9 HERITAGE DRIVE - BUILDING INSPECTION 9 HeritageDr
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No._ S —^� City of Salem Ward
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'�cuaxc�'d
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant 9 � _e to complete all items in sections:1, Il, Ill, IV, and IX.
AT(LOCATION) / / It ;7�G e �9 ZONING
I. ��//✓/� / DISTRICT
LOCATION ( ') (smEaT)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
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 ❑ Additio (If residential,enter number of new 12 ❑ On f�R n/Iy 18 ❑ Amusement,recreational
hous' units added,it any,in part D, 13) 2, - 19 ❑ Chruch,other religious
13 wo or more family-Ente umber g
3 iteration(See 2 above) of units .........................a...,.................... 21 ❑ 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 number23 E] 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 77 [:] Other-SpecHy 26 [:] School,library,other educational
27 ❑ Stores,mercantile
B.OWNE IP
28 ❑ Tanks,towers
8 rivate(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,
/ 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................................................................I.......... - 6 6
/
b. Plumbing.......................................................................... C_ /Ali ` /-(a
,17
c. Heating,air conditioning.............................................
d. Other(elevator,etc.).....................................................
11. TOTAL COST OF IMPROVEMENT $ J "�—
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 ❑ Ves 47 ❑ No
43 ❑ Private(well,cistern)
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
48. Number of stories ....... .......................
as. Total iafeet f area,
all flone Has Approval from Historical Commission been received
ors,based oneexterior
dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No_
50. Total land area,sq.ff.... ....... 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:
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_ 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.
1. Z.T 1 ��2 ' R.
Owner or �
Lessee
2.
'/ z4 j Lf 1 ,2fi h? 021) � yf;u
Contractor
5741Z,4
f Z L/ /n / Buuders
x /1 N License No.
3.
Architect
En r
I herebycertify that the p pos d o is authorized by the owner of record and that I have been authorized by the owner to make this application
as his horized a e nd e r to conform to all applicable laws of this jurisdiction.
Signature a lira Address Application date
c .
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building / ��� Cf FOR DEPARTMENT USE ONLY
Permit number `y /
Buildingp use Group
Permit issued U`` 19 9�
Fire Grading
Building VU
Permit Fee $ Live Loading
Certificate of Occupancy $ occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $ -
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TITLE
NOTES AND Data • (For department use)
R
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l 3 too
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