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4 SCENIC TER - BUILDING INSPECTION (2) City of Salem Ward i CL� f APPLICATION FOR I PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to comp—Bite aN items in sections.4 it, lll, IV,and IX. L AT,LOCATKW 44 J e e—ry/L /e!r-rn.0 L. ZOISIRICf LOCATbN s+o1 RVQ d JCe�,I��(Y010 OF eETwEEN OTs 0r OF �(�1�oy BUILDING i"� 5LOT " llO/1 s SU60MSION _ _ LOT_BLOCK _ ern: 10 (� /U FI- II. TYPE AND COST OF BUILDING-AN apokants compieib Parts A=D A. TYrrrP,fffE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOUTIOW USE MOST RECENT USE 1/0 New buk*q RpWMt1W Naaaattle"d 2 Q AddWw re residers&,errror nomara trove 12 One fsmdy 15 Q Aasraepma.taaeroral n0uaeg una apded.C wy..n pad 0.13) 13 Q9 Two a mr!hmtly-Error number 19 Q-1 ChurA airor Migipr 3 Q AM Mbn ISee 2 abo ) a urges 2a Q kdoMr 21 Q Psi* grape Q Repo tePraCemera 14❑ svwfxs*oleo,malel a dormibry• 22 Q=Servb.Mebm repaegaspe Enairnun0era'orw 5 Q WMd"(/r'nuWw1*MSdrraa(Ot MMbv .,. 230-11oapiO4 eaYAwW d LVM n buddng in Part 0.13) 1513 Grape _ 24 Q Orwa baMLpideaeoiul 6 Q Mw w(eb=bx* 15 Q Cwpw 25 Q PubYC airy 7 Q Fb mK Mon oav 2e Q.SanbL atrrY,00W edurab" 17 ❑ odw-saw4y 27 Q SIOML arale B.OWNERSMP 25 Q ur*L Ybrara e PrMa wdniduw.torporawm mrlprdb am) 29 Qrr Ob •SpeaYY M0(Naon: 9 Q Paab WedamL SOL or bcal gaartnard C.COST (on*cwtro) Nwrwarrmp-OwMW nde0a.nrppmeo use of Ouwnw a.9.boa prommv mm maatta wam.WAAky ouidhg M nospaaL can snwv ersrpol.eapararY OWMA caU9e. ISb Vbb l aarpwraacalMMi M39ara0 Jareeeabnrr som mar 0W=buA*4L ariw OrreM9 to Cow a imoro�enea s 600 at r4uw rpw*b we of e+sbrg btwcb g 0 ben9 pbrrIed.a"pmpaed To be iiiY eutnd ae4rded in ow"A" a BecbM.•ai % 000 7 0 0o b. PhxWNlp /t1)p00 IV -000 - .t fleetiw.at 9 0 07 pp CL Gea►raeMlor.Bret yyee�� 11.TOT&COST OFIMwR .. . 9O W L)S.6lN III, SELECTED,CHARACTEAISTiCS.OF BUp D . For new buildings and addoons,compfais Parts E-L;dem *bon, ca'ri on Parts J 8 iN,aH others ski to N E. PRINCIPAL TYPEOF FRApAE F.PRNCr&TYPE OF REATM RM G. TYPE OF SEWAGE DISPOSAL L TYPE OF UECIIAWAL 30 Q:1NabIaYlM+beadrlR 35© Gas AOX_PubkwprMaladmrAMw NAMrabeararalak 31 maw Mew 36 a 01 41 ❑ Rive*OMPI C W*Met.meowy as PQ w Q e 45 No 330Mianmawma 38-Qcow N. TYPE OF WATER SUPPLY .wiieraeYanaiMO✓I 34.0 Obr-Spew* .3p.Q G60Y-Sped* -42% ReYCOF.P OWCOMPNIr 48_Q Yb 47 Q ND 43:Q.PtMO►PaQfarrM . J. . 48 N.DIMENSIONS 0 M. DEMOLITION OF STRUCTURES: ae NemDer or srones _...._.. _._..�.._._ ____—._.. ae. Toad souare kN om a::Boors.oasts a =or e area Has,Approval from Historical Commission been received for,any structure over fifty(50)years? Yes_ No 50. Tore!Tana area.so.„ j C�00 Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES St. Eaa!aea_ Pest Control: sz oamoom HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? Yes No L RESIODMAL BURDNGS ONLY sa Ercloeed Ro r' C I� RA Sewer: 54:11iaaer a + �au.00me _ DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED FMnm BEFORE A PERMIT CAN BE ISSUED. I a IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No_ (If yes, please endose,documentation from Ha f OM) Conservation Area? Yes_ No�C Of yes,Please enclose Order of Conditions) Has Fne4Yevernion approved and stamped plans or applications? Yes_ No_ Is property located in the SA.A.district? Yes— No✓.. Comply with Zorft? Yes_✓ No_ (If no.enclose Boardot Appeal decision) Is lot grandlathe ied? Yes— No_ (If yes,submit documentationfrf no.submit Board of Appeal decision) If new consWction.'has the_proper Routing Slip been enclosed? Yesi No_ Is Architectural Access Board approval required? Yes._ No✓ (B yes submit documentation) Massachusetts State Contractor License# Salem License# Home Improvement Contractor# Homeowners Exempt torn(d applicable) Yes ✓ No_ CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT CONSTRUCTION IS TO BE COMPLETED BY: j'f f j{ 200 g� If an extension is necessaryr please submit in writing to the Inspector of 90&9s. V. IDENTIFICATION• To be completed by all applicants M maT� / Makda amass•MurOe%mat say,aro son ZIP Code Tel Na. roam ar Ghc�l VQ_ryr� H I t- C?n 7q Lou" 6S/ 12. r�I u!` lM l;ce�Fla 1 Cair.yr� Sn61,OZn !✓ ) ALra ST L _ _ ... '7�( 9.�� Amh.W or s oh eha Z22.3 I t!ereby Certify that the Proposed work iwoAxIraed by the owner of record and that 1-have been authorzed by the owner m make ftde appkahm as his authorized aaem ano we aaree,to Conform to all aodfcable laws of this jurisdiction. sg�u �u( Loa A)!R s Appli awn date Ta a DO NOT WRITE BELOW THIS LINE VI. VALIDATION Buiiding FOR DEPARTMENT USE ONLY Perm@ number Building use Grow Permit issued 19_ Fire Grainy Building Permit Fee $ , ( � Lin loatluy Certificate of Occupancy $ P0°'Pl'Load Approved by. Drain Tile $ Plan Review Fee $ AT1E ' NOTES AND Data•(For department use) i s PERMIT TO BE MAILED TO: ILL (TC'.t—m N ! ClUttook kk S6,Lzm MA DATE MAILED: Construction to be started by. Corr Dlftd by; I i VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD t REAR YARD N07ES SRE OR PLOT PLAN•For Applicant Use oN r-fLe- c.. A FoL�ctallor4 'IT ON i CITY OF SALEM gl ROUTING SLIPwte-p, o 9 ,- Zo �n IJ CHECKED DEPARTMENTS REQUIRE SIGNATURES BEFORE BUILDING PERMIT WILL BE ISSUED. LOCATION: T Je2/11 C e rra C9 DATE: G ( O `I APPLICANT: �-okm JCI'rr�l Q ASSESSORS OFFICE @ 93 WASHINGTON ST. FRANK KULIK ���Glsfs� DATE: b9B Ctf ❑ CITY CLERK(if involving a new street) �I 93 WASHINGTON ST. DEBBIEBURKINSHAW ' ` DATE: PUBLIC SERVICES(Engineering Dept.) @120 WASHINGTON ST,4-FL. BRUCE THIBODEAU '�y ' DATE: _ WATER DEPT. G @120 WASHINGTON ST,4TH FL. HELEN JIADOSZ DATE: J CROSS CONNECT SUP'R BOB DESCHENE µn @120 WASHINGTON ST,30.0 FL. ✓ " // DATE: J PLANNING @120 WASHINGTON ST.,30.D FL..V DRRSE DATE: I I VA��k*6 v-ljs;w - CONSERVATION COMIVIIS ION (planning Dept. 14 @120 WASHINGTON ST.,3"D FL. DATE: b // a �--1 u ELECTRICAL @ 48 LAFAYETTE STREET,2HD F EAR t,/ JOHN GIARDI DATE: c I� FIRE PREVEN I @29 FORT AVE(WILLOWS ARE ' CAPT.HUDSON G DATE: [] HEALTH @120 WASHINGTON ST.,471F . JOANNESCOTT DATE: BUILDING DEPT �e � � , Div P @ 120 WASHINGTON ST.,:"D FL. TOM ST. PIERkE41e� DATE: ***SUBMIT I KITH PERMIT APPLICA ION WHEN COMPLETED*** CITY OF SALFM BUILDING DEPART1v M HOMEOWNER LICENSE E?MNIPTION Please Print 6 DATE � 21� T JOB LOCATION SCerj/C • Nolgowm l 6u ais�t �1- ADDRESS Hol'saw l9( 9 7 g TELEPHONE 0 PRESENT MAILING ADDRESS 1 6 c� �6 4, o S,,L� 1J'I '�197 The cm.Tat r-crmpdon of`homeowners was r-nendcd to biclude 9wocr-Occu➢led dwemm,p ctTWO Uuiu or less and to allow such homeow=x to engage an ir&i iduO fta him who does ttiol Poasna a liccnse,.pr yk> rhea the owoer ad as superviwr. DEFINITION OF HOMEOVVNF1l Penn(s)who owns a pw=l of land on which hc/ahe resides or intends to rsside,on which if r . intended w be,sox to rw0 family dwelling,attached or detached strucnnes od shall nol be eor8A red farm swctures.A person who cortsuum most than one home in 8 t� Pa a bomcmuct. Such`homcowmf shaJ submit to tht Building on a form a m*6 Building Official,that hdshe be rupoumble to all such work palomxd wider the buildiag PcUX The trade signed`homeowner"assranes responnbility for compliariec with the Stale Bwndmg code and olhcr applicable goes by-laws,rules and regulations. The tmdcz 1pmd'homeowrle ccrdfies that hclshe track-sands the City of Salem Bwkrmg Depw=crt. minimwn inspation pmccdum and rcgttircmcnu and thal Wshe will comply with said poeedttrea atd regtriremerts. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING INSPECTOR Sc- 01beT Side for Stott code HOMEOWNER'S EXEMPTION The crock suits that.' "airy homeowner performing work for which a buildiq permit is regubtd sha11 be exempt from the pro+isiow of this section (Section 3l qaa 7-dosing of Construction Suptrvisoro; Provided that is a homeowner engages a person(s)for hue to do.such work,that such homeowner shall taQ as supervise Many borneowntts who use this cxt;Pdon arc imawan that they an asswna the rtspomstbtb'ues Ora svpayisoT (w Appeodia Q,Rules amd Regulations for Lkzosiog Construction Supervisors,SertiN .1.a4 This lack of awareness often nuts in serious problems,particularly when the horneowmbho urjkcnsed pcnam In this case your Board cannot proceed against the ratlieet cad pexsou as it would wig licensed S4cnisor. Tbt aomeowotr*cling as viperviwr is vW=xt!V rrspousibk. To tunrt that tht homeowner is fully aware of Whet respowlbilities,malty eommtatidts rapine;as peel of the permit applieeSon,that the homeowner cmify that Wshe wukrsum&the responsibilities of a suptr ism. You may care to amend and adopt such a Porn omifieation for um is your exmm=!p. L v, ,. • yr r�rrvy .+��. �..�� - - PUBLIC PROPERTY DEPARTMENT ACR 120 WASHINGTON STREET, 3RD FLOOR SALEM,MA O1970 TEL. (976)745-9595 EXT. 380 UG FAX (978) 740-9846 STANLEY J. USOVICZ, JR. MAYOR - DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of MGL c 40,SK I aclmowledge that as a condition of Building Permit# , all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid-waste disposal facility,as defined by MGj,c III,S150A./ The debris will be disposed of at: Location of Facility QA ture o ermi licant Date FULLY complete the following information: (PLEASE PRINT CLEARLY) �l 61•�. Name of Permit Applicant Firm Name,if any Address,City&State The above statute requires that debris from the demolition, renovation,rehab or other alteration of building or structure be disposed in a properly-licensed solid-waste disposal facility as defined by MGL cM, S150A, and the building permits or licenses are to indicate the location of the facility. MAP 9 LOT 21 JERMYN REALTY TRUST ALB s _ 56110'4t"E �/ J S6110'41"E — 52.11' A�9 50.39' 2 •�— 9i LOT AREA 111,890 t S.F. GLORIA J. JERMYN, I TRUSTEE OF GLORIA REALTY TRUST 30SETBACK LINE A 9 WOOD DECK F I LIO T 83 �I MAP 9 MAP 9 W YI LOT 81 LOT 82 W 00 a Iwz to U Z of a U I� 24.9' �o MAP 9 I 203' LOT 80 I \ I ROBERT A. LUBAS I EXISTING FOUNDATION L \ 19 4' 15' SETBACK LINE U) uj 50.10, 32.77' 21.40' N56'26'30"W N56 26'30"W N56'41'05"W OUTLOOK AVENUE (UNDER DEVELOPEMENT) DEED REFERENCE FOR LOCUS IS RECORD BOOK 7199 PAGE 111. — THIS PLOT PLAN IS THE RESULT `SN OF nFs OF AN INSTRUMENT SURVEY. �P sqc� PLOT PLAN OF LAND GAIL 3-5 OUTLOOK AVENUE I CERTIFY THAT THE BUILDINGS SmirH SALEM, MA HEREON ARE LOCATED ON No.35043 PROPERTY OF THE GROUND AS SHOWN. �° �FcisreR`° ���� FSSzo"AL LpNOSJQ' JOHN E. JERMYN REALTY TRUST �J SCALE 1 " = 20' JUNE 14, 2004 �� c y NORTH SHORE SURVEY CORPORATION A PEG. PROF. LAND SURVEYOR 47 LINDEN ST., SALEM, MA # 2222