11 BOARDMAN STREET - BUILDING JACKET rsuperTab.
90%Larger Label Area
' /// SMEAD
KEEPING YOU ORGANIZED
No. 10301
FXMPEMM
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UAMwUSA
GET ORGANVMATSMEAD.COM
APPOINTMENT FOR FINAL Saeem Fite Depa4,tment
INSPECTION MUST BE F-ivee Ptevention Bureau. APPOINTMENT FOR FINAL
MADE AT LEAST ONE WEEK 48 La4ayette Sticee INSPECTION MUST BE
Salem, Ma 01970 MADE AT LEAST ONE WEEK
AHEAD--------------- — (5 0 8) 745-7777 AHEAD.---••-._-
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT
i
In accordance wtXii, the p eovz4tort6 o4 the Ma-6-6achu4et She Buttd i.n9 Coda
and the Sa,eem F-ZAe Code, apPt-Zcat.ion -i.6 heaeby made 4on app�LovaZ o4 ptan,6
and the -4,64uance o4 a cettiitcate o4 app-tovaZ 40n, a buttdiny peg .et by the
Sat'em F-vice Depa4.tment. (Re4. Section 113. 3, Mamie. State BZdg. Code)
Job Location:
vL(!v�L_ T� N •�
Owne�L/Occupant:
r 'Wu-r, 9a 3
EZectt t cae Cont,%acton-: r 2 y
F-vice Suppn.e44don Conttacton: N
err �r� o P
S-ignatun.e 04 ��n, n
Appt,i.eartt: �CG �- Phone
Addne44 o4Qinw � C-(ty
Z.Ccon
Appant: �D `f�f � fU� Town: SQ.�8�12
Appnova e dote: lyo l / 4
Centi6-i.eate o4 app-tovaZ <.6 heteby 94xLrtted, on appiLoved ptand on. 6ubmtt-taz
o4 pAojec-t detatt,6, by the Salem FtAe Department. AZt pZa " ace approved
4oZety 4or tdent-i.4,Ccation o4 type and Zocation o4 JtAe protection deutce4
and equtpment. AZZ pta.n,6 ane 4ubjeet to approvat o4 any other authority
having juAi-4di.cti.on. Upon eomptet-i,on, the appti.eartt on. .i,n.6tatten(4) 4hatt
neque 6t an tn,6pection and/or te.6t 04 the 4-ZAe pnotectl on dev.ice4 and
equipment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** )
New co"truetion.
0 Property Zocation ha4 no eompZiance wi th the provt-6ton�s o4
Chapter 148, Section 26 C/E, M. G. L. , retati.ve to the
trt6tatati.on o4 approved 4.i to ata,%m devtce6. The ownex o4
th-i�6 prope�tty t4 requiveed to obta,i,n comptiance " a
cond,iti.on o4 obtaLntng a Buttd4ng Pe-rm.i t.
® Property location t4 -i.n eomp2 ia.nce w.i th the ptov-i-6ton 6 o4
ChaptevL 148 , Seatl.on 26 C/E, M. G. L.
Expt44tion date: y .
S-i.gnatu,%e"v4 Fite 064.iciae
Fee dua: under 7 , Sq. Ft. C.l�
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT
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 w
issued. The Massachusetts State Building Code requires compliance °J
Z—
approval of the Salem Fire Department, with reference to provisions of um w ,
Articles 4 and 12 of the Building Code, the Salem Fire Code, Massachusetts z F_ oz i
General Laws, and 527 Code of Massachusetts Regulations. U- j
( ;
The applicant shall submit this application with three (3) sets of plans, UJ zo
drawn in sufficient clarity, to obtain stamped approval of the Salem Fire f- �-
Department. This applies for all new construction, substantial Kw w o
alterations, change of use and/or occupancy, and any other approvals d CCO
L a =
required by the Massachusetts General Laws, and the Salem Fire Code. < z
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. In 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.
ENT FORFOVt
01N VST E
Form 81X (10/90) App0114TM N MAST BE REEK INSPECT��EpST ONE WEEK
1NSPECTIO EAST ONE W MAOE A ...- -
MADE ATAHEAD..._..........
AHEAD.........._..
No.—,�- _— . City of Salem Ward a
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete X.
1. AT(LOCATION) all items in sections:1, 11. 111, IV, and I
I I BO's`rd imngn STY e E ZONING
!J
1/ _ q �l DISTRICT
OFCATION BETWEEN Ndl !Jebb s AND �u �111 /) J u EAST
R� 9
BUILDING ICROSS STREETI CROSS SI
EN
5) Q�
SUBDIVISION Visci_. 7 LOT BLOCK SIZE 3cX�YJ0 �-^l_
^
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 df resmenbal,enter number of new 12 ❑ One family is ❑ Amusement.recreational
housing units added.A any.in pan O. 131 19 ❑ Chruch.other religious
13 Q more lamely-Enter number 20 C] Industrial
�Alteratgn)see 2 above) of or units _....._.....____.............___.........
—4 ❑ Repair repacement 14 ❑ Transient hotel,motet.or dormitory. 21 ❑ Parking garage
Enter number of unite ...........................
22 ❑ Service station.repair gangs
— 5 ❑ W reckmg(Il musiamdY iesoenfial.enter number _ 23 ❑ Hospital.insaulional
of units in buiomg in Pan O. 73) t .:rine 24 ❑ Office.bank,professional
6 ❑ Moving Ireocatlonl 16 ❑ Carport 25 ❑ Pubic utility
7 ❑ Foundation only 26 ❑ School.library,other educational
17 ❑ Other-Specd, 27 ❑ Stores."tcantlle
B.OWNERSHIP
28 ❑ Tanks.towers
8 Private(individual.corporation.nonprofit 29 ❑ Other.Specifyinstitution,etc.)
9 ❑ Public(Federal,Sate.or,oral government
7 C.COST romd cents) Nonresoental-Describe in dead proposed use of buildings,e.g.loop processing pant,
machine shop.aundry building at hospital,elementary school,secondary school,college,
10. Cost of improvement ._............._ Mitchel school,parking garage for department store.renal office budding,othos budding
""""""""""""' $ at industrial plant.If use of mating budding is being changed.enter proposed tae.
To be installed but nor included
in the above cost
a. Electrical........... ..................... 110 tog
.......
b. Plumbing..._.._......._...................................
........_..........
Heafind.air conditioning ..................................._._
C. Other)elevator,elci ....................................................
1I. TOTAL COST OF IMPROVEMENT g V
111. SELECTED CHARACTERISTICS OF B ILDING - nor new buildings and additions. complete Parts E - L: demolition,
complete only Parts J& M, all others skip to IV -
7 E. PRINCIPAL TYPE OF FRAME F: PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL
;A ❑ Masonry twall bearing) 35 JoGas 40 Pubic or private company Will there be central air
31 Wood biome 36'❑ Oil d1 ❑ Private l5ep(q tank.¢10.1 conortonmg?
32 ❑ Structuralsteel 37 ❑ Electricity " ❑ Yes 45-dNo
H. TYPE OF WATER SUPPLY
33 ❑ Reinforced concrete 38 C] Coal Will thea by an eleyatM
34 ❑ Other-Soeclfif 39 ❑ Other-SpeciN 42 Public or private company 16 ❑ Yes 47�j No
43 ❑ Private Iwell.cisteml
ME
I NomceNorcro es .............. ___. ____ M. DEMOLITION OF STRUCTURES:
:d. Tatar scuare feett r,eareractor area
al floors.resect o Has Approval from Historical Commission been received
l
dimensaos .........-................................_..___._____. for any structure over fifty(50)years? Yes_ No_
Twat rano area.sa.h_.............___. Dig Safe Number
NUMBER OF OFF-STREET PARKING SPACES Pest Control:
il. Encloses
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
2. Outdcors
Yes No
IESIDENrIAL BUILDINGS ONLY Water. -
°.a. Endosed.......... ...................._..._..._...._..._.. Electric: -
Gas:
Fuu..........._. ..................... Sewer:
A. Number of
bamrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial ------------- BEFORE A PERMIT CAN BE ISSUED.
COMPLETE THE FOLLOWING:
Historic District? Yes_ No✓ (If yes,please enclose documentation from Hist Com.).
Conservation Area? Yes_ No—Z (If yes,please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes ✓ No_
Is property located in the S.R.A. district? Yes_ No�
Comply with Zoning? Yes✓ No_ (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes_ No_ (If yes, submit documentation/if no. submit P—
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 #
Home Improvement Contractor # Homeowners Exempt forth(if applicable) Yes✓ No
CONSTRUCTION TO BE COMMENCED WITHIN SIX (6)MONTHS OF ISSUANCE OF BUILDING PERMIT
If an extension is necessary,please submit
NSTRUCTION IS TO BE COMPLETED BY: in writing to the-Inspector of Buildings.
? IDENTIFICATION - To be completed by all applicants
Name C Mailing addff? s-Numner.sneer.cry.and state ZIP CcOe el.No.
=r or
actor
Builder's
Cleanse Na.
:act or
rear
hereby certity that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application
s his authorized agent and we agree to RRnform t I applicable laws of this jurisdiction.
—ature of applicant Addressr' �0 ��N Applicattion d,at
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION ^
Building 9� FOR DEPARTMENT USE ONLY
Permit number r
BuildingQ n V�p use Group
Permit issued j 19 q/ Fire Grading
Building f— 0
Permit Fee S v � ) L"Loading
Certificate of Occupancy S Occu.Dan y Load
Approved by:
Drain Tile S
Plan Review Fee S
E
NOTES AND Data • (For department use)
2 �n
PERMIT TO BE MAILED TO:
DATE MAILED: % —
Construction to be started by: 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
v
i%PPHOVED- -7ltq {
"+-I :.` :,0 approval by any cAhor
7, n b Ang jun.,dut,rn.
Lar rZrUs
_ i«
4&C, sY-�('MD /-
Fl/aN1i ARE APPnYED:�:LECY iGR IDE4TIFILAT01i OF
TY?. AND LWT!C'. OF FIRE PROTECTION DIMn.
�`�\`j•. ALL FIRE PROTSJTICII DEVICES ARE SUBJECT 5'0 A
V- c _ FINALTESA'i ;7tiPZCTIDN,FOR COMPLIM COMPLI
t\\\ AME P-0TY.THE FIRE COOS
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