16 RAYMOND RD - BUILDING INSPECTION (2) 'MAVISI WISEfL41940IDAPPROVED8r
JMBPZC=PRW TD A PERMIT BEING GRANTkD
CITY OF SALEM
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Is Plops lly Loatsd ti
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ft 14mom orWdwt? Yes—No
Is P10PON Loalad In
rM Co wmtbn AM? Yak-_No
Permit to: BUILD= PERMIT APPLICATION FOR:
(Clyde whichever apply) Roof, Remd, Install Siding, Construct Dq*. Shed, Pool,
Repair/Replace. Olher L /C 4�1 _J f rsArF+
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCESSWG
TO THE INSPECTOR OF BUILDINGS: '
The underagned hereby applies for a permit to build aoco"iLlg to the followktg
speafloations:
Owner's Name
Address & Phan ( [n a/y 11N LJ (�1 1 r / �� �'�•S - �.3.�7
Architect's Name
Address a Phone
Mechanics Name
Address 6 Phone ((11 ( t
What Is f►r pu m of tarYdk . r r a ✓� r V�r' s r � ) € 14c Z
MalarW a bundrg7 C �c�o,,Lrl n a dwatwp,for how nw.m Rarefies?
We b m q=ft...to law? yr.5 AabsWM? /- cl
F.senatad coat -�-Cx`b . �� dly Lk;taw r altla Llaiw r
�.LC. S � n.vi�. f hn-r• Gv l�fi'
Signature.of Applicant
810NED UNDER TW PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
4
i t �CL B e�2c'�.
r
�c 1 1-I4 v (L
MAIL PERMIT T0:
NO:
APPLICATION FOR
PTO
LOCATION
PE MIT GRANTED
10
APPRO D
INSPECTOR OF BUILBINEW-
PUBLIC PROPERTY DEPARTMENT
120 WASNrNAMN STREET,aRD FLOOR
SALEM,MA C r SF70
TEL (979)74n-Y5E3 nT.360
FAX (9") 740-96"
STANLEY J. USoVNZ, JR..
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accardmoo with the Provisioner of MGL c 406 SK I aclmowledge drat m a cm&dm
of Building Permit S .all debris resulting fiam the constmft m acdvpty
governed by dris Building Permit d M be disposed of in a properly licensed solid wmw
disposal facility,as de$oed by MOL c IIL S1301A.
The debris wr71 be disposed of st C9
Sisutur6 ofPermitApplicaat Dift
(PLEASE PRINT CLEARLY) msoon .
Name ofPermrt Apphoaot
Firm Naa %if any
Address,city&state
MW above Statute requires that debris 5om die demolition,renovation,rrhab or other•
alteration of building or structure be disposed in a properly-licensed Solid-waste disposal
facility as defined by Mtn,ccIII, S130A,and dw building pamits or IieXmereer are to
indicate the location of the facility.
y
C11Y OF SALEM
BUnMINGDEPART1vIM
HOMEOWNM LICENSE F)MO11ON
Pkae PAN
)OBLGCATIAi f Cr, � M i i � +.n
. - � • HOIvjF.OWlii'� J — �AY i'7 �Nr,) �_� ��+��.r-c I'1 �l-
•HOivIEGWi= l - Z`� •3 l
TEIEPUM
PRESENTIdOM.0 ADDRESS �,a A� a
• Ths amor,ouraptioo d9war�ownad'was eatcade6 to bschde eweer�P�.�O�� .
UWw a lei=d a allow such-----woes to erryapa an bdivAw*r bbe who dace mm ponesa E
Ihct..p vvidCd that*B ewass at as apeawlem -
DEFOCTENCFHONFAMAM
Paso(s)who owm a psral d bwd oa whkb bLWa asides a bacsdi 10 mM%Oft'w A these k,w k
bu=AW w be,a one ie ma tunfly dwcMn&attsdad a dcudwd strumu eooeaa710 sae►m WAAK
farm svucu m A pram who comvaeo mole thm ome home in a two-year Polod*a mat be omddw 4
s bomaowaet. 5yey'lwrrssow�e{'shaIIaubrtdt to the BuOdtapmider � 7tit
Bat'ldbt{Odrd4 fiat Wft be tespanabk 10 all so&work pafatmd
The tatdasip w`homeowae osvtrs tsaponstbilipr for eo®Pliatee withths State Bt nft Code sod
otha aWscabk Soce by-kws,raka and Mubdo00.
The mtdasiprd-b=wmvu-artifice thsl hdshe mdasaads the Ciq of Sa as Daft Dgwoma.
minienaro irup.==pracdma and reqiieaecros sad that blobs wig comply wits said Pro O&M sod
HoNT.O NER'S SIGNATURE s • ,�
APPROVAL OF BUILDING WSPECTOR
See otha side for sou code
4,
HOMEOWNER'S EXEMPTION
Tu cc&sakes that; 'wiy hoaKowm i performiq wmk for wrhkb a boD&*permit IS regied,hall M
exc=p fiam tht prorisiom of this secdon (Secttw]Oysd-Uctelttot of Com reclks Sepervitmo
provided that b a homeowma cnMa p pmsoo(s)for Dire to do.such wsst,tbat si cb Dosneowaer skids stilt
u
mm hozae wnm who we this exempdM are in~&the they at assmabs tltt melt
suparbor(see Appeodls Qs Ruks and Repbtbm ter Ltacesbs Ceostrerc"Super deem Secllm
.2.24 M lock of awareness ohm tesnhs lo serf,:problems.panknLr�wiKa*a DoaeA W Dinh
nnikvued persms In tbht ease your Beerd carytol procc d atalrst the mmeemea p mpa as ltwatl0 win
liaased Satpo+isa. TDe Domeowwsr at11a�su superviwr it shisne>e�ssstos}RItV
To ensure that the horaeow uff IS lift,.rats of hybaf respaosiblm"dms,mnrq eommdst ftPbv:as pail
of an permii appikado4 that the homeowna cusify/that bLww mrdosmrda the tesyc"h ilde Its
sttpavbm You may canto aacad cad adopt see!a knuturd mados them 112700 eam®m119-