4 PETER RD - BUILDING INSPECTION VWMS1WSi'�EiNMrMiD ApPiwVED BY IWE
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CITY OF_SALEM
laost"m Of
YwNow OWolt� Yeo_No_ 1 uuw �PT2d
to t+oowiv 1000wd In
WA OWMfA orr MA Yoh N0_
BWLDMdti PERWT APPLICATION FOR:
Permit I=
(Coda wfriohawr apply) P&W RWoA Ing"404)COmma Dock SMwd. Pod,
PL""FILL GIR LE MLY A COYPIA WILY TO AVOW DELAYS W PROCESU46
TO THE 446PWTOR OF BW DINOS:
The hereby appow for a Pam* b b" acme rp to oho talkft"
ONW&Nama
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SIGNED UNDER THE PENALTY
DESCRIPTION OF WORK TO BE DONE OF PEIIV W
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CITY OR SAL9349 MAssACHUSVms
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Dahs�a Dfseesal•e� +
bs accmdance with the psovidoas Of MM c40 3 A a cmd1dom otyeae
Building Pbrmit Is that the ddbda 3 doss dde wa t shall be&posed
o[is a peopedy lieeased SON wasos facMy as defiNA by MM
Chapter IM 3ISO A.
Mw debris will be disposed at bo
s__(Locadoo a(Fa ility)
3ipaatnraotA plk
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Date
CITY OF SALSMg MASSACHUSETTS
PUBLIC pROptRTy ptPARTM[NT
120 WASHINOTON STRttT, 3t0 FLOOR
SALEM. MASSACHija Ts OI*70
TtttrNogt: "S-745-9698 Off. !q
FARI 978-740-9e4e
HOMEOvmn Uc=8z RxKMM0,q
PUMP"
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Jab I ocatiaa 41 2 t er
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11
OMa�rTelaphoge-97s v,5 �� 7a
Ptereat AddalsA ,• „ s
of
darol>�nBs ot'twa UAdW Of lsss Bud to allow apcb
hue who doss not possess A!tans%P�dad that mop an mdlvidual� far
. :.. .. as Blpaeviaor.
DBFIIViTION OH WiVBJ: J
P�(aI�vho olva/•paloel a[hasd aai rhicb hda6a maiden W a intends tohich three k ar i.T "MM to be.a aoi a two �on
s"com accawry to Blob use imd/ar AM who con o detached
than am home is A two year Palod shut act be mvidaed����
"homeowna r Shan submit to the Btnlft Oak*on a!byes acceptsb1a
P dw
OfffeK "he/she be responsible for all Such wort l�mad underthe B Building
The 1111 znad
"homeownes"assumes responsibility�
DWI&$Cade and other applicable by:lawa aad comPhanw with the Stste
re:3uladons,
T!v undersigned'homeownee carilles that'WA4
Bud&S D minimum i �dastaods the City of Salem
W ID eompfy with Said Pmeadurss •ref wA eta sad that he/She
iremeft
HOMEOWNERS SICNATURB
APPROVAL OF WELDING INSPECTOR �
See other Side for state cod@
1
via& whiob s BU*bg Peed u
SUM dot «may Ha°°°OiMOeram ofd&, ( 109.1.1`,
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do Ma W0916 Wd&A mgwwo the tbA7l WO mfoodogt�
wd fw his iaeb�
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adh*
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Too the th° 35 s go of tho Pamit APPic�tiw Wt pop of NO�°is
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hddr � ��Yaau4►�+oos��s�
fond a ',�O ,usedby�Cs tAyQw oo •,• . , .
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