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4 SCENIC PLACE - BUILDING INSPECTION 74520 40°,b P4 �v -FIELD COPY M CITY Of SALEM BUILDING s SALEM. MASSACHUSETTS 01970 PERMIT //F/ DATE NovAmber ? 19 CLQ PERMIT NO. APPLICANT Rob4 't OUEIlettP_ ADDRESS "5 Osborn St ,. P' ishody,kaSS_ 05�r21,• _ (.0.11 (STREET) ICONTA'S LICENSE' PERMIT TOAdd7.t tOII {_1 STORY 1M1TP 111➢" NUMBER OF DWELLING UNITS-1 'TYPE OFAMPROVEMENTI M0. 'PROPOSED USE) ZONING AT (LOCATJONI 4 Sroia AC P1.ACP DISTRICT P'-I (NO.1 ISTPEET) BETWEE I: AND _ ICROSS STREET) .'CROSS'STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE MY FT. LONG BY FT. IN HEIGHT AND SMALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION .. .. ...,. (TYPE) REMARKS: Buil , addi 7 d.Oh IS' $ 13 Li,111 P.} LEES AREA OR _ PERMIT R VOLUME. ESTIMATED COST `7".' FEE S_ AO . 'CUBIC SQUARE.FEET' OWNER +lT't an idhi-r. ADDRESS �' Cnn,�i• Ol gra- 4n1,>A- _ INSPECTION RECORD DATE NOTE PRQGRESS - CRITICISMS AND REMARKS INSPECTOR - ZD c No. 16H City of Salem Ward - � X APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete all items in sections: sesections:I, ll, Ill, IV,and IX- I. ZONING AT(LOCATION) SC. 'L n I C •� 6"��Vi: D STRICT LOCATION (NO') (STREET) OF BETWEEN AND (CROSS STREET) (CROSS STREET( � BUILDING / LOT SUBDIVISION LOT Q`b BLOCK SIZE 7�1 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(If residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational (rousing 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- 22 ❑ Service station,repair garage Enter number of units ........................... 5 E] Wrecking(h 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 E] School,library,other educational 7 ❑ Foundation only 17 ❑ Other-Specify 27 ❑ Stores,mercantile B.OWNERSHIP 28 ❑ Tanks,towers 8 ®,Private(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, Ifr r� parochial school,parking garage for department store,rental office building,office building 10. Cost of improvement ......................................................... $ 7 O at industrial plant.If use of existing building is being changed,enter proposed use. To be installed but not included in the above cost q C)U a. Electrical........................................................................... �1 b. Plumbing.......................................................................... c. Heating,air conditioning............................................. d. Other(elevator,etc.)..................................................... 11. TOTAL COST OF IMPROVEMENT $ Y.F00 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 41 ❑ Private(septic tank,etc.) conditioning? 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 ® Public or private company 46 ❑ Yes 47 Z No 43 ❑ Private(well,cistern) J.DIMENSIONS M. DEMOLITION OF STRUCTURES: 48. Number of stones ............................................................ 49. Total square feetf floorarea, all Boors,based o HApproval from Historical Commission been received nexterior as pp dimensions ......................................................................... �� for any structure over fifty(50)years? Yes_ No_ 50. Total land area,sq.k .................. 7 113 sgt I Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed ..............................................._..........._.............. HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? 52. Outdoors Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed ......:_.................................................._.........._.... Electric: Gas: Full ........... / Sewer: 54. Number of bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial."-"."-------..--..-- / BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ NOS- (If yes,please enclose documentation from Hist. Com.) Conservation Area? Yes_ Nom (ft 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_ No Is Architectural Access Board approval required? Yes_ No_ (If yes,submit documentation) Massachusetts State Contractor License# O S--.t.? z Salem License# Home Improvement Contractor# /OA 7 7 7 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 me Mailing address-Number,street,city,and state ZIP Code Tel.No. 1. Owner or to Lessee z. ti�� L/�7 zS ar/el Contractor GGA Bi e /O License N No. Q 5 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. Signature of applicant_. ',,� _ Address G� / ^ / Application date DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building /I �C FOR DEPARTMENT USE ONLY Permit number Building Use Group Permit issued 19 Fire Grading Building /� Permit Fee $ 0-n ae"- \ Live Loading Certificate of Occupancy $ Approved by: Occupancy Load Drain Tile $ kz 1 11 1 Plan Review Fee $ TITL NOTES AND Data •(For department use) PERMIT TO BE MAILED TO: DATE MAILED: - 1 Construction to be started by: Completed by: VI ZONING PLAN EXAMINERS NOTES DISTRICT // -� USE Pro d e 1 aj FRONT YARD a ry SIDE YARD G SIDE YARD 3 REAR YARD 30 ' NOTES SITE OR PLOT PLAN -For Applicant Use O N MORTGAGE INSPECTION BAY STATE SURVEYING ASSOCIATES 234 CABOT ST., BEVERLY MA LOCATION mf," 55, NOTES: SCALE < I ' =30 FT. DATE _ __-•-g ZS 2 •This is a Mortgage Inspection survey and not an . - instrument survey,therefore this lot Ian is forREFERENCE ----- -- ... mortgage inspection purposes only. SSE 5�. DIST •This survey is based on survey marks of others. ... .... .. .. . .. .. ..... .... . ..... . ... .... •Bushes, shrubs,fences and tree lines do not To - 5%�Cjvl /— l/E /VK��T CoR� necessarily indicate property lines. The location of the building(s) as shown,either complied with the 'In my professional opinion the building(s)are not located P in the special flood hazard zone, as defined by H.U.D. local zoning set backs at the time of construction or is exempt •Whenever an offset is 1'± or less, an instrument survey from violation enforcement action under Mass. G.L.Title VII is recommended to determine prop. lines. Chapter 40A Section 7. •Offsets shown are approximate by tape survey. LOOKOUT (OR ) OUTLOOK AVENLfE -78.Ool - -_ _ D 5- 4 oT LCT (3' 6 \.,n $# 4 c"9 3GI veeA = -7113 5 F. s 7s.00' _ ' C? S � BE A• C - u0 4 'Af lCiSTtq��\�Q°W �GEtJ1G P►� AGE S�N4t 1AN05 -77——7-------— ----- ------ ' apPHOVEDher 3ub,;11-t to approval�y y having jure ca SALEM,I VE,NTIO SOLELY I UTIF1 ot'OF LAI, AR PROTECTION DEVWES. 1 OF FIRE I JECT TO A TYPE AND R E, I �l DEVICES R PLETECOMPL- ALL Fl- IN, e"TION, com FIN'At- 17, v CODE. P �s h ... _. - - j T' ... _.. _ i iJ ' 4 j ; I ' I I I, I I S - 1 _ 1 __ _r.___�._.____._ ..__.._____�._________�_�._._.�_____.-- s �______.__._. 1 _-_ � i ---------------- � �� s � � { � � � � � � � �' � 'I ga,, i �� iE 4 � V x �..._. .e_.._ � � _ � 1 ..�� I � r �. C i r �� h s I -t-7-7 37- I)37 ♦ C ..__- --- � � mac+ „'..��---•—<---_ 14 If I � I � a— r �0 p i r COMMONWEALTH OF MASSACHUSETTS = E Eek DEFAKrMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET fames, Camcoei, BOSTON, MASSACHUSETTS 02111 omm:ssone WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, (I icenseei perminee) with a principal place of business/residence at: (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that: ( ] I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number [ ] I am a sole proprietor and have no one working for me. (� I am a sole proprieto general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: C M d k"7 U ? Y 3 o S Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number (] I am a homeowner performing all the work myself. . . NOTE: Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)),application by a homeowner for a license or permit may evidence the legal status of an employer under the Workers' Compensation Act. I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of Insurance for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalues consisting of a fine of up to$1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day against me. Signed this Z day of l/— , ' 19 7 ? Licensee/Permiaee licensor/Permittor Saeem F4, a DepaAtmen& Fvee P2even�i.on Su Leau 48 La4ayette SZ,%eet SaBem, Ma 01970 (508) 745-7777 FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT In accordance w4th the pnov44tone o4 the Mm66achu,6ett6 State BwadLnq Code and the Saeem F4:,te Code, appZica Won 4.6 hereby made 402 appnovaE o4 ptano and the 4-66uance o4 a centi,4.Lcate o4 app2ova2 502 a bu i Qding Penin{t by thy Salem F.Lce Department. (Re4. Seetlon 113. 3, Ma,66. State BCdg. Code) Job Loco tZon: t Rai 4,d EEect�caE Contmacto2: F-vice Supp2e6.6ton Cont-tar-to-t: S_gnatun.e 04 // /� / Appt4cant: o'/ //.✓I Phone Addle-66 o4 T City o2 Z APPi.cant: 02 f a S�orlt ➢ [ Town: App2ovaZ date: /� y Ce2tt44cate 04 app2ova2 .L6 he teby 92anted, on app2oved ptan4 02 bubm.l-tat 04 p2oject detai.P4, by the SaCem F-ite Depa&tment. AZC pt,=4 mte app2oved 6oZeZy 4o2 tdent444xat-Lon o4 type and Zocati.on o4 44,te p2otection dev.lce,s and equipment. Alt plan, a%e 6ubject to app2ovaZ o4 any othe2 autho2.ity having Jut44d4cti.on. Upon eomptet,ion, the aPPttcant o2 tn6ta Zex(el ahat 2equ"t an lnbpeet ion and/o2 t¢.6.t o4 the 44:, a P2otec t i.on dev- ce-6 and equ.tpment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** ) New conbttuetton. P20Pe2ty location ha6 no compliance wtth the p2ov44torw o4 Chapte2 148, Section 26 C/E, M.G. L. , 2eeatfve to the 44t4ta.2at.4on o4 app2oved 4,1 e a 4AM devtme6. The owne2 o4 th.i a p2opetty 46 2equt4.ed to obtaus compliance a6 a condi Zo.n o4 obta.inin.g a Su4tdi.ng Pe-=4.t. _P20pe2ty -Zoeat:Lgn 4,6 4n compliance wi th the p2ovt4ton6 04 _ Chaptea 148, Secton 26 C/E, M.G. L. ExpZu tLon date: cG 3 6 23 Fee due: unde-,c 7, 500 Sq. Ft. 0 7 , 500 So. Ft. o2 Zazyen . 00 Foam #81 (Rev. 10190 ) FIRE DEPARTMENT CERTIFICATE OF 4PPROVAL 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 issued. The Massachusetts State Building Code requires compliance approval of the Salem Fire Department, with reference to provisions of Articles 4 and 12 of the Building Code, the Salem Fire Code, Massachusetts General Laws, and 527 Code of Massachusetts Regulations. The applicant shall submit this application with three (3) sets of plans, drawn in sufficient clarity, to obtain stamped approval of the Salem Fire Department. This applies for all new construction, substantial alterations, change of use and/or occupancy, and any other approvals required by the Massachusetts General Lawa, and the Salem Fire Code. 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 1489 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. Form B1X (10/90)