13 PURITAN RD - BUILDING INSPECTION (3) What is the current use of the Building?
If dwelling.how many units?____�
Material of Building? Asbestos?
W,u the Building Conform to Law?
Archited's Name
Address and Phone
Mechanic's Name
Address and Phone
Constriction Supervisors License# HIC Registration is
Estimated Cost Off�Pr�o/Ij��eJJd t�� Permft Fee
Permit Fee i Cak ulatlar
� 1 — Estimated Cost X$7/$1000 Residential
--- ---_---- -- __ ___ _ - Estimated Cost X511/$1000CommercW------
An Additional$5.00 is added as an
Administrative charge.
Make sure that all Heide 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
Date
0
N
y \
x o, 'd 9
LIM,.ti _
PUBLIC PROPERTY
DEPARTIMEINT
AI\dFN N pYKtYY 1 Y / �v
NAroa 0 J
130 W&%"NCMM!hUEr
�sw.NASSAO/LSllA 0197
MM.97l US-%%•FAX 975.740-96i
APPLICATION FOR THE REPAIR RENOVAUg-N- CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPAyCY FOR ANY EXISTING
STRUCTURE OR BUILDMG
1.0 SITE INFORMATION
Location Name: Building:
- -
Property Address:----
13 --
Properly is located in a:Conservation Arse YM Historic Dftk;t YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: (�
Telephone: — Qb 251
3.0 COMPLETE THIS SECTION FOR WORK IN EXISIUILp BUIMONLY
Addition E
Renovation Number of Stories R
Change in Use Ne
Demolition Ex
Approximate year of j , qbj
Area per floor (sf) Re
construction or renovation
Of existing building Ne
Sdd Description of Proposed Work
(�
-------------
Mail Permit to:
CITY OF SAI.EM
PUBLIC PROPERTY
DEPARTMENT
KI�NF.tl.6Y DtlSI:OLL
MAYOR 130 WMMNGTM S"M•SAIEK MA MM34LSL11901970
Ta-978-735-9595*FAX 97&740-9&4
HOMEOWNER LICENSE EXEMPTION
Please Print
Date�4jdlkk_ _ ff
Job Location
Home Owner Address
Home Owner Telephone -7 Q 1
Present Mailing Address ��-a yl- .
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 "homeowne► '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.
HOMEOWNT ERS SIGNATI.
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
KA11ii Plbl'^MIl1:V 11.
\1.15C'1` L_'0 VtrA5111XGiON S:RCET •SALF-t,11.%SiAC tt.SL 1-1'i Jig/C
-rn:978-745-)595 s P.ax:978-74C784b
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 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit It _ .,___ 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)
The debris will be disposed of in
-� - (namr of facility) III
i
-- ,Ir�pdnnit applicant -
:atc
' 'T" lnspedon excludes Ms coomwo e d
moresble sheds as to zoning setback
+�+r If built more than ten years ago, may be
grandfathered, Chap. 4On, Sec. 7. If less
than ten years old, it violates Zotling.
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MORTGAGE INSPECTION PLAN
BUYER. r�t~Y1 PPTR:c1y 1 cT%p , 1 mim M
m TNe E SI'-��ILS'f I/�p�TGAGG Lo l a c � S kl-I=/A
AND ITS emrnE>is
I CERTSY NAY I HAVE OW WED D THE PRFlKW AND W SIAIDMS Sim DO ) MAM04USEM
DONFDRM TO 1W Z"4 LAWS AND AMETEME M Lw(fRONT, =V, M NAR YARD WMAQ(
F URT
HAZARD Rt6hT 1E ESTAIIf FLOOD DEEDONLY orRC
COMMUNITY PANEL NO.: 25pbz_ a*GD DATE: 0.5. 8S soar
LMAMR"71 N OF THE WOPRDS IS MADE ONLY SUBSEQU0fT 10 " REQWW DATE OF 1W Z'yD
LATEST DEED AND DOER NOT WC UDE VEIIIFMa 1119 AOa1RMY OF THE DEED DEOW4"OW PACK
PPEW" 10 M DATE OF Wo".
CERT. N0,
QA1E COMPANY t6 NOT BESPDN9p:j~ FOR ANY RIDFWUM MADE SUBSEOUENT TO THE REoamEb
73
DAT Or TN6 LAt[SF 0!L°A OF REOOgDED.
YABNSNDt pURDB1OS ARK SHOWN =3 THAN ONE FOOT MW 7W PNaPEATY LAMS IT Is ADNSICT PLAN SK 104
PAK
THAT A Mg1E PR EOM SURVEY K MADE TO VIDtI Y 11i W MFASUI MWM .
N01�; BAN � 55 DATED_._.
22'
16x16'
1S'x 2 Deck
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19.5'