3 OSBORNE HILL DR - BUILDING INSPECTION City of Salem ward
APPUCATION
FM
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUC"
IMPORTANT-AppfcwW to cwwl ft M Po9rrlE In socdo`(n -41& A% N. and Df —AL
-L AT 0.0GT10» �/7I.C� �� Wj" 0 OISIIYCB_.
OR LOCATION BETWEEN d C� /.�/,�/ AND
BVNQ! Sl19OM910N //���G C/ '"'�-
,unss
- nor �F BLOCK 31a
L TYPE AN OST OF BUILDWO-AI appticants complelf Pbrel A-D
A. Tres u MOVEMOff D. PROFos® FOR"DEMOUTIOW USE Most RECENT USE
1 Naar *4(ff m 14 13 eanual
a Q Adarwl p rsUdrrY,anrr nwnbr d narr to Orr rnt/y 19 ❑ AsarrnrlL�r1
Sou4k9 uNr addaq T a"..n ml A 131 13 ❑ 19 Q C"4k cow mewas
3 Q ANWO*m(Sw T abti y �mas frnYY-F,ry numeipr 20 Q nett-
4 ❑ RapaW epbm yd 14 ❑ 3hlrrlyd hda1,morl a&wwA r,- 21 ❑ 110"VwW
Fnrr nwrew of umU --- 22030 aios aftem-sort wow
S Q wm*bv(if mur9Y.t11 nadwwA ww write. 23 ❑ HoaplK tirrlWar
Of un r n bUAt*W ti PW 4 13) 1S ❑ Oara99
9 ❑ Mtse6to(dtio on) 44 ❑ OOs brdt,orrraabttr
is ❑ capon 29 ❑ A :�uWb
T ❑ stir 17 ❑ O9tw-Sw6 A Q Bla..-trt«aat o adtc lrrtr
ILo m Q Taft roars
B" prlM.(rL sit)
dirt.aorp«.don.ronp-dr 79 Q Opt.-spectf
9 ❑ PWft(Feft SWa.a bol 9ararn+rr
C-Co3T Pam UiWraYl-Onw ibs in daW pe0oaad ur d buddr."sp,rod Draora.Ml 06v"—.
LliWi maCNr alrA Ytatdr,bt"r hoap9d.aarrtartrry aelral aaoordrY aeltoal :
t C Call d imptovsrrtard SdWA 9 at Ytdtrbrl plattL I w d"Oft bud&q isb**Uan-srtrl o�pmapand urn.
7b W htplrld Nd nor iwL*d
d%abotir coat l fJ�r,[.(J ^ �•�✓ "t / r"1 aK' -.
R FWartb.q.._.._._..__._.._ �✓r�-✓
vv
t/. TOTK COST OF IMPROVEMEM
ILL SELECTED CHARACTERISTICS OF BUILDING -For new buildings and addition; Complete Pacts E L-' demolition.
Cam to on v Parts J S M aN others skip to N
E PRulC7p/1< OF FRAMs F. PRP OF MEATM FMkKTYPE
PE SEWAGE OL4POSAL L tYPs OF ME
F30 ❑ f Wal ow. 3S G. PLtft a pmrla consrrry 'M arts as
31 Abod!rams
34 Q Sln.civar sties b ❑ ENcatoy ❑ prtvar laapet:tank wel a� `M .S Q
33 ❑ Rs.dacW comer 39 Q Cad ATER SUPPLY W9 urs b,an ar.« W?
N ❑ ou,.-Spac'AY 39 Q ou,.-Spac/, pla9e a mMal dOntpally ,,9 Q ,OB •T
QFrM (W clot-.(
�! r
i
i DNAEwoNs / M, DEMOLITION OF STRUCTURES:
sa MONM co sow"
as •�,W,4, 0 rw d to are � Has Approval from Historical Commission been received
Ad%o wsm 0#. v a`L� for ary sliucturs over fifty(50)years? Yea__ No—
smarrns ._ ..
sa a.r r a a.a+o It _ ��t`�SF Dig Sale Number
K.wsrser OF a�r�sn�!� Poet Contrab
sr E r vss C,_(jJY ryAyE THE FOLLOWING UTILMES BEEN DISCONNECTED?
u Ouedwffl ___----...__..-_- _.__ Yea No
L 066neL OULDM6a OW
Ekdft
SS Hefnre _._—._—.— .__—
GaE
Sewer
s' wftw d p0(XIMENTATION FOR THE ABOVE Ml1ST BE ATTACHED
bdrM=" PERMIT CAN BE ISSUED.
IV. COWLETE THE FOLLOWWG:
Historic District? Yes— No_ (h ya&Please amiss doaertentatloe from HIsL Cant)
Conservation Area? Yes— No (B yes,please ertt— Order of Conditlonel
Has Fire Preverttlon approved and stamped plans or appticatlone? Y No—
Is prop"located in the S.RA 9xlrW Yes— No
Comply with Zoning? Yee__ No— enclose Board of Appeal decision)
Is lot grartdlathered? Yee— No— (If yes,submit documentatloNif no,submit Board of Appeal decision)
If new construction,has the proper Routing Slip been enclosed? Y No_
Is Architectural Access Board approval required? Yes_ No (If yea,submit documentation)
Massachusetts State Contractor License r Salem License r a l� , /
Hans Improvement Contractor a Homeowners Exempt form(if applicable) Yes_ No_L/
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
B an extension is necessary,please submit
CONSTRUCTION IS TO BE COMPLETED BY' in writing to the Inspector of Buddinge.
a6w
V. IDENTIFICATION• To be completed by all applicants
wry Ua.q.mrrs v,,mow.east:h.aM snit ZIP Coat "u Na
a 7d
z l%sG W 70 all �/ 33
E.qr�
I hereby the proposed cork is auerorized by the owner at record and that I have been audwzed by the cwrer to-make this application
as his au z He agA to corfam to all 3mikabis laws cl mis,unsdictiom
Sgralure ddress J� � 7� A
C/
DO NOT WRITE BELOW THIS LINE
FPeffrftildN
VALIDATION
FOR pEpWTMEM USE OPLY
lding
R number u»Gmw
19_ F^CrakV -
pbrmit issued
Buknq U+e IadrV
Permit' Fee : ppcuparcy lde
Certilic.ale at Occupancy f Approved by
Drain rile f
Plan Review Fee _
rrnE
NOTES AND Dab• (Fa department use)
1
Ad
$ U
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by. Completed by
A ZONING PLAN OWANERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE ON PLOT PLAN•For Ap ic&W Use
O N
4
I
F12 295- -
Professional Land Surveyors Er Civil Engineers
ESSEX SURVEY SERVICE. 1958 - 1986
OSBORN PALMER 1911 - 1970
RRADFORD_B_VNEEn 1885-1—%72-
PLOT PLAN OF LAND
LOCATED IN
S9LEM MASS. "/ OLO(j
Lo7 1 LoT 2
9366�� o
i
tc Lc T 3
Sa'
P&AZLIK
Lz ,2
s6s 9. 311
a1ZAI 141ZZ D/ZeV
I hereby certify to the 5W6el
Building Inspector that the pro-
ZONE.1Z:I c TAT AREA: /1bAlC LOT FRONTAGE: �D/U Posed construction shown conforms
to the dimensional zoning of
FRONT YARD: `SF7 SIDE YARD:./6/L/ REAR YARD: 3067! 5%LCp/ Mass.
SCALE: �6�hAli� 7 7 4aP is
DATE: /7/'�JLLG/ LL, LCJ�O / V OPHER
REFERENCE: PZ BK 4oZ PG 75� Christpffer R. Mello 31 .IW17 H
0
SFr. K�fl�
104 LOWELL STREET
PEABODY, MASS.01960 ,
(978) 531-8121
FAX:(978) 531-5920
Cj- Y OF & .&A AkSS.ICHUSETM
Bt: wmil;DEPAIZTIENT
110 WASHINGTON STREET. Jiew FLOOR
Tar+ . (978)143.9595
FAx(9711) 1i49&M
KBIDIE FY DRMO[L T MbW ST.Plam
MAYOR, DIRECTOR Of PC®LIC PROPERTY/et:T DLVG CoSL%rtssforER
Workers' Compensation Insurance Allldavit: Builders/ContractonlElectrlciamlPlumbers
> t Ilean In nrmatla Name tunnrOryannratonitLvtduAl): 6 rl I
Address:
CityiState/Zip. L� G/ • Plwne M:�l/`
,fro you se empleyer'Cheek the appropriate boas Type of roJoel(required):
I.Q I am a employs with 4. ❑ t ors a srneral contraetar and I b ,New consauctioo
.mployse(full and/or pan-time)." have hind the stascontmcmrs
1.Q I am a sake proprietor to partner- di
partne
listed on e attached shrat.1 7. Q Remodeling
+hip and have no employee Thesesudeontruetom have a. Q Demolition
Watkins fos me in any capacity, workers'Comp.inatrsnea. 9. Q Building addition
INo workers'comp. insurance S. Q We are a coeporsdm and its 10.Q Electrical repairs or additions
r ytdred J odicars have exercised their
5.Q 1 am a homeowner doing all work risks of estasmprion per MOL I I.Q Plumbing repairs or addiftne
myself.(Na workers,comp. e. IS2,41(41 and we have no 12.0 Roof repairs
insurartcerequited.(t emp ee.( ow I).QOthv
comp.insurance require/.)
•Any appanr the chac4 bra At ertw Ater 00 MIA 111111,111131011 below attrwfy thdr wmbm'cwvfms thw ptdiey"'Ave'trix
't hwwuwwxa•hs udtaw ois aeldavn indltatine thy am Joins All wok And thm him aaaidr ueeracram erw aJtmk a new amJwit Wikeina oak
<'.wtrsyw that cbwk ibis Mrs tinge aesbd as additiwal.hIat d".i"e dw tutor ar ar A&►vG ark m AM thalr wabem'Con -PdKy inrwnrtls
/us ow etwpkyer rhwrbPrwrJd/nR twrbrrs'cowPrnndrnlwsrrowajer aq ewplrryeot eeMr b/Af pal4y ew/Ja1 sbr
in/ernrWfo� � -
Insurance Company Name:
Policy e or Self-ins.Lie.IT: DO` 766 _1o1 Eapirasion Data: r�•a a�f
Job Sire Addrers:/?/V'�!J//�L� X/ ,N,w Cityistate/Zip
.%ttsck a copy of lha werhars'compensatlon policy daelatratlen pap(showing the policy number and eaplrsdoa tlab�
h'aiiuru to sccurs coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a Rue
Of up to S2S0.00 a day asainsl the violator. Ile adviuvl that a cupy of this statement maybe forwarded to the OlYice of
htv.ausatium ofilia DIA f insurance co•emp rcriftcation.
I de hereby eerrify /W the riwa yr ' ejPer/rq Cher l injrr allow Provide,above Isr ♦1 and ecared
-e2 �j Data!
P'•urc A /�/ 33�r < ��
OJJlcia/us"only: Do not wrirr in this arse,le bit.atnO/rrctl by city or/atvw rt//!c•ial
I
City or turn: YrrmiN.lcrnst/__.
1%suin j Aulhunly Icircle tine):
I. ❑uard of IleaUh 1. Rwldlns Department 5. City/rower Clerk J. Electriai inspector 5. Plumbing Inspector
6.thher
l ,,nuvt Person: _ ... Phone d:
City of,Salem, Massachusetts
Fire Department
48 Lafayette Street
David`W. Cody Salem, Massachusetts 019 70-3 695 Fire Prevention
Chief TeL 978-744-12-35 Bureau
978-744-6990 FaT 978-745-4646 978-745-7777
dcody@salem.com
FIRE DEPARTMENT CERTIFICATE OF APPROVAL. FOR A BUILDING PERMIT
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 CERTIFICATE OF APPROVAL FOR A BUILDING PERMIT
BY THE SALEM FIRE DEPARTMENT. (Ref. Section 113.3 of the Maass. Bldg. Code)
JOB LOCATION: G��r//I���'i i�Q( �i� 411e 2
OWNER/OCCUPANC:
ELECTRICAL CONTRACTOR: Z/,�//U//��
FIRE SUPPRESSION CO CTOR:
SIGNATURE OF ONE
APPLICANT: �
ADDRESS 0 ��. yr„X CITY/TOWN
APPLICANT: ✓�
APPROVAL DATE: _ o
Certificate of approval is hereby granted,on approved plans or submittal of project details,by the SALEM
FIRE DEPARTMENT. All plans 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 fire
protection devices and equipment. (ADDITIONAL REQUIREMENTS SEE OTHER SIDE.)*****
X NEW CONSTRUCTION
PROPERTY LOCATION HAS NO COMPLIANCE ATTH THE PROVISIONS OF CHAPTER
148; SECTION 26 CIE,M.G.L.RELATIVE TO THE INSTALLATION OF APPROVED FIRE ALARM
DEVICES, THE OWNER OF THE PROPERTY IS REQUIRED TO OBTAIN COMPLIANCE AS A
CONDITION OF OBTAINING A BUILDING PERMIT.
PROPERTY LOCATION IS IN COMPLIANCE WITH THE PROVISION OF CHAPTER 148
SECTION 26 C/E, M.G.L.
EXPIRATION DATE: 1 Z 9 v
SIGNATURE FIItE OFFICIAL
UNDER 7,500 SQ FT �$50< .000, CHECK#
OVER 7,500 SQ FT �IIIo.oV