27 WOODSIDE ST - BUILDING INSPECTION "PLIV611wsV11E fKfS4A9 APPROVED BY THE
1dsP B P8W TDA.P.ESYIr JWWa GRANTED
CITY OF_SALEM
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BUILDING PERMIT APPLICATION FOR:
Permt to.
(Circle whictwver apply) oot,. Romf. Install Sidhp. Construct Dock. Shed, Pool,
Repav/Reploce. Other:
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDING&
The undecagned hereby applies for a permd to build according to the following
somodications
Ownses Nwne ti' ` ' ` Q A ) \ A r� G A a o,�j_e
Address A Phane U300a s\ de S^ f97ji 7 `/% 6 U7`�
Architect's Nape
Address & Phone 1
Mechanics Name
Aftess 6 Phone f
vam Is v a plapm of bWWYg9
MaW W al tM�ldlrlp4 II a exam,for how ffmy wab"4
wo bAoq oor lum to low? Asbestos?
Es*ww eat � Ow Lw~a N A 81ata
so= ma t
SKiNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO' (V
NO. �Q�
APPLICATION FOR
PERMIT TO
LOCATION
PERMIT GRANTED
INCSPEGTO OF BUILDINGS
p
L
CITY OR SALIEF49 MASSACHUSSTTS
PUBLIC PROPt;RTV p[PArtTM[MT
120 WASMINCTON STII[aT, aSO ILoon
SAL[M, MASSACHUS
aTTS OIi70
T[L[PNOFAX 57674e.eett{ EXT. 3e0
_. _. .. _ RAxi e7e-7�09e4e
HOMEOWNEII I.Icusl EXEMPTION
Plow Riot.
Date
Job Locadm oc)A s e S _
Homo Cote Addeeat.
HeoM Qw ?deohtaq� E q l u1 LZLL—b t z —
Pte�tot M Addsw 7 i.7 0 0 S+ v S�
1be notdweft Mileati"Homaowa w eateoded to
Wm vft�dm Of nd oa Ilan a n is agmrovi anew ao°M° Wuviaw fa
P a Pded due as MVWAaa.
DI3FIIVITIQN CW EMMWMM , s
Pawn(a who am a p W oot o[Lod as w hdr>d reside Or iateode to
which there L,or ie iotmdad i4 bS a aw a two r�aride,os
am h ach um sod/Or$a A�
Yw period 60 not be mddwW a Mmwww
"homeownd'" tabmit to the Bn hft ofikiA,oo a . Soch i
OINK that hdahe be raponable to an 1dln
PI RWA work pafan'W undo the Building
nw unu asip"�wy-bm c=vuma with the St"
The undaWgua"hO'n@O%I W caMn that be/ahe understands the City otSalem
Bnildind Deparfaaent minimum inspection procedure atld mqWrmwno and dw he/she
will comply with said Procedure and re/9uifmcft
HOMEOWNERS SIGNANU (Xl/ r
APPROVAL OF BUILDING INSPECTOR
Sea otha tide for stata code
wod�her which a BuiWint Yae:�t is
.. perbru mf .1.1—Lieae+ont
cam"aa t� Anl► Oa of this secdca(�1p 9.1.1 )for hirer to
nlsvmp d au to coop trek P'e""7 Homeowom�a
sypae�rie°r' Suu act m SwwviAw-
of Cm����Ho`ne°w°0` �h.
M>�H��araeea who A this A04 a no&
der ota jss a Wm 11$ otawa[a d p duet in this we Y' u
cane °O s '°"`e hea dw Heme;,a„a biro °a'°on'
Prob M th• Is it�oold ue�d
is&" awm of bbAw y there
To come that the Many
Homedwm of the Permit A"Ucmdal dobe patp otthis is"n a
�,un t tb• ota Superviaa•�+oo anwodand s�sub s
bdd>w wtd ��beM�, 1Con may
CITY OR $ALt49 MASSACHUSalrT!
PUBUC PRCP[RTV OtPARTMtNT
120 V'""'NGMN "MaT, 300 ILGOA
UL[M. MASSAONW$gM 01*70
T<LaP"nea 970-749-0694 an. 300
PAW 976-7404 "S
FozM
In accordance with the PfOvisions of MGL c4O 3 549 a condition of
&Wdin Panic your
3 it that the debris resulda� loom this wodt shall be disposed
of in a pmpedy licensed solid waam` facility as defined by MGL
Chapter UL 3ISO A.
no debris will be disposed of in:
i>ov"`t� a=adon of Facility)
#644paut
6'J /-0
Date �