24 WILLOW ST - BUILDING INSPECTION fL�NlsilAtlsT�Efi AW*4D APPROVED BY T414E
JWPJ:C=PRIGR TD A PEHIMIT BEING GRANTED
CITY OF SALEM
No. �> Data
Ward
Zorrng clew
Is Properly Located in Locationof�
Me Hkdodc District? Yes No
Is Properly Located b
the Cagervation ArN? Yas No
Permit to:
BUILDING PERMIT APPLICATION FOR:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Shed, Pool,
Repair/Replace, Other.
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS: '•
The undersigned hereby applies for a permit to build accordwig.to the following
specifications:
Owner's Name
Address & Phone -1 --A 7
Architect's Name
Address & Phone If )
Mechanics Name
Address & Phone arpoae 0-4,-�L,c /1/d/
Whet Is the P of WbdkV? �C/T ea,�
MtlMlal or brlldrq? ////�ar1 n a dwaft for hm In"famaes? 3
wa bulk m conform to law? ,Ye- S- Asbestos?
EWaslad cost aO,
Neese L mWen.at
. �I7
`Signature of Applicant
SIGNED UNDER THE PENALTY'
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
'7
No.
APPLICATION FOR
PEROT TO
LOCATION
PERMIT GRANTED
7� F 19
A7P,MVf D -
15�,x•�
INSPECT09 OF BUILDINGS
MORTGAGE INSPECTION
BAY STATE SURVEYING ASSOCIATES INC. JOB #
100 CUMMINGS CENTER, SUITE#316J, BEVERLY,MA., 01915
L
ALCM .
OCATION :..5...............�... tQ:a.......,...,,,,,,,,,, Nj Tti s is a mortgage inspection survey and not an
SCALE : 1" = 7— 3—p/ Instrument survey,therefore this plot plan is for
ZQ DATE :..................................... mortgage inspection purposes only.it is NOT to
be used to establish boundaries or for the construction
REFERENCE : .. N?.:.�.�.�.�.(... .P�a.; s(�7 at any type of Improvements.
"'""""' 2)This survey is based on survey marks of others.
2)Bushes,shrubs,fences and tree lines do not
.........................................•........... necessarily indicate property tines.
VL— �FC�/1�' �4)Whenever an offset is V+.or iess,an instrument
TO:.._._....._..__...1�!j....�._ „.— Z_ ' _r.._.„„,,, ,,,;) survey is recommended to determine property
The location of the building(s)as shown,either Imes,and any possible encroachments.
complied with the local zoning setbacks at the time of 5)Offsets shown am approximate,and are to be
construction or is exempt from violation enforcement action ' used only for the detemdnation of zoning,Not to
under Mass.G.L Title VII Chapter 40A Section 7 be used to establish property lines.
6)In my professional opinion the building(s)are not
located in the special flood hazard zone,as
defined by H.U.D.MAP#
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y�J�tLfAMS gERUB�
(AREA = 3375 5.F.t)
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IF THE SURVEYOR'S SEAL IS NOT
EMBOSSED.THE PLAN IS A COPY
THAT SHOULD BE ASSUMED TO
CONTAIN UNAUTHORIZED ALTERATIONS
THE CERTIFICATION CONTAINED ON
THIS DOCUMENT SHALL NOT APPLY
TO COPIES.
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5 PUSUC PROPERTY DEPARTMENT
120 WisMular0lr STIIEET, 3RD FLoom
SALEM.MA 01 970
TEL.(976)7454595 EXT. 360
FAX (976) 740-Y/46
STANLEI/ J. USOVKZ, JR.
MAYOR
DISPOSAL OF DEBIM AFFIDAVIT
In accordance with the Pwvisiom of MGL c 40,534,I acknowledge that as a condd=
of BMI&S Permit M .all debris resulting from the ism,a;vily
govered by. this Building Permit dbafl be disposed of in a PvPaiy licensed sorWwamte
disposal faca7ity.as defined by MGL c D%S1JQA.
The debris wi8 be disposed of at
Location ofFacrlty
Signature of Permit Appll Dab
(PLEASE PRINT CLEARARll L�
Name ofPennitAppheant
Firm Name,if any /
Addreas,City A State
The above statute requires that debris from the demolition,renovation,rehab or other
alteration of bmlding or structure be disposed in a properly-licensed solid-waste disposal
fatality as defined by MQ,cM S I30A. and the building permits or licemes are to
indicate the location of the facility.
. � l..ontmonnrfw6ti/� Of !//a�.sathudS�O .
boo Ula logs -ed
rafwa 1 woe. &dew% /// "sJu nab 021 If
c.iasaa..
Workers' Compensation lammuce AffidWk
1, ' // c-.�—yGv' �.�� o.✓ . c v Coo-..�5� . -
wMi.a principal plea at bns6ness as
do hereby'car* under x)n pales and penildaa at pvMa don
() Ia an employer providing workers' compenntka coveralls for my siapioroea woeltlnp m
Insurance Con"Mir Pe Numbas,
I awn a sole propriete►and haw no one working fir me in nary opadiy.
() 1 am a sok proprfessr, general comraetor or am wowner (Cb one) and have M"d die
centwttots listed bekw who-hew the folknving workars' compensation pe9dm
Cenvoo Irsurs"ie Company/Po Number
Cossaaor Insurance Company/Po Nttmbw
Contractor Insurance Compaery/Policy Rumber
0 1 am a homeowner performing all the work myself.
•1 vnftrw"ew a CM of W,waaaaeoa va be fevwwfts w w Office it M.airnwr of dw M N ta.wane edkoba one ew hbm w rvt
co.a,ra a rewau.esor Sedge Ifs of WU 1 S 2 can kin w w irasaaiaw of- I isa aware cewdm of a lure of as n4 t.f00A0 anwer w
rears'kwoem m a.ue a 64'saw o in the iom of a STOP W ORK ORDER aw a ise of s 100A f a M+pbe sr.
Signed this der of —
.icerseei'Fermittet iouf ,ding Dep rtn.ent
Licensing, Ecane
Selectmen Office
=calth Depammer!
.eeC.r yr ` _ 9ce 4pc qpe 77c