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385 LAFAYETTE ST - BUILDING INSPECTION � ; ���2�0 � C'�✓� — � _ --- I'h�Comnwm��;ihh of�bias+:�chusclls _ �lIlu:�rJ of l3uilding Krgul;�tiuns ;md SI;mJ:irJs CI I'1' UF �' �'� tiALli\I � � ,,, � ��t;iss;irhusctts St:itc Duilding CuJc. 79U CMR /r.•ri.�rJ V�u�:n// ��1/ 'ti:,.. 13uilJing Pcrmit Applit:rtiun fn Cons�nict. Rcpair. Rcnuv:�t¢ Ur pontulish u Uud-ur 7'uu•Fumilr D�rrllin.� � fhis Srction Fur ORi•' I Us�Onl UuilJing Permit Numbcr: U e A plicd: J 11uilJiny Ulticial�Nrin�N;unc) Siy�i�wrc Umc � SECTION I� SITE INFOR�IATION 1.)P�per1Y A�er. - j� 1.2 aa�eewn,�lyp.A Purce Numben a : _ I.I a Is Ihif an ncee trd slrcet? �ef no ��I:�p Nwnhur I'urcul Numlxr I.! Zonln� Informutlon: I.� Property Dlmen�lanu Luning Diy�nct Pn�poxJ U+e Lat�mu Isy Il) Pronwgu(II) 1.1 BuIlJlna Setbaclu(ft) Frunt Yurd 5iJa Y�nit Rew Yurd Reyuired I'ruviJed Neyuirtd Pruvid�d Nryuired I'roviJed �.6 1Vxter Supply:�M.G.I.c.JU,§!a) 1.7 Flood Zone Informqllon: I.S S�w�Q� Dl�pa��l Sy�tem: 2ona: Uuuide Flood'Luna1 Ih�blic❑ Priva�r O — Chack if �ue0 Munieipd O On�ita Jispuxul y�vt¢m O SECTIONl: PROPERTYOWNERSHIP� 2.1 Own�r�of(teco�d: .Tnsz�ip� w. ���.,�7-�A S�G�m, /l�A. �i97o N;une 1 Prinq Ciq�.Slmu.'l.IP 3����x�Av�T% s� �i7�9y�o9 .r/,•cays�a�c�.���;�r�� Nu.anJ Simet I'clephune � Fmuil nJdnsa SECTION J: DESCRIPTION OF PROPOSED WORK'(cAeck rll thrt apply) New Construction Exiiting Buildiny❑ Owner•Occupied ❑ Repairs��) O Al�erotlon�s) ❑ Addi�iun ❑ Demuiition O :\ccassoryBldg.O NwnberofUni�s Other �Specily: Sf�t�O �riafOefcriptionofProposrdlVark': " U.` D F`G . Y '�irl<'G✓� �%f�D D/L STZJ/I/)tSP SECTION �; ESTI�I.�TED CO�VSTRL�CTION COSTS ��`i� Esiimated Costr Ofllclul Ufe Only I I.abur and.\I;nrrialfl 1. OuilJing 5/�j�,p_ do o I. BuiWing Pertnit Fee S Indicate huw fee ie JetermineJ: o Standard City�Tu��n Applic�tion Fee i ' kkcirieal S t7 O Tutnl Project Cust'Utem 61 r multiplier __-- c - .._ _ � 1. Plumhing S --� Q '. Other Fees: S ". - I {. \la�li.mie.d ill1� \('1 S •.--- � Lifl: --"--" -_ —'..__ . . . ' S Vr.li.miail iFirc 5 _� --------�—�- -- - �-- .._ .. __. . ._ . � C.� fafal .\II Fdcs: S �u �ve.i i o n 1 —.-------- ('hrcA \o.� (�I�eck:\muunt l'.nh �\m�nuu: �� 1bl:Wl I'roj¢Cf Cu�l' ) �� O��j ❑ p.iid in Full �Uulst:mding 1).il,mre Due: , _ St:('I'll)� S: ('ONtiI'RI�C'fIQN tiF:HVI('F:.S S.I ('unstrucliun Supen isur I.ice�ue lCtil.� 1 ieenec �\'umhar "... .... I:�piraiiau Il;na . .. _. .._.. .. .... . __...._._. ._.._--- ' ,V.inieul'CSI Il��lder " I ul C51. I'��:I�ec b.lu��1.'_ - ------._--- - ...__..--'--- 'I'�pu I)cscripliun N��. .inJ Sv.et --------- . 1� t�nrestnc�eJ i UuilJin�e�i io 13,U�10 eu. II.1 ..—.---'--.. . .__ It R..+tric�.J �:t? f.unil D��cllin Cil�if����n.tiiu�e.Lll' �I ,\Ixiun � ItC HaHin Cu�erin _._. N'� N'indaw,mJ.tiiJin � $p tiulid I'uel Iluminy A�PIIJIIC�Y � �II]II�J111111 �f.lc hun¢ Ifmuil aJdraay D Dcmulition �1 Rr�btcreJ tlumt Improvrmrnt Cuntrnctar(HIC) � IIIC Regiaua�iun Nwnlwr Ilcpirwiun b�W I IIC Compan) N010C Of I IIC R��(IAlfJlll NJIIW Nu. ;md Su�:el ILITJII J��RY.Y Ci /Town. Stnte ZIP 1'elc hune SECTION 6s WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 1l3.� 35C(6)) Worken Compensation Ineurance ot7ldavit muet ba completed and submilted with thi�appliution. Failure to proviJe this affidavit will result in the denial of the Iseuance of the building permit. Signed AlTidavit Auached? Ye� .......... O Na......,....� SECTION 7�:OWNER AUTHORIZATION TO BE C0111PLETED 1VHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDINC PEttD11T I, a�Owner of Iha subject property,hereby authoriza to act on my beholf,in all mnuen relotive to work awhorized by thia buildiny permit applicaNan. I'nnl U��ncr'f Nwna lElcewnic Signutun) Duta SECTIOIV 7b:OWN6R� OR AUTFIORIZED,►GENT DECLARATION By entering iny nvine belaw, I hereby attest under�he puin�ond penal�ie�of perjury that all uF the infurmntiun containrd in thi�appliwtion is true and acwrote ro ihe best of my knowledge and understnnding. `�"os.�"P�l cJ� �fl�. ,��-e�2.4 � �a I'rinl l)��ner'�ur:\wh��riieJ,\g¢m's N;ima I lilecauoic.4iynawro) a1� vo res: I. .\n O��nrr��hu ublains �building prnnil lo do his her u�vn �vurk,ur an o�vner��ho hiree an unrcgistertd cunlrocwr �nu� registarcd in ihe Hume linprovemem CumrecwrlHlCl Programl.�vill nn have ucess to ihe arbitritiun program ur gu�r:mty funJ und�r�LG.I..c. 11'A. Uthur impunan� infonnn�ion on ihe HIC Proyram can ba Ilwnd a� ������ n�.r.. ���� .�..i Informaliun un ihe Construetion Supen'isor Lictnse can be found�t������ ������' >:'� '�I" � \1'htn subsi:uiliol��ork is planncd, pru�iJe ihe intunnitiun bclaw� fowl tlour orca I�y. Il.l _�----..—i induJing y;irige. linishad bu.m¢nt auics.Jccks or purchl Urussli�ing ,ircaisy. R.i __... fl;ibiiabltruum.uunt - -. ... . . . i \iunh¢rollire�+la..5 -... _... . .� Vumh.fufheJfwnni . . . . . . . I � \unih.rn(haihnwnis .. ... _ . .. --- ��umb.�ul'liall'h:uh.s , . I I'�pa ot h..uing s�:t¢in - . . \umh.r of'�..ki, p��r.hcs I i ��� ��\�W��� i�'O�II1L i\QCIO ��Ili����it� ..� CII � � ..���I.I� ��fi��CCI1��11:IfC �'�1P1.14d Ifl:l\ �'V �IIhH11111C�� �Uf"�U�.I� ��fOfCC� ����1�• ''. ' CITY OF S.�L.E.tit PUB11C PROPERTY DEPAR'I'�tEN'I' u.,a.�aa�o.uuxL w,�a� i]o�r.a.McraM tn.ss• snua�wo�oR s�m o��-s nL r��,i�sr� .r..s r.f�+o�w HON�OW�lER LIC&�1SE EX�.I4PTI0�! Ptew M.t . aw �01r�_ �� c«�do. .��5 L,9��YFT7"E -� r�m.o�r wa�. .� s t � y� - s�' Hom�O�ar Telephoa� 6/7 � z79�— 9c� ��e a�u��we�.. .s�.-n r Th�current aempdoo o["Homeowmers"w� ataded to imlud�ow�nar-aceupied davUin�otnvo Unib or fa��ad w allow�ucA homaow�oen w mas� m ind{vidual for hir+ who doa aot po�s IiemM provided that th�ow�aar aen ar aupa�vtaa. DEFRYITION OF H011�OWNEA Panon(a) whs o�var a paned otLod os whlc6 hd�rra�tda ar tntendr w raid� on whk6 ther�i� or fi inteaded oo b�, a aa�or two (i�mity dweWn�. athched or detaehed �trucnun acceswry to iueh usr aad/a farm atrueturea A panos who comtrucb mors �haa on�hom� w a two year paiod�haJl not b�eon�idavd s homeownar. 9ueb ..homaov►md'�hall �ubmit to c!u Huild�n�OQleial� on s torta �ccrytabl�w th�Buildin� O(tleial. that hd�h� b�responsibb Cor aU�ucA wort parfortned uader�h� euildina Pamit Th� undem�ud "homeownd'iuurna responaibiGry for compliane� witb �h�Stat� 8uildin�Cod� ud a�ha �pplicablt byr�laavt u�d rc�uluiona, The undmi�ed "homeownd'cerofta �hal hd�h�wdmtand� �h� City of Salem Buildin� Department minim�un irupecrion proce,dura �nd requircmcny and that hdihe .vill camply with �aid ptoee�dura utd requiremmt�. HOti1E0WYER9 SiGYATL'RE C/97�h ��rG�� .�PPROVAL OF BUILDI.�1G Lb'SPECTOR Scs o�ha �ida for sqte cait __ �. ��`�'� � � K�S �2essu,Qc iJ2c�j9'leD .- I ��-� - � �_ � . - ,.-/� s � � e ,� �,� � , -- _ e��..-_-_ _ - - - — - ��� ��((o.s IZ vo ,� � � i � x 5'x �9 w�1�s ' o�S:De <✓��c5 i � �� P�Yavoor� I ' � � ' , � I I -r'yVe k w RAP � � I � ✓;����2 � � � y 9a�a f � � : ly �� ���� , � I ; j ' ! � � � ;. � � + � ' i � i , � ; � � _ . __.,_ . _ 1 _ _. . _.; — - -- f � � _ �� �/1 B pcl 7� a -�x��s E—_ _-_ _ _ _ _ _ _ — . --- ___ _ :�- - — ._�_T_ � r —_ r_ ______ � ; � ��___._� � , �� � , � � � �, i i j � 9a �a 1 i � ; � ! � � o � 1 I � I � I � � � ,I � ; � I ' '� � � � i � I � ; �r____�.'__.�_ _ " _ � f � --- - ------ /a � - � ---� ��"__ �o� ( oa�2 or'e'✓.NG �