14 WOODSIDE ST - BUILDING INSPECTION CITY OF SALEM
PUBLIC PROPRERTY
DEPARTM. ENT
�l„�vt l�Vr.�u ttN::At`s 7[sCT•s.�L'.�.Lt.�vcu::a .t:t1s::er.
Construction Debris Disposar Affidavit
(required for all demolition and renovation work)
in accordance with the sixth edition of the State Building Code,780 CNIR section 1 t 1.5
Debris.utd the provisions of MGL a 40.S 54.
Building{ Permit A _ . _ is issued with the condition that the debris resulting f m
this work shall be disposed of in a property licensed waste disposal facility as defined by%1GL c
1 It. S 150A.
The debris will be transported by:
— —-- /VM
(name of hauler)
fhe debris will be disposed of in
wanes of famluy)
/ WOodSlG ff Sj
i..d.:rexa of Ya:iLty)
. 1
CITY OF SM.EM
PUBLIC PROPERTY
DEPARTMENT
Ki101�!cv rvw•,v
Nnroa t3ow.�vuNcror+sr.F.er SiLLPJt NASSAOIt;5E1'[S 01910
Ta.97&73S-9S9S 0 FA3L 97&74&99"
HOMEOWNER LICENSE EXEMPTION
Please Print
Date // / z O 7
Job Location /
Home Owner Address sour/r' s v !?W o i rI
Home Owner Telephone 9 2 f _ 92 7—6 z 3 0
Present Mailing Address S asr 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 inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE pp
APPROVAL OF BUILDING INSPECTOR . }i
See other side for state code
. -Cr
PUBLIC PROPERTY
DEPARTMENT
KI..aWALZV OntSCLV
130 wwswwc.WW hMErLT 0 yu04 U.%1LU3u ft-1-S 01970
71111:97a.745_9M•FAX:M7
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION,
DuMOLITION. OR CHANGE OF USE OR OCCUPY CY_ FOR ANY EXISTING
STRUCTIM OR BUILDING
1.0 WE INFORMATION
Location Name: kle Building:
Property I----w---- - - - -_ - - - - -- - -- - - _
�
Properly Is located in a:Co mmilon Ame Y/N Al_Historic Obeid Y/N
2.0 OWNERSHIP INFORMATION
2.i Owner of Land `
Name:
Address:
Telephone: 7 - y 3 U
3.0 COMPLETE THIS SECTION FOR WORK IN BUILDINGS 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 fV
of existing building 00 New
B&J Description of Proposed Work: ��A--� eL 4z i�;�c
--- Mail Permit t0: - -
use of the Building? ��i r�Si a • .
What is the Current Z
Material of Building? w o ed Fra-we- it dwelling,how many unitsT
Will the Building Conform to law?
�1 Asbestos? NO -
Architsas Name
Address and Phone 1
MechanWs Name 12. _ D/yiS 9 If-��2 v 3 v
Address and Phone
construction Supervisors License ti HIC Registration
Estimated Cost of Projed t Penns Fee Cala�latlon
Permit Fee S 2 5�-- Estimated Cost X$7/$1000 Residential
- --_ __-- - .--- Estimated Cost S41/$1000 Cormrnerdal-------..___--
An Additional$6.00 is added as an
Administrative charge.
Make sure that all fields are property and legibly written to avoid delays in processing.
The undemigned does hereby apply for a Building Parma to build to the above stated
specifications. Signed under penalty of perjury
ate
s\J S
N%