13 NAPLES RD - BUILDING INSPECTION What is the current use of the Building?
Material of Building? � If dwelling.how many unitsT
Wfil the Building Conform to law? � L]
Asbestos? 0%
Architect's Name
Address and Phone ( 1
Mechanids Name
Address and Phone
Construction Supervisors Li HIC Registration#
Estimated Cost of PrOAM i�7'" Pemdl Fee Calculation
Permit Fee: Estimated Cost X$71$1000 Residential
Estimated Cost S41/i1006
An Additional$5.00 is added as an
Administrable 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 above stated
specifications. Signed under penalty of perjury
Date b`1
0
VQ
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'� ��°�✓�� CITY OF S.U.EM
PUBLIC PROPERTY
DEPARTMENT
�.ryc. cv Nw•ry
.MAW*
130 wmm TcNsn= �t, &%ACHLSrM01970
TEL 97&745-9S9S*FAIL 976740.9&M
HOMEOWNER LICENSE EXE-M"ION
Please Print
Date
Job Location i 3 K) (-,
Home Owner Address
Home Owner Telephone
Present Mailing Address
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Unite or less and to allow such homeowner to engage an individual for
hire who,does not possess a license,provided that the owner acts as supervisor.
DEFMION OF HOMEOWNER
Persons)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 Lk-
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
\l.t�iIt I?Q W.\91IXl�:JNS3EET •SAU:N,MMi.U:hL iLCIS:i97:
TEL:978-745-9595 • F.":978.74G9846
Construction Debris Disposal Affidavit
(required fur 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 1.50A.
The debris will be transported by:
(name of hauler)
1'he debris will be disposed of in :
(lame of facility)
facility)
�igCalui�JI 7C[nllt apimcaat
aC) U
cnwrm
PUBLIC PROPERTY
DEPARTNIENT
KI\dFM N DRLSCOtJ.
NAYDe 130 WAst NGW N!ftf •SVAiK NA%U3R:ShT15 01970
Tm-97e.7./S-M•FAx M740.9W
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF I PANCY, FOR ANY EMSTIN,C
STRUCTURE OR BUILDING.
1.0 SITE INFORMATION
Location Name d Buik tng; 1 St Iv u r-
13 N �' � a ✓�-� , 11 dl�}l �C -7 v
Properly is iocated in a:Conservation Area Y/N Q Historic Otqfflot YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: /i -
Address:
Telephone: q_7& -7 y y- 7 -7 S
3.0 COMPLETE THIS SECTION FOR WORK IN EXISXING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use a New
Demolition Existing
Approximate year of Area per floor (sO Renovated
construction or renovation
of existing building C� X � New
8def Description of Proposed Work:
— ---Mail Permit to: - - - --