53 LARCHMONT RD - BUILDING INSPECTION (3) VVhat is the Currea use of the guiidk*? ��d
uzad �i�w It dweas how many unib9�—
Matw d d sufldw _ Asbastm?
will I"tev�Conttann to l aw9_T
Archileds Name 1
Address and Phan
Msclwtk's Name
Address and Phan HIC Reysb'aWn to
Cangridlon&40rvisms Licsnss M
ExIbnated Cost ofPMJQO � O Pa Fee Cala n
Eaymaad Cod st X$7/i1000 Residential
Pamlt Fes i E�t�Cost X i11K1000 CanrrterGa4
An AddrJWW i6.00 is added es an
AdmY>IStratlw chwOR
Matte sun than an 11elda are propwly and WOW written to avoid delays In proceeslrO
Tt+s urgers do"h.,.by apply for a Sulldirtp Pwmlt to build to the above stated
apO.ft.Wn& Styned under penalty Of PmJurY
Date
nl
o g a
� � w
' CITY OF &NIFM,
PUBLIC PROPERTY
DEPARTMENT
KI OI�_w n�w•ry� -
NAYM
130 WASMC"Sn EU•SALEK MAUAa4L-SKM 01970
7ki 97s•74S-959S♦FAY 978•740.9846
HOMEOWNER LICENSE EXEMPTION
Please Print
Date Co I i � o i
Job Location S 3 "
Home OwnerAddreat s 1Rc� 1. 0 r �o
Home Owner Telephone _�t-I aI-W4
Present Mailing Address nn t E
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 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 SIGNATL
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
\LUTR LC WAi11iVG"i0NS;AEET•SAL VM. %1ASiAC tl_iLt'1S 0197C
TEt:979-745-9595 .17.+X:978-74C-9M
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions ofMGL c 40, S 54;
Building Permit # _ _ ._ is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
i 11.S 1.50A.
The debris will be transported by:
_O 2 rr- r/t 1 h
(name of hauler)
Hie debris will be disposed of in
(name of facility)
I
iig:ature of panr,it app,icaat ---
— C9(It lo`l
,iatr
I. �._� ...� vas "• q
PUBLIC PROPERTY
DEPARTI%MNT
u.+a.a�arersr••
Niroe 130VIiLww�w 9nosr•
�wr�oRs�rnoto'fo
tr.saafss!•rile srt�eLa>M
APPLICATION FOR THE REPA_M R>ILNOYATIOIY CONDUCTION .
DMf MN, OR 00fil OF USZ OR OCCU* N_Cy, FOR A_Ny E7iQ3T NG
MMUCTURE OR aim, prG
. �.o SITE INFORMATIoN " -
Pmpeft
Loatlon Wamac g
Address:_ _
Aoparty Is Webd In a:CCnswvMon Anse YM U mmm i)' "P YIN 1-4
2.1 OWNERSHIP INFORMATION
7.1 Owner of Lead
Nan c
Addrum P D
5A-L4-- i MAA
Telephone: 1 9-1 g 1-741- -,s& 20
3.0 COMPLETE THIS SECTION FOR WORK IN 9XWj Q BUILDINGS ONLY
Addition Existing
Renovation ✓ Number of Stories Renovated
Change in Use New
OemoGdon Existing
Aptxoximate year of Area per floor(sQ Renovated
constructlon or renovation �q
of existing building New
Adel Description of proposed Work:
- - . ... - MailPermitto: p �1�' Iiev s3 La��r^ -- ." .-