7 AMANDA WAY - BPA-07-1143 icy oy
City of Salem Ward _
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APPLICATION
FOR-
PERMIT TO BUILD ADDITION, MAKE AkTERATIONS OR NEW CONSTRUCTIO
lllwoRrAMT-Applicant to owww 'aN#*=in secdo .4 a,tµ w,and a.
L AT(IACATIDf1► . ►'Y1
LOCATN)N _''
OF eEfwm M CCA�boytUa i_ �za-
AMBUN DING (CFAMaueomm* 04sn r 1tie -H I I 1 S LOT q , �°sS
N. TYPE AND COST OF BUILDING-AN applA:ants-complete Pans A-D
A. TYPE OF WFROVEMENT m Pniopos D USE-FOR"DEMOLITION"USE MOST RECENT USE
/ ��biaip Raa�ldanral � .
2 0 Addition(N ms dwd*wrw number of new 12 l.7 6 11* - is 0 maaw '.ntaaYMyl
Musing wft adde4 s any,a MR A f3) tg f nck caw rdiaars
13 ❑ 7irrD or lardy-Fnwr munbw
3 0 AIOsa1Wn rise 2 above) of wds 20 ❑ IrAmbW
4 0 Repair replacwrnnt 14 Q Trwtetera holsk maW.«dondbry- 21 0 POkk tlnage
firMnumber a unb—_—_—. 22 0 Swvim sb*t rapsb gwaga.
5 0 of un ft,i (b ddN iniy rrt a 13tel eater numbw 23 0 Hoap,Y,irwOudornl
d units a Budd ip A Part a 13) 1S Q Garage 24 ❑ otllok brat prate..brW
8 0 Movft(rebeation) 1s p Carport. - 25 0 Pubic udill r
7 0 FOtxWa p o* - 17 p outer-sPeery 20 ❑ Sehookiarary.ogureducaliaW
27 [3 Star..,.wocas
B.owNER8Ji1P 28 0 Twda,taws
8 L]-]-06vate(MMividuek wrporshm nanprofM ❑ and-
Institution,ate.)
29 S 0 Public(Fade*State.or local govnnnwa
C.COST (omit cent) NorvosidwaW-Describe in dwP proposed use of uredna,&9.bW t>oossaHg glom.
'ntC yy�en,������ mu"we dap,law ft bcrYdbg d MoePad.eterromry school secondary settobl coaege.
1Q Coda impcovenrera 4�-U� i= i MochW scltocl Pat%ft owage for dePnbrrent ears.verve office buirW4 offce buadbg
d irdrsbtd Plar+.d use d e:ietYrg buidbq te b.bg wncea«+der p�vdese u.a
To be kmhbbd but not r4kaMd -
in the above spa/ y o
L Electrical �J
wee -------- 0 0 n -
d. othw(elevator,
11. TOTAL COST OF IMPROVEAIEM Is
IIL SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions,complete PaAs E-L;demolition,
complete only P&RS J&M aH others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRNCi�L TYPE OF HEATWO RIEL Q TYPE OF SEWAGE DISPOSAL L TYPE OF MECHANICAL
30 ❑ Mm«ry fwaY boning) 33 Gas 40 1g RiAc or p wase company � ae
32 Q Soh.*steci 37 ❑❑ y 01 ❑ Prirei.(eepfe trot eb.) " QIQ u 0 No
33 ❑ RaYdorced concrete 38 ❑ Coal IL TYPE OF WATER SUPPLY Wg 1lw a by an etevs
34 ❑ Od w-SW* 39 ❑ Odrw-somat7 42 �Pubae«prMfsoompwrY 48 p 1be 47-�No
43 0 Pmsta(we4 cistem)
J.ostiMPAWWAM
I M. DEMOLITION OF STRUCTURES:
as .----- _-...__ -..._..---ore. fed a'M�.. Has Approval from Historical Commission been received
W on..M artCt 8ny structure over fifty(50)years? Yes— No-
----�G-"-I�-sae.as R--4(P�L7 Dig JBtiB NumberK nua-srn�r awrwo SPACES Pest Control:
sr. En**W_-_------------ HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52 amoas_..—..--------- Yes No
sa Ens Electric-
F,d Sewer: .
sa N,.m.a°'w°°n` DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
BEFORE A PERMIT CAN BE ISSUED.
Farr.�-- i
i
IV. COMPLETE THE FOLLOWING:
Historic District? Yea— No - (ti yes.please enclose docsmientatlm from.HISL Cana...
Conservation Area? .Yea_ No_ m yea;please enclose Order of Conditioner
Has Fire Prevention approved and stamped plane or appriicatlons? Yes:_ No_
Is property located in the S.RA:district? Yea___ No-le-'
Comply with Zoning? Yes_ No_ (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yea_ 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?c Yeses_ No_ (If yes submit documentation)
Massachusetts State Contractor License# ��� 19 1 Salem License# ,Fs-t
Home Improvement Contractor# Homeowners Exempt form(d applicable) Yes_ No
CONSTRUCTION TO BE COMMENCED WR711N SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
If an extension is necessary,please submit
CONSTRUCTION IS TO BE COMPLETED BY: Vem Sf QQ� in writing to the Inspector of Buildings.
V. IDENTIFICATION• To be completed by all applicants
Name v.&&v ad&M-Mw W,SNW cM•and Sri ➢V Coda TOL Nor
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acedaa ar
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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 tltis application
as his authorized agent and we agree to conform to all applicable laws of this jurisdiction
Signature of applicant Address A icatian date
nn .
DO NOT WRITE BELOW THIS LINE
rUlKu
IDATION
FOR DEPARTMENT USE ONUf
umber Use GMW
19_ Fire Gm*q
ssuedg LN°L0�q
Fee $ ow4wcr�a
ate of OCDAWICY $ Approved byile. $ `
Plan Review FeeIFILE
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NOTES AND Data•(For department ON
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PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by. Completed by
A ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARO SIDE YARD
REAR YARD
NOTES
SERE OR PLOT PLAN•For AoPbc"use
ON i
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1 Dire De ariment
'oA F ;,4 L a lQ_f2 tt e,ti t r; t 29 rort
`W4S,GC/PiIt.rLC 01'9i0-. aq5 -1(' Fri
'Tel :,7,S-744-1 a35 Tu I C:;U
918-745-4t,46 `+'`d•74'7-7 7;
IF FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR A BUILDING PERMIT
IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE
AND THE SALEM FIRE CODE, APPLICATION IS HEREBY MADE FOR THE APPROVAL OF PLANS
AND THE ISSUANCE OF A CERrtrICATE OF APPROVAL FOR A BUILDING PERMIT BY THE
SALEM FIRE DEPARTMENT. ( Ref. Section 113.3 of the Mass. Bldg. Code)
JOB LOCATION:
OWNER/OCCUPANT: / e l
ELECTRICAL CONTRACTOR: -
FIRE SUPPRESSION CONTRACTOR::
SIGNATURE OF PHONE ,: Z�/��! `! /
APPLICANT: /I/ �
/i"
ADDRESS T: Z 71 CITY OT
APPLICANT: CUB TOWN:
e�t 9lf!/
APPROVAL DATE:
Certificate of approval is hereby granted, on approved plans or submittal of
project details, by the SAY EH FIRE DEPARTMENT. All plane are approved solely
for identification of type and location of fire protection devices and equipment
All plane are subject to approval of any other authority having- jurisdiction.
Upon completion,- the_ applicaot or Installer(s) shall request an inspection end/or
test of the fire protection devices and equipment. (ADDITTIONAL REQUIREMENTS,
SEE REVERSE SIDE
NEW CONSTRUCTION. (i✓ ' ��` �` ®�` ��
PROPERTY LOCATION HAS NO COTL'LLANCE 14ITR THE PROVISIONS OF
CRAFTER 148, SECTION 26 C/E, H.G.L. , RELATIVE TO THE INSTALA-
TION OF APPROVED 'c'IRE AL15M DEVICES. THE OWNER OF TNIS PRO-
PERTY IS REQUIRED TO OBTAIN CO.MPLIA:;CE A.`• A CONDITION OF
03TAINLNG A 3UILD711C PERMIT.
- _ PP097'r._ f LOCATION IS I5 OOP[P` 1ACl ;i:H !'t: F',)Vi5IO4 ;F C:i Ar'7 .,
143, SECTP;v 26 U, M . .L.
$ n
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