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PUBLIC TRERTY
'S, DEPr1RT AFNT
Kl.%IBERLEY ORISLULL
MAYOR 120 WASHINGTON SrREE7♦SMkM MA.SSACM:ShIIS 01970
TPJ.:973-74S-959S* FAx 978-740-9946
APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION.
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1 A SITE INFORMATION
Location Name: uilding�:
Property Address:
Property is located in a; Conservation Area YIN Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: fP t ,42�
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
Jt�`7 i�£ceJ �F�KS OUP j1NruJ
( — ---
Mail Permit to:
What is the current use of the Building?
Material of Building? �— If dwelling, how many units?
Will the Building Conform to Law? Asbestos?
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Architect's Name
Address and Phone ( I
Mechanic's Name / 2
Address and Phone l ���c,�L, '�/ •�'/E f��6 ��2 ' S (7L
Construction Supervisors License# -Ocr/ T HIC Registration#
Estimated Cost of Project$ 2� pa2�71 Permit Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are property 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
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Date ✓��° 1 S z�7
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January 25, 2007
Mr. Roger Boucher
17 Linden Avenue
Salem,MA 01970
Re: Deck Construction
Dear Roger:
I am writing to memorialize our recent agreement in which you agreed to serve as the
general contractor for our club's deck reconstruction project. As you are aware, this is a
volunteer project that will be completed with the assistance of our members volunteering their
time and efforts. Nobody will be paid for services provided.
This letter shall also confirm our agreement to indemnify you, and to hold you harmless,
from any and all liability for personal injuries that may arise from your ordinary negligence. The
club will also be responsible for the cost of all permits and materials.
Finally, let me take this opportunity to thank you for your w.11. ess to step up and help
the club with this project. Your willingness to do so is greatly ap iated.
Ve ruly yo s,
William T. Cassano, Commodore
cc: P.C. Robert A. Connors, Secretary
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