55 PERKINS ST - BUILDING INSPECTION pL-"*SidWT qE flt£� 11PPROVEfl BY 744E
JdSI'FCILIA PNOB TD.A.PEMT BEING GRANTED
CITY OF SALEM
No. Date 6
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Is Propel Uxam h Location of
VW Historic Dwte4? Ye6 No?� Building S S (2f Q!c 1,3 Cr-
is Propwty Located in
Ufa CorgerAgon Awa9 Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Ins ding, Construct Deck, Shed, Pool,
Repair/Repia ther:
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 S S PL?K:: )-c-- S (91 �- yu Y Y
Architect's Name
Address & Phone f i
Mechanics Name
Address & Phone / f
who is the purpose of bWidbtp?
Matwfai of beam ? --t>C7 r Gl- n a two",for how many families? Oti`r—
ww twom mdorm to law? `(yS Asbestos? K O
Es*mM cost 1(9,(90 0 City UWW r N
v eeamt k tatsrd anse s
Bma Iapro
Lie. rr ae ture of Applicant
SK:RD UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
/
IIiE9Lh-c-" (-A'e S` W 1 -2i
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is Mpncc' 1D&5-)LA-epytk Ox ;f s� fi-e.'L) _
MAIL PERMIT TO: S S U LAC i pc5 4�„ 5 A c cost )t, 4 t 4 7 0
No.
APPLICATION FOR
PERWT TO
��F�{.oc. e2E.P,�+,cs, Fh�•am,✓
t91 cS�EP��LG ✓�aa �_
LOCATION.
emll
PERMIT GRANTED
dAtC-
APP OVfD
,c
rpTOR OF BU INGS
CITY OR SALSMv MASSACHUStTTS
PUBLIC PROP[RTY OKPARTM[NT
120 WAS"'NOTOM STM66T. 3110 FLOON
SALEM. MASSACMYStTT9 01970
TSLSPMONN: 979.749-9999 9". 39O
FAX: 979-740-9"9
Salem Bull In.n...4.e.e....*
Debris DkROW 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:
(Location of Facility)S t-?,
Si of licant
Date
/. CITY OF SALEM, MASSACHusuTTs
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STR[tT 3no FLOOR
SALKN. MASZACNUS" 01070
T[L[►NONt: 97L71S-G89a Off. 360 _.. FAR: 97e-740.9846
HOMEOWNER U
fEN3E EXEMPTION
Plena Plant
Dees K v
Job Locatim S sar ,�
H�oz --�
� A�UORS � PCwk . LDS 4'r SAC.S� d Q
���eQIPd�O�"Hemleillaer��{�e�temOd t01rlClleda OiYp{E-epy�Od
hire who does not or]esa end to allow t h engage an individual for
Pow dwellings of tww LWO a licerese,Provided that se
supemsa
DEFINITION OP.HO11fEpyVrl M
Pw1Q0(elaho aw*apmoel.of Lndos which hdahe
which dears k er is bteodad to be,a out a two As W, or�to recuk att
structure accessory to such use and/or 8rm ems'20whW a detached
then one home in a two yew Period r m A P�who m
"homeowner"shW submit to the Building Ofiicial�on a�a�0 m6le. such
Official,deaf he/she be responoble for all such Wort[ ale to the Building
Permit. performed under the Building
The undersigned eownd'assumes n~lpomrmhty for wmptisna with gee Stets
Building Code and other applicable by-laws and r pWionL
The undersigned lwmeOwne"certifies that he/she understands Building Department minimum i tion the City of Salem
will comply with said proc and �trirealrnta aad that he/she
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
SoMZOWNE
wmt Which a Buitdint Permit is
state the "Any Home, Z.�AWMU ofgeeefon 109.1.1 —Lisa wnt
toplIld ahslt be a�camO� eoarmar mtarl a Parson(`) Wm to
1Coaattncaon swu wade,�g k ,h,�at as gam •
S ' *A&gywe
N[saY Rom wha use thin Gm Men , Q.hate and Regulations fW I.kgm t
°igyq�eCvior, 3ectiupwiisor oa 2.t �iceised ne,
I,dds cam YOut
pmpeulsrl7f n it would wi&a licensed
Board�cm, sot 0d'gat°at ,s a�avis�oc
g��, The Hmna°'°w°er • . i� `
'tics„n�►Y
To ensure that the Homeowaac is�Y �e of the RD��col"@wt
eOynnunitt0e z a PWt of the Permit App . Qn fp]sd Pate otthts issue
is a
the rwpo of a Supah mend and adopt s a
WOW
by reveael toxins. Yea may cats
farml 8or use m your tY•
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