15 MAY ST - BUILDING INSPECTION 1
What is the current us a of the wilding?
Material of Building? If dwelling,how many units?
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WiU the Building Conform to Law? Asbestos?
-
Architeas Name
Address and Phone
Mechanic's Name ��as vl j ` e✓s
Address and Phone
Construction Supervisors License 0 HIC Registration#
Estimated Cost of Project 5 ? .00 2_—� Permit Fee Calcuiatton
Permit Fes i �4 5,�� Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/i1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
.7 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
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specifications. Signed under penalty of perjury
Date
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PUBLIC PROPERTY
DEPARTNIEINT yd
Y:I�NFJIEY D�151"Wl
MAYOI 120 WASMN GTON SnEET 0 &ALhW 5/ACtaorLSh'l13 01970
14L 975-745-959S 0 FAx:979.740-96"
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDIN .
1.0 SITE INFORMATION
Location Name: Building:
Property Address:
Property Is located in a;Conservation Area YIN Historic Ok&k;t YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: ��v �a . -j" _'
Address: {S Kc. c
S 11 • 01920
Telephone: In - 9 4y ` 17 S x
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation ;/ Number of Stories Renovated
Change in Use p` New
Demolition ✓ Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work: t/a L
pin..
-- - Mail Permit to:
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CITY OF SM.EIM
PUBLIC PROPERTY
DEPARTm NT
�u�o��ourcau
130VAMMGUM S"MT SN.B�l 97sERS 01970
Tm--M745-959S•FAX 979-740.9W
HOMEOWNER LICENSE EXEMPTION
Please
Date
Job Location
Home Owner Address
Home Owner Telephone — —
Present Mailing Address 13 ,
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 requjreomts.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR ,
See other side for state code
CITY OF SALEM
rum PUBLIC PROPRERTY
DEPART%. fF.NT
aLM. l3C 7.�ILVi: s 7taT�'UL:W.VAVghr*AS: 4
�:�OeJa�t91! �fate 90eJ�p+teM
Construedom Debris Disp"at Affidavit
(required !br all dsntoli m add senovatiort work)
in monlanea with dw dlxdt eadm otdr Sets SuMing Cods.730 CAIA section It 1.11
Debris.add dte provisions of v/Q.a 40.S 54
SWk isl;Permit p _ _ is iswtsd with the aoddidtoe that the debris muddas boas
this wart shall bs disposed of in a property lieedsed wawa disposal &dlity as dented by MaL e
l I t. S 15OA.
rho debris will be eransported by:
(t>oms of hoard)
rho kbris will be disposed of in :
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ki
(11:Y11f of f.1".111{y� '
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