250 DERBY STREET - BUILDING JACKET .-250 DERBY STREET
a
t ' ::noerj -93
PERMIT '1UST :°T: i �;ED 3EFORE _ _; INNING .:ORK
7PL!C:,T1 �N r','JST ,E -MIT =_ =_ ! LED '.LITH THE
=LAINING GE°ARTMEdT . 'ID _T AR1t1G --E - °j _ — ?LAiINING,
/
:F°r.nT11ENT) 7-._ _ ILDI! ; I :;SPH-7-711 (/l
Lock c c . rec. , Dlete
irea =or Every Sin.
and _
i Le^ i l2Daraat_ o _ 9
� Application for Permit to Erect a Sign
� .
Salem, I9as5achusetts +� )So 194�j
70 THE llll. lil^: I `ISPECTCR:
undersi :neU .`.ereby applies `o. a perm o J Erect , _ Alter , _ Repair
sign on t :, fol lowing descried bui 1di,- :
Loc:,: ion and ilo. �Zoninc/Di ; [ric[
ar,e of Property Owner
',ane of Sign Owner uyduz Qtv.VV&vv- kewv.a\
ddrass
If Caner is a corporate body na-e or resaonsible o fico Slkpwa'^ Q7 ,
(lame of Licensed Sign Erector StSv E'fnceSS I TvoteWtcl
{� (� Salem
address ��1 "' A^ S� "W �( License No. tOaa
Use of Buiidinn: Ist Floor V/ 3rd Floor
22nd Floor 4th Floor
Type of Sign: V Sur focc , Right Angles to 3uilding , Free Standinc ,
_ Other (specify) Heigh[ :
Sign Materials
Sign Dimensions 11 10" fav" I ap" }ag" Sign Area Sc
Existing Signs: Surface: ) NOD Sign Area a SF
Right Angles : Sign Area SF
Free-Standing Sign Area Sr
Other Sign Area SF
Signs to be Removed: Type ��® I` Sign Area �4 SF
Frontage: Building %' FT Property l9-�� FT
Signature of Owner
SignatureofOwners Authorized Representative
Address
Estimated Cost
of New Work (Oa Telephone
APPROVALS: LQ 00 TYe y
Signature of Property Owner S�`'� � I
I
Sal m a� i g Department Superintenent o
-7t•etHistorical ommission
ON REVERSE PLEASE SHOW SIGN SIZE, COLOR, LOCATION; LOCATION OF OTHER SIGNS AND
BUILDING ENTRANCE.
g PLAN OF LOT
SH041 SIGN SIZE , COLOR AND LOCATION ON BUILDING;
kPPLICATION FOR PERMIT FOR Show Location of Prescnt Structure LOCATION OF OTHER SIGNS AND BUILDING ENTRANCE
ALTERATIONS, REPAIRS AND and Signs
DEMOL
.....................................CLASS BUILDING
LOCATION
... ..-. ;
Ward......................
r..........................................................................
/ n C�ONNDTf�IOpNS�,,
1�...-:�- /'fest'...._............ : _ _ _...
.......................
..........
............................................................ . '1 - - - - - - - -
........................................
Permit Granted
... 19.... .....
...........................................................................:.
O
ao"w ti �" �� po5,y,
This .raving .COptscontains proprietary roper y Of U.1ton ed
and hics, concepts and is property of onited
forax. your, Inc. It ue DelIt presented to you
for your toexclusive
any... use. It any not he copied
or ahovn to myons outette your orgenis etlon
without the express written permission of
Unlled Graphics,
Inc.
ZT
T9 SO"
PTUIEZID,L'y v n o za m
This drawing contains proprietary information
end design concepts end in property of United
Graphics, Inc. It is being presented to you
for your exclusive use. It say not be copied
or shown to anyone outside your organisation
wlthout the express written permission of
United Graphics, Inc.
ap"� ti 1c, I� repo
CO�L�TUN�b t:ALTH OF MASSACrIU3ETTS
DBPARTMEN. C OF PURLIC HEALTH. -
HOSPITALS AND AMBULATORY CARE FACILITIES
r CLINIC 4UARTI;RLY FTRE L�ISPECTiO\'AL RGPOP,'1 (\/
ov N
In accordance with the requirements of General Laws, Chapter 1.18. Sectlon•4, the
Marshal or the head of a fire dcha-rtme;tt, to whom he may delegate authority shall
make an inspection every three months of institutions licea"d by and under the -
supervision of the Departmcnr. OF aiblic. Health, and sliaki make a retort of such
ins?ection to the DepaYiment of Pubiic Health on forms provided by the Department
of Public Health.
In accordance with the statutory mandate, the `
Lydia Pinkham Clinic
q.
1\&MC o :nic
239 Derby;,,St .Salem-Mass 01970.
tress N UL1.111C
i
was inspected on
12-16-82
e of luslS CUt ;
hY Raymond T l) eat
Name of kispector
T - • (\/�`
REPORT OF INSPECTION
APPROVED Conditions satisfactory atltimeof inspectian.
r•
DISAPPROVED
at.
..cam: �1��.- �. Fire Chief
ignatar� iI'Te,
Z&-a-0112-
Da te...
,cc: Building Inspector
Health Dept. ( Salem) -
Occupant, ONE COPY SHOULD BE SI�lT TO CLINIC
Dept. of Public Health (mass. )
F...-, file.
Please.Return This Report To;
Carolyn Zavarine, M.D.
Department of A.:bl.ic Healrh
Hospitals and Ambulatory Care Facilities
fiRoom 940, 80 Boylston Street C
Boston, Mass. 0206
Form #39
Q4 E, I
LAI
�'!.14,�, Qj�LMONWLALIFH OF ,MASSACrRjSrTT-,
'j.)EPART\MZNT OF,-PUIRLIC HEALTH
-ORY CAJIE bAamvxlff .
SjA4,'N Q t�WMLAI
Z CLINIC F T.R E INSPECTIONAL R E RT
QUART! PO
117-–7-
7
EeFIVET
General
MASS. r1
o .0
e.,T
i:��;9r,,,T.hgjieaq of a' lirl dct)arLrmat,, to whom.he uwy cicicpate author hall
a' (r aSce+Tana lio cvp months Of insLitutioiislicmisr.o by aind'undely
�thrqc:mo r
tbe
9 ii e 0M X,:Tlie, e:pa.3:tr,9ciit:6-' 1'Pb1i-cJ-IcaLQf, and sl k.i make 'a.3:Pport of such
TV" I!
0 Ct pk.ffii'c'.'Hcajt�' oil to-rm is pfo'vidl6l] h y th Im t
a Dc
Il't "j ip
e .,t '.!I,;,
" I
4
'-3 Itut.0 mandate thc
mandat
t -Finkliam Clinic
It
lydia7
NJ; M u irfic
'40 19 7 C)
239Derby_ St Salem I'la s s
W'J:C'-'S OL
way I -82 (Third Quarter Inspection)
10 07
pted,on
�7,-..DT7_617
y Raymond 'T D,,-i n s r e a u
411
ZLme-0 u1SJ1x,'C:-C)r
PJ
REPORT OF INSPECTION
'101
Conditions satisfactory at time of inspection.
A,rl F,
DISINIP
'�D
jQct. '-1?, 1982
I R A', -1, �7
Piro Chief7, 1.9
At
I
t
cc ,k'vBu:i1'0'i1nk" InspectorI
;
Halthlle t
COPY SHOU,LD BE SENT TO CLLNIC1Ia -
O'coupa JI.- ONT,
gi
(Mass.
"I ig
I 'T
-iil; L4
L ii I
i�iRep
1$ P q,rt,,To:
-,, .0arwO, D. �i
r; . c fl� i ic Hpalt-h
S. t' jaqd�� Fnbtliatory Cure Fa�;Mtics
of
PTI,
Y'�
treet;
a s 2110
4 f I
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VZ11 In'""i11
Form m39r .r
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. . . _199'1• 1 1'PI'1'1••1 ■•
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09 12+00 NNNN14-06 045
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,A4• U Y The Cunumum e ]III of , assVutie(tS Z
Board ut l3wldilig RegtdL IN Stundalds
Massachusetts State Building ( ode 7ti0(T4R. 7°i edition tit;
f �
Building Permit Application To Construct, Rt!pau'. RenoNate Or Demolish a R�rn ,l-Jwuu,
One- ur Tit o-FamilyDit rllin,q 'oral`
T s Section For Otficial Use Only .
Building Permit Number. Da Applied: L
NSignature: - -- ---
13uildill (. .�t crtor u I Datu
f� { ON 1: SITE N ORMATum
eJ l.h rr)pefI. Addres;A _ /J „/ 1.2 :Isseswrs Map & Parcel Numbers
l I.la Is this an accepled street?yes_ no Map Numher P:urcl 7Jumho
1.3 Zoning Information: to Property Dimensions:
Zoning District PropuseJ Use - Lot Area(sq It) Frontage ill)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
! Required Provided Required Provided - - Required Pn it idcd
W(Print) "
y: (M.G.L c.40, §54) 1.7 Flood-Zone Information: 1.8 Sewage Disposal System:
- Zone:_ . .. Outside Flood Zime'- -. . -
ate❑ Check iFloo❑ Municipal❑ On sitcdisposal .sysiciit ❑
SECTION 2: PROPERTY OWNERSHIIP'Address for Serviee:
t ' Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK"(check all that apply)
New Construction ❑ 1 Existing Building ❑ - Owner-Occupied ❑ Repairs(s) ❑ Alieration(s) Cl Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Speedy:
Brief Dzscr'piion of p )sed VJ0r�k�2l�. O� ----.— -
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item 1Labor and Materials)
L Building I S Y 9 Oa L Building Fee: S Indicate hose fee is determined:
. ❑ Standard City/Town Application Fez .. . .
3. ElectrtcaL, „ $
❑Total Project Cost (Item 6) .x multiplier x i
3. Plumbing S — 2. Other Fees: S
J..Mechanical (HV;AC) 5 List: —
5. Mechanical (Fire ----
Su. �res+iF�n) S Total :?II Fees:
$
Check No. Check :?mount ('a,h :\nnuutt__. .
b. Totai Project Cost: X p-1 A 0 Paid to Full ❑ Outstmding Balance Doe ___ -____'
SECTION 5: CONSTRUCTION SERVICES x
/;..I Liicen�sed Construction Supervisor(CSI,) 577sZ -1
- Lirrnw N'uinhtt I: Itu:wrn 1)aia
I i+t('SI_'Pcpe t>Ce helowl __
. L L'nrestnged i ill)to ti.1100 CIE 1:1,1 I
R Resiricled L@_' Famil\ Dlt elliuc 1
M Nlasonn OnIN . ..
yay12C= Residential Koutinc('olciinu .__ ..
Telephone _. \\'S Re>tdruual \VinJot, and 5iJine _
SF 12csiJ.•ntiel .tiolnl ftiCl liunune \ tlleatee In.t.Jl,mnn~J
D RemWelltial Dentoliwm
5.2 Zegis re I Tome lY t ro ement C' nj{:ytitolr 011C) 101669
O// D —
Ijl C np; ry N' m•o h C Re t n �,/W e K'(:; Regisualti0un Number
YPlratmn :ae
coot r Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Fat ut pnwide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... ❑ No ._.. ..... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subjecFpritperty hereby
authorize S . .. to acron my-behalf, in all matters -
relative to wo k authorized by thiduilding permit application.-I�Tt ---- - - - --- - _- _.
nature of vner Date V
h�^ SECTION 7b: OWNEW O7R AUTHORIZED AGENT DECLARATION
I S p / tr G 1) rl,l� ,as Owner or Authorized Agent hereby declare
that the statements and in rmation on the foregoing a lication are true and accurate, to the best of my knowledge and
behalf.
P nt. t
AA 7 �d
Signature of Owner( Authorized..Agent Date
I Siened under the pains and penalties ofperjury)
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered Contractor
(not registered in the Home Improvement Contractor(HIC) Program1, will not have access tn.the arbitration
program•or guaranty fund under M.G.L. c. 1.12A. Other important information on the HIC Progr,un and .
Construction Supervisor Licensing (CSL)can be'fnund in 750 CMR Regulations 1 I(j.R6 and 110 R5. respectiwly.
When substantial w(;rk is planned, provide the'tntormatioh below:
Total floors area iSq. Ft.i (includingwrage, finished base men Uattics, decks(tr pnrcht
.I Gross livmg area(Sq. Ft) --- - - ., . Habitable room count,
I Number of fireplaces - - Numberat•hedrooms _._._.
Number of bathrooms Mtmber of half/hath.s .
fvpe of heating system Number of decks/ pi,rchcs
Type otcooling s)stem Enclosed Open .-_-- -- --
1. 'Total Project Square Footage- may be Substituted tur 'Total Project Cost" ��