72 ORCHARD ST - BUILDING INSPECTION (3) -Pb%"S Mt#SY�BE fi .E9--A D APPROVED BY T44E
MpFCIDB ,PWR TD.A.PEMT B,EWG GRANTED
CITY OF SALEM
No.� ' Date f d
•; s: � r1
Is Properly Located In Location of
the Historic District? Yak_No V fiuildin8 7Z 6&1,962> S
I
is property Located in i
Me Cor% arvatim Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Ro fL.install Siding, Construct Deck, Shed, Pool,
epaidReplace Other: r e ^�^ SQ^0 ,0
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS PRO IN
LI-P 8 "5 `cow
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name 11^^11 1, '/r`I
Address & Phone
1
Architect's Name C,
Address & Phone (.l e 5f-t C"'c ( /.03) `f 6 6 5 -7 -7 a
Mechanics Name 14Y 41 M c-V-c r Q
I I to In (IaLmvc En f7 —oZ9�6 112
Address & Phone
m>r vim,
What is the purpose of building? resde iAc 0
MWWW of brrfldirtgq n q Q , , ,, If a dwelling,for how many families?�;
WW building cordoml to law? C� Asbestos? 1 rl
Estimated coat AV Q6 6 Ctiy License• N A State License A
Raise Laptoverrant !
Lic. ar Si tune of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Qve.bac��l-ivw, roaw�s 3cc� ��t�or ��a�yao��
0 S kS �o w,�f �ss ��o�—Ts4Qlo Cult-
�� cQ< e�ec$r�ccrQ Sc(5�ery zmsl, 4 OC)r tr
Ib rCf c.�4, 'for- 4'g c9 -ib
S v^la'. ., S TO Eo
MAIL PERMIT TO: - tr .. co ti rl 6
1
No.
APPLICATION FOR
PERMIT TO
,Vlloe2-
dA�/l.�ianf. J.r1EET,��s��
._s7C�u6�j3� cor,erd�� �,EvytO 6'.F.fif6E
LOCATION.
7*2—, ojecWwe2) sr
PERMIT GRANTED
APPfIOVFD ,
,:
ECTOR OF UILDI AS
4DCITY OR SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. SRO FLOOR
SALEM. MASSACNUStTTS 01970
STANLEY J. U90VIcz, Jot. TELL►MONt: 978-745-9S9S EXT. 380 _
MAYOR FAX: 978-740-944E
Sete din&�,Knt
Debris Dis _ 1 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 im Sy
(Lrll (Location of Facility) =L)Iy�y
5-7 3- 7 4J�--o a a G \ _
1478 SSG - g6v +
Si cure of Applicant
Date
CITY OF SfALEM9 MASSACHUSETTS
• PUBLIC PROPERTY DEPARTMENT
120 WASMINOTON STREET. SRO FLOOR
SALEM. MASSACMUSETTS 01970
TELE►MONE: 97&718-9399 EXT. 390
FAIL: 970-740.984a
HOMEOWNER UMSE E,XEMMON
Plege Print
Data b Co
Job Location 7
Nome Qwpar Addlam n Q 0 g 2 b
1A 0 Hemq Owner?elepuboga g z� ., y,u �,��� �—.--8�_7 C�
Pte�entMalhOjAddteaa �.: ,,,._ „ n
11M current examptim of"Hmeoww w was,atonded to Include
dwellings of twO.Unils err Ira and to allow such, engo deal for
hire whw does nOt possess a license,Provuded that the owll a!a1lPervjaDt,
DEFINITION OP,HOMEOWNER, -'
Peraon(21.who_owns a pmd-of land oa which,he/she red"or intends to rude,�
hn
which there h6 or is t aW to be6 a one or two family der el>ing, attached or detached structures accasory to such use and/or flora slnwtttm, A person w}m cogotift moro
than one home in a two yew period shall not be coixidered a homeowner Such
O�c t��submit to the Building O>�s on a form accePtable to the Building
Permit. responsible for all such work performed under the Building
The undersigned"homeowner"assumes responsibility for compliance with the S
Building Code and other applicable by-laws and regulations. tate
The undersigned"homeowner"certifies that heJshe undentanda the City of Salem
will co Building Departnent minimum inspection Procedures and requirements and that hWshe comply with said procedures and requirements.
HOMEOWNERS SIGNATURE l _.
APPROVAL OF BUILDING INSPECTOR
See other side for state code
.. fl011flC WNERS F.7�ONI
work fa which a Buildia`Permit u
The Cade states that: "Any P ° i�(Sectiaa 109.1.1`,Irk
of Com�an S���'prO��that a cut*hom tM Po Homeo�°dam a
do such w .k.and that such Homeowner shall act as Supa v"
Many HmaeDvmm wbo use this ",aid Rem
bilidas of a Su WAW(so AP of awatmea ofto rewlb m serious
Sachoa 2.1 S In this case Your
Cow S�°0tf�the Homecwna bum udceo�ed person•
probWm4,PardculadY, ttu nnliemsed Pas°a as d wonid with a licensed
Board camwtPeed aft as is �esponsibht.
Sup 11te
wnar is W[Y aware of hislhat oukfic4 Many
wne cattily that
To enure that the Homeo of the Permit Application. "'"�xom�� �is s
communities require.as a Pd ties of a Supa:visa. �°the last Par of this
towns. You mAY Cate to aaend and adapt aucdt s
fotm/cad&xdcA.fOr by mv
ua°is your commudtY•
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