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3 WITCHCRAFT ROAD - BUILDING JACKET 3 Witchcraft Rd. i Na City of Salem Ward 7 00 r yr 4hoe<vd APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT•Applicant to complete all items in sections:1, ll, /it, IV,and IX. I. AT(LOCATION) 3 ���� C LZdF7� R� DISTRICT LOCATION !� NO' OF BETWEEN Iy S mT n �� AND LI�GC.�C SIJ BUILDING //q C{RO�SS STREE (CROSS STREET) SUBDIVISION .S SIZE �� LOT LOT © BLOCK 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 Residen Nonresidential 2 ❑ Addition(it residential,enter number of new 12 One family 18 ❑ Amusement,recreational /rousing units added,it any,in part D, 13) ❑ 13 ❑ Two or more family-Enter number 19 Chruch,other religious 3 ❑ Alteration(See 2 above) of units ................................................ . . 20 ❑ Industrial 4 Fg" pair replacement 14 ❑ Transient hotel,motel,or dormitory- 21 ❑ Parking garage Enter number of units ........................... 22 ❑ Service statron,repair garage 5 ❑ Wrecking(tl multifamily residential,anter 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 E] Stores,mercantile B.OWNEASHIP 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, parochial school,parking garage for department store,rental 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 in the above cost a. Electrical............................................-...._....................... r b. Plumbing.......................................................................... c. Heating,air conditioning.........._._............................. d. Other(elevator,etc.)..................._................... ............ 11. TOTAL COST OF IMPROVEMENT 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 ff Public or private company Will there be central air 31 WWood frame 36 Oil41 ❑ conditioning? Private(septic tank,etc.) 32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 16No 33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY 34 ❑ Other-Specify 39 42 V Public or private company 46 there es an elevator? ❑ Other-Specify 46 ❑ Yes 47 TffNo 43 ❑ Private(well,cistem) , J.DIMENSIONS MDEMOLITION OF STRUCTURES: 48. Number of stories ........_.__..............................._..... M......_ 49. Total square feet of floor area, all floors,based on floo(exterior Has Approval from Historical Commission been received a dimensions ...................._.............................._.............._.. for any structure over fury(50)years? Yes_ No_ 50. Total land area sq.ft........................................__ _ Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed ......................................................................... HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? 52. outdoors..............._..._............................................_..... 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# 03C/OG Salem License# ?- Home Improvement Contractor# 1 XIrIg Homeowners Exempt form(if applicable) Yes_ No—/ CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT CONSTRUCTION IS TO BE COMPLETED BY: If an extension is necessary, please submit in writing to the Inspector of Buildings. V. IDENTIFICATION • To be completed by all applicants Name Mailing address-Number,street,city,and state ZIP Cade Tel.No. O V� Owner or Lessee 2. J�r/�o / Contractor Builcers License No. 3. Gr 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 wq�jagree to conform to all linable laws of this jurisdiction. Signature of a ica tAdd At do at v DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building �! Permit number FOR DEPARTMENT USE ONLY CJJ Building Use Group Permit issued — 199y Fire Grading Building Permit Fee $ 'd, Live Loading Certificate of Occupancy $ Approved by: Occupancy Load Drain Tile $ ��� Plan Review Fee $ TITEEI NOTES AND Data - (For department use) a- -Q- ,-Q 4 t✓T-, VQ a a o0 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 oN o. js�D `Loon N ,4�t win'CX1cJ ��1 RC�t7h'� ecff}Sill�Ca4C .�=xrsr/ivG A,;K� ^ A - GLos — - - - c f114-k1 Mew ZLk�loll; I I I Exi�rlrv� � 'i I. I L