27 NURSERY STREET - BUILDING INSPECTION 7
Ala
No. 3 'S� City of Salem Ward
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1, It, Ill, IV,and IX-
1. AT(LOCATION) c� � AlU/Z.S sooP ZONING
LOCATION "o.l IsmR )
RICT
OF BETWEEN AND
BUILDING (moss srREE1) (CROW LOTEn
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(it residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational
housing units added,if any,in part D,13) 19 E] Chruch,other religious
13 ❑ Two or more family-Enfer 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 ❑ Wrecking(it 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
7 ❑ Foundation only
26 ❑ School,library,other educational
17 ❑ Other-Specify 27 ❑ Stores,mercantile
E.OWNERfiHIP 28 ❑ Tanks,towers
8 mate(individual,corporation,nonprofit 29 ❑ 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 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
in the above cost 2 -Ze1W /ZQpg
a. Electrical............................................................_..........
b. Plumbing....................................._.................._...._._.__. TCao<�dE2 I�/7CiYL�h+ --y( -;2v/'Lr
c. Heating,air conditioning.........................._............. u /,2 r
I d. Other(elevator,etc.)..........................._...._...._...._......
�l
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 Wood frame 36 ❑ Oil 41 ❑ Private(septic tank,etc.) conditioning?
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No
i
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 E] Yes 47 ❑ No
43 ❑ Private(wall,cistern)
I
J.DIMENSIONS
as. Number of stones ............................................................ M. DEMOLITION OF STRUCTURES:
squ
as. Total ors.based offloor , Has Approval from Historical Commission been received
all Acorea based on exterior area,
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:
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
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 documentationfif no, submit Board of Appeal decision)
It 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# 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
CONSTRUCTION IS TO BE COMPLETED BY: If an extension is necessary, please submit
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 1a SU O/9?O �t�•-�
Lessee
2.
Contractor
evaders
License No. 8�
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 authoriz and we a ree to conform to all applicable laws of this jurisdiction.
Signature of app' n Address Application date
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Buildingp r / FOR DEPARTMENT USE ONLY
Permit number ,
j Building /,/ / use Group
fi Permit issued19 7 f
\ Fire Grading
Building / GJ
! Permit Fee $ r Live Loading
i
Certificate of Occupancy $ Approved by: Occupancy Load
Drain Tile /� —
L6
Plan Review Fee $
TITLE
f
r NOTES AND Data • (For department use)
I
t
i
k
r
PERMIT TO BE MAILED TO:
F
DATE MAILED: Gj
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
�Jct�oe �
APPLICATION FOR
PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete
all items in sections: 1, 11, 111, IV, and IX. O
I• ZONING
AT (LOCATION) / 7 r t� U/C+� ✓/� �� L�Y/ DISTRICT
LOCATION EEn
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D a
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
m
1 ❑ New building Residential Nonresidential
2 ❑ Addition(If residential, enter number 12 One family 18 ❑ Amusement, recreational
of new housing units added, if any, Two or more family - Enter in Pan D, 13) 13 TflE19 Church, other religious❑ ❑
3j2r-Alteration (See 2 above) number of units- - - - - 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5 ❑ Wre cking (IJ multifamily residential, Of units ------- -�- 22 Service station, repair garage
enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13)
6 Moving (relocation)
16 ❑ Carport 24 ❑ Office, bank, professional
❑
17 ❑ Other - Specify 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School, library, other educational
B. OWNERSHIP 27 ❑ Stores, mercantile
8,K51 Private (individual, corporation, 28 ❑ Tanks, towers
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, mac.iine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electricol.......................
6. Plumbing ....................... G
c. Heating, air conditioning.........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $ ev�.
III. SELECTED CHARACTERISTICS OF BU DING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30❑ Masonry (wall bearing) 40>WJ Public or private company 48. Number of stories................
31 CaWood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32❑ Structural steel dimensions
.....................
33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 ❑ Other - Specify Public or private company 50- Total land area, sq. ft. ...........
3 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35 ❑ Gas Will there 6e central air 52. Outdoors........................
36 ❑ Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44 ❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39 ❑ Other - Specify Will there be an elevator?
54. Number of Full..........
46 ❑ Yes 47 ❑ No bathrooms
Partial........
NOTES and Data — (For [department use)
Z2 :IiDo r-
IV. IDENTIFICATIONIF be completed by all applicants
Name Mailing address — Nmnber, street, city, and Slate ZIP code Tel. No.
Owner or Qi3 'e-zoeirc V till SU2 GEo9 O/970 7�/S
Lessee
2. LiCiU�NI Bcenuildseer'No.
s
Contractor
g(C
3.
Architect o
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 t application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Sign ure of plicantAddress
Application date
� N/V sgyl�OGz /6a2J=y
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check PI°" Review Date Plans B Date Plans
Fee Started y Approved By Notes
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date Number B Permit or A royal Check Date Number Obtained y pP bBy
y
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued ^ fq
Building ` n 1 Fire Grading
Permit Fee $ ?7 L7e /✓/
Live Loading
Certificate of Occupancy $
Occupancy Load
Approve :
Drairi Tile $ by
Plan Review Fee $
TLE
VIII. ZONING PLAN EXAMINERS NOiFS
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
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