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9-11 COUSINS ST - BUILDING PERMIT APP No. 632 City of Salem / , and In /U Z11/-S Z J / APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION fr IMPORTANT-Applicant to complete am#a m In sections:4 11, 114 IV,and IX. L AT(LOCATION LOti jrr.$ 7T . oISiPoCI' LOCATION RAW Bin (e" 4 b- �'r AM OF IGIOae81NFEr1 d110lr S1REEn BUILDING LOT SUBONISION LOT_BLOCK - 512E II. TYPE AND COST OF BUILDING.All applicants complete Parts A-D A. TYPE OfrIMP11OVEMOff D. PROPOSED USE•FOR"DEMOLITION"USE MOST RECENT USE t I�j¢/N"O,WtlNg Rwdrlur h�11y Nar.rorwr 2 0 AddhhM ram da"Af.ORW WM*WOf mw 1213 one to 0 ARIL AoaIaW housm urM add@ A&W.n OW 0.131 —^f/ 19 0 CMrJLo"wmNgias 13 wo a rnom rtm1Y•Enar rrarte@r 3 ❑ Attarauon(See 2 aaora) d urpe T w 200 lrtdrkW 4 0 Rear repleOW01 14 0 Trertelem hoW MWL Or daRMaY• 21 0 poke 9raw EnetrramlEVd unit 22 0 Salvia araau mpr,Ord9e S 0 wmatrg le mumameyresdtrrp raw motor 23 0 NwpeL itrdludonel' of unne m bulmn9ln Pm 0. 73) 18 ❑ Garage 2413 Odre,t1r9L PrarerurW S 0 Moreq Inbnaortl 19 ❑ Ca vw - 28 ❑ Ptdee umv .. .. 26 ❑ Sdro4 YDrM OdW Garr WW 7 ❑ Fotrwrrn Of" 17 ❑ Otlw•speedy 27 0 swm i1lemw N 2B O TadW towers9.OBW rvrNIPnan 29 ❑ Odrr•spscey ' rW9Non rGl 9 0 Pump IFedenl.Star,w q 8J Q0vWrarw* C.COST IOm1oNr1 NaReWr9W•040aea in der/a ooeaa use of bLd*lge,aq-We Pi" madlkte Noq wUrdhv bLNwq at noepaaL elm rW.0 edlpaL eeconOrY edtaa4 mae9a, �1p ao0- prdalW edraL arekg 9raP for 0@Derartem pare.nnW Gffiw OWdkg.dire atrdirtI 10. Cop Of knawamrl S l7 , at 11OwOrl Plant d uee d @:Wing adldrg s can9 L'nrl9ed.r9r Oropoaad tw. To as evsalw ad Aw vtck9w M ft 80"cow a. Elemm_ a. P1umDag ZA- GOO. a. 11evft wwrldllarq ZQ Dnv, a ojhw!, w,and 5' /C zc' 0�6• 11. TOTAL COST OF IMPROVEMENT s ZZA 00O IN. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and addition@, complete Parts E-L;demodb", complate only Parts J 8 M,all others Skip to IV E PRINCIPAL TYPE OF FRAME F. PRe1faCML TYPE OF HEATPID MR G. TYPE OF.SMAOE DMOSAL L TYPE OF MECHANICAL 300 Mame, v two'aerk0 3S Go 40 GI/Pkdjk or drawcoY wA� ?cerawsk 31 0 Vlldad home 36001 41 0 Prlwvr 128M W k%.rGl 4s � / ❑ 32 ❑ Smreerr rer 37 0 8i -1� It TYPE OF WATER SUPPLY (� NO 33 0 Rakdolcedconcrer 38 0 CoM wr 9We Dy an arAw 34 / M.speedy 39 ❑ arr•SOaod► 42 p co mOrry 46 E3 yn 470b J. moNs 48 N. M. -DEMOLITION OF STRUCTURES: ms my sm ae bm a noon a:noon Waco of are,<rror m His Approm2l from Historica l Commission been recanted for any structure over fifty(50)yam? Yes_ No_ 50. Tam w o a as as It.._-- V;Dig Safe Number IL NUMBER OF OFF-MEET PARRBNi SPACES (w C *&. 52 oaamn _ r_. HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? Yes - No L REB�BnML MDBK35 ONLT 9''� ".•, - 4 T. S4 Nw ra- Seva z, - DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED , Pa,mm— BEFORE A PERMIT CAN BE ISSUED. N. COMPLETE,THE FOLLOWING: y Historic District? A Yes_ No_ (B yea Please:enclose documenfaGon from Hi Co lt m►"-' s j .,'m. Conservation Area?= Yes_ No1G (N Yes,please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yes— No= Is property located in the S.RA district? Yes_ No_ Comply with Zming? YeaL�No_ (If no.endow Board Of Appeal dedaWn) Is t grandlalhered?x Yes` No v(If yes,submit documentation/if no,submit Board of Appeal decision) If new corretruC6on has ft prom Routing Slip been enclosedT. Yes_Z No_ Is Architectural Access Board approval required? Yes_ No v(If yes,submit documentation) Massachusetts State Contractor License t OS fi 3�f�/ Salem License# Home Improvement Contractor# Hortternnaers Exempt form(if applicable) Yes_ No CONSTRUCTION TO BE COMMENCED WITHIN SIX(B)MONTHS OF ISSUANCE OF BUILDING PERMIT„ CONSTRUCTION IS TO BE COMPLETED"BY: J 0 an extension is necessary,please submit o� D in writing to ffte Inspector'of Bull tgs. V. IDENTIFICATION• To be completed by all applicants Nr1M Mwig awrow•N,~Weer.mwwsmw LP Coda Tel No. owww— ' G�©Se cotes%�5 CrdP s2r, J Ol q(�a ?6lP laaMe,..,, LC.G..� 2. . 47S 4qo a A1aeIN,t or I hereby Certify that the proposed work is authodzed by the owner of retard and that I have teen authorized by the owner to make this appG�Con as his aulhariz agent ano we agree to conform io all aodicaele laws of this iunsdichon. Signature of nddrew 9 �� `r /� - Application daze