74 ESSEX ST - BUILDING JACKET Essex
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/// I S M EADO
KEEPING YOU ORGANIZED
No. 10301
PATENTPENDING
SUSTAINABLE
FORESTRY MIN.RECYCLED
INITIATIVE CONTENTIOY.
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MADE IN USA
GET ORGANIZED AT SMEAD.COM
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PLANS MUST BE FILED AND APPROVED BY THE
INSPECTOR PRIOR TO A PERMIT BEING GRANTED 1
Building Permit Application For: /
Location of Building Z
'(Circle whichever applies) Roof, Reroof, Install Siding, Construct Deck, Shed,Pool
Addition, Alteration, repair/Replace,Foundation Only, Wrecking
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:
OwnerdName,
_( �_1 Contractor: PW roUzO,/6C
street �/b �P�h,s G�'1� citSS/�e/y street 90 City 044 61 *140
State•Lt-ai— Phone t4L Slate f16 Phone 07)f 33 —
Architect: �� City of Salem Lic#
Street City State Lich O 2-62 HIP# /W97L
State Phone ( ) _ Homeowners Exempt Form___ycs ,�r no
Structure: (please circle) Single Family, ulti F y;f_Other 01A &,.e-J,rh
Estimated Cost of job S S� /d U a
Will building coorirm to law?
yes no
AsbcAos?_tea�no //
Description of work to be done: /I P ti
fe ,
Drawi ubmitted:_yes_ no Mail Permit to:g n �^
Signs of Application,SIGNED UNDER THE PENALTY OF PERJURY/"
CONSTRUCTION TO B&COMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE
Department use only: Pe4#\3�11-\ Zoning Map/Lot
Permit fee$
COMMEWS:
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I The Commonwealth of Massachusetts
t. Department of Public Safet
.%lassac husrps St.]to Building Ct de i80 C.\I R) f
Building Permit Application for any Building other an a One- '1•wtrFan,iIy Dwelling
('Phis Section For Official Use Ot v)
Iklilding Permit Number _._.._. Date Applied: Bit got eial:
SECTION l: LOCATION(I'lease indicate Block N and Lot p fur locations for which a street address is not available)
No.and.Street City /rown /it'Code ,Name of Huilding(it applicable)--_----_
SECTION 2:PROPOSED WORK
Fdilioll of .MA State "'de used It Net%Construction check here Our check all that apph, in the two rote%below
F\isling Building❑ Repair Alteration ❑ Addition ❑ 1 Demolition O (Ple,lse till out.utd submit:\ppcndix l)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: fl2jp_ 6��WF
.\rebuildingplum i I/orconslrttet ion dtwunienis being suppliedaspartofthis permit application? Yes ❑ No a— ----
Is an Inde F 6 I tendent Structural Engineering Peer Review r v wired?
Yes ❑ No
Brief Description of Proposed Work:_ rJ�/2r n Gtnf`1 /�y
SECTION 3:COMPLETE'rHls SUCTION IF EXI
STING BUILDIN
G UNDERG
OING RENOVATION,AUUI'f10N,OR
CHANGE IN USE OR OCCUPANCY
Check hcra if an [silting Building Investigation and Evaluation k enclosed (See M C(%IR tl) ❑
Evisling Use Cnmp(s): ._—_--- proposed Use Gruup(s):_._____..__._._
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Flours/Stories(include basement levels)& Area Per Floor(sq. ft.)
1'uLd :\nra(sy. (t.)and Told Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly:\-1 ❑ A-213 Nightclub ❑ A-3 ❑ :\-! ❑ A-3 OT B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ 1:2❑ 1 If: Ili h Hazard 11-1 ❑ H-2❑ 11-t ❑ 11-4❑ li-i❑
I: Institutional I-I ❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ li: Residential 11-10 R-2❑ R-3❑ R-4 ❑
S: Storage 5-1 ❑ S_'❑ U: Utility❑ Special Use O and please describe below:
Special Use
SECTION 6:CONSTRUCTION L`YPF- (Check as a icable)
I:\ ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ II16 ❑ IV ❑ VA ❑ %'B ❑
SEC"rioN 7: SITE INFORMATION(refer to 780 C.MIi I I I.0 for details on each item)
Water Supply: Ruud Zone Information: Sewage Disposal: Trench Permit. Uehris Removal:
I'll[,l is ❑ Check it outmde Hood Zone❑ Indicate municipal ❑ A trench will not be Liconvod Pi.posal tine❑
Pri%, is❑ or mdvnlil} Gme: - or on site st stew, ❑ nvluin•d ❑or booth or spok if% .. _
pvr n t is rnr luwd ❑
Railroad right-of-way: Ila[ards to Air ,\'a%igatiun: .
.\pphrablr❑ Istilruc twe t,ohin.urport approa,h,owa! Ntheir It%wit iomplrlyd! .
„r C on.rut it, Budd,it,I...e,l ❑ le.❑ hr\'a ❑ Irv❑ \'o ❑
SFI. IION S: CON EN'I't lF CI'It I'11:1C\I E• OF OC("UPANC'Y
I JiWmul ('odr- C.r(;miVy`I- I\ a•ol C',,mm�lt lu,n.
I I n upourt I t,,LI per I Igor.
)nr+ Ihr hlli1dinl;,,,nLun .w<jimikh rtit mrm!- �por 1e1 ;I it'll 1.11 inn`:
Sl_:C_I'ION `); i'ROI'lilf tY UWNER AUI_I IOIiIYAIIUN___ f _____
.N,unc and :\ddress ul 1n0prrly lh%ncr
Name(I'rint) .No and Street City/ fawn Z4p
I'rt+pvrIv Owner Cun Ltet Infonmtion: _
I ide _� ------ — frlrphnne Nil. (business) -.relephone NO. (cull) e-mail.tddress
it +pliCable, the properly mvner hereby authorizes I
( Name Street Address City/Town
State Zip
lu art on the +ru pert owner's behalf, in all matters relative to work authorized b , this I)Oilding permit a p+lication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than.13,0IM)cu.ft.of enduxvl s ace and ur nut under Cunstntclion Control then check here O and ski p Section 111.1)
Ill.1 Registered Professional Responsible for Construction Control
Name(Registrant) felelphone Nu, a-mail address Registration Numb
ve��y C- r L N r/ 18+ _ I o R F_— ` -(o•�f y
St=Cet Address City'/Town Stale Zip Discipline Expiration Date
10.2 General Contractor
1 0 twti -tRAfiJZ--T 3t1— coNs +-.,ter, ze..—
Company Name
l It,n tQa w^aT /11177L9i --
Nance of Person Responsible fur Cunslructhm License No. and Type if Applicable
rs vrau�w sr L�N� — 0fre0Y
Street Address City/Town State Zip
AEI 55�- fat( - --
Tcly phone Nu. bsi uness Tele,ho o ne N . (cell) e-mail address
t t AIPI V,n t h,S_ yV,I11,XM 1� .v l l(�•�\'II M.G.L.c. 152. 25C 6
A Workers'Compensation Insurance Affidavit fnxn.the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affid.tvit will result in the denial of the issuance of the building permit.
Is a si rued Affidavit submitted with this a lication? Yes O No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and \laterials) Total Construction Cost(from Item 6) 'S--__--
I. Building 55.,ooO.t>IZj Building Permit Fee'Total Construction Cost x _(Insert here
1 rl ctrical S appropriate municipal factor) ' S
I Plumbing S contact nnmici +ails
1. .Mechanical (IlVAQ S Note: \lininuun foe ='S__( l )
S. Mechanical Other S Enclose thick p.m•able to -
n. Total Cost $ , O0 (contact nuinic ipality) and tcrite chuck number here _----- -- -
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
RV catering ill{' none below, I hereby attest under the pains and penahieS of perjury that Al 'It the information contained in (his
al,plicalion is IrIJV Mill accurate to the best of my knot%ledge and underslanditlg.
efL_ +7ei .594 Dot lo.-�Q lW
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�tnri \,1,1 resS cp.f57- ✓P2.ONz"tT CIIV/ down Y
\hot is i pal l nspectur to f i ll out this sect ion a pun app licatiun apprw'al: _ _ ._.____-___._.___._ ._ ...
I ,,\'alter ILdv
co STREET PERMIT ,
Citp of barerrY
®ffiie'of 3noyettor of Ouilbingg '
-ermission is 12ere6y yiuen to P_'PTT r1 NYO I-LC) VA -KPM
!o occupy fog r 71 purposes
I
in fron!of eslale �7 y 'L�� X
of j rJetva&, Ir eel.
7sis perini/is lmiledlo x-\17 P 27, - 7.. i-, 20 Lf sufec!!o,/lie.'
proms/ons oldie orA;a!nces ano slalules in relalron to c5lreels andliie.9nspeclIon
and conslruaiion of J3u/ldi/9s in llie c:y of csalem... `—
, 'diirc/w o`J�6/c c$elwcu - .�ntpee/or o`.`Aui/dn9r
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