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82 BAY VIEW AVENUE - BUILDING JACKET z �� �'� �� rar;_ u r w y! i1 .1]'�{�y{y� s-,. _ -AAT �r A3•` P t 6i�l� �I� 1 T b •J Y 5. ip � t�3 � s♦r '�,� t 1 � R'4 le vS'.a�yttA � i t1N'' N 'r J�� 5' f - J1 i• a� 1�� F�;. arts f S� {+ '�4�Y d*S,j,1�rT•. £ y {ji} 9G ff t f j Sj{irt�y c Ft i. T.e _ Tyt PSI i V� �q SZ 3Ay��� C r� 'n fv n ��/ ; i �;r �i✓y "(�f iv �, �µk� r , r c s, d dk w s � s r A F 34lAifPuuViart-� u���. }?.':YY� x we ef`� �4� � I 17, 4 I 4( Nc��_ 9q City of Salem Ward t x APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete afll items ii�ny7sections;1, It, Ill, IV,and IX. I. AT(LOCATION) V 2— /3�Y V.i�i//� /,r/ DISTRICT ING LOCATION (NO.) y (STREET) OF BETWEEN OT AND BUILDING ICRoss sTREen (CROSS STREET) SUBDIVISION LOT BLOCK SIZE IL 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 (rousing units added,if any,in part D,13) 19 ❑ Chruch,other religious 13 ❑ Two or more family-Enter number 3 ® Alteration(See 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(ti 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 ❑ Private(individual,corporation,nonprofit 29 ❑ Other-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, 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 aElectrical........................................................................... b. Plumbing.......................................................................... c. Heating,air conditioning............................................. d. Other(elevator,etc.)..................................................... 11. TOTAL COST OF IMPROVEMENT $27'5:000. III. SELECTED CHARACTERISTICS OF ILDING -For new buildings and additions, complete Parts E-L;demolition, complete only Parts J& M, all othersi 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? 34 ❑ Other-Specify 39 ❑ Other-Specify 42 ® Public or private company 46 ❑ Yes 47 ® No 43 ❑ Private(well,cistern) All J.DIMENSIONS 3 M. DEMOLITION OF STRUCTURES: 49. Number of stories ............................................................ as. Total square feet of floor area Has Approval all floors,based on exterior Z300 pp oval from Historical Commission been received dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No_ 50. Total land area,sq.it....................................................... Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed ..................... ...-.......... 52. 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-x/ (If yes, please enclose documentation from Hist. Com.) Conservation Area? Yes_ No (If yes,please enclose Order of Condi ions) Has Fire Prevention approved and stamped plans or application . Yestff! No Is property located in the S.R.A. di ict? Yes_ No Comply with Zoning? Yes--L/ No If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ No_ (If yes,submit documentation/if no,sub oard 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# Salem License# 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. 1. 1sv� 27,6TN 7 �i, v Ski✓- L /yam .r-rsr� /vJA, �/5'y 63/�zis' Owner or Lessee 2. �1� 'or�h c26 arae �- r e�eQd R,463 656 Contractor Builders 0.4 License No. 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 confr to all applicable laws of this jurisdiction. Signature of applicant W - Address Applic ion oate 7�e�S�a'�2 Liv_ �liR��HoAv � 3, Sy DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building /J _ �J i( FOR DEPARTMENT USE ONLY Permit number Building Use Group Permit issued 19 Fire Grading Building Permit Fee $ ! (J Live Loading Certificate of Occupancy $ Approved by: occupancy Load Drain Tile $ Plan Review Fee $ TITLE NOTES AND Data-(For department use) �4 C�- 2til ., V ,. Z rL PERMIT TO BE MAILED TO: DATE MAILED: Construction to be started by: Completed by: VI ZONING PLAN EXAMINERS NOTES DISTRICT USE d FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN -For Applicant Use O N DEPARTMENTAL APPROVE L FOR CERTIFICATE i �44 of'OCCUPANCY adf COMPLIANCE l n , L Ttbe tilled in bIy each division indicated hereon t i Ll n corn Ietion of its final' inspection. ro' •BUII LDNGS { ; Pe'mt No. 28-94 j 211iii°J!nnringi 2/26/94 oved byL - 3 Date l - 4 SID Remarks PLUMBING ` i j ' Peimit No. tks, APRroVed by Penn pD t Ross rj ate 10/12/94 .,k n m �. Remarks ELECTRICAL" I ; I Pewit No. 4 Approved by� F 3koski�i ! i Date :10/694 PAC Remark9 4d " �i omT Ewwa��;Pei�t No. r x i rte , c Approved by Dennls; Rose N Date 10/12/94k >n, &,led r ` Remarp/k�-s-q �P , dl✓ � �ti i IL 1 j r_„ ? I OTHER Pe(init No t A prod.by tt m • 3 + ♦t qr � n 3 s ,Pld .5.�,t�'FE{p'.F_�r`�+k4r.` .:. e 4' �7c sa't-"+a.a r I.h r ¢d ,`.'n"a. c.t`tV l;� 3a.. �, �... e-e*�V•'+--c�+el:'s±v '�fr`wr.. ^ad; m yr¢a ,fM .e'fi GERTIFIGAT G' a:k"s.A' .c: k A s77 k� * � z �' w �' e'f rj"2�; 1946 -CITYtOF SAALEM' ii t'M SALEM MAISSACH LlSETTS.Of 9 0*t * BUILDING"PERMIT; ' 6 CERT FICAi Ef3OCCUPANCY 1y•. U w:41 T y - -DATE _e ruary 4 19; 9p PERMIT No. 1.28-94 I PPl1CA Eder Construct ,ion A - ADDRESS _Z� 'T�QaTal.SCI@8L arb1Ead,Mais -.1x0.5 1STREETI ICONt A•S LICENSE, Alcerarions - t DweYli f ; a NUMSER F t .PrE,BMIT TQ •' `� {- Y 6TORY �, QWEitiNG UNtTfi` S. T jirvE Or IInPROv ErA[Nil I _M� X ' IPROPR5E0�YxE) ) t ZONING 1{t �w AT {LocsyrwN + Bgvv+ Ave. {Qnrd t DISTRICT NE.,t,� CND;1 C ISTREET/ c E� EY 6-:� . -max# Apo w x'm ia,Z. {Q(li INSFT Yi1QE Pr FT. LONG BY FT dN NEIa MT ANO SMA1,L CONORM*-i^N.CONST RUCi ION � r t 1.`; a Tp TYPE yY JSE GROUP ` BASEMENT WAILS 4k FOUNGAT ION IT�vEI °: .aeMARKs�� :-� teabuatxoas Pie*; e3ect£xca1,,.�ilun0iu���=Nei: earD�txn� .'+ i.'. s : _ t Ir MIX milt AREA OR w. - J1 . •, t.. VOLUME. - c .s,c souaRE 'It' OMAN David l.`. 41 A..+IP AIO'wew sw+orns ns nbo BE POSTED ON PREMISES swWoanR OWNER � _ TO RE POSTER ON PREMISES AOOAES>: 3,A2 SEE R� EJS+DFJ�piTIONS OF CERTIFICATE - -' a Salem- Foxe Depyrtment: FZ,%e P-tevenxi,on Bureau 48 La4ayette Stxeet Salem, Ma 01970 (508) 745-7777 FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT ,. in accordance whit the prov4-4--on,6 o4 .the Ma44achu.eett4 State Buil _q Coda and the Sat'.em F,ze Code, appZzcat .on 4.6 hereby made 4or approvae o4 ptan.6 and the 4a4uance o4 a ce ti.44cate o4 approvat Jo-t a buZZdLng permit by the Sat'.em F4r%e Department. (Re4. Section 113. 3, Ma44. State BZdg. Code) Job Location: Alm Owner%/Occupant: fi'tli. Et:ectn.i.ca.e Cont,%actor: oRt�Art/ �idS7 'r/cTZo.¢/ F%re Suppre64-Lon Contaacto4: Appt 04 tin : L /� Phone At: Addre44 o4 { City or Appt,icant: 7 Town: App.wva.e date: Ce4t-444cate o4 appnova.e is hereby granted, on approved ptama or 4ubm-ittat 04 project detai..e•e, by the Salem FZ&e Department. AZe ptana axe approved 4oteey 4or 4dent.i44cat4on 04 type and ZocatLon 04 44r%e proteeCt Lon dev.4ce4 and equipment- AZe ptana "e 4ubject to approva.B o4 any other authority hay.%ng JuriadZct.Lon- :Upon eompZett.on, the a.ppt4x=nt or 4"taeee%(4) 4hate. reque4t an Zn4pectLon and/or te4t o4 the 4ixe proteC.t•i.on device4 and equipment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** ) �{ New eonatructton. Property Zocat.Lon ha-6 no compliance with the prout4t.orw o4 Chapter 148, Section 26 C/E, M.G. L. , net Live to the .Ln4taeatLon o4 approved 441rce aearm devtceo. The owner o4 th44 prope4xy 4-6 requ.bted to obtain compti.ance as a cord it bon o4 obta.LmZng a 3u4Zd i n4 Permit- 0 •Prope x-y Zoca.•tLon 4.6 4n compt-lance with the pnov.4-64-on4 a6 Chapter% 148, Sect,i.on 26 C/E, M-Q.L- ExptAati.on date: glls- 1� �S S.(.gnatune o4 Fixe 044.Zci. Fee due: under% 7 , 500 Sq. Ft. - � 7 . 5nn .l to _ F!' stn Pn »r... . .. s i; nn F.iwnkR 1 /A.>�� FIRE DEPARTMENT CERTIFICATE OF 4PPROV'AL FOR BUILDING PERMIT V: In compliance with the provision of Section 113.5 of the Massachusetts State Building Code, and under guidelines agreed upon by the Salem Bldg. Inspector and the Salem Fire Chief, the applicant for a building permit shall obtain the Certificate of Approval (see reverse side) and stamped plan approval from the Salem Fire Prevention Bureau. Said application and approval is required before a building permit may be issued. The Massachusetts State Building Code requires compliance approval of the Salem Fire Department, with reference to provisions of Articles 4 and 12 of the Building Code, the Salem Fire Code, Massachusetts General Laws, and 527 Code of Massachusetts Regulations. The applicant shall submit this application with three (3) sets of plans, drawn in sufficient clarity, to obtain stamped approval of the Salem Fire Department. This applies for all new construction, substantial alterations, change of use and/or occupancy, and any other approvals required by the Massachusetts General Laws, and the Salem Fire Code. Exception: Plans will not be required for structural work when the proposed work to be performed under the building permit will not, in the opinion of the Building Inspector, require a plan to show the nature and character of the work to be performed. Notice: Plans are normally required for fire suppression systems, fire alarm systems, tank installations, and Fire Code requirements. Under the provisions of Article 22 of the Massachusetts State Building Code, certain proposed projects may not require submission of plans or complete compliance with new construction requirements. rn these cases, provisions of Article 22, Appendix T, and Tables applicable shall apply. This section shall not, however, supersede the provisions outlined in the Salem Fire Prevention Regulations, Chapter 148, MGL, or 527 Code of Massachusetts Regulations. All permits for fire code use and/or occupancy shall apply for the entire structure; fire alarm and/or smoke detector installation shall apply to the entire structure based upon current requirements as per Laws and/or Codes, but the existing structure may comply with regulations applicable for existing structures. Notice: Sub-contractors may also be required to file individual applications for a Fire Department Certificate of Approval for the area of their work. Such sub-contractors shall file an Application to Install with the Fire prevention Bureau prior to commencing any work for those areas applicable. Form 81R (10/90) COMMONWEALTH OF MASSACHUSETTS � � G c�2 DErAK.- ENT OF INDUSTRIAL ACCIDENTS 604 WASHINGTON STREET amen Canaae}, BOSTON, MASSACHUSETTS 02111 y�,.,....ssipne• WORKERS' COMPENSATION INSURANCE AFFIDAVIT 1�IeLntet/ptrmineet with a principal placeof businessiresiderice at: n7 n ��i�� �_�"---'rl,%"'"=dI'L•Ph Pa c.✓ � t1,�f Y.S� (CirylSurcizip) do hercbv certify, under the pains and penalties of perjury. that: 1 am an employer providing the following workers' compensation coverage for my employees working on this iob.��// ' —j aAP#Kkrf- 1ev 0geact�- 63)- 00ll lnsuranc Companv Policy Number ( j I am a sole proprietor and have no one working for me. [ � 1 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 f J� /J�t/^�/a� Name of Contractor Insurance Comp y/Policy Number 1DaW0Q1 el0Vrcg72w 2 2 cionQ7 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 awve that while homeowners who employ persons to do maiou,nanre,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 are not generally considered to be employers under the Workers' Compensation Aa(GL G I52,sect. 1(5)),application by a homeowner for a license or permit may evidence the legal tutus of an employer under the Workers'Compensation Act I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of Insurance for coveragt vtnfication and that faiiure to secure coverage as rebutted under Section 25A of MGL 152 can lead to the imposition of criminal penalties constsung of a fine' p to $1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of$100.00 a ay ainst Signed his �dayof Jl 29 LicenseeiPermittec licensor/Permitsor ��O/'Glary Ca/!S�' • Gab l,' e ooh mPOO;Lo? (oZo3S­-PwF (�rdCwS Comp . :z7 TT//4r r rlo ek- � I I r +4` - I �I 1 f 0 o b4- I ° i .4cr%t , � Mr-( r�p�+=' r/% H TP '1+�. G y tr F- T, f I , i I ' I I -. �.r•. r�cElf.`c-r, �z-r ---- i - �'_ s�l-�'II�'E-f �f���G� _ . cs.p�IUF� I NO. 11 I i _ , j�Zk' ' I-q APPD " -q` b N _ - ..� L-•, *..}I - "I - it THS ,� pa „moi - - k'XX'J w - I , - II + . - - I rn TAI p / — i � Platfhtsr - hl NINt� i114Gt�II �J1 Il�.�il�I� -- _ 0 �rrK I LMt,1�T �z"'f✓} / I� 4-9 j,L�.u_ ;.,iT�.��l-1',�-t`-�xl(1-t=� � - — - � i- If L - I ` �-1-1- � �p-�1.d-1�.,,A���` ��-� Q .s I _ T ---•- �J�Gj"��/�{G`� '� _ I � r�aDw unNrwu -MH blriNG rt _ c� I2o.ic44 l� ��► i I wNw pa . WILL x4ili-r-e4 i'52 If I _ I i� I l 74 .