5 OSBORNE ST - BUILDING INSPECTION What is the curent uss of the uiiding7
N dwelling,how many unRs4�
Material of Building? Nt Asbestos? n(R as the Building Conform to Law?
Amhiteds Name
Address and Phone
Mechanies Name
Address and Phone HIC Registration t1-------
Conalnwiiom Supervisors Ucense fi
P!O Fee Caksuletbe
Estimated Cost of Woled S
Pernit Fee S Estimated Cost X S7I111000 Residential
GU
- Estimated Cost S11(S1000 CommerclatAn 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 s
spec Iftayons. Signed under penalty of perjury
aew
Date
I
r 1 N
s
a )C6
4-- ---
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
120 OV.191 Trl:978-74A595 + .kX: 78-71(9946 I-Ii0i9/�
Tet:97&7+i'�i95 �F.a�c:978-7+i.98+6
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 11 1.5
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:
t name of hauler) �
Tlie debris will be disposed of in
Mello . � /Mof e Ca c-
(name ut'facility)
G-edr�C' m J 15d[CM
laddress of faraity)
ct� _ i
si_lwturo of ,xnrat al;pilcant
5h /
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KnOWA "DRISC
Unraa
130ww5wwc,-[oN anrFt+T 0 SALE14.WStA61u5EfIS 01970
To-978.74S.9S95*FAx 978-740.984
HOMEOWNER LICENSE EXEMPTION
Please Print
Date
Job Location 0,56 r jP 5
Home Owner Address c r
Home Owner Telephone =f2
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 them 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 "homeownee'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 an requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
PU
LICEI P"I'Y`EPARThIE,�1T
/:IaroF�uav Dusr.�u.
MAYM
130 WAnmacrcxr ynW*yma4 V.AAACKShTM 01970
114 97B-74S-9S"•FAX 97L740.9W
APPLICATION FOR THE REPAip, RENnv4TTpN CONc UCTION
DE,IOLITION. OR CHANG OP UcS' OR OCCtrp
VIFTr- VTIM ANCY FOR ANY EXISTING
_... OR BUIL_._Dnvr_
1.0 SITE INFORMATION
Location Nana: 0 d Building.
Property Address
Property Is located In a:Conservation Ares Y/N Historic DleM Y/N
p
NERSHIP INFORMATION
ner of Land /V5 0s awene: -
3.0 COMPLETE THIS SECTION FOR WORK IN Plf!ffi un BUILDINGS ONLY
Addition Existing
Renovation ✓ Number of Stories Renovated
Change in Use L New
Demolition
Existing
Approximate year of Area per floor(SO Renovated
construction or renovation 12�i� I 5 New
Of existing building
Bdef Description of Proposed Work: �-
ReMcrc�e� �a �rQCa� in�5 dll nIaj
CQ� 1N���
Mail Permit to: _- -