28 PURITAN RD - BUILDING INSPECTION -x
L.WS j"T.&E fNA94MO APPROVED BY T44E
J�pJ aR pWOR TpA.pEBUff BEING GRANTED
CITY OF SALEM
No. Data
s:
is P► Wty Located in Location of
ttte Historic District? Yet No+�
is Property Located in
0»C monition Area? Ya No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct D , Shed, Pool,
RepaidRepiace, 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
Address & Phone "` L9��j 7Y's —63F6
Architect's Name All,
Address & Phone f
Mechanics Name
Address & Phone
Wtwt is aw puryae Of build' ?
Mewttot d butkWtp7 �vo o�/ �ii s�a dwelling,for raw many famim?
Wit buidkq orm to kw? �Q 7 "? '
Eaftated cost hod CAy L"m e N A stow Umnse e
Rowe Ywprmawent
Sig ure of Ap t
SIGNED UND E PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
G!/J d•e1 /o x rz- s I�za�e shy
MAIL PERMIT TO:
No. 99 O
APPLICATION FOR
PERMIT TO
LOCATION.
PERMIT GRANTED
2.006
APP OVFD
I OR OF BUI NGB
CITY OF SALE149 MASSACHUSKTTS
• PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET. 3RD FLOOR
SALEM. MASSACmUSE1TS 01970
TELSPNON[: 97e-745-9595 [AT. 380_-.
FAX. 978-740.9e4e
Please print.
Data oG
Job Location 2 %f -
HMG QMasrAddtm.
�owwT 2� S
dVb 9 7� T V�s—
Ms�Addresa
110 corset e><=*t=of"Homeownwe was,awn"to Mchwe O
dwellings of two.Units Or leas ad to Sam snch w°0r`OO� ed
hire who does not Pon=a license,Provided� Visor pp an �for
DEFINITI0N OP.K0w0* M
Ptsson(sj.who ojvey a ptaieel.of land oB which hdshe resides or intend tp reside osr
which these i;err is su to
sttvcnrras accessory to an a oni or two&Wly 4 WOftS atWJW a detached
to such dea use and/or Brno art ft" A person who congraft more
than one hone in a two year period shall not be conudeced a homeowner. Sub
"homeowner"shall submit to the Building Offic*on a form
Official,that hdshe be rrapowible for aU such work accepbble to the Building
PeemiL Performed wader the Building
The undersigned"hotmwwe amumee responsibility for cOmPliance with the State
Building Code and other applicable by-laws and regulatioru.
B�goed"homeowner"carti9a that belshe understands the City of Salem
will cog Departrnertt minimum inspection procedurea and requiremmb and that Wdw
mply with said Procedures and requirements.
HOMEOWNERS SIGNATURE r
APPROVAL OF BUILDING INSPECTOR
�i
See other side for state code
r
fl011i1ZOWNlrt�L
fWatPwhich a Buildit Prima is
1be Code slats that " 6roirHoo°° P ssocticn(Secd �109"'1 s, w w
oCcostr+�o°Sw �k 'hatlS"pevsws Pa
o such and that �
are unaware that they go ssa n6ag
MW�eownan wtro use this m Aip 4 Rulm and m fw Lks"ms
jmwpjmbihtiaa of a SuP Swd s002.1 IS*of w,rer�ae o00 raulla i alm Y ua
cones supavis^ bbo unucen a to this cane rout
when the liomao with a heenaed
Pat V aunu sae d wontd 11a
Tbe
is awM of many artily that
60
TO
9q ss ILHanwo�of tha Permit�►P _ the lad pap Ofws iWe is a
tha ihtias Y a amaod sad WOO su4 a
foss eutt�h►need by savant
fondc °d Bor are m
R� `I�Isaos
I _"