30 BOARDMAN STREET - BUILDING JACKET U 30 BOARDMAN STREET
APPOINTMENT FOR FINAL' Salem Fite Depaa tment
INSPECTION MUST BE F-i-%e Prevention Beau APPOINTMENT FOR
48 La4ayette Street INSPECTION MUST BE'
MADE A7 LEAST ONE WEEK Sa.Zem, Ma 01 970
MADE(508) 745-7777AT LEAST ONE W
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT
In accordance w.l th the prov.i6ton6 o4 the Maz,6a.chuzett6 State ButZd in.9 Code
and the Salem F.vice Code, appZ.icat,ton 4,6 hereby made 40r approvat 04 plans
and the t.64uance o4 a ee4t,,4tcate 04 approvaZ 4or a buZed.i.n5 pe unit by the
Salem Fvice Depa4.tinent. (Re4. Section 113. 3, Masa. State Bldg. Code)
Job Location: II y
-95 �adrd(ingL, �4 �Pi T v N
Owners/Occupant: c� Z
S,,�
EZec ii ica 2 Contractor: � -e M O>^/ r,\ a
r 3
F-vice Suppne-6.6ton Cont,%aato.%: p
Signature 0 r
AppZtcant
Phone #: -2
Addreaa o4 C-ity 0r
APpt,4Lcant. 2,4 / Town:
ApprovaZ date:
Ce4tZ4tcate o4 approval d.6 hereby granted, on approved plans or 6ubm-ittaZ
04 project detai.2.6, by the Salem Fite DepaAtmerit. AZZ ptan6 are approved
aoZety 4or identl.4tcation 04 type and ZocatLon o4 6- te. proteeti on devtr-
and equipment. Att plan- ace aubjeat to app-covat o4 any othea authon,ity
having juA,44dtction. Upon eomptetlon, the appZLcant or trrstaZZer(a) ahatt
requeat an -in,6pecti.on and/or teat 04 the 4-& a pn.otecti.on devtce6 and
equipment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** )
New eonatruction.
D PrOpenty Zocat.ion has no comp.Ziance w4 th the p-cov-4L4ton 6 04
Chapter 148, Section 26 C/E, M.G. L. , re2.ative to the
tn.6ta.Zation o4 approved aZaAm devtce6. The owner o4
this property 4,6 requt-ted to obtain compttan.ce as a
condi tion o4 obtai.n4n((/2ja Bu i. 'q Permit.
Property Zocatl.on 4-4 XnIcomptiance with the pr .i
ov6tona o4
Chapter 148, Section 26)�C/E, M.G. L.
Exp i4.a t i On date: r` l
V/ d /S`.iynatwce o4 F-vcte(/064tc-i-at
Fee due: under 7 , 500 Sq. Ft. - r 0. 00
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT ,
In compliance with the provision of Section 113.5 of the Massachusetts f
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 W
approval of the Salem Fire Department, with reference to provisions of U. W w
Articles 4 and 12 of the Building Code, the Salem Fire Code, Massachusetts W i- oz
General Laws, and 527 Code of Massachusetts Regulations. 00
N
3
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 Z w W o
alterations, change of use and/or occupancy, and any other approvals a w a
required by the Massachusetts General Laws, and the Salem Fire Code. a ?
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.
TMENT FOR FINA1, 1
BE
Form 81X (10/90) OINTMENT FST BE A� APSPE 11ON SSs 14E WEEK
APP ONE WEEK IN ,?Er
AT SEP
IMADE AT kEP$ r
-rte AHO._._..........
NO City of Salem Ward Z
Z`
9
x
4coeec�'
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT Applicant to complete all items in sections:I, It, Ill, IV, and IX.
I. AT(LOCATION) 3a 13oaelDMRti �VtLEr ZONING �—L,
(NO.) (STREET) DISTRICT
LOCATION 1 1 J
OF BETWEEN Vl U96 ST• AND �JqSAI- SQ C— ST
(CROSS STREET) )CROSS STREET)
BUILDING LOT rt
SUBDIVISION LOT BLOCK SIZE 000
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(If residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational
housing units added,it any,in part D, 13) 19 E] Chruch,other religious
13 Two or more�r!�ily-Enter number
3 ® Alteration(See 2 above) of units.�i_Awt.a.,6 a,;d4..0 CUTS 20 ❑ Industrial
?0 UNLT Z 21 ❑ Parking garage
4 ® Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 22 ❑ Service station,repair garage
Enter number of units ...
5 ❑ Wrecking(K multifamily residential,enter number ❑ 23 E] Hospital,institutional
of units in building in Part D,13) 15 Garage
24 ❑ Office,Dank,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 N Private(individual,corporation,nonprofit
institution,etc.) 29 E] Other-Specify
9 ❑ Public(Federal,State,or local government
a _
C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant,
•r-• machine shop,laundry building at hospital,elementary school,secondary school,college,
-n1 parochial school,parking garage for department store,rental office building,office building
10. Cost of improvement ......................................................... $�D O ODr�V;, at industdalfnanLlf use;of existing building is being changed,enter proposed use.
f
�,. To be installed but not included -
in the above cost
• ..a. Electrical........................................................................... 3, 000-00
r;b. Plumbing_ ,,// '�f5600. 00
r'- c. Heating,air Conditioning............................................. ` ,060,00
•. •- d. Other(elevator.etc.)..................................................... I %T
r 11. TOTAL COST OF IMPROVEMENT $
III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition,
complete only Parts J&M,all others skip to IV /V
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 N Public or private Company Will there be central air
31 Wood frame 36 ❑ Oil 41 E] Private(septic tank,etc.) conditioning?
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ® No
33 ❑ Reinforced Concrete 38 E] coal H. TYPE OF WATER SUPPLY Will there by an elevator?
aI
- 34 ❑ Other-Specify 39 ❑ Other-Specify 42 ® Public or private company 46 ❑ Yes 47 ®, No
43 ❑ Private(well,cistern)
J.DIMENSIONS j/L M. DEMOLITION OF STRUCTURES: W
49. Number of stories ...
es .................................. .......................
/017110
49. Total square feet of floor area, Approval all floors,based on exterior Has pp oval from Historical Commission been received
dimensions .........................-...................................._....... for any structure over fifty(50)years? Yes_ No_
50. Total land area,sq.It....................................................... Dd4+ Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES O Pest Control:
51. Enclosed.............................................................................
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. Outdoors............................................................................. Z Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed......................................................._................... Electric:
n Gas: /
54. Number of Full......................._.........._...... I� Sewer: V
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.X_ (If yes, please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes_ NO-X—
Is property located in the S.R.A. district? Yes_ Nox—
Comply with Zoning? YesX No_ (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_ NoA (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: �a .1 �f f; in writing to the Inspector of Buildings.
V. IDENTIFICATION - To be completed by all applicants
R Name 1 f� Mailing address�Number,street,city,and state ZIP Codde7 n /Tel.No.1.
7
Owner or `TIG�A.rO ,'Y ✓� c3o tc� U.4-c�vha old". ' Q�� / U T.1�d'�( ��)
Lesse,
�2. xl+Gt .fL„ J/
Caitractor
Builder's
License No.
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 hi uthorized agent and wepgree to conform to all ap licable laws of this jurisdiction.
Sig a of pplica Address Application date
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building - FOR DEPARTMENT USE ONLY
Permit number �j
Building Com! Use Group
Permit issued 19
Fire Grading
Building
Permit Fee $ J Live Loading
Certificate of Occupancy $ Approved by: Occupancy Load
Drain Tile $ AA
Plan Review Fee $
TITL
NOTES AND Data• (For department use)
e
e �
PERMIT TO BE MAILED T0:
DATE MAILED:
Construction to be started by: M&VCA 4, 144Completed by:
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
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