73 TREMONT ST - BUILDING INSPECTION (3) 3�
AR
IS "MWIDEfILM4*0 APPROVEfl 13Y 744E
J UPJ:C=PWR TD A PERMIT B SING GRANTED
CITY OF_SALEM
No `a " \ \ Date U 6— —D
\ Jae Wald
Zor*V District
Is PmPwty Located
ON Histalc Dbtdcl?� Yes No °t o€
Is Property Located in
the Corroenadon Arse? Yes No—
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '•
The undamigned hereby applies for a permit to build accordwiq to the folbwing
Specifications:
Owner's Name
Address & Phone j7 C�Z 9
Architect's Name
Address & Phone [ 1
Mechanics Name
Address & Phone
WtW b the pupoee o1 buNdbrp? � �5�`C�Pi, C�
MOM"a tltilldhnp? It-0 n a dweb for how many lamMes? T W 0
Wa bulk/rq conform to law? S Aebeetoe?
Eabneled cod L • 6 CRY Lk: m M a"License N
Halle Improvement
Signa�of Applicant
S13NED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
-Ti, L /S A;n 4 ceC ,P/
MAIL PERMIT TO:
APPLICATION FOR
PERINT TO ,
LOCATION
PERMIT GRANTED
19
tD
INSPECTOR OF BUILDINGS
_ Yn
ry
CITY OF SALEM
BUIMING DEPARTMM
HONZOWNEIt LICENSE E?�'AOZi
Pksae Pdit •
DA7E
JW LOCATJM, o E �-C 3 -T Pl-
H01MEOV=
TELF�E
PRESENT MALING ADDRF�
' The avecatsxmptioo d'iwmeoernea'wtd nacmded b brhdc aeses►sCwpied.dwalfsp o[7�
Unbs a ko snd to allow such 1!omeowsers b eeg<aje am bdivSdo�l is hks wko dee sal P�•
lkcme,.paovided thm the esrser�d sm�srviaas: .
DETV4710 CFHONRDWMM
• Pcrsos(s)wb owm•paQa]d hvd m svhkh ha/ahe asides a kresds b tesids.oa whlab tlws k a Y .
bu=W ed b be,a ens b pro famU dwcft&*=Chad a d9mcbW sensaoses Baal b Bob us awAOW
farm sovcwm A pcnm wbo consouats mom 4sm amc home bt a two-ycv Period shy sot It eonsldw d
o bomwwma. Such`iwmeow•mef shay submh to the Buildh*OfmcbLwder a�e:tp"ID**A
Bw'ldbtf Odicid,that UAhe be tcspooskk to aA soah work perlamad
The wdcrsiptd-bomwawwdo Law=re spmL-&MV foe wwPliana with the sort Bvn ft Code w d '
otha appscabit Sao by-isw%TWu and vcZabaSom
The wmkniyacd')wawawm"o ufm that ht/she widastands the Ciw Of Sokm Bmlbft Depeoest
mimimwo bapwdm pmczdwis and ngvi aKms and that hlsbc win cuvy Wilb am Ptooedsmss ad
regedreme --
HONt£OWNER'S SIGNATURE
APPROVAL OF BUILDING 2M.CI'Qlt
See other side for mu oode
�, i
r �
HOMEOWNER'S EXEMPTION
The code scut lhac •�9'Dtoaigow,ter performia�vigat fot wdlkh a bafldirlS patch b ttetpoited art M .
csempl 5vm the pvamm cf tbb section (Secttw 70fJ.1-]J«oatoS d Gasttvcttor Sgervbo *
provided*m b a bmwwna ec pga p pxnm(f)fer bhs to do.ncb w7�tbst Sn&bomeoeraer tdrTi tat
Malq bomeowwsa who me lilt/campdor we imam the they we mumbg dw jewot *Adar oft
wpervim(am Appendttt Q.I¢uks and Re=ubtbw for llocoeto=CeoatStietlan SoSetyfeote,SedIN
.2.24 Tbb bet of n+arerrsS d kea rase)«Is serto n pabkmm6 l,ordatloh wfien>be`oseo.vaQLbs
tuilteeaSed perroaa lath care yw 3mid eatmot posed spefim the mimed perqmukw- w!S
It«mcd Supavbgr The bomeoe„er acting as wpervlwr b ngMrte�r reSpowSuM�.
To eanos dm do homeowner h taW wwwt ctbVtm tespoarlbWdm%==W avmSamdde •past
of an pant{appriatim that dig bcmeow•na ocr ft Om bLWx mde--d the respmsibTNdsS de
Suprsvbm Ym may ears to atneod sad adopt weh a formken ordso for trs to yom ea®dam
PUsuc PROPERTY DEPARTMENT
120 WASHINGTON STREET, UD FLoon
SALEN,MA O t a7O
T[L.(976)745-95" ExT.380 i
FAX (676) 740•9046
STANLEY J. UsOVIC2, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the pmviaiom of WX c 40,S34,I aclmowledge that as a cadition
of Bm'ldmg Permit 0 . all debw re uhmg fits the coiMMICUM„chvAy
govemd by this Building Permit"be disposed of in a pTopely licensed soH&wuw .
disposal facility,as defined by MGL c nL S150A. /
The debris will be disposed of at: k/,n�6,ff a r
Location of Facility
c /►/
Si re ofPamit Appligst Date
FULLY complete the following int'ormalm
(PLEASE PRINT CLEARLY)
Name of Permit Appbicamt
Firm Name,if any
Addrea,City k State
The above statute requires that debris from the demolition,renovation,rehab or other
aheration of btrildirtg or mucttne be disposed in a propaly-licensed solid-watts disposal
facility as defined by MM cIII,S150A, and the building pamits or licened are to
indicate the location of the facility.