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61 BARSTOW ST - BPA-07-934 SIDING What is the curtest use of the Building? any units Material of Building? If dwelling,how Asbestos? WIN the Building Conform to Law? Amh"dsName Address and Phone Mechanics Name c n Address and Phone HIC Registration S nn Construction Supervisors License -- �Project:_._.-- PeK Fee CaleuhUon Estimated Coat Estimated Cost X i71i1o00 Residential Permit Fee: � , U - - - — EaWnated Cost X S111s1000 Commerc►at-- - - _ An Additional$5.00 is added as an Administrative charge. Male sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a SuIWIng Permit to build to the above stated speoiflccations. Signed under penalty of perjury Date v \ � N s � 1 V a 4— '.V ar — CITY OF SALEM 7 PUBLIC PROPERTY DEPARTMENT Klfdc��Gv D{ISl'WL Slnroe 130WA44IMGTON STKM•';A'EM MASLUNNSE 1301970 Ta-978-745-9S9S#Fnx:978.740-984 HOMEOWNER LICENSE EXEMPTION Please Print Date Job Location le l i o eL 7` Home Owner Address ':raAIV lWrZlvl,,Xl Home Owner Telephone Present Mailing Address 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 APPROVAL OF BUILDING INSPECTOR See other side for state code -� CITY OF SALEM ,, 1 PUBLIC PROPRERTY �: � DEPARTMENT 'NAI rr K l.r.l'!J my pUI1. 120 WASIIING!ONS':'REET•SALIA1,MASSACNI6L1 i.01 1C TFI.:978.745-9595 •F.ax:978-74G9846 Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 7S0 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit ft __ _ __ 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) ,'lie debris will be disposed of in (name of facility) ottacilay) - 5 i 1:a141"C Ut �k[I ' I Cll[ ,lace — En-r©erg, 'W' PUBLIC PROPERTY DEPARTII,IE,, ORWAXL .%"Vc a 14l 97{.745-9S93•FA1C M?48.9W APPLICATION O REP RE VA N ON TR CTI N DE, AI'p FOR T)� AIR. NO S U O rIOLITION. OR CAANGE O1R US* OR (1 r•rt>aJA STRU ttQ ANCY FOR ANY EXISTING -� OR BUILDnvc 1.0 SITE INFORMATION Location Name: G Building: Property Address ---- --— -- - — ... s/ �c vj 7D Properly Is located in a:Conservation Ares YIN Historle 0w=YIN 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: ///P Address: s/ �f D/°/ 7n Telephone: 3.0 COMPLETE THIS SECTION FOR WORK IN EAMuzu BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor(50 Renovated construction or renovation I of existing building New Brief Description of Proposed Work: Mail Permit to: —