23 WILLOW AVE - BUILDING INSPECTION (2) f°pra� Sa�� zh5 �1ap FPS
ft*NSiM W-8E ffLf94W9 APMOVED BY TIE
JeIMC=PPJ0R TO A PERMIT BEING GRANTED
\\ , CITY OF_SALEM p Gi
NO` "� \ Date a CJ o
Wam
ZMft DIaW
la Property Located in Locationof23 I A
the Nlatorlc Diddct? Yew No
Is P10Mly LoceMd In
the Cormervalon Ann? Yak No x
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding Construct Shed, Popl,
idneplace Other:�Q In+ 11 sl' 7P a o r D a rc)h
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:-
The undersigned hereby applies for a permit to build accor&ag,to the following
specifications:
Owner's Name _Tko1m cks ��, L Makon
Address & Phone 2 W i 3 l low p ve- , (R7) 7 y N - 0 z
Architect's Name
Address & Phone ( )
Mechanics Name
Address & Phone ( )
What Is Im prapoee ct tsdl*lg? �cv�Co ((''
Adds m a wow I 1 j n'A t a dwawg,for how many tamNm? -C'wV; 1
WN bLM*q corft m to law? �le-S Asbestos? Yl 0
Eo*natad cat I O� 0 0 C) Cty Ucwm s IiuSIgn
alsa r s
o� r
aa impro� t 1
Lie. 0
J .
e of Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE 1 1
-e'h o 11�Pi 2X 1 S I Vl 0 Y1 I �-i v-5 1 0 o Y
a ti W i i-h e x Ou o+ ri,V1 C1 1
su.re rn eAts e n h e.
TPA Oh'lt✓ ,
MAIL PERMIT TO: o yyo-s G A ak I r.
z3 ' vj 0w +Aj-
)\.A W 0 1 a 7 0
.t
APPLICATION FOR
PERWT TO
LOCATION
PERMIT GRANTED ` \
AFfD
1 IINS�PECTOR F BUILDINGS
fUJ& PU9UC PROPERTY DEPARTMENT
120 WASMINCTON STREET, 3RD FLAOR
&M",MA 01970
TEL (978)745-0395 EXT. 360
FAX (Y79) 740.96"
STANU[Y•J. U90VICZ, JR.
MAYOR
DWOSAL OF DEBRIS AFFIDAVIT
In accordance with the pmvisioaa of M(X c 40,S34,I w3mowledge that as a condition
Of BmldinS Permit 0_ .aII debris molting from&a cooMnctiom, fivity
Soverned by. this Building Pam n shall be disposed of in a properly licensed s0bA waste
disposal facility,as defyoed by MQL c nX slsa&
dcE wM be disposed of at I—/ , �I�� ( CZ I T7 V(
/LwAhm ofFaciW
3rgoa,�e of Permit Applicaet D
FULLY complete the following filknnsdm.
(PLEASE PRW CLEARLY)
Name ofPemit Appliew
Fiam Narma,if my
Addreas,City R 3aate
The above statute requim that debris from the demolition,renovation,rehab or other
alteration of buUding or structure be disposed in a pmpaiy-licensed solid-waste diapoal
facility as defined by MGL cA S 150A, and the building pamits or liceosp are to
iadreate the location of the facility.
CrN OF SAIF.M
BUMDING DEPARTMENT
H0ME0WNER LICENSE E MQM0N
Pk=prbtl
)CBLOCATM, M <
•liol�awr�t �7 8- 7��- •l-`-�-0 2 . .
TELZFH 1s
] sexr>'dAa m►G ADORES= �' �N I l.o UO k U e,
The cmrcnt.aormptioo d`bomwwnesd'was utcoded m bends errocs-sCWPW.dwd16P e[TW0
Ualm a les and is allow such bomcowwers to cWp an bdividuotbr bbe wbo don sot poo d
Hocnot,provided that tha eweer'set as mresrtsm
DEMM W'lOFHO1v1EOWlIM
penoo(s)who owns a prnxl of Lad on wbkb behhe asides of braids a sesldt,on wbick dwe k a Y
rounded to be,a one a two hn ft dwcMn&smchsd m do tar xum mccc�y to mxb me endhr
farm swomwee A person wbo consumers mole tlaa on hove b►s two-year period"sot lx eonslded
s boauowav Sods`ltomeow•ad' sh+4 stdrmdt a the Snr7diaj OSteid.oo s lbrsp a tM
Bw'ldbej Odieial.that hclsltc be tsspomtbk a aA sad►worlt pcformad miler tAe bn��perai '.
The wdersipred-bomcowou-asstmes tespor,&MV for=MPH==w•1th t m state BuD t j Coded '
other app6obk joss by-lots,nrla sad iejeiadom
The wW.,pW—homeowm-e dfm em henna wtdc=uae s the ClW of Salem Baflft De wmM
minimma bepoction pmmdwe togooreaeems andthat b/sbe willsrhA said ptooedtoes ad
nqdmmcmL
HOMEOWNER'S SIGNATURE
APPROVAL OF B=ING INSPECTOR
See otber ode for start code
HOMEOWNER'S EXEMPTION
The code asta tb= •wq b=wowaa pof %iv*fa wbkb a bnfldirq permit Is tegedred,�N
exeunt from the po iseom of ibis seedos (:.emus 709.L1-1Jccasing at Comnreake tsperwbu
provided ibit Us lea mwwma enpga!persom(s)fdf hies to do.sosh wcd6 that art boemm m shale t
MW yr MWWAea wLo ntt ibis exempticn ax"wan that they art assttMbg*A PWOmlbOtits do
DAM
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Uriioemed pa"ma In tbir east yaw Bard eatmot Footed apba the m eamea pews r itwoold va
Itaared sopenisa. 71t bomeon„er,aimf a.super+IsK Is.Mtm+te¢ratowill6
To emtiet door d><hoeseawrea!s fuibr matt d hilber•tesponribl8da.rme4���:ss I�
of an pttmti sppliados►dot dm bomwwm co*y dot hehhe mdasatds tit respansllO "at*
mpavbm Yon mq cart town ad and adopt svm a lotmAoerelliotion!oe ttaa is yev oommamlq.