18 NICHOLS ST - BUILDING INSPECTION 1
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�L�IINSiNli6T13EfILf� APPROVED 8Y 'T*IE
.INS =TDB.PfWfl TP A.PEAMIT.S,EWG GRANTED /
CITY OF SALEM
No `\ � �i \ Date 1 / _ yJ
Is Property Located In // Location of
s 7/
the Historic District? Ye No bxwing
Is Property located In
the Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof eroof� I stall Siding; onstruct Deck, Shed, Pool,
epair place, her! f�i'u
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/ /y
Address & Phone `/ /I ��1�� Sri (fin�zS (q;9) 777 — S-77�
> Architect's Name
K
Address & Phone ( )
Mechanics Name
Address & Phone
What Is the purpose of building? ell A4
Material of Witting? 4"�6'd� If a dwelling,for how many families?--�
Will building conform to law? _ /r f 5 Asbestos? /14n
Estimated cost 3 S d U City License# N A state License :
sows I�rovem�ent ,( —�,
Lic. / /1.
Signature ai Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DES`�CCRIPTION OF WORK TO BE DONE/
MAIL PERMIT TO: LG �✓•(/j�< C�'
No
APPLICATION FOR
PERMIT TO
kOqATION,.'l M
PERMIT QRANTED
APPROVED
VECTOR OF B ILDINGS
• t
CITY OF SALEM
BunDwri DEPARTivlW
HOIEOWIER ucENii E xornow
Pkmse Psit •
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PRESENT MA&WO ADDVMI ��✓1!°t'_ 57L'
nA cwxw.exmption d-bvmwwgwf was emcndce w InchAt ownerspCevk+dwdliv.iTWO
Unhs a ko and to allow,meb lomoowneri a�� .�bbe abo sots as P�•
>iesaae..P,v�idea,4�a�cea.er".et.e.w♦ee.leea .
DEFRGrMOFHONIF.OWWft
Pena(I)wbo CWW a Panxi o]Lad w w•bkb behie asides of bnenda a reside.oo q&M kr
inunded w be.a one a two�9 dwcl>iap,suad w ao
rcd a d &W saoees f aolis eood "
farm svncwm A yen=w•ho comaum nwee Om cm home in a twt Yw paled
md
s bom wwaa. svcb nwmww=f sha>lsvbmdl a the Bwldia�OlGcisl.m�idet >ibe
Bwldb$OEici4thatb dshe be respomnbk w eA=cbw=k pee d
The wdasipud-boawowneT m maa tesp mibMV fa CC=PftWC WW tlee sure Btu code l"
other appSobk goo by-bws,rules nd refubd=&
Tic wodc sipad-hcmwwBe ardLa that wft mdustam&tic Ow of sak=Burmag
miaiaaoa D�spestion praadmes and req ' thn bl
HOMEOWNER'S SIGNATlJR1< Q _.--
APPROVAL OF B=DING INSPEC70R vG
See mba side for sm code
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HOMEOWNER'S EXEMMON
Tha Coda sutea t}mc oq aw=—.. rm yaror .i�lc ror whkb i bandies yamit Is tegalred 1 M —
eatmpt Lam►dta padi&m oftbb sccdoa (Sec►taa UP44-UauaiaS of Comnndm Sup avbsrlo;
provided that b a bcmeowma aygas p pawa(s)for ldm io do.Furl wod6 t M aim&laaaeowaa aai
as ..
M,)mpemmi wbo we tlb amm�pdaa am iaowue tbst they are aasaatioS do papoodbMdo are
supaviwr(see Appesdb Qr Roks and Rtpbtlm for llacoslog Cosstrwcdom SupervboM Seedaa
.2.206 7bb bak of swwcnen dka usahs fn urim prcblem 6�tls I 'Witta Lbw
unikcnud persoaa b tbb cau ytwr Bond arntol proceed apm- tle paioa rr ilvroald vldr
lkeased Smpovim. 74 bome"t.ding"sspuvbw it ddmst.*nnpwrik
To ensure that d►e borseomm. b fully nrae dbVha-mspcndbMdc%matgr oommom(dasngk%.aspal
or die permli spplfadm dot da 1"W"na CMW do Wan mdasaa I da sespmsbmn da
aWavboL Yoe arq ears to amesd smd adopt welts loraJaardfl=dsa f w ass io yov oommmiW.
CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
k SALEM, MA 01 970
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
-- -- --- of-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/ I,
III, S 150A. /
The debris will be disposed of at: 1 d ll h
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Name of Perinit Applicant
Firm Name,if any
AW
Addiess, 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 cIll, S 150A, and the building permits or licenses are to
indicate the location of the facility.