3 BUTLER STREET - BUILDING JACKET r 1
3 BUILER STREET
No. �?s City of Salem Ward
4ciwRc d*'
APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all items in sections:1, It, Ill, IV, and IX.
3 �V 1 tm ZONING
I. AT(LOCATION) DISTRICT
LOCATION A(NO') (STREET)
OF BETWEEN 1 = 5 LSAND �Ul 10Q
BUILDING (CROSS STREET) (CROSS ET)
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(It residential,enter number of new 12 5-0ne family 18 ❑ Amusement,recreational
(rousing units added,if any,in part D,13) 19 E] Chruch,other religious
13 ❑ Two or more family-Enter number
3 Q Alteration(See 2 above) of units ....................................................... 21 ❑ Industrial
21 ❑ Parking garage
4 ❑ Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 22 ❑ Service station,repair garage
Enter number of units ...........................
5 ❑ Wrecking(It multifamily residential,enter number 23 ❑ Hospital,institutional
of units in building in Part D, 13) 15 ❑ Garage 24 ❑ Office,bank,professional
6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility
26 ❑ School,library,other educational
7 E] Foundation only 17 ❑ Other-Specify
27 ❑ Stores,mercantile
B.O.Wr/NIERSHIP 28 ❑ Tanks,towers
8 ml Private(individual,corporation,nonprofit
institution,etc.) _ 29 ❑ Other-Specify
9 ❑ Public(Federal,State,or local government
C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant,
machine shop,laundry building at hospital,elementary school,secondary School,college,
o` parochial school,parking garage for department store,rental office building,office building
10. Cost of improvement ......................................................... $ V at industrial plant.If use of existing building is being changed,enter proposed use.
To be installed but not includedI
1
in the above cost `��� W
a. Electrical ........................................................................... ,�y^�O
b. Plumbing............................................................._.._._.... "1 VILOOK
c. Heating,air conditioning............................................. fY.
tl. Other(elevator,etc.).....................................................
11. TOTAL COST OF IMPROVEMENT $
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 Wood frame 36 ® Oil 41 ❑ Private(septic tank,etc.) conditioning?
32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 allo
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 EA No
43 ❑ Private(well,cistern)
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
48. Number of stories ............................................................
floor
as. rlllft ors,square based
fee ofeet on exterior area
all al , Has Approval from Historical Commission been received
dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No_
50. Total land area,sq.n. ........... Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51. Enclosed .............................................................................
52. Outdoors.............................. HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
. .......... Yes N
L RESIDENTIAL BUILDINGS ONLY Water:
53. Enclosed ............................................................................. Electric:
Gas:
Fall......_.......�._....................._ Sewer:
54. Number of
bathrooms I PaDOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partial.................................... BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No)C- (If yes,please enclose documentation from Hist. Com.)
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 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 # 2mmoggplown Salem License#
Home Improvement Contractor# Homeowners Exempt form (if applicable) Yes-'Z, No
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT
CONSTRUCTION IS TO BE COMPLETED BY: p a If an extension is necessary, please submit
(p /3(71 I 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.
1. _;?>QMEL > M b1QR0 X141-yS
Owner or
Lessee
2.
Contractor Builder's
License No.
3.
Architect or
Engineer
I hereby certify that the proposed work is autho' ed by the owner of record and that I have been authorized by the owner to make this application
as his authorized agent and wear to cenf all applicable laws of this jurisdiction.
Signature o Iicant Address _ Ap lica'on date
J S L—_iL T1AL
i d.
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building 3- FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued t 9�2_ Fire Grading
Building � 000
Permit Fee $ / Live Loading
Certificate of Occupancy $ Approved by: Occupancy Load
Drain Tile $
Plan Review Fee $
TITLE
NOTES AND Data-(For department use)
PERMIT TO BE MAILED TO:
DATE MAILED: �/ 3
Construction to be started by: Completed by:
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN -For Applicant Use
O N
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT
In compliance with the provision of Section 113.5 of the Massachusetts
State Building Code, and under guidelines agreed upon by the Salem Bldg.
Inspector and the Salem Fire Chief, the applicant for a building permit
shall obtain the Certificate of Approval (see reverse side) and stamped -:-
plan approval from the Salem Fire Prevention Bureau.
Said application and approval is required before a building permit may be _J w
issued. The Massachusetts State Building Code requires compliance z 3
approval of the Salem Fire Department, with reference to provisions of IC m w
Articles 4 and 12 of the Building Code, the Salem Fire Code, Massachusetts o p
in
General Laws, and 527 Code of Massachusetts Regulations. = N ;
z !
The applicant shall submit this application with three (3) sets of plans, � p
drawn in sufficient clarity, to obtain stamped approval of the Salem Fire F- Ptz
Department. This applies for all new construction, substantial o w w G
CL
alterations, change of use and/or occupancy, and any other approvals as in a =
required by the Massachusetts General Laws, and the Salem Fire Code. a z a
Exception: Plans will not be required for structural work when the
proposed work to be performed under the building permit will
not, in the opinion of the Building Inspector, require a
plan to show the nature and character of' the work to be
performed.
Notice: Plans are normally required for fire suppression systems,
fire alarm systems, tank installations, and Fire Code
requirements.
Under the provisions of Article 22 of the Massachusetts State Building
Code, certain proposed projects may not require submission of plans or
complete compliance with new construction requirements. In these
cases, provisions of Article 22, Appendix T, and Tables applicable
shall apply. This section shall not, however, supersede the
provisions outlined in the Salem Fire Prevention Regulations, Chapter
148, MGL, or 527 Code of Massachusetts Regulations. All permits for
fire code use and/or occupancy shall apply for the entire structure;
fire alarm and/or smoke detector installation shall apply to the
entire structure based upon current requirements as per Laws and/or
Codes, but the existing structure may comply with regulations
;applicable for existing structures.
Notice: Sub-contractors may also be required to file individual
applications for a Fire Department Certificate of Approval
for the area of their work. Such sub-contractors shall file
an Application to Install with the Fire prevention Bureau
prior to commencing any work for those areas applicable.
ENM E
Form 81X (10/90) App01NSM N V V( N Be PNSP A��ENs SOW.��K
1N CT10 EAS ,,_*r,0p0
MpoE PS T PNFp,D................
Sa2.em Fite Department
APPOINTMENT FOR FINAL' Fol xe Prseventi.on Bwceau ! APPOINTMENT FOR FINAL
INSPECTION MUST BE 48 La4ayette Street INSPECTION MUST BE
MADE AT LEAST ONE WEA Salem, Ma 01970 MADE AT LEAST ONE WEEK
AHEAD---.----- (508) 745-7777
FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT
In accordance with the prsovt-6ton,6 04 the Ma-6.6achuzett,6 State Bwil2.d i,ng Code
and the Saeem F.i-ce Code, apPtLcati.on t.6 he-.eby made 4ors apprsovaC o4 pR.a.ns
and the -w4ua.nce o4 a ceAti,4tcate 04 apprsova2 4ors a butZdZng perm-it by the
SaCem F-ivice Department. (Re4. Section 113. 3, M"4. State Swig. Code)
Iob Location:
Owners/Occupant:
e
Eeect,,LZcaC Conti acto-c:
F-rice Suppae.6.6ton Conticactors:
S.Zgn.a tw e. o4 n n I �J n
AppZccant. y, _ , II\ZJ\ I` kF/IA a Phone #: (�11
--1�K£Vl --CJC Vyd
Add t".6 o4 C.i ty ors
Appt ,Lca.nt: cG m e Town:
Apprsova2 date: �4/f3
CeAt44.4cate 04 approval .i.6 hereby -g4Anted, on approved ptarz4 on. 6ubmjt.t Z
o4 prsoject detc -6, by the Salem F.lice Depairtment. AP,E ptan4 ane approved
4oZeey 4ors tdenti.4-Lcat4on o4 type and -Coca .Zon 04 44i,%e ptotec-Lon devtce6
and equ.Lpment. AZZ ptan6 ane 4u.bjeet to apprsovaZ o4 any other autho&u ty
having jun,1.6d1.ctZon. Upon eomptetZon, the appttcant ors trwta ter(4) 4ha21;
rsequ"t an -Zn6pectlon and/ors te6t o4 the 4t4e prsotectWn devtce6 and
equtpment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** )
New con6t%uct4on.
Ptopeaty -location ha4 no eomp-Plance w4th the p�covi-6ton4 o4
Chapter 148, SectLon 26 C/E, M. G. L. , rselative to the
tn-6taCatCon 04 apprsoved 4.(ice alarm devtce-6. The owne% o4
tyws prsopersty t4 rsequZted to obtain compRlance a6 a
condZt-Lon o4 obtain Zng a Bui.ld,Lng Penm.l t.
® P,copersty .location -i.6 .en compti.ance with the prsov.i.6ton6 o4
Chapters 148, Seeti,on 26 C/E, M.G. L.
ExpdicatZon date: 7/A5-43
S-Lgnatune o4 Fierce 069tc aZ
Fee ,.-u.z_ under 7 , 500 Sq. Ft. $10. 00
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Subjc-'to approval by any o er
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FLANS ARE APPROVED SOLELY FOR IDENTIPC INJ-V OF
TYPE AND LOCATION OF FIRE PROTECTION DEVIEtS:.:
ALL FIRE PROTECTION DEVICES ARE SOBJECt T6 A>
FINAL T6T AND 1;iSPECTION,FOR CONIPLETE COWL'
ANCE MIYFI TF1=.FIRE CODE
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