The URL can be used to link to this page

9 PICKMAN RD - BUILDING INSPECTION (2) 7v- e�d Crry of SALEm PUBLIC PROPRERTY DEPARTSGNT a��• t�"IAYLN7:,7N�71LT�1ui1��A�LL1l»N,l�hi�' tt,:'IONN+1l�U�f.�70iJ�6lW r- Construction Debris Dbp ut Affidavit (retiomd lix all demalidoe and senovatice wort) to mcwhme with the ttixdt edition of do State SuMWS Cad@6 7W CN1R soction 111.5 tkbrij6 wA dw provisions of MCL a 44 3 S* 9uildtnd Famb t _ to lssnad with the cood doe dot the debris reaidnf loos this wait JWl be disposod of in a property licensed woos dispoed fbeility s deMod by M(3L e The debris will be traannspWal by: Inaree`,i(hould) Medcbris will be disposed orin: .raI'Ar �U rf, C 1n.m.ut'rxit�ty,)II n �,M:rsfn of t'x:Lty) .w CITY OF SAI.EM PUBLIC PROPERTY DEPARTMENT �..rc� ry,vw•n 130 wnaarwWO SnWT•&W!K MANACHLWM 01970 M 9 W145-95"•FAX.978-740.9$" HOMEOWNER LICENSE EXEMPTION Please Print Date Job Location y 0i Rd V� �c� Home Owner Address 19 6ja-c� 4Ji. 014-10 Home Owner Telephone 414- vGW--09 0 Present Mailing Address 4,,vu n, 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 s Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE V APPROVAL OF BUILDING INSP CTOR n,o See other side for state code EITrOF S-= - ... PUBLIC PROPERTY DEPARTMENT KINOWU"ORLWAX u"'a 130 wwuru rM,bum 0 SALWk.VA.SMa,cst„s o1970 710-97a.74i95"•PAX 97L740.96K APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BUILDING _ 1.0 SITE INFORMATION Location Name: Building: Property Address. Gl t zd� Property is located in a;Conservation Area YM Hlatorio DWUId Y/N K) 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: G c Address: I y 6�yr-(- <,.;.k SaleW. M4 olclgo Telephone: 6e, UC,$5 �Ac� 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition A ng Renovation Number vated Change in Use Demolition ng Approximate year of Area per floor (so Renovated construction or renovation of existing building New BrW Description of Proposed Work:: 1 . '��p�nrCtvv� r'Gvnr,GW� t �1Gr�vv �� i7�Wv�.�1� �1h'(1 2��G{liC.Ai� in G� S�n�Lt. AG+✓».�y f11o.9aae,_ (�'fl.��csc,.+, — -Mail Permit to: �1— c�c .-. VA. What is the current use of the Building? Material of Building? If dwelling,how many units? Will the Building Conform to Law? — Asbestos? Archited's Name Address and Phone Mechanles Name Address and Phone Construction Supervisors License# HIC Registration S Estimated Cost of Project 3 000 Permit Fee Calculation Permit Fee$ Y"F Estimated Cost X$71$1000 Residential t P QO Estimated Cost X S1141000 Commercial —- �D An 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 stated specifications. Signed under penalty of perjury X ©ate 1 R 4 10 N � aa� w 2 a ' U MM V n 1M O .. O 1