hassion Units Lost: ,, ;� fit;. AT: 37-39 LINDEN STREET Dig Safe#: r ISSUED ON: 27-Dec-2011 AMENDED ON: EXPIRES ON: 27-May-2012 TO PERFORM THE FOLLOWING WORK.- AIR SEALING&INSULATION jbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: Service: Meter: Footings: Rough: Rough: Rough: Foundation: Final: Final: Final: Rough Frame: Fireplace/Chimney: D.P.W. Fire Health Insulation: Meter: Oil: - Final: House# Smoke: Water: Alarm: Assessor Treasury: Sewer: Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount BUILDING REC-2012-001639 27-Dec-11 864 $25.00 GeoTMS©2012 Des Lauriers Municipal Solutions,Inc. CITY OF SALEM �� 3� el ROUTING SLIP _ X,, / New Construction !/ �G�4 Certificate of Occupanc2 LOCATION XC O* A'FE� ASSESSORS. DATE 93 Washington St. CITY CLERK"s Y DATE '•: `93 Washington St. , 7--, ` r PUBLIC SERVICES DATE 120 Washington St. WATER V DATE 6ILf✓ ��' 120 Washington St. JZ�_ CROSS CONNECTION Abe' '✓�J�WATE 5 Jefferson Ave PLANNING , ha �k DATE s;I24 �12 120 Washington St. CONSERVATION TE 2— c-- (- _ 120 Washington St. ELECTRICAL ='»' ;r, DATE r = 4A Lafayette St. FIRE PREVENTION DATE Z 29 Fort Avenue HE �I TF7r�-tr d' D ATE! t• +:'. `F* #v% '. 120 Wa3hfngfo`n'SC"' -�` BUILDING INSPECTORp;�"fE 3 ��- 120 Washington St. i