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003 WINTER ISLAND RD - B-09-438CITY OF SALEM PUBLIC PROPFIR Y Dl PARl ME:NT L UJRI RLI.1 INf b .ul 1. I_'11\\.\il llSl•II IS\fill-.I.f * 1\Lli:l,\L\V.III al.I-I II `I_II 4 APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT ALL [BUILDINGS EXCEPT ONE AND'2 FAMILY DWELLINGS INIIIORTAN,r: z%pplicants must complete all items om this page SrrEINHgarolnTloN , w\a 4y ao e Location Nali\e;a..e-Ne ucm/ kcY a:. i Building LQ L ©Q f g Property Address Located in:Conservation Area Y/N \ Historic district APPLICATION DATE Use Groups check one) Group Homes I23_R4_ Residential (3 or more Units) R2_ Type of improvement Residential (hotel/motel) RI _ check one)Assembly (Theaters) Al _ New Building Assembly(restaurants & clubs) A2r_A2nc_ Addition Assembly (churches) Al _ Alteration Business B Repair/Replacement Educational E Demolition Factory(moderate hazard) F1 _ Move/Relocate Factory(low hazard) F2_ Foundation Only High Hazard H_ Accessory Building Institutional (residential care)11 _ Institutional (incapacitated) 12_ Institutional (restrained) 13 1 Mercantile M _ Storage S1 _Moderate Hazard Storage S2_Low Hazard OWNERSHIP INFORMATION(Please tvq4) Print Clrarly) / OWNER Name _?,z_ k:0 S ocd Address- 3 W;h ,ter s/a n Rom Telephone 4 4tis 17v Signature DESCRIPTION OF 1VORK TO BE PERFORMED L,rec 1I ICS"I'INIATF,D CONSTRUCTION COST yy CONTILACTOIt INFORNIATION Name Address % psi-° l yvyr-- Telephone "176 lz;7 9 i 4 L/ Construction Supervisor's Lic # C 1 Home Improvement Contractor#o`F ` G ARCIIITECUENGINEER INFORMATION Name Address Telephone Mass. Registration # old, Lq l / yd PERMIT FEF. CALCULATION Estimated Cost x $11/$1,000 + $s.00- y y a CONINIENfS The undersigned applicant does hereby attest that all information stated above is true to the best of my knowledge rrrrde penalties of erjury I Signed owner) (accnt) rl APPROVED BY : DATE APPROVED: O I a g! ..... 479 tiN 0,As so0 Ad)pGAN 566 0rZIO Z V4 ry of CA 9/Z I- YE Y P4 SSOCIA 7 ir.5,14) TZ667r A)YEIZ5 PLAN OuK RIMAAA!eV IF WAS. Deir'04T OF lLSco 0 '4 19 1CE/zr/py 'r,P(-AWJ EVrI7766-Pl 4.pig q-47 Lj: 4ccoeo,4A.)Ce kvl rjq -ryE IZUC65sAjair, P;zaps-lerr wlcimm e- ;Y,4y OF 7-06 Z5j/SrE le 9,A4. W1440W.1 j 0 DEEDS f7 /922 CMU . 71,- r#OLalJOA/Z ED :49Y 1.45 A+ 4PP4 I.0 er,Met,