9 RAND ROAD - BUILDING INSPECTION ROAD,A
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No.,66S 4 l City Of Salem � �jl� Ward
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APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1, 11, III, IV, and IX.
I. NING
AT(LOCATION) Cl DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) CROSS LOTET)
SUBDIVISION LOTBLOCK SIZE
IL 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 JZAddRlon(If residential,enter number of new 12 One family 18 ❑ Amusement,recreational
housing units added,it 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 ❑ Transient hotel,motel,or dormitory-
Enter number of units ........................... 22 ❑ Service station,repair garage
5 ❑ Wrecking(If 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
26 ❑ School,library,other educational
7 ❑ Froundaticn only 17 ❑ Other-Specify
27 ❑ Stores,mercantile
B.OWNERSHIP 28 ❑ Tanks,towers
8R Private(individual,corporation,nonprofit
29 ❑ Other-Specify
institution,eta)
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..........................................................................
c. Heating,air conditioning.............................................
d. Other(elevator.etc.).....................................................
11. TOTAL COST OF IMPROVEMENT $ 47
III. SELECTED CHARACTERISTICS OF B LDING -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�L.I Masonry(wall bearing) 35 n 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 45Zf No
33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator?
34 ❑ Other-Specify - 39 ❑ Other-Specify 4 Public or private company 46 ❑ Yes 47,�N No
43 ❑ Private(well,cistern)
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
48. Number of stories ..........................................................:.
loor
49. Total ors,based n exterior
Has Approval from Historical Commission been received
all al square
based o f exterior - PP
dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No
50. Total land area,sq.ft............. Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed ...................-........................................-..............
52. Outdoors HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed .......................................................... Electric:
Gas:
54. Number of full._........................................ Sewer:
bathrooms Partial. DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
--`---------........-- 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_ NOV— (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—V
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 '71No
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 Mailing address-Number,street,city,and state ZIP Code Tel.No.
Owner or
Zii
Lessee 0..�
2.
Contractor
Bene
License No.
3. -Asp-ivoi,- -v `Q. lD .. Q
Architect or
04
Engineer -5 ",.
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.
Signature of a06
ppli nt Address Application date
I
Ir
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued t9 Fire Grading
Building
Permit Fee $ Z Live Loading
Certificate of OccupancyApproved by:
$ Occupancy Load
Drain Tile $
Plan Review Fee $ G0�
TITLE
NOTES AND Data•(For department use)
r f
A � e- lie i V Q L✓ uklvlo
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
oN
BOARD OF ASSESSORS 6,
93 WASHINGTON STREET, CITY HALL,SALEM, MASSACHUSETTS 01970 (617) 744-0660
NT 2,0 In
CRY OF
October 28, 1986
Mrs Josephine R. Fusco
City Clerk
City of Salem
Salem, Ma. 01970
Dear Mrs. Fusco
Please be advised that the proposed singlejamily house to be built
on a portion of Assessors' Parcel #28-0016 located at the -end of RandN
tRoad on the left-hand„side.has-been.assigned_the_street address of -
9 Rand Road.
-
I
Very truly ours,
Peter M. Caron
Chief Assessor
PMC/cj
cc: Mr. Kenneth B. Cahill , Postmaster
Chief Joseph F. Sullivan, Fire Department
Margaret R. Hagerty, Principal Clerk; Water Dept.
William H. Munroe, Inspector of Building
Engineering Dept. , City of Salem