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19 OAK VIEW AVE - BUILDING INSPECTION � 4 V�I*WT.1 Ef+LflriflD APPROVE{) BY T44E wpzcum PFWR TLD A PERMIT BEING GRANTED CITY OF SALEM Date a 3 No. sajy � ^wAT\I'' •� Location of is Property Located In Yes_ NO Y Building 101 111 t-v A vcAuc the Historic District? Is Property Located in yes,No the Consemdon Area? BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof Reroof, Install Siding, Construct Deck, Shed, Pool, epair eplace, 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 Address & Phone ICI ©mot=-�� t��"� ' lag 745 3G-L1L Architect's Name Address & Phone Mechanics Name Address & Phone What Is the Purpose of building? F � T Materiel Of building? W 00'0 If a dwelling, for how many families?�— Nil building conform to law? u C Asbestos? N O �8 O city License# N A state License # Estlmated cost — gone Improvement j Lic. SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE 51DE1,J 1�niT 1�A,— A-Crk MAIL PERMIT T0: 1 No. APPLICATION FOR PERMIT TO LOCATION PERMIT GRANTED APR V�D INSPECTOR BUILDINGS CITY OF SALEMO MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WA[11IN4T0N STR[R, 3RD FLOOR 5AL[M, MAttACH USC"S 01970 T[L[►NON[: 978-74"595 EXT. 380 FAX. 976-740.9846 HOMEOWNER LImsz gXEMMON Pl eae Print. Date 3 . Job Location l 9 o c vc y i e w R vi� Home Owner Address s— &n � HOm4 Owner Telepholp 9 -7 9- S 3 6.a a Prauat Address �R� c, ef'Hameoa'naes'_was at4Med todwe include ownatcccupied P ';Or Ina and to allow sW& engage - individual for biro who does not poaeaa a license,provided that�=_ DEFINMON OB,HOMEOWNEg. : w� owa a paeel.of head as which IW#be resides or intends to raids an bas w or is Wended to be,a one or two family dwelling, wed or detached structures; �arory to ouch use thanonand/or farmstructusek A p�wbo Moro . than one home is a two year period shall not be eotiiidered a homeowner. Snob "110� submit to the Building O>�ial,on s form acceptable to the Building PermitOffi responsible for all such work performed under the Building The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable by-laws and MgnladonL The B !pled"homeowner"certifies!bat heJshe understands the City of Salem will co g Department minimum inspection procedures and mquirements and that lWshe mply with said procedures and requirements, HOMEOWNERS SIGNATURE tom _ e APPROVAL OF BUILDING INSPECTOR See other side for state code Roma WN>fQS F.7�QTIOPi work for which a Building peemn is The Code states that: NAnywonpt�H o Pa6 Sthis�ar(for 109.1.1 1 required"ofCoas ° icalaillll II Su for bite to Provided that a Homeowner e° a paesotti( ) do such work.sad that such Homeoarnm shall act as Se>por o wMVdM aces unaware that they an ash to Many Kohn a ofa who ease (we Q.�w d �I.icewrio mobilities of a 3»peNiw 214 This lack of awatmem oft a reatib in aerlo Supermom ull Section uwicrosed gym, In this case your �� y"When the Homeowners btu aj it would with a liemesed I �. csmmt Mod the unllcrosed perton ',�,�y bla The Homeowners acting as sac>4 '— ia' SupOvesae; , i� To ensure that the Homeowner is �Y aw as of hill w bilitiek m=Y *that of the ApP11 °a �OIIomOO commuaittq require. a . .� Supervisor. On the last page of this issue is a helahe undadaudl We h You may care w=end and adopt such a form cuttmtlZ used by teve�towns form/catt8cadoq forumigyOWcominunity. r CITY OF SALE1019 MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASMINOTON STRtET. 3S0 FLOOR SALEM. MASSACHUSETTS 01970 STANLEY J. USOYIe=, J11. TELEPHONE: 978-749-9393 EXT. 380 MAYOR FAX: 970-740-9844 Salem Buildins�i .�lrtn.onf DDebria Dkmd Form m 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 III, S 150 A. The debris will be disposed of in: 11)L C lk I w (Location of Facility) Signifi re d Apph ant 3 �3 Date