9 VALLEY ST - BUILDING INSPECTION (2) O
What is the current use of the Building?
Material of Building? it dwelling,how many units?�—
Wid the Building Conform to Law? a Asbestos?
Architect's Name
Address and Phone
Mechanics Name
Address and Phone
Construction Supervisors License S - HIC Registration 0
Estimated Cost of o' S Permit Fee Calailatlon - - -
Permit Fee S Estimated Cost X$7/51000 Residential
- - - Estimated Cost X S11/51000 Commercial-
An Additional $5.00 is added as an
Administrative charge.
Make sure that all rields are property and legibly written to avoid delays in processing.
The undersigned does hereby apply far a Building Permit to build to the above stated
specifications. Signed under penalty of perjury x
Date fl
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L
EI`I'Y-OF
PUBLIC PROPERTY
DEPARTMENT 7 �r�\
IG�OIFJISY O�15ClILL `�'
WaA09:sh11S 01970
Mm.MUS-M•FAr M740.9"
APPLICATION FOR THE REFAHL RENOVATI N CONSTRUCTION
DEMOLITION,OR CHANGE OF USE OR OCCUP xrv___ FOR ANY 9207MG
STRUCTURZ OR BUII.DDtG
1.0 SITE INFORMATION -
Location Name: 8ui'wmw
--- -
Prop"is located in a;corlservation Ares YM AJ Historic 01grod YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: I
Address: q -.
Telephone: q'` g-S057-16 So 10 7n - 3 Ito ` &gef
3.0 COMPLETE THIS SECTION FOR WORK IN EYlSI1dLi BUILDING?; ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition ✓ Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New.
91ie[Description of Proposed Work:
——- - ---Mail Permit to:
CITY OF SAI.EM
PUBLIC PROPERTY
DEPARTMENT
KI�01�!cv new-ry
%IAYOt 120 wAVUNGTM S7nF=•SAtFK%rAttA[SU:SEris 01970
TM-97b704S"•FAI:979-7i0.9&4
HOMEOWNER LICENSE EXEMPTION
Please Print
Date t7 0
Job Location
Home Owner Address 6-Home Owns Telephone B- g-o - D
Present Mailing Address 9-
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.
DEFINITION 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 dwelling, 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
"homeowner"shall submit to the Building Official, on a fora 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 :d/equiremcrits. n- 19HOMEOWNERS SIGNATUREC� QI U PST ) f 6cti PQ/l.Q.t.�
APPROVAL OF BUILDING INSPECTOR
See other side for state code
DURABLE POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS:
That I, Fabian Pereira, of 9 Valley Street, Essex County, Salem, Massachusetts,
hereby constitute and appoint my attorney, Hector A. de Jesus, of 23 Central Avenue,
Suite 416, Lynn, Massachusetts, as my true and lawful attorney with authority to perform
any or all of the following actions for me, in my name and on my behalf, upon such terms
and in such manner as my Attorney may determine:
1. To draw checks and withdrawal orders on any of my bank, brokerage and
investment accounts; to endorse notes, checks, drafts and bills of exchange; and to
receive, receipt for and deposit proceeds thereof,
2. To sell, lease, mortgage, transfer, convey and deliver any of our real or personal
property; to receive and receipt for proceeds thereof; and to execute any bills of sale,
stock and bond powers, deed or other instruments necessary or advisable to effectuate the
same, with no transferee to be responsible for the application to the purchase money;
3. To make and execute any contracts;
4. To demand, sue for, receive, receipt and give releases for all debts, monies
securities and other property to which I am now or may hereafter become entitled; to
appear in all legal proceedings; and to prosecute, defend and settle the same;
I
5. To represent me in connection with any matters involving my taxes before any
court and any taxing authority, local, state, or federal; to execute and file tax returns,
abatements, protests, refund claims, waivers of statutes of limitations or similar
documents; and to make any settlements relating to the same;
i
i
6. To exercise any of my rights as a stockholder, bondholder or otherwise;
7. To have access to any safe deposit box;
8. To transfer any of my real or personal property to any revocable trust established
by me at any time during my lifetime which authorizes the trustees to expend the income
or principal thereof for my benefit, including a trust which contains testamentary
provisions; and to execute any deeds, stock and bond powers, affidavits, letters of
instructions and other instruments necessary or advisable to effectuate any such transfer;
9. To make gifts on behalf of any of my real or personal property to any individual
(including any Attorney hereunder) and charitable organizations, so long as such gifts are
consistent as to amount and identity of the donees with gifts which I have personally
made prior to the time of such gifts;
10. To take charge of my person in case of illnesses or disability of any kind; to
authorize our admission to a medical, nursing, residential or similar facility, and to enter
into agreements for our care; to consent to surgical or other medical procedures; and to
remove and place me in such institutions or places a our Attorneys may deem best for my
personal care, comfort, benefit and safety after giving consideration to any wishes I have
previously expressed on this subject; and
11. In general, to do all acts and execute all instruments in the management of my
estate, affairs and property of every kind, wherever situated and whenever acquired, as
fully and effectively as I might do if I were personally present and acting.
I authorize my Attorneys to appoint one or more additional Attorneys and to substitute
one or more Attorneys for any of them for any or all of the aforesaid purposes and to
revoke any such appointment or substitution.
Any authority granted to my Attorneys hereunder may be exercised by any one of them
acting pursuant to this power of attorney.
This power of attorney and the authority granted to my Attorneys herein shall not be
affected by our subsequent disability or incapacity.
My attorney serving hereunder may resign at any time by a signed writing attached
hereto, written notice of which shall be given to me, and to the person named as
successor herein. If any attorney herein named shall cease to serve for any reason, then
Hector A. de Jesus, of Lynn, Massachusetts is hereby appointed to act as my said
attorney.
If the appointment for me of a conservator or guardian of my estate, or a guardian of
my person, shall become necessary, I nominate my attorney, Hector A. de Jesus to serve
as such, or if that person shall fail or cease to serve as much, I nominate Hector A. de
Jesus to serve as such. I request that no such conservator or guardian be required to give
any bond or security for the faithful performance of such fiduciary's duties, but if such
bond shall be required, I request that no surety thereon shall be required.
Any third person may rely on a photocopy of a signed original of this power of
attorney if such photocopy is certified by any Attorneys as a true copy of the original
IN WITNESS WHEREFORE, I have hereunto set my hand and seal this 9th day of
May, 2007.
FABIAN PEREIRA
COMMONWEALTH OF MASSACHUSETTS
ESSEX, SS May 9, 2007
Then personally appeared before me the above-named Fabian Pereira and
acknowledge the foregoing to be her free act and deed.
NOT Y PUBLIC
MY COMMISSION EXPIRES: