27 LINDEN ST - BUILDING INSPECTION (2) What is the current use of the Building? r
Material of Building? U/O®a If dwelling,how many units? -.
Will the Building Conform to Law? Asbestos?
Architect's Name
Address and Phone ( )
Mechanic's Name
Address and Phone
Construction Supervisors License S HIC Registration S
Estimated Cost�OfrProjed Permit Fee Cafes Won
Permit Fee S Estimated Cost X$71$1000 Residential
Estimated Cost X S411S1000 Commercial
An Additional$6.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of perjury
Date v` O
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L 1
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PUBLIC PROPERTY
DEPARTNI&NT
�a.�a�nar o�LSCl�1.
NAvaa 130 Www*NcnW snFBr•sALEK MTM 0t970
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTION
DEMOLITION,OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BIRMG
1.0 SITE INFORMATION '
Location Name: Building:
Li So,I
Properly Is located In a;Consmatlon Arse YIN Fiistork:Dbtrto4 Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: cLe- / a_y- 1 ' 1 vi !t
Address: �7 I J h U e., St , G OL t o�, M 6
Telephone: "—v7 H-Z 7'?
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
kemcwcam/ of C) Pl e. &a,r cleel^a9 e .-Prom
Troperfj , No rebu', Id, s x pcct fev► e �,
— - - - -Mail Permit to: a 7 %/7 derr ���. �Sc� /wri ✓�
CITY OF S�ULEM
PUBLIC PROPERTY
DEPARTMENT
Maros
130 wwwww MN S71<FJ+T•SMM4 M���SEM 0197o
lki 976L74S-9S9S•FAIL 97$.74o.9&4
HOMEOWNER LICENSE EXEIMMON
Please Print
Date
Job Location Q 7 ,i v,i✓ y/ ���-� c, / Lo�/ ]�
Home Owner Address�c P.
Home Owner Telephone
Present Mailing Address scc,m P-
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.
DEFMION 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 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 INSPECTORS fiO
See other side for state code
CITY OF SALEM
t ' I PUBLIC PROPRERTY
DEPARTMENT
nl\L';c NI AT!''ttiM�tl 1.
\IAWK 110 W.%SI9\AT:0NSC3EET •SALIA.S1Mi\C*,-u iLl tS:197:
"ret:97&7i5.1595 *f.%r:979-7iG9Bi6
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of vIGL 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
111,S 150A.
The debris will be transported by:
l yt tt~S Bee e Nord eDepot)
(name of hauler)
Hie debris will be disposed of in :
(name of facility)
. . - -- iaddres+o(tuciLty�
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