239 JEFFERSON AVE - BUILDING INSPECTION 1
L'
C l. 1�11 1 VC J
ALENr
PUBLIC PROPERTY
3A L( b DEPARTMENT
URLSCv L MAVOa 130 WA5MNGT N!b% E9r
SALEK NW&Aatt;stz'ts 01970
TEL 978-74S-9S9S*FAX 97&740-OW
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION. OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRU�OR BU"WG
1.0 SITE INFORMATION
Location Name: 23 F aWej-Soj 4Ue Building:
Property Address: ,t
_Z39/ �e�femor, s0. (e-Ut` Ci
Historic/Lt O
(�i76
Property Is located in a: Conserve don Area Y/N Dletriat Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISIM 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:
Coo roof
— Mail Permit to: _-
r
What is the current use of the Building? if dwelling, ho�many units?
Material of Building? P in n i�
Asbestos?
Win the Building Conform to Law?
Architect's Name
Address and Phone
Mechanic's Name ✓ _ //��
Address and Ptwne v HIC Registration
Construction Supervisors License#
PertnR Fes Calculation
Estimated Cost of Project 5 Estimated Cost X S7IS1000 Residential
Permit Fee$
Estimated Coat X$11/a1000 Commercial
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
specifications. Signed under penalty of perjury X
Date
� I
Q N
O x
a
a
� o
O 3. 6i V L
r a �\ 96
To: City of Salem, Ma.
Public Property Department
Building Inspector
1, Robert Lavoie, landlord of 239 Jefferson Avenue, Salem,Ma.,give permission for
Steven Hadley,tenant at said premises,to construct a shed/building for storage on the property.
Sincerely,
.l �
Robert Lavoie
245 Paradise Road
Swampscott, Ma.01938