1 OSBORNE HILL DR - BUILDING INSPECTION �
,,�, City of Salem �•d
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a�p��y �v�� tr _
� APPLICATION _
- . wn- .:
PERMIT TO BUILD ADDITION, MAKE AEETERATIONS OR NEW CONSTRUCTi�:
lA�pRTAKT-AppBa�M to oumpMti'aKItMK!n secfbro:�, 1N, IV,and/X.
, �. .��-AT(LOCJN�ON► '� �U"�.S QO'-,/L-� .: : �i: . Zqg7filCtfT I
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L TYPE AND COST OF BU�DING-Ap appllcanta compfeA�Patts A-D
l� TYPE IMiROVEMENT � Q PROPOSED l�E•F�i"DEMOUTION'USE MOSf RECEM USE
. .. . �- �--.... _ .. . . .
t Ww�r OWdiq R�YO�nWI .. . Nar�tldnWl
! Q Mdltlon/M�aHrWl�GenMnumWrdnw - 12 �i.� - � �a_Q M..«�.r,�:nw�r
� MuNnp uMs adtle0,f arry,in prf 0.f3) - 19 Q ChueJl�w��
a Q �,rs»z,ea.� 's � �"n"amw-�w� �
zo i�u�mr
a� � ww�w c.+a
s ❑ neoar norc�wr u � n..ur now,mow.«ao�mwn• as 0 s.ryt..mm.�.o.r w�.u.
. s Q �wscktio ryr�m�wr�ar�w�a�r ou�ro.. � �^rr numa.ra uma�----• � O�rrmao�r
d unrre n nuuna h v.re 4»I i s Q_car.p� �, . � .. . zs Q ae�o�wnk o�«�
9 Q Mwhqlrebeatbn) 1e � p�. .� 28 ❑ HibYeufAlY � �
. 7 Q Fau1WatlonaNY . . . T8 Q.BrLud.YhrY�ollyr�
. �� � ��'��' 27 Q Sloir,mNerMM
� &OWNERSWP ZB Q 7aiiu,bwrs
a � Pn�n a,an,a�.�o«em�.�«+o�nc � 0 �,.�.,,�,
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9 Q Pudb(Fader�l.StaO�.or bW qora�m�ara - . .
C.COST (Omt�y NoirsiA�nW•Dscnb�n OMY pu0�d ur d buiCnY�.W,bod WocwFY PVM.
//'U�000 �nr,.a�ov.m�.�an e�arw a ro.o�r.�.n�und.a�owww sa�oa,easa,
ia ca.i a+mwoYsmanr_ _ s wroa,w x��oct a�Yw a.�ea wr aeoaN�s�e aeois.�r ewa�o.on�o.a++ara
m ird�strW qanl M ue�a e*ietkw Eui�rw is Dsirw Nnq�4«Or paOo�ed ur
rowr�e.aeurnoth�e��d�e - �� �.`'SIP ��r `l`�
ae�r�a�rr�--------------------- lOi 0(�D, � k. �_I
a �.�.p ..__.___.-----._____— /Gi a0o� � /`�o�� ( �Q�hy �l�r,f�P � �
� "�^¢�,�,.------- �G OaO� ' ` '
a onr.�ewv«.�e.>-----.- �U 044 ���' _
11. TOTAL C0.qT pF IMPHOVEMEM ,
III. SELECTED CFIARACTERI3TIC3 OF BUILDIN(i -Fw new buiWings and additions, complete PaRs E-L:demolition.
com te on Paris J 8 M aN otheis ski to/V
E PRINCIPAL TYPE OF FRAME F. OIiNCPAL OF MEATINfi FUa O. TYVE OF A(SE DISPOSAL l TYYE OF MECNAN�CAL
30 ❑ lwar Dearinc) .. 33 � ao HEae a a�M�I wi mw�w ai
31 �ham� � �8 ❑ OY 41 Q PrivaM(�O�C taYl e1G)
32 Q Shuclval els�l 37 Q ElectrkAy � � � ro
FI. TYPE OF TER SUPPLY
33 Q ReiMaW wrrJels 38 Q CaY Wi tlw�W an eNvaM
y� � �'�Oe��Y 39 ❑ ONar'SpecdP 42 N+CYC a OAvab m�anY 48 � yes Q No
43 � Privab(we�,ci�4m)
� _— _ . . . _. - _ 1
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1 DYEIISION6
a���S�t/t/,�S M. DEMOLITiON OF STRUCiURES:
as. wnie..as�a. ---------._...----__._-- � .: •
49. �adl aP�+faal d Ma ais. „ F�e ADPro!�al from Historical Commissioo been received �
�m�.�.�e�..,�. �2�;5�'i�SG tar a,,,,�ure ove►r�y cso�v�s� v� No—
-----._._.
m'u"m^s r---' (' , _ _ .
O� -:lM1�2-. .� .tit ,�;j.
wrarm�a,�...oM1�9I��_.---- _. Di9_�eieNumbei
a, r;
R.MU�B6�Of OSF- vAltltlllG SP�CES PbB�C.OflhC�
f
SL Fnclaed— . —.."'.—_ _'__ __
- HAVE THE FOklOWING UTILITIES BEEN OISCONNECTED?
s2 wam�s__--.------ Yea No
ow �
L s3 E�cw..e�- ` —���� EIeCtr�� '
FW � .S61Nlf: . . . . ° �.
x NiiO"d DOCUMENTATION FOR THE ABOVE MUST BE ATfACHED
°'�'°°"` wmr.�--: BEFORE A PERMIT CAN BE ISSUED.
N. COMPLETE T11E FOLLOWING:
Historic DistricCl Yea_ No (H Yes.P�enClose doCw�lerlffition irom_Hiat Can.). ._
' / . _. _ . _ _ . -. , . ... __:.. .
Conservation Ar�4 :Ye8_ No v (M y�;please endose Ordat of Cor�didon8l
Has Fre Preventian aPP►oved and stamPed Dlane or aPP�iCatlons? Yea�IG No_
Is propeAY bcated in ffie S.RJ1:dlsMcYt Yea—v No_
Compy with Zontng7 Yes_v No_ (n no.encbse Board of APPeaI decision)
Is bt grandfatheredT Yea_ No Uf yes,submN�rt�entatlan/N rw.submR Board of Appeal decision)
If new constructlon,has tt�e prope►Rout(ng Slip been encbsed? Yes__ No�
Is Architectural Access 8oard aPP►oval required? Yes_ No�(If yes,submit dxumentatbn)
Massacnusens stace contracta ucense# CS Da '76�f� sa�em �icense x ��
Home Improvement Contracta# Homeowners Exempt form(ff apPlk�able) Yes_ No_
CONSTRUCTION_TO BE COMMENCED WIT:i1N SIX(8)MONTHS OF ISSUANCE OF BUILDING PEFMR
I If an extension is necessary.Pl�se submit
CONSTRUC710N IS TO BE COMPLETED BY: ' �j� �d� in writlng to ihe Inapecta d Buddinga
V. IDENTIFICATION• To be completed by all applicants
N,,,,s wu�am�.-�,wac oq,ma wn �cae. rx rio.
,. �' �v�/P S .G •�3e� Zf� /i�i D�'i'�/O ZG/ 33
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Z � � � _ d. �✓ox ��D dlac Cd'�Ti �l 33 �
�"'�` CD/z 2/���/�/ �•�. 9� 1
�7�/� 9
��� n `� � � per��l�i a
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I herebY certiN tl�at the work ia authariz the owner d record and that 1 have been authorized tY the owner to make this apWicaho^ '
as his autlrorized w ree t f �caWe Iaws of this iurisdiction •
Sgnadue of appl' A �D �di�. i J" 1 . p`y' APdo� D e '
i
, �
I VL VALIDATION
Permit number
Building
Pernik issued
Budding
Parmill Fee $
Ca lkate of occupancy
Drain Til
Plan Review Fee
NOTES AND Data - (For department use)
s
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by.
DO NOT WRITE BELOW THIS LINE
19
Completed by
FOR DEPARTMEM USE ONLY
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faX 9i8 745-,446-
I FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR A BUILDING PERMIT
I
IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE
AND THE SALEM FIRE CODE, APPLICATION IS HEREBY MADE FOR THE APPROVAL OF PLANS
AND THE ISSUANCE OF A CERLIFICATE OF APPROVAL FOR A BUILDING PERMIT BY THE
SALEM FIRE DEPARTMNT. ( Ref. Section
� 113.3 of the Mass. /Bldg. Code)
JOB LOCATION: zd'14fxwe Ar//
OWNER/OCCUPANT:
00
29 1"Ort A'
F,7 -e Pre:encicr
T,U; ;u
9''i-74'
ELECTRICAL CONTRACTOR:
FIRE SUPPRESSION CONTRACTOR:
SIGNATURE OF PHONE P: ���%!7y
APPLICANT:
ADDRESS OF'�J CITY OT
/
APPLICANT:G� l� TOWN:
APPROVAL DATE:
Certificate of approval is hereby granted, on .approved plans or submittal of
project details, by the SALEM FIRE DEPARTMENT. All plana are approved solely
for identification of type and location of fire protection devices and equipment
All plans are subject to approval of any other authority having jurisdiction.
Upon completion,._ the . applicant or installer(s) shall request an inspection and/or
test of the lire protection devices and equipment. (ADDITTIONAL REQUIREMENTS,
SEE REVERSE SIDE +'*•)
NEW CONSTRUCTION.
PROPERTY LOCATION HAS NO COMPLIA-NiC,''. WITH THE PROVISIONS OF
CHAPTER 148, SECTION 26 C/E, M.G.L., RELATIVE TC THF. INSTALA-
TION OF APPROVED FIRE ALARM DEVICES. TAE OWNER OF THIS ?RO-
PERTY IS REQUIRED TO OBTAIN CO,%WL'L';C-- :\`, -\ CONDITION OF
OBTAINING A ?U £Inlilri PERMIT.
FiV ISIO
pFe,pc i'j.'-i LOCATION IS Iii C,tirr .
(hC':c; ;iii! .'F. N JF C�Ar'_,.-
1.
143, SECTD,N -16 _.':, `1 o,L,
/tit ✓/y t _ C> -._
$30.00
CHECK;
Professional Land Surveyors & Civil Engineers
ESSEX SURVEY SERVICE. 1958 - 1986
OSBORN PALMER 1911 - 1970
BRADFORD & WEED 1885 - 1972
PIAT PLAN OF LAND
LOCATED IN /
57Ccr•9 MASS.
Liz -
79/9��'
a, ZG I
ZONE: V; TIff AREA- A inm Fnnnrrer_V. /1
FRONT YARD: IS i? SIDE YARD: Iurs REAR YARD:
SCALE:
DATE:
REFERENCE: f�Z BK `1)2_ PG % J
X1z'/c_'i
�
104 LOWELL STREET
PEABODY, MASS. 01960
(978) 531-8121
FAX: (978) 531-5920
I hereby certify to the 54Z,'-1-1
Building Inspector that the pro-
posed construction shown c
to the dimensional zord
/Xf Mass.
R.
MELLO
No. 31317