2082 WASHINGTON STREET - BPA-1994-554 CONVERT 2ND FL 282 Washington St. '
i
City Of Salem Ward
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n ,y
Pest dd
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT--Applicant to complete allitemsin sections:1, It, 111, IV, and IX.
I. AT(LOCATION) `�'� � N 1 – DISTRICT
Ef
LOCATION (NO.) (STREET)
OF BETWEEN AND
(CROSS STREET) (CROSS STREET)
BUILDING LOT 6 3, 66
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(It residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational
housing units added,d any,in part D,13) C] 19 E] Chruch,other religious
13 Two or more family-Enter number
❑3 ld Alteration(See 2 above) of units ....................................................... 20 Industrial
21 ❑ Parking garage
4 ❑ Repair replacement 14 ❑ Transient hotel,motel,or dormitory-
Enter number of units ........................... 22 E] Servicestation,repair garage
5 ❑ Wrecking(It 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 c� 25 [:] Public utility
7 E] Foundation only Other-Specify �OI�V4 t � 26 E] School,library,other educational
17
`r— 27 ❑ Stores,mercantile
B.OWNERSHIP � 1,10lgoKO
a 28 ❑ Tanks,towers
8 ❑ Private(individual,corporation,nonprofit /
institution,etc.) fp 1, etr"�rnr"./J7- zs ❑ char-specny
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,
000 parochial school,parking garage for department store,renal office building,office building
10. Cost of improvement ......................................................... $ at industrial plant.If use of existing building is being changed,enter proposed use.
To be installed but not included //i/
in the above cost 30O Ct��»'n+l� �iAll t��f IS I Sj- 40.6,
a. Electrical........................................................................... ,.nW
b. Plumbing.......................................................................... HD 4W 91 4J 6W Ala-
c.
1 /QOc. Heating,air conditioning............................................. 2 N1) ,4d.- ( 1I
d. Other(elevator,etc.)..................................................... Q
11. TOTAL COST OF IMPROVEMENT $ ✓
" 000
111. 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 JZ 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 48 ❑ Yes 47 ❑ No
43 ❑ Private(well,cistern)
l
J.DIMENSIONS 3 M. DEMOLITION OF STRUCTURES:
48. Number M stones ............................................................
4e. Total square feet of floor area, Approval all floors,based on exterior Has pp oval from Historical Commission been received
dimensions ........................-................................. for any structure over fifty(50)years? Yes_ No_
so. Total land area,sq.ft..............63.I'.8 Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed ........................._.........................................
........
^ /s HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
sz. Outdoors........................11... Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed ..................................... .......................... Electric:
Gas:
54. Number of Full....._...J........................ Sewer:
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial-----------.`---` BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ Nom` (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_ No (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes_ No (If yes, submit documentationAf 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.
immsokaa0 9/ lc/~ AL4 AVP. Mau" Mr9-a- 01 95T 617-5y3-IYS
Owner or
Lessee
2.
Contractor
Builder's
License No.
3.
Architect or
Engineer
I hereby certify that the proposed work is authorizeo by the owner of record and that I have been authorized by the owner to make this application
as his authorized a ent and we agree to CorA6rmA aYapplicable laws of this jurisdiction.
Signature of applicant O Gh/ Address (.j/ /1 „ /J Appli tion date
l' i /� !1
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19
'\ �J Fire Grading
Building
!!I
Permit Fee $ �L W PJ Live Loading
Certificate of Occupancy $ Approved by: Occupancy Load
Drain Tile $
Plan Review Fee $ ff
TITLE
NOTES AND Data • (For department use)
i�
PERMIT TO BE MAILED TO: 9
DATE MAILED:
Construction to be started by: Completed by:
l
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN -For Applicant Use
O N