22 FORRESTER ST - BUILDING INSPECTION What is the current use of the Building?
Material of Building? �/ If dwelling, how many units?
Will the Building Conform to Law? / Asbestos? l
Architect's Name
Address and Phone ( )
Mechanic's Name oo F� -
Address and Phone(� /
Construction Supervisors License# 621 F 7 HIC Registration# /06
Estimated Cost of Project$ Permh Fee Calculation
Permit Fee $ 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 buildto the above st t d
specifications. Signed under penalty of perjury X
Date 5 G
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CITY OF SALEM
` PUBLIC PROPERTY
DEPARTMENT
FIMHERI.EY DRISCOLL
MAYOR 120 WASHINGTON STREET♦SM-LM,MASSACHLSErlS 01970
TEL,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
1.0 SITE INFORMATION
Location Name: c/2 cS r S Building:
Property Address:
as fa/? 5 � s
Property is located in a; Conservation Area Y/N Historic District YIN
2.0 OWNERSHIP INFORMATION
2.1 owner of Land �, SLS&/r nn d
Name:
Address: a c1a
Telephone: fr 2 O
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 (so Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
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Mail Permit to: