8 OSBORNE HILL DR - BUILDING INSPECTION ward N, City of Salem
M :off Samar Jaye s
Lo b3oq
�tavv+ l6rC NO
APPLICATION
FW
" PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTIC"
IMPORTANT-Applleant to complef e#Items In secoon 4 14 IV,and IX.
L ATy.00ATT0t1F S ' r ZWBiRICT �L�.
LOCATRJN
OF 8ETI VEEN �C117 1 �2 UP AM _
BODING o/ ` , fn1 �Oi e�oac � 110 f s 1EF
L
L TYPE AND COST OF�BUILDING Al applicantsl'complete Parts A-D
A. TYPE W FO PROVEMENT D. PROPOSED USE• R"DEMOLITION"USE MOST RECENT USE
1 Her Wttl1q .11,e1dentlY .. rbrrealean8al ',
2 ❑ AddMbe(r re low ffi(wrrnumbrd new - 12 &One W* - 18.❑,AnwwnwIL naaitbnal
Aw wng unee added r wm in pert a 13) 18 ❑ 0mck oe w moolas
3 ❑ ARarwikm roar 2 above) of 13 ❑ NO Orft move hmYy•Enler numbr ❑
Za IMudrW
21 ❑ Pukh 9rpr
4 ❑ Repair roptetarrmcd 14 ❑ TmWwt halal,MOK or damllo y_ 22 ❑ 8ewba sia9 .rapr ilarao
5 ❑ VWeckiw Nov O&MI mador"0*1 rwm0ar 23 6rMnumWrdumb_--___—.
Aoral
d units r buddbrg in Pot a 13) 15 (ierno ❑ Mapte4 1W.W010"
❑. 24 ❑ Oeb.trroL Oroteeeional
8 ❑ Movhv(rebeaom) 18 ❑ carpal 28 ❑ Pu01c u y
7 ❑ FPrWalbn ony 17 ❑ O&M-SpNy 26 ❑ odraLtTtrm wore"wom
L O SHIP 27 ❑ Monm nareerree
28 ❑ Twkr.Wawa
8 P&.Me(W..duel.wrMalion.rronprde 2g ❑ OyWr-Spdy
inebbAbn,elm) ._
9 ❑ Pudb(Federal,Star,or local 9wenwnre
C.COST P#4 an41 NweadwN-Desabe in dsdi proposed ua d buil&w e.a.bad procewiry plank
/�/� .darter shop,bwdry builder-at hoepW elo wUry scrod,seco fiery school coar9r.
tQ Cat d anprovemerrW — —�_ 8 I `-1J`' waded debar peddng grape for dsprbnns able,rwW allbr tsaWda'q.oyba twadlrp
at iw sb w prat If ua d exatim buadfrp a b"danpa0,erox prapoad um
7O be b8ptled but not bakrdad "
in/M above we
a. Electrical-----.--.---.---------_-.--
G Nabn9,ar a.---------- s G
a Odw(revator,
11. TOTAL COST OF IMPROVEMENT l If
IIL SELECTED CHARACTERISTICS OF BUILDING .For new buildings and additions,complete Parts E-L;demolition,
complete only Parts J&Mall others skip to IV
E PRINCIPAL TYPE OF FRAME F. RaN-iWA�L TYPE OF HEAT=FlA3 rL TYPE OF SEWAGE DISPOSAL L TYPE OF MECHANICAL
t-CA
30 ❑ Maeony(was bearm) 35 I. ,8ff- 40 A�blb oval piwin eoaprry VM e,ra be central ate
31 a/Abw frarr a 36001 41 ❑ Privala(wp8e Wwll ale.) condebdra7
32 ❑ Struckral steel 37 ❑ Ebetrfcey u ca-yes 45 ❑ Nb
33 ❑ Rebdacsd ranaale 38 ❑ Cal H. TYPE OF WATER SUPPLY we ft,;by an ewaM
34 ❑ Oyler•SW* 39 ❑ Oyler-sped, 42 gl"or prt M wrgwy 4e 0 re. 47 rao
43 ❑ Private(we4 usiam)
7La!A%w='bAsWj
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M. DEMOLITION OF STRUCTURES
s .---.........._..---- ,
+ Has App►arai from Historical Commission been received
a2 l0 0 S for any structure over ft(50)yearn? Yes_ No-
-------
o .} Q_� -- DI9$ale Number
OFFSTMU PIIWJW SPACES Pest Control:
51 ---------------- . HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
sa oumaa,------------- Yes No
of" Waw-
a
aa�
Gas
AA Sewer:
DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
PWr.I-- BEFORE A PERMIT CAN BE ISSUED.
I
N. cowLETE THE FOLLOWMG:
Historic District? Yes No— (tl yes,please endow documentation kin Hist.Coma
Conservation Area? ..Yes— . No_ (If yes;please enclose Order cf C adores
Has Fire Prevention approved and stamped Plans or applications? Yea_IC No_
Is property located in the S.R.A:district? Yes_ No_
Compy with Zoning? Yes No— (If no,enclose Board of Appeal decision)
/ I
Is lot grandfaRrered? Yes_ NoJ'� (N yes,submit documentation/rf no,submit Board of Appeal decision)
a
If new construction,has the Proper Routing Slip been enclosed? Yes_ No
Is Architectural Access Board approval required? Yes_ No Z (f yes,submit documentation)
i
Massachusetts State Contractor License# S (����{ Salem License# g , /
Home Improvement Contractor # Homeowners Exempt form(if applicable) Yes— No-
CONSTRUCTION-TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
yt Han extension is necessary,Please submit
CONSTRUCTION IS TO BE COMPLETED BY: J in writing to the Inspector of Buildings
V. IDENTIFICATION• To be completed by all applicants
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I hereby that the proposed wok is authorized by the owner of record and that I have been authorized by the owner to make this application
as his ed and we to conform to all:rAddi
a laws of this jurisdictionSigress Application date
�I ��
tDO NOT WRITE BELOW THIS LINE
IDATION
FOR DEPARTMENT USE ONY
number use crowg 19_ Rre Gradrpissuedg Lee Loaakq
Fee $ o�omw Laeate of oxupancy $ Approved by:ile $
No Review Fee $ ��---
HIM
4
NOTES AND Data•(For department use)
� r
i
$ U
C S .
l
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by. Completed by.
w ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
I
SITE OR PLOT PLAN•For Applicant Use
O "
1
i
fr! VL U'S 15 1i 17 i I I CC Is
UJ
Ire Depariment
019"(L�o-)5 29 Vort ,
Tel ..-8-144-1;J5
97.,' FaX 978-745-4646 978-74 771
FFIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR A BUILDING PERMIT
IN ACCORDANCE WITH THE PROVISIONS OF THE KASSACHUSETTS STATE BUILDING CODE
AND THE SALEM FIRE CODE, APPLICATION IS HEREBY MADE FOR THE APPROVAL OF PLANS
AND THE ISSUANCE or A CERTIFICATE OF APPROVAL FOR A BUILDING PERMIT BY THE
SALE14 FIRE DEPARTMENT. Ref. Section 113.3 of the Mass. Bldg. Code)
JOB LOCATION:
01WER/OCCUPANT: '446- x rl_
ELECTRICAL CONTRACTOR:
FIRE SUPPRESSION CON CTOR: A!�ld
SIGNATURE OF PRONE 0:
APPLICANT:
ADDRESS OF 141-2 CITY OT
& _ IL04 1;?IAe4f-
APPLICANT: -e TOWN: 71VI
APPROVAL DATE:
Certificate of approval is hereby granted, on approved plans or submittal of
project details, by the SALEM FM 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.--th,a applicant or ingtaller(s) shall request sin-inspection and/or
test of the fire protection devices and equipment. (ADDITTIONAL REQUIREMENTS,
SEE REVERSE SIDE
NEW CONSTRUCTION.
PROPERTY LOCATION HAS NO COMIOLLANCZ '41TH TRE PROVISIONS OF
CHAPTER 148. SECTION 26 C/E. M.G.L. , RELATIVE To THE INSTAILA-
TION OF APPROVED FIRE ALARM DEVICES. THE OWNER OF THIS PRO-
PERTY IS REQUIRED TO OBTAIN COMPLLOUC-� A' A CONDITION OF
OBTAINING A BUILDIMr PERMIT.
PF01r;7i LOCATION IS COXF,' 11,C!J- ""F F"). 1-1 7F C4
143, SECTL(jl 26 E, 4 17.L.
all
F
30=00