23 NAPLES RD - BUILDING INSPECTION (3) -l1&I.-AW- WST-9E fiL£9--A*9 APPROVEO BY T44E
.W5P,F.CTDB PRJDR TD A.PEMT 13EMO GRANTED
CITY OF SALEM
Date 3 q�05
No.
Is Property Located In Location of u� 1
the Historic District? Yes No✓ Building
Is Properly Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Constr ct eck, h , Pool,
Repair/Replace, Other: ,�: I k n,
PLEASE FILL OUT LEGIBLY& COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name
Address & Phone �3 �!4 �� 71 SSA
?fir 30 &47 ced
f
Architect's Name
Address & Phone 1
Mechanics Name
Address & Phone
What is the purpose of building? � (( I 5 i,A
Material of building? 11 00 If a dwelling,for how many families? I
Will building conform to law? �l�/1 Asbestos? 4A /
Estimated cost City Licenser N A State License N ilk/
Z � �° Imem
pant pa/�t 'd of'Nei
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Feflau kjln uftw rodc Z�Itvytl/v W,
MAIL PERMIT TO: DrkVrcr� ItnSP�
23Na�° ���
�i�6,. PAP, 01 q,7(7
No.
APPLICATION FOR
PE O
0
C
-w
L TION
PERMIT IRA ED /
APPROVED
S ECTOR 09 BUILDINGS
t
Q
1
Wl 1 OF Sf1LEM
BUDDING DEPARTMENT
liMaOWNEIL LICENSE E)MO'IION
Plan PAN
Jul e
.Ho�aa►rm�
TE "HM
• The eiaraY.e�O°d-n�vo�'.�a.exundee a ittl�e owoe�rk+.a+►�i�:a a[Ywp
unit.er ks aaa to ailow such homeowmers>o enia�s m ��*'yO and act powes a .
ikewq.peovided da>be enr�si art s+a wPse+i..a .
DEFIKn"OFHcMEOW =
• person(�)w1q owm•porsl d kad oo.rLki►behhc resides a Lrenda to testa.ao���radd�
intended t0 bs.•one to two farnib dwclt�,»uuhd O dwdied terucnod nosooe7iLC art
farm svuchouL A perm WM coruenieta more t me ow Immc in a twwym p� be eom{doad
s homso*•am. so*nwr cow ner shai rAnA to the BoDdhs OJf+cK ott a f6rap macquble"65
Sm7db�Odxiai.tlmhdshcbe>rspoas�bktoailsndt�orkpafaemedta�� PQ� •.
The wdesipxd'homeowne aawna nsporuift for wMyft=w•t&*A Stan Btdlft Code ad
Oha appBobk Soo k-isw:;roks and te=uLt=L
The wW"ipssd-M.Ownef ardsa that wft wdw=T&the cw d Sty > .
m m.inspection p o=dwa and ngt�emems and that hhhs WW murV
HOMEOWNER'S SIGNATURE
�a
P•�sr,�
APPROVAL OF B=ING DWECr0A c
Sa Oder a&for an code
HOMEOWNER'S EXEWWnON
The code antes IINC'aq oa�r�paformin�wmli for—iv�teb s bn�diu�paadt�iegob�d 1 M ——
eacmpt Am du pruMora o[thb swim(Senior 7VJJ-1Jccoslog d Cewnw m Sopervboril
Prwidzd that b a nWia p peraou(�foe bins to do.sueb vral�stet ri>eb bomeowaet s�aal
a a�perrLoR'
bdaq bpmmwnat vim on tbb mmom are i w ns tint they we m mntnq dm pVcvdbWw vfs
arpwAm(oec Appeodit Qo Rub and Re=uistiom for IJQoshq Ceostrwcdm Superrbast,Salta
.135} M tuk atsv+ MMM o
mdi fla►tcsuht in scrfoos problems.psakob�vrhea the bsaeosraa lib
onaed persons yom Bard armot proceed a jabrt the mdlatrad papa r baotda veldt
lieeased Soper i b tLit macw. The bomeowlcr sates as apuvbw r obbate§!esjoodit .
To emme that dst homeovrna is fulb swwt cthVbra repoodbtlddtl6 mmq eamsoo ld"saq&46-a putt
of die permilspplbodM that the bomwwoa eaft that bchhe miderswrds tie inpsosibnkw Ira
arpavbm You mq ors to amend and adopt rA b a brmArsrdlfodan lsr nss in ya.oomm®1jV6
CITY OF-SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
j. JQ SALEM, MA 01970
TEL. (978)745-9595 EXT. 380
FAX (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40, S34, I acknowledge that as a condition
- o£Building Permit-#- - - , all debris resulting-from-the-construction-activity ------- --
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility, as defined by MGL c III, S I50A.
The debris will be disposed of at: ✓t`etM,
Location of Facility
3)4 [o��
Signature of Pe miit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
Firm Name, if any n
Address, City & State
The above statute requires that debris from the demolition,renovation, rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.