16 SUMMIT AVE - BUILDING INSPECTION (2) What is the current use of the Building?
Material of Building? if dwelling. how many units?
Wilt the Building Conform to Law?
Asbestos?
Architect's Name r`
Address and Phone !�A
Mechanic's Name G yQ -g SJ�
Address and Phone t��.vrw rr $? s�r6e,� +v9
HIC Registration 0 a'
Constriction Supervisors License p
of 't r a 3 I b
Estimated Cost of Project S 1 Permit Fee Cale hdlOn
Estimated Cost X$71$1000 Residential
Permit Fee$ 8 a Estimated Cost X S1141000 Commerciat -
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 b lid to the above stated
specifications. Signed under penalty of perjury
Date 'fig
Oc
0
Q
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x m b a - a a
,CITY-OF-S - -
• PUBLIC PROPERTY
DEPARTMENT
1:�.NFa1S+Y o�usuxi.
-S� ✓�U TEL 97L7ii95"0 FA 975EK�� �01970
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION,OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING=
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Building:
Property Addresr.
16
Property Is located in a; Conservation Area Y® Historic District Y&
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: V�nL Grc�
Address:
16
Telephone: 73 7 v y - y 8`i �
3.0 COMPLETE THIS SECTION FOR WORK IN FYtaTtua BUILDINGS ONLY
Addition ®Renovated
Renovation Number of Stories
Change in Use
Demolition
Approximate year of Area per floor (sf)
construction or renovation
of existing building New
grief Description of Proposed Work:
i
L
-Mail Permit t0: W:t I - - -
CTTY OF SALEM
PUBLIC PROPRERTY
DF.PAR'TNUM
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To.I ►t464 M•/•%*a1s74&04
t-
Construeden Debris Disposal Affidavit
(required FM all dausardast and moff attoa worts)
to WCOMancs with the shdt aditim of dw Sate Building Code.7W CNIA soctiae 111.5
Oebrie,wA do provisions of M. CL It 44 S 54
SuilAn4 PWMN it is iswtad wide dw candW a dim the debris resulting Sao
Ibis wort sWl be disposed of in a property Maw"waste disposal &dlity as dented by WX e
ld1.S1"A.
rhyo-debris will be transported by:
_. lae)sa of hadM
rho&-bds will be disposed of in :
1 d c� 7
Ia.rl>r of fa.11lry)
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