69 TREMONT ST - BUILDING INSPECTION (2) 44AII'1 *lW9EflI!a MD APPROVED BY IRE
JWZCMR.PRIOR TD A PERMIT BEING GRANTED
CITY OF SAL EM _
No. Data
Ward
ZO" Dl W
Is y Located inLocation of
fro Iiistaic DWIW Yw No Dnimia6
Is in
Bn COrAwva*m Ana? Yas No
Permit to: BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Consftruct Deck, Shed, Pool,
Repair/Replace, Other. 1'7M® d t��fh Y fI nhR
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '
The undersigned herby applies for a permit to build accordiig.to the.following
specifications: I� r
Owners Name t i6i r, �, a,.1 fie- G / 2 r �Lu y` &¢(,kt/
Address & Phone
Architect's Name
Address & Phone f
Mechanics Name
Address & Phone �^ to
What Is the prpaa of is 1*q? �Gi M { V [/ W t ll i n 9
fddow of ta1Nlrg? ( ff a dw80q,for how mmy kamaes?
we bm"conforin to law? �e ) Aeheatoe? h /J
EMWAd coat D G ® 66d1y Ucw s state Llc N
Bane Iagrovw t
Lie. /
Signature of Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Lee min d it /lath
MAIL PERMIT T0:
.t
No.
APPLICATION FOR
PERNT TO
6
�OCATION
1 J
PERMIT GRANTED
-1 4o/d
AP D
INSPECTOR �EIUGUL�NGS
CrrY OF SALEM
BURDING DEPARTMENT
HOMEOWNER LICENSE E MOMON
Plea PAM
DAME L"« O`t
• HOitvffAR M H L
g0!„lEOgrN9t 7 f
TEIFFHOW
rRESbfrMALI NGADDRt
The cwmm,oamptlm of`lwmwwnor was-rotated to bxhAt ewoa-aFwpkd.dwdvip e[TWO
Unix a kk and a allow aaeh Domeowtteea to Q+faia m bd}vidugllor bbs wbo des that poaaes•
iktme..phoe ided*=to wwear s d so wrarvkaa
DEFRa T10N OF HON>EOWNM
Pcnoo(s)wins owns a parcel of Led on wbkb bthhe tuAft a bmnds to TMW oa.rlddt theta k,4 k
intaAW to be,a one to two bmty dwcllba,ntadmd a daadod svutroes 00=S eaj a ad ttae WrAft
farm svucaoa.A pence wbo wravums nwu thm o u beme In a two-year period AM trot ba wWw d
a bomeowamr. Such`lwmeowvd'shslw&mdt a the BuM29 OlfmbL oa a'a* to a fa
Building Odhd4 that brhdha be aspotmbk so an Fach w=t ptsknWA WAU the ba pu;;
Mn wmkniped-bomoownap Lamm teapot aWW for compftm with the sure Daft Code o d '
other appStabk foes by-lewd,ntla and re=uLr=a
The wWcnip,ed-homwwne aniSa lho htwo WACM tds th Oiw of Salem Bdi ft Depwomm.
nd imm bnpccdm procedures and and that hhhe wW V vA*hold ptooedtos r
ra0muasi
HONMOWNER'S SIGMA
APPROVAL OF BLWING VWECTOA
Sec otha side fa s m code
• 1
HOMEOWNER'S EXEMPTION
The cods sues that: •aq bmwowaa pufonaing k*for wrhitb a btdldba&pump b mgobed sbati b
cM Mpg fmm the p avbic=of this eacd= Ocratao 709.m-]Jocasta&of Casa rvellm Sopesrb O
• *MIS.homeowaa p)fet bite to do.srwb wsdr.&bat sbd bomeowaes toss set
irrwrded mega. pu+oa
a apervLa`
M,bomeownem wba we llhb camp t=we iaawau tba they ae asamata&the tayo�ltbs dtl
mp vism(*a Appcadis Q9 Rules and Repinloa far Liasasio&cooamcdaa Sapetvisem Sactfaa
.2.2!4 This bids ed swanmm cites tcsnhs i4 serious pobkms.pwda►1v�w Lea At I C '- av 160
urikea+�pusom bt lids au yam Bald&arms&poeaed a jaiQat the toi6oemed papa n ilwwld wid
Banged Sapmism. 71e bome"s going as wpuvbw 1.0 attbgste�sssjoorMi
To easae dra the homeowner is!ally swan of b1Arcc respondbilides.rasa ao�dea a pat
of the permit gppliodos�that Ore lromcv..aa oerdly tha hc/dte mrdersmrda tie sespoaslEftlde ds
sapavism Yoo mq care to amend and adopt rase!a l raVe nifiotlm f e tan eo 7w oom®aal*
PUBLIC PROPERTY DEPARTMENT
120 WASHINaroN WMEW, 31tD FLOon
SALKU,MA O 1970
TCL.(971111)745-MOM Err. 360
FAX (ols) 740.9"6
STANLaY J. USmIC7, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the Provisions of MGL c 40,S34,I acknowledge that as a condition
of BmldinS Permit#)_ all debris resulting fiom the Congmet=,arvgy
govaned by this Building Permit dA be disposed of in a properly licensed solid-waste
disposal facility,err de6md M($,c 30A.by >�SI
The debris win be disposed of at SGi rL' tI�GLli1s�^2!/ `�r�tiati
Locadm ofFamMy
r- /G �o
i ofPermit Date
FUZZY complete the following kft mdm.
(PLEASE PRW CLEARLY)
Name ofPermkANnew
Firm Name,if any
Address,City k State
The above statute requires that debris from the demolition, removadon,rehab or odw
alteration of building or Owtum be disposed in a properly-licensed solid-wsste dispoaat
AaW as defined by MQ,cnL S I BOA, and the buikdiog pamits or licenses are to
indicate the location of the 5cility.