43 PRINCE ST - BUILDING INSPECTION :.
141kIV 1AUSTeE fIL*G4&40 APPROVED By T44E
,IAWFXTIDR PFWR T-0 A.PERMIT B,EWG GRANTED
CITY OF SALEM
Date
Ward
� mns Zoning District
Is Property Located in Location of
the Historic District? Yes_No Building , �Riri
Is Property Located in
the Conservation Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to: I
(Circle whichever apply) Roof, Reroof, Install Siding Construct Deck, Shed, Pool,
Repair/Replace, 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:
Owner's Name P,\n l AUVM.Q M
Address & Phone 154 yy?/_ rre
Architect's Name (�() �f?S(hhQ o-„P f2 Rn
1
Address & Phone L4 .Lpftam- L
Mechanics Name IAOQ/19 kC' /5/PrrG; 4
Address & Phone
What is the purpose of building? ���1�lln 11t�1 n k2k i,)
Material of building? 1--TD1.41 ��_ ��]_ii1�—If a dwelling, for hrnt!:many families? d7
Will building conform to law? Asbestos?
Estimated cos& (�City License ft state License a 5K� • �S'C�y�n
a2 �/ Hone Improvement
J Lic. I )a t /
Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
AL&
C 1
MAIL PERMIT TO: 2.,yL l C P. Li
No.
APPLICATION FOR
PERMIT TO
i
LOCATION
PERMIT GRANTED
- /6 0 `�
APPROVFD
INSPECTOR OF BUILDINGS
PUBLIC PROPERTY DEPARTKENT
120 WASHINGTON STREET, 3RD FLOOR'
rJ'ALEM,MA O 1970
TEL (978)745-9595 EXT.860
FAX (978) 740-9646
STARLEY U. 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
govemed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility,as defined by MGL c III,S150A \\
The debris will be disposed of at: Nn j6 h R,`S F ID E C- a-c�
Location of Facility
Signature of Permit Applicant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Y�IA�I�iG. InIz),(Q
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 clII, S 150A, and the building permits or licenses are to
indicate the location of the facility.
CITY OF SALEM
BUILDING DEPARTMENT
Jj0l ,OWNERL1C.ENSEExEMFT1ON
Pkase 1�
DATE /
JOB LOCATION
ADMM4
TELEPHONE
pRE513N'C MA71,11`iG ADDRESS
homeowvan"was eateoded to include owocs-xurp�dwel0ap dTWO
The avrent cxmpuo°of
Units a kas and � imdiridra!l fa hire who does not poaaes•
limnse,pr. wWcd .
DEFnaTM OF HOBO 1 N IL en wbJch Lc/ahc residrs a iAends to m1de.on wmcb tan 1%of b
Pcrson(s)who owns a Para dwcllinf,minded a dctadrcd tea s�7 to sob=t amdkt
intended w be,a one to two fan3h "eotbe considered
farm sovcnva.A person who construm more thmn one hams in a twa4 Parod
7rf OARFnbn*to the Blinding MJ3da1.on a foam uli table tolls
a bomcouildin ffl Such'lbrJ ft bk to all sad►work pesfotsoed mdet dte pQ�
BuildinS Official.that hclshe be tcspomt .
assevnes b' for ezmpliara a whb$►e State BmD ft Code sad
'llh tmdcsiabk Sacs
by-I st ndes and��
other appyeable goes by-tm.+s. '
The rm knipwd'hovKowro"cotfia that heishe rmdaswrds the a4'of 5 km > .
minimtvo insp=m pmezdma and n qv c=Tas and that WOm wW�pb
rcgrg� «/J
HOTv>E VOIER'S SIGNATURE
APPROVAL OF BUDDING INSPECTOR �!� e
See other side for Sate code
r
1
jmwo"Ews EXEMPTION
The code states that 'any homeowner performing work for which a butldtrtg permit is required stall bt
cxcmpl from the pno%m ms of this sccdOn (Section 20PJa-licensiog of CoDseructioo Supervisor*
Provided that is a Lonreowtter ertgaga s+person(s)for Lire to do.such work,that such Loxneowaa aLfL aeK
as atpaviret'
bomeow mn who use this exe They �i es oft
Mara' mpdoa at imawaic that we the
rapervism(net AppcDdh-Q4 Rules and Regulatiow for licensing Construction Supervisors.SUMM
.2.24 Tbls lack of swwamm ollat resuhs in scTiong problem4 pardcuituV when tits bomeownerbivo
uydkmsed persoac In this can your Board c mtot proceed agairm the tmlioersed pawn as it would wa
licensed Supcnisar. 71Pc LOmeowDer acting as supervis its oldurateb reaEoosPolb
To ensure that the homeowner Is fully swat of hi w respounbIBtl s,massy eotDaDmdd es tRalm-as Post
of the pcm3i spplkadaq that the hornemvrrcr certify that hCWK understands the tspousibiNda eta
sopcnism. You may eat to amend and adopt such a f Wccn fimtkn for use in your coaowsq•