13 SAVOY RD - BUILDING INSPECTION 1
What is the current use of the BuildingT many unds?_
fib<G �-- if dwelling,hoW
Material of Building? -� — ti�® S Asbestos? 4�� k'
Will the Building Contain to Law?
Archited's Name
Addreu and Phons
Mechanic's Name
nr ( ,r � fi J�/%•G l/
Address and Phone �) / 7�HIC Registration#1 k.
Constriction supervisors license 0
PermN Fu Caleulation
Estimated Coat of project
Estimated Cost X$71$1000 Residential
Permit Fee i _ Estimated Cost X S111S1000 CommereiaE
An Additional S5.00 Is added as an
Administrativs'chargs•
Make sure that all fields ars properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building permit to build to the a eL su"d)
spaoiflc dws. Signed under penally of penury X
Date
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��� ✓✓ CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
rn.mtaruasoott
Na►raa t20WAtMr=MstunaU KJIr►t;a0ttWM0IWG
T is 97fN45MM a FAx 9Jy.7OM%
Workma' Compemdot.Imoran"Afd& t! Batlderr/Co
AnnUnal Info ades Plan hint
Name l :�/U/ /11 A 54 Y 2
Addrear: /a 74 u6 y i
c�(yisp: Sri U cis �,� p SS Plem
An you a.pNyarf CM&tb approprlab leas
I. I ma.a employer wM I. ❑ I am a Eeowalama oomr and i Ty"of Project
employaa(ft8 sod/ar part dos4l, haw hirad tha tL Now caamtrcdoe
2.❑ I m a sole proprietor or pwmao- limed Oa the attached show,t 7. ❑RemodeHsg
ship and have no employeaa These mdecatm corm have L ❑Demoifdaa
working for try is any capacity. wadtra'COMP kANOoee.
RIO wwkete'camp imemm a 3• ❑ Ws are a wpwedoa and im 9. 1311teilding eddtdae
3. tip1 am ooeowenr ofllcwa haw saerelaed their 10.[]Electrical ropain or additions
doing ad wont right ofeliwopdaa Par MGL I i.❑Phtmbieg repnirn or addidom
myself No wa it=,Comp a. 132.;1(11 and we have no 12-eRoof tep os;
Maureen foquired.)f employees.(No wadtwa' 13.0 Orhec�U7`f`[r7�
cam ie�
;Aq adyllra dam etrab has tit aeaa rho oa dr sortie halrw showers ntl ,
HaoaaowaerureaawaitWdatadraamdleviVsayMdOYarromitr/ftr6iaa�hW@Moslemrlr SOWN aM�
TCoraetae Art eYwa data hat Coat iroeaad r sddhleert than newly er aeon of dV w►aaaraase rd dark woahrd'0MP id�ma IML
dme.
few lwjenaalloia trios LprorldJwB wwfierd'corpewpalon/earronCa jarary rarpftyrry Below b rAtPA7 tad fob adY
Insurance Company Name•.
Polity N or Salt-ine Lic N c� S ,6oi piradoo Darr
Job Site Addrae:
Attach a Copy d the workers'co pemados pogey deeberatle4 Pap(showing the policy ember and eaplradwe doh)6
failure to saw coveralls ad r9liub'd under Secdoa 23A of MGL L 132 can lead m the imposition of aimbW parodies of s
fine up tog 0.00 a d and/or one-year impriaonmea as wall'a civil penalties in the fmm of a STOP WORK ORDER and a Rae
of up to f230.00 a day against t!y violator 8s advi sed that a copy of this statement may be forwarded to the Office of
Investigations of the OtA for imuraoes coverage verification,
I Jo hereby eeabf/j enQia a etf peep of ruy rAm At 1Af Mr<dmaPro U,0d above 4 ar/comres
10 C7
Phone N: / 7
D,Q? W use oelp De tart wrW In rho ores,to bt etsp/tW by efty or knee CQ c/t(
City or Tows: PermlULleease N
Issuing Authority(cWf@ one):
I. Board of Health L Building Department 3.CI lrow
6. Other iY a Clerk 4. EJeetrieal Inspector S.Plumbing Inspector
Contact Person
Phone M:__.
CITY OF SALEM
� PUBLIC PROPRERTY
DEPARTMENT
\Ln'i+K 120 W.Y.iI IIVI:i ON S1ltEET •SALP M.%IM!LACc It IL I-I S OO/C
TFt:978-745-9595 ♦PAx:978-74F7846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CNIR 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
111, S 150A.
The debris will be transported by:
(?-6 sue_ —
(name of ha—
uler)
s
Fhe debris will be disposed of in
(n;une ut facility)
. ____..__ ioddress of facility)
. igi.aturc of; entii[appiiean[
- - .;ate --
C P
PUBLIC PROPERTY
DEPAR'I1bIE1�IT
iaw*Ausr o■ti-..L
Navas
130WA%L%Gw*s1W= Sum MAMACHLShTr301970
TEL 9'L7.15.9M•FAX 978.740-960
APPLICATION FOR THE REPAM RENOVATION CONSTRUCTION
DEMOLITION, OR a N R
STRUM _ QMMANCVFOR EMI TIN
OR B m nE4G
1.0 SITE INFORMATION
Location Narrw.: . a6,Q ill BUildtng:
Property Address:-- -- -- -
Property Is located in a.Conservation Ares Y Historic DIeMcI YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land -
Name:
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN MaSMNp BUILDING8 ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use
New
Demolition
Existing
Approximate year of Area per floor s
Construction or renovation Renovated
of existing building New
Md Description of Proposed Work:
l� 514/I 4/-Pa/ 44 c/ 0 Ga17'e�
Cv 12 fttI
--- -- -- ------ -- -
Mail Permit to: A