21 AMANDA WAY - BUILDING INSPECTION (4) 4 •1 The Commonwealth of Massachusetts
I !� 7> CITY OF
Board of Building Regulations and Standards SA EM
j bfassachusetts State Building Code,780 CN[R Revised Ylar 201
Building Permit Application To Construct, Repair, qenote Or Demolish a
One-or Two-Family avellm
[his SectionFor-Official`UseOnl
r
Building Permit Number: Dale Apphedi'.
Building 0lficial(PrintNama) � �Sgn uc - Date
SECTION I:SITE INFORbG1TION
I.1 Prop rty Address: LZ Assessors hlap& Parcel Numbers
M H'0' 4 a2hA /
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.01 c.40,§54) 1.1 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if es❑
SEGTIONI; IPROPERTV'OWNERS1EU?
2.1 Ownert of Record•
Name(Pri t) --v Ci Stat ZIP
l /�x,,9,u log I,� lt-t Y WAD
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED iVORW'(check ail that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) At eration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units Other ❑ Specify: .
B ief Description of reposed Work2: L L-
D
SECTION 4: ESTIMATED CONSTRUCTION COSTS-
Estimated Costs:
Item Official Use Only-;.
Labor and Materials
1. Building S ��� 1..Building PermitFee:S Indicate how fee is determined:
❑Standard,C y!T'uwnApplicationFee.
3. Electrical $ ❑TotaI Froject Cost (Item 6),c multiplier x
3. Plumbing 5 2. Other Fees S r
t. Mechanical (IIVAQ i List:
. Mcchanical (Fire $ .
5n ressiun) _ Ntal All Fees:S_
Check No. _Check Ainuunt: Cash r\nwuuC
1'11fal Project Cusf. $ / S 1
LiI(�f! • id in Fill ❑Outstandim, Ik hace Ihw: - - - -
SECTION 5: CO:Ns rRUCTION SERVICES
5.1 Construction Supervisor License(CSL) "Le q 6 Q - a�
16 C L4AA d A OcrA u ip i- _ License Number Gxpiruion Uate
Namc of CSL I lulder below
p List CSL Type(see )
F1 K�l LL 41 y ry e Description
No. and Street Urim-tricted Buildings up to 35,000 cu. tl.)
Restricted 13r2 Family Dwelling
(. ti y/Town,State, ZIP M Nlasonr
RC Ruutin Cuverin
WS Window and Sidin•
SF Solid Fuel [turning Appliances
�.i8m, V tot(7 s [ Insulation
Telephone Email address U Demolition
5.1,,Registered Home Intf ovement Contractor(if L /old 0
1 egistr do 1 Number xpiranun ate
IIIC Cump.nt Name or It Rcgist u�yne / 1 /� ? CcWU4 1-6
filtv/TowN.Stite.
Street n i t"- 7 Pl d-�r :f DD Emad address
I A( / J Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152.1 15C(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 Affldavit Attached? Yes.......... No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO DE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BBUILDING PERMIT
I, as Owner of the subject property,hereby authorize r(i l 6N iA -.L. (i e-o t-a(7
to act on my behalf, in all matters relative to work authorized by this building permit application.
, �4 (L� /ZJ
int Owner's Name(Electronic Signature) 'to
7SECTION 7h: OWNEW OR AUTHORIZED AGENT DECLARATION
eniteringe below, I hereby attest under the pains and penalties of perjury that all of the information
lication is tru and accurate to the best of my knowledgeand understanding.
rized.\gent'Y N,true(Electronic Signature) Date
NOTES:
I. alit 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 ant have access to the arbitration
program or guaranty fund under M.G.L. c. I42A. Other important information on the FIIC Program can be found at
Ioww.n:us.euv/uca Information on the Construction Supervisor License can be found at www.ina. .,�v_dL
2. When substantial work is planned,provide the information below:
Tul:d tloor area(ski. It.) _(including garage, tinished basementlattics,decks or purch)
tiro:; Living area(sy. it.) _ ffabitabte room count _
Number'IttirapI.tcei_—_------- Number ufbcdruums ._-- ----------_-...-_--_--
Numbcrotbathrnunls ----_---___-- Number ofhalG'baths
- -- - - —
1\pc of heatingiystcnl _ -- ._-- Numberofdeck,"purchcs
I)peofcoolingiyueul __--_- .-.-.-.- F:uclaicd_ --_ _ Jlpcn _-----_--
� t. 'I',a.il I'r,q.rt Sylcire Pt.lq�" in.ly br ;nh;tinit:d t.,r"I' t.il I'ruj,:c( lb;t"
a i+ r n^r. 'M +.sr L ri�,•,. sT�Si 'j' a +' rt.waym� "" ",c fi"T3 9°e v.y�.+h+ayx n .n
y a
i CITY OFS.1LE.�i1tL1ss1CHUSETTS
B1:ILDING DEPARTJIEDIT
120 WAsHINGTON STREET,3no FLOOR
TEL. (978)745-9595.
FAX(978)-740.9846
Kl.%fB Rt F.Y DRISCOLL
MAYOR THONLUST.PIERM
DIRECTOR Of PUBLIC PROPER4Y/BUHb11NG COMIMIONER
Workers' Compensation insurance Affidavit: Builders]Contractors/Elecfricians/Plumbers
A licant Information Please Print Legibly
Name(BusiivWOrganizatioivindividual): d L vtF
Address:
City/Statc/ZiP:. (/� Phone n2"� z "
Are you an emplayer?Check the appropriate box: 'type of project(required):
I. am a cmpioye with,' 4. ❑ I am a general contractor ands 6. ❑New conktruction
onlployees(1611 and/or part-time).* have hired the sub-ciintractors
2.❑ 1 am a sole proprietor or partner+ listed on the attached.shect t 7• Q Remodeling
ship and have no cmptoycey..; ; These sub•conttactors havo a. f]_Demolition
working;;for me in arty capacity:r workers'comp.insurance g Duitding addition
[No worker comp.insurance. 5. (] We are a corporation and it's- i
required.); oincers have exercised their:. 10 E1 Eleciricairepairs or additions
3.0 1 am a homeownu doing all work right of ex Lion per MGG l l.❑Pluisibing repairs or additions
myself.',[No workcis'comp. c, 152,§1Ms.an we have no' 12.r] Roof repairs
insurance required.]t` omployees:[No wortrers':' 13.❑Other'
earn nstrrarice rcgoircddJ
•Any applicant that chaks box rl must also rill uut the sticalm below showing their varkeµl aampeowiun peliay infurmetfott,'
fi t hxneuwneis rho submit this affidavit indiadng they are doing ail work andlhee hire outride Contra=i must submit a new aMdavit indicating such•
:Contrautors that chuck ilds box mass attached an additfund slusat showing the name of the sutVCanr7den snilthalf wurkrn'cwnpp puliey infdimmioe:..
lam
njo�as employer thW fir prodlding workers'romprnsofioa uvarbnca jor my empluyerx'Belaw Ls the poiicygadJo6 site
Insurance Company Name:�_� �--
Policy#or Scif-ire.Lic.d: �] ,�1 ' / Expiration Date:
job Site Address:—k` 1x m A A VA A,1City/State/Zip:
.luach a copy:of the workers'compensation policy dec radon papa(showing the poiley number and expiration date).
Failure to sceurc coverage as required under Section 25A of iv1OL c 152 can lead to the imposition of criminal penalties of a
tint up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S230:00 a day against the violator. De advised that a copy of thisstucment inay fits forwarded to.the Office of
Investigations orthe D1A for insurance coverage vcriticaliun.
!do hereby c rr ukr r/ r r a I ojper that the firjoinrarlar provided uba is True nd correct.
Oflitda/use ordy. Do not write in t1l is area,to be completed by city or Iowa 4JJk1oE
City or*rown: PermittlAense# _
Issuing Auihori/y(circle one):
I. Board of Ileaith 2.Building Department 3.City/town Clerk 4. Electrical inspector 5. Plumbing Inspector
6.Other
Contact Person: _ _ Phone#•
CinoFSiU.r..�,l' L` LASSi,CHUSEi lS
y
BL:LWLNG DEP.IRTIENT
CU.13NLVGTON STREET, 3 °F�OOR TaL(978) 715-9595
,'<ismE2i.EY DRISCOLL Ftt(�78) 710.9345
AiYOR -1ItO.N4U ST.nERRB
DI ECTOR OF FLOCK PROPERTY/BL:LWL-1G CCNWI5SIO,NEA
Construction Debris Disposal AFl7davit
(required t'or all dcmglition and renovation work)
In accordance with the sixth edition ofthe State Building Coda, 730 Cjv1R section 111.5
Dcbris, ind the provisions of tbICL c 40, S Sd;
Building permit k is issued with the condition that the debris resulting from
111 work shall be disposed of in a properly licensed waste disposal facility as defined by NICL a
I t t, s l sn,�.
The debris will be transported by:
D -
(name urhaular)
The dubris will be disposed of in
(Manta of t•.tadity)
(;dJress ui rittilit�)
o
C
;i•tnamra nt permit a I'tutr NP t�
I
�O two
Office o(Cousumer faits mess, egulatwo;.
HOME IMPROVEMO NNBT CONTRACTOR Type:
Registr
ation: 1,
I - 10 Padnershi
Expirationp
.- 120/2014
C 'OLO REMOLD.ELI N.�.-G�� r��'
RICHARD CERUOPOF -�
51 KIMBALL AVE
REVERE,M02151 Undersecretary
,
.v. Massachusetts- Dep:utruent of Public Safet\ -
1� Board of Buildim_ Rc[ulatiuns and StandarJs'
Construction Supervisor License
License: CS 28480
�r
RICHARD A. CERUOLO {
51 KIMBALL AVE
REVERE, MA 02151;
Expiration: 8/26/2013
Trp: 20823
WE
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Specs for Amanda Way, Salem
2x6 Walls: R-21 (unfaced) fiberglass batt.
-TAPE sides &staple TYVEK to exterior surface of wall framing adjacent to attic space.
-On walls adjacent to EXTERIOR WALL ONLY: apply 4 mil. poly to interior surface.
-Bathtubs/shower adjacent to exterior wall needs poly taped to frame at interior side.
Sloped Ceilings:
-Ventilation baffles throughout, SEAL w/sprayfoam to roof,to Ridge beam, and at
eave to subfloor. SEAL all gaps that exterior air can leak into insulation cavity.
-Insulate w/ R-30 (unfaced) fiberglass batt.
-Attach between sheetrock strapping: 5/8" white "bead" foamboard.
Flat Ceiling:
-Attach between sheetrock strapping 1x3: S/8" white "bead" foamboard.
-Install R-30 (unfaced) fiberglass batts to be in contact with above foamboard.
Windows,Jack-Studs and bottom plate:
-Seal gaps between framing with canned sprayfoam and/or painter's caulk:
BEFORE Sheetrock:
-Staple %-width strips of foundation sill gasket foam to top-plate of ALL exterior and
interior walls (sheetrock is installed to COMPRESS this gasket to seal top-plate gaps to attic).
Ducts: All seams are to be sealed. NEW ducts to be insulated to R-8 and tested for leakage.
-Caulk register boots to sheetrock.
Final Airsealing:
-Caulk recessed lights, electric boxes, and all other penetrations to sheetrock.
-Attic Hatch: insulate and add weatherstripping to seal it. Add weight on top to
compress weatherstripping.
R-21: 765 s.f. R-30: 1405 s.f. TYVEK: 270 s.f. Baffles: 120 4' lengths
4 mil. Poly: 500 s.f. 5/8"white "bead" foamboard: 1400 s.f.
777:1
Ian Rex, Principal 978.233.1433
11 Broadway, Suite 3, Beverly, MA 01915
email: tan@TheEnergVHound.com
www.TheEnergyHound.com