58 WILLSON ST - BUILDING INSPECTION (3) f1'ANS*W13E-RLflW ND AIWROVED BY 771E
JMBPECM0 PIIOR TD A PERMIT BEING GRANTED
Il\_ CITY OF_SALEM
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: ius7 . :Zw-rtf
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 T�=
Address & Phone b 9 k-1, //Sa r S T— (10-7A 7Y5
A7chitecrg Name
Address-4-P [ 1
Mechanics Name ?111q L C - C K c`//�f7T;E.
Address & Phone ( 1
WM is In pmpm cf WNW
Matadd of tallldktp4 60 d d n a dwNNq,for how mmy famaas7
WIN h oft canfam to low? }Y E� Aspseto ? 0
EatMmW cost 35-60 ,y o Cloy LI=M• anaa N CS GS (9
Lies I�sosawant
tea. i►
Srg'Iature of Applicant
SIGNED UNDER THE PENALTY,
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
Cal J �� co/S 7irJ S T✓9 %/ Gv�.J o!o �s �itirre :� d ti
MAIL PERMIT TO: s7 ��cl I S
APPLICATION FOR
PERMT TO
LOCATION
PERMIT GRANTED
LD-u 19
APPR7D
INSPECTOR 0BUILDIWGS
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poS�rrcc OF colwdo tNlTS�Xy !1
�Crro�E •¢m'n D,sansF OF �Z�Nr�vE A^'D ➢.S�osE
Dc�t,¢�n Sr.9�zs SG,� lSC2
CrrY OF SALSd
BUBDINGDEPARTtvlM
HOMEOWNER UC.ENSF.E mvnoN
Pkaar PM
S LOCATml1 ° ���d S
Tnmwol E
MrSENTW23-GADDRESS
• The oarers.erampdoo d`homeowoerti'waa erncadea to bslude ewdet�wpkd dwelS:p e[TNp
UWa ar ko and b dkw meb bomwwmn to CWP m bWhidw0*r bate who dm Bot POa tt
Jkcjm prodrded t m ie eweer'aei as mp arhaa
DEnNTIONOFHCME.OWNM
• IktsoB(a)who owaa•pocd d had oa wbkb be/ahc resides a baodr to resides.ao wldeb tbeee k,er Y
upended w be,a one a two!sadly dwcMi&atadwd at dwdwd saucuass aooeaor7 to WA&=9 Bddlrr
farm:oveaaea.A peraoa who eomtrncts awe tiara ame hnme k a two-year Period sba0 Botbe oonefdered .
a bomeowaer. Such lwmeowud" shay m &w the BUDOTS OMd4 m a ar bou �bk�is
Building Ofidal,"bclshe be tes mns%k to aA web weak paimmed
wduThe mrdempcd`mnowne asrmia mponsr%MW for eompft=with the Staff BdCdrg Code WA
wha appbobk Soes by-kwa,wks aad mgobrdw L
The wwcrsipod-bomwwad oati5es*a hLwz nadasuadt the Ciq of SBkm Bwmg DepoaB�
roiaimmd bBpwu=pros cdwa and =nmzma aW I)m Abbe w►jU cmuplyywi*aid poctdid-ad
regrdremest C'�l.S� �
HOMEOWNER'S SIGNA �-
APPROVAL OF B=ING DgSPECI OR (22�L
sac otha sde for mu code
HOMEOWNER'S EXEMPTION
The code:tarn thaC •aTp }mmeowmet perfotTa>i�.vadt foT wrhieh a hnDt>ittg yams b tt:gabee abaf k .
exempt from the pmiitom of this ucdm (Section UP.L2-Lecosioi of CmurdWm Sopervis"
Provided that L•bamcawTw enpga p persco(a)fa ldrs to do.such vroTb:ths4 sucb bomoowaer"Rod
u sopwisac' .
MW bmmwwmnwbo me thk exempdas ax imswao t a they we asrou ft dw tnposidblUm oft
supavim(sec Appeodis Q.Ruhs and Regubttoa for 3Uocosiog Ceorirrelfoa Ssynrfssta.See*w
.3.24 7bb U&olswa own m%m Testths in scTiow poblemt.pw*oLr4 w�bat the bone m -a bba�
Urdloatsed ppsaa h this eau yan Bard — - m pooce0 apJm the mod pc*m r it wotdd va
licensed Sopa+isar. The bomeowmr acting as tupuvbw Y
To eaTtre thss the hotneoTrtea$fidb twaTe�ltiAses Terpomlhi8tief.Taaq ODm�litl�:a iP� .
of the permit applicatim that the homeowner cutit am bwx wo'com Tads the Tespmsbmm eta
s wavisoti You moy tare to wncod and adopt aft a brinkcnifiollm*f tsaa Is your eon®1*
PUBLIC PROPERTY DEPARTMENT
120 WASNINQTON STREET, 7RDFLoow
SALtM,MA O 1970
' TEL (978)745-0595 EXT.8e0
FAX (Y7a) 740.96"
BTANL[Y J. (JBOv1CZ, in.
MAYOR
DISPOSAL OF DEBRL4 AFFIDAVIT
In w=dance with the provisions of MGL c 40,S34,I aclmowledge that as a canditien
of Building Permit g_ all debris resulting ftm the won W"
governed by this Building Permit sW be disposed of ffi a propaly hcenged solid waste
disposal facility,a.defimed by M( L c BL 3150A.
The debris w171 be disposed of at �c� s.n/>sco r y2�
Location of Fad tty
Signature of Permit Appycaot Date
FULLY complete the following infinma M
(PLEASE PRWr CLEARLY)
Name ofPenmt Appheant
Firm Name,if say
Addneu,City k State
The above statute requires that debris ftm the demolition, renovation,rehab or other
alteration of bttikfing or atructuie be disposed in a properly-licensed soH&wasta dispose(
facility as defined by MGM cA S150A, and the building pamtits or lie= =to
Mica te the location of the facilitf.