7 PERSHING ROAD - BUILDING INSPECTION 7 PERSHING ROAD
r
No. 4� 9-1?-5 City of Salem Ward
o-4eL�
l 9
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:I, it, Ill, IV, and IX-
I. AT(LOCATION) -a—v,
1vr D STRICT
LOCATION IN0.) (STREET)
OF BETWEENOT
AND
BUILDING caoss STREET) cnoss STREET)
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
, Addition(It residential,enter number of new 12 Vone family 18 ❑ Amusement,recreational
housing units added,it any,in part D,13) 19 ❑ Chruch,other religious
13 El Two or more family-Enter number
30 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 muttitamily�esidendal,enter number 23 ❑ Hospital,institutional
of units in building in Part D, 13) 15 ❑ Garage
24 ❑ Office,bank professional
6 E] Moving(relocation) 6 ❑ Carport 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School,library,other educational
17 ❑ Other-Specify 27 ❑ Stores,mercantile
B.OWNERSHIP 28 ❑ Tanks,towers
8 VPrivate(individual,corporation,nonprofit +
29 E] Other-Specify
institution,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
a. Electrical... .......
b. Plumbing r372r T '
c. Heating.air Conditioning.............................................
d. Other(elevator.etc.)..................................................... lI a
11. TOTAL COST OF IMPROVEMENT $ V U
III. SELECTED CHARACTERISTICS OF BbILDING -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 4Wn Public or private company Will there be central air
conditioning?
31 Wood frame 36:g Oil 41 ❑ Private(septic tank etc.)
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No
33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 42 t16
Public or private company
46 ❑ Yes 47 ❑ No
43 0 Private(well,cistern)
J.DIMENSIONS
48. Number of stories . .................. M. DEMOLITION OF STRUCTURES:
...........V.....�'�....�......
49. Total square feet of floor area,
all floors,based on ex�tenor Has Approval from Historical Commission been received
dimensions ........................ .................. for any structure over fifty(50)years? Yes_ No_
50. Total land area,sq.fl..........-3 6a................ 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:
Full........................................... Sewer:
54. Number of
bathrooms PaDOCUMENTATION 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
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
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
MSailing address O-Nu/mber,street city,and state ZIP Code Tel.No.
CYOwneor (V
Lessee �,1�117d
z.
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 we agree to conform to all applicable laws of this jurisdiction.
Signat of plica `� Address
d Appli tion atg
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
I
NOTES
SITE OR PLOT PLAN -For Applicant Use
w
N
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 $ Approve Occupancy Load
Drain Tile $
Plan Review Fee $
TITLE
NOTES AND Data • (For department use)
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by: Completed by:
APPOINTMENT FOR FINAL Salem F ih.e Department
F•i to Prevention Bun.eau + APPOINTMENT FOR FIS
INSPECTION MUST BE 48 La4ayette Stteet INSPECTION MUST BE
MADE AT LEAST ONE WEE Salem, Ma 01970 MADE AT LEAST ONE WEEK
AHEAD__..___•••- (508) 745-7777 AHEAD_..........
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT
In acco4da.nce w4th .the pn.ovt-6ton.6 o4 the Ma-"achu,6ett4 State Buitdtng Code
and the Salem F-ivre Code, appZ•Lcation •t.6 hereby made 4o., app- oval o4 pta.n,6
'and, the t4auance o4 a ceAt,i4tcmte o4 appn.oval 4on, a bu,i.Cdi.ng permit by the
SaZ:em F•vice Department. (Re4. Section 113. 3, Ma,aa. State Bldg. Code)
Job- Location:
Owner/Occupant: ( 1 , P
14
EZectttcal Cont cacton:
�� )i
F•vice Supp., e•6a.i,on Cont cacto,,: ,r /
r
S.ignatwre o4
AppZ.icaxtt: Phone #:
Addne .6 o4 City on /
Appt Lcaxtt: S Town:
.a
_J
Approval date: 3
CeAtZ4•icate o4 appnovaC t4 hereby granted, on appaoved piano on 4ubm.ftt4v-Z.
o4 project detattZ6, by the Salem Ft4e Depa, tment. AZZ ptan-6 ate approved
-6otely 4o-% tdenti4.tcati,on o4 type and Zocntion o4 4vie pnotecti.on devdcea
and equipment. Att pta.n,6 ace .6ubject to app.,covat o4 any oche¢ authoAity
having ju4i.6dtction. Upon eomptetion, the appttcant .on tn6ta ten(•6) eha t
nequ"t an tn.opeetl on and/o4 teat o4 the 4Z4e p4oteetion devl ce4 and
equdpment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** )
0 New conztnuction.
Pnope+ity Zocatdon ha-6 no compZ•ia.nce w4th the p.,eovl aion.o o4
Chapter 148, Section 26 C/E, M.G. L. , -tela ti,ve to the
tn.4taZatZon o4 apptoved 4Z&e aZa%m devtce•6. The owne�L o4
tht-6 p-,cope.,ty t4 nequticed to obtain compt.ta.nce a,6 a
cond4tion o4 obta i,ni.ng a Buttdi.ng PeAmit.
P.,copenty Zocati.on 44 to compti,ance with the pn.ovi 6ton-6 o4
Chaptee 148, Section 26 C/E, M.G. L.
1
Expt4ation dater
ce F , 4ti
Fee due: under 7, 500 Sq. Ft. V- 10. 00
$R 1 1,Po
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT
In compliance with the provision of Section 113.5 of the Massachusetts
State Building Code, and under guidelines agreed upon by the Salem Bldg.
Inspector and the Salem Fire Chief, the applicant for a building permit
shall obtain the Certificate of Approval (see reverse side) and stamped
plan approval from the Salem Fire Prevention Bureau.
Said application and approval is required before a building permit may be _J w
issued. The Massachusetts State Building Code requires compliance z 3
approval of the Salem Fire Department, with reference to provisions of U_. m w
Articles 4 and 12 of the Building Code, the Salem Fire Code, Massachusetts o �p j
General Laws, and 527 Code of Massachusetts Regulations. � CO
z
The applicant shall submit this application with three (3) sets of plans, 2 p -
drawn in sufficient clarity, to obtain stamped approval of the Salem Fire z
Department. This applies for all new construction, substantial W w G
CL
alterations, change of use and/or occupancy, and any other approvals a " < 6
required by the Massachusetts General Laws, and the Salem Fire Code. a z a
Exception: Plans will not be required for structural work when the
proposed work to be performed under the building permit will
not, in the opinion of the Building Inspector, require a
plan to show the nature and character of the work to be
performed.
Notice: Plans are normally required for fire suppression systems,
fire alarm systems, tank installations, and Fire Code
requirements.
Under the provisions of Article 22 of the Massachusetts State Building
Code, certain proposed projects may not require submission of plans or
complete compliance with new construction requirements. In these
cases, provisions of Article 22, Appendix T, and Tables applicable
shall apply. This section shall not, however, supersede the
provisions outlined in the Salem Fire Prevention Regulations, Chapter
148, MGL, or 527 Code of Massachusetts Regulations. All permits for
fire code use and/or occupancy shall apply for the entire structure;
fire alarm and/or smoke detector installation shall apply to the
entire structure based upon current requirements as per Laws and/or
Codes, but the existing structure may comply with regulations
applicable for existing structures.
Notice: Sub-contractors may also be required to file individual
applications for a Fire Department Certificate of Approval
for the area of their work. Such sub-contractors shall file
an Application to Install with the Fire prevention Bureau
prior to commencing any work for those areas applicable.
S FOR FWA�' ,
FINA EN E
Form 81X (10/90) APpO1TA
NTMENMUST BE gEK i 1NSpE T��EAS SONE WEEK
INSPECj10N ST ONE W MADE AT �_....••-''
MADE AT 1 EA
AHF 'D........
..._..