37 MOFFAT ROAD - BUILDING INSPECTION 37 Moffat Rd. .-.l�
a -
No. y �g City of Salem Ward 7
�Y,.ceNerq-
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APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete X.
•�plete all items in sections:1, ll, 111, IV,and I
1. AT(LOCATION) 3,7 l "Io ZONING
LOCATION `/r '
(NO.) (STREET) DISTRICT�_
OF BETWEENX,Cr'N�c9 0a-2— AND
BUILDING (CROSSSTREET) (CROSS LOTET )
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(n residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational
(rousing units added,if any,in part D, 13) 19 E] Chruch,other religious
13 ❑ Two or more family-Enter number
3 ❑ Alteration(See 2 above) of units....................................................... 20 ❑ Industrial
21 ❑ Parking garage
4 ® Repair replacement 14 E] Transient hotel,motel,or dormitory.. 22 ❑ Service station,repair garage
Enter number Of units ...........................
5 ❑ Wrecking(if multi/amily,esidential,enter number 23 ❑ Hospital,institutional
of units in building in Part D,13) 15 ❑ Garage
24 ❑ 08ice,bank,professional
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
7 ❑ Foundation only 17 ❑ Other Specify 26 C] School,library,other educational
27 ❑ Stores,mercantile
B.OWNERSHIP
� 28 ❑ Tanks,towers
8 Private(individual,corporation,nonprofit 29 E] Other-Specifyinstitution,etc.)
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 offce building,office building
10. C t of impro/vememy..{. .�`.i. .....('.'.y^�ry^' S.S........ $ iat industrial plant.If use of existing building is being changed,enter proposed use.
Floor
To be installed but not included
in the above cost
a. Electrical.......^^..�.................................................................
b. Plumbing Ja,•l -....
c. Heating,air conditioning.......................
d. Other(elevator.etc.).....................................................
00
11. TOTAL COST OF IMPROVEMENT $ Cb
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
a31 L_I Wood frame 36 ❑ Oil 41 ❑ Private(septic tank,etc.) conditioning?
32 Structural steel 37 ❑ Electriclty 44 ❑ Yes 45 141 No
33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator?
34 Other-Specity 39 Other-S i 42�Public or privatecompany
❑ ❑ Pecty 46 ❑ Yes 47 RrNo
43 ❑ Private(well,cistern)
J.DIMENSIONS f M. DEMOLITION OF STRUCTURES:
48. Number of stories ........ .................................................
floor
49. Total squors,re based of exterior Has Approval from Historical Commission been received
all floors,based on exterior
dimensions .......................................1, ,od........... 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 .................'...........................................................
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. Outdoors
Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed ............................................................................ Electric:
Gas:
54. Number of Full......_..._I..........................- Sewer:
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial... BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No—Z (If yes,please enclose documentation from Hist.Com.)
Conservation Area? Yes_ No—Z (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_ Nom
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# DS 1135 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 Cade Tel.No.
C
1. �kC t
Owner or `"�r
Lessee
2. 1 Ca Er Sa MIs_ -7ysap
Contractor
Builder's
License No. lf�
3.
Architect or
Engineer
I hereby certify thatPGropos9d work is authorized by the owner of record and that I have been authorized by the owner to make this application
as his authoriz Aent and yft agree to conform to all applicable laws of this jurisdiction.
Signature of a lc nt Address Application date
/-7 ), on
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building h FOR DEPARTMENT USE ONLY
Permit number A
Building // Use Group
Permit issued '7 19 h
/ Fire Grading
Building
Permit Fee $ Live Loading _
Certificate of Occupancy $ Approved occupancy Load
by:
Drain Tile $
Plan Review Fee $
711f E
NOTES AND Data• (For department use)
S
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
1 ..
i1 CERTIFICATE ISSUED
DATE October 6 1993
CITY of SALEM BUILDING PERMIT -
s SALEM, MASSACHUSETTS 01970
a CERTIFICATE OF OCCUPANCY
Gpm E1
DATE7 19 J3PERMIT NO._ y�v0
ADDRESS IcoNTR•s UccxsEr
APPLICANT T INC.) (STREET)
HUMBER OF 1
QWELLING UNITS
PERMIT TO -'�' (�I STORY L)WE% I pROP SCG Sfl
IT�RE OF IU,..VE-C-Tl O.
ZONING -y
`yl-. n' i DISTRICT
AT (LOCAT)0N1 ISTREEII
tNOa )
LLIi: .Ip +iVe. AND (CROSS STREET)
BETWEEN )CROSS SIREFTI
LOT
LOT BLOCK SIZE
SUBDIVISION'
FTw10E,P.�. FT. LONG BY- 'FT. IN HEIGHT AND SHALL:CONFORM�IN CONSTRUCTION
BUILDING IS TO BE , - -
�----
BASEMENT WALLS OR FOUNOATION
TO TYPE USE GROUP ITrREI
dci.._J
REMARKS: g
iff
AREA OR
VOLUME
O:AIV SE WAC FEET)
O."NerFlsPxFewlefT VC!Is1.1blflbO E POSTED
V.'9FOtTIO
_ C ' TO BE POSTW ON PREMISES
OWNER SEE,) VERSE:SWE U?QRI CdltlQIT 1AN5 OF CERT IF ELATE
ADDRESS
,-_-;:,QEPARTMENTALAPPROV'AL FOR CERTIFICATE
4 < of OCCUPANCY and COMPLIANCE
fi Tore filled in b� each IliJision indicated hereon
upon completipnj of its ail inspection. i
BUILDINGS ' Permit No. 433-9317
Approved by Bohn T. Jeririingg;Date October 5 , 1993
Remarks
PLUMBING Peimit No.
App[oved by c Date
i
Remarks
ELECTRICAL Permit No.
Approved by Date
Remarks
OTHER Permit No.
Approved by_ Date
Remarks
OTHER Permit No.
I Approved by Date
j Remarks
BUILDING
PERMIT
JOB WEATHER CARO.
GATE ` 19 PERMIT, NO.
APPLICANT ADDRESS i - _ L.. s. .�.. •. ..
(M0.) •(STREET) • ICONTR•5 LICENSE'
PERMIT TO -+�-- (_) STORY i4r411..::•y NUMBER OF
"'' DWELLING UNITS
(TYPE Of IMPROVEMENT) NO. (PROPOSED USE)
` ZONING _
AT (LOCATION( 1U+ "(^ DISTRICT
(X0.) (STREET)
..�1_..-C.C'i r:Ji.
BETWEEN AND
(CROSi STREET) (CROSS STREET)
SUBDIVISIONLOT
LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS:
call i Yyriiiii to Occupy
VOLREA OR UME ESTIMATED COST ° FEEMIT 5. .. v .
�CUBIC%50VARE FEET)
OWNER
ADDRESS tBUILDING:DEPT.�a
BY
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY 09 SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
► PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP.
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL gPPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
ALL CINSPEONSTRUCT
TIONS NSTRUCE OU IREDfOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PFRMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND
1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIREO,SUCH BUILDING SHALLNOT BE OCCUPIED UNTIL
MINAL INSPECTION
TO LATHE FINAL INSPECTION HAS BEEN MADE.
]. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
1 do rL e
2 T 2 2
aa ��
l� 1J
ON
BOARD OF HEALTH GAS INSPECTION APPROVALS FIRE DEPT. INSPECTING APPROVALS
1 rL0 %Q 1 nIr o-lz
A
OTHER CITY ENGINEER 2 2 o-c
• W iA.`nlapf
WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD
INSPECTOR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. OR wR ITTEN NOTIFICATION.