3 RED JACKET LANE - BUILDING INSPECTION 3RED JACKET LUNE
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No.j,3-9.3 City of Salem Ward
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RECENED
APPLICAT10hTY OF SALEFH,XASS.
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1, It, Ill, IV, and IX-
I. AT(LOCATION) d L d � t 1 �c ZONING
DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
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
2 ❑ Addition(//residential,enter number of new 12 ® One family 18 ❑ Amusement,recreational
/rousing units added,if any,in part D,13) 19 ❑ Chruch,other religious
- 13 ❑ Tvro or more family-Enter number
3 ❑ Afleretion(See 2 above) of units ....................................................... 20 ❑ Industrial
21 [-] Parking garage
4 Repair replacement 14 E] Transient hotel,motel,or dormitory-
Enter number of units ........................... 22 C] Service station,repair garage
5 ❑ Wrecking(If multifamily msidemis,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-Specity, 27 ❑ Stores,mercantile
B.OWNERSHIP 28 ❑ Tanks,towers
8 Private(individual,corporation,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,
machine shop,laundry building at hospital,elementary school,secondary school,college,
10. Cost of improvement ......................................................... $ e_0 parochial school,parking garage for department store,rental office building,office building
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 $
III. 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 47 ❑ private(septic tank,etc.) conditioning?
32 Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No
33 r Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 42 Ij Public or private company
46 ❑ Yes 47 ❑ No
43 ❑ Private(well,cistern)
J.DIMENSIONS 3 M. DEMOLITION OF STRUCTURES:
4e. Number of stories ............................................................
49. Total square feet ofloor area
all floors,based onextenor
, Has Approval from Historical Commission been received
dimensions ....................................... ............ 2J0 V
for any structure over fifty(50)years? Yes_ No_
50. Taal land area,sq.If...................................................... Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES �7 Pest Control:
51. Enclosed......................................................................... Z
52. Outdoors............................................................................. HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?Yes No
L RESIDENTIAL BUILDINGS ONLY I / Water:
53. Enclosed ........... v Electric:
FullZ Gas:
54. Number of Sewer:
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial ........... L 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—Z
Comply with Zoning? Yes_ No (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes_ Nov (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)
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: L _ Z y� 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.
1 cc w« Al Yte frcfa sr� t— N1174)
Owner or
Lessee E
2.
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 a ree to conform to all applicable laws of this jurisdiction.
Signature of pplicant Addre Application date
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number ,
BuildingUse Group
Permit issued —� 19,�
- - Fire Grading
Building s�
Permit Fee $ �f -- Live Loading
Certificate of Occupancy $ Approved by occupancy Load
Drain Tile $
Plan Review Fee $
TITLE
NOTES AND Data -(For department use)
V, Lj t v`
E Ev
ZLoCQ 6 uJ
PERMIT TO BE MAILED T Q, yam/ Z10p 1 9
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
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1
611�
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