1 RAYMOND ROAD - BUILDING INSPECTION / Q�o� rn a n � �D n�`L •�
J.DIMENSIONS
aa. Number of stories .................._L................................. M. DEMOLITION OF STRUCTURES:
49. Tsquare teat f area,
all Has Approval from Historical Commission been received
all 11 floors,based On exterior
exterior
dimensions .................................................._................. for any structure over fifty(50)years? Yes_ No_
50. Total two 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? I
Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed............................................_......................... Electric:
Gas:
Full............................_............. - Sewer:
54. Number of
bat^ooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial"""'-'------.-----_.. BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ Nom (If,vas,please enclose documenta?ion. from Hist Com.)
Conservation Area? Yes_ Nom (If yes, please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes_ No4
Is property located in the S.R.A.district? Yes_ No
Comply with Zoning? Ye - No_ (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes (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)`' h
Massachusetts State Contractor License# O 4 4 £ G 4 Salem License# � 7J
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
3014in writing to the Inspector of Buildings.
V. IDENTIFICATION • To be completed by all applicants
Name Mailing address Number,street city,and state LP Code Tel.No. J#
RLR K Con ti E u 2(} ww tip rLj2 S/+L'CH w a . 741 -1134.
1
Owner or
Lessee
2. S 1ti u 2 u-o u 2 S GgLF�C Ear
Contractor l-1 i"'t er's 4-6-154-1
Builder's t*-&S 6-4
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.
Si nature of applicant Address Application date
L L3 Ca'KLC(`r S . NH"`lut-u—' 4¢ Q
Y
4
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building
Permit
number FOR DEPARTMENT USE ONLY
Permn7 7
Building /�� n, Use Group
Permit issued l t(Q !l 19
—i Fire Grading
Building
Permit Fee $ % Live Loading
Certificate of Occupancy $� Approved by: occupancy Load
Drain Tile $
Plan Review Fee $ r
/TITLE
NOTES AND Data-(For department use)
� U c2 �. O 2 ✓
i
L7 ln,,
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u
4
i
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by: Completed by:
'r
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES 1
SITE OR PLOT PLAN •For Applicant Use
i
oN