9 GENEVA ST - BUILDING INSPECTION (2) What is the current use of the Building? ar
Material of Bidding? 'el if dwelling,how many units?_.__—
WiY the 8uildirg Conform to LawT
Asbestos? �D
Archit Cfft Name
Address and Phone I
macherdes Name
Address and Phone
Construction Supervisore 0 HIC Registration 0
Estimated Cost i Permit Fee Cg!g2 etlon
E � Estimated Cost X:7/51000 Residential
Permit Fee f
- — -- -- Estimated Cost X 5111$1000 Commercial -- --An Additional $6.00 is added as an
Administrable charge.
Make sure that all fields are properly and legibly written to avoid delays In Processing.
The undersigned does hereby apply for a Building�Peernit�ld to the above sta pd
specifications. Signed under Penally of pe►lury „
Date
N
° Kr 13 9
"
fig 3
__ - �•--
- EIT r F-
PUBLIC PROPERTY
DEPARTMENT
w.oe laoW&%UN Wsmear.swnKwruo&5e„s01970
7U.M74i9S"0 FAx;M740.9W
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
D&MOLITION,OR CHANGE OF USE OR OCC[1pwNCY FOR ANY EXISTING
STRUC rM OR BUILDTIITG
1.0 SITE INFORMATION
Location Namw c� auung:
- .- Property Address:---
Property In located In a;Conservation Arm Y/N Hlstoft Obkkx Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner o1 Land
Name: B v
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN UILDINGS ONLY
Addition Existing
Renovation 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:
�h
-- — - -Mail Permit to:
1 , `
CITY OF &U EM
PUBLIC PROPERTY
DEPARTMENT
K1101�!Fv rvw-ry L
.%IAYOI 130wA91NGW*S RM•SAN EM %USLUN1SEriS01970
71:1978-74S-9S9S•Fwx:978-740.964
HOMEOWNER LICENSE EXEM"ION
Please Print
Date ' —D
Job Location /(�;p /��h�/�� i ✓� /1�
Home Owner Address ' -� 2
Home Owner Telephone /7 D 9
Present Mailing Address SQmP 2r a —e
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.
DEFINMON 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 "homeowned'certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirem ts.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
, ,as- DEPARTMENT
12C
Tn:9M743.1595 •Fix:97f-74G9844
Construction Debris Disposat Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 Ci`1R section 111.5
Debris, and the provisions of. GL c 40, S 54;
Building Permit 0 _ __ is issued with the condition that the debris resulting from
this worst shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111. S 1.50A.
The debris will 1; r i sported by:
i
(name of hauler)
fhe debris will be disposed of in
t u:unr of facility)
i:.ddres+ of fucill.q .