29 WINTER STREET - BUILDING INSPECTION 29 WINTER STREET _ �,
�o FIELD COPY
CITY OF SALEM BUILDING
SALEM, MASSACHUSETTS 01970 PERMIT
VA LIDA.T IDN .
•4ED"
DATE March 2. 19 93 PERMIT NO. 59-93
APPLICANT Brendan (N1Pary ADDRESS (1tTinF�TTFMA_ 1355 _
(MO.I I5111([tl ICONIF'S .I(ENSEI
NUM
PERMIT TO REP-T'�IRSf (_I >TORV DWELLING OWER OF
LRING UNITS ??r
Ilv( 0• IM,KOV(MENTI N0. - IPPO,OSED USE' -
AT ILOCPTIONI 29 WINTER STREET WARD 2 ZONING R-2
DISTRICT
'(X0.1 s IS\gETI
BETWEEN AND
IC.05. STREET) ICPOSS STPEEI)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING ISJO BE FT. WIDE BY FT, LONG By FT. IN "EIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
y ITr Plj
REMARKS: Instal wall & two egress doors "" CALL FDR.INSPECTION 745-9595"
INSPECTED APPROVED BY DAT ARA ORp
PER
IOL UME ESTIMATED COST 900.00 FEE MIT
S 20.00
:C':PIc SOOAAE FEE
DWNER T73chinc;tnn Gr1 aro M Tn ¢i-
i•nORESS 2.2 i7 dchi at sq. No salim'MA
INSPECTOR OF B ILDINGS
INSPECTION RECORD
DATE NOTE PROORESS - CRITICISMS AND REMARKS INSPECTOR
No. City of Salem Ward 2
� x
�(U}' APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:I, Il, ill, IV, and/X-
Q
I. AT(LOCATION) 1 ICJ 1 .1-1e L S / D STRICT o`
LOCATION (NO.) (MEET) n p/2/ —/
OF BETWEEN CO �.A.5 IIrM S �r^ SC1 // U AND A& ( �` k -S/
BUILDING (Cl BTREEO CROSS LTORTE
SUBDIVISION LOT BLOCK SIZE
11. 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
(rousing units added,it any,in part D,13) 19 ❑ Chruch,other religious
13 ET.or more family-Enter number
3 3 Alteration(See 2 above) of units ....................................................... 20 ❑ Industrial
21 ❑ Parking garage
4 E] Repair replacement 74 ❑ Transient hotel,motel,or dormitory-
Enter number of units ........................... 22 ❑ Service station,repair garage
5 ❑ Wrecking(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.OWNERSHIP 28 ❑ Tanks,towers
8 E]-Private(individual,corporation,nonprofit
i 29 ❑ Other-Specity
institution,etc.)
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,
10. Cost of improvement --------"---"" $ U�y parochial school,parking garage for department store,rental office building,office building
at industrial plant.If use of existing building is being changed,enter proposed use.
To be installed but not included p
in the above cost
a. Electrical...........................................................................
b. Plumbing..........................................................................
c. Heating,air conditioning.............................................
d. Other(elevator.etc.).....................................................
11. TOTAL COST OF IMPROVEMENT $ r/ r
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. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL 1. 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 ❑ No
33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator?
34Other-Spec'd1' 39 Other-SPec Specify 42 ❑ Public or private company
❑ ❑ 46 ❑ Yes 47 ❑ No
43 ❑ Private(well,cistern)
f
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
48. Number of stories ............................................................
as. Total orsquare, sed on exte area, Has Approval from Historical Commission been received
all Boors,based o f exterior
dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No
50. Total land area,sq.B. .......... Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed .......-....................................................................
sz. Outdoors..........................
HAVE 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)
1
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# nS 7 y2 S Salem License#
Home Improvement Contractor# omeowners 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: v/31 " 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
/_ s �d . l��s S ✓10 fy )d 50 �-
Lessee u s 7- S l 4 , o� 7 °
2. �`C�� 9' s7-
Contractor Builders
�- —7'21e--t_ 6"?/ 21 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 But hoqized agent and we a ree to conform to all applicable laws of this jurisdiction.
Si ure of a li nt
Address ^ A pli tion date
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building —O 'L� ? FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued ^� 19
Fire Grading
Building
Permit Fee $ a U Live Loading
Certificate of Occupancy $ Approved by: occupancy Load
Drain Tile $ —
Plan Review Fee $
/ TITLE c
NOTES AND Data-(For department use)
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by: Completed by:
l
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
i
SIDE YARD SIDE YARD
i
REAR YARD
NOTES
SITE OR PLOT PLAN •For Applicant Use
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COMMONWEALTH OF MASSACHUSETTS
F� DEPARrMEN'T OF INDUSTRIAL.ACCIDENTS
k
600 WASHINGTON STREET
,lames J Camooeu BOSTON, MASSACHUSETTS 02111
-omm:ss one- WORKERS' COMPENSATION INSURANCE AFFIDAVIT
], Egf ) A- Lzz 7
(licenses/perminee)
with a principal place of business/residencc at:
-� ACLS -s—/ �o (4 u W g E1/
(City/State/Zip)
do hereby certify, under the pains and penalties of perjury, that:
[ J I am an employer providing the following workers' compensation coverage for my employees working on this
job.
Insurance Company Policy Number
[ J I am a sole proprietor and have no one working for me.
I[� I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below
who have the following workers' compensation insurance Policies:
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
[] I am a homeowner performing all the work myself.
NOTE: Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a
dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto arc not generally
considered to be employers under the Workers' Compensation Act(GL C. 152,sett. 1(5)), application by a homeowner for a license
or permit may evidence the legal status of an employer under the Workers' Compensation ACL
I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of Insurance for coverage
verincation and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to $1500.00 and/or imprisonment of up to one year and civil penalties in the form ON Stop Work Order and a
fine of 5100.00 a day against me.
Signed this a�J day of � 1922L /J
0 �Lw
Licensee/Permittee Licensor/Permirror
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