2 SMITH AVE - BUILDING INSPECTION (3) t _a BY T44
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CITY OR SAL61019, MASSACHUSUTTS
PUBLIC PROPERTY DEPARTMENT
120 WASHI HOTON aTR69T, 3R0 ILOOA
SALEM. MAf{ACHUf[TT>t 0I070
T[L[PHOM[: 978-74s 89S nT. 380
rAx: 97a-740.9No
HOMaOWM'JCV S$XEMPTION
Planer PrFot.
Date
Job Location
80"O"sAdber.
Pretest Ma�A�.,.
n,e cmreot��;,o['Nomaorl,�•�avaodee to iachrde
dwoll�nila of Ewer vAits a leer ad m allow
biro who doaa not poaw a Hea M PMvided f, mtl�as� for
as=pwviaor.
Peraan(a� cw is WMW m laod as yhich hdaha r=wm or intande to maidar as
eura or an a orw a two flmp�d'�i seheb�a detached
>oceewe m aach uae and/or flop
than ono hosaa is 19,two yea paw a d not�det d a bomsopma owwna�'
PA"�eownes"3ha11 rub"m the Btuaft O>;icfal�on a form accepublsBui
W. that hdahe be raponable fa All such wc*Performed under the Building ldinp
H un Ctade m otheroo "aMhya�� complium with dw Stem
repladom
flurldin Depa Umm hWse Imdavm&the City of Saleas
will comply with said pmedurm eta and that hNshe
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTO v�
Sea other side for scam code
wodt 6or which
�g�peemrt u
1b cods states dut: �H aat do POVo of d&seu~clto wpow psesoa(s) o0
do suds crash.and
des sa mp"a,1a(M° o dut that►�
firms who qb Ruw wA>�°Oa .
�spoaab °tom g 11A r� ° ft. Tathi.care Y
aw
oyhm the Hameoe►am . _. �w a lieeosed
sao ! MAW
Homaovnw is , Mw of bisArat� a„aar as"tw
To mozea °� ots Qa for last)W o °is
halaa und9a � - to,Mar„ Yoe au�7►�t°mad ad adapt
fom catY
�egett�Cst
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CITY OF SALEM� MASSACHUSETTS
?I PUBLIC PROPERTY DEPARTMENT
q�M1P16 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380
MAYOR FAX: 978-740-9846
Salem Building Department
Debris Disposal 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 111, S 150 A. /n
The debris will be disposed of in: y
1 (Location of Facility) sC� I A//A
Signature f pplicant
Date