52C PICKMAN RD - BUILDING INSPECTION f�li T-BE FIL A AMID APPROVED 8Y 744E
imSpECM8 PWR TOA.PEBWT RE MO GRANTED
CITY OF_SALEM
No. /�67 D,6
is fly Locem in Location of I �
uta WMak Dmdd? Yu Q No ftLuiag C � 1Gm PA
Is Propow Locem In
sm C Amdgon Ana? Yu_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, nstruct Deck, Shed, Pool,
RepaidReplace, 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:
Ownsr's Name n
Address & Phone Ui C V.ag r,, D/73,
Architect's Name
Address & Phone
Mechanics Name K.
Address & Phone ( 1
taaww a bttldlrq? �,a���7/K i I'tv n.awwrw,for t►ow m.ny tamiYrc7
WN ttAWN oodonn to law? AWW Ws? P S
cs
l.sonWad cost � Clgt Lk�tw r N A SIaM Lktarwa r
�/�O� ao.. Lpro.r•.nt � �
X- .
�—� pnature of Applicant
)aV 3s�- SIGNED
UNDER THE PENALTY
URY
DESCRIPTION OF WORK
r,TO BE DONE )J d l
Le VY ume 4 t yi fd la(P 141 O10& o P �� r o'ro l'
MAIL PERMIT
No.
APPLICATION FOR
PEFWr TO
LOCATION
PERMIT
^^GRANTED
APP VfD
INSPECTOR OF BUILDINGS
{
® CITY OF SAL6Mv MASSACHUSUTTS
PUBLIC PROPERTY DEPARTMENT
120 WAsbtiNQTCN 971199T. 340 FLoon
3ALEM. MAssACNUiaTTa 0I970
_. TaL[►MONa: i7�71a.eaaa EXT. 380 -
FAX. 679-740-984S
HOMEOWNER L msz EMMMON
Platy print.
]ob Location �aC C
Hama
gw+me Mdteq cP n ela� d lOMagrT � ,�r�u rlili9 nvo ph0� %7F �G
p� Ad�hesa_ 'vn e
dwel ��o['�lcmeownat>r�'was,extended to inclode ownar.occtrpied
gs ottaa Ua its Q leas and to alloar swi
ao hire who does not ponm a liceoee,P�ded that tlh�i�iei�h �� individual for
_ a supervisor
DEFINMON OHIiCALBOWNBR
pason(s)who oWM a pasrd.af land ere which he/she Mon or intends to makk which these k err is h taodod to be.a oni or two�dw as
seucAtra s<'caaory to arch useand/or i�q p , A 'pmM dOMW or detached
than am home in a two year period Ad not be co idmed who
�°10e0
ORM4 that�aub ial.
mit to the Building Offic on a f� le to the Building
Permit be rwponable for all work performed wader the Building
The undersiguM"homenwne= me$raponedidity fOr compliance with the State
Building Cade and other applicable by-laws and mgatati=
Building u � �" aowner'caUcv that Walls understands the City of Salem
will oo meat minimum i� w tion pedtaes and requirements and that he/she
mPiY with said procedures and
rrequiremeab.
HOMEOWNERS SIGNATURE C/ \
APPROVAL OF BUILDING INSPECTOR
See other side for state code
HO1bR0�•
which s Buttd Petty is
daat
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t ahan beg aorek pgovidiA did& na P°��°°(s)fa h>A 10
fboadmedon a<d duet a m HOmwwnw' ad as Supw4im- mAoI
the
who uw this m m'c°�g�*os ht Lief
MM H00" a (we Appel 4 Rtilw idea rea b 6 mious
es°f geedoa Z.131• �m icau�ed P ODS' �this was your
C0°d` p ularli! ,a„.�it Wmw V. •ed
SuPe� Hoeneo im adiao a 4. - F enrim. many
drat the Romeo is hilly aware of cH that
Tc°o = �Togy�rs,a�,a putt of the Pamir . (M p of this iewe is a
hdalm w you mq ww to amaad and adopt each a
c moo need mr'Qel
form
far ttN is yov;
fosnJ .
r
to
CITY OF $ALZMp MASSACHUSuTT!
PUSUC PROPINTY 08PARTUMT
120 WA"'Ma " STRUT. 300 /LApa
ULW. MAsaamusam atS70
Tal.ap""at 27►74¢6096 a2T. 300
PAM 678•74&""
In u=da= with the visions of M Pro (3L 14.c40 3 a condidon of your
�1 s Pbradt is that the debrL i from this wash sW be disposed in a
Pmpedy Mewed solid wsaWdispold fadlity as defined by Mc3L
C'haptar UL 3150 A.
Mw debris will be disposed of hL
fl-L (U adou of Facility)
3iPM=of Applicant
i� d