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162 MARLBOROUGH RD - BUILDING INSPECTION zz use of the Building? What is the current ± Material at Building? If dwelling,how many units?L Asbestos? Will the Building Conform to�Law? �S N�- Archited's Name Address and Photo Lieehanles Name Address and Phone Construction supervisors License 0 HIC Registration 9 Estimated Cost of Pr°led s 2 F-00 0- Permit Fee Calculation Permit Fees J Estimated Cast X s7Is00 10 Residential -- - tea Estimated Cost X$111SIo00 Commercial---_-- - - An Additional $5.00 is added as an Adminla"We dtarge. Make sure that all fields are Properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build to the above stated specikatkme. signed under penalty of perjury Date 2 © 7 o N 3m � N v yr_ �_ PUBLIC PROPERTY i DEPARTMENT 0- w> o.� 1 6 � NAYM 130 WMMH=W srusr•&MAK W.NucHLUM 01970 14a:97674&9S9S•FAW M74e 96N APPLICATION FOR THE REPAIR. RENOVAOrwmw CONSTRUCTION DE.yIOLMON. OR CHANGE OF USE OR OCCUpANCy, FOR ANY FMSTINPX STRUCTURZ OR BUILDIN[_ 1.0 SITE INFORMATION Location Name h 2 /)� Buwkw ---- Progeny Address:-- j6-2 5'�t flv� 0r97o Properly I•located Ina:Consanatlon Area Y/N N Historic Ohtrkt YM 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land L 02LAID f (E�� 6 Z w�lnLgonOL)&bi K 6 979 7`f Y `f 79(? 3.0 COMPLETE THIS SECTION FOR WORK IN "12111410 BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation Of existing building New Bdef Description of Proposed Work: 1%77fzeoorin Uq-lV fT- f ^co2logo ejZ? tea Mail Permit to: /6 Z &t' C9,6"UGh CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT SL,wK 12C W.\.91tK4:J0NS.7HEET•&AUM. To;v7t1.7♦3ms •F- 9MAC.9846 Construction Debris Disposal Affidavit (required for all demolition a►ui renovation work) In accordance with the sixth edition of the State Building Code, 780 CNIR section 111.$ Debris, and the provisions of viGL c 40, S 54, Building Permit N _ _ is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defused by.1GL c 1 I L. S 150A. The debris will be transported by: �/n9D�2/ND CA7-fJL� � (name at hauler) fhc:lcbris will be disposed of in NO,-ZT f.( rh6 cam_ [ T irv� (name of r"111ty) SG��-il^ _fcoT 12� S�L�t 1I J�fta4i�.t:/� . ♦i g.:a�i:.)I 7C:11:1t..t:�7.I�adl _ ____ B z © ? ..at. - • I ' CITY OF SMXM PUBLIC PROPERTY DEPARTMENT KI101�8v n�ww� MAYM 130 wAslalnc T0N TMFZr• •,eu Mwcuan:sfl7s 01970 T FL 978-74S-959S•FAX 978-740.9U6 HOMEOWNER LICENSE EXEMPTION Please Print Date Z 0 7 Job Location /6 2- Home Owner Address f6 2 (lbtfFrt f h'D�0!>C9Ff Home Owner Telephone g78 7 9 g Y 7 Y Present Mailing Address (6 Z pk4i<L arc. ub tt 2 J-- L FP A /W� y! 7,-) The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two Units or less and to allow such homeowners to engage an individual for hire who,does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official, on a form acceptable to the Building Official, that he/she be responsible for all such work performed under the Building Permit. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable by-laws and regulations. The undersigned "homeownee'certifies that he/she understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE / �7 APPROVAL OF BUILDING INSPECTOR See other side for state code