198 LORING AVE - BUILDING INSPECTION (3) What is the current use of the/Building?/ � �Fs iAni Ti AC'C ai++f,Pf"�L
n es F fii� If dwelling,how many units?=
Material of Building? Asbestos? No -
Will the Building Conform to Law? vC�—
Architects Name t
Address and Phone
Mechanie's Name k L t c 2
Address and Phone
Ms, O���f$ 7tic-75``32/ZS��
HIC Registration#
Consution Supervisors License# ✓�43`6tf
tn
Estimated Cost of Project i v`� `✓ Permit Fee Collation
Permit Fee i D Estimated Cost X$71$1000 Residential
--- . -- -- l -- Estimated Cost X i11l$1000 Commercial---- -
e An Additional $6.00 is added a$an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the abovestated
specifications. Signed under penalty of perjury
Date
N
L' A
� O e
F O V O
1
s� CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
nnn;ent.ev!m SCIA1. +
116 W.Ulil\(':TON STFEET+5:\L13 V, MASiAC11C5L rr5 t1197C
Tn.:978-745 9595 ♦F..Nx:978-74C-9846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # ___---..._ is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
i 11, S 150A.
The debris will be transported by:
(name of liauler)
The debris will be disposed of in
Sf7�E�.c __�t'�9NS 7�Ee S7`.4 ia�i
d Pf� (name of facility)
��— — (address i>f facility)
tiitf permit applicant
date
:c6rsa: .dnc
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
antaaaasntna600ts.
tM wASF ,OM Sr W a SAux MASUCHLU to 019M
Trk 9W43-"93 •FAX MN7 SW
Woriten' Compen adon Instaraace Affidavit: Bundewcontmto
ben
Apallnut Informationmt�N n.A Lamy
Name i y /?rr..
Address:— J 10 /= j P
CityiState2ip: . , o2�yr�1 Phone*• Tel -
9
Are you am amplaW Cbeck eke appropriate bow
1.❑ I am a employer with 4. ❑ I sm a general CooanoW and I T1Pe of project(n9a4edl�
employees(&a and/or part-time)• have hired the wb.eonaactura 6• ❑New caomutn3m
2.❑ 1 no a sale proprietor or pusaw. listed on the attaehed a6eat t 7. 13 Remodeling
ship and have no employees These sub oomuaebra have L ❑Dam Helm
working for me in any capacity workers'camp iaaasece
(No warkara'comp insurance S. ❑ We am a carporadau and its 9. 0 Building addition
required.) otlkers have eaarcbW risk 10.❑Electricd rapaira ar addk{ena
3.❑ lam a homeowner doing in work right otmtampim per MOL 11.0 Plumbing at addidom
myadt(No worksra'comp o. 112,41(41 and we have no 12.p Roof mpaira
insurancercvim&j t employees.(No workee'
comp.insurance required.) 13.❑Other
;Any Svw asat mar m adw bra at mow abo ar the Ssaoa tadow'h••das tub eodrma•mmpuwwca 7eibr bdsrba
Hmrewams Chmhmnalbanut MWono doing d we*Sr60hieomldeeemepaamae submit aaw
tCaeasemo don dad[ads bon rear aa"W a WMead Sham rhorbe aw mma of liar •eve�rm,
mbeaaaaapa and thdr aahms romp wear i
/ass an ewnpbryar Mar It providing,workers'ctsapswsadow 4asarawee of
lwfonwadaa f my
eaap/oyea Blow k tkt pabbey awd tb sft
Insurance Company Name:
Policy 0 or Self-iaa.Lie M
Expiration Date:
lab Site Addrm:
City/Stata/Lip
Attack a Copy of the warkan'Comvessatloe policy declension a
_ pap(skewkng the poliky camber and eaplratlow dads FrM ailure to f 1900 0o erager one-year M d under Section 23A of MGL a 132 Can lead to the imposition of criminal penalties of a
of up to f2S0.00 a day s on onflunlk as wail as civil penaltiesm in the form of A STOP WORK ORDER and a Aare
y against the violator. ra advised the a copy of this am
may be forwarded to the Office of
Investigations of iu DIA for insurance covenga veriAcatioa.
/do hereby eeld j/under Nb paW and pewa/da of, r/wry tier dart!w fornaadow provided above Is trkt an/correct
Phone ?7 /- 717
Of)lelaf kid only. Do not write In Mr area,to be compkfed by c4 a loww oQ&lai
City or Town: Permll/Lieease#
Issuing Authority(circts one):
i. Board of Health 2. Building Department 3.Cltyfrow■Clerk 4. Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Rhone#•
• MORTGAGE INSPECTION
PLAN IN TO EASTERN BANK, t
ITS SUCCESSORS AND/OR ASSIGNS
S THEIRMAY
SALEM , MASS. I CERTIFY ITHATEST THE DWELLINGRIS LOCATED
AS N ANDREID LAND SURVEYORS SET BACYK REQUIREMENTS CONFORMTHE
TTHE CITY OF ZONING
365 CHATHAM ST., LYNN, MASS. SALEM WHEN CONSTRUCTED, OR IS
EXEMPT FROM VIOLATION ENFORCEMENT
UNDER M.G.L. TITLE VII CH. 40A SEC. 7.
N/F
GUY
I NOTE: FENCES, WALLS, SHRUBS,
DRIVEWAYS, ETC. DO NOT NEC-
ESSARILY REPRESENT PROPERTY
LINES.
O,
.p LOT B
C) 7260f S. F.
/ � I
o{fl'�r'`�5
Z � 00
qy /� N N/F
Ln FAHEY
O 2 STORY �►� Ht OFV
ALUMINUMSIDED RALPH
• 1 98 o`So WILLAM
o REID
No.29422
<� W 8,} A90 �P i
3688' L=24.17' ! ►,Mosugv�
'':...�
e
198 LORING AVE.
"1, HEREBY, CERTIFY TO THE BEST OF MY KNOWLEDGE NOTE: THIS PLAN WAS PREPARED FROM A
THAT THE PREMISES SHOWN ON THIS PLAN ARE NOT LOCAT-
ED WITHIN A SPECIAL FLOOD HAZARD AREA AS DELINEATED MORTGAGE PURPOSES ONLY. OFFSETS SHOWN
ON THE MAP OF COMMUNITY p250102-B PREPARED BY THE ON OR SCALED FROM THIS PLAN, ARE
FEDERAL EMERGENCY MANAGEMENT AGENCY OR IT'S
SUCCESSORS DATED 8/5/85. PANEL 5 , ZONE C ." APPROXIMATE ONLY AND SHOULD NOT BE
I FURTHER CERTIFY THAT THIS INSPECTION WAS PER- USED TO DETERMINE PROPERTY LINES.
FORMED IN ACCORDANCE MATH THE "TECHNICAL STAND- SCALE: 1" = 30' DATE: JUNE 16. 2003
ARDS FOR MORTGAGE LOAN INSPECTIONS" AS ADOPTED
BY THE MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS BOOK: 5741 PAGE: 582 CERT.#
AND CIVIL ENGINEERS.
THIS CERTIFICATION DOES NOT INCLUDE SHRUBS, WALLS, CONTROL #:P03-0701 L
FENCES OR DRIVEWAYS AS THEY DO NOT ALWAYS INDICATE
PROPERTY LINES. DLO
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PUBLIC PROPERTY
DEPAR'I'bIENT
%(Avoa
130 WASIUN f W S1nW &U&K rs 01970
T L•978-74S.95%#FAx 97L7.10.984
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION OR CHANGE OF U SE OR OC ANCY FO
R ANY EXI SING
STRU __ S' OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property A (drew— ----- -- --- - -
L /�v
Property is basted in a:Ccnswvatbn a Y/N Hlatorb Dbhlat Y/N
41
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN 7rstodeo
GS ONLY
Addition g
Renovation Number ated
Change in Use
Demolition Approximate year of Area per flotedconstruction or renovationof existing building
add Description Of Proposed Work: /��,� d�F ys ,�E�v�H�E
S 1 `)u,'LLW �Ei�� 6 u i2
-- - --- Mail Permit to: /'Vwz