7 HODGES CT - BPA-14-774 ZBA PERMIT; ADD DORMER, INTERIOR IL, The Commonwealth of Massachusetts
3As Board of Building Regulations and Standards CITY OF
T Massachusetts State Building Code,780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Ap t d:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro erty A dress: 1.2 Assessors Map&Parcel Numbers
e5 Cour-r 3�.-v3k
1.1 a Is this an accepted street?yes no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
� I
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 pply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage isposal System:
Public ' Private❑ Zone: _ Outside Flood Zone? Municipal Sewage
site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
%-Aai uA S 4 Arzefl7 -Ca ter+ v/A�a
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPT N OF PROPOSED WORK'(check 1 that apply)
New Construction❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) Erl Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of ProposedWorV: ✓— "/z/
r CCJ it
I S' a
a
ace Aer wc,a n,+
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ cav,GD 1. Building Permit Fee:$ Indicate how fee is determined:
2. $ C �,i
❑Standard City/Town Application Fee
Electrical V
� ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 20 001)_ . 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Supression Total A0 Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due:
14"97 Cab y 1 S
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /Ord 4l.?��2o/y
nYILt Wk~ License Number Expiration Date
Name of CSL Holder �a.� s7c U�4- �O
�t v ' L.. �O9 / List CSL Type(see below)
No.and S etr a Type Description
D �9/S Unrestricted(Buildingsa to 35,000 cu.tt
Restricted 1&2 Family Dwelling
Cityrrowff,State,ZIP M Masomy
RC Roofing Covering
WS Window and Siding
90- ¢ -049/ J, c0� -Co SF Solid Fuel Burning Appliances
/jy/oOdlno' �""�� P I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) / ,;? 9 4/
.fib iCA/J & ( HIC Regi]iss``tration Number Expiration Dale
HIC C amepr MIC RcgLs tranlName
No.and S et Email address
r /fo tale 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 ..........❑ No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) ate
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of pepury 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. 142A.Other important information on the HIC Program can be found at
www.mass.got v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dpss
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) Z (including garage,finished basementlattics,decks or porch)
Gross living area(sq.ft.))7 8`Ko• Habitable room count lo
Number of fireplaces / ' Number of bedrooms
Number of bathrooms 3 Number of half/baths /
Type of heating system GI I i6c• Number of decks/porches D
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF &U ENI, NLNSSACHUSEM
BUILDING DEPART%(ENT
a 120 W�SHiNGTON STREET,r FLoOR
�j TEL (978)745-9595
FAx(978)740-99"
IQMBERI.EY DRISCOLL
MAYOR THOMtis ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDLNG COMNUSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business,Organization/Individual):
Address:
City/State/Zip: Phone#:
,ire you an employer?Check the appropriate box:
Type of project(required):
1.❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑Ne nstruction
em ees(full and/or part-time).• have hired the subcontractors
2_ am a sole proprietor or partner- listed on the attached sheet.l 7. emadehng
ship and have no employees These cob-contractors have S. ❑Demolition
working for me in any capacity. workers'comp.insunmcr. 9. ❑Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its p0.❑Electrical repairs or additions
required.] officers have exercised thew repa
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees.[No workers' 13.❑Other
COMP.insurance required.]
'Any applic ni that dtcxks box A must also fill mat the section below,slowing their worker'compwu tim Policy information,
t I Inmeownra who submit this affidavit indicating they am doing all work and then hire ouride contractors want submit a xr affidavit indicating such
=Cumwcton that cfinek this lox must attached an additional Wines showing the name of the mb.comuocian and their workers'comp,pot icy information.
I am an employer that Is providing workers'compensation Insurance for my employees. Below Is the pollcy and fob site
information.
Insurance Company dame:
Policy#or Sell ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration data).
Failure to smure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 andfor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a rune
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
investigations of the DIA for insurance coverage verification.
I do hereby certify unde.teepains an er of perjury that the information provided above is true and correeL
. i• -n grey '//% [)are:.
Photte
Official use only. Do not write in this area,to be completed by city or town ofciat
City or Town: Permit/l.iccnse#
Issuing Authority(circle one):
1.Board of lleallh 2.Building Department 3.Cityffow t Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
CITY OF S.U.&M, NLksSACHUSETTS
BUILDIING DEPARTMENT
P• 120 WASHNGTON STREET, r FLOOR
T-EL. (978) 745-9595
FAX(978) 740-9846
KI1(BERLEY DRISCOLL
MAYOR THoMAs ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING CONMSSIO.iER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
rflG 2�/f,�D�2�
(name of hauler)
The debris will be disposed of in :
(name of facility)
(address of facility)
signature of permit applicant
date
debrisatr.dw
--- I'hc C omnionwe:dth of Massachusetts
Iloard of Building Regulations and Standards CITY OF
,MilMIchusctts State Building Code, 730 CNIR SALEXI
Rerieed Uur-+
fNl
Building Permit Application To Construct. Repair. Renovate Or Demolish a
One-or Tiro-Funult•Du eflhq%(
This Section For 011ieial Use Only
Building Permit Number: Date Applied:
Building 011icial lPrint N+une) Signature Bata
SECTION I:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Slap& Parcel Numbers
I.Ia Is this an acce ted street^yes no Slap Number I'ur el Nw
1.3 Zoning Information: 1.4 Property Dimensions:
Luning District I'mpowd Use Lot Area Isq 11) Frontage(11)
1.5 Building Setbacks(it)
Front Yard Side Yards Reor Yard
Required Provided Required Provided Require Provided
1.6 Water Supply:(M.G.1.c.40.§Sa) 1.7 Flood Zone Information: 1,11 Sewage Disposal System:
Ihtblic❑ Private 0 Zone: _ Outside Flood Zone? Municipal O On site disposal s7 alan ❑
Check if csO _
SECTION2. PROPERTY OWNERSHIP'
2.1 Owneri of Record:
IG+01AAM-1 14 'P I SaNlPvA MA otc��o
Nnmc(1-nnl) City.Slate,ZIP y ' - • -
�
No.an Street Ce11 relephone Email Address
SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteradon(s) O Addition 0
Demolition ❑ Accessory Bldg.O Number of Units_ Other ❑ Specily:
Brief Description of Proposed Work":
SECTION J: ESTIMATED CONSTRVCT1ON COSTS
licnt Estimated Costs: Official Use Only
11.aburand.. Materials)
I. 0uilding S I. Building Permit Fee:S Indicate how fee is determined:
_'. lil«trica( S ❑Standard CityrTuwn Application Fee
❑Total Project Cost'l Item 6)x multiplier
l I'hunhi°q S '. Other Fees: S
J. \Iech.mical tll\' sC) S List:-- '---- -'----
S \Icch.mical iFuc _-
�u+.res>ion) S rotal .\II Fees:
Chcd \o. C'heck Annnutt: l'.i�h Anunmt:
n Tulal Project Cost: S O Rtid in Full ❑Outstanding Ilal.uice Due:
r
SEC ION St l'0NS'fRl1('TION SF-RvicF...S
S.I (bnstructint Supers isor license(C'SL►
I ieense Nuu+her F,pirali+w Dale
' Y.nneoll'Slllnldcr
IstC'SI. 1')pcL+.eMoo) —
Nu. .ud Slreel I)pc Description ,
U UnmsiricteJ I9addin' up u+ lt•IRa)cu. 11.11
------- . . R Rc,lrictcd 40 F.anil MwIlin
C-it)iroo it.SLac.LII' N Nlasun
ry
RC Rooling l'onerin
...—. R'S I Window and Sitting
SF Solid Fucl Iluming Appliances
_ I Institution
I'ele hone Fnutil aJJrc,a D Dumolitiun
1.2 Registered Hume Improvement Contractor(HIC)
I IIC'Ncgisuatiun Number I\pirttiun Wit:
IIC'C'nnpwt) N,unc of I IIC'Rcyistranl Name
No.;ud Street
L'mail adJmsa
Ci /Town,State ZIP Telcithune,
SECTION 61 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 1l2,126C(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..........o No...........Cl
SECTION 7s.OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Nwne(ENctrunic Siynuturc) _ 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 and accurate to the best of my knowledge and understanding,
Print Uoncr'i or AmhordeJ Agou'i Motto IFlectronic Signaturo) Date
Nam.
I. .Nn O+sner ssho ubtains a building permit to do his.her own work,ur an owner who hires an unregistered cuntractur
i nut registered in the Hume Impruvcnsent Cuntmctur(HIC)Program),will no have access to the arbitration
program or guaranty fund under.M.G.L. c. 1 ?A.Other important information on the HIC Program can be found at
,,,,1+ � % .., t Information on the Construction Supervisor License can be found at
2. %%hen substantial cork is planned,proN ide the information below: '
rota) (lour area(sq. 11.1 - _--_ _(including garage. finished basement attics•desks or porch)
Gross lis iog area i sq. 11.) _--,._ - - Habitable room count
\'uuther ul'hedruoms -,
\untherofhathrvons - - _ Ninhcrufh:dfh:nhs
I')pe of hvming ;),lent \lnnher ol'decks porches
I)penl'conling ,)oem L'ndo,ed ))Fen
t
I',q.d 1'rigect S+luarc 14+ot.+5e"n61) he•uh,uhiteJ liv..I'aial 1'rojtcl('oaf'
®euise Cascade Double 1-3/4" x 16" VERSA-LAM®2.0 3100 SP Roof Beam\RB01
Dry 12 spans No cantilevers 1 0/12 slope Monday,April 07, 2014
BC CALL®Design Report- US
Build 2627 File Name: BC CALC Project
Job Name: Andy Description: Designs\RB01
Address: Specifier:
City, State,Zip:Salem, MA Designer:
Customer: Yankee Pine Company:
Code reports: ESR-1040 Misc:
�o
12
BO B7 2o-ed-0o 20-00-00 B2
Total of Horizontal Design Spans=40-00-00
Reaction Summary(Down/Uplift) (Ibs)
Bearing Live Dead Snow Wind Roof Live
BO 1,472/0 4,388/0
81 4,905/0 13,500/0
B2 1,472/0 4,388/0
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125%
1 Standard Load Unf. Area(lb/ftA2) L 00-00-00 40-00-00 15 45 12-00-00
Controls Summary value %Allowable Duration Case Location Disclosure
Pos. Moment 23,315 ft-Ibs 54.3% 115% Completeness and accuracy of input must
7 07-11-08 be verified by anyone who would rely on
Neg. Moment -36,811 ft-Ibs 85.7% 115% 9 20-00-00 output as evidence of suitability for
End Shear 4,824 Ibs 39.40/6 115% 7 01-04-14 particular application.Output here based
Cont. Shear 8,114 IbS 66.3% 115% on building code-accepted design
9 18-06-04 properties and analysis methods.
Total Load Defl. U417(0.576") 43.2% Na 8 31-01-07 Installation of BOISE engineered wood
Live Load Defl. U529(0.453") 45.3% Na 10 09-00-08 products must be in accordance with
Total Neg. Defl. U999(-0.028") Na Na 7 21-10-01 current Installation Guide and applicable
Max Defl. 0.576" 57.6% Na 8 31-Ot-07 building codes.To obtain Installation Guide
or ask questions,please call
Span/Depth 15 Na Na 0 00-00-00 (800)232-0788 before installation.\MnBC
CALC®,BC FRAMER®,AJS-,
Cautions ALLJOISTO,BC RIM BOARD^ BCI®,
BOISE GLULAM^" SIMPLE FRAMING
For roof members with slope (1/4)/12 or less final design must ensure that ponding instability SYSTEM®,VERSA-LAM®,VERSA-RIM
will not occur. PLUS®,VERSA-RIM®,
For roof members with slope(1/2)/12 or less final design must account for Rain-on-Snow VERSA-STRAND®,VERSA-STUD®are
surcharge load. ttrraoddemctarksL Boise Cascade wood
Notes
Design meets Code minimum (U180)Total load deflection criteria.
Design meets Code minimum (U240) Live load deflection criteria.
Design meets arbitrary(1") Maximum total load deflection criteria.
Minimum bearing length for BO is 2-1/4".
Minimum bearing length for B1 is 7".
Minimum bearing length for B2 is 2-1/4".
Entered/Displayed Horizontal Span Length(s) =Clear Span+ 1/2 min.end bearing+
1/2 intermediate bearing
Calculations assume Member is Fully Braced.
Design based on Dry Service Condition.
Deflections less than 1/8"were ignored in the results. k 1
Page 1 of 2
®9ols Cascade Double 1-3/4" x 16" VERSA-LAM® 2.0 3100 SP Roof Beam\RB01
Dry 2 spans No cantilevers 1 0/12 slope Monday,April 07, 2014
BC CALL®Design Report- US
Build 2627 File Name: BC CALC Project
Job Name: Andy Description: Designs\RB01
Address: Specifier:
City, State,Zip:Salem, MA Designer:
Customer: Yankee Pine Company:
Code reports: ESR-1040 Misc:
Connection Diagram
b d
a
• �•
c
•4
a minimum=2" c= 12"
b minimum=3" d=24"
Member has no side loads.
Connectors are: 16d Sinker Nails
Page 2 of 2
®Belse Cascade Double 1-3/4" x 16" VERSA-LAM® 2.0 3100 SP Roof Beam\RBO1
Dry 2 spans No cantilevers 1 0/12 slope Monday, April 07, 2014
BC CALL®Design Report- US
Build 2627 File Name: BC CALC Project
Job Name: Andy Description: Designs\RB01
Address: Specifier:
City, State,Zip:Salem, MA Designer:
Customer: Yankee Pine Company:
Code reports: ESR-1040 Misc:
�o
12
B0 20-00-00 . ... 20-00-00
B1 - _.62
Total of Horizontal Design Spans=40-00-00
Reaction Summary(Down/Uplift) (Ibs)
Bearing Live Dead Snow Wind Roof Live
BO 1,472/0 4,388/0
Bt 4,905/0 13,500/0
B2 1,472/0 4,388/0
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tan Description Load Type _ Ref. Start End 100% 900/6 115% 160% 125%
1 Standard Load Unf.Area(lb/ftA2) L 00-00-00 40-00-00 15 45 12-00-00
Disclosure
Controls Summary Value %Allowable Duration Case Location Completeness and accuracy of input must
Pos. Moment 23,315 ft-Ibs 54.3% 115% 7 07-11-08 be verified by anyone who would rely on
Neg. Moment -36,811 ft-Ibs 85.7% 115% 9 20-00-00 output as evidence of suitability for
End Shear 4,824 Ibs 39.40/6 115% 7 01-04-14 particular application.Output here based
Cont. Shear 8,114 Ibs 66.3% 115% 9 18-06-04 on building code-accepted design
properties and analysis methods.
Total Load Defl. U417(0.576") 43.2% n/a 8 31-01-07 Installaton of BOISE engineered wood
Live Load Defl. U529(0.453-) 45.3% n/a 10 09-00-08 products must be in accordance with
Total Neg. Defl. U999(-0.028") Na Na 7 21-10-01 current Installation Guide and applicable
Max Defl. 0.576" 57.6% Na 8 31-01-07 building codes.To obtain Installation Guide
or ask questions,please call
Span/Depth 15 Na Na 0 00-00-00 (800)232-0788 before installation.\n\nBC
CALCO,BC FRAMER®,AJS—,
ALLJOISTO,BC RIM BOARD-" BCI®,
CBUSIODS BOISE GLULAMT" SIMPLE FRAMING
For roof members with slope (1/4)/12 or less final design must ensure that ponding instability SYSTEM®,VERSA-LAM®,VERSA-RIM
will not occur. PLUS®,VERSA-RIM®,
For roof members with slope(1/2)/12 or less final design must account for Rain-on-Snow VERSA-STRANDS,VERSA-STUDD are
surcharge load. trademarks of Boise Cascade Wood
Products L.L.C.
Notes
Design meets Code minimum (U180)Total load deflection criteria.
Design meets Code minimum (U240) Live load deflection criteria.
Design meets arbitrary(1") Maximum total load deflection criteria.
Minimum bearing length for BO is 2-1/4".
Minimum bearing length for B1 is 7".
Minimum bearing length for B2 is 2-1/4".
Entered/Displayed Horizontal Span Length(s) =Clear Span+ 1/2 min. end bearing+
1/2 intermediate bearing
Calculations assume Member is Fully Braced.
Design based on Dry Service Condition.
Deflections less than 1/8"were ignored in the results.
Page 1 of 2
®Balm Cmmde Double 1-3/4" x 16" VERSA-LANE® 2.0 3100 SP Roof Beam\131301
Dry 2 spans No cantilevers 1 0/12 slope Monday, April 07, 2014
BC CALL®Design Report-US
Build 2627 File Name: BC CALC Project
Job Name: Andy Description: Designs\RB01
Address: Specifier:
City, State,Zip:Salem, MA Designer:
Customer: Yankee Pine Company:
Code reports: ESR-1040 Misc:
Connection Diagram
+ib - d
�—
• ,•
a
1c
a minimum =2" c= 12"
b minimum =3" d=24"
Member has no side loads.
Connectors are: 16d Sinker Nails
Page 2 of 2