5 FRANCIS RD - BUILDING INSPECTION What is the current use of the Building?
Material of Building? ODj� !P If dwelling.how marry un'ds?
Will the Building Conform to aw? Asbestos? /t� --
�
Architect's Name
Address and Phone
Machanies Name
Address and Phone
Construction Supervisors Uce Se# __ HIC Registration#
Estimated Cost of Project s�� Permit Fee Calculation
Permit Fee s Estimated Cost X$71s1000 Residential
Estimated CostX 5411111000 Commercial----An Additional$5.0o is added as an
Administrative charge•
Make sure that all flelds are property and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of perjury
ate O
O - s � V
Cm-or - --
PUBLIC PROPERTY
' DEPARTMENT
1:I.�O�FJIIiY ORISC4)11
�� 130 Wwvutwlsw S`nEer�Sntby,Nwvnon;st�'�s 01970
-M-M745-9S"•FAXM7404W
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDIN.,,G
1.0 SITE INFORMATION
Locadan Name: Building:
- --- — Property se: ,3--��1�/G
Property Is located in a.Comwntion Area YIN Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land A�)
Name:
Address:
Telephone: - —
3.0 COMPLETE THIS SECTION FOR WORK IN 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:
Mail Permit to: p( _ - -
CITY OF SALEM
3 'I PUBLIC PROPRERTY
DEPARTMENT
12CW.WIt\*c::0,%S:aEET SAUAI.%IMN.U:iu;L CIS:IwC
CeI:97&743-1595 #F%-X:978.7iG9W
Construction Debris Disposal affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 CMR section 111.5
Debris,and the provisions ofvtGL 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 150A.
The debris will
be transported by:
— ----�'mn of hauler)
)
I'lie debris will be disposed of in :
(name of facility)
. ._— �ldd�es+ of facil.tyl .
�i_datLLl'G )I IJf I11tI 1I71),Iclat —_--__
.iatt
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIf01�! Mw•ry
MAY0a
130 WARONGTON SMW=♦SA`Al WANACIMIUM 01970
741:970.74S•9595♦FAX 97L740.964
HOMEOWNER LICENSE EXE.MMON
Please Print
Date oZ0 0
Job Location v!_ ���ffi/c<�S Cf, S �EJ LI
Home Owner Address � �� c
Home owner Telephone
Present Mailing Address
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 dwellin& 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 "homeowner"certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedui/ECTORrem
and ui ts.
HOMEOWNERS SIG�IATIJ
APPROVAL OF BUILDING c
See other side for state code