7 FLORENCE ST - BUILDING INSPECTION (2) No- =�5 City of Salem Ward
a
x
( 6 edL APPLICATION
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION
IMPORTANT-Applicant to complete all Reins in sections.L ll, Ill, IV,and IX.
I. AT(LOCATIOM -1 �10aw•.ct , .S-4
LOCATION In03 is1Rffn
OF BETWEEN 6Ek..rA VG -- Cw'� G)A]'k �� AND
BUILDING ICRbSS STREET) (CROSS SmEen
LOT
SUBDIVISIONLOT_BLOCK SIZE
II. TYPE AND COST OF BUILDING -All applicants complete Parts A -D
A. TYPE OF IMPROVEMENT D. PROPOSED USE•FOR"DEMOUTIOM"USE MOST RECENT USE
1 ❑ Now budding Reeldenew Nonwdendo i
2 ❑ AAd9bn(a residential.ever number of new 12 ❑ one Nmiy 18 ❑ Almpamenl.rettsawnia
nounng unds added,d arry.In part 0.131 19 ❑ ChRCK otrwr rel 9 =
13 ❑ Two or more family.Enter number 20 3 Q Anerabon(Sea 2 above) of units
❑ Industrial
21 ❑ Parki g garage
< ❑ Rew rrn a repaceerw 14 ❑ Trannent motel,moth,or dormitory• 2213 Sarvioe suapn.napaagarags
6rMmtmbeiol ands���
5 ❑ wteaag(s muwm*resrdantat arernumber / 23 ❑ fWepeal krehhaporal
of units in budding in Port 0. 13) 15 LRJY Garage 24 ❑ 08be,burF,proleserorW
8 ❑ Moving trebaoon) 18 ❑ cannon 25 ❑ Public miry
7 ❑ rvundmbnomy 28 ❑ Sdwd.library.odo educaborW
17 ❑ oarr•SOSCOY 27 (3 Stags.meroanals
6.OWNER HIP 28 ❑ Tare.mwe s
8 rwee hndmdual.corporation.nonPrdd 29 ❑ Other•Specdy
�nldhdion.etc)
9 ❑ Publie(Federal.State,or(Gal governorate
C.COST (Omd tens Naaeemum al•Describe in deaa proposed use of buodi gs,e.g..kM oropeaeg owe
Reotwne anted."Wry budding at nospuL ew"WdWy seMd,se=NWV edictal NWga. I
10. Coat of snprowamend ..___ S /�oti 11 .. al eVioa1.flaring garage W defiant a afore,rental of im budding,oflloe bnoddk 9
at nd rtal plant It use at exis"building a being changed,enter proposed ues.
To be instated but not arcsrW d
In the above cost Y/� /'/�l ,L•�J
a Eecboor
b like ON _ -
e. a Mob ad coMakaang.
d. Outer(ew alor.nil
11. TOTAL COST OF IMPROVEMENT S �d co
IIL 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. PRN�/CPAL TYPE OF HEAT=FUEL G. TYPE SEWAGE DISPOSAL 1. TYPE OF MECHANICAL
30 ❑ Masom Mail bearag) 35 L1d = 40 Ed Public orp aseeomEMW we tare be CMMY air
31 ❑�/Wood hams 38 ❑ Od 41 ❑ P&AM e W W-
eppe k. ) corldearwnn47
32 �SWcluW alMf 37 ❑ Electricity4A ❑ Veil 4S (D No
33 ❑ Rekeaoed cove 38 ❑ Coal H. TYPE Qf WATER SUPPLY wo 8ers by an eyl�on /
34 ❑ Odnar-SoWdy 39 ❑ OBm.SpeeM 42 Pabae a pdwar edneerr as ❑ veil
43 ❑ Private lwae.ratxeml
J.DIMENSIONS M. DEMOLITION OF STRUCTURES:
Ja Numcer Or SIOn05 _.............__...........__......................__
ae. Total aware reel of floor area Has Approval from Historical Commission been received
a..fleora oasse en ft re
c,memiana .__..........._......_._.._........_........._.........__... for any structure over fifty(50)years? Yes_ No_
so Total we area so.b........__._..._.__...._..._.__..__ Dig Safe Number
K.NUMBER OF OFF-STREET PARKING SPACES Pest Control:
51 Emiom.............._._._.._.._....---- .__..._.__.___.. --..
HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
sx. omaoore.._..._.......---------_...__.— Yes No
L RESIDENTIAL BURDINGS ONLY s Wafer:;>
53. Erdwo....__ Electi C.. .
Gas
Full_ Sewer:
50. Number of
,a,Noom, DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
Partiell-- ----- 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 applica' s? 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 Ucense �Ott 6 a Salem License#
Home Improvement Contractor # Homeowners Exempt torn(if applicable) Yes_ No_
CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
�obws� �v � 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
Nerve Ma m address•Number.u/est crri%and able LP Coda TeL No.
Carrier or vvMN o(Slo 9?8 —ms o
x.
pamapor
B ilde/e
Hume No.
3.
Amlaac or
Enpmer
I hereby certify th roposed work is authorized by the owner of record and that I have been authorized by the owner to make this application
as his authorized anent sno we Solve to conform to all aoDliceble laws of this Jurisdiction.
Signature of appli n Address �.`� Application date
b 31(aS Fassw �
DO NOT WRITE BELOW THIS LINE
VI. VALIDATION
Building FOR DEPARTMENT USE ONLY
Permit number
Building Use croup
Permit Issued 9- Fire Gretl ng
Building
Permit Fee $ Lne Loading
Certificate of Occupancy $ �iOLy toad
Approved by,�
Drain Tile $ J
Plan Review Fee $
TITLE
NOTES AND Data-(For department use)
1
PERMIT TO BE MAILED TO:
DATE MAILED:
Constriction to be started by. Completed by.
VI ZONING PLAN EXAMINERS NOTES
DISTRICT
I
USE.
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SRE OR PLOT PLAN •for Applicant Use
ON
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JOB 7 Flonc,,.,ct 5�- S'A14.ti VtiVi
E.M.R. DRYWALL, INC. SHEET NO. I OF
631/2 Jefferson Ave. CALCULATED BY DATE
SALEM, MA 01970
(978) 744.5050 FAX (978) 741-8005 CHECKED BY DATE
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E.M.R. DRYWALL, INC. SHEET NO.- I Or I
631/2 Jefferson Ave. CALCULATED BI DATE
SALEM, MA 01970
(978) 744-5050 FAX (978) 741-8005 CHECKED BY DATE (b 0 S
i/SCALE
Lot� v.,i'<i�.. �6`�".F '.:rG.c. C 7A
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D PRODUCT 207