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2 WARNER STREET - BUILDING INSPECTION �� ,�c��j __ _ _� __ _ M r .. _ __ _ ��W� 9� NG City of Salem warn � x <uoert . APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete all items in sections: X. � 1, It, Ill, IV,and I I. AT(LOCATION) W rd2NCAi r.71 I i1 ZONING W44P LOCATION (NO.) STREt71 ( DISTRICT OF BETWEEN 19�b L 11 AND 8� m4-6,y -y-�7-j// /ice.- (CROSSSTREET) (CROSSSTREET) BUILDING C1-��5 Cao ✓� Lor L12 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(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 [1Twoor more family-Enter number ' 3 ❑ Alteration(See 2 above) of units...................................... ............ 20 ❑ Industrial 21 El Parking garage 4 Repair replacement 14 E] Transient hotel,motel,or dormitory- Enter number otunits .........�.............._ 22 E] 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 7 ❑ Foundation only 26 ❑ School,library,other educational 17 ❑ Other-Specify 27 ❑ Stores,mercantile B.OWNERSHIP 28 ❑ Tanks,towers 8 �rivate(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 ......................................................... $ oQ16r CH 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.............................................................:............. 3,Q6,C1 b. Plumbing.......................................................................... I'd c. Heating,air conditioning............................................. d. Other(elevator,etc.)..................................................... 11. TOTAL COST OF IMPROVEMENT $ 3 O 600'e, 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 O SEWAGE DISPOSAL I. TYPE OF MECHANICAL 30 [—] Masonry(wall bearing) 35 RrGas 40 blic or private company Will there be central air 31 VWpool frame 36 ❑ Oil 41 ❑ Private(septic tank etc.) conditioning? 32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 eNo 33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator? 34 ❑ Other-Specity 39 ❑ Other-Specify 42 Public or private company 46 -] Yes 47 NO 43 ❑ Private(well,cistern) J.DIMENSIONS Y 48. Number of stones . M. DEMOLITION OF STRUCTURES: .........._�.(...a- 49. Total square feet of floor area, r all floors,based on emedHas Approval oval from Historical Commission been received dimensions ........................:..ark. ..3�L. for any structure over fifty(50)years? Yes_ No 50. Total land area,sq.ft. 9-?-7 ..TT Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 52. OutdoorsHAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?............................................................................ Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed.................................................................._..._.. Electric: Gas: 54. Number of Full......--A..................... Sewer: bathroomsDOCUMENTATION 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--Z- (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_ 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 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. 1 Lo Owner or Lessee 2. Contractor - nsNo.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. Signatur f applicant AddressAp icatio ate i44 DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building Permit number � /f — / 7(�// FOR DEPARTMENT USE ONLY Building use Group Permit issued C✓h 19 Fire Grading Building � Permit Fee $ G� 3 Live Loading Certificate of Occupancy $ Occu cy Load Approved by: Drain Tile $ Plan Review Fee $ CG TLE NOTES AND Data-(For department use) a Epi b e- �j vt-, 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 CITY OF SALEM _UILDING DEPARTMENT HOMEOWNER LICENSE Ei;EMPTION Please Print DATE ,Jd-N Qv�4 JOB LOCATION its K/le p, Number Street address Section of Town "HOMEOWNER 41AV A L oc6cc05 7Kt,r_ &6 ie0 Name Home phone Werk phone�.�j�Q ,�rsf, PRESENT MAILING ADDRESS Q/G 4,>6-2/dCJ6 -S7- 5A- ST5A-LSM A_b4 fl 7 9 76 City/Town ;tate CiD Cade he current exemption of "homeowners" was extended to incivae owner-occupied Jweilinas of six units or less and to allow sucn homeowners tD enaage an in- dividuai for hire who does not possess a license, provided that the owner cts as supervisor. State Building Code Section 109. 1 . 1 ) DEFINITION OF HOMEOWNER: Person(s ) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official , on a form acceptable to the Building Official , that he/she shall be responsible for ail Such work oerformea under the buildino Dermit. Section 109. 1 . 1 ) -he unaersioneo "homeowner' _ssumes responsibiiity for compliance pith the State ;uiidino code and other aooilc3ple codes . `Jv- laws . :'U les and reaUldt10n5. The undersigned "homeowner" certifies that he/she understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER' S SIGNATURE A,& APPROVAL OF BUILDING OFFICIAL 'DOTE: -hree family dwellings 35.000 cubic feet. )r larger. ::ill be required to comply with State Buildina Code Section 127.0. Construction Control . HOME OWNER 'S :XEMPTION The Code states that: "Any Home Owner performing work for which a building permit s required shall be exempt from the provisions of this section (Section 109. 1 . 1 - Licensino of Construction Supervisors ) ; provided that is a Home Owner engages a person( s) for hire to do such work, that sucn Home Owner snail act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for Licensing Construction Supervisors , Section 2. 15) . This lack of aware- ness often results in serious problems , particularly when the Home Owner hires unlicensed persons . in this case your Board cannot proceed against the unlicensed person as it would with licensed Supervisor. The Home Owner actinq as supervisor is ultimately responsible. o ensure that the Home Owner is fully aware of hisjher responsibilities . many communities require. as part of the permit application. that the Home Owner c=ertify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns . /ou may care to amend and adopt such a form/certification for use in your community. ...!• _..: .. ., .'. ....:::. .. .... ::.�.;., e. .-.:.'.,:-. .'..:c....', _... ,..._.... . ._... . ... „.i,ta�. ha.fl.. >J ��fSaCL$�:�ty, Sateen F-ite Depantmen- F-vte P,Levention Su Aau. 48 La4ayette St,Leet Salem, M2 01970 (508) 745-7777 FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT In aeco4dance W4V1 the ptovZ4Lon.6 04 the Mm44aehua6ett4 State ButZdL,19 Cvde and the Salem F-iAe Code, app.Q�,cat4, Con a he,Leby made 4o2 app,covaC` v4 pZ and the weuance o4 a ee�ti4.Gcate o4 app-LovaC 40,L a buZCd,Cng peani t by the Salem F-ite Department. (Re4. Section 113. 3, Ma6.6. State B.Cdg. Code) lob Location: � Woe. Al rit Owne2/Occupant: 1. I ;veto L* G lid Etecth icat Cunt facto.%: I �4 l 1e6 f.�l�S I F4,te Suppteaadon Cont4acto4: S.i.gnatwxe o4 AppZZcant: iv4- Phone #: '_ 0 Adde. ,La-a o4 � C.C.ty o-L Appli cant: /Z./Y10s'K Lei y / � Town: A Approvaa date: 1241. 2Y/c/ c/ Ceat44.Ccate 04 app,Lovat 44 hete-by 94anted, on app-Loved ptana on aubmttt tZ o4 project deta4Z6, by the Salem F4Ae DepaAtment. ACC ptam6 a&e appn.oved -6oteCy 4o4 tdent t4.i.ca tion 04 type and .Cocation o4 4-4:,te p,cotection device-6 and equipment. A.e.2 peane ane .6ubiect to appxovaC 04 any other autho4 f ty -hay.Lng au4Z4dZctCon. :Upon comptet-Zon, the appt4c4nt o,L .in6tae.e.e,L(.6) .6ha e -Lequeat an .Cnbpeetion and/o,L te.6t 04 the 44:'%e pn.oteetion dev i,ce.6 and elqu—,ipment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** ) New eon,6tucct4on. ( P,Lope%ty 2oca*-Zon has no compliance w4th the p,Lovt-6,i,on6 04 Chapte,L 148, Section 26 C/E, M.G. L. , ,&tatZve to the Znataeation o4 apptoved 4d,ze aCa,rm. devtm .6. The own" 04 thea p,sope,cty L6 nequ &%ed to obtain. compliance a.a a condition o4 obtaatn.ing a Bu f ed,Cng Penm-itt. 0 -Paope%ty'Eocati,on 1,6 .Ln evmpt i,ance wi th the Pxov-i.a.Cvna o4 Cha.pte,% 148, Section 26 C/E, M.G. L. Expt4aation date: c/ '00: � �D , d _ g 04 F . O44 Cci ae Fee due: unde,c 7, 500 Sq. Ft. - 7 . 500 So _ F.t o,. .,,,, . - nn 7"..... 491 in"„ f n 1l FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT 4- In 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 Laws, and the Salem Fire Code. Exception: Plans will not be required for structural work when the proposed work to be performed under the building permitiwll 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 1480 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 81% (10/90) � 4weizti��- S� i� s, a.t'�Rt)V�D �ctjj rD /7 �.* r ; val nyer s1B �in8.iurisdiction. 'Ell MASS XTION 13 TI-i:is C) ;. ." \ice TO �� t3F AHENT.FPPRGYEOLEN/F r FI.Fn LQL'4TIv`r. Or fJFE FRDTECFI I�ICAI'10;l OF FIPIAL i',;P"�T`�(iu`if DEVICES AR ON DEVICE, t^TAFSD GISPECTION.FOR E EJBIECT TO A I ` ANCE P,'TI?ThE F1!tE CCDE CO�4IPLETE COMPA& Gvl_Di;\Go 1 � 3 cp, ` r ' '> EQLlvsCf.. ' i i I i lLNrx" S J T � N _ t I y n 1 I f 1 i i 1 a� 0 i r v� 1 �, a �� w � CZN � 1� �� -____--_„_ 1/ a w,� «�� s� 3 �.:;,� _-I--F __ - _ _____ ��X3 9 � _ { �� i � (� �a59I ` —�-- "�' ��.� w i i �� i t 1 t i � t ...,..___.,,w..w.�.,, I ._ _........._ .._.,...r C/��o �� ry f � ✓ � i !. �� i