128 BOSTON ST - BPA-2005-768 U2 KITCHEN & BATH City of Salem Ward
Qr .
APPLICATION
FOR
PERMIT TO BUILD ADDITION; MAKALTERATIONS OR NEW CONSTRUCTIOP
IINPORTAW•AMficant to 666 ptets SO he=in sections:4 IW ILL N,and D!.
L,_ . ;.. ATILOCAT10ap ! ee`1' zoT
LOCATN N°'IO
- OF' BETWEEN iiid4TSor,1 " . AND 9RO✓e_ $7.
BUILDING „FAMST"�n a5loaaSTREF11
tor`
'' S r�
. LOT=e�OCM B, SI
U. TYPE AND COST OF-BUILDING-All applkan6-compMte Parts A' p
A. TYPE OF IMPROVEMENT D: PROPOSED USE•FOR-"DEMOLITION"USE MOST RECENT USE
1 C New euiltlMq AaatlanbY" "t .
2 ❑ AddMbn ra lwaYa dNt WlW MMNr Of' 12 a Ono fm* ". i Is Anwin nYa,IaLlwaa0lW
hQUINn4 umb 4ddrd,it m7.n W 0.13) __ - -
-, .. 13 ❑ Two«Yon httuyr.•EnAr//annfiar 18 C CMrJt odW 1Y1'IOYm-
3 C Ahwrawn awe 2 aboq Of uas 20 ❑ kdnk Y- ,.. .
21 Q.PwO* pnaba
.. a�gepwr repla�smsia . 14 Q bo0rl nnw,«tlemyory• 2213� ' g0/10v W Slab SYwan. wr omw
e ❑
'-
230 HoaorY autlnNonY
of unt n 0AdM n Part a IM 15 Gvgp , 24 13 OWAL balk tSolaaawtY
._ 6 0Mang-Uweolctll., .. : . '.. Is.C CUM" . . _, ." 23 ❑ PtM uft .
is 13 4 7 Fouwalen«ay 17 CYr OII •Specov - adla aY
B.OWNERSHIP. .
-. - 20-13 TsW,iowwa ,
B�j6j.I�PrigOa lraiMW bnrMMM naPdY':.
nslMon eeel 2913 OIMr-Apirlp
9 C-Fable lreYY.sma«NON lawatttntrw
C.COST omai Nw taYantr-Doemba ind@W«Somn a a o buYilpa,wb-Imd utccuaep Sun. i
. rtarJrr om awwrr bwow as' @lot w"v aeMat aewncON/@GINA L^oftW
I' 10. COY Or►n«orenwR Fr, 7 Z`(1' PatbCY I arJe eb
OL onSStO OYSba for dna tn r voM mnlo otralr bu cift OItlaw buW V
-- - .. Y n awww o YlL o taw at osarq .. Y bMq eY«pnlpa�d ua
apawau Ae PetnOatlSd `_ .. ,
i ,a Sr Scow Cow - �. •�
a GMtbot � •c
OIL PkN ON
e:IlaYYq.ar eaMMoiMnq ._ _.
- - 6 OOtSrlsiwSlr<.wG -
.. 17. TOTAL COST OF ILiROVEMENT
OL SELECTED CHARACTERISTICS OF BUILDING-For new buildings and addiLronA,complete Parts E-L:dernakWon,
3 c only Parts J 8 U.all others Sho to IV
E. PEAL TYPE OF FRAME F. NSNC1Ri TYPE OF HEAT=FUEL 'G TYPE OF SEWAGE DI3POSAL 1. TYPE OF IR:C1WrGL
30 Q Nbddbatlr b W _. .. a0 C.Fable«prMyoonwM'. -. rar
32 ❑'anAft"Yawl 37 ❑ EtCdtlly tl ❑ PrAwla lapfe WYt:,atW a4r1laS w
0 No
33 ❑ R4:+atae boner 3a ❑ CON H. TYPE OF WATER SUPPLY ws Srwbr an Mamol/
- 34.0 Otn.-Sorerr 39 C.Odw-SM* 42 11,P1tbkor, con"now ae C.y- 47 C Nb
.i m C RMNI...aYYn,
a.
a oaaENswNs M. DEMOLITION OF STRUCTURES:
48 qe a amaa ......._...._..._.___.............._.._.._.. ._.
49. Taw soma Nm a am area -- Has Approval from Historical Commission been received
a:uaaia oaaae an samicr 9 Yes— No—
a for 9rry structure Over fifty(50)Years
50. Tar mna area aa.RL..--- '-Dig Safe Number
IL NUMBER OF OMSTREEr PAR10N0 SPACES Post Control:
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
• 52. Oua mm..._ Yes No
L aEttenamiLL aUanaws OW
50.
FtA
DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
"tlYOp~ ralw. "BEFORE A PERMIT CAN BE ISSUED.
N. COMPLETE THE FOLLOWING:
��//
Historic District? Yes— No — (If Yes,Please erRdose documentation from KISL Com) .
Conservation Area? Yes— No (tl Yes:please enclose Order of Conditions)
Has Are Prevention appr_Qved and stamped plans or applications? Yea` Nou—
Is property located in the S.RA district? Yes— NQL
Comply with Zoning? Y No— (if no,enclose Board of Appeal decision)
Is lot g►andfathered? Yes_• No— (ti Yes,submti:documentationld no,submit Board of Appeal decision)
If new construction,has the proper Routing Slip been en&osed? Yft . 1 No_
Is Architectural Access Board approval required? Yes_ No (H yes submit documentation)
Massachusetts State Contractor License# Q oZ I 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
F
exterision is
submit
CONSTRUCTION IS TO BE COMPLETED BY: I D If an writing lo the I ,p
8 in writi te Ilease
nspector of Buildings.
V. IDENTIFICATION• To be completed by all aparcants
Name MM"ammr-Nu elf.meat CLL:a w ram ZIP Cana TaL Na
o..m« L 3Ave- L v Nfl OP o19yp I7-
LMMa
r 019ty0
2 - 5`/I e
a C°e ` S t V o 19 3 -
AElameMp or 8
I hereby a e work is auaRa¢ed by the owner of record and that 1 have been authorized by the owner to mace ft spplicaGon i
as his a owe to inform al aoolieade laws of this iurisdictbn. y II i
�SQnaur of Address M P/rlaU 1 daze
DO NOT WRITE BELOW THIS LINE
M. VALIDATION
Bulding. FOR DEPARTMENT USE ONLY
Permit number
Budding
Use craw
Permit Issued 1 9— Fie GMdM
Budding lie LaederB
Permit Fee $
LoadCertificate of Occupancy 5 Ocao�cY
APp►pYed by.
gain Tile $ -
Plan Review Fee 5
TrrLE
NOTES AND Data•(For department use)
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 Appbcan►Use
ON
rom acpr //YANVUbw LIMY &W
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exuaw 6�+ j"29
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128 Bosrw STREET
aw now
E7 E'V - ,52.1
I CERTIFY THAT THIS PLAN SHOWS UNIT 12 BEING CONVEYED AND TH£
IMMEDIATE ADJOINING UNITS AND THAT IT FULL Y AND ACCURATEL Y
DEPICTS THE LAYOUT, LOCA7TON, DIMENSIONS, APPROXIMATE AREA, MAIN
ENTRANCE AND 1HE IMMEDIATE COMMON AREA TO WHICH IT HAS ACCESS
AT 128 BOSTON STREET, SALEM, MASSACHUSETTS AS-BUILT.
DATE PROFESS/ONAL LAND SURVEYOR S �T
UNrr #2 �1A COCK CHK. 8Y.•
BOST(�NI Survey Associates, Inc. OAT£
185 CENTRE STREET, DANVERS, MA. 01923 2/14/05
CONDOWNNM VOICE (978) 777-3050, FAX (978) 774-7816
128 BOSTON STREET SCALE• 1+ = 8' JOB
NO.
SALEM, MA 0 .l 8 16 117M
n Ra nra ny ra a;rms-ma m
CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MA O1970
- TEL. (976)745-9595 EXT. 380
FAx (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34, I acknowledge that as a condition
- -- — of Building Permit#----------. all debrisresulting-from-the-consinicAoaactivi
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.
The debris will be osed of at: w �t l� MA
Location of Facility
%nature of Permit App t Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant ,(
Firm Name,if any
Address, City & State
The above statute requires that debris from the demolition,renovation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cUL S 150A, and the building permits or licenses are to
indicate the location of the facility.
The Commonwealth of Massachusetts
Department of Industrial Accidents
h -- awe of
600 Washington Street, 1`h Floor
Boston Mass. 02111
�Ly Workers'Com ensatiou Insurance Affidavit: Buildia lumbia lectrical Contractors
namc
address:
city state•
°hone#
lv ILI 9
❑ 1 am a homeowner performing all work myself. Project Type: ❑New Construction emodel
❑ I am a sole proprietor and have no one working in any capacity. ❑Building Addition
arf pdinenPI°YerBw°fkerse° , maa yertpt°fewo onhls(obpe — —
—
2°....ti j•Y*fir.+ Gf'15, + >.
ckr
R' tyt�
19, Y
Bulky
❑ 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers'compensation polices:
x xtv *«•
. k
addrean
in
company name,
11liElllaelte N. " ""'"` edlee r• a•a,. t - .w.Hwb.,r� K �3 au ~K, r
kK,empam Dome:
Failure to mum Coverage as required under Section 25A of MGL 152 can lead to the imposition orerimlaal pedNties of a not up m f1,500.00 and/or
one years'imprisonment u well as civil penalties in the form of■STOP WORK ORDER and a Bne of S100.00 a day against me 1 understand that■
copy of this statement m f ed to the Omce of lavenup,man of the DIA ror coverage verification.
l do here cent' and he '
�' o}'perjury that the information provided above is true and correct
Signature Date
q O �
Print name Phone#
official use only do not write in this area to be completed by city or town official
city or town: permit/license a
E]BuiWfog Department
❑ebeck If immediate response is required 01.1censiog Board
C]Sekctmeo's Office
contact person: phone a; 0Nealth Department
ar.,rw srr�.asni 00lher
ILIDEucrL Two CBGTIPr-ATE IS LSSULD AS A MATTER OF IGFORMATm
CASMY A EOCIATES IDS ASCY ONLY AM CONFERS NO F MTIB UPON THIS CERTIFICATE
HOLDER, THIS CERTIPICATE DOES NOT AMEND, MEND OR
TD HIGH STREET ALTER THE COVERAGE AFFORDED BV THE POL CIES SELINA
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ANY REOUIREAENT, TEMA OR CONDITION CI AGT Wi RMCT ON OTHER DOCLIMCNT WITH RESPECT TO WHICH THIS CERTFCATE MAY U ISSUED OR
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