94 NORTH ST - BUILDING INSPECTION �I ° O
-IaL-A ISili WT'9E fjilg-E '!D APPROVED $Y T+IE
I1 P�CJ.LpR ,PWDR TD A.P1E113WT srtNG GRANTED
CITY OF SALEM 3 a
Noo
�/��//pp� ��� Date
No.22z__Z r
Location of
Is Property Located In No B„Uding / N
the Historic District? Yes
Is Property Located in
the Conservation Area? Yes_No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Poo,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY &COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owners Name �* �
Address & Phone
Architect's Name
( a -
Address & Phone
Mechanics Name
I 1
Address & Phone Q
What Is the purpose of building? \e
(•tl o o� II a dwelling,for how many families?
Material of building?
will builrbng conform to law? � 5 Asbestos? V
Estimated cost o:2
060 °= COY License r N A State Li
Herne impravement
�. x S ture of Applicant
SI ED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE \
Cep
MAIL PERMI
T TO:
I
No.
APPLICATION FOR
/n PERMIT TO
LOCATION
PERMIT GRANTED
1�3/0 �$
AP OV D
INSPECT. OF BUILDINGS
r
CITY OF SALE1010, MASSACHUSETTS
W PUBLIC PROPERTY pBPARTMENT
120 WASHINGTON STREET, 3R0 FLOOR
SAL1'M, MASSACMUs" 01e70
TEL[►MONt: e7e-745.9993 EXT. Sep
FAIL: e7e-740•ee4e
HOINEOWM'JMSE EXEMPTION
Phtase Punt.
Date - . v3 0 �.
Job Location o gx� Sfi-� 5 �
The currant eampdm of"Homeowne re was mctpoded to iachrde owneFoocupied
dwellings of two-Uai�s Of Lela mod to allow suck hire who does not posses; Ikea a ;',provided that the owner 8n for
DEFINITION OF,,HOlt�pq .'
wath e orns� on�dcb he/she resides or intends to maids on
Or is tended to boo a one or two family
ucduroa accessory to such use and/or f tm dwellings ti or detacbed
than one bane in a two yar period shall not A Perms who more
"lmmeow W shall submit to th e waadaeo a ccMI veer. Such
Official, that he/she be Building for'on a form acceptable to the Building
Permit responnble for all such work paPormed under the Building
The undersigned'%umeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
71*Building undamped"horne�owme certiHa that he/she understands the City of Salem
Depsttrrtent minimum inspection procedures and
mqukm
will comPly with said proceduresTOR
. °�and that he/she
HOMEOWNERS SIGNATURE APPROVAL OF BUILDING IN
See other side for state code
P V
w j pwnQ '*4 wait foe which a Buikft pwmtt is
The Code states that: AnY W "o'f'thi. .dw(gym 109.1.1 -Licensing
required shall be ateanpt$fintheled
�Hoo mwasr eswana Pusan(s) �°to
of Casa swwvnsma Pro"
3itpaMsa•
do soh work and that Such Homeowner shall act as
who use this a c mPdm M nnawaie that they are g the
I capj FIom 2 Rules and gegulatlons far Licauing
ties of a S» ,(800.14 This
hick of awaranea s ofto rmft in serious
Ste,Section n a wauaLira unlicensed Persons' In this case Your
vo
Hoard tea;rdcuWy when�t ualteensad P �s it would
y la
gipe<visoy The Homeow +'
To ensure that the Homeowner is fti11Y aware of his/her e H ies.many �*that
as a pert of the Permit ApP1��oa' Pia
commumtios reg111t0� ties of s$iipaNisa• Qw is a
of this issue
h�j, towns. Yost may cad°to,small and adopt sit a
f�/ gcatioq for fam use in Your ctY•
W vv �
CITY OR SALEM9 MASSACHUSBTTS
• 1.
PUBLIC PROPERTY DEPARTMENT
120 WASNINOTON STREET. 3110 FLOOD
SALEM. MAESACNU3ETT8 01970
STAHLEY J. UEOYICS, JR. TELEPNONI: 978-745-8085 EXT. 380
MATOR FAX: 878-740-se48
�lDf B i dino l�lDB-efn+snl
Debris�Ennce� p..�
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter lH, S 150 A.
The debris will be disposed of in:
(Location of Facility) /Uo 5, a,,
Slgn of Applicant
(o
Date