7 ASH STREET - BUILDING JACKET
No. a5� - 3 City of Salem Ward 1),
4�4aMF
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:I, ll, 111, IV,and IX.
ZONING S
I. AT(LOCATION) "oDISTRICT
LOCATION .) MEET) _
OF BETWEEN �� r dQ Q AND � s
OSS STREET) (CROSS STREET)
BUILDING LOT
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(If residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational
housing units added if any,in part D, 13) 19 ❑ Chruch,other religious
13 E] Twoor more family-Enter number
3 ❑ Alteration(See 2 above) of units ....................................................... 20 E] Industrial
21 E] Parking garage
44 Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 22 ❑ Service station,repair garage
Enter number of units...........................
5 [:] Wrecking(H muttifamity residential,enter number 23 E] 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 Private(individual,corporation,nonprofit
29 ❑ Omer-specify
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,
. .n�ri1^eo parochial school,parking garage for department store,rental office building,office building
10. Cost of improvement ................
IJJ/ -.-...-..-.-.-.---.-.---- $ (/L�r/ at industrial plant.R use of existing building is being changed,enter proposed use.
To be installed but not included
in the above cost
a. Electrical................................................................. 029L70
b. Plumbing............................................................ dv Its
c. Heating,air conditioning.............................................
d. Other(elevator.etc.)..................................................... Q'/J�g��
11. TOTAL COST OF IMPROVEMENT- $ /l ' � '� ev
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 dMasonry(wall bearing) 35 ❑ Gas 40 Public or private company Will there be central air
31 Wood frame 36 Oilconditioning?
41 E] Private(septic tank,etc.)
32 ❑ Structural steel 37 ❑ Electncity 44 ❑ Yes 45 BIN.
33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 42 ErPublic or private company 46 ❑ Yes 47 Min
43 ❑ Private(well,cistern)
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
48. Number of stories ............................................................
49. Total squors,b fed of floorarea, Has Approval from Historical Commission been received
all floors,based o f exterior
dimensions ......_................................................................ for any structure over fifty(50)years? Yes_ No
50. Total land area,sq.a .......................... 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 applica' ns? Yes_ No
Is property located in the S.R.A. 'strict? Yes_ NOV
Comply with Zoning? Yes No (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes_ No (If yes, submit documentation/if no,sub9i1foard of Appeal decision)
If new construction, has the proper Routing Slip been enclosed? Yes_ No_
Is Architectural Access Board approval required? Yes_ ��N//o (If yes,submit documentation)
Massachusetts State Contractor License# d_ (� Salem License# (-) 6-0
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.
Owner or
dl X70 7�i163
Lessee
2 r
Contractor
Builder's
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.
Signature of applicant Address Application date
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 1g
Fire Grading
Building
Permit Fee $ 3. U Live Loading
Certificate of Occupancy $ Approved by: Occupancy Load
Drain Tile $
Plan Review Fee $
TITLE
NOTES AND Data-(For department use)
PERMIT TO BE MAILED TO:
DATE MAILED: �g 3
Construction to be started by: C 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
faT'IE. -
�ap
CERTIFICATE ISSUED
Q DATE September 2, 1993
1' CITY OF SALEM
SALEM. MASSACHUSETTS 01970 BUILDING PERMIT -
.�c,m CERTIFICATE OF OCCUPANCY
(���.(.�,� � DATE. july.19 19 93 PERMIT NO. X56-93
APPLICANT Addition ADDRESS
�5��.�..1 L.��f. 1110.1 If TR LLTI IC4N1+•5 LICCNf(I
OF
PERMIT TO
(Se--odel bath I_1 STORY DWELLLRING UNITS
' 111 P( OE IMPAOV(ML M11 NO. � IMIOPOS(D YfE1
y 7 �t Wtrd 2 ZONING —
AT (LOCATION) l_ _ DISTRICT_
INOl1"'' @1P((TI
BETWEEN AND
-CROSS S1R((TI (CROSS f111CR1
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE �.� (T. WIDE P• ET. LONG BY ET. IN HEIGHT <ND SHALL CONFORM IN CON57RUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
IirPEI
Remodel riz10 bath
REMARKS!
_cBy Dew
- - � - L , (p��B�fl( lllllll oil
AREA OR V(N,
VOLUME —
o-.flc.SQUIRE F(nl SRW(,
T,`� TZl1l8S0•1 srrlor(IsrNswloeYlseYlrwlse'r,sr•lloclloewo�lsrr,s_S srrloe'Ne
Nam
OWNER (. - F,0 BET P_q�7�D__��111��1PR EMISES
Z'� LJ(.+ .7d.lt?I[iFl3ti+ SEE 11tV�h5 EV91or ioM160syilR•IDNS OF CERT IFICAiE
ADDRESS
BUILDING
PERMIT
JOB WEATHER CARD
DATE •I''•I / - 19 PERMIT NO. 3'C
=� "J3Ct
APPLICANT L....... ?YY$1LJ.HCl ADDRESS
1x0.1 IS1RCEi1 ICORTR•S LICENSE-
PERMIT TO A.", ,'Iy' I_I STORY NUMBER OF A
DWELLING UNITS
-TYPE 0E IMPROVEMENTI 40. (PROPOSED USE)
AT (LOCATION) Jt• :-L rrl ZONING •��
• (X0.) ISTREETI DISTRICT
BETWEEN AND
ICROSA STREET) (CROSS STREETI
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BV FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
ITYPEI
REMARKS:
Call for Permit to Occupy
AREA OR �Mxt)SJW Ru FEE
C .IJPV�
VOLUME ESTIMATED COST J
C'JSl CJSOUARE FEET)
OWNER �'ciC:`5?T. l':L'.Fi.'1�1i�i►1{ _ J �9
/ .{i1 �IYP wA.AALA?Z:IACS3R BUIl09BV: N1• .:t?'••01.j.�:(LT.Ri
AOOPE53 By
TNI$ PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET. ALLEY OR SIDEWALK OR_ INSPECTOR OF BUILDINGS
ANY PART 711EPEOF. ETHER TEMPORARILY OR
Poo. PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPE f.IFICALIY PERMITTED UNDER THE BUILDING CODE. MUST BE AP-
PROVED BY THE JUR ISD-CTIO N. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE.OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CO_ppJ TIONS
OF ANY APPLICABLE SUBOIV ISI ON RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR AFRMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORN: CARD KEPT POSTED UNTIL FINAL INSPECTION NAS BEEN ELECTRICAL, PLUMBING AND
I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
E. PRIOR TO COVERING STRUCTURAL QUIREO,SVCH BUILDING SHALLNOT BE OCCUPIED UNTIL
MEMBEPS(REAOY TO LATH). FINAL INSPECTION HAS BEEN MADE,
3. FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSECTt N APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
2 �� 2 �' z
POARD<'F HEAL GAS INSPECTION APPROVALS FIRE DEPT. INSPECTING APPROVAL$
11A 1
�c I
OTHER CITY EN N R 2 - Z
/u/
WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARO
INSPE: JR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE
STAGES of CONSTRUCTION. PERMIT 15 ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION.
v BUILDING
PERMIT
JOB WEATHER CARD
DATE .l i.;Ir' 1 19 PERMIT NO.
APPLICANT tYYSI.S.-'+.'vEl ADDRESS e'50
(M0.) (STREET) (CONTR'S LICENSE'
PERMIT TO _1 STORY NUMBER OF
DWELLING UNITS
ITTPE OF S�IM�PROVEMENTI NO. (PROPOSED USE)
AT (LOCATION) `Yx! St. ZONING
(N0.) (STREET(
BETWEEN AND DISTRICT
(CROSS STO[E T)- (CROSS STREET)
LOT
SUBDIVIS IOM LOT BLOCK SIZE
BUILDING IS TO BE FT, WIDE By FT. LONG BV FT. IN HEIGHT AND SMALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE(
E�A"s :YY:e.t LAC? Tjan
REMARKS:
,.:il4L.'>tc'Y.:";.7.r,K] ? ?t?T]Y'1Ji'C!i ^' . ��♦
call for Permit to Occupy
p
AREA OR ZlFJW.�i1.� PERMIT S San MJ
VOLUME ESTIMATED COST
[1 -C 9lIU SO V<RE FE[il
OWNER 46C1'1ZL':. r:L�w.`)Bkd11
ADDRESS
.�611x kit. S3#.A'rl na. BUILDi8d_.WRj. ..Ct.'1,jjjt.TS
INSPECTOR OF BUILDINGS
THIS PERMIT CONVEYS NO RIGHT 10 OCCUPY ANY STREET, ALLET OR SIDEWALK OR ANY PART TIIEREOF. ETHER TEMPORARILY OR
►
PERMANENTLY, ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-
PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED
FROM THE DEPARTMENT OF PUBLIC-WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE COtGUTIONS
OF ANT APPLICABLE SUBOI VISI ON RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION MAS BEEN PF RMITS ARE REQUIRED FOR
ALL CONSTRUCTION WORK: ELECTRICAL. PLUMBING AND
I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL OUIREO,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL '
M (RE TO LATHE FINAL INSPECTION HAS BEEN MADE.
). FININAALL INSPECTION BEFORE
OCC UPANC T.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSECT) N APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
;/C�
FOARD 1'F HEALj/ GAS INSPECTION APPROVALS FIRE DEPT. INSPECTING APPROVALS
1 1
2
1
OTHER CITY ENJ31NEJER Q 3
N1 —I /:�<\ I
WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARO
INSPE: DR NAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE
STAGES 31 CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION.
The Commonwealth of Massachusetts
i, Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 730 CMR SALLM
.I _
Building Permit Application To Construct, Repair. Renovate Or Demolish a HrriseJ Gu 'fll/
One-or Ttvo-Fami1v Dtrrllb{e
This Section For Offic'• .Use Onl
Building Permit Number: Dal Applied:
Building Oltkial(Print N:unc) V `
Signature Date
SECTION 1:SITE INFORMATION
1.1�operty S ryss: 1.2 Assessors Map& Parcel Numbers
1.la Is this an accepted street?yes no_ N6,p Number Parcel Nuinh r
1.3 Zoning Information: 1.4 Property Dimensions:
inning District Proposed U e Lot Area(sq It) Frontage(a)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check ifcs❑ Municipal❑ On site disposal s)stcm ❑
SECTION2: PROPERTVOWNERSHIP'
2.1 O)vner�of Bee
iy S, k,/ ` 2
N; o 2 P rr /7A
City.State,ZIP
��So�Yrr 3 7
No.onJ Street Telephone Emuil Address
SECTION 3: DESCRIPTION OF PROPOSED WORK`(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Ot er ❑ .Specify:
Brief Description of Proposed Work: �'erz CJ d 0
!2 Ri r .
AA
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and .\laterials) Official Use Only
I. Building S I. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical 5 ❑Standard City?own Application Fee
❑Total Project Cosh(Item 6)x multiplier. Plumbing 5 ?. Other Fees: S _ __ x --- -_
4. \Ixhanical 1111" 1('1 S List:_.____ /-
5. .\leclianical I Fire
Suppression) 'total :\II Fees:
--
�!v. Total Project Cost: 5 2(( Check No. __('heck Amount: _ -- — ('ash .\mount: _ -
�/ ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: C'ONSTRUcriON SERVICES '
5.1 Construction Supervisor License(C'SL) ff
d e ,P License Nwuhar I �piralion Uule
Nmnc of C'SI. I)older
�r List CSI.'I\pc(see hclowl
I.%pe Description
No. .111J Street
/ (i I hlmtnetcJ(Buildings u'p to}S,OnO eu. Il.l
R Restricted Ia? Famill Dtwllin
C ll\'I foP n,.Slate.LIP M1I M1lasnnr
RC Rooting C'uecrin
W'S Window;aid Sidili
SF Soli)Ivel Burning Appliances
.5-?,7 d:56 5>4 315 I InuJution
Icic hone 1(111ail address D Demolition
5.2 Registered Home
7 L &ImprovementttContraactttorr(HIC) i3 1A0 �—aZ�
.Z-ttll Pn Gap zf I- I IIC Rcgistru� wn Number lispirniun Date
I IIC'Company Nano or HIC Re tat it Nam
No. and �G a 66�5 Entail address
City/Town. Slate.ZIP!� rAe hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.1 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... O No........... O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Nmne(Electronic Signature) Date
SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION
By entering tiny name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true a ate to the best of my knowledge and understanding.
Print Owner's or:\u n thorcd Agents Nmne 1 . e runic.Sign;nur¢1 Date
NOTES:
I. An Owner who obtains a building permit to do his.her own work,or an owner who hires an unregistered contractor
(nut registered in the Hume Improvement Contractor(HIC) Program),will 1 have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at
„N%\% nl•t,, of •v.t Information on the Construction Supervisor License can be found at ml
2 When substantial work is planned, provide the information below:
Total floor arca(sq. ft.) _ (including garage, finished basement"attics,decks or porch)
Gross living area Isq. 11.) ---- _ Habitable room Count
\umber of fireplaces._-_ -- Number of bedrooms
Numher of bathrooms -_ Number of l)alf ballis
Number ol'Jecks, porches
l\pC I CJUhllg mile lit _ - Lncloscd _ Open .
3. "foi,il Project Square Footage-loaw he iuhititutcd tiff''Ibtal Project Cost'