15 RIVER ST - BUILDING INSPECTION (3) What is the current use of the Building?
r
Maww of Bu"M? LU Cl-mil N d"W4,how,many unils9
vets to Suj&V Conform to law? Asbestos? —
Architeds Name
Address and Phew l 1 -
z
s NarrN -
Mechanb'
Address and Phone 2
mrstn�on Suparvisors Liea�ae 0 HlC Reg
n7 � btratlon# L k- �C
Es*nabd Cost of Projad$ �; i U ,lPsnvd FN CQ.
alaaVtlon Y/1
Pem k Fat i Es*nabd Cat X$7/51000 Residential
Es*nabd Cat X 511/$1000 C4mnwcla4--.-An Additional 56.00 is added st an
Administrable chargIL
Make sun that as tidds an properly and legibly writion to avoid delays In processing.
The undersigned does hereby apply for a Building PwwA to build to the above stab
apwAcatlons. Signed under penally of perjury
Date T
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s
I� UC PROPERTY
DEPARTINMNT
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4AMOe 130WAeat+[. W 9rMW•Su&K.MAaAQILWM01970
nL•M745.95y•FAm M74oA*
APPLICATION FOR THZ REFAM RENOVAMON_ CONSTRUMON
DEMOLITION. OR CHANGt OF USE OR OCCUPANC __ FOR ANY rjpffm _
STRUC MU OR SUtiLDIINC
1.0 SITE INFORMATION
Location Name:Property
/,S- /�,,
txreparly M klceted h a;Corlservatlon ArN Y Historic Dtatrlct
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
New
Address. /L5-
Telephone:
3.000MPLETE THIS SECTION FOR WORK IN EYIMMO BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of Area per floor(so Renovated
construction or renovation
rDLescrdpfion
ing New
of Proposed York: �j�� J
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- — Mail Permit to: r
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.ITY OF SALEM
' PUBLIC PROPRERTY
DEPARTMENT
\J.m'x 130 WASTING'ONSTREET •SALIA1.MASSAt: U iL ITS:191C
TEI:978-745-9595 • F.vX:978-74G9846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.3
Debris, and the provisions of MGL 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 1.50A.
The debris will be transported by:
(name of hauler)
The do ris will be disposed of in
G/ �e-'
(aaammeeUffacility)
i address o t'Cac i l,t Y)
C — -
,�enn¢appaunt
3 / -
ia0.
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
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Name ZS_QI tZ / J �7i r
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t. I aas a eaiployar eritb L ❑ I am a Imud caetradw and i Type dprbsa ba7mkS*
amploym("ao&ar pwbdm4o haw hind the ad.o staxam s 6•
2.(3 I was sole paopetemmr ar pwaaw Hobd not the a,aahed rim L t 7• ❑Remodelhq
a*and have sec amplayste Theme mb ambecum beve L 13mata last
working for me Its my eapedq. wad me camp,istassoa g, ❑g addttiaa
Pb worlam'Comp.smom na 3. ❑ we am a cospoadoe and its
3.01 oftars have warmest their 10.0�1 npdm a addhtaee
doing all woek right ofaaenpd=par Mt8. 11.13 pq MPWM or mdMom
my"K(No wakes'
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ke 'comp, a. 1A 11(/).and we have no IL /Roof _
in 1 t v*en,oft waebsom' 13.f 9A0f
das
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tCartaswm*Aab*tamboasotsim"Wasaddd dAsiaAwlgdomaimdamaiaemtsaepeatdabarias'Como,mae4rb6mmdmL
abmr b pnviBse worRen'emmmpstredee GwnaKo/ip sr e+�Ployeea e./ofr lr rdepotlq ad job a&#
Insurance Compmey Namr.
Policy M ar Self-im.Lie. / F.xphdoo Date:
Job Site Addreae `1� �/ 6 L��s- // 'Y� Ci Y SUWZ* �.
Adult a eW of the worbmraa eompmt twiea Polley dwiand"pap(+bowls{thepogey aamhn and m
FaLluce to seem coven spn a data
p Y requiead aeries Session 2JA of M01•a 132 can tad f9 the impomidas of criminal paneltlme of a rum up to g 1,J00.00 and/or one-yewinWimonmau,as well am civil penaluea in the foam of a STOP WO1[IC ORP an- and a fine
of up to$250.00 a day apish the viotatar. Be advised that a copy of this statement maybe forwarded to the RDE a(tnvmtigadene of the DIA for inmunac covemp vaaificgdos
f Jo hemp eeregj rke prism aed pre of rhea tAe/eforaudowOrorl/d above eras awf anew
F
atr on/p Doas wrW G Ihh arse,to be eowp/dd bl C*a tow*oQf W
uthority(circle one).
of Health L Building Department 1.Cityfrowe Clerk 4. Electrical Inspector 3.Plumbing Iwpeetar
Persoa•