35 WINTHROP ST - BUILDING INSPECTION f �
.i L,*"SiMWT ft fiL.Eg-A 1D APPROVED BY 744E
WPELMpB pWR Tp.A.PE MIT BEING GRANTED
CITY OF SALEM
No.A 1 N Date Z
is Pmpsity Located in Iaeatlon of
Rw Historic District? Yea_No� Building ui14-IRdl}°S(
is Properly Located in
to Coroervatlon Area? Yis No
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Ins ng� Construct peck, Shed,
Repair/Replace ther:
PLEASE FILL OUT LEGIBLY &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 pL F(L-
Address & Phone 6 W C &e)o&L klF- ST� l I 1 S 3 G — Y ir2
fgOSTU/J M�
Architect's Name �yr , �o4�ti — t2d10'f o/I�f UV�yfU�
Address & Phone ( I
Mechanics Name
Address & Phone f
Whst is fhe Purpose of tx>tlding? — L9 f=-n
m"w of buYd m? /2/LJ-<,I L n a dwelifn9,for how many families? CU
WN build ng cordorm to law? YF5 Asbestos?
Ertl N"d coA42y( ity Ucerae s N A State a<
Bases Iaptoveant
r.LC. f
S' afidre of Applicant
ED UNDER THE PENALTY
fiW PERJURY
DESCRIPTION OF WORK TO BE DONE
i3Uy�dJ U�i ,rUt�J P� ✓1f1�✓LCirW� d— �=`i—Gf��-�
MAIL PERMIT TO: (16,( ' l0A
57�61M A4- ar9 7'0
No. A _
APPLICATION FOR
PERWT TO
LOCATION
Sf
PERMIT GRANTED
y/l9faG 20
APROVfD
INSPECTOR OF BUILDINGS
CITY OF SALLM, MASSACHUSETTS
• PUBLIC PROPERTY DEpARTMENT
120 WASMINOTON STREET. 3R0 FLOOR
SALEM. MASSACMUSETTS 01970
TELEPHONE: 970-7411-95901 EXT. 3e0
FAX: 978-740.9846
HOMLOWNLB L msz g,XE wnoN
Plase print
Dana iz 6i0
Job Location 3s cam— 112U(J
Home Qwnor Addeew�tl 82ir� t ,�cis r7��u nn�i 7 /(
H=4 Owner Telepi ( L Z
PreteStMsili�Addraa42Z iS✓n�,✓ �,�� ref- nZll�
'Ire cwnw o("Homeowwe was,mttmded to include owm"ccul)ied
dwellings of two WIN or lem and to allow such
b
hire who does not poescas a license,provided that se>p dual for
DEFINITION Of HONSOWNEH
Person(aZ,who ow=a paceel.of land on which he/do resides or intends to reakk oil
which dump is,6 or is intended to b4.a one or two family dwelling,�+cbod or detached
structures accessory to such use aud/ar fans attuctlavroi, A person who congotiq more
than one home in a two yea period shag not be considered a homeowner. Such
Official,
�aub be res to the Building Ofciai�on a form acceptable to the Building
Permit responsible for all such work performed wader the Building
The undersigned"homeowner'assunnes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned"homeowner'certifies that he/she understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements,
HOMEOWNERS SIGNA
APPROVAL OF BUILDING ECT
See other side for state
a
HOMEOWPtEi!B t:x�itdZTIONI
afiming work fa which a Buildil*Permit is
The Code states that 'Any section(Searoa 109.1.1 -Liceoaini
oCow an s � Fovi&A that a Homaowna edia�a P° s0�a)fat�0 LO
do such worir,and that such Homeowmr shalt S" '
an that d"are msum�the
Many Home�'�a'hO ut0 this as U0°a' mad far Licamini
ilities of a S (M(�1AHx RulesThis b* nwAs in saious
responso3
Conatntction �sonlicassed
whm the Homeowner.hira imlicrosed pawns. this ease YOut
aftBoatel cmmot P °0d°�the unlicensed hacson err it ovould vn>h a
� ' .
nap h>
SupeM [heHcn►aow»a i�,,
aware of MAN WWM6 many
To ensun that the Homeowner is fd P h�� Homeowner cert►fl+that
regoin,as,a pert of the Permit App t1;e led Pap of this issue is a
eommurut4aopt�ilities of a SupeMeot• On
forni cut by se VcW towns. You MY care to amend and such a
form/cacfica>ioA,fa use in yobcommunity-,
R� �I�Isaor
r
CITY OR 3ALEM9 MASSACHUSEtTTS
PUBLIC PROPERTY DEPARTMENT
I20 WASNINOTON STIICCT. 3Ro rLoCW—
SALCM. MAf/ACNUSWna 01970
STAULCY J. UCOVICZ, JR. TCLCPMONC: 970.743-989S 6IIT. 380
MAYOR FAX: 970-740-9846
Salem Buildh a DeDArhnent
Debris Mood Form
In accordance with the provisions of MGL c40 S 549 a condition of your
Building Permit is that the debris resulting from this work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL
Chapter M. S 150 A.
na debris will be disposed of in:
�o014 Si Qr (Z ILT" (Location of Facility) _ lz J- ' (��
IaturiA 9pplicant
Date 17