81 WASHINGTON ST - BUILDING INSPECTION (4) What is the current use of the Building?
it dwelling.how many units?- ---
Material of Building? Asbestos?
WIN the Building Conform to Law?
Architeas Name
Address and Phone
Medmies Name
Address and Photo GC OrcC%C a HIC Registration 5
Cons^Supervisors Lice�nsefs -
Estimated Coat,off JRTGIed�S -= Pennft Fee Cateulatlon
�6`- // Es�na� Cod $7IS1000 Residential
Fee S
--- _ - Es*nated Cost X S111S1000 Commerdal
- An Additional$5.00 is added as an
Administrable darge.
Male sure that all fields are properly and legibly written to avoid delays in processing-
The undersigned does hereby apply for a Building Permit to build a above stated
specifications. Signed under penalty of perjury f3 l Q
Date ��
vJ N
y g
1
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GIT�OFAALEXI
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- PUBLIC PROPERTY
DEP1,R'I11dE'VT
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130 WMmx nw bn "♦SMAK MAMACHLs�rn 01970
TEL M745-9S"•FAIL 97L7410.9W
APPLICATION FOR THE REPAIR RENOVATI N f ONSTRUCTION
DEMOLITION, OR CHANGE OF USE R OCOMANCY FOR ANY EXISTING
STRUCTC�� OR BUII nn_"►
1.0 SITE INFORMATION "
Locadon Name: Buikttng:
Properly in located in a:COnswvadan AM Y/N His tact Dbtrict YIN
2.0 OWNERSHIP INFORMATION
4.1 Owner of Land
Name:
Address:
Telephone: g w 2-
oApproximate
PLETE THIS SECTION FOR WORK IN E7pSIING BUILDINGS ONLY
Existing
on Number of Stories Renovated
in Use Nero
n Existing
ate year of Area per floor (sf) Renovated
ion or renovation
building New
Brief Description of Proposed Work:
—- - Mail Permit to:
y
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
\l.ltie 11C W.191IXG:0NS3EET #SALi%1, fit.\tii\l:Ht iL 17i�.9/�
Ter:9M7454595 •FA.X:978.74G9846
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordanec with the sixth edition of the State Building Code, 780 CNIR scction 111.5 -
Debris, and the provisions of v1GL c 40, S 54;
Building Permit # _ _ is issued with the condition that the dcbris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by .1GL c
111. S 150A.
The debris will be transported by:
5L
(name of hauler)
me dcbris will be disposed of in
(11"Me of raollty) i
laddres+ of faa Lty) - - .
,:ale