0003 FRANCES RD - BUILDING INSPECTION 9rv-off
CPPY OF SALEM
- PUBLIC PROPRERTY
DEPARTMENT
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Construction Debris Dkposaf Affidavit
(reyuiml rot all demolition and renovation worst)
In aa.Ordance with the sixdt edition of dw State Building Code. 7SO CAiR section I 11.11
Debris,and the previsions of NGL c 40.S S*
Building Permit A _ _ is issued with the condition that the debris resulting hoot
this wart shall be disposed of in a properly licensed waste disposal facility as defined by%IGL.a
11 1,s ISOA.
The debris will be transported by:
r 4_s�_C_
the @sbris will be disposed of in :
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Nam of fullity)
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P P ROPERTY
FDEPARTMENT
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Marna 130 WASUNGUW SMMr•3MA24 MAMAQW-S►rs 019M
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APPLICATION FOR THE REPAIR RENOVAnOr,(_ CONSMU(MnN_
D&MOLMON.OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXIW G
STRUCTURE OR BUII.D1tNG
1.0 SITE INFORMATION
Location Name: t3utiding:
J Fco-Y) Gis 90,A , 01970
Property le located in a;Caaenation Am YIN Historic District YIN
2.0 OWNERSHIP INFORMATION
2J Owner of Ladd
Nam. —
Address: 1
3 / fA lC; � Kos SG�er ML? 0)ci 7U
Telephone: 9 7 7 y s ,53 9 5
3.0 COMPLETE THIS SECTION FOR WORK IN E7(ISIlOb3 BUILDINGS ONLY
Addition Existing
Renovation F oo-F Number of Stories Renovated
Change in Use . New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
FLdd Description of Proposed Work:
/goo-' 4, bk PxiS nJ
PQ fer_ Gn v �� 1y t. ,r 5�;,) � - 1� i�S4,1)o'. Tn J\J�q
� rr" Rr
by CoaA LL IL 1
Horvv 0(-jnRc- 7 �;-, 'F, CAn7rJor r..�i44 Co,, "c,,A r PRrm;5,s;c'1
c6ni;rMed Tr-N P;crr�- CJ Sale.., 13� 4 1 'fnA 1e,14
--- -- ---Mail Permit to: czt/u-� -
What is tM uurent use of the Building? L Material of suudkq? wm3 H how maM uriis7�
Will do&AdbV Conlon^/to Lam�es Asbestos?
Ard9leas Marne N12
PhWW
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Modmis Nam 0c \s; Moo«
Address and Phone 3
Construction Supervisors t.kw"to HIC Region>< 5 G 6( 7
Estlrnsted Cost a 3 7,50 Per"E".CalmAftn
Permit FN= Estlrnaw Cast X$7/111000 Residential
_-- --- _ _ Estimated Coat X a t/:100A COrrOmolat• --- - -
An AW-14onal i5.00 is added as an
AdminbtraWe charge.
Make sure that all gelds are property and kobly written to avoid delays in processing-
The undarslpned does hereby apply for a Building�P/wn*to build
to pthe above stated
spaAcatlons. Signed under penalty of perjury //!
Date �12C 7
c
s �
r '90 A �