7 SPRING ST - BUILDING INSPECTION "J%"SiM XT9EfR*B4AD APPROVED BY INE
IWPEC=PWR TD A PERMIT BEING GRANTED
CITY OF SALEM
No.
Ward��
zw" District
Is PMParty LoesOed In / Location of
me Hhtoric DMdcl? Yes No✓ animina ✓iH S
Is Piopoiy LocaMd In
tlN Coibarvatlon Area? Yes No�
Permit to:
BUILDING PERMIT APPUCATION FOR:
(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 aocorcLig.to the,following
specifications:
Owners Name �ame s l,l dod
Address & Phone el 54vinu .5� . ( ►
Architect's Name
Address & Phone ( ►
Mechanics Name _
Address & Phone
WhO is Via purpoaa of buildW 11:N n
mdow of bundYg? U00A !6me n a rl", ,for how many lames? 01
WN a+fo Cal ftn to law? 0 Asbestos? VV1 k m w�
Eatlre tad eoet D,ou a cny Limm« stm ucane..
soma Improvement
Lic. s
SXKature of Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DOVE
SIAS
tmove. Somt lnoh- 6.)t;4d bteo-1 nn IAa11 S
" J
MAIL PERMIT TO: ''� .S_.o rT►�_S �.
NO.
APPLICATION FOR
PERII<T TO
LOCATION
PERMIT GRANTE 19
30
Oct
APgROVFD
/ e
INSPECTOK OF BUILDINGS
• J!
PUBLIC PROPERTY DEPARTMENT
t UT& 120 WASHINGTON 57marr, 3IID FLOoN
4 BALKU,MA 01 B70
TLL. (279)745-9595 EXT.360
FAX (97B) 740-96"
STANLa:Y J. UBOVKZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the PrOviaio»s ofMGL c 40,S34,I aclmowledge that as a coo"m
of Building Permit f .aU debris resulting from the OmMmctlm wbvgy
Scva'ned by this Building Pemrit shall be disposed of in a prapaly licensed solid-waste
disposal facift as defined by M($,c III,S150A.
The debris will be disposed of at D Y Y
Locatim of Facrlty
Sjolkturlb of Permit Appycao< ab
(PLEASE PRW CLEARLY)
I10,mcs. , Inn �
Name ofPamrt Apphamt
Firm Name6 if any
�'DViYIA S�. )/A �2VV1 A
Address,city&State J
The above statute repimes that debris fiom the demolition, rmvsbon,rehab or Other
altastion of bmldmg or stiucnue be disposed m;a pmpaly-licrased solid-waste disposal
facility as Mned by MG,cll1, S 150A, and the building Permits or he mes are to
indicate the location of the facility.
t
CITY OF SALEM
BUnDING DEPARTMW
HOMEOWNER LICENSE MMOMON
Plan Pft
DA 1
JOB LOCATION SOrr ne �+
HOMEOWNER lI
HOMEOWNER /97 73 7
TE EAIo►s
FRESENTIdAII.1TIGAD'DRES!_�I ,�`°Y��� � .
me Cw aa.aanow af'mmtnwgal'wm emnw w Iwbwk ewoar 0 wPkd.d+raltleda s[TIYp
Unto a ka ind o aftw soeb bomeowwas b CWV as bdVWW*ff wm wm daa sat poaaaat•
ltocaafmvided tbatibc away aas d aePervisas:
DE rft4 n0N OF HO1MEC W N=
Person(s)wbo am a peal of land m wbkb bLWit aside a kftu&w Tcd ft CQ wW S then k er k
Guarded w be,a an w nro firmly dwcUb%&aaadud a dcadad uracwes 9000"ay is aeb s SWk
firm swucwm A pass►wbo eomvoets mom Oaa mw home Ina two-yaa peaicd aball am bt towidatd
a boatsowaer. Sods`homeowvef sha>taobndt to the Bu�dind OltdaL tb a lbasp aeta�abls to tla
Bm7dind OlfieAL that uwa be aspomipk to aU mcb wok pafa w d mda tba baudb4 paatk
Tht wdesip w-booteowatd Lamm re 90=tft for compliano wuh tote State Bnft Code r
other appocabk goe by-laws roles ad uptb dwL
Tbc vowkniped`hwwowne ecrriSe that hdshe wdernands the aq of sakao BnildhK Depatrnas�!
mWmaa becWm proadwe and rcgmremcros and 4m Wsbc win comply w i&tail prawitow sad
rwFITcmCwL
HOIvMEOWNFR'S SIGNATURE
APPROVAL OF BUILDING INSPECTOR "
See otba side for some cods
. r
: y
HOMEOWNER'S EXEMPTION
Tm code sum that 'viy botraowma paformiap-.iv*tar w Wd s bnhdq permit is regabed:bait is
exempt Sane the p vvisioaa cc"sccdm (Senics lt*.u-3Jccasisp d Comenxtloa Soperriser$.
prwidad that is a bomeoana enp ga s persm(f)fee*a io do sooh wsdlr.tbat Sub Lomaowaa*mA sal
as Wavbm6
Mary bomwwma who the this oscmpdon are itrnaan that they are u m bg tisa p9awkwo lea
nrparisoa(see Appcndb g.Ruks sad ReSubsfoa for 3lccosis9 Com nwil n Sgerrbna.Sec*a
.2.26 This bat of swamm=ohm rcmiu 6t striate pcblems.pardca t*9lonbosr—Taws
anfiemsd persons, hi thh case yom Bard=mat peoeesd ap bM tawOcc=W pegeo ss ltwoald sad►
liatmedSspcnisea. T1sbomeowwrsoing"svperviawIstrMfmat to ,
To casms t!m the homeosrncr is tabs swats ctu#ha nspomibmdes,rmrq regdea.as past
Of the permti spplieadM that the homewrna sadly tint hchhe WAUSands tha rapoasbuM=eta
mpavkm Yoe mq care to amend and adopt suM a hrmkcrdliotion IN tna in yar eoa®1*