4 OSBORNE HILL DR - BUILDING INSPECTION (2) Fw
//y>—dr City of Salem we.a
Map: 09 Fey (0 y ri ��
Lot . 030 � � �J
I,kacY- .
APPLICATION
FOR-
PERMIT TO BUILD ADDITION, MAKE A AERATIONS OR NEW CONSTRUCTIC
IMPORTAINT-Axwe nt to ComepAw;Aol ltwm in wcuonv 14 A%N,and It p1Nq
L . . -AT 6.0110411.10M1 f�:.. . ,r l/'S �OVI�L ::Tt �.! Dye ve ZD131A1CT _
OLOCATION eETvaEEN I ohyrr ;. Awn
BUIQIi h . OGh �d -
BUMMINGs
fl Y Sl P ��.S LOT�_BL.= �
L TYPE AND COST OF BUILDING-All applicants compla9i Parts A-D
A TYFE C)F aIIFROVEMENT D. PROPOM UM•FOR"DEMOUT10M USE MOST RECENT USEt rl..eWano R.eldrrlrr NaesWrldr
2 0 Additions rsrdrWd.weirnumbw of 12 121�96 ft lly 18.0 miu a nertL r.osvbrw
housing unM added,s arty,in Mrt 0.13) 73 0 19 0 1.'letrd4 oom r.lipbus
3 0 AMsallon is@*2 abow) Wb o twrYy•Eraer 20 0 b iuserw
21 0 Per"9
4 0 Repdr replamwit 14 0 Trrm*d horl,mc6K or d«mibry• 22 ara9e
0 multi N*matlsnMl arrr number 23 O 9era0a
5 Wrecking
0 of units inbuk"in Part a 13) 1 s ❑.Grags .
24 0 Oleos,sent lsawsbrW
s 0 Mwft(rsbeasar) is ❑ Carport. 25 0 Pudic utsllr
' Q Uw-SPSCrp 27 0 sbna,rrrrtaNM atlucatlorral
0 0* 17 O
B.OWN,PSHW 25 0 Tw*16benvs
s ICrIptWab(individual c«P«a mnonprdi 29 0 glur-sWr'yY
IneUhAior4 esm)
9 0 Pudic(FedereL sWM.«bral W mrnwd
C.COST (Cnra con" NorresWsrs41.0escribs in detail propord uns d laridir*w e41.loud poossahrg PANT
1.� mwhkw shop Wsrdry IarI I g at l+Oepisl sWrlerd ry ma"sawndery sdicd COMP.
- IQ Coat d hnpronenrera 'aW /. o00- Mother edroal,,Wft guaP for depuh we stem mrir orbs bui*o%office bnadin9
at iriduW W Piave.It ues d eaietirg buid4rp is OWp dWO4 wiser prcpdsad use.
To Ds lnahpM but not behded " d Goo
(�
in Ms above Cod
is. Vl/`�. Ekcok l—_—__._--_____.___.__
a PkwnbbV -- _— --- - -- S 006
C. FlestiM air cmWitim ng — -
d Odw(ebvat«,elm)— .--
11. TOTAL COST OF IMPROVEMENT OO
IIL SELECTED CHARACTERISTICS OF BUILDING •For new buildings and additions,complete Parts E-L;demolition,complete only Parts J&M aN others skip to IV
E PRINCIPAL TYPE OF FRAME F. PRNCiA�TYPE OF HEATRq FM O TYPE OF SEWAGE DISPOSAL L TYPE OF MECHANICAL
30 0❑y/M�omy hvai beeirMl 33 lrv-l�/Gas 40 rG�Pubk«piiw4 osmpany tWaidewee b9e ceroal air
31
32 0 Sds.4val steel 37 0 Sectricty 41 ❑ Drivels(septic bsal ele.) rr� 45 0 u�
33 ❑ Reirkv mxrets 38 Q Cod K TYPE OFiWATER SUPPLY ypl�J by an d«mb/r�
34 0 o1n«•sPx7y 39 0 Offer-SWAY 42 ,L•,�s/A+biC«WMYcon4rrY 48 yys 47 FIc1
43 0 PrivaEe(well ciswn) .
r`
J.MOFO�ff-MMM-
M. DEMOLITION OF STRUCTURES:
onp .._______NSPACES
-------------
%m d mw am. Has Approval from Historical Commission been received
ses m e�v for any structure over fdty(50)years? Yes— No—.. m n—7 Ku �MMM-vu Past Control:
s,. a dor.d--_------------ - HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
szoWaoon_--------- Yes No
water
Ss. FscWesd r Elecb'i�
Ful Gaza
x Ni O"a DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? . Yes___ No (ff yes,Pie enclose documentation froM HisL Cam).._
11
Conservation Ares? ,Y No (ff Yes D enclose Order of Conditiara)
Has Fire Prevention approved and stamped Plana or applications? Yes✓ No_
Is property located in the S.R.A:district? Yes---
Comply with Zoning? Yes_ No_ (ff no,enclose Board of Appeal decision)
Is lot grandlattwed? Yes_ No Z(lf yes,submit documentatlan/ff no,submit Board of Appeal decision)
It new construction,has the proper Routing Slip been enclosed? Yes_ NoJZ
Is Architectural Access Board approval required? Yes_ No— (If yes,submit documentation)
Massachusetts State Contractor License# C S OD 7 I H1 Salem License# a
Home Improvement Contractor# Homeowners Exempt form(if applicable) Yes— No_�
i
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
If an extension is necessary,please submit
CONSTRUCTION IS TO BE COMPLETED BY:Ahvember 3 1 st- 2007 in writing to the Inspector of Buildings.
V. IDENTIFICATION. To be completed by all applicants I
m,,,,s mm"adams-munber,sneer,Co.aid swe av Cady Ter N 1111
Less" Y• U ' 0� d
CS 001 -3312. - �
ContractDr r lu n 0 - s7v,F(ecdddies
9 1
a { 1
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I hereby cerffly that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application
as his aujWzed agent and we agree Ip conform to all a laws of this jurisdiction
SigrWur Address Application date
1
DO NOT WRITE BELOW THIS LINE
VL VALIDATION
Building
Foa oEwwn�xr tue orrur
Permit number use craw
FEUIding 19_ Fee Gra&v
Permit issued
BUMM9 Li+Loadp
Permit Fee $ 00momcr LOW
Certificate of Oca4uncN $ Approved by
Drain The. $ ,"'V
Plan Review Fee $
Im F
NOTES AND Data•(For department use)
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PERMIT TO BE MAILED TO:
r DATE MAILED:
Construction to be started by. Completed by.
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A ZONWd PLAN E%AMINERS NOTES .
DISTRICT
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MONT YARD
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SIDE YARD SIDE YARD
REAR YARD
NOTES
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SITE OR PLOT PLAN•For A~Use
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FaX 978 7 45-4646
�I —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 TILE ISSUANCE OF A CERTIFICATE OF APPROVAL FOR A BUILDING PERMIT BY THE
SALEM FIRE DEPA.RPnENT. ( Ref. Section 113. 3 of the Mass. Bldg. Code)) _
,JOB LOCATION:
OWNER/OCCUPANT: ef "/ f ✓1 i ,�
ELECTRICAL CONTRACTOR:
FIRE SUPPRESSION CO CTOR:
SIGNATURE OF
APPLICANT: PHONE
ADDRESS OF
/BOx �/
APPLICANTT:: 7G�/ CITY OT
�• TOWN: �llI l ��''�
APPROVAL DATE: ) .
Certificate of approval is hereby granted, on approved plane 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 plane 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. (ADDITTIONAL REQUIREMENTS,
SEE REVERSE SIDE
NEW CONSTRUCTION. 14
PROPERTY LOCATION HAS NO CO2L'LIANCu WITH THE PROVISIONS OF
CHAPTER 148. SECTION 26 C/E, M.G.L. , RELATIVE TO THE INSTALA-
TION OF APPROVED 'riRE ALARM DEVICES. THE OWNER OF THIS FRO-
PERTY IS REQUIRED TO OBTAIN COMYLL'l:( A' A CONDITION OF
OBTAINING A 3U_1D NC PERMIT.
PPc•oc%i "i tOCATION IS :ii Cv;iP[ :ACM= %i ::! 't F. i''it'iSI tJ • ;F l:i:;,`il.;
143, SECTL;N 26 = C, 4 . .L.
a30. 00
$50- 00 a
CHF.CF