74 WHALERS LANE - BUILDING INSPECTION f
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74520 40% P4
Commonwealth of Massachusetts
��ONaly�
9' City of Salem
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a ' 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595x5641
PERMIT REPORT BY ADDRESS
Address: 74-U126A WHALERS LANE
PIN Permit For Parcel ID Occupancy Type Building Type Work Description Construct. Fee Paid
Cost
TE-16-1541 Lighting Retrofits 12-0003 Residential Single Family Condo REPLACE TWO(2)EXTERIOR 0 15
FLOOD FIXTURES FOR
RETROFIT PROGRAM
G-17-28 Remodel and Repair 12-0003 Residential Single Family Condo 1 VENTED GAS LOG SET 0 20
P-15-237 1 Plumbing Fixture 12-0003 Residential Single Family Condo 1 METER 0 . 0
Total Permits: 3 0 35
1 oft
No. /y 9 City of Salem Ward 3
� x
o-
� l 9
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1,�11, ill, IV,and IX.
I. AT(LOCATION) ? ! ' L L /Y DISTRICT
✓ rk
LOCATION (NO.) (STREET)
OF BETWEEN AND
(CROSS STREET) (CROSS STREET)
BUILDING / , 1j LOT
SUBDIVISION� /�/i 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 t0,One family C'(y/�C (9 18 ❑ Amusement,recreational
housing units added,it any,in part D,13) 19 ❑ Chruch,other religious
13 ❑ Two or more family-Enter number
3 ❑ Alteration(See 2 above) of units ....................................................... 20 ❑ Industrial
21 ❑ Parking garage
4N.Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 22 ❑ Service station,repair garage
Enter number of units .......................
5Wrecking(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.ORSHIP 28 ❑ Tanks,towers
8 Private(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,
/ n� parochial school,parking garage for department store,rental office building,office building
10. Cost of improvement ......................................................... $ G' 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...........
.......
..L........._..¢ �..S...(.rY.4 G
b. Plumbingt /•,
c. Heating,air conditioning.............................................
d. Other(elevator,etc.)..................................................... .,
11. TOTAL COST OF IMPROVEMENT $ ( ,3
III. SELECTED CHARACTERISTICS OF BUILDING -For new bu dings and additions, complete Parts E-L; emolition,
complete only Parts J&M,all others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TY E F SEWAGE DISPOSAL I. TYPE OF MECHANICAL
lxl
30 ❑ Masonry(wall bearing) 35 Gas 40 Public or private company Will there be central air
/� conditioning?
31 Wood frame 36 ❑ Oil 41 ❑ Private(septic tank,etc.)
32 Structural steel 37 ❑ Electricity 44 KYes 45 ❑ No
33Reinforced concrete 38 Coal H. TYPE OF WATER SUPPLY
❑ ❑ Will there by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 42 g Public or private company
46E] Yes 47 ❑ No
43 ❑ Private(well,cistern)
J.DIMENSIONSM DEMOLITION OF STRUCTURES:
46. Number of stories . ......................
49. Total square based onfloor teriorarea, Has Approval from Historical Commission been received
a0 Boors,based on exterior PP
dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No
50. Total land area,sq.8....................................................... Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed ........-...................................................................
71"o I
52. Outdoors THE FOLLOWING UTILITIES BEEN DISCONNECTED?
............................................................................. Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed .........................._................................................ Electric:
Gas:
54. Number of
Full- .. Sewer:
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_ 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 # 6 J 1 - 9 7 L Salem License#
Home Improvement Contractor# j( 7— ® 223 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: Q ��S 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.
goIOwner or ,�
Lessee � )-7 2
z.
Contractor 'p o Builder's
1 license No.
3. ✓
Architect or
Engineer 3 /
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 o iGan Addressi Ap Ii t- d to
I
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building 11 1 _ (n� FOR DEPARTMENT USE ONLY
Permit number / `I /
Building Use Group
Permit issued 19 9
—� Fire Grading
Building ��
Permit Fee $ � �-a--a-�_ �d'� Live Loading
Certificate of Occupancy $ Approveby: Occupancy Load
d
E Drain Tile $
Plan Review Fee $
TITLE
1114
NOTES AND Data- (For department use)
t
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
O N
�1
_ y
Michael S. Dukakis v�{ufO Vivsmcwl A" ��
Governor Vn0 D'Qudsmanom JL" — .7 404 430!
Kentaro Tsutsumit ,17aaslow, A&MM"diya 0$108
man 18171 7_ -
curies J. Dim=
Admmatratar
MEMORANDUM
TO: All Building Departmenmwwte Building Inspectors
FROM: Curies J. Dieeao. Administrator
DATE Ocwacr 31. 1788
SUBJEC17. MGL can, S54. Added fly r5R4. 19 nr the net n( 19R7
The above-mentioned statute rcpuirck that debris resulting tram tile demolition. rcnovatt0n. rchnbilitatma
ut Olner 21MMllOn of a buddine or structure he disposed, of in a property ltcc=cu solid waste dttp0/11
iactlity as daftnml by MGL 6111. 5150A anis that Muting permits or iiccnsrs arc ai mdaam the loauoe
Of the lactttty at which the said, dchM a to he disposed. THIS REOUIREMENT DOES' NOT
,APPLY TO NEW rONSTRUC170N.
In order to sim0nfv the process and ut provide uniformity. we are attacntng a capv of a form whfeb y0o
can coker reproduce attd, use as it is stn¢the compicica form wall be alWcnW 10 the Otlicc copy o(butmag
permits or hectises: or reptoauce it On your tcttetmad.
In Glc of municipal.commercial.industrial.or muld•unit housing construction. Inc contractor mr hot kow
the dumpster subcontnaor at the time at the budding permit application. in such cases. the atlaeheN mpy
of an Affidavit can be used.
The complete taw is contained in the NOvemner issue of CODEWORD which will he mmlal 10 y0u in the
ticks two weeks. if van should have anv uucstlon. picase let us know.
UD/km
AFFIDAVIT
As a result of the provisions of MGL c 40, 554, I acknowledge that as a condition of Building Permit
Number all debris resulting from the construction activity governed by this
Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL
c 111, S 150A.
I certify that I will notify the Building Official by
(Two months maximum) of the location of the solid waste disposal facility where the debris resulting from
the said construction activity shall be disposed of, and I shall submit the appropriate form for attachment
to the Building Permit.
Date Signature of Permit Applicant
(Print or type the following information)
Name of Permit Applicant
Firm Name, if any
Address
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111. S
150A
The debris will be disposed of in:
(location of Facility)
Signature of Permit Applicant
Date