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70-80 COLBY STREET - BUILDING JACKET 76-86 Colby St_ Aj j. ? ( 40t � C� No. ��0 �i City of galem Ward APPLICATION ✓aS FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant l!toeecomplete all items in sections:1, Il, Ill, IV, and/X. I. AT(LOCATION) -76 �b W �_l 7 �'T DISTRICTONING�p IN0'1 / sin 1 OF BETWEEN_ Tl��l i�L�Y\� �J AND BUILDING (CROSS STREET) IcaoSS Lo UTI SUBDIVISION LOTBLOCK 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 ❑ Addition(If residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational housing units added,8 any,in part D,13) 19 ❑ Chruch,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- 22 ❑ Service station repair garage Enter number of units ........................... 5 ❑ Wrecking(M multifamily residential,enter number 23 ❑ Hospital,institutional of units in building in Part 0, 13) 15 ❑ Garage 24 ❑ Office.bank,professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 7 ❑ Foundation only 17 ® Other-Specify S 1 fi'C_. 1 In _/I 26 ❑ School.library,other educational �l 27 ❑ Stores,mercantile B.OWNERSHIP 28 ❑ Tanks,towers 8 ❑ Private(individual,corporation,nonprofit institution,etc.) 29 ❑ Other-specify 9 ❑ Public(Federal,State,or local government 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 is being changed,enter proposed use. To be installed but not included in the above cost aElectrical........................................................................... b. Plumbing.................................................................--. c. Heating,air conditioning..................._...................... d. Other(elevator,etc.)..................._................._....-....... 11. TOTAL COST OF IMPROVEMENT $ . III. SELECTED CHARACTERISTICS OF ILDING -For new buildings and additions, complete 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 ❑ Masonry(wall bearing) 35 ❑ Gas 40 ❑ Public or private company Will there be central air 31 ❑ Wood frame 36 ❑ Oil 41 ❑ Pdvate(septictanketc.) conditioning? 32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No 33 ❑ Reinforced cororete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator? 34 ❑ Other-Specify 39 ❑ Other-Specify 42 ❑ Public or private company 46 ❑ Yes 47 ❑ No 43 ❑ Private(well,cistern) J.DIMENSIONS 48. Number of stones ...........-.................... M. DEMOLITION OF STRUCTURES: 49. Total square feet of floor area, all floors,based on exterior Has Approval from Historical Commission been received dimensions ...................... for any structure over fifty(50)years? Yes_ No_ 50. Total land area,sq.n....._................ Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 52. Outdoors............................................................................. HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? Yes No L RESIDENTIAL BUILDINGS ONLY Ater; 53. Enclosed.............-..............................................(.....'......... Iectric: Gas: Full................................_........ 54. Number of Sewer: bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Pa -- - -- BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWI G: i Historic District? N (If yes, please enclose dor entation frT Hist Com.) ConsKation A a? Yes_ No (If yes, lease nloserder o Conditions) Has bre Preve ion approve rid stamped plans ap ions? Yes_ No_ Is pro orated int S.R.A. ' trict. esU o_ Comply with Zoni ? Yes O_ (If no,enclose Board of Appeal decision) Is lot grandf Bred? Yes_ If yes,submit documentation/if no,submit Board of Appeal decision) If new c struction, has th prope outing Slip been enclosed? Yes_ No_ Is Architectural Access Board approval required? Yes_ No_ (If yes, submit documentation) Massachusetts State Contractor License# 03.002115? Salem License# )45,� Home Improvement Contractor# 10 1 M(a 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 Name Mailing address-Number,street,city,and state ZIP Code Tel.No. 1. A Pf Lev--, (Z 70 Owner or Lessee ;UN ©dSCJ9 `J�c,�. 2. W\v�. � Yh0Y -$VIZ I—O�(,C✓ + A-ANJ S v"\yo�— 2 -))40laS Contractor Builder's License No. 3. Architect or Engi eer 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 authorized agent and we agree to conform to all applicable laws of this jurisdiction. Sig tur pljcant.n Address Appli tion date .L =0WLfr tZ 1) hJCr 1 1 DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building / FOR DEPARTMENT USE ONLY Permit number & (/ 7 Building / I Use Group Permit issued y / 1 / 19 Fire Grading Building Permit Fee $ Live Loading Certificate of Occupancy $ Approved b Occupancy Load Drain Tile $ Plan Review Fee $ / TITLE NOTES AND Data - (For department use) l 42— PERMIT TO BE MAILED TO: 2 . DATE MAILED: Font c'o 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 "