21 TURNER ST - BUILDING INSPECTION 114l 0 c /o 7�, R �ti �. �9 6a - Q L0,-•',5
Stile h�
�-\ ONE OR TWO FAMILY DWELLING
v� The Commonwealth of MassachuseW
State Board of Suit Regulations and
Massachusetts State Building Code
\SJ \ 780 CMR ''�
Y \ APPLICATION TO CONSTRUCL REPAIR.MMOVATH OR DEMOLISH A ONB OR TWO FAMMY DWELUNO
^ JJ The3aiimflr06zialUx
Qy) Mdin Permit lier Datelsmed:
Signature ,Dulldinn Issbner/Local inspector Data D .
SECTION 1-SITE DEVORMATION
LI Property Address 13 jl ars Map A Pared Number
)dap Numbs Puntl;mba
L3 Zoning Inrormatlem: 3-4 Property Dom°
ZooingDistriet Proposed Vre(Na.ofdweEmp) w LotAm(s.Q Ftonbge(}L)
1.5 Building Setbicle,
Front Yard. Side Yards Rear Yard
Regnired provided Required Provided Rcga'ved Provided
L6 water Sap QY-c-4M S 54) L7 Elood Zone Information: ❑ La Sewage INs_p°sal System:
YubHo Private ❑ Zoor Net applicable _ I hakipal eptia rystem ❑
L9 Special Permit ].l0 Old Mstorie Commb&n 1memsernflen Commtsslon
DateFdcd NotAppSmbb ❑ Nmba MAppliable. ❑ Numbs —ITotApplieable
sp=oN 2-PROPER1Y OwNERsmr i AurnomzizD AGF.NS
2.1 Owner orReeorda
IAO
pd up
p evex?
Si ature Telepbone
orlred Agent ��/�.
3 C^�Ji�,TQc�r,��l� ' e ��i�'(�� Let H(
15 Nam t) AddreSfor'Scmce � i
{�f /
-2 Signs n V I lephone 1,
n` SECTION 7 CONSTRUCTION SERVICES '
V J 3.11Aceased Com6vetlon Supervisor Not Applicable , ❑ ..
Lieen 5 �,o iAlf� License Number
lr � Yed Construction S upervis
.Address Expiation,Date
signature - Telephone
3.2 Registered Home Improvement Contractor. Not Applicable ❑
, �Dft�ha� ��-�
corany ame Re ' tntion Number
Add r
Expiration Date
li tna 'Telephone O /
-suCMit . Si<th Y.JiGon _,
reu�tvtFt S-t A 1 E BOARD(3r-BUILDING REGULATIONS AND STANDARDS
SECIIONI-WORKERS CO11Q
pNJATION WSURAN(�
Worker CemPeaWioa Ina A171DAVft PtfO-L e.ISl J
pDldarit wiH dcalaloftthhedlsauZZI.tyo be d)
m Anac the eomPkled pad attbmitkd with[hla application,Failure to provide this
Slgued Affidsvh,ytached Ya �iPcrmit
SECTIONS-D No.._..
>�RTION orpgppO�D WORg .
New Comtmetian ❑ HxIstia >D nPPHmble)
g Btu7ding
' Accetsoq Hldy ❑ �'� - Alterations)
Dmtolitioa Other ❑ Addition
orpro
HrlefDweription Spey'
Dosed Work:
Q lNi7
SECTION 6 _..ZSTnU7.ED CON STRIICIION COST) r
Item
Estimated Cost(D.Hers))
I.Building - OFFICIAL U38 OIAT
2.Elechie5l -� ®� �� (a)Bulding permit Fee
Multiplier
-'—� (b)Estimated To Cost of
3.PlumbinTotalConstruction from
.... ch>ol eaIIHVALy
5.Fire protection BoHdingperrrdt
tS- Total= - (e)x(b)
(1.2 3-F +5)
SECTION 72-0 �O -~ Check Number ( �D
O�RIAOFl7T on-4 OIU 7ON-TO HE COb"T'ITED�N
IO -
A1:PfDr,SBORHUIIDW6PRR II'T
I,
hereby authorize / .u Owner ofihe sub'e
my beha all mattes relative to work a Ld 1 ct property
c
nthorizedbythh uildin
permit application. to act on
�9nature of Gainer -
SECTION76 OWNER/ADTHORIZED AGENT:DECLARATIONDate ,
-
L
here b
knowled eelam that the statements an information -.
ge and belief' - e forgo 8 application are m��t/Authorked Agent
and accurate,to the best of my
Sign under the Pains and penalties of
Perjury.
Print
Signa a r/Agent
SECTION 8-NOTES AND EXPLANATIONS Date
Fees:The amount of fees shall be E15/St,Opp(Building:$10;Wring-
performed and materials used in conjunction with This pering:$ 0; i $3_Plumbing:
the roil$n O
n9l in based on the total Feet of the work
9 ffidal.Minimum Fee:$30.00
672
7Sp C'MI2- '"111 Edition
CITY OF SALEM
Jry PUBLIC PROPRERTY
II_.
DEPARTMENT
I 1 1 v'5.-1; ':'Y 'l: it
' i lip
construction Debris Disposal .at'lid.
(required for all cicnwlition and rcnurali )n "wrk)
In accordance \% ith the sixth edition of the State Building Code, 7S0 CNIR section I 11 .5
Dcbris, and the prop isions of MGL c 40, S 54;
Building Permit 4. is issued with the condition that the debris resulting from
this work shall he disposed of in a pruperly licensed waste disposal lacility as defined by MGL c
t t L S 150A.
The debris will be transported by:
S
I uamc of hau cr
I he debris will be disposed of in
l aline ul IxJny)
t:uhire;. ur IJrilnvl
.renaW it p: ni .yy�h<�nl
,lur