2 SMITH AVE - BUILDING INSPECTION I
No. —0 City Of Salem Ward 2
1gL95- A
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all Items in sections:1, II, ill, IV, and IX-
I. AT(LOCATION) 19, V/\71 fq/ L/ A TI VQ ZONINGDISTRICT
LOCATION ,(� /� (S
OF BETWEEN /"IJJ4LdJ k ( AND
BUILDING CROSS a1REETt Icnoss LOT
fFn
SUBDIVISION 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 Residential Nonresidential
2 ❑ AddMon(if residential,enter number of new 12 dOne family 18 ❑ Amusement,recreational
housing units added,it any,in part D, 13) 19 ❑ Chmch,other religious
13 ❑ Two or more family-Enter number
3 ❑ Alteration(See 2 above) of units ....................................................... 20 ❑ Industrial
21 ❑ Parking garage
4 ❑ Repair replacement 14 ❑ Transient hotel,motel,or dormitory-
Enter number of units ........................... . 22 E] Servicestation,repair garage
5 ❑ Wrecking(H multifamilyresidental,enter number 23 ❑ Hospital,institutional
of units in building in Part D, 13) 15 ❑ Garage 24 ❑ Office,bank professional
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
7 ❑ Foundation only 77 ❑ Other-Specify 26 ❑ School,library,other educational
27 ❑ Stores,mercantile
B.OWNERSHIP
28 E] Tanks,towers
8 2"Private(individual,corporation,nonprofit
institution,etc.)
29 E] Other-Specify
9 ❑ Public(Federal,State,or local govemment
C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant,
machine shop,laundry building at hospital,elementary school,secondary school,college,
parochial school,parking garage for department store,rental office building,office building
10. Cost of improvement ......................................................... $ at industrial plant,If use of existing building its,being changed,enter Proposed use.
To be installed but not included ,0\/) (� ,nH 9�/nr�cT A/p-V 514S 1-P
in the above cost U (� 6r
aElectrical ........................................................................... v�
b. Plumbing..........................................................................
c. Heating,air conditioning.............................................
V-tl
d. Other(elevator,etc.).................................................... V'V
11. TOTAL COST OF IMPROVEMENT $ V -1
III. SELECTED CHARACTERISTICS OF BUI ING -For new buildings and additions, complete Parts E-L;demolition,
complete only Parts J& M, all others skip to 1V
E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE F SEWAGE DISPOSAL 1. TYPE OF MECHANICAL
30 ❑ Masonry(wall bearing) 35 u Gas 40 I/ Public or private company Will there,be central air
31 ('Wood frame 36 ❑ Oil 41 ❑ Private(septic tank,etc.) conditioning? /
32 ❑ Structural steel 37 E] Electricity 44 El Yes 45 LJd No
H. TYPE OF WATER SUPPLY
33 ❑ Reinforced concrete 38 ❑ Coal �( Will there by an elevator?
34 ❑ Other-Specify 39 ❑ Omer-Specify 42 Ir I Public or private company
46 ❑ Yes 47 B"No
43 ❑ Private(well,claim)
ML
a.4 DIMENSIONS
�qJ M. DEMOLITION OF STRUCTURES:
48. Number Nsumber of stories ...h..�...._....._......._....._............ i
49. Total square feet of
exterior
Moor area,
m all floors,based Has Approval from Historical Commission bee eceiv&-v
dimensions ........._.........................0........U.od'..D...L...._.1....._- for any structure over fifty(50)Years? Yes No=
('21(0� g zDQ(p2/ ��S15
Sg. Total land area.sq.ft....t....._....i.!..............y.._...._..�, Di Safe Number
i
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. Outdoors...... ..................................._............................... Yes NO I
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed ......:.I................................................................... Electric: t/
Gas: i
Fin........�............................ Sewer:
54. Number of
bathrooms I DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partin ------ BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:Historic District? Yes_ Nov/ (If yes,please enclose documentation from Hist Com.)
Conservation Area? Yes✓ No (If yes,please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes_ 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 documentation/if 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 # l'.SO6-9 Salem License #
Home Improvement Contractor# /z ���_ Homeowners Exempt form (if applicable) Yes_ No
CONSTRUCTION TO BE COMMENCED WITHIN SIX (6) MONTHS OF ISSUANCE OF BUILDING PERMIT
CONSTRUCTION IS TO BE COMPLETED BY: If an extension is necessary, please submit
in writing to the Inspector of Buildings.
V. IDENTIFICATION - To be completed by all applicants
Nam Mailing address-Number,street,city,and state LP Code Tel.No.
Owner or
Lessee n
2.Contractor - Uc;ense No. ,✓�'r�✓�HP
A l Wl �ti(� U n� 3(,
Architect or
Engineer 1
I hereby certify that the proposed work is authorized by the owner of record and that 1 have been authorized by the owner to make this application
as his autho' nd w to conform to all ap liceble laws of this jurisdiction.
Signature appli Address Application qate
rakx j�/�
000,
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19 Fire Grading
Building
Permit Fee $ Live Loading
Certificate of Occupancy A
$ Occupancy toad
pproved by:
Drain Tile $
Plan Review Fee $
ITLE
NOTES AND Data- (For department use)
e +
Pe-
AJ
t ,
Sa-- C, ka U
C✓L /V
Lu i S
�� Ss L-
PERMIT TO BE MAILED TO:
DATE MAILED:
q
Construction to be started by: Completed by:
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN • For Applicant Use
O N
I:
l
i
i
IJ
MAP
CITY OF SALIEM
j ROUTING SLIP
NEW CONSTRUCTION f '
CERTIIFICATE OF OCCUPANCY
LOCATION:
i
APPLICANT: l4
R
ASSESSORS
FRANK KULIK � DATE:�•Ir�4��
(93 Washington Stree
CITY CLERK
CHERYL Y APOINTE ` DATE:
(93 Washington Street)
PUBLICE SERVICES
BRUCE THdBODP.A DATE:v/r
(120 Washington Street)4 oor
WATER \
DOTTIE THIBODEAU DATE:_
(120 Washington Street)4 Floor \
_
CROSS CONNECT SUPERVISOR �� ✓ COIL �0� / f �Y� .- 1
BRIAN THIBODF.AU DATE. i
(5 Jefferson Avenue)
PLANNING S �l eC
G{ W 1611e DATE:
�h (120 Washington Street) 3'"Floor
/fONSERVATION CONIMISSI N
FRANK TAORMYNA t---�"' DATE: S
(120 Washington Street)3nd Floor
ELECTRICAL 1 /
JOHN GIARDd �'Ce.�—DATE:�LLZ/�L
(48 Lafayette Str
FIRE PR IFFI N
ER/N GRIFFIN �" —" - �-- _ DATE: � �-3 Bd�
(29 Fort Avenue)
HEALTH
JOANNE SCOTT DATE:-_(,,a�lL
(120 Washington Stn#40 Floor
I
BUILDING
THOMAS ST.PIERRE DATE:_.__. _
(120 Washington Street)3 d Floor
no CoeaeioXWe a th OIM409dhitsett4
Dept of Inh�dL1 Acdda�ta
Of
6"w.:l+f�i .stand
Boatirny MA full
Wwkera'Compwadoa lnsarance A®daft BuGhn Contradon/Eledrldanwlplambera
Aoollewd T ftnatio lrtdjLlaiDlr
Name /��T /'tea �cYa �y�— ( ,OTSr! G1J4Ok"
Aeldt'esf<: � 3Y��
An yoe u Chet!thF" Type of pryaet Fmk
.. ,
eei�Iq�ery seoprlau
1.� I am a empkya w+it! [�I am a Reaa1 acetraeter and I 6. New eoeat+eelos
aoployeae(1L1 aed/ar Dui-dme}� Levelid fleas
2 Q I>o a aoYt paoprieaor ar psl� 110d an Ae attached aback i 7. S Rmoddbg
•Yip sad Pave eo esepbyep That mb-cantraeoo Yaw d. ❑Demolhlaa
wadtbr 1larmai aq eapecttp. 0!. . .1 9. Q Building addition
(xo w�O&M,camp,ieav<aoos s � e �d i4. I&O EWcWcd npm cw ad&*=
regehed?.� o tbd[
3.❑ I a>i a Yomeowms doiei ap wadc sigdtaf }�ervM 11.Q PUMbLsa mpaise or additbm
mysex Ph wadi owv a .�)�. ae �lellsye'no 12.Q RoofsepaYtl
ioaetaaoa sapshod i*, OWV6 '�•(1'b,. ... ,..L 13.0 q Other
Any �dd /1 eamtdoftbmtnodsho8�e1R4[+�1� �e�4.}a /ampvtlo�Pdky
;Any
cams.lo.Imka�YemOtvltemserivAgw dabs ri mmaL
tCwr.emeA144b"AYboi'motrevawa8606motAmAmbsarnmwftsobvOE MOMM enk edpom'eaq 'dbytalxmmdoL
�...K iwpbi.tlwd er s+w.dns'�«y nr�iw a►ussaraAi►>4aw ed6 a rm.er db q foi Aft
ftft r a SdMw I.ia.p: J DaOx U��D
job She clWAMMA ff d1�7�
Attach a copy of the workers'eaoipaaetloa po ft dedwadoe pap(whit do ply number aW eMbudon date}
Fas7 ov io ncare swims o s requked under Seedee 25A ofMGL a 152 can lad a the impoeMoe acrbsind penaidea of a
Mee up to$I.SOQOfi md/er one•yew bwrbowne%as keel ai dvg paella fa the fotm of a STOP WORK ORDER and a fee
ofup a S230Ao a dry agamat the vfot=L Be advbed that a copy ofthia ataoemeat my bs fbewaded a the Office of
levadsW=of the DIA fbr mmraoe coveaae vaiftad mL
It As Assy Awpebs mdpowi f r 000101M PAW*0lofffmadxx pvW&d abm As vw and avrrea
o6
O,QIeld na M46 Deism wF t a IM&"a,a iw c&M~y cIvaiAMw t,Qk"
Cny or?owe, rermq/Ilceeaa p
Isaatag Authority(drde ores
1.Board of Health L Building Department 3.Clty/rown Clerk d.Bleetrleal Inepedor I Plumbing Inspector
6.Other
Contact Person Phone A
Information and Instructions
mat Lim chmair 1s4 wrim an bs0. eraepfges , �►
is de ad�. _. ► w
Utsu>�as b dds so
aprexs as kgOie4 opt of writs M_
_ stemb" OaEt h�l eattaty.of»MY twa of moss
at a6 i ��a �mCt � 9(a 40000d tb at 0
raedva at tansbs of at ioalvi Pp►>tiodadoa a odwr Iwo atity4.ewplayaas emtpbYesa aC>SiFrOWCVCK t>aa
dweninghouse bavtos trot mop dm eves apr mmft Mod who raider aaei►ac er dwtoi bom
dw Owner ert�who es°p*II palm copbwasanctiosym�be deemed a be:empIOW
or as dw tisougag arbur'ldmn i MP=rvM
apter 15Z.12$Qd)MIND stars do"eva7 I'm"er UM�MsesK7+ cummmwkbb@U tM hawses or
mM ab
restewai of a Maass or Personte'p�a a hedsas e r to eomb se
"bssesap tM amsouwevYe for r<7
Violence nieorpos sa wW do bwraaes eaNDraM 0� don
9dsei"
=ariy.MCII.dww JA PSM dM ?;Cow dw MUMMweaft aviw nwat otiks I'd ov
cow bw ANY oo D ofpublk wdt=0 ampable
vopkCammotais dopes Lava been peesmlld IS dw eoaOasdos.aedeaogR'
affidavit,.gg *.by c�dwbous drat apptY b yus aimatloa<an4 it
necessary.IV ssb weasc ) M),addrw(evI�P�mtbbea(tt)aloes win dseir )sd
I3abatibi Canapa�iav( ,�or 1.tmibd Qt prwr I blpa ad p)wide m�—otbet man the
mmvbas or prtaees,we no teVW b clay wad'ep ` of balsam
eapbyas a poHey is required. Be advised dMt b s1Oa.aa dab the amdavIL Tee affidavit should
weaMesmb rite owibawd°`of iomtaoea arvetase Aar the pesmit a�Hexma is Lacs retptaoed.nut ma DepxMncmt of
be eempd b dw dw a tows the the appHcadm ma htw or rfyoa ae eegdaeet b abtak a worlitas'
b&wuW'Acddcmft Shgaldyaabttve a4Y : s . rttoaid met mar
COUVOUstim pleas can as DeOsiraat si due muiba lfsOd M sclFivsored cosapa
seisissmas0a Homae eon�ae
Has
City er Tema 010dvis
Pkaw be sera ar the aHlddavit is aompkb and peivtgd lestbly. Ths Department Las psuvided M space at the beitbm
of cos affidavit tar yaa b 8D out is the event the O k of in be
used
as he to contact Yea r Is
the a 2
Hcmt
Pkass be sore to ®is the paMW&4 me"sorbs whieb win be n ye s a wed
tcwc0*s comber Ia ddidoa. li aPP�
mat matt submit aadtiple pamWUccm�Heatiam is any pr m year,stood miY submit one affidavit isdicatins�
poft b* as(if necasrY)sad ender"Job Sins AddraP'the BO&Ja should wft"aII badow to (dw or
1U.s
bwal"A ooP9 oohs affidavit ass has bows odlefa>4►atsoge4 aL> bX>be�!ar tows may be ptwvided b the
VWSA a at3<davit it a fits 6ts Amore pe mdo a&msa. A Mew at�davit mobs mled oat Melt
Wpiicsss pr s� s owarr at cithow is obtsidet a Scow a permit not rdated,b any business a aOwnutc al vesture
y b bra kava ear.)said pares i NOT regd"b O0e°p�min affidavit
(is a dos ffixme or pewND yes and should bave any Quemions.
TM Ofaw ottava"IUM wain l&a b mans yaa is advance A=your coopcmdoa
please do not bel bb b j"us CA
1be Depa =cos address,tckpbm ad Ar mmbr:
The CommonwCW& of Massachusetts
Deparmte nt of hh&U W Aai&MO
of a of Uvesblgsdons
600 Washington Street
Bosto%MA 02111
TeL #617-7274900 ext 406 of 1-977-MASSAFE
FxK#617-727-7749
Raviscd 5-26-05 wwwmm.gov/dia
y.i
13uhiic fro}tertgi i9egartmcnt
Nuilbing 19cpariment
(One dalem 6rren
508-745-9595 Fxt. 380
I
Leo E. Tremblay
Director of Public Property
Inspector of Building
Zoning Enforcement Officer
Section 116.0
i
DEMOLITION OF STRUCTURES
Structures over fifty (50) years old must have approval of. the
SALEM HISTORICAL COMMISSION
UTILITY DISCONNECTIONS REQUIRED
I.
Authorized Agent Date of Disconnection
I
i
i
WATER:
ELECTRICAL:
ti' GAS:
✓ SEWER:
i
DIG SAFE NUMBER:
I
PEST CONTROL:
***DOCUMENTATION OF ALL THE ABOVE MUST BE ATTACHED BEFORE***
** PERMIT CAN BE ISSUED **
I
iFee for Demolition: $5.00 for application plus $2.00 per 100 square ft.
gross area, minimum $15.00
I,
I
I
I
I
, CITY OF SALEM
CONSERVATION COMMISSION
September 26, 2005
' III
Patrick &Carol Farrell
1 Smith Avenue
Salem, MA 01970
I
Re: Order of Conditions DEP #64-403 —2 Smith Avenue, Salem, MA.
Dear Mr. & Mrs. Farrell:
Enclosed, please find the Order of Conditions for the above referenced project. Following
the 10-day appear period and prior to starting any work on site, this document must be
recorded at the Essex County Registry of Deeds. Please fill out and return the Recording
Information on page 9 of the Order of Conditions, which will indicate to the Salem
I
Conservation Commission that the document has been recorded.
If you have any further questions please feel free to contact me at (978) 745-9595 x 311.
Sincerely,
rank T tmina
Planner/Consetvation Agent
Enclosures
I
120 WASHINGTON STREET, SALEM, MASSACHu SETTS 01970 , TEL: 978,745.9595 FAx: 978.740.0404 , WWW.SALEM.COM
i
Massachusetts Department of Environmental Protection DEP File Number:
�,-- Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions as4_4os —
Massactsusetts'Wetdands Protection Act M.G.L. C. 131, §40
G. Recording Information
i .This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in
which the land is located, within the chain of title of the affected property. In the case of recorded land, the
Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land
I subject to the Order. In the case of registered land, this Order shall also be noted on the Land Court
Certificate of Title of the owner of the land subject to the Order of Conditions. The recording information
on Page 7 of this form shall be submitted to the Conservation Commission listed below.
Salem -- -----------
! Conservation Commission
Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission.
-------------------
.............. .°---------- - -------- -------------------------------------------------
To:
Salem -------- — - -- --- -- ---
Conservation Commission
Please be advised that the Order of Conditions for the Project at:
2 Smith Avenue ___ —_ #64-403
Project Location DEP File Number
!i
y
Has been recorded at the Registry of Deeds of:
In
County Book ------ Page
for:
Property Owner — -------- -- -------
and has been noted in the chain of title of the affected property in:
Book Pa e
9
in accordance with the Order of Conditions issued on:
Date
If recorded land, the instrument number identifying this transaction is:
Instrument Number
If registered land, the document number identifying this transaction is:
ii
.ram
- --------- ---------------------
iDocument Number
Ili Signature Of Applicant ------- ---------_-_--
i
wpalorn5.tlec• •ev.3IfN5 Faye 3 Y 9
i national rp
USVp R.Sil%N mn
I eupemea or support sonboa
November 14, 2005
Patrick Farrell
2 Smith Avenue
Salem, MA
Re: Removal of electrical service for demolition.
I
Dear Mr, Farrell,
This letter is to confirm that the electrical services,and meter(s) were removed from 2 Smith
Ave. Salean, MA on Thursday November 10, 2005, If you have any questions or need further
assistance,Please feel free to contact me at 781-388-5342.
Sincerely,
Irving R. Silverman
Supervisor of Support Services
IRS/cmo
I
II
I TO M*dford atrow
Mahn,MA 02146
78f-S6s•6342
2 d
i
I
i
November 19, 2003
I
i
i
i
To Whom h May Coo
The drop wire at 2 SwA Ave bu bow removed and Vaizon wimps beve bem cleared st
this Iocadon•
I 11 satin �G��
Yet Sate® SaWn
-
i
I
i
I
� I
+� TGTRL PRGE.01
I
i
® New England
Operations
North Shore
i Division
t r�6ergy Delivery 44 River Street
Beverly, Ma.
01915
Tuesday, November 22, 2005
1 To whom it may concern:
This letter is in regards to 2 Smith Avenue, Salem. Please be advised that the gas service to
this building has been cut off in the street.
If you have any questions or concerns you can call me at 781466-5782.
Sincerely,
o e ve
Fie Coordinator
North Shore Divisions
I
I
I
I
i
i
This is a confidential message, intended solely for the person to whom it is addressed. if you receive this
I� message in error,please forward it to the correct person, or back to us at fax 978-927-7459
r-
WORK ORDER: 314023
General Environmental Services WORK DATE. : 05/081/06
9.3 rn 0 Easte Avent-te Monday
Malden/ MA 02148
781 'act '�F6o,�
Work
Bill To: 11065383 Location: E 1065381 978-745—
PATRICK FARRELI_ PATRICK FARRELL.
1 SMITH AVENUE: ,� SMI -
a fH AVENUE
SAL_EM, MA 01970 SAL_EM, MA 01970.
o
12:00 PM 74 PATRI:CF'. MCHHLE
•
NET 30
I I'
I'!
DEM DEMOLITION/CONSTRUCTION REPORT 12
I
I
i4J Cif-vSl -
MININ
.. • . . •
l S
i 6
3 7
a a
e • . es
Kitchen Living Room _ Dining Room(s) _ Bed Roomy
—.— Attic _— Shed(s) Garage(s) — Crawlspace( }
Officals) Lawn Area Dumpster Area _ Basement(e}
Bars) -- Store Room Rodent Burrow — Rodent Pala
Bathroom(s) Other Family Room/Den Laundry/Utili
Baseboards Cabinets Carpeting Furniture
—_ Sill Area Eaves Wall Voids ---- Other —
Outside _.— Outside Other Under and Behind
Perimeter Beddinits Kitchen Equipment
—_ Spot Treatment ULV Machine Broadcast Fan Spray
_ Space Spray C& C Aerosol _ — Duster Air Sprayer I
-- Fumigation Granulate — Rat Station Mouse Stal)oq
Actisol Machine -- Drill &Treat Voids .--- Slab Injector _ Total P, ease r 1
-- Other
agree outstanding over 30 Jays(runt the date of service I hereby acknowledge the salisLtciory completion of all ser en e d
subjrr to n 11/2'&,FICJANCE CHARGE PER MONTH and agree to pay the col of servioes as specified ahove.
IV
annual Pe'cee?nlage rate of 18%. X
c7t an* r it
Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978)745-9595 EXT. 311 FAX(978)740-0404
WAIVER OF THE DEMOLITION DELAY ORDINANCE
(s hereby certified that the Salem Historical Commission has waived the Demolition Delay Ordinance for the
Oposed demolition as described below, as per the requirements set forth in the Historic District's Act (M.G.L.
. 40C) and the Salem Historic Districts Ordinance.
i
address of Property: 2 Smith Street
me of Record Owner: Patrick Farrell
¢scription of Demolition Work Proposed:
fmolition of residential structure.
I '
i
Wed: 12/16iO4 SALEM HISTORICAL COMMISSION
By.
HIS IS NOT A DEMOLITION PERMIT. Please be sure to obtain the appropriate permits from the Inspector
(Buildings (or any other necessary permits or approvals) prior to commencing work.
I
CITY OF SALEM
'+
FIRE DEPARTMENT • FIRE PREVENTION BUREAU
••a' �
s Salem, Massachusetts 01970
Jac 9 PERMIT
Date :' f't& g
In accordance with the provisions of Chapter 148, G. L as provided in Section 10A
this permit is granted to p /
Name
(run n®.a ,em 6 it=a corpmutlou Oraml.d permit)
to conduct demolition operations per Salem' Fire Code .
State clearly Massachusetts Fire Prevention Regulations and
purpose for
which permit Massachusetts State Building Code.
is granted
Restrictions As per Mass State Codes and City of Salem
Ordinances. Clearance from Salem Historic Commission.
at L--2= S GUlTi�/ l / ,tl
lCl.. lecodm Y. .W.1 and m.. or d..erlb. to web mem.r m Ie p,o.lde ed.q.,t. .ndu amt. of lomtl 1
Fee Paid $—JMIK—aS
(5 awhlr. eltictol�IInO Prmltl
This permit will expire. --���
m- (THIS PERMT MUST BE CONSPICUOUSLY POSTED UPON TIM PREMMM) 'W
Form #29C
a
CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
Salem Building Department
Debris Disposal Form
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
/ (Location of Facility) so, e
Signature 4 Xpplicant
J ,-�" / e�
Date
SITE PLAN T
SCALE: 1"=20'-0"
BASED ON PLAN OF LAND rN� sMu
BY RURAL LAND SURVEYS
DANVERS, MA '•
DATED OCTOBER 30, 2005
NEW BUILDING LOCATED ON SITE
BY: RICHARD W. GRIFFIN, ARCHITECT
37 TURNER STREET
SALEM, MA 01970A2fzELL
(T) 978-740-9979 S 6�-
(F)978-740-235214
1 7
'zLd/4-
720 /iti I \
a.e o (
tirt w{Cl � ToP c * o
=1 (�`N :8u11;Dit1Cr.. S r. 0 'a s
sc-
1cv , — *
M , Wr ate, 8
cQ;�� �� l
V
p 00 CA M M
/ q' � fir:. �` a �� 2.7�R `2• 0\ �
4
F14,� I 5
/ 8 Lw oIo
y
N
IZ7 co
�A r 2 `C
13' agc a� h Qo lD q 8
��c,9 k8 1 B ,00 �.
Qq A,-, >3 as
x �v
u
S.1 I
@0 6b\\ J N M
�oX
Q v ti a\8 9 `� 2y l
>
/Z m4