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9 GREENWAY RD - BUILDING INSPECTION ■ No. City:.of Salem Ward APPLICATION �I .,FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete all items in sections:1, 11, Ill, iv, and 1X. I. A70.00ATIONI 9 Green way Road 6101,11 C LOCATION 1H°' OF BETWEEN Highland Avenue AND dead end ICAM STAEETI ICRO53 STRun BUILDING LOT SUBDIVISIONa LOT_BLOCK SIZE It. TYPE AND COST OF BUILDING -All applicants complete Paris A.-D A. TYPE OF IMPROVEMENT D. PROPOSED USE•FOR"DEMOLITION-USE MOST RECENT USE - 1 ❑ New Wddln9 RasWenW ._ Norresldentlet., 2 ❑ Atldtbon of resnenrral.anw numbw of new 12 Oro temay IB ❑ Aneaemaa reveettonsl nw"umrs sdded,a any.n pan D. 13) 18 ❑ ci;t otMr Mq'ws 13 ❑ Tw a nw,Iandy-EnW number 20 ❑ 1,6MV111 3 ❑ Altwstc tSaa 2 above! Of tna 21 ❑•.Padit9 tWaDa.. 4 ©C Reoas nepwcemen 14 ❑ Transws how.tr OWL W d=.WY. � ❑ Sa siawn.nm"wage Ender number Of unb. 5 ❑ Wrerxeq Is rrvaraay,es;eennal..nsfr tearwr 23 D-HosDial iteliltAlo(W d units in bvadiV n Pan D. 13) 15 ❑ Ga" 24 ❑ Offtce,bank ptoleasimW 8 ❑ Moain9 trelowiatl 18 ❑ c.rovl 2s Q:Pudk laNly: 7 ❑ FoundatDn only 28'❑ SrJtod,abrary.ou+x edovoral 17 ❑ OvW•speedy .27 ❑:Sk n s,:msmarase S.OWNERSHIP - 28 ❑ -ranks,w~s B D{PMate 1n6+Ct2.cprPvattaM1 rwrlpdy . ..:.:.29 ❑ OtW•SPPCNV' wtiwtion etel - 9 ❑ Podic IFederaL:Stale,v local gamn~t C.COST tOma wits) NaysaidadW Oescnbelt detAv,00posad w d bAdinMA4.•knd P=@Ww Plank madtin shop.blnft NAdM al ttosDkA ebrnertary.ache ,.Wid&7 WOOL ccee96. 7,000.00 w0chd sd"d-pan1Qq�Pa for dePartnW9 OWL rental o1Tse WMing,offs.hal" 10. Cost of impnwenwt Sat ktdtabw plant.8 use of exiswV btddiq b belrq chwQW.enerIXOPO d w. To be i waled but not iwAx1W in Me ab"=1 vinyl siding a Ebcvia b. Plumbrq .. G HeelYq,s CvtdnIon4q 0. Olhm lei"W.etO - 11. TOTAL COST OF IMPROVEMENT S 7,000.00 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 Y E. PRINCIPAL TYPE OF FRAME F. PRNCPAL TYPE OF HEATING FUELG. TYPE'OF SEWAGE DISPOSAL L TYPE OF MECHANICAL 30-a Maso y M'N beariq) 35 ❑ Gat 400 Pilbw W priMtO WMPMY WIN BMre be CW*W air 31..❑ VNod hams 3e ❑.OE 41 ❑ VMale(So ptlo lank W-) IFrWRbrtig9 32 ❑ Sbtteral areal 37 EM&MCky--❑ _ 4A Yp. 45 ❑ NO TYPE OF WATER SUPP 33 ❑ Reidorced wnvete 30 ❑ Cal H. gr WE "M' y aed.,b .�ta!) 34 ❑ oa,er-soar,,, 30 Cl Omer-sauY 42 ❑ Ptcap or W"ta oontprW .. 46 Q yr 47 0 No 43 0 Prs sia teed dswn) J.DIMENSIONS +a ,NRpa,a,,,,1eY M. DEMOLITION OF STRUCTURES: +e. raa he of Am as w&'+"` C' -Has Approval from Historical Commission been received `� V any structure over fifty(50)years? Yes_ No_ - 50. rail MW H fa IL ,CKSafe Number ti NUMBER OF OFF-STREET PARKING SPACES pest-Gontrd: 51. 6r1osW " HAVE THE FOLLOWING UTILffIES BEEN DISCONNECTED? w sx. o io - Yes No L RESIDENTIAL BUILDINGS ONLY Water S1 Gas: s+. Nuroera WiboOim DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED pam w BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE 7k11 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 SILk district? Yes_ No_ Comply with Zoning? Yes_ NO (If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_. 'No_ (it 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_ (It yes,submit documentation) ........... Massachusetts State Contractor Ucense CS 027156 Salem License 7t. 1042 Home Improvement Contractor a0 103699 Homeowners Exempt form-(il:applicable) Yes_ No hoc CONSTRUCTION TO V E COMMENCED WITHIN SIX 16) MONTHS OF ISSUANCE OF BUILDING PERMIT CONSTRUCTION4 TO BE-COMPLETED BY: December 2003 If extension is necessary, please submit in writing to the Inspector of Buildings. V. IDENTIFICATION • To be completed by all applicants .. .. Name Maiiq aEp,ess•NuniGer,snxt cAr.VIa aqb ZIP CcOe Tel NF 78 r - Patricia Marcus 9 Greenway Road Salem MA 0197074r-71179 O..a a Lou" 81 a 599-1 ..53 tovuw 1110. . 027156 E±yw I hereby.Certify that the proposed wo*isauQ ed by the owner of record and that I have been authorized by the owner to make this appticatlon a5 ha authorized - 1 and we agree to conform to all'.applicabte laws of this iunsdlctlon. SigrlaWre d appborq� Address •Apphcauon date (( ,y 81 Centre Street, Lynn, MA 10/8./03 , ommonwea ��//Clh fin// / (w (y77s c o� YY/ae�achuj2fb 2eparlment 600 �Ao�,� daef�ia��ccidenfd p/ gqV�qVai�i ylon 4� �treet James J.Campoell odton, //tadeachsuette 021 J J Commissioner Workers' Compensation Insurance Affidavit I, Frank E. Obey (Ile>mee,permieeee) with.a principal place of business at: 81 Centre Street, Lynn, MA 01905 xleynowzlo> do hereby certify under the pains and penalties of perjury, that: @x I am an employer providing workers' compensation coverage for my employees working on this job. AuI.M, Mutual Insurance Co, VWC 600461001 2002 000 Insurance Company Policy Number () I am a sole proprietor and have no one working for me in any capacity. I () 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Conrractor Insurance Company/Policy Number () 1 am a homeowner performing all the work myself. I understand that a coot'of this statement will be forwarded to the Office of Investigations of the DIA for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S 1,500.00 and/or one Years' imortsonment as well as civil penalties in the form of a STOP WORK ORDER Sno a fine of S 100.00 a day against me. Signed thisj� �8th day of 0Ct Iser )W 2003 Licensee/Permittee Building Department Licensing Board Selecrmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617.727-4900 X403, 404, 405, 409, 375 LZII7 III S�iP12I, a���rhu�r � '�.��' $uil>3intt ?rp-srtmrni L�ifY De�2_t 6tzz:t - sna= �. 3B17 D15?05AL OF DE_BIIS AFFIDAVIT a with the provisions of YGL c 40 , 554 , 1 acknovledga_ That as a In accordance all debris resulting fro= the condition of Building Fe Mir: f construction acti'+ity Soverned ty this Building ?erc shall be disposed or disposal facility, as defined byMGL c III a properly licensed solid waste , S 150,A. Transriver Marketing - West Lynn The debris will be disposed of at: location of izciiity 225 Commercial Street, Lynn, MA 10/08/03 ,a - t Ap 1=_cant Date Signature of _ p Fully co=plete the following inforzrion: (?lease print clearly) Frank E. Obey Nape of Permit App `-icant Firm Name, if any 81 Centre Street, Lynn, MA 01905 Address . City d State The above SiatL'T_e ra7Uir=: that debris from the demolition. renovation. Leh or other alteration of building or structure be disposed of in a properly osal facility as defined by MGL clIi . 5150A and th licensed solid wasie disp building permits or license5 are to indicate the, location of the facility a ` DO NOT WRITE BELOW THIS LINE VI. VALIDATION FOR pFFJFi7MFNt use 61LY Building use Grow Permit number Fee GraOag Building 19__ Permit issued Lre Load;,,g -- — Building Occwv Laxc Permit Fee $ Certificate of Occupancy $ Approved by. Drain Tile � r $ /`/�� �p dl—:,,mow • — Plan Review Fee iFTE NOTES AND Data • (For department use) PERMIT TO BE MAILED TO: DATE MAILED: Completed by. Construction to be started by. • s VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONTYARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN • For Applicant Use O N