24 SOUTH ST - BUILDING INSPECTION (2) O� CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
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Construction Debris Disposat Affidavit
(required for all dettaoudw and renovation wont)
la aoconlaoee with the sixth edition of the Sets Building Coda 730 CAIR soctim It I.!
lkbr*and the provisions of MOL c 40.3 S*
SWIMS pffmit* _ is issued with dw mmgdon thou the debris tssaldng&oss
this wort shall be disposed of in a properly licensed waste disposal facility as defined by.dGL a
I11.5 is"
The debris will be transported by:
(name of haws)
rho&-bris will be disposed of in :
(�t+rotr ur fxtGty)
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CITY OF S.UMM
PUBLIC PROPERTY
DEPARTMENT
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7M-97L70-9"S•F.Xc 97L740-96"
HOMEOWNER LICENSE EXEMPTION
Plea"Print
Date
Job Location V SS"n<
Home Owner Address sa ,
Home Owner Telephone
Present Mailing Address
The current exemption of"Homeowners"was extended to include owner-0ccupied
dwellings of two Units or lest and to allow such homeowners to engage an individual for
hire who.does not possess a license,provided that the owner seta 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 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 shall not be considered a homeowner. Such
"homeowner"shall submit to the Building OSicisl,on a form acceptable to the Building
Official, that helshe 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 and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
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See other side for state code
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PUBLIC PROPERTY
DEPARTMENT
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SM13k MASSACHtShTR 01970
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APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION
DEMOLITION,OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Narrw--T .p' e cY Building:
- Prop"Address:------- -- - - - ----- - - - - - -- ---
All
5a
h Property Is bested in a;Conservation Area Y/N-AZ—Historic District YIN AZ _
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
,o
Address:
Telephone:
Z.
3.0 COMPLETE THIS SECTION FOR WORK IN UILDINGS ONLY
Addition Existing.
Renovation Number of Stories Renovated
Change in Use New j
Demolition Existing
Approximate year of Area per floor (st) Renovated
construction or renovation
of existing building New L!
Sdef Description of Proposed Work:
40,A
----------
Mail Permit to: 0 sc e 4 , - - - --
What is the Current use of the Building?
t � d �tjr ..✓l
,how many units?
Material of Building? w If dwellin9
onform to Law? Asbestos? �''a
Will the Building C �v r c
Architect's Name
Address and Phone l )
Mechanles Name
Address and Phons 2 ° =�
Construction Supervisors license 0 HIC Registration 0
PemAt FM Calcu IsUon
ed S
Estimated Cost of Pro t t- --�''—
Permit Fee$
1J.c Estimated Cost X$7IS7000 Residential
Estimated Cost X$41/51000 Commercial—
An Additional $5.00 Is added as an
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
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