24 NORTH ST - BUILDING INSPECTION (2) fLiIMSiM�Sfi-BE f "PROVED BY T44E
JAISP pglpS TDA.PESW WNG GRANTED
CITY OF SALEM
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck. Shed, Poo
RepaidReplace. 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:
r
Owner's Name Cy
9
Address & Phone
Architect's Name
Address & Phone
Mechanics Name
Address & Phone
wnl is nr pWpo.. / ate',U ""`,
�w 7 G✓ooc� n.dwNw+o,for how many remilios4
eonben W law? Aaoauoa?
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ZS•� ame ywrave"t
Lie. — Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT T0:
No. 90
APPLICATION FOR
PERMMT TO
Cilm/l,C' /�'J�ill s£�fe.�7/oid a00.CJ .
LOCATION.
z
PERMIT GRANTED
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AP ROVED
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�MPEQTOR 9P BUILDINGS
CITY OF $ALSMp MASSACHYltTT!
PUSUC PROPKRTV 0SPARTt4gNT
"a WAS"'MOTOM STMXCr, 3ne Roots
!AL[U. MASSM:NUSarrg 01070
TtIEPMONtt 07F74"866 [RT. 300
PAM 070.7/001A!
Debris BMW Form
In aomrdance with the provisions of MGM c4O s 549 a condition of your
Building Permit is that the debris resWdng ff0m this work shall be disposed
Of is a properly licensed solid waste`disposal facility as defined by MGL
Chapter III. s 150 A.
The debris will be disposed of in:
sr 4 (I.ocadon of Facility)_ S7
0 "q,� ,, P /�k-�
Signature of Applicant —
s 2/04(0
Date
j
CITY OR SALgM9, MASSACHUSETTS
PUBLIC PROPMRTY IMPARTMENT
120 WASNINOTON Srnagr 3R0 FLOOR
SALEM. MASSACIIUSXTTS 01970
T[L[PNONt: i7b74S.9399 X". 3@0_FAX: 976-740-994e
HOMEOWNER LIMSZ RXEMP'I'ION
Please Print.
Dan S � ' 6 .
�d,Location z y �l���
Haae QW=Addrer s c4-L.e
Hea4 owwr?elaplso4►�Z�- 7y�/-0711
MsiIkyAddtau
The current�doB ad"Hameownege was,ate0ded b include owndr6
dwellingsa leer and to allow vx&
hffe who does not possess a licesrser Provided that mW�B 41�viduai for
as arperviaor,
DEFINITIQrJ OP HOIIIB S,M -'
Paa(s)w.ho 0W04 a pored-of lead on which he/she rerldea or intends to render
which throe or is inteodad to be. on
a o=or two family
strucp dwelling,auaclipd a degched
nros accenory to such sad/ar Etrne
thu one home in a two year period da not �wnar muse
"homeowner"shW submit to the Building OftA on a ecceptable to die form Building
Offind .that he/she be responsible for all
Pat. such work performed under the Building
Permit
ui �undersigned
cb responsibility Code and other Ircabi � ,WfOr cLOMPlis=with the State
Building�gnW"homeowner"certit3a that he/she understands the City of Salem
hem minimum inspection procedum and du n and that hdshe
will com
ply with said procedures and rrequiremeft
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
cdtm which a Building Pacmtt is
stator that .•My Homeowner pe�g ( 109.1.1 —Lk=SWB
the Code be WAMPt fto the Povwum w mr WSW"a pis)for hue to
shall Homed
that a
Ccaatt s w4om)k P�o" OdMwaar*a ad as S»pac4uw
ace ucawam the theY no �
nj►Homaow�'who use this f, Q.Kula and Re�nlw t Lich
ewe lack of awscmm 'n mlOes
ties of a Supacviaa 2.13} oRaa"In this cane Yo
C S Owmww hiraa= c" Prom'
pcobWI,P�� the rmlicmW P°1M W it worm
Boacd csand Pi'0C°0� ate,`a,a>peM�r4
Srrpecvis The ,�`` . . manY
that H�wtw is MY aware of cectity that
To insure �a pot of the Permit App of this ism is a
�ocruoittoa ro9 tie of a Supocvrser. 4n the last Page
holehe rind�e Yee mall rate
to mod and adopt W&s
�uie in Yoh _
XAO visa zoo Ir
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