5 OSBORNE HILL DR - BUILDING INSPECTION (2) �13 6ur=/ v City of Salem w■.a
q
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUC"
IMPORTANT-APPleant to C0MPJIsft a/(tans in s0cd"& K K N, and OL mat
L ATaocana. ' 6M
oTXW
aErAMM 1/ Mo
BULDINci sueonl,sow �r�� G7l/� �G!/� Ior -3 awac SSIIM
L TYPE AND COST OF BULDMO-Ar 8ACIA arlta Cat"ple1a Pans A-D
A. TYM OF 0. VII010!!®UR♦t•FOR"DEA�OU710Nf 113E M08t RECEt/t t13E
/ arariy II�I�O 1w,a`ll/ Nwaaaedw0d
2 AddlaawpnlAidrrrl wrwr AWFAW Of nwr ,a p N awraft
Aoualrea WM slda4 2 a"..n pwe 0. 13) 13 p 1Ye at mwa hnrl, Fnar reentert9 p Chuck- ma9loew `
3 p Atheism ism,2 nboW d urna 2013 lrrsrw
d p Repalr rapracrewit 14 p 7rw.4n1 ear,wow,or donrrawy- 21 p Panrlq-waarr
! p Mhadr.V if-.Wm*nwtllneW wrrr rWrdr ErAw numOn d una—_--- 220 9wrrs sesM Warr,peerage,
air un 4 n ti lYy 6 M 0. f A 1913 ar.-! 2313 �nnludlerr
24 p 0aoa bark ad.arwr
s ❑ movil nabr:.nw l 160 tarpon 25 p public r+F
> p dd, a p Sdoal wom, oa..aeorratr
7 p an.-SprJp 27 p !�mwvAa
L O 2a p Tardrar bears
in
8 PrMb(Irmft)r+t cwpor.rn.nonOrdl, 29 p cow anc*
wau110r%e1¢
9 p P Aft IFddwd.Slift cr lxar-ouwranwd
C.COe1T �,..lCrreb crap Nor Vista -DwtvEa n dwel prcooaad u•d huauYp,op.loud 1lracasana Oats.
madrY0 dwA hurdr brAdirig at hoaprl Wor rdwy gichool secondry aerrooL corpe
1a Coal of Ynprorsmdd — _—_-- a oaraclrhr fth A padrur,g , to,do"arrwd dwal marl dsoo MAWS dlba buddl�
at irdrsarl last.a uda of"=*V buiAiq Y b&*drwr-d,w,w PaOaaad ur
lb 4 ardaaed bed nor iecisim,
In Its above coo n� P� �)"" t-e
a Elacylcal
d. Other tws sm.
11. TOTAL COST OF IMPROVEMENT �CUU
11L SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additn4 Complete Parts E L-' demolition,
Cora to on Parts J 6 M ad O&W3 ski to IV
L W9g,AowdTYFE OF FlIAII[ F. PRedC OF rEATo10 i118 G. TYF[OF AaE OWBOUL L TVF[OF mICHAPSCAL
30 (wal Oaarrrp) J! Gab 40 Rdie a pn,b[anrpanr 'M dress a A/
7t 'caeca 38 ❑ ON .1 0 PnvaallnplC tw+<wy cons
- 32 p Sln.nvw ri p 32 p Elect" M as Q
i 33 ❑ Ra4dorcdd tar mit 3e p Cod K TYV�E OF/VYAIER BUPFLT '
p' 34 ❑ C, w•SW* 19 42 1(d'�ae n prhab doniGwM �a�an«w�dao/7 47 �
odes-sa.cb
__ 43 ❑ Pnvwalw4cmarpq
a orriaroNs S M. DEMOLITION OF STRUCTURES
Is raMerdsw •
,a .,,A's W at+om.nor �/�/ Has Approval from Historical Commission been received
Ad%W b""W..ry (/ fOf anY 9trUC1U(e over fifty 1�D)years? Yea`— No—
snam+ -.. - . .. _
So •mr WW a+s4 s -- 1� Dig Sale Number
K. so or s Ercmad Peal control
�` G HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
u WOW —..-- --- - —.. Yes No
u rferoem L susasrOs OW Walat
n 6rlo.r ...._.__.—._—.----
Electrla
C>as:
FJ— -......._ Sower
s'' ManbW d DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
°d`O"• Fr�rr .__�__.___ BEFORE A PERMIT CAN BE ISSUED.
IV. CodPL.ETE THE FOLLOVYWG:
HislOric DiSOW Yes_ No_ (M yes,plosee enclose downentatlon from HISL Cam)
Conservation Area? Yea_ No (#yes,please moon Order d Cod"
Has Fire Prevention approved and stamped plane or applications? Y Nc
Is property located in the S.RA cflp&W Yee_
Comply with Zoning? Yee-- No_ (if m endow Board of Appeal decision)
Is let Wandfatheredl Yee_ No (M yea,submit documentation/if no,submit Board of Appeal decision)
If new construction,has the proper Routing Slip been enclosed? Y
Is Architectural Access Board approval required? YeesJ_ No (If,yes,submit documentation)
Massachusetts State Contractor License N o` Salem License r►
Home Improvement Contractor • Homeowners Exempt form(if applicable) Yes_ No-6/1�
CONSTRUCTION TO BE COMMENCED WITHIN SIX(9)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 Sudding&
V. IDENTIFICATION• to be completed by all applicants
wms Va"3daw Vwrbw snwl.4.rW am ZIP coo 'r Na i
e eow II11
i�M'Iy Y
Z G {
Enprvi
I r ereby cer*that th roposed cork.s auNaized by the owner of record and that I have been authorized by to Cwner 10'make this apptkation
11 his autinorized 3gW and'me Wee IO .torm t0 as gilcabIG laws 01 TIIS NfiW-KtOfl
Sgrature of appf Add p/e /,O�v
DO NOT WRITE BELOW THIS LINE _
VL VALIDATION
FOR pEpMTA1EMr USE ONY
Building
Permit number wo Gm o
Buildlrq 19_ Fn Ordno —
Pefrrl�issued
Building LrA taear9
Pon.M' Fee S oocup2 r v Low
Cart kale of Occupancy S Approved by
Drain Tile
Plan Review Fee f
rr1tE
NOTM AND Data• (for department use)
gh
! S U
C
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by. Completed by.
f
VI ZONWG PLAN MANNERS NOTES
1' �I
DISTRICT
i
USE
FRONT YARD
SIDE YARD SIDE YARD �I
REAR YARD l
NOTES
I
i
WE OR PLOT PLAN•For ApWAVN Use
O N
CITY OF SM-E.`[, ANLUSACHL:SETTS
BIHING O STREET.
� ,5
• I'_0 W.tJ11CVGTON STREET, )M FLCIOR
TEL (978) 14S-9595
F.%x(978) 740.9911111
KI.jIDEALAY DR13COLL TtobW ST.PMRU
HAYOA DIRECTOR OP gel BLIC PROPERTY/RL'ttDNG CO%L%OSS1O'%El
Workers' Compensation Insurance AlTidavit: Ouildert/Contractors/Electr(elantiPLumbers
%littlicarill In ormat(o
Name tNwme+roryamrari 1 tduall'
Address:
CitylStatdzip:
Phone N:��������T'/
,ere you am employee!Check the appropriate boss Type of project(required):
1.❑ I am a employer with 4. Q 1 am a grneral connaeror and 1 b• Q New coestructioe
cmployea(full and/or part-time).• have hired the sa¢rcmrs
2.❑ I am a sole preprietar its,partner
listed an the attached+lent. 7. Q Remodeling
+hip and have no cmpbyce The stib•contreotors have a. Q Demolition
working for nit in any capacity. workers'comp.insurance. 9. Q 0viWing addition
LNG worker'comp insurance S. Q We are a corporation and is otlkers hew exercised their I0.❑Electrical repairs or additioro
r quire/j
J.❑ 1 am a homeowner doing all work right of exemption per MOL 11.Q Plumbing repairs or additions
myself.[No workeri comp. c- I32.41(e),and we have to 12.Q Roof repairs
insurance requited.)t employees.( o w 13.[]Otttee
comp insurance required.)
-Any appanr nir abarte ban el mar err no wr tlr rntim bolo%sswioa ttak al 'Conpn an lea pinky iaAM1141 ►
't 6,n ftno"M wlr subrY Ok aledva indicating dwy as doing all worsted tMa him autaii clew ertar mar aahrm a Ilex atmdeA ind(arina err►
{,"mve IM cheh d+is ban MM anulnd to 2"610011 Ann dlewiq the Iry d Ara elbgeareraa ettd,hek warbea'ramp poiky taB nnsdo@.
/u/r raw rerpbyer rAes b prer!/Mp der'coayrtut/Ma lntrrestq jN aq ewpGryesst QI%M/s I1N pelky eet/js1 JIM
injornrwlaa r
Insurance Company Name: j `
Policy a or Self-ins.Lie..# 41a � r/�O�'� Expiration Date;
lob Site Addrear. 4fd.jzi f 1/ 41 `a"�'%� Cityistateizip
,%track a copy of the worker'compensadas Pau"dotlantloe pap(skewing the policy member and expiration daft}
Failure to secure coverage a required under Section 25A of MOL a 152 can lead to the imposition of criminal penalties of a
fine up to S 1.500.00 and/or one-year imprisonmetK as well as civil penalties in the farm of a STOP WORK ORDER and a Roe
Of up to S230.00 a day allainst the violator. Ile advi.*W that a cupy of this statement maybe forwarded to the Ol71ce of
inv"ittprtluns of li+e DIA for ntsutlnee coverage v¢mticattae.
I do hereby card] ri ere Ike i and ties ejperjury,that/ba in erwerlaw provided ubow is r e end correct.: ,. t I?air ✓���
P`u a' �/�
� nf/&'lal eke eulyL Oo/let wan in/hu erey a Ara.urnp/nr/by city or rewn I//J!i•ir!
I
City or ruwn: eermiN.leenseM__.
Iwuutnit.%ulhunty (circle erne):
1. 11uard u(llcullh 1. Ruddlnd Departmunn J. City/town Clerk t. Electrical linpcctor S. Plumbing Impactor
6, thher
Phone c
,' �Ci7�190L7 +11 ��:lOL.1 �l;]L3 V0� C.L�G1�0�+.1C:91�0�fl �QQo
Professional Land Surveyors Er Civil Engineers
ESSEX SURVEY SERVICE. 1958 - 1986
OSBORN PALMER 1911 - 1970
RADFORD-B-WER) L885�-97ti
PLOT PLAN OF LAND
LOCATED IN
54LZFM MASS.
n Oz� SD-cE
Sz.o 0
_ Lit 3
/ o
.LUiZ. 4a ' LuJ `f
P�1�P�r�n
9Z�J
aSC3afZNE 111ZL L7 VL
I hereby certify to the SiJLEsy
Building Inspector that the pro-
ZONE: ��1 LOT AREA: .�o/G( LOT .FRONTAGE: /GOrt/E posed construction shown conforms
to the dimensional zoning of
FROM YARD: 15/ SIDE YARD: /0% REAR YARD: 36�i S�JZCiLI Mass.
SCALE: A W OF
DATE: /f &11� ' 2 Z L o/Q _ HRISTOPHER yGi^
1 R.
REFERENCE: //C BK Qo Z PG 7F Chi topher R.JMello 1� � o ti
�Fc I
104 LOWELL STREET
PEABODY, MASS. 01960
(978)531-8121
FAX:(978) 531-5920
�o r
City of Salem, Massachusetts
r o "ire Department
�rnne W 48 Lafayette Street
David Cady Salem, Massachusetts 019 70-3 695 Fire Prevention
Chief TEL 978-744-1235 Bureau
978-744-6990 jax 978-745-4646
978-745J77'
dcody@saCemcam
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 Mass. Bldg. Code)
JOB LOCATION: 2 e SNAKi z /1yi///
OWNER/OCCUPANT: ����///� /771�
ELECTRICAL CONTRACTOR: LZ 2 //�/�
FIRE SUPPRESSION CO CTOR:
SIGNATURE OF HONE#:APPLICANT:
ADDSOF
APPLIICCSANT: 115�d fi -lee CITY/TOWN
APPROVAL DATE: 110
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.)*****
NEW CONSTRUCTION
PROPERTY LOCATION HAS NO COMPLIANCE WITH THE PROVISIONS OF CHAPTER
148; SECTION 26 C/E,M.G.L. RELATIVE TO THE INSTALLATION OF APPROVED FIRE ALARM
DEVICES, THE OWNER OF TIM PROPERTY IS REQUIRED TO OBTAIN COMPLIANCE AS A
CONDITION OF OBTAINING A BUILDING PERMIT.
PROPERTY LOCATION IS IN CON TLIANCE WITH THE PRO SION OF CHAPTER 148
SECTION 26 CIE, M.G.L.
EXPIRATION DATE:
SIGN?,l F F OFFICIAL
UNDER 7,500 SQ FT $50.00
OVER 7,500 SQ FT 00 CHECK# -;�-30(0 _