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136 BAY VIEW AVENUE - BUILDING JACKET V superowst�Tab. mm M A7Cr KEEPING YOU ORGANIZED No. 10301 PMWFE M Osremmss pwtmsm IOU . OO vwx. mmmu A GETORGMUMATSAEW-COM � ! C/ - / / S f9 � APPLICATI N FOR PLAN EXAMINATION AND BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. o I�'9` `, ZONING I. AT (LOCATION) �� sJ� i � kve DISTRICT LOCATION (NO.) (STREET) t�Cjt y OF BETWEEN lel�rlCrT AND cl BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE VA IL TYPE AND COST OF BUILDING — All applicants complete Parts A — D a A. TYPE OF IMPROVEMENT D. PROPOSED USE — For-Wrecking" most recent use M M 1 ❑ New building Residential Nonresidential 2 ❑ Addition(1/ residential, enter number 12 ❑ One family 18 ❑ Amusement, recreational of new housing units added, if any, in Part D, 13) 13 Two or more family — Enter r] 19 ❑ Church, other religious 3 ❑ Alteration (See 2 above) number of units— — — — —► G- 20❑ Industrial 14 ❑ Transient hotel, motel, 4 5?rRa pair, replacement or dormitory — Enter number - 21 ❑ Parking garage 5 ❑ Wrecking (1f multifamily residential, of units ------- — y 22 ❑ Service station, repair garage enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional Part D, 13) 6 Moving (relocation) 16 ❑ Carport 24❑ Office, bank, professional 17❑ Other — Specify 25 ❑ Public utility 7 ❑ Foundation only 26 ❑ School, library, other educational B. OWN�J25HIP 27 ❑ Stores, mercantile 8 Private (individual, corporation, 28 ❑ Tanks, towers 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, macoine shop, laundry building at hospital, elementary 10. Cost of improvement,--„-,-,--,,,„ 600 school, secondary school, college, parochial school, parking garage for, department store, rental office building, office building at industrial plant. To be installed but not included If use of existing building is being changed, enter proposed use. in the above cost O //'/� y� n /� �7 a. Electrical....................... L6PLAC(5 /0/CT/6-nL) 01-- b. Plumbing ....................... IiV�CC AW A77-IC tli�/C_ STS-/ C. Heating, air conditioning.......... d. Other (elevator, etc.)............. p t� -LAW 49C 13 !R� SL E 11. TOTAL COST OF IMPROVEMENT 2 106 cc) 84cIK Q Q AGC) III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L; for wrecking, complete only Part J, for all others skip to IV. E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 30 ❑ Masonry48. Number of stories............... (wall bearing) 40 Public or private company 31 O Wood frame 41 ❑ Private (septic tank, etc.) 49- Total square feet of floor area, all floors, based on exterior 32❑ Structural steal dimensions ..................... 33 Reinforced concrete H. TYPE9F WATER SUPPLY 34❑ Other — Specify 42 M Public or private company 50. Total land area, sq, ft. ........... 43 ❑ Private(well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed ....................... 35 n Gas - Will there be central air 52. Outdoors........................ 36 Voil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 ❑ Electricity 44 ❑ Yes 45 No 53. Number of bedrooms.............. 38 ❑ Coal 39 ❑ Other — Specify Will there be an elevator? 54. Number of Full.......... 46 ❑ Yes 47 No bathrooms Partial........ NOTES and Data — (For department use) �7714 Z2 /' r U) VIII. ZONING PLAN EXAMINERS NO'i FS DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES IX. SITE OR PLOT PLAN — For Applicant Use P,(J 1-}- 119W, : AA.4�4 i .��e I C 95��20 �QOD� L S?Ul��Sz �, T..., { b -i "' +-G.'fi- iSiNDE�''t' ""i -fir *'t�';,-...-{ , -7, �A�rs ruCGuD r "'+�+ {3 "3}�?Si • �i wri--a II'. } 'G/liy4'.= -zL� IC 4:r _+ rr,. ` J 1y +- r� riki 1 L"l/V `7'�'\� (rs, N t r rr t tft — 1 i24 m'1'i,+ }} ,:, + r J:t } �T' lx• Z I ).' a- I I 'I Yii 1''' { Y�ft 1 41+r yZiY ' XI rpt � - , b -ttj t ht 7 ' y - t r f t 'i i ;. J xl '" f i; + { r � r 77 + p 511 4 t, BOCP FOO!A PPEBP - 669 C1969 CLI:.OIAG OFFICIALS d COOr ADMINISTNATORS NT ERNATI"AL. INC IV. IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, street, city, and.State ZIP code I Tel. No. owner or M4 )Q 2a dilT L�Ieea !✓olla� s 2c! 2rcl�zco„�( U/t 612SY p�2S� 43[ 69p- Lessee ,p i. GC.�/ moi'/orL "iLL C9 c-'/..C"f Lacer er No. 7 S17U Contractor 20 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,91, applicant Address Application date /2�z � A/ ,G g,,,,n, 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Review Required Check Plan Review Date Plans Date Plans .. 9 Fee Started By Approved By Notes BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval Check Date Number B Permit or A royal Check Date Number B Obtained y pp Obtained y BOILER PLUMBING CURB OR SIDEWALK CUT ROOFING ELEVATOR SEWER ELECTRICAL SIGN OR BILLBOARD FURNACE STREET GRADES GRADING USE OF PUBLIC AREAS OIL BURNER WRECKING OTHER OTHER VII. VALIDATION Building FOR DEPARTMENT USE ONLY Permit number Building Use Group Permit issued 19 Building r7 Fire Grading Permit Fee $ /. «� Live Loading Certificate of Occupancy $ Occupancy Load Approved b Drain Tile $ Plan Review Fee $ 61�� TIT?'E Business (:ertificate �Citp of *atem, Angatbugettg DATE FILED /9 'Type: Z New Expiration Date p?37 2997 ❑ Renewal, no change Number 1-3— 46&74 ❑ Renewal with chance In conformity with the provisions of Chapter one hundred and ten, Section five of the Massachusetts General Laws, as amended, the undersigned hereby declare(s) that a business is conducted under the title of: r-f/5 T F::jv0 at. /3 !o 13/YyV/eF&/ /4y , F"A? AW, a/-57Fv type of business ft+'eX/Nin OFP/Ce; - OS77g7-J--- P eV4W1101F /1 by the following named person(s): (Include corporate name and title if corporate officer) Full Name Residence D• �/zY�n/ gy��t/S l3(n 8i9-1 U>El r/fit/ , Sfa z e to i7d _ Si 'Snatures ------------------ ---------------- ------------------------------------------------------ ----------------------------------------------------- ----------------------------------------------------- r on > EG 2 9 19-23-the above named person(s) personally appeared before me and made ;In oath that the foregoing statement is true. -------------------------------------------------- CITY CLERKNotary Public (seal) Date Cotnmission Expires Identification Presented State Tax I.D. # S.S. # (if available) In accordance with the provision of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5, of Mass. General Laws, business certificates shall be in effect for four(4) years from the date of issue and shall be renewed each four vears thereafter. A statement under oath must be filed with the town clerk upon discontinuing, retiring, or withdrawing from such business or partnership. Copies,of such certificates shall be available at the address at which such business is conducted and shall be furnished on request during regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars ($300.00) for each month during which such violation continues. .t. No. =v� APPLICATION FOR PERIfT TO LOCATION PERMIT GRANTED ,9 C INSPEMA OF MALOPM � 1 a . fLwr+a�eEwlf■adlNo aN�ov�ar TiiE �e raooie Lwow�aA.PEBWBJ n,Ia GRANTkD CITY OF SALEM wwd zo"Is Pjawy Loomd in Deere ON HWAHC OYblW YM No ioeatioa of ��a l 3G 73irr /�c�y firs M P'"Wiy Loomd in 10 CorMPA§on Awn? . YG No_ Pannk to: Mrp BINLD PERM APPLJCATION FOIE to (Chb whichever apply) Roo Install Ogler: ConsJW ONK mod. Pool. �Pt PLEASE FILL OIf r LRONt.Y a COMPLETELY TO AVOID DELAYS N PRDCWWMfiO TO THE INSPECTOR OF BUILDINGS:The i '. herby appMss for a pwmk to balid a=rd n to the t lw&*rp owners Nam. 7)m c-L Row L=-- Address a Ptam _� 7 G i'K= coY791 74�- 1129 Aroirksrx's Now J ie t G IT r-F 7-oQt-itil Address a Phone 1C) AVC- 3 g� Msohaniq Nana E 7 ,, L; 9 7 s 745 llddress a Phone G 0t y1 ✓U- F 5ft941 (r'i5 1 74�s-,l78? �Ib "w Is faN PuPw al wjdw �LtI�ZG tl G I wow of aidrmi Cc)lwo )5a r is dw.arg,for now stint U~-- , aresq oonfonn a wn Me..1e.9 t=wsoed oar cro umm o stw u.d D jLd anso e Lin. I� Siprnban of Appiicm Slaw UNDEII THE PWAALTY' OP POUM oEacwPnoN OF WON TO eE DONE i�"IULL-n SVAJ12OPt! s sir-ow�J �� s�,��a,,v�r✓� MNL PBW TO: q5::--ZrTziJrn t✓(c $l The Commonwealth of Massachusetts 't Board of Building Regulations and Standards RECEIVED"' CITY OF Massachusetts State Building Code, 780 CM14NSPECTION'AL $ERVMMM Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish lvi 54 One-or Two-Family Dwelling Z015 AUG 1 This Section For Official Use Only �- Building Permit Number Date Applied: 00 Building Official(Print Name) Signature _ Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 3 1�) a6y Vl y j A i/e:- L la Is this an accepted street?yes V no Map Number Parcel Number I— 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of A:A: yr Name(Print) City,State,ZIP 13 G gXy i01 kvc. i7€3 d wonf No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed World: ul 5'f�Mt< G�'r SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ boo 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ s v© ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x" 3. Plumbing $ 2000 2. Other Fees: $'. 4. Mechanical (HVAC) $ List: cl 5. Mechanical (Fire $ Total All Fees: $ Suppression) .. Check No. Check Amount: Cash Amount. 6. Total Project Cost: $ C,5_00 p Paid in Full ❑Outstanding Balance Due ? FMattZro vo c r,_n-- %X/ Ig SECTION 5: CONSTRUCTION SERVICES _ 5.1 Construction Supervisor License(CSL) /-11 ao4 � E-Ze-Tz lm i �.- _ License Number Ex do Date Name of CSL Holder t, List CSL Type(see below) No.and Street Type Description i ryLr. l� w U Unrestricted(Buildings up to 35,000 cu.ft. ,J R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry MA 01970 RC Roofing Covering WS Window and Siding /� /'� SF Solid Fuel Burning Appliances 978 S76 11 1 /'/�/1[C.4Ql ��St AXT I I Insulation Telephone Email address D Demolition! 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expi anon Date HIC Company Name or MC Re istrant Name l Fk-n it f?4(aeaM&15T. u No.and Street Email address City/Town, State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 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 .......... ❑ No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 'l I,as Owner of the subject property,hereby authorize to act Zony behalf, in all matters relative to work authorized by this building permit application. t Print 's Name(Erectr6nic Signature) c Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print O er's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty find under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www,mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost"