2 RIVERVIEW AVE - BUILDING INSPECTION (2) 14:0M WT�E f UEO-ANO APPROVED BY 'TiiE
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j=P1=DB p,q= TD.A.PEMIT UING GRANTED
CITY OF SALEM
Date
is Property located in Location of
Rw Hwpric Mod? Yea_,No� a..i�a�� Z �JC2d /eve
is Property Located in
the Consenretlon Ares? 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: I/ Q
Owner's Name k/ - //i G � )6, = S
Address & Phone ��(�f�U� P to (C//; L)
Architect's Name �7z? r /Vy do
Address & Phone IV, � 1 V�/� Ir7
Abr'^ mom
Mechanics Name
Address & Phone
What is the purpose of tsrfldlrrp? �?� ? /c7 G,2 G
MaWW a ivadinp? b100 V n a dwelft,for how many lamil s? rf
wo wud m cordorm to law? V-Pf Asbestos? (7
Eatlmsted coat City LIWW a N A State 1Jcense a
1ZS some Isprovement
Lie' Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
o
MAIL PERMIT TO:
No. 4
APPLICATION FOR
PERMIT TO
LOCATION
z K,JEle ✓�C'cJ /�
PERMIT GRANTED
APPROV�D
r2
;'Il ECTOR OF ILDINGS
e
CITY OF SALEM* MASSACHUSETTS
Is
PUBLIC PROPERTY DEPARTMENT
120 WASNINOTOM STREET. 3R0 FLOOR
SALIM. MASSACNUSETTR 01970
STAML V J. USOVICZ, JR. TCLE►HONE: 978•745-9395 W. 3SO
MAYOR FAX: 979-740.9946
Salem Building pemrtment
Debris Dig 1 Form
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
7�� 1PL 7 '°h (Location of Facility) N
Signature of Applicant
V—/d�
Date
CITY OR SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STRSST. 3110 FLOOR
SALMM. MASSACNUSSTTa 01470
TSLEPNONs: 978-745.0545 EXT.. 360. i
FAX:i7e-7409e4e
HOMEOWNER'JC"SL EXEMPTION
phrase pdmt.
na uY
Job Location .w
Home owner AddteN ;� r
H=4 0WnW Telap
Present Malting Ate.:.
The waft uuVdm of"Hombowna a wal.atmdW to iOchrde ownef-occupied
dwellings of hm Units or lees and to allow such homea engage an individual for
hire who dos not possess a license,provided that the assupwAm.
DEFINIT19N OP,HOMOWNEL
Pason(s)..who owm a pacal-of land on which he/she resides or intends to reside,OB
which there is.or is interned to be.a one or two family dwelling, attvJW or detached
structures accessory to such use and/or fmn spy , A p�who mare than one home in s two year period shall not be considered a homeowner. Such
"homeowner"shall submit to Officiai, that he/she be responthe Building Ofilcial,on a form acceptable to the Building
sible for all such work performed under the Building
The undersigned"homeowner"awnes
Building Code and other applicable by-laws MpMon compliance with the State
The undersigned"homeowner"certifies Building Department minimum inapectio that he/she understands the City of Salem
a procedures and regwre�ts and that he/she
will comply with said procedures and requirements,
HOMEOWNERS SIGNATURE
2
APPROVAL OF BUILDING INSPECTOR
See other side for state code
HOMEAWPI��F�— IOl�i
wont for which a BWWin*Permit is
ibe Code states that: "Any Hom°0� �se'd.(S.'d. 109.1.1 -l icalins
rc sha11 be atampt fgm v.��eowner®W a Psi fa him to
of Construd►�Supavtsoe),�o
shall ad as Supa dw.
do rich work sad that such Homeowner
are unaware that they see aaumini the
MW Homes who use this atempdm u awsRule IW Ikermini
yties of a S ( ious
SuPmMsOM Section .1AamIm 4 This of awa sum o� this case Your
Pro
CO ft : weawaa
miliHO cmead a wo�s' it wrould with a Hem's°d blanAw
Boatel ce��,P���eoana actin as.evpa"��._ �
gigtavi•aot, t�",
awaro of hislher bilidaa.many
To ensure that the Homeowner is f dly that
comntum49e�4 +a!a> of the Permit Applicsti� of s isrie is s
oaubilities of a Snpa�t am rich a
he/ehe under sv-eiw towtu yon MAY
cafe to amend adopt
force ty.used by
fmtnlcat►fic for use is your commu>utY ,
r
R� 6I se $00 r