1 LEMON STREET CT - BUILDING INSPECTION .
� :��' �� � /��� ` � .
� ` : � - , �� The,Cnmmonwenith�of Mrssachus�tts � ., , 1 OR r -
� �. - �� �a Bourd qf$Il�lding Regu ns u rnndnrc�S :� - MUNIc IP.0 I1 i
= 1 Massrchusetts§tnre Huil g Code 7Bt►C R 7 rd�aon WE
� t ,s , `Bu�ldmg Eerm�t Applicahon T -Constru% _Repa�r, nnvntn Or�molish u� ' Rei���J J�in�xui
,- ;
` ;,One o iT,��e F Dn ng, , , l, 'rN64
. r = _
,, . _. -�.: . .. :: ...,_::., �., : :,.. , ,� ,:, , s
, ._ :Th ��S i n al'Use.Onl `
, Bwldmg Permrt Itlumtie. � :_r . _ . ' ;D C}\pPLed.
,
, . i .. ` 5 � ��� � _
-: ; ,fr�.� r i ,
$IgIIOWfC :� n . � ! ._�.� . � -
Bu{hlmgCumidsWanrA�l -�nmrnf Bwl� Uule, < <.� _
` ' , :SECTIONI_.Sl-TB'INFOBMi►TION " '
, � ,. � 3 �
, �
, '{ . : ..5:4. , ..,.. ;:.. . .. ..:: ... .:. � , k.-.n f. _... \ r.
"' '.� .�_ . .., . .., -
" l:l Propc*ty_Address 4 r I:2 Assessor`a MOp&Percel Numtiers ,
`,r ,L���F.,�„�T C� .
� : , _.�:. �x.�; ,
l�:tu Is Uus wi accepted.§u'eet7 yes ��_ no � �M�P Nwn6er���. .:, Pantil-Nu4nlrcrf �i� � - - _..,
i � -_ . ..r . _ : - �
_ � 1:3 ZoainS laforncttloa�. ° 1�4,Proput�Dlmeoslons < � ' `
.;i: �.-:r_ � :.3 .: _�` .'; .;,5 . � , ,+�s,
.��: �-Zp D�stnct ' , ,.,�Proposed Use';y . . �.4-,,. . .- -:Cnt Are¢1s9-.R) -�. .. -,- Fron�oge fRl .-,F ' .:
- . ni^8.....,.._,. _. .<,� -:..-:_._ , x ::.--- .
` IcS'BuOdlog Setbxlce_(ft) ° �- - � `,s � �
Z ,� y � +
-�Fmnt,Yord. :��S�de:Yorde" � �.rReurYnrd`� ' -
-��t �� Requfred::= ,, " _Pmnded ,;.�.: ,.-�:�,.Req�Ured '..,.,; . �Pmvided �,. ,. :.;RMuired �:`.- * .�.IhovWed '
, s � s
� ' _ _ � r
� 1,6WateeSupPly (MG:Lc40,§54) 17 Ebo�,Zonelnlbrmatloos� ' 1.8SewagexDlspoast$qatem. ' ,` t
- : '; .� --�+ 7�ne � OuLSid!Floud-ZOoeT t � F :
,=� � �-.. � � t .- ,.>�� 1 �:- �+ r t 5 MwildpnY�Onslted�sposulsysian �' :: .
.-.: t Publlc� ,.:..`Pnvate0 � , .s.,. ,. ;:ChecififYaO_:_-._ -.._. �... .. .. ...:... ... . � t s ;;
,. _; .. .._ . . _ . . :
,. , ' :s . ,. ,:. . . ;SECTION'2 . PROPBR'�S'OWNER6FIIP:". . ; r . �
Z'1 OWrte��o�Raard �� a� L ": ' < ,,_� < ... � �. � �. t �
s�ay.� nr�p�y .�e-{ � � � t��^noN Sr �T SRt�eM NtA � ;
- , � Nome f : `� AJdrcss For Savtce �. . . „ ;r ,�.
= . �°�:n�� - , ,. � . ���� k 5,� ����� h Yi
� � ,
'$10[UfC� k .� m �:n i ' TG�l�Itlll! 4._'i, � s�.tY� +, s-.�.j e� � .c i� v, 2 �, �.
S9 T -. . :.. . .. � . �. ._
' `. r,�, , ,' SEC1'[ON 3°DB$CRIPTiON OF PROPOSED�N!,URltr(ehexk`all�tdat nPP�Yj`1`a� � ,� ti:
„, fle�Construction 0 E��snng BuilAffig Oz .0ivner�ecupledA O y`Repous(S)'O�, Altwanon(s) O T „Add�nun, O:„a
:� ... ��. SI ..3"T PS'. `^WA 11 Y 1 i�"'C l �..y ..� �
' . Demol�doa --;' ❑ Accessory,Bldg Q� , ,NumbaofUnl�s � ? �Odrcrcr sCl s�xclry r' "' v , . ` , '
� - r
; .. , � � � `� � � ,
' B,ncf Deurlpuon of Proposed Wark. 'x b �
�.; .: . - �_. :.., , - �. �, . r ��:�,�
-�: , ...-.�. r ��.��� .� �:.:, �_. ..., . � .r , ..-. .,....:_ :� - _
' " , < r:
..:rj . e,.,, _.. -.
.il: .'.::: . -.., v �. .v.. ` 'tf 5 -.r � � _
_ .3:� ..:, '. f � , I [ d?-' �h `.
f � }�
-_ : , r . l'.1 ...J � )f f l- 1 Y � � :
' ' , '.,`. �. „ , ' SECTIOH 4t BSTINIATED CONSTRUC'FIOAT,COSTS, ", .? " " i" t ,
�
_ , :
,
[tem f EaHmeted Costg�- t s + ��� r ry r ' , ... . , a ^
a...r-- ''��lj'8�tiSC DO��n f t t
[nbm and MWerin"Is)
��Q tvHwldi PermltFee $�" �nd�rntehuwfeeisdetermiircd t
` I,Bwlding ; � = S, CI Stand"�ai�r Clt'y/fown.°1pp�Pee ' x
2<��ncal c , � $"`r`.�« T � ` [�TatalPro Cost3 Ircm�x'multi I�er 'n
I� ( R
3:Plumbin8 ' , T $ ' Y 3`OU�erFees $ 3 ; � ,r��
Lest ' ` �
4 Mcehnmcpl' (HYF,C) : 'S' _ ' - < ,' ` 1J ,
^ ` i ` ` .
5�rMech4ntcW v(Firii� :_{. s y , �-. ,° � ...r , >^.h a s� -�. • 4.
, . -: ' " y s� -r� Totnl Ai(Fses S , '
; ' ,Su ression ;,! '_'.,._,. � ; —�-- : �� -
r '. _ � � r .--. ; x r-r ../ CheckNo, ���l�IILL]WIt� �:-_CmhAm�wnt
b,;;r�rroj�co�.`� s -4 o:t� , ,� �.; � , ::. , �
' , __.. ,,._. . .. . .,..,. .-,.: = O Puid m Full a _;:..a Q Owatn�mg.Balonce Due, '� ' .t: " � ,
� t 1 v �
) 4.. _
r• ; � - f `. L ..� 1 r� � y :
.
k� � �� f ( �..� 1 � '
. V 4 . ! �.� � _ �.'! i i_'
y � 4
�_ . . . . .. , - �:
2 t 1 '
2 i� Y3 J {�. L� � " �� 4 S �ry � j .: : � 1 h "
S
s ' Y _ $ '. � 1A�ac� L�� ?a4, Pk�F {S � e_ns '. r � ��;
�. ! 3 fi�r , .t r - Rl'�Y�' } S � �*`"�aY:�n_°Xt:�p�7K�"�`.U._c^k tT,'� i s}�"+e`�f s r 7t)x 1 r ',x r. . . .. . ..._ .
�
_. :.... ..t. .'. �. , .�� . . .�:: ., _ .,.�s ,_ �x.��c�t..,, � ... ,;_ .. . °
City of Salem. MA - Forms / Applications
Virtual Town Hoe
Municipal S[tes
virlwitovmhallnst
http://iN-%xi .salem.com/Pages/SaleiiiNIA_PtiblicProperties/applicatio...
Salem City Hall 93 Washington Street, Salem, MA 01970
Phone: 978-745-9595
City Hall Hours of Operation: Monday, Tuesday & Wednesday SAM - 4PM Thursday SAM - 7PM Friday SAM -12PM
,j
2 of 2 6/24/2008 10:19 PM
CITY OF
a
PROPERTY
%"Von 130wA9anerowST=a • SAUE SLMA0/l.'MM01970
TEL 9'. US-%" • FNc 978•740.9a46
HOMEOWNER LICENSE EXEMFnON
Pleas Print
Date O
Job Locatka /41e. '7�, r/T G
Home -Owner Address i .l c"A a o
Horne Owner Telephone
Prem Mailing Address / li
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 fans 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 SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
\I "If I_'. \\,\il ll\Ir., 7f 1 I : I'T • y.\I I'\I, \hli\t
'I'I:I:')'8-T4;`);IA ♦ I'.\X:'i'8,'4 9846
Construction Debris Disposal Affidavit
(ICLluircd flur all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 Cb1R section 111.5
Dcbris, and the provisions of MGL c 40, S 54;
Building Permit t _ is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal Facility as defined by MGL c
111, S 150A.
The debris will be transported by:
-� eA,1 0 L t l� I
(name of hauler)
'I he debris will be disposed of in
-sem r/,/
--- _
(name of facility)
(address of ILcililv)
1, 1'...,1 i.r ,
Nignaturc of permit applicant
date