13 LINDEN AVE - BUILDING INSPECTION '40 CrrY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
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Construction Debris Disposat Affidavit
(required for all demolition and renovation worts)
to aacordame with the sixtb edidou of ides Star 1>luMng Cods.7110 0611t section 111.5
Debris,and the provisions of NfGL c 40.S SIC
9uil % Permit A _ _ is issued with the condttioe that the debris resulting f m
this wort shall be disposed of in a property licensed wane disposal fbcility as defined by%iGL c
lt1.! 156A.
The debris will be transported by:
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rho&-brie wilt be disposed of in :
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CITY OF S.umm
PUBLIC PROPERTY
DEPARTMENT
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HOMEOWNER LICENSE EXEMPTION
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Job Location 13 L, f� 4 M o o l 4 }�
Home Owner Address I C . cle.✓ a j c a L¢r MR o l 4 7l0
Home Owner Telephone 9�e �y / s—a y!-
Present Mailing Address 13
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 fors acceptable to the Building
Official, that hdshe 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
OF
P P ROPERTY
FDEPARTMENT
MAWS 130 WeswrwTw must•1ALKK wsuow stile 01970
11L l7(1.7464M•Psz lre.7404M
APPLICATION FOR THE REPAIR. RENOVATIAAI_ c0NSTgU n0N_
DE.KOLITION.OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXLgff MG
STRUCTURE OR BUILDING-
1.0 SITE INFORMATION
Location Name: /3 a vC Buildha
-- Property ci vc
Property Is located in w.Conservation Are YIN / HisloAo Dismot YIN_AL_
M OWNERSHIP INFORMATION
2.1 Owner of Land _
Name: r/7 c-k u e,1 2� 4 I
Address. 13 L.N o�oN S/+l e I-1 A 0 GC✓2 � v�,
Telephone: 0(?8 7 y y o y 5
3.0 COMPLETE THIS SECTION FOR WORK IN E7II8=ldt3 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:
(>(9 da -k 1am. 4chc
----- ---Mail Permit to:
What is the current use of the Building?
Material of Building? If dwoMM law many units?
Win the BuNdkg Conte to Law? - Asbestos?
Architects Name U
Address aid phone l 1
Meawwa Name
Address and Phone
won guparvisors License a HIC 8,WuW ROGWAtton 11
Es*n&Wd Cost of ROOd s i ° �ake Cold
Permit Fee i _ Estlmated Cast X i7/i1000 Residential
— — - Estimated Cost X i41/i1000 Camr wcW
An Additional $5.00 in added es an
Adminmmtive charge.
Make sun that all flelds are properly and legibly written to avoid delays in proceesfng.
The undersigned does hereby apply for a Building pwTrat to build to the above stated
spy, signed under penally of penury
Date
I 0
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