68 SUMMER ST - BUILDING INSPECTION (2) fL11P161Atl6t�EfRAD4640 APPROVED BY T44E
mS,PF,CM PI91L1R TDA.PFBWT AEWG GRANTED
CITY OF_SALEM
DOG a 3
is Prop"wcaod
imeauan of
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Install S , Construct Deck, Shed, Pool,
OtherQ a� rn t can, v�eta �� ✓r r lti.
1/ 1
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DECAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS.
The underagned hereby applies for a permit to build according to the following
specifications:
Owners Name C Ce'i a I-4ELkj
Address 3 Phone
Architect's Name
Address & Phone !
Mechanics Name
Address 6 Phone i
Whtl k 1w PWPm of buYdn jb /r h z n Q
m"W of koft4 J/Vl14— I a dwdWV,for how a my WOW
vm t>may=wom to kw? d Mbastos4 R 10
ESWUMCM44 Obo.n ary wwm• N A Mato Lwwna•
so.. Iapsws..nc
rSe. J
ignature ol Applicant
SKi an UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT T0:
NO. _
APPLICATION FOR
PERYT TO
4J,em.J�iTeeo,+e, f ,2ooii�
LOCATION
PERMIT GRANTED
ZOo6
APP ovfD
OR OF BUILDINGS --
1
CITY OP 'AL IgMs, MASSACHUSUTTS
PUBLIC PROPERTY DEPARTMENT
120 WA9MINOTON STR[[T. 2Ro FLOOR
,a SALtM. MAttACNU4tTra 01970
T[l[►NOlilll
FAX 97*74e•959e It". 3e0
. .. _... .. .. _ FAX 979.740.9e4e ._.
HOMEOWMEI!UC MSZ E ULWnoN
Pbaae Riot.
Imo. 5' V o
Jobtaeadw
Addroea e c- a'
The
cm:aat"Vftp e:emptto„O["Homaown�wm axtaoded m iaclodo
dothMs Uai1r a lean and m aOO�v
h amp oyua!to
ire who oaa not popeae a Ncao[�Payd9d t69t�@A L
P�on(a� i+► iotaoded m imd as hdahe render;or attend;to Ndk as
which than Or be,a oo@ a taro
&mia see ow in ry m snch uae mdtor i>tmt Apm=wW 0=a d9hched
than ase hasoe m a taro yealr Parlod shsun oot be oOoddwW a boamwnx Snch
"homwwnd'shsJl wbmit to the B11'&g 0fficSL Oo a iblm
P thonk'ALat hWWw be raponmble for A such work performed lmdar the Buddlni ldmp
The under mwd"homaOwnas"mum"'wM=b'fib tar comPlimm with the state
limos Code and other APPlieable by-Iawr and mplgdom
III lmdeWVW`1wMMMW ae elfin that hdshe lmderstaoda the City ot3alem
will ly mad �0�and mqWremmb and that hWshe
requiremoft
HOMEOWNERS SIGNATURE
APPROVAL OF B=JNG INSPECTOR
Sae other side for state code
aTho
8mld�t�"
Co&stayer due "�1°4►H°°n°°"YeMc P Sec "(Sediaa 109.1.1
I"pited dabs OMO� ri"did a Homeo�►' M e.
o a
b,.W rd S W Hamao�vmc"ed r SWW"eot-
do ssxh eraris. Au1ea� yjR�a 'ng dw
afis wa Ms�10'�°a uoaMe�
otsSupa e°c 11 °taM'c°i�aee 'BMW"
Sypsvie°ee' �a wed p N=& Ta dds wra e Your
Ceo °O �dw Homeow� . arauld vA*a liceoeed
pcob14e4w►P , ,t ttwadvoomsweyts „�reepece�bla
. der acthy�! i'°r ul maQY
gonneoaaer is MY0 otbielher ,� sty isae
To a wwo a r ,a of 0sr Peewit App to Wt 'is a
cow.. such
hd"� 1Coa nnaY +oo�pe"d and edoP1
RxuM in,yaw comolly
�
CITY OR SALXmq MASSACHNltTT!
PUBUC rROPXWM D7rAATM[t4T
120 V'A""Wl 'S SUM, its PUms
ULtM' M"GMMU49M 0I870
TtL[►HOHtt 67`748-049e tit 3"
PAW 976740-/t40
Q®
In mcmdance with the PtOvfdm of W X c40 3 J4r a condition of your
Hn>ydins Plermit is that the debris S from this wok shall be
Of in a P mpedy licensed solid waste° facility as deliW by MM(X
Chapw UL 3150 A.
no debris will be disposed of in:
CKJ%14 (Location of Fw ity) 1E ,n ��
3ignaptra of Applicant
s/Zy�a �
Date