126 BOSTON ST - BPA-2005-769 KITCHEN & BATH 6 N City of Salem Ward
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APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTAW A�7p�pikant to coompNte all Items in sections.4 11, 114 IV, and IX. 7q�
L AT 9.00ATIONI 19
TX�SI -5'/ i _ STRICT
LOCATION vol
OF BETWEEN_IOXIN �7. AM 4"R 57.
,CRMSralan (CMULOIn
T Ac
BUILDING e 5
St.111gy60141 LOT BLOCK sin
I. TYPE AND COST OF BUILDING-All applicants complete Parts A -D
A. TYPE OF IMPROVEMENT D. PROPOSED USE•FOR"DEMOUTION"USE MOST RECENT USE
1 Q Nana buttwng Realdenibel Nonrestdsow
2 ❑ AedM"re residerttw.snow MMbw01 mw 12 ❑ om tamp 18 ❑ Anmwenoft tawdbmr ,,
)rorl39V unm adtled,it&W.m aW 0.13) 19 ❑ CluuCIL dery wq ow
13 ❑ Two w mwe smdY•Enw m mbw ZD ❑ IndtnMw
3 a AAerwarr 1See 2 abw!) of Law s 4 Taw m or dal nYdY• _
/J Erstmmbwaluns 22 Q SwWw M_bm eW W119
5 Q Wrm*mg(dMuW *msdmEYL.m.m,mw 23 Q rro.p+lr.WOUbMW .
el unrw m bwld V ai Put D. 13) 15 Q Garage 2413 Omm bark Ptdlar4crwl
6 Q mom m traromw) 15 Q cmoae 25 Q Pubic umv
25 Q Stdlaol.abia-V 0Mw90AN011111
7 Q FOWNWW way 17 Q otw-Seedy 2713 SImM.rrmew
B.OWNERSHIP 28 13 Threw wwws
5 la,l Primes imdividw4 mrPomicn.11WO t 29 13 odw.5peav
[j nmWubom mcl
9 Q Pubic IFedm Stale or amt poMnmem
C.COST iomroriw NOMNdw"-Decee m desa W000wd uas CO wrmngs.e.9..rood oMeerew PASK
mawsm snap,aundry balding at ndsprW.ewrwsery Sandi.socwMV sctabt.masgR
to Cove d enoroMrrwe s p , oatdwaw vJndl.twang 9en9a lw deoemnara srore.nafiW o5ic,s wading.dlloe 1 g
w Plus.a use a MsWw btredaq t mg cttwtgs4 enter wdpaeed raa
To he/Wladed bul not aaardad
m ma sw"Coat g,ha .� A.,
3 Elsetrot_ r U iTi�U} //,f ln►
0. Phm"q
�v�` fffl
a Naweq.ar omidiwrg
d.OIIw a*AdW.OW
11. TOTAL COST OF IMPROIIEWW
IL SELECTED CHARACTERISTICS OF BUILDING -for new buildings and addidom complete Parts E L:dantolibon,
complete only Parts J&M,all others skilo to IV
E PRI ICIPAL TYPE OF FRAME F. PRNCM TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL L TYPE OF MECNAMCAL
30 Q Msiici Md baenwe 35 Q Gsa 4o Q Pwft w mkale cwwww Wig�aY
31 Q Wood bane 38 Q Og 41 Q PnNala(sepdb lank sae.) a4 o Ww Q
32 Q Siru UW saw 37 Q EN0tty H. TYPE OF WATER SUPPLY
No
33 Q Rwdw=ddomrM 36 Q Cow WIN Nwebynowwor,
34 Q OMW-SpeYy 39 Q Ogw-SpNy 42 Q Pieoe or pnfaele dwntp�ty 46 Q yes 47 Q No S
43 Q Prbale tiwse.COWM
J.DIMENSIONS
se N.m m elaae . M. DEMOLITION OF STRUCTURES:
sg. Tow swan.Nn at Ma area.
a. Has Approval trom Historical Commission been received
:Mors aaea ore eaeror
ams ll _........_........_........_...............__. for any structure over fifty(50)Years? Yes_ No_
50. Taal la no ares.so.a._.-----_--.._----- Dig Safe Number
A.NUMBER OF OFF-STREET PARKING SPACES
Pest Control:
52, OulbOara
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
....-..—______
Yes NO
L RESIDENTIAL BIRDINGS OW Water:
sa EaaoMa_- Ebebir~
Gex
Full Sewer:
Se. NumMr a
oaeaaana Parrot DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No.,d,_�/
(If yes,please enclose documentation from HisL Corn)
Conservation Area? Yes_ No,�— (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_ NoX—
Comply with Zoning? YOXNo_ (If no,enclose Board of Appeal decision)
Is Icl grandhathered? Yeses No_ (If yes,submit documentationlrf no,submit Board of Appeal decision)
If new calstruction,has the proper Routing Slip been enclosed? Yes_ Nq
Is Architectural Access Board approval required? Yes_ NOX (if yes,submit documentation)
Massachusetts State Contractor License Salem License#
Home Improvement Contractor# Homeowners Exempt form(d applicable) Yes_ Nd
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
CONSTRUCTION IS TO BE COMPLETED BY: S Ifan extension is necessary,please submit 0 in writing to the Inspector of Buildings.
V. IDENTIFICATION- To be completed by all applicants
Nome Maig atom-Number,sum car,aro am DPCam Tel No
o.Mror USE) 3 LL Akle— LX&V 1� NO A4D 09V 17-
u me
2. Me-:6)PW Cjqj-0 olgk
moo, c 5w- Ce �lke 5 �e S o19�3
1 hereby the proposed work is authorized by the owner of record and that I have been autha¢ed by the owner to make this application
as his ap ano we acree to mnfnrm to Al applicable laws of this Kinsdiction.
Sig re of pl Address
AppM �ldp 1 p"date
ner
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Sawment
I' Floor
�► 126 Boston
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