58 PERKINS ST - BUILDING INSPECTION (3) pj:MS.MWTgE f*gE9#N0 APPROVED BY T44E
=PLC= pf31oR TD.A.PERW RING GRANTED
CITY OF SALEM
yl�y o
Is ply Located in Location of (/J ` '
to Historic District? Yak No_ finil+din6 /Q�f— ] �7 2}
is Property Located in
ow Cor~dbn Ares? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof Reroof Install Siding, Construct Deck, Shed, Pool,
RspaidReplace, they:
PLEASE FILL OUT LEGIBLY A 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: rr
Owners Name (o/' L"el I fG°nS
Address & Phone h(e pel)1'10 5
Architect's Name
Address & Phone I 1
Mechanics Name
Address & Phone I 1
What is the purpow of a) WUV? rt'h90te 1 nSe AJIc✓, POW an��nd %Ir
MatuW d bt"V? arywYll� (tl n a dw*&V, for how many famines?
WIN Wk*v cWonn to law? Y6 Asbestos? nnn
Esmoatad cod 3,OV�)p CRY License a N A Slate LlcarrseLie. 0 X ���
s
dome D*rovesmt
C�516� Si slurs of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Remme old P/as�z kom Iaz�/s aR 2 = (1oL
YGi/1S�ic./ �l�✓ ,�/A��ri�/,� d✓�� D1"SIPf
MAIL PERMIT TO:
APPLICATION FOR ;
/y PERNQgTTO
LOCATION
,o
PERMIT GRANTED
PLC Llb 2.0
AP Ol f D
4N0
INSPECT. OF BUILDINGS
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CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINOTON STREET. 3R0 FLOOR
SALEM. MASSACHUgg"S 01970
9TAHLEY J. UaMiCt. JR. TELEPHONE: 978-745-9399 EXT. 380
MATOR FAX: 979-740-9846
Salem Building De --A
Debris Dk2WdZ=
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)
Si 6of
u-
Date
r
CITY OF SALEM0 MASSACHUSETTS
• PUBLIC PROPERTY DEPARTMENT
120 WASNIN9TON STREET. 3RD FLOOR
SALEM. MASSACNUSaTTa 01970
TELErNON E: 976.743-9396 E". 380_.
FAX: 978-740-9646
HOM'"M U Ma EXEMPTION
Pwase Print.
Date l/-2N-off
� JobLocatiOn ��Sl re�'luns S� rr/P/1'! /�% D/C/`IO
Home01vn rAddrm.
HMO 0wnasTeIgphW
Presrent Mailing AeMteta.
The current exemption Ot"Homeownan»was Caen"to include owndr occupied
dwellings Oftwo.Units Or Ion and to allow
hire who does not tt Tow Capp an individual for
poeaees a license,provided that the neu;` as
DEFINITION OF.H0MEOWNES.
Person(sj who owns a pn ed.of land on which hw/abs resides or intends to reside,on
which there i/6 Of is intended to bq,a on@ or two fatuity dwelling,athwhild or detached structures accessory to such use and/or Enna . A person who conepveb more
than one home in a two year period shell not be coiuidavd a homeownw Such
"bomeowner"Shan submit to the Building 0l8ciai,on It form acceptable to the Buddin
Official, that he/she be responsible for all such work performed under the Building g
Permit
The undersigned"homeowner"amuncs responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned"homeowner"certifies that heVerbs understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and re quire mentL
HOMEOWNERS SIGNATURE 4' 1 L
APPROVAL OF BUILDING INSPECTOR 6,-�o
See other side for state code
aol�owrrERs���ort
The Code slaw that Any Homeowner
ow„ Pairm'ng work for which a Buikbg Permit is
of this section(Section 109.1.1 -Liemb*
required eh4 be exempt ftm =,wna env*0l a pasou(s)6x hue to
Of Construction Supavt ich om shall ad as Supavisa•
vided did a
do such work,and that such Homeowner
Homeowners who use this exemption an sae that they we a mming the
� as� for Licettt>i�
eapjM. ties of a Supavisos(see SectionA R l.14 This lack Of w refW in serious
Cow S omeowoer hits unl crow persons. Your
die Iagainst mod
the udicrosed Parson°s it w°»>d a"
thtfica
SupeMS H�eowtur acdnR ssfh�slhac � bilitias.many
To ensure that the Homeowner is hilly swatthat
commuoit q m4 &Put of the Permit Apylicatian �is a
ties of a Supavisa. &a lid pqP of
he/she uncle form � You MAY care to amend and adopt s�s
q for use in coommuitY.,,
R�✓ G I I sows*
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