4 PURCHASE ST - BUILDING INSPECTION 14ANS11 WT19E fK994A9 APPROVED BY 774E
INSPFC=PWR TO A PERMIT BEING GRANTED
CITY OF_SALEM
No Iab 102 /0 H
WWd
zawq DIEM
Is Ply Laoated in ✓ Location of
the Historic Mild? Yw No Bai7dias q PwRc t S�
Is Ptapnty Located In
Nre Cane vatlon Area? Ym No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, eroof nstall Sidin Construct Deck, Shed, Pool,
Repair er: _W ��ows;caf�rc� ce�l���
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '
The undersigned hereby applies for a permit to build accorchingto the.following
specifications: nn
Owner's Name CA S M W 4-C4
Address & Phone Qwec(t4c sf,- �9 k'A jam) 7N5=88 0 7
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
WirtbNufxMmsamm*W 11 �tstJcx)C£
MWWW of bfrldYtp? 0003 N a dweb for how nmy famba?
WIN bukin9 ca ftn to law? Asbestos? 0
00
Essnl do cost _a2Sa 1)00 CRY Lim"• sum uoiim N If
aewe 1"MW mmt
Lin. fi
S ature of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE 1� /
S£cotij piodZ F}O� t �OnJ ';"J dQ£i0N0y't aA)
MAIL PERMIT TO: i
NO. ���� a�
APPLICATION FOR
PERT T TyyO
LOCATION
PERMIT/GRANTED
(/o 19
AP OVFD
INSPECTOR OF BUILDINGS
PUBLIC PROPEMY DEPARTMENT
120 WASHINOTON STRarT, aRD FLOOR
SALKN,MA 01 S70
i TXL. (878)748-MOB EXT.360
FAX (878) 740-8848
STANI.EY J. USOVKZ, JR.,
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34 I aclmowle*that as a condition
of BuildinS Permit M .all debris resulting fiorn to am bucdm activity
governed by this Building Permit sball be diapered of in a properly ficmwd soli&wssm
disposal facility,as de$Ded by M(3L c Iq S1SOA.
The debris will be of at ,R; dC &M42e f
Location of Facility
g-o z-o
�fPOW of Permit Applica t Data
(PLEASE PRINT CLEARLY)
mfomaahon
Nave ofPeinit Applicant
Firm Name,if any
City&Sto
The above statute regnires that debris 5om the demolition, rmvsft%rehab or other
alteration of building or Anucture be disposed in a properly-licensed solid-waste disposal
facility as defined by MU cID, S1SOA,and the building permits or licenses ere to
indicate the location of the facility.
CITY OF SALEM
BIWING DEPARTMM
HOWZOWNML LICENSE E)MOMON
Please p"
DAB 9-02'Oq
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TELEPHOMB
rnEsarrw►a.n?o ADDRF3f s'�"' � •
The amar.oamptiai d-cameo vnoi'.wat cxteade�to incinae ewoc +vie+dwal"p etTwo
vniu a kg and a albw am%Lomeowaen to cow am bwiyida»l!a bw vm dome sa pones s
came.p vvww*balm owaer'ad es wpa-&m
DErH4TIONOFHOWDOWSM
Pcnom(s)who oww a parcel of kud on wbkb bLWK ToMm a bands to tesida,OR"NA there k,a Is
bunidW w be.a an so nw bmt dw d8n&susdbd a daudwd svnetmes 00mqaJ to sack we wAAw
farm strwwm A penm wbo wrameu abet tMm cm bank ins twoyav period AA"ba wOWhm dl
a bmwowma. Su*l meowad'anal to the BuOdbts OII+dd.o � *s
Bwldbg Oddal,that k Ww ba nspoimbk to all soeb weak p ed ofam
ML
The underaisned`honbvwad'aanmrs teapanstbiBp for camplisna w�tbe Sate 8tdidha:Coded '
otha aMgcabk Sots by-lens,rala aced icpb nL
The mdosip W-Mmwwner"=Ufm thsl Wft mAasandt the Ciq of Saktm Bnildlas Dgwumd.
minitaam ba wdm proadaea ad regtnmmems and iJsbe wm wmpb'with said p000doe d
Te9�
HOMEOWNER'S SIGNATURE
APPROVAL OF BLMMING WSPECfOR
See other sde for saa code
1
HOMEOWNER'S EXEMPTION
The code sous thsC 'mq bomeowm performing 4 *for whkb s boDft Permit Is IM be
cacmo bon t s proddow of this seedoo(seelou 309.3.3-13ccnsims of Coosuvctios►Sapervlaars0
provided this b a bomeow'na cWles a pen=(s)for Um to do.sucb welt,tbut sbd bomeowaa dom so
ae nrpavissa` -
Marq bomewwwIll wbo On this cmmptioo na imawuu that they sn ummmlmg dte s[S _
svpavyor(see Appendle Qe Rules and Regulstiow for Lisle=Coassruetdnt syesvdsem Eo mm
2.3�. M&lads of swamum ,fleausulm in wrier,,problems.palm wbca the`oneoersabbM
Uriieeased penomr. In tbls case your Hand cambt poceed asairst*t mi$eemed pawoo n b aoula V46
liaased Sopenisa. 7tie boweowaer acting as superrisw Y mhTwvle� spw ,
To crime dnt the bcmeowna b Billy aware otMrau responsibWdes,mmrq ao taq&%-n pnt
of an permdi spo adom,that the bcmwwna caNy*A behbe mrdasands tbs tesponebliffim d•
supavkm You mq care to amend and adopt su&s twmakmNsm tlos Jbf ass is ymar eooami4.
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PROTECTrerc er:c s •sib cT To
t:�9ALT+_ST P.ND INSPECTION,FOR COtdPLETE.C'CM,J.
ASC-V'ITH THE FIRE CODE,
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