9 SAVOY RD - BUILDING INSPECTION (3) I
fLAWlAUWft#%dW4ftD APPROVED GY IM
CITY OF SALEM
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la 14ovwb Laaobd In
: b Caawwaon Am? . YM No
Pannk to: AIULDM PNMNT APPLICATION POR:
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(CkoM MAllol~apply) Roof. Raroof, lnsW 8klrq, Q!W: t Da &ad, Pool,
RNOW"oplaoa, 011lar:
PLEAW M L OUr LAMLY a COMPL.EMY TO AVOID DBAWI N PROCEsfNAD
TO THE INSPECTOR OF BUNAINtWS: '
Tha lrndaralip or' hwft a*ft for a pemk to build a000r ftto tha,foNorrirp .
apaolfloatlorra: -
Ad*m a Phone c� So vo.) >?6 C1£sl 15-7 (o ,io i $'
ArohitaWs Nwma
Addren a Phone ( 1
Mechanics Name
Aditu a Phone
MOMI b lb PAPM i l Nd dW 0 CYYI,9
Mddd a 6viarg4 A a dwtlln9 for law M"brrraM7
MIN 6mft aadam to bw9 tJ�
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a n of Applicant
iftm IMfOER Tw PENALTY'
OP MUM
DescrAP110N OF WORK TO OE DONE
Fiv, Leh base"L'i
MAIL PERMIT TO• S a vc'/ K d S u w
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PUauc PROPERTY DEPARTMENT
r.*�. 120 V"SHJNaM WMZffT. aRD FLDOR
SANK.MA 01 t)70
TSL. (278)748-MOO CR.a!O
FAX tt1711) 7404141"
STANLEYAJ�T(J10VIC7,JI ;; -- ----- --— -
ON
DISPOSAL OF DEBRIS AFFIDAVIT
In amm*mce with tW Povi6 ms of MC$,c 44 M I aclmow*p tWt as a coodioon
Of Ball%g Permit/ .aD debris reodit Bom me comet wb m acd ty
Sowemed by this Bmlft Permit"be diapered of m Is Properly Ho rased solld-waata
digxnd 8oi&y.a deffmad by M(lt,c U.S1St)A.
The debris wM be disposed of at '4 C-:Z D s po s
Location ofFwft
1- J-4 A.c A Ow l it D 4' (U (O . [.( . 0,5—
SrSostme OfParmit App Data
FULLY compkoe iW fDllOWWS Mfom AUM
(PLEASE PRW CLEARLY)
'Pi1-j-w ; c.10—Cre !P✓
Name o0ca mb Apphcost
Firm Name,if=7►
Addren.City&state - — - - ---
The above statute regains that debris fmm the demolition,rmovatiom.rehab or other
sltaadm ofbmldins or ttacbn be disposed in a p mperly-hceased so)i&WWC disposal
facility err del aed by MGL cID.S15Q&and the bl Uft Permits or hceases we to
indicate the bead=of the faalty.
CITY OF SALEM
'• BLWINGDEPARTMENT
liMaOV NER LICENSE EMOMON
plan Pdn
DATE
JOBLOC/►TION G'L SA Von( �cf
. • iloi�a�vr>at � s �Jd�/ �.�
'Iialmo*ftm i s j co
TELEPHM
The ewro-.exam acs cf-no�was aacow w bic>ude eweer-OPWPW ann:o a?Mo
Usin cr less and w albw Loch lomaownaa to CWP on bdlsidaO*g his wbe does sat posaeaa a
Ucicnsr,.pvvidee,mttffie ewsa"aa me virsav6sm
DEFR4TWCFHONEDVnM
Pasco(a)who cm a pwod of WW w wbkb bmwig asides or kmerds to nsidR OR wbkh*an la,or Y .
iruadad to K a am a two bmib dwtMn&aosdad ce deeded arucum aooeesorT tome aadhr
farm str amm A pence wbo comarum mars that me home in a twc-Ym Paiod*4 sot be 000ddasd
a boasowaer. 5ueb-Iwmeowwd' shall aubedt to th Bu�lditod Oaieial,e�� ��fs
Bw'ldind Odrdd.that helsle be taspormbk to all sad►work pafartoed '.
The wrdeniped-bomaowrd sssmm nsparAMW fot wmplin=withtla State Bsild%Code cad
otha appBobk pas bp4nvk Tda sad uV Ando tL
The wdosiped-bomeowncr arti5a"helde wulosurds the Ciiq of sskm Bwwbg Ds�omn�
n=mma insp==pmrsdwes wd rcgA=w m and that blde will WmPIY with acid pmoedaaea ad
icaok=jaa `
HOIMOWNFRB SIGNATURE U" (,
APPROvAL OF B=ING INSPECTOR
Sac other side for feu Code
HOMEOWNER'S EXEMPTI
ox
The mde:Isla*w -wW homeowner perfombS wsdt for wLieb s building paint s:ngobW eirl M
esempt tout the podd m of Ibis section (Brehm 309.3.17-licensing of Countvaioa SoperAwO
provided tbse L a Lomeowrter en�sies p persaa(A)for Line to do.suet srerl4 tbsa sis!homeowner shy net
u wpavi�at:'
MLmy bomeo� ho w me Wit esam�pdoo are i mrwm tbsf they are aeam�the I I NMI eta
rep rvimi. (see Appcodbn Q.Rules and ReguLtiow for I.ioensiMg COOMY10etiert Sger+Aass.Sa Wksm
2.3�. This brie orswar�ess e�Urdu in serious pmbk=s.pardealy wLY°the Loseosraer LIwO
walvensed pcnm Intbht ease yaw Bard earn - proesed agaiva O&muxxmeo PC*=a it 01 via
iletnsed Svpavbwr. Tba bomevwvst:ding as supervb.r(r•htaade�sestow1Y10.
To enwre dam on homeorwacr is Aft saran:of bL%a responeiDNd,96 trotp aomM¢da=Pb%-•PA
of the penal spoiodo4 tint drt homeowner cenify*A bLWW mrdessmrds the n WmsibnMw ats
mpervboG You rmy an to amend and adopt sorb a fvrmk crtlfiesdm Iw Ira he yasr eo�m14.