31 BEAVER ST - BUILDING INSPECTION CITY OF SALEM
PUBLIC PROPERTY
� DEPARTMENT
KIMMI.EY DRISCOL.
MAYOR 120 WA.IHINOTON STREET•SALEM,,,tASSACHLSEM 01970
1Fi 978-745-9595♦FAX:978-740-9846
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
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1.0 SITE INFORMATION y
Location Name: Building: o
Property Address: �L
Property is located in a; Conservation Area Y/N IV Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: LAJt 1ta.wt4o,
Address: �\ J+
Telephone: '7t 0-3a7
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) FNe
ated
construction or renovation
of existing building
Brief Description of Proposed Work:
Mail Permit to: 6t S. �,P-m IM 1 c (��
What is the current use of the Building?
Material of Building? QdQJ If dwelling, how many units?
Will the Building Conform to Law? I e S Asbestos? A-In
Architect's Name
Address and Phone ( )
Mechanic's Name
Address and Phone
Construction Supervisors License# HIC Registration#
Estimated Cost of Project$ `foCl Permit Fee Calculation
Permit Fee$ ZS• Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to bull Ttt above stated
V P
specifications. Signed under penalty of perjury ^ _
Date - 30—(X
0
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d
a � b
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