3 OAK ST - BUILDING INSPECTION (4) fL �IlSi'�EfKA84*11i APPROVED BY THE
y�,pF�TjaB PWOR TDA.P.EAYIT BELNR GRANTED
CITY OF_SALEM
Is Ord Laomd in iocatioa of
flea N4bde Oldd d? Yo No_ lalldlaa
Is NoWtV LoaWd In /
ar Caw wwOm Am? Yos No V
BLALDWG PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Root, Retool. Install Sklinp, Con" Dock, Shed. Pool,
RpauNRoplace. OMer:
PLEASE PILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE INSPECTOR OF BUILDING&-
The underaigrwd harsW appals for a permit to build &=xding to the following
Owners, Nwne �1 1 . r - aura o L/
Address& Phew l re o ! h P �7 r (7-2,9 ZYJ
A chkoces Name
Address 3 Phone f
Mechanics Name
Address 3 Phone f
NO a an PAPM a1 WkW r'ejeqznf/s
C
WAWW of Owdtrp9 A fi C, r a dwom,for now many WNW? ?�.
we bAW4 codmm to law? Aw w ? Aj
EOMWAd aw S O� My Lbaw a N A Of Uco •
C7/01 �
XSighabm of M . t
SIGNED UNDER IE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TQ (7
N0 A
APPLICATION FOR
PEWW TO
cr �e2o�o
LOCATION
3 6A SQL,
PERMIT GRANTED
Ne— 1.3 24� D6
AP RovfD
OR OF BUILDINGS
k
1
CITY OR SALSMa MASSACHUSETTS
PUaL1C PROPERTY IMPARTMENT
120 WAS11INGTON STIISST 3ND ILOOA
' SALIM. MASSACNUS" 01570
.. . _ TaL[►Nana: 97&745-e55e EXT. 380 -
_. FAX$ 5741-740-5545
lfomo% m Ucrosz EXEMMON
Plan Pdd.
J
Jab EAcadca
tQ!aoeA'd�Su eg
Asm!Owns.?elsphaq� ,
Pi F Ddai Addeieu,.
lbe cuRaot eaeemptloa a['Rome , !wal.esaanded to iaclud5
d�nRa ownw-occigiot"M Units a las Sod to albw" 01111914111 individu� for
hire who doe not poser m s HcaR peONidOd!loth@Na�
as mvw*isor.
PmSoo(i)<wlto o�rq aa�
WWch&W or is iaaoa to b46d=o wh'*bWAS or iateoda to makk
i4 htWodedto bed a on.of two aftello
soubm accaroey tO mch ua sndtor 8°0d� ' or debaW
than ono ho®e in a two Year Period d Nl not omoownw. Sw* ma's
"balm oee"shop submit to the Buil ft 0fib*an a tbsm
Permit ORICIALthat he/she be resimoble for All such wait Perfumed under the Building
ding
� adeade and other spplieabaj and�ty for Lba with the State
Thy uodeeiSoed`lwmaownd•cwtiaa that hdsht
Buildinmumnqwtiosg uoderneoda the City o
will �PIY Ptacedura� '��and eta and that hW3M
HOMEOWNERS SIGMA
APPROVAL OF BUMD1N INSPECTOR
Sea other side for state code
r
rich
s Bum Pae�u
Homecnwmr p °�wadi fig • a 109.1.1-
,b n e LMO to "��fio°°e°M°e`m�a Pan°°���fa�to
rwpile& SUPWifOO "aee r gin ar.
d ,�,b.e, °0�
do owl waA6
WL&W H BN �g�en,Isw(a.Aov��' of .�aoe�s o�ea r°' b is mdoro
P0°° sedios 11$ In tLis ems•1
,m1i�v�
co °O g, wan.uw I�°ma°°"°°tUna` it.aa fd A*a 50006
� W
boo 'ib '"
;.dilty gwm dbWW mmY ca"Out
Out 0u gomaovin+a amA ucsaaa „ tb'd,pwof* l i,.
To auu� of t�P APV of dds
re�lira ? Os
s
tiu r y yo�md gad doPt auh s
heldM uwdb7 nw
`I�� saws,
CITY OR SALT M, MASSACHUSRTTS
PVSUC rttOr[RTV 09PARTM[NT
1'a %VA"'UGMIG STRUT, Us IL"o
SALUM. MAUUACMUSUTTS OLS70
Ta"PH48144 07*749-SSSS ZXT ]q
PAM 970-740.SS4e
pabrb
In accordance with the provisions of MC>'t.cAO S 31, a condWm of your
HuU tt`Pam*is that the debris S fi7om this wok SW be dispowd
Of in a pcoPedy licensed solid wasWdispood facility,as defined by MCiL
Chapter HL S 150 A.
The debris will be disposed of in:
o '
(Location otPacility) � ��
Sim otAp li t
Date