10 PALFREY CT - BUILDING INSPECTION (3) - CITY OF A C S LEM
PUBLIC PROPRERTY
DEPARTMENT
Y
\L\I�`M t3C q,\ywm;;aNS itELT i UU V.%t.%'&%t:"L
Yst:Y71F�ii•)S9! �F.�x:97i7iCr9iK
Construction Debris Disposal affidavit
(required for all demolition atxl renovation work)
In accordance with the sixth edition of the State Building Code, 780 Cb1R section 111.5
Debris,and the provisions of MGL c 40.S 54.
Building Permit 0 _ _ is issued with the condition that the debris resulting from
dis this wont shall be posed of in a pmperly licensed waste disposal facility as defined by vIGL c
111.3130A.
The debris will be transported by:
t nama or haular)
rho debris will be disposed of in :
M:+ma of iaciGt
Y)
�I1,t'":lay)
---
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIlME�!4y p�w•ry�
MAYCO 130 WA4Ubl rM SUM•C..Eu M,SsnaruSM M 01970
741:97a-745-959S• Fnx:978.740-9&M
HOMEOWNER LICENSE EXEMPTION
Please Print
Date Z
Job Location /6 pa.(F- / 012
Home Owner Address 01 `l ZL
Home Owner Telephone 17 Z6 0
Present Mailing Address 0 toq C .
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 714cj
uirements.
HOMEOWNERS SIGNATUREp pt
APPROVAL OF BUILDING N EC OR L
See other side for state code
EI'I`Y`OF
PUBLIC P'a ROPERTY
DEPARTMENT
KI%dFM GV ORLWAXA.
drat 130WA"N=w!,mwr# '�J{MAStAQIl5tTf4 Ot970
1ta:97L745-959i•pA c 979.740.9W
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR P—ANCY. FOR ANY EXISTING
STRUCTURE OR WELDING
1.0 SITE INFORMATION .
Location Name: Building:
-- - ._ Property Addessa -7dt E�� ` r►
- -_ _ _ ._.- . _ - - ----- -
Property Is located in a;Cormnation Ares YM Historic Dbt kt YIN AJ
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: 2 k
Address: /o N kipire
'S-k(eV W O c)
Telephone: 71� •- ��76
3.0 COMPLETE THIS SECTION FOR WORK IN EXU Tr a BUILDINGS ONLY
I
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brie[Description o/fPf roposed Work/
------Mail Permit to: _--
I
What is the curtent use of the Building? -
Material of Building? V)30 d If dwelling.ho_w, nY units?, ,
wig the Building Conform/t/o Law?
2 Asbestos? C7
Architect's Name
Address and Phone -- l
Mechanic's Name
Addressand Plane
---
Constnu Lion Supervisors License# ----- - HIC Registration#
Cd, CJO PermN Feta CabuWW
Estimated Cost of Pr�$
Permit Fee S Estimated Cost X S7/$1000 Residential
Estimated Cost $111i1000 Comrnercial-
An Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are property 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 X
Date
�1
N
s � �
v
a
`6