27 HORTON ST - BUILDING INSPECTION .��aa• GCS �`—�.��
The Commonwealth of Massachusetts
a Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CMR,7 s edition Ois SALEM
Revised January
Building Permit Application To Construct, Repair, Renovate Or Demolish a 1, 2008
\ One or Two Family Dwelling
l on For Official Use Only
BuildmgPermitNumberm ����� i�r� m . Date lied �� ss � ;
St iture f ti
I wilding Commissi er/In o f mgs ,s, _ ,Data r a 4 a L B
E ON 1:SITE INFORMATION"-1 e(': -?
- ���.
1.1 PropertyA,ddrre�;s: �/ j �j 1.2 Assessors Map& Parcel Numbers
Lla K 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 a 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`.. i?e
2.1 Owner of Record:
Na t) Address for Service:
Signature Telephone
SECTION 3.DESCRIPTION OF PROPOSED WORKZ(check all that apply) 'g
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) nd Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify:
Brie escription fProposed Work 2: eyn,Y o 1' L a- -
SECTION 4-ESTIMATED'CONSTRUCTION COSTS
v. fit!.m.._.. e _,_:. :--
Esfimated Costs: =r. ial
Item Official Use Only
Labor and Materials)
..u=�r, .r-- .-...
1.Building $ .1 i.Building Permit Fee $ Indicate how fee is determined:,,
2.Electrical $ i Q Standard City/Town Application Fee a
❑Total Protect Cost(Item 6)x mulhpher. z x- i
3.Plumbing $ Q 2. Other 11 Fees. $ ' { k
k x
4.Mechanical (14VAC) $ List _ •��__ =1
5.Mechanical (Fire
Su ression $ TotalAl)Fees $# '" a�� * '(
f Check No + �Check'Amount. . =Cash Amount y
6.Total Project Cost: S ( p Paid in Full_ ,. ; ❑Outstanding Balance Due:Lam_,
:SECTION S:(CONSTRUCTION SERVICES I " ' 's gt
5.1 Licensed Construction Supervisor(CSL) •r
T` `7 �i/e r0 a /3
License Number Ex irati n Date
Name o SL-Hol eyy t' G(/� List CSL Type(see below) U
' t
Addr T e=; at,!.. �_�_ �� �==Description --� a;
U Unrestricted(u to 35,000 Cu.Ft.)
R Restricted 1&2 Family Dwelling
nly
—L tq�^ y7/_ `c(`i'' C ResidentiaM Masonry l Roofing Covering
Telephone !� / r TT WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Regis//k``er,ed Hoory�l prove ent Contractor(HIC) ��'( cQ
y7vt2 CdrL��-ui CA �t> 11
HIC CoSnpan y Oi N. ne or FB ,Reg istr N e> J �i Registration Number
c( `?/`• . ;ra�btxxsr
Addre
V � �/ ��jL
7/ (�T7 E*imtiorY Date
Signdine Telephone
SECTION 6 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G.L:c 152 §
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'ai a f
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,,.-T.-` ..., ._. i , -• -_
I, as Owner of the subject property hereby
authorize to act on my behalf, in all matters
relative w rk thorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER'OR AUTHORIZED AGENT DECLARATION
1, r/ t7 414 (.-0i^- as Owner or Authorized Agent hereby declare
that the statements and i formation on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
�7 eve,
Print Name
Signature of er or Authorizeid Agen Date
_(Signed and the pains and penalties of perjury)
.. W.
._n,.°' e -.. NOTES. , � �� , .a .. " x mt t. � (=F
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 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"
17ie Commonwealth of Massachusetts
Department oflndustrial Accidents
Office oflnvestigafions
600 FPashingtortStreet
Boston, AL4 02I1I
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A-pplicant Information Please Print Leaibl
Name (Business/Organization/JnEvidual):
Address:. /L
City/State/Zip: X !I Phone#:
Are you an employer? Check the appropriate box:
4. I am a general contractor and I Type of project(required):
);
1. []� I am a employer with� ❑ g
/_ employees (full and/or part-time).* have hued the sub-contractors 6. New construction
2. ❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling
ship and have no employees These sub-contractors have g• ❑ Demolition
working for me in any capacity- employees and have workers'
cum insurance.# " 9. ❑ Building addition
[No workers' comp. insurance P•
required ) 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 1'l.❑ Plumbing repairs or additions
myself [No workers' comp, right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4), and we have no -
employees. [No workers' 13.❑ Other
comp.insurance required.] '
*Any applicant that checks box#1 most also fill out the section below showing their worhms'compensation policy info®ation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside cmtracton mast submit a new affidavit indicating such.
$Contractors that check[his box most attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub-contractors have employees,they Est provide their workers'comp.policy number,
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. T/ �/ T /�
Insura oce Company Name: ,t C tr¢�'jg :n a/f cy Em ✓eof 1disA zc e. CIJd�ll✓R/ 4
Policy#or Self-ins. Lic.#: Vt/ 4DI C Fie 98/ol Expiation Date: �f
Job Site Address: r 7� ]dl i?/7 - G' (/¢ City/StataZip: 7d �/ (, �13V
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fuze
of up to $250,00 a day against the violator. Be advised that a copy of thi$ statement may be forwarded to the Office of
Investigations of the IDEA for insurance coverage verification.
I do hereby cerfify e pains a d nal ' s ofperjury that the information provided above is true and correct
Sienamre: / qw Date:
Phone# ( —
Official use only, Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board ofHealth 2. Bu ilding Department 3, City/Town Clerk 4. Electrical inspector S. Plumbing Inspector
6. Other
CM OF SM.F. . UrksSACHUSETTS
• BUIMLNG DEP�RTJ1&NT
120 WASHNGTON STREET, Y'FLOOR
T F1- (978) 745-9595
FAX(978) 740-9846
1QJtBERI.EY DRISCOLL
N"YOR T HOMAS ST.PtERRB
DIRECTOR OF PUBLIC PROPERTY/BUMDING COMMSIO,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
I It, S 150A.
The debris will be transported by:
�Fccet/e (frryi(r?�
(name of haulerL
The debris will be disposed of in
(name of
facility) /
(address o�facility)
signature of per t applicant
date
dcbriwll'Jac
®Bolob Cascade` Double 1-3/4" x 7-1/4" VERSA-LAM® 2.0 3100 SP Floor Beam\FBO1
BC CALL®3.0 Design Report- US 1 span I No cantilevers 1 0/12 slope Tuesday, November 13,2012
Build 517
File Name: BC CALC Project
Job Name: EISNER JOB Description: F1301
Address: Specifier:
City, State, Zip:SALEM, Designer:
Customer: Company:
Code reports: ESR-1040 Misc:
is 07-00-00 j
BO,3-1/2" B1,3-1/2"
ILL 1,680 lbs ILL 1,6801bs
DL 725 Ibs DL 725 Ibs
Total Horizontal Product Length=07-00-00
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 1150/6 133% 125%
1 Standard Load Unf. Area(psf) L 00-00-00 07-00-00 40 10 12-00-00
2 Unf. Lin. (pit) L 00-00-00 07-00-00 0 80 n/a
Controls Summary value %Allowable Duration case Span Disclosure
Pos. Moment 3,676 ft-Ibs 43.9% 100% 1 1 - Internal Completeness and accuracy of input must
End Shear 1,789 Ibs 37.1% 100% 1 1 -Left be verified by anyone who would rely on
Total Load Defl. U616 (0.127") 38.9% 1 1 output as evidence of suitability for
Live Load Defl. U882 (0.089") 54.40% 1 1 particular application.Output here based
Max Deft. 0.127" 12.7°% 1 1 on building code-accepted design
Span/ Depth 10.8 n/a 1 properties and analysis methods.
p p Installation of BOISE engineered wood
products must be in accordance with
%AIIow %Allow current Installation Guide and applicable
Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide
BO Post 3-1/2"x 3-1/2" 2,405 Ibs n/a 26.2% Unspecified or ask questions,please call
B1 Post 3-1/2"x 3-1/2" 2,405 Ibs n/a 26.2% Unspecified (600)232-0768 before installation.
BC CALC®,BC FRAMER®,AJS-.
Notes ALLJOISTO,BC RIM BOARDT-, BCI®,
Design meets Code minimum (U240)Total load deflection criteria. BOISE GLULAM- SIMPLE FRAMING
Design meets User specified (U480) Live load deflection criteria. SYSTEM®,VERSA-LAM®,VERSA-RIM
n meets arbitrary 1" Maximum load deflection criteria. PLUS®,VERSA-RIM®,
Design rY( ) VERSA-STRANDS,VERSA-STUD®are
trademarks of Boise Cascade Wood
Connection Diagram Products L.L.C.
b d
a �
c
a minimum =2" c=3-1/4"
to minimum =2-1/2"d=24"
Bolts are assumed to be Grade A307 or Grade 2 or higher.
Member has no side loads.
Connectors are: 1/2 in. Staggered Through Bolt
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