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171 NORTH ST - BUILDING INSPECTION (3) n t� �QS What ie the current use of the Buildi�? � ( AM e if dwelling.how many units? --- Material of Buiding?�1 ---- Asbestos? c ^� Wig the Building Conte to Law? — ArchaeasName Address and Plane i Mechanle's Name S�•eC� be `rm bJ;l� bit �Qo n.c� Address and Phone 2A C 2 i Sk�en� Cons^ Supervisors Licenses HIC Rsgistratbn 0 poo Permit Fee Ca wlmdon Estimated Cost of Proled= - Penng Fee i 0 O Est4nated Cost X i7/i1000 Residential ---.-- -- Es*natsd Cost X it il$i000 Camnwcial - An Additional $s.00 is added as an Administrattve charge. Make sure that all fields are Properly and legibly written to avow delays in Procsesing. The undersigned does hereby apply for a Building Permit to build stated specltkatbns. Signed under penalty of PerlurY , Date 7- Zcl- o �I N y a a `d - CITMFSALEX - PUBLIC PROPERTY DEPAR-n, I&vT /:I�NFJLiY D�w•w / 6 %CAVM 130 w'"NUMN 3rRM•jNAiK M&UM3 SKIM 01970 TZL-M743.9M 0 FAX 978..14&gW AAPk ICATION FOR THE REPAIR RENOVATI N CONSTRUCTION DEMOLITION, OR CHANGE OF USE OR OC rr�NrY FOR ANY EXIS , STRUCTLrn� OR BUII DNE 1.0 SITE INFORMATION " Location Nemec. Building: Property-- Address:- - -- _ t7 1 N©R'T 1l S� Property Is located In a; Conservatka Area Y/N O Hlesmrle Dlshkx Y/N A) O 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: C 2 `C /'o rz /rJ Address: I-7 l No2TK S T- Telephone: 9 7 Ff - -7 q S 3.0 COMPLETE THIS SECTION FOR WORK IN EYISSJNLiVOUILDINIGIONLY Addition Renovation Number of Stories Change in Use Demolition Approximate year of Area per floor (sf)construction or renovationof existing building Brief Description of Proposed Work: Qv i1fX nc� New She E L,� bAQ-k yA20 , Mail Permit to: _LZl /Jorz r CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KI�OI�cv MAYON 13DwA411NGTON SMLEar•Six S(AaUalLSEM 01970 T FL.,978.74S-959S*F&,c 978-740.99" HOMEOWNER LICENSE EXE..M"ION Please Print 1 Date '7 - /Z - y 7 Job Location /7 / / o z ,— 1 ( 5 7— Home Owner Address i -1 Home Owner Telephone 9 ,7 R- -7q S - i -z Present Mailing Address 1-1 i 1.3n,z T- I-. S \ 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 fort 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 APPROVAL OF BUILDING INSPECTOR 5C See other side for state code CITY OF SALEM PUBLIC PROPRERTY ti1ENT DEPART ..nr.::■Lr.�'rRtr:�.u. NIA It1K 12C WA91INt;:JN S:REtt7 *SAL FN, MANSAC:❑ AXIS i / Tn:9M745-9595 •fAx:978.74G9846 Construction Debris Disposal Afridavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 Cb1R section 1 11.5 Debris, and the provisions of viGL c 40, S 54; Building Permit p _ _ 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 v1GL c 111. S 1.50A. The debris will be transported by: C M0 (7t�y (name of hauler) The debris will be disposed of in S:Cke Q-A 1ttIV1 Olume of(aGlllty)P o 7- la - o -7