16 WILLIAMS ST - BUILDING INSPECTION CPPY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
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Construcdos Debris Dispossf Aftiidsvit
(required !or all demolition and mtovadon work)
In aoeontanee w ith the sixth edition of the State Building Cods 7So CNIR section l l l.S
Debris,and the provisions of MtGL a 40,9 Salt
9tsildinS Permit 0 _ _ is issued with the condition that the debris resulting fto
this walk shall be disposed of in a property licensed waste disposal facility as defined by U. GL c
111. 315"
The debris will be transported by:
loam of haWN)
fhe debris will be disposed ofin :
_ ln,mtt uY fxtlrty)
..1W
7 CITY OF S.ULEM
PUBLIC PROPERTY
DEPARTMENT
KI!Wes!�v tyww�
MAYM 120 wASMNGMN SrREff•SAF EM MASSAO1USEM 01970
TEL 979-745-959S*FAX 978-740.9"
HOMEOWNER LICENSE EXEIMMON
Please Font
Date G r✓1 G CJ� pn nn
Job Location S� C j
Horne Owner Address
Home Owner Telephone ck -iFj 7 ` t i Li i L
Present Mailing Address
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
Persons) 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 inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
22
See other side for state code
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PUBLIC PROPERTY
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DE31OLi'1TON.OR CAANGE IF USE Olt OCCCMANCy FOR AMUK31URIE On BIT", h"a' F.aQ3T�11['
LDDUG
1.0=T9 INFORMATION
Location Name: SuMnw
--
Prop"is bowled in w:Cord rvallon Area I Hislorb DkM YIN
9.0 OME:ROW INFORMATION
2.i Owner o/Land
Names
Address; Sl
LA I
Telephorw
z.000MPL §THIS SECTION FOR WORK IN E7tlSM" BUILDINGS ONLY
Addition Fjdsdng
Renovation Number of Stories Renovated S
Change in Use Now
Demolition
Existing
Approximate year of Area per now (so Renovated
construction or renovation 181 b
of existing building New
god Oescripdon of Proposed Work:
S tom, e� Cx� Z2N a
--- -- ---Mail Permit to: -
use a(tlw Building? -"
What i•iM eurtent It dwMM� .how n"�?— --
rlal of Bum? ? No
Mlfr*a B&**Conforttt to Law?
Asbasl s
Archhods Naew
Addnsa and Phew
L4*dwyhes N m
Addrea and MoreLjcer
c`� l c, HIC Regisk
Estimated Cost at WORM* �-- �--�
Es*nalad Coat X$7I:1O0O ResidsnWl
Permit Fee i ` E Coat X$411i100O COmmwc aL-- _
An AddRiWW S&OO Is added se an
AdmindtrSWe aherg&
Make pus that aY flelda are properhl and wo"wt t n to avoid delays in Proosesin4
The W.W,.d does h r by apply for a Building Pump to build to the above stated
P,,M=Uorw. signed under Penally or Pulury
Date G G - C
o
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