136 FEDERAL STREET - BUILDING JACKET 136 FEDERAL STREET
O
`---
� � C0.'^!ONHEALTII OF ."_15SACHDSaii3 '
CITY OF SALEM
CR.
U C1-
APPLICATION FOR CERTIFICATE OF INSPECTION
Date S- f/ - �� ( ) Fee Required S "�-
^ ( ) No Fee Required
O
J
in accordance with the provisions of the Massachusetts State Building Code.
t: 108. 15, i heresy apply for a Certificate of Inspecc:on for the below-named pren
located at the folloving address:
Street 6 Number �D�(�.�p s/�iQ (IP P4' // �7
Name of Premises a � ,rte s t/0/a 6
Purpose for which Premises is used t* - ire �s nIO��Q
License(s) or Permic(s) required for the premises by other Governmental Agencies:
License or Permit ARencv
�f1m�f/ni e 1V/i OXY LV
P)e
Certificate co be issued to: af-W S "`21141 Df� MoD gy�pA�i!/yDy�-./u
'T" G�Address:
Owner of Record of Building:
Address: "q
Name of Presenc Holder of
Name of Agenc, if any. _ . ^^� J
�����6
Si Lureoc Person co venom tezt_:ieaze SZZ'LE /1 �
i ssued or hisiber authorized agent
ate o
INSTRUCTIONS: Day time phone
1. Make check payable to: The City of Salem
2. Return this application with your check to: inspector of Buildimzs. City of Safi
Buildimz Deaarrmenc. One Sales Green. Salem. MA. 01970.
PLEASE NOTE:
L. Application form with required fee moat be submitted for each building or sr-uc
of part thereof to be certified.
2. Application 6 fee must be received before the cert'.ficnre will be issued.
J. The building official shall be notified within cen (10) days of any change in t.
above informarian.
f CEBTTFICATE f C70 ERPIRATION DATE:-5 36 — y
o(� � gV?SJI�,�
aw � � � � �
., .
�. � ..
PERIODIC INSPECTION REPORT
This form is to be completed each time a Periodic Inspection is made. At the time
a new Certificate of Inspection is issued, a notation indicating that the fee has
been paid will be made to Application Form prior to the new Certificate of Inspection
being issued. Any changes since the last inspection are to be added to the file card
of the premises. / J� /
Street & Number j ✓ C� / c �J,,-,l
Name of Premises Ale- (vlz ALCn T�'
Certificate to be /issued to: LTfe'f9(c.r L ,.y^J /4", ✓' l//(��'✓��j,J o9sSaa,
Address
Owner of Record of Building �r/'srr(e� /-
Address 3 7 /-//Ci 1 S f Ga ti r' At
Purpose for which premises are used L%1-7; /( ,� G.^o ;- lec
Changes since last Inspection (required on file card also)
1.
2.
3.
4.
S.
Date Order Issued:
Order Issued To: Address
Date Violations Corrected:
REMARKS:
I have this day inspected the above premises, and the same conforms to the pertinent
requirements of the Massachusetts State Building Code and the rules and regulations
pursuant thereto.
�/-
Date 11wlldffig Official
0041,2- - 5P P' Date Issued:
Certificate # �f p
Date Expires: / . 30 - / 9
Recommended Neat
Inspection: s
� �I�r (t��nmmurimrttl#!� of ,�tt��ttr��tttr�ttt
CITY/TOWN OF
In accordance with the Massachusetts State Building Code, Section Z08. 15, this
CERTIFICATE OF INSPECTION
isissued to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ITertitU that I have inspected the. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .known as. . . . . . . . . . . . . . . . . . . . . . . . . . .
located at. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .in the. . . . . . . . . . . . .of. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
County of. . . . . . . . . . . . . . . . . Commonwealth of Massachusetts. The means of egress are sufficient for the following
number of persons:
BY STORY
Story Capacity Story Capacity story Capacity Story Capacity
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly Place of Assembly
or Structure Capacity Location or Structure Capacity Location
R_S I.5T- drel.�. .
I
Certificate Number Date Certificate Issued Date Certificate Expires Building official
' The building official shall be notified within (10) days of any changes in the above information.
'a
c_71 F6 n1a�,
e y
CERTIFICATE ISSUED
Mav 1994
DATE
CiTY OF SALEM
SALEM. MASSACHUSETTS 01970 BUILDING PERMIT
c CERTIFICATE OF OCCUPANCY
DATE AugUSL 17 _*9__ PERMIT NO 93 p 350-93
APPLICANT James AcKinnon — ADDRESS la Emig
L ane Peabody 997
ING.) (STREET)
PERMIT 10 Alterasions NUMBER OF
STORY DWELLING UNITS
411p, Cr IYIROYEMENiI NO. Ip.OpOScO USE) .
136 Federal Street 2 ZONING R_2
AT )LOCATION) DISTRICT—
is"E'll
BETWEEN AND
'CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT—BLOCK SIZE
BUILDING IS TO BE FT. WIDE P. IT. LONG By—FT. IN HE-G.7 AND SmALL CONFORM IN CONSTRUCTION
TO TYPE IJSE GROUP_BASEMENT WALLS OR FOUNCAY,ON T11(I
Remodel fi.rvc door backroom
REMARKS:
AREA OR N
MI
VOLUME C BIC SOwQIE IJET.
.IWNER TO BE POSTED DR PREMISES
ADDRESS -' riejjd t iynniplass . SEE,TRapERS E.ALDE JW=MDUVDS OF CEPT IFICATC
DEPARTMENTAL APPROVAL FOR CERTIFICATE
( r of OCCUPANCY and COMPLIANCE
To be filled in by each division indicated hereon
upon completion.of its final inspection.
f�
BUILDINGS Permit No. 350-94
j, .Approved by John J. Jennings Date 5/5/94
Remarks —
i� it
PLUMBING Permit No.
Approved by John LeCterc Date s/5/94
i. Remarks
it
ELECTRICAL Permit No.
Approved by
Al Palkowski Date 9/30/93
'
I
Remarks
i
i
OTHER ire Permit No.
Norman' T.aPoi_ntP 5/4/04
k Approved by_ Date
Remarks
OTHER Permit No.
Approved by Date
r i
Remarks
I
i
1.
BUILDING
PERMIT
JOB WEATHER. -CARD
DATE PERMIT NO.
APPLICANT " Zl ^.tl❑ ADDRESS «:1 A, - ai-. L '. a-Af E,ii'G Eir
1X0,1 (STREET) (CONTII'S LICENSE)
NUMBER OF
PERMIT TO -- � ' (_I STORY DWELLING UNITS
(TYPE OF IMPROVEMENTI N0. (PROPOSED USE)
AT (LOC>TIONI I ={ Ct'AE9Sdi en@i: �Z pk ZONING
DISTRICT
(NOd ISTREETI
BETWEEN AND
(CROSa STREET) ICROSS STPEETI
LOT
SUBOI V IS ION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT ANO SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPEI
REMARKS:
nv
AREA OR tj U,L4
RE P
VOLUME ESTIMATED C05T p " �`�" L`I FEEMn S
C JOIC,SOUAIE FEE"
OWNER -'CW9 C.-. ais :.'A:1:c:1 _ }iF :. ,--_
r
L'i Yl ll BUILOIiC'r.SEPr,r -. t CIn7 V.
AODPESS = 5.1.&it C! t:L $ei;lu L'> BY INSPECTOR T� - .. - ...
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PARTJTpILq TOR QC BUILDINGS
G E EDF. ETHER TEMPORARILY BE OR
► PERMANENTLY. EJURDDI JURISDICTION
R PUBLIC PROPERTY NOT SPECIFICALLY PERMITTED TI OER THE LIC BUILOING CODE, MUST AI AP-
PROVED BY TME TMENT 1C TI ON. STREET S. ALLEY GRADES AS WELL AS DEPTH ANO LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT `POM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS,
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REOUIPEO FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PFPMITS ARE REOUI RED FOR
ALL CONSTRUCTION WORN: ELECTRICAL, PLUMBING AND
I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECH AR! AL IN 5 TALLATIONS.
¢, PRIOR TO COVERING 5TRUCTURAL QUIRED,$UCH BUILDING SHALL NOT BE OCCUPIED UNTIL
M EMBERS(READY TO LATHI.
]. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE.
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILOING INSPECTION APPROVALS P ING INSPECTION PROVAI ELECTRICAL INSPECTION APPROVALS
%' � lZg. 3
VI 2 C7
F'JARO IF HEALTH GAS INSPECTION APPROVALS FIRE DEPT. INSPEC NG APPROVALS
I r
c//
ti y
OTHER CITY ENGINEER 2 2
WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD
INSPEC. JA HAS APPROVED THE VARIOUS WORT( IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION.
c�l�r (Samutnnwralt4 of
o CITY OF SALEM
yIn accordance with the Massachusetts State Building Code, Section 108. 15, this
CERTIFICATE OF INSPECTION
is issued
to GREATER LYNN MENTAL HEALTH 8 RET . ASSOC
I (UrtitH that 1 have inspected the premises known as I�• l f4. H. R. A
located at 01.;:36 FEDERAL_ STREET in the city of Salem
County of Essex Commonwealth of Massachusetts. The means of egress are sufficient for the following
number of persons: -
BYSTORY
Story Cap"ac�i95G5s�s �r� Capacity Story Catyq� % 70 ) 459: Capacity
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly Place of Assembly
.. or Structure Capacity Location or Structure Capacity Location
R-5 11 IST k. 2,1iD FLOOR
/l
Certificate Number Date Certificate Issued Date Certificate Expires uild i n g 011T,tial
The building official shall be notified within (10) days of any changes in the above information.
J
Tito of *011em, massur4usletts
Public Properttl Department
Guilbing Department
(one lbalem %reen
500.745-9595 Fact. 300
Leo E. Tremblay
Director of Public Property •; rx
Inspector of Building
Zoning Enforcement Officer
January 5, 19945
Paul Tempseta
P.O. Box 408
Lynn, Mass. 01903
RE: 136 Federal Street
Dear Mr. Tempesta:
Upon my inspection of the newly renovated work at the exterior of the
above mentioned property, I noticed that at the upper deck, which is the
second means of egress from the second floor level, the hand rail needs to be
extended to meet the required State Building Code of 42 inches.
Please contact this office as soon as it is completed. Thank you in
advance for your anticipated cooperation in this matter.
Sincerely,
Leo E. Tremblay
Inspector of Buildin s
LET: scm
cc: Councillor Harvey, Ward 2
No. City of Salem Ward
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1, 11, /it, IV, and IX. �k�
L AT(LOCATION) 0 PC�Ci�� DSTRICT 'nzi,
LOCATION - n o.l (STREET)
OF BETWEEN 1 9I1� 2 AND
BUILDING c6oss STREET) (CROSS ET)
LOT
SUBDIVISION LOT BLOCK SIZE
II. 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 ❑ NOW building Residential Nonresidential
2 ❑ Addition(It residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational
housing units added,if any,in part D,13) 19 ❑ Chruch,other religious -
13 ❑ Two or more family-Enter number
3 [RAlteration(See 2 above) of units ......_........... .......................... 20 ❑ Industrial
21 ❑ Parking garage
4 ❑ Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 22 ❑ $ervice station,repair garage
5 Wrecking(If multifamilyresidential,enter number Enter number of units ...........................
❑ ❑ Garage 23 ❑ Hospital,b institutional
of units in building in Part D,13) 75
24 ❑ Office,bank,professional
6 ❑ Moving(relocation) 16 ❑ Carport _ 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School,library,other educational
17 D<her-Specify 27 ❑ Stores,mercantile
B.OWNERSHIP - a re YJt
QK n "e 7//1/1 S�eGAI 28 ❑ Tanks,towers
8 invate(mclividual,corporation, proftt- ❑
j L �+ 29 Other-Specity
institution,etc.). PY�f/ S ,/UUS/ r/ 0/
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
a. Electrical...........................................................................
b. Plumbing..........................................................................
c. Heating,air conditioning.............................................
d. Other(elevator,etc.).....................................................
11. TOTAL COST OF IMPROVEMENT $ -
III. SELECTED CHARACTERISTICS OF B 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 F5 Oil 41 ❑ Private(septic tank,etc.) conditioning?
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 [Z]-N6--
33 TYPE�TER SUPPLY
33 E] Reinforced concrete 38 El coal 42 ublic or private company Will there by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 46 ❑ Yes 47 0
43 ❑ Private(well,cistern)
1'-
J.DIMENSIONS
46. Number of stories ............................}�........................... M. DEMOLITION OF STRUCTURES:
49. Total square feet of floor area Approval all floors,based on exterior Has pp oval from Historical Commission been received
dimensions ........_..................c...,.......-................_........ for any structure over fifty(50)years? Yeses No
50. Total land area,soft........ ,....to..._g......_.. Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed .............................................................................
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. outdoors...................................... Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed .........................)(L.P....._g.._..:.................:....... Electric:
Gas:
Full.._..`.._1..................... Sewer:
54. Number of
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial.............d................. BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yeses No (If yes, please enclose documentation from Hist. Com.)
Conservation Area? Yes_ Nom (If yes, please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yeses No
Is property located in the S.R.A. district? Yes_ No_
Comply with Zoning? Yeses/No (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes1L No (If yes,submit documentation/if no,submit Board of Appeal decision)
If new construction,has the proper Routing Slip been enclosed? Yes_ No k//#
Is Architectural Access Board approval required? Yes-Z'
es No (If yes,submit documentation)
Massachusetts State Contractor License# 112 2- 5.3o? Salem License #
Home Improvement Contractor# ZU 7 gy7 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
/^µ Namee.� /Mailing address-Nuumber,street,city,and state ZIP Code Tel,No.
Owner
Lessee L'/;II/0,o howl/,.
z. MCH14464 em $!. 535'-/?g!
Contractor Builder's
!YIPS MCkr rill" / /j License No. d 7"5 7q(211
3. .0- 13c a �OVI
Architect or
Engineer
I hereby certifyth theroposed work is authorized by the owner of record and that I have been authorized by the owner to make this application
as his authod - we agree to conform to all applicable laws of this jurisdiction. -- -
Signature of appli Address // Application date
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building �l)
Permit number FOR DEPARTMENT USE ONLY
/ (i
Buildingd VI _ , L� Use Group
Permit issued y (�U 19
Fire Grading
Building ,6',
Permit Fee $ LJ7 G"� Live Loading
Certificate of Occupancy $ Approved by: Occupancy Load
Drain Tile $ .
Plan Review Fee $
TITLE
NOTES AND Data • (For department use)
(_
/ls0/LAc-
"-, 7_. "'U , %a 1Je 12
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by: �� p 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
j
ON
i
it
No 5b City of Salem Ward
x
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to compllette�all items in sections:1, ll, Ill, IV,and IX.
I.
AT(LOCATION) �� FGi/CV<A / /7 DISTRIT
LOCATION o.r EETI
OF BETWEENAND
BUILDING CROSSS REE (CROSSSTREET)
SUBDIVISION LOT BLOCK SIZE
II. 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,it any,in part D,13) 19 E] Chruch,other religious
13 ❑ Two or more family-Enter number
3,K 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] Service station,repair garage
5 ❑ Wrecking(if multifamily residential,enter number 23 IN 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 � -�/�AA//pQ n_ �$. 26 ❑ School,library,other educational
17 1=1 Other-Specify L �'IJ/ A 27 E] Stores'
mercantile
B.OWNERSHIP Q LtP i1T� l 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,
3
10. Cost of improvement ......................................................... $ parochial school,parking garage for department store,rental office building,office building
QV v at industrial plant.If use of existing building is being changed,enter proposed use.
To be installed but not included /� /
in the above cost /dOJ/ii2q
, a. Electrical........................................................................... �- ^
tb. Plumbing.......................................................................... tt.Gr-v J
c. Heating,air conditioning.............................................
d. Other(elevator,etc.).....................................................
11. TOTAL COST OF IMPROVEMENT Qd a
III. SELECTED CHARACTERISTICS OF BUILDING 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
I 30 ❑ Masonry(wall bearing) 35 ❑ Gas 40 ® Public or private company Will there be central air
31 ❑ Wood frame 36 ❑ Oil 41 ❑ Private(septic tank etc.) conditioning?
32 ❑ Structural steel 37 ❑ Electricity 44 �f Yes 45 ❑ No
r 33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 42 g Public or private company 46 ❑ Yes 47 ❑ No
43 ❑ Private(well,cistern)
1
J.DIMENSIONS
na. Number of stories ............................................................ M. DEMOLITION OF STRUCTURES: -,
squ
re
as. rlllal ors,based on exterior Has Approval from Historical Commission been received
all floors,based on floor area,
dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No
50. Total land area,sq.e....................................................... Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES
Pest Control: 7
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed ....................................................._...._............... Electric:
Gas:
54. Number of Tull..................................._...._ Sewer:
.
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Pa"'� BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No (If ye "lease enclose documentation from Hist. Com.) —J
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) N
Is lot grandfathered? Yes_ .No_ (If yes,submit documentation/if no,submit Board of�f
Appeal decision)
If new construction, has the proper Routing Slip been enclosed? Yes_ No_ /1/ 14
Is Architectural Access Board approval required? Yes_ No_ (If yes,submit documentation)
Massachusetts State Contractor License# 022— aZ Salem License# 9 0
Home Improvement Contractor# 107 /7 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.
Owner or � ' J ?
Lessee
�. fA�e, Mc rear, I
Contractor
�" � Builders
(J7 r�
yV/ License No. (l 75: W
3.
Architect or -
Engoeer
I s "a%rtify 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 hi aut orized agent and we agree to conform to all applicable laws of this jurisdiction.
Sgnet6r 'applicant Address
u
0
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building
Permit number FOR DEPARTMENT USE ONLY
Building Use Group
Permit issued 19
n�( 0� Fire Grading
Building
Permit Fee $ o(-/ �7""'�«-eL Live Loading
Certificate of OccupancyApproved b
$ Occupancy Load
Drain Tile $ -�
6y
Plan Review Fee
1 TITLE
NOTES AND Data• (For department use)
`n o I S F< L. Co
PERMIT TO BE MAILED TO: 3�0
DATE MAILED: 1 9 9,�
Construction to be started by: 1.3 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