7 OSBORNE HILL DR - BUILDING INSPECTION (2) „,o Z� City of Salem Ware
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APPLICATION
FOW
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTIOI
IMPORTANT APPM=w to ownpkWak Nano In secda 4 M,M4 IV,and It
L 4*fidCATloll► s :l�lrtom-, 11 �>r. ”' ►�1
LOCATION
OF eETwEEa .M av . . ro ua l 2 A _-
ICRO
BUILDING susoms" osa ,5 LOT BLOCK "%IMT ► I � O�o sft
L TYPE AND COST OF BUILDING-AN applicants compbb Parts A-O
A. TYPE QF MWROVE MOfr D. PROPOSED USE•FOR"DEMOUTKW USE MOST RECENT USE
2 ❑ AdtlHMn(M mWar a6 amber mnew ot nwe 12 L"J-"n ly 1&0 Amawrrnl,naaWor�1
Aouana unitr adda4 it arty,in apart A 13) 13 ❑ 19 0 rwipiww
3 ❑ A4walon(Sae 2 abort' NO IamYY•EMw numbw 19
21 ❑ Prkn9 para9a
4 ❑ Repair roplacanwnl 14❑ TranaYnl ho1N,mold,or dwrdkxy• 22 ❑Eder numbw of unb
Servica sialm msa 9wso
—__--_—.
s ❑ Wracking;(it mulOYarrdy realdandaL error number 23 Q 1loepaaL krtlhrirnd o
d units in buadlnp in Part A 13) 1S ❑_Dwgp 24
s ❑ Mwft(ralocallon) le ❑ Claw", 25 ❑ Public:uft prolaasonr
7 ❑ Foraldatim a* 17 ❑ other-Spech, tlucomw
26 13❑ sclSlo waRamM e
S.OWNEg8HIP 26 ❑ AMybwera
a MFilwada(indiwdud,wmaral m ncnpdA 29 ❑ Otl1w•SperJy
insomlbrl ao.) .
9 ❑ Public(Fodwd,Slab,or oW Wm nnwd
C.COST (Omit cel" Maawwwdw-Desaft in daaN propoe"uaa of&M' **&&a.Wd Proonav pool.
�rX( [[-l�� f� mod"shop. d Yun y buil0v w hoepa od al,elamer"ad semMwy adoek cobte.
1Q caw ofwwouenrwo ;sue_ 'ftv�C A±L0k^ % 06 O parocidal adoa(parkop g■ep 1w depww m lobe,rear csoe buadkq,dam Erddn9
at irncl etrW P"d uM d a■is&abu is bent da rntad.«a vrwdaa u+
70 be kufdJed bd W inekuyd
in the mow cow
a. ENcbical
b. Rwa..----------------- $ V b
a Hewbnp,air carWMmM.-----_--- '�
/r7/r00-1,o rrra �I ,D00
d. other(elavaor,wa). AiodM9_ O�
11. TOTAL COST OF IMPROVEMENT
III. SELECTED CHARACTERISTICS OF BUILDING-For new buildings and additions,complete Pans E L;demolition, .
COMPIWO OnlY Parts J&M aH Others Skip to IV
E. PRINGPAL TYPE OF FRAME F. PRI ,�M.M, TYPE OF HEAT94 FUEL O. TYPE OF SEWAGE DISPOSAL L TYPE OF MECHAWCAL
L�
30 ❑ Masonry(wallbearvVi 35 16/ 40 EFOollcdprNalecompany Will dnwe be antral at
32 ❑ Sbuctural steai 37 ❑ Electricity41 E] Pnvale(aeplk lanll so) 1.7`g 45 ❑ too
33 ❑ Rai.1, oo,,ft 3e 0 Coal K TYPE OF WATER SUPPLY YVeL,w;7 by an WrAd ?
34 ❑ ONw-SWdy 39 ❑ O9nw-SwAV 42 Ey Fjbk or pdvaU oduparry 4613 yya 47 No
43 0 Pdrala(v A cialem)
a o�reraroNs M. DEMOLITION OF STRUCTURES:
48. manbw of SW"---
,s Tana,,,,.faa a ads a s Has Approm from Historicai Commission been received
at noo,a cased oe e.ro w f
_. (�S�f� far Arty stricture over fifty(50)years? Yes._ No-
5
n r«ar rand and w ti Number
IL WWO OF of-srnEr F w swicEs Peat Controt
sl. ErOMW------ ------ - .HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
sa a cm«.__--.---------- Yes No
u euannse o' r water:
ss Ezneea--�-CSb�= EW*k ..
Gas: .
Fur ._-- Sewer:
x M ni v of DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
°'sYOOrw Femr. —.. BEFORE A PERMR CAN BE ISSUED.
S
N. COMPLETE THE FOLLOWING:
Historic District? Yea— NO (If Yea,please enclose documentation tram.Hist CoMJ
Conservation Area? .Yea_ No (M Yes;plea8e enclose Order of CordlIMr
Has Fire Prevention approved and stamped plans or applications? Yes_✓No_
Is property located in the S.RA:district? Yea— No—
Comply with Zoning? Yes_✓No_ IN no,enclose Board of Appeal decision)
Is lot grandfathered? Yes. . No (tl yes,submit documentatkmld no,submit Board of Appeal decision)
If new construction,has ft proper Routing Slip been enclosed? Yea_ No'
Is Architectural Access Board approval required? Yes_ No✓✓(If yes,submit documentation)Massachusetts State Contractor license# 11 -) [�Salem Ucense* b 1 D
Home Improvement Contractor# Homeowners Exempt form (it applicable) Yes— No—
CONSTRUCTION.TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
b r If an extension is necessary,pose submit
CONSTRUCTION IS TO BE COMPLETED BY: 1211in writing to the Inspector of Buildings
{
V. IDENTIFICATION• To be completed by all applicants
Naar Na"adftn Numbr,meal city,and AW ZIP cod$ Tel.No.
r A�« J r\l
2.Cwrsmr `(\� &Awe
V YGL G�'1 •V• Loan.ft
asses« u 010 �I-
Er9mr a 5�
I hereby certify,that oposed work is aufhaized by the owner of record add that I have been authorized by the owner to make this application
as his authaized adWand we.4ree-jo conoZo all applicable laws of this plrisdicbm
Signature of appl' A rasa A Ication date
01 6 6
i
DO NOT WRITE BELOW THIS LINE
kPwri*
VALIDATION
FGra*V
ENT USE ONLY
ldiing
nWnber mig 18_ FirePennil issued
Building
Pem,A Fee $ OoaO Y Lmd
Certificate of occupancy S Approved by:
Drain Tile. $
Plan Review Fee S !!!
NOTES AND Data-(For department use)
i ,
AJ
S U
N
C S
i
f
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PERMIT TO BE MAILED TO:
f DATE MAILED.
u
Construct on to be started by. Completed by.
i
A ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN•For Applicant Use
ON
1
n
Lire Department
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7 ,'47 o9_�L7 Fax 978-745-•7646
IFIRE 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 MAIZE 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 1the Mass. Bldg. Code) 7/
JOB LOCATION: Y� OS`a/'r><__ l .�� /,/�• "
OWNER/OCCUPANT:
ELECTRICAL CONTRACTOR:
FIRE SUPPRESSION CO TOR: /Y111"411
SIGNATURE OF _ PHONE
APPLICANT:
ADDRESS OF a OUX .70 CITY OT
APPLICANT: 0 �p G� TOWN:
APPROVAL DATE: D
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.
Upoa_completion, the applicant or iastaller(s) ,shall request an inspection and
test of the fire protection devices and equipment. (ADDITTIONAL REQUIREMENTS,
SEE REVERSE SIDE
NEW CONSTRUCTION. r�
ED PROPERTY LOCATION HAS NO COMPLIANCE WITH THE PROVISIONS OF
CHAPTER 148, SECTION 26 C/E. M.G.L. , RELATIVE TO THE. INSTALA-
TION OF APPROVED F[RE AI.r15`M DEVICES. THE OWNER OF THIS ?RO-
?@RTY IS REQUIRED TO OBTAIN CO,4PLIA`(Cl- A CONDITION OF
OBTAINING A BUC[.OIt1C PERMIT.
pRr"`ii^[ LOCATION IS lii CO`;Pl IAC`J %i ;il .JF. < iVLSION
143, SECTU;N 26 C, M '--.L. `
CHECK :