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CERTIFIATE ISWD 1994.
DATE MCI: '
~ " . CITY OF SALEMBUILDING PERMIT_ - 1 i
SALEM, MASSACHUSETTS0
01970 4 1 =
CERTIFICATE. OF OCCUPANCY
�cDmE{ ± s p 1 - 9a:- �. - !164-93
GATEl 1L 1_, .39y _ PERMIT NO. 1 +
-1 f .joDe ,a, vw.11amADDRESS ♦a[s/r:+>, _ i t :.
APPLICANT W -- 1.0A ISTREETIICON\R SLICE )EI
1 i wa'IC[Ef l'N1+ NUMBER OF.
MIT TO _I STORY SAt3]uMA+3� DWELLING UNITS
PERMIT TO 1{CSK/\[sS�sMYM VS0103[O uSU
Or'IM�IfR OY[�SYS[M11 S�S,T�SSO yN�O.S� y ZONING
24 WI,P[[SYeaY ROAD 6111�D DISTRICT_
AT (LOCAiIONI hY.I 1 ISTR[ET)
1 AND J� :
BETWEEN - \CROSS Slott" _ ICPO33 5\R[[TI
. LOT I
LOC'' BLOCK SIZE _
SUBDIVISION
] 1 FT IN ME1GNT AND SMALL CONFORMINCONSTRUCTION
FTHIDE P• FT. LONG By __
BUILDING IS •0 BE . - -
'J6E GPOUP BASEMENT WALLS OR'FOUNDAT ION �TYF[I Nt �yyp�
TO-TYPE -F\�UES��EE/�GR vTpO �S.S�Rp� 7 ]���mC wseq� ryE+���,/.� .rY�33\ MICR ) Mn al D01111S
-. yA,y�AS M Flo
_LB[['1Si4 , ++`-�'--Ac+ NEW .4 b1ULU" �SS[fE1YaR 1lYA iis+
no
[ CALL FM RIFT ZO OCCWY i45-99�55$91I5�y{��{��II
A�1»III�IE�7�IS�li�l
AREA OR
VOLUME longs _
Pobert Wal I&= vf'IISA1sfTSA\slYlsn I.A,." itIT SND- ^,�^1OE
OWNER RS .E SEE REVERS CE-_"DI-ITI�ONSy OF CERTIFICATE
..rn��s
ADDRESS ..
5
DEPARTMENTAL APPROVAL FOR CERTIFICATE
of OCCUPANCY and,' COMPLIANCE ,
g' ;To be filled in by each division indicated hereon
upon completion 104,its linpl inspection. i
k eaN I , 164F_03 ! i
BU�:DIGS I + I Permit NI. � � I
Approved by Jo.rn . 0ennirig I Date 13/1 I/°4
Remarks j
i
'„3 1 I
RCUMBING Perintt No.
1
t�t Approved by Torn T1eC!erc ! Date 3/ 11/Q4
IRemarks L^ i
t I I j j l
ELECTRICAL Permit No.
1 i I {
v
Approved 'by I JOhri 9I.ardiI Wte 2/28/94 T I
�.
Remar s— I •; i
r
I
OTHER Fi'1e' ! son Permt l�o_ t
T't . Hud3/ 14194
Approved by' 'I f Date
L ;
[f R ertrark�l
r kOTHE RS Permit No. '"}t
Approved by I I ! I Date
I
{I Remarks'
I
r '
i0.,
= BUILDING
PERMIT
„r q3 JOB WEATHER Cj%R D
�a;+
.10`Zg ,I DATE 10 I
PERMIT NO. �-
APPLICANT .� 5..?n Cv"„}+v:. .:..
' ADDRESS - `�•'i- r:FA" ..
two.) (STREET) -- ��
(CONT N'! I
PERMIT TO s -- \T 1.1 riL1l (_I �STOgY LR .N!Ls NUMBER OF LC[N!!1
1
IT", or ......NTI yl DWELLING UNITS
A��af! !„x'sn IrRlrOlEl us[I -��
AT ILOCATIONI a� r• 1� RIM -� �ryaA{{y � ZONING
IlTA[[TI D15TA ICT 1
•wxvy..Mv:.
BETWEEN
(Coos, STKEETI AND
(CROSE STPE[TI
SUBDIVISION LOT .,,-f`�x LOT _
BLOCK SIZE
X58..
BUILDING IS TO BE FT, WIDE Br FT. LONG BY
FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
j
TO TYPE - USE GROUP BASEMENT WALLS OR FOUNDATION
R1ENupKs, ,•; r2F�'3 a•�tE. l�t�I,r T��[.rw?� i!a4:d � ?-.t,�"eS &•-G'�-�i:Jt T'::;•,;,.; � :'.�'.11trtlG'4-0. :1'��a. .
a1LL
IIWWrl .11 XCta-N 145-9595 t
VOLUME pp VFI`rht�l 1. .l :i..11
ESTIMATED COST 0 PE4MIT
.Culla SouJRE F[ET) FEE
'�Xitv'.s't el 1ac"I
OWNER
ADDRESS --� - BUILDING CEPYI-ii ..• ,.A._'[il�,'N'[�}�
THIS PERMIT CONVEYS NO RIGnT TO OCCUPY ANY Si REE T. ALLEY O4 SIDEWALN OR:ANr paa,SPIECTOR OFREOF BUIPDLDIRNG§R
PERMANENTLY. ENC BOAC HMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE. M RAR( B AP-
►ROVED BY THE.JURISDICTION. STREET OR ALLEY GRAPES 45 WELL AS pEPTn ANO LOCATION OFPUBLICSEWERS MAY BE'O BT SINE
'iROM YHE-"DE P'i R'-f ME'NT Oi-PUTFC'TC'EIORRS"'Tn CT9YUfNTE-01•`TENS'PFEEMY'n$OES+}rOr•RF•L e'a31r-T NE�'no•PtTC•
OROM
UY APOLICABLE SV BOIVISION RESTRICTIONS.
MINIMUM Oi Tnq EE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS. wnERE APpLIC ABLE SEPARATE
(NS-EC
E C TIONS REOUIREp FOR
ALL CONSTRUCTION WOq N: ,b CARD KEPT POSTED UNTIL FINAL INSPECTION MAS BEEN PFRMi TS ARE REOUIREDi9 POR'-
I, FOUNDATIONS OR TOOTING 5. MADE` WHERE A CERTIFICATE OF OCC U.PA NCV I$ RE- MECHANICAL INSTAL PLUMISINGIV ND.
2. PRIOR TO COVERING STRUC TUR AI QUIRc O,S VCN BUILDING $HALL NOT BE OCCUPIED UNTIL
MEMSER5IRE ADY TO LATH(. FINAL INSPECTION NA5 BEEN MAGE.
J. FINAL INSPECTION BEFORE
OCCUPANCY. p-+E
POST THIS CARD SO IT IS VISIBLEFROM STREET '
BUILDING INSPECTION APPROVALS SING INSPECT( N APPgOV 415ELE C.TRICAL INSPECTION ♦PPROV Ab9
/0
( -
I�/f3 -b'G� - g�3 .. q3
2 IRI
2 •
POARD IF HEALTH S INSP TION APPROVALS RE DEPT. INSPECTING APPROVALSRR
1 I 3 q,yl9 y �.,..�.� a
r
OTHER CITY ENGINEER 2 2
WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRU
STAGES OF CONSTRUCTION. CTION INSPECTIONS INDICATED ON THIS CARD
WAGE: !)R HAS APPROVED TIE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE
CAN BE ARRANGED FOR BY TELEPMQNE
PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION.- s-
No. ry City of Salem Ward
� x
y'cr..ovE�
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applican�tt to complete all items in sections:1, It, /it, IV,and IX.
I.
AT(LOCATION) o2 ZONING /J
(NO.)
IsmEErl DISTRICT/' �.
LOCATION
OF BETWEEN AND
BUILDING (CROSSSTREET) ICROSSET
LOT
SUBDIVISION LOT BLOCK SIZE
II. TYPE AND COST OF BUILDING -All applicants complete Parts A-D
A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION'USE MOST RECENT USE
1 ❑ New building Residential Nonresidential
2 ❑ Addition(if residential,enter number of new 12 NI/One family 18 ❑ Amusement,recreational
housing units added,i/any,in part D, 13) 19 ❑ Chruch,other religious
13 E] Two or more family-Enter number
3 ❑ Alteration(See 2 above) of units ....................................................... 20 ❑ Industrial
21 ❑ Parking garage
4 Repair replacement 14 ❑ Transient hotel,motel,or dormitory-
22 C] Service station,repair garage
5 ❑ Wrecking(if multifamily
number of units ...........................amily residential,enter number 23 E] Hospital,institutional
of units in building in Part D,13) 15 ❑ Garage
24 ❑ Office,bank Professional
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
7 ❑ Foundation only 26 ❑ School,library,other educational
17 ❑ Other-Specify 27 ❑ Stores,mercantile
B.OWNERSHIP
28 ❑ Tanks,towers
8 r9r Private(individual,corporation,nonprofit 29 E] Other-Specify
institution,etc.)
9 ❑ Public(Federal,State,or local government
C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant,
O machine shop,laundry building at hospital,elementary school,secondary school,college,
10. Cost of improvement .....d..l..��a d Parochial school,parking garage for department store,rental office building,office building
�"......""---"------ $ �� �Q Q' at industrial plant.If use of existing building is being changed,enter proposed use.
To be installed but not included
in the above cost ^, 0 Q a S-'LfQ
a Electrical.............
..... .......................................................
OB _
b. Plumbing....._ ..Svc._ ...'......^............................. 07
c. Heating,air conditioning '
d. Other(elevator,etc.)............................
11. TOTAL COST OF IMPROVEMENT $�S��U-t�
III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition,
complete only Parts J&M, all others skip to IV
E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL
30 ❑ Masonry(wall bearing) 35 ❑ Gas 40 ❑ Public or private company Will there be central air
31 F1Wood frame 36 ❑ Oil 47 ❑ private(septic tank etc.) cendifoning?
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No
33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator?
34 ❑ Other-Specify 39 ❑ Other-Specify 42 ❑ Public or private company
46 ❑ Yes 47 ❑ No
43 ❑ Private(well,cistern)
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
4e. Number of stories . ......
49. Total square feet of floor area, A
all floors,based on exterior Has Approval from Historical Commission been received
dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No
50. Total land area,sq.ft................................._..._.............. Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed .............................................................................
sz. Outdoors HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?............................_..._..._.........._......................... Yes No
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed............................................................................. Electric:
Gas:
54. Number of Full........................................... Sewer:
bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial-----.......................... BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No_t�_ (if yes, please enclose documentation from Hist. Com.)
Conservation Area? Yes_ No-e (If yes, please enclose Order of Conditions)
Has Fire Prevention approved and stamped plans or applications? Yes_ No Z
Is property located in the S.R.A. district? Yes_ No/
Comply with Zoning? Yes—v' No (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes_ 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? Yes_ No_ (If yes, submit documentation)
Massachusetts State Contractor License# 01910 3 Salem License#
Home Improvement Contractor# 76M 2 Homeowners Exempt form (if applicable) Yes_ No_
CONSTRUCTION TO BE COMMENCED WITHIN SIX'(6) MONTHS OF ISSUANCE OF BUILDING PERMIT
If an extension is necessary, please submit
CONSTRUCTION IS TO BE COMPLETED BY: '711-21 93 in writing to the Inspector of Buildings.
V. IDENTIFICATION - To be completed by all applicants
Name Mailing address-Number,street,city,and state ZIP Code Tel.No.
"7 0JAL(aat— ` 0( &te- il<,41,1 ret9- C 4l9aq U
Owner or
Lessee
z. rte Aed C C@JgC(acrG L( 4 91,?,9.r1 d7'. dg1I(ae4( 071q, d11 . 3 97y-74Fi3
Contractor
Builders
eoa,;�7
License No.
3.
Architect or
Engineer
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 this application
as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signatur f ap ntAddress Application date
c t cL L c� G Z�l���� a'W IFrl/ r z ,3
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building / FOR DEPARTMENT USE ONLY
Permit number C( y
BuildingUse Group
Permit issued �_ 19 lu
Fire Grading
Building
Permit Fee $ ��' Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by:
Drain Tile $
Plan Review Fee $
LE 014
NOTES AND Data-(For department use)
qj22 ccC s�F/iNi RIV 7' 19lC
eX/41/1?1, , Al2t) --7,k17-e/10 Z 4
D4ew ev(A(&Wj f R( i cov, /A//2czJ
,il/ZCTr 24L) cMX (c4- t i//� 141110 elewlel? rCa
LS/ �uc/97- SI�T/ /ALL MMS
1/2CAJ 14167- Z-c Iq'7,eX i9 IVOe , 1�P ��i01/� /9C'C 7-6
J� sAt2tfri
PERMIT TO BE MAILED TO: V) L G a /
DATE MAILED:
Construction to be started by: Completed by: 7 �,2 9✓�
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN -For Applicant Use
vV Y_
SUBURBAN ADJUSTMENT
172 North Main Street Salem, NH 03079 603-893-5990
24 Ray Avenue, Suite 201 , Burlington, MA 01803 617-272-5151
Form of Notice of Casualty Loss to Building
Under Mass. Gen. Laws Ch. 139 , Sec. 3B
To: Building Commissioner or Board of Health or Fire Dept. or
`Inspector of Buildings Board of Selectmen Arson Squad
RE : Insured • pp
Property Address : I�C�UN0.V� �pQoY
Policy No . :
Loss of : �- L�r�s/ 19
p i
File or Claim No :
Claim has been made involving loss , damage or destruction to the
above captioned property, which may either exceed $1 , 000 . 00 or
cause Mass . Gen. Laws , Chapter 143 , Section 6 to be applicable .:
If any notice under Mass . Gen . Laws , Ch . 139 Sec . 3B is appropriate
please direct it to the attention of the writer and incl1'ude/a�
reference to the captioned insured , location, policy nun�tyf, date
of loss and claim or file number .
Title : TER --�)
On this date , I caused copies of this notice to be sent to the persons
named above. at the addresses indicated above by first class mail .
4�. lla79�
nuanddat
- Speed Letter® 44-902
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Subject
MESSAGE
40
Date Signed
REPLY
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Date Signed
WilsonJones RECIPIENT—RETAIN WHITE COPY. RETURN PINK COP
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