49 LAWRENCE STREET - BUILDING INSPECTION 49 LAWRENCE STREETMM
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City of Salem Ward
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�4'cemrT..ad
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT•Applicant to complete all items in sections:1, I�t,I�lX.
]ll, IV, and I
1. AT(LOCATION) �� GA IAf�I,lW 6r ZONING
LOCATION (N ) (STREET)
ICT
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS 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 ❑ Addition(If residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational
housing units added,it any,in part D,13) 19 E] Chruch,other religious
13 E] Two or more f ily-Enter number
3 ❑ Alteration(See 2 above) of units ........ 20 ❑ Industrial
21 El Parking garage
4Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 22 E] Service station,repair garage
Enter number of units
5 ❑ Wrecking(M muttAamily residenfial,enter number 23 ❑ Hospital,institutional
of units in building in Part D,13) 15 ❑ Garage
24 E] Office,bank,professional
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
26 ❑ School,library,other educational
7 ❑ Foundation only 17 ❑ Other-Specify
27 ❑ Stores,mercantile
B.OWNERSHIP 28 ❑ Tanks,towers
8 ❑ Private(individual,corporation,nonprofit
institution,etc.) 29 ❑ Other-Specify
9 ❑ Public(Federal,State,or local government
C.COST (Omit cents) Npnresidential-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 ,�/ yy ^ �A ` °
in the above cost V,y 7r ' p A Fj f/,z/f
a. Electrical........................................................................... q / / /�
b. Plumbing...................................... ........ / A&//V,6
`vS aJ-Aeve kO
c. Heating,air conditioning.............................................
d. Other(elevator,etc.).....................................................
11. TOTAL COST OF IMPROVEMENT $
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 �oodframe 36 ❑ Oil 41 ❑ Private(Septic tank,etc.) conditioning?,I
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes i. 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)
i
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
48. Number of stories ...........................................................
49. Total square feet of floor area,
all floors,based on exterior Has Approval from Historical Commission been received
dimensions ........................................................................ for any structure over fifty(50)years? Yes_ No_
50. Total land area,sq.n.........._......................................._. Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed .................._........................................................
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
Sz. 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 # _t9lJ 71 Salem License # /.3 0 1
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
�11� 9 hE ee ST. S �t
Lessee
2.
Contractor
Builder's
License No.
3.
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 w@ agree to conform to all applicable laws of this jurisdiction.
Signature of appl' t t Address /� licat n date
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19
Fire Grading
Building 00 J ®
Permit Fee $ a3— il°2a lz. ����i t7lJ Live Loading
Certificate of Occupancy $ Approved by: occupancy Load
Drain Tile $
Plan Review Fee $ �� 1�t-S Ily.
TITLE
NOTES AND Data • (For department use)
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
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