3 SPRINGSIDE AVE - BUILDING INSPECTION (2) r'
1M1V4S-Mt#ST19E fiL{-G-ANG APPROVED BY T44E
LUSPfXT.4R ,PRIOR TD A PERMIT.BEING GRANTED
CITY OF SALEM
't, �'�\ Date ���� `✓
H '
ward�-
\fcimNeo�' Zoning District
Is Property Located in Location of
the Historic District? Yes_No Building 2Mrr �/A d
-3 Is Property Located in
the Conservation Area? Yes_No
p BUILDING PERMIT APPLICATION FOR:
Permit mlt to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: CkZV L-
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 )fl�v� —0 ,nwo-P
Address & Phone 3 S?2 t wc, six-
Architect's Name C
Address & Phone <k P ( )
Mechanics Name Sa,- e
Address & Phone 5,4 " e ( )
What is the purpose of building?
II
Material of building? _[LI()19 + if a dwelling, for how many families? �C
Will building conform to law? Asbestos? 4k
Estimated cost /'5y,Oc? 0 City License 8 State Lice se #
Home Improvement
Lic. i
id
Sign re of Applicant
SIGNED UNDER THE PENALTY
OF ERJURY
DESCRIPTION OF WORK TO BE DONE
nuiCZeec> L C: C'.ei 4N
MAIL PERMIT TO: 3 (;,,Jr. Ave- Sii lG'm�q A4+ 01 9 ?c-)
\kc*
No. _�V'v�.
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
G/t�/01 19
Afc—
INSPECTOR BUILDINGS
1
Y'
CITY OF SA M&
BUnZ]NG DEPARTMENT
HOMEOWNER UCENSE VOOM014
Pkm Pda
DATE U
cl
]LOCATION
moroowNsrlt � e
ADDRESS
HOMEO OM �t o. cj 2-L ------------
TELEPMC
Pp,ESENTMALW.GADDRESS v~
"was cmaded to include owoeroceopkd dwemv atTWo
The e+m Ws and 0Uoa of homeowners bite who don sat panes d
Units a Ws and to allow•suds .homeowners to cop an
an irtdlv+da!l.
limae,.prov+ded thtntbe owner wpe
DEFIIGnON CF HOv1EOWkWL
Penn(s)w•ho owns a PwW of lud on which Wshc resides or iruends W reside,oa wdddt k
intended w be,a one to two family dwelling,aasched or detached strut°» MA vot sbA not �w
farm smrcttoes.A pcnm wbo constructs a=than oat home In a twc-y paled
a homoowner. Such"horaeow trc>" staff svbm6t to the ad
Building OffrdaL ca a fam seecpeabk to to
i3x4 that he/she be nspoturbk to&I suds work performed tinder the bufidiag perms
Building O
The undersigned`bomoow•act"asstattes tespom'bMV Sot cornPluma waht w Stale Bail ft Code and
othu appB=bk goes by-laws,tines find tV1ad
The tmdersipsd-homww'ne>'•=mfm tho Wshe undcstards the Cdy of Sskm
srlth
minimtoo irrspation proczd»res and utretrtems and that 1Jshe wiU taraply
HONI£OwNER'S SIGNATURE Iti`--
APPROVAL OF BVIIDING 1N LECTOR
See other side for staff code
i
HOMEOWNER'S EXEMPTION
The code atatcs that 'any homeownr performing-,;to*for which a binding permit it required sbal be
csempr from the prvvWow of this section (Stoics]Oyaa-13aasiog of Construction Superviaoro
Provided that is a homowner cngages at pawn W for hire to do.such worst,that such homeowner d3raU sort
Marry homeow ran who use thls excarption are Lmwarc that they art mmmbg fife? eta
sipaviwr(aa Appcodis Q,Rules and Regulations for Lioteshng Coostrmc&m Superrbors,SaWm
.2.16)6 •ibis lack of awarcrms often=DIU in scrim problems.pardeuhrt wises tht horneoaier Lbas
unlicensed pentim In this cast yom Board eanrct proceed against the trrtl muted person as it world via
licensed Suprni%F. 71Pe boUK"- er&ding as Fu rvbor b ntdaaat*reszowibls.
To cnsarc that the horoeowncr h fully aware of bmm tespomrbilities,nmsy oommmdda regiL t-as pat
of the perndl appliodoq that the homwwacr ccrdfy that hWm trade nulls-the responsumes eta
supmism. You may care to anKad and adopt Fad a f Wecnificadm floc»ae in your eoat>imasIp,
i W PUBLIC PROPERTY DEPARTMENT
120 WAsHINGTON STREET, 9RD FLOOR
SALEM,MA O 1970
TEL. (979)745-9595 EXT. 880
FAX (978) 740-9846
STANLEY J. USOVICZ. JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I acknowledge that as a condition
of Building Permit# ,all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility,as defned by MGL c III,S150A.
The debris will be disposed of st: AkM E-Aij �
Location of Facility
Signature of Permit Applicant b Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Ja�� �lowv�e
Name of Permit Applicant
Firm Name, if any
3 s F9l � 5td� �vC S� elm s
Address,City&'State
The above statute requires that debris from the demolition,renovation,rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
d1nB drspo
facility as defined by MGL cIII, S 150A, and the building permits or licenses are to
indicate the location of the facility.