17 HAZEL ST - BUILDING INSPECTION (3) CK
The Commonwealth of Massachusetts R CEI �y OF
Board of Building Regulations and Standards 11♦SPEC R E
Massachusetts State Building Code, 780 CMR �dMar2&F
Revised Mar 2 I7
Building Permit Application To Construct,Repair,Renovate Or Dena'S"JUN 22 /4
One-or Two-Family Dwelling 4$
This Section For Official Use Only
Building Permit Number: Date Applte `
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Prope Address; 1.2 Assessors Map&Parcel Numbers
1.In 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(it)
1.5 Building Setbacks(it)
Fmnt Yard Side Yards Rear Yard
Required Provided Required Provided Required Pmvided
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 yesO
SECTION 2: PROPERTY OWNERSHIP'
`23'L tOwne/r+t of ReG1ord: t , � /�✓/1 C
Name(Print) City,State,ZIP
k l—o. e�QQ�
N and SVeet Telephone Email Address
SECTION 3-DESCRIPTION F PROPOSED,WORKZ(check all that apply)
New Construction❑ Existing Building Owner-Occupied ClRepairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units Other ❑ Specify:
BriefDescription of Proposed Work: 9,Q10v.
.L'c—
2 A 4cJ
SECTION 4:EATIMATED CONSTRUCTION AOSTS
Item Estimated Costs: OfficialUse Only
Labor and Materials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application:Fee
❑Total Project Costa(Item 6)x multiplier
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
6.Total Project Cost: $ 2 p pC1 Check No. , Cheek Amount: Cash Amount:
r ❑Paid in Full ❑Outstanding Balance Due:
' I
r
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) G�) !�
License Number E4,piration Date
Name of CSL Holder
rr(' List CSL Type(see below)
/ `t �'d'�•V �el/•. Description
No.and Street
/]/) U Unrestricted(Buildings u to 35,000 ca.ft.
�/Y j 1" '� i' 4 fl Z Restricted 1&2 Family Dwelling
Cityfrown,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
c� atlPS I Insulation
Telephone Email address L D Demolition
5..-2•�.Registered Home Improvement Contractor(HIC) /6C�O
•� So^I �°--6`^� C HIC Registration Number I Ex iratio e
HIC Company N/anatmce or HIC Registrant Name
No.and Street II c,� Z_ —c�(r��j� Email address c0 �
Ly,.1,J l"tQ= I1 .J
City/T6wn,St te,ZIP Telephone
SECTION'6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c,152.g 25C(6))
Workers Compensation Insurance affidavit must ompleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Iss ce of the building permit.
Signed Affidavit Attached? Yes . .'.❑ No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE CO ETED WHEN
.
OWNER'S AGENT OR CONTRACTOR IES FOR,. II,DING PERMIT f
I,as Owner of the subject property,hereby authorize
to act on my be If,in all matters relative to work authorized this b Idmg pe ' lion. /
'6" ( be
2.o Jd
P 'nt Owner's Name(Electronic Signature) D to
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 and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Name(Electronic Signature) ate
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 can be found at
xvww:mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.rovg /dns
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"
r
CITY OF SALEM, MASSAaiUSETTS
{K BuQLDING DEPARTMENT
120 WASHINGTON STREET,31D Fi.00R
nL(978)745-9595
FAX(978)740-9846
KIIvIBERLEYDRISOOLL
MAYOR THOMAS ST.PIERRE
DIRECTOR OF PUBLICPROFERTY/BUI DINGCOMUSSIOMR
Construction Debris Disposal Affidavit
(required for all demolition an
d renovation work)
in accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris;
and the provisions of MGL c40, 5 54; Building Permit# is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address of facility)
!!nSignat a of applicant
Date
Boston Porch and Deck Co.
Custom Build / Design / Restore 781-990-1729 781-584-8060 978-360-0060
Proposal www.BostonPorchandDeck.com
Page _ of _
Date:
Hal
17 Hazel Street
Job Location:
Salem, Ma. 01970
We propose to brace the top roof%cei:ling with T
braces . We will remove the lst and 2nd floor decks ,
railings . We will instal 3 12 " x48 " footings , 1 new
48 " xl4 "x10 " deep pad for the stair landing . We will
frame 2 aprox . 6 ' xl6 ' decks [ same as existing ]
211x8 " , 16 " o . c . frame double rimmed with joist
hangers at each joist end . We will install 4 DTTZ1
ledger deck braces to each deck ledger . We will
install 2 , 8 " ledger locks every 18 " . We will install
316 "x6 " p . t . column supports notched and ledger
locked into the frame . Both decks will be properly
flashed where they meet the . house . We will install
t&g fir decking to the 2nd floor deck, 1 "x4 " sq .
edge to the 1st floor deck as well as the stair
treads . We will install a 4 ' wide staircase . All
posts will be trimmed and boxed out with 1 "'x AZEK ,
band molding will dress boxes . RDI composite
railings 42 " , will be installed to both decks , 36 "
RDI railing to stairs . We will frame 2 " x4 " p . t to
accept vinyl lattice around the bottom of the lsy
floor deck . We will picture frame the lattice with
111x5 " AZEK . All Azek will be screwed with stainless
screws and bunged . We will install wainscott panels
to the ceiling on the 1st floor deck . We will
install 1 1 /8 " bed molding around the perimeter of
the ceiling . 1 " x10 " , AZEK will go around the ' outside
of each frame , 1 " x8 " risers . All debris will be
removed from the site , all work will be performed in
a professional manner . cost $22 , 000 $ 7 , 300 on
commencement , $ 7 , 300 after demo and footings , $3 , 700
after decking , 387 Atlantic Avenue Marblehead, MA 01945
$ 3 . 700 on completion .
ACORD o6i17/27/2 CERTIFICATE OF LIABILITY INSURANCE DATErvD15
PRODUCER (978) 745-6464 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Rose Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
66 Loring Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 958
Salem MA 01970- INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA:ESSEX INSURANCE COMPANY
J. Serven dba Boston Porch and Deck INsuRERB:Guard Insurance
387 Atlantic Avenue INSURER C:
INSURER D:
Marblehead MA 01945- INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR AOO'L POLICY EFFEcTNE TYPE OF INSURANCE POLICY NUMBER DAM(MMIDDIM DA CY MI
RATION
LTR INSRD M(MMIDD M LIMBS
A GENERAL LIABILITY 3DU5402 05/19/2015 05/19/2016 EACH OCCURRENCE 6 1000000
X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ce s 100000
CLAIMS WOE 7 OCCUR / / / / MED EXP(my one arson a 5000
PERSONAL&ADV INJURY 6 1000000
GENERAL AGGREGATE a 2000000
HGENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO 6 2000000
POLICY JECT LOC / / / / NOW
AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT
ANY AUTO (Ea acdden0 a
ALL OWNED AUTOS / / / / BODILY INJURY
SCHEDULED AUTOS (Per person) 6
HIRED AUTOS / / / / BODILY INJURY
(PM aCaidMl) 6
NON-OWNED AUTOS
PROPERTY DAMAGE
(Per a denl) a
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO / / / / OTHERTHAN EA ACC 8
AUTO ONLY: AGO 6
EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE 6
OCCUR F-ICLAIMS MADE AGGREGATE S
a
DEDUCTIBLE
RETENTION S WyyCC gg TTUU 6
B WORKERS COMPENSATION AND JORC561905 09/30/2014 09/30/2015 X TORYLAMRS DER
EMPLOYER$'LLABILITY
ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT S 100000
OFFICERIMEMSER EXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEES 100000
If yes,dmcdi uMer
SPECIAL PROVISIONS Mm E.L.DISEASE-POLICY LIMIT 1 a 500000
OTHER
DESCRIPTION OF OPERATIONS&OCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS VIRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
Hal WurBter FAILURE TO D SO SHAL 1.IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
17 Hazel Street INSURER ITS AGENTS OR REPRESENTATIVES.
Salem, MA 01970 AUTHO PRESENTATIVE C
ACORD 25(2001108) O ACORDICORPORATION 1988
INS025(0I08).06 Page I oft