29 ORCHARD ST - BUILDING INSPECTION (,IC # 3?�
-VL*NS-WMT'BE fiLE�.APPROVED 8Y 774E
,IAI; .ZCIDB ,PWR TD.A.PEAMIT BEING GRANTED
CITY OF SALEM
No.dO '� Date--�
Is Property Located in Location of S OC ry4
the Historic District? yak__No// ba"in8
is Property Located in
to Conservation Area? Yea NO
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Coqstruct Deck, Shed, Pool,
Repair/Replace, Other: �lo4 - j vb
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 t LW �72., �, W 1978)
Archit Name
A & Phone If )
Mac • s Name
Adarest'& Phone 11 f )
What is the Purpose of building?
Material of building? V/ if a dwelling,for how many families?
Will building condomr to law?
Estimated cost 2 SO 0 Cny LICOW r N A State License#
Hama Iapsweraent �A �w�
`' Signature of Applicant
SIGNED UNDER THE PENALTY_
OF PERJURY
DESCRIPTION OF WORK TO BE DONE ++ II
t
MAIL PERMIT TO: Rr`t hW �ric2 v -TO ?�OX 746 s d-Q� VI'141
(0f970
APPLICATION FOR
PERMIT TO
LOCATION.
PERMIT GRANTED
2-0
A ROV�D
INSPECTOR OF BUILDINGS
i
1
I
CITY OF SALEMt MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RO FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
Salem Building Department
Debris Disposal Form
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:
tlon of Facility) �
��
Signature of Applicant
O
Date
CITY OR SiALEMg MASSACHUSETTS
PUBLIC PROPERTY OEPARTMENT
' 120 WASHINGTON STR[tT. ]Ro FLOOR
SALEM. MASSACNUSETTf 01970
TELEPHONE: 978-743-9898 EXT. 3e0
FAX: 87e-740•984e
HOMEOWNER UMSE E MMMON
Please Print
Date 6 0
Job Location 2`j'
Home Owner Addley a 1M D 19'Z O 2 9 O v c,6,j St•Mainel
Owner Telephogr 92 g �,g f -3 l 6 Sf J
Present Mailing Addrau ,
The currsat eaao>ption ol'Z3ombownertr'was.erttended to inchlde Ownet�occupied
dwellings Of tw*Uniss or lea and to allow spry
hire who does not engage an individual for
POaew a license,provided that the ownie as.
DEFINITION OF HOWWMEIt. .
PUWXS)..who.OWM s pmd-Of land on which he/she resides or intends to reside,at which there is or is intended to bq sons or two family dwelling,attsclW or detached structures accessory to such use and/or farm structures. A person who pousoucta mom than one home in s two year period shall not be considered a homeowner. Such
Offiei"hom�vnnw"s that �submit to the Building Ofileial.on a form acceptable to the Building
Permit. be
responsible for all such worm Performed under the Building
The undersigned gned "homeowner"assumlea responsibility for compliance with the State
Building Code and other applicable by-laws and regulation,
The undersigned"homeowner"certifies that he/she wxkratands the City of Salem
Building Department minimum inspection procedures and requiremrnts and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE 5
APPROVAL OF BUILDING INSPECTOR ,
See other side for state code
r
V
NOW
work for which a Builft Permit u
jjbe Code states that "Any
H M P'o�s .(Sedton 109.1.1 —LiceosinS
shall Wm W Supmviaa provided that a Homeowner Capps a pasou(s)-for hire to
ofbonstructim that such Haneowna s1�a11 ad as S •
that they ace aw sinS the
May Hoona°wners who
use ( are
see Rulers and Re�'m for I:icensiei
wlilities of a 3 ,This lack of awaronw OAM molts 1II seci°u•
Coiuft ion s�so s won Z'13� hires unlicmeed persons. in this case your
when the Homeowner a licensed
d d.ud[caoeed Person�' it world jeqombla .
13e Homeoavna acttna as ssOr'o,-- Jz
Supwvi
To ensure that the Homeowner is "aware of h NIM r�on�bilitiea.many
oration,tit the Homeowner certilY
co=u000s m4�as a pact of the Permit App On
the lad P&P of this issue is a
be/" do�p0Wmt0wn s of a Superv�e and adopt such a
form cmcgoused by several towns. 1C� Y rate
fotm/ceNBcs A.foc use in your coomwty.
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