9 HARTFORD STREET - BUILDING INSPECTION 9 Hartford St.
I �
No7U-9� City of Salem Ward
4coorn.vo'
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT•Applicant to comple a all items in sections:1, It, Ill, IV, and IX.
1. AT(LOCATION) D STRICT
LOCATION (\��,,,ao.
LO BETWEENMln\` \ V`� - AND
BUILDING (CROSS STREET) (c6oss STREET)
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 Residen' Nonresidential
2 N—Addition(If residential,enter number of new 12 One family 18 ❑ Amusement,recreational
(rousing units added,if 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(ifmuttilamily residential,enter number 23 ❑ Hospital,institutional
of units in building in Part D, 13) 15 ❑ Garage
24 ❑ Office,hank,professional
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School,library,other educational
17 ❑ Other-Specify 27 ❑ Stores,mercantile
B.OWNERSHIP 28 ❑ Tanks,towers
8 Erprivate(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,
n� parochial school,parking garage for department store,rental office building,office building
10. Cost of improvement ......................................................... $ cVat 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........................................................................... �Q
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 skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL 1. TYPE OF MECHANICAL
30 ❑ Masonry(wall bearing) 35 Gas 40 Public or private company Will there be central air
31 Wood frame 36 ❑ Oilconditioning?
41 D Private(septic tank,etc.)
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ yes 45 g No
33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE O�WATER SUPPLY Will there by an elevator? /
34 [:] Other-Specify 39 [:] Other-Specify 42 Public or private company 46 ❑ ra-r/
Yes 47
43 F] Private(well,cistern) No
`�i CF S,3'
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
48. Number of stories ............................................................
49. Total square feet of floor area, p� Has Approval from Historical Commission been received
all floors,based on exterior �O r pp
dimensions ...........................pp...........r_................................. for any structure over fifty(50)years? Yes_ No_
50. Total land area sq.ft..........A....\.v .... ............ 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...........................................................-................ Electric:
Gas:
Pull... Sewer:
54. Number of
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial................. .............. BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ Nov (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 YNo_
Is property located in the S.R.A. district? Yes_ No—z�
Comply with Zoning? Yes_ No (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes_ No_ (If yes,submit documentationAf 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—ALI—iIf yes, submit documentation)
Massachusetts State Contractor License# Salem License#
Home Improvement Contractor# 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 at/applicants
Name Mailing address-Number,street,city,and state ZIP Code Tel.No.
Owner or
K fit\ M O1q`la `1't�-0�`t
Lessee
2.
Contractor
Builder's
License No.
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 a ent and we agree to conform to all applicable laws of this jurisdiction.
Signature of applica Address A I ratio ate
�J
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building 7 b � FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued --19 93 Fire Grading
Building
Permit Fee $ �' V Live Loading
Certificate of Occupancy $ Approved by: occupancy Load
Drain Tile $
Plan Review Fee $
ITLE
NOTES ANDj Data•(For department use) v
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by: Completed by:
f
I
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