72 ORCHARD ST - BUILDING INSPECTION (2) What is the current use of the Building? '
Material of Building? If dwelling,how m y units?�
WIN the Building Conform? Asbestos? Nr7
Architect's Name
Address and Phons t )
Mechanic's Name
Address and Phone
Construction Supervisors License 0 HIC Registration 0
Estimated Coat of Project S a 0 0 Permit Fee Calculation
Permit Fee S Estimated Cost X$71111000 Residential
-- --
_ --.- Estimated Coat X$41IS1000 ----- — —
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 lid e a tated
specifications. Signed under penalty of perjury X r
Dat I
CITY OF SALEM
< i PUBLIC PROPRERTY
DEPARTMENT
120WASJ1TN6.0NSi'REST ♦SALF\t.MASSACHLSLrIS7197C
TFt.:978.745-4595 FAA:978.74G9846
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
I It, S 1.50A.
The debris will be transported by:
(name of hauler
Hie debris will be disposed of in
(name of facility)
.. . IallltfCl\ of tuc:ldV)
' 1 dSt '� o �)CC1113I A(7 j),IC aiII �—_—
,fall ._._ I
f
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
K110WAL"ouu a,
�"Yoa
t ao WA"NcnnN SnM•six SUMAMSEM 0t970
lki 973-74S-9S9S 9 FAx 97L7iLL984
HOMEOWNER LICENSE EXEMPTION
Please Print
Date����5�y/
Job Location :21 Orc I f yL SL
Home Owner Ad z
Home Owner Telephone
Present Mailing Address
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 roc ores and requirements and that he/she
will comply with said procedures jr entsHOMEOWNERS SIGNATUREAPPROVAL OF BUILDIN S
See other side for state code
CITY OF-SALhim -- -
' PUBLIC PROPERTY
DEPARTMENT
►r�.�.,�,orusaxi.
`r^YM 130ww5urwn» brW=• „A . wsUo,Lst„s01970
APPLICATION FOR THE REPAIR RENOVATION. CONSTRUCTION.
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
u SITE INFORMATION
Location Name: Building:
Property Address:7� - --- - -- - - - - —
Property is located/In a;Conservation Area YM Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: �YVAOAA a,
Address: -7 L
�G?
Telephone: — —
3.0 COMPLETE THIS SECTION FOR WORK IN EX18IING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of /�� Area per floor (so Renovated
construction or renovation U
of existing building New
B&I Description of Proposed Work:
--- - - ---Mail Permit to: