0003 BARNES AVENUE - BUILDING JACKET 3 Barnes Ave. +c.
CITY OF SALEM
BUILDING DEPARTMENT 181b SEP -b A 11: 05
120 Washington Street, 3d Floor, Salem, MA 01970
ABANDONED AND FORCLOSED PROPERTIES REGISTRATION FORM
PROPERTY INFORMATION
Address. 38ar/, S Parcel ID# Qo 1'3-(
Square Footage of Building: 1 o S Number of Stories:
Sprinkler System: Yes_ Nc.44Operational yes/no)
Pipe System:Yes No _ Operational yes/no)
Fire Detection System. Yes---140—(Operational yes/no)
OWNER(S)'OF RECORD (*attach additional sheets if necessary)
Owner: -94?-A LLAhas
Address: )r>1 7-Lf OL I Mf% 4 as Lk� qff All 6
Tel. No.: E-mail:
CONTACT PERSON/REGISTERED PROPERTY MANAGER
Name: Aja+lk )0+hv\
Primary Address (No P.O. Box) c,,d G,-Ctk (4LLU�,,e ,�.blf 2S
Business Tel. 6o Non-Business Tel,#:
E-Mail Address:
Emergency Telephone#- 24hr/day fo�-J!'S 2-- &Zo
IS THE PROPERTY LISTED FOR SALE?Yes No
If yes, Real Estate Agency
Address- Tel. No.
VACANT BUILDING PLAN: Please check which-applies.
1. . The building is to be demolished'.
2. _The building is to remain vacant.
3. The building is to be returned to appropriate occupancy or use.
SIGNATURE OF OWNER(S)/OWNERS AGENT:
DATE:
REGISTRATION FEE $300 Cash/Money Order/Cert. Bank Check
CITY OF SALEM
�
SCHEDULE OF DEPARTMENTAL PAYMENTS TO TREASURER
1 � �It
Department Name ' , SQ 4G Date Q
Department# ` Fiscal fear 9/10 Form#
FROM WHOM ACCOUNT NUMBER&DESCRIPTION AMOUNT TOTAL
1 �
Total 9/10 Comprised of:
Cash:
Checks:
TOTAL DEPOSIT
- -------- -------------
THE COMMONWEALTH OF MASSACHUSETTS,DEPARTMENT OF CORPORATIONS AND TAXATION,BUREAU OF ACCOUNTS
Noaa 204
To the Department Officer making the Payment: I
Received of ( 1�E.`�l,��C� ��[n F]lpll^f�A the sum of
Dollars,
for the collections from -te-".et�L Z" Doi to for
collections as per schedule of this date,filed in my office.
Treasurer Treasurer
Hl,.N,'C'2,N614,11
Plans must be filed and approved by the Inspector before a permit will be granted.
i �
No' ` /j
71 City of Salem Ward_
F! -
A X
Home Phone # 74(5-g ) V7
Bus. Phone # 7'#O --' o'M
APPLICATION
FOR
PERMIT TO INSTALL A SOLID FUEL BURNING STOVE
Salem,Mass.,
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby apRlies for a permit to build according to the following specifications:
Owner's name and address P'2rte`, J "mac.. k iQ-k�—
Architect's name 0 P W E vig�,9_yCt "'9 e5
Mechanic's name and address V
Location of building,No. -3 '�ceCt.C.7 'L S a LJ e-
What is the purpose of building? _�u'S--
Material
Material of building? _ (k- ooc�
If a dwelling,for how many families?
Will the building conform to the requirements of the law? ¢-.5
Estimated costont rs c.No.
Signature of applicant
C �� ' 6V REMA KS
f �
�S
Na.��� Vvazd
APPLICATION FOR
PERMIT TO INSTALL A
SOLID FUEL BURNING STOVE
Location
PERMIT GRANTED
APProve
/o ccs./ ilding 1spe�ctor