11 ORLEANS AVE - BUILDING INSPECTIONI
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101s" MISMfllfifiA O AVMVED BY T44E
HAPMD PROR TDA.1B16ff ASM GRANTED
CITY OF_SALEM
No. -11-70,6
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BU LDING PERWT APPLICATION FOR:
pupa Ia
(Circa wlw"m amv) Roof. Raroof. Wasm hiding. C ama Dock shad. Pool
RepaidR.p o.. 01rr:
PLEA"FILL our LiLI WLY&COYPLLWLY TO AVOID DELAYS IN PROCESWa
TO THE INIAPECTOR OF RUL DINGS:
The LvidenLiplad
hereby appliaa for a Wm to bWW according to she Io"WQ
Address& Phone d l 19 ) 7
Amhkada Name
Address t Phone j
mecwnica NOW
Address A Phone
VAN in m pupon d
Lw■w or eurarMt r s werrq,for now wny rrsany
am kAfts mom a lour s.n..e■�
00 0 o Cly Lbws. N A mob Llouw o*at
,
ppwcant
ER TW PENALTY
OUCKPIM OF TO BE OWE
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of AWAGd
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CITY OR SALEMO MASSACHUSETTS
! • PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STRcaT. 7Ro FLOOR
SALE11. MASSACNUaaTTE 01970
TELE►NowE: a7W748.969s EAT. 880-
FAX. 876-740•at4t
HOINEOW n umsz$XEMM0N
Plana Print.
Job Location e
Heola QMna Addteea. 1 V1
FIam!O�TelaphogF _ � _O
Pre�otMa�gA�,._ r�rrY)�
7b0 old aefptlerl o["Kamaaar was eraanded tc iWludo owed
dhills HnPwho O I"UAW
a leas and to Wbw a aWp as individual for
s M poeret a Hcanear provided theta ft a avp�viaor.
DEFINITION OH I OW .�
w (a)b alvna a piaiea�.othmd asp w1dc�hdihe ra+�o or intends to Md4 as
�► interda¢to b%a ow a taro&Wly da,�i ett cW or detached shuchm swesemy 10 vxb nee and/or&M stench mm
then one haft in a taro yea period ehslltint bo
submit to the Building Oft4 ao a form scuptable to the Building
pamitngwm'ble for all such wort performed under the Building
The IM&Nsigned"homeowme=Me responsibility fa compliance with the State
Building Code and other applicable by-laws and Mpladong
wldin pW` wmwwnw"certitla that WAG undmtande the City of Salem
g Dapnerr<minimum ina{lactian procedure and
requiremanp and that hNshe
will comply with said procedure w maOte.
HOMEOWNERS SIGNATURE
APPROVAL OF BUII.DING INS CTOR
See other side for state code
� -�r�d►�tt�E7Q�'�
which a ByiWit Pam is
11W Cam SUM that "Any Haaneo"i+aat (S�1pg.l.l —Liceos�
be aacmnPt$ok�vtd�ed�Aomaoaroer m� for hua do
f wogtonwd�W& �ba11 ad as Swat
whWHOUWpwrnats who ma this eotaaKew" and Re��ms tm
a of a S �lA��O( ofiM ter dd c Sodom
dlYO
Cco ��, � lam, In dds cane y
w�da HomeI*wM . .:
paobloa>�P 'rn::, dis reesss as d world wi$a i
Board
acdog al
dwe SMY
H is tldly aware of caedh dnt
To aaaare the of dw Parmit App
the
commv a ° a,t S of s Sypw'a°t 4n and adopt auch+ a
lmfabr used ty �, you may caae toyour
amend
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