5 OSBORNE ST - BUILDING INSPECTION (2) � , I
What is the current use of the u Iding? it dwelling,how many units?�._ .
Material of Building? Asbestos? �ln
Will the Building Confb"to Law?
Arcwods Name
Address and Phone
Mechanies Name
Address and Photo MIC Registration#t
Construction SupervisorsLicense 5 a_fir-----V*
rmN Fee Calwiatlor
Estimated Cost of Project pe 3 �' Estimated Cost X$"$'000 Residential
Permit Fee i O
Estimated Cost X s11ls1000 Commerofa4— -
An AddiBonal$5.00 Is added as an
Administrable ahar96-
Make sure that all flelds are properly and legibly written to avoid delays in processing.
The undersigned does hereby aPPy for.a Building permit to build to the above s tact
specwAtions. signed under penalty of Perjury
Date
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CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIlOIFtL6Y DRLSI:OLL
MAYOR
130 WAouwC7oN STREET•C.LEK%/A-%A61u5E1'IS 01970
I'm.978.735-959S*FAx:978-740.9846
HOMEOWNER LICENSE EXEIM"ION
Please Print
Date
Job Location
Home Owner Address r
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 procedures and requirements and that he/she
will comply with said procedures and equirements./�
HOMEOWNERS SIGNATURE �!
APPROVAL OF BUILDING INSPECTOR /'160
See other side for state code
s
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT .
120 WA911Xt::ON S-:BEET •SALFM.Nt.\Si.U:'R iL rl S 0191':
Tn:978-745-9595 ♦FAX:978-740-9846 j
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 7S0 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 150A.
The debris will be transported by:
n me of haulzr)
Fhe debris will be disposed of in :
0 e ut'tacdtty)
I Jl1l1rC11 U( f0l':�lly1 ''
1i�1:11t1111C )f �1iflllll d`;)iKal[
,ste
PUBLIC PROPERTY
DEPARTI4IE►�IT
KINSER L,Y o.l.A)
w..ro.
12owA"NGTf*snwwr &uxK N.Uuan sers or97o
71i M745-9S"•FAX 97L740.9H6
APPLICATION FOR THE REp, RENOVATr N ONSTRUCTION
DEMOLITION, O CHANGE O1R Ltcr OR OCr'�rp,I�Cy FOR ANY EXIgTING
s—TRUC'TLm�r OR BLm.nnvr�
1.0 SITE INFORMATION
Location Name: 3 UqqploBwkltng, J
Property Address-- -
5 �sEo rcX
1
Property is located In a:Consmatlon Area YIN__Al__Hk+talc DkdI cI YN
2.0 OWNERSHIP INFORMATION
1.1 Owner of Land
Name: fij h
S
Address: 5 Osbor�ve 5 ,
Telephone: - 8
3.0 COMPLETE THIS SECTION FOR WORK IN EXIMMIM 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
Of existing building ��� T �C) New
Sdef Description of Proposed Work:
5
5jo
Mail Permit to: - -_ -- -