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24 BARNES CIR - BPA-11-168 2 STORY ADDITION a The Commonwealth of Massachusetts Board ot•Suilding Regulations and Standards CITY i SALEM s Massachusetts State Building Code, 780 C'MR. 7'edition Rrvi��rr/Jonuan• Building Permit Application To Construct. Repair, Renovate Or Demolish a /. :o/AY One-or Two-FuntilF Dwelling This Section For Official Use Only �- Building Permit Nu r: 4 Date Applied: Signature: oJ2�� Building C rmis ' ner/Inspector of Buildings Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers IT IWNAS GIQGLw I.la Is this an accepted streel?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Am(sq 11) Frontage(tl) 1.3 Building Setbacks(R) From Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water upply:(M.G.t.c.40•§54) 1.7 Flood Zone Information: l.a Sewage Dis I System: Zone: Outside Flood Zo 7 Public Private❑ Check if es@' Municipal site disposal system O SECTION 2: PROPERTY OWNERSHIP' 2.1 qwneKJ of C9 f V-) CA P N Address Service:,-- 5n/� t Si ore Telephone SECTION J: bkSCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work': y6ki Z 570✓ZY /W0/7-10tJ wyy4f ffvc.-OtrS 4 )"Ihfi"d:R $�0•fD�n �i 3/t7-H n�v PrRST FCa�. (�Aa�dtO KITLNrtr' < L/v�i-?r SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Omclal Use Only Labor and Materials I. Building S/ZCR Oo 6 1 I. Building Permit Fee:S Indicate how fee is determined: 2. Electrical S - ©D o ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 1. Plumbing S SDa O 2. Other Fees: S 4. Mechanical (tIVAC) S List: 5. Mechanical (Fire S Su ression Total All Fees:S Check No. Check Amount: Cash Amount: 6. Total Project Cost: I S 3C)i p0 O ❑Paid in Full O Outstanding Balance Due: '7-'qr L =Co ECTIONS: CONSTRUCTION SERVICES Licensed Construction 0�C L�' 1.isi C'SL Type(see below) Q N✓1!e/J tL f Descri iontimestrictrJ u Io 35.DOOCu.Ft. R Restricted Id2 Family Dwelling: Signature ! /� M M lhtl RC Residential Roolins Covering felephone WS Residential Window and Siding 11 SF I Residential Solid Fuel BuntingA liance Installation D ResiJemiof Demolition 5.2 Rt br Lte re�rdDH-ro mTel �roverneat Contractor(HIC) �4gZ V (m_ t;ONJ7�l Registration Number MCC Company Name or HIcORcgrstraim N;un ear AddressO ' b '0 Address b�> �1��(�l Es cation Dale Signature Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. I52.! 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 Attach .......... No...........O SECTION 7a:OWNE AUTH(JAUZATION TO BE COMPLETED WHEN OWNER'S/AGENrOft CONTAACTOR APPLIES FOR BUILDING PERMIT <� as Owner of the subject property hereby author; a 'N to act on my behalf,in all matters relative sow all orized b th' b ilding it application. ��h Si re of Owner Date /SECTION 7b:OWNER R AUTHORIZED AGENT DECLARATION 1, 'O&L//s G-0 u ZaHLE 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. Print Nome , X/ 17/I6 Signature ofOwner Authorized Agent Dal r S SiAned under the pains and penalties of 'u 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 Ugj have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.R3, respectively. ? 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/boths Type of heating system Number of decks/porches Type of cooling system Enclosed Open ). "Total Project Square Footage"maybe substituted for"Total Project Cost" • � '� �las.cachusctts - bcpartmcnt of Public `;dots 1y Board of BuildinL' Re-ulations and Standards Construction Supervisor License License: CS 40282 Restricted to: 00 PHILIP GOUZOULE 50 EVANS RD MARBLEHEAD, MA 01945 Expiration: 4/17/2012 (-numivaionrr Tr#: 24721 s a 7Ptr(T, I ua o iw mK ReRulati ns and StandarJs HOME IMPROVEMENT CONTRACTOR Registration: 144872 Expiration:. 1 111 612 01 0 Tr# 277365 Type: OBA PHIL GOUZOULE CONST, PHILLIP GOUZOULE'" 50 EVANS RE) ��y...G1-�•...� MARBLEHEAD, MA 01945 Administrator ..-.•,,..,o..... _ ..tea..---••—•,—"-r'---"'-^-_ ..,. ... s CITY OF SALEM ,.�, iti PUBLIC PROPRERTY '• s DEPARTMENT L I k11r KI EY DHIiCU I.I. �i�Ytln 12CWAibtivc.A0NS'rnEET0SAt.hu,MAss.x(:iirii%*iis01971 _ '1e1.:978-745-9595 • FAX:978-74^•9846 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A f olicant Information l't- Please Print Leeihly Na me ie (13ucincxyOr�anizatioNlndividuall: .v,L - GP zvN`�C coN�RU C�foIi - Address: SO C UA VS Q i7 CityrStarelzip: /'" klo, LJ4f�tCf�10���1`1�S Phone %: Are you an employer? Check the appropriate bolt: 'Type of project(required): I.❑ 1 an,a employer with 4. I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).' have hired the sub-contractors 7. ❑ Remodeling 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. : ship and have no employees These sub-contractors have 8. ❑ De olition working for me in any capacity. workers' comp. insurance. 9. uilding addition No workers' cumP• insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers haveexcrclscd their - right of exemption per MGL I L❑ Plumbing repairs or additions 3.El I am a homeowner doing all work S P myself. [No workers' comp. c. 152, j 1(4),and we have no 12.0 Roof repairs insurance required.j I employees. [No workers' 13.❑ Other comp. insurance required.] -Any oppllcatn that checks box ill must alsu till out the eclion below showinll their workei compensation policy information. I I lomatwrxrs who submit this atYdavir indicating they ate doing all work and then him uuisidc cenmcton must submit a new afridavit indicating Such. ;C.,ntncton that check this box most attached on additional sheet showing the name of the sub-contractors and their workers'comp.policy information. l tun or employer that is providing workers'c•otnpen.cation insurancefor mty employees. Below is the policy and fob site irrforntution.Policy 4 or Self-ins. Lie. t: Expiration Date: Job Site Address: City/Slate/Zip: Attach At copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of NIGL c. 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against flit violator. 13c advised that a copy of this statement may be forwarded to the Office of Invrsligations of the DIA for insurance coverage verification. l du hereby certi t or the pains and penulrics of perfttry that the information provided abov is true mad correct. Sicnamrt. ( Darr 6 9 �0 Phl lnc tie - Offie•ial use only. Do not sprite in this area, to be completed by city or town aJJicial. City or Town: Permit/License Issuing Authority (circle one): 1. Uuard of health 2. 1311ildtug Department 3.CilyfIFown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Cuutuct Pcrsou: _._.._ _ _--_ Phone if: Information and Instructions \lassachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an er»plgree is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more engaged in a joint enterprise, and includin the legal representatives of a deceased employer,or the of the foregoing� zn u s, rP g g 6 6 b 1 receiver or trustee of an individual,partnership,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 dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." \iGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has riot produced acceptable evidence of compliance with the insurance coverage required." .additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subilivisions shall enter into any contract for the perfomhance Of public work until acceptable evidence of conpliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill 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 nunhber(s) along with their certificate(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 Accidents for confirmation of insurance coverage. . Also be sure to sign and date the affidavit. The affidavit should be retumed 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 self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to till in the pennidlicense number which will be used as a reference number. In addition,an applicant that must submit multiple pennidlicense 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 town)."A copy of the 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 for 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.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. 1'11c Office of f live sit gations would like to thank you in advance fur your cooperation and should you have:my questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: h The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax #617-727-7749 Rcviscd 5-26-05. www.mass.gov/dia CITY OF SALEM PUBLIC PROPRERTY ,`,,'�;;�• DEPARTMENT ::,I ..• a: L'; U.�,�u�,.,,��iiin,r r • S.N I M. \1.\'IN, Construction Debris Disposal Affidavit (required lix all demolition and renovation work) In accordance \ill, the sixth edition of the State Building Code, 780 CMR section 1 1 1.5 Debris, and the provisions of NIGL c 40, S 54; Building Permit if is issued with the condition that the debris resulting from this \vork shall be disposed of in a properly licensed waste disposal facility as defined by MGL c I 11. S 150A. The debris will be transported by: J-4VAftjs 7-KvcGtr,t)6- I nanlc(it llanler) I he debris will be disposed of in l�AfZO%�lfKl}� T/1�}o�srG2 si.iT�"� (name of facility) IuJdres. ul facility) .ignat rc of pcnnit .yrplicant ,late REScheck Software Version 4.0.0 Compliance Certificate Project Title: Doherty Project Report Date:08/23/10 Data filename: C:\Documents and Settings\FmnkW\Desktop\Doherly.rok Energy Code: Massachusetts Energy Code Location: Salem,Massachusetts Construction Type: 1 or 2 Family,Detached Heating Type: Other(Non-Electric Resistance) Glazing Area Percentage:. 17% Heating Degree Days: 6268 construction Site: Owner/Agent: DesignerlContractor: 24 Barnes Circle Phil Gouzoule Ryan McShera Salem,MA 01970 Phil Gouzoule Construction Pitman and Wardley Architects 50 Evans Road 32 Church Street Marblehead ,MA 01945 Salem,MA 01970 philgouzoule@gmail.com (978)744-8982 pitmanwardley@verizon.net Ceiling 1:Cathedral Ceiling(no attic): 552 36.0 3.0 - 14 Wall 1:Wood Frame,16"o.c.: - 812 22.0 2.0 43 Basement Wall 1: Solid Concrete or Masonry: 464 19.0 10.0 13 Wall height:4.7' Depth below grade:4.0' Insulation depth:4.0' Window t:Wood Frame:Dcuble Pane: - 79 0.300 24 Door 1:Solid: 16 0.300 5 Dow 2:Glass: 91 0.300 27 Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the Massachusetts Energy Code requirements in REScheck Version 4.0.0 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. The heating load for this building,and the cooling load S appropriate,has been determined using the applicable Standard Design Conditions found in the Code.The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the design load as specified in Sections 780CMR 1310 and J4A. ko M4'7N"tk , $ 23 7p Name-Title ignaWre Date Project Notes: Owner Information: Kevin and Rol Doherty 24 Barnes Circle Salem,MA 01970 REScheck Software Version 4.0.0 Inspection Checklist Date: 08/23/10 Ceilings: ❑ Ceiling 1:Cathedral Ceiling(no attic),R-36.0 cavity+R3.0 continuous insulation Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame, 16"o.c., R-22.0 cavity+ R-2.0 continuous insulation Comments: Basement Walls:. 0 Basement Wall 1:Solid Concrete or Masonry,4.7'ht 14.0'bg/4.9 insul, R-19.0 cavity+R-10.0 continuous insulation Comments: Windows: ❑ Window 1:Wood Frame:Double Pane,U-factor:0.300 For windows without labeled U-factors,describe features: #Panes_Frame Type Thermal Break?_Yes_No Comments: Doors: ❑ Door 1: Solid, U4actor:0.300 - Comments:. ❑ Door 2:Glass,U-factor:0.300 Comments: Air Leakage: Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage are sealed. When installed in the building envelope,recessed lighting fixtures#meet one of the following requirements: 1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated,in accordance with Standard ASTM.E 283,with no more than 2.0 drn(0.944 Us)air movement from the the conditioned space to the ceiling cavity.The lighting fixture has been tested at 75 PA or 1.57 lbst t2 pressure difference and shall be labeled. Vapor Retarder: Installed on the warm-in-winter side of all non-vented framed ceilings,walls,and floors. Materials Identification: Materials and equipment are identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. Insulation R-values and glazing U-factors are clearly marked on the building plans or specifications. Insulation is installed according to manufacturer's instructions,in substantial contact with the surface being insulated,and in a manner that achieves the rated R-value without compressing the insulation. Duct Insulation: Ducts are insulated per Table J4.4J.1. Duct Construction: All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air,are sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions.Mesh tape may be omitted where gaps are less than 118 inch.Duct tape is not permitted. C) The HVAC system provides a means for balancing air and water systems. Temperature Controls: Thermostats existfor each separate HVAC system.A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor is provided. Heating and Cooling Equipment Sizing: Q Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: Circulating hot water pipes are insulated to the levels in Table 1. Swimming Pools: All heated swimming pools have an on/off heater switch and a cover unless over 20%of the heating energy is from non-depletable sources.Pool pumps have a time clock. Heating and Cooling Piping Insulation: 0 HVAC piping conveying fluids above 120 degrees F or chilled fluids below 55 degrees F are insulated to the levels in Table 2. Table 1:Minimum Insulation Thickness for Circulating Hot Water Pipes Insulation Thickness in Inches by Pipe Sizes Non-Circulating Runouts Circulating Mains and Runouts Heated Water Temperature(°F) Up to 1" Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes Fluid Temp. Insulation Thickness In Inches by Pipe Sizes Piping System Types Range(°F) 2"Runouts 1"and Less 1.25"to 2.0" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant and 40-55 0.5 0.5 0.75 1.0 Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD:(Building Department Use Only)