24 MEMORIAL DRIVE - BUILDING INSPECTION a y /'�Erioxs�, c. �.i2
® O
Bedroom Bath
�5 x 6 Bedroom
9 x 10
it 1/2 x 10
Down
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Bedroom Bedroom
8 1/2 x 14 08 1/2 x 14
0
C5
32 Feet
Second Floor
APPROVED )OI q Aq
&i ,,!t to`approvRI by my All
:having juriDdi.,ins,:
Ci:' 3liLEYaI,PdA,SS.
BY
H.JWC.AREEJAPPAVtOSb-EIYFSIii IDEI}71FICATfO _ f it
Tf?E AND WCATION of F1RE PADTECTiIONo---
"'t'L i.IRk-P."OTECTION DEVICES ARE %)8JMVM A
fi11Al.TkST.AIiD'iNSPECTiD]{;FDADDAYf'LE�.ODMgU'
-1tNCEiV?ITi,I 2i IEFBE C1�OE.
eer
Dcdroom
Living Room
i
En LtInA M.eb lrrA
O.est.e 4.uti.n
Bath Gloact
Gloeet Up
Bath
Den
Kitchen
Down
Playroom
Dining Room
� i First Floor
Crawl 5pace
Full Basement
Up
Basement
rlozss
���QO� bn�d �Dp�O� 0�3�30Q�n�0�3� �OQo ►^
Professional Land Surveyors 8 Civil Engineers
ESSEX SURVEY SERVICE. 1958 - 1986
OSBORN PALMER 1911 - 1970
BRADFORD 8 WEED 1885 - 1972
PLOT PLAN OF LAND
LOCATED IN
SAL-EM, MASS.
Lok S� �2 pc7
LpT (PI
s
'6100`SF.
5-
0
IF
„5+,„y L o+ (,Z
o✓u^rN::g ,20'
Isi l
' PRo�o SE p`s'
Z do 'r'LoorZ
gaurr�oN
Ss
r
I hereby certify to the_c,i-eIr,
Building Inspector that the pro-
ZONE: M LOT AREA:I SFLOT FRONTAGE: o posed construction shown conforms
to theJVAT 1 zoning of
FRONT YARD: .1 r ?. SIDE YARD: IO FT REAR YARD " v Fz S ,,h �'r/PSC 61SU SS.
_ .'� 7�0 CHRISTOPHER'r
SCALE: ( ' - : �r IR
.
DATE: c' c 18,i Wq-.
REFEREI\TCE:xc-DBKC%q PG -J" Z _-Chris tb he'rs'A`''M2`llo PLS 3131/
104 LOWELL STREET AU
PEABODY, MASS. 01960
(508)531-8121
FAX:(508) 531-5920
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Front Wier
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Loft Ties
} COMMONWEALTH OF MASSACHUSETTS
DEPART."HENT OF INDUSTRIAL ACCIDENTS
600 WASHINGTON STREET
_zmes. .,ampoer
BOSTON, MASSACHUSETTS 02111
-__�.gg�One•
WORKERS' COMPENSATION INSURANCE AFFIDAVIT
t hcenseer perms nee)
with a principal place of businessiresidence at:
(City/State/Zip)
do hereby certify, under the pains and penalties of perjury, that:
, I am an cmpiover providing the following workers' compensation coverage for my employees working on this
iob. i A
insurance Company Policy Number \ r�
C.ciSs,q ` `gsoc�q�eS
I am a sole proprietor and have no a wo for me. `^10
�)cLr\,O ens l�'iA
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below
who have the following workers' compensation insurance policies:
Name of Contractor Insurance Company/Policy Number
`lame of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
;j 1 am a homeowner performing all the work myself. --
NOTE: Please be aware that while homeowners who employ persons to do maintenance.constmaioo or repair work on a
dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are cot generally
considered to be eroviovers under the Workers' Compensation Aa(GL C. 152,sea. 1(5)),application by a homeowner for a license
or permit may evidence the legal sums of an employer under the Workers' Compensation Act.
understand that a copy of this statement will be forwarded to use Department of Industrial Accidents' Office of Insurance for coverer
lcnrtcauon and that failure to secure coverage as required under Section 25A of MGL 152 can icad to the imposition of criminal penalties
.onsisung of a fine of up to 51500.00 andior imprisonment or up to one yew and civu penitis m the form of a Stop Work Order and a
ane of 5100.00 a day against me.
Signed this day of 19
—' icensee/Permiaet Ucensori Permirtor
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..",. :.." K. HOYLE CONST. CO.
. : d .Builder & Developer SHEET NO.V- -k tNa "0 �-ft- PtFM \
L_ WENHAM, MASSACHUSETTS CALCULATED BY DATE
........ - - 'l -11.1... --, ____ - ) 68-4275 CHECKED BY DATE
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mIOWCT M(,_%�Itc Globo.Mm 01471 To 010if PHONE TOLL FREE li&(in� I
�
.
/1 �if / 1
No. /% c City of Salem Ward
�N,couorr� -
2
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1, ll, 111, IV,and IX.
I. AT(LOCATION) �y M bt:�\— CDM\yE ZONING
LOCATION (NO.) (STREET)
CT
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 Addition(It residential,enter number of new 12 N O e family 18 ❑ Amusement,recreational
housing units added,it any,in pad D, 13) 19 E] Chruch,other religious
13 ElTwoor more family-Enter 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 E] Servicestation,repair garage
5 J—] Wracking(if muttitamily residential,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 Wilily
7 ❑ Foundation only 26 ❑ School,library,other educational
17 ❑ Other-Specify 27 ❑ Stores,mercantile
B.OWNEFj$HIP r
DAG/ X 28 Tanks,towers
8 Private(individual,corporation,nonprofit
institution,etc.) 29 E] 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 It use of existing building is being changed,enter proposed use.
To be installed but not included
in the above costn�
a. Electrical........................................................................... u 00
b. Plumbing.......................................................................... 4 1
c. Heating,air conditioning............................................. 060• -
d. Other elevator,etc.
11.TOTAL COST OF IMPROVEMENT $
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 1. TYPE OF MECHANICAL
30 ❑ Masonry(wall bearing) 35 ❑ Gas 40 ❑ Public or private company Will there be central air
31 RoW.cd frame 36 ®Oil 41 ❑ Private(septic tank,etc.) conditioning?
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45No
33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 42 SePublic or private company
46 ❑ Yes 47 �No
V 43 ❑ Private(well,cistern)
J.DIMENSIONS
48. Number of stories ...................
M. DEMOLITION OF STRUCTURES:
.........................................
squ
re
floor
49. Total ors,based n exterior Has Approval from Historical Commission been received
all floors,based o f exterior
dimensions ....................................................................... for any structure over fifty(50)years? Yes_ No_
5o Total land area,sq.ft............. .................................. Dig Safe Number 48
K.NUMBER OF OFF-STREET PARKING SPACES
Pest Control:
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. Outdoors............................................................................. 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 V (If yes, please enclose documentation from Hist. Com.)
Conservation Area? Yes_ No--i--'(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_ NoJZ'
Comply with Zoning? Yes—V 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
o Is Architectural Access Board approval required? Yes_ No_ (If yes, submit documentation)
Massachusetts State Contractor License# _1113�La 4� Salem License#
Home Improvement Contractor# Homeowners Exempt form (if applicable) Yes_ Nom
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 Cade Tel.No.
Owner or o t q70Lessee Q
z. \���v�/ \�o \S� \�1 L� \ ` \\ /\V v- .! -�/" r 6\01,SS�A
Contractor
Builder's
License Na. V(�
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 we agree to conform to all ap licable laws of this jurisdiction.
Signature of applicant Address Appli ation d to
rv\ \o -\
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19 Fire Grading
Building
Permit Fee $ �� �� Live Loading
Certificate of Occupancy $ AppOccupancy Load
Approved by
Drain Tile $
Plan Review Fee $ N
e556 -
ITLE
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
O N
DEPARTMENTAL APPROVAL FOR CERTIFICATE
of OCCUPANCY and COMPLIANCE c u
To be filled in by each division indicated hereon
upon completion of its final inspection.
BUILDINGS Permit No. 519-94
Approved by L. Tremblay Date 2/25/97 rC3 d
Remarks
PLUMBING Permit No.
Approved by J. LeClerc Dale 1/6/97
Remarks
i
j
ELECTRICAL Permit No. `�— ----- --
i
Approved by A. Falkowski Date 12/14/94
Remarks
I
OTHER Fire permit No. 12/13/94
Approved by Date i.
i
Remarks
i
OTHER Permit No.
Approved by Date
Remarks
i
i
CERTIFICATE ISSUED
5 DATE 2/25/97
CITY OF SALEM
s SALEM. MASSACHUSETTS 01970 BUILDING. PERMIT -
'a���E CERTIFICATE OF OCCUPANCY
DATE 10/26 19 94 PERMIT NO.
APPLICANT rux'' F'oylY — ADDRESS 1C
1.0.1 IS.TREETI ICON/R'S LICENSEI
PERMIT TO 1(" 1_1 STORY QWc111P.F.: NUMBER OF
DWELLING UNITS
(TIRE OF IMPROYEMCNTI -N0. ;PROPOSED USE)
ZONING
AT (LOCATION) 4�_ T'lf P,O^_:L:'.1 D', l*3T'0. DISTRICT
INC.) ISTREETI
BETWEEN AND
(CROSS STREET; (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS ZO BE ET. WIDE P FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCT ION
TO TYPE USE GROJF BASEMENT WALLS OR FOUNDATION
(TYPE:
REMARKS: bui]L6 Llld _J.COr additlOD.-FZ iicdr00ffi3 fl .. bat-ri :,LiiY. SF
AREA OR q�TI �I.qq��
VOLUME am - mol]IYI[
C':81C i SO Uf R E FEET; �BRQQ'„QQ+�II {.9N1=4 ��11EE(Qp�qI����yE�FEZ�qE1YYEER"L1L����Q4I�
•i i vf1lvf11 Ef'110f'.ION71A1'f110'1�ORPEIAT O BE lO TED ON PREMISES VCT10
OWNER Steve J10CCG��ii.:. '_ TO BE POSTER ON PREMISES
ADDRESS24 ife> rir Dr N.t, SEE gV,ERS'ttj$ I Ig,QR'',CONDITIONS OF CERTIFICATE
u� ,.1,
i
i
CERTIFI T OF OCCUPANC
Issued" hermit iY:
)9- t
City of Salem Buildin Dept.
i