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BAKERS ISLAND - BUILDING INSPECTION (24) CITY OF SALEM PUBLIC PROPERTY DEPARTMENT 0u MAYOR 120wAOUNCWN S RE"• SQL.MASSA0IL'SETIS 01970 lli 97&74S-9S9S*FAx:978.740.9&M HOMEOWNER LICENSE EXEIMMON Please Print Date R-Z 7- O ? Job Location l-04- 9 0-�S -4S I o•t J Home Owner Address 19 Noble 1401 R e y+ v i M A Home Owner Telephone 978 Z 3 Z 9 S17 Present Mailing Address 19 Mo6le Hill KA 15evvtyf MA oiys- 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 them 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 "homeownee'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 See other side for state code CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT �.\11::NI GY'''R:1wQ11 l!C w'.\91fW::OPi$AEtT 1�.\ti4,�t.\\YuaLL a11s;:aY. To.%W45--)M •F.%x-9MAC-984 Construction Debris Disposat Affidavit (required for all demolition atxl renovation work) In accordance with the sixth edition of the State Building Code, 780 CNIR section 111.5 Debris,and the provisions of M. GL c 40, S 34; Building Permit N _ . ._ is isatted with the condition that the debris resulting*am this work shall be disposed of in a properly licensed waste disposal facility as defused by MGL c l 11. 3110A. The debris will be transported by: (/coma of tauter) fhe debris will be disposed of in II �CZ_ Wa5 ,L (mane of faaillty) 3 tfo S4 54, pe y ...A:fcx, of faciLl;/) 8- 22- 07 ..�tr E ©F _. PUBLIC PROPERTY DEPARTNIE,�1T APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION DEMOLITION,OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BIMMM 1.0 SITE INFORMATION - Location Name: 'Ts l rn.\d Building: House S "1 --- Property Addross:---`-C4 Property I•located in a.Coneervatlon Aron Y/N M Historic District YIN 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land ` Name: A /A Slq'v) 2. Co /Z%eert+ 4,,ry � e� Fib✓ G'sc \,6 ly Address: / c/ AJobi Hill RI. 3evRe-INS MA O17 /.5, Telephone: 119 Z 3 Z (1 S 1 3.0 COMPLETE THIS SECTION FOR WORK IN EXISXING BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use Now Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation of existing building New Beef Description of Proposed Work: a� jL&t4-a\, 11 Wo-v �- bJ �� o� S s eau s e C7 x l0) ------Mail Permit to: /7 Nol,(e Ii1 r' ll A J- e v�•! at d1 q l S - - ._ U u.i �5� ti What is the current use of the B W ro Building? ' Material of Building? ° If dwelling.how many units? win the Building Conform to Law? Asbestos? NO _T -- Architect's Name N Address and Phone /A ( ) Mechanic's Name Address and Phone Construction Supervisors License# HIC Registration# Estimated Cost of Proecd OZ90 Permit Fee Calcubdion Perm&Fee S Estimated Cost X$7/51000 Residential Estimated Cost $41/41100000mmerCiat--=------ - - -An Additional S5.00 is added as an Administrable charge. Make sure that all fields are property and legibly written to avoid delays in processing. „ The undersigned does hereby apply fora Building Permit to build to the above stated specifications. Signed under penalty of perjury X Date r O j N s q L\ (— Z v` av' C7 a g 3