18 WILLOW AVENUE - BUILDING INSPECTION 18 WIIWW AVEME
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No.�g-3 rlc City of Salem Ward
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APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items inX.
tsections:I, Il, ill, IV,and I
I. i AT(LOCATION) �(, (%rte '0l.��JZ
ON
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LOCATION (RO.) (5MEU)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSSSTREET)
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(I/residential,enter number o/new 1 One family 18 ❑ Amusement,recreational
housing units added,it any,in part D, 13) 19 [-] Chruch,other religious
13 ❑ Two or more family-Enter number
-A ration(Sea 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 ❑ Wrecking(1/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
e Private(indiWdtl 1,corporation,nonprofit
institution,etc.) 29 ❑ Other-Specify
9 ❑ Public(Federal,State,or local government
C.COST (Omit cents) Nwesidential-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 .1.........�..fJ._v..o................. $ at industrial plant.If use of existing building is being changed,enter proposed use.
To he installed but not included
in
in the above cost
a. Electrical................ ...................................
b. Plumbing..........................................................................
c. Heating,air conditioning............................................ L
d. Omer(elevator,etc.).....................................................
11. TOTAL COST OF IMPROVEMENT $ V
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 1. TYPE OF MECHANICAL
30 ❑ Masonry(wall hearing) 35 ❑ Gas 40 ❑ Public or private company Will there be central air
31 ❑ Wood frame 36 ❑ Oilconditioning?
41 ❑ Private(septic tank,etc.)
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No
33Reinforced concrete 38 H. TYPE OF WATER SUPPLY
❑ ❑ Coal yWill there by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 42 ❑ Public or private company
46 ❑ Ves 47 ❑ No
43 ❑ Private(well,cistem)
I
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
4e. Number of dories ...............................
as. Total square featf er area,
all floors,based o Has Approval from Historical Commission been received
nezl xte
dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No_
50. Total land area,sq.ft.. ..... Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
i
51. Enclosed .............................................................................
. 52. Outdoors................................................................ HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed ............................................................................. Electric:
Gas:
j
54. Number of Full
Sewer: I
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial..................................-- BEFORE A PERMIT CAN BE ISSUED.
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IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No--t< (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)
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If new construction, has the proper Routing Slip been enclosed? Yes_ No_
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Is Architectural Access Board approval required? Yes_ No (If yes, submit documentation)
Massachusetts State Contractor License# 60 K9 1� Salem License (
Home Improvement Contractor# Homeowners Exempt form (if applicable) Yes_ No_ I
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.
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V. IDENTIFICATION - To be completed by all applicants
Name Mailing address-Number,street city,and state ZIP Code Tel.No.
1. 1 Gh
Owner or
Lessee
2.
Contractor Builder's 4
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.
Addr 4 c plicati n ,Q
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DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
BuildingJ� / FOR DEPARTMENT USE ONLY
Permit number /`Y /
Buildingp use Group
Permit issued — 19 9.3
/ i Fire Grading
Building
Permit Fee $ / D� Live Loading
Certificate of Occupancy $ Approved by: Occupancy Load
Drain Tile $
Plan Review Fee $
TITLE
NOTES AND Data-(For department use)
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PERMIT TO BE MAILED TO:
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�! DATE MAILED:
4 Construction to be started by: Completed by: P
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VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES t
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SITE OR PLOT PLAN •For Applicant Use
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