12 CHURCHILL ST - BUILDING PERMIT APP The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
SALEM
Massachusetts State Building Code, 780 CMR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One- or Two-Family Dwelling
Building Permit Number�;
Date,'-,,
BuLl in, Offir,�l
$ECTION1 SITE INFORMATION
1.1 Property s 1.2 Assessors Map& arcel Numbers
Lla Is this an accepted street?yes V' no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning—District Proposed Use Lot Area(sq it)— Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6—Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 16/ Private 0 Zone: Outside Flood Zone? Municipal D'On site disposal system 13
Check if yesO
FRSF[IP
10
2.1 Owner'of Record:
Lauea Lghev�
Name(Print) City, State,ZIP
_L?K�Id ky,4; dzuflo�a
No. and Street Telephone Email
Address
SECTION 3;DESCRIPTION.Ofi
2(check'all that apply)
New
Demolition New Construction 0 Existing Building 09/ Owner-Occupied Cg/ Repairs(s) 0 Alteration(s) 01 Addition 11
0 Nuar Other 0 Specify:
0 Accessory Bldg. 0 Number of Units Other
Description of Proposed Work:
SECTION 4 ESTIMATED
'A
Estimated Costs:
Item w a. a Offictaruse"nJLY ,,
�.A
(Labor and Materials)
deturnmed:4
$ Indicate.how Lfee'JS
1. Building
yrvApplicahbn,F66
K
2. Electrical $ X'Cost:
3. Plumbing 1;
4. Mechanical (HVAC) $
5. Mechanical (Fire tal�Alj,FecS
Suppr ssion)
: Cash A-m6uht.,,,
Check N Check Amount..
6. Total Project Cost: 0do lj,Paid ifi.FuV ❑ Outstanding Balance Due
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor Y License(CSL) qWq�N ZOL3
It) i Lt'A Y1^t h 67 (_k) License Number Expiratio r Date
Name of SL Holder 11 T
y.3 NO��-i'� List CSL Type(see below)
� („J
No. and
rr Street Type Description-
U Unrestricted(Buildings u to 35,000 cu. ft.)
Y✓/ O C47C>
/ R Restricted I&2 Family Dwelling
Cityolwn�,l State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 1 177 Y)13
k'J.-r �"� ^ 1-�q lq (2-� HIC Registration Number xpv [ion Date
HIC Company Name or HI�Registra t Name
f
o. and treet Email a ess
or u 9 7y Po8 Coo
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 .......... H'- No ........... ❑
SECTION 7ai OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILLLDING PERMIT"
I, as Owner of the subject property,hereby authorize L_VY1G h witS
to act on my behalf, in all matters rela ive to work
authoriz d by t 's building permit application.
Print Owner's Name(Electronic Si nature) Date
SECTION"7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true 40 accurate to the best of y kno ledge and understanding.
��h v- &/-
Print Owner's or Authorized ge 's Name(Electronic Signature) Date
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 can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass._Tovilns
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 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"
Existing 2x Post, Add Post Cap
Reinforce as Required
IIr Delete Existing Door
i c I Existing 2x Post,Add Post Cap
BA HROOM I I Reinforce as Required
�U
p II
` - - - - - - - - - - - - - — - — - — - —
STAIR FRAMING:
(3)2x12 Carriages
Metal Carriage Hanger
(2) 9112" LVLs for CarriE
II ` - — - — - - — - — _ — _ — _ — _ — Provide Railing per Cc
Width per Code
- - — - — - — - _ — DN ` - — - — - — - — - — 12 Risers @ 81"v' 9"Ti
— - — - — - — - Existing Stair DOWN
- - - - - - - - - 2t9LVL = ` - - - - - - - - - - -
_ New Double Rim Boan
- - --New2xP-osiw_/PoetQap — W Top Plate and Sill Plat(
Ul t at Entire Perimeter for
Locate Above Existing
— — y BearinaWall at First Floor 0 0 Third Floor Deck Fram
Lu
-
KITCHEN .616 I 6J r New 2x Post w/Post Cap ° La
oeate-Above€x+st+ng
LLB IIIN l I r Bearing Wall at First Floor w _
---- - - — - --��-- -- --= — � --_--- _-- --- ---- Line of Bearing Wall.
a - --- --- Below Second Floor Fram
- - - - - - _ - - - - - - - - - - -
- - - -
III W I
= IW I ° _ - _ - _ - _ - _ - _ -
IIr O I UP -6 O
III�_ m U _ — _ — _ —
c2> 9VLs00 cc
I — _ — - — - —
FRAMING NOTES:
I ` - -E - -
r 5 r E > All Floor Framing to be 91""
— _ _ — _ — _ — _ — _ — _ — All Hangers to be Top Flanc
All Posts to be (3) 2x6 Multi
I r q All Beams Noted as LVL arf
°°;� - ` - �` - ` - — - — - — - — - — - Gang-Lams of Width of I
®� _ l I - — - r - — - — All Headers to have (2) Jacl
(1) King Studs at Each E
All Headers to be(2) 2x10
Rim Boards to be (2) 91/2"x
III Existing 2x Post Provide 2x4 Squash Blocks
Reinforce as Required Under Walls
Top Plates IIII I tes tc
Existing 2x Post All SubflooraPa end ilsll Ptoabe 3/
Ill—_ — _ _ I Reinforce as Required Glue and Nail, w/Finish
Limit of Work
1 L Reinforce All Existing Secor
Land Minimum ON I wore
I I
Existing Roof
at Bathroom
II ''
I
I I I I I I I I I I I I I I I I I I I I I I I
�N
I I I I I I I I I I I I I I I I I I I I I I
R:quigr:by ode Existing Ridge Beam
I I I I I I I I I I I I I I I I I I I I I I
I_ --1 _ _ STAIR FRAMING:
(3)2x12 Carriages
=1 1= =F = T F �7 = T = T - T' -1 Metal Carriage Hang,
(2) 91/2" LVLs for Carr
Provide Railing per C
Width per Code
a � I I I r 1 V4„ 9"
I Existi g R fterFlamin Existing Rlfter J Iramii 19 12 Risers @ 8
r—�
Rein orce s Require Reinforce as R quire
g Roof
stair 11
ry I I I FRAMING NOTES:
All Floor Framing to be 911�'
All Hangers to be Top Flanc
4 All Posts to be(3)2x6 Multi
p
All Beams Noted as LVL an
Gang-Lams of Width of I
All Headers to have(2) Jac
(1) King Studs at Each E
1 All Headers to be (2) 2x10
1 1 Rim Boards to be (2) 91/2"x
ip Provide 2x4 Squash Blocks
ip Under Walls
ICI Top Plates and Sill Plates tc
III _ All Subfloor Panels to be 3/
Limit of Work 1 Glue and Nail, w/Finish
1 1 Reinforce All Existing Secoi
%Ad Minimum /91 I revere r
(2) 2x4 Plate
Finished Floor Finished Floor O enin Finished Floor
/ Subfloor @ 3rd Floor Subfloor @ 3rd Floor for Stair Subfloor @ 3rd I
hP,y Floor Joists @ 3rd Floor t
Floor Joists @ 3rd Floor i : Floor Joists @ 3
Joist Hangers Joist Hangers Joist Hangers
(3) LVLs, Continuous (2) Rim Boards (2) LVLs for Stai
from Post to Post
(2) 2x4 Top Plate i
Existing 2x Framing
Existing Exterior Sheating
Detail @ LVL Beam Detail @ Rim Board 7 Detail @ Stair
SCALE: 3/4" = 1' -0" SCALE: 3/4" = 1' -0" SCALE: 3/4" = 1' -0"
L