41 FORT AVENUE - BUILDING INSPECTION 41iFort Ave.
Pee 10.00
It14T of �3ttlera, gassadjusetts
3irt Orpartment 3frabquartrrs
PRE-DEMOLITION APPLICATION FOR PERMIT
In accordance with the provisions of the Salem Fire Code, and Salem Fire Code,
and Salem Fire Prevention Pegulation #29C made under the authority thereof; an
inspection is requested of the proposed structure to be derolished, and a permit
issued subject to the following rules or recomrendations which shall be complied
with under provisions of the law.
Owner of Land �e. _ SSE1' 4= AC fw -
Address of Project n �,
Inspection requested by: *y e.�� _�fn
Address of Applicant tZ C �
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1. Per the Salem Fire Code this structure shall be demolished in a workmanlike
manner under provisions of the Mass. State Building Code and the permit issued by
the Salem Building Inspector for said demolition.
2. All debris from each day's activities shall be kept apart from the basic structure
and wet down at the end, of each workday. No debris shall accumulate over twenty-four
(24) hours at the site, and no mare than twenty (20) percent of any one day's debris,
at any time.
3. The use of City of Salem water shall be approved by the City of Salem Water
Department or by use of a paid off-duty firefighter on watch.
4. The contractor shall have a current welding and cutting permit in effect. Use
of said welding and cutting equipment shall be subject to the Salem Fire Prevention
Bureau regulations. A paid off-duty firefighter fire watch may be required by the
authority having jurisdiction in cases where it is deemed necessary, because of
increased fire hazard.
Failure to perform the operations in an approved workmanlike manner, may be cause
for an im(ediate "around the clock" fire watch by a paid fire departrrent detail.
This shall be taken into consideration by all contractors and shall serve as notice
of this requirement. An advance payment shall be required when deemed necessary
for this fire watch.
Applicant's signature
Foran .#29C (Rev. 9/77)
-----------------------------------------------------
.c� CITY OF SALEM A2J Jowlt H Y2
FIRE DEPARTMENT - FIRE PREVENTION BUREAU �®
s Salem, Massachusetts 01970
it v 1 g g+�
l EXX1 S Date :
y� Z
In accordance with the provisions of Chapter 148, G.L as provided in Section 10A
this permit is granted to
Nome - LI n,f 1 Pw 1a
(Full name of ponos firm or corporation 4ronted permit)
to conduct demolition operations per Salem Fire Code
State clearly Massachusetts Fire Prevention Regulations and
Purpose for Massachusetts State Buildin
which permit og Code•
is granted
Resrrctions: As per Mass. State Codes and City of Salem
Ordinances. Clearance from Salem Historic Commission.
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(Give Ixatlaa h. street Gad no., or d•sarabe to such ma •r to rovid• adequ • atlli
Fee Paid $ ]o.nR '
Slgnotun d +tlal a+�.tina armfu
This permit will expire �19
(TWO
w, (nUS PEW.= MUST BE CONSPICUOUSLY POSTED UPON THE PREMISES.) 'W
Form #29C
VYCity of Salem Ward
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APPLICATION /
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1, 11, 111, IV,and/X.
I. AT(LOCATION) d r I�v '` DISTRICT
LOCATION INd.i (MEET)
OF BETWEEN AND
(CROSSMMT) (CROSSMEET)
BUILDING 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 ❑ New building 1110 n 1 Nonresidential
2 ❑ Addition(ll residential,enter number of new 12 One family 18 ❑ Amusement,recreational
housing units added,it any,in part D,13) 19 ❑ Chruch,other religious
13 ❑ Two or more family-Enter number
3 ❑ Aaeration(See 2 above) of units ......................_............................... 20 ❑ Industrial
21 ❑ Parking garage
4Q Fl6pair replacement 14 ❑ Transient hotel,motel,or dormitory- 22 ❑ Service station,repair garage
�Q/ Enter number of units ...........................
5 Wrecking(It muftdamily residential,enter number 23 ❑ Hospital,institutional
of units in building in Part D, 13) 15 ❑ Garage
24 ❑ Office,bank,Professional
6 ❑ Moving(relocation) 16 ❑ Carton 25 ❑ Public utility
7 ❑ Foundation only26 ❑ School,library,other educational
17 ❑ Other-Specify 27 ❑ Stores,mercantile
B.OWNERSHIP 28 ❑ Tanks,towers
8 ❑ Private(individual,corporation,nonprofit
i Nutlon,etc.) 29 E] Oher-Specify
9 1 Public(Federal,State,or local govemmmnt
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!nominal plant.N 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 BUILDING -For new buildings and additions, complete Parts E-L;demolition,
complete only Parts J& M,all others sLi2 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 Cenral air
31 ❑ Wood name 36 ❑ Oil 41 ❑ Private tseptic tank etc.) conditioning?
32 ❑ Structural steel 37 ❑ Elachichy 44 ❑ Yes 45 ❑ No
33 ❑ Reinforced concrete 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,
exterior
all floors,based on ezl Has Approval from Historical Commission been received
dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No_
50. Total land area,sq.It............... Dig Safe Number / 10 0 �d d
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed .............................................................................
sz. Outdoors............................................................................. HAVE THE FOLLOWING UTILITIES BEEN DISECTED?
Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed.......................................... ........................ Electric:
Gas: ✓
Full........_................................ Sewer:
54. Number of
bathrooms Partial...................................... DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ Noc�'(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-1 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_-__�Of yes,submit documentation)
Massachusetts State Contractor License# d-7-- ti I S Salem License# 2.0
Home Improvement Contractor # 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
n 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. S.
Owner or
Lessee
2.
Contractor Builder's r1C—j ,n
License No. ,5 7!0
3.
Architect or
Engineer
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 to applican Address
�.�.�^ �� /�Uf Application date
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building Q FOR DEPARTMENT USE ONLY
Permit number
Buildingn Use Group
Permit issued _�/� 7 9 k/ 19 Fire Grading
Building
Permit Fee $ Live Loading
Certificate of Occupancy $ occupancy Load
Approved b
Drain Tile $
Plan Review Fee $
TIT
NOTES AND Data-(For department use)
— /-'
PERMIT TO BE MAILED Td
DATE MAILED:
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
i
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ON