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28 MASON ST - BUILDING INSPECTION o� %v>'n '�er � Vrrtat is the current use of the Building? m� ell e Material of Building? cem eh�B/oXS If dwelling,how many units Wiq the Asbestos? Building Conform to Law? Archit ds Name y ( 1 Address and Phone Mechsnies Name Address and Phone HIC Registration 0Construction Supervisors License t of project 3 1p Voc— Permit Fee Calculation Estimated cost Estimated Cat X$1/$ 00 Residential Permit Fee f S _.- _ Estknated CatX s11li1000 Cornmerciat-- An Additional$5.00 is added as an Administrative charge. Make sure that all fields are Property and legibly wntten to avoid delays In processing. The undersigned does hereby apply for a Building permit to build to the above stated specifications. signed under penalty of Perjury ' ` C Date S^2 -© d � a o � � N ^ y � N Emto�gAr.� - PUBLIC PROPERTY DEPARTNIEIVT KI%QWALE rouu,ti. Stwrae I30WW�SnIEhT 11l&M.. &UACHL$hTM 01970 T L M. 745-9M•FAX 978-740."* APPLICATION FOR THE REPAIR, RENOVAT►ON CONSTRUCTION DEMua,i i i lr u ( l1AlYG O OR F R EXI TIN STRUCTLmp OR B1ILDR46 1.0 SITE INFORMATION Location Narrlk Building: ooe FaM;/y ---___ Property Address: 2g Maso�t -ST Sq/ems Properly w krc w in a;Conservation Aron YM It, Historic ohbid Y N ROwnw NFORMATION ' 3.0 COMPLETE THIS SECTION FOR WORK IN cAuujad BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of / To Z Area per Hoor(SO Renovated construction or renovation Of existing building *T7ok.17fA New S&J Description of Proposed Work: 740r --- - -------- MailPermitto: Z.r /'9as'e,n Sr Sa /e,�, �R - _.-- _ - all 9 70 CITY OF SAI.EM PUBLIC PROPERTY DEPARTMENT K1�01�!�DllSl'OLL MAYOR 130 wAv-UNGTON STRM•&M.M MASSACKusEm 01970 7Fj.:978.735-959S*Fnx:97&74&9&4 HOMEOWNER LICENSE EXEMPTION Please Print Date 5-2— - 0 7 Job Location 2 S ' 1*50 h 7� Home Owner Address rr Home Owner Telephone F7F-75`5-73 / Present Mailing Address S�r/�-i e 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 "homeowner"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 uGsti C // APPROVAL OF BUILDING INSPECTOR �Z See other side for state code CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT ::via-al.et ! Nixxn 1. \I.'% L'K 120 WA91ING!'O:STREET ♦SAL11N,\,1A5iAt1'LLSLFii 019/C Tel:978-745.9595 • r.ax:978-740-9846 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 111, S 150A. The debris will be transported by: c l- a/eJ,rct)3 co�sTUc7l- �4 _.-. �hauler) I'hc debris will be disposed of in jr T"6 -7 (name of facility) a_rature of pcnnit applicant data —__ 9�y o� ._ .