38 SCHOOL ST - BUILDING INSPECTION (2) ¢, CITy OF SALEM
PUBLIC PROPRERTY
DEPARTNHNT
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Construction Debris Dispossf Affidavit
(reyuirod roe an 4einalwas and twtmvation watt)
Iu=onwnee with the sisdt edition of dte Stus Huildh*Coder.7SO ChtR section 111.5
Dario,and the provisions O(MGL a 40,S Sk
8uiidis{Permit* _ is Wool with the condition that the debris nmAdns fan
this watt shalt be disposed of in a properly licensed waste disposal facility as defined by.%tGL e
ttt. ! MA.
The debris will be transported by:
(ranee at hews')
rho: --brie wilt be disposed orin :
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CITY OF &U.EM
PUBLIC PROPERTY
DEPARTMENT
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Neves 130 WAvmNGTON SIM=•Suet{MAUAnassrrs 0c97e
TEL 978-745-9S9S*FAX.971-740.9W
HOMEOWNER LICENSE EXEMPTION
Please Print
Data (D-Ira - (-,2
Job Locatioa
Home Owner Address 34 c c ,�mp/_ f S r
Home Owner Telephone y - 77( - )./z
Present Mailing Address 3 A S r
The current exemption of"Homeowners"was extended to include owns-
occupied
dwellings of two Units or less and to allow such homeowners to engage an individual for
hire who.does not possess a licens%provided that the owner acts as supacvism.
DEFINMON 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 dwellin& 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 shaU 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
Building Department minimum inspection procedures and requirements ments and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
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PUBLIC PROPERTY
DEPARTMENL T
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APPLICATION FOR THILREPAUL QONSTRuca"
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DEMOLUTON. on z OF OXFOEMPMNO
�.o airs INFORw►noN "
Location Names S !6 f
--
Properly Addraae:----- --—--- ----- -- - - - - - -----
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2.0 OWNERSHIP INFORMATION
2.1 Owner Of Land
Name: SiL vi , .v- G .._
Addrasa:
TMephone; - /- 7
3.0 COMPM§THIS SECTION FOR WORK IN E7(1snNa BUILDINGS ONLY
Additions0�
Renovation Number of Stories Renovated
Change In Use New
lDemoudon Existing
Approximate year of Ana per floor NO Renovated
construction or renovation
of existing building I I New
Wd Description of Proposed Work: /O r /0 p�G�iv
--- -- ---Mail Permit to. - -
l
V11hat fs the aara+t use of the Building? _ . .
k dweN{rq.how^ww
meterhl of BuldiW? Asb*M=?
We to Buildrq Confbnn►D Law?
( 1
Canso gFFOW- as Lim"B HIC stfon B
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gslbneted Cost Of Projed s / -- Pam CalaJstlon
Fee
PemalFa+i
Es*nated Cost X i7/i1000 Residential
_ - C;;>o: p-p Eslknetad Cat X i11/it00A Cormnenla4
M tonal$LoO is added as an
Ad nWWaWe d wge.
MiaM sure that all flelds are properly and wo*written to avoid delays In D n4
The unoarsigned doe►Eby apply for a Build to build to the above stated
speaifla*wa. Signed under pawfly of Peflt+
Date
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