10 HARTFORD ST - BUILDING INSPECTION (2) ' I
s %,hat is the current use of the Building?
G. oc 6? , If dwelling.how many unit?---
Material of Building? `j S Asbestos? AD
"a the Building Conform to Law?
Amhitect s Name
Address and Phone
Meeha Ws Name
Address and Phone HIC Registration g
Construction Supervisom License 5
: Partnit Fee C
Estimated Coat o Off Project aloulatior
v , Estimated Cost X$7I:1000 Residential
permit Fee=
Esenatsd Cod X$11/i1000 Commercta�--- -
- 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 build to the above stated
iflcations. Signed under penalty of psrjurY
spec _
Date C1 S n7
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CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KaMGn NDIIW.OIL
MAYOR 130 wASMNGTON S[MET c.K A%nAONSEI9S 01970
7E:978-745-959S*FAx 978.740.9&6
HOMEOWNER LICENSE EXEMPTION
Please Print
Date -/
Job Location /0 f n � ,, �Y Sa/r� M
Home Owner Address
Home Owner Telephone r1��i-S(oq 3
Present Mailing Address 10 Nc. 1• r F< h2
t
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.
DEFDUION 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 "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 procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR wro
See other side for state code
EI'I'�tOF� -
PUBLIC PROPERTY
DEPART�IE,1iT
Mersa
f ao W,�wttact+[x�S17Fi7�yy,�Messaaasers 01970
Tr1:918-7i3-gS"9 FAXM740.9W
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY FM TING
STRUCTURE OR BUILDIN
1.0 SITE INFORMATION
Location Name: Building
Pmp"Address- IQ -Hc ^'F - - S pL .. .
!�C,I e,,v , , i,),l J101 ,a
Property Is located In a:Conservation Area YIN N Historic D4Md Y/N I_
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: YY1 i[ l�n l Frr e i —
Address: 10
Telephone: 017 '�' - S`1 Y- S-(o cl 3
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 (sl) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work: �/
�d/�S'fr�� �r new Id de I C Pc✓S4e ,
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Mail Permit to: