6 OSBORNE HILL DR - BUILDING INSPECTION (2) No. City Of Salem Ward
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APPLICATION
FOW
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTIC
IAVOffrANT AppBoa t to oor Wk a,R.H ms In ssaNaa 6 A;B% N,and X.
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BUILDING —.
LOCATKM
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wson=m �e� UY{L Q 1 S LOT 36 mom LOT 914 ' eft
L TYPE AND COST OF BUILDING-Ad applicants complete Parts A-D
A. TYPE WMIPROVEMENr D. PROPOSED USE-FOR"DEMOLTnON"USE MOST RECENT USE
1 3„r'/ �q PrNMNY MoItlin1Y
2 L❑ r d
AddM=(it msbwdK emvnwnb now 12 la
Y 18-0 Amsnrnl eve l
MueNrp drib added,7 arry,n Wn Q 13) 19 ❑ aruci%odw re igim
3 ❑ AAwdbn(See 2dcw) 73 ❑ Wbmae Hmey-FirYr number is
❑ bdrdhW
21 ❑ Pa kV peeps
4 ❑ Repairrepixwrwa 14 ❑ Tnrelara hooknolel,«dormXory- 22 ❑ 9wrice asdbn.reer'r paep�
5 ❑ Wreekinp(7 Mblism i msdendal mW dmbw Fslr rwnber or"aft ._
23 ❑ HoaPilal.'ralYrrSorw
of units in Duddep In Pea 0./3) 15 ❑.Chaps 24 ❑ onim bs,*Prdeesonsi
8 ❑ Mo*V(reoralon) t8 ❑ CsrPore, _ 25 ❑ Pubeeuasy
7 ❑ Fowdation only 17 ❑ C11frw-Spcly 26 ❑ Brhwk 11rary.o8rr sdr atim-A
27 ❑ Sorg,mwpntss
&O Grpfta 4P 26 ❑ Tarrk. -
8 Prlvaea(rrd tc.)NgRSwd ,rnrPOreDOrr.nmpdb 29 ❑ OBrr-SW*
indbullon,elc) �
9 ❑ Pubic(Federµ Stec,or WW porwrurnd
C.COST (Omi OWN NorresidwAisl-Describe ar deed popoead use of euidirpe.ep.bed panssmp Oesrr4
msebew drop brer6Y brdds4 d hoePiai.aWrremsry seenae,eecorrdsry aelroat eOrP.
10. Cad of Ynpowm«M �P( 8 paa«dei aolrod,pwkft preps for deparbrwrl store,rerMW office b WI%dlbe bu7dYq
W irirm ww 0"it ur d mimtV brddbrp is being cMrrpad,weer pa0aaed use
TO of IrIBM d bw not oeerded -
in Me above coal
L Ekcbiad----.._.__.----.--.—.--.—_._-- G
b. Manbbp--__.---------'---- Q
Hasum air .---------- S OU b
11. TOTAL COST OF IMPROVEMENT
IIL SELECTED CHARACTERISTICS OF BUILDING-For new buidings and addiuons,complete PartS E L;demolition,
complete only Partft J&Mall others ski to iV
E PRINCIPAL TYPE OF FRAME F- PRNCiAL OF HEATIt10 FUB. G. TYPE OF SEWAGE DISPOSAL L TYPE OF MECHANICAL
30 ❑ Meeorry lwai bearm) 35 Oases` 40 Er uAft cr prrwa oor par. VA7 dress be central ar
31 Wood frame 36 ❑ OII 41 ❑ Prtrda(appaL lank sit) Cpii o~
32 ❑ SMack ai M.W 37 ❑ Elecoway 44 ❑IXO I 45 ❑ W
33 ❑ Reidoresd ooncrels 3e ❑ teal K TYPE Oj WATER SUPPLY WE 8wi by an rw WovdW?T
34 ❑ off -Spaciy 39 ❑ (Mw-SW4 az Pumc«1xMladompany 48 ❑.Yes 4-1I.l <
43 0 PrrWe(.elcidem) .
r'
AMO&WASOM y M. DEMOLITION OF STRUCTURES,
atone ...-----.%d d'M arse, Hffi Appmal from Historical Commission been received
13ed oae1sotIfor any structure over fifty(50)yars? Yes_ No—
r—aces wNumber
KM OFF-STREET vAMrulG SPACES Rest Contra
St. ErclmW---------------
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
sz Qddoor.----- -----
Yes No
u RE8b61IML auaOEm aatr WetBf
/add Eleclft
sa Fxbadd-- yam^
�] Gas: . .-. ..
Fue—.PC-- Seww-
s< Noterat DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
b0PO IS PadW.O.-- BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yea— NO '� (lf Yes,place enclose d0=0ntation from H'SL Can.)
Conservation Ares4 .Yew No_ (M Ya4 pwm enclose Order of Coondidonsr i
Has Fire Prevention approved and stamped Plans or applications? Yee\L No_ Ij
Is prop"located in the S.R.A:district? Yea._ No
I
Comply with Zoning? Yes_ No— (If no,enclose Board of Appal decision)
Is lot grandlaClered? Yes_. No (If yes,submit documentaftVd ra,submit Board of Appeal decision)
If new construction,has the proper Routing Slip been enclosed? Y No_
Is Architectural Access Baud approval required? Yes_ No_ (If yes,submit documentation) r
Massachusetts State Contractor License# Salem License
lz
Home Improvement Contractor# Homeowners Exempt form(if applicable) Yes— No
CONSTRUCTION_TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
^ ' ff an extension is necessary,p�submit
CONSTRUCTION IS TO BE COMPLETED BY: 'V in writing to the Inspector of Buildings
V. IDENTIFICATION• To be completed by all applicants
Naft Ma1iq addrou-Number, ba seb c4,and stare ZIP Code Td NO.
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I hereby cer*We proposed work is auhorized by the owner of record and th I have been authorized by the owner to make this application
as his authori and we agree to jgform to all a laws of this iurisdem
Signature of I' ress ication date
1 b
DO NOT WRITE BELOW THIS LINE
VL VALIDATION
FOR DEPARTMENT USE ONLY
Building
Permit number Use craw
Building 19— Frs GradYq
Permit
�issued
BuilBuilding
di it Fes $ UA L08*V
Ooc*WW Load
Certificate of Occupancy S Approved by
Drain Tile.
Plan Review Fee
Tme
NOTES AND Date•(For department use)
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S a
A!
C S
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PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by. Completed by
VI ZONM PLAN EXAMINERS NOTES
DISTRICT
USE
FRONTYARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN•For A~Use
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FIRLE DEPARTMENT CERTIFICATE OF APPROVAL FOR A BUILDIP7c: 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 DEPARTICENT. Ref. Section 113.3 of the Mass. Bldg. Code)
JOB LOCATION: - 411 11,1211?
adNER/OCCUPANT: /fo 7;
ELECTRICAL CONTRACTOR:
FIRE SUPPRESSION COCTOR:
SIGNATURE 0 PHONE f., X1
APPLICANT:
ADDRESS OF CITY OT
APPLICANT: Xd,�- 71e TOWN:
k
APPROVAL DATE:
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 applicamt orinstaller(s) shall request an inspection and/or
test of the fire protection devices and equipment. (ADDITTIONAL REQUIREMENTS,
SEE REVERSE SIDE ***)
NEW CONSTRUCTION.
PROPERTY LOCATION HAS NO CGMLLLANc£ .41TH IRE PROVISIONS CF
CHAPTER 148, SECTION 26 C/E. M.G.L. , RELATIVE -0 THE INSTATLA-
TION OF APPROVED lriRE AT--NRM DEVICES. TEE OWNER OF THIS FRO-
%� �IL
?.'R'rY IS REQUIRED TO OBTAIN COMPLIAA: Z
�- CO1_MIT
TION OF
OBTAINING A PERMIT.
LOCATION IS 1ii COMLF, :PF. i' ,)11151614 pF
143, SECTI'j-N 26 E , 'i .L.
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$5n . oo