24 HANSON ST - BUILDING INSPECTION (3) (sr-- C0�22S `�
16 1q I ?8o
ti
ommomvealth of Massachusetts INSPECTIONAL ERV SOF
Building Regulations and Standards SALEM
setts State Building Code, 780 CMR1814 NOV 10 Re2se�l�Iar 2011
Building Petion To Construct, Repair, Renovate Or Demolish a
ne-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number. Date.Applled
Ib
Building Official(Print Mia Signature . . Date
ECTION 1:SITE INFORINIATION
1.1 Property Address: 1.2 Assessors blap&Parcel Numbers
I.1 a is this an accepted streno Map Number Parcel Nurmber
1.3 'Zoning Information: I.d Property Dimensions:
'Coning District Prop Lot Arta(sq it) Frontage(It)
1.5 BuildingSetbacks(R)
Front Yard - Side Yards Rear Yard
Require) 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:
Zone: Outside Flood Zone? Municipal 0 On site disposal s stem ❑
Public Private❑ — Check if es0 p po y
SECTION2: PROPERTYOWNERSNIP!`
2.1 Owner'of Record:
^� ; � (e UL4 A
time(Print) City,State,ZIP
au nC4A50�, S7 -A►,&"-7776 rOIdOWVIiMrn 7c 00 COL-H
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑TExisting Building M- Owner-Occupied 0 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify:
77
r�B7rrr�ief De cr tion of Proposed Work': O di /C4 S��
i7rm,,V 07, ...,"nn '?'✓ M .S"jY✓G1LP/�t / �fZC/ ir/,e�
SECTION a:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials -
I. Building S Q I. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
?. Electrical $ 0 Total Project Costs(item 6)x multiplier x
3. Plumbing $ �?,(�iher Fees: $
d.Mechanical (11VAC) S List:
F6rotaj
Mechanical (Fire S 'total All Fees:S
Suppression)
/ Check No. Check Amount: Cash Amount:
Project Cost: S L 1Q0e 0 Paid in Full ❑Outstanding Balance Due:
M Ac 1 t_t� 1 l I I g
SECTION 5: CONSTRUCrION SERVICES
5.1 C unstruction Supervisor License(CSL) J
v(I w t.�jle 7 ;'L t C. /Q t(�' 7& 9 Licensc Number Expiration Date
Name of CSL Holder List CSL Type(see below)
' 11065 -7
Type Description
No. and Street
S T o�how
w ^ oa 9O U Unrestricted 1 (Buildings s u el ing cu. It.)
TO l�tu �'f EI R Restricted l&2 Family Dwelling
Cityfrown,State,ZIP M Masonry
RC Roofina Covering
WS Window and Siding
�a8 _ y � SF Solid Fuel Burning Appliances
('— 1 Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) %V —/&�
HIC Registration Number Expiration Date
HIC Comp:my Nnme or FI[C Registrant Name
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 ..........to, No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED.W HEN.'
OWNER'S AGENT OR CONTRACTOR FOR PERMIT
I,as Owner of the subject property,hereby authorize (O V Y ry�q
t9 act If,in all matters relative to work authorized by this building permit application.
7 r/ - 9- � y
Print Owner's Name(Elect ignalure) Dale
SECTION 7b:OWNERI 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 and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent'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. I42A. Other important information on the HIC Program can be found at
www mass cov'out Inrormation on the Construction Supervisor License can be found at ww�Alos
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. 11.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halt%baths
Type of heisting system Number of decks/porches
Type of cooling system Enclosed Open
]. 'Total Project Square Footage"may be substituted for"rota) Project Cost"
IPAL
C°ANY N01 S EXIST. STONE WALL STREET SIDE
I. ANY AVSTIN ABOUT ME IHTDTO TH N SHOWN W Mf DESIGNER
DRAWINGS PROCEEDINGSHALL BE BROUGHT 10 ME AITWORK a•ME DESIGNER
GENRESTALLCONFORM
TO THE
WORK.
2. ALL WORK ONG DE, 8M 10 ME PROWSPoNS OF THE MAGWE 20ETTS
51AIE BUILWIC CODE, 8M EiJlliC4(RESIDENTIAL)INaDOXVG WE 2009 -
NEW JaSTINTERN470W RESIDENTIAL CODE. 3 �l r OR IB TRAWINC NGLEES
J. ALL aNENSIONS SHALL BE FIELD VERIFIED. W AT EXIST MWDSE-TENON EXIST SUBfi(X1R
4. ALL NDIC4IED OETaLS SHALL BE CONSIDERED FFXAL FOR SULAR
WNaTIOHS. ti p m r NEW HANGERS (TYP.) CONNECT _
5 WE GENERAL CONIRACRA4 SHALL BE RESPONSIBLE FOR WE SaE1Y OF ^ 1l IXAST.. JOISTS
WE JOB SITE DURING CONSMUCMN IN CONFORMANCE WIIN FEDERa AND NEW TURN-
SIATE LAWS. MIS INCLUDES BN IS NOT LIMITED 70 MILPORARY SNORING I� BUCKLE
OF FLOORS.AS REWIRED BY ON SITE QM'aRONS co J `y E
6. WE GENERAL CONIR4CRR SH4LL BE RESPONSIBLE iDR ME CGGRONATION k NEW I%WlLL -
OF THE WORK OF ALL TRADES ME MEANS AND NERIODS 0.< W k r EXIST 12X 12 BRICK PIER HOLE MID-DEPTH NEW %STEEL Roo w'o
COMSIRUCTIOM1;'AND ME FIE10 VERMGTIW OF ELEYATIWS AND W OF BFA' W/THREADED END `N c DIMENSIONS
NEW OR EXIST 6X6 BEAM EXISTING SEW 2 E
7. NO NEW OR IX MODIFIED,
R CUT WZH ELEMENTS EXPRESS
BE ROVALPOF _ c
NEIGHED.MOaFlED, OR CUT WITHINR WE IXPR6S APPROVAL OF THE h w
DESIGNER
BOWED AREA
STRUCTURAL DESIGN LOADS - NEW J/A 6 STEEL ROD F SECTION 2 y m N
1. GROUND SNOW LOAD PG=40 PSF OF STUD L
z.WIND SPEED V- iM MPH ti ABOVE ti Y1� = 1-O�
J FLOOR LIVE LOADS RESIDENW FIRST FLOOR=b PST I (i c1 Ci
SLEEPING ROOMS JO PST [) £xlsT COL. ' 0
O Y
(ZS
A1RCS WIN STORAGE 10 PSF
CNI NEW 57R STEfi m
F. NEW.WiTI/Ra STEEL NGPLATES AND RODS SHALL EXTERIOR WALLS
TO L B AJ6 N
2. SIEFI.OUTSIDE OR PASSING WRWGII ME COMPOUND
AWAILS SS W
HOT DO WBH ZRC COLD CALYANIZINC COMPOUND. INTERIOR STEEL N® 7 N ® ® ^
J. THREADED CONED CMYS. TURNBUCKLES AND NUTS SHa1 BE USED. NO I W W STAIRS L g
WELDING OF STEEL IS PERNIIIEO. NEW J/'9 STEEL ROD sHfA�iIN IXRT STUD WALL 0
1. N FRAMING
1. NEW DAMELUMBER
I LUMBAR 0W7H BE SPRXCIFIE OR MASONRY
Y SHALL B IXIST.. SUBFLOOR p U
1. NEW LUMBER N CONTACT EDH SOUTHERN
W MASONRY seat BE EXIST COL. EXIST 6X6 BEAM SILL
PRESERYgiNEALL BE
MIXED sA6LE R6 PNE j2. WOOD SILL EXIST. W000 JOIST Z
J. FASIENNC sIW1 BE PER lRC 7ABlf R602.J AND PER ME REQUIREMENTS EXIST 12I'12 NEW WASHER Q � 4
OF WE MEAL CONNECTOR MANUFACTURER. J &NUT =
BRICK PIER
EISIZZ BRICK AND SME MASONRY CONSTRUCTION m ¢ NEW SIM N
I. ME COMMACTW SHALL EXAMINE ALL EXPOSED MASONRY FUR CRACKS, 1 3 R-8X6X'/e NEW J144%STEEL ROD r�
BROKEN UNITS.AND LOOSE°R MISSING MORTAR.ALL EXPOSED MASONRY J� L� W/WRFAUm ENDS
WALLS SHa1 BE Po/NIID aN0/W r1EPNRN as REWIRED Al DETECRIf NEW HANGERS (TIP.) 2 POINT UNDER SILL 2 LOCATIONS N
LOCATIONS.ANY CONDITIONS IN MICH MASONRY WALS ARE TILTED OUT OF �O AS REQUIRED /h
PLUMB.BOWED, W BULGED SIMLL BE REPORTED TO ME DESI ER. EXIST. STONE WALL
2. ALL GAPS OR HOLES IN SRQIE MASONRY SHALT.BE FILLED SOLO WITH DRY U1l
PACK CONCRETE W LIQUID NW-SHRINK GROUT k y PONT&REPAIR i
J UNDER NO gRWMS7ANCfS SY14LE PAINr, WATER REPELLENT COATINGS, rAS
CEMENT PATE,, OR STUCCO FINISH BE APPLIED OIER EXISTING MASONRY.
ALL MASONRY AND WORTAR JOINTS SHALL REAWN 09BLE AND ACCESSIBLE m e s% '
WNEMER INSIDE OR OUTWE ME BULOPIG
EXIST STONE WALL SECTION 1 �� g
YYz = 1�-�• bss Eg SA e' o
More FIRST FLOOR FRAMING PLAN
NEW STEEL 7)E RODS SHALL ki 0
BE INSTALLED SNUG TIGHT— Y4.= 1=0�
DO NOT MOVE EXIST WALLS cm
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;•T° Q-1-Y OF SALEM, l%'L-1SS:1CHl;SETTS
BL•mn tG DEPART?IENT
it �jl 1 120 WASHIINGTON STREET, 3m FLOOR
d� TEL (978) 745-9595
RuX(978) 740-984,6
KI.NIBERLF-Y DRISCOU THOM tis ST.PlFYRS
r -
;,q.%YOR
DIRECTOR OF PL'OLIC PROPERTY/BCBD(tiG CO\L\IIS5f0\iER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Ani licant Information } Please Print Leeibly
�I
Name (Ilusinuss Organiraticm'Indi victual J: 6•� `
Address: 30 _C�-T s� // p
� City/State/Zip: ✓l�lil4MPhoneH: &17 " (J a®p f�7�
Are you can employer?Check the appropriate box: 'type of project(required):
I.❑ I am a employer wish 4• (3'f am a general contractor and 1 6. ❑New construction
employees(full and/or pan-lime).• have hired the sub-contractors
2.❑ I am a sole proprietor or pannvr- listed on the attached sheet. • 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working fir me in any capacity. workers'camp. insurance. ), ❑ Building addition
INo workers•'comp. insurance 5. ❑ We are a corporation and ifs
officers have exercised their 10.0 Electrical repairs or additions
required.)
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.[No workers'comp. c. 152. §1(4),and we have no 12.❑ Roof repairs
insurance required.) t employees.INo workers' 13.0 Other Roddisi a C///S
cuntp. insurance r quired.J
•Any applham der chucks bee tl mwt also rill out ae section below showina their worker'cumpenradon policy infimmadon.
'I b.mcuwm"who submit this amdnvil indicating they arc doing all work and then hire outsideconrractan mini submit a new amdavil indicating such.
$'.n,omemn Our chwk this bus most mtaehat on addiliwval ahmi showing the name of the subrmmncton and their wnrkcraI comp.pulley information.
fain can employer lbat is providing workers'caniptnsadon hirteranee for my employees Below/s die policy uudjab fill,
h1fornrution.
Insurance Company Name: ----
policy it or Sclf-iiw. Lie. d: ,I0 Q p 7 Expiration Date:
Job Site Adtkuss: 01 !�z r/I G°( 50-1 �,/ City/State/Zip: S'l lei
,\each a copy of the worlters'compensation policy declaration page(showing the policy number and expiration date).
h'uiluro to secury coverage as required under Suction 25A of MGL c. 152 can lead to the imposition ofcriminal penalties of a
tine up to S1.500.00 und/or one-year imprisnnmcnt,as well as civil penalties in the form of a STOP WORK ORDER and aline
of up in S250000 a day against the violator. De advised That a copy of this statement may iw furwarded tothe 0111ce of
Invcsligations ul'Ihe MA for insurance covcngc verification.
/do hereby renify uo •/N�e pubes and penatdes of per/ury rlml the hifurnmllan provided above is true t aird correct.
lien m re: �� \ Mate:
Phone a: _
Official use wdy. Do not wtile in Ills area, to be completed by city or town n/f/cial
City nr'ruwn: Permit/l.lceese p _,__.-__. . _
Issuing Aulhurily (circle one):
I. Board cal'Ileallh Z. fluildlnq Dcpartinew 1.Ciiyfrurvu Clerk J. Electrical Inspector 5. Plumbing luspecror
6. Other
l Coatncl 1'crtnn: ___ _ .. Phalle a: