0005 HARDY STREET - BUILDING JACKET 5 HARDY ST.
i
No.
Aq City of Salem Ward
�c�.cornrV,b 2
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1, ll, /it, IV, and IX.
I. AT(LOCATION)
'IFI+-P q S7-- DISTRICT
LOCATION /L[LL('10G4 rsmEM c
OF BETWEEN L'JJ!_K Ste: AND ��lLS 7 qtr
BUILDING CROSSS REE (CROSS LOTETI
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(It residential,enter number of new 12,E One family _ 18 ❑ Amusement,recreational
housing units added,it any,m part D. 13) 19 ❑ Chruch.other religious
13 1:1 Two mom number ❑
3 � Alteration(See 2 above) of units
20 Industrials .......................................................
�I 21 ❑ Parking garage
4 Ig1 Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 22 ❑ Service station.repair garage
Enter number of units ...........................
5 ❑ Wrecking(it multifamily residential,enter number 23 ❑ Hospital,institutiorW
of units in building in Part D. 13) 15 Garage 24 ❑ Office,bank,professional
6 ❑ Moving(relocationl 16 ❑ Carport 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School,library,other educational
17 ❑ Other-Speclty 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-Descnbe in detail proposed use of buildings,e.g..food processing plan,
machine shop,laundry building at hospital,elementary school,Secondary school,college,
10. Cost of improvement """"""""""""""""'""'"""""""'""" parochial school,parking garage for department store,rental office building,office building
$ Z at industrial plant.If use of existing building is being changed,enter propo"d use.
To be installed but not included
in the above cost
a. Electrical........................................................................... .tote
v
b. Plumbing..........................................................................
.s'
c. Heating.air conditioning.............................................
d. Other(elevator,etc.)....................................... r
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 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 40Public or private company Will there be central air
31 Wood frame 36 Oil ql ❑ private(septic tank.etc.) conditioning?
32 ❑ Structural steel 37 ❑ Electricity 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 6�Public or private company 46 ❑ Yes 47 ® No
43 ❑ Private(well,cistem)
DIMENSIONS M. DEMOLITION OF STRUCTURES:
48. Number of stories
49. Total square feet of Hoo,area Has Approval from Historical Commission been received
all moors.based on exterior
dimensms ........................... for any structure over fifty(50)years? Yes_ No
50 Total land area.sq.m......................___.................... Dig Safe Number
.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed ..........
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. outdoors................................................._.._...................... Yes No
RESIDENTIAL BUILDINGS ONLY Water: -
53. Enclosed.......................................................................... Electric: ..
Gas:
Full........ Sewer:
54. Number of
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial...................................... BEFORE A PERMIT CAN BE ISSUED.
I. COMPLETE THE FOLLOWING:
Historic District? Yes_ Nom (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_ Ni
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-X- (If yes, submit documentation/if no,submit Board of Appel decision)
If new construction, has the proper Routing Slip been enclosed? Yes_ No_
Is Architectural Access Board approval required? Yes_ No-)�, (If yes,submit documentarian
Massachusetts State Contractor License # Hyl S1 7 Salem License #
Home Improvement Contractor # ®W.7" 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
INSTRUCTION IS TO BE COMPLETED BY: lU 131 ct q in writing to the Inspector of Buildings.
IDENTIFICATION • To be completed by all applicants
Name Mailing address-Number,street,city.and state ZIP Code Tel.No.
-ter or
;ee
Tractor Buildef�1,r� ZAA—' l// F�r License No 0q(5>-
law or as
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.
nature of applicant Address �1 Application date
. �l A //4 L/X r'a '� Ori ve rt MA-rin> /.�7 N
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19 Fire Grading
Building
Permit Fee $ 7 Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ /„ C
�vVTLE
NOTES AND Data - (For department use)
T
IV /ec
L
PERMIT TO BE MAILED TO:
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
ON