272 ESSEX ST - BUILDING JACKET City Of Salem ward
r _
APPUCATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCT
IMPORTANT-Applcna to omipNtd a/". !n sectbna 4 14 AV N, and IX- p��q
L AT(LOCATIOM -�>� L�U 64STf11f.T_
LOCATION
OF aETV#VXN AND
BUILDING awes main LOST
SUBDIVISION LOT BLOCK Sta
L TYPE AND COST OF BUILDING -AI applicants complete Parts A -D
A. TYPE OF ItlPROVEMENT D. PROPOSED USE•FOR-DEMOUTIOPP USE MOST RECENT USE
1 ❑ Mar Wrldlnl NaalrarrlYl MotresidnAr
2 O Addltlen(it Maidrnrr agar m.wer cW 12 ❑ Orr hnW ISO AmMOMWIL�rJrttla�r
(µ, Aourn9 urota add@4 r ow,,Ir Pot a. 13) /3 O 19 O Chita k a0w migimn
3 I�t AMrNbn(S"P.ow�) o Unds �^ZY'Enr nwnGr 20
O mow.q .
a ❑ ROpri rap4cwn d 14 O TMNbwM hold,marlL w dmnftV- 22 O Swyba ataNnft Mprr 9ar89r
s ❑ W.acta:n9 R n.,rrnw re+uanndat arr raurreav &MV Monew at UAW 23 O HoapYL irdYWprr
of unib in orwdkV in Pwr O. 13) IS O Dra91 24 ❑ OIBoa Nwdi.prdaaaorW
d O Mowm(Mbcoon) 1B ❑ CwPwt 23 O PuW udW
7 ❑ ra.,dMbn or#1 17 O OMw-sower—i!'r r{'L J�7 I d 26 O�q 9dm4 Ift- odr 6dU Zd0 W
2 Mx
9.OWNEwsHW 7 elms n�canllr
zs Q Ta ry W. S
a 6 PrNal.(Wxftidt ak corporatim rwnprdM za Q o.r. swtlY
insift Afork aim)
9 O Putlb(Federr.Stab,w brill Umwmr.M -
C.COST (OMW orgy Npr.aaidVrr•Daar be a doW qi Popoaadbm d rV ad r,ay,bd Wochook OWr.
`/�/j1{ '� rrrJarr dwF fu+drY bridlnY r 1wrP�Or4 rarrrYrr arJrpo4 raoondrrY rolwoL cobOr.
l n Cord Ynprmr _s�"' o O.w_ • r bdr.mr ptrL M um d aabtlnl O eWdn�v M C.iw tlr.rw.a.+.wcvo..d u..puadtr=:,
70 oa abae c out rw1 irwMCad
" .in db aOoyM coy
1. PIUrnb ,a ._._....._..-- - -- --- a s (�ICJ
c I+r.tlrw.a.mrdilbnYp..------------------ N C ct1 Gv 'I�-)-S
I I. TOTAL COST of jMPIIOVEMEHT d ,sd d•OU a Ar C LJ VM T v� r'7'�'}} I
ILL SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additionA complete Pacts E L.' demolition,
com to on Parts J 6 M aN others ski to IV
E. PFUNCIPAL TYPE OF FRAME F. PRNCPILL TYPE OF HEATING FUEL O- TYPE OF SEWAGE OLSPOSAL L TYPE OF MECHANICAL
30 Q Maaorry(waa Gaara4) 36 Q ca. 40 (5 PUNIC or pmab company "&h a c try air
32 ❑ S lood 1, atMl 37 Q E4ctwry 0 of 41 ❑ Prhab("m w IL arc) `wrrd*Wrwg7 <
33 Q Ra.,ac.d mnuab 3B Q cc.I H. TYPE OF WATER SUPPLY ❑ '
we&we try w aw.en
34 ❑ Other-Sps o 39 Q Cow-SP-dr 42 in PUDIC w p&mft cempanr 46 Q yes 47 M
f• _ 47 Q Prlv.b(wa4 cistern)
i
r -
a oerarstors M. DEMOLITION OF STRUCTURES:
Aa riot,Q, few a im Alfa Has Approval from Historical Commission been received
r%0 a baeef m A.wv lot any structure Over fifty(50)yew? Yes__ No_
se low brel r.. .a f ..._ .. Dig Sala Number
K rueeer OF OSF srnfn vuxwG svec® Petit Control
SlErc1ue0 ..__....._.__ .______._.._.._..__...._..—
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED
szQ,e,,a ..____._-.__-------...___........___.. Yes NO
t_ecareerua etanerres orar Walar:
Electric
FJ_—___.._..__..— Sewer:
or DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
°°r`O"1e ..____.—------ BEFORE A PERMIT CAN BE ISSUED.
IV. CoLoti TE THE FOLLOWING:
Historic District? Yes— No (If Yes.•please enclose documentation tram Hist.Corn.)
Conservation Area? Yea— No—IZ(K yes,please enclose Order 0f Condidoms)
Has Fire Prevention approved and stamped plans or applications? Yee— No
Is property located in the S.RA district? Yes— No
Comply with Zonktg? YML — (if no,enclose Board of Appeal decision)
Is lot grandfattwed? Yee— No— (M yes, submit documentationfd no,submit Board of Appeal decision)
If new c0 WMXti0n,has the proper Routing Slip been enclosed? Yes— NO—
Is Architectural Access Board approval required? Yes— NO_ (If yea, submit documentation)
Massachusetts State Contractor License N 0 1^ Salem license *
Home Improvement Contractor * J q /p S 3 / 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: in writing to the Inspector of Buildings.
V. IDENTIFICATION . To be completed by all applicants
%y 4a"imreae .%Ammer.sneK COV,14 stab ZIP Cove '°r Na
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c.rar Y f r-1
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Erpreer
I hereby certify that the proposed'.vork.s aufrized by the owner of record and;hat I have been authorized by the owner to make this application
as his auth ed went Mwe aes to conform to as licade laws of this;unsdictx n.
.y� iCatiort date
Sigrature of appl
i
DO NOT WRITE BELOW THIS LINE
VL VALIDATION FOR DEPARTMENT use Oran
Building
Pxmit number use cmo
Building 19 Fore Grad"
PxnA issued
L M LoodbV
Permill fee S load
OonDr+n
CertifipEs of Occupancy $ Approved by
Drain Tile S -
Plan Review Fes s M
7
YTTIE
NOTES AND Data• (For department use) 1
_ \ / /a,i a
aid 14L4A7
h p ohs
4
! AJ s e, Cr ke 0
N -
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by. Completed by.
A ZONWG PLAN EXAMWERS NOTES
OISTRICT
USE
FRONT YARD -
SIDE YARD SIDE YARD
REAR YARD
NOTES
STTE OR PLOT PLAN-For AposuW Uss
' O N
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration 149537
Ezpiratlon =1120/2010 Tr# 262816
Type: Individual
1.
SCOTT LEVASSEURk.,
SCOTT LEVASSEUR ,
28 MELROSE AVE.
HAVERHILL,MA 01830 Administrator
J ae 10001t/n(!arGBOUIL �� t
BOARD OF BUILDI G R UL TI S {
License: CONSTRUCTION SUPERVISOR p
r Number: CS " 091683 I
I�r Birth date: 07/03/1967
Ettpires,07/03l2008 �Tr.no: 91683
Re 0 f
' SCOTT LEVASSEUR
12 HILL TOP W
i BARRINGTON, NH 03825;' Commissioner