64 TREMONT ST - BUILDING INSPECTION (3) uV
What is the current
of the tiding?
Material of Build " �� If dwelling.tow many units?
Will to Binding Conform to law? aS Asbestos? \�
Arehited's Name
Address and Phone l )
Mechanic's Name � j Add1
nd Phone
Construction ction Supervisors II COg-ko HIC Registration 0 �
Estimated Cost of Projed S Permit Fee Calculation
Permit Fee S Estimated Cost X$7/111000 Residential
Estimated CostX i41/111000 Commercial--- - -An Additional $5.00 Is added as an
Administrable charge.
Male sure that all fields are properly
and legibly written a4the
sing.
The undersigned does hereby apply for a Building Parrott ated
specifications. Signed under penalty of penury
Dat
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PUBLIC PROPERTY
DEPAR'I1��.NT
IU.%GW-K vDyISC.v1
aAtMK.VA>rsAaase'r1s 01970
APPLICATION FOR THE REPAIR. RENOVATIAN, CONSTRUCTION
D LITION. OR CHANGE OF USE OR OCCUPANCY- FOR ANY EXISTING
STRUCTURE OR BUI62ING-
1.0 317E INFORMATION
i Location Name: Building:
----- PropedyAddme ------ --- - --- _ - -- - _ - -------
Property b located in a:Conswvadon Arse YIN Hbtoft Ob&kt YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Nams:
Address
Telephonic:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISIINt3 BUILDINGS ONLY
Addition Existing
Renovation Number of Stories ®Renc4vahedChange in Use Demolition Approximate year of Area per floor (sf)
construction or renovation
of existing building New
Bdef Description of Proposed/IWork:
Fc
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CITY OF SALEM
PUBLIC PROPRERTY
4i
DEPARTMENT
To.WW4P)M F.M 97L7+69eK
Construction Debris Disposai Affidavit
(required for all demolition"renovation work)
In accordance with the Sixth edition of the State Building Code.7S0 CUR section t 11.5
Debris.and the provisions of M- GL a 40.S S*.
Building Permit N _ is issued with the condition that the debris resulting ltom
this work shall be disposed of in a properly licensed waste disposal facility as defined by%IGL c
l It.S 130A.
The debris will be tram y:
(Aurm d hauler)
I' fhe debris will be disposed fin
tn:uneurta:drty)
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