42 PRINCE ST - BUILDING INSPECTION qPLIk"SIdUST-9E ffLfl APPROVED BY T44E
.IWFXTPA PFWR TD A PERMIT BFMG GRANTED
CITY OF SALEM
No. Date
�' 1 ,fin i:y�1 I ill
Ward
��rrnnvx ' zoning District
Is Property Located In Location of
the Historic District? Yes No_ Building qflg i n
Is Property Located in
the Conservation Area? Yes No
Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, nsta I Sidin Construct Deck, Shed, Pool,
Repair/Replace, ter:
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:n\1-
Owner's Name Q1 r..,f=C3�c�,�
Address & Phone
Architect's Name
Address & Phone
Mechanics Name
Address & Phone /l ZOA!2,4 ��L��Yj— /07/,p
What is the purpose of building?
s
Material of building? VL �—If a dwelling,for how many far,!ftas?
Will building conform to law? Asbestos?
Estimated coW$1 40 0 City Licensee State License a
Home Improvement �, d 6 DDT p
Lic. 1 �Signature
ca nature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE /
J LD,�EI Jam,( r,A; ,M U;,I£��.� ,lLt a[�-�l�i A-,- a"
MAIL PERMIT TO: yj '?zf)C2 S� .
N0�
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
APPROV�D
INSPECTOR OF BUILDINGS
,p.
} PUBLIC PROPERTY DEPARTMENT
f 120 WASHINGTON STREET, 3RD,FLOOR
SALEM,MA O 1970
TEL (978)745-9593 EXT. 360
FAX (976) 740-9846
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
visions of MGL c 40 S34 I acknowledge that as a condition
h1 accordance with the B
Pr'o . .
of Building Permit# , all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-wawa
disposal facility,as defined by MGL c 1%S 150A
The debris will be disposed of st Q,\o Q1�C111 all nIALR �J�
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
IKQAPSY-n CA k��fQ'
Name of Permit Applicant
Firm Name,if any
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 an to
indicate the location of the facility.
CITY OF SALEM
BUIIDING DEPAPTIaiM
HOMEOWNERLICENSEE? OMON
Please PAN
DATE G —I L - 04
.>3m ��rtk� • • •
Tim
pnSETi•I'MAII 1r.G ADDRESS
TAc my=,c=mpdco of Unnowms"was cxtanded m brchAt ow•ocroeen➢kd dwclicgo of Two
Units cr ka nerd to allow ancb bommwnas to engage an fndividual.lm biro wbo dots am pown s
liccme,.prwidcd thm the owner see as supeevinr.
DPFf GTM OF HOMEOWtWL
pctsoa(s)VIVA owns a parcel cf bud on which bchhe msidcs or irucads m reside,op+v10 sch��
intcrded m be,a one w two famfly dwclft sud ed of dctschW stmcnuss $bap not be eoosideted
farm svurnuc+ A person who eonstnxts ttwre than one home inuilding k oa a!�s�bk b*t
a bou,cowna. Such"bomeov>Txf td sffbsubaat to�woorkk afosmed mda drc building Pets.
Building Official,OW bc/shc be wipotur
it
aa»nns rssponsibllity fat C=FIIW a whulm State Bun tg Code and
thTI.tmdoicablepcd oaby-laws roles and=guhlim&
i other applicable goes by-laws,
Tnc tadasigncd =ff)a*m Wshc tmdamnds the Chy of lcm •
minimum itapwuon procedures and tcgtdre ms atd that bhhc will mimpi7
nquiscumm
HOMEOWNER'S SIGNATURE j, ��
APPROVAL OF BMDING INSPECTOR 'f
See orbs sde for start code
i
. . C
HOMEOWNER'S EXEMPTION
The code sutes thaC 'any hoateowncr performing wodt fm which a but7d'mg permit is required sia8 tie
cxempl from the pto+isiQw of Ibis ucdon (Section 30PJa-13aosiog of Construction Supa vbsra
Provided that is a Lomeowiter engaga t+person(s)for b6e to do.sucb work that suet bormwwmq shop�
bomeowma who use Ibis cxs tM ass�ag reVo>�des eta
Man1 mption are wmwate that arc the
supmisvr(sa Appcodla Q.Ruks and Regulatiow for I3ecosing Coostruetiom Snperrbors,Seedat,
.2.14 Tbis bek of ewa amu ollert tcst)u in aetibnt pmbli s pardechiV wbem the bomeowma bbiI
»rJkcnsed pemm In this case yom Board arutot proceed apbst the mttiocnsed person as it would•ft
lieettud Super%isar.7be bomeo++ver scileg as supervbor b nhieut*- r BEo sibit
To ettswe that the hotneomtcr Is hilly aware of lilRr r respoanbiUdes,marry ootnmmddea nqub%as pact
Of the permil eppliadoq that the}wraeowrter scrtify that b&Ww understands the responsibi ld"eta
supertisor You may are to amend wA adopt such a brudemifiotias forme in your counmadW.