19 RAYMOND AVE - BUILDING INSPECTION What is the current use of the Building? Str-16tg IFAKtLY I�SLIOQ�� ,
Material of Building? WOOD E If dwelling. how many units? 00q
Will the Building Conform to Law? YES Asbestos? No
Architect's Name Pt. Y�%�KS
Address and Phone 80 LAFM-M S-C 1`44&&A M}C ( ) 761 -631-794
Mechanles Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ Permit Fee Calculation
Permit Fee Estimated Cost X$7/$1000 Residential
UOc 0r d Estimated Cost X$11/$1000 Commercial
A
AnAdditional $6.00 is added as an
7 69 Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of perjury
Date S ��
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96
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"AW Oz--X CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
Kl�dlco�cv DRiSI'OLL
MAYOR 130 wASMNG'rON STREET•$
uFM.WAscnait:sertS 01970
TFi 978-745-9595♦ FAX 978.740-984
HOMEOWNER LICENSE EXEMPTION
Please Print
Date 3 1 0
Job Location is R4-frtctvo Air SA1.V1 KA 0mo
Home Owner Address ot AA( N o
Home Owner Telephone &A m -(91fi) 7q I�q� w (9i$ -7 fe(bl,
Present Mailing Address ►A AA,[Mo-jo A�lg SA,t MA exq-t O
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
Building0epartment 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
1 F
CITY-OFTEN -__ ._
PUBLIC PROPERTY
DEPARTNIENT
Ki.mWJU-Er oRswu.
MAYM 12OWMHINGTONhhR •-SAL&KMMSAb4LSLrS01970
Trl'97$445-MS!FA)t 9.76740.9846
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: 19 FAIMOtip WOL7 '
Sg1.F� t� 01910
Property is Located in a; Conservation Area YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: PtSf 12►GK F� C,uirJ
Address: lot 9wK0ND h%*Avc
5RWrM, Mpg o1g140
Telephone: i4onE: (976) "7q5,1;-q0, \.40"1 915 7q95•6161
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New oTIC
Demolition Existing
Approximate year of tq`l°� Area per floor (so Renovated
construction or renovation i aA0-
of existing building New talk- ar
arid Description of Proposed Work:
`r1R`7r fioo2 ,may^-►p exlery 'r-WW-`f A�VK,A9A Pd,40Q02dOK Ar►9
aw5t-C SPtNw . 0foXtt+A ev< X010 T1,
�eE RT-+'�-tizo DkA�a6S)
-_- Mail Permit to: la 'd`r1�io��D A 'uE . SA�-t MIS 001 o