14-16 WARD ST - BUILDING INSPECTION What is the current use of the Building? L r r r/o � e-
Material of Building? If dwelling,how many units? —
Asbestos? 00 —
Will the Building Conform to Law?
Architect's Name
Address and Phone
Mechanic's Name
Address and Phone HIC Registration S
Con Vucdcn Supervisors License
Estimated Cost of Project s SRO Pemdt Fee Calculatlon
Permit Fes i ` 1 O� Estimated Cost X$71$1000 Residential
Estimated Cost S111$1o00 CommemalAn Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are property and legibly written to avoid delays In processing.
The undersigned does hereby apply for a Building Penn to build to the above s ted
specifications. Signed under penalty of perjury
Date
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PUBLIC PkOPERTY
DEPARTMENwr /C�
i 3%QWJU"onuuu
%IAVM I "yMIAwuxt;skrm 01970
TU.978-74S 9S"♦FAX 97e-740.""
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY yasmC,1,
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Nanvs: Building:
Property Is located in a;Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: [ I ICi 1 rl n� ^
Address: 1 LA, Ito
Sca)e-iM nck OlR
Telephone: 9 Y - `7(f 6 - C- 0/8-
3.0 COMPLETE THIS SECTION FOR WORK IN PYIQTIN13 BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
VO k L 5icA c KS
-Mail Permit to: 14 —1
I
' CITY OF SALEM
PUBLIC PROPERTY
i DEPARTMENT
KI y
MAYOR 130 wnsmacraN S Rm•
c.LEJ4 MAMnCHuW'ts 01970
TM,97&745-9595*FAX 978-740-96"
HOMEOWNER LICENSE EXEMPTION
Please Print
Date
Job Location ux3a 2 Sa
Home Owner Address r I
Home Owner Telephone cP r —7 RFD —67,c?w- A/D n.e- cam!/ q75-335- 98%a
Present Mailing Address 5 4-y -e,
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 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 ins tion procedures and requi ents and that he/she
will comply with said procedures an requirem
HOMEOWNERS SIGMAAt. 17
APPROVAL OF BUILDING INSPE OR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
�;w;rkLer�m(iu:u.
\L" %1,\ilitXGiON S'l KLET ♦SALFV, MASS.H:Hl.:ili 1-Ii Q197�
-rn.:978-745--9595 • FAx:978-74G98+6
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(tame of hauler)
The debris will be disposed of in
f
(name of taclhty)
(address of facility)
c
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