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8 HERITAGE DRIVE - BUILDING INSPECTION 8 Heritage Dr. No. � a '93 City of Salem Ward �H.co�rr� <UaMS. APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete all items in sections:1, ll, Ill, IV, and IX. I. A7(LOCATION) U /-FtFLIT/3(sF i2.1 V -Qt r t $ o STRICT LOCATION (NO.) smEEn OF. BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) T 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 ❑ Addition(If residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational (rousing units added,it any,in pan D,13) C19 E] Chruch,other religious 13 Two or more familyY-Enter number 3 Iteration(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 E] Wrecking(11 multifamily residential,enter number 23 ❑ Hospital,institutional of units in building in Part D,13) 15 ❑ Garage 24 ❑ Office,bank,professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 7 ❑ Foundation only 17 ❑ Other-Specity 26 E] School,library,other educational 27 ❑ Stores,mercantile B.OWNEFj$HIP 28 ❑ Tanks,towers 8 rL'7,/Private(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, 10. Cost of improvement ......................................:. �O 00 O parochial school,parking garage for department store,rental office building,office building -- ---'-. $ at industrial plant.If use of existing building is being changed,enter proposed use. , To be installed but not included in the above cost 'R 6 FLt&WSL1 &u LJ JAYS 3 F bo.X a. Electrical........................................................................... 000 ! {' J b. Plumbing.......................... / c'-Ay j�A..J-r I T f t'A-rL Aa _ c. Heating,air conditioning............................................. 1 d. Other(elevator.etc.)..................................................... / 11. TOTAL COST OF IMPROVEMENT F$ zl 00 C) w Y/✓YJ-�n�L� 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-Speclly 39 ❑ Other-Specify 42 ❑ Public or private Company 46 ❑ Yes 47 ❑ No 43 ❑ Private(well,cistern) J.DIMENSIONS M. DEMOLITION OF STRUCTURES: 48. Number of stories ............................................................ 49. all floors, based n extrarea, Has Approval from Historical Commission been received all Total square based of exterior dimensions ....................................................................... for any structure over fifty(50)years? Yes_ No 50. Total land area,sq.ft.....................-............................... Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed ............................................................................. 52. outdoors.......................... HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? .................................................. Yes No L 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. 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 # 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 all applicants Name Mailing address-Number,street,city,and state ZIP Code Tel.No. C 1. Owner or Lessee 2. ` 3 Contractor4' Builder's a Z J License No. y 3. Architect or Engineer I hereby certify that the pro rk is authorized by the owner of record and that I have been authorized by the owner to make this application as his lhorized agent an w ree to conform to all applicable laws of this jurisdiction. Ign e o applicant Address Application date DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building �� O i FOR DEPARTMENT USE ONLY Permit number Building ry O/� <( Use Group Permit issued - / 19 / ) Fire Grading Building �^,�/' o D , Permit Fee $ �4 =` �� Live Loading Certificate of Occupancy $ Approved by: Occupancy Load Drain Tile $ Plan Review Fee $ TITLE NOTES AND Data . (For department use) PERMIT TO BE MAILED TO: DATE MAILED: Construction to be started by: Completed by: f 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 cD� CERTIFI TE OF OCCUPANCY CITY OF SALEM mot / ?5 Pprtmt M: `'30- -54 r�= SALEM, MASSACHUSETTS 01970 of Salem Ulding Dept 12/7 93 530-93 DATE 19 PERMIT NO. APPLICANT Princeton CIossing (Owner) ADDRESS (NOJ (STREET) (CONTR'S LICENSE) CITY Salem STATE MA ZIP CODE 01970 TEL.NO. PERMITTO renovations NUMBER OF ( ) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT(LOCATION) { 8 Heritage Drive Apt:-- 1132 ZONIDISTNG CT (NO.) (STREET) -- BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT.WIDE BY FT.LONG BY FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TOTYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS. Refurbish hallways 3 floors, carpeting. AREA OR PERMIT Q � VOLUME (CUBIC/SQUARE FEET) $ESTIMATEDCOST$ 21,000. FEE X OWNER Princeton Crossing Sem, BUILDING DEPT Salem, MA . ADDRESS BY The Commonwealth of Massachusetts Executive Office of Health & Human Services Department of Mental Retardation 160 North Washington Street Boston, MA 02114 Area code(617) Philip Campbell 727.5608 Commissioner TDD Line 727-9866 7 -,3 qs Date F. AFFIDAVIT TO: Local Building Inspector City/Town Q- o bPrfi I hereby certify that the residential program at operated by �j` n fen (8YDf �Y© meets or exceeds all DMR requirements pertaining to smoking regulations, staffing ratios, individual classifications and individual restrictions (if any) by floor. The program staff's ability to evacuate individuals safely within 2 1/2 minutes has been confirmed through a fire drill In accordance with procedures outlined in DMR regulations. A Certification will be issued to this Agency in accordance with Department of Mental Retardation protocols. IlkQuality Enhancement Specialist cc: Provider AFFIVQE REV. 1/11/95