65 TREMONT ST - BUILDING INSPECTION fL 161"T11E f KaII14AG APPROVED BY T44E
JAtSp= LIB pp" ToA.,PEAf1ilIT BEING GRANTED
CITY OF SALEM
No. Date ' I
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Is Properly located in Location of
bS 1Ycµor'�t S1'•
#a mmoric Dwrict? Yak_No _ Building
Is Prowty Located in
ow Gareemman Am? Ye_No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, k,1t1uN c 5 r�i Ai3ul LIaS£T
r,aPktr wMl
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:2
Owner's Name E- 0S0-mfl—
Address & Phone hS
Architect's Name
Address & Phone ( 1
Mechanics Name
Address & Phone
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EaWmM Coat d 5 000.0U City Lica"r N A State License r
ame L"ro.e.ent �(
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
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MAIL PERMIT TO: ► SANE: l&5i+tk bS II IMIjaN1 51.. SAL. t t qA
• 61q�0
No.
APPLICATION FOR
//PERMT TO
// /
U/6� L.
S9ertte,eo/ ePArer e% ede z-
00 i
LOCATION
PERMIT GRANTED
APPROVED
EC,TOR OF BUILDINGS
CITY OF SALEN9 MASSACHUSETTS
• PUBLIC PROPERTY DEPARTMENT
r
120 WAs"INSTON S-rnt[T. 3to FLOOR
SALtq. MASSACNU3aTTS 0I970
TtL[/NONa: 97W743-9eee EW. 380 ,-I FAA: 97e-740-9e4e
HOMEOWNER LICENSE EXEMPTION
Pta u pdo
Dsas 4 Zb
Job Location >S lam_
HomeC1'MmrAddless G,C rr,oR.t,rv1 �Sf� S� /1-
Hmo Owns
�°�°0t Addraaa b Is ✓_o �,n Sfi
The culrm boa o['Ham6owtlela"was ssMU d to While .d
of hire whoodoes�n span a leas and to alborroved d th mgsgs aB individual far
posaw a licemaa4 provided that the owner¢ as
DJEWWj oN OB HOWOW M
PWWo(a)who a"m a psmd-of land e'a which hdahe raw"at intends to d0.ast
which these a is intended to b%a oat a two
sbuchuve accessory to such use sud/ar fn<at A ems'� or detached
than one home in a two year Period shalt n be conadaed�who c. Such
q mere
shall submit to the h0II10p Snch
OfIcial. that he/she be d'on a foam acceptable to the Building
Permit reponun'ble for all such work Performed undar the Building
The u daaiWW"homeowna"= me@ naponsibility for complimm with the State
Building Code and other applicable by-laws and regnWonla.
The 1ndempw'Wmeowme ccMfi=that he/she
Building Dgmrtrnalt mmunum i stands the City of Salon
will COmPiY with said procedure�rm and� a and that hNshe
HONEOWNERS SIGNATURE
APPROVAL OF BUILDING INSPECTOR
Sea other side for state code
- 1
BOO
wodLwhich a Buildins Permit is
The Code SWO that: N��provinan' otehu section(s d i 109.1.1`,�to
t shall be WAIDO PCOtided a Homeowner m� P�
Of s�orbk shalt sd as s�s
,y�wne that they ate ebr
I,iceotbs
Many H0°'Uh" (see A���a� "gob in suioaa
avisom Salon 21Saavw& in ehia case your
"SOP �„>�en tie Hem "�; v
Ino"**A do mdicanaed Pet 's'�b world le.
S„pecvteos; The�°t°°°Yoa'ctia as � "i j'` . . Y
weer it id awae of Uca cal"that
omeo ti o Homes
To ensure that the H
ere a pert of the Pernut�►Ppli On ti l""otthie ism is a
conim, ttO te4vuO�___r ititiea ors swat v or. sad adopt s�a
W" leveed toaraa. Yin IM cage to,
f� used by
focmlc �!br ue in
r
R� bl�Isadr
CITY OR 9ALEMO MASSACHUSaTT!
PUBLIC PROPERTY DEPARTMENT
120 WAS"'NCTO" 5T1a% 3NO RLOOA
SALE", MASEACHUSC Tf 01570
TELE►MONE: 978.745-9595 EXr. 380
FAX: 975-740.5544
SaIlm Bnl! 1N nt
Debris DisB t x......
In accordance with the provisions of MGL c40 S 54, a condition of your
Building Permit is that the debris resulting from this work shall be disposed
Of in a properly licensed solid waste disposal facility as defined by MGL
Chapter III, S 150 A.
The debris will be disposed of in:
I��N,o t I—S}2 (Location of acility) f� t71s s„�Glau�� e,vfp
Signature o Applicant
2b
Date
A