1 HAYES ROAD - BUILDING INSPECTION 1 Hayes Rd.
F
1
No. City of Salem ward
x
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1X-
, It, Ill, IV, and I
I.
AT(LOCATION) l Haves e l1, ZONINGT
LOCATION ` (NO.) ISTREE /
OF BETWEEN 1 or n Q V I— AND J V r r-0 Y
BUILDING SS STREE CRO ET)
LOT
SUBDIVISION LOT BLOCK SIZE
11. 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 1K Addition(it residential,enter number of new 12 ❑ One family _ 18 ❑ Amusement,recreational
housing units added,if any,in part D, 13) 19 E] 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(If multifamily residential,enter number 23 ❑ Hospital,institutional
of units in building in Pad D,13) 15 ❑ Garage
24 E] Office,bank,Professional
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
7 ❑ Foundation only - 26 ❑ School,library,other educational
17JK Other-Specify 27 ❑ Stores,mercantile '
B.OWNERSHIP l 160 28 ❑ Tanks,towers
8 ❑ Private(individual,corporation,nonprofit
institution,etc.
a rid i1�� 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,
D 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 •3 �d Oa
a. Electrical...........................................................................
b. Plumbing.......................................................................... Q�
c. Heating,air conditioning.............................................
d. Other(elevator,etc.)..................................................... ,.
11. TOTAL COST OF IMPROVEMENT Ls /
111. 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 40 Public or private company Will there be central air
31 Wood frame 36 R'Oil 41 ❑ Private(septic tank,etc.) conditioning?
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Ves 45 X 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 ❑ Ves 47 No
43 ❑ Private(well,cistern)
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
49. Number of stories ............................................................
49. Total square feet of floor area,
all floors,based on exterior Has Approval from Historical Commission been received
dlmensions ......................................................................... for any structure over fifty(50)years? Yes_ No
50. Total land area,sq.it....................................................... Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES
Pest Control:
51. Enclosed ......................................................_....................
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. omdorim.......... Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed ......................................-..................:.................. Electric:
Gas:
54. Number of
Full..................................._...... Sewer:
-'
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial................... .......... BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ NONN (If yes, please enclose documentation from Hist. Com.)
Conservation Area? Yes_ No—V (If yes,please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes-c No_
Is property located in the S.R.A. �
district? Yes_ No
Comply with Zoning? Yes--'C/No (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes_ No_ (If yes, submit documentatioMf 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 (If yes,submit documentation)
Massachusetts State Contractor License # N Salem License #
Home Improvement Contractor# Homeowners Exempt form (if applicable) Yesvel�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
Name Mailing address-Number,street,city,and state ZIP Code Tel.No.
Owner or
e a
Lessee r , a. G
2. zv
Contractor Builder's
1'"�'C r t v�$ Q Y1► License No.
3. 603 84 3 -jq
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.
Sign ure f appli nt Andress A plic t'o i to
W1111111-
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building / /j FOR DEPARTMENT USE ONLY
/
` Permit number 1 r/ /
Buildingv� 'g � Use Group
Permit issued (Oct, ,h
Fire Grading
Building nn //II
Permit Fee $ O J Live Loading
Certificate of Occupancy $ Approved by: Occupancy Load
Drain Tile $
Plan Review Fee $ D f
C Q�� TITLE
NOTES AND Data-(For department use) n
7T r
O r -ROC-4-
42,
-
Q„a st.
aW 6 U itnt-oar
N e. Q. O
N2 o-,- r-
712 7 (,oc, S er
PERMIT TO BE MAILED TO: , lzk�
DATE MAILED: a
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
.O .N
---------------
(situ of *a1em, massstllusPtts
FIRE DEPARTMENT-FIRE PREVENTION BUREAU Fee Paid$10.00
t "
: 5 48 Lafayette Street
a Salem, Massachusetts 01970
PERMIT TO INSTALL- FIRE ALARM DEVICES Date: March 3, 1992
Permit is hereby granted to install approved fire alarm devices. All equipment and wiring are subject to approval of Salem Electrical Dept.
Location: 1 Hayes Road Owner: Joseph Morris
.. Installer: Colonial Remodeling License#
Installer shall note special equipment required, as listed on reverse side. UPON COMPLETION, THE INSTALLER HALL REQUEST AN
APPOINTMENT FOR A TEST, BE PRESENT FOR THE TEST,AND SIGN A CERTIFICATE OF MP TION. �`
Date of expiration: May 30, 1992 i =(%/i/G
"(Signature of Fire Official)
(Title
(THIS PERMIT MUST BE CONSPICUOUSLY POSTED UPON THE PREMISES)
Forth Ye1F(Rev.12/ae) (OVER)
NOTICE:
1. All equipment and devices shall be U.L. or F.M.type.
2. All zones(if required)shall be approved prior to installation of system. Zone plates shall be of a permanent type, and attached with
non-returnable screws or rivits. If back lighted type, be sure to list approved zone completely.
3. The A.C. power shall be provided by use of a circuit breaker. Said circuit breaker shall be painted red, and provided with a screw
lock.
4. A Sq.D 9001 KS11 K3 approved silence alarm key switch,with approved plate, shall be installed when any system has a fire alarm
panel. Switch may be located on the fire alarm panel or the annunciator, as approved by the fire official.
5. An audible trouble buzzer shall be located in a common hallway or area open to the occupants. This audible buzzer shall be
located on the exterior of any fire alarm panel or annunciator,to provide adequate audible volume.
6. Any deviation from approved plans or approved listing of devices, or approved location of said devices, shall require a request in
writing,to the fire official. Request will be approved if the original intent and approval is not compromised.
7. Failure to request an appointment for testing of devices, shall be considered a violation of the fire code,and such action as deemed
necessary shall be taken.
8. The installer shall have tested all equipment and devices, prior to test appointment time.
9. Adequate notice is required for appointments. Fire Emergencies may require a cancellation of any appointment.
t � _: a i rv•;���;` '2a : .. r,°.wa2:,• -,„§S ai r<-a:.�,,.a,°^X� y z'?-. n.,y.,i t:.:,.' r
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDINGPERMIT
In compliance with the provision of Section 113.5 of the Massachusetts
State Building Code, and under guidelines agreed upon by the Salem Bldg.
Inspector and the Salem Fire Chief, the applicant for a building permit
shall obtain the Certificate of Approval (see reverse side) and stamped _ .
plan approval from the Salem Fire Prevention Bureau.
Said application and approval is required before a building Y
q g permit may be w
issued. The Massachusetts State Building Code requires compliance
approval of the Salem Fire Department, with reference to provisions of U_ m w t
Articles 4 and 12 of the Building Code, the Salem Fire Code, Massachusetts e: �- O
General Laws, and 527 Code of Massachusetts Regulations. :) F-¢ i
The applicant shall submit this application with three (3) sets of plans, Wzo W
drawn in sufficient clarity, to obtain stamped approval of the Salem Fire = a
Department. This applies for all new construction, substantial Z ww 0
alterations, change of use and/or occupancy, and any other approvals a m a
required by the Massachusetts General Laws, and the Salem Fire Code. ¢ z g
Exception: Plans will not be required for structural work when the
proposed work to be performed under the building permit will
not, in the opinion of the Building Inspector, require a
plan to show the nature and character of the work to be
performed.
Notice: Plans are normally required for fire suppression systems,
fire alarm systems, tank installations, and Fire Code
requirements.
Under the provisions of Article 22 of the Massachusetts State Building
Code, certain proposed projects may not require submission of plans or
complete compliance with new construction requirements. In these
cases, provisions of Article 22, Appendix T, and Tables applicable
shall apply. This section shall not, however, supersede the
provisions outlined in the Salem Fire Prevention Regulations, Chapter
148, MGL, or 527 Code of Massachusetts Regulations. All permits for
fire code use and/or occupancy shall apply for the entire structure;
fire alarm and/or smoke detector installation shall apply to the
entire structure based upon current requirements as per Laws and/or
Codes, but the existing structure may comply with regulations
applicable for existing structures.
Notice: Sub-contractors may also be required to file individual
applications for a Fire Department Certificate of Approval
for the area of their work. Such sub-contractors shall file
an Application to Install with the Fire prevention Bureau
prior to commencing any work for those areas applicable.
FOR F1NA1.
FINA ENT gE
Form 81X (10/90) APPOINT ON MUST BE WEEK ANSP 'A L Pt
MS SONE OK
INSPECA
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Sae'em= F:Z te: Di?:pa;4tmen;t.. r w
r APPOINTMENT FOR FINAL'- Fine: Peeve tI,-Lon. Bwteau - APPOINTMENT FORFINALINSPECTION MUSTE WEEK 48 Lasayette Street- INSPECTION MUS
MADE,AT LEAS T BE
5atem, Ma 01 970 MADE AT LEAST ONE WEEK
AHEAD--------_.------ (508) 745-7777
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT �
i
In accordance with. the provi.6ton.6 04 .the Ma.6,6achLuett-6 State Surtd ng Code
and the Salem F-ite Code, appZZczti,on i-s hereby made Jon, approvae o4 ptan,6
and the 46aua.nce o4 a eenti4tcate o4 approval 40r a butZd-ing pehmit by the
Salem Fierce DepaALtmemt. (Re4. Section 113. 3, Ma-6-6. State 13Zdg. Code)
Job Location:
Owner/Occupant:
EZect-ucat Contnaaton.:
Fite Suppre-6zton Contnar-tor:
Signatu,Le o4
Applicant: Phone
Add.te s.6 o4 QQ.'��((�v��1--'''' � ,, !t�' \ City or
AppZ,.cant: S A 1��1 �� � �1� Town:
ApprovaZ date:
Ce-ttib-i-cate o4 app-Lovae ins hen-eby gn,anted, on approved pt-an,-6 on, 6ubmitta
v4 project deta.i-Z , by the Salem Fire Department. AZl plan-s ate appn.ovea
-soZely 4or i.dent-,.4,Cca -jon 04 type and Zoc Lt-on o4 44AC protection devtce,s
and equipment. AZZ ptan4 an.e 6ubjer-t to approvaZ o4 any other authon.ity
having jurisdiction. Upon eomptetton, the appt-i.camt or Lm6tater(,5) 6h--U
request an tm6peeti-on and/or test 04 the 4ite protection devi_cey and
equipment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** )
New cvn4-YiLuct.i,vn.
Property Zocat-Lon ho-6 no compy i.ance wi th the pnovirsLon s v4
Chapter 148, Section 26 C/E, M. G. L. , relative to the
i,n-6tatatton o4 approved 4.i,%e aZcvcm device-6. The owner o4
tlu-6 pr.openty t-6 xequ4Ae-d to obtain compZi.ance a,6 a
condi ti.vn o4 obta,LA Lng a Su.i.Zd i,ng Pe-,unit.
Property Zocatton i.6 Zn compy i.ance wi th the p�Lovj,4ton s o4
Chaptee 148, See_ti.on 26 C/E, M.G. L.
Expi, at i.on date: �30 C�� in sem_
S.cgnatwLe o4 Fite 044tictaZ
'Fee due: under 7 _`500 Sq. Ft.
T 500 'q• F 000 rU vrr ''#81 ice:' =r I SAg
MORTGAGE SURVEY
u
PLAN IN
SALEM, MASS.
�rD LAND Sc�vE•rORs
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1 certify that the dwelling is g,4 YZ•s 5 7-
toeated as. shown and con-
formed to the zoning IZIM of
the C'• r 5 � .
M1a�a constructed. A A3
Bar Iter. cwrlhY ry 1rEBarY NAU THIS PLO WAS PA�PARED FRLrA! A
err 77Ev77 ,a, riffs RAVAM cK TAPE SUAYEY AA+D rs rNT NZP FOR
L=7M PRWMw TAW A AM MAt AEEA As LL4.M7M ,4C3,'T&46E PY �'3 pKY. Ca�FSETS SHOWN
oar 17E INP aF CAWNM AMIA2-e A29PAQW SY 71E GW OR SCALED FHLW THIS PYA AAF
FEML &6ucY MAMA96vr A99CY X ITIS AA12MUMArz MY AV NOT BE
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