42 MASON ST - BUILDING INSPECTION fbw6l"vlGEfNAD#m9 APPROVED BY T44E
E{, jC=PRIOR TDA.PEAWT BEINR GRANTED
CITY OF SALEM
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WADING PERMIT APPLICATION FOR:
Perms to:
(Circa whichever apply) Roof. Reroof. I Sid4p Conctruc:t Dim*. Shed, Pool.
�� Other:
PEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDING&
The un bm grwd fwreby apples for a permit to build according to the following
speciflications-
Omwea Name T f tV'�d�G'?1'
Address A Phone
Archited s Name
Address & Phone L
Mechanics Name
Address 6 Phone f 1
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mm"a tx~ a oxw o,for now away Wuwaz Z
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S4mdum orApWAnt
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WOIW TO BE DONE
— Ir
MAIL PERMIT T0: l 2 �IC J'O'�� S'fi —Ju �47 O�970
No.
APPLICATION FOR
PERYT TO
we �6I�G6 Si7�i !G
LOCATION
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PERMIT GRANTED
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APPROV f D
OR OF SWILDINV28
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CITY OR SALUM9 MASSACHUStTTS
PUSUC PROPURW DEPARTIACM?
120 VW1f111MOTON SURSTo Us PI
!Alan. ""OM MUS&M ale"
Ta%a►MOMat "S-740-6111111 MW. 380
PAM /70•74& M0
3alens Bn&VMt .+......�
�dt�41�lLLQDa
In as crdance with the provisions of MM cQ 3 J4 a coodidon of your
Bug din9 Pleamit is that the debris reqddnl li OM thin work shall be disposed
of in a propedy licensed solid wsste'disposd facility as defined by MCiL
Chapter HL 31 50 A.
The debris will be disposed of in:
won of Facility) &7Gt Pec a J/vt
Signature of-1 L/Z�L�
pplicant
Date
CITY OR SALBMO MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASNINatoN STRS[T 3Ra /Loon
SAL214. MASSACNOS" 01970
TELE►NONS: e7W7/8.999S 9". 380
RAa: e7e-740_Se4e ._.
HOINEOW n I.Icusz RXEMP't'ION
Platy pr3ot.
Dole 2! b
job Location 112 /"1 asp sfi
Home Qlrnse Addeeet_ �iZ_ ter. 10, 1 ,
OM,>wr?dephslgr y __ 9
Ap not- 7� , a��, 1
The emrmt aoamplia.aCHomeoanals"way aateoded to inchlde
Mgr ottwa Tlaite a lane and oo albw wc�a Neml%Pwvl mgag, for
hire who doe not poaaae ded that_ >a Saar
D>iQrlrimgq OB Wi�lBtt a
Pm*sl who OWN a paeralaf land ae whit►hdah@ rwWw or in cz&to
which thee i4 ea is ioteodea to bA a one a two reckk°Q
steceuoa WIANSO ry to wd nee and/or a or &1* 'aeWdW ar de wlW
than one bane in a two year Podod Ad not espwa wW�a�aee
"�mwnd'shalt submit to the Bm'lding O®ciel.on a Ioem wcqpbbl@
P that lWgw be rapoodble for all sucb work Performed under the Building lding
ode " wn�aumw ra t'for�Pbmw with the State
applicable by6lawa and megulatiom
73e wWffWB M"h0mao*zer"catiilee that bwsM lmdergazwg the City of Salem
Building Ikpalp ent minimum inapaetioo Proeedum and
will oomPly with said procedure and aft requirometi sad that be/she
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
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