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12 1/2 NORMAN STREET - BUILDING INSPECTION 12z NORMAN STREET llll PlilG No. 153L-2 HASTINGS. MN LOS ANGELES-CHICAGO-LOGAN.OH MCGREGOR.T%-LOCUST GROVE.GA U.S.A. ^1 COMMOAVEALTit OF iMASSACIIU-" TTS KY CITVTVA:1N-OF S A L E 11 - I,�\\ APPLICATION FOR CERTIFICATE OF INSPECT-COx 1 Date (pZu V%) Fee Required Amount . . S o O No Fee Required In accordance with the provisions of the ;lassachusetts State Building Code , Section 108, 15, I hereby apply for a Certificate of Inspection for the below-named premises located- at the following address: Street and Number Name of Premises--/_/ i Purpose for Vhich Premises is Used X(/4//01-/ License(s) or Permit(s) Required for the Premises by Other Governmental Agencies : License or Permit Agency J500b 111(f E, 00M"ldy Certificate to be Issued to ` Address Owner of Record of Building— Address Name of Present Holder of Certificate Name of Agent, if an}* SIGNATURE OF PERSON TO WHOM TITLE CERTIFICATE IS ISSUED OR HIS AUTHORIZED AGENT DATE INSTRUCTIONS TELEPHONE 1 ) Make check payable to : CITY OF S_4LE`i 2) Return this application with your check to : SALEM BUILDING DEPARDIENT City Hall Anne On , em.Green, Salem, Pa01910 PLEASE NOTE: 1 ) Application/form with accompanying fee must e 7ub ed o ch building or structure or part thereof to be certified. 2) Application and fee must be received before thef' ail be issue( 3 The building official shall be notified within 0, days of any chang .in the above information. CERTIFICATE EXPIRATION DATE: FORM SBCC-3-74 t CU}@IONVEALTH OF MASSAC3IU"PI TS ,F i. (;'. CI1'Y/'1 S ,-OF S A L F 11 \1 APPLICATION: FOR CERTIFICATE OF I\SPECT-rm\ Date /p V%) Fee Required (Amount).C;�� d 0 ) . No Fee Required In accordance with the provisions of the Massachusetts State Building Code , Section 108, 15, I hereby apply for a Certificate of Inspection fc;r the below-named premises located- at the following address: Street and Number /p` 0 4 Name of Premises .Purpose for 11hich Premises is Used License(s) or Permit(s) Required for the Premises by Other Governmental Agencies : License or Permit Agency �JL Se,�u/C� �1�,� �` C�2�a.� � 6.5.4'�/ ' �•r Cn ho,v URS ti 'i.UCs o A Certificate to be Issued to Address Ovner of Record of Building Address Name of Present Holder of Certificate Name of Agent, if an} SIGNATURE OF PERSON TO Zi'I-IOM TITLE CERTIFICATE IS ISSUED OR HIS AUTHORIZED AGENT DATE INSTRUCTIONS• TELEPHONE 1 ) bake check payable to : CITY OF SALEM 2) Return this application with your check to : SALEM BUILDING DEPAMENT Cit • Hall Anne Onem.Green, Salem, Papp. PLEASE NOTE: r6 /, 1 � Application form with accompanying fee must e submi ed o ch buildin or structure or part thereof to be certified. 21 Application and fee must be received before the certif- t 11 be issue( 3 The building official shall be notified within ten ( 10) days of any (hang( in the above information. CERTIFICATE EXPIRATION DATE: FORM SBCC-3-74 Y 122 Norman;,Street Belle ' s Cafe F-3 177-1 NAME OR ADDRESS JAN IFEB AR PR AV UN UL AUG EP OCT INOVIDEC I USE I YEAR PURPOSE USED Luncheonette PROVIDE THE FOLLOWING INFORMATION AS APPLICABLE # OF STORIES 1 CLASS OF CONSTRUCTION Wood DATE ERECTED CERTIFIED CAPACITY: (BY STORY OR TYPE) Luncheonette - 32 - First Floor NUMBER OF ROOMS - HOSPITALS, SCHOOLS. HOTELS: (BY STORY OR TYPE) NUMBER OF DWELLING UNITS PER STORY FORM_SBCC-2-74 EMERGENCY LIGHTING SYSTEM Battery' Pack MEANS OF DETECTING AND EXTINGUISHING FIRE Chemical extinguisher - hood suppression system # OF ELEVATORS HOW HEATED hot air BOILER OR OTHER HEATING APPARATUS roof unit HOW LIGHTED electric HOW VENTILATED natural - A C PLACE OF ASSEMBLY: )CXES NO PURPOSE USED Luncheonette IN WHICH STORY first floor STANDARD BOOTH INSTALLED LOCATION FIXED SEATING 12 stools # OF AISLES AND WIDTH FIRE RESISTANCE OF CURTAINS OR DRAPERIES # OF SANITARIES 1 LOCATION first floor # OF GRADE FLOOR MEANS OF EGRESS DOORWAYS # OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY 9 OF APPROVED INDEPENDENT EXITWAYS PER STORY 1 CERTIFICATE DATA EXPIRES ISSUED CERTIFICATE NO. INSPECTOR 8 11Z22Z77 195-77 Munroe . . ..__ ORDERS . ISSUED COMPLIED ISSUED COMPLIED 19 19 19 19 19 19 19 19 19 1919 19 REMARKS _-- Approximately: 14 X 2 STREET & NUMBER 122 Norman Street DATE 11/22/77 OTHER LICENSES OR PERMITS REQUIRED - Mild and Cream - Salem Health Department Common Victualler - Salem Licensing Board OWNER OF RECORD OF BUILDING Elizabeth D. Boula'er ADDRESS 12Munroe Road, Salem, Mass. 01970 CERTIFICATE ISSUED TO Camille M. Belle D/B/A. Belle ' s Cafe ADDRESS 122 Norman Street , Salem, Mass . 01970 NAME OR ADDRESS JJANJFEBARPRAYJJUN JJUL UG PEP PCTINOVPEC I USE I YEAR 121 Norman Street Belle ' s Cafe I F-3 I 77, PERIODIC INSPECTION INFORMATION SHEET Instructions: This information sheet is not an inspection checklist. Each time a permanent file card is typed for a new building or a new card for an old build- ing, this information sheet can be prepared by the building inspector as a work sheet from which the file card can be typed. The items of information on this sheet are identical to the items on the file card. If all the information on this sheet cannot be entered on the file card, this sheet should be filled out and not discarded. Street and Nun Z7f� Name of Premises 0 er Licenses or Permits equire ll caner of Record of B ildin c gQ. l Address y -i Certificate to be Issued to Address e Use Group Classification Purpose Used Public or Private Number of Stories z Class of Construction Date Erected Certified Capacity (By Story or TI `1 Number of Rooms - Hospitals, Schools, Hotels (By Story or Type) Number of Dwelling Units Per Story Emergency Lighting System tjk c7C U�/ / Means of ete ti and Exti guishiug Fire - 611 e Fire Alarm System Number of Elevators How Heated Boiler or Other Heatin Apparatus — How Lighted How Ventila d Place of Assembly: Yes No Purpose Used In Which Story Standard Booth InstalledLocation 4 o /- Fixed Seating v o £ , Number of Aisles and Width of Each - !r o - v Fire Resistance of Curtains or Draperies Number of Sanitaries Location 1, _ d/ Number of Grade Floor Means of Egress Doorways Number of Separate Stairways Accessible Per Story Number of Approved Independent Exitways Per Story Remarks: �dj�, Date Certificate Issued Date Certificate Expires Date Orders Iss}}}}}gu4�����yd Date Orders Complied Inspector 41 y Date FORM SBCC-1-74 COMMONWEALTH OF DIASSACfIliSETTS CITY/TDir'N Or S A L E M �:. _ l > APPLICATION FOR CERTIFICATE OF INSPECTION Date G ( ✓rFee Required Amount) 25, No Fee Required In accordance with the provisions of the Massachusetts State Building Code , Section 108 , 15 , I hereby apply for a Certificate of Inspection for the below-named premises located at the following address : Street and Number oi ✓ ( D ,{ _/r �j S of Premises :: ,IGe- Puroose for Rhich Pre:ices is Used Ne Off -4Z- License(s) 'Licenses) or Permit(s) Required for the Premises by Other Governmental Agencies : License or Permit Agency Certificate to be Issued to Address �i J Omer of Record of Build a, / 3 9 43alw Address lit /! Name of Present Holder of Certificate- Name of Agent, if a71 ny t �? IGNATuMF OF PERSON TO 11i30M TITLE CERTIFICATE IS ISSUED OR HIS AUTHORIZED AGENT DATE INSTRUCTIONS: - 1Make check payable to : City of Salem 2) Return this application with your check to : John B. Powers , Inspector of Buildings City Hall Annex, One Salem Green, Salem, Mass . 01970 PLEASE NOTE: 1 ) Application form with accompanying fee must be submitted for each building, or structure or part thereof to be certified. 2) Application and fee must be -received bef'ore the certificate trill ,be issued. 3) The building OCficial shall be notified within ten ( 10) clays of any change_, in the above :inf•ormation. CERTIFIC_�ITE EXPIRATTON DATE: k FORM SBCCC--3--74 1 . PERIODIC INSPECTION INFORMATION SHEET Instructions: This information sheet is not an inspection checklist. Each time a permanent file card is typed for a new building or a new card for an old build- ing, this information sheet can be prepared by the building inspector as a work sheet from which the file card can be typed. The items of information on this sheet are identical to the items on the file card. If all the information on this sheet cannot be entered on the file card, this sheet should be filled out and not discarded. Street and Number .2 0/-2- ,iC iglu S? Name of Premises it „¢ 0 er Licenses or Permits Re uired S L La'�i A9 /L i Owner of Record of Building Address �� Certificate to be Issued to / G Address Y L is ey7AV%e Use Group Classification . Purpose Use Public or Private Number of Stories Class of Construction d Date Erected Certified Capacity (By Story or Type) ..-6fT� 3 2-7- Num - Number of Rooms — Hospitals, Schools, Hotels (By Story or Type) Number of Dwelling Units Per Story Emergency Lighting System Means of Detecting and Extinguishing Fir ,OA. ,S4t�7✓' Fire Alarm System Number of Elevators How Heated Boiler or Other Heatin App#ratus How Lighted L?. 71 to How Ventilated .*A — Place of Assembly: Yes_ X No Purpose UsedA4_de#*_c jnwFP1 In Which Story /!ry" Standard Booth Installed Location Fixed Seating S ,f Number of Aisles and Width of Each Fire Resistance of Curtains or Draperies Number of Sanitaries Location S" Number of Grade Floor Means of Egress Doorways Number of Separate Stairways Accessible Per Story Number of Approved Independent Exitways Per Story Remarks:.6 . Date Certificate Issued Date Certificate Expire Date Orders Issued Date Orders Complied Inspector r Date FORM SBCC-1-74 5 CITYlTeW- OF S A L E M ,W In accordance with the Massachusetts State Building Code, Section 108. Z5, this CERTIFICATE OF INSPECTION Camille M. Belle D/B/A Belle ' s Cafe is issued to . . . 7nt ,�t t Luncheonette Belle' s Cafe Y TalifU that I have inspected the. . . . .known as. '. . . . . . . . . . . . . . . . . . . . . . . . . . 12j- Norman Street City Salem located at. . . . . . . ?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .in the. . . . . . . . . . .of. . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . Count o Essex . ,Commonwealth o Massachusetts. . The means o egress are sufficient or the following � f. . . . . . . . . f f g ff' f f g number of persons: BY STORY Story Capacity Story Capacity Story Capacity Story Capacity BY PLACE OF ASSEMBLY OR STRUCTURE Place of Assembly Place of Assembly or Structure Capacity Location or Structure Capacity Location Luncheonette 32 :First Floor 195-77 11/22/77 8/1/78 L� Certificate Number Date Certificate Issued Date Certificate Expires l Euilding OfficiaZ The building official .shall be notified within (ZO) days of any changes in the above information.