LOT 8 BAKERS ISLAND - BUILDING INSPECTION camt use of the Building? St tMM&\ CdJ"S 4Frt
MateriWW al d 8u ? W3dA F2A�M�i K� ,how nUM wits? —
Will tine Building Conlbnn to law?
y�S Asbestos?
ArdOds Name ( i
Addm"and Phone
MealWi s Naane
Addmu and Phan• -� HIC Registration 0
Cons kwn License B
EstYnated Cost of Project a 10 Pan*
®a Estkeatad Cad X$71$1000 Residential
Permit FN: �'� EMMI Oad Cost X:11/: rar
1000 Cawalai-
An Additbnel$5.00 is added as an
Admknkrtrative dwge.
Make sure that as flelde us properb and legibly wMM to avoid delays in processin4
e undersgned dose hereby apply for a Bulkpq Permit to build to ti>•above stated
speoifleatlone• Signed under penalty of Perjury
Date 8 0
0
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CITY OF SALEM
PUBLIC PROPERTY
,iv
DEPARTMENT
VAYO!
lam:972-74S-9S9S 4 FAX;974740.9&"
HOMEOWNER LICENSE EXEIMMON
Please Print
Date Eta a g o�
Job Location LOTS P>AKt+%s L-<Ck�wp
Home Owner Address " 4• •1QA A
Home Owner Telephone t,o 3 - I IA
Present Mailing Address SAA 4: As A& Az
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.
DEFRUION OF HOMEOWNER
Pawn(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 INSPECTOR
See other side for state code
a
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
110 Vr.\Sl l[\Gi JN SIAEET 4 SdLFl1,St.\Si.\(:;It.iL 1-15 O i97C
Tat:978.745-4595 1 F.vX:979-740-9846
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 l 11.5
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
111.S 150A.
The debris will be transported by:
---oW dd LtA
(name of hauler)
I'hc debris will be disposed of in
-7"r ONQ4 9t k.S 7b_M xs AN ei si'rv6 u(m rtmrw �L-
(nameoffacility) l VrAPIL FAA)6& A &6V4 TO Mt -TAKv
AISilbA.A' ``b Mq 'l,bdRl T2ANSFev\ SrA'rU" J`N ►QAA j
DAn/G�JV�v
I f tul:lay)
yl rat r• of p'rn•ic'113 nt
,ace —
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PUBLIC PROPERTY
4,01
DEPARTINMNT
��om,�n„�,cns,srsr.s�,urw�ouso�+,o
APPLICATION FOR 1'H)t t<fPAn Q1tNO %UQ CONDUCTION .
DpurION, OR O&KI OF USE on R ANY
SERIMM122 ORB nrntr�
. �.o mE lNFofwAnoN '
Laeallon Mama .-O T B tfufdina
P►ov«ti �Akt�S �sl,ANb _
Roperty ie located in a;conser woon Arne YM N _Hlefab okmd YM
10 OWNERSHIP INFORMATION
2.1 Owner of Land
' AlLD S iZ-o44V AA CYol�zn!
tea' D!L , D AN 6tA
2'1 ,NQ 6573o
T�10^e: ��� �b8 - 3�135 978 �85'7-1o�y �v-
3ACOMPLETE THIS 3ECTION FOR WORK IN E7aWMG BUILDINGS ONLY
Addition Existing a
Renovation !/ Number of 3torlea Renovated
Change in Use New
Demolition
Exlsg
Approximate year of 'q , Area per floor(30 Renovated 12,o
construction or renovation
of existing building New l^
8dd Description of Proposed Work.
,c:� cllbzL Ktrc,gtN
MEW WSNboW
` IUD (AUNRA.�
ti� F V earl.
-Mail Permit to: _!�R SSA U)vnb d-A OAru PU&V i N H o�t�,a -