16 PINGREE ST - BUILDING INSPECTION qft*M ffbEM IMD APPROVED BY T44E
W3PFXTOA ,PFUDH TD A.PEMT.B.BWG GRANTED
�� CITY OF SALEM
No.ql~ ..� a�.,rl\ Date U— /
aryl ' ;rl� Ward
Zoning District
Is Property Located in Location of (��.�J
the Historic District? Yes_No_ Building I Q _
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroo In�Siding, Construct Deck, Shed, Pool,
Repair/Replace,
PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING
a
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name ��5
Address & Phone
Architect's Name
Address & Phone e, • (Q (S02S�S /oZ/ _
Mechanics Name
Address & Phone ( )
What is the purpose of building?
Material of building? \)— t �k( (t 11 a dwelling, for how many families?
Will building co form to law? Asbestos?
Estimated cost 6 d ,C City License# State License #
Al P/ UT Home Inrov nt
V V ' V Lic. t ' i f If ok
�^
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TOJ(- i>\n G P &., �-< -4-
�-
t
No,:: V\
APPLICATION FOR
PERMIT TO
Jn
LOCATION
PERMIT GRANTED
19
APP V�D
INSPECTOR F BUILDINGS
i
PUBLIC PROPERTY DEPARTMENT
! 120 WASHINGTON STREET, 3Ro FLOOR
SALEM,MA 01970
TEL (978)745-9595 EnT. 360
FAX (978) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I acknowledge that as a condition
of Building Permit# , all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed soli&waste
disposal facility, as defined by MGL c III,S 150A
The debris will be disposed of at: C \a In r'. P �T r 14�
Location of Facility
Signature of Permit Applicant Da e
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
od\eSynG 2 1 e,m Q
Name of Permit Applicant
Firm Name,if any 44 an
Address,City&State
The above statute requires that debris from the demolition,renovation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
CPIY OF SALEM
BUDZING DEPARTMENT
limmowm LICENSE voonm
Pkau PAS
IOBLOCATION .
ADDIUM
HOMEOW1�l � ` � • ( . .
TIIFPHONS
PRESENP MMUNG ADDRESS
P indlvidtnl euPkd d
WO
Thea., auf bmneowne "was anuded md *ff bie who doe6 m POaM 6
Unlua es ad o alow such bomeowner to cnPV an
Lccaft .providmd dun dam owma ad as O"Tvbw-
DErvgTJW OF HONZOWIM'
Penn(s)who owns a pnl of lend on whleh bclshc raida or d wvc m tcsSde.m dews 4 R 4
interded m bc.a one a two faa3)Y dwclgr46 sasdied of dcadted strtrcnaes scccmq to such tas�dkt
farm structim A pawn who constructs imam rhea one home in a two-year pc6od shall aot be eonsldcm6
a homeowner. Suds`homeow>,te' shaII subtset m the Building Official,on s lore sazpubk w tls
Building Official,that bc/she be nspombk to all salt work paformrd teller the bui ft PD= L
The uadcmiptd"bomeowna-Lw mKs respor�n'biliq tot compliaaec with the State BnDd£ng Code Old
othu applicable goes by-laws,rules sad rmgubficM
The UrAkimped'Domeow•ne arn5a that he/she tmde+s r&the Coy of SSa� > .
nuaimmn inspection procedures and tcq,,iremcras Will that hhhe will eorr�'�
*W&==&
liON1fOW?m'S SIGNATURE
APPROVAL OF BUIIDIIaG 1NSPECTa3t tj�D
Sec other ode for sate code
L
r
HOMEOWNER'S EXEMPTION
The code strata that: 'any hotnaowner perfcnnb4 work for which a bagdh g permit is rcgobed stall be
cxcmpl from the PFV%mons of Ibis action (Section]O dd-Lansing of Constructiots Supawlsoro..
Provided flat is a bomeowtta engaga at pcnw(s)for biro to do.such wadt3 that such bouteowaer shall ttttt
borneowners wbo use Ibis exc +�i ? der der
Marl mptionareunaware>yu arc ite
rupervism(era Appeadh Q,Roks and Regulations for Licensing Coostruatba SoptrdsoM Secd.m
.L24 M lack of swamnesa e� ins l�k�.patio �basneowna titi
unnamed rsoas in Ills case promcd sphat ft Wiccom.ed Palau as k woaid wi&
lioeased Supervisor. TDe Domeowwer swing u tupctvitar is OWNWtelly ttnEoos At
To caum that th t homeowner is!ally aware of bmw r aponsrbMtfa,nmg cutunnaddes tegaiM are
of the permil application,that the homemvna oerofy that behAe undana ds the responsibilhiq are
supervisa You may can to amead and adopt stAk a*mWccnifieatien Im use in your eoamadq.
✓die pimxa�ae¢/.�i ✓Llad�ar/ude�
Board of Building Regulstions and Standards
HOME IMPROVEMENT CONTRACTOR
Regiatmtlon: 141214
lug Expiration: 1122/2006
1. Type: Individual
WALESKA SIERRA
WALESKA SIERRA
14 LEONARD AVE.
LAWRENCE,MA 01641- Administrator