28 SABLE RD - BUILDING INSPECTION (4) f131111N6lAbST40E fNLf94AD APPROVED BY 744E
JNSPECM8 PRIOR TTI A PERdII'T BEING GRANTED
CITY OF_SALEM /
No,
r\x aye Ward
zw" fAaMq
Is PmPWy Located In Location of
Me HWAft District? Yes NO Building 2 fs SAIaLC R
Is Properly lacelsd In
BN Coneervabon Am? Yes No_
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Root, Siding, Construct Deck, Shed, Pool,
Rep dReplace. er: \.J 11\, o w
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 �1.�L1 E K I R K d'PLES
Address & Phone 28 SAI >Ll= RD (978 ) -716S - 6029
Architect's Name
Address & Phone ( )
Mechanics Name q)ULt'a Hflvn- /
Address & Phone ':�4! Gy-&t-w u,oon S i 07k) 5(ocr -6Wo(v
v.W v{zCESTF h
k , /�
What is the PUMM a1 txdltlinp? i2 FS r F Kr M i4 L
V IWVL
Ma1Wtl 01 bldldirtp? w I W ire u 7 B a dwaWng,for how Itw1y famaes?
we bxdl V conform to law? Asbaetos?
F.atlnratad aW )( (00O CRY Limm a slate LbIm a
sr•a Ialrrovueut
Lic. s LPL Signature of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
'lJ� sT21..c i L'12 c C'-�tJ GI-
MAIL.PERMIT TO: ZL 1.3 ZH 0 r%C-7- b e rF0-r
Z( CO3L�RN 2�
�fJo-s�2O �MA- a)s��
.t.
NO.
APPLICATION FOR
PERNT TO
LOCATION
PERMIT GRANTED
" 7D
AP ovLD
INSPECTOR OFf BUILDINGS
VOm�On�.T�L .•/o.1•m�rIM.Yf�
1Jp. r �e�lr:�t�ssiVal.' i
boo w.Aib.., .%.d
1 eweaw+ &slew. "kw.J.A 02111
c...w.war .
Workers' Compensation Jammaee Aftidavk
. • whit.a prbidpd plies of bash ss an
Qi661-
;,
de Iasi eiry'esedi+ under qss pains and of per}y, Sim
i) i am an wpbywr pravL g workesc.compsmadara coverage fax-a anilo'fnoes +Waking as
tuir
I`r�7�i'2/C*A/ /�omE✓tssGr,�'.4NcC` ap�7vvc29�l9g j�
Insreran" Cowe"a r p "umbwr
1 awn a axis prop.kaw and haw me one working fir ma in MW tapadWe
O 1 am a sale proprlewe general concraeaw or hom low Mr (drde oew)::aud,hw n bind der
comeracton line/ below who-have the fogowkag workvsa compensation pelldaB
Conaraeawr Inmwnis Cormpoftyfr "amim
1
Contraaer insurance ConsPaNY/Poky Number
Coaaseaax Isuuranee CouWasY/Folla Number
O I am a homeowner performing all she work thyself.
t vaewasae"s 4M of ei RMOM ue WE be sec wwove w an Oaks It Imedpaa,e of ow MA tm co+erave•w4Mw we an lie w ssowe
c..map a evowts wow fair ZIA e(WA 152 can 4se Mow bnendw el abW m eawaiw as mdit.f a r.c of•M I.IeaA70 sWer ew
+esq':sa.wmret.vs.dcr scasm'e w.0 farm ds STOP WORK ORDER moo sec s( f if eAc s ON epfamom.
Sirned this a�a Zcsoc/
.icerse�ee canimng Depircn.enc
Licensinr Ecare
Seieamens Office
:�ealth Depar:mer,:
-- -- - - - - - 7-45CC ` g : ' 404 40S, 405, 17S
- �II
PUBLIC PROIntIM D[PARTMaNT 1
120 wAiRIRaRON s Wff >1RD FLOOR
sALaat.MA 0163
TaL, (87B)740->a3>i5 EiT.Sao
Fiat (Y7f) 7IOAlAO
8TANLEY J. U80VIC2. JIL
MAYOR
DIS OM OF DEBRIS AFMAVU
IA wcmdanoe wide the pioviliom ofMM c 401 SKI wjmowlWp that Be a CmWh on
Of Peamit/_ -80 debris=fig Fmm the cmmticsam udvjly
governed by dds'BnUft Pemik dafl be&Pmd of is A*PalY Hoemod sA&waate
diepoaal faw'lity,a defined by WX c UL 81501A.
The ddaia'WM be ftoeed of at 3�S �?�2xz7VGu�rjZ� i
Location of PaoiLty ZtJ a�C�STD��yf,¢ O�bo
Pe®it App ' Deb
/04(
of
FULLY complete tie knowing bh m mow
OL13ASE PRW CLEARLY)
/ ome7-7
Firm Nam4 if any
SZ/5
Addteo,city a stele
Mw above statute mgWra that debris fzma the dernolidM f"Witick mhab or other
abandon ofbmlftMuctm be disposed in a Properly-Bc cuW tolid-WmW dirpt W
faLtility M by OL S150A, and the bugding pem its or licenta in to
indicate the location of the Styr.
i