14 1-2 FORT AVE - BUILDING INSPECTION What is the current used the Buildup? "�[4
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Address and Phone
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Make an that an flNds are proparly and leg"written to avoid delays In procaselnp.
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s done. Sipped under penally of PWAO
Date 6
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CITY OF SALEM
UBLIC PROPRERTY
DEPARTMENT
MA10K /
/�/ � � I?Q W.W IrVGiON 51REET�$.;LF\t,Nt.Ui.lCtllSl:I I5 J191C
TEE:978-74549595 •F.\x:978-74C 9%46
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
I It,S 150A.
The debris will be transported by:
(lame of hauler)
I'lie debris will be disposed of in
(name of facility)
ag :aturc � ' ; • r,it al;p,iunt ---
CITY OF SALEM
PUBLIC PROPERTY
C
DEPARTMENT
K(\WFQI Fti DRISCDLL
MAYOR
120 WASHINGTDN SMLESr♦SAE %&MACHUSES 01970
TEL 978-745-9595• FAX;978.740-9W
HOMEOWNER LICENSE EXEMPTION
Please Print
Date Ce i D-
Job Location 10 ��� � AU
Home Owner Address
Home Owner Telephone q7-cK — zULiq
Present Mailing Address s Q CXbov—
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 "home
owner"eowner'certifies that he/she understands the City of Salem
Building Department minimum ins p tion procedures and requirements and that he/she
will comply with said procedures and equirements.
HOMEOWNERS SIGNA
APPROVAL OF BUILDING INSPECTOR
See other side for state code
—� � v A Va LLAL"V&
PUBLIC PROPERTY
DEPARTIdENT
1:I.�Oi�.iYOVICattJ.
130 WA&WAM r ft"W• 1rLf�aLs�s OIl70
APPLICATION FOR TH! REIPAUt RENOVATION ---QIMSMUCTiON
D
. �.o me INFORMAnoN "
Location Now g
Property Addreser -i
/q
Properly Is located In a;
Conswvdon Atee YM Nlslorb Dbbtel YM
2.0 OWNERSHIP INFORMATION
2.t Owner a Laird
N~. _
Addreee: /y
Tom: Gll-�C6
3ACOMPLET1111 THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition
Exieting
Approximate year of Area per floor(sq Renovated
construction or renovation
of existing building Now
8dd Description of Proposed Work: