10 PEARL ST - BUILDING INSPECTION (2) �l>1lNS1M1�S -BE fiLfi 4*10 APPROVED BY T44E
JNSPEC=,PP" TD A.PEWIT DEMO GRANTED
CITY OF SALEM
Date' A _
No.res
s:
Is Property Located h Location of
to HWorlc Dlstdct? Yes No Z �8
Ia Property Located in
Bre Cormervadon Area? Yes No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Rero Install Sldin Construct Deck, Shed, �:col,
Repair/Repiace, 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
spectfications:
Owner's Name �� �' • ��`
Address & Phone CNC\L(S ):5�0
Architect's Name ���
Address & Phone L
Mechanics Name
Address & Phone
What Is the pwpose of WON? �1-'
MEN"of buYdlrq? Ll tz� It a dwe",for how many tarns?
WIN WkKrq conform to law? I Asbestos?
EMmatad coat CAY ucerae a N A state LW"tt
ate Ymprovaaant r'i`' _Signature of Applicant `c
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
x"
MAIL PERMIT TO:
APPLICATION FOR
PERMR TO
LOCATION.
PERMIT GRANTED
2.0
APP OVfD
INSPECT OF BUI INGS
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CITY OF SALEM, MASSACHUSETTS
• PUBLIC PROPERTY DEPARTMENT
120 WASHINOTON STR[R 300 FLOOR
SALtM. MASSACNUS" 01970
TELK►NONII: 97e-743•9e99 E". 380.
FAX:-97e-740-ae4e
ROMEOWM umsa EMMMON
Plew Print
Date l�S
Job Location r.) ,r
HM=QwnerAdrineaa. p
HomeOWWTdvhw
Mom :.
--------------
The cunreot ciaraption of"Homeownere»was atmded to include
dwellings of tw*UJd%or lees and to allow sub owner-OoCyp1ed
hire who doe+not possess a license,provided dud M"an individual for
DEFINITION OB 80[1�AWIVEB: �'
Person(+1 who okra a pateel.of land which hdahe
which there i4 or is uuertded to r0ald0+a intends to reAk
b%a one or two family dwOftL d or detached
atructums Or
to such use and/or Iium ague, A PersoB who oorsoucts more
than one home in a two year period shall not be
"homeowner""shall submit to the BuildingiaL on Aed a ho�0table Such
Official, that he/she be �+1.on r form acceptable B the Building
Permit n+Pon+lble for all such wont performed under the Building
The undersigned"homeowner"assume+ 'bill
Building responsibility compliance with the
g Code and o Stste
other applicable by-laws and� rogulations,
Building�uundersigtred"h0meOWW certifies that he/she understands the City of Salem
Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and rrquirerm
entL
HOMEOWNERS SIGNATURE �.
4
APPROVAL OF BUILDING INSPECTOR
See other side for state code
-.... .. . ....xrv-♦1M.vv'Wwrt•Yr/nn�..rvn...rtrrr...r..« r. ...r.. •.e.r - •
HOMEOWN� E�MITION
"Any�eownar Pacfo ° work for which a Building Pandit is
The Code �f�do FQvisiom of this a a l s)�to
oraf uuedC on S�vismt provided that a Romeo
do�work and that rich Homeowner shall ad at Supan!i�
ara that they are i the
ley Homeowners who use this Rules am fw tice�i
ti s of a S (no Isck swarm W malts in serious
�Co Ste,Section 2.1 mo T b �m In this cane your
rly_when tha Homeowner • ae it would with a lica dad
pr°b agpind the udicmaad peraoaieqom l&
Hoard csmwt Pi'H6 '� vigor is
• Super The.
f WOW bilitus.mAnY
wner is fully aware o *that
Homed
To aosure that the "' the Aomaowner
as a part of the Parmit!°►ppttcati�the last page of this issue is a
cotnmum49!m9 of a Super •
helthe and the reepo°s! Yon»Y era to emend and adaptsuch a
form currently uteri by sesroial towns. .
form/cecdScado 4 for Use is YFPW comity
it
RA✓ I S I saw S