10 QUADRANT RD - BUILDING INSPECTION What is the current use of the Building?
Material d Building? If dwelling.how many units?__--
' WIM the Building
Conform to Law? Asbestos?
Archited's Name
Address and Phone
Medunies Name
Address and Photo
Construction Supervisors License S p5 N T d- HIC Registration 0
Estimated Cost of Project: 7� Perrnit Fee Cakula8om
(� Estimated Cost X s7/111000 Residential
Permit Fees --
- -- - - - - Estimated Cost X Si l/s1000 Commercial
An Additional$5.00 is added as an
Administrative chary'.
Mal.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. ig S ned under penally of perlurY /�
Date "I `T"� 7
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4 CITY�OF SALEM
PUBLIC PROPRERTY
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DEPARTMENT
aurnt.r.1!'Aucidi.
\l:,vt r.
120 W.\irltVG:JN 5-t'AEET #5.1Lra+,VtAtii:lCki15C'l'il0i9Jr.
Trt:978-745 9595 •F.ax:978-74G9846
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 1115
Debris, and the provisions ofMGL c 40, S 54;
Building Permit 4 ___--._— 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
I It, S 150A.
The debris will be transported by:
T (tame of hauler)
I'he debris will be disposed of in
(name of it ity)
taddress of facility)
si stale oI pe tit applicant
_ date ----
/ EITrOI?gALE.�
PUBLIC PROPERTY
.�...• DEPAR"I'�IE1�1T
KINMFJLHY ORMCIX . , .
MAYCA 130W&%U =W]fir
1AUK YtiWonscrIs 01970
TEL 976743-9M•PAZ 976-740-NO
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OC ip NCY FOR ANV E�QSTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
L=don Name O v q 1 /A T 2 Suilding:
--
as _..
Property Is located in a;Conservation Area YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land '
Name: (Y\ r r y r h
Address: ( � ,� a r� T
.S�lei- n-✓d . �-�P- � � 5 z�
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor(50 Renovated
construction or renovation
of existing building New
9net Description of Proposed Work:
�er-,)o
— - -- Mail Permit to: (C."f