73 PROCTOR ST - BUILDING INSPECTION ieL�A1SiMHST-DE fB£�-APPROVED BY T44E
JAISPFCTAF1 .PWR TD.A.PEWT 9,EWG GRANTED
CITY OF SALEM
No.Z'-�- Date
Is Property Located in Location of
Me Historic District? yak__No BuilLdin6
Is property Located In
the Conservatlon Area? Yes No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(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 '�-W°"'Ae� 'Q ./ Z�+M,o 4r �
Address & Phone 73 L97gi 7S zoz¢
Architect's Name
Address & Phone I
Mechanics Name
Address & Phone
Whet is the purpose of building?
Mdarlal of building? If a dwelling, for how many families?
Will building conform to law? Asbestos?
Estlmated oost i <— City Uoense N N A state License M
umme Isproveant x
U Lie. III igna of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO/� BE DONE 2
P=Ml� .497 05Sl I o K emo jo bornW fAj 1 rJ�- l x 11I nroym ..
N-4jei ��A,-4 arµ�v 4,JJ AJdd 2"id BA- e00M
n
MAIL PERMIT TO-
No.
APPLICATION FOR
PERMIT TO n
LOCATION C/
PERMIT GRANTED
o 20
APP OV D
INSPECTOR10F BUILDINGS
CITY OF SALE149 MASSACHUSETTS
J PUBLIC PROPERTY DKPARTMENT
120 WASNINOTON STR[[T. 300 FLOOR
SAL[M. MASSACNUS[TTS ot970
T[L[rNON[: 978-745-9599 EXT. 980
FAX: 978-740-9844
HOMEORtNU LIfEN3E EXEMPTION
Phms Print.
Dass 3 36- o4
JobLocsticu---73 / rB err s �A err
1Q .w If-aG d!�
Ow=lerepna q78 7�s 2oz�{ e"
Pee�ent Mailing Addma .773 o
The current examoon of"Homeownar was.CdWA ed to iacludeowner-occupied
dwellings of tam 1124%err Ices and to allow
hire who don not posam a such,httr00�en8 an individual for
v�0.provided that the owriet� as fir,
D$FII QNOB,HOMEOWNER,. _
Peraon(aj,.who 01=a psreel.of land on which he/she reaidn Ear intends to reads,on
which sham iti aria intended to beR a one or two famine dwelhng, d or detached
stnvctlun accessory to such use=&Or&M s{ ucpuy, A 1m=who congouct more
than one home in a two year Period Shall not be c�eidaW a homeowner. Such
"homeowner'Shall Submit to the Building Ofcial,on a form acceptable to the Building
Official, thit he/she be responsible for all Such work performed under the Building
Peewit.
mlding Cignaode and other"eapplicables responsibility for compliance with the State
regulations.
The undersigned"homeowner"cerdfi=that hdsbs understands the City of Salem
Building Depafte rg minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirem
HOMEOWNERS SIGNA
APPROVAL OF BUILDING INSPECTOR
Sot other side for state code
flOMB WNM FJ�rV OII
for which a Building Permit is
the "Any Homeow Pg Section 1p9.1.1 -Licensing
Code states of this sects
ro0g xed shall be WOmPt 5om the pm� s)for biro to
Ste);provided that a Homeowner mgsgro a p�
domo �and that such Homeownw sa Supav .
unaware that they am a inning do
?deny Hownas who uas this mwpdw ltulro ,fw lk mpg
ties of a 3 (9m pppmdx b�cic'of awarooeas AM resu b in anions
Sir,Section 2.14 T� udcrosed pas0nf' In this case your
Constn whan the Homeowner hires
"against the timHeanaed patina it aravld with a bNc ed
as nst
Sy ,The Homeowner acting )
aware of hisl6ar rbilitiea many
To ensure that the Homeowner is flillY brain tha Homeownro that
c n hq require, w a part of the permit App ' ,.do p of this issue is a
the respons'bilities of aSupervisor• orb a
4n
bol
by seveeal towns. Ywt mal►cat°to amaad and adopt
ftm
form/ca8 °�fa use m your comity,
Rw 6I Sol sae r