1 TECHNOLOGY WAY - BPA 06-259 CEMENT PAD N��� �� City of Salem wa.d
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APPLlEATION
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PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTIOl��
- ►A�ORTIIM-APP!lcant to eon�Na aY Nems rn seetlons:l, Ib ul, N,and Ul.
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11. TYPE AND COST OF BUILDING•All applkants complede Parfs A-D � �
A TYPE OF IMPROVEMENT O. iROPOSED USE•FOq"DEMOtJiION"USE MOST RECENT USE ��
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i t. TOTAL COST OF I�iROVE7dEHf •� v� � � \ .V J .
OL SELECTED C�OF BUILD •For new buildings and addidons,com�Par4s E-L:denwliO�cn.
com e on PaAs J 8 M,aU o1f�s ski to IV
E PNMC�AL TYPE OF FRAME F. PRNCPAI T1'PE Of MEATWIi FUEL 4 TYPE OF SEWAfiE DIBPOSAL L TYPE Of MEqfANCAL
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33 Q ae�raoacaoow� 39 Q CoY . M. TYPEOFWATERSUPPLY wi�Mn�r.ron
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J. DIMENSIONS
ie N.m P Sidllee..._...___...___..._........._.._...___..
as Tmal e m Net of noon
a: noxi Oueo do earrcrYeS—
aunermrone
50. TOM Iwo ora e6 IL ..__--
M. DEMOLITION OF STRUCTURES:
:_ .
Has Approval from Historical Commission been received
for any structure over fifty (50) years NO—
.-, Dig Safe Number
C NUMBER OF OFF-STREET PARNa/G SPACES
Erppre
Pest Corthrol:
51
52. Owde _
'
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
Yes No
L RESIDENTIAL eUaOalGSO
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53. Erle•d .. MIT
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,. ..,.'...,...,... ,. _ _ F .. -
f bcft
Full
5e: N~CO - - - - -
5a°e0pe` Pad
Sewer:
- DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
BEFORE A PERMfT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District?TM Yes— NoZ (If yes, please enclose docuncentatibn from Hist. Can.) a -<
Conservation Area? Yes_ Nq� (H yes, pie enclose Order of Conditions)
Has Fre Prevention approved and stamped Plans of applications? Yea_ N9
Is property located in the SRA district? Yes— No
Com* with Zoning? Y %�. No—(if no, enclose Board of Appeal decision)
Is lot'grandfadiwed? Yes_ No— (If yes, submit documentation/if no, submit Board of Appal decision)
If now corlstrtictioh, has the proper Routing Slip been enclosed? Yes_ NO_
IsArchitectural Access Board approval required? No_ (If yes, submit documentation)
cYes—
Massachusetts State Contractor UcenSS # l 1 �� Salem License #
Home Improvement Contractor # Homeowners Exempt form (if applicable) Yes— No—
oCONSTRUCTION
CONSTRUCTIONTO BE COMMENCED WITHIN SIX (6) MONTHS OF ISSUANCE OF BUILDING PERMIT
� necessary, p ee submit
in writing ip the Inspector of Bungs
CONSTRUCTION IS TO BE COMPLETED BY: �U 3� Q $ ' ,, e, .: i an ifin to
V. IDENTIFICATION • To be completed by all applkanG
Nems
MMip adleee : Numfisi, eOlK W art NIM
ZIP COw
Tel N0.
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tAMW
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AvCN K.
0/y 76
1212
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CoNam
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screens
um" Na.
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Al hMq or
EnPNir
I hereby cerMy no the proposed work Is authorized by the owner of record and Mat 1 have baso a fit med by the owner to make this applieaGan
as his eo Spent a eto coMorm 10 all aooticable laws of this jurisdiction.
rlatu
Addreae
Appteanon date
V1. VALIDATION
DO NOT WRITE BELOW THIS LINE
Building _.
Permit number
Building _
Permit issued 19—
Building
Permit Fee $
Certificate of Occupancy $ Approved by
Drain Tile $
Plan Review Fee $
NOTES AND Data - (For department use)
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by. Comoleted by,
FOR DEPARTMENT USE ONLY
Use GMLQ
Fire CwuWq
Live Loednp ..
O=Vwcy Load
TITLE
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD _
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN • For Applicant Use
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The Cammotwem Of hfu ach=dts
Depatm d al'1 *sod Aoeida b
01Ba athwadpllaeti
600 Waei�ii�a Shat
Boskm6 iii OZ111
TeL p 617-7274900 ext 406 or 1-877-MASSAFE
Fait 9 617-727-7749
Rrwed 5-2645 www mos pv/dia
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035792
"�� � ¢" Tr. no• 13891Re
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ROBERT E DILISIO, _
1050 HUMPHREY ST� J...a
i SWAMPSCOTT, 61A�"I'g�TjJs'�
�- - "Admin(strator"-