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177 NORTH ST - BUILDING INSPECTION What is the current use of the Building? 2 Material of Building? If dwelling.how many un'ds? Wig the Building Conform to Law? A5 -Fat-as r kn ow Asbestos? Na Architect's Name Address and Phone ( ) Mechanles Name Ala H i s c Address and Phone 1-7 7 /Ua2 Sf Consbucdon Supervisors Licye/ns�e S HIC Registration# Estimated Cost Of2Prolect i "1�— Perna Fee Calculation Permit Fee: Estimated Cost X$7/$1000 Residential _ _ Estimated Cost X S411s100©CommercW— An Additional$5.00 is added as an Administrative 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 a � n L r y n r O a �. yh. s a PUBLIC PROPERTY DEPARTMFINT w�.mF�u sr o�usc•ti r CJE/ y� %"VM f 30 WANUmcr(W ME"• S•'&14 WssAtitMI'R01970 Ti L•97e-715-gS"•FAS M740-96M APPLICATION FOR THE REPAIR RENOVATION, CONSTRUCTION DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: '] `7 or t� r Building: ----- -- - Property Address: I-7 Property is located in a:Conservation Area Y/N Al Historic District Y/N_dam 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: Address: I-77 Noon St Telephone: 3.0 COMPLETE THIS SECTION FOR WORK IN EXU TWO BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of L per floor (sf) Renovated construction or renovation of existing building New ar&Description of Proposed Work: sf�ce�s Si ISic�ih� Rid /� Mail Permit to: - - -- P t ' f CITY OF $.UMM PUBLIC PROPERTY DEPARTMENT Kll••e�.w etiwvr KAYO! 13awAsuNcrcwSrwar•S,LLFx%LwAcHLSW ISotre 7E1:978-745•9S%•FAX:97S.740.9W HOMEOWNER LICENSE EXEMPTION Please Print Date { Job Location 1 Nor ' h St- 5 ab-rV1 Home Owner Address 1"7 7 eg r Home Owner Telephone �:Z 8 7<fs Present Mailing Address The current exemption of"Homeowners"was extended to include ownw-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 sets as supervisor. DEFINITION OF HOMEOWNER Pawn(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 APPROVAL OF BUILDING INSPECTOR See other side for state code C1TY OF SALEM PUBLIC PROPRERTY DEPARTMENT a(.�u• I'1'7.�ti�t::JMf 7laT�i�t:1t.at�vut7N.t�1a::�1 Construcdos Debris Dkpossf Affidavit (requital Cot an demolition and anovatios worst) is merdmo with the sixth edition of tle State Buildieg Code.7S11 CAIA Sadao 111.S Oebria,and the provisions of rtGL c 4q S Sk gwidiM Permit* _ _ is sassed with the condition that the debris mRdtka Sots this wort shag be disposed of in a properly licensed wave disposal facility as dented by WL a lLL.! 15" The debris will be transported by, yy _ laama a naut«i rho&--bds wilt be disposed of in : .. tnameur�fxdtry)- 4