14 HERITAGE DRIVE - BUILDING INSPECTION 14 Heritage Drive
No. 7 City of Salem Ward
4,L.COr.>y4-
Z� of
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4C4aHE
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:I, Il, Ill, IV,and IX.
I.
AT(LOCATION) / / ��C9G dI L'
ZONING
LOCATION (" '1 (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
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 ❑ Addition(tt residential,enter number of new 12 ❑ One family 18 ❑ Amusement recreational
housing units added,if any,in part D, 13) 19 ❑ Chruch,other religious
13 - wo or more familyy�-,Eater number
3 ❑ Alteration(See 2 above) of units ........._.......::G... ................... . 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 ❑ Hospital,institutional
of units in building in Part D, 13) 15 ❑ Garage 24 ❑ Office,bank,professional
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
26 E] School,library,other educational
7 ❑ Foundation only
6.OWNER P 17 ❑ Other-Specify
27 ❑ Stores,mercantile
28 ❑ Tanks,towers
e institution,
(in,etc.)al,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,
`ipL� �tdv� machine shop,laundry building at hospital,elementary school,secondary school,college,
10. Cost of improvement .........!. j._^�. .................... $ 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
a. Electrical................................................... Soo
b. Plumbing............... .....................................................
c. Heating,air conditioning.............................................
���.n��GC.�Lr
d. Other(elevator,etc.)..................................................... �
11. TOTAL COST OF IMPROVEMENT $ 201
4000 _
111. SELECTED CHARACTERISTICS OF BU LDING 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 ❑ my(wall bearing) 35 [:] Gas 40 ❑ Public or private company Will there be central air
31 frame 36 ❑ Oil 41 ❑ Private(septic tank,etc.) con illoning?
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
46. Number of stories .. M. DEMOLITION OF STRUCTURES:
...... ....
49. Total square feet of Noor area, Approval all floors,based on exterior Has oval from Historical Commission been received
dimensions ......... ........................ 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.............................................................................
52. Outdoors........................................................................ HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?..... Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed ...................................................... Electric:
Gas:
54. Number of Pun........................................... Sewer:
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial.----..........-................ BEFORE A PERMIT CAN BE ISSUED.`
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No-L (If yes, please enclose documentation from Hist. Com.)
Conservation Area? Yes_ Nov (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# 02 6�1Salem 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.
Owner or `¢ —
Lessee
2.
Contractor Builder's
Ucense No.
3.
Archit or
En ser
I hereby certify thilt the prop w s thodzed by the owner of record and that I have been authorized by the owner to make this application
authorized ent a e a ee o nform to all applicable laws of this jurisdiction.
'gnature of a lica Address Applicatio date
6 12
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
BuildingJJ FOR DEPARTMENT USE ONLY
Permit number -3
Building Use Group
Permit issued ( J 19!J
Fire Grading
Building /
Permit Fee $ 1r�,4• C,�b o,& do4k Live Loading
Certificate of Occupancy $ Approved by: Occupancy Load
Drain Tile $
Plan Review Fee $ U
TITLE
NOTES AND Data . (For department use)
2 c1nors
Q D ver
Lj
Vi red
PERMIT TO BE MAILED TO:
or
DATE MAILED:
Construction to be started by: Completed by:
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