4 SUTTON AVE - BUILDING INSPECTION (2) What is the current use of the Building?
Material of Building? //!/�4t� If dwelling.how many units?
WIN the Building Conform to Law? _ Asbestos?
Architect's Name
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors ucenSO S �5S�/z oGl HIC Registration
Estimated Cost Of Project iTI4� Permit Fee Calculation
Permit Fee i iLL21 — Estimated Cost X$71$1000 Residential
Estimated Cost X$1141000 Commercial=— ---_
An Additional $6.00 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 penally of perjury /rIAOLl //�
Date 7
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PUBLIC PROPERTY
DEPARTMENT
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7V-978•745-9M 9 PAZV&740-9M
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location New Building:
- Prop"Address:-t/- -.3u�— — - �-- — --
Oly7o
Property is located in a;Omservatlon Area Ym Historic District
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land `
Name:
Address:
T 117f
3.0 COMPLETE THIS SECTION FOR WORK IN E7II8T1Np BUILDINGS ONLY
Addition Existing
Renovation ;/ Number of Stories Renovated
[Approximate
ange in Use New
molition Existing
year of Area per floor (SO Renovated
nstruction or renovation
of existing building �`T/U New
Brie[Description of Proposed Work:
-- Mail Permit to: AAlbR64 U473b, Surnr��fur, 5
CITY OF S.ULEM
PUBLIC PROPERTY
DEPARTMENT
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NAVOK 130wASIuNGTON Sim•SAI.FJ4 WA4No11.'StT1301970
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HOMEOWNER LICENSE EXEMPTION
Please Print
Date C O
Job Location j J�Uri7 wy,4V/,
Home Owner Address SUrTT�N 4A/ i�l
Home Owner Telephone —
Present Mailing Address ,A4A O/9`7 0
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeowners to engage an individual for
hire who.does not possess a license,provided that the owner acts as supervisor.
DEFUMION 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
"homeownee'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 and that he/she
will comply with said procedures and requirements.
HOMEOWYERS SIGNATL'RE�J
APPROVAL OF BUILDING INSPE CTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
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Construction Debris Disposat affidavit
(required for all deetotition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 C*NIR section I t.S
Debris,and the provisions of vtGL c 40.S A.
Building Permit N _ . ._ is issued with the condition that the debris resulting*om
this work shall be disposed of in a property licensed waste disposal facility as defined by MGL c
It1. 3130A.
The debris will be transported by:
Iname of hauler)
me debris will be disposed of in :
Ia4aw offa:drty)
Ot