16 ORNE ST - BUILDING INSPECTION �L�et/SiIAI�Sfi EfjLe 4f/D AfkPROVED BY T44E
,IyS,PECTLIB Pt310A TD.A_PEANUT DEMO GRANTED
CITY OF SALEM
No. `�� Date fiw7P47tdwf30, l00(0
is Property Located in Location of
the Historic District? Yes_No Boil ding /� 02N C SY
is Property Located in
6»Conservation Area? Yes_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
epaidReplac 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 n R nr ST. (176 1 ')Y5 • cr E 35
Architect's Name
Address & Phone f 1
Mechanics Name = N -r- -T�u-rr �k
Address & Phone G S1'flu1�lK6 tLD . Gt aQGi`rawti/ J g981 �3 9.- f 9a 3
Whet is the purpose of building? Si di/am id y
Material of INA&tg? 1asoa7 "a dwelling,for how many families?
ww uAding cordorm to law? ya-5 Asbestos?
Estimated cost $�oo a City License s N �` state Ucopse r
Home Improveant Y
Lic. 0 13,2 a In ignature of Ap
SIGNED UNDE E PE ALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Cvt4V�rz-" kj-rC 0Af `,t'9 A Pdw��2 2oot� �3FY�1iTLadN`t
�nrb �x�,4nf� BN15 l`iaD� iz E �2"1' -1 o OR B�3Hila�7`�1
MAIL PERMIT TO:
No.
APPLICATION FOR
PERMR TO
�G�nfO 1/A-7 2
LOCATION
�S'QcJA�e-
PERMIT GRANTED
AP ROVPD
ECTOR OF BU LDINGS
CITY OF SALSM9 MASSACHUSaTTS
PUBLIC PROPERTY DEPARTMENT
is 120 W"NINGTOM STREET. 340 FLOOR
SALEM. MAS9ACNUSETT9 01970
STANLEY J. U90YICZ, JR. TELEPHONE: 978-745-959S EXT. 380
MAYOR FAX: 978-740.9848
hem B IdinB]k
# Dkog ji'�rm
In accordance with the provisions of MGL c40 S 541 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:
G�a2G�raw � tQancs eP sru (LocadonofFacility) ! dL 6FT1510V �f},
ti .
store of Appliq
_r Rctf /3a � 7 oo 6
Date --
CITY OR SALEMj, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WAS141MGTCN 91TREET. 3110 FLOOD
SALEM. MASSAC14USETTS 01970
TELEPHONE: 978-745-9599 EXr. 380
FAX: 976.740.9646
HOMEOWNER U MSE RUMMON
Please Print.
Date�1ARCN 30 20Q(p
Job Location 16 aOZN ST
Nome Qwper Addrem s 4np
Nome OwnW,
P><ereat Addlma SRr�F -------------
The em"0111 6miption of"Hombownere was extended to include owaRwccupied
dwellings of two.Urrih ae brae and to allow such
hire who dos not ponces a license,provided that the owner = in"an
dal for
DE['A1iTI0 OF HOMEOWNER »'
Person(sj wlto 1M a pat d.of land on which he/she red"Of intends to reside,oa
which thane w Of is intended to ba,a one or two famibr dwellia&allWIW of detached
strucdues accessory to such use MWO'r&M..�dae dp�b�mpuca more
than one bome in a two year period shall not be
"homeowner"shall submit to the dw
Official, that hdabe be Building��'on a form acceptable to the Building
Permit. responsible for all such work perfomred under the Building
The undersigaW "homeownao assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulation.
Building uundersigned"homeowner"certifla that he/she urderstanda the City of Salem
Department minimum inspection procedures and
will comply with said procedures and nirementa n9uimrlena and that he/she
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
ROMEOWNEW L-�MITIOIY
work fx which a Bu wh*Pan*is
The Code states that: "A°y H�neoweier secti�(Section 109.1.1 —Licensing
nquind aha11 be am$Sons the was O*NP a petsm(s)fat h�to
S �Provided that a Homed
of Cmsttuct<mi ovaa shall ad
do such woek.aid that such How
ate imavvare that they see a the
I� W�aowaaA who use this fw Liceorin3
ties of a S (w0 Q'Rules� a raw to in serious
Section 2.151 Thin lack of awara� this case you
Co p� when des Hom wwnm boas .�. Heensed
B°bt p m0 muiau ed t bte.
g�i Hoeneow! actm�a�Asa
To ensure that the Homeownm is awue of hislhat 'bilities.»Y �that
re of the Permit.°►p�ucsdam, - Homeoweiar is a
cpmenueiiti9s nq..
a litiet of a 3upe ., . On the last page o�issue
form cumm*'und by eeriest towns, Ycat maY to imeed and edit
focus/cesh&�On for uee in your commimitY
� `�1plyaos
R