49 SCHOOL ST - BUILDING INSPECTION City of Salem Ward
? A
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete/RN Items
`iinnsections:L It, III, IV,and IX.
I. AT(LOCATION) �/ SG�OaL �/- 6610AR CT
LOCATION NOA
OF BETWEEN AM
BUILDING cnosa smeen (C n LOT
SUBONISION LOT_BLOCK SIZE
11. TYPE AND COST OF BUILDING-All applicants complete Parts A -D
A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR."DEMOLITION"USE MOST RECENT USE
1 ❑ New building Raaldartuld Nonnasmoseaw
2 ❑ Addition lib M3dennal.enernumber of new 12 ❑ One tam4y 18 ❑ Amurrrtera,leraworrtl
louenq un,b added,d any,m pan 0. 13) 3 19 ❑ CMtrA other rNigiwte
130 Two or more tamely•Entet numeer ❑ Ir Wtrfe
20
3 ❑ Aeereton)See 2 eboas) d unas 21 ❑ Puliog garage
4 Radon reowwrie a 14 ❑ Transent Motel.motel,or dorm8ory- 22 ❑ Seryld!da60r4/epee garage
Enternumbei of units
5 ❑ Wn ckmg(a m ft-w y resdrtdt Irlr names/ 23 Q ftaeaeaL i siboromml
of units m eurldbv in Pen 0. 13) 15 ❑ Cwags
24 ❑ OfNoa bank proleaSC1W
8 Cl Mo.,.g(relorat w) - 18 ❑ Carom '- 25 ❑ Public udelly
28 ❑ SrdtooL ebrw.dean colt= m
7 ❑ Fdundaton only 17 ❑ other•sway 27 ❑ Stone,mercanNa
6.OWNERSHIP 28 ❑ Tanks,toeera
8 ® Prwate Imdbdual.corporahm nonpmt4 29 Other•Specdy
mwmdon,etcl
9 ❑ Public lFed".Slate.or brae govern rent
C.COST (Onrn canal Nonresidential-Describe n detail croposso use of buddea)s.e.g.rood to XMSWIg P"
r/t machete shop.laundry buddag at hospital.ektmentw wAool,secondary school.odeegs.
10. Coat d inprovenled _-- S �)Dt� parOWN school.Parking garage for aectadnm eg,e at&.rental 01 budd oBlpe tnddalp
e eduetrtel phut d Irse d esmwq buedulg o berg Helped.enter ootnaed use.
To be erstelfed cut not X(uded
in the awvo Cost j_ 3Go
a. Ek lD
etrim_—
b. Flit to LD 300 -
d. Other televow.elG) i
11. TOTAL COST OF IMPROVEMENT s 69,1 90c) f0 5 .p,/c1Jl r fez
IIL SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, c p/ete Parts E L;demolition,
complete only Parts J&M.all others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL
30 ❑ Mno ry twaa bean of 35 ❑ Gas 40 ❑ Puts is or taMY eomdemy Wn)here be(erne air
31 ❑ Wood there, 38 ❑ Oe 41 ❑ Private teepee M010M) c4ndblafeg7
32 ❑ Sht=nisrd 37 ❑ esMioly 44 ❑ Yes 45 ❑ No
33 ❑ R.- I -, Colorer 38 ❑ Coal H. TYPE OF WATER SUPPLY WN thee by an erteedt7
34 ❑ Other-Speeey 39 ❑ Other-Spec* 42 ❑ Public or pMleownpaM
48 ❑ Yes 47 ❑ tip
43 ❑ Ptiver IweY.r7statrll
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
48 Num 'or SWrlBs ...._............ ................
ae to!at aware ten a hoot area. - Has Approval from Historical Commission been received
a..hoop basso w ex
o, s ....._...._._......_....._........_.................---__.. for any structure over fifty,(50)years? Yes_ No—
So. Toth Iwo arm so.n....._.__._..._.__....-..__..._..__ Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control-
5t Enogseo......__......_—...........................
_.__
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. omaco s...._.._..-- --........--....— Yes No
L RESIDENTIAL BUILDINGS ONLY Water. -- -
57. FJxlweb____ FDIC:
Gas
Full—_ Sewer:
54. NwVm of
baeeooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
---- BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No_ (If yes,please enclose documentation from Hist.Com.) I
Conservation Area? Yes_ No_ (If yes please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes-X No_
Is property located in the S.R.A district? Yes_ No_
Comply with Zoning? Yes_ No_ (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes_ No_ (If yes,submit documentationiif no,submit Board of Appeal decision)
If new construction,has the proper Routing Slip been enclosed? Yes_ No_
Is Architectural Access Board approval required? Yes_ No_ (If yes,submit documentation)
Massachusetts State Contractor License#CS 006�!001 Salem License*
Home Improvement Contractor# lLj I y 9 p, Homeowners Exempt form(if applicable) Yes_ No
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
If an extension is necessary,please submit
CONSTRUCTION IS TO BE COMPLETED BY: in writing to the Inspector of Buildings.
V. IDENTIFICATION• To be completed by all applicants
Name Mntrg aoorese-Number,street city,av stile LP code TeL No.
nor kul S lme C- sl '78/
Lague se.o� Jul Lf} o 36 -6000
Z o A RPM Q-(3 3a 978 9Z58-00)
L �g7do
3.
A
Arcneecl or
Ejwsser
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application
as his authorizea Spent ano we agree to conform to all applicable laws of this iunsdiction.
Signature of applicant Address Application date
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Gmua
Permit issued 19_ S/3
Fire GraOing
Building qC/ co
Permit Fee $ 6/Jr Live Lading
Certificate of Occupancy $ Approved by. Oca oarcy Load
I+� Drain Tile $
Plan Review Fee $
1,1,f9e-70X,
TITLE
NOTES AND Data- (For department use)
:2l TfiR/Ole
//I/CLU,�/!/� 0� �cc�A� U/D/RAG. ll/i[�FEiv.Y Z3�4��J' Gc//�i/!�v—�.✓J
yp
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by. Completed by:
M
J
i
{
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD _
REAR YARD
NOTES
SITE OR PLOT PLAN •For Applicant Use
ON
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f
GRANITE STATE INSURANCE COMPANY 13102 71224-0000 WC 831-17-89
------------------------------------ --
•••••' \\0 013-66-1203-00• a PENNSYLVANIA ` � \ OV�
JOHN PANTAFAS
PO BOX 3213 �� Member Companies of
BEVERLY, MA 01960-0000 American International Group
EXECUTIVE OFFICES:
SEE NAME AND ADDRESS SCHEDULE - WC990610 70 PINE STREET, NEW YORK, N.Y. 10270
I.D#
WORKERS COMPENSATION AND EMPLOYERS PARENTS INS AGCY INC
LIABILITY POLICY INFORMATION PAGE PEABODY,SET MAE01960-0000
INSURED IS PREVIOUS POLICY NUMBER
INDIVIDUAL NEW
OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - WC990610
ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's
mailing address FROM 12/16/03 TO 12/16/04
ITEM A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed
here:
MA
B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A.
The limits of our liability under Part Two are:
Bodily Injury by Accident $ 100,000 each accident
Bodily Injury by Disease $ SO0.000 policy limit
Bodily Injury by Disease $_ 100,000 each employee
C. Other States Insurance: Part Three of the Policy applies to the states, if any, listed here:
SEE ENDORSEMENT - WC200306A
ITEMa The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.
All Information required below is subject to verification and change by audit.
Estimated Total Rate Per Estimated
Classifications Code Number Remuneration 5100 OF Re. Premium
Annual 3 Year muneration Annual 11 3 Year
SEE EXTENSION OF INFORMATION PAGE - WC7754
TAXES/ASSESSMENTS/SURCHARGES $14
EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $1. 2 MA
MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $500
If indicated below, interim ad)ustments of Premium shall be made:
11 Semi-Annually ❑ Quarterly Monthly DEPOSIT PREMIUM
ENDORSEMENTS(FORMNUMBER) SEE ATTACHED FORM SCHEDULE - WC990612
02/06/04ASSIGNED RISK 66
Issue Date •?-.tel ing Office Authorized Representative WC 000001
39967
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s'-7" s'-11' COMMON
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BEDROOM 2 13'-2"
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d9_ UNIT 49 _i --
COMMON
AREA I 12 —s"
24'-11"
THIRD FLOOR PLAN
AVERAGE CEILING HEIGHT: 7' 9" APPROVED t1� &CEO,/
UNIT 49C = 0,000 S. F. Slkjbct to approval Ly rry c;:-
COMMON AREA = 0000 S. F, authorit:;hvinSJcnisuctic. .
CITY of
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149A UNIT 49A
t I
COMMON AREA
25'-5"
FIRST FLOOR PLAN
AVERAGE CEILING HEIGHT: 8' 6"
UNIT 49A = 0,000 S. F.
COMMON AREA = 0,000 S. F.
` 10/25/2004 15:09 17815935291 TOWN HOUSE PAGE 02
14'-5"
COMMON
AREA
UP
i ® WATER
HEATER N
CHIMNEY
COMMON
AREA
a 1
.r
w STORAGE
710 UNIT 46A
OIL TANK
COMMON
AREA
STORAGE 1
I UNIT 468 ; o
FURNACE � °•
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STORAGE
UNIT 46C "
DARKROOM N,l
.;
I 7'-4"
ELECTRIC
PANELS GAS METERS
a
i 25'-5" �.
BASEMENT FLOOR PLAN
AVERAGE CEILING HEIGHT: 6' 11"
UNIT 49A = 0,000 S. F.
UNIT 49B = 0,000 S. F.
UNIT 49C = 0,000 S. F.
COMMON AREA = 0,000 S. F.
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DISPOSAL OF D�AFFIDAVIT
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d Wmd heft.r&&W by Imo.o Ix 2150L
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aloaatioa d dMb g ar atelscoRe be diVOM in a p mpwb%H'efoud solid walla dgma
Am y►s&&W by MM cA SISQA.and the buBft pa mra or lieaoaw ase b
iodieafe to bcwm dde baby.
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ro m
areas a Caaoar �w M. A.6 021 J J
Caa.aaaaew '
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M- OMi.
d•haeblr•c?* ewdv qm P" ad Ra imm o/PWINYS tbssl
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() 1 am a sale oroorkw, general conmaeior or homed ww (drele ewe) and how lied da
oaaarattom ibud below who haw she loilowbW workers° PeNdw
�� Irtterartca Corat>atty/� ,
Comracser lasmance Compony/Folky Haumbeff
Cow saw laswancs Cornpa»l►/ N
O I am a homsowow Performing all the work nryseM-
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c. ,r a�,wre,.ae fcnin 21A WA I f 2 e,s kat se w,iwesi"of 0%*m N M aaw ta,uei ,
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