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96 SWAMPSCOTT RD - BUILDING INSPECTION (10) i+LlkfraSiAliS��E fIL{$A+W APPROVED BV T44E IAISP JL R ,PFWR TP A.PEAMIT BKMG GRANTED CITY OF SALEM Date No. sjiry �. is Property Located in Location of the Historic District? Yes_No Building is Property Located In the Conservation Area? Yes_No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool, Repair/Replace, Other: " '��tT IKTL=r4e47 ��— PLEASE FILL OUT LEGIBLY &COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: Owner's Name , �� 5`6 >x�-�aTT I�°B� 11 G ATT' Il -L 13 c®Rt i lrtT pp'V Address & Phone Y'`, "` � °I94 f 7a1) c. Architect's Name 1FAV-IAM 1� � �'S ec> Address & Phone a�""' J r1 °�� x 631 - 7D SO) Mechanics Name 4 Address & Phone of building? �Ni� IS S DIL � lsl What Is the purpose n9 A,�- � � � �f'P ��S Material of building? 5 It a dwelling, for how many families? N/ Nil building conform to law? Asbestos? N A Estimated cost /qq 6 S� city License« N P' state u s[C 100 Zlo y Bose Improvement Lic. t Signature of Appli ant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE t lr�cw�i f -llllcfit� Gt�ol�srtD 00 5 P06F, MAIL PERMIT TO: No. 1 Gi APPLICATION FOR PERMIT TO LOCATION PERMIT GRANTED o 2.0 AP ROVfD INSPECTOA OF BUILDINGS r v CONSTRUCTION CONTROL AFFIDAVIT Project t:umber. Date: Project Title: Ttzl' G1-17-t S�L43 Project Location: uN r[' 4 3, ?(v '5K?M)rE= r::!2 *17 Name of Building: 15/1rL6M 6© (N1W1 t Ct= EA Scope of Project:)5"tpie-,y fps f rt 9ff1.G� 6- 12 Td I t>ET Iz M IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUIDING CODE, I )ILU?Jft . MASS. REGISTRATION NO.33 8to BEING A REGISTERED PROFESSIONAL Aaf rvac-,T,� HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS, AND SPECIFICATIONS CONCERNING: Civil Architectural V Structural Mechanical Electrical Fire Protection Other(specify) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS, AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND ALL APPLICABLE LAWS FOR THE PROPOSED PROJECT. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2. 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code required control materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specked in the accepted engineering practice standards listed in Appendix I. SEBEu H PURSUANT TO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A PROG \qRB kc TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING INSPECTOR. UP PLE OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS T 1 SATI A sO AND READINESS OF THE PROJECT FOR OCCUPANCY. ; MA53.. D(p Signature 4�TyOr�p55 r SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF 004 My commission Expires: !� Notary Public } j , CITY OF SALEM, MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RO FLOOR SALEM, MASSACHUSETTS 01970 STANLEY J. UlOYICZ, JR. TELEPHONE: 978-745-9595 EXT. 380 MAYOR FAX: 978-740-9846 Salem Building Department Debris Disuosal Form In accordance with the provisions of MGL c40 S 54, a condition of your Building Permit is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL Chapter III, S 150 A. The debris will be disposed of in: 0`Id 123) (Location of Facility) r 4&gna!�eof p 'cant Date