52 WASHINGTON STREET - BUILDING INSPECTION 52 Washington ST. - ,
No. City of Salem Ward
°�.cuurrt.��*
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1, Il, Ill, IV,and IX.
I. AT(LinATION) 9 r 1 ,- D STRICT
LOCATION
OF BETWEEN �' '� 4 N R / AND iP�4 X 4 �h p
BUILDING (CRO STREET (M LOTEn
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,if any,in part D, 13) 19 Chruch,other religious
13 E] Twoor 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 ❑ Wracking(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 /!VI/'G�") 26 ❑ School,library,other educational
17 ❑ Other-Specify 27 ❑ Stores,mercantile
B.OWNERSHIP `
28 ❑ Tanks,towers
8 Private(individual,corporation,nonprofit
institution,etc.)
\ 29 E] Other-Specify
9 ❑ Public(Federal,State,or local government , a
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 ......................................................... $ v�0 at industrial plant If use of existing building is being changed,enter proposed use.
To be installed but not included //
in the above cost 00 /ns�a/ J�r+,,,,�a•��a� �!O d r ref
4 GG
. . Z
QLb. Plumbing........................................................................ t'r
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. PRINCIPAIyTYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF AGE DISPOSAL I. TYPE OF MECHANICAL
30 rL�,To�^/a-sonry(wall bearing) 35 r❑� Gas 40 Public or private company Will there be central air
Ly1•• L7 ❑ Private(septic tank,etc.) -conditioning?
31 ootl frame 36 Oil q1
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 E'MO
33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF V�A7ER SUPPLY Will there by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 42 L^y't�ublic or private company
l 46 ❑ Ves 47 ❑ No
43 ❑ Private(well,cistern)
J.DIMENSIONS �J M. DEMOLITION OF STRUCTURES:
48. Number of stories .................1+....................................
49. Total square feet of floor area, Approval all Aoors,based on a tenor Has pp oval from Historical Commission been receiv d
dimensions .............................._Z.�..................... for any structure over fifty(50)years? Yes_ No
50. Total land area,sq.h....................................................... Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed......................//)....,..... .....................................
fpY/ HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
sz. Outdoors............................. ......... ............................... Yes No `
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed.. ........................................................................ Electric:
Gas:
Full .............. Sewer:
54. Number f
bathrooms DOCUMENTATION 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 (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�o (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 # 04119 0 71! — Salem License # /3 Z 16
Home Improvement Contractor # /0&S,341 Homeowners Exempt form(if applicable) Yes_ No2c�—
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 I,—V Y-' C
Lessee y.
2. kal F
Contractor , Builder's '/
tJC lL MI- r V� CJ Y`cG[ License No. T6L)7f,
A
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 authorized a e t and we agn to conform to all applicable laws of this jurisdiction. 42 9
ure of ap can Add
re ppI,tion
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building �/r 9 j FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19 9—J Fire Grading
Building
Permit Fee $ 71_ DO Live Loading
Certificate of Occupancy $ Approvy: Occupancy Load
ed
Drain Tile $
Plan Review Fee $
TITLE
NOTES AND Data•(For department use)
J
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by: 3 Z Completed by: Z
I
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN •For Applicant Use �
O