23 JACKSON ST - BUILDING INSPECTION (2) What is the Current use of the Building? J
Material of Building? k) �� If dwelling.how many units?
"I the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone l )
Medwanic's Name
Address and Phone
Construction Superv"M License Cs 6 16 3 C Registration N
Estimated Cost of Project o o PemAt Fee Calculatlor
Permit Fee= Estlmated Cost X i?K7000 Residential
------ _ Estimated Cost S41K1000 C4mme►cia4-----...---
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 bui d to the ov tated
specftatkxu. Signed under penally of perju
N
A `3
E; tOFT IRM
PUBLIC PROPERTY
DEPARTMENT ` r�
saw wsswOu:se„s 01970
• APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLMON. OR CHANGE OF USE OR OCCUPANCY. FOR ANY paSTIIMG
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location NWW T445,o,, r — 9uildln�
Properly is located In a;Conservation Area YIN Hislorlo DIs1Ad YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: L,'o
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EYI8T1NQ BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use 4New
.
Demolition
Approximate year of Area per floor (sf) ed
construction or renovation
of existing building
Mef Description of Proposed Work:
-Mail Permit to: - -
CITY OF SALEM
4D PUBLIC PROPRERTY
DEPARTMENT
IX W.%i1 d%A-:JK l:lEET•114t:%%t.%VLU::it
Construction Debris Disposal Affidavit
(required for all demolition atxi renovation work)
In accordance w ith the sixth edition of the State Building Code, 730 C1461R section 111.5
Debris, and the provisions of M. GL a 40.S 54;
Bttilding Permit M - _ is issued with the condition that the debris resulting fi m
this work shall be disposed of in a properly licensed waste disposal facility as defined by v1GL c
111. 3150A.
The debris will be transported by:
_ — (Sta"4T at hauler)
I ha debris will be disposed of in :
I,
ot
l u:unr ur ta:illry)
.+.A:reaa .li CxiLly)
At.
,�, 2 co