23 LEMON ST - BUILDING INSPECTION (8) What is the current use of the Building?
Material of Building? M dwelling,how many units?
W it the Binding Conform to Law? Asbestos?
Architect's Name
Address and Phone �- I
MedtanWs Name
Address and Photo _ --- --
�-
Construction supervisors License* HIC Registration M
-
Estimated Cost of Project i '?coo Permit Fee CaicubdOn
Permit Fee: 2�' — Estimated Cost X$7/Si000 Residential
Estimated Cost X if t/:lot O Cmnmerciat- -
An Additional $5.W Is added =an
Administrable charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
specftatkns. Signed under penalty of perjury X
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EITY OFr
PUBLIC PROPERTY
DEPARTMENT
Y.I AEF's f M lu L
�(/1VGe 130WA9NWGtitt snw r 3.uiK YAMAOp:ik-'fs Ot970
IV-M71S.9M 9 FA=M7404M
APPLICATION FOR THE REPAIR RENOVATION_ CONSTRUCTION
DE,yiOLTTION,OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
to SITE INFORMATION
Location Name: c 2 Building:
Property ,�Z3 L -- -
Property is located In a;Consaroallon Area Y/N A r HW"lc Obtrlct YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: /114,-, l glut I
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN EKlSX= BUILDINGS ONLY
Addition Exlstng
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
B&J Description of Proposed Work:
--- ------Mail Permit to: --- -
CITY OF SM EM
PUBLIC PROPERTY
DEPARTMENT
l-30 WA%dNGTM SMM•SANK M&UAGAISEM 01970
Tm-970-74S-9595•FAX;978-740.96W
HOMEOWNER LICENSE EXEMPTION
Please Print
Date 9/F-0--7�
Job Location 23 sT'
Home Owner Address a3 4,ft-7�
Home Owner Telephone 9.20 ors o 70.3
Present Mailing Address a 3 cn si
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 dwellin& 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 foam 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
4
PUBLIC PROPRERTY
DEPARTMENT
�1.���'r t��.L9 iNt::Jiti 3 1E,eT�S\L:11.>•1.\vl\l.�LL.t t1a::9Y.
To-.~W.)m f.\tt 97L7�69eN
Construction Debris Disposat AfBdsvit
(required rot all demolition and renovation wont)
In=onlamc with the sixth edition of the State Building Code,730 CNIR section I I I.5
Debris,and the provisions of NGL a 40,S SIC
Building Permit N _ _ is issued with the condition dtst the debris resulting fom
this work shall be disposed of in a property licensed waste disposal fheility as defined by.IGL c
I 11.S 150A.
The debris will be transported by:
IuC4 S.z _
lnarmt%
me&-bris will be disposed of in :
Iaameurtxilty)