172 FEDERAL ST - BUILDING INSPECTION VVhat is the Current use of the Building? how many unit?
Malarial a,Building? / �'0 p If dwsitlng.
Wltl dw BUI&V Conform to Law? `��� AaDsstos?
ArchigaCs Name
Address and Phone
Medw Oes NOM I L Goo lE
Address and Phone A 60 KO. alF2Q l K�}¢A� r'� o(��s 617-6 JJ-gel
C,,, tlon Suparvjwm t.icca�nae#_of 0 L 8 L HlC RGgWSWn d a' L
ed: ,. 7 Z
Estlrnated Cost of ProJ Pame Fes Calcubtlon A
Pam*Fee i Estimated Cad X i7I:1000 Residential
EdWnaW Cost X:11/:1000 CanmarCi4---_�5 0
An Additional$5.00 Is added as an
AdminMmd"dwrge.
Make an Mat all flslds are propgdy and legibly written to avoid delays in processing.
The undersigned does hanby apply for a Building PwMM t build to the above stated
spec*ationa. Signed under penalty of perJanY
Date n � �
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✓ CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
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Addmm Sa E o+w BCD.
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emPkyar(Ada WAN pmF hw ,o haro hkod the ❑�eamhoeda�
2.[31 es a Win- g a or prima Wed m tie ateeehed eUK t 7. Roawoddhrg
ship end hove as omobyon Theme
working the me is awry cep chy. woe'dm comp b m mahave K p Domoutin
(No wodkeeo'camps iennaan J, p Wa m a OWPomft sod it 9. p stdidwe addkton
3.❑ l�h meow wsr do6tk ell wroek d�hm�� Iap�'� m or e�OAe e1(41 an w par ittt3t. l l.p�mpdee or eddhioae
)t c°'ep a 157.3!(4�►and wn 5ave ne 12.p Rootmpaite
waft reuoekear 13.p othew
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Innrraece Company Name
Policy N Or UV.WL Lia.t>
Fspicufae Data:
Job Site Addrewe
Attack a copy a[the workem'eamponsatkn cY *
Failure to secure coven poultry daelentlea pate(show'"the Polk!aemhee wary apindee 6u).
p as required under Seedoa 2SA at11 M a I J2 cm lead a due i of criminal postmen of
fine up ro f O.00a d y warspine
anayevi inpr, a aR as we a en civil peoaki a is the form of a STOP WORK ORDER tad a fim
If up to f2S0.00 w day apioet thn violator, Be8e advised that a e
Invesdpeioua of the D fat i+twunaa toveta'e veritkedoa *"of tkil trl�my be forwarded to the Office of
/Jo harlj c rAe pwlwe ew/oewe/r!e o/Pn/r7'u1�u4/w/oanwwfow
Ororf/d shore 4 nw ewf toereea
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offle4 t use OXIA Do mot wrly 4 rhle erre,to at comph" jar clip�Jowa oQlt/o(
City w Towat Permltil lcew•
hitting Authorily(circle one)z
I. Board of Health L SuMiial Department 3.City Town Clerk 4. Electrical leepalor
4 Other S.Plumbing Inspector
Contact person:
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CITY OF SALEM
PUBLIC PROPRERTY
Vi- DEPARTMENT
\1.iYCh LQ W.C411I\*(�i ON STREET•SALF\t,MASiACHl9L FI5 0197C
Trn:978-7454595 •F.+x:978-74C-9M
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 # 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 1.50A.
The debris will be transported by:
6�( C 77, 015POV�L
(name of hauler)
]'he debris will be disposed of in
(name of raeiltty)
—��� IaSires. ofCacility)
/,�4/ tic of,xnnit applicant --
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PUBLIC PROPERTY
DEPART INMNT
Ii1.�Ofi.tY n.v.r�
4nroe 130 Wwurwvtw�tflrar�SKI V+�rLsr7ts Ot970
111:fl4UMM•FAX M1464W
APPLICATION FOR THE REPAIR. RENOVAnm,^w [`nilleTor,rTrnly
DF-,Ml_ TION. OR CHANGE OF USE OR OCCUPANCY- FOR ANY �g�G
STRUCTURE oR Rimmc
1.0 SIT[INFORMATION
Location Neel« &+
- Property Address:
Properly is looted in s;Ccns@rvs*m Ares YM HWAft
2.0 OWNERSHIP INFORMATION
II Owner of Land
Name:
Address -20
44,
ELLA�( — .32
T"phww: —
3.0 COMPLETE THIS SECTION FOR WORK IN E7pSIWp sUILDINGS ONLY
Addition Existing
Renovation 1 Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of F Area per floor NO Renovated
construction or renovation
of existing building Now
Brief Description of Proposed Work:
- - — Mail Permit to: FFf(L Gcvz��c[� CvNsT Er'ur}Nf Rn rr�}����yy�tao n� olti�3