166-172 WHALERS LN - BUILDING INSPECTION A
fL1d161iANSi�EfN*1114YN9 A"ROVED BY T44E
JdSPF.CIt1B PBIOR TDA.PEBANT UING GRANTED
CITY OF_SALEM
No. - \ owo D6
is Property Locoed in 10"tion of
the Watorfc Dri1W Yee No _ '•.'---Via'-=S
is opm&yLacewin CU� SG
fha Cornmellon Ana? Yee No_
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Ro , Reroof Install Siding, Construct Deck, Shed, Pool,
Repau . Other:
PLEASE FILL OUT LEGIBLY A 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:
Owner's Name
Address & Phone 0,09i OBa✓u�f1r� ��Il q3o� 907�9
Architect's Name
Address & Phone L
Mechanics Name
Address & Phone
oa P6�
Who Is a"puma"of W*"?
Mae"of bA*Q? fl a dwNW*,for how marry Wan"?
Will wow conform to law? MbaWc?
EW Wed coo city f.mm r ►� A maw I iewM e
Now 7mproveraent
Lie. it fgrtature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
!��'/S�i� w°a L✓141;ly k
MAIL PERMIT T0: �-��/S
l
No.
APPLICATION FDA
PERMIT TO -
LOCATION
4 T / 7 �i4 ��s Ice, �
PERMIT GRANTED
2.0
APPt��
FD
INSPECTOR OF BUILDINGS
f
1 .
CITY OR SALZmp MASSACHUStTTS
PUBUC PROPIKMTV C6PAJtTW9%T
Sao VJ"N'MaMft MUM 311411 ROOA
!Aare " AGG*ANUSWM of ne
TRUIPMOba 11711.74"ges ft?. 380
FA4t 170.746.""
Is a000rdaace with the provisions of mm co's A a conditlm of wo our
BoildlaS ftn*is that the debris r S from this wont shall be y
Of is a properly liceaaed solid wssteldisposal facility as Mned by M�(3L,�
Chapter III. 3150 A.
The debris will be disposed of in:
amadon of Factility)
gnattue otApplicant
L 0�
race
r lu Comarostw4/tii Ofm ssischu a
D�
Sm tdMS&dd
Workers'CompensadOu buWlm Ak r"'d•
I /,J/ / y/ BWMallContradoia Mecbidg� ee
mbe
Name � /
1
Ane a• ` . �.., C10eleW, rrletepaar' :; . '
JxRft
emaist aaataea asd 1 �'°'dpenjeet�plre�e
2[] II (hz and/or pet�d=).O bays Iied ft nve0w,p� 6- 13 New eoe I pis �
Popeietorayt arma6 Hod as �t 6 Q R �
>�#anti Lve m eaopbyee, Tbeae ❑>�aa
waditkgmobnaperVu*. wador�!cool,. .bwm"
INe wadme�i ommoo !. ❑We age i�Do� i sil id' . 9. ❑Soma a i n
3.� I m a>tomeOwmr doing ail,wgk �� � 10.[7 ENetiear neprL,of addaioor .
myna!(Ne wodro�'.aomp a 1 au 11.0 pfem6fei reF,b,ar addhbm
11
I213 Rooi',epah
13.13 Omer
'Nr MUrAm Ar 3wa.bom-N=r dim sl.t tot�cda bdor ro.he art
aesau....,..rmKs�Y.ma��k ydwliam.aos
�'!��Y••do�a 4 robin!er.I�i�'e.rY,ao�i+wb.d.rmbeie.m..manY
tcarmam ersbsasYbai`aot rrrbM�d�lart s..+,.dq arosstek ins••cY
i�wesodAiwoeer.•oeq per .
law 4'�P�wdat b�B awitrs,.
btirmetiom e �a4Xia Desarbalr/eRgaslJoisdM
bunco cnapayNsms
Fa ft t Of sacra.Lit tr
E*mdoa namc 7
Attack it ecP7 Ouse warserd eonspusn a paMey dedaratbn Y+Raqpo
Fa7ioa b seems coverage a mgt*W ender Section 25A otMM a 152 ca k a �y aa� moat date}
fine up to SIPMOO sed/ar ono year 3aprisoomenf,a wd a dv� otabdoal peaaltiea;tam
otup to S210.00 a day ate to vbbnoft Be advbed mat, pmhiaa in me lbrm ota S1�0!WORK ORDER
ravertigatianr of Me MA tar meorao,oovaagaadoa otmi ae.temeat my be fi
d to me ORIce of
rrAauyeodbsadirrw ./ dlerrArblsnaatioa
arOvllr/ebow 4Oty salarnrsri
Odk'd Di ad avhr 4 aidr enq h 6r eowpfe�y/b eb aihan n�(�
CRY or Towns
InitialA (drde one): TarmM/rlsxae,N
L Board Of Halts t Budding Department L Clly/lowm Clerk C
IL OdWr EltWitai Iaspestor 3 Flamblsg Inspector
Conlatt Fermm
Fbooe fs
Information and Instructions
masbas"�eQalLawsCbMwss ���la60
�av ° �► orbice►
Oss ar lSao a w owl awrMOMM dr otba lcP►a ar a9►two ac moa J
ae"a'mdivi�.P eorprado� qEa dooeatad cwpbyK or
Horenvok do
�p,db:io� �,dstaaroQtrrteolad4►• tfeooa���
goer of a dvr� AS�POM o=�.9bywco b.damd be A COVI�
"e�mtb°°r° arbnAft appoles s� tM Maws"air
c as*0 tico�s
Am Chooses1sZ,�(�d W SON tbd"�!•asa or loe+ avid bW 01 w a sawave a -A ..w
rd as tleeaaa at Pam is ode a odams
srldeare deanpnaoeaeee dtan
,ppnenrt WW t eat p �p"N r*a convemw otmoiPBaeoa �e OOP
cow oa AN � per6m to�ao
�ofddt dW
thebaaxa did Amoy
� Odoa sfddavtt oomP � )��their oaoteaodF)of t>ae�
rkan(Roll dM �taerar(p)=M(pl add0w(�=0ftmn �,�,y).vae�o °�°d,as
soccomy,mp* Li*WW =or Lfwbd . Mwaismuft If xS=a LW dw Tie
wcspims or as sot s daft W 7be alit aboold
eogboycm a PC"k�°��oe eavaap Mw IN tg t*dP of
deolr ihr aaaA01 1br the panrit ar);eea.s is beiat a a
ar ro�vn>brr me app ., dre law ar i<ya tbetr
be read 10218 y0ohsve OW 4oadaas r beto� SelF%Mvd eom�ahoed army
O"gnma
mks
MORM(W or TOM �sa�
bar D�°d st&e boMM
dare be we �°'®dsvo mO°°0pihe cvmt of�Imradp&°' to Y� Is ad"06 a
of dr.Mdavir Oar yM ra 6 M nonber whit WM be aced s a n[o*wbwk one afup*�**�
pkwemH pnm rppliaatlmd is my d a yM��d odY W&Man badoa iS (fir of
the lieaot dioald
woe(iLim am)am wider Job Silo AddrwM aPP dt ab or WWS MV be 1f`"b die
tyoft arnv A 6oPy of"aftldalt tlrttua a �aL � A aew stT;devit b died
a pot wa a a va o afndav ob�at s�0i 1 oot tefsood ro my alddarit
a d&M it Naf regat"t0 w®plda
(�a� �a�to bma lava aa)raid peta� �shoald)a have anY 4a�D0�
The Otnoe of la wtodw
rlroaW h7ta>D dtaot you is advance far yoar coopendott
pkare do ON begbW b 10"as a tmmber.
The�a�t'r rddtar•tekphoae ealth of Massachagetts
weep of b j&vwAAcddaob
Olen of faveidgiaod
600 Washington Stied
BoAm MA 02111
TeL #617-7V- 900 61t 406�49 7 E
MASSAF
Reed 5-26-05 www.anm gov/dia