40 NICHOLS ST - BUILDING INSPECTION I'
-PL4MIAUSfiIDEfiL-E� APPROVED By T44E
jUjppXjDB pp" Tp.A_PERMIT BEING GRANTED
CITY OF SALEM
No. Date
s: A
wr it
Is Property Located in Location of
the Hstoric District? Yes_No Lfailding yU A)1C14QLrt. ST-
Is Properly Located in
the Conservatlon Area? Yes No.
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct D Shed, Pool,
Repair/Replace, Other:
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 q lIA-• (-d Al k az S
Address & Phone 40
Architect's Name
Address & Phone
Mechanics Name
Address & Phone t
What is the purpose of building? S
Mstedal of buYdtrq? WOW H a dwelling,for taw many families?
Will building cont to law? Asbestos? 0
Estimated co /i 5`a d Clly License s N �' x7UT
Haas Improvement
C10 Lie. i
�6bSi re of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
�1ati� — GUSH PURC&LASI� JG- 4 ILL
MAIL PERMIT TO:
I
No.
APPLICATION FOR
PERM
IT TO
LOCATION
PERMIT GRANTED
APPR D
INSPECTOR OF BUILDINGS
3
1
CITY OF SALL'Mj, MASSACHUSETTS
PUBLIC PROPERTY pEpARTMENT
120 WASHINGTON STRt[T 3RD FLOOR
SALII.M. MASSACNUS" 01970
TtLt►MON[: 976.745-9399 EXT. 380 '
FAIL: 976-740.9646
HOMEOWNn L'CZNsa EXEMMON
Pleads Print.
DOD w o
Job Location YO -
Home Owner Addt .
4 ep Tdvbw -
�1D� 79/bt bT
The
dwellingsc��exemption of"Homeowners"wall to include
of two ' -occupied
ac lean and to alloy such
hire who does not poaaeaa a hCcnse,provided that the ownw, dual for
DEFINiTONOB1H0NW* IER . �)
wch there) any:pe<eel.of land which ha As resides or intends to reddq on
or is mtedea to be,a one Or two hz*dw
stuctmres accessory to such use and/a&m eWng' wed°r detached
than one home in a two year period shall not dar d�� oconstructs more
"homeoweea"shall submit to the homeowner. die
Official, that he/she be 1�6 Official,on s form acceptable to the Building
Permit. nsponalble for all such work performed under the Building
The undavigned"homeowner"assumes responsibility for compliance
with the State
Building Code and other applicable by-laws and regulationa.
The undaaigned"homeowner certifies that he/she undastarda the City of Salem
Building art minimum inspection procedures sad required
WIMU comply with said pruccaunsutrem dshe
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
fl011�OWNE1t8 EXLMITfONi
.. wnar p `"O t for which a Buildi9 permit u
The Code SUM that Any Home* of this section(Sects 109.1.1 -L.icenaini
id
required shalt be exempt t�the PCWA W a a)for hire to
of CoastzuckonS A-) r � a I upwmw. Pam(
are uoawara that they are" u nk*me
Many. Houaeownms wbo use this axa�on, RUIN fw Lkeoani
ilities of a S Supavim% eet•'�(we 1 leak of awstcOm 060 results m serious
In this case your
Co on S when the Homeownw hose uahce<�ad as licensed
per 'P� ��° �s unlicensed personas it arould
SuPmvisae; 1 mwwoar achni as !'�sa i4 bla
To ensure that the Homeowner is �y aware of bia4lw many certiFy that
a part of the Permit Appli�� �e HOm is a
cowtnuni4ea m4 �mpoopib him of a SupeMaor. th0� ° sv�a
belshe una You may care to amend a�
form cutrentiY used by eeveel towns.
fonnlcatiScsttoA.f�,11°°vs Y01w commmity. ^ •
,AO