11 LINCOLN - BUILDING INSPECTION What is the current use of the Building? 1 p —"►
Material of Building?6( /J I P ZAaeA
dwelling.how many units?
Win the Building Conform to Law? s Asbestos?
ArchitacCe Name 7 LJ'J ^- d G' 3d
Address and Phone /1 J / i✓�.✓,L /t/ 61O�411_l )
Mechanics Name
Address and Phone
Constructior►Supervisors License# HIC Registration#
Estimated Cost of Project$ / OO b. 00 Permit Fee Cakxdatbr
Permit Fee f a, . O� Estimated Cost X$71$1000 Residential
Estimated Cost Xi?141000Commercia4-- -
-- An Additional $6.00 is added as an
Administrative 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
ttto build to the
above
/stated
specifications. Signed under penalty ofperJury
Date / G
I I i
0
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06
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PUBLIC PROPERTY
DEPARTMENT
yV.Yx\LAtUU/Lst1'M01970
TU.M, 745 9S"s FNa 97s.740.9s"
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BIMA .
1.0 SITE INFORMATION
Location Name: (Building:
Property is located in a:Conservation Area Y/N Historic Obbict YIN
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land `
Name: Al C 1 2 _ ,k1- e,t7
Address:
�. l C �, B
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN E7(ISIINQ BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of Area per floor (sf) Renovated
Construction or renovation
of existing building New
Eiriet Description of Propos W P t? /P G
------------- ------- ---
Mail Permit to:
' CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
\l.t Y i IK t?G V(�.\9lIXc :JK S:AEET •SAL F.M.\t.\\iAG tt SL VI S]:91.
Tel,973-7+5.1595 *F.a_`c:978-74C-) 6
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 CMR section ill.5
Debris, and the provisions of MGL 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
t 11. S 150A.
The debris will be transported by:
(name of hauler)
i'he debris will be disposed of in :� I
I:+di:rcs. oft Ctlly)
� �_
uldq )illl'.lC .i(;j),IC14C&
__ 2 0
41
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIf01�cv n�w•ry
MAYOR
130 wASONG'TON STREET♦SMAK MASSAp11;SEM 01970
TM:976.73S-9595 9 FAX 978-740-9846
HOMEOWNER LICENSE EXEMPTION
Please Print
Date 1 O
Job Location
Home Owner Address !mod A
Home Owner Telephone —74� / ,- r1 o 3 r,
Present Mailing Address
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 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 T"
APPROVAL OF BUILDING INSPECTOR
See other side for state code