0001 BERRYWOOD LANE - BUILDING JACKET 1 Berrywood Lane ti
aa3 R- 1
No. L/5 4 City of Salem a Ward
r1
APPLICATION �► 5�j ��� '� '
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1, ll, Ill, IV,and/X.
n ZONING
I. AT(LOCATION) �Ll t rd2 �� DISTRICT
LOCATION (N .) srnEEn
OF BETWEEN crAND
BUILDING oss MEET) LOTETI
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 E3-9"— buffding Residenpal Nonresidential
2 ❑ Addition(It residential,enter number of crew 12 1TC.1f/One family 18 ❑ Amusement recreational
housing units added,if any,in part A 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 domtitory- 22 ❑ Service station repair garage
Enter number of units ...........................
5 ❑ Wrecking(it multifamily reside TV4 enter number 23 ❑ Hospital,institutional
of units in building in Part D,13) 15 ❑ Garage
24 ❑ Office,bank,professional
6 ❑ Moving(relmation) 16 ❑ Carport 25 ❑ Public utility
26 ❑ School,library,other educational
7 ❑ foundation only 17 ❑ Other-Specify 27 ❑ Stores,mercantile
B.OWNERSHIP 28 ❑ Tanks,towers
8 nB P/nvate(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 stop,laundry building at hospital,elementary school,secondary school,coitege,
$ •� parochial school,parking garage for department Store,rental office building,office building
10. Cost of improvement ........................................._...._._. Q f)0 at industrial plant.If use of existing building is being changed,enter proposed use.
To be installed but rot included
in the above cost
aElectrical_.......................................................__......_...
b. Plumbing....._........._.................................._...'-"-._...
c. Heating,air condi inning..............................._.__...
d. Other(elevator,etc.).................._..................._.........
11. TOTAL COST OF IMPROVEMENT $ S
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 ❑� Masonry(wall bearing) 35 [:] Gas 40 ublic or private company Will there be central air
31 WQ name 36 Oil 41 E] Private(septic tank.etc.) contlitbning?
IJ /
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 Er'No
33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevato(d
34 ❑ Other-Specify 39 ❑ Other-Specify 42ublic or private company 46 ❑ Yes 47 ❑ No
43 ❑ Private(well,cistern)
J.DIMENSIONS
48. Number of stories ............................................................ M. DEMOLITION OF STRUCTURES:
49. Total square feet of Noor area, Has Approval from Historical Commission been received
all flows,based on extenor 0-0
dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No_
50. Total land area,sq.n. .._%?3...`1(- Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed ...........91.........................................................
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. Outdoors...........ff.............._...................................... Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed... ............................................ Electric:
Gas:
Full..........�...............:........ Sewer:
54. Number of
bathrooms PaDOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial..........�.......................... BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No—C- (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 l/ d. 9a, i� hGus If 2
Is property located in the S.R.A. district? Yes_ No«
Comply with Zoning? Yes�o (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_L�'(If yes,submit documentation)
Massachusetts State Contractor License # Salem License# Z
Home Improvement Contractor# 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: i if an extension is necessary, please submit
J U "/5 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.
O
Owner or
Lessee!
2.
Contractor
m Builder's
License No.
3.
Architect or !1
Engineer �j C( � GC..r-11ij G& 4
�Z�-ii-� a/9
I hereby certify that th proposed work is authorized by A owner of record and that I have been authorized by the owner to make this application
Ias his autho'z d a n and we agree to conform to all applicable laws of this jurisdiction.
Si ature of ce Address/Z//- �pli ion d
i r
p
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building /� 5 C�' FOR DEPARTMENT USE ONLY
Permit number w J
P BuildingUse Group
I Permit issued a 'a 19 nn�7
Fire Grading
Building
Permit Fee $ Live Loading
Certificate of Occupancy $ occupancy Load
'y Approve
I Drain Tile
Plan Review Fee $
TITLE
I
I NOTES AND Data-(For department use)
S Z G
rJ
PERMIT TO BE MAILED TO: r�
DATE MAILED:
Construction to be started by: Completed by:
:,v
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
w�
f OC
' . A ��
-.
7.
al
IVA
_\ gB T£''r, ��•�,�� �$ X83°0� 2� '���� �o�ps ,
(o c Tel
0
4
ti
415 zt�r
vj
40� 1126
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r
* i4 ro�4+ �'f r r, t'r{ ` r k'�"! = s` tt ✓ '. .'.:► > IV\_ . ' ,,y MI/'.
F, ' V Y' 'i "�^�"'- r,.r Y�il» .. Q � /� \� ✓u vet•
�```� f" �•FL7lCdTE`�7�0l�iiV •s�dC� h ,
• J � .'v� 7 :t°le, rwr.f.j Cj'Yf ,� <l r• > c Jy- ���F �> �1,..�,:(�- �`6 '
of �5alem, assazhusdis
R ® UTIN SLIP
REVIEW AND PASS ON AS INDICATED
LOCATION: 6e-,r(4It)0 G
DATE
APPLICANT: vn or2e5r?C
INSERT DATE WHEN PASSING ON
1pp ApTmFNT. Assessor Date
74A c,
CONTACT PERS Peter Caron J 1�
2 Fire Department
or Insp. LaPointe '
3 Department of Public Services
Director
4 DEPARTMENT: Water Department j 71
CONTACT PERSON: Margaret Haaerty/HelenJiadosz
5 Planning Dept.
�� 14c-
tSeLn U2U5" r16U1,9
6 DEPARTMENT: City Clerk ( if involving new streets )
CONTACT PERSON:
7 DEPARTMENT: ELEXTRIC DEPT.CONTACT �c
F PAUL TUTTLE
8 DEPARTMENT:
CONTACT PERSON:
RETURN TO
r.
( occyym.monwea& ol// P11appidat
/JcLieE
2epartmenf o��ndulfriaC �tccidenfl
600 gql/VaiLgton Street
James J.Campbell 1 onton, /i'laadachudetfe 02111
Commissioner
��tt /Workers' Compensation Insurance Affidavit
(Ilansee/permittee)
with a principal place of business at:
M"zip)
do hereby certify under the pains and penalties of perjury, that:
() I am an employer providing workers' compensation coverage for my employees working on
this job.
Lf - 41 /
Insurance C mpany Policy Number
() I am a sole proprietor and have no one working for me in any capacity.
() I am a sole proprietor, general contractor or homeowner (circle one) and have hired the
contractors listed below who have the following workers' compensation policies:
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
Contractor Insurance Company/Policy Number
() 1 am a homeowner performing all the work myself.
I understand that a copy of this statement will be forwarded to the Office of Investigations of the DIA for coverage verification and that failure to secure
coverage'as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to $1,500.00 and/or one
years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me.
Si ed th's oZ ( day of 19
)ce a/Permittee Building Department
Licensing Board
Selectmens Office
Health Department
TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375
�J7� Ur arx�na�tcuea.� �"!�LlIdtlltle"/i�,ldP
�tichaei Governor Ono lz .." j%sw - Aoow. iso!
Kentaro Tsutsumt G w. A&U"w4o ems odes
Chairman
tem
Charles J. Dineao
Adnamrstratisr
MEMORANDUM
TO: All Building Departmentustatc Building Inspectors
FROM: Charles J. Dine= Administrator
DATE October 31. 19M
SUBJECT: MGT. c4O, S54. Added 1tv c584. S9 M the Acts of 19117
The above•mentioncia statute requires that ucbns resulting tram the demouubn. rctu vataarrebabiMnub
„r tnhcr alteration of a htnldine or structure he dtsposcd of in a properry ltccnscu solid-wws d"W
tachiv as damned by MGL %At I. S150A and that nutldme permits or Itcebses are to inUILM U ootto
tat the taoilty at whteh the Said dbbrts IN ui he dtspascd. THIS REOUIREMENT DOES.Na
,APPLY TO NEW CONSTRUC170N.
In order in suncto the process and to p"Mdc ualformty. we are attacntne a copy tat a torarohirh To,
Call either rcprodues and use as It is stars the camplctcd form wall be auatmal to the ouicc wprof bmil6.
permits or IICCAICa: or rCF. UCC It on vOur ictterhad.
In case of municipal.comment L Industrial.or multiunit housing construction.the contractor maw not Imot
1 Pa the dumpier suttcvntrataor at the time of the building permit appitatton. In such cas=the atmcwd MP.
;Tse of an Affidavit an be used.
-The comptete.taw is anntaam in the Novemner issue of CODEWORD which wdl he matled in wM in tht
- — - ne=t two weeks. If,von should have anv questinn. please tet us know.
UD/km
AFFIDAVIT
As a result of the provisions of MGL c 40, 554, I acknowledge that as a condition of Building Permit
Number all debris resulting from the construction activity governed by this
Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL
c III, S 150A.
I certify that I will notify the Building Official by
(Two months maximum) of the location of the solid waste disposal facility where the debris resulting from
the said construction activity shall be disposed of, and I shall submit the appropriate form for attachment
to the Building Permit.
J C? j A� ,
Date ' Signature of Permit Applicant
(Print or type the following information)
Name of Permit Applicant
v tMA-
irm Name, if any
Address
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111. S
150A.
The debris will be disposed of in:
(Location of Facility)
t nature of Permit Applicant
A to
,
L-- i
1
ClW1�IT1_ yy
e ! CERTIFICATE ISSUED-
CITY OF SALEM DATE March 40 129 ,4—
SALEM.
99 4—
SALEM• MASSACHUSETTS 01970 BUILDING PERMIT -
a�``°m^ CERTIFICATE OF OCCUPANCY
µ{,}
APPLICANT l'QUIiLy ._^0Ei .. DATE li'[w I'-(9. „J,"/�4 tt( .-14
.PERM1.7 NO..
ADDRESS +-'i'8 .L' ..)J:
(NO.I IS.TP ESTI
PERMIT TO JU1'6 -+ I<ONIgbLl[E NSE(
(_I STORY !'Lu'"!�- NUMBER OF _
ITrRf OF IMRq OVE M[xll -xo OW
Ipp O/OSE9 USE) ELLING UNITS
AT (LOCATION) - ',0T'T-.'W 1000 ;_;r•
IN9.1 . _ 20NING
(STREET) DISTRICT -
BETWEEN
(CROSS 9igEEil AND
I<RO55 Si pEF it
SUBOIV IS ION
LOT BLOCK LOT
-SIZE
BUILDING IS TO BE FT, wiOE P..
FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP_
BASEMENT WALLS OR FOUNDATION
REMARKS: 'li._� _ _ - (TYRE)
AREA OR
(�R..iiTT rry Y
VOLUME
C 91 a 50 V e p E E S T I (E.�.{I yAF�Wyt]pL�Wy{ 29FryrNa�wN(J1(;
OWNER .moi•`. •(: dR-p o' oRT
Yp11 onl dnl enl dnlbCllpl^/1 pnl AIIA'TIO'n161F sn10lTIO
ADDRESS
�) -i':. --. -••T OT66-.POSTEa-ON PREMISES
SEE REVERSE S'IOE�FO"IDWDITIONS OF CERTIFICATE
DEPARTMENTAL APPROVAL FOR CERTIFICATE
of OCCUPANCY and COMPLIANCE
To be filled in by each division indicated hereon
upon completion. of its final inspection.
BUILDINGS Permit No. 615-94
Approved by John J. Jennings Date 3/30/95
Remarks
PLUMBING Permit No.
Dennis Ross 3/29/95
Approved by __ Date ----
Remarks _Remarks
ELECTRICAL Permit No.
Approved by
Paul Tuttle Date 3/27/95
Remarks
OTHER Fire Permit No.
Approved by_ Capt. Hudson Date 3/28/95
Remarks
OTHER Permit No.
Approved by Date
Remarks
IBUILDING
PERMIT' '
alL _ JOB WEATHER . C.AR.p.,
DATE -_f9 �I�A11� ,PERMIT,NO. ^�
APPLICANT l�"C-( 1 '�)�n�¢� ADDRESS 1� Ll � UCT.TI CuVp�l,C I,I
/\��� I�Mco*0.1 (STREET( (CONTR'9 LICENSEI
NUMOF
PERMIT TO ! 1 STORY ' �"++�IK ,I, DWEB LING UNITS
(TYPE OF IMPROVEMENT(
IND.) N0. (PROPO$ED USE)
ZONING
ALT ION) RX LVP GIST RICT
19TREETI
AND
(CROSS STREETI (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS:
AREA OR MI
VOLUME ESTIMATED COST A /1 } I/t� r r
S
:C'181fi'SO U<RE FEET( ' FEE
OWNER
.. ... ...., _.. __ BUILDING DEPT.:
AODRESS BY
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY 09 SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST Be AP-
ROVED 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 CONDITIONS
OF ANY APPLICABLE SUBDIVISION 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 HAS BEEN PERMITS 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 QURED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MINAL IN IRE TI i0 LATHE FINAL INSPECTION HAS BEEN MADE.
3. FINAL INSPECTION BEFORE
OCCUPANCY,
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
BOARD OF HEALTH GAS INSPECTION APPROVALS FIRE DEPT.. INSPECTING APPROVALS
1 1 .31-
OTHER CITY ENGINEER 2 2 `
X
WORK SHALL NOT PROCEED UNTIL THE
S PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD
INSPECTOR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE I CAN BE ARRANGED FOR BY TELEPHONE
STAGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION.