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5 HERITAGE DRIVE - BUILDING INSPECTION 5 HERITAGE DRIVE No 3 21'�3 City of Salem Ward A APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-(Applicant to complete all items in sections:1, ll, III, IV,and IX. ING I. AT(LOCATION) V V N C, toV �0.\ b� DSTRICT LOCATION (NO.) EETI OF BETWEEN AND Q�• X01 y saSTREE caossLOT STREET) BUILDING Ic SUBDIVISION V 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 ❑ Addition(if 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 L:J RVO or more family-Enfer number 3 ❑ 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 ❑ Service station,repair garage 5 ❑ Wrecking(if multifamily residential,enter number 23 E] Hospital,institutional o/units in building in Part 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 17 ❑ Other-Specify 27 ❑ Stores,mercantile B.OWNERSHIP - 28 ❑ Tanks,towers 8 ©Private(individual,corporation,nonprofit 29 ❑ Other-Specify IrIStItUI10n,etc.) 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 $ r 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 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 ❑ 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 stories ......................).,............................. M. DEMOLITION OF STRUCTURES: 49. Total squarefeetf floor area, all floors,based o HApproval from Historical Commission been received nexterior as PP dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No_ 50. Total land area,sq.a. ........... Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed............................................................................. HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? Sz. oumnnm....................................._...................................... Yes No L RESIDENTIAL BUILDINGS ONLY Water: ✓ 53. Enclosed .............................................. Electric: _ Gas: 54. Number of Pull........................................... Sewer: bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial.----------..........-- BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No '! (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_ 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 ✓ (If yes,submit documentation) Massachusetts State Contractor License#_.104/.310 1?s Salem License # 1 :� 8 7 Home Improvement Contractor #_ I I a 1 87 Homeowners Exempt farm(if applicable) Yes_ No CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT C I If an extension is necessary, please submit CONSTRUCTION IS TO BE COMPLETED BY: J evv\6-v In, 1993 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 Y\ Lessee z. Mn- —n 2 d 3 e-zi L. L SA . Contractor Builder's Co, Ov-CA k o V� k'Aw'0A61vo License No. OW3685 3. Architect or Engineer I hereby certify that the proposed walk 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 a ree t onform to A applicable laws of this jurisdiction. Signatu plican _ Address Application date Wes i CnIrl ko S - t- O' 6 Volvl — a'— DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building j�1/_� FOR DEPARTMENT USE ONLY Permit number Building Use Group Permit issued 19 Fire Grading Building - n Permit Fee $ e o r�C Live Loading Certificate of Occupancy $ Approved by: Occupancy Load . Drain Tile $ Plan Review Fee $ 6r TITLE NOTES AND Data- (For department use) 1 � I nok CLkC S o S eS v �e a � le 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 ' O N