11 POND ST - BUILDING INSPECTION (2) �tllrlRiruii�EfKA0440*OPROVEO BY UK
JURN99=PAM XDAPfJkVff A04 MAN=
CITY OF_SALEM
wopwq,�oo�o ti i.o.ts" Qf i
a Nwaro otal"? VW_.No
L LLti
�r�rMrraMAM? Yw_No
NU LDM PERWT APPNCATM FOR:
Permit tQ
A*ww"m apply) Roof. P."A kwas SkM66 Comma D" Shad. Pool,
�Iaos. Other.
PL"m Rtl OUT L mmy&cammAnLY To Avow DEuvs W PROCEsuAG
TO THE 4APECTOR OF KXDVOGL-
The
booby applies for a permit to build aoo No* to dww following
opoodaim
OWwra Nanw qo A-A) dJ4 r w N
Addoo&$Phalle
AmNleft Now
PAW"s l wan. j
bladwnip Now
Addraas t Pham f
"Nis at pmpm d mm
M"W a k~ r a dwlWq,for hmr achy wm"?
NokdwvGo"=wim? �
�5_aa t►o.a..r N �` uoMw r
S10Nfi THE PENALTY
Ot�PeEniuRr
DESCRWIION OF WORK'fO BE DONE
k"PEAwTt�;
-• � 8 NIO'3� d � � ��
9 7 --/Q Fc.�J
OUNVW up3d
Nouwom
Ol JWVA3d
Vod NOLLYOnddr
CITY OR SiALIE NO MASSACHUttTT!
PUBLIC PROPtRTY D[PARTM[NT
120 WAt11INOTON aTtttT. !to FLOOD
3ALtM, MAttACNUftTTt OIe70
T[L[►NONt: a7e.7�e ease WM. 340 ._. 11At1 e74-740-944e
HOINEOwm LIEusz EmwnON
Plena Frint_
D te ;
Job iLocatieo /
MUMSAddmi.
eftp
The alereat a["Homeownetf�'w+a esteoded to .wed
othve LWO of Iess and to 1111m
re atic� m se victual for
hi who does not Pew s Neeos�peovided that_ samparAm.
DBFIIVIITO�I OB Ii01i[SpWr1B� ,,,
P�(slwho otrq wh apsaeet.o/laodaa!vl>i�hdahe te�idea a intends to
ieh tale Or i4 b intended to be.s as a taw °B
Mck" y to woh mr eod/a 9 of �►dwdb&sfo4 a detached
ehso one bases ins taw year Period acted not der dpomo
"bOmeowaee 5W submit to the Buddies Oft4 on s l6rm
P� that hdahe be neponnble fa sU such work l—rmad uada the Burin`1dlas
BmldlalnIgood'nmm*we a =dor
wmPti mpWiom sow with the State
Thy undereisaed"homeoamer'c tisa thathe/she aodi the City ot3alem
Building Minimum inspection Procedural and mqukmmb and that he/she
will COMPIy with said Pmeedurm nd mqu mae ft
11
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See otha side for state Code
sBmWintPa�u
Cow atatea thaC wc for VA"
"Any HOWSaw°at (ge�tiaa lag.l.l
and did avada Hewes
bag ad 0 SuPwAmw-
doVrAw ����dio
aibo>w tb3s � Ono
�yM�oos itirlieam�M
Romeo ate (of supw� wwww ago nub is wrious
Coca O° whm t�1Zameow� , _ w ould�rid1 a HOWS@&
1 10
is tl�lly Many
swam otbial mN� fly that
To a ! �e.Hameownff a$ of*!,Penis Awlics r �US�ott6ia iawe is a
nuo tto4 tw°tlw t[ea ots Sop Ot cavtomad arch s
behiMtd4 �; Yoa msli
z
Rw
CITI OP SALI9349 MASSACIiYlt; MS
PUSUC PROPUMM oaPA"Mgkl
120 1%%"IMa10M !roam, 2N ftm*
$"ask M+ua�oN+ssR�O1 a7o
TOLSM'"* blf. Tao
PAS 679.74&@"4
Mr
Is a000edmm with the P MVISIOas Of MM a40 S 54 a condi"Of your
Haildlell IPltxmit is drat the debris �. g�� rhos workSW be dbpow d
of is a Paopedy IkM Md SON waft m odapo fAdft as defined by MM
Cbspter lM 91JO A.
MW ,debris ,will be disposed of hu
��`���`� D (tocadatotPacility
Date
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