94 WASHINGTON STREET - BUILDING INSPECTION �s 94 Washington St.ri
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Bay Contracting, Inc.
Exterior Restoration Specialists
Caroline Rooney
Office Administrator
camline.rooney@bayconuacting.com
' Masonry
Waterproofing 56 Felton sweet
Waltham,MA 02453
General Contracting oft'ice.617.779.8811
fn.617.779.0888 1
www.baycontmcting.com 1
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�o STREET PERMIT
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NAT-24395-1
April 28th 2015
Please find enclosed a check for the renewal of a street permit at 94 Washington St, Salem Ma to have staging
occupying the sidewalk.
If you have any questions or need any more information please feel free to call me
Regard Q
P tt rlJ� (;�
CAROLINE ROONEY
Caroline.rooney@bavcontracting.com
BG ♦ 56 Felton St♦ Waltham ♦ Massachusetts ♦ 02453
Telephone 617-779-8811 ♦ Facsimile 617-779-0888
i .
Architecture Planning Interior Design
16 June 1992
Building Department
One Salem Green
Salem, MA 01970
Att: Building Commissioner
RE: Red Lyon Smoke Shop
Washington Street
Salem, MA
Gentlemen:
A final inspection was made by CSS Architects Incorporated
on 10 June 1992 , at that time the gas, plumbing and
electrical services had been inspected and approved by the
respective city officials. The only work remaining to be
completed was the exit lighting and on 15 June 1992 that
work was completed and the fire department has inspected
and approved the work. The project has been built in
accordance with drawings prepared by CSS Architects dated
17 April 1992 , with the exception of the changes identified
in items 6, 7, 8, 9 and 10 in the attached field report No.
2 dated 10 June 1992 . The changes made in the field have
no affect on Code compliances. We feel the project is
ready for occupancy as of the date of this letter.
Very Truly Yours:
CSS Architec Incorporated
John J. Savasta, AIA
Principal
Attachment
cc Roger Bresnahan
CSS Architects Incorporated
Corporate Place 128
Audubon Road,Building 2
Post Office Box 1460
Wakefield, Massachusetts 01880
617 245 8400
CSS Architects Incorporated
Corporate Place 128 ARCHITECT'S
Audubon Road, Building 2 FIELD
Post Office Box 1460
Wakefield,Massachusetts 01880 (617)245-8400 REPORT
PROJECT: RED LYON SMOKE SHOP FIELD REPORT NO. : 2
CONTRACT: INTERIOR CONSTRUCTION ARCHITECT'S PROJ. NO. : 706
DATE: 10 June 1992 TIME: 4: 30 pm Weather: N/A TEMP RANGE: N/A
EST. °% of COMPLETION: 100% CONFORMANCE WITH SCHEDULE(+, -) : On Schedule
WORK IN PROGRESS: PRESENT AT SITE:
Store Fixture Installation Roger Bresnahan
Dick Anderson
John Savasta
OBSERVATIONS:
1. Aluminum store front exterior entry system is installed at the
front and rear of the Red Lyon Smoke Shop space.
2 . Acoustic ceiling, lighting and sprinkler heads are installed in
the sales area.
3 . All drywall has been installed and painted on the walls
scheduled for drywall in the sales area.
4. All vinyl tile and carpet has been installed in the sales area.
5. All interior doors are installed, stained and finish hardware
have been installed in the sales area.
6. The rear storage area is complete. All wall finishes have been
installed and painted. The gypsum board wall finished schedule
for the rear wall shall be left unfinished. The floor shall be
left unfinished and no vinyl base shall be installed.
7 . The single leaf door scheduled at the entry to the storage room
has been changed to a dutch door.
8 . The Men' s and Women's toilets have gypsum board walls installed
and finished. Toilet fixtures, accessories, mirrors, and grab
bars have been installed. Lighting, ventilation and ground
fault receptacles are installed. The ceiling has been changed
from acoustic tile to gypsum board painted. The door to the
Women' s room has been shifted to the left of the original
location. The water closet and lavatory in the Women's room
have been installed with the water closet located adjacent to
FIELD REPORT
RED LYON SMOKE SHOP
Page 2
the wall dividing the Men's and Women's room. The scheduled
floor finish and vinyl base have been deleted from the
contract.
9 . The hall wall which is perpendicular to the Men's room has been
shifted down to the existing chimney.
10 . A door has been added from the office area into the unoccupied
space at the rear of Beneficial Finance.
DIRECTIVES:
1. Carpet shall be installed around the columns in the sales area.
2 . The gas, plumbing and electrical services have been inspected
and approved by the respective city officials.
ITEMS TO VERIFY: None
INFORMATION OR ACTION REQUIRED:
1. Exit lighting is scheduled to be installed on 11 June 1992.
2 . The fire department has been notified and is scheduled to
inspect the work on 12 June 1992.
ATTACHMENTS: None
REPORTED BY: John Savas
cc: Roger Bresnahan
Salem Building Commissioner
CSS Architects Incorporated
Corporate Place 128 ARCHITECT'S
Audubon Road, Budding 2 FIELD
Post Office Be.1460
Wakefield,Massachusetts 01880 (617)245-8400 REPORT
PROJECT: RED LYON SMOKE SHOP, SALEM FIELD REPORT NO. : 1
CONTRACT: CONSTRUCTION ARCHITECT'S PROJ. NO. : 706. 02
DATE: 15 May 1992 TIME: 2 : 30 pm Weather: Clear TEMP RANGE: 50'
EST. % of COMPLETION: 40% CONFORMANCE WITH SCHEDULE (+, -) : On Schedule
WORK IN PROGRESS: PRESENT AT SITE:
Plumbing Work Roger Bresnahan
Electrical Work Dick Anderson
Drywall Work John Savasta
OBSERVATIONS:
1. All demolition work has been completed.
2 . Store front on Washington Street has been installed and
rear entry door frames are in place but not complete.
3 . Rough plumbing and domestic water service have been
installed in the wet wall at the mens and womens toilet.
Plumbing inspector has reviewed the installation and
approved the installation without comment.
4 . Rough wiring and the load panel have been installed and
inspected by the electrical inspector and he approved
the installation without comment.
5. The fire treated gypsum board has been installed to the
underside of the floor joists.
6 . Additional floor joists have been sistered-in to
increase the floor load capacity for the second floor.
FIELD REPORT
RED LYON SMOKE SHOP
Page 2
DIRECTIVES :
1. HVAC duct work to begin on Tuesday 19 May 1992 .
2 . Sprinkler work to begin on Wednesday 20 May 1992 .
ITEMS TO VERIFY:
None.
cc: Roger Bresnahan
Salem Building Department
EIIJILDINC DEN
C55 Architects Incorporated
Corporate Place 128 ARCHITECT'S
Audubon Road. Building 2 JLN �a ( [
_ FIELD
Post Office Boz 1460
Wakefield.Massachusetts 01880 (617)245.8400 R L"E I I_0 REPORT
CITY OF SAL !4,H?lSS.
PROJECT: RED LYON SMOKE SHOP FIELD REPORT NO. : 2
CONTRACT: INTERIOR CONSTRUCTION ARCHITECT'S PROJ. NO. : 706
DATE: 10 June 1992 TIME: 4 : 30 pm Weather: N/A TEMP RANGE: N/A
EST.% of COMPLETION: 100% CONFORMANCE WITH SCHEDULE(+, -) : On Schedule
WORK IN PROGRESS: PRESENT AT SITE:
Store Fixture Installation Roger Bresnahan
Dick Anderson
John Savasta
OBSERVATIONS:
1. Aluminum store front exterior entry system is installed at the
front and rear of the Red Lyon Smoke Shop space.
2 . Acoustic ceiling, lighting and sprinkler heads are installed in
the sales area.
3 . All drywall has been installed and painted on the walls
scheduled for drywall in the sales area.
4. All vinyl tile and carpet has been installed in the sales area.
5. All interior doors are installed, stained and finish hardware
have been installed in the sales area.
6 . The rear storage area is complete. All wall finishes have been
installed and painted. The gypsum board wall finished schedule
for the rear wall shall be left unfinished. The floor shall be
left unfinished and no vinyl base shall be installed.
7 . The single leaf door scheduled at the entry to the storage room
has been changed to a dutch door.
8 . The Men' s and Women's toilets have gypsum board walls installed
and finished. Toilet fixtures, accessories, mirrors, and grab
bars have been installed. .Lighting, ventilation and ground
fault receptacles are installed. The ceiling has been 'changed
from acoustic tile to gypsum board painted. The door to the
Women' s room has been shifted to the left of the original
location. The water closet and lavatory in the Women' s room
have been installed with the water closet located adjacent to
FIELD REPORT
RED. LYON SMOKE SHOP
Page 2
the wall dividing the Men' s and Women's room. The scheduled
floor finish and vinyl base have been deleted from the
contract.
9 . The hall wall which is perpendicular to the Men' s room has been
shifted down to the existing chimney.
10. A door has been added from the office area into the unoccupied
space at the rear of Beneficial Finance.
DIRECTIVES:
1. Carpet shall be installed around the columns in the sales area.
2 . The gas, plumbing and electrical services have been inspected
and approved by the respective city officials.
ITEMS TO VERIFY: None
INFORMATION OR ACTION REQUIRED:
1. Exit lighting is scheduled to be installed on 11 June 1992 .
2 . The fire department has been notified and is scheduled to
inspect the work on 12 June 1992 .
ATTACHMENTS: None
REPORTED BY: John Savas
cc: Roger Bresnahan
Salem Building Commissioner
COMO, CERTIFICA6T yS$}J,E0
N DATE ////yy ll
y F'. CITY OF SALEM
3 SALEM. MASSACHUSETTS 01970 BUILDING PERMIT -
a� y
CERTIFICATE OF pOCnCUPANCY
' Vw. ....L,.... DATE April 29 E9 92 PERMIT NO. 183-92
APPLICANT Bressahan ADDRESS Beverly,14A
p�yyy�pTT(�T�� 1.0.1 iCOnTR`S LICENIEI
PERMIT TO {-) STORY RETAIL STORE
NUMBER OF
DWELLING UNITS
Ii+#[ 0. IMI,ROVLME NTI MO, E.'_,.,� {yR0#OE[D UE[t
AT (LOCATION$ 94 NMbiroM St. Ward L ZONING
1X0.1 iSTPEETI DISTRICT
BETWEEN AND
4ROSS SIOEET) ICROSS SIRLETI
LOT
SUBDIVISION LOT BLOCK SIZE.
BUILDING IS 706f FT, WIDE R FT, LONG BV FT, IN MCIGMT AND SMALL CONFORM IN CONSTPUCTION
TO TYPE USE GROUP BASEMENT WALL$ OR FOUNDATION
{,'�'y� qry /�}��[� I T+vf)
REMARKS: RLI1MAAiTIO NS TO OUSTING SPACE, FOR RETAIL STORE
CALL FOR PERMIT 7O OCCUPY 745-9595 KK-��� �-��((
AREA pR
I$
VOLUME
b'BIC SOVARE F[[TI
L1}F1f1M'yHT CEIII,{ER 4w14111aFRslVIow14 w1sf114wINO BE POSTED ON REMISE Tl4w.4LTl4
OWNER AiSY�Al11 "`NC lflail TO BE POSTED ON PREMISES
ADDRESS 161 Cabot cut•• Beverlv.MB. 01915 SEE REVERSE SIDE FOR CONDITIONS OF CERT�lific
ASSISTANT BUILDIING INSPECMR, David Harris
BOARD,JOFASSESSORS -
n f 93 WASHINGTON STREET,CITY HALL,SALEM,MASSACHUSETTS 01970
3^ a (506)745- tf261::...
(508)744-59185918 FAX
J�cUaxt�:.n _
April 21 , 1992_
Mrs . Josephine R. Fusco
City Clerk -
City Hall .
Salem MA 019'70
Dear Mrs . Fusco:
Please be advised that the new location of the Red Lion
Smoke Shop, ,to be moved to the former. Foodland building
(Assessors Parcel # 35-0015 ) , has been assigned the mailing
address of 94 Washington Street .
V tr 1 yours ,, .
Peter M. Caron
Chairman
cc: Postmaster Joseph L . Leccese
Chief Joseph F . Si. 11ivan, Fire Department
Margaret R. Hagerty, Principal Clerk, Water Dept . -
tXilliam H. Munroe, Inspector of Buildings
Richard Lis , Engineering Dept .
.. Red Lion Smoke Shop Inc . , 99 Washington St . Salem
K- 0135rSERYM
The Commonwealth of Massachusetts REC
Board of Building Regulations and Standards NSPECTI01Massachusetts State Building Code, 780 CMR 2I SMar2011
Building Permit Application To Construct, Repair, Renovate Or t��eYt K2 1
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Ap ied:
_S• a
I Building Official(Pont Name) Signature Date
iS t SECTION 1: SITE INFORMATION
PI1.1, Property Address: 1.2 Assessors Map&Parcel Numbers
1.1 a Is this an accepte sOfreeV yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Public❑ Private❑ Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'ofRecord: ( Ae O19�h
Mt� ern,�--
Name(Print) City, State,Z
qL\ Email e,21 e
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed WorkZ: 't1i,.,jXA w\
\ t vv v OY\ ! 4
rz erg kiltqcy nptYE
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (14VAC) $ List:
5. Mechanical (Fire $ Total All Fees: $--
Suppression)
( �0O O O Check No. Check Amount: Cash Amount:
l
6. Total Project Cost: S � ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
1 'Construction Supervisor License(CSL) O t
V.4�YYQi�� GC�nU�0. m nseNuber SExxp_iratitionDate rce
Name of Holder
,,H'older
V_Q • 1.1 7X S / ' �,7p •`� ` r�V� List CSL Type(see below)
No.and Street / Type Description
�nt��I N m� oiae5 R Unrestricted(2 Family
s u el ing cu.ft.
R Restricted 1&2 Famil Dwelling
City/Town,Sudd,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
Gm 11 I Insulation
1 cle hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
C Registration Number Expiration Date
C Co any Name or HIC Registm Name
LLVand ekStreet mA ^� tr 1 Nv Email addr s
Ci /Town, tate,ZIP 'L V' Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. C. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuan of the building permit.
Signed Affidavit Attached? Yes .......... No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner o the subject property,hereby authorize��r ce\k CnMrNpn / l ran yuc l�Yl
t act_on a alf,in all m re to work authorized by this buildmg'penntt applicafi n.
i
Print Owner's Name(Electr i Sign re) D to
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Icy. y a015
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass. og v/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
HED LION SMOKE SHOP, INC.
94 WASHINGTON STREET
SALEM, MA 01970
978-745-2050
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The Commonwealth of Massachusetts
Department of Public Safety
:\fassac huse l is State Building Cade(780 C\IR)
Building Permit Application for any Building o Ilan a One-or'I'wo- a»ily Dwelling
(Ibis Section For Official LXe Only)
Building Permit Number Uale Applied: ______ Bui1 gOfficial
' SECTION l: LOCATION(Please indicate Block R and Lot p fulflocatioefr ich street address is not available)
S '_— SA Le,A, P..4_ J Reg L,,,n� .Sr,.ohG Tb"o
No aunt Street City /Town Zip Code Name of Built inl;(if.Ipplicable)
SECTION 2: I'ROPOSEU ORK
Edition of MA State Code used_— If New Cunslrucliun check here❑or check all that apply in the two rows below
lixi.vlinl; Building❑ [?,pair❑ 1 Alteration 0-- Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
;1rc building plans and/or Construction d,k uments being so ppl Jed as part of this permit application? Yes ❑ No O --_
Is an Independent Structural Engineering Peer Review royuired? Yes ❑ Nu ❑
Brief Description of Proposed%Vork:.L� r.JaF /o v-rr 'r 3"C-1 7TL.
SECI'ION 3:COMPLETE'Tms SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 C\IR 14) O
Existing.Use Group(s): —_ Proposed Use Group(s): _
SECTION 4:'BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq. ft.)
Total Area(Ski. ft.)and Total Height(ft.)
SECTION S: USE GROUP(('heck as a licable)
A: Assembly A.1 ❑ AQ❑ Nightclub ❑ A-1 ❑ A4 ❑ A-i❑ B.- Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: Hi h Fiaz,ud H-I ❑ H-2❑ 1-I-1 ❑ 11-a❑ 11-i❑
I: Institutional I-I ❑ IQ❑ 1-1❑ I-1❑ ,�I: Mercantile❑ R: Residential R-10 R-?❑ R-,\❑ li--{ ❑
S: Storage 5-1 ❑ S-2❑ Ur Utility❑ Special Use❑and please describe below:
.. Special Use
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ tL ❑ JIB ❑ 1111110 FIB ❑ IV ❑ VA ❑ \'11 ❑
SECTION 7:SITE INFORMATION(refer to 780 CJIR 111.0 for details on each item)
Water Su p ply: Flood Zone Information: Sewage Disposal: French Permit Debris Rcuuw al:
Public❑ Chock if outside(load Zone❑ Indicate municipal ❑ A trench will not be Licensvd Disposal Site❑
I'm ale❑ or iodentik lour: or on silt s\stem❑ reyuir,d ❑or trench or specify:.____. -
. permit is CnCl09ell❑
Railroad right-of-way: Ilaiards to Air Navigation: `1 ' i:: 1L , ' . ..:.,,I., :. ,.
Not Al'I'licablo❑ Is 91n,c lure within airport approach area? Is lheir r,•y i,•,v,omplclod'
ar Con.ent to liudd enc lu.ed ❑ 1 es❑ or.No❑ Yvs❑ .No ❑
SI[CT ION H:CON'ITNT OF CFRl IHCA I E OF OC'CLPANC'Y
I dilian A C,nle. _ . ".. l'.r Gn,uplsl: - - 1\pe of Construction: lh cupant Load Par I I....
to,. the building;contain ao pl,rmklvr SN Wm'. - tipeCi,d >Iipulatione:
e
SEC"IIONY: PROPER I OWN ERA Ul"IIOI4IZA'P[ON
Name,md Address of Property(honor
RcZ�_ tea t_7--No
L U L . _°1`1 `_Si . =-��1 --��
N,ime(Pearl) No and Street Cityj TopGn Zip
propertyy�Ow1ner Contact Information:
tl l•ML �b� __ �L7S-��1_�' '�a-� M•At /Gi-L.9n
I"ills telephone No. (business) -Telephone No. (cell) C-mail address
If.applicable, the property owner hercbv authorizes "-
----- Street Address city/town State Zi
Name Y/ Pr
to act on the property owner's behalf, in all matters relative h)work authorized by this building permit a p plication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
if building is less than 35,000 cu.ft.of enclosed s pace andl or not under Construction Control then check here O and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
to
Name (Registrant) Telephone No e-mail address ,Registr ion Number
Street Address City/Town State Zip .Discipline Expiration Date
10.2 General Contractor
n2,gF�� SQri'�¢•r Sac
Con parry Name
0s4 -f 3
Name of Person Responsible for Construction License No. and Type if Applicable
Ss (L p'lA;k-- - QA� - 004
Street Address 1ty/Town State Zip
9L� S3L � 6f ; -sus - 63`ln °�/rs P.t r�aF, C��
Tole phone No. business Telephone No. cell - n& ail address
SECTION 11:�)', ytti,i.[:�, ( (_)yrl1 Ni,.\I It p.\_I,NId iq,\_\i r AH 11".1 '1 M.G.L.c.152.§ 25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the is uance of the building permit.
Is a signed Affidavit submitted with this a lication? Yes No ❑
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and \lateriais) Total Construction Cost(from Item 6) 5_
1. Building 5 Building Permit Fee-Total Construction Cost x_(Insert here
2. Electrical S- appropriate,municipal factor) -$
3, Plumbing S
1. \lechanical (HVAC) S Note: \linimum fey 5__(con Lrct mwaicipalily)
3. \Icchanical (Other) I S Enclose ihcck parable hp _
h. rotal Cost $ 'a f 3� Q— (contact municipalih')and write check nundmr here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I hercbv attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the best of my knowledge and understanding.
-bA✓_L.._r �_�'^ _ Pits
I loose pri at ood .ign n.une I itle I Olrphone No. D,alc
n
�trvct Address nr/ Paton Mate /ip
I
\tunicipal Inspector to fill out this section upon application approval:
--Nome _. .._ 11nd----
What is the current use of the Building?
Material of Building? B dwelling,how marry un'ds?
Wilt the Building Conform to Law? �`� Asbestos?
Architect's Name
Address and Phone ( )
Mechanids Name >1
i�k '�d (�tx��h3 fY1C �1Gb�
Address and Cons Phone
isors License tt ,— L2` HIC Registration X
CO
Estimated Cost of Project S ��S�� - Permit Fee Calouladon
Permit Fee S Estimated Cost X$7/57000 Residential
- - Estimated Coat X ill/$1000 C Wnerolal—-—---
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of perjury
Date a5 b
3 �
N
e u a p
# O 9 V
loft CITY-OF-
PUBLIC PROPERTY
DEPARTNIENT
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&UXK Nnttnall:sti'rIS 01970
TU--97 US•9S"•FAX M740.9W
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING]
STRUCTURE OR BUMDIN
1.0 SITE INFORMATION
Locadon Name: p Building:
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Property Address:-- - --- __ -- --- - -- ---
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Property Is located In a;Conservatlon Area YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land ✓t
Name: fy1 \b
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation LA
Renovated
Change in Use New
Demolition Existing
Approximate year of Renovated
construction or renovation
of existing !wilding New
Grief Description of Proposed Work:
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-- — - --Mail Permit to:
,QED LION SWIKE SHOP, INC.
D4 WASHINGTON STREET
SALEM, MA 019M
NO 745-20W
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RED UON SW KE SHOP, INC.
84 WASHINGTON STREET
&LLEM, MA 019M
008 745-2050
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