25 WEST TER - BUILDING INSPECTION i L*"6 A T,6E~s4AD APPROVED BY T+IE
110mcm PBIGR TDA.PERMIT)31t:INO GRANTED
CITY OF_SALEM
No. \� Data 16
I
ZSWe57
Is Propwty located in Location of
the mmcdc DINW? Yes No saitdiad TGK✓��e
is PmPerly Lamm in
the CarwymOM Am? Yu_to
BUILDING PERMIT APPUCA71ON FOR:
do
�a o 7 Circles twhichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
/yo 1fiep . der: 94oCatt W;ni�ow it stt//
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS.
The undersigned hereby applies for a permit to build according to the following
6pectlications:
Owners Name J ��",
/ r� ��CL
Address & Phone z;- l.)e S r (E68) 35 3 L y 3
Architect's Name lei/�
Address A Phone f l
Mechanics Name - --
Address A Phone 1 l
What Is to WMM of WWft?'A�7yc
mom of buYdlrq?fa °lit`//�/usl`� n a kfwNWg,Ia how mmy tamilios? �_
WN WWV conform to Ww? el; Aabaalos? YI o
t.aft"cost ;Z n. My L"m r N A &me um"r /7
Ems 1"ravt at
Lie. J A
gnatu a of Applicant
SIGNED UN
DER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
s e s�7/�f
Lr� r ex I— 41Ze � T
r7 �Gf lea 1'
MAIL PERMIT TO, fpea-7-
25 Lie 5 r TevLKac�
54 1��"' m/3 6/970
No. S<<=Gfo
APPLICATION FOR
PERYT TO
LOCATION
PERMIT GRANTED
0 2.0
AP OVjM x
INSPECT OF BUILDINGS
CITY OR SALKNO MASSACNUSIETTS
• PUBLIC PROPROTY DEPARTMENT
120 WASHINGTON STR[aT. 3no FLoom
SALSM. MASSACNUSSTTS 0I970
T[LS►NONS: 97a•749'9896 Off. 380
_.. ... . .. ..._ FAM 970-74"446
HOMEOWNER L msz RXEMMON
P%M Priat.
Data S 11 o 6
Job Laca4m 25 o e S T 7_cyc�Ac e / j3
Herne�1unlr Addleq 2 ✓cc r ftm
H=4oW�
Add?�ekpbyp�q max 353 2u �u
The off" of Y�'1m e was oxico"to��LL�. OQ
him who dome not Of IaraaM t0 agm� mph Is�000 dual for
P�a Hems%provi"than� as lnl iaor
w atPaMobe a patrd.o[huld as whitdt bwdw le�dee or intends to ride,on
h taoded to b%a one or two family dwellhs&sftcbW or detached
shucpatea aceaasory,to such use W&Of pm= SW*
than one home in a two year padod shall not be
"hOm . that"suubmlt to dw Building OIDciaL on a fowl acceptable to the Building
Parmit bs responsible for all such work performed under the Building
The undamVW`honwwnes"assumes mopmobility for compliance with the State Bud&S Code and other applicable by-laws and mpWiom
Building�pa Immmwme ca Un that he/she uodastands the City of Salem
will di DVwbnft minimum inspection procedures and eta and that he/she
mply with said procedures and requiremmtL
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING IN ECTOR
See other side for state code
i
unt�,QWPiE���,r*eitrtilOPl
which t BuildiotCode"In Pae�is
that: "Aol►�60VA r. S�edon(S.,f.109.1.1-tum+ont
shall be °� eovna m P�'D0(`)6a>mS
to
of & � wh���r"a ad a Ste` .
videm
do W sych C[e wwwG the dray Cm the
TiRanY H01°0i0Owasol whu wN d&O App 4 Aida Cod ReSabdom#ar t icesliof
oft So�°r( of awatemo odCt;nomb in miova
TWSISA
gypCcviCoea.S°�° hnar�mliwu�Pam' In dds cum Yas
Hamm*vrobla�►P�R ; tdr,mficeatadyNc+ "it`°ood
wiesficsimed
d,at the Homeowoa u Hilly ranee of t :: tia Cat*duct
HonwWwOm
To COMM didof the Paarit APp ft last PW of aria'"W iC C
hdClts� �` You um Can to
Coimd�"d0R`ucb a
formy eyed by mv
av tcwoa.
R�✓ ISO I sae r
CITY OR $ALXNp MASSACHUSRTT:
P%JmUC PROP[RTY o[PARTM[NT
Sao WAlMIMO10M 01114417. Us ILOOA
SALEM, MAsigACpystTM OI a70
TWLtPMONtI $711.713-YItYf 611T. 780
'AXI 1174•740-o"a
Debda DlseessL per....
In M=danee with the PfOV siona of M(M c40 3 54, a condition of your
Hu&&g Permit is that the debris resuldag hom this WO*shall be disposed
Of
is A r IOQ� 9130�d �UHF W facility as defined by MGL
The debda will be disposed of in:
�oirH D�•'�''� (Location of Factility) Sl/P��
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