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14 PALFREY CT - BUILDING INSPECTION (2) CrfrOFSALENZI a, PUBLIC PROPERTY DEPARTNIEINT (\o 1:mauj .syD4YAlLL %�3 %IAVM 130 WAmaNGww 3nw-ur S"LkAk 4wtta0ast'1'r5 O1970 T=9747i5-9S" 9 PAM 97S.740-98" APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION. DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Nams:,'J,4.nCS G 11,Wc t,1 Building: 5M&j, s pAwtc Property Address•. oc f I,3CC4ZCJ C-7-. Property Is located in a:Conservatlon Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land _ Name: �ftm� L✓efi9C v Address: i`t Telephone: 9? 8 - -)Yf - o9,f L- 3.0 COMPLETE THIS SECTION FOR WORK IN EY18111413 BUILDINGS ONLY Addition Existing Renovation I/ 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 Brief Description of Proposed Work: Z I/ST/i� L /n/ovt� STV C/C-- T�-aL F3 vS '4_ Mail Permit to: What is the current use of the Building? �(1A lfli is �f .J�i fit'i'UwC Material of Building? If dwelling• how many units? Will the Building Conform to Law? Asbestos? Architect's Name N� Address and Phone ( ) Mechanic's Name �� & t9vtM Address and Phone ski? Construction Supervisors License 0 Kul — HIC Registration 0 Estimated Cost of Projed S Permit Fee Calculation Permit Fee$ 2`� Estimated Cost X$71$1000 Residential Estimated Cost X 511/111000 Commercial An Additional S5.00 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 Perm t build to the above stated specifications. Signed under penalty of perjury X Date �- Z g—©S ui s b Qa y sgg w 0 3 C CITY OF SALEM PUBLIC PROPERTY DEPARTMENT KAQ*Jd"ORMCC" VAYM 130 WA ST=.T•SMEK%1M%AOII•WM 01970 7XL 979-74S-gM• FAx.979-7449846 HOMEOWNER LICENSE EXEMPTION Plesse Print Date L-Z 9- 08 Job Location /I/ 4i9&c�V GT• S/fCe—is'! Home Owner Address s Horne Owner Telephone 97.4 Pre.9eat 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 Persons)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 structure 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 procedure r anquirements.e HOMEOWNERS SIGNATURE APPROVAL OF BUILDING IN PECTOR See other side for state code