96 LORING AVE - BUILDING INSPECTION What is the current use of the Building? f
Material of Building? i v� If dwelling.haw many units?
will the Building Conform to Law? Ye >
Asbestos? N
Archited's Name
Address and Phone
Mechanic's Name
Address and Phone
Construction Supervisors License* HIC Registration#
Estimated Cost of IS '100° '00 Permit Fee Cakadatlon
Permit Fee Estimated Cost X$7/$1000 Residential
Estimated Cost X S11/51000 Commercial - -
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are property and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of pedury /- � `� v
Date l �`Q °$
of
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96�
PUBLIC PROPERTY
DEPARTME.ITT
KIN o iCL ,
MAYOR IAWA$kUNcnW brims•SALEK MAssAo/L5lTR 01970
APPLICATION FOR THE REPAIR, RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDIN •
1.0 SITE INFORMATION 1
Location Name: Building:
Property Address:
96 Lorin y 4✓e .
Property is located in a: Conservation Arne YIN_N Hlatwk:D!s Y,^d
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: Els;e Na�✓✓'�eK
Address:
?6 Lor,",ty A4 e .
Telephone: 7?g — 7 4- f — R 3 7 p
3.0 COMPLETE THIS SECTION FOR WORK IN UILDINGS ONLY
Addition oExistti'ng
ng
Renovation Number of Stories vated
Change in Use
Demolition
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building �00 New
Bdet Description of Proposed Work:
Add a. Pellet bar A -L j A00C 1'o r� ar'c4 u.,ea .
— Mail Permit to: --
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIlOIF� ev new-,v
NAYM 120 WASUNCTCH SUM•S.LL.M%UMACHUSEM 01970
T a:97L74S-959S* FAIL 978.740.9&4
HOMEOWNER LICENSE EXEIMMON.
Please Print
Date-jYr s 0 8
Job Location 96 Lor,-,y A e.
Home Owner Address % Lori"= it U P ..
Home Owner Telephone 97$- 794 - 9 376
Present Mailing Address 5% A e.
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 fort 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 "homeowned'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
CrTY OF SALEM
PUBLIC PROPRERTY
DEPARTUBNT
]l��•a 13C v.%sear.-adsatsT•Wilk 4vtttar.t�1s::4
r-
Construction Debris Disp"af Affidavit
(mluimd Aw an d nwtidan and smovatios work)
fs arconMnaa with dw A%&edidos at dw State Building Code.7W CMA soctice It 1.3
Oaria.nrd dw provisions oRMtGL a 44 S 54
fluildias Permit fa is fanned with the aondidon do dw deMs mmuldnS flm
This work shall bs disposed o(W a properly licensed waste disposd facility as defined fry.%IGL a
Il1,S15"
rho debris will be mnspoeted by:
_. �aomr of I+aded
rho debris will be disposed of in :
_ t,�.m.�r rkrcrcyl-
,..w:rasa of Ya�a.ty)
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