1-3 NAPLES RD - BPA-05-176 PL'ArNS1Mtl6T*Ef&*B4A9 APPROVED BY 774E
ARPECTAl:1 PWR TD A PERMIT BEWG GRANTED
CITY OF_SALEM
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If Property Located in Location of
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Is Pr"WIV Locfsad ti / �L�IY,�_
I»Carrfarvaloo Aran? YM No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Romof, Install Siding Construct mac, Shed, Pool,
Repair/Replace, Other: �/✓�/� O (��y r (Ore 4e f
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a Permit to build accorcLag.to the following
specifications:
Owners Name l r P-0 ('c) N c� 1� G e S /v'q�, N
Address & Phone 3 Al q J?Ae r f %apt 7 `(S- o T 7
Archkecrs Name v /�
Address & Phone
Mechanics Name /V
Address & Phone
what Is ttra prapofa a tfd~ e s d e.-e (L —
mdWW of tarlldYq? IN i) o 1 a dwaft for how many fa ngm?
wa dadkrp cm nn to law? V e 1 _Aft ems? A--,I.)
ErimxW soft c�0 0 a City Licarm« stela Lim"«
ao■. rf4to....nt Lit. I W
Signature of Applicant
SIGNED UNDER THE PENALTY,
OF PEWUPY
DESCRIPTION OF WORK TO BE DONE
f � e�lacz sMa1I aarc4ej 0 FERr v �
C�C��;r���Cepoor o�/i/vdr)LJ,
MAUL PERMIT TO:
i
No� ,
APPLICATION FOR
PERRW TO
LOCATION
l- 3 A/�� 5
PERMIT GRANTED
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AtOVFD
INSPECT OF BUILDINGS
t.
CrrY CiF SALEM
BXWING DBPARTMENr
HMaOwrmi UCENSE EMOMON
Plan Pda
DA72
10B1ACATION
•HOMEO�Wl� • . . .
TELEPHOW
PAE'.iff MAII•MO ADDREN
The earest,CwMdou d'lwmeowga was exeaded to betide ewwcT-pF sl d'�p W TNO
Wo a lea and le allow god bomeowm a to aVP ss bidfvidu� *r Idas who does twt Poem a
lkt me..pmided rhos dw owww"ad ss mpuvbm
DEFR4710"OF HONVA)Wti!'t
Person(s)wbo owns a pared d land as wWcb bLWW mida a brads to tedd%at w bkbt wm k R is
buaAW m be,a as to two tw&y dwt%M assdrd a dcmdwd mucrau scocomT to m b rate avt 11
fum savcnves•A pesos wbo ocnsv=mane tlan one home ins twvYcw period shoo nestle t mwWasd
s boswowarL Svcs 9wmcow of sW subs&to the BuDdbig Off. � ft
Bulldind Odid4 that b ehhe bt tespom%k to ap so*wok pelamsd s
The wmkniped`bomtowne assumtt nspont%mV fa compBwa wth lht Suit Bull tg Code and
wha appl cabk goes by4ovos,raks and tegobitita
The wwknipad'hoveownd'aerates thn hdahc wAcV ands tta Cfd d Salem Building Dvooma.
nfu imvm inspection pmcsdum and mq*=w=and that blalx will=MOY wish said pmodaa ad
HOMEOWM'S SIGNATURE l
APPROVAL Of BUILDING INSPECTM
Sec other side for sync code
HOMEOWNER'S EXEMPTION
The code sues tint 'arq b=wcvwm perfamiq wc*fw w bkb a boOdi 4 permit it tt:in'red sin"M
excmga from loft p ur;d ms of-Obit sects m ($tether]OV.L1-licensing of Comeraeetan Sqa vbw
prorAw that Is a bomeOwttet owgu a pasan(a)I&hill 10 do such wcdr.AM tib bo®eocraa dame
MI q bomeosmas wb0 are ft ommptim all t nmm t o they we asatodmg dw q de
svpervyor(ace Appcods Qc Rub and Regubtba for 1Jecostog Coostr oclUm gopes+Asoss,Secd.w
.2.24 Tbu b ck of awasiws Chem tatdu in Scrim prablesm partieolvl,'wwa dw howeoeraet bfisd
willecaKd pctsome In ttds can yaw Band tsrmot pwcsed apbo to=Mcmed pela as It wew1Q wld
Ikt=W Stglenism. Tbl boommur acing as mwvbw b NNW".*!Srwbl& .
To cmn that*c homeowner Is!ally imam of bVtm reapomlbi8dea, taq&%-as paa
of am perwit applio km om the mmwwma clrtlty that he/on mounwods tS nspowisho ds eta
supayboe. You tosy cane to wood and adopt are!a hnaktrdikatim Jat'ttm, in your ooam®l*
PUBLIC PROPERTY DEPARTMENT
12O WASMINOTON VMff T, 3RD RADA
&MXN.MA O1970
TaL (979)740-E5E5 EXT. s!O
FAX (976) 740-9e146
STANLEY J. USOVICZ, JIL
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MCJL c 40,S34,I acknowledge that av a chop
of BuildinS Permit S . all debris resulting from the cmmmcdm activity
govaned by this Building Permit sW be disposed of in a properly licensed solid-waft
disposal facility,as defined by MQI,c 11%S1�k&
The debris-win be diepoeed of at
Iocado m of Facrlty ,
SrgoaWm of Permit A hcw t Dad
FULLY compile the folloWioS inf m&dM-
(PLEASE PRINT CLEARLY)
Name ofPeamitAppnewS
Firm Name,if any
Address,City&State
The above statute requires that debris fmm the demolition,renovation,rehab or od w
alteration of building or sMxtr m be disposed in a properly-licensed solid-waste disposal
facility as defined by MQ,cA S]50A, and the building pamits or fireman am to
indicate the location of the facility.