31 SUMMIT ST - BUILDING INSPECTION tkNSiiMl6��EfIL{-0*14110 APPROVED BY T+IE
1AIS,Pz=DB PAIQR TD.A.PERMIT BBWG GRANTED
CITY OF SALEM
NQ!p_1 —r Date
is Property Located in Location of
to Historic District? Yes No BULILding
is Property Located in
Qw Cormervad4n Ares? Yet No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FALL 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 �-Obr (��L -
Address & Phone 3 1 :5VM 44 17— S t OW) 741S a- S7
Architect's Name
Address & Phone 1 )
Mechanics Name
Address & Phone f )
What is the purpose of building?
Materiel of briidUq? n a dwom", for how many tam!"?
Wig twiidtrqCVomto law? Asbestos?
Eatknated oo& /69S y��Criy ucense r_►J " state Lim"M
��-� eo,. �.�--
Lic. t /1 Signature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO-
No.
APPLICATION FOR
PERMMT TO
/NHS>BGL G X/O c SFFED
LOCATION
3) , 6oMMIT ST.
PERMIT GRANTED
/U G 2-7, 2.00 S—
APPROVfD
P TOR OF BUN DINGS
�• ' CITY OR SALEMs MASSACHUSETTS
s PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STR[aT, 3Ro FLOOR
SALtM, MASSACNUSaTTa 01970
TaL9►110Na: 97e-743-9e9a a%T. 300.
_.._ FAM 270-740-9946
HOMEOWNER IdE: n EXEMPTION
ple m
Daea_ � .
Job Location
Ho®e OfflW Addreq.
FN!OWW Tdephw
PreNat Mat8 AddMw;.
dwellings of t"L%W The coupdan of"MmIeownera"wan,exterded to include ownw-oocvpled
hire don not Of ku and to ado�v spclt engage as individual for
P a liceesq,provided that as aupw"iaw.
D$PWM0N OP.13011e11z0i_M *'
Pason(al who o vw a pared-of load on which IWAO taidea or
which tber+e ce ea is inteodm to ba a oni or two family dwefts Attached detached
strncturea accaaory to ouch use and/or� A
than one bo�me in a two year Period chap not bs�deteda wLo cona{inW mor e.
"ho wwIIw"shay submit to the Building Oficiai,on a form Such
Official, that he/she be reaponsible for all such work stable to the Building
Permit Performed under the Building
The undersigned"homeowner"assume
bili
Building Code and Other O0°� wmptisnce with the State
applicable by-laver and ram,
IU
Bui l undersigned lwmeowme eerhSes that ode the City of Salem
Bui g went minimum inspection procedures and requ�mb and that hatsha
willco mPly with said procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
See other side for state code
90MtO��t�t7
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,OM atataa dat "AAY HOU160 0m`. for
109qWred .t.t —Lieeoeins
Ia
ab It be a amp ftm the PIm"dadoms of m�t P°no°(i)foe�'0 Lo
o` Cooe �s �k� abaft ad as sum-
do such av that dwy no ash the
Mm HOWAa°Pnm Vito um al unaw
�(aae APPaod'n 4 Rula and °0e� is aaioas
y y$etkmft
a oit sapaN wdon lt5. laet�of twarawo ads cane your
c s„�,,,ao,.wdoHw ownw ties
probltawd spind caoaed pen a it taponate.
ttoad _ ' Heawoar a.a>pav�ar
sw�� T�'° , .»Y
is y ,orate of bialhar o �y that
To en"m that ttte Homaow� App
bcadau. fife
Comm q �t o�SUPWMW- 4n�and Aw emb a a
hdebe used by aev6 4 ioaoa.- You mtyform amuldy Dace oo amend
f�mlceiia ?►far ue ti Y� ,