21 SUMNER RD - BUILDING INSPECTION isL_M61IAWT-qE ffL*944NO APPROVED BY T+IE
JpIS ECIDB PPJQR TD.A.PERWT BEING GRANTED
^� CITY OF SALEM
N 'y Date 311 7/O-r
Is Properly Located In Location of
Nw Historic District? Yee No Dailding '21 1/h1-/7Gi� ed.
Is Property Located In
Ow CansewatIon Ares? Yak_No k
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
d§ok�/Repla� 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 according to the following
specifications:
Owner's Name �V opvk Cc "j on-0- x
Address & Phone a ( �U "^e r (0ti ) "0 — 09 6 �
Architect's Name
Address & Phone ! )
Mechanics Name
Address & Phone 1 )
What Is the purpose of building?
Md"of Wk q? N a dwelling,for how many famMies?
WIN buikft conform to law? Asbestos?
Ed mated cost SW' 0_V City Licenses N k state Lkw= N
Muse Loprovement bjv _ C 2:��
\ Lie. / Sloiature of _
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
�,�is 1„r.g �anrz.y+ne�•k
MAIL PERMIT TO:
i
N71
APPLICATION FOR
PEFOT TO
LOCATION r
z/ Somme l
PERMIT GRANTED
343 1
APRR V�D
S TOR OF BUI S
a
CITY OF SALEM9 MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
$ SALEM, MA 01 970
TEL. (978)745-9595 EXT, 380
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 defined by MGL c III, S 150A.
The debris will be disposed of at: A"rW Cgf-" r she .
Location of Facility
3li � �aS
SignattkVe of Permit Ap cant Date
FULLY complete the following information:
(PLEASE PRINT CLEARLY)
Vo n n e C J-6rt.e s
Name of Permit Applicant
Firm Name, if any
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
facility as defined by MGL cIII, S 150A, and the building pen-nits or licenses are to
indicate the location of the facility.
CrrY OF SAVEM
BUILDING DEPARTMW
HOMEOWNER LICENSE EM T10N
Plan Pdo
DA 3 ( os—
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a
HOlv1E0Wl� f —07 a
TELEPHM
pRWBPITMAII.II'1G A=U= S ��-
7Le e�vroa.aempdai of-u= owmf was ctaeadsd to btchde awao-OPWpkd dwdbV QCTWO
Vniu a ko end to Snow sacb bomeowaaa b WR wbo den so Pt a
Jkcaae,.peo�'ided tbat the ewaatr'aet n apenbtati .
DEF24TIONQHCMEOWN=
Ptn m($)wbo owm a parcel d Lad on which Lchbe resides a brtada to taab}R en wWdt k w b
bttaAw to bt,a one to we family dwcMR&sttadted of deudod twvcnm t ��
farm a meova.A pcnoa wbo=nsyuen moos tlmt emc homt in a tw IM Period
B OfBcta(ebmwowM.SS tl Wftbt mpotmbk to mA M&weak pafamed=dw ft bond%pa=IL
Tw wAc3sigmd-bomwwnce mimes tespotmbMV fa=my%=wuh lbt State bvnft Code ttd
other Wgabk Soo by-Lwa,take and tegabd art.
Ter WACMPW 9tomtwwne ocher thtl Wft wdastands tbt aw of Sakan Bwwb g D"m".
minimwo impcWcn pmesdwes and ngtmtmemt and that Wsbe w•Bi comply wm aald Ptoodtm"ad
TtqdmmcM
HtOMEOWtfER'S SIGNATURF� � t/�
APPROVAL OF BMI)ING II�SPECI 0!l
Sa aba ode for state twde
HOMEOWNER'S EXEM MON
The Code sates lbli:'any orta�ivsk for.rhicb s�oDdit�ymnit�ie�dmd 1 tie —
Cxempt tiom dte podsiona of thb section(Scat"2lXU-1JecastoS d Coostntctloa Sape�be�
provided that b a homeowner erWp;p perwo(s)far Mm io do.wch warti.the saes so®eowaer tdsdl Cal
Mara homeowners wbo meek exempttoo are i6mmmR the they sm aumminS de;espoa�q da
sopawim(tee Appeada Q.Rub and Replatioos tar IJecostoS Cewstssietbw Superstaosa.Saetu
LISN Tbb tads cf vwwa m eaea resWu in arias;pnbins.pardmal w be?the bseosrIm bb /
aniiwmod persons In 02 Date yam Bard"mot proceed ajalso tic IDweemeo pops►te It wrlS
liaawd Saper%iKr. 7%q bomeowur aetinS as tiiperdaer le rgimate tnnpwpla .
To ctsise drat t1m ho�aeowrncr b falb awe otldlher respoafbilWa�raarq oomaamddas tapba;•pet .
of the penult appiteadvA that the bcmeow na ca t)r dm bLWw tadesande sae respeosibilOw eta
sopavisar. Y"totq arc to amend tad adopt sue!a formAaerdlieadea Se tsas 1a yegr ooa�