2 PLANTERS ST - BUILDING INSPECTION What is the current use of the Building? If dwelling.how many un'ds?--
Material of Building? W
,S
y Asbestos? /07 i/� Sir�n
"a the Building Conform to Law? —
Amhitect's Name
Address and Phone
Mechanic's Name
Addreas and Photo HIC Registration N
Construction Supervisors License
Estimated Cost of Project S • a Pem*Fee Cakxilatiat
Permit Fee S La D Estimated Cost X$71=1000 Residential
--- Es*nated Cos<X S11/i1000 Cammercial'---
An Additional S5.o0 is added as an
Administrable 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
specftatWs. Signed under penalty of perjury
Date
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/ ErrrOF&XLEM _.
PUBLIC PROPERTY
DEPARTLI&NT
%IAVM 130 wA*9NGTM S1kT•&MAiK NAUACMSk-1zs 01970
1ti 9'67iS 9S9S FAx M740.9"
APPLICATION FOR THE REPAIR.RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUP N", FOR ANY EMSTING
STRUCT OR BUILDIN
1.0 SITE INFORMATION
Location Naar: Iluikting:
Property Address: _
Property Is located in a;Conservation Ares YM Historic 01sirlat Y/N_ V
2.0 OWNERSHIP INFORMATION
Z Owner of Land =JA / vc _<2/7A? c.5 ZW
Name:
Address:
Telephone: '1 7 g- -7 y S—O.3 '7
3.0 COMPLETE THIS SECTION FOR WORK IN EXIATINQ BUILDINGS ONLY
Addition Existing
Renovation / Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor NO Renovated
construction or renovation '1160
of existing building I New
Beet Description of Proposed Work:
N ti
— Mail Permit to:
0*��M
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
\1:0 0K 120 W.\91r%Gi ON S rREET •S. UM.\i,\tii.1C;1LtiL 1'C5 0.9lC
To:978.745 9595 •F.vX:978-74G9846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixih edition bf the State Building Code, 730 CMR section 1l 1.5
Debris, and the provisions of vtGL 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:
— — (name of hauler)
]'he debris will be disposed of in
(aurae of facility)
I laddrcss of Cacility)
si3raturc of perntit appiican[
,.ate ----
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
� .vc��cv DIW:Wl
Mwroe
I30 wAswrGTor,b1RE[+T•S LEK MASM34LSETM01970
TEL 97&745-9595 0 Fnx:978-74&9"
HOMEOWNER LICENSE EXEMPTION
Please Print
Date / D
Job Location
Home Owner Address `3 r�i we 4f
Home Owner Telephone
Present Mailing AddressThe 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 requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code