10 WYMAN PLACE - BUILDING INSPECTION What is the current use of the Building? if dwelling,how many units?----- —
Material of Building? Asbestos?
"I tM Building Contarnm to Law?
Arch"dsName
Address and Phone 1 A @ w
MecMrmb's Name Zl S V'CX 2,\ a S`r
Address and Phone HIC Registration# C Lq 1-7
Construction SuPerv�License is_
of D 0Permit Fee Caleulatlon
Estimated Cost Estimated Cost X S71S1oo0 Residential
Permit Fee i _ Estknated Cost X$i li$'000 CwwwcW------
-- An Additional$5.00 is added as an
Administrstfve charge.
Make sure that all fleids are properly and legibly m"~to avoid delays In processing.
does hereby apply far,a Building;m1at build tome s stated
The undersigned /
speofteli na. Signed under penalty of Psdury
Date P"
I
r
Q
a
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
aawsttaav neacara
Maros !20 WAsrmwP=W 4t W a Swart M&mA]a. M 01970
T\:9W45-M a PA*gwo9Nd
WorUW Compe\siado\Iasuramea Amdavit: gypd"WCo
AnnHeatat Isttormado\
M a Ph4w►i.aiAh.
Naate l _`ll` I i Cl yn I 4 1 4 1 1< R
CityiS ttw7* Lynn rYYAsS 0►9�y
Are you as employe!Cheek the appropekta lost
1.6 I m a eondayet with 4. 01 sm a general aaatraetor and l GN '
dmPblmee(ArB=Nor Part dm4o haw hived the d' ❑New COOS
2.[31 am a sob proprietor or pmmno- limed an the maehed Sheet.t 7. 0 Remodeling
ship and have no as epbyw These,adfaooaeetere haw >L 0 Demoi&bet
woMes ter me is may capacity werkone camp ienvaoeu
(No wakara'comp mmrasa J. 0 We are a=gwados and its 9. 0 mandins addition
a
3.[31 homeowner ot3lene haw uncised thek lo.0 mectrieat meho or addhtase
doing all work right oramspdon per M(8. 11.[3 Plumbing mp*s or addidow
my"IL(No works s'comp a. 132.¢1(41 and we have no 12.0 lrepaQe 00 G snfrsrann ]t' empbyata(No wakens' 13.�Roa Roor_pan
camp Warsaw nevaind.)
;Any Wftw dlea dwha boa et mom arm n eat dw Nedoe bdmdmety drt oeAme•
nomemmwNor Sob"ridsw1dwiteaaadesdoawdaiegdaeriered des trio am"oaaft"Iamenno wtaamdN- - fadawksSprit rCoeseaaa 60 ago*ride bum mmr See"m ad"wd dome dwahie den eewe of rim roboeeaemaw rd ride walla'comw eeft tedawdoa
Jr om on AWAYMPgigot borovld/ngr wwtas'IIOAIPOO2 8 Guweweeja mmadvaP ooy/ryep Briar is tAePesa7 owuf fat she1 Insurance Company Name: 4 rn To S
P014 N or Wine.Liicc.N:_4vic 70/ 6 7 ` y`t 12-<no F.xpiratime Darr�dl / " 0.33
Job Siteaddrae °�� tJ n S'-f- S' IP r✓1 City/shta/ly
Attach a Copy of the workers'compssratl o potley decLratlos pap(ahowieg the P0I number and espkV S date)6
Failure to seeuee coverage As required Under Section 23A 0tMt3L a 132 can lead to the imposition of arimiosi patalda Ora
rme up to S 1.300.00 and/or one-year imprisonmen%as well as civil peaaltip in the tons of a STOP WORK ORDER and a Are
In es ig lion 0 a e DAfo'Ping the violator. Be advised that a copy or thin statement may be forwarded to the Of W of
Investigation of die DG for insurance coverage veriliation.
/do hereby c snJp rite peers an/pena/1br ojperfrsry tAm t14 JnjorawafoeProrldef above terse and eorrees
Signature: ANP _ Dow �/cj Q 7
Phone tit -7 R 4 t-( -
Of old use only► Do nod wdu In this once,to be eomikud br dry or tows of)fela
City or Town: PermiVUcare N
Issuing Authority(cirete one):
I. Board Ot Health 2. Building Department 3.City/rowa Clerk 4. Ptectrial Inspector S.Plumbing inspector
6.other
Contact Person
'Phone M:__
f:
-� CITY OF SALEM
PUBLIC PROPRERTY
1 DEPARTMENT
ri\I I li-.Rl.P.Y!�K!5Ct1LL.
120 WAIJUNC"f'ONSTREET ♦SALIAL MASSACI it.S6'I IS C197C
TEt:978-74 9'595 ♦ FAx:978-74C-984h
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:
(name of hauler)
The debris will be disposed of in
� ht1 1..>Zg !� Sq, Tjav)
'(11umq of facility) .
------sicatur�of pcnttit 1tcant
ate —
En'�C OF
g
PUBLIC PROPERTY
DEPARTI4IF,�TT
Xl-%Q*-UnoRMUL
MAVCM
1AWwuHctnr,sneeT yVa4 MANACNI:SIMM 01970
T9L'97 ?4&9S9S•AM 978-740.9W
APPLICATION FOR THE REPrRt RENOVA PION CONSTRUCTION
DE�iOLITIO u t; E OR
STRU i>atP FOR ANYEXI TIN
�_ OR BUILDnv�
1.0 SITE INFORMATION
Location Names Building;
Property Address:
Property Is located In a:Conservation Arse YM Hkllortc 01gi t YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: i rVl
Address:
I wyr"\ay) Pla�e�
Telephone: r (o
3.0 COMPLETE THIS SECTION FOR WORK IN EXISLNG 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
Edel Description of Proposed Work:
' lZS6 �
Mail Permit to: - - —