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17 WOODSIDE STREET BPA 18-08 3' RETAINING WALL What is the current use of the Building? ` - Material of Building? if dwelling.how many un'ds?T- Will the Building Conform to Law? r- Asbestos? Architect's Name Address and Phone Mechanles Name Address and phone Construction Supervisors license P w-MIC Registration 0 Estimated Cost of Project Permit Fee Calculation Permit Fee$ ZS '— Estimated Cost X S7I1111000 Residential Estimated Cost X S11I411000 Commercial` An 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 Permit to build to the above stated specifications. Signed under penalty of pedury - Oate 3 a x ` J V o, a os- - - - Wr i CITr. oras.Alklm - - PUBLIC PROPERTY DEPARTME►i T NI�UIFJWY De,v,v� MAYOR 130 WA9QNGTM S'MWr SAW0k%4,f5SAO1L5hllS 01970 14i 97a-745.9M•PAZ w&.740."ft APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR WELDING 1.0 SITE INFORMATION . Location Name: ff)t r c I-rqd-z i s a,n Building: - Ij9- l.)oo "�,>Si'�,e 5'r < liaL&J� Properly Is located In a:Conservation Area Y/N-AL_Historic DWhkx YIN 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land f✓t e-r le e an Name: TLn'iLc 14-e..cek� S Address: 1 9-(,0oo JS r tk Telephone: q) W o 3.0 COMPLETE THIS SECTION FOR WORK IN any LW BUILDINGS ONLY Addition %Rn. Renovation Number of St Change in Use Demolition Approximate year of Area per floorconstruction or renovation of existing building t3det Description of Proposed Work: 3 i--+ ae-fu.•- , L>36"f- ©rn ia¢- j yLaWf- 40 G-*f-- Mail Permit to: cEga, kL cpkv ISCDc):!)DS,Z�-p :5!'. 0 19 40 - - - -- CITY OF & I.EM PUBLIC PROPERTY DEPARTMENT KI�OI�cv tuww� NAVOI 130 WMMNGTON S-nW=•SN.F.K LWM 01970 TFi 979-735-9S9S#FAX 974.740.9$46 HOMEOWNER LICENSE EXEM"ION Please Print Date U( DOo Job Location / ? 1,00066 i L S -L So Lrk;g ` eA , Home Owner Address / Home Owner Telephone Present Mailing Address S> 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 foam 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 requjrqlncnts. HOMEOWNERS SIGNATURE __ M APPROVAL OF BUILDING INSPECTOR See other side for state code -� -.CITY OF SALEM 3 , i PUBLIC PROPRERTY DEPARTMENT t.l st,K I2C W.ly tf�c:JN 5 iRE£7 •5.ur At.MAST u:;a ;t:rn]19I. Tn:978-745.9595 •F.U(:978.7449846 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 viGL c 111, S 150A. The debris will be transported by: lu a of hauler) The debris will be disposed of in (name of facility) ,:ate ._ ...