6 ST PAUL ST - BUILDING INSPECTION � r=/�rntiy
What is the current use of the Building? ��?
Material of Building? --
�OC8 it dwelling.how many
to Law? c S Asbestos?
WIN the Building Conform -X
p rchuds Name I j
Address and Phone
Mechanic's Name f31 SOYr��/c
Address and Phone 7=s t �S�JAr���IC�l�r rl?fy 2
Comwuc*m Supervisors U C S lo9,7k�L HIC Registration M
Estimated Cost of Projscf a Q Permit Fee Cakxrlallon
Permit Fee$ 16 -- Estimated Cost X$71$1000 Residential
- Estimated Cost X:1 uslo0b Commercial, -
An Additional$5.00 is added as an
Administrative charge.
Make sure that all flelds 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
speciflcatkms. signed under penalty of Perjury X
Date Z
N �
0
s
a
- 4 -
1
ism Irs-
PUBLIC PROPERTY
DEPARTNI MINT ` ���
I:IM N Dt1SCUll
NwrOt 130 WAnuwGWO brU= '
��%rALSACtishlls 01970
APPLICATION FOR THE REPAIR RENOVATr N CONSTRUCTION .
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY. FOR ANY EXISTING
STRUCTURE OR BUILDIN
1.0 SITE INFORMATION
Location Name: S 7- ?P� Si tuilding;
Property Address:- __._ _ _ . - .. ..
'5&�w%- MA- 0070
7a
Property is Iocated in a:Conservation Area Y/N-d_Historic listri t YIN /11
2.0 OWNERSHIP INFORMATION
9.1 Owner of Land
Name: !C tl Pn>i CC
Address: y 3 'S p vn�clv�0
5L)41'V1 j>SCoT ir4 0tso7
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXI-WING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Z
Change in Use New
Demolition Existing Z70o +
Approximate year of Area per floor(st) Renovated 1
construction or renovation
of existing building New Z-jDo
Met Description of Proposed Work: stAll c'Mr`1- eAP� khr
t� „ S S 0)1 "i
Nn4 LAcr Sdr+,(cAles t'Ae W.*,/ z i g4kd 6r,TS2.
vt":CK A4 slf4rN�t Mr •tv
L.A^,�10r6 me-Wr,
_ it S43 dwi,4 Isr fraz AfrLs;ro�)
_ �pdi<k R��s�alei va(K s4^jee 1srr-/a^1E
- Acid V-r 76 uirr.c 1Ett d) S 5 isTq�lN3P
— -- Mail Permit eel y S 46 d�lC�Tfi19 917 -
CITY OF SALEM
PUBLIC PROPRERTY
h DEPARTMENT
k(.h:,'I)KN :,ML.
\l.;S<P. LL Vt�,\itii�(;i JN STREET• SALF%1,N'tASSACHt.,L rtS 0197C
Tn:978-745-9595 •D-X: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 111.5
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
l 11, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in
bW1 S/P/ C^-7-r11L16
(name of facility)
�Gve /j7fi Off 7d
(address of facility)
w
�Ila tuic Of l)CCllllt at)t)li Cant
date
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
MAYM 120 WAweHtaert Stew a UUK t:0lW0
Tft 97W45-%%a PAst:97W1a9N6
Worllen' Compeandon Iaawaate APadavW Bra WaWCoa
Anudnat Itsfwrmwlbt! pi a hint r eldbl.
Address °a ! J"e dAJ 11-e-
cityiState/Zip: l(��%/1l� LLd7 om
Are yew AS as pbyso Chet the app raprWe
1.13 I ses a myloywr with 4 I am a poem)coetrww and i of praise
employee(AdI and/or part-time).• have hind eke wtbeontmcotns d Q N@w 00Om°ctina
2.a1 an a sole p mpeldw or peemeo- lived an the attached dea t y. (gassoodomial
ship and have no employees Thee wboasmaaan hew L Q D*moBtlon
Working Ice me in say capacity. waken'COMW iewuaea, g, ❑gag addidm
(No wadWe Camp.itlaeranp S. Q We an a carpaadm and id
mgaint] aAfeaa haw mrmalsad thei< 10®.E1*c011W tspairs or addhicsts
3.[31 ages a homeowner doing a8 work right of uuWdow pt MOL I I Z 'hsmbing mpain or addidow
mysolt(No workers'wma a 152.f 1(41 and we have no 12.13 Roof repeim
inguntaee nquhc&j t employee.(Ne wodma' t3.Q Other
comp Woolens uelttited.)
�Aer wvua■ersd.areD.a n n.a.4e ws ore daretla6tlo�sMalyeekeakm'r..o..ri..veror i.6isrloa
eem.o.e.awrw.tt tals.miw�+4 esy m deiasi.odtatdtt�uwamweo.r.sm meei.a.re.l!ldtealtlarlaa e.eL rCaeaaaa dot yak BY hdent s m"W a.d""d dm devise ey eo.d ea A.=kca.ebu Md awk NNNNNWNE�mboo,amp PON h& e
the 4 prov/dlieB wwhas•eompaerrdon AWWAnee foe cep ewPIRY" Befow&thePo5w medM der
Insurance Company Name:
Policy M or Self-ma Lic. Exphdm Darr
)orb site Address Ciry/Stue/Zip
Attach a copy of the workers'eompawtlow ponry deelantlow pap(sbowbsg the poBey Camber and OVkSt on dap)6
Failure to sear*coverage as requited under Section 25A of MGL a. 132 can Ind to the imposition of a bobu l penddp of e
rule up to 31.500.00 and/or on*-ye"inWrisomagem as won as civil penalties in the form of a STOP WORK ORDER and a Aw
of up to$230.00 a doy apioat the viobuor. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage veriAadoe.
f do hereby eerd/)r nalt6sr o Prr/nrp that the le orarufon
/ Provided oboes is lone ant Cored
Syi o
0,flold Al"010A Dr not wdte In this area to be eojwpkW by e*or Iowa gQ?elal
City or Town: Permlutleeaso N
issuing authority(circle cog).
L Board of Health I.Building Department 3.Cityrown Clerk 6.Other 4. Electrical Inspector S.Plumbing Inspector
Contact Persoa• Phone M;__
UO s andStandards
Board of Building Reg GTOR-
NOMEIMP�R,.OVEMENTCONTRA
Rs9lshaMoi;. 125079
mEgpi�s loon__ti�OR12007
gALDACCI DESI ANi{II
RICHARD RAID t ` /f �Oyu✓
43 SAMPS0 AVE v
gy�gMPSCOTT,MA 01907 Administrator
3oard of Building Regulations and Standards
'Construction Supervisor licenso.
Lies&' CS 69764
SikkRhdate�21311963s Tr# 9349...
EzpiraUon ZI312009
RICHARDR BALDACCl Pa ^!
43 SAMPSON AVE F , '1
Commissi
SWAMPSCOTT,MA 019tr7 ._
f