391 ESSEX ST-27 FLINT ST - BUILDING JACKET No. City of Salem Ward
T�
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all Herne in sections.-4 11, Ill, IV,and IX.
I. AT(LOCATION 7 n 4/ CZ v U/ OISTRM
I LOCATION 1NO'
F OF BETWEEN IESSG'X �Cih/T AND
BUILDING CROge STUFFY (CLOT n
SUBWSION LOT BLOCK SRP
IL TYPE AND COST OF BUILDING-All applicants complete Parts A -D
A. TYPE OF IMPROVEMENT D. PROPOSED USE•FOR"DEMOUTION"USE MOST RECENT USE
!t 1 ❑ Nine butting Resid- UN Nonrwaden"
❑ ❑ %nWv 18 ❑ Amlwrnrv.nxraavaW 1
2 AddMon(n rosioentrr.enrernumbarol new 12 One
housing units aI.it arty,in part D.13) 19 ❑ chruch.Other relgoue
13 �7wo a mac family•End number
3 Aeerarpn(See 2 above) of unit_..._
_ 20 ❑ InGlWrae
21
Parldriggerap
4 ❑ ReW reolae�4 14 ❑ Traneiara haul... or mlmmry• zz 0
5 sense.t raWr.9va8e _
f mutslanuy rostoarttle,rrdar number Enearmmaimun4a____� I
❑ Wrxkeg(it of units inburldeg in Part D. 13) 15 ❑ Garage 24 ❑ Office.bank p
rolessional
p 6 ❑ Manng(relocation) 16 ❑ Carport 25 ❑ Public Laity - f
7 ❑ %bummu tan an 28 ❑ School.library,arm emrnearve
17 ❑ Other.Specify 27 ❑ Slane,mercantile
B.OWNERSHIP 28 ❑ Tanks.powers
8 &Private Imorvioual.corporation.nonprofit Other Specry -
vnteutam etc! 29 ❑ O t
9 ❑ PPublic(federal.Slate.a!oral goverment t
C.COST fora cerrtst Norcasloemw•Describe in detail Proposed Lee at buidage,e.9..load wpcessag Mrs.
maChare ism laundry budding r hoapeai.ebwemary,school,secondary school cose9e,
10. Cost at anproverrlartt ...__.. S ParaolrW SOW OarIuM garage lot decter"emag St .rental allies,bu4drng.oeloa buatlug
at arduebrl d we.ei esetiffg budding I/a/46a/�ICa/11g dnlenLge0.efnte1r�proppam ngRM
TOW►tia,,e cast not tttcoMed \ 1 \`l� / `'�J✓G:/r�u�--�
in ma move cost
a. Eleemol
b. Pits the
c Ilemrrg,as,Wndltions �`•�
d. Dow(revrw.eta)
11. TOTAL COST OF IMPROVEMENT
IIL SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions,complete Parts E-L.•demolition,
complete only Parts J&Mall others skip to IV
E PRINCIPAL TYPE OF FRAME F. PRUp-W�rAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL
30 ❑ MeewSY(cone beragl 35 gGas 40 Public or Privies corrtostry WA!here W cabal W
31 f Wood trams 36 ❑ Od 41 ❑ Privepe(septic terdL eM) cmxvcn
rlv
32 ❑ Struceft ales,! 37 ❑ Electricity 44 [9 ee 45 ❑ No
Q
33 ❑ Reaswcm bwra.r 38 ❑ Ca H. TYPE
l ItE11F WATER SUPPLY we own by an swim?34 ❑ DOW.Specify39 ❑ Off.Spee/Y 42 Public ar p, adnoeny 46 ❑ Yee 47 (ZINO
43 ❑ PrNre lwaa cifrrrrl
I
1
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
48 Numoar of S10na4 .-..........-........................_........_.. 3
se. Tout square rear at now area. Has Approval from Historical Commission been received
a.:vows oases an esreaw
�imerggns ......................._......_........_......_............__-.. for any structure over fifty(50)years? Yes_ No_
so. Tow Lana area.sa ft.._---.__..._._-----------..-- Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES
Pest Control:
51 Enepsea ....------..._._.___._....._..__.__._...__._.__
Z HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52. ONdoors...._..._..._.._._...._.'_._'_..._....— Yes No
L RESIGENTUU.BUILDINGS ONLY - Water:"-
53. E¢Imea____� .
Gas ..
Full—. Sewer.
54. Nwnbar Of
as Warns DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Paft - — BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes No_ (if yes,please enclose documentation from Hist 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_ No-
Comply with Zoning? Yes No_ (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yes No_ (If yes,submit documentationld no,submit Board of Appeal decision) 1
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* 03,9 yG7 Salem License#
Home Improvement Contractor it /"" Ki 7 Homeowners Exempt form(if applicable) Yes_ No
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
CONSTRUCTION IS TO BE COMPLETED BY: rt • 0�00� If an extension is necessary,please submit
in writing to the Inspector of Buildings.
V. IDENTIFICATION - To be completed by all applicants
Name Main address•Number.street edl',and safe LP Code TeL No.
towbar or U AiV / b E L- C2` �s9 04 y7 3 6=/&n
I°eee° �E�UG � G6 Start
2. of- r7S' ZN76e t! /Lh L 14A 7ftt�
Cann= L;�i+o o�a567 j
Aiaefan or G� AO . 9Rf - 5,G Uetw1 Asa=yap
Erww
I hereby certify that th w s authorized by the owner of record and that I have been authorized by the owner to make this application
as his authorzed nt anD e a o con rm to all apDlicble laws of this iunsdiction.
Signature of a-Polidan Address Appli bon date
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building - / �b FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19_ Fire Gra&Q
Building �e
Permit Fee $ `�//� L c Live Loadog
Certificate of Occupancy $ Oawarcy wadAppr d by.
Drain Tile $ e
Plan Review Fee $ ice fn,5��
TrrL E
NOTES AND Data •(for department use)
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by. Completed by.
E
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN -For Applicant Use
O "
W
jj
i
-PL414P -MOST-OE ffLfGlfJD AffROVED BY T44E
U�SPECT 3 ,PF9Jb�R TPA .PERMIT BFJNG GRANTED
CITY OF SALEM
N\<
q c .c�- Date
r;r:
Is Property Located in Location of
the Historic District? Yes No_ Building ::?2/ Z--��SE x
Is Property Located in
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owners Name i v77G-G Es
6�)
Address & Phone Z r�DC2a �- gf ram) s S'3-6-�F 9
Architect's Name
Address & Phone
Mechanics Name T�4?, (lO� GENG2 �L CoaY�z�Ti�v�
Address & Phone > m 73 f=- �
Whet is the purpose of building?
Material of building? o v t, m bD If a dwelling, for how many families?
Will building conform to law? Asbestos? /L lb
Estimated cost /O --City License a N " State License st o
Home Improvement
Lic. 1
S, atur p icant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO: IV 7-6 -
J
i
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT QRANTED
APP OVFD
INSPECTO OF BUILDING
S