46 VALLEY ST - BUILDING INSPECTION (4) qPL IEfN/NkND APPADV r� affo a RE
ToA'MM n'UM ORANTIED
CITY OF SALEM
No.
No. . • or.
Mhrd
zw"n
IAA womft OYYIat?„ ys Ne �!
Is Rommy Loomw in
b Con rAmn Awo4 YON NO_
NN.DM�Ki POW APPLICATM PM
ParmN to:
(Cs whWwwr ap*) Roof. Rod kMlall SMft CarWWW Dook. Shad, Pool.
PAPBWPAPMK OIfNr:
PLUM M L GUr LEML.Y&COMP ATILY TO AVOW DW AVS N PRDCN
TO THE INSPECTOR OF BUILD W&- '
hereby appNdo for a mmk to bM umdkto ft.1mNowUl0
Oates Name E� w R �u�cSoL
Address A Phone 1+(- \fALLey sr- !�AJjSnnt MA
AmhitW* Nww
Address a Phorm ( 1
Msdlani= Name
Address A Phom ( 1
MOM a•n Pq a s Ndldrp9 R �sT w� o Buz Q s
ww"of buI 1 11 u.oo D I Ulu vi_ N a dwsanp,for how NM N~
Mal W4 om kom to Nw?
EON"=d � S� Yb� � 6� Cp LIoOIM• ��UowIM•
ue f a of APOYorn
>110N■IN f 1ME PENALTY,
oP paum
MCWl WN oP VX=To SE DONE
MAIL PERMIT ML_�,
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rvMuc rMNPK T DMPAMMEff
120 VW"INWM VMKIT, aao FLOM
SAL a%m 01070
TRL(070)740.0i00 nT.ago
FAX MG)7404 0"
STA1Lt1I rwOy1CZ, Jet.; - -- -- ---- - -----
DLSPOM OF DEM AFFIDAVIT
la=car&=$wim ft pecvi&m Of UM c 4%334,I aclmawlo*dt to a cooMm
of B nift Permit Q .an deb&radtio8 8om the=Ma ud=ud tp
"rwd by Qua BuDft Patmit aha8 be dtapoaad of is a pfgPai)r itcamed aolid+waab
diapmd AcUllY,a.&d aed by MM c 11;81-4ft
MW dab&w M be ftpaed of at
Loeahaa of Faeal W
3se o: itppueao� Dab
X AU P=4r CIRUL
. TLtt-�C,oC,
P1ame ofPumk Applieaot
Fam Names,if a w
qb Tl�-Lu=y Gr. ;S �tk`M nrt . ai��o
Addmok City Stab
Mw above atatab leq um dud debris Sam Qu demoNdcq ramvadem,rehab or ether
WtaWm of bml ft or*won be diapoaed m a propaly-lug aoNdmoo dbpoaal
f cffly as de8md by MOL cUL SIJOA,sad the boiWalB' pamb or lice ate to
mdieab the bead=of Abe heft.
CTPY OF SALEM
BumiNG DEPARTmM
xONEOWMUCENSEEMOMO
Pkaa PAN
DATE a -I 11 a
1080LOCJ►TION ��� M�
• i�or�owrmt `� U���y sT s �� . o «-r u •
ADUMV
•HOMEO*
TE1m'IIm 4`a--?gq -ML
..�N c t 7U
PRESENrMAl �.GADDRESS �L V�LL Sl SKI.L�M,. M E
The eiarus.eumµlm of-Iw=vwwn'was cmnftd o bchv&ow• OrcuDW BOO dTWO
Uniu or Im and w al ow such homww mu 10 c4W fn bedivWW im bite wl>o does I"poaaasa 1
Iiocme,.yvovided dmthe ewster se:t<v w�erviaar.
DEF DII nOI'I Of HOMEOWNM do reside.ua wbidt Owe
Pcnoo o)wbo owns a pual of land oo wbkb hc/shc insides of$vends to ale!!toe adAlt
into Aed to be.a one w two laadly dwcUin&smd ad a dcucbw saucsu a s>7 sotbe ma
���
farm swocwm A perm wbc cOmurum mole than omc hums in a two-Y to
a humcowma. such-lwmeuw'ae shaysuka 10 the Busldin OSxA om w a w bail Wt ��
Building Off e4 that WsU be tespolmbk w afl sorb work pcimm°d
unda The undersigned-bomeow•ne1-ass resporLsibl"to[compliwc wi**t State BmD ft Code sd
other applicabk goes by-laws,rake amd tegu izft L
The im knipicd-homww•ntt•'c='d that hehhe w4a=m&the Chy of Salem B°rift Dcpmvmft.
minimrw Inspwum p=dwa and n g*cmcros and that bhhe will wmpb with aid p 9mdmes ad
regrd�
HONZOWNWS SIGNATURE ±L=�
APPROvAL OF BtWrNG INSPECTOR
See orbs side for state:code
P
. r '•
HOMEOWNER'S EXEMPTION
TM rode ststa that 'arty homeowner performing imA for wbieb a bnildirrg pem k is regobvd SW Is
exempt from the pro+isiow orthis scc don (Section 3IP41-33assiog of Coaauvadioa Sow
Provided*9 is a Lomeowna engages p pen=(s)fa hire to do.such wok that sireb botmeowaa dtail gal
MwW banwow ras who on this oampJm are imawaro the they an-worn the xegandbMdo.
are
sapavim(sm Appcodfa Q•Ruirs and Rcgulstfow for Vocasiaf Coostrwcdm Supetrvbora,Seedoa
.2.24 This lack of swwwwo olka mmlu in scrims pmbkms•portico"wbm the b=mowaa hbo
ortiisased persons. In this an yaw Bond cmW proomd agahm dre wOccowd papa as it world via
Hawed Sopmisar. The bosseowaer sdia=a wpervisor 8 oldgisfe�sss�oarsplg, •
To corms that the ltmneomrcr b fu11y swan of htAta.resspone3bf6tSa.trorq Idea requba;a past
of the peradi spOkadoq that the iwmeowrtet certify that hcAft mtderatnttda the respousibnid=eta
supavism. You may can to amcod and adopt tail a ftaadectdfieatiaa Aw un in yom eommu ft