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268 JEFFERSON AVE - BUILDING INSPECTION What is the current use of the Building? Material of Building? v v v cr1 If dwelling,how many unfts? Conform to law? i s Asbestos? r> o wiu the Building — Archited'a Name Address and Phone ( ) Mechanles Name Address and Phone Consbu:don Supervisors License# HIC Registration# Estimated Cost of Proled S��i°O©• V d Permit Fee Calculation Permit Fee S Estimated Cot X$7/$1000 Residential Estimated Cost X$41/51000 CammercW— An Additional $5.00 Is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build to the above stated Xspecifications. Signed under penalty of pedury - Date a + o � N � s YO QI �Y1 a a i DEITY OFF " -- PUBLIC PROPERTY DEPARTMENT Kl.%U►F.VJ"DI SCULL NAYOt 130 WASUNG"S'[7F.&T &MAiK XASfAtNl:Shl1S 01970 T L•M745-959S♦FA1C 97S..7.10.960 APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION, DEMOLITION, OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION J Location Name: Building: Property Address: -------- _ -- 26Ss Property is located in a;Conservation Ares Y/N A 0 Historic District YIN y\ o_ 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land ^y _ Name: Address: 2 G Fs ���.c'� Ste'•. /�'" e Telephone: 2'?3 o qcl 3.0 COMPLETE THIS SECTION FOR WORK IN DINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use --cz New Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation q of existing building f New Roef Description of Proposed Work: \ p Mail Permit to: 3`? `3 Fs 5 e x r _ L a _ u!jo polodslp aq 111'A tP9-''. MU (a pm p•maul _ :4q pmjodm= oq 11un sugaP mil OM1='111 0'! K PpWoP st AiuW 1�1P ouJ m Pnmou �d a a!)o POS�1P oQ I">�M s1VJ �SyAI���qap�1QW 1N+wd�1P1!R8 1K S Vt 0 IDK)o VJM!wog MP Pw%-L O 5'111 m!1 >s %a 061 Woo ftwM. mmS ap30 om, 1Pxp nP W!'N mmuom n1 (11 "".pew=Pm mw.imw ut i1 p urloj) 3149pw ' jesodslo sqJgaQ V*PWLJSslw, aF`:sv+J�n:.w�vyc'war�•asJtc fs�c.:�Js,Jtw Rt .n.1C lX3 UVVd3Q - vaws ao Alo ,. J CITY OF S.UMM PUBLIC PROPERTY DEPARTMENT Wvaa 130wAOUN raMSnEsf99MMkYwUM". M01WM 7$:973-735-9S"•Fns 978.740-9" HOMEOWNER LICENSE EXEMPTION Pheru Print Date ! o? Job Location �s e Home Owner Address Home Owner Telephone -�g Present Mailing Address 5 ex 5-e w 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 dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constricts 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 INSPECT Z See other side for state code