239 NORTH ST - BUILDING INSPECTIONr
-PL t 4SiN T-9Ef4Lf� APPROVED BY 744E
jU5p,ECIDA PfWfl TD A PEMT BEING GRANTED
CI
TY OF SALEM
No. �r�-�`" Date 3 D
is Property Located in Location of
the Historic District? Yak_No_ fftillAiB
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, 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 -DxwlrL Al S')L
Address & Phone .L 3 g 4✓e ?77l4 S t &71) 7 y`/- q 6 t! 3
Architect's Name
Address & Phone f
Mechanics Name
Address & Phone
What is the purpose of Iwiiding?
MWO of buNding? If a dwaWng, for how many farnMes?
WIti buUding conform to law? Asbestos?
Eaftated cost 5_10W .pry City Licenser N A _State License r
i Hasa Isprov=-nt f
Lie.
l ignatur of Apolicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
1
No.
APPLICATION FOR
PERMIT TO
LOCATION.
PERMIT GRANTED
30 2.0 o �
APP OVFD
S ECTOR OF BUILDINGS
h
r
CITY OF SALEMp MASSACHUSETTS
i'
PUBLIC PROPERTy DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SAL[M. MASSACHUS[7T[ 01970
T[L[►NON[: 978-745-9599 EXT. 380
FAX: 978-740.9848
J
HOMEOWNER LIMSE EXEMPTION
Plus Print
D to 4
3 1) .
Job Location
Home OwnerAftm. Ai
Hemp
OWW T
Adder s,n� ------------
1130 current axamption of"Homeowna e-was atooded to include OW=600c*ed
dwellings of twat Uaitr or leas and to allow sgcb Capp an hire who does not possess a keened,provided that the owmet_' dual for
DEFII MON OF Hchiko 1 NElt.
Pason(s):who,ownaparri.ofland whichhdahe
which thaee 14 ar is intended to bo,a one of two fly dw resides�'nteads to reads,
structure �attae W of
to detached acasory such use aed/a tltrm conoucts than one home in a two be A Pam►whomore
yar peaiod shall not be considered a homeowner Such
"h°ma°wned'56811 submit to the Building Official,on a form
Official, that he/she be fr apona'ble for all such work acceptable the Building
Permit pa�ormed under the Building
uilding
The undersigned"homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
B
undersigned"homeowner'certifies that he/she under the City of Salem
g Dapartmant minimum inspection procedures and requirements and that he/she
will co mply with said procedures and requirema"
HOMEOWNERS SIGNATURE Ga
APPROVAL OF BUILDING INSPECTOR t `
Sete other side for state code
t
HOME WNEIIS F.XB�TiON
"Any Homwo Pig work for which a Building Permit is
'11w Code states that:WMO 6onn �vid�of this section(Se>ction 109.1.1 —Licensws
orefquimdC n S �Pfor Wre to
rod thst a Homeoana m8�a P�O�
do Mh wat and that Stich Homeo�shall set as Super{viaar•
are that dtey are assum�g the
M.Homeowners who use this examgstioa an ' f w Uca dog
responOW"u ofS w�2.1 of a�waarr�a Plad otnocw
"case yota
robit ..Partic>alady when6
udicertsed perion a it would with a hcanaad
owd 6 n T�HOm00 Asa 4 dftwtv kspawlw
many
Homeowner is tW1Y aware of hiOM r �tie� wni �*that
To ensure that the Pad of the Permit Application. the Homeownm tsatre is a
cornmumfa9a m4 a iel. >iet♦of a S °0?• 4°the Pam°of this
tualebe�md � bt � Yet may
care to amend and adopt s s
form cture> Y in
use your commmty-,
formlcactiSe:atw
RA Isplyaer