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15 DUNLAP ST - BUILDING PERMIT APP (002) JACKET k: -RECEIVED ICES The Commonwealth of Massachusetts IK• R �` jP Board of Building Regulations and Standards CITY OF qMassachusetts State Building Code. 780 CMR 1S C� �,M M h �., ° 9 r /v t12er1h3dalJ/ 7P Building Permit Application To Construct_ Repair,Renovate Or Demolish a ?) One-or Two-Family Duelling This Section For Official Use Only Building Permit Number: Date p icd: �— Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Prvnp h'Ad m 11.2 Assessors Map& Parcel Numbers l�t_ lc�2C L la Is this an accepted street? ves_—L 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.G.I.c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone? Public❑ Private❑ Check iI yes❑ Municipal ❑ On site disposal systcm El SECTION2: PROPERTY OWNERSHIP' 2.1 Owner of Record: c c c�u k C)c\ �c� Name(Pont) City, State,ZIP 1 y q -Lcq- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction ❑ molition Existing Building❑ Owner-Occupied ❑ Repairs(,) ❑ Alteration(s) ❑ Addition ❑ De ❑ Accessory Bldg. ❑ Number of Units ther ¢Specify, Brief Description of Proposed Work 2: � . s)—f �l1 J pam t) C)ic!� l. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1. Building $ 1 b 1. Building Permit Fee: $ Indicate how fee is determined: �. Electrical $ 1�1 �iQ ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 4. Plumbing $ 2. Other Fees: $ 4. Mechanical (TIVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount:6. Total Project Cost: $ O000 Paid in Full ❑Outstanding Balance Due: Cry a 1 4 MF (221 15 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supenisor License(CSL) a 1.7 C1�� License Number EXpiraC n Date Name of CSL 1 1. List CSL Type(see below) No.and Street Type Description � ) U Unrestricted(2 Fanply up ming cu.ft.) _ - R Restricted IR2 Family Dwelling CaN. State; 71P M Masonry RC Roofing Covering WS Window and Sidin,, ^^�� SF Solid Fuel Burning Appliances 6b��A\J ';lq) OCID] I Insulation 1'elz hone Email address D Demolition 5.2_Begistero Home Improvement Co r tractor(HIC) \ , .- m l Registration Number Espirati6��0(n Date HIC'ConTrmO Nam.or HIC RIcl- 1�ise+z trairt o. rid S e t Email address Citv/Town,State,ZIP �— Tzlephone J SECTION 6: WORKERS' COMPENSAT ON 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 Issuanc 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 Owner of the subject property,hereby_ authorize to act on my behalf,in all matters relative to work authorized by this building permit applicap on. cm)-oAoy �_�_�cr [[ q F riot Owner's Name(Electronic Signature) Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contain -d in this p r tion is tnae and accurate to lire best of my knowledge and understanding. riot Owner's or Aulhorir Ageni s Name(Electronic Signature) D e 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 MG_L. c. 142A.Other important information on the FIIC program can be found at taryew.mass.gov/oca Information on the Construction Supervisor License can be found at www.masseov/dvs 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 lialf/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" Optimize Engineering Co., LLC P.O. Box 264•Farmville•VA 23901 Ph: 434.574.6138.E-mail: grichardpe@aol.com Richard B. Gordon, P.E. President September 1, 2015 Salem Building Department Salem, MA Re: Solar Panels Roof Structural Framing Support To Whom It May Concern: I hereby certify that I am a Licensed Professional Engineer in the State of Massachusetts. Please note the following conclusions regarding framing structure, roof loading,and proposed site location of installation: 1. Existing roof framing: Conventional framing is 2x6 at 24"o.c.with 8'span(horizontal rafter projection). This existing structure is definitely capable to support all of the loads that are indicated below for this photovoltaic project. 2. Roof Loading • 4.33 psf dead load (modules plus all mounting hardware) • 27 psf snow live load (45 psf ground snow live load reference) • 4.5 psf dead load roof materials • Exposure Category B, 115 mph wind uplift live load of 19.6 psf(wind resistance) 3. Address of proposed installation: Residence of Cheryl Casey, 15 Dunlap St.Salem, Massachusetts This installation design will be in general conformance to the manufacturer's specifications,and is in compliance with all applicable laws, codes, and ordinances,and specifically, International Residential Code/ IRC 2009, 2011 NEC,and 2012 ICC Energy Code. The spacing and fastening of the Unirac mounting brackets is to have a maximum of 64" o.c.span along the rail between mounting brackets and secured using 5/16" x 31h" length corrosive resistant steel lag bolts. In order to evenly distribute the load across the roof rafters,there shall be a minimum of 2 mounting brackets per rafter&min.2" penetration of lag bolt per bracket,which is adequate to resist all 115 mph wind live loads including wind shear. The mounting brackets shall alternate between adjacent rafters between rail rows for better distribution of roof load. Penetration of anchors for modules mounted within 18"of ridge and edges of roof is to be a minimum of 3". Rails may be attached to either of two mounting holes in the L-feet. Mounting in the lower hole for a low profile, more aesthetically pleasing installation or mount in the upper hole for a higher profile to maximize airflow under the modules to cool them more. Slide the 3,8-inch mounting bolts into the footing bolt slots. The rails will be attached to the footings with the flange nuts. Very truly yours, Optimize Engineerin C , LLC� Richard B.Goo en;^ .E. Massachusetts P.E. Licei se No.49993 cr% OF' -Mq s 5 MECHANICAL, CIVIL, ELECTRICAL ENGINEERING s'r� �C, �z N v�'I RIC.HAnO .d O pgECHA!11CAL �1i•\j �'C <V� �FFSSiow&c`�, 1.1. REM YV RI MODULE.im.Gv UNIPAC CLAMP U:D.L BEETS M01WRHT1MUNE0ULE Imtsrrcxnra m-N !! ! ExR rMC F � souRMoouLf POLAR MouE DRT,T`RE ,"DERGANIFREF iETEFDA S AERE AHE LS UNIBAC I TRMONNL REAM KEF,U,ApLTG b UHIRACLFOOT IME--ITT. maT® 4 \\1]ISI y/ F (REFER TO THE UNIRAE ME vu RNEI—. CrvE YEP ASPHALT OiNGlES tR I,o µUl FDA 11 T�xFµ)D ENFNG 6VNM000 FIASmIuwG MOC SFNAxi ry \ /'Y "� xEw DLD aP,mleu Ia¢Mea ,ro.oLT"' G- (PEFERIOTNELMMC RNN - AL" MVTImSTµLgTION P ECEM'0 uEX1 $pSWEEDPEAKHEIGH NDT —� RTNLEaF � GJ{ISTHG RAFTER EXCEfOPFM HEIGHT P£FEPTOTHEUNIR4C COOECOMPLWrtIN9TµLATOH uµ>3.l FDA ARE []ATTACHMENT&CLIP DETAIL OETR V MODULE ATTACHMENT ON ASPHALT SHINGLE ROOF EIGHTFROM GROUND LEVELTO PEAK OFROOF n HmuE VEcs FOa scuE mT TOSCNE suLErrorTOSCu[ ACTUAL MOCLLE EMEND ONE NNWj I R.AdoND M DC no. WTE u0 P Ac Pm'Oct nuD.DAttrq:Pox].N,:,L CASEV,CNFNYL Ep ' � T mlxnv ® Pl.ct AddN,.D' I q 1E OUNIAP ST 3 SALEM,MA 0I970 BACK C Dnwln Tltle' L FRONT PROPOSED 3.9kW SOIAPSYSTEM Drew tlOn L LT INformeM HN TI- L A ■ C5 Ism INtoNT : ■ URE L OHµ TI I: SUN.. x01F5' t)NL EOWFNENT SHµL DE WaT DIN KLDNANEE MTH THE MANRLOLTDCEREPSIRM[M SHARE M[ANN 111Ovrs Rev Na R NLUI 0.UME ttl11 NPAiIXO.r1µL LDUTIO ARE FrEPOnMn1E AND..IR 11.YEwflaiWAlEJ ROOFTOP SOLAR INSTALLATION ONLY PV ARRAY WILL NOT EXTEND BEYOND THE EXISTING BUILDING ENVELOPEPARRAY SCHEDULE SYMBOL LEGEND PLUMBING SCHEDULE EQUIPMENT SCHEDULE �+ L IN T ® INwwrEa RwF cevOruTwr:.AFFEP TO MX URFE, I Lnury D.s�G..FE DE NEw EHIDnIP.TYPICµLREFER TO THE UxIRAC ory MR., .PN+YsaEOLLEFOR MORE.NFORMAnoN UD p IrtvDE ® s°E°mE;�°�z�ANrI. ON N. cDN.sMaw PDLSVPI MODULE 11CN�IW� L .D.RN ETNLE 1 IPIHM[ _ 0.1P.11-L I REFER TO THE WMC LJ IDDJGU5 Escl.,,D WPOR ROIATpXWMIN Try Iryl INOMA2SE%�9r1MMERPLOCATW I.. jEO ..THATL MEW ME M NDINERECSu� M EECL.ONE]GIM6PGCAANOOETALQ •• NEW UHIWD MR,TYPImL OTHER 099TRULTIONS EP LNOCGIEON F=F„CIXICµ PINEL P IRENUUIDAR PPDJUCPDHNEIERTO BE (REFER TO THE LNIFPC CWE.CCN£1WIT INTWED01nynL IMOTµLAT•ONMMHU4FORaR ES AND PEDd M tOLAR INOIGIE9NEW MAN OECONXER 109fi OIGIESXEW IM/ERIER TORE REEMOVXTNO POOR ARACMMEM POINTS. Ll�.Llenlmtlgetl OPG.WEDWIMMA!NPµEL I"TRUEOONEIDF T(REAL REFER TO ENO MESHO LErtSP FOR WJLNm MINy DI]IP wnw.rXnirySeLr:em REFER TOEOJIPMENi SCMEDUEGFORSPECS IRRRONOAEDOETAU% F Commonwealth of Massachusetts 1 City of Salem )a a�nT 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 e n° Return card to Building Division for Certificate of Occupancy Permit No. B-15-971 FEE PAID: $112.00 PEF-021MI"il TO BUILIHIIJ DATE ISSUED: 9/16/2015 This certifies that CASEY CHERYL A has permission to erect, alter, or demolish a building 13 DUNLAP STREET Map/Lot: 260113-0 i�. as follows: Solar Panels INSTALLATION OF A ROOF- MOUNTED PHOTOVOLTAIC SOLAR SYSTEM (15 PANELS, 3.9 kW) @ 15 DUNLAP ST!'AND 13 PANELS, 3 38kW) @ 13 DUNLAP ST. fill' Contractor Name: GREGG LACASSE a hilw,;p i6 F .. DBA: TRINITY HEATING & AIR, INC yl ♦MI t` 43F Contractor License No: 103631 6 �fll6'. � `I 9/16/2015 I�tyi'�'t BEY e. j Building Official 's+ '-' Date yethis permit "ix This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon wetter request �,:,� r, ," 'I+G "'KVI + �'.a rz-t,Crc.3 3t9P�i6�5. All work authorized by this permit shall conform to the approved application and the approved construction documents forwhic7-this permit has been granted. All construction,alterations and changes of use of any building and,structures shall be in compliance with the local zoning by-laws and codes. ems: Jk ' ;l This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. aIt�++ , ,ar y ;`y a The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. _ H IC#: 170335 "Persons contracting with unregistered contractors do not have access to the guaranty fund'(as set forth in MGL c.142A). Restrictions: + I Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. Commonwealth of Massachusetts City of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 O Return card to Building Division for Certificate of Occupancy I Permit No. B-15-971 FEE PAID: $112.00 PERM 1`1 TO B Run I L .E.' i DATE ISSUED: 9/16/2015 This certifies that CASEY CHERYL A has permission to erect, alter, or demolish a building t•c13 DUNLAPSTREET Map/Lot: 260113-0 as follows: Solar Panels INSTALLATION OF A?ROOF= MOUNTED PHOTOVOLTAIC SOLAR SYSTEM (15 PANELS, 3.9 kW) &WILL-ADD 67,70 ROOF HEIGHT.- �tW,1l� , v „ t �hr Contractor Name: GREGG LACASSEUn lire h s ai �A - r - r ,t t1 '�I4 'v I'51 n DBA: TRINITY HEATING & AIR, IN $ Y ,a Contractor License No: 103631dli�1�1'i3ta, Ji +�s hr iVc g.t: t lµ �- t ... 9I16I2015 21 �" Building Official t tii ` " rzm Date Y=.q- gr.,,.; i the ea >z .e c -with in six . This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written requestl; i t :-TO r., M E pdh All work authorized by this permit shall conform to the approved appllcahon and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any budding and structures shall be in compliance with the local zoning by-laws and codes.g This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. i ji1Pt I Ar1!°; v c t The Certificate of Occupancy will not be issued until allapplicabli,signatures by the Building and Fire Officials are,provided on this permit. l� du i` '4 y, +R i Ir -k+ t�'L' al it r n�.r. dis ,d ii' ,v4 an HIC #: 170335 'Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.147A). h '+ 4 9441it Lc rl ar Restrictions: ' Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. ut uowLE.TFTB x uxIRAC CLAMP iGO AGED,AN.CCu RRILEE°uLE rxESxcxslFwrtTces A nP.C. IERIN svnClrv4 souR MOOVLe sawn MaouLE ENGINEERING""E"', �rxwury w.cxuLTYEFW I—EB".111TAID NI.-1 A.RGU.N.®ssnN �N..ANAcFVE oT 1 dJESLAYER ASPHALT SHINGLES § ^oE >IE ry\ co°ELLFOR FOtDIS AY SUNMBEFF iORWHAAIa �'`EE ntaAPOG E Ecni N— ueNUusoRsrtcsnx°osiuLq ITAr pPOC SEpIrcm NEW Ex°CLIP.THEW Isaac ¢Lr — INEEE WMN TO THE UHMC cO OELON 'TIllTl TION nwwvw X..� cs u FOR SP[ m "`°" souR uoouLEs sHUL nor �5. E%IsiING PAETAILS FTER EXCEED PEP%HEIGHT , . 1 lW REEER TO THE UNIRA. " COD nATTACNMENTB LLIP DETAIL o[iaLASNP EORsaEcs um nPVM000LEATTACHMENTONASPHALTSHINGLEROOF r'1HEIGHT FROM GROUNOLEVELTO PEAICOF ROOF V SWE:xor TosWE x0 lJscaenOTTOxa[ suLE.roTTa scuE ASTRAL %EOILIERAGAS Issuetll R°Nsions M U0 P AC Project Tide°EscR rT on cASEr cHERrL ,\ IRA TV ACIT ]°LSEE953 \\\ \ � Prged Aaeresa \ \ 13 DUMAP APL 15ALEM,MAA 01970 BACK p �3 CLEARPATH \T V ��' DraWln9 nue, PROPOSED BBSFW T. T FRONT SOLAR SYSTEM Draw,Inr.—D. OFFAVANG DATA INGY \ ■�' i 1�. 4 � � BVslem Int 1 I ANTH RID LNEITY °E LPE:DEALEuxxovA t.I ALL EQUIPONG SHALL BE INGRATTATED IN ATECIRCANCErwrN THE Rev.No SOeel lu S✓ dN, -J' .iOLARI IA 7Y " 1 C, 1.1.6 i,l� L el[' FL _J UI F P1 PV — 2 ARRAY SCHEDULE SYMBOL LEGEND PLUMBING SCHEDULE EQUIPMENT SCHEDULE IxU uEox uT uivwu [aARATI°N NANuu GFGR TO THE xIRAc uUeTM.eo• STY SPEC A 1 Ri HOWAGSBEnF UD L © AFGH-B-FF-GOICS IRLa TPNA1FARUe-1m Pmsoel I..1 eATESEas xo xEreaLauT E ONo 0 sEcnoxs.ls FOR Svcs ANDNMANAuxuuc m°A us Or OTHER OBSTRUCTIONS Tr+ yn1 EP .,OF.xsnsmsnT rcaP L A np T° uFTERTo eF NEW UNARRE GAL n,IER To.1 Ury vPIGALL ws��Osw�uLA �•�"�O L/A u u NGAIN Puw C<rOaz RTa eE °OuµREF(REFER EEwrrGAIETRR el.rvrnle..�yo leis ..mw.nNITSJr�an Marcia Kirkpatrick From: Sally Murtagh Sent: Thursday, September 17, 2015 2:18 PM To: Marcia Kirkpatrick Subject: FW: remaining number of panels for 13 Dunlap St. From: Tammy Marot [mailto:tammv.marotc'litrinitysolarsystems.com] AY � Sent: Thursday, September 17, 2015 2:16 PM To: Sally Murtagh Subject: RE: remaining number of panels for 13 Dunlap St. Hello, So we are asking that 13 solar panels that could be added to the permit. This new addition will be a 3.38KW system. Should you need anything else please feel free to contact me again. From:Tammy Marot [madtoaammy marot @trinity-solar.com] Sent:Thursday, September 17, 2015 11:55 AM To: 'smurtagh@salem.com' <srnurtaghL@salern.com> Subject: remaining number of panels for 13 Dunlap St. As we spoke on the phone I am attaching the plans for the remaining panels that are on the roof of 13 Dunlap St. I will be mailing out the remaining fee of$98 today. Thank you very much for all your help in resolving this matter. Respectfully, Tammy Marot Trinity Solar Permit Dept. 508-291-0007 ext. 1209 Please note the %12ssachuwtts 5eeretaev of-State's office has determined that most enuails fo and from mtmir3pai officials are public records.I'Mi please refer Co: httix:/r�c�vcvsecstate.ma.usiPre?preidx.ht:m. Please consider the environment hcfore Printing Chi;euafl. 1 Marcia Kirkpatrick From: Sally Murtagh Sent: Thursday, September 17, 2015 1:41 PM To: Marcia Kirkpatrick Subject: FW: remaining number of panels for 13 Dunlap St. Attachments: Casey, Cheryl plans.pdf From: Tammy Marot [mailto:tammy.mar t@tnntL�y5olarsystems com] Sent: Thursday, September 17, 2015 11:55 AM To: Sally Murtagh Subject: remaining number of panels for 13 Dunlap St. As we spoke on the phone I am attaching the plans for the remaining panels that are on the roof of 13 Dunlap St. I will be mailing out the remaining fee of$98 today. Thank you very much for all your help in resolving this matter. Respectfully, Tammy Marot Trinity Solar Permit Dept. 508-291-0007 ext. 1209 a'iea,e 110te Ole:Viassactrusetts wecrch'.rs of 5tatl 's offkwe ibati determined tilat most emaJN to and from municipal offi6a3s are public records. F MI please refer to httu:i/w�cwsec tate.anaa�slm'cinreidx.t trn. Please consider the c vironmeni before pr atiug faros ema.ii. 1 i City of Salem ►J r ` g1 � , t Building Dept. Request for'additional panels to be added to the permit for 13 Dunlap St. Hello, I am writing you to ask that you add these additional panels to the permit for 13 Dunlap St. I've included a hard copy of the additional panels along with a check for$98 as well as a self-addresses stamped envelope for the return of the permit. I thank you for all your help in resolving this matter. Respectfully, f ILI Tammy Marot Trinity Solar Permit Dept. IINIW,C L., wErra;LLE LIT'll.l..lA; EE..A�I , EN. cLF'O",Ta"^"" Flan moouts soLAn uonuLE _____r_ s s NLra ti W e Y LI L IPAc SO ANIII UNTULAN INNS �� V E I_ R, Fom OLD Fx sl rvcLs — II 9URM0" 9 —\ AFOL A.AVT k \/a,- / \/,I ITEFILIT III On' _ _____-_ pC: M,D _ SOIAPMOOULE35XRlL NOi �I F.FGEF]PENS NEIGM. IPEE. OID ILR IFL I0aI;PECS UID nFITPGHMi�AF111'OE FAIL MLIL'a �PV MODULE ATTACHMENT ON ASPHALT 8111NOLE ROOF IINEIGIIT FROMGROUND LEVEL TO'I OF ROOF EEdl a!'[r.c NV Usva3[-xmicsrr,[ rroi rOF r .CITE NNI I0x,RLINNE ISSUc-0 I ReV191gt5 1 exscxll,:em M]ElP Ac Pro rTI'D eP CASEY,CHEFYL "Ll"ATa.3V15639 C. Pm]act ALtlreslc 13 DUNIAP ST. APT I SALEM,MA 019I0 BACK C\L Y Drawm nun'. ' L AR PPOPOSED 3.38kW FRONTMEN M SOIFR SY4EM R� Drawn Intormellon NPN+Iwils ■ xzhs[erIIL System Intormaticn' ■ 1 ALLPLIN 6Uv>W,Q WI IT LITELiYCE. NNWP Ir +I� e we Rev Na. 51me1 eJ ROOFTOP SOLAR INSTALLATION ONLY PV ARRAY WILL NOT EXTEND BEYOND THE EXISTING BUILDING ENVELOPE ARRAY SCHEDULE RYMBOLLEGEND PLUMBING SCHEDULE EAUIIMEIT SCHEDULEDDILLI 1+ r V G "are rl 4l eNr,.19P ® n E INDIOLIN OLIN OLIN [FMs ICI v=c O UD © p NOPOL a y _ 1 1 N cEI N E P' ©CATE ISLI'VOOLARDODILINNER11111TIES 1 sL3acV.Ls E E n 011 IER OBSTRUCT IONS ONT I+PRI,N,I4 u nueo omsoE. INLOLLATIONFOROPENI DETmw --SOLAR o , a ^ IXF.IL DISCONNECT q [nT [ .ETED TO FLOOPIN".LINEN",NZO LI END M mrx ONI "I"NI. I! I ..�. i The Commonwealth of Massachusetts Board of Building Regulations and StandardsOFSALEM CITY I Ulf Massachusetts State Building Code, 780 CMR, 7`h edition Revised January (� u� Building Permit Application To Construct, Repair,Renovate Or Demolish a 1, 2008 One- or Two-) mily Dwelling u This Sec n For Official Use Only Building Permit Number: Date Applied: r1 J Signature: `mil rj Building Comm er/I N2T of Buildings Date SECTION 1: SITE INFORMATION 1.1 P o t Address: 1.2 Assessors Map&Parcel Numbers 1.l a 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.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' / 2.1 caner of Rgcoreje�Q v /J DU/I1(9� IJ17 / �lzQ r� a ( '�- Na Pr't) Address for Service: I � a r Telephone Tgr SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building ❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Wor1�' Z4,5 tug/ //Z/ ii� � �,eu rP✓� ��ct Incto SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1. Building $ GO 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑ Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $Suppression) Total All Fees: $ `� oa Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 7 0 Paid in Full 0 Outstanding B lance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) 5 77 3 3 QYz License Number Ex iration ate Name of CSL-Holder List CSL Type(see below) A r s Type Description U Unrestricted(up to 35,000 Cu.Ft. R Restricted 1&2 Family Dwelling nature / M Masonry Only RC Residential Roofing Covering Telephone _ WS Residential Window and Siding SF Residential Solid Fuel Burning A liance Installation D I Residential Demolition 5.2 Registere om I rovement C n ctor(HIC) /D�� D /1 HI Co pan me or Regis aneNarRe Registration Number �7/,� �c Ex iration ate Sl�rKt&VTelephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be ompleted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issu 0 e 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, - e , as Owner of the subject property hereby authorize S to act on my behalf, in all matters relative to work authorized by thil building permit application. Si nature of Owne Date /i / SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION 1, ( /1 r t S I U r ZD r Z-(_i{/ as Owner or Authorized Agent hereby declare that the statements and information on the foregoing app ation are true and accurate,to the best of my knowledge and behalf. S ZC) Y Z PrintN e nil /0 Signature of Owrkr or Aut orized Agent Date es7 _(Signed under the pains and penalties ofperjury) 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. 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/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" The Commonwealth of Massachusetts FOR Board of Building Regulations and Standards MUNICIPALITY q I Massachusetts State Building Code, 780 CIvIIZ 7°i editiop i USE dA Building Permit Application To Construct,Repair,Renovate'Or Demolish a Revised January One-or Two-Family Dwelling 1, 2008 This Section For Official Use Only !SSignature: ilding Permit Number: ate pplied: Building Commissioner/Inspector ofBu'd Date SECTION ITE INFORMATION 1.1 Property Address: 1.2 Assessors Map &Parcel Numbers /0o Sf Ll a 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(fi) 1.5- Building Setbacks(It) Front Yard Side Yards Rear Yard Required Provided El! uued Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood ZoneInformation: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Cbeck if es❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) Address for Service: q77 ' Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check a8 that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Rep Ers(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify: Brief Description of Proposed Work : -r G F SECTION 4: ESTIMATED CONSTRUCTION COSTS -� Estimated Costs: Official Use Only Item Labor and Materials 1.Building $ - 1. Building Permit Fee:$ _Indicate how fee is determined: - ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: 4.Mechanical (HVAC) $ List: J 5.Mechanical (Fire $Suppression) Total All Fees:$ o Check No._Check Amount: Cash Amount: .` 6.Total Project Cost: $ 99 95. Il al ❑Paid in Full ❑ Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES ' r uction Supervisor(CSL) 77 License Number Expiration Date - 'S List CSL Type(see below) Ii cr_3 Hilt#o,4fte:Sttmyet Salem MA`Vl70 Type Description U Unrestricted(up to 35.000 Cu.Ft. Signature R Restricted 1&2 Family Dwelling M Masonry Only RC Residential Roofmg Covering Telephone�q (' WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) / y � o F '1 HIC Company LUM, Registration Number Address 61 �-d �'seft Ave "" _22Expiration 17— Salem MA 01970 Gl�cl -7 �t�-S'/Y 3 Expiratio nD to Si tu gnare / 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 lssuanc f the building permit. Signed Affidavit Attached?. Yes ....-....... No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT ORCONTRACTOR APPLIES FOR BUILDING PERMIT 1, C e—p k/ I `C-Se- - as Owner of the subject property hereby authorize C (,0.(� to act on my behalf,in all matters relative to work authorized by this building permit application. Si�naMeof er Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION 1, (_ (- ( " ei-I ,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. Et, (-9k1 Print Name b-7— Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of a "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 not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I I O.R5,respectively. 2. 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 - - Numberoffireplaces Number of bedrooms Number of bathrooms Number of halfibaths 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"