12 BRISTOL ST - BPA-2009-102 No City of Salem Ward
• � 3�J
APPUCATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCT
IMPORTANT-APPAC&M to compMn a#Novo in s ctiom 4 q AK IV, and fix.
L AT 0LOCAMC" !e2 Brt s-fD l E->T-: DISTRICT —
LOCATION
OF eETM EEM AND
BUK DIMO �C1r]ds STRM , itleOm$11011 1,
sueonnslon7 LOT
LOT etoac sla
IL TYPE AND COST OF BUILDING -AS applicants complete Paris A -O
A. TYPE OF IMPROVE&tEtrr D. PROPOSED USE-FOR"DEMOUTIOPP USE MOST RECENT USE
1 ❑ NOW wrdrq Raatdorr9s" Norrsdiaardal
2 ❑ AddMM(/msi wdA*xW numesr of nwr 12 "wrrr 15 ❑ Arr UMMM ,Modf lW,al
Awiebq unas adds4 r 4ny,h odn A IM 13 ❑ Tso Cr nsors k"*-Erof numbw 19 ❑ Cwuc k Comm Magiiad
3 ❑ Ansration(Sea 2 abow) of mils 20 ❑ bduwW
4 Q,9"M raplsanwd r 0C � I P 14 ❑ TmuWd holK moMl a dwnWkwy- 21 ❑ PnkYq Wa"
Error nurnbwa unb—___--- 22 ❑ SdMon gill mL now Woo
3 ❑ VYrsckirp(I mWtr4miy rssidsndse enr nunifr 23 Q Hospiel4 sWWr I
of unip n budd&V In Part 0. 137 15 ❑ awgp
a ❑ Maw"(abcaft 24 ❑ oaron ewc PmaaabrW
a
7 ❑ rwwkllon only 170 Ol w Spoor 29 ❑ SdWA Wxwy odw adlrMiorW
S.OWNERSMIP - 27 ❑ SI m.tr rdr
5 EYPrWaa(bdH du k corpaalbn. "spay 2e ❑ Twft w`d
in svnnbn sec) 2913 oar--%mcdf•
9 Q Pudic(Federal.Sw*m but qDwamnwd
C. COST ()nsl cw" Nmsssiasnlrl-040miEs n doW pw0owd U111D Of INAMMI4*Al-boa pocass.19 PMrt.
mscl,Y,s snow wary bulc q at hospsl6 sisrrwdsry sel+od sscondry sClsoa4 CM.9a
edwalpalt
1 O. Cool a inprormard _ -D-�S _. 9 al jtlurW owit M9 d sais*g ouidn9 is b"v dwrP4 sn o orWCMd UM
7p Ge Msaasbd otd nW IWAX d
in Mr abom COW
a ElsCerlcai .___._......_....-..._................
__...._... -�
1
isPkanbing.._........___.............._._.._._.__.____.___.
c HMZW 9.a,corditlonsq�._.___.---------_--
d Ot w isMra m.sac)..t-yC ld1-(�
t,. TOTAL COST OF IMPROVEMENT I7KS
IIL SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E L.' demolition,
com to on Parts J 6 M all others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRW-VAL TYPE OF HEATWO FUEL G. TYPE OF SEWAGE DISPOSAL L TYPE OF MEC W40CAL
to �Msrprs (wall Dern9) 35
3, ❑ �Atppd M1arrr � �W ao ❑ Public ar orrvNs ecnw.ny •,rr tN,ws be ur.usl as
❑ of 41 Q P&r M(aspic Ink or-) Goridtloriip7
32 ❑ Strtattssl atssl 37 Q Elm," 44 ❑ Yes 430 ':
33 Q Rs'4.rcad co,us 38 Q Conl K TYPE OF WATER SUPPLY Ki lim try M sievssol7
34 Q Otnsr-SprrJy 39 Q Oatw-Spw4i. 42 Q Public w MMM Cm Wri, 46 O vat 47 0 o.
__ 43 0 P,W (.ek cieewn)
I MANSIONS M. DEMOLITION OF STRUCTURES:
+s WwbW Or
,g .OM,a,a,e I"d lea uaa Has Approval from Historical Commission been receiveO
r 5oarf oa+rrd an a.ury for any structure over fifty(SD)yeas? Yes_— No_
50 'alai lord nna+6 R ._.-....___.... .__.__..__
Dig Safe Number
x.Ktwm Or 0#*-STRM PAWM6 S 110ES Pad Contrut
51 Exaa�d ___........___.................. ....._._.... .....__
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
Yes No
L RESMBr1ML dal OMY WaW.
Electric:
Gait
FVI____—_.._..__..__ SOWW.
DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
.._.-------.___.....__ BEFORE A PERMIT CAN BE ISSUED.
N. COLVI IETE 111E FOLLOWING:
Historic District? Yea_ No N yea,please enclose documentation from Hist. Cam.)
Conservation Area? Yes._ No`�(ff ye0.Pie encloes Order d Conditions)
Has Fire Prevention approved and stamped Plans or aPPlfcat"? Yea-- No—
Is property located in the S.RJL district? Yee— No+�
Comply with Zoning? Yea— No— (if no,enclose Board of Appeal decision)
is lot grandfathered? Yes— No— (d yes, submit documentationld 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— No�If yes, submit documentation)
Massachusetts State Contractor License * 0�5 RUB L/ Salem License a
Home Improvement Contractor Homeowners Exempt form(H appiicable) Yes_ No
CONSTRUCTIONTO BE COMMENCED WFTHIN SD((6)MONTHS OF ISSUANCE OF BUILDING PERMIT
If an extension is necessary.Please submit
CONSTRUCTION IS TO BE COMPLETED BY: `jJ in writing to the Inspector d Buildings
V. IDENTIFICATION • To be completed by all ap scants
,. +.wp address. .V.MOY.stmK cey,and srab ZIP Cade 'd Na
i a 1nSa u4n, MA O)ri ;?0
C.rw a
,aaas
Contr&l" lterr N6
1
a",too X gD/
Ergr�
I hereby certify that the proposed'work is authorized by the owner of record and:hat I have been authorized by Me owner to make this application
as his authorized 3gent and we agree to Contoml to all Ikade'lawb Of MI9 uhsdPdkn
Sigrature of A � Application date
rG- `7/S -O
DO NOT WRITE BELOW THIS LINE
FBuildir;g
FOR DEPARTMENT USE ONLY
Us Gmv
J : lIFn C+dnOPerrrd issue /
Buildi1 L
0L s /Z�/ - M occupowy ,
Certificate of Occupancy f Approved b
Drain Tile t
Plan Review Fes
Tm.E
NOTES AND Data• (For department use)
„
S 0
N
C �
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by. Completed by.