10 LAURENT RD - BUILDING INSPECTION d
1Mhat is U►e omm t use of the Building?
MatwW of Budd M? ` o0c M dwaNkq.how Mary unb?
tiW IM Bai&V Cadlocm to Law? `le S Asbastas? N�
Ardftas Name '
Addnas and Photo
mod wdes Name
Address and Phan MIC RegistOw 0
Canstr.M:mn SUPOVisas Liaenfe B
Es*r,ded Cost of Projad i oo Pannr Fad Ca1a+Wfon
Parma Foe i Estknated Cost X i7/i1t>DO Residential
Ealknated Coat X$11/11MG CammwdsrG---_..An Additlonal S&OO is added as an
/l�ss�srative - .�
Make sun that all itelds an propwly and may written to avoid delays to Proc"Ging-
The undwsigned do"hwnby a"for a Budding Pwn*to build to the above s M
spg a*m Signed under penally of Pw1r+rY
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CITY OF &U.EM
PUBLIC PROPERTY
DEPARTMENT
KiNO . GY DRMCO 1.
VAYM 1''A wASNINGMN SrRM•SM.EK MAMUNL'SEriS 01970
7M--978-745-959S* FAx:97&740.9&W
HOMEOWNER LICENSE EXEMPTION
Please Print
Date Jdj14lo7
Job Location Gd re -A Sti(p� /1/4
Home Owner Address /o " re n+ RoA d Se,le,--, MA
Home Owner Telephone 9 7 9 - ss,e - .s 3(e o
Present Mailing Address i o z- ,,,e e, r i 41+
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 "homeowned'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 SIGNATI. D1vl
APPROVAL OF BUILDING IN PECTOR
See other side for state code
:AR
OFPPDTMENT
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wro. 130WADMAMN meat•su+oti�fAs�.nas.,,s01970
,ti M7464M..AX M7469w
A_*PLCATION FOR TRZ REPA—m- R1eNOVAnON QBAIQLCMQN-
DZ,HOI.Pi' &OR CAANGZ OF U3Z OR OCCUPANCY FOR ANY EX15NG
S'TRUCrURZ OR RU LDWG
1.0 UM INFORMATION
Location Name: t?fuYdlna
Poly Addreec---- --- — _ --- - -
Properly is located Ina;Conservation Area YIN H Wft 0kM d YM
2.0 OWNERSHIP INFORMATION
9.10wowa/Land on oVi k vise � S
Name:
Address: /0
S a 7
Telephone: S ;`( - S 3 cR O
ff
THIS SECTION FOR WORK IN 9XUMma 13UILDINGS ONLY
Existing Number of Stories Renovated
Change h Use New
Demolition ExhUng
Approximate year of Area per floor(sf) Renovated
construction or renovation
of existing building New
grid Description of Proposed Work:
7r7;.,s llafi.,n ((e f S �✓t
--- -- ---Mail Permit to: - - -