72 ORCHARD ST - BUILDING INSPECTION What is the current use of the Building? if dwelling.how rnanY units?
Material of Building? Asbestos? \ 1
"I the Building Conform to Law?
AmKdedsName
Address and Phone
Mechanie's Name
Address and Phone HIC Registration is
Construction Supervisors u�^S°
p�ermM Fes Cak,ulatlan
Estimated Cost of Pro Estimated Cod X$1/$1000 Residential
Permit Fee: EsW ted Cost S111i1000 Com rmcW
_ - An Addidonsl$5.00 is added as an
Administrative charge.
Ms.sure that all fields ars Property and legibly written to avoid delays In processing.
i
The undersigned does hereby apply fa.a Building Permit to to the above stated
Specifications. Signed under penalty of Perjury
Datp J
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U a ' Q ` a r.
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PUBLIC PROPERTY
DEPAR'I'hlE,�iT
riamEnsr oeuc�u.
Nwroa
130 WASH�2rj2K „—LEK Urn 01970
1t7:978-743.9M•FAX M740.9W
APPLICATION FOR R1 RE PA RE NOVA 1'�ON CONSTRUCTI N DEMOLMO N O ert>twn O gM
STRUC t>Q>If FOR EXI TIN
ORB nnvG
1.0 SITE INFORMATION
Location Nams (3L
Building;
Property Address -Property Is located In a:ConservatkHistoric District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
P
Telephone: _
3.000MPLETE THIS SECTION FOR WORK IN=311MG BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use
New
Demolition
Existing
Approximate year of Area per floor(sQ Renovated
Construction or renovation
Of existing building New
Brief Description of Proposed Work:
10
CITY OF SALEM
�i PUBLIC PROPERTY
DEPARTMENT
KIlM�L�DLLY:Wl
MAYOR I20wA*UNC[DN Si M•SMEK VAMAa4LISM301970
TFj-978.74S.9S95*Fnx:978.740.9&4
HOMEOWNER LICENSE EXEM"ION
Please Print
Date
Job Location L
Home Owner Address
Home Owner Telephone — 476,
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 inspectio eprocedures and requirements and that he/she
will comply with said procedures and quirements.
HOMEOWNERS SIGNATURE
i
i
APPROVAL OF BUILDING INSPECTOR
See other side for state code